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Access information about CIEE鈥檚 Insurance Plan provided to all participants below. For more information call 1-888-268-6245 or email insurance@ciee.org.
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Important Information You Should Know 黑料网911 Your 黑料网911Insurance Plan:
Claims Form (PDF)
Summary of Coverage (PDF)
Insurance ID Card
黑料网911Contact 1-888-268-6245 or email to request a new insurance ID card
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黑料网911has arranged for you to access a Preferred Provider Network through Aetna that provides you access to over 650,000 Doctors, Hospitals and other medical providers throughout the country.
To maximize your savings and reduce your out-of-pocket expenses, we recommend that you select a Preferred Provider. It is to your advantage to use a Preferred Provider because significant savings may be achieved from the substantially lower rates these providers have agreed to accept as payment for their services. Preferred Providers are independent contractors and are neither employees nor agents of 黑料网911or Aetna. If you use a provider outside the network, additional coinsurance will apply for covered illnesses, as outlined in the Schedule of Benefits.
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If you cannot locate a Preferred Provider in your area please call 黑料网911at 1-888-268-6245 or email us at insurance@ciee.org.
The information contained on this page and on the links below are for participants who are covered under 黑料网911Group/Policy No.: CIEE-697401. Your Group/Policy No. can be found on your Confirmation of Insurance form. If you need any assistance in confirming your Group/Policy No. or have questions regarding your insurance please contact us.
All charges, costs, expenses and/or claims (collectively 鈥淐harges鈥) incurred by an Insured Person and directly or indirectly relating to or arising from or in connection with any of the following acts, omissions, events, conditions, charges, consequences, claims, Treatment (including diagnoses, consultations, tests, examinations and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this insurance, and the Sponsoring Organization shall provide no benefits and shall have no liability or obligation for any coverage thereof or therefor:
1. The Sponsoring Organization shall not be liable for and will not provide coverage or benefits for any claim or Charges incurred with respect to any Illness, Injury or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising or incurred in connection with or as a result of any of the following acts or events (collectively, 鈥淥ccurrences鈥):
(a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war;
(b) mutiny, riot, strike, military or popular uprising, insurrection, rebellion, revolution, military or usurped power;
(c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the Government de jure or de facto or to the influencing of it by violence of any type;
(d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege; or
(e) Terrorism.
Any claim, Charges, Illness, Injury or other consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether or not directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Occurrences shall be deemed and considered to be consequences for which the Company shall not be liable under this Master Policy, except to the extent that the Insured Person shall prove that such claim, Charges, Illness, Injury or other consequence happened independently of the existence of such abnormal conditions and/or Occurrences; and
2. Charges resulting from or relating to pre-existing condition or complications of pre-existing condition.
3. Charges for Treatment of congenital conditions; and
4. Charges for pre-natal care, delivery, post-natal care, and care of Newborn, including complications of pregnancy, abortion, complications of delivery or complications of Newborn; and
5. Charges for Treatment of alcoholism, drug addiction and other addictions or illnesses or accidents caused by the excessive consumption of alcohol or drug or medication abuse as well as suicide or attempted suicide and the consequences therof/or Substance Abuse; and
Charges or costs of accident or illness caused by mental illness or impaired consciousness, if this is a result of the consumption of alcohol, drugs, intoxicants or sedatives, sleeping tablets or other narcotic substances; and
Charges incurred resulting from the abuse of alcohol or intoxicants, or any illicit drugs or abused drugs by the insured, (abused drugs include prescription drugs that may be used illicitly); expenses incurred due to substance abuse treatment.
6. Charges for any Treatment or supplies that are:
(a) not obtained or received by an Insured Person during the Period of Insurance; and/or
(b) not presented to the Company for payment by insured person by way of a complete Proof of Claim within ninety (90) days of the date such Charges are incurred; and/or
(c) not administered or ordered by a Physician; and/or
(d) not Medically Necessary; and/or
(e) provided at no cost to the Insured Person or for which the Insured Person is not otherwise liable; and/or
(f) in excess of Usual, Reasonable, and Customary; and/or
(g) HIV, AIDS virus, AIDS related Illness, ARC Syndrome, AIDS, and/or any Illness arising as complications from these conditions and/or charges for treatment which is incurred by Insured Persons who were HIV Positive at the time of enrollment in this insurance whether or not the Insured Person had knowledge of his/her HIV status; and/or
(h) provided by or at the direction or recommendation of a chiropractor or physical therapist, unless ordered in advance by a doctor of medicine; and/or
(i) performed or provided by a Relative of the Insured Person; and/or
(j) not expressly included as Eligible Medical Expenses as defined in Section G, above; and/or
(k) provided by a person who resides or has resided in the Insured Person鈥檚 home; and/or
(l) required or recommended as a result of complications or consequences arising from or related to any Treatment, Illness, Injury, or supply excluded from coverage or which is otherwise not covered under this insurance; and
7. Charges incurred for telephone consultations or due to a failure to keep a scheduled appointment; and
8. Charges incurred for Surgeries or Treatment or supplies which are:
(a) Investigational, Experimental, or for Research Purposes, and/or
(b) related to genetic medicine or genetic testing, including without limitation amniocentesis, genetic screening, risk assessment, prevention and/or to determine pre-disposition, genetic counseling, and/or gene therapy; and/or
(c) Non-urgent and elective surgeries which could be reasonably delayed and performed in the Home Country of the Insured Person.
9. Charges incurred while confined primarily to receive Custodial Care, Educational or Rehabilitative Care; and
10. Charges incurred for any surgery, Treatment or supplies relating to, arising from or in connection with, for, or as a result of:
(a) weight modification or any Inpatient, Outpatient, Surgical or other Treatment of obesity (including without limitation morbid obesity), including without limitation wiring of the teeth and all forms or procedures of bariatric Surgery by whatever name called, or reversal thereof, including without limitation intestinal bypass, gastric bypass, gastric banding, vertical banded gastroplasty, biliopancreatic diversion, duodenal switch, or stomach reduction or stapling; and/or
(b) modification of the physical body in order to change or improve or attempt to change or improve the physical appearance or psychological, mental or emotional well-being of the Insured Person (such as but not limited to sex-change Surgery or Surgery relating to sexual performance or enhancement thereof); and/or
(c) cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is Medically Necessary and is directly related to and follows a Surgery which was covered under this insurance; and/or
(d) professional and/or intercollegiate athletics, (including without limitation Injury sustained while (1) participating in any intercollegiate, or professional sport, contest or competition; (2) traveling to or from such sport, contest or competition as a participant; or (3) while participating in any practice or conditioning program for such sport, contest or competition); and/or
(e) any Injury or Illness sustained while taking part in mountaineering activities where specialized climbing equipment, ropes or guides are normally or reasonably should have been used; aviation (except when traveling solely as a passenger in a commercial aircraft); hang gliding; parachuting; glider flying; skydiving; parasailing; sail planing; air ballooning; rock climbing (indoor/outdoor); bungee jumping; snowmobiling; jet skiing; snow skiing (except for recreational downhill and/or cross country snow skiing and/or snow boarding), ski stunting, ski acrobatics, ski flying, ski jumping, snow board jumping, free-style skiing, heli skiing; skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body; racing of any kind including by horse, motor vehicle (of any type including off road vehicles such as 鈥渇our wheelers鈥) or motorcycle; spelunking; scuba diving; boxing of any kind, wrestling, martial arts of any kind, white water rafting above level III and/or Non High School related/run programs such as rugby, boxing of any kind, or martial arts of any kind; and/or
(f) travel in or upon, sitting in or upon, alighting to or from, or working on or around any motorcycle or recreational vehicle, electrically powered or fuel powered, including without limitation: two- or three-wheeled motor vehicle; four-wheeled all-terrain vehicle (ATV); jet ski; or ski cycle; snowmobiling; water skiing, tubing, wakeboarding; golf cart; and/or
(g) any Illness or Injury sustained while participating in any sporting, recreational or adventure activity where such activity is undertaken against the advice or direction of any local authority or any qualified instructor or contrary to the rules, recommendations and procedures of a recognized governing body for the sport or activity; and/or
(h) any Illness or Injury sustained while participating in any activity where such activity is undertaken against medical advice; and/or
(i) any Injury or Illness sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician but not for the Treatment of Substance Abuse; and/or
(j) any willfully self-inflicted Injury or Illness; and/or
(k) any venereal disease; and/or
(l) any testing for the following: HIV, seropositivity to the AIDS virus, AIDS related Illnesses, ARC Syndrome, AIDS; and/or
(m) epidemics or pandemics of infectious diseases as defined by the World Health Organization or the U.S. Centers for Disease Control and Prevention, unless the Insured Person, prior to infection and prior to becoming a Participant, received a vaccine approved for use by those organizations and also met all requirements for travel into the U.S.; and/or
(n) any Illness or Injury resulting from or occurring during the commission of a violation of law by the Insured Person, including, without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations; and/or
(o) speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy; and/or
(p) orthoptics, visual therapy or visual eye training; and/or
(q) any illness or Treatment of the feet, including without limitation: orthopedic shoes; orthopedic prescription devices to be attached to or placed in shoes; Treatment of weak, strained, flat, unstable or unbalanced feet; metatarsalgia, bone spurs, hammer toes or bunions; and any Treatment or supplies for corns, calluses or toenails; provided, however, that claims for Treatment or supplies for the feet may be eligible for coverage under this insurance at the sole option of the Sponsoring Organization and subject to all other Terms of this insurance when related to an Injury to the foot arising from an Accident covered hereunder; and/or
(r) hair loss, including without limitation wigs, hair transplants or any drug that promises to promote hair growth, whether or not prescribed by a Physician; and/or
(s) any sleep disorder; and/or
(t) any exercise program, whether or not prescribed or recommended by a Physician; and/or
(u) any exposure to any non-medical nuclear or atomic radiation, and/or radioactive material(s); and/or
(v) any organ or tissue or other transplant or related services, Treatment or supplies; and/or
(w) any artificial or mechanical devices designed to replace human organs temporarily or permanently; and/or
11. Charges incurred for any Treatment or supply that either promotes or prevents or attempts to promote or prevent conception; including but not limited to: artificial insemination; oral contraceptives, including complications of contraceptives, Treatment of infertility or impotency; vasectomy or reversal of vasectomy; sterilization or reversal of sterilization; and
12. Charges incurred for any Treatment or supply that either promotes, enhances or corrects or attempts to promote, enhance or correct impotency or sexual dysfunction; and
13. Charges incurred for Dental Treatment, except as otherwise expressly set forth in Section I. Dental Treatment Benefit, below; charges incurred for treatment related to cavities, fillings, braces, crowns, bridges, caps are excluded from Dental coverage
14. Charges incurred for eyeglasses, contact lenses, hearing aids, hearing implants and Charges for any Treatment, supply, examination or fitting related to these devices, or for eye refraction for any reason; provided, however, replacement prescription eyeglasses are covered to a maximum benefit of $135 if loss occurred related to a covered Accident; and
15. Charges incurred for eye Surgery, such as but not limited to radial keratotomy, when the primary purpose is to correct or attempt to correct nearsightedness, farsightedness, or astigmatism; and
16. Charges incurred for any immunizations and/or routine physical exams; and
17. Charges incurred for any travel, meals, transportation and/or accommodations, except as otherwise expressly provided for in this insurance; and
18. Charges or expenses incurred for nonprescription drugs, medicines, vitamins, food extracts, or nutritional supplements; IV vitamin or herbal therapy; drugs or medicines not approved by the U.S. Food and Drug Administration or which are considered 鈥渙ff-label鈥 drug use; and for drugs or medicines not prescribed by a Physician; and
19. Charges and all costs related to or arising from or in connection with trips outside the country where an Injury or Illness occurred, except as otherwise expressly provided for hereunder and as approved by the Sponsoring Organization; and
20. Charges for Treatment or supplies for temporomandibular joint syndrome and/or craniomandibular syndrome in excess of the limited benefit expressly provided under this insurance as listed on the Schedule of Benefits/Limits; and
21. Charges and all costs related to or arising from or in connection with all trips to the Host Country undertaken for the purpose of securing medical Treatment or supplies; unless approved and coordinated by Sponsoring Organization in advance.
22. Charges and all costs related to or arising from or in connection with Emergency Medical Evacuation, Emergency Reunion, or Return of Mortal Remains unless coordinated in advance by the Sponsoring Organization; and
23. Charges for Treatment of learning disabilities, attitudinal disorders or disciplinary problems; and
24. Charges incurred for hospice care; and
25. Charges for Treatment of an Injury or Illness Ninety days (90) days from the date of initial Treatment thereof; and
26. All expenses resulting from or relating to treatment of acne, tattoos or piercings; and
27. Medications prescribed or purchased in the insured鈥檚 home country, including complications resulting from the medications.
28. All expenses when an Insured does not respond or cooperate with requests for additional information in order to process claims.
The information contained on this page and on the links below are for participants who are covered under 黑料网911Group/Policy No.: CIEE-697401. Your Group/Policy No. can be found on your Confirmation of Insurance form. If you need any assistance in confirming your Group/Policy No. or have questions regarding your insurance please contact us.
This section includes some of the definitions applicable to the plan and are defined below.
Accident: A sudden, unintentional, and unexpected occurrence caused by external, visible means and resulting in physical Injury to the Insured Person.
Agreement to Provide Insurance: The Agreement to Provide Insurance entered into by the Company and the Sponsoring Organization contemporaneously with the issuance of this Certificate, as the same may be amended, modified or extended from time to time by further written agreement of the parties, which by this reference shall be incorporated in and become a part of the Master Policy and this Certificate.
AIDS: Acquired Immune Deficiency Syndrome, as that term is defined by the United States Centers for Disease Control.
ARC: AIDS related complex, as that term is defined by the United States Centers for Disease Control.
Assured: Council on International Educational Exchange (CIEE)
Baggage: All types of luggage and baggage owned by and in the possession, custody and control of the Insured Person, including without limitation suitcases, duffle bags, backpacks, carryalls, flights bags, handbags, knapsacks, garment bags, overnight bags, satchels and other travel bags, and including clothing and other related non-Valuable personal items which are owned by the Insured Person and contained in any such Baggage.
Calendar Year: The twelve months beginning on January 1 and ending on December 31, annually.
Chronic Illness: An Illness which lasts more than ninety (90) days, or recurs more than one time in a ninety (90) day period beginning on the initial date of Treatment thereof.
Coinsurance: The payment of Eligible Medical Expenses at the percentage specified in the Schedule of Coverage and exclusive of the Deductibles.
Company: The 鈥淐ompany鈥, as referred to in the Master Policy and the Agreement to Provide Insurance, is International Exchange Travel Insurance Company, headquartered in South Burlington, Vermont.
Copay: The amount that must be paid by the Insured Person at the time services are rendered by a Provider. Copay amounts are the responsibility of the Insured Person
Custodial Care: Those types of Treatment, care or services, wherever furnished and by whatever name called, that are designed primarily to assist an individual.
Deductible(s): The dollar amount(s) of Eligible Medical Expenses, specified in the Declaration and/or the Schedule of Benefits/Limits that an Insured Person must pay per Illness or Injury per Period of Insurance prior to receiving benefits under this insurance, and exclusive of Coinsurance.
Dental Treatment: Treatment or supplies relating to the care, maintenance or repair of teeth, gums or bones supporting sound natural teeth, does not include treatment related to decay.
Durable Medical Equipment: Medical Equipment prescribed by treating physician to treat covered conditions, unless otherwise specifically excluded by policy.
Educational or Rehabilitative Care: Care for restoration (by education or training) of one鈥檚 ability to function in a normal or near normal manner following an Illness or Injury. This type of care includes, but is not limited to, vocational or occupational therapy, and speech therapy.
Effective Date of Coverage: The date an Insured Person is first entitled to receive benefits under this insurance.
Eligible Medical Expenses: As defined in the Description of Medical benefits.
Emergency: A medical condition diagnosed by a Physician, which meets all of the following criteria: (1) there is present a severe or acute symptom requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of your condition or places your life in jeopardy; (2) the severe or acute symptom occurs suddenly and unexpectedly; and (3) the severe or acute symptom occurs while you are covered under this policy.
Extended Care Facility: An institution, or a distinct part of an institution, which is licensed as a Hospital, Extended Care Facility or rehabilitation facility by the state or country in which it operates; and is regularly engaged in providing 24-hour skilled nursing care under the regular supervision of a Physician and the direct supervision of a Registered Nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation prescribed by a Physician; and provides each patient with active Treatment of an Illness or Injury. Extended Care Facility does not include a facility primarily for rest, the aged, Substance Abuse, Custodial Care, nursing care, or for care of Mental or Nervous Disorders or the mentally incompetent.
HIV: Human Immunodeficiency Virus, as that term is defined by the United States Centers for Disease Control.
Home Country: The country of which the Insured Person is a citizen or national; or maintains his/her residence or usual place of abode; or the country of which the Insured Person is the possessor of a validly issued passport.
Home Health Care Agency: A public or private agency or one of its subdivisions, which operates pursuant to law; and is regularly engaged in providing Home Nursing Care under the supervision of a Registered Nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation and Treatment prescribed by a Physician.
Home Nursing Care: Services provided by a Home Health Care Agency and supervised by a Registered Nurse, which are directed toward the personal care of a patient provided always that such care is Medically Necessary and not primarily for Custodial Care or rehabilitative purposes.
Hospital: An institution which operates as a Hospital pursuant to law; and is licensed by the state or country in which it operates; and operates primarily for the reception, care, and Treatment of sick or injured persons as Inpatients; and provides 24-hour nursing service by Registered Nurses on duty or call; and has a staff of one or more Physicians available at all times; and provides organized facilities and equipment for diagnosis and Treatment of acute medical, surgical or mental/nervous conditions on its premises; and is not primarily a long-term care facility, Extended Care Facility, nursing, rest, Custodial Care, or convalescent home, a place for the aged, drug addicts, alcoholics or runaways; or similar establishment.
Hospitalization: Confined and/or treated in a Hospital as an Inpatient.
Host Country: The country or countries other than the Home Country that the Insured Person is traveling to/in.
Illness: A sickness, disorder, illness, pathology, abnormality, ailment, disease or any other medical, physical or health condition. Illness does not include learning disabilities, attitudinal or disciplinary problems. All related conditions and recurrent symptoms of the same or related condition will be considered one Illness.
Injury: Bodily injury resulting from an Accident.
Inpatient: A person who is an overnight resident patient of a Hospital, using and being charged for room and board.
Insured Person: A Participant, on and after his/her Effective Date of Coverage and prior to his/her termination date, who has been properly listed on a census submitted to the Company by the Sponsoring Organization in accordance with the Terms of the Agreement to Provide Insurance, and for whom the proper Premium has been timely paid by the Sponsoring Organization.
Intensive Care Unit: A cardiac care unit or other unit or area of a Hospital that meets the required standards of the Joint Commission on Accreditation of Healthcare Organizations for Special Care Units.
Investigational, Experimental, or for Research Purposes: Any procedures, Treatment or supplies that by nature or composition deviate from, or are used or applied in a way which deviates from, generally accepted standards of current medical practice.
Maximum Limit: The cumulative total dollar amount of all available benefit payments and/or reimbursements available to an Insured Person under this insurance during the Insured Person鈥檚 lifetime, which shall not exceed $100,000.00. When the Maximum Limit is reached, no further benefits, reimbursements or payments will be available under this insurance.
Medically Necessary/Medical Necessity: A Treatment, service, medicine or supply which is necessary and appropriate for the diagnosis or Treatment of an Illness or Injury based on generally accepted standards of current medical practice, as determined by the Company. By way of example but not limitation, a service, Treatment, medicine or supply will not be considered Medically Necessary or a Medical Necessity if it is provided or obtained only as a convenience to the Insured Person or his/her provider; and/or if it is not necessary or appropriate for the Insured Person鈥檚 Treatment, diagnosis or symptoms; and/or if it exceeds (in scope, duration or intensity) that level of care which is needed to provide safe, adequate, and appropriate diagnosis or Treatment.
Mental or Nervous Disorder: Any disease or condition, regardless of whether the cause is organic, that is classified as a Mental Disorder in the current edition of the International Classification of Diseases, published by the U. S. Department of Health and Human Services or is listed in the current edition of Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.
Negotiated Charge: The maximum charge a Preferred Care Provider has agreed to make as to any service or supply for the purpose of the benefits under the plan.
Newborn: An infant from the moment of birth through the first thirty-one (31) days of life.
Other Coverage: Other insurance, membership benefit, workers鈥 or workplace compensation coverage, government program, reimbursement or indemnification coverage, right of contribution, recoupment or recovery, contract, or any other third-party obligation or provision of benefits which would be available to provide such benefit or to pay or reimburse or provide indemnity for any claim.
Outpatient: A person who receives Medically Necessary Treatment by a Physician or other healthcare provider that does not require an overnight stay in a Hospital.
Participant: A person who is actively participating and properly enrolled as a student in one of the Council on International Educational Exchange student exchange programs as listed and identified in the Agreement to Provide Insurance.
Period of Insurance: With respect to each Insured Person, the period of coverage and available benefits under this insurance plan, beginning on the Insured Person鈥檚 Effective Date of Coverage and ending on the date of termination of coverage under the Terms of this insurance; provided, however, that there shall be no coverage or available benefits under this insurance plan during, and no Period of Insurance shall be deemed or construed to include, any period of time an Insured Person does not fully meet the definition of 鈥淧articipant鈥 and/or any period of time any Participant or Insured Person is physically located in his/her Home Country for any reason.
Personal Papers: Credit cards, checkbooks, airline tickets, passports, visas, birth certificates, negotiable securities, commercial and administrative documents, and other personal papers owned by and titled in the name of an Insured Person and in the possession, custody and control of the Insured Person during the Period of Insurance
Physician: A duly licensed practitioner of the medical arts. A Physician must be currently licensed by the state or country in which the services are provided, and the services must be within the scope of that license.
Pre-certification/Pre-certify: A general determination of Medical Necessity, only, made by the Company in reliance and based upon the completeness and accuracy of the information provided by the Insured Person and/or the Insured Person鈥檚 healthcare providers, guardians and/or proxies at the time thereof. Pre-certification is not an assurance, authorization, pre-authorization, or verification of coverage, a verification of benefits, or a guarantee of payment.
Pre-existing Condition: Any injury, sickness or condition that was diagnosed, treated or with reasonable medical certainty, existed at the Effective Date of Coverage for the Insured Person or at any time within twelve (12) months prior to the covered person鈥檚 Effective Date of Coverage whether or not previously symptomatic or known.
Premium: The premium payments required to effectuate and maintain the Sponsoring Organization鈥檚 and the Insured Persons鈥 respective insurance coverage and benefits under this insurance, in the proper amounts and at the times (鈥淒ue Dates鈥) established by the Company in its sole discretion from time to time and as set forth in the Agreement to Provide Insurance.
Reasonable Charge: Only that part of a charge which is reasonable is covered. The Reasonable Charge for a service or supply is the lowest of:
- The provider鈥檚 usual charge for furnishing it; and
- The charge the Sponsoring Organization determines to be appropriate; based on factors such as the cost of providing the same or a similar service or supply and the manner in which charges for the service or supply are made; and
- The charge the Sponsoring Organization determines to be the prevailing charge level made for it in the geographic area where it is furnished.
In some circumstances; the Sponsoring Organization may have an agreement; either directly or indirectly through a third party; with a provider which sets the rate that the Sponsoring Organization will pay for a service or supply. In these instances; in spite of the methodology described above; the Reasonable Charge is the rate established in such agreement.
Registered Nurse: A graduate nurse who has been registered or licensed to practice by a State Board of Nurse Examiners or other state authority, and who is legally entitled to place the letters 鈥淩.N.鈥 after his or her name.
Related Third Person: Any individual or natural person who is a Relative of the Insured Person, a traveling companion of the Insured Person or a Relative of such traveling companion, and any other person, individual or family member with whom the Insured Person is residing or being hosted.
Relative: Parent, guardian, spouse, son, daughter, or immediate family member of an Insured Person.
Rider: Any exhibit, schedule, attachment, amendment, endorsement, rider or other document attached to, issued in connection with, or otherwise expressly made a part of or applicable to, the Master Policy, the Certificate, or the Agreement to Provide Insurance, as the case may be.
Sponsoring Organization: The Council on International Educational Exchange, Inc., headquartered in Portland, ME.
Substance Abuse: Alcohol, drug or chemical abuse, misuse, illegal use, overuse or dependency.
Surgery or Surgical Procedure: An invasive diagnostic or surgical procedure; or the Treatment of Illness or Injury by manual or instrumental operations performed by a Physician while the patient is under general or local anesthesia.
Terms: Terms, provisions, conditions, definitions, limits, sub-limits, limitations, wordings, restrictions, qualifications and/or exclusions.
Terrorism: The systematic or planned use of violence, fear, or the threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand.
Third Person: Any individual, natural person, or other legal entity or person, other than the Insured Person or a Related Third Person.
Totally Disabled/Total Disability: The inability, due to Illness or Injury, of an individual to perform all of the substantial and material duties of their regular employment or occupation.
Treatment/Treated: Any and all undertakings, services and/or procedures rendered or employed with respect to the management and/or care of an Insured Person for the purpose of identifying, diagnosing, treating, curing, resolving, preventing, monitoring, attending to, controlling and/or combating any Illness or Injury or the symptoms or manifestations thereof, including without limitation: verbal or written advice, consultation, examination, discussion, diagnostic or laboratory testing or evaluation of any kind, pharmacotherapy or other medication, and/or Surgery.
Treatment Period: The ninety (90) day period of time for which benefits shall be reimbursable or payable for Eligible Medical Expenses incurred with respect to an Injury or Illness. At the end of the Treatment Period, no further benefits will be available for such an Injury or Illness, whether or not additional Eligible Medical Expenses are incurred with respect thereto.
Usual, Reasonable and Customary: The most common charge for similar Treatment, services, medicines, or supplies within the area in which the charge being reviewed or considered for reimbursement or coverage is incurred, and so long as those charges are reasonable, all as determined by the Sponsoring Organization in its sole discretion. In determining whether a charge is Usual, Reasonable and Customary, the Sponsoring Organization may consider one or more of the following factors, without limitation: the level of skill, extent of training, and experience required to perform the procedure or service; the length of time required to perform the procedure or service as compared to the length of time required to perform other similar services; the severity or nature of the Illness or Injury being Treated; the amount charged for the same or comparable Treatment, services, medicines or supplies in the locality; the amount charged for the same or comparable Treatment, services, medicines or supplies in other parts of the country; the cost to the provider of providing the Treatment, service, medicine or supply; and such other factors as the Sponsoring Organization , in the reasonable exercise of its discretion, determines are appropriate.
Valuables: Items of personal property and other objects (other than Baggage and Personal Papers) having a value in excess of $175.00, which may include jewelry, cameras, video cameras, leather goods, watches, computer equipment, sound recorders and video or DVD players; provided however, that the term 鈥淰aluables鈥 shall expressly not include any sports or sporting equipment, components, or supplies, mobile telephones or other personal communication devices, MP3 players, IPods, IPads, portable DVD players, or similar tablet devices, portable GPS devices or similar personal electronic devices.