Participating Member is not eligible, the Evidence of Insurance issued by the Master Policy will be Null and Void and all Premiums paid will be refunded. In order to be eligible and qualified for coverage under this insurance, a Participating Member must:

  1. Compete and sign an Application (or be listed thereon by proxy as an applicant and proposed Participating Member) 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 Application or Continuation of Coverage from the Scheme Administrator; 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/or
  7. US Citizens:
    1. Plan to reside outside of the US for at least one hundred (180) days of the next three hundred sixty four (364) days of the Participating Members Coverage Period;
    2. Depart from the US not more than thirty (30) days after the Initial Effective Date or Continuation of Coverage Date; or
  8. Non-US Citizens:
    1. Reside outside the US at time of Application or Continuation of Coverage Date; or must plan to reside outside of the US continuously for at least one hundred (180) days for the next three hundred sixty four (364) days of the Participating Members Coverage Period with departure from the US not more than thirty (30) days after the Initial Effective Date or Continuation of Coverage Date; or
    2. If located inside the US at the time of Application or Continuation of Coverage Date, must not be eligible for any other medical insurance plan which is available to individuals similarly situated and located in the US and must provide the Scheme Administrator an Affidavit of Eligibility.

Subject to the Terms of this insurance, which would include without limitation the Deductible and Coinsurance (unless otherwise expressly set forth to the contrary), and the various limits and Sub-Limits set forth below, the Scheme Administrator promises to provide the Participating Member the following Benefits and coverage arising out of Injury sustained or Illness suffered or charges, cost or Expenses Incurred while the Evidence of Insurance is in effect.

Maximum Limit $5,000,000 Maximum Limit
Deductibles $250, $500, $1,000, $2,500, $5,000, $10,000 per Participating Member per Coverage Period
Family Deductible Maximum of 2 Deductibles per Family per Coverage Period
Coverage Area
Area 1- Worldwide Including US & Canada Area 2- Worldwide Excluding US & Canada
Coinsurance - Claims incurred in US or Canada After the Deductible the Plan will pay 90% of the next $5,000 of Eligible Medical Expenses, then 100% to the Maximum Limit. The Coinsurance will be waived if Eligible Medical Expenses are incurred within the Preferred Provider Organization Network
Coinsurance - Claims incurred outside US or Canada After the Deductible the Plan will pay 100% of Eligible Medical Expenses to the Maximum Limit
Pre-certification Penalty 50% Eligible Medical Expenses
Pre-existing Condition Same as any other Injury or Illness if fully disclosed on the Application and not excluded or limited by a medical rider (After 364 days of Continuous Coverage)
Maternity- Normal or Complicated Delivery Same as any other Illness, additional $5,000 Maternity Deductible, $100,000 Maximum Sub-Limit (After 364 days of Continuous Coverage)
Newborn Care Included as part of Maternity benefit for the first 60 days of life
Human Organ/ Tissue Transplant $2,000,000 Maximum Sub-Limit for Covered Transplants
Hospital Room & Board -Coverage Area 1 & 2 Usual, Reasonable and Customary
Intensive Care Unit - Coverage Area 1 & 2 Usual, Reasonable and Customary
Surgery Usual, Reasonable and Customary
Local Ambulance Usual, Reasonable and Customary
Emergency Dental - Due to an Accident $500 Sub-Limit per Coverage Period
Prescription Medications Reimbursement Only, Usual, Reasonable and Customary, Subject to 20% Coinsurance in the US
Vision Care $250 Sub-Limit per Coverage Period for exams and materials (After 364 days of Continuous Coverage)
Mental & Nervous Disorders $50 per day, $15,000 Sub-Limit per Coverage Period for Outpatient Treatment only, $30,000 Maximum Sub-Limit (After 364 days of Continuous Coverage*)
Wellness - Adult $350 Sub-Limit per Coverage Period for Participating Members age 25 and over, Not subject to Deductible or Coinsurance (After 90 days of Continuous Coverage*)
Wellness - Dependent Child $200 Sub-Limit per Coverage Period for Participating Members age 18 and under, Not subject to Deductible or Coinsurance (After 60 days of Continuous Coverage*)
Physical Therapy $50 per day, $1,000 Sub-Limit per Coverage Period, $10,000 Maximum Sub-Limit
High School Sports Injury $10,000 Maximum Sub-Limit, Subject to an additional $250 Deductible
All Other Medical Expenses Usual, Reasonable, and Customary
Emergency Room - Illness/Accident Usual, Reasonable, and Customary, Subject to additional $250 Deductible if Illness or Injury does not result in Hospitalization
Emergency Medical Evacuation $110,000 Maximum Sub-Limit, $55,000 Maximum Sub-Limit for Participating Members ages 60 and older
Return of Mortal Remains Reimbursement up to $30,000 for the return of a Participating Members Mortal Remains to his/her Home Country, Not subject to Deductible or Coinsurance
Emergency Reunion Reimbursement up to $10,000 for travel expenses related to the Emergency Reunion of a relative or friend resulting from an Emergency Medical Evacuation of a Participating Member
Complimentary Medicine $175 Sub-Limit per Coverage Period, One service per Coverage Period for Acupuncture, Aroma Therapy, Herbal Therapy, Massage Therapy or Vitamin Therapy (After 364 days of Continuous Coverage)
Dental Coverage Optional Rider - $750 Maximum Limit per Participating Member per Coverage Period. $50 Deductible per Participating Member. Schedule of Benefit payout: Class A=90%; Class B= 70%; Class C=50%; Ortho=No Coverage (After 180 days of Continuous Coverage*)

All charges, costs, expenses and/or (collectively, "Charges") incurred by the Participating Member and directly or relating to or arising from or in connection with any of the following acts, omissions, events, conditions, charges, consequences, claims, treatment (which would include diagnoses, consultations, tests, examinations and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this insurance, and the Scheme Administrator shall provide no Benefits and shall have no liability therefor:

  1. War/Military Action/Terrorism — The Scheme Administrator shall not be liable for and will not provide coverage or Benefits for any claim or Charges, Illness, Injury or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising in connection with 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; and/or
    2. Mutiny, riot, strike, military or popular uprising, insurrection, rebellion, revolution, military or usurped power; and/or
    3. Any act of any person acting on behalf of or in connection with any organization with activities directed toward the overthrow by force of the government de jure or de facto or to the influencing of it by violence of any type; martial law or state of siege, or any events or causes that determine the proclamation or maintenance of martial law or state of siege; and/or
    4. Terrorism; and
  2. Pre-Existing Condition — Any Illness, Injury, Mental or Nervous Disorder, sickness, disease, physical, or any other condition or ailment for which medical advice , diagnosis, care, or treatment (which would include but not limited to receiving services and supplies, consultations, diagnostic tests, or prescription medications) was recommended or received during the 730 days immediately preceding the Effective Date of the Evidence of Insurance or Effective Date of the insurance; any condition that manifested itself (whether known or unknown) in such a manner that would cause a reasonably prudent person to seek medical attention, treatment, advice, diagnosis, or care that with reasonable medical certainty. For the purposes of the Complications of Pregnancy coverage offered herein, Pregnancy will not be included within the definition of a Pre-existing Condition; and
  3. Wellness/Routine — Charges for Routine Physical Exams are excluded from coverage under this insurance until the Participating Member has maintained coverage under this insurance plan continuously for at least ninety (90) days, and except as otherwise expressly provided in the Master Policy and/or any Evidence of Insurance issued by the Master Policy. In no event will the Scheme Administrator reimburse the Participating Member for more than one Routine Physical Exam during any three hundred sixty four (364) day Coverage Period; and
  4. Charges Incurred for Surgeries, Treatment or Supplies —
    1. Investigational, Experimental, or for Medical Research purposes; and/or
    2. Charges for any Participating Member under the age of fourteen (14) days; and/or
    3. Any treatment for or related to any congenital condition; and/or
    4. Any charges that are not incurred by a Participating Member during his/her Coverage Period; and/or
    5. Charges that are not submitted within the timely filing limits; and/or
    6. Treatment, services or supplies that are not Medically Necessary; and/or
    7. Related to genetic medicine or genetic testing, which would include, without limitation, amniocentesis, genetic screening, risk assessment, prevention and/or to determine pre-disposition, genetic counseling, and/or gene therapy; and/or
    8. Psychometric, behavioral and Educational testing; and/or
    9. 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/or
    10. When Treatment is not administered or ordered by a Physician; and/or
    11. Charges in excess of Usual, Reasonable, and Customary; and/or
    12. Treatment performed or provided by a Relative of the Participating Member; and/or
    13. Not expressly included as Eligible Medical Expenses as defined in Section 29 above; and
    14. 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/or
    15. Charges incurred for telephone consultations or due to a failure to keep a scheduled appointment; and/or
  5. Charges Incurred While Confined Primarily to Custodial Care, Educational, or Rehabilitative Care; and/or
  6. 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 (which would include, without limitation, morbid obesity), which would include, without limitation, wiring of the teeth and all forms of bariatric Surgery by whatever name called, or reversal thereof, which would include, 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 Participating Member (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 that was covered under this insurance; and/or
    4. Medical expenses for Injury or Illness resulting from Amateur Athletics, Contact Sports, intercollegiate, interscholastic, intramural, and club sports or athletic activities and Professional Sports which would include practice; mountaineering at elevations of 7,000 meters or higher, avalanche training, rock climbing, and caving; aviation (except when traveling solely as a passenger in a commercial aircraft), and hot air ballooning as a pilot; base-jumping, hang-gliding, parachuting, paragliding, parasailing, kite-surfing, sky surfing, bungee jumping, absailing, and zip lining; heli-skiing, snow skiing, or snowboarding, recreational downhill and/or cross country snow skiing or snowboarding, bobsleigh, skeleton or luge, and ice climbing; sub aqua pursuits involving underwater breathing apparatus unless PADI/NAUI certified, or accompanied by a certified instructor at depths of less than 10 meters; white water rafting, spelunking or cave diving, surfing, body boarding, waterskiing, wakeboarding, windsurfing, knee boarding, kayaking, and jet skiing; off-road motorized vehicles which would include all-terrain vehicles, snowmobiles, motorized dirt bikes, and tractors; racing by any animal, skateboarding, BMX biking, mountain biking, and speed trials and speedway; any type of boxing or martial arts, powerlifting, and wrestling; big game hunting, wild safaris, running with the bulls, and horseback riding; Aussie rules football, jousting, modern pentathlon, and quad biking outdoor endurance events; 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 sustained or Illness suffered after the consumption of intoxicating liquor or drugs. This would include Illness or Injuries sustained while operating a moving vehicle after consumption of intoxicating liquor or drugs, other than Prescription 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 which would include watercraft, aircraft and non-motorized bicycles and scooters for which no permit or license is required; and/or
    8. Any willfully self-inflicted Injury or Illness; and/or
    9. Any venereal disease; and/or
    10. Treatment by a chiropractor; and/or
    11. Orthoptics, visual therapy or visual eye training; and
    12. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy; and/or
    13. Telephone consultations or failure to keep a scheduled appointment; and/or
    14. Any testing for the for: HIV, seropositivity to the AIDS virus, AIDS-related Illnesses, ARC Syndrome and AIDS; and/or
    15. Any Illness or Injury resulting from or occurring during the commission of a violation of law by the Participating Member, which would include, without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations; and/or
    16. Any Substance Abuse; and/or
    17. 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
    18. Any artificial, non-human organs, or mechanical devices designed to replace human organs temporarily or permanently; and/or
    19. Any efforts to keep a donor alive for a transplant procedure, whether or not the transplant procedure is a Covered Transplant; and/or
    20. Any transplant Expenses Incurred outside the Scheme Administrator's approved independent Managed Transplant System Network; and/or
    21. Any Covered Transplant in excess of one (1) during any three hundred sixty four (364) day period of coverage under this insurance plan, except re-transplantation Charges if incurred during the initial Covered Transplant Hospitalization; and
    22. Allergy testing; and
    23. Treatment or complications resulting from the Zika Virus; and
  7. The Feet, Which Would Include, Without Limitation:
    1. Orthopedic shoes, prescribed orthopedic devices to be attached to or placed in shoes; and/or
    2. Treatment of weak, strained, flat, unstable or unbalanced feet; and/or
    3. Metatarsalgia, bone spurs, hammertoes or bunions; and
    4. 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
  8. Hair Loss:
    1. Which would include without limitation, wigs; and/or
    2. Hair transplants; and/or
    3. Any drug that promises to promote hair growth, whether or not prescribed by a Physician; and
  9. Any Sleep Disorders; and
  10. Any Exercise Programs — Whether or not prescribed or recommended by a Physician; and
  11. Nuclear or Atomic Radiation — Any exposure to any medical or non-medical radioactive material(s); and
  12. Any Artificial or Mechanical Device — Designed to replace human organs temporarily or permanently; and
  13. Fertility/Infertility — Charges incurred for treatment or supply that either promotes, prevents or attempts to promote or prevent conception; which would include, but not limited, to;
    1. Artificial insemination; and
    2. Oral contraceptives; and
    3. Treatment for infertility or impotency; and
    4. Vasectomy or reversal of vasectomy; and
    5. Sterilization or reversal of sterilization; and
  14. Sexual Dysfunction — 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
  15. Dental Treatment — Except for Emergency Dental Treatment necessary to repair or replace sound natural teeth lost or damaged in an Accident covered hereunder or as necessary treatment of sudden, Unexpected pain to sound natural teeth, and subject to the limits set forth in the Schedule of Benefits/Limits;
    1. Routine or general dental care; and
    2. Charges incurred for treatment of the temporomandibular joint; and
  16. Vision — Charges incurred but not limited to;
    1. Eye Surgery, included, but not limited to, radial keratotomy, when the primary purpose is to correct or attempt to correct nearsightedness, farsightedness or astigmatism; and
    2. Charges for Treatment of cataracts or glaucoma
  17. Hearing — Hearing aids, hearing implants and charges for any Treatment, supply, examination or fitting related to these devices; and
  18. Accommodations — Charges incurred for any travel, meals, transportation and/or accommodations, except as otherwise expressly provided for in this insurance; and
  19. Taxes and Other Miscellaneous Fees — 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 Participating Member; or
    2. Based upon the Company's election hereunder, if any, to pay Benefits directly to providers; or
    3. For any other reason; and
  20. Non-Prescription and Over-The-Counter Medicine — Charges or Expenses Incurred for non-prescription drugs, medicines, vitamins, food extracts, or nutritional supplements; or IV vitamin; drugs or medicines not approved by the US Food and Drug Administration or which are considered "off-label" drug use and for drugs or medicines not prescribed by a Physician, or that can otherwise be purchased over the counter; and
  21. Disease Outbreak — Diagnosis, testing or treatment of Injury or Illness resulting from a disease outbreak in a country or location for which the United States Center for Disease Control and Prevention (CDC) has issued a Warning Level 3 if:
    1. The warning has been in effect within one-hundred and eighty (180) days immediately prior to the Participating Member(s) date of arrival; and
    2. Within ten (10) days following the date the warning is issued the Participating Member(s) has failed to depart the country or location; and
  22. Against Medical Advice — Any Charges and or services related to Inpatient, Outpatient or Emergency room services in which the Participating Member chooses not to comply with recommended treatment and or where the Participating Member terminates such services, or leaves the facility against medical advice (AMA); and
  23. Rare Condition/Defect — Any claim, Charges, Illness, Injury or other consequence happening or arising during the existence of Rare Conditions/Defect (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 Scheme Administrator shall not be liable under the Evidence of Insurance , except to the extent that the Participating Member shall prove that such claim, Charges, Illness, Injury or other consequence happened independently of the existence of such Rare Conditions/Defect; and
  24. Mental or Nervous Disorders — Charges for Inpatient Treatment of Mental or Nervous Disorders are excluded from coverage under this insurance.

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, which would include any chronic, subsequent or recurring complications or consequences associated therewith or arising or resulting therefrom.

Taking advantage of Azimuth’s broad selection of quality US preferred providers benefits you by allowing cost advantaged access to US medical care and the significant ease of finding a qualified health care provider virtually anywhere in the US. For providers outside the US, you may access care anywhere of your choosing, or simply contact Azimuth for a suggested referral.

Annually renewable increment of one month

Cancellation By Participating Member — All cancellation requests must be submitted in writing to Azimuth Risk Solutions To be eligible for a full refund, the request must be received before the Participating Members requested Effective Date. Cancellation requests received after the requested Effective Date will be subject to the following:

  1. A $25.00 cancellation fee; and
  2. Only the unused portion of the Premium cost will be refunded; and
  3. No claims will be eligible for Premium refund.

Termination Of Coverage For Participating Member — Coverage and Benefits for the Participating Member under this insurance will terminate effective at 11:59 PM, EST, on the earliest of the following dates:

  1. The next day following the end of the period for which Premium has been fully and timely paid; or
  2. The termination date as shown on the Proof of Insurance for the Evidence of Insurance; or
  3. The date the Master Policy is terminated; or
  4. The date the Participating Member first fails to meet or no longer meets the eligibility requirements for this insurance as set forth in the Master Policy and outlined in the Evidence of Insurance; or
  5. The date the Scheme Administrator and/or Underwriters, at its sole option, elects to cancel from the Beacon/Axis Series Group Insurance Plan (sometimes referred to herein as "this insurance plan" or "the plan") all Participating Members of the same sex, age, class or geographic location as the Participating Member, provided the Scheme Administrator gives no less than thirty (30) days advance written notice by mail to the Participating Member's last known place of residence or mail - forwarding address of its intent to exercise such option with or in conjunction and the express written consent of Underwriters; or
  6. The cancellation date specified by the Scheme Administrator and/or Underwriters pursuant to Subsection 15.1, above; or
  7. The cancellation date specified by the Participating Member, or upon return to Home Country; or
  8. The date specified by the Scheme Administrator and/or Underwriters in any notice of cancellation, forfeiture or rescission issued pursuant to or as a result of the circumstances described in Sections 7, 12, 15 and above, or Section 16 below, or as otherwise permitted by the Terms of this insurance. Coverage for the Participating Member shall remain in full force and effect unless terminated pursuant to the provisions of this section, except as otherwise provided in the Master Policy or the Evidence of Insurance.

PROOF OF CLAIM — When the Scheme Administrator receives notice of a claim for Benefits under this insurance, and it will provide the Participating Member with form(s) ("Claim Form") for filing a Proof of Claim. The Claim Form is provided with all fulfillment documents issued by the Scheme Administrator. The Claim Form is available at all times via the Scheme Administrator's website at www.azimuthrisk.com. 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. Itemized bills from all Physicians, Hospitals and other healthcare or medical service providers involved with respect to the claim(s); and
  3. Receipts for any expenses that have been paid by or on behalf of the Participating Member(s) with respect to the claim(s); and
  4. The Participating Member(s) shall have ninety (90) days from the date a claim is incurred to submit a complete Proof of Claim, and the Scheme Administrator may deny coverage for any Proof of Claim submitted thereafter or for an incomplete Proof of Claims. All claim decisions made by or on behalf of the Scheme Administrator are with the express consent of Underwriters. All Complete Proof of Claim(s) can be submitted as follows:
    1. Mail; and/or
      Azimuth Risk Solutions
      PO Box 627
      Indianapolis, IN 46206
    2. Email; and/or
      service@azimuthrisk.com
    3. Fax; and/or
      1 (317) 423-9620
      1 (888) 201- 8851 (outside of the US)

CLAIM SETTLEMENT — Eligible and covered claims under this insurance, which have previously been paid by or on behalf of the Participating Member at the time of the Scheme Administrator's adjudication thereof will be reimbursed directly to the Participating Member, by check in USD, at his/her last known place of residence or mail-forwarding address. While the Evidence of Insurance is in effect, the Participating Member shall undertake to promptly notify the Scheme Administrator of any change in such addresses subsequent to the Effective Date of Coverage. Eligible and covered claims that have not yet been paid by or on behalf of the Participating Member at the time of adjudication will be paid by check to the Participating Member at his/her last known place of residence or mail-forwarding address, or at the sole option and discretion of the Scheme Administrator, and as an accommodation to the Participating Member, directly to the provider(s). All claim settlements are subject to the applicable Deductible and Coinsurance, and to the benefit limits and Sub-Limits and all other Terms of this insurance. No provider or other third-party shall have any direct or indirect claim or right of action against the Scheme Administrator under the Master Policy or any Evidence(s) of Insurance issued by the Master Policy, whether by purported assignment of Benefits, subrogation of interests or otherwise, unless first expressly agreed and consented to in writing by the Scheme Administrator, and notwithstanding the Scheme Administrator's exercise or failure to exercise any option or discretion under this section regarding the method of claim payment. No provider or other third-party is intended to have or shall have any rights as a third-party Beneficiary under the Master Policy or Evidence of Insurance issued by the Master Policy.

APPEALING A CLAIM — In the event the Scheme Administrator denies all or part of a claim, the Participating Member shall have ninety (90) days from the date that the Notice of Denial was mailed or mailed to the Participating Member's last known place of residence or mail-forwarding address to file a written appeal with the Scheme Administrator. Upon receipt of a written appeal, the Scheme Administrator will respond in writing as soon as reasonably practicable and in any event within ninety (90) days from receipt thereof.

FRAUDULENT CLAIMS — If any claim or request for Benefits under this insurance shall be in any respect fraudulent or deceitful, or if the Participating Member or anyone acting for or on their behalf under this insurance uses any fraudulent or deceitful means or devices, all Benefits and claims under this insurance shall be forfeited and waived, and the Scheme Administrator, Underwriters and/or Master Policyholder shall have no liability for such Benefits or claims.