SECTION 1 - SCHEDULE OF BENEFITS - ELIGIBLE CLASSES Show The Classes eligible for coverages available under the Policy are shown below. SCHEDULE OF BENEFITS - TABLE 1
*50% of Deductible for an Injury or Sickness is waived if treatment is received at Recognized Student Health Center or if the initial treatment for an Injury or Sickness is received at Recognized Student Health Center.
SECTION 2 - DESCRIPTION OF COVERAGES - Coverage A - Medical Expenses
SECTION 3 - DESCRIPTION OF COVERAGES - Coverage C - Repatriation of Remains Benefit If a Covered Person dies, the
Insurer will pay the necessary expenses actually incurred, up to the Maximum Limit shown in the Schedule of Benefits, for the repatriation of the Covered Person's remains to his/her Home Country. This benefit covers the legal minimum requirements for the transportation of the remains. It does not include the transportation of anyone accompanying the body or visitation or funeral expenses. Any expenses for repatriation of remains require the Insurer's or the Administrator's prior approval.
SECTION 5 - DESCRIPTION OF COVERAGES - Coverage D - Medical Evacuation Benefit If a Covered Person sustains an Injury or suffers a sudden Sickness while traveling outside his/her Home Country, the Insurer will pay the Medically Necessary expenses incurred, up to the lifetime Maximum Limit for all medical evacuations shown in Table 1 of the Schedule of Benefits, for a medical evacuation to the nearest Hospital, appropriate medical facility or back to
the Covered Person's Home Country. Transportation must be by the most direct and economical route. However, before the Insurer makes any payment, it requires written certification by the attending Physician that the evacuation is Medically Necessary. Any expenses for medical evacuation require the Insurer's or the Administrator's prior approval. No benefits are payable under any other provision of the Policy for expense incurred by the Covered Person on and after the date of the evacuation.
SECTION 6 - DESCRIPTION OF COVERAGES - Coverage E - Bedside Visit Benefit Bedside Visit Benefit: If the Covered Person is Hospital Confined due to an Injury or Sickness for more than seven (7) days while traveling outside his/her Home Country, the Insurer will pay up to a maximum benefit of $750 for the cost of one economy round trip air fare ticket to, and the hotel accommodations in, the place of the Hospital Confinement for one person designated by the Covered Person. With respect to any one trip, this benefit is payable only once for that trip, regardless of the number of Covered Persons on that trip. No more than one (1) visit may be made during any 12 month period. No benefits are payable under this provision prior to the end of the seven (7) day Hospital Confinement. No benefits are payable unless the trip is approved in advance by the Administrator. SECTION 7 - PRE-EXISTING CONDITION LIMITATION The Insurer does not pay benefits for loss due to a Pre Existing Condition during the first one (1) year of coverage. Pre Existing Conditions will be covered after the Covered Person's coverage has been in force for one (1) year. SECTION 8 - GENERAL POLICY EXCLUSIONS Unless specifically provided for elsewhere under the Policy, the Policy does not cover loss caused by or resulting from, nor is any premium charged for, any of the following:
SECTION 9 - DEFINITIONS Unless specifically defined elsewhere, wherever used in the Policy, the following terms have
the meanings given below.
Coinsurance means the ratio by which the Covered Person and the Insurer share in the payment of Reasonable Expenses for Medically Necessary treatment. The percentage the Insurer pays is stated in the Schedule of Benefits. Complications means a secondary condition, an Injury or a Sickness, that develops or is in conjunction with an already existing Injury or Sickness. Confinement (Confined) means the continuous period a Covered Person spends as an Inpatient in a Hospital due to the same or related cause. Congenital Condition means a condition that existed at or has existed from birth, including, but not limited to, congenital diseases or anomalies that cause functional defects. Country of Assignment means the country f or which the Eligible Participant has a valid passport and, if required, a visa, and in which he/she is undertaking and educational activity. Covered Medical Expense means an expense actually incurred by or on behalf of a Covered Person for those services and supplies which are:
Covered Person means an Eligible Participant and any Eligible Dependents as described in the appropriate eligibility section, for whom premium is paid and who is covered under the Policy. Deductible Amount means the dollar amount of Covered Medical Expenses which must be incurred as an out of pocket expense by each Covered Person on a per Injury or per Sickness basis before certain benefits are payable under the Policy. The Deductible Amounts are stated in the Schedule of Benefits. Drug Abuse means any pattern of pathological use of a drug that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn. Durable Medical Equipment means medical equipment which:
Eligible Participant means a person who:
Emergency Hospitalization and Emergency Medical Care means hospitalization or medical care:
Experimental or Investigational means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used, including any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice; and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. The Insurer will make the final determination as to what is experimental or investigational. Home Country means the Covered Person's country of domicile named on the enrollment form or the roster, as applicable. Hospital means a facility that:
Injury means bodily injury caused directly by an Accident. It must be independent of all other causes. To be covered, the Injury must first be treated while the Covered Person is insured under the Policy. A Sickness is not an Injury. A bacterial infection that occurs through an Accidental wound or from a medical or surgical treatment of a Sickness is an Injury. Inpatient means a person confined in a Hospital for at least one full day (18 to 24 hours) and charged room and board. Medically Necessary means medical and dental service, treatment or supplies which are:
Mental Illness means any psychiatric disease identified in the most recent edition of the International Classification of Diseases or of the American Psychiatric Association Diagnostic and Statistical Manual. Other Plan means any of the following which provides benefits or services for, or on account of, medical care or treatment:
Outpatient means a person who receives medical services and treatment on an Outpatient basis in a Hospital, Physician's office, Ambulatory Surgical Facility, or similar centers, and who is not charged room and board for such services. Participating Organization or Institution means the organization or institution which has elected that its Eligible Participants and, if applicable, the dependents of those Eligible Participants be covered under the Policy and which has been accepted by the Insurer for coverage under the Policy. Physician means a currently licensed practitioner of the healing arts acting within the scope of his/her license. It does not include the Covered Person or his/her spouse, parents, parents in law or dependents or any other person related to the Covered Person or who lives with the Covered Person. Physiotherapy means a physical or mechanical therapy, diathermy, ultrasonic, heat treatment in any form, manipulation or massage. Policy Year means the period beginning on the Participating Organization's or Institution's effective date. It includes the period beginning on the date a Covered Person's coverage under the Policy starts. It ends on the date the Covered Person's insurance under the Policy ends. Pre Existing Condition means any Injury or Sickness which had its origin or symptoms, or for which a Physician was consulted or for which treatment or a medication was recommended or received one (1) year prior to the Covered Person's effective date of coverage. Reasonable Expense means the normal charge of the provider, incurred by the Covered Person, in the absence of insurance,
Recognized Student Health Center means a health facility of an educational institution that provides basic health services for students for a minimum of 10 hours per week during the school semester. Basic services must include staffing by a licensed medical provider (M.D., C.N.P. or R.N.) for the purpose of assessment and treatment of minor Sicknesses and Injuries and/or referral to a PPO Provider and is approved as a Recognized Student Health Center by the Administrator. Registered Nurse means a graduate nurse who has been registered or licensed to practice by a State Board of Nurse Examiners or other state authority, and who is legally entitled to place the letters "R.N." or "R. P.N." after his/her name. Sickness means an illness, ailment, disease, or physical condition of a Covered Person starting while insured under the Policy. Written Request means a request on any form provided by the Administrator for particular information. 11:59:59 p.m. means 11:59:59 p.m. at the Covered Person's location. 12:00:01 a.m. means 12:00:01 Eastern Prevailing Time in Washington, DC. SECTION 10 - EXTENSION OF BENEFITS No benefits are payable for medical treatment benefits after the Covered Person's insurance terminates. However, if the Covered Person is in a Hospital on the date the insurance terminates, the Insurer will continue to pay the medical treatment benefits until the earlier of the date the Confinement ends or 31 days after the date the insurance terminates. SECTION 11 - EXCESS COVERAGE The Insurer will reduce the amount payable under the Policy to the extent expenses are covered under any Other Plan. The Insurer will determine the amount of benefits provided by Other Plans without reference to any coordination of benefits, non duplication of benefits, or other similar provisions. The amount from Other Plans includes any amount to which the Covered Person is entitled, whether or not a claim is made for the benefits. The Policy is secondary coverage to all other policies. SECTION 12 - ELIGIBILITY REQUIREMENTS AND PERIOD OF COVERAGE Eligible Participant: Eligible Participant means any person who satisfies the definition of an Eligible Participant and the requirement of an applicable
class as shown in Section 1-Eligible Classes.
Thereafter, the insurance is effective 24 hours a day, worldwide except whenever the Covered Person is in his/her Home Country. In no event, however, will insurance start prior to the date the premium is received by the Insurer. When an Eligible Participant's Coverage Ends: Coverage for an Eligible Participant will automatically terminate on the earliest of the following dates:
Any unearned premium will be returned upon request, but returned premium will only be for the number of full months of the unexpired term of coverage, less any administrative fees. Premium will be refunded in full or pro rated if it is later determined that the Covered Person is not eligible for coverage or if the enrollment form contained inaccurate or misleading information. Coverage will end at 11:59:59 p.m. on the last date of insurance. A Covered Person's coverage will end without prejudice to any claim existing at the time of termination. SECTION 13 - PREMIUM - For Individual Enrollment
Payment: Coverage is provided in return for payment of the required premium. Premiums may be paid monthly, quarterly, semi annually, annually, or for a specified term, as arranged with the Administrator. Coverage will terminate if the required premium is not paid to the Insurer. Premium is charged from the date insurance for each Covered Person takes effect. Premium is payable to the Insurer or one of its authorized agents. If payment of a premium is not honored by the bank or
credit card drawn upon, the insurance is deemed to have not been purchased and not to be in effect.
If cancellation is after 10 days, premium will be refunded in whole months only. SECTION 15 - CLAIM PROVISIONS Notice of Claim: Written notice of any event which may lead to a claim under the Policy must be given to the Insurer or to the Administrator within 30 days after the event, or as soon thereafter as is reasonably possible.
Time for Payment of Claim: Benefits payable under the Policy will be paid immediately upon receipt of satisfactory written proof of loss, unless the Policy provides for periodic payment. Where the Policy provides for periodic payments, the benefits will accrue and be paid monthly, subject to satisfactory written proof of loss. Payment of Claims: Benefits for accidental loss of life under Coverage B will be payable in accordance with the beneficiary designation and the provisions of the Policy which are effective at the time of payment. If no beneficiary designation is then effective, the benefits will be payable to the estate of the Covered Person for whom claim is made. Any other accrued benefits unpaid at the Covered Person's death may, at the Insurer's option, be paid either to his/her beneficiary or to his/her estate. Benefits payable under Coverages A, C, D, and E shall be payable to the provider of the service. Benefits payable under Coverage B, other than for loss of life, will be paid to the Covered Person. If any benefits are payable to the estate of a Covered Person, or to a Covered Person's beneficiary who is a minor or otherwise not competent to give valid release, the Insurer may pay up to $1,000 to any relative, by blood or by marriage, of the Covered Person or beneficiary who is deemed by the Insurer to be equitably entitled to payment. Any payment made by the Insurer in good faith pursuant to this provision will fully discharge the Insurer of any obligation to the extent of the payment. Physical Examination and Autopsy: The Insurer may, at its expense, examine a Covered Person, when and as often as may reasonably be required during the pendency of a claim under the Policy and, in the event of death, make an autopsy in case of death, where it is not forbidden by law. SECTION 16 - GENERAL PROVISIONS Entire Contract: The entire contract between the Insurer and the Policyholder consists of the Policy, this Certificate, the application of the Policyholder and the application of the Participating Organization or Institution, copies of which are attached to and made a part of the Policy. All statements contained in the applications will be deemed representations
and not warranties. No statement made by an applicant for insurance will be used to void the insurance or reduce the benefits, unless contained in a written application and signed by the applicant. No agent has the authority to make or modify the Policy, or to extend the time for payment of premiums, or to waive any of the Insurer's rights or requirements. No modifications of the Policy will be valid unless evidenced by an endorsement or amendment of the Policy, signed by one of the Insurer's
officers and delivered to the Policyholder. In accordance with state insurance law, this certificate is composed of the following forms on file with the
State Insurance Department. Any provisions of this certificate that may be in conflict with the laws of the state where the purchaser is located will be administered to conform with the requirements of that state's laws, including mandated benefits.
This plan is administered by: Worldwide Insurance Services 933 First Avenue King of Prussia, PA 19406 1.888.350.2002 What is amount to be paid by insured meaning?Definition: Claim amount can be defined as the sum payable at the maturity of an insurance policy or upon death of the person insured to the beneficiary or the nominee or the legal heir of the insured.
What happens if the insurer discovered that the insured's age?What happens if the insurer discovers that the insured's age was accidentally misstated on an application for an individual life insurance policy? Benefits will be calulated according to how much coverage the premium paid would have purchased for the correct age.
Which of the following is an example of nonforfeiture?Life insurance policyholders can select one of four nonforfeiture benefit options: the cash surrender value, extended term insurance, loan value, and paid-up insurance.
How many months can a life insurance policy normally be backdated from the date of application?Most life insurance companies allow you to backdate your policy a maximum of six months or up to your last half birthday, whichever is the shortest amount of time.
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