|
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. |
|
|
|
|
|
*Aggregate Maximum Limit (per insured
person) includes Medical, Dental, and Home Health Care. |
|
|
|
| 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 |
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/EXTENDED INJURY BENEFITS
After the Deductible has been satisfied, this plan pays
the Usual and Customary Charges
incurred for Medically Necessary Covered Accident
Medical Services or Dental Services received by a
Physician due to the covered Injury. 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. 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 Catastrophically Disabled, the plan
pays for the following expenses:
- Family Adjustment Benefit:
Immediate family counseling and training of the
Immediate Family to perform rehabilitation or
Custodial Care for the Injury of the Insured.
- Family Travel Expense: Travel for
the Immediate Family to visit the Insured at the
Hospital or rehabilitation facility.
- Loss of Earnings Benefit: 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.
MEDICAL AND DENTAL SERVICES BENEFIT:
The plan pays for the Usual and Customary Charges
incurred for Covered Accident Medical Services and
Dental Services of a motor vehicle for the Insured.
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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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, Heart or Circulatory malfunction:
coronary thrombosis, a cerebral vascular accident, or a
myocardial infarction resulting from participation in a
Covered Event;
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
Events;
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.
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.
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.
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 24 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.
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.
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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