|
Extended
Injury Benefit
Aggregate Maximum
Limit* for Extended Injury
| Benefits
(per insured person) |
$450,000 |
| Incurral
Period |
60 Months |
| Extended
Injury Benefit - Benefit Period |
60 Months |
| Family
Adjustment Benefit Limit |
$30,000 |
|
Family Travel Expense Benefit Limit (per Calendar
year) |
$10,000 |
|
Loss if Earnings Benefits Limit |
$10,000 |
|
Family Training Benefit Limit |
$10,000 |
| Special
Expense Benefit Limit |
$30,000 |
| Education
Expense Benefit Limit |
$50,000 |
|
|
|
|
|
|
| Spinal
Subluxation Benefit Limit (per calendar year) |
$2,000 |
|
less any amount under the Immediate Excess Medical
Expense Benefit. |
|
|
|
|
| Mental and
Nervous Disorder Benefits Limits |
|
|
| Outpatient
Maximum (per visit) |
$90 |
| Outpatient
Visits Maximum (per calendar year) |
50 Visits/1 per day |
| Inpatient
Visit Maximum (per calendar year) |
45 days |
*Aggregate Maximum Limit (per insured
person) includes Medical, Dental, and Home Health Care.
Death Benefit
| Principal
Sum |
$10,000 |
|
|
Please Note: All items listed under the Extended
Injury Benefit Section are subject to the $450,000
Aggregate Maximum Limit |
|
|
|
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Covered
Activities
Covered activities include Covered
Events and Covered Travel.
Covered events are both athletic and non-athletic
activities organized, conducted, sponsored and
supervised by the appropriate officials of the insured’s
school participating in the program, under the
jurisdiction of the State High School Association such
as:
- Interscholastic sports not
covered by the State High School Association
- School Sponsored Camps
- Summer Clinics
- Open Gym
- Field Trips
- School Dances
- Special Events
- Other Normal School Activities
Covered Travel is travel directly to
or from a Covered Event, which has been authorized by
the insured’s school participating in the plan.
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Benefit Summary
Immediate Medical Expense Benefit: If an
Insured suffers an Injury that requires him or her to be
treated by a Physician, the Company will pay the Usual
and Customary Charges incurred for Medically Necessary
Covered Accident Medical Services or Dental Services
received due to that Injury. Benefits shall be
payable up to the Immediate Medical Expense Benefit
Maximum shown in the Schedule of Benefits, subject to
the Other Insurance – Excess Nature of Policy provision,
for all Injuries sustained by any one person as the
result of any one occurrence, after the Immediate
Medical Expense Benefit Deductible has been met,
provided charges for such services are incurred within
the Immediate Medical Expense Benefit Period. The
Immediate Medical Expense Benefit Period shall begin on
the date of the accident that caused the Injury. Covered
expenses must exceed the Immediate Medical Expense
Benefit Deductible within the Incurral Period shown in
the Schedule of Benefits. The Incurral Period
starts on the date of the accident that caused the
Injury. The Immediate Medical Expense Benefit Deductible
will be waived for an Insured who is Catastrophically
Disabled.
Extended Injury
Benefits: If an Insured is determined to be
Catastrophically Disabled as the result of Injury, the
plan pays the following medically necessary Extended
Injury Benefits. If an Insured is determined to
have suffered a Catastrophic Injury as the result of
Injury, only the Medical and Dental Services Benefit
will be paid.
Family Adjustment Benefit.
If, as the result of Injury, an Insured is
determined to be Catastrophically Disabled, benefits
shall be payable for the following expenses, subject to
the Family Adjustment Benefit Maximum and within the
Extended Injury Benefit Period shown
in the Schedule of Benefits:
1. Family counseling for the
Immediate Family of the Insured during the 104-week
period following the occurrence of the Insured’s
Catastrophic Disability, provided such counseling is:
(a) Medically Necessary; and (b) furnished by a
qualified and licensed practitioner specializing in the
treatment of mental or nervous disorders.
2.
Training of the Immediate Family to perform
rehabilitation or Custodial Care for the Injury of the
Insured, provided such training is: (a) received
during the 24-month period immediately following the
date of the accident resulting in the Catastrophic
Disability; and (b) for Medically Necessary services
which are applicable to the Injury for which claim has
been made. Benefits for such training shall not
exceed the Family Training Benefit Maximum shown in the
Schedule of Benefits.
3. Travel for the Immediate
Family to visit the Insured at the Hospital or
rehabilitation facility where the Insured is being
treated for the Catastrophic Disability, provided such
travel occur within 24 months immediately following the
date of the accident resulting in the Catastrophic
Disability. This benefit includes regular coach
fares on a regularly scheduled airline, regularly
scheduled train or bus, lodging, meals, and car rental
not to exceed the Family Travel Expense Benefit Maximum
(per calendar year) shown in the Schedule of Benefits.
This benefit is limited to one round trip per family
member during any period of six (6) consecutive months.
4. With respect to the legal
spouse, or one parent or legal guardian of the Insured,
up to 75% of the gross lost earnings due to time off
from his or her regular occupation, not to exceed the
Loss of Earnings Benefit Maximum shown in the Schedule
of Benefits, provided such time off: (a) is
necessary solely for the care of the Insured due to the
Insured’s Catastrophic Disability; and (b) occurs during
the 24 consecutive months immediately following the date
of the accident which caused the Catastrophic
Disability. Gross earnings will be determined
based on the average monthly gross earnings for the
12-month period immediately preceding the accident which
caused the Catastrophic Disability.
Special Expense
Benefit: The plan pays for Usual and Customary Charges
incurred for modification(s) to the Insured’s home or
automobile as required to facilitate his or her
Catastrophic Disability.
Medical and Dental
Services Benefit: The plan pays for the Usual and
Customary Charges incurred for Covered Accident Medical
Services and Dental Services.
Education Benefit:
The plan pays for the full cost of the Insured’s
attendance at an Institution of Higher Learning to
obtain an undergraduate degree or vocational training
certificate.
Home Health Care
Benefit: The plan pays for Usual and Customary charges
incurred for Home Health Care for the treatment of the
Insured’s Catastrophic Disability.
Mental and Nervous
Disorder Benefit: The plan pays for Usual and Customary
Charges incurred for the treatment of a Mental or
Nervous Disorder occurring subsequent to the Insured’s
Catastrophic Disability.
Death Benefit:
If Injury to the Insured results in death within 365
days of the date of accident that caused the Injury, the
plan pays the Principal Sum.
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Eligibility
All
students of the participating school/school districts
while attending during normal class time and/or while
taking part in its sponsored and supervised activities,
including travel to and from.
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Insured’s Effective and Termination Dates
Effective Date:
An Insured’s coverage under this Policy begins on the
latest of : (1) the Policy Effective Date; (2) the date
the first premium for the Insured’s coverage is paid; or
(3) the date the person becomes a member of an eligible
class of persons as described in the Classification of
Eligible Persons section of the Master Application.
A change in an
Insured’s coverage under this Policy due to a change in
his or her eligible class or Covered Activity becomes
effective on the later of: (1) when the change in his or
her eligible class or Covered Activity occurs; or (2) if
the change requires a change in premium, the dare the
first changed premium id paid. However, a change
in coverage applies only with respect to accidents that
occur once the change becomes effective.
Termination Date:
An Insured’s coverage under this Policy ends on the
earliest of: (1) the Policy Termination Date, unless
renewed; (2) the premium due date if premiums are not
paid when due, subject to the Grace Period, except as
the result of Clerical Error; or (3) the premium due
date following the date the Insured ceases to be a
member of an eligible class of persons described in the
Classification of Eligible Persons section of the Master
Application.
Termination of
coverage will not affect a claim for a covered loss that
occurred while the Insured’s coverage was in force under
this Policy.
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Exclusions
This Policy does not
cover any loss caused in whole or in part by, or
resulting in whole or in part from, the following: (1)
suicide or any attempt at suicide or intentionally
self-inflicted injury or any attempt at intentionally
self-inflicted injury while sane; (2) unless
specifically provided by this Policy, sickness, disease,
or infections of any kind except: bacterial infections
due to accidental ingestion of contaminated substances
or pyogenic infections which result from an injury; or,
with respect to participation in Covered Activities, a
Heart or Circulatory malfunction; (3) the
Insured’s commission of or attempt to commit a felony;
(4) declared or undeclared war, or any act of declared
or undeclared war; (5) the Insured’s participation in
any team sport or athletic activity, except
participation in Covered Activity; (6) the Insured
being intoxicated, or being under the influence of drugs
or narcotics, unless used as prescribed by a physician
for a medical condition other than drug addiction.
An Insured shall be presumed to be intoxicated if the
level of alcohol in his or her blood is determined to
exceed the level above which a person is held under the
law of the location where the injury occurred, to be
intoxicated if operating a motor vehicle, regardless of
whether the Insured is in fact operating a motor vehicle
when the accident occurs.
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Definitions
Catastrophic
Disability/Catastrophically Disabled means due to an
Injury an Insured has suffered one of the following
losses, which the attending Physician determines to be
permanent: (1) the severely diminished mental
capacity due to brain Injury or other neurological
Injury which results in the inability of the Insured to
perform normal daily functions, including cognitive and
behavioral disorders; or (2) the severely
diminished physical capacity due to spinal cord Injury
which results in the inability of the Insured to perform
normal daily living and ambulatory functions.
Catastrophically
Disability will be deemed to occur on the date the
Catastrophic Disability first manifested as determined
by a Physician specializing in the appropriate medical
discipline.
Catastrophic Injury
means an Injury suffered by an Insured which results in
the exhaustion of the Immediate Medical Expense Benefit
and which does not result in a Catastrophic Disability.
Covered Accident
Medical Service(s) means any of the following services:
(1) professional ambulance services for transportation
to and from a Hospital; (2) services of a Physician for
care and treatment; (3) Hospital inpatient
services, including room and board (not exceeding the
semi-private room rate for each day of confinement,
unless a private room is Medically Necessary); (4)
Hospital ancillary services and supplies, including
intensive care services and daily Hospital charges for
personal services (including television, radio, barber,
telephone, and beauty services up to a maximum of $300
per month); (5) outpatient and emergency room care
and treatment; (6) Home Health Care; (7)
Spinal Subluxation, up to the Spinal Subluxation
Maximums (per calendar year) shown in the Schedule of
Benefits; (8) treatment of Mental or Nervous Disorders;
and (9) prescribed therapy, prescription drugs,
and other medical supplies commonly used for therapeutic
or diagnostic services which are Medically Necessary.
Medical expenses shall not include charges
in excess of the Usual and Customary Charges, or for
Experimental or Investigative Treatment unless
authorized by the Company prior to treatment.
Covered Activity
means those activities set out in the Covered Activities
section of the Master Application, with respect to which
Insureds are provided accident insurance under this
Policy.
Custodial Care means
the services and treatment provided to an Insured,
designed to help the patient with daily living
activities, which can be reasonably performed and safely
provided by a person who is not medically skilled.
Custodial Care includes: (1) personal care, including
but not limited to help with: walking, getting in and
out of bed, bathing, eating, exercising, dressing, or
other like activities of daily living; (2) homemaking,
such as preparing meals or special diets; (3) moving the
patient; (4) acting as a companion or sitter; or (5)
supervising medication which could otherwise be
self-administered.
Dental Services means
repair or replacement necessary as a result of Injury to
sound, natural teeth.
Heart or Circulatory
Malfunctions means coronary thrombosis, cerebral
vascular accident, or myocardial infarction resulting
directly from participation in a Covered Activity.
Home Health Care
means: (1) Custodial Care; (2) Medically Necessary
nursing care and treatment; and (3) physical, speech,
and occupational therapy, when initiated in conjunction
with discharge placement through a Rehabilitation
Facility and approved by the attending Physician;
provided to an Insured in his or her home as part of an
overall extended treatment plan.
Hospital means a
facility which: (1) is operated according to law for the
care and treatment of injured and sick people; (2) has
organized facilities for diagnosis and surgery on its
premises or in facilities available to it on a
prearranged basis; (3) has 24-hour nursing service by
registered nurses (R.N.), on duty or on call; and (4) is
supervised by one or more Physicians. Hospital
does not include: (1) a nursing, convalescent, or
geriatric unit of a hospital when a patient is confined
mainly to receive nursing care; (2) a facility which is,
other than incidentally, a rest home, nursing home,
convalescent home, home for the aged, or a facility for
the treatment of alcohol or drug abuse; nor does it
include any ward room, wing, or other section of the
hospital that is used for such purposes.
Immediate Medical
Expense Benefit Deductible means the amount of Usual and
Customary Charges for Medically Necessary Covered
Accident Medical Services or Dental Services that must
be incurred by the Insured for treatment of an Injury
within 52 consecutive months following the date of the
accident causing Injury, for which no benefits are
payable under this Policy.
Injury means a bodily
injury caused by an accident that: (1) occurs while this
Policy is in force as to the person whose injury is the
basis of claim; (2) occurs while such person is
participating in a Covered Activity; and (3) results
directly and independently from all other causes in a
covered loss.
Insured means a
person: (1) who is a member of an Eligible Class of
persons participating in a Covered Activity; (2) for
whom premium is paid; (3) while covered under this
Policy.
Medically Necessary
means that a Covered Accident Medical Service or Dental
Service: (1) is essential for diagnosis, treatment or
care of the Injury for which it is prescribed or
performed; (2) meets generally accepted standards of
medical practice; and (3) is ordered by a Physician and
performed under his or her care, supervision or order.
Mental or Nervous
Disorder means any condition: (1) identified as a
psychiatric disease in the Diagnostic and Statistical
manual of the American Psychiatric Association; and (2)
which occurs as the result of an Injury.
Physician means a
licensed practitioner of the healing arts who is acting
within the scope of his or her license who is not: (1)
the Insured; or (2) an Immediate Family Member.
Rehabilitation
Facility means a legally operating institution or part
of an institution which has a transfer agreement with
one or more Hospitals and which is primarily engaged in
providing comprehensive multi-disciplinary physical
rehabilitative services or rehabilitation inpatient care
and duly licensed by the appropriate government agency
to provide such services.
Spinal Subluxation
means dislocation of the spine or treatment for the
general purpose of correction of nerve interference and
its effects by manual or mechanical means when such
interference results from or is related to misalignment
of the vertebral column.
Usual and Customary
Charge(s) means a charge that: (1) is made for a Covered
Accident Medical or Dental Service; (2) does not exceed
the usual level of charges for similar treatment,
services or supplies in the locality where the expense
is incurred; and (3) does not include charges that
would not have been made if no insurance existed.
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American International Companies® |
Administrative Offices
600 King Street
Wilmington, DE 19801 |
Your
Privacy is Important to Us
We are
committed to providing you, our Customer, with top-notch
products backed by consistent top-quality customer
service. While information is fundamental to our ability
to do this, we recognize the great importance of keeping
your non-public personal information secure.
Accordingly, these are the practices and policies that
we, American Home Assurance Company, Illinois National
Insurance Company, The Insurance Company of the State of
Pennsylvania, American International South Insurance
Company and National Union Fire Insurance Company of
Pittsburgh, Pa., have established with respect to the
collection and sharing of our current and former
customers' non-public personal financial and health
information ("Customer information").
·
We are dedicated to serving your needs for
privacy as well as for creating products that you may
find valuable.
·
We maintain physical, electronic, and
procedural safeguards to protect Customer Information.
·
We permit only authorized insurance agents
and employees who are trained in the proper handling of
Customer Information to have access to that information.
·
We collect and use Customer Information
only to the extent necessary to conduct our business.
We are committed to maintaining the
security and confidentiality of Customer Information.
Accordingly, we expect any third party that serves you
on our behalf to adhere to our privacy policy. These
third parties are also subject to and governed by
federal and state privacy laws and regulations, and we
are not responsible for their actions.
Information Collecting
We
collect information about you from your applications,
transactions, and other interactions with us or our
affiliates, as well as from credit reporting agencies
and other third parties. We will collect and disclose
this information only in accordance with applicable laws
or regulations or in response to your request for a
product or service from us. The information we gather
helps us identify who you are, manage our relationship
with you, and develop products and services that meet
your needs.
Information Sharing
We may
share Customer Information with third parties under the
following circumstances:
· Affiliates:
We may share Customer Information with our affiliates.
These affiliates may include providers of financial
services such as other insurance companies, banks,
securities broker-dealers, and insurance agents and
agencies. They may also include affiliated non-financial
entities such as marketing companies, e-commerce service
providers, and companies providing administrative
services.
We will not share our Customer's non-public personal
financial
information with our affiliates, other than transaction
or experience-related information, without first
providing you an opportunity to direct that such
information not be shared. Furthermore, we will not
share our Customer's non-public personal health
information with affiliates except as directed or
authorized by you.
· Non-Affiliates:
We may also share Customer Information with
non-affiliated companies for administrative purposes,
the purposes of risk management, underwriting, to detect
and prevent fraud, as directed or authorized by you, or
as otherwise permitted or required by law.
From time to time, we may also enter into joint marketing
and/or service agreements to share Customer non-public
personal financial information with
non-affiliated third parties as permitted by law. These
third parties may include providers of financial
products or services such as insurance companies,
financial institutions, and securities firms.
The types
of information we may share include identifying
information (e.g., name or address), application
information (e.g., income or assets), transactional
information (e.g., premium history), and/or information
received from a consumer reporting agency (e.g., credit
history).
You Can Depend on Us
We
consider it our privilege to serve your insurance and
financial needs and we value the trust you have placed
in us. Your privacy is a top priority with us and thus
we will continue to monitor our privacy practices in
order to protect and respect that privacy.
|
American
International Companies®
|
l
The Insurance Company of the State of Pennsylvanial
National Union Fire Insurance Company of Pittsburgh, Pa.
l
American Home Assurance Company
l
Illinois National Insurance Companyl
American International South Insurance Company
Members of American International Group, Inc.
Privacy Statement
AIG RESERVES THE RIGHT TO COLLECT AND
STORE IDENTIFYING INFORMATION OF USERS OF THE SERVICE,
INCLUDING IDENTIFYING INFORMATION YOU PROVIDE WHEN USING
THE SERVICE. AIG AND ITS AFFILIATES, AND THIRD PARTIES
PROVIDING SERVICES TO AIG MAY USE THIS INFORMATION
INTERNALLY AS NECESSARY TO PROVIDE THE SERVICE AND OTHER
SERVICES TO YOU AND CUSTOMERS OF AIG. AIG MAY USE
VOLUNTARILY PROVIDED DATA TO COMMUNICATE WITH YOU ABOUT
NEWS AND OFFERS WHICH AIG BELIEVES TO BE OF INTEREST.
American International Companies®
Privacy Notice
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