Group Accident Insurance – Medical Insurance Programs
In the past, group accident insurance – medical insurance coverage for riding clubs, sports teams, leagues and athletic association was either too costly or not available at all. Individuals were either forced to pay extremely high insurance premiums or to run teams and clubs without proper insurance protection; running the risk of personal exposure to lawsuits or a participant or staff member’s injury claim.
We have developed a comprehensive program to specifically cover the inherent risks involved for today’s riding club and athletic associations. This Group Accident Insurance- Medical Insurance Program is designed to help eliminate the financial and emotional burden one can incur as a result of injury in today’s athletic arena.
Who is covered? Accident Insurance – Medical Insurance:
All participants of the Policyholder are covered while participating in sponsored activities. A member is also covered while traveling, directly and without interruption, to and from any Policyholder sponsored activity and his or her home or place of residence.
Example of Accident Insurance Benefits:
• $100,000 Medical Maximum, excess only
• $2,500.00 Deductible
• Reasonable covered expenses are payable in full subject to the following limitations:
A. Hospital Room and Board – Semi-private room rate.
B. Dental – Reasonable Expenses per sound and natural tooth. $1,000 maximum.
C. Outpatient Physical Therapy – Reasonable Expenses. $500 maximum
D. Outpatient Orthopedic Appliances and Braces – Reasonable Expenses. $500
• Treatment must commence within 30 days from the date of injury.
• Coverage up to one year from the date of injury.
• Coverage is excess to other insurance.
Accidental Death & Dismemberment
Benefits are paid for losses which are incurred within 180 days from date of injury. The following benefits (the largest
applicable amount) are paid in addition to the medical benefit:
• Loss of Life $30,000
• Double Dismemberment $30,000
• Single Dismemberment $15,000
“Loss means with regard to hands and feet, actual severance above the wrist or ankle joint; with regards to sight, the
entire and irrevocable loss thereof.
Paralysis schedule is as follows: $25,000
• Both Upper & Lower Limbs 100%
• Both Lower Limbs 100%
• One Lower & One Upper Limb 100%
• One Lower Limb & One Upper Limb 100%
The Paralysis must occur within 180 days after the date of the Accident, continue for 6 consecutive months and be diagnosed by a doctor as being complete and not reversible
Accidental Death & Dismemberment
If a covered injury results in any of the losses specified below within one year after the date of the accident, the Company will pay the applicable amount.
- Full Principal Sum for loss of life
- Full Principal Sum for double dismemberment
- 50% of the Principal Sum for loss of one hand, one foot or sight of one eye
- 25% of the Principal Sum for loss of index finger and thumb of same hand
If the Principal sum is payable, no indemnity will be paid for dismemberment. In any event, the double dismemberment indemnity is the maximum amount payable under this Benefit for all losses resulting from one accident.
Why offer group accident insurance?
- Accidents happen. More than half occur in or around the home, and the potential out-of-pocket costs of care following an accident are growing.
- Employee’s payout doesn’t depend on income or other insurance
- Cash benefit paid directly to the insured to use any way they wish
- No health questions asked – coverage is always guaranteed
- Multiple benefits available for any one accident
- Dependents eligible for same benefit amounts as employee
- Easy for employees to enroll at work and pay through payroll deduction
- Coverage is available at affordable group rates
Maximum Medical Expense Benefit
If the Covered Person incurs eligible expenses as the result of a covered injury, the Company will pay the charges incurred for such expense within 52 weeks, beginning on the date of accident. Payment will be made for eligible expenses not to exceed the Maximum Medical Expense Benefit, subject to the applicable deductible amount (if any). The first such expense must be incurred within 60 days after the date of the accident.
Note:Excess Coverage. This plan does not cover treatment or service for which benefits are payable under any other insurance or medical service payment plan available to the insured.
Exclusions and Limitations
This Plan does not cover any loss to or resulting from:
- Sickness or disease in any form, except pyogenic infections due to an accidental cut or wound.
- The use of drugs or narcotics, unless administered under the advice of a physician.
- War or any act of war, whether or not declared.
- Participation in any riot or civil commotion.
- Air travel or the use of any device or equipment for aerial navigation, except as a fare-paying passenger on a regularly scheduled commercial airline.
- Suicide or any attempt thereat or any self-inflicted injury.
Nor does the Plan cover:
- Service provided by any person or facility employed or retained by the Policyholder or member organization.
- Service provided by any member of the Insured Person’s family or household.
- Dental treatment, except as the result of a covered injury.
- The repair or replacement of any artificial dental restoration.
- Expenses payable under any Workers Compensation Law or similar legislation.
- Injury sustained while riding in or on any two or three wheeled engine driven vehicle.
Policy Minimum Premium – $150.00