Accidental Death and Dismemberment With $25,000, $50,000 or $100,000 Coverage
Eligibility for Insurance
If You are in one of the Classes of Eligible Person shown on the Policy Schedule of Benefits, You are eligible to be insured on the Policy Effective Date, or the day after You become eligible if later. We retain the right to investigate eligibility status and attendance records to verify eligibility requirements are met. If We discover the eligibility requirements are not met, Our only obligation is to refund any premium paid for that person.
Effective Date of Insurance
You will be insured on the later of the Policy Effective Date or the date You are eligible, if You are not required to contribute to the cost of this insurance. If You are required to contribute to the cost of this insurance, Your insurance is effective on the latest of the following dates:
- The Policy Effective Date.
- The date You become eligible.
- The date We receive the completed enrollment form.
- The date the required premium is paid or
- The date payroll/account deduction is authorized for this insurance.
Deferred Effective Date
If You are not in Active Service on the date insurance would otherwisebe effective, it will be effective on the date You return to Active Service.
Termination Date of Insurance Your coverage will end on the earliest of the date:
- The Policy terminates
- You are no longer eligible
- The period ends for which premium is paid.
Schedule of Benefits
|Coved Loss||Benefit Amount|
|Life||100% of the Principal Sum|
|Two or more Members||100% of the Principal Sum|
|Quadriplegia||100% of the Principal Sum|
|One Member||50% of the Principal Sum|
|Hemiplegia||50% of the Principal Sum|
|Paraplegia||75% of the Principal Sum|
|Thumb and Index Finger of the Same Hand||25% of the Principal Sum|
|Uniplegia||25% of the Principal Sum|
“Quadriplegia” means total Paralysis of both upper and lower limbs. “Hemiplegia” means total Paralysis of the upper and lower limbs on one side of the body.
“Uniplegia” means total Paralysis of one lower limb or one upper limb.
“Paraplegia” means total Paralysis of both lower limbs or both upper limbs.
“Paralysis” means total loss of use. A Doctor must determine the loss of use to be complete and not reversible at the time the claim is submitted.
“Member” means Loss of Hand or Foot, Loss of Sight, Loss of Speech and Loss of Hearing.
“Loss of Hand or Foot” means complete Severance through or above the wrist or ankle joint.
“Loss of Sight” means the total, permanent Loss of Sight of one eye.
“Loss of Speech” means total and permanent loss of audible communication that is irrecoverable by natural, surgical or artificial means.
“Loss of Hearing” means total and permanent Loss of Hearing in both ears that is irrecoverable and cannot be corrected by any means.
“Loss of a Thumb and Index Finger of the Same Hand” means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the hand).
“Severance” means the complete separation and dismemberment of the part from the body.
Exposure and Disappearance Coverage
We will pay benefits shown in the Schedule of Benefits if the Covered Person sustains a Covered Loss in the Schedule of Covered Losses that results or resulting directly and independently of all other causes from unavoidable exposure to the elements following a Covered Accident.
If the Covered Person disappears and is not found within one year from the date of the wrecking, sinking or disappearance of the conveyance in which the Covered Person was riding in the course of a trip that would otherwise be covered under this Policy, it will be presumed that the Covered Person’s death resulted directly and independently of all other causes from a Covered Accident.
We will pay the Coma Benefit shown in the Schedule of Benefits if a Covered Person becomes Comatose within 31 days of a Covered Accident and remains in a Coma for at least 31 days.
We reserve the right, at the end of the first 31 days of Coma, to require proof that the Covered Person remains Comatose. This proof may include, but is not limited to, requiring an independent medical examination at Our expense. We will pay this benefit in periodic payments and a l ump sum as shown in the Schedule of Benefits. Periodic payments will end on the first of the following dates:
- The end of the month in which the Covered Person dies;
- The end of the 11th month for which this benefit is payable;
- The end of the month in which the Insured recovers from the Coma.
A person is deemed “Comatose” or in a “Coma” if he or she is in a profound stupor or state of complete and total unconsciousness, as the result of a Covered Accident.
Repatriation of Remains Benefit We will pay Repatriation of Remains Benefits as shown in the Schedule of Benefits for preparation and return of a Covered Person’s body to his or her home if he or she dies as a result of a Medical Emergency while traveling 100 miles or more away from his or her place of permanent residence. Covered expenses include:
- Expenses for embalming or cremation;
- The least costly coffin or receptacle adequate for transporting the remains;
- Transporting the remains.
- Escort Services: expenses for an Immediate Family Member or companion who is traveling with the Covered Person to join the Covered Person’s body during the repatriation to the Covered Person’s place of residence.
All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the Covered Expenses for similar transportation in the locality where the expense is incurred.
Benefits will not be payable unless We (or Our authorized assistance provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our assistance provider.
Classes of Eligible Persons:
You are eligible for coverage if you are a non-U.S. citizen member of the Policyholder who is age 69 and under.
ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS
Class 1 Principal Sum – An amount selected by the member of $25,000, $50,000 or $100,000
Exposure And Disappearance Coverage:
Principal Sum applicable to the Covered Loss, as shown in the Schedule of Covered Losses
Coma Benefit: Benefits are payable initially as 1% of the Principal Sum per Month up to 11 months and thereafter in a lump sum of 100% of the Principal Sum.
Repatriation of Remains Benefit: Benefit Maximum is 100% of Covered Expenses
Notice Of Claim: A claimant must give Us or Our authorized representative written (or authorized electronic or telephonic) notice of claim within 90 days after any loss covered by the Policy occurs. If notice cannot be given within that time, it must be given as soon as reasonably possible. This notice should identify the Covered Person and the Policy Number.
Claim Forms: Upon receiving written notice of claim, We will send claim forms to the claimant within 15 days. If We do not furnish such claim forms, the claimant will satisfy the requirements of written proof of loss by sending the written (or authorized electronic or telephonic) proof as shown below. The proof must describe the occurrence, extent and nature of the loss.
Proof Of Loss: Written (or authorized electronic or telephonic) proof of loss must be sent to the agent authorized to receive it. Written (or authorized electronic or telephonic) proof must be given within 90 days after the date of loss. If it cannot be provided within that time, it should be sent as soon as reasonably possible. In no event, except in the absence of legal capacity, should proof of loss be sent later than one year from the time proof is otherwise required.
Claimant Cooperation Provision: Failure of a c laimant to cooperate with Us in the administration of a claim may result in the termination of a claim. Such cooperation includes, but is not limited to, providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due.
Time Payment Of Claims: Any benefits due will be paid when We receive written (or authorized electronic or telephonic) proof of loss.
Payment Of Claims: If the Insured dies, any death benefits or other benefits unpaid at the time of the Insured’s death will be paid to the beneficiary our records indicate the Insured designated for these plan benefits.
If there is no named beneficiary or surviving beneficiary on record with Us or Our authorized agent, We pay benefits in equal shares to the first surviving class of the following: 1) Spouse; 2) Children; 3) Parents; 4) Brothers and sisters. If there are no survivors in any of these classes, We will pay the Insured’s estate.
All other benefits will be paid to the Insured. If the Insured is: (1) a minor; or (2) in Our opinion unable to give a valid release because of incompetence, We may pay any amount due to a parent, guardian, or other person actually supporting him or her. Any payment made in good faith will end Our liability to the extent of the payment.
Beneficiary: You may designate a beneficiary. You have the right to change the beneficiary at any time by written (or electronic and telephonic) notice. If You are a minor, Your parent or guardian may exercise this right for You. The change will be effective when We or Our authorized agent receive it. When received, the effective date is the date the notice was signed. We are not liable for any payments made before the change was received. We cannot attest to the validity of a change.
Assignment: At Your request medical benefits may be paid to the provider of service. Any payment made in good faith will end Our liability to the extent of the payment.
Physical Examinations And Autopsy: We have the right to have a Doctor of Our choice examine the Covered Person as often as is reasonably necessary. This section applies when a claim is pending or while benefits are being paid. We also have the right to request an autopsy in the case of death, unless the law forbids it. We will pay the cost of the examination or autopsy.
Legal Actions: No lawsuit or action in equity can be brought to recover on the Policy: (1) before 60 days following the date proof of loss was given to Us; or (2) after 3 years following the date proof of loss is required.
Recovery of Overpayment: If benefits are overpaid, or paid in error, We have the right to recover the amount overpaid, or paid in error, by any of the following methods.
- A request for lump sum payment of the amount overpaid, or paid in error.
- Reduction of any proceeds payable under the Policy by the amount overpaid, or paid in error.
Payment of Premium: The first Premium is due on before the Effective Date of Your coverage. If any premium is not paid when due, Your coverage will be canceled as of the Premium Due Date, except as provided in the Grace Period section.
Your Grace Period: If the required premium is not paid on the Premium Due Date, there is a 31-day grace period after each Premium Due Date after the first. If the required premium is not paid during the grace period, Your insurance will end on t he last day of the period for which premium was paid.
If benefits are payable during the grace period, We will deduct any overdue premium from the proceeds payable under the Policy.
Entire Contract; Changes: The Policy (including any endorsements or amendments), the signed application of the Policyholder and any individual applications of Covered Persons, are the entire contract. Any statements made by the Policyholder or Covered Persons will be treated as representations and not warranties. No such statement shall void the insurance, reduce the benefits, or be used in defense of a claim for loss incurred unless it is contained in a written application.
To be valid, any change or waiver must be in writing (or authorized electronic or telephonic communications). It must be signed by our President or Secretary and be at tached to the Policy. No agent has authority to change or waive any part of the Policy.
Clerical Error: If a clerical error is made, it will not affect the insurance of any Covered Person. No error will continue the insurance of a Covered Person beyond the date it should end under the Policy terms.
Conformity With State Laws: On the effective date of the Policy, any provision that is in conflict with the laws in the state where it is issued is amended to conform to the minimum requirements of such laws.
Not In Lieu Of Workers’ Compensation: The Policy is not a Workers’ Compensation policy. It does not provide Workers’ Compensation benefits.
Definitions Please note, certain words used in this document have specific meanings. These terms will be capitalized throughout the document. The definition of any word, if not defined in the text where it is used, may be found either in this Definitions section or in the Schedule of Benefits.
“Active Service” means a Covered Person is either 1) actively at work performing all regular duties on a full-time basis either at his or her employer’s place of business or someplace the employer requires him or her to be; 2) employed, but on a scheduled holiday, vacation day or period of approved paid leave of absence; or 3) if not employed, able to engage in substantially all of the usual activities of a person in good health of like age and sex and not confined in a Hospital or rehabilitation or rest facility.
“Covered Accident” means an accident that occurs while coverage is in force for a Covered Person and results directly and independently of all other causes in a loss or Injury covered by the Policy for which benefits are payable.
“Covered Loss” or “Covered Losses” means an accidental death, dismemberment or other loss resulting from Injury covered under the Policy.
“Covered Person” means any eligible person who applies for coverage and for whom the required premium is paid. If the cost for this insurance is paid for by the Policyholder, individual applications are not required for an eligible person to be a Covered Person.
“Doctor” means a licensed health care provider acting within the scope of his or her license and rendering care or treatment to a Covered Person that is appropriate for the conditions and locality. It will not include a Covered Person or a member of the Covered Person’s Immediate Family or household.
“Hospital” means an institution that: 1) operates as a Hospital pursuant to law for the care, treatment, and providing of in-patient services for sick or injured persons; 2) provides 24-hour nursing service by Registered Nurses on duty or call; 3) has a staff of one or more licensed Doctors available at all times; 4) provide organized facilities for diagnosis, treatment and surgery, either: (i) on its premises; or (ii) in facilities available to it, on a pre-arranged basis; 5) is not primarily a nursing care facility, rest home, convalescent home, or similar establishment, or any separate ward, wing or section of a Hospital used as such; and 6) is not a place for drug addicts, alcoholics, or the aged.
“Immediate Family” means a Covered Person’s parent, grandparent, spouse, child, brother, sister, stepchild, grandchild, step-grandchild or in-laws.
“Injury” means accidental bodily harm sustained by a Covered Person that results directly and independently from all other causes from a Covered Accident. The Injury must be caused through accidental means. All injuries sustained by one person in any one Covered Accident, including all related conditions and recurrent symptoms of these injuries, are considered a single Injury.
“Insured” means a person in a Class of Eligible Persons who enrolls for coverage and for whom the required premium is paid making insurance in effect for that person. If the cost for this insurance is paid for by the Policyholder, an eligible person will not need to enroll to be an Insured.
EXCLUSIONS We will not pay benefits for any loss or Injury that is caused by, results from, or is contributed to by:
- suicide or attempted suicide, intentionally self-inflicted injury.
- war or any act of war, whether declared or not.
- a Covered Accident that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, We will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days.
- Sickness, disease, or any bacterial infection, except one that results from an accidental cut or wound or pyogenic infections that result from accidental ingestion of contaminated substances.
- piloting or serving as a crewmember or riding in any aircraft except as a fare-paying passenger on a regularly scheduled or charter airline.
- Injury that occurs while the Covered Person is legally intoxicated (as determined by that state’s law) or while under the influence of any drug unless administered under the advice and consent of a Doctor.
- commission of, or attempt to commit, a felony.
This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit Us from providing insurance, including, but not limited to, the payment of claims.
CANCELLATION POLICY Refund of premium, less a $25 processing fee, will be considered only if the Cancellation Form is received by the Visitor Insurance Coverage prior to the effective date of coverage. After that date, the premium is considered fully earned and non-refundable. All cancellation requests should be submitted by completing the Cancellation Form found under ‘Members Area’ section of the web pages. The form can be faxed to 408-520-4967. Policy changes cannot be made under any circumstances once the policy becomes effective.
Visitor Insurance Coverage, USA
PO Box 5124
Scranton, PA 18505-0556
(800) 336 0627 Inside USA
(302) 476 6194 Outside USA
(302) 476 7857 Fax