Participant Accident Coverage provides Accident Medical and Accidental Death & Dismemberment coverage to enrolled clubs. Accident Medical expense coverage is excess coverage, meaning it is secondary coverage to any other health/accident insurance in effect at the time of injury.
Claims are first paid by Club Member primary health/accident insurance. This excess plan pays only after primary insurance and pays remaining balances for eligible benefits, co-pays, and deductibles. If no primary health/accident insurance coverage is in effect at the time of injury, this plan becomes primary insurance.
Accidental Medical Expense
Full Excess Maximum Benefit
$25,000
Deductible
$100 per injury
Accidental Death & Dismemberment
$5,000 Principal Sum
Exclusions
- Charges for treatments that are not medically necessary.
- Conditions that are not caused by a Covered Accident.
- Pre-existing injury, illness, or disease.
- Any use of a Diving Board
- Charges which are in excess of Usual, Reasonable and Customary charges.
- Services or treatment rendered by a Physician, Nurse, or any other person who is employed or retained by the Policyholder.
- Services or treatment rendered by an Immediate Family member of the Covered Person.
- Heart attack, stroke or other circulatory disease or disorder, whether or not known or diagnosed.
- Dental care or treatment other than care of sound, natural teeth.
- Eyeglasses, contact lenses, hearing aids, braces, appliances, or examinations or prescriptions.
- The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices.