Premier No Health Screening NC
A Doctor or
means a person who: is licensed by the state to practice a healing art; and performs services for a covered
person which are allowed by his license. Doctor or physician does not include any covered person or anyone related to any covered
person by blood or marriage, a business or professional partner of any covered person, or any person who has a financial affiliation or
a business interest with any covered person.
is a specified area within a hospital that is designated for the emergency care of accidental injuries. This
area must: be staffed and equipped to handle trauma; be supervised and provide treatment by doctors; and provide care seven days
per week, 24 hours per day.
means a place which: is run according to law on a full-time basis; provides overnight care of injured and sick people; is
supervised by a doctor; has full-time nurses supervised by a registered nurse; and has at its locations or uses on a pre-arranged basis:
X- ray equipment, a laboratory and an operating room where surgical operations take place.
Notwithstanding the above, a hospital is not: a nursing home; an extended care facility; a skilled nursing facility; a rest home or home
for the aged; a rehabilitation center; a place for alcoholics or drug addicts; or an assisted living facility.
Care Unit means a place which: is a specifically designated area of the hospital called an intensive care unit
that provides the highest level of medical care and is restricted to patients who are critically ill or injured and who require intensive
comprehensive observation and care; is separate and apart from the surgical recovery room and from rooms, beds and wards
customarily used for patient confinement; is permanently equipp
ed with special lifesaving equipment for the care of the critically ill or
injured; is under constant and continuous observation by a specially trained nursing staff assigned exclusively to the intensive care unit
on a 24 hour basis; and has a doctor assigned to the intensive care unit on a full-time basis.
A hospital intensive care unit is not any of the following step down units: a progressive care unit; an intermediate care unit; a private
monitored room; sub-acute intensive care unit; an observation unit; or any facility not meeting the definition of a hospital intensive
care unit as defined in the policy.
Care Unit means a place which: is a specifically designated area of the hospital that provides a
level of medical care below intensive care, but above a regular private or semi-private room or ward; is separate and apart from the
surgical recovery room and from rooms, beds and wards customarily used for patient confinement; is permanently equipped with
special lifesaving equipment for the care of the critically ill or inju
red; and is under constant and continuous observation by a specially
trained nursing staff.
A hospital sub-acute intensive care unit may be referred to by other names such as progressive care, intermediate care, or a step-down
unit, but it is not a regular private or semi-private room, or a ward with or without monitoring equipment.
means a wound to a covered person’s body that is caused solely by or is the result of a covered accident.
Unit is a specified area within a hospital, apart from the emergency room, where a patient can be monitored
following outpatient surgery or treatment in the emergency room by a doctor; and which: is under the direct supervision of a doctor or
registered nurse; is staffed by nurses assigned specifically to that unit; and provides care seven days per week, 24 hours per day.
is a person, who: possesses the designation “Occupational Therapist Registered (OTR);” is licensed
by the state to practice occupational therapy; performs services which are allowed by his license and performs services for which
benefits are provided by the policy. For purposes of this definition, occupational therapist does not include any covered person or
anyone related to any covered person by blood or marriage.
An Off-Job Accident means an accident that occurs while a covered person is not working at any job for pay or
benefits. An On-Job Accident means an accident that occurs while a covered person is working at any job for pay or
is a person who: is licensed by the state to practice physical therapy; performs services which are allowed by
his license; performs services for which benefits are provided by the policy; and practices according to the Code of Ethics of the
American Physical Therapy Association. For purposes of this definition, physical therapist does not include any covered person or
anyone related to any covered person by blood or marriage.
Unit means an appropriately licensed facility that provides rehabilitation care services on an inpatient basis.
Rehabilitation care services consist of the combined use of medical, social, educational, and vocational services to enable patients
disabled by accidental injury to achieve the highest possible functional ability. Services are provided by or under the supervision of an
organized staff of physicians. The rehabilitation unit may be part of
a hospital or a freestanding facility. A rehabilitation unit is not a
nursing home, an extended care facility, a skilled nursing facility, a rest home or home for the aged, a hospice care facility, a place for
alcoholics or drug addicts, or an assisted living facility.
An Urgent Care
means a place other than a doctor’s office, hospital or emergency room that provides emergency care
and treatment for injured people.
IS NOT COVERED BY THE
We will not pay benefits for losses that are caused by or are the result of any covered person’s:
engaging in hang-gliding, bungee jumping, parachuting, sailgliding, parasailing, parakiting, jumping, parachuting, or falling from
• any aircraft or hot air balloon, including those which are not motor-driven or any similar activities.
committing or attempting to commit a felony or engaging in an illegal occupation.
riding in or driving any motor-driven vehicle in a race, stunt show or speed test.