Diplomat Long Term - Including USA

Plan Detail

Plan Administrator: Global Underwriters | Allied World Assurance Company (Europe) DAC; rated "A" (Excellent) by A.M. BEST

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Benefits

 

Benefit Limit
Policy Maximum: $500,000, $1,000,000
Deductible: $0, $100, $250, $500, $1000, $2500, $5000
Accidental Death and Dismemberment (AD&D) If within 365 days after the date of a covered accident, the Insured Person’s Injury results in death or dismemberment, this Plan provides the following benefits for loss of:
Description of Loss:                                                                   Indemnity
Life:                                                                                                 Principal Sum
Both Hands or Both Feet or Sight of Both Eyes or
One Hand and One Foot or Either Hand or Foot
and Sight of One Eye:                                                                  Principal Sum
Speech and Hearing in both Ears:                                           Principal Sum
Speech or Hearing in both Ears:                                              One-half the Principal Sum
Either Hand or Foot or Sight of One Eye:                                One-Half the Principal Sum
Thumb and index finger of same hand:                                  One-Quarter of the Principal Sum

*The amount of the Principal Sum is $25,000 unless the Enhanced AD&D Benefit is purchased.

Disappearance - If the body of an Insured Person has not been found within one year of the disappearance, forced landing, stranding, sinking, or wrecking of a conveyance in which such person was an occupant, then it shall be deemed, subject to all other terms and provisions of the plan, that such Person shall have suffered loss of life within the meaning of the plan.
Enhanced AD&D Benefit (If Benefit Purchased) The Principal Sum is increased from $25,000 to the selected amount not to exceed $1,000,000 of coverage.  The Enhanced AD&D Benefit is not available to children under 18 years of age.

Beneficiary Designation and Change - The beneficiary or beneficiaries of an Insured Person shall be that person or those persons designated by the Insured Person and filed with the Plan Administrator. Any Insured Person who has not made an irrevocable designation of beneficiary may designate a new beneficiary at any time, without the consent of the beneficiary, by filing with the Plan Administrator a written request for such change but such change shall become effective only upon receipt of such request by Plan Administrator. When such request is received by the Plan Administrator, whether the Insured Person be then living or not, the change of beneficiary shall relate back to and take effect as of the date of execution of the written request, but without prejudice to the Company on account of any payment theretofore made by it.
Paralysis Benefit If a Covered Accident renders an Insured Person Paralyzed within 365 days of the date of the Covered Accident that caused the Injury, in any one of the types of paralysis specified below, The Company will pay up to a maximum of $25,000 as follows:

Type of Paralysis (Loss)                                         Indemnity
Quadriplegia ..............................................................$25,000             
Paraplegia...................................................................$18,750
Hemiplegia .................................................................$12,500
Uniplegia .....................................................................$6,250

Quadriplegia means the complete and irreversible paralysis of both upper and both lower limbs.
Paraplegia means the complete and irreversible paralysis of both lower limbs.
Hemiplegia means the complete and irreversible paralysis of the upper and lower limbs of the same side of the body.
Uniplegia means the complete and irreversible paralysis of one limb (Limb means entire arm or entire leg).

If the Insured suffers more than one type of paralysis as a result of the same accident, only one amount, the largest, will be paid.
Coma Benefit If a covered Injury renders an Insured Person Comatose within 90 days of the date of the accident that caused the Injury, and if the Coma continues for a period of 30 consecutive days, The Company will pay a monthly benefit of $250. No benefit is provided for the first 30 days of the Coma. The benefit is payable monthly as long as the Insured remains Comatose due to that Injury, but ceases on the earliest of
  1. the date the insured ceases to be Comatose due to the Injury.
  2. the date the Insured dies.
  3. the date the total amount of monthly Coma Benefit paid for all Injuries caused by the same accident equals $25,000.

The Company will pay benefits calculated at a rate of 1/30th of the monthly benefit for each day for which The Company is liable when the Insured is Comatose for less than a full month. Only one benefit is provided for any one month of Coma, regardless of the number of Injuries causing the Coma. The Company reserves the right, at the end of the first 30 consecutive days of Coma and as often as it may reasonably require thereafter, to determine on the basis of all the facts and circumstances, that the Insured is Comatose, including but not limited to, requiring an independent medical examination provided at the Expense of The Company.
Seat Belt and Airbag Benefit

The Company will pay a $25,000 benefit when the Insured Person suffers accidental death such that an Accidental Death benefit is payable under the plan and the accident causing death occurs while the Insured Person is operating, or riding as a passenger in an Automobile if:

  1. You are wearing a properly fastened seat belt, properly installed by a factory authorized dealer and
  2. You were positioned in a seat protected by a properly functioning Supplemental Restraint System, properly installed by a factory authorized dealer that inflates on impact. Verification of the actual use of the seat belt at the time of the accident, and that the Supplemental Restraint System inflated properly upon impact must be part of an official report of the accident or be certified, in writing by the investigating officer(s). This benefit is in addition to any other Expenses of the program.
Felonious Assault Benefit

The Company will pay a $25,000 benefit when an Insured Person suffers one or more losses for which benefits are payable under the Accidental Death & Dismemberment Benefit or Coma Benefit provided by the plan as a result of a Felonious Assault:

  1. that is not a moving violation as defined under the applicable government motor vehicle laws and
  2. that is not an act of an Immediate Family Member, another insured or an individual who resides with the insured on a permanent basis. Only one benefit is payable for all losses as a result of the same Felonious Assault. This benefit is in addition to any other Expenses of the program.
Home Alteration and Vehicle Modification

If an Insured Person:

  1. suffers an accidental dismemberment or paralysis for which an Accidental Dismemberment and Paralysis benefit is payable under the Policy.
  2. did not, prior to the date of the Accident causing such loss(es), require the use of a wheelchair to be ambulatory; and 3) as a direct result of such loss(es) is now required to use a wheelchair to be ambulatory; The Company will pay Covered Home Alteration and Vehicle Modification Expenses that are incurred within one year after the date of the accident causing such loss(es), up to a maximum of $2,500 for all such losses caused by the same accident. 
Covered Home Alteration and Vehicle Modification Expenses

As used in this Rider, means one-time Expenses that:

  1. are charged for:
    • alterations to the Insured Person’s residence that are necessary to make the residence accessible and habitable for a wheelchair-confined person or
    • modifications to a motor vehicle owned or leased by the Insured Person or modifications to a motor vehicle newly purchased for the Insured Person that are necessary to make the vehicle accessible to and/or drivable by the Insured Person and
  2. do not include charges that would not have been made if no insurance existed and
  3. do not exceed the usual level of charges for similar alterations and modifications in the locality where the Expense is incurred; but only if the alterations to the Insured Person’s residence and the modifications to his or her motor vehicle are:
    • made on behalf of the Insured Person.
    • recommended by a nationally-recognized organization providing support and assistance to wheelchair users
    • carried out by individuals experienced in such alterations and modifications and
    • in compliance with any applicable laws or requirements for approval by the appropriate government authorities.
Emergency Dental Treatment (Palliative) Benefits are paid for Reasonable and Customary Expense up to $100 for the emergency Treatment for the relief of pain to natural teeth.
Emergency Medical Evacuation and Repatriation

Benefits are paid for Covered Expense incurred up to $500,000, for any covered Injury or Illness commencing during the Period of Coverage that result in a Medically Necessary Emergency Medical Evacuation or Repatriation. The decision for an Emergency Medical Evacuation or Repatriation must be pre-approved and arranged by the Assistance Company in consultation with Your local attending Physician. Emergency Medical Evacuation or Repatriation means:

  • Your medical condition warrants immediate transportation from the place where You are located (due to inadequate medical facilities) to the nearest adequate medical facility where medical Treatment can be obtained.
  • After being treated at a local medical facility, Your medical condition warrants transportation with a qualified medical attendant to Your Home Country to obtain further medical Treatment or to recover.
  • Both a. and b. above. Covered Expenses are Expenses for transportation, medical services, and medical supplies necessarily incurred in connection with Emergency Medical Evacuation or Repatriation.
  • All transportation arrangements must be by the most direct and economical route. Expenses for special transportation must be:
    • recommended by the attending Physician and
    • Pre-approved and ordered by the Assistance Company and
    • required by the standard regulations of the conveyance transporting the Insured Person. Expense for medical services and supplies must be recommended by the attending Physician. Transportation means any land, water or air conveyance required to transport the Insured Person during an emergency evacuation. Special Transportation includes, but is not limited to, air ambulance, land ambulance, and private motor vehicles. Non-Emergency use of special transportation is excluded from this policy.
Return of Mortal Remains If You should die Benefits will be paid for Reasonable and Customary Covered Expense incurred up to $50,000, to return Your remains to Your Home Country. Covered Expenses include, but are not limited to, Expense for embalming or Cremation, a minimally necessary container appropriate for transportation, shipping Expenses, and the necessary government authorizations. All Covered Expense in connection with a Return of Mortal Remains or Cremation must be preapproved and arranged by the Assistance Company.
Emergency Medical Reunion When the Assistance Company and Your attending Physician determine that it is necessary and prudent for You to have an Emergency Medical Evacuation or Repatriation, this Plan will arrange to bring an individual of Your choice, from Your current Home Country, to be at Your side while You are hospitalized and then accompany You during Your return to Your current Home Country. Benefits will be paid up to $50,000 for a round trip economy air fare ticket as well as for reasonable travel and accommodation Expense up to a maximum of 10 days, as pre-approved and arranged by the Assistance Company.
Return of Minor Child(ren) Should the Insured Person be traveling alone with a Minor Child(ren) and be hospitalized because of a covered Illness or Injury and Your Minor Child(ren) is left unattended, the Assistance Company will arrange for a one way economy fare(s) to Your current Home Country. If an attendant/escort is necessary to ensure the safety and welfare of Your Minor Child(ren), the Assistance Company will also arrange these services. The Plan will pay for these services up to a maximum of $50,000 provided all transportation and services are pre-approved and arranged by the Assistance Company. Meals and lodging are Your responsibility.
Interruption of Trip

If Your trip is interrupted due to one of the following reasons:

  1. Death of an Immediate Family Member.
  2. Serious damage to Your principal residence from fire, flood or similar Natural Disaster (tornado, earthquake, hurricane, etc.). Benefits will be paid up to $5,000 for the Expense of economy travel less the value of applied credit from an unused return travel ticket to return You home to Your area of principal residence.
Loss of Baggage

This plan will reimburse You for loss, theft, or damage to Your baggage or personal effects, checked with a Common Carrier provided You have taken all reasonable measures to protect, save and/or recover Your property at all times. This plan is secondary to any coverage provided by a Common Carrier and all other valid and collective insurance. This plan will pay the lesser of:

  1. The actual cash value (Expense less proper deduction for depreciation at the time of loss, theft or damage).
  2. The Expense to repair or replace the article with material of a like kind and quality; or 3) $50 per article, to a maximum of $250.
Political and Natural Disaster Evacuation

Coverage is provided up to $50,000 ($100,000 if the  Enhanced Political and Natural Disaster Evacuation Benefit is purchased) if the Insured requires emergency evacuation due to the following reasons, which places him/her in Imminent Bodily Harm as determined by the Assistance Company security personnel, in accordance with local and U.S. authorities or due to a Natural Disaster, which makes his/her location Uninhabitable, or, your location in the Host Country is deemed Uninhabitable by the Assistance Company security personnel, the Assistance Company security shall arrange, B17 and the plan will pay for Insured’s transportation to the nearest safe location:

  1. Officials of the Foreign Country or the embassy of the country with which the Insured is a national has issued for reasons other than medical, a recommendation that categories of persons which include the Insured should leave the Foreign Country; and/or
  2. Insured is being expelled or declared persona non grate on the written authority of the recognized government of the Foreign Country; and/or
  3. The Political and Military Events in the Foreign Country have created a situation in which the Insured is in danger of Imminent Bodily Harm to the extent that the Insured must be removed from the Foreign Country; and/or
  4. Officials of the Foreign Country or the embassy of the country with which the Insured is a national has issued for reasons due to the Natural Disaster situation, a recommendation that categories of persons which include the Insured should leave the Foreign Country; AND
  5. Insured cannot obtain commercial transportation to the nearest safe location within a time period which will enable the Insured to leave the Foreign Country in time to avert Imminent Bodily Harm or to comply with the time allowed to leave the Foreign Country pursuant to the orders of the recognized government of that Foreign Country. The Insured must contact the Travel Assistance Company as soon as possible, as delays may make safe transportation impossible. The method of transportation will be as deemed most appropriate to ensure Insured’s safety.  If evacuation becomes impractical due to hostile or dangerous conditions,  Travel Assistance Company  will maintain contact with and advise the Insured until evacuation becomes viable or the  Natural Disaster situation has been resolved. The Assistance Company shall arrange and the plan will pay up to $100 per day up to a maximum of three (3) days for reasonable expenses related to lodging if the Insured is delayed at a safe haven. Travel Assistance Company shall also arrange and pay for one-way economy airfare to return Insured to his/her Home Country following an Evacuation. Economy airfare and lodging costs shall not exceed a combined single limit of $5,000 USD. Should commercial flights be available, but transportation to the airport will place the Participant in Imminent Bodily Harm, Travel Assistance Company  shall arrange and pay for his/her secure transport to the airport. Airfare change fees are the responsibility of the Participant once he/she reaches an airport where normal commercial flight is available. No benefit shall be payable if there is a travel warning in effect within 60 days prior to the insured person’s date of arrival in the host country. The Assistance Company must make all arrangements for the Insured. Services rendered without the Travel Assistant Company’s coordination and approval is not covered. No claims for reimbursement will be accepted. If the Insured is able to leave their host country by normal means, such as changing a commercial airline ticket, the Assistant Company will assist in rebooking flights or other transportation. Expenses for non-emergency transportation are the responsibility of the Participant.
Enhanced Political and Natural Disaster Evacuation Benefit
(If Benefit Purchased)		 The Enhanced Political and Natural Disaster Evacuation Benefit Rider increases the Political and Natural Disaster Evacuation maximum benefit from $50,000 to $100,000. This Benefit is not available if the optional War Risk Rider is purchased.
Home Country Coverage (If Benefit Purchased) The Home Country Coverage Rider provides limited coverage under Your Medical Expense Benefit while in Your Home Country. The plan pays 80% up to $5,000 of Covered Expenses, then 100% to a maximum of 1) $50,000 for Incidental Trip(s) to your Home Country or 2) $10,000 for Extension of Benefits (Follow Me Home Coverage).
  1. Incidental Trip(s) to your Home Country: During the period of coverage, You may return to Your Home Country for incidental visits of up to 60 days per 12 months of coverage, or pro rata there of (approximately 5 days per month of purchased coverage). If during an incidental trip home, You suffer an Injury or Illness, this Plan will pay up to $50,000 of Covered Expenses.
  2. Extension of Benefits (Follow Me Home Coverage): This plan will pay up to a maximum of $10,000 for Covered Expenses incurred in Your Home Country related to an Injury or Illness which originally occurred, was diagnosed and treated outside Your Home Country during Your period of coverage.
War Risk Rider (If Benefit is Purchased)

It is agreed that the policy is amended as follows: any Exclusion under this Plan for “declared or undeclared war or any act thereof” is waived for an Insured Person’s loss caused in whole or in part by, or resulting in whole or in part from, declared or undeclared war or any act thereof. Subject to the following restriction: The waiver only applies with respect to accidents that occur within the geographic limits or territorial waters of, or airspace above the geographic limits or territorial waters of a Designated War Risk Territory (as defined herein). War Risk Coverage in a high risk country listed in the Definition of “Designated War Risk Territory(ies)” requires payment of an additional premium and advance notice of travel. Termination Date: War Risk Coverage ends on the earliest of:

  1. the date the Policy terminates or
  2. the date specified in the Company’s written notice to the Policyholder or Participating Organization of the Company’s intent to terminate War Risk Coverage (or 10 days after  the date the written notice is received by the Policyholder or Participating Organization, if later).

Termination of War Risk Coverage will not affect a claim for a covered loss that occurred while War Risk Coverage was in effect. Changes in Terms and Conditions: The terms and conditions of War Risk Coverage, including but not limited to the definition of the Designated War Risk Territory(ies), may be changed at any time to reflect conditions that, in the opinion of the  Company, constitute a change in the war risk exposure of the Participating Organization or the Insured Person. Coverage is Not available inside the United States or inside the Insured Person’s Home Country.
Athletic Sports & Hazardous Activity Rider
(If Benefit is Purchased)		 The Athletic Sports & Hazardous Activity Rider provides coverage if Your Injury or Illness results from the below enumerated Athletic Sports & Hazardous activities:
  • Intercollegiate or Interscholastic Athletics, Club Sports, and Organized Amateur Sports (Medical Expense Benefit is reduced) and
  • Other Athletic Sports and Hazardous Activities. NOTE: Any Athletic Sport & Hazardous Activity not expressly covered hereunder is excluded from this policy unless the activity is non-contact and engaged in by You solely for leisure, recreation, entertainment, or fitness purposes only.
  1. Intercollegiate or Interscholastic Athletics, Club Sports, and Organized Amateur Sports - Under this rider, the Medical Expense Benefit is reduced to $20,000 for any Covered Injury or Illness resulting from: Baseball; Basketball; Cheerleading; Competitive Cycling (Road, Track, CX); Cross Country; Diving; Equestrian; Fencing; Field Hockey; Football (no Division One); Golf; Gymnastics; Ice Hockey; Lacrosse; Martial Arts; Polo Horse; Polo Water; Rugby; Skiing (Slalom, Giant Slalom, Downhill); Soccer; Softball; Swimming; Tennis; Track and Field; Volleyball; Wrestling.
  2. Other Athletic  Sports and Hazardous Activities: Arial Photograph (Use of proper restraints required); BMX (Racing or Competitive); Bobsledding; Bungee Jumping; Canopying; Diving with Sharks; Flying in any Chartered or Leased Aircraft or Helicopter; Hang Gliding; Heli-skiing; Horseback Riding; Jet, Snow, and Water Skiing; Kayaking; Martial Arts; Motorcycling & Motor Scooter; Mountain Bike; Mountain Climbing (if over 14 thousand feet, guide required); Mountain Climbing (under 14 thousand feet); MX; Paragliding; Parasailing; Piloting any Non-commercial Aircraft; Running with Bulls; Safari; Safari & Big Game Hunting (use of firearms); Scuba Diving; Security Detail (use of firearms); Skydiving; Snowboarding; Snowmobiling; Spelunking; Surfing; Trekking; Whitewater Rafting (up to and including class V rapids only); Wind Surfing; Zip Lining.

MEDICAL EXPENSES

Medical Expenses incurred Outside the US

We will pay Reasonable and Customary charges for Covered Expenses (as listed below), in excess of the chosen Deductible up to the selected Medical Maximum ($500,000 or $1,000,000 for ages 14 days to 69; $100,000 for ages 70 to 79; or $20,000 for ages 80+) incurred by You due to an accidental Injury or Illness which occurred during the Period of Coverage outside Your Home Country (except as provided under the Home Country Coverage). All bodily disorders existing simultaneously which are due to the same or related causes will be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement, the Disablement will be considered a continuation of the prior Disablement and not a separate Disablement. The initial Treatment of an Injury or Illness must occur within 30 days of the date of Injury or onset of Illness.  For a covered disablement, after you pay the per person Deductible, the plan pays 100% of eligible costs up to the Medical Maximum.

Medical Expenses incurred Inside the US
 
We will pay Reasonable and Customary charges for Covered Expenses (as listed below), excess of the chosen Deductible and Coinsurance up to the selected Medical Maximum ($500,000 or $1,000,000 for ages 14 days to 69; $100,000 for ages 70 to 79; or $20,000 for ages 80+) incurred by You due to an accidental Injury or Illness which occurred during the Period of Coverage while You are outside Your Home Country (except as provided under the Home Country Coverage). All bodily disorders existing simultaneously which are due to the same or related causes will be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement, the Disablement will be considered a continuation of the prior Disablement and not a separate Disablement. The initial Treatment of an Injury or Illness must occur within 30 days of the date of Injury or onset of Illness. For a covered disablement, after you pay the per person Deductible, the plan pays 80% up to $5,000 of eligible costs, then 100% to the Medical Maximum. There will be an additional $250 deductible for each emergency room visit as a result of an Illness. The emergency room deductible will be waived if hospital admittance is within 12 hours of the incident.
 
Covered Expenses
 
Only such Expenses that are specifically enumerated in the following list of charges that are incurred for the medical care and supplies which are: (a) necessary and customary; (b) prescribed by a Physician for the therapeutic treatment of a disablement; (c) are not excluded under the policy; (d) are not more than the Reasonable and Customary charges (as determined by the Company); and (e) are incurred within: i) 365 days for US Citizens; or ii) 180 days for Non US Citizens from the date of the disablement will be considered.
  1. Expenses made by a Hospital for room and board, floor nursing and other services, including Expenses for professional services, except personal services of a non-medical nature, provided, however, that Expenses do not exceed the Hospital's average charge for semi-private room and board accommodation.
  2. Charges made for Intensive Care or Coronary Care charges and nursing services.
  3. Expenses made for diagnosis, Treatment and surgery by a Physician.
  4. Charges made for an operating room.
  5. Charges made for Outpatient Treatment, same as any other Treatment covered on an Inpatient basis. This includes ambulatory Surgical centers, Physician's Outpatient visits/examinations, clinic care, and Surgical opinion consultations.
  6. Expenses made for administration of anesthetics.
  7. Expenses for medication, x-ray services, laboratory tests and services, the use of radium and radio-active isotopes, oxygen, blood transfusions, iron lungs, and medical Treatment.
  8. Expenses for physiotherapy, if recommended by a Physician, for the Treatment of a specific Disablement and administered by a licensed physiotherapist; With regards to chiropractic care, eligible charges up to $50.00 per visit, with a maximum of 10 visits.
  9. Dressings, drugs, and medicines that can only be obtained upon written prescription of a Physician.
  10. Hotel room charge, when the insured, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified  Physician in a hotel room owing to the unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond the control of the insured; The charges enumerated above shall in no event include any amount in excess of the Reasonable and Customary charges (as determined by the Company).  To determine if Expenses are Reasonable and Customary, the Company will consider the following: the medical care or supplies usually given and the fees usually accepted for like cases in the area.  “Area” means a region large enough to get a cross section of providers or medical care or supplies.  All Expenses are deemed to be incurred on the date such service is received.

PLAN DEFINITIONS

Automobile means a self-propelled private passenger motor vehicle with four or more wheels which is designed and required to be licensed for use on the highways of any state or country. Automobile includes but is not limited to a sedan, station wagon, or jeep type vehicle and a motor vehicle of the pickup, panel, van camper or motor home type.  Automobile does not include a mobile home or any motor vehicle used in mass or public transit.

Benefit Period means the allowable time period You have from the date of Injury or onset of Illness to receive Treatment for a Covered Injury or Illness. If Your Plan terminates during Your Benefit Period, You will still be eligible to receive Treatment so long as the Treatment is within Your Benefit Period and outside Your Home Country (except as provided under the Optional Home Country Coverage). 
 
Child(ren) means a person who is over 14 days of age and under 18 years of age.
 
Coinsurance means the percentage amount of Covered Expenses, after the Deductible, which is Your responsibility to pay.
 
Coma/Comatose means a profound state of unconsciousness from which the Insured cannot be aroused to consciousness, even by powerful stimulation, as determined by a Physician.
 
Common Carrier means any motorized land, water, and/or air conveyance operating under a valid license for the transportation of passenger for hire.
 
Company means the company shown on the declarations page.
 
Covered Accident means a sudden, unforeseeable external event which:
  1. Causes Injury to one or more Covered Persons and
  2. Occurs while coverage is in effect for the Covered Person.

Deductible  means the amount of Covered Expenses which is  Your responsibility to pay before benefits under the Plan are payable.

Domestic Partner means  a same or an opposite sex partner who has met all of the following requirements for at least 12 consecutive months immediately preceding the Effective Date of Coverage:
  1. resides with the Insured.
  2. shares financial assets and obligations with the Insured.
  3. is not related by blood to the Insured.
Felonious Assault means any willful or unlawful use of force upon the Insured:
  1. with the intent to cause bodily injury to the Insured.
  2. that results in bodily harm to the Insured; and 3) that is a felony or a misdemeanor in the jurisdiction in which it occurs.
Home Country shall mean, the country where an eligible person(s) has his/her fixed and permanent home establishment and to which he/she has the intention of returning.
 
Hospital means a place that:
  1. is legally operated for the purpose of providing medical care and Treatment to sick or injured persons for which a charge is made that the Insured is legally obligated to pay in the absence of insurance.
  2. provides such care and Treatment in medical, diagnostic, or surgical facilities on its premises, or those prearranged for its use.
  3. provides 24-hour nursing service under the supervision of a Registered Nurse at all times; and 4) operates under the supervision of a staff of one or more Doctors. Hospital also means a place that is accredited as a hospital by the Joint Commission on Accreditation of Hospitals, American Osteopathic Association, or the Joint Commission on Accreditation of Heath Care Organizations (JCAHO). Hospital does not mean:
    1. a convalescent, nursing, or rest home or facility, or a home for the aged.
    2. a place mainly providing custodial, educational, or rehabilitative care or
    3. a facility mainly used for the Treatment of drug addicts or alcoholics. 
Illness means sickness or disease of any kind first manifested, treated or diagnosed after the effective date of coverage for an Insured Person: causing loss covered by this plan.
 
Immediate Family Member means a person who is related to the Insured in any of the following ways: spouse, Domestic Partner, brother-in-law, sister-in-law, daughter-in-law, son-in-law, mother-in-law, father-in-law, parent (includes stepparent), brother or sister (includes stepbrother or stepsister), or child (includes legally adopted or stepchild), and grandparents.
 
Injury means bodily harm which results, directly and independently of disease or bodily infirmity, from an Accident.  All injuries to the same Covered Person sustained in one accident, including all related conditions and recurring symptoms of the Injuries will be considered one Injury. Any Loss due to Injury must begin after the Effective Date of this Policy.
 
Loss in reference to quadriplegia, paraplegia, hemiplegia, and uniplegia means the complete and irreversible paralysis of such limbs. Loss in reference dismemberment means:
  1. with regards to hands and feet means the  actual severance through and above the wrist or ankle joints.
  2. with regard to eyes, entire irrecoverable loss of sight and
  3. with regard to thumb and index finger the actual severance through or above the joint that meets the finger at the palm. Loss in reference to other coverages means injury or damage sustained by the Insured in consequence of happening of one or more of the accidents against which the Company has undertaken to indemnify the Insured. 
Natural Disaster means an event of natural cause, including but not limited to: wildfire, earthquake, hurricanes, tornados, windborne dust or sand, volcanic eruption, tsunami, snow, rain or wind, that results in widespread and severe damage such that the government of the host country issues an official disaster declaration and determines the affected area to be uninhabitable.
 
Physician means a doctor of medicine or a doctor of osteopathy licensed to render medical services or perform Surgery in accordance with the laws of the jurisdiction where such professional services are performed, however, such definition will exclude chiropractors and physiotherapists.
 
Pre-Existing Condition means:
  1. A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment during the 18 months prior to the Effective Date of coverage under this Plan or
  2. A condition for which manifestation, medical advice, diagnosis, care or Treatment was recommended, received or noticed during the 18 months prior to the Effective Date of coverage under this Plan.
Reasonable and Customary means the maximum amount that the  Company determines is Reasonable and Customary for Covered Expenses the Insured Person receives, up to but not to exceed charges actually billed.  The Company’s determination considers:
  1. amounts charged by other Service Providers for the same or similar service in the locality were received, considering the nature and severity of the bodily Injury or Illness in connection with which such services and supplies are received.
  2. any usual medical circumstances requiring additional time, skill or experience; and 3) other factors the  Company determines are relevant, including but not limited to, a resource based relative value scale. For a Service Provider who has a reimbursement agreement, the Reasonable and Customary charge is equal to the amount that constitutes payment in full under any reimbursement agreement with the Company. If a Service Provider accepts as full payment an amount less than the negotiated rate under a reimbursement agreement, the lesser amount will be the maximum Reasonable and Customary charge. The Reasonable and Customary charge is reduced by any penalties for which a Service Provider is responsible as a result of its agreement with the Company.
Supplemental Restraint System means an air bag which inflates for added protection to the chest and head areas. 
 
Treatment means a specific in-office or Hospital physical examination of or care rendered to You, consultation, diagnostic procedures and services, Surgery, medical services and supplies including medication prescribed or provided by a Service Provider.
 
DISCLAIMER
 
This Description of Coverage and evidence of insurance provides a summary of the policy features only and does not cover all the terms, conditions and limitations of the Master Policy. The Master Policy (on file with Global Underwriters) contains the actual terms, conditions, and limitations, of the coverage to be provided. If there is any conflict between this description of coverage and the Master Policy the Master Policy will govern in all cases.