Accident Insurance Program
| Provided to Members by US SAILING Policy #99064424 | |
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DESCRIPTION OF COVERAGE: THE PLAN: As a US SAILING Member, you will be automatically insured against accidental loss of life, limb, sight, speech or hearing while participating in a sailing activity recognized by the US SAILING (including a regatta), that incorporates the rules and regulations of the US SAILING. Coverage includes while participating in US SAILING fund raisers, banquets or meetings as well as traveling to and from US SAILING activities.
ELIGIBILITY:
This insurance plan is provided to all active dues paying members
of the US SAILING.
BENEFICIARY:
The Loss of Life benefit will be paid to the beneficiary
designated by you. If no
such designation has been made, that benefit will be paid to the first
surviving beneficiary in the following order:
a) your spouse, b) your children, c) your parents, d) your
brothers and sisters, e) your estate.
All other indemnities will be paid to you.
THE BENEFITS:
The full Benefit Amount of $50,000 is payable for accidental loss
of life; loss of speech and loss of hearing; loss of speech and one of
loss of hand, foot or sight of one eye; loss of hearing and one of loss
of hand, foot or sight of one eye; loss of both hands, both feet, loss
of sight or any combination thereof;
50% of the Benefit Amount is payable for accidental loss of hand,
foot or sight of one eye (any one of each); loss of speech or loss of
hearing. 25% of the Benefit Amount is payable of loss of thumb and index
finger of the same hand. 'Loss'
means, with respect to a hand, complete severance through or above the
knuckle joints of at least 4 fingers on the same hand; with respect to a
foot, complete severance through or above the ankle joint.
The Company will consider it a loss of hand or foot even if they
are later reattached. "Benefit Amount" means the Loss amount at the time of an accident.
The loss must occur within one year of the accident. The Company
will pay the single largest applicable Benefit Amount.
POLICY AGGREGATE LIMIT OF INSURANCE:
If more than one (1) insured person suffers a loss in the same Accident,
then we will not pay more than $500,000.
If an accident results in Benefit Amounts becoming payable, which
when totaled, exceed $500,000 then the Policy Aggregate Limit
of Insurance will be divided proportionally among all insured
persons, based on each applicable benefit amount.
ADDITIONAL BENEFITS:
Base Plan
Excess Accident Medical Expense: reimburses you, up to $25,000 for
excess accident medical expense if accidental bodily injury causes you
to incur medical expense for care and treatment within 90 days of the
accident. The benefit
amount is payable only for medical expenses incurred within 104 weeks
after the date of the accident.
This benefit is payable on an excess basis; we will determine the
reasonable and customary charge for the covered medical expense.
We will then reduce that amount by amounts already paid or
payable by any other plan. We will pay the resulting amount, less the
$2,500 deductible for excess accident medical expense.
DEFINITIONS:
Accident or Accidental means a sudden, unforeseen and unexpected event
which happens by chance.
Accidental Bodily Injury means bodily injury which is accidental, the
direct cause of a loss, is independent of disease, illness or other
causes and occurs while you are insured under this policy, which is in
force. Medical Expense
means the Reasonable and Customary charges for Medical Services that are
Medically Necessary for the care and treatment of Accidental Bodily
Injuries sustained in a covered Accident.
Medically Necessary means any medical or dental service, supply
or course of treatment which: 1) is ordered or prescribed by a Physician
or a dentist; 2) is appropriate and consistent with the patient's
diagnosis; 3) is in accord with current accepted medical or dental
practice; and 4) could not be eliminated without adversely affecting the
patient's condition or quality of medical or dental care. Medical
Services means the costs for the following Medically Necessary services:
1) medical care and treatment by a Physician or a dentist; 2) hospital
room and board and hospital care, both inpatient and outpatient; 3)
drugs and medicines required and prescribed by a Physician or a dentist;
4) diagnostic tests and x-rays prescribed by a Physician or a dentist;
5) transporting the Insured Person in an emergency transportation
vehicle from the location where the Insured Person becomes injured to
the nearest hospital where appropriate medical treatment can be
obtained; 6) dental care and treatment due to injury, subject to the
Dental Benefit Amount shown in Section V of the Declarations, Benefits;
7) physical therapy,
including diathermy, ultrasonic, whirlpool or heat treatment,
adjustment, manipulation, massage and the office visit associated with
such therapy, subject to the Physical Therapy Benefit Amount shown in
Section V of the Declarations, Benefits; 8) treatment performed by a
licensed medical professional when prescribed by a Physician, if
hospitalization would have been otherwise required; 9) rental of durable
medical equipment designed primarily for use, and used primarily, by
people who are injured, such as a wheelchair or a hospital bed; 10)
artificial limbs and other prosthetic appliances; 11) orthopedic
appliances or braces.
EXCLUSIONS:
This insurance does not cover loss resulting from:
emotional trauma, mental or physical illness, disease, pregnancy,
childbirth or miscarriage, bacterial or viral infection (except
bacterial infection caused by an accident or from accidental consumption
of a substance contaminated by bacteria), or bodily malfunctions,
suicide, attempted suicide or intentionally self inflicted injuries;
declared or undeclared war.
ADDITIONAL EXCLUSIONS:
This insurance also does not apply to an accident resulting from:
being in, entering or exiting any aircraft owned, leased or operated by
the Policyholder, or operated by an employee of the Policyholder, on the
Policyholder’s behalf; entering, or exiting any aircraft while acting or
training as a pilot or crew member, but this exclusion does not apply to
passengers who temporarily perform pilot or crew functions in a life
threatening emergency; being intoxicated; being under the influence of
any narcotic unless taken on the advice of a physician.
CLAIM NOTICE:
Written claim notice must be given to us or any of our appointed agents
or brokers within 20 days after the occurrence of any loss covered by
this policy or as soon as reasonably possible.
Failure to give notice within 20 days will not invalidate or
reduce any otherwise valid claim if notice is given as soon as
reasonably possible.
CLAIM FORMS:
When we receive notice of a claim, we will send you forms for giving
proof of loss to us within 15 days.
If you do not receive the forms, you should send us a written
description of the loss.
CLAIM PROOF OF LOSS:
For claims involving disability, complete proof of loss must be given to
us within 30 days after commencement of the period for which we are
liable. Subsequent written
proof of the continuance of such disability must be given to us at
intervals we may reasonably require. For all other claims, complete
proof of loss must be given to us within 90 days after the date of loss,
or as soon as reasonably possible. Failure to give complete proof of
loss within these time frames will not invalidate any otherwise valid
claim if notice is given as soon as reasonably possible and in no event
later than 1 year after the deadline to submit complete proof of loss.
CLAIM PAYMENT:
For benefits payable involving disability, we will pay you the
applicable benefit amount no less frequently than monthly during the
period for which we are liable, subject to our receipt of complete proof
of loss. For all other benefits, we will pay you or your beneficiary the
applicable benefit amount within 60 days after we receive complete proof
of loss and if you, the Policyholder and/or the beneficiary have
complied with all the terms of this policy. As a handy reference guide, please read this
and keep it in a safe place with your other insurance documents.
This description of coverage is not a contract
of insurance but is a summary of the principal provisions of the
insurance while in effect.
Complete policy provisions are contained In the
Master Policy, which can be obtained from the Policyholder.
Plan Administrator:
Answers to specific questions can be obtained by calling the Plan
Administrator. To make a
claim please contact the Plan Administrator.
Plan Underwritten By |
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