Port Arthur Health Plan

Port Arthur Health Plan

     The language of the Port Arthur Health Plan usually starts out very simply. Here is a typical example: “in return for payment of the premium and subject to all the terms of this policy, we agree with you as follows:” Clear and to the point . . . so far.

     Of course, life is rarely that simple. The terms of the agreement itself must be set forth. The purpose of the definitions section is to limit the parameters of the coverage by specifying exactly what various terms, which might otherwise be subject to more than one interpretation, really mean in the context of the Port Arthur Health Plan. Here is an example of how this works:

     Assume that injures to a “residence employee” are covered under the terms of a particular i Port Arthur Health Plan. Assume further that you work out of your home and employ a secretary, who is injured while at work. The question would arise as to whether or not the secretary was a “residence employee.” After all, the secretary is employed by you and works in your home. If that isn’t a residence employee, what is?

     The answer should be in your policy’s definitions section. Here is some typical language used by the insurance industry to define a Port Arthur Health Plan:

                Residence employee means: an employee of an insured whose duties are related to the maintenance or use of the residence premises, including household or domestic services.

Thus, under this definition the secretary would not be a “residence employee,” since the work he or she performed was not “related to the maintenance of the resident premises.” Therefore, at least in the case of this particular hypothetical policy, the secretary’s injuries would not be covered

Thus, it is easy to see how important definitions are to the insurance agreement and why you need to understand them if you are to be a Port Arthur Health Plan.

Agreement

If the declarations page can be thought of as the face of the policy, then the agreement portion is its heart, for here will be found the exact terms of the contract itself.