Detail

If an Insured Person is not eligible, this policy is void ab initio and all premium paid will be refunded.

  1. complete and sign an Application (or be listed thereon by proxy as an applicant and proposed Insured Person) with all questions answered truthfully and completely; and
  2. pay the required Premium on or before the Due Dates; and
  3. receive written acceptance of his/her Application or renewal from the Company; and
  4. be at least fourteen (14) days old but not yet seventy-five (75) years old; and
  5. not be Pregnant, Hospitalized or Disabled on the Initial Effective Date; and
  6. not be HIV+ on the Initial Effective Date; and
  7. (a) if a United States citizen, must (i) not qualify for or be able to obtain adequate coverage under a US domestic insurance plan that will provide continuous coverage outside of the United States; and (ii) provide the Company a signed Statement of Residence, a defined herein; (b) if not a United States citizen must (i) provide a non-US residence address; or (ii) provide the Company a signed Statement of Residence; and
  8. be a Professional Marine Crew Member, as defined herein

Subject to the Terms of this insurance, including without limitation the Excess (Deductible) and Coinsurance (unless otherwise expressly set forth to the contrary), the exclusions set forth in Section W, below, and the various limits and sub-limits set forth below, the Company promises to provide the Insured Person the following benefits and coverage arising out of Injury or Illness incurred while this Certificate is in effect:

Benefit/OtherLimit/Sub-limit
Area of Coverage Area 1: Europe Only
Area 2: Worldwide Excluding US/Canada
Area 3: Worldwide
(as indicated on the Declaration)
Excess (Deductible) Nil, £50/$85/€60, £100/$170/€120, £250/$425/€295, £500/$850/€600, £1000/$1700/€1200, £2500/$4250/€2950, £5000/$8500/€6000 or £10,000/$17,000/€11,800 per Insured Person per Period of Insurance, as indicated on the Declaration. An additional Excess (Deductible) of £150/$250/€175 will be applied for each Emergency Room visit for treatment of an Illness which does not result in a direct hospital admission
Maximum Limit £1,500,000/$2,500,000/€1,750,000 per Insured per Period of Insurance
Inpatient Treatment– Subject to the Excess (Deductible), then payable as shown:
Hospital Accommodation & Theatre Full Cover
Accidents, Emergencies & Intensive Care Full Cover
Surgeons, Consultants, Anesthetists & Nurses and Ancillary Charges Full Cover
Medical Practitioners Full Cover
Prescribed Drugs, Dressings and Durable Medical Equipment Full Cover
Reconstructive Surgery Full Cover
Diagnostic Tests and Procedures, X-rays, Pathology & MRI/CT Scans Full Cover
Cancer Tests, Drugs, Treatment and Consultants Full Cover
Physical Therapy Full Cover
Parent Hospital Accommodation – with an Insured Child under 18 Full Cover
Post Hospitalization Treatment (received within 90 days of discharge) Full Cover
Hospital Cash Benefit £150/$255/€175 per night payable where no charge is made by the hospital
Limited to 60 nights per Period of Insurance
Organ Transplant Limited to £100,000/$160,000/€117,000 Lifetime Maximum
Prosthetic Devices Full Cover
Psychiatric Treatment
(after 12 months of continuous coverage)
Full Cover to a maximum of 30 days per Period of Insurance
Outpatient Treatment – Subject to the Excess (Deductible), then payable as shown below:
The following, when combined, are limited to a maximum of £5,000/$8,500/€6,000 per Period of Insurance
  • Family Doctor, Treatment & Referrals
  • Specialists and Consultants
  • X-rays, Pathology, Diagnostic Tests and Procedures
  • Prescribed Drugs, Medicines, Dressings and Durable Medical Equipment
  • Physical Therapy, Homeopathic and Osteopathic Therapy (further limited to a maximum of 15 visits per Period of Insurance)
The following are NOT included in the above limits, but may have their own limits as indicated below:
Outpatient Surgery Full Cover
MRI and CT Scans Full Cover
Cancer Tests, Treatment and Consultants Full Cover
Complementary Medical Treatment Up to £500/$850/€600 per Period of Insurance
AIDS/HIV Treatment Up to £5,000/$8,500/€6,000 per Period of Insurance with a Lifetime Maximum of £10,000/$17,000/€11,800
Hormone Replacement Therapy Full Cover up to 18 Months Lifetime Maximum
Home Nursing Care Up to £75/$130/€90 per visit. Limited to 45 visits per Period of Insurance
Rehabilitation Full Cover up to 90 days per Period of Insurance
Extended Care Facility Full Cover up to 6 months following Inpatient Treatment
Hospice Care Full Cover up to 6 months per Lifetime Maximum
Adult Wellness and Health Check
(after 12 months of continuous coverage)
Not subject to Excess (Deductible). Limited to £150/$255/€175 per Period of Insurance
Child Wellness and Health Check
(after 12 months of continuous coverage)
Not subject to Excess (Deductible). Limited to £150/$255/€175 per Period of Insurance
Psychiatric Treatment
(after 12 months of continuous coverage)
Up to £2,500/$4,250/€2,950 per Period of Insurance
Travel, Transportation and Out-of-Area Benefits – Subject to the Excess (Deductible), then payable as shown below:
Emergency Local Ambulance Full Cover
Emergency Evacuation and Transportation Full Cover
Accompanying Relative Travel and Accommodation Full Cover
Cremation/Burial or Repatriation of Remains Up to £7,500/$13,000/€9,000
Compassionate Home Visit (after 12 months of continuous coverage) Up to £1,500/$2,550/€1,750 per Period of Insurance. Limited to 1 trip per Period of Insurance
The following two (2) benefit provisions apply only to Insured’s who elected Area 1 or Area 2 coverage:
USA Elective Treatment within the Provider Network
- Excludes non-emergency travel & accommodation
Not subject to Excess (Deductible), however subject to 20% coinsurance. Limited to £500,000/$850,000/€600,000 per Period of Insurance
Worldwide Accident and Emergency Out of Area Cover Up to £20,000/$34,000/€23,500 per Period of Insurance Limited to 45 days maximum
Pre-Existing Conditions and Chronic Conditions
Pre-existing Conditions
(after 24 months of continuous coverage)
Up to £2,000/$3,400/€2,350 per Period of Insurance with a Lifetime Maximum of £20,000/$34,000/€23,500
Chronic Conditions and Palliative Care Covered as part of Pre-existing medical limits above
Stabilization of Acute Chronic Episode Full Cover
Dental Treatment - Subject to the Excess (Deductible), then payable as shown below:
Emergency Dental Inpatient Treatment Full Cover
Accidental Damage Up to £250/$425/€295 per Period of Insurance
Maternity – available after 12 months of continuous coverage, then subject to Excess (Deductible) and payable as shown below:
Pregnancy Complications including medically required C-Section Up to £10,000/$17,000/€11,800 per Pregnancy
Normal Pregnancy and Delivery Not Covered
Newborn Hospital Accommodation Not Covered
Newborn Examination Not Covered
New Baby Benefit Not Covered
Cover for Newborns Up to £10,000/$17,000/€11,800 per Pregnancy
Non Medical Covers and Benefits
Out of Country Legal Expenses Subject to a Special Excess (Deductible) of £250/$425/€295 Up to £5,000/$8,500/€6,000 Lifetime Maximum
Trip Interruption Not subject to Excess (Deductible) Up to £5,000/$8,500/€6,000 per Period of Insurance
Lost/Theft – Luggage/Personal Papers Not subject to Excess (Deductible) Up to £500/$850/€600 per Period of Insurance
Special Marine Benefits – Subject to Excess (Deductible), then payable as shown below:
Amateur Sailboat Racing Coverage Up to £6,000/$10,000/€7,100 per Period of Insurance with a Lifetime Maximum of £29,000/$50,000/€34,000
Recreational Underwater Activities Coverage
(includes Sports Diving to depths of 30 meters)
Full Cover
Special Crewmember Return Benefit Not subject to Excess (Deductible) Up to £600/$1000/€700 per Period of Insurance
Pre-certification
Transplants No coverage if Pre-certification provisions are not met.
All Other 50% reduction of Eligible Medical Expenses if Pre-certification provisions are not met.

With regard to the foregoing Schedule of Benefits/Limits, the references to “continuous coverage” mean continuous unbroken coverage under the CrewSelect International Medical Insurance plan. The applicable benefits described will become first available to the Insured Person only at the end of the continuous coverage period so specified.

Exclusions

All charges, costs, expenses and/or claims (collectively “Charges”) incurred by the Insured Person and directly or indirectly relating to or arising from or in connection with any of the following acts, omissions, events, conditions, charges, consequences, claims, Treatment (including diagnoses, consultations, tests, examinations and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this insurance, and the Company shall provide no benefits and shall have no liability therefor:

  1. War; Military Action

    The Company shall not be liable for and will not provide coverage or benefits for any claim or Charges incurred with respect to any Illness, Injury or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising or incurred in connection with or as a result of any of the following acts or events (collectively, “Occurrences”):

    1. war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war;
    2. mutiny, riot, strike, military or popular uprising, insurrection, rebellion, revolution, military or usurped power;
    3. any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the Government de jure or de facto or to the influencing of it by violence of any type;
    4. martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege; or
    5. Terrorism.

    Any claim or Charges incurred with respect to any Illness, Injury or other consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether or not directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Occurrences shall be deemed and considered to be consequences for which the Company shall not be liable under the Master Policy or this Certificate, except to the extent that the Insured Person shall prove that such claim, Charges, Illness, Injury or other consequence happened independently of the existence of such abnormal conditions and/or Occurrences; and

  2. Pre-existing Conditions

    (i) For medical conditions existing at the time of Application which are fully disclosed on the Application and are not excluded or restricted through a Rider attached to this Certificate and for medical conditions which existed but that were unknown at the time of Application, charges resulting directly or indirectly from or relating to any such Pre-existing Condition are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least twenty-four (24) months, and thereafter such Charges are limited in coverage as provided in Section C, Schedule of Benefits/Limits, above; and (ii) Any expenses incurred, obtained, or received by an Insured Person for any Non-Disclosed conditions will be excluded under this insurance; and

  3. Illness or Surgery Within 180 Days

    Charges for Treatment of the following Illnesses or Surgeries which manifest themselves and/or involve procedures which take place and/or are recommended during the first one-hundred eighty (180) days of coverage under this insurance plan, beginning on the Initial Effective Date: asthma, allergies, any condition of the breast, any condition of the prostate, tonsillectomy, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, diverticulitis, hysterectomy, hernia, intervertebral disc disease, gall stones or kidney stones. Note: Coverage and/or benefits for these Illnesses or Surgeries (or for similar or different Illnesses or Surgeries) may be separately or further limited and/or excluded under the Pre-existing Conditions exclusion and definition; and

  4. Maternity and Newborn Care

    Charges for pre-natal care, pregnancy, post-natal care, and care of Newborns, except as expressly provided in Section K; and

  5. Mental or Nervous Disorders

    Charges for Treatment of Mental or Nervous Disorders are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least twelve (12) months; and

  6. Wellness

    Charges for Routine Physical Exams are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least twelve (12) months, and except as otherwise expressly provided in Section I, above. In no event will the Company reimburse the Insured Person for more than one Routine Physical Exam during any twelve (12) month period; and

  7. Charges for any Treatment or supplies that are:

    1. not incurred, obtained or received by an Insured Person during the Period of Insurance; and/or
    2. not presented to the Company for payment by way of a complete Proof of Claim within one hundred and eighty (180) days of the date such Charges are incurred; and/or
    3. not administered or ordered by a Physician; and/or
    4. not Medically Necessary; and/or
    5. provided at no cost to the Insured Person or for which the Insured Person is not otherwise liable; and/or
    6. in excess of Usual, Reasonable, and Customary; and/or
    7. incurred by an Insured Person who was HIV + at the Initial Effective Date of this insurance; whether or not the Insured Person had knowledge of his/her HIV status at that time and whether or not the Charges are incurred in relation to or as a result of said status; and/or
    8. provided by or at the direction or recommendation of a chiropractor in excess of the the maximum limits as stated in Section M; and/or
    9. performed or provided by a Relative of the Insured Person; and/or
    10. not expressly included as Eligible Medical Expenses as defined in Section H, above; and/or
    11. provided by a person who resides or has resided in the Insured Person's home; and/or
    12. required or recommended as a result of complications or consequences arising from or related to any Treatment, Illness, Injury, or supply excluded from coverage or which is otherwise not covered under this insurance; and
  8. Charges incurred for telephone consultations or due to a failure to keep a scheduled appointment; and

  9. Charges incurred for Surgeries or Treatment or supplies which are:

    1. Investigational, Experimental, or for Research Purposes, and/or
    2. related to genetic medicine, genetic testing, surveillance testing and/or wellness screening procedures for genetically predisposed conditions indicated by genetic medicine or genetic testing, including, but not limited to amniocentesis, genetic screening, risk assessment, preventive and prophylactic surgeries recommended by genetic testing, and/or any procedures used to determine genetic pre-disposition, provide genetic counseling or administration of gene therapy; and
  10. Charges incurred while confined primarily to receive Custodial Care or Educational Care; and

  11. Charges incurred for any surgery, Treatment or supplies relating to, arising from or in connection with, for, or as a result of:

    1. weight modification or any Inpatient, Outpatient, Surgical or other Treatment of obesity (including without limitation morbid obesity), including without limitation wiring of the teeth and all forms or procedures of bariatric Surgery by whatever name called, or reversal thereof, including without limitation intestinal bypass, gastric bypass, gastric banding, vertical banded gastroplasty, biliopancreatic diversion, duodenal switch, or stomach reduction or stapling; and/or
    2. modification of the physical body in order to change or improve or attempt to change or improve the physical appearance or psychological, mental or emotional well-being of the Insured Person (such as but not limited to sex-change Surgery or Surgery relating to sexual performance or enhancement thereof); and/or
    3. cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is Medically Necessary and is directly related to and follows a Surgery which was covered under this insurance; and/or
    4. any Injury or Illness sustained while taking part in mountaineering activities where specialized climbing equipment, ropes or guides are normally or reasonably should have been used, Amateur Athletics, professional athletics, aviation (except when traveling solely as a passenger in a commercial aircraft), hang gliding and parachuting, snow skiing except for recreational downhill and/or cross country snow skiing (no cover provided whilst skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body), racing of any kind (except as otherwise expressly set forth in Section V 1. Amateur Sailboat Racing, above) including by horse, motor vehicle (of any type) or motorcycle, spelunking, and subaqua pursuits involving underwater breathing apparatus (except as otherwise expressly set forth in Section V 2. Recreational Underwater Activities, above); Practice or training in preparation for any excluded activity which results in injury will be considered as activity while taking part in such activity; and/or
    5. any Illness or Injury sustained while participating in any sporting, recreational or adventure activity where such activity is undertaken against the advice or direction of any local authority or any qualified instructor or contrary to the rules, recommendations and procedures of a recognized governing body for the sport or activity; and/or
    6. any Illness or Injury sustained while participating in any activity where such activity is undertaken against medical advice; and/or
    7. any Injury or Illness sustained as a result of being under the influence or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician but not for the Treatment of Substance Abuse; and/or
    8. any Injury or Illness sustained while operating a moving vehicle after consumption of intoxicating liquor or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician. For purposes of this exclusion, “vehicle” shall include both motorized devices for which a driver or operator license is required (including watercraft and aircraft) and non-motorized bicycles and scooters for which no permit or license is required; and/or
    9. any willfully Self-inflicted Injury or Illness; and/or
    10. any venereal disease; and/or
    11. any Illness or Injury resulting from or occurring during the commission of a violation of law by the Insured Person, including, without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations; and/or
    12. any Substance Abuse; and/or
    13. speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy; and/or
    14. orthoptics, visual therapy or visual eye training; and/or
    15. the feet, including without limitation: orthopedic shoes; orthopedic prescription devices to be attached to or placed in shoes; Treatment of weak, strained, flat, unstable or unbalanced feet; metatarsalgia, bone spurs, hammer toes or bunions; and any Treatment or supplies for corns, calluses or toenails; provided, however, that claims for Treatment or supplies for the feet may be eligible for coverage under this insurance at the sole option of the Company and subject to all other Terms of this insurance when related to:
      1. an Injury to the foot arising from an Accident covered hereunder; or
      2. an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment; and/or
    16. hair loss, including without limitation wigs, hair transplants or any drug that promises to promote hair growth, whether or not prescribed by a Physician; and/or
    17. any sleep disorder; and/or
    18. any exercise program, whether or not prescribed or recommended by a Physician; and/or
    19. any exposure to any non-medical nuclear or atomic radiation, and/or radioactive material(s); and/or
    20. any organ or tissue or other transplant or related services, Treatment or supplies, except for Covered Transplants as defined herein and covered pursuant to the Terms of this insurance; and/or
    21. any artificial or mechanical devices designed to replace human organs temporarily or permanently; and/or
    22. any efforts to keep a donor alive for a transplant procedure, whether or not the transplant procedure is a Covered Transplant; and/or
    23. any transplant expenses incurred outside the Company’s approved independent Managed Transplant System Network; and/or
    24. any Covered Transplant in excess of one (1) during any twelve (12) month period of coverage under this insurance plan, except re-transplantation Charges if incurred during the initial Covered Transplant Hospitalization; and
  12. Charges incurred for any Treatment or supply that either promotes or prevents or attempts to promote or prevent conception or birth; including but not limited to: artificial insemination; oral contraceptives, Treatment for infertility or impotency; vasectomy or reversal of vasectomy; sterilization or reversal of sterilization; surrogacy; or abortion; and

  13. Charges incurred for any Treatment or supply that either promotes, enhances or corrects or attempts to promote, enhance or correct impotency or sexual dysfunction; and

  14. Charges incurred for Dental Treatment, except for as expressly provided by in Section L. Dental Treatment; and

  15. Charges incurred for eyeglasses, contact lenses, hearing aids, hearing implants and Charges for any Treatment, supply, examination or fitting related to these devices, or for eye refraction for any reason; and

  16. Charges incurred for eye Surgery, such as but not limited to radial keratotomy, when the primary purpose is to correct or attempt to correct nearsightedness, farsightedness, or astigmatism; and

  17. Charges incurred for Treatment of the temporomandibular joint; and

  18. Charges incurred by the Insured Person for the Treatment of his/her Newborns (or for supplies related thereto); and

  19. Charges incurred for any immunizations and/or routine physical exams except for the eligible benefits and covered expenses provided for under I. Wellness Expenses, or as otherwise expressly provided for hereunder; and

  20. Charges incurred for any travel, meals, transportation and/or accommodations, except as otherwise expressly provided for in this insurance; and

  21. Any taxes, assessments, charges, fees or surcharges imposed by any governmental agency or authority:

    1. arising out of or as a result of any Treatment or supplies received by the Insured Person, or
    2. based upon the Company’s election hereunder, if any, to pay benefits directly to providers, or
    3. for any other reason; and
  22. Unless otherwise expressly included under Section M. Complementary Medicine Benefit, Charges or expenses incurred for nonprescription drugs, medicines, vitamins, food extracts, or nutritional supplements; IV vitamin or herbal therapy; drugs or medicines not approved by the U.S. Food and Drug Administration or which are considered “off-label” drug use; and for drugs or medicines not prescribed by a Physician

Conditions that are fully disclosed on the application and have not been excluded or restricted by a Personal Medical Exclusion Policy Endorsement, will be covered after coverage has been in effect for 24 continuous months.
illnesses which exist, manifest themselves or are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions and are subject to the waiting period


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 Initial Effective Date of this insurance, whether or not previously manifested or symptomatic, diagnosed, treated or disclosed on the Application or on any Claim Form or otherwise, including any chronic, subsequent or recurring complications or consequences associated therewith or arising or resulting therefrom.

Special Benefits: (applicable to Area 3 coverage only)

If Treatment or supplies eligible for coverage under this insurance are received directly from the Company’s approved list of independent PPO providers while the Insured Person is in the United States: (1) the Company will reduce by fifty percent (50%) any part of the Excess (Deductible) applicable to such claims, and (2) the Company will waive any and all Coinsurance applicable to such claims. However, all claims for Treatment or supplies received in the United States from a non-PPO provider will remain subject to the applicable Excess (Deductible) and Coinsurance, whether or not the Insured Person may be eligible for the foregoing special benefit relating to Treatment or supplies received from PPO providers.

USA Elective Treatment with the Provider Network (applicable to Area 1 and Area 2 coverage only).

Elective Treatment received under the terms of this benefit must be received from a PPO Provider in order for benefits to be considered eligible. All such Treatment will be subject to a Nil Excess (Deductible) and a 20% coinsurance to the maximum indicated in the Schedule of Benefits. All Treatment is subject to the Terms of this insurance as stated in this certificate, including Pre-Certification Requirements as indicated in Section E, above.

PPO Information:

The Company, through the Plan Administrator, endeavors to maintain a contractual arrangement with an independent Preferred Provider Organization (PPO) that has established and maintains a network of U.S.-based Physicians, Hospitals and other healthcare and health service providers who are contracted separately and directly with the PPO and who may provide re-pricings, discounts or reduced charges for Treatment or supplies provided to the Insured Person. Neither the Company nor the Plan Administrator has any authority or control over the operations or business of the PPO, or over the operations or business of any provider within the independent PPO network. Neither the PPO nor any provider within the PPO network nor any of their respective agents, employees or representatives has or shall have any power or authority whatsoever to act for or on behalf of the Company or the Plan Administrator in any respect, including without limitation no power or authority to: (i) approve applications or enrollments for initial, renewal or reinstated coverage under this insurance plan or to accept Premium payments, (ii) accept risks for or on behalf of the Company, (iii) act for, speak for, or bind the Company or the Plan Administrator in any way, (iv) waive, alter or amend any of the Terms of the Master Policy or this Certificate or waive, release, compromise or settle any of the Company’s rights, remedies, or interests thereunder or hereunder, or (v) determine Pre-certification, eligibility for coverage, verification of benefits, or make any coverage, benefit or claim adjudications or decisions of any kind. It is not a requirement of this insurance that the Insured Person seek Treatment or supplies exclusively from a provider within the independent PPO network. However, the Insured Person’s use or non-use of the PPO network may affect the scope and extent of benefits available under this insurance, including without limitation the applicable Excess (Deductible), Coinsurance and Extra Excess (Deductible), as set forth above. An Insured Person may contact the Company through the Plan Administrator and request a PPO Directory for the area where the Insured Person will be receiving Treatment (therein listing the Physicians, Hospitals and other healthcare providers within the PPO network by location and specialty), or may visit the Plan Administrator’s website at http://www.imglobal.com to obtain such information.

Renewal of Coverage

Subject to the Terms of Sections B(17), (18), and (19), above, coverage under this insurance plan may be renewed from year to year in accordance with and subject to the Terms of the plan then in effect (including the Terms of the then applicable Master Policy) and so long as renewal Premium is paid when due and the Insured Person otherwise continues to meet the applicable eligibility requirements of the plan. The Company’s commitment and the Insured Person’s ability to renew is also subject to termination upon thirty (30) days written notice to the other party prior to the expiration date of the then existing Period of Insurance. The Company reserves the right in its sole discretion to make changes, additions and/or deletions to the Terms of the Master Policy, this Certificate, renewals or replacements of either, and/or to the CrewSelect International Medical Insurance plan (including the issuance of Riders to effectuate same) at any time or from time to time after the Effective Date of Coverage of this Certificate, upon no less than ninety (90) days prior written notice to the Insured Person (“Notice of Amendment”). The Notice of Amendment shall include a complete description of the changes, additions and/or deletions to be made, the effective date thereof (the “Change Date”), and notice of the Insured Person’s cancellation rights as set forth below, and shall be sent first class mail, postage pre-paid, to the last known residence or mailing address of the Insured Person. Upon issuance of the Notice of Amendment, the Insured Person shall have the right to request cancellation of this Certificate pursuant to the provisions of Section B(11), above, at any time prior to the Change Date; provided, however that cancellation under this Section B(23) shall be at the option of the Insured Person, and coverage under this insurance shall terminate with effect from the cancellation date specified by the Insured Person (subject to the provisions of Sections B(18)(a)-(f), and (i)). If the Insured Person does not elect to cancel this Certificate in accordance with the foregoing, the changes, additions and/or deletions as made by the Company and specified in said Notice of Amendment shall take effect as of the Change Date specified in the Company’s Notice, and this insurance shall thereafter continue in effect in accordance with its Terms, as so amended and modified.

PROOF OF CLAIM

When the Company receives notice of a claim for benefits under this insurance it will provide the Insured Person with forms (“Claim Forms”) for filing Proof of Claim. The following items must be submitted to be considered a complete Proof of Claim eligible for consideration of coverage (“Proof of Claim”):

  1. a duly completed and signed Claim Form; and
  2. all original itemized bills from all Physicians, Hospitals and other healthcare or medical service providers involved with respect to the claim; and
  3. all original receipts for any expenses that have been incurred or paid by or on behalf of the Insured Person with respect to the claim.

The Insured Person shall have one hundred and eighty (180) days from the date a claim is incurred to submit a complete Proof of Claim, and the Company may deny coverage for Proofs of Claim submitted thereafter or for incomplete Proofs of Claim.

APPEALING A CLAIM

In the event the Company denies all or part of a claim, the Insured Person shall have ninety (90) days from the date that the notice of denial was mailed to the Insured Person's last known residence or mailing address to file a written appeal with the Company. Upon receipt of a written appeal, the Company will respond in writing as soon as reasonably practicable, and in any event within ninety (90) days from receipt thereof.

Cancellation

The Insured Person shall have fifteen (15) days from the Initial Effective Date of Coverage (the “Review Period”) to review the benefits, conditions, limitations, exclusions and all other Terms of the Master Policy as evidenced and outlined by this Certificate. If not completely satisfied, the Insured Person may request cancellation of this insurance retroactive to the Initial Effective Date of Coverage by sending a written request to the Company by mail or fax and received by the Company within the Review Period, thereby qualifying to receive a full refund of Premium paid. Upon effectation of such cancellation and refund, neither the Company nor the Insured Person shall have any further rights, liabilities or obligations under this insurance.

After the Review Period, the Insured Person may request cancellation of the Declaration and this Certificate by giving the Company not less than sixty (60) days advance written request. Cancellation is at the sole option of the Company, except as provided in Section B(23), below, and the Company may request and/or require the Insured Person to execute a release of claims as a condition to and/or in consideration of granting such cancellation. If the Company grants cancellation, coverage for the Insured Person under this insurance shall terminate with effect from the cancellation date specified by the Company. The Company shall calculate the amount of Premium earned upon the Declaration and Certificate through the requested date of cancellation (Short Rate Earned Premium) in accordance with the Short Rate Cancellation Table in effect as of the date of the request for cancellation. If the Insured Person has paid more than the Short Rate Earned Premium, the Company shall refund the difference between the amount actually paid and the Short Rate Earned Premium. If the Insured Person has paid less than the Short Rate Earned Premium, the Insured Person shall remit to the Company the difference between the Short Rate Earned Premium and the amount actually paid as a condition to cancellation as of such requested date, or the cancellation date will be established retroactive to the date through which and for which Premiums have actually been paid.