Meridian Clear

Plan Detail

Plan Administrator: Azimuth Risk Solutions | AM Best Rating: A "Excellent" | Underwriter: Lloyd's of London

Description


ELIGIBILITY

MERIDIAN CLEARELIGIBILITY — Participating Member is not eligible, the Evidence of Insurance issued by the Master Policy will be Null and Void and all Premiums paid will be refunded. In order to be eligible and qualified for coverage under this insurance, a Participating Member must:

22.1 Compete and sign an Application (or be listed thereon by proxy as an applicant and proposed Participating Member) with all questions answered truthfully and completely; and

22.2 Pay the required Premium on or before the Due Dates; and

22.3 Receive written acceptance of Application or Continuation of Coverage from the Scheme Administrator; and

22.4 Be at least fourteen (14) days old but not yet seventy-five (75) years old; and

22.5 Not be Pregnant, Hospitalized or Disabled on the Effective Date of Coverage; and

22.6 Not be HIV+ on the Effective Date of Coverage; and/or

22.7 US Citizens:

22.7.1 Plan to reside outside of the US for at least one hundred (180) days of the next three hundred sixty four (364) days of the Participating Members Coverage Period;

22.7.2 Depart from the US not more than thirty (30) days after the Effective Date or Continuation of Coverage Date; or

22.8 Non-US Citizens:

22.8.1 Reside outside the US at time of Application or Continuation of Coverage Date; or must plan to reside outside of the US continuously for at least one hundred (180) days for the next three hundred sixty four (364) days of the Participating Members Coverage Period with departure from the US not more than thirty (30) days after the Effective Date or Continuation of Coverage Date; or

22.8.2 If located inside the US at the time of Application or Continuation of Coverage Date, must not be eligible for any other medical insurance plan which is available to individuals similarly situated and located in the US and must provide the Scheme Administrator an Affidavit of Eligibility.

15.2 Termination Of Coverage For Participating Member — Coverage and Benefits for the Participating Member under this insurance will terminate effective at 11:59 PM, EST, on the earliest of the following dates:

15.2.1 The next day following the end of the period for which Premium has been fully and timely paid; or

15.2.2 The termination date indicated on the Declaration Page of Insurance for the Evidence of Insurance in in Section in SectionⅡ; or

15.2.3 The date the Master Policy is terminated; or

15.2.4 The date the Participating Member first fails to meet or no longer meets the eligibility requirements for this insurance as set forth in the Master Policy and outlined in the Evidence of Insurance; or

15.2.5 The date the Scheme Administrator and/or Underwriters, at its sole option, elects to cancel from the Beacon/Axis Series Group Insurance Plan (sometimes referred to herein as "this insurance plan" or "the plan") all Participating Members of the same sex, age, class or geographic location as the Participating Member, provided the Scheme Administrator gives no less than thirty (30) days advance written notice by mail to the Participating Member's last known place of residence or mail - forwarding address of its intent to exercise such option with or in conjunction and the express written consent of Underwriters; or

15.2.6 The cancellation date specified by the Scheme Administrator and/or Underwriters pursuant to Subsection 15.1, above; or

15.2.7 The cancellation date specified by the Participating Member, or upon return to Home Country; or

15.2.8 The date specified by the Scheme Administrator and/or Underwriters in any notice of cancellation, forfeiture or rescission issued pursuant to or as a result of the circumstances described in Sections 7, 12, 15 and above, or Section 16 below, or as otherwise permitted by the Terms of this insurance. Coverage for the Participating Member shall remain in full force and effect unless terminated pursuant to the provisions of this section, except as otherwise provided in the Master Policy or the Evidence of Insurance.

EVIDENCE OF INSURANCE THE MERIDIAN SERIES CLEAR UMR (B0618UB17A109B)

This Evidence of Insurance is issued by the Master Policy on behalf of the Master Policyholder, as so authorized by Underwriting Members of Lloyd’s, who have hereunto subscribed their Names (”the Underwriters”) to this Evidence of Insurance and the Master Policy; the Beacon/Axis Series Group Insurance Trust (Anguilla). As, such certain Underwriters of Lloyd’s authorize Azimuth Risk Solutions as the (“Scheme Administrator”) of the Master Policy and all Evidence(s) of Insurance issued by the Master Policy.

MASTER POLICYHOLDER— Master Policy Number: A92355005, whereas the Master Policyholder has sought Insurance on behalf of its Members, the Master Policyholder is hereby recognized as the Beacon/Axis Series Group Insurance Trust (Anguilla). The Master Policyholder recognizes the Master Policy effective date as March 1, 2009, and shall remain in effect until terminated by the Underwriters in accordance to Section 16 below. This Evidence of Insurance issued by the Master Policy is subject to annually Continuation of Coverage unless otherwise expressed. All Evidence(s) of Insurance issued by the Master Policy shall be effective as of the Effective Date of Coverage indicated on the Participating Members ID Card and shall remain in effect until terminated in accordance with Section 15 below. The Evidence of Insurance is not part of the Insurance contract. The contract is the Master Policy (held by the Master Policyholder), the Application and any applicable Rider(s). The Evidence of Insurance is merely a description of and evidence of Member rights and Benefits under the contract. The Master Policyholder hereby recognizes Azimuth Risk Solutions, as its authorized agent and representative. Azimuth Risk Solutions as the Scheme Administrator of the Master Policy and all Evidence(s) of Insurance issued by the Master Policy is hereby subject to all provisions set forth hereto. All communications, notices and payments that are required or permitted under the Master Policy and/or as described in the Evidence of Insurance issued by the Master Policy for its Members shall be transmitted through the Scheme Administrator, and receipt of the same by the Scheme Administrator shall be consider receipt by the Master Policyholder on behalf of the Underwriters.

LLOYD’S BROKER— The Lloyd’s Broker has negotiated such insurance on behalf of the Master Policyholder, it is mutually understood and agreed between the Underwriters and the Master Policyholder, that Azimuth Risk Solutions is recognized as the Scheme Administrator. The Underwriters hereby recognize BMS Intermediaries Ltd, One America Square, London as the Lloyd’s Broker of record herein.

SCHEME ADMINISTRATOR— The “Scheme Administrator”, as referred to herein; Azimuth Risk Solutions, acts solely as the disclosed and authorized agent and representative for and on behalf of the Master Policyholder and Underwriters, and has and shall have no direct, indirect, joint, several, separate, individual, or independent liability or obligation of any kind under the Master Policy or the Evidence of Insurance to the Participating Member or to any other person or entity.

QUESTIONS OR CONCERNS ABOUT THIS INSURANCE— In the event that Participating Member has any questions or concerns about this insurance or the handling of a claim the Participating Member can refer the matter to Azimuth Risk Solutions at the contact information below.

Azimuth Risk Solution
5218 S. East Street, Suite E-1
Indianapolis, Indiana 46227
Email: service@azimuthrisk.com
Telephone: 317-644-6291 or 888-201-8050
Fax: 317-423-9620 or 888-201-8851

COMPLAINTS ABOUT THIS INSURANCE— However, if the Participating Member wishes to make a complaint, the Participating Member can do so at any time by referring the matter to either Azimuth Risk Solutions, LLC at the contact information below:

Azimuth Risk Solutions
Attn: Complaints Department
5218 S. East Street, Suite E-1
Indianapolis, Indiana 46227

Or to the Complaints Team at Lloyd’s at the contact information below:

Complaints, Lloyd's

One Lime Street, London EC3M 7HA
Tel: 020 7327 5693 Fax: 020 7327 5225
Website: www.lloyds.com/complaints Email: complaints@Lloyds.com

SPECIAL NOTIFICATIONS:

Sanction Limitation and Exclusion Clause— No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.

Important Notice Regarding The Patient Protection and Affordable Care Act (PPACA)— This insurance is not subject to, and does not provide benefits as required by PPACA. As of January 1, 2014 PPACA requires U.S. citizens, U.S. nationals, and certain U.S. residents to obtain PPACA compliant insurance coverage unless they are exempt from PPACA. Please note penalties may be imposed on persons who are required to maintain PPACA compliant coverage but fail to do so. Eligibility to purchase, extend, or continue coverage for this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including PPACA. Note, it is the insured person’s sole and exclusive responsibility to determine the insurance requirements applicable to them, and neither Underwriters nor Azimuth Risk Solutions shall have any liability whatsoever, including any penalties a person may incur for failure to obtain coverage required by any applicable law including without limitation PPACA. For information regarding PPACA and how it applies to you or if you are eligible to purchase products administered by Azimuth Risk Solutions, please contact us at: http://www.azimuthrisk.com/service@azimuthrisk.com or by calling 1-317-644-6291/1-888-201-8850.

1 EVIDENCE(S) OF INSURANCE ISSUED— This Evidence of Insurance replaces any other Evidence of Insurance previously issued covering the Insurance described herein. Please refer to your Application for details on the selected coverage amounts, Deductibles and Coinsurance.

1.1 The Scheme Administrator will issue in respect of each Participating Member an identification number and Evidence of Insurance; and

1.2 The Scheme Administrator shall retain a copy of all such Evidence(s) of Insurance and shall make available a copy to Participating Member(s) upon request; and

1.3 The Scheme Administrator shall make available on behalf of the Master Policyholder Evidence(s) of Insurance to the Participating Member(s) as soon as practicable, but in any event, no later than forty-five (45) days after inception, or in accordance with local legislation; and

1.4 The Scheme Administrator shall advise Underwriters of all additions and deletions of Evidence(s) of Insurance.

2 PERIOD OF INSURANCES EFFECTED IN ACCORDANCE WITH THE MASTER POLICY:

2.1 The Master Policy is effective during the period from December 01, 2017 through January 31, 2018, both days inclusive and for thirty (30) days, if required, as may be mutually agreed upon; and

2.2 No Evidence(s) of Insurance shall be bound hereunder for a period greater than three-hundred and sixty-four (364) days in respect to annual cover; and

2.3 Every Evidence(s) of Insurance issued shall commence during the currency of the Master Policy.

2.4 In the event that the Master Policy is cancelled or terminated, each Evidence(s) of Insurance issued hereunder shall run to its contractual expiry date, unless cancelled in accordance with its individual cancellation provision; and

2.5 In the event of cancellation of any Evidence(s) of Insurance issued hereunder the Master Policyholder, the Scheme Administrator and Underwriters shall comply with any applicable provisions of law relating to the cancellation of such Evidence and to the return of Premiums, commissions, fees and any other charges.

3 ACCEPTANCE BY THE UNDERWRITERS — As a condition precedent to the Underwriters liability hereunder, the insurance provided to Participating Member(s) pursuant to and in accordance with the Terms and Conditions of the Master Policy, as represented by the Evidence(s) of Insurance issued by the Master Policy (such insurance being sometimes referred to herein as “this insurance” or “the plan”). The Master Policy, which would include the Application, the Evidence(s) of Insurance, the Declaration Page of Insurance, and any Endorsements, shall constitute the entire agreement among the Policyholder, Underwriters, and the Participating Member(s). Underwriters hereby recognize Azimuth Risk Solutions as the Scheme Administrator. The Evidence(s) of Insurance issued by the Master Policy is an outline of the coverage provided by the Master Policy and agreed by Underwriters.

4 TERRITORIAL LIMITATION:

4.1 The Scheme Administrator is hereby authorized to issue Evidence(s) of Insurance for Participating Member(s) domiciled worldwide with the exception of US citizens residing in the US or Anguillan citizens residing in Anguilla; and

4.2 The territorial limits of each Evidence(s) of Insurance issued hereunder shall be worldwide, except;

4.2.1 When a US citizen purchasing a travel policy while residing in the US; or

4.2.2 When an Anguillan citizen purchasing a travel policy while residing in Anguilla.

5 MAXIMUM LIMIT OF LIABILITY/SUMS INSURED:

5.1 The Scheme Administrator is authorized to issue Evidence(s) of Insurance in the following Sum Insured or Limits of Liability, which shall not be exceeded in any circumstance. The below figure is always considered to be in US dollars: 5.1.1 $2,000,000

6 PREMIUMS AND DEDUCTIBLES:

6.1 All Premiums for Evidence(s) of Insurance issued under the Master Policy shall be remitted to the Scheme Administrator:

6.1.1 On or before the Effective Date of Coverage; and

6.1.2 Prior to any Continuation of Coverage Date under Section 17, below.

6.2 All Deductibles for Evidence(s) of Insurance issued under the Master Policy are in US dollars, as follows:

6.2.1 $250; or

6.2.2 $500; or

6.2.3 $1,000; or

6.2.4 $2,500; or

6.2.5 $5,000; or

6.2.6 $10,000.

8 ASSIGNMENT, CHANGE OR WAIVER — Notwithstanding any law, statute, judicial decision or rule to the contrary, which may be or may purport to be otherwise applicable within the jurisdiction, locale or forum state of any healthcare provider, no transfer or assignment of any of the Participating Member's rights, Benefits or interests under this insurance shall be valid, binding on or enforceable against the Scheme Administrator unless first expressly agreed and consented to in writing by the Scheme Administrator. Any such purported transfer or assignment not in compliance with the foregoing Terms shall be void and without effect as against the Scheme Administrator, and the Scheme Administrator shall have no liability of any kind under this insurance to any such purported transferee or assignee with respect thereto. The Terms of the Master Policy, as evidenced by the Evidence(s) of Insurance issued by the Master Policy, shall not be waived or changed except by the express written agreement of the Scheme Administrator.

9 SERVICE OF SUIT — It is agreed that in the event of the failure of Underwriters to pay any amount claimed to be due hereunder, Underwriters, at the request of the Participating Organization or Participating Member, will submit to the jurisdiction of a court of competent jurisdiction within the United States. Nothing in this clause constitutes a waiver of underwriters’ rights to commence an action in any court of competent jurisdiction in the United States, to remove an action to a United States District Court, or to seek a transfer of a case to another court as permitted by the laws of the United States or any state in the United States. In any suit instituted against Underwriters hereunder, Underwriters will abide by the final decision of such court, or of any Appellate Court in the event of an appeal. Further, pursuant to any statute of any state, territory or district of the United States that makes provision therefor, the Scheme Administrator hereby designates the Superintendent, Commissioner or Director of Insurance or other officer specified for that purpose in the statute, or his/her successor or successors in office, as its true and lawful attorney upon whom may be served any lawful process in any action, suit or proceeding instituted by or on behalf of the Master Policyholder, Participating Organization or any Participating Member arising hereunder, and hereby reserves the right to designate an attorney of the Scheme Administrator’s choice in conjunction with Underwriters, as its attorney-in-fact and agent for service of process to whom said officer or Commissioner is authorized to mail or serve such process or a true copy thereof.

10 INSOLVENCY — The insolvency, bankruptcy, financial impairment, receivership and voluntary plan of arrangement with creditors or dissolution of the Master Policyholder or any Participating Member shall not impose upon the Scheme Administrator any liability or obligation other than that specifically included in this insurance.

11 SUBROGATION CLAUSE — The Participating Member undertakes to pursue in his/her own name and stead, and to fully cooperate with the Scheme Administrator and/or Underwriters in the prosecution of any and all valid claims that he/she may have against any third party who may be liable arising out of any act, omission or occurrence that results or may result in a loss of payment or coverage of claim by the Scheme Administrator and/or Underwriters under this insurance, and to account to the Scheme Administrator and/or Underwriters for any amounts recovered in connection therewith, on the basis that the Scheme Administrator and/or Underwriters shall be reimbursed and entitled to recover first in full for any sums paid by it before the Participating Member shares in any amount so recovered. Should the Participating Member fail to so cooperate, account or prosecute any valid claims against any such third party or parties, and the Scheme Administrator and/or Underwriters thereupon or otherwise becomes liable to make payment under the Terms of this insurance, then the Scheme Administrator and/or Underwriters shall be fully subrogated to all rights and interests of the Participating Member with respect thereto and may prosecute such claims in its own name as subrogee. The Participating Member's submission of Proof of a Claim, acceptance of coverage or Benefits under this insurance shall be deemed to constitute an assignment of such subrogation rights by the Participating Member to the Scheme Administrator and/or Underwriters. Any amount recovered by the Scheme Administrator and/or Underwriters shall first be used to pay the costs and expenses of collection incurred by the Scheme Administrator and/or Underwriters, which would include reasonable attorneys' fees, and for reimbursement to the Scheme Administrator and/or Underwriters for any amount that it may have paid or became liable to pay under this insurance. Any remaining amounts recovered shall be paid to the Participating Member or other persons lawfully entitled thereto, as applicable.

12 MISREPRESENTATION — Any misstatement, omission, concealment or fraud, either in the Participating Member's Application which forms a part of the Master Policy or Evidence of Insurance issued by the Master Policy, or in relation to any statement, certification or warranty made by the Participating Member or their representatives, agents or proxies, whether in writing or otherwise, to the Scheme Administrator or their respective agents, employees or representatives, or in connection with the making of any claim under this insurance, shall render the Evidence of Insurance null and void and all claims and Benefits under this insurance shall be forfeited and waived.

13 RIGHT OF RECOVERY — In the event of overpayment by the Scheme Administrator of any claim for Benefits under this insurance, for any reason, which would include without limitation because:

13.1 All or part of the claim was not incurred by or paid by or on behalf of the Participating Member; or

13.2 The Participating Member or any member of the Participating Member's Family, whether or not the Family members was a Participating Member under this insurance plan, is repaid, is entitled to be repaid for all or part of the claim by Other Coverage, or from a source other than the Scheme Administrator; or

13.3 All or part of the claim was not eligible for payment or coverage under the Terms of this insurance; or

13.4 All or part of the claim was paid or reimbursed based on an incorrect or mistaken application of Benefits under this insurance; or

13.5 All or part of the claim has been excused, waived, abandoned, forfeited, discounted or released by the provider; or

13.6 The Participating Member is not liable or responsible as a matter of law for all or part of a claim. The Scheme Administrator shall have the right to a refund and to recover the amount of overpayment from the Participating Member and/or the hospital, Physician, or other provider of services or supplies, as the case may be. For overpayment of claims as specified under Subsections 13.1 through 13.6 above, the amount of the refund and recovery shall be the difference between: (i) the amount actually paid by the Scheme Administrator, and (ii) the amount, if any, that should have been paid by the Scheme Administrator under the Terms of this insurance. For all other overpayments, the amount of the refund and recovery shall be the amount overpaid. If the Participating Member or the hospital, Physician or other provider of services or supplies does not promptly make any such refund to the Scheme Administrator, the Scheme Administrator may, in addition to any other rights or remedies available to it (all of which are reserved): (i) reduce or deduct from the amount of any future claim that is otherwise eligible for coverage or payment under this insurance, to the full extent of the refund due to the Scheme Administrator; and/or (ii) cancel any Evidence(s) of Insurance and all further coverage of the Participating Member under the Master Policy by giving thirty (30) days advance written notice by mail to the Participating Member's last known residence or mailing address, and offset against the amount of any refund of Premium due the Participating Member to the full extent of the refund due to the Scheme Administrator.

16 TERMINATION OF MASTER POLICY — The Master Policy can be terminated at any time by Underwriters or the Master Policyholder by giving at least thirty (30) days written notice to the other, thus providing the same such notice to the Scheme Administrator and to the Participating Member. Such termination will have no effect on the Evidence of Insurance prior to the date of the termination, or on eligible coverage or Benefits under this insurance accrued prior thereto. No Evidence of Insurance will be issued or a Continuation of Coverage accepted after the date the Master Policy is terminated.

17 REINSTATEMENT OF COVERAGE — In the event coverage under this insurance lapses or is terminated for failure to pay Premium, the Participating Member may apply to the Scheme Administrator for reinstatement ("Reinstatement"). Reinstatement is at the sole option of the Scheme Administrator, and shall be subject to the Scheme Administrator's retained right, without obligation or liability of any kind, to reassess and make determination of acceptable risk in its sole and absolute discretion. In order to be considered for Reinstatement, the Participating Member must submit all of the following to the Scheme Administrator:

17.1 A written request for Reinstatement; and

17.2 A newly completed Reinstatement Application, which shall become a part of the Master Policy and any reinstated Evidence of Insurance; and

17.3 A written statement of health, including any relative medical records; and

17.4 A written statement giving full details of the reason for the previous failure to pay Premium when due or to accept continuation terms in a timely manner; and

17.5 Payment of all Premiums due and $100.00 reinstatement fee.

18 APPLICABLE CURRENCY — All benefit amounts, coverages, monetary limits and Sub-Limits, and other amounts stated in the Master Policy, the Application, the Declaration Page of Insurance, the Evidence of Insurance, and in any Riders, which would include Premium, are in US dollars.

20 UNDERWRITING DECISIONS; EXPLANATION OR VERIFICATION OF BENEFITS — In the event of any verbal or telephone inquiry, every attempt will be made to help the Participating Member and his/her healthcare providers understand the status, scope and extent of available Benefits and coverage under this insurance; provided, however, that no statement made by any agent, employee or representative of the Scheme Administrator will be deemed or construed as an estoppels or to create any liability against the Scheme Administrator or be deemed or construed to bind the Scheme Administrator or to modify, replace, waive, extend or amend any of the Terms of the Master Policy or the Evidence of Insurance, unless expressly set forth in writing. Actual eligibility and/or acceptance determinations, final coverage decisions, and benefit or claim payments can be determined and adjudicated only at the time a proper and complete Application and/or Proof of Claim is submitted (as the case may be), an opportunity for reasonable investigation and/or review is provided, cooperation required hereunder received, and all facts and supporting information, which would include relevant medical records, are presented in writing. The Terms of the Master Policy govern all available coverage and payments made or to be made. If a definite answer to a specific Benefits or coverage question is required for any reason, the Participating Member or his/her provider may submit a written request to the Scheme Administrator, which would include all pertinent medical information and a statement from the attending Physician (if applicable), and a written reply will be sent by the Scheme Administrator and kept on file. If the Scheme Administrator elects to verify generally and/or preliminarily to a provider or the Participating Member that an Injury, Illness, diagnosis or proposed treatment is or may be covered under this insurance, or that Benefits for same are or may be available as outlined in the Master Policy and or the Evidence of Insurance, any such verification of Benefits does not guaranty either payment of Benefits or the amount or eligibility of Benefits. Final eligibility determinations, coverage decisions and actual reimbursement or payment of claims or Benefits are subject to all Terms of this insurance, which would include without limitation filing a proper and complete Proof of Claim under Subsection 7.1, above.

23 PRE-NOTIFICATION PROVISIONS & REQUIREMENTS — Pre-notification is a general determination of Medical Eligibility, only, and all such determinations are made by the Scheme Administrator (acting through its authorized agents and representatives) in reliance and based upon the completeness and accuracy of the information provided by the Participating Member and/or his/her Relatives, guardians and/or healthcare providers at the time of Pre-notification. The Scheme Administrator reserves the right to challenge, dispute and/or revoke a prior determination of Medical Necessity based upon subsequent information obtained. Pre-notification is not an assurance, authorization, or verification of coverage, a verification of Benefits, or a guarantee of payment. The fact that treatment or supplies are Pre-certified by the Scheme Administrator does not guarantee the payment of Benefits or the amount or eligibility of Benefits. The Scheme Administrator's consideration and determination of a Pre-notification request, as well as any subsequent review or adjudication of all medical claims submitted in connection therewith, shall remain subject to all Terms and Conditions of the Master Policy, which would include exclusions for Pre-existing Conditions and other designated exclusions, benefit limitations, and the requirement that claims be Usual, Reasonable and Customary. In addition, any consideration or determination of a Pre-notification request shall not be deemed or considered as the Scheme Administrator's approval, authorization or ratification of, recommendation for, or consent to any diagnosis or proposed course of treatment. Neither the Scheme Administrator (nor anyone acting on their behalf) has any authority or obligation to select Physicians, Hospitals or other healthcare providers for the Participating Member, or to make any diagnosis or medical treatment decisions on behalf of the Participating Member, and all such decisions must be made solely and exclusively by the Participating Member and/or his/her Family members or guardians, treating Physicians and other healthcare providers. If the Participating Member and his/her healthcare providers comply with the Pre-notification requirements of the Master Policy, and the treatment or supplies are Pre-certified as Medically Necessary, the Scheme Administrator will reimburse the Participating Member for Eligible Medical Expenses Incurred in relation thereto, subject to all Terms of this insurance, which would include the Deductible and Coinsurance. Eligibility for and payment of Benefits are subject to all of the Terms of this insurance.

23.1 Specific Requirements — The following treatment and/or supplies must always be Pre-certified for Medical Necessity by the Scheme Administrator, which would include:

23.1.1 Inpatient treatment of any kind; and

23.1.2 Any Surgery or Surgical procedure; and

23.1.3 Care in an Extended Care Facility; and

23.1.4 Home Nursing Care; and

23.1.5 Durable Medical Equipment; and

23.1.6 Artificial limbs; and

23.1.7 Diagnostic testing such as MRI, CT scan and PET scan; and

23.1.8 Chemo/Radiation Therapy; and

23.1.9 Emergency Medical Evacuation; and

23.1.10 Labor and Delivery.

23.2 General Requirements — To comply with the Pre-notification requirements of this insurance for the treatment and services listed in Section 23, healthcare provider and/or Participating Members must comply with the requirements below:

23.2.1 Contact the Scheme Administrator at the telephone numbers printed on the ID card and/or email the Pre-notification details, as follows:

Inside the United States:                                                            (Ph.) 1-317-644-6291 (Collect if necessary)

Outside the United States:                                                         (Ph.) 1-888-201-8850

E-mail:                                                                                            service@azimuthrisk.com; and

23.2.2 As soon as possible before the treatment is to be obtained; and

23.2.3 Notify all Physicians, hospitals and other healthcare providers that this insurance contains Pre-notification requirements and ask them to fully cooperate with the Scheme Administrator; and

 23.2.4 Comply with the instructions of the Scheme Administrator and submit any information or documents required by the Scheme Administrator

24 LOSS OF COVERAGE/BENEFITS FOR NON-COMPLIANCE WITH PRE-NOTIFICATION REQUIREMENTS — If the Participating Member or his/her healthcare providers do not comply with the Pre-notification requirements or the treatment or supplies identified in Section 23 through 23.2.4 above, or if such treatment or supplies are not Pre-certified, Eligible Medical Expenses Incurred with respect to said treatment and/or supplies will be reduced by fifty (50%) percent.

25 EMERGENCY PRE-NOTIFICATION — In the event of an Emergency Hospital admission, Pre-notification must be completed within forty-eight (48) hours after the admission, or as soon as is reasonably possible.

26 CONCURRENT REVIEW — For Inpatient treatment of any kind, the Scheme Administrator will Pre-notify a limited number of days of confinement based upon the medical condition. Thereafter, Pre-notification must again be requested and approved if additional days of Inpatient treatment are necessary

DEFINITIONS

DEFINITIONS— Certain words and phrases used in the Master Policy and the Evidence(s) of Insurance issued by the Master Policy are defined below. Other words and phrases may be defined elsewhere in the Master Policy or Evidence(s) of Insurance issued by the Master Policy, including where they are first used:

Accident: A sudden, unintentional, and unexpected occurrence caused by external, visible means and resulting in physical Injury to the Participating Member

Affidavit of Eligibility: The properly completed form provided to the Scheme Administrator that certifies that an applicant is eligible to be covered under this insurance plan because they do not meet the citizenship and/or residency requirements of other insurance companies in the area where they reside.

AIDS: Acquired Immune Deficiency Syndrome, as that term is defined by the United States Centers for Disease Control.

Amateur Athletics: An amateur or other non-professional sporting, recreational, or athletic activity that is organized, sponsored and/or sanctioned, and/or involves regular or scheduled practices, games and/or competitions. This definition does not include athletic activities that are non-contact and engaged in by the Participating Member solely for recreational, entertainment or fitness purposes.

Application: The fully answered and signed individual or Family Application/enrollment form submitted by or on behalf of the Participating Member for into, Continuation of Coverage under, or Reinstatement in this insurance plan, which by this reference shall be incorporated in and become a part of the Master Policy and/the Evidence of Insurance. Any insurance agent/broker assigned to or assisting with the Application is the representative of the applicant/Participating Member and is not an agent or representative for or on behalf of the Scheme Administrator, Underwriters and/or the Master Policyholder.

ARC Syndrome: AIDS related complex, term is defined by the United States Centers for Disease Control.

Canada: A federated country in North America made up of ten provinces and three territories, (Canada).

Coinsurance: The payment by or obligations of the Participating Member for payment of Eligible Medical Expenses at the percentage specified in the Schedule of Benefits/Limits contained herein and exclusive of the Deductible.

Complicated Delivery: A delivery in which some condition puts a mother, the developing fetus, or both at higher-than-normal risk for complications during or after the delivery.

Continuous Coverage: With regard to the foregoing Schedule of Benefits/Limits, the references to "Continuous Coverage" mean continuous unbroken coverage under the Beacon/Axis Series Group Insurance Trust (Anguilla). The applicable benefits described will become first available to the Participating Member only at the end of the Continuous Coverage Period so specified

Continuation of Coverage: When a Participating Member continues coverage under the Beacon/Axis Series Group Insurance Plan beyond the original Coverage Period. At the end of each Coverage Period, a Participating Member is generally invited to continue his/her coverage.

Continuation of Coverage Date: The date a Participating Members new Coverage Period begins after his/her Continuation of Coverage under the Beacon/Axis Series Group Insurance. This date is indicated on Declaration Page of Insurance in SectionⅡ.

Coverage Period: The period beginning on the Effective Date of Coverage indicated on the Participating Members ID Card or the Continuation of Coverage Date indicated of the Participating Members Declaration Page of Insurance in SectionⅡand ending on the earliest of the following dates: (i) the date specified on the Declaration Page of Insurance, or (ii) the termination date as determined in accordance with Section 15 above. The Coverage Period can be no more than three hundred sixty four (364) consecutive days.

Covered Transplant: A transplant involving the heart, heart/lung, lung, kidney, kidney/pancreas, liver and allogenic or autologous bone marrow.

Custodial Care: Those types of care or services, wherever furnished and by whatever name called, that are designed primarily to assist an individual.

Death: Complete and irreversible cessation of life.

Declaration Page of Insurance: The Declaration Page of Insurance issued by the Scheme Administrator to the Participating Member contemporaneously with the Evidence of Insurance (and/or upon Continuation of Coverage or Reinstatement hereof) evidencing the Participating Member's insurance coverage under the Master Policy as evidenced by the Evidence of Insurance, which Declaration Page of Insurance shall be incorporated in and become a part of the Master Policy. The Declaration Page of Insurance serves as a descriptive document highlighting the coverage limits, Deductible(s), coverage dates, amendments and/ or riders, and names of Participating Members for all Evidence of Insurance issued by the Scheme Administrator on behalf of the Master Policyholder and Underwriters.

Deductible: The dollar amount of Eligible Medical Expenses specified on the Declaration Page of Insurance, that the Participating Member must pay per Coverage Period prior to receiving benefits under this insurance, and exclusive of Coinsurance.

Dental Treatment: Treatment or supplies relating to the care, maintenance or repair of teeth, gums or bones supporting the teeth, which would include dentures and preparation for dentures.

Dependent Child/Children: A Participating Member who is less than eighteen (18) years of age at time of Application and shares your home for at least half the year (if divorced, the Dependent Child may live with former spouse); and must not provide over one-half of his/her own support (scholarships excluded); or must be less than twenty-six (26) years of age at time of Application and a full-time student and claim your residence as his/her official residence while away at school; and must not provide over one-half of his/her own support (scholarships excluded); and must be your biological, step, or legally adopted Dependent Child/Children. A policy in which the only Participating Member on the policy is eighteen (18) years of age or younger at the time of application will be considered a Dependent Child for the purposes of the Dependent Child Wellness Benefit.

Disabled: A person who has a congenital or acquired mental or physical defect that interferes with normal functioning of the body system or the ability to be self-sufficient.

Durable Medical Equipment (DME):Durable Medical Equipment consists of the following items: a standard basic hospital bed; and/or a standard basic wheel chair.

Educational: Care for restoration (by education or training) of a person's ability to function in a normal or near normal manner following an Illness or Injury. This type of care includes, but is not limited to, vocational or occupational therapy, and speech therapy.

Effective Date of Coverage: The date the Participating Member first obtains coverage under the Beacon/Axis Series family of Insurance plans and maintains continuous unbroken coverage thereafter, this date is indicated on the Participating Members ID Card.

Eligible Medical Expenses: Expenses for Injuries, Illnesses and cost incurred by a Participating Member in which all Terms, Conditions and Limits of the Evidence of Insurance have been met in full. Eligible Medical Expenses will not be determined until the Scheme Administrator has received and reviewed the Complete Proof of Claim. Eligible Medical Expenses are subject the Limits, Deductibles and Coinsurance set forth on the Participating Members Declaration Page, Schedule of Benefits and Evidence of Insurance.

Emergency: A medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Participating Member's life or limb in danger if medical attention is not provided within twenty-four (24) hours.

EST: US Eastern Standard Time.

Evidence of Insurance: The document issued by the Master Policyholder to the Participating Member, which describes and provides an outline and evidence of eligible coverage and benefits payable to or for the benefit of the Participating Member under the Master Policy, and which includes the Participating Member's Application and any Riders attached thereto.

Expenses Incurred: Expenses rendered by a Participating Member that have or may not yet have been paid by the responsible parties.

Experimental: Any Treatment that includes completely new, untested drugs, procedures, or services, or the use of which is for a purpose other than the use for which they have previously been approved; new drug procedure or service combinations; and alternative therapies which are not generally accepted standards of current medical practice.

Extended Care Facility: An institution, or a distinct part of an institution, which is licensed as a Hospital, Extended Care Facility or Rehabilitation Care Facility by the state or country in which it operates; is regularly engaged in providing twenty-four (24)-hour skilled nursing care under the regular supervision of a Physician and the direct supervision of a Registered Nurse; maintains a daily record on each patient; provides each patient with a planned program of observation prescribed by a Physician; provides each patient with active Treatment of an Illness or Injury. Extended Care Facility does not include a facility primarily for rest, the aged, Substance Abuse, Custodial Care, nursing care, or for care of Mental or Nervous Disorders or the mentally incompetent.

Family: A Participating Member and his/her Spouse (see definition of Spouse) who is covered as a Participating Member under this insurance plan and his/her Dependent Child or Children (see definition of Dependent Child; Children) who are under the age of eighteen (18) or less than twenty-six (26) years of age at time of Application and a full-time student and claim your residence as his/her official residence while away at school and covered as Participating Members under this insurance plan.

HIV+: Laboratory evidence defined by the United States Centers for Disease Control as being positive for Human Immunodeficiency Virus infection.

Home Country: The country of which the Participating Member is a citizen or national; or maintains his/her residence or usual place of abode; or the country of which the Participating Member is the possessor of a validly issued passport.

Home Health Care Agency: A public or private agency or one of its subdivisions, which operates pursuant to law; and is regularly engaged in providing Home Nursing Care under the supervision of a Registered Nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation and Treatment prescribed by a Physician.

Home Nursing Care: Services, provided by a Home Health Care Agency and supervised by a Registered Nurse, which are directed toward the personal care of a patient, provided always that such care is in lieu of Medically Necessary Inpatient care.

HospiceCare: An institution which operates as a Hospice ; and is licensed by the state or country in which it operates; and operates primarily for the reception, care and palliative control of pain for terminally ill persons who have, as certified by a Physician, a life expectancy of not more than one hundred (180) days.

 Hospital: An institution which operates as a Hospital pursuant to law; is licensed by the state or country in which it operates; operates primarily for the reception, care, and treatment of sick or injured persons as Inpatients; provides twenty-four (24)-hour nursing service by Registered Nurses on duty or call; has a staff of one or more Physicians available at all times; provides organized facilities and equipment for diagnosis and treatment of acute medical, surgical or mental/nervous conditions on its premises; and is not primarily a long-term care facility, Extended Care Facility, nursing, rest, Custodial Care, or convalescent home, a place for the aged, drug addicts, alcoholics or runaways; or similar establishment.

Hospitalization; Hospitalized: Confined and/or treated in a Hospital as an Inpatient.

Illness: A sickness, disorder, Illness, pathology, abnormality, ailment, disease, any other medical, physical or health condition. Illness does not include learning disabilities, attitudinal, or disciplinary problems.

 Injury: Bodily Injury resulting from an Accident.

Inpatient: A person who is an overnight patient of a Hospital, using & being charged for room and board.

Intensive Care Unit:A Cardiac Care Unit or other unit or area of a Hospital that meets the required standards of the Joint Commission on Accreditation of Healthcare Organizations for Special Care Units.

Investigational: Treatment that includes drugs, procedures, or services which are still in the clinical stages of evaluation and not yet released for distribution by the US Food and Drug Administration.

Master Policyholder: The Beacon/Axis Series Group Insurance Trust, (Anguilla).

Maximum Limit: The cumulative total dollar amount of benefit payments and/or reimbursements available to a Participating Member under this insurance during the Participating Member’s Coverage Period. When the Maximum Limit is reached, no further benefits, reimbursements or payments will be available under this insurance.

Medical Research: Research conducted to aid and supports the body of knowledge in the field of medicine. Medical Research can be divided into two general categories: the evaluation of new treatments for both safety and efficacy in what are termed clinical trials, and all other research that contributes to the development of new treatments. The latter is termed preclinical research if its goal is specifically to elaborate knowledge for the development of new therapeutic strategies.

Medically Necessary; Medical Necessity: A Treatment or supply which is necessary and appropriate for the diagnosis or Treatment of an Illness or Injury based on generally accepted standards of current medical practice as determined by the Scheme Administrator. By way of example but not limitation, a Treatment or supply will not be considered Medically Necessary or a Medical Necessity if it is provided or obtained only as a convenience to the Participating Member or his/her provider; and/or if it is not necessary or appropriate for the Participating Member's Treatment, diagnosis or symptoms; and/or if it exceeds (in scope, duration or intensity) that level of care which is needed to provide safe, adequate, and appropriate diagnosis or Treatment.

Mental or Nervous Disorders: A mental, nervous, or emotional Illness which generally denotes an Illness of the brain with predominant behavioral symptoms; or an Illness of the mind or personality, evidenced by abnormal behavior; or an Illness or disorder of conduct evidenced by socially deviant behavior. Mental or Nervous Disorders include without limitation: psychosis; depression; schizophrenia; bipolar affective disorder; and those psychiatric Illnesses listed in the current edition of the Diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association. Mental or Nervous Disorder does not include learning disabilities, or attitudinal or disciplinary problems. For purposes of this insurance, Mental or Nervous Disorder does not include Substance Abuse.

Mortal Remains: The bodily remains or ashes of a Participating Member.

Newborn: An infant from the moment of birth through the first thirty-one (31) days.

Normal Delivery: A Vaginal delivery with no unexpected complications before or after delivery.

Outpatient: A person who receives Medically Necessary Treatment by a Physician or other healthcare provider that does not require an overnight stay in a Hospital.

Participating Member: All participants enrolled in the Beacon/Axis Series Group Insurance Trust (Anguilla); under the Meridian Series Plan.

Participating Organization: A business, society or association that purchase medical coverage for a group of individuals.

Physician: A duly licensed practitioner of the medical arts. A Physician must be currently licensed by the state or country in which the services are provided, and services must be within the scope of that license.

Pre-notification; Pre-notify: A general determination of Medical Necessity, only, made in reliance and based upon the completeness and accuracy of the information provided at the time thereof. Prenotification is not an assurance, authorization, or verification of coverage, a verification of benefits, or a guarantee of payment. See Section 23 above, for further details.

Pre-existing Condition: Any Illness, Injury or Mental or Nervous Disorder that, with reasonable medical certainty, existed on or at any time prior to the Effective Date of Coverage, whether or not previously manifested or symptomatic, diagnosed, treated or disclosed on the Application or on any Claim Form or otherwise, which would include any chronic, subsequent or recurring complications or consequences associated therewith or arising or resulting therefrom.

Premium: The Premium payments required to effectuate and maintain the Participating Member's insurance coverage and benefits under this insurance, in the amounts and at the times ("Due Dates") established by the Scheme Administrator in its sole discretion from time to time.

Pregnant/Pregnancy: The process of growth and development within a woman's reproductive organs of a new individual from the time of conception through the phases where the embryo grows and fetus develops to birth.

Professional Athletics/Professional Sports: A sport activity, which would include practice, preparation, and actual sporting events, for any individual or organized team that is a member of a recognized Professional Sports organization, is directly supported or sponsored by a Professional team or Professional sports organization, is a member of a playing league that is directly supported or sponsored by a professional team or professional sports organization; or has any athlete receiving for his or her participation any kind of payment or compensation, directly or indirectly, from a professional team or professional sports organization.

Rare Conditions/Defect: Conditions/defect which affects a small number of people compared to the general population and, because they are rare, can present challenges with regards to diagnosis, Treatment, and prevention. A condition/defect is considered to be rare when it affects 1 person in 2,000 or fewer.

Registered Nurse: 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." after his or her name.

Rehabilitation Care: Care for restoration (by education or training) of a person's ability to function in a normal or near normal manner following an Illness or Injury. This type of care includes, but is not limited to, vocational or occupational therapy, and speech therapy.

 Relative: A parent, guardian, spouse, son, daughter, or immediate Family member of the Participating Member.

Rider: Any exhibit, schedule, attachment, amendment, endorsement, or other document attached to, issued in connection with, or otherwise expressly made a part of or applicable to, the Master Policy, the Evidence of Insurance, or the Application, as the case may be.

Routine Physical Exam: Examination of the physical body by a Physician for preventative or informative purposes only, and not for the Treatment of any Illness or Injury.

Short Rate Cancellation Table: The table used by the Scheme Administrator to calculate Short Rate Earned Premium in the event of cancellation. A copy of this table is available to the Participating Member upon request.

Sports Diving: Recreational underwater diving activities requiring the use of underwater or artificial breathing apparatus, and carried out in strict accordance with the guidelines, codes of good practice, and recommendations for safe diving practices as laid down by an Authoritative Diving Body.

Spouse: Wife/husband or domestic partner living at the same address and sharing financial responsibilities but not including business partners or associates.

Sub-Limits: Extra limitations in an insurance policy's coverage of certain losses. They are part of the original limit. That is, they do not provide extra coverage, but set a maximum to cover a specific loss. Sub-Limits may be expressed as a dollar amount or a percentage of the coverage available.

Substance Abuse: Alcohol, drug or chemical abuse, misuse, illegal use, overuse or dependency.

Surgery/Surgical Procedure: An invasive diagnostic or surgical procedure; or the Treatment of Illness or Injury by manual or instrumental operations performed by a Physician while the patient is under general or local anesthesia.

Terms: Terms, provisions, conditions, definitions, limits, Sub-Limits, limitations, wordings, restrictions, qualifications and/or exclusions.

Act of Terrorism: An act, which would include, but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes, which would include the intention to influence any government and/or to put the public, or any section of the public, in fear.

Treatment: Any and all services and procedures rendered in the management and/or care of a patient for the purpose of identifying, diagnosing, treating, curing, preventing, controlling and/or combating any Illness or Injury, which would include without limitation: verbal or written advice, consultation, examination, discussion, diagnostic testing or evaluation of any kind, pharmacotherapy or other medication, and/or Surgery.

Unexpected: Sudden, unintentional, not expected, and unforeseen.

US: The United States of America and or any of its territories.

Usual, Reasonable and Customary: The most common charge for similar services, medicines, or supplies within the area in which the charge is incurred, so long as those charges are reasonable. The Scheme Administrator reserves the right to determine, in the reasonable exercise of its discretion, whether charges are Usual, Reasonable and Customary. In determining whether a charge is Usual, Reasonable and Customary, the Scheme Administrator may consider one or more of the following factors, without limitation: the level of skill, extent of training, and experience required to perform the procedure or service; the length of time required to perform the procedure or service as compared to the length of time required to perform other similar services; the severity or nature of the Illness or Injury being treated; the amount charged for the same or comparable services, medicines or supplies in the locality; the amount charged for the same or comparable services, medicines or supplies in other parts of the country; the cost to the provider of providing the service, medicine or supply; and such other factors as the Scheme Administrator, in the reasonable exercise of its discretion, determines are appropriate.