A serious medical condition is defined as an illness, in the opinion of MyCare’s medical director, that:

• requires inpatient care in a hospital or other medical facility; or
• if left untreated is likely to result in significant deterioration of health, permanent disability or death; or
• requires a major orthopedic procedure.

Disability: A severe and prolonged impairment in physical or mental functions.

Hospital: A healthcare facility providing patient treatment with specialized medical and nursing staff and equipment.

Illness: Any unexpected and unforeseen condition or disease manifesting itself while the MyCare program is in force.

Inpatient: A person who is admitted to a hospital upon the recommendation of MyCare’s medical director as a patient for more than 15 consecutive hours and who receives medical treatment.

Major orthopedic: Procedures concerning bone and joint replacement and serious spine procedures.

Sickness: Any unexpected and unforeseen illness or disease manifesting itself while this plan is in force as to the member and which causes the plan member to incur medical expenses.