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These insurance
benefits are available as part of your membership in the Freedom or Freedom Plus
Packages.
Persons Insured*
Coverage includes all members, spouse, and dependent children. Dependent children
under 18 years of age (under 23 years if a full-time student at an institution of
higher learning) are eligible, subject to state requirements. Any dependent child
of an insured who is permanently mentally or physically challenged and incapable
of self-support is eligible for coverage, at any age.
When Coverage Applies*
You are protected 24 hours a day - worldwide - while on business or pleasure.
This does not cover loss due to sickness.
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Insurance Benefits Included in Membership
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The following limited benefit insurance
is under the Group Accidental Death and Dismemberment and Medical Care Insurance
policy and is an added benefit of your membership featuring:
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Accidental Death & Dismemberment
Benefit:
Pays the beneficiary up to the benefit
amount listed for the member’s death or loss of certain body parts in a covered
accident or a portion or that amount for the accidental death of a family member,
if this is a family membership, (50% for covered spouse, 20% for covered dependent
children).
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$7,500.00 (Freedom)$10,000.00 (Freedom
Plus)
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Accident Medical/Dental Expense
Reimbursement:
Pays part of the expenses you are
charged by a hospital, doctor, or certain other charges, up to a maximum of the
amount listed if you are injured in a covered accident. $100 deductible applies.
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$2,000.00 (Freedom)$5,000.00 (Freedom
Plus)
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All benefits provided by
this insurance are subject to the terms, definitions, conditions, exclusions
and limitations, of the group policy. To obtain more information about this
insurance, please ask to speak to a licensed agent or click on the link above.
All members of the Freedom
and Freedom Plus Programs are enrolled into the American Consumer Health Association
to be eligible to receive these benefits. The insurance benefits are underwritten
by The United States Life Insurance Company in the City of New York, a member company
of American International Group, Inc¹, NAIC # 70106. United States Life is
domiciled in the state of New York with a principal place of business of 830 Third
Avenue NY, NY 10022-6565 and licensed in all states, plus DC, except PR. These
benefits are under Group AD&D & Medical Care Insurance Policy
(Form No.
G-19000) issued
to American Consumer Health Association.
¹The underwriting
risks, financial obligations and support functions associated with the products
issued by The United States Life Insurance Company in the City of New York are its
responsibility. The United States Life Insurance Company in the City of New York
is responsible for its own financial condition and contractual obligations.
THIS IS NOT BASIC
HEALTH INSURANCE. THIS OFFER INCLUDES DISCOUNTS AND/OR SERVICES PLUS ADDED
LIMITED BENEFIT INDEMNITY INSURANCE. NONE OF THESE, INIDIVIDUALLY OR IN COMBINATION
ARE A SUBSTITUTE FOR BASIC HEALTH COVERAGE, MAJOR MEDICAL INSURANCE OR ANY OTHER
MEDICAL EXPENSE REIMBURSEMENT INSURANCE PLAN.
GENERAL EXCLUSIONS
No benefits will be paid
by this policy for any loss or Injury that is caused
by, results from, or is contributed to by:
1.
Intentionally self-inflicted Injury,
suicide or attempted suicide, while sane.
2.
War or any act of war, whether declared or not.
3.
Active participation in a riot or insurrection.
4.
Service in the military, naval or air service of any country, or international organization.
5.
Piloting or serving as a crewmember or riding in any aircraft except as a fare-paying
passenger on a regularly scheduled or charter airline.
6.
Work related injuries covered under Worker’s Compensation, Employer’s Liability
Laws, or similar occupational benefits
7.
Medical mishap or negligence, including malpractice
8.
While traveling outside the United States, Canada, Mexico, or any United States
possessions, except for a Medical Emergency or a covered Accidental Death or Accidental
Dismemberment..
9.
Treatment provided in a governmental hospital, benefits provided under a government
program (except Medicaid or Medicare), and any other services for which no charge
is normally made in the absence of insurance.
10.
Treatment by an Immediate Family member or a member of the Covered Person’s household.
11.
Alcoholism, drug addiction or the use of any drug or narcotic except as prescribed
by a Doctor.
12.
Cosmetic care, except for Medically
Necessary reconstructive plastic surgery. Reconstructive plastic surgery is
defined as:
a.
Surgery to restore normal bodily functions; or
b.
Surgery to improve functional impairment by anatomic alteration made necessary as
a result of a congenital birth defect; or
c.
Breast reconstruction following a mastectomy.
13.
Dental treatment, except for Injury
to sound, natural teeth.
14.
Hernia, adenoids, tonsils, varicose
veins, appendix, disorder of the reproductive organs, voluntary abortion, or elective
sterilization with 6 months after the Covered Person’s effective date of insurance.
15.
Rest care, convalescent care, or rehabilitative
care.
16.
Treatment of Mental or Nervous Disorders.
In addition to the General
Exclusions, no benefits will be paid by this policy for Injury or death to which
a contributing cause is:
1
The Covered Person’s violation
or attempt to violate any duly enacted law, or the commission or attempt to commit
an assault or a felony, or that occurs while the Insured is engaged in an illegal
activity or occupation.
2
Injury or death from an
Accident where the Covered Person’s intoxication would be considered a contributing
cause to the Accident. Intoxication is determined according to the laws and/or
regulations of the jurisdiction in which the Accident occurred. It will be
considered a contributing cause if:
a.
An investigation into the cause of the Accident by a police
department or other government body makes such determination; or
b.
It meets a “prudent and reasonable” test. “Prudent
and reasonable” means that a review of the circumstances of the Accident by an ordinarily
prudent person would find that the most reasonable interpretation of the facts indicate
that intoxication was a causal factor.
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Loss for
which the Covered Person would not be responsible in the absence of this Coverage.
In addition to the General
Exclusions, Accident Medical/Dental Expense Benefits will not be paid for:
1.
Treatment of hernia, Osgood-Schlatter’s Disease, osteochronditis, appendicitis,
osteomyelitis, cardiac disease or conditions, pathological fractures, congenital
weakness, or detached retina unless caused by Injury, whether or not caused by a
Covered Accident.
2.
Pregnancy, childbirth, miscarriage, abortion or any complications
of any of these conditions.
3.
Mental and Nervous Disorders (except as provided in the
Group Policy).
4.
Damage to or loss of dentures or bridges, or damage to
existing orthodontic equipment (except as specifically covered by the Group Policy).
5.
Expense incurred for treatment of Temporomandibular or
Craniomandibular joint dysfunction and associated myofacial pain (except as provided
by the Group Policy).
6.
Covered medical expenses for which the Covered Person would
not be responsible in the absence of this Coverage.
7.
Any expense paid or payable by any other valid and collectible
group insurance plan.
8.
Conditions that are not caused by a Covered Accident.
9.
Any treatment, service or supply not specifically covered
by the Group Policy.
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