VBA Accident Insurance Summary of Benefits

This content is provided for educational purposes only and is not an offer of coverage and is not intended to represent a communication from an insurer.


2The Benefit Amounts shown above for Dental, Physical Therapy, Orthopedic Appliance, and Transportation are part of, and not in addition to, the Maximum
Benefit Amount for Accident Medical Expense. Payment of these Benefit Amounts reduces and does not increase the Benefit Amount for Accident Medical Expense.

If an insured person has multiple losses as the result of one accident, the policy will only pay the single largest benefit amount applicable.

24-Hour AD&D Insurance:
covers you 24 hours a day, 365 days a year, anywhere in the world while at work or at play.

Accident Medical Expense:
This benefit will reimburse up to the maximum amount if accidental bodily injury causes you to first incur medical expenses for care and treatment within 90 days after an accident. The benefit amount for accident medical expense is payable only for medical expenses incurred within 52 weeks after the date of the accident causing the accidental bodily injury. The benefit amount is subject to the deductible and the maximum benefit amount. Payment of the benefit amount for accident medical expense is subject to the sub-limits for dental, physical therapy, orthopedic appliances and transportation expenses shown. In no event will total payments for your dental care and treatment, physical therapy, orthopedic appliances, transportation and medical expense exceed the benefit amount for Accident Medical Expense. For residents of CT, ID, IN, MD, NJ, NY, and SD, this benefit is payable on a primary basis. For residents in all other jurisdictions, this benefit is payable on an excess basis; we will determine the reasonable and customary charge for the covered medical expense. We will then reduce that amount by amounts already paid or
payable by any other plan and will pay the resulting amount less the deductible. In no event will we pay more than the maximum benefit amount. The deductible will be deducted from any benefit amount for Accident Medical Expense that is paid. This Deductible applies separately to each Insured Person and each Accident.

Limitation on Accident Medical Expense: This benefit does not apply to charges and services 1) for which you have no obligation to pay; 2) for any injury where worker’s compensation benefits or occupational injury benefits are payable; 3) for any injury occurring while fighting, except in self-defense; 4) for treatment that is educational, experimental or investigational in nature or that does not constitute accepted medical practice; 5) for treatment by a person employed or retained by the Policyholder; or 6) for treatment involving conditions caused by repetitive motion injuries, or cumulative trauma and not as the result of an accidental bodily injury. This insurance applies only to medically necessary charges and services.

Extensions of Insurance: Exposure
– If an accident causes you to be unavoidably exposed to the elements and as a result of such exposure you have a loss, then such loss will be insured under the policy.

Disappearance
– If you have not been found within 1 year of a disappearance, stranding, sinking, or wrecking of any conveyance in which you were an occupant at the
time of the accident, then it will be assumed, that you have suffered loss of life insured under the policy.

Exclusions:
Insurance does not apply to any Accident, Accidental Bodily Injury or Loss when the United States of America has imposed any trade sanctions or there is another legal prohibition to providing the insurance, or when caused or resulting from:

1) an Insured Person acting/training as a pilot or crew member. (unless temporarily performing duties in a life threatening emergency.);

2)an Insured Person’s emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection (unless the bacterial infection is caused by an Accident or by Accidental consumption of a substance contaminated by bacteria.), bodily malfunctions or medical or surgical treatment thereof. ;

3) an Insured Person’s commission or attempted commission of any illegal act, including but not limited to any felony;

4) an Insured Person being incarcerated after conviction;

5) an Insured Person being intoxicated, at the time of an Accident.;

6) an Insured Person being under the influence of any narcotic or other controlled substance at the time of an Accident. (unless taken and used as prescribed by a Physician.);

7) an Insured Person’s participation in active military service (except for the first 60 consecutive days of active military service);

8) an Insured Person’s suicide or intentionally self-inflicted injury;

9) a declared or undeclared War.

Description of Coverage: Once you are enrolled in the plan, you will receive a description of coverage.

WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.

Insurance is underwritten by Federal Insurance Company, a member insurer of the Chubb Group of Insurance Companies. The coverages described in this literature may not be available in all jurisdictions. This literature is descriptive only. Actual coverage is subject to the language of the policies as issued
(Policy # 9907-05-81 & 9907-05-82). Exclusions Apply. This policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. The expected benefit ratio for this policy is 85%. This ratio is the portion of future premiums which the company expects to return as benefits, when averaged over all people with this policy.

IMPORTANT NOTICE—THIS POLICY DOES NOT PROVIDE COVERAGE FOR
SICKNESS.

Chubb, Box 1615, Warren, N.J. 07061-1615

Highlights of coverage are listed here. 

The source of this content is the product brochure.

 

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