Common use of Disabled Dependent Clause in Contracts

Disabled Dependent. This is an enrollee's dependent who is (a) incapable of self-sustaining employment by reason of developmental disability, mental illness or disorder, or physical disability; and (b) chiefly dependent on the enrollee for support and maintenance. The enrollee must give us a written request for coverage of a disabled dependent. The request must include written proof of disability and must be approved by us, in writing. We must receive the request within 31 days of the date an already enrolled dependent becomes eligible for coverage under this definition. We reserve the right to periodically review disability, provided that after the first two years, we will not review the disability more frequently than once every 12 months. Emergency Accidental Dental Services. These are services required immediately, because of a dental accident. Emergency Health Care Service. This means a health care service necessary to treat a medical condition in which the absence of immediate medical attention could reasonably be expected to result in a condition described below: • a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: o placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, o serious impairment to bodily functions, or o serious dysfunction of any bodily organ or part.