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Volunteer Accident Medical

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Accident Coverage for Volunteers


This plan outline provides a brief description of the important features of the Accident Medical Insurance coverage for Volunteers.

Eligibility: All volunteers* registered with the policyholder. Coverage is mandatory for all volunteers of the policyholder. Coverage applies while on a volunteer assignment, within the
United States. Coverage includes travel directly to and from a volunteer assignment and any incidental travel while on the assignment.
*Coverage is not available to police, fire, construction or other emergency or
medical response team volunteers.

Accident Benefits

Accidental Medical Expense
If accidental bodily injury causes an insured person to incur medical expenses for care and treatment within 90 days of a covered accident, this insurance will pay up to the maximum Accidental Medical Expense Benefit Amount, including covered Dental, Physical Therapy and Orthopedic expenses. Accidental Medical Expense is payable only for medical expenses incurred within the benefit period. For policyholders located in Indiana, Maryland, New Jersey and Texas, coverage will be coordinated with other plans. For policyholders located in all other states, coverage is excess of all other plans.

Accidental Loss of Life
Schedule of Benefits: If an accident results in any of the following losses within one year after the date of the accident, the plan provides the following benefits:

Percent of Loss of Life
Accidental Loss of: Benefit Amount
Life or Quadriplegia 100%
Speech and Hearing 200%
Speech and One of: Hand, Foot or Sight of One Eye 200%
Hearing and One of: Hand, Foot or Sight of One Eye 200%
Both Hands, Both Feet or Sight of Both Eyes or a
Combination of a Hand, a Foot or Sight of One Eye 200%
One Hand or One Foot or Sight of One Eye 100%
Speech or Hearing 100%
Paraplegia 75%
Thumb and Index Finger of the Same Hand or Hemiplegia 50%
Uniplegia 25%
If an insured has multiple Losses as the result of one accident, the single largest Benefit
Amount applicable to the Losses suffered will be paid.

Temporary Total Disability
If an accidental bodily injury causes an insured person to suffer a temporary total disability that continues for at least 7 days and is expected to be of continuous and indefinite duration, as determined by a physician, then the policy will pay a weekly benefit for a maximum of 52 weeks.

Maximum Limit of Insurance
The policy will not pay more than the $1,000,000 maximum limit of insurance. If an accident results in benefit amounts becoming payable, which, when totaled, exceed the applicable maximum limit of insurance, the maximum limit of insurance will be divided proportionally among the insured persons, based on each applicable benefit amount.

DEFINITIONS

Accident or Accidental means a sudden, unforeseen, and unexpected event which: 1) happens by chance; 2) arises from a source external to the insured person; 3) is independent of illness, disease or other bodily malfunction or medical or surgical treatment thereof; 4) occurs while the Insured Person is insured under the policy which is in-force; and 5) is the
direct cause of loss.
Accidental Bodily Injury means bodily injury that is Accidental, the direct cause of a loss, and occurs while an eligible person is insured under this policy when it is in force.
Loss of Foot means the complete severance through or above the ankle joint. We will consider it a Loss of Foot even if the foot is later reattached.
Loss of Hand means complete severance of at least 4 fingers at or above the metacarpal phalangeal joint on the same hand or at least 3 fingers and the thumb on the same hand. We will consider it a Loss of Hand even if the fingers and/or thumb are later reattached.
Loss of Hearing means the permanent irrecoverable and total deafness, as determined by a physician, with an auditory threshold of more than ninety decibels in each ear (which cannot be corrected by any aid or device).
Loss of Life means death, including clinical death determined by the local governing medical authorities.
Loss of Sight of an Eye means the permanent loss of vision in one eye. Remaining vision must be no better than 20/200 using a corrective aid or device, as determined by a physician.
Loss of Speech means the permanent and irrecoverable total loss of the capability of speech without the aid of mechanical devices, as determined by a physician.
Loss of Thumb and Index Finger means complete severance through the metacarpal phalangeal joints of the thumb and index finger of the same hand. We will consider it a Loss of Thumb and Index Finger even if one or both are later reattached.
Paraplegia means complete and irreversible loss of all motion and all practical use of both legs that lasts longer than 365 days, as determined by a physician.
Quadriplegia means complete and irreversible loss of all motion and all practical use of both arms and legs that lasts longer than 365 days, as determined by a Physician.
Hemiplegia means complete and irreversible loss of all motion and all practical use of one arm and one leg on the same side of the body that lasts longer than 365 days, as determined by a physician.
Uniplegia means complete and irreversible loss of all motion and all practical use of one arm or one leg that lasts more than 365 days, as determined by a physician.

EXCLUSIONS

Insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting from, directly or indirectly:

An insured being in, entering or exiting any aircraft that is owned, leased or operated by the policyholder or on behalf of the policyholder or operated by an employee of the policyholder on the policyholder’s behalf. This exclusion does not apply to leased aircraft which are chartered for single trips.

An insured being in, entering or exiting any aircraft while acting or training as a pilot or crew member. This does not apply to passengers who temporarily perform pilot or crew functions in a life threatening emergency.

An insured’s emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions or medical or surgical treatment thereof. This does not apply to an insured’s bacterial infection caused by an Accident or from Accidental consumption of a substance contaminated by bacteria.

Suicide, attempted suicide or intentionally self-inflicted injury.

An insured participating in military action while in active military service with the armed forces of any country or established international authority. However, this exclusion does not apply to he first sixty (60) consecutive days of active military service with the armed forces of any country or established international authority.

A declared or undeclared war.

An insured being intoxicated (as defined by the laws of the jurisdiction where the Accident occurs) or under the influence of any narcotic or other controlled substance, unless taken and used as prescribed by a physician.

Any occurrence while an insured is incarcerated after conviction.

Insurance also does not apply to any Accident, Accidental Bodily Injury or loss when:

1) the U.S. has imposed any trade or economic sanctions prohibiting insurance of any Accident or Accidental Bodily Injury or;
2) there is any other legal prohibition against providing insurance of any Accident or Accidental Bodily Injury. In addition, the Excess Accidental Medical Expense benefit does not apply to charges and services for:
1) which the insured has no obligation to pay;
2) any injury for which Worker’s Compensation benefits or occupational injury benefits are payable;
3) treatment by a person employed or retained by the Policyholder;
4) for any injury occurring while fighting, except in self-defense;
5) treatment that is educational, experimental or investigational in nature or that does not constitute accepted medical
practice;
6) charges and services that are not medically necessary; for treatment involving conditions caused by repetitive motion
injuries, or cumulative trauma and not as the result of an Accidental Bodily Injury.