SCHEDULE OF BENEFITS

POLICY MAXIMUM BENEFITS

*Not subject to Deductible
** This is a non-insurance service and is not a part of the insurance underwritten by Crum & Forster, SPC.

POLICY TERMS AND CONDITIONS
All benefits payable are subject to the Maximum Benefit Limits, and any applicable sub-limits, listed in the Schedule of Benefits.

MEDICAL EXPENSE BENEFIT
If a covered Sickness or Injury occurs during the Policy Period, and the Covered Person requires medical or surgical treatment, benefits are payable for the following covered expenses that are incurred during the Benefit Period. The first covered expenses must be incurred within 90 days after the date of the Covered Accident or Sickness. No benefits will be paid for any expenses incurred which are in excess of Usual and Customary Charges.
1.    Hospital Room and Board Expenses: the average daily rate for a semi-private room when a Covered Person is Hospital Confined, and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge. All charges in excess of the allowable semiprivate rate are the responsibility of the Covered Person.
2.    Hospital Emergency Room Visits: Emergency Room Visit for an Illness with no direct Hospital Admittance will be subject to an additional deductible as outlined in the schedule of benefits.
3.    Ancillary Hospital Expenses: Services and supplies as Medically Necessary and approved and covered by the Policy including meals and special diets (only for the Covered Person), use of operating room and related facilities, use of intensive care and related services to include x-ray (including reading charges) , laboratory and other diagnostic tests, drugs, medications, biological anesthesia and oxygen services, and administration of blood products. This does not include personal services of a non-medical nature.
4.    Intensive Care Unit Expenses: Room and Board: 3 times the average semiprivate room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.
5.    Physician non-surgical treatment and examination expenses including the Physician’s initial visit, each
Medically Necessary follow-up visit and consultation visits when referred by the attending Physician.
6.    Physician’s Surgical Expenses.
7.    Assistant Physician Surgical Expenses when Medically Necessary.
8.    Anesthesiologist Expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an outpatient basis.
9.    Outpatient Medical Expenses.
10.    Physician Visits.
11.    Physiotherapy Physical Medicine/Chiropractic Expenses on an Inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy.
12.    X-rays.
13.    Emergency dental treatment and restoration of sound natural teeth, including x-rays, required as a result of an Accident or to relieve pain.
14.    Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Physician.
15.    Emergency medical treatment of pregnancy.
16.    Mental or nervous disorders: Benefits are provided for psychotherapeutic treatment and psychiatric counseling and treatment for an approved psychiatric diagnosis. A Physician or a licensed clinical psychologist  must provide all mental health care services. Services of a clinical psychologist must be rendered in the provider's office or in the outpatient department of a Hospital. Services Include treatment for Bulimia; Anorexia; Non-medical causes of insomnia. The following services are excluded: Aptitude testing, educational testing and services; Services for conditions not determined by Us as to be emotional or personality Sicknesses; Psychiatric services extending beyond the period necessary for evaluation and Diagnosis of mental deficiency or retardation; Services for mental disorders or Sickness which are not amenable to favorable modification; Bereavement; Family counseling of any kind; Marriage counseling of any kind.
17.    Treatment for Cardiac Conditions up to the maximum as stated in the Schedule of Benefits.
18.    Medically Necessary treatment for COVID-19, SARS-CoV-2, and any mutation or variation of SARS-CoV-2.


ADDITIONAL MEDICAL EXPENSE BENEFITS
ACUTE ONSET OF PRE-EXISTING CONDITION for an Acute Onset of a Pre-Existing Condition up to the maximum as stated in the Schedule of Benefits provided the condition or event: 1. occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent and immediate medical care; 2. occurs a minimum of 48 hours after the Effective Date of the Policy; and 3. treatment is obtained within 24 hours of the sudden and unexpected outbreak or recurrence.
Any repeat/reoccurrence within the same Policy Period will no longer be considered Acute Onset of a Pre-Existing Condition and will not be eligible for additional coverage. This benefit covers only one (1) Acute Onset episode of a Pre-Existing Condition. Sudden and Acute Onset of a Pre-Existing Condition Coverage expires upon medical advice that the condition and onset is no longer acute, or the Covered Person is discharged from a medical facility.

WELL DOCTOR VISIT
Benefits will be payable for a Well Doctor Visit per person during the Policy Period. The Covered Person may use any Physician. Telemedicine is not eligible. To be covered:
1.    the visit must occur within the first 21 days from the effective date of coverage: and
2.    the Covered Person must purchase at least 30 days of coverage initially; and
3.    the Physician must use specific ICD10 codes for the Well Visit which are the following three Diagnosis Codes only a) V70.0-Routine medical exam; b) Z00.00-Encounter for general adult medical examination without abnormal findings c) Z00.129-Encounter for routine child health examination without abnormal findings. Visits with ICD10 Codes not listed here are not considered Well Doctor Visits and are not covered as such but may be covered under another Policy benefit. Please register for this benefit with the Plan Administrator.
Visits with ICD10 Codes not listed here are not considered Well Doctor Visits and are not covered as such but may be covered under another Policy benefit. Please register for this benefit at: https://trawickinternational.com/wellness/register
TRANSPORTATION BENEFITS
AMBULANCE SERVICE BENEFITS
Ambulance Service Benefits are provided for medically necessary emergency ground or air ambulance transportation as required from the emergency site to the nearest Hospital able to provide the required level of care.

EMERGENCY MEDICAL EVACUATION
Benefits are payable if a Covered Person suffers a Sickness or Injury during the course of the Trip and the Hospital or Medical Facility they are at, in the opinion of the Assistance Provider, is unable to provide appropriate medical treatment, the Assistance Provider will coordinate an Emergency Medical Evacuation from the Hospital or Medical Facility where the Covered Person is at, to the nearest Hospital or other medical facility where appropriate medical treatment can be obtained. An Emergency Medical Evacuation includes Medically Necessary medical treatment, medical services and medical supplies necessarily received in connection with such transportation.
Benefits will not be payable unless We authorize in writing or by an authorized electronic or telephonic means all expenses in advance. Benefits will not be payable unless: 1. the Physician ordering the Emergency Medical Evacuation certifies the severity of the Covered Person’s Sickness or Injury requires an Emergency Medical Evacuation; 2. all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible; 3. the charges incurred are Medically Necessary and do not exceed the usual level of charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred ; and
4.    do not include charges that would not have been made if there were no insurance.
MEDICALLY NECESSARY REPATRATION
If You have been evacuated under the Emergency Medical Evacuation, or You are Hospitalized due to an Injury or a sudden and unexpected Sickness and it is determined by Your attending Physician and the Assistance Provider’s Physician that You need to be medically repatriated back to a Hospital or medical facility in Your Country to recover, the Assistance Provider will coordinate a medical transfer, by any means necessary, to a Hospital or medical facility near Your home once your condition has reached maximum medical improvement.

Benefits will not be payable unless We authorize in writing or by an authorized electronic or telephonic means all expenses in advance. Benefits will not be payable unless: 1. the Physician ordering the Medically Necessary Repatriation certifies Your Sickness or Injury has reached maximum medical improvement; 2. all transportation arrangements made for the Medically Necessary Repatriation are by the most direct and economical conveyance and route possible; 3. the charges incurred are Medically Necessary and do not exceed the usual level of charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and 4. do not include charges that would not have been made if there were no insurance.

POLITICAL EVACUATION
Benefits are payable for the Covered Person’s extrication from the Host Country due to an Occurrence which could result in grave physical harm or death. The Occurrence must take place while coverage is in effect, and while the Covered Person is traveling outside of Their Home Country. Benefits will be paid for Transportation and Related Costs to the Nearest Place of Safety, necessary to ensure the Covered Person’s safety and well-being as determined by the Designated Security Consultant. Benefits will not be payable unless We (or Our authorized Assistance Provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by the Assistance Provider. The Assistance Provider is not responsible for the availability of transport services. Where a Political Evacuation becomes impractical due to hostile or dangerous conditions, a Designated Security Consultant will endeavor to maintain contact with the Covered Person until a Political Evacuation occurs. Political Evacuation Benefits are payable only once for any one Occurrence. If, after a Political Evacuation is completed, it becomes evident that the Covered Person was an active participant in the events that led to the Occurrence, We have the right to recover all Transportation and Related Costs from the Covered Person. Benefits will be payable for evacuation during a period of civil unrest, insurrection or natural disasters that could not have been foreseen prior to the Covered Person’s departure from Their Home Country of origin.
NATURAL DISASTER EVACUATION
Benefits are payable for the Covered Person’s extrication due to a Natural Disaster Evacuation that results in You being placed in imminent physical danger. Natural Disaster Event results in such severe and widespread damage that the area of damage is officially declared a disaster area by the appropriate local government authorities of the Host Country, and the area is deemed to be Uninhabitable or dangerous.

We will pay, up to the Maximum Benefit Amount shown in the Schedule of Benefits, to transport You to the Nearest Place of Safety necessary to ensure Yours safety and well-being as determined by Us or Our designated Assistance Provider. We will also pay reasonable expenses incurred at the place of safety for lodging and meals, up to the Amount shown in the Schedule of Benefits, if you have been evacuated by the Assistance Provider. The Natural Disaster Evacuation must occur within 2 days of the Natural Disaster Event, and the arrangements will be by the most appropriate and by most efficient, practical and economical means available and consistent with Your health and safety.

EMERGENCY REUNION
Benefits are payable for the cost of one economy airfare ticket and other local travel related expenses including the reasonable expenses incurred for lodging and meals of a Covered Person’s Immediate Family Member for a period of up to 10 days, to join the Covered Person at the Hospital where the Covered Person is confined and to accompany the Covered Person back to their Home Country, if needed, provided: 1. the Emergency Medical Evacuation Benefit is payable under the Policy; 2. the Covered Person is alone outside of Their Home Country; 3 . the place of confinement is more than 100 miles from the Covered Person’s Home Country; and 4. expenses were authorized in advance by the Company.

RETURN OF MINOR CHILDREN OR TRAVELING COMPANION
If the Covered Person is the only person traveling with minor Dependent children who are under the age of 21, or with a Travel Companion, and the Covered Person suffers a Sickness or Injury and must be Hospital Confined for at least 48 consecutive hours, or are medically evacuated to another location, benefits are payable for the cost of the Dependent or Travel Companion’s one way economy airfare ticket and/or ground transportation ticket to Their Home Country. All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the usual level of charges for similar transportation in the locality where the expense is incurred. Benefits will not be paid unless all expenses are approved in advance by Us, and services are rendered by the Assistance Provider.
REPATRIATION OF MORTAL REMAINS
Benefits are payable for preparation and return of a Covered Person’s body to Their Home Country if they die due to a Sickness or Injury. Covered Expenses include Expenses for embalming or cremation; The least costly coffin or receptacle adequate for transporting the remains; Transporting the remains by the most direct and least costly conveyance and route possible. Expenses must be approved in advance and coordinated by the Assistance Provider.
LOCAL BURIAL / CREMATION
Benefits are payable for preparation, local burial or cremation of the Covered Person's mortal remains at the country of death in accordance with the commonly accepted cultural and religious beliefs practiced by the Covered Person. If the Local Cremation or Burial is chosen, the Return of Mortal Remains benefit will not apply. Expenses must be approved in advance by the Assistance Provider. Failure to utilize the Assistance Provider to approve these services will result in the denial of benefits. Coverage is not provided for burial and cremation costs incurred for: religious practitioner, flowers, music, food or beverages.
ADDITIONAL BENEFITS
HOSPITAL CONFINEMENT
Benefits are payable, if the Covered Person is confined to a Hospital provided; 1. The Hospital stay is the direct result, from no other causes, of Injuries sustained in a Covered Accident or Sickness that occurs while the Policy is in effect; and 2. The Hospital stay begins within 3 days of a Covered Accident or Sickness and lasts for at least 3 days. The benefit will be paid retroactive to the first day of the Hospital stay. Benefit payments will end on the first of the
following: 1. The date the Hospital Stay ends; 2. The date the Covered Person dies; 3. The 10th day of hospitalization; or 4. The date the coverage terminates.
ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) – 24 Hour
Accidental Death and Dismemberment will apply to Covered Accidents incurred by a Covered Person. If Injury to the Covered Person results in any one of the losses shown below within 365 days from date of the Covered Accident, We will pay the Benefit Amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.

Exposure and Disappearance Benefit – Benefits are payable if a Covered Person is exposed to the elements after the forced landing, stranding, sinking, or wrecking of a vehicle in which They were traveling. The Covered Person is presumed dead if They are in a vehicle that disappears, sinks or is stranded or wrecked and Their body is not found within six (6) months of the Covered Accident.
If a Covered Person is Injured while wearing a seatbelt and operating or riding as a passenger in an Automobile resulting in any one of the losses shown above within 365 days from the date of the Covered Accident, we will pay benefits as outlined in the Schedule of Benefits.
ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) – FELONIOUS ASSAULT & VIOLENT CRIME
We will pay the Benefit Amount for felonious assault, if Accidental Bodily Injury that results from felonious assault causes a Covered Person to suffer one of the losses shown below within 365 days from the felonious assault. The Benefit Amount for felonious assault is payable in addition to any other applicable Benefit Amounts under this Policy. Any assault by a family member is not covered under this benefit.

EXCLUSIONS
We will not pay for any Accidental Death and Dismemberment or Paralysis loss or Injury that is caused by, contributed by or that results from:
1.    intentionally self-inflicted Injury.
2.    suicide or any attempt thereat while sane or self-destruction or any attempt thereat while insane.
3.    war or any act of war, whether declared or not.
4.    service in the military, naval or air service of any country.
5.    disease or bacterial infection except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food.
6.    hernia of any kind.
7.    piloting or serving as a crewmember or riding in any aircraft except as a passenger on a regularly scheduled or charter airline.
8.    commission of, or attempt to commit, a felony.
9.    Injury or Sickness that occurs while the Covered Person has been determined to be legally intoxicated as determined according to the laws of the jurisdiction in which the Injury or Sickness occurred, or under the influence of any narcotic, barbiturate, or hallucinatory drug, unless administered by a Doctor and taken in accordance with the prescribed dosage.
10.    flying in any aircraft being used for or in connection with acrobatic or stunt flying, racing or endurance tests; flying in any rocket propelled aircraft; flying in any aircraft being used for or in connection with crop dusting, or seeding or spraying, firefighting, exploration, pipe or power line inspection, any form of hunting bird or fowl herding, aerial photography, banner towing or any test or experimental purpose; flying any aircraft which is engaged in flight which requires a special permit or waiver from the authority having jurisdiction over civil aviation, even if granted.
11.    specific named hazards: Abseiling, Aviation (except when traveling as a passenger in a commercial aircraft), BASE Jumping, Bobsleigh, BMX, Bungee Jumping, Canopying, Canyoning, Caving, High Diving, Hang Gliding, Heli-skiing, Hot Air Ballooning, Inline Skating, Jet Skiing, Kayaking, Luge, Motocross, Motorcycling, MotoX, Mountaineering, Mountain biking, Mountain Climbing, Paragliding, Parasailing, Parascending, Piloting any Aircraft, Racing of any kind, Rock Climbing, Rodeo Activities, Rappelling, Scuba Diving, Ski Jumping, Skydiving, Snow Skiing, Snowboarding, Snowmobiling, Spelunking, Surfing, Trekking, Water Skiing, Wind Surfing, White Water Rafting, Zip Lining, Zorbing.
12.    All professional, semi-professional, amateur, club, intramural, interscholastic or intercollegiate sports.
13.    Extreme Sports.

In addition to the Exclusions above, We will not pay Medical Expense Benefits, Transportation Expenses or Additional Benefits for any loss, treatment or services that is caused by, contributed by or that results from:
1.    Pre-Existing Conditions, as defined.
2.    chronic or recurrent Illnesses.
3.    declared or undeclared war or any act thereof.
4.    services, supplies or treatment, including any period of Hospital confinement, which were not recommended, approved and certified as necessary and reasonable by a Physician.
5.    payment for any subsequent medical services incurred for an Illness or Injury of the Covered Person leaving a medical facility against the medical advice of the attending Physician will not be covered for 90 days following the date the Covered Person left against medical advice of the Physician.
6.    a)  Injury sustained while participating in a professional or semi-professional sport.
b) Injury sustained while participating in an amateur, club, intramural, interscholastic or intercollegiate sport (except as provided by the Optional Sports Activity Rider).
7.    Sickness resulting from pregnancy (except as provided by Emergency Medical Treatment of Pregnancy).
8.    miscarriage resulting from Accident (except as provided by Emergency Medical Treatment of Pregnancy).
9.    immunizations, routine physical or other examinations where there are no objective indications or impairment in normal health, or laboratory diagnostic or x-ray examinations except in the course of a disability established by the prior call or attendance of a Physician, except as specifically provided for in this Policy.
10.    cosmetic or plastic surgery, except as the result of an accident.
11.    elective treatment, surgery, health treatment or examination that a) can be postponed until the Covered Person returns to his or her Home Country, b) is deemed by Us to be Experimental or Investigational, or
c) are not recognized and generally accepted medical practices in the United States
12.    any mental or nervous disorders or rest cures (except as provided in the Schedule by Mental or Nervous Disorders Charges).
13.    any dental treatment (except as provided by the for Dental Treatment for Injury and Emergency alleviation of pain).
14.    eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or for the fitting thereof, unless caused by accidental bodily Injury incurred while covered under the Policy.
15.    congenital anomalies and conditions arising out of or resulting therefrom.
16.    services, supplies, or treatment expenses which are non-medical in nature.
17.    the ordinary cost of a one-way airplane ticket used in the transportation back to the Covered Person’s country where
an air ambulance benefit is provided.
18.    expenses as a result of or in connection with an intentionally self-inflicted Injury.
19.    treatment paid for or furnished under any other individual or group policy, or other service or medical pre-payment plan arranged through an employer to the extent so furnished or paid, or under any mandatory government program or facility set up for treatment without cost to any individual.
20.    childbirth, miscarriage, birth control, artificial insemination, treatment for fertility or impotency, sterilization or reversal thereof or abortion.
21.    organ transplants, marrow procedures and chemotherapy.
22.    any sexually transmitted or venereal disease; and/or any testing for the following: HIV, Vaccine induced seropositivity to the AIDS virus, AIDS related Illnesses, ARC Syndrome, AIDS.
23.    any treatment, service or supply not specifically covered by the Policy.
24.    treatment by any Family Member or member of the Covered Person’s household.
25.    treatment of hernia; Osgood-Schlatter’s Disease; osteochondritis; osteomyelitis; congenital weakness whether or not
caused by a Covered Accident.
26.    expense incurred for treatment of temporomandibular or cranio-mandibular joint dysfunction and associated myofascial pain.
27.    contact lenses, hearing aids, wheelchairs, braces, appliances, examinations or prescriptions for them, or repair or replacement of existing artificial limbs, orthopedic braces, orthotic devices, artificial eyes and larynx.
28.    treatment or service provided by a private duty nurse or while confined primarily to receive custodial care, educational or rehabilitative care or nursing care.
29.    covered medical expenses for which the Covered Person would not be responsible for in the absence of the Policy.
30.    conditions that are not caused by a Covered Accident.
31.    vocational, recreational, speech or music therapy.
32.    traveling against the advice of a Physician, traveling while on a waiting list for inpatient Hospital or clinic treatment, or traveling for the purpose of obtaining medical treatment abroad.
33.    any potential fatal condition which was diagnosed before the date your coverage became effective or any condition for which You are traveling to seek treatment.
34.    Expenses incurred in your Home Country except as provided: under Benefit Period or under the Home Country Coverage, if purchased.
35.    any infection of the urinary tract (including, without limitation, infection of the kidney, ureter, bladder, prostate or urethra) and any complication, medical condition or other Illness directly or indirectly arising therefrom, that occurs within ninety (90) days of the Effective Date of this Insurance and that requires Treatment of the Covered Person in a Hospital as an inpatient.
36.    declared or undeclared war or any act thereof.
37.    Complications arising from or treatment of an Injury or Illness that is not covered under this Policy.

We will not pay Political Evacuation benefits for expenses and fees:
1.    payable under any other provision of the Policy.
2.    that are recoverable through the Covered Person’s employer.
3.    arising from or attributable to an actual fraudulent, dishonest or criminal act committed or attempted by the Covered Person, acting alone or in collusion with other persons.
4.    arising from or attributable to an alleged:
a.    violation of the laws of country in which the Covered Person is traveling while covered under the Policy; or
b.    violation of the laws of the Covered Person’s Home County.
5.    due to the Covered Person’s failure to maintain and possess duly authorized and issued required travel documents and visas.
6.    for repatriation of remains expenses.
7.    for common or endemic or epidemic diseases or global pandemic diseases as defined by the World Health Organization.
8.    for medical services.
9.    for monies payable in the form of a ransom, if a Missing Person case evolves into a kidnapping.
10.    arising from or attributable, in whole or in part, to a) a debt, insolvency, commercial failure, the repossession of any property by any title holder or lien holder or any other financial cause; b) non-compliance by the Covered Person with regard to any obligation specified in a contract or license.
11.    due to military or political issues if the Covered Person’s Security Evacuation request is made more than 30 days
after the Appropriate Authority(ies) Advisory was issued.

We will not pay Natural Disaster benefits for expenses and fees:
1.    If You do not evacuate an area due to a potential Natural Disaster, when evacuation notice (mandatory or voluntary) has been issued or posted by the local, state or country government of Your Home Country or the Host Country for a period of more than three (3) days prior to the Natural Disaster Event.
2.    The benefits and services described herein are provided to You only if authorized, arranged and coordinated by Us or Our designated Assistance Provider;
3.    We will not pay for any loss or expense recoverable under any other valid and collectible insurance or through an employer;
4.    We or Our designated Assistance Provider has sole discretion regarding the means, methods and timing of a Natural Disaster Evacuation. However, the decision to travel is Your sole responsibility;
5.    We are not responsible for the availability, timing, quality, results of, or failure to provide any service caused by conditions beyond Our control. This includes Our inability to provide You an evacuation or any additional services when United States of America law, local laws or regulatory agencies prohibit the rendering of such evacuation or service. We will not cover a Natural Disaster Evacuation from OFAC designated countries;
6.    the actual or threatened use or release of any nuclear, chemical or biological weapon or device, or exposure to nuclear reaction or radiation, regardless of contributory cause;
7.    We will not pay for more than one (1) Natural Disaster Evacuation from a country or territory per Policy Period;
8.    We will not pay for any loss or expense arising from or attributable to a) fraudulent or criminal acts committed or attempted by You; b) alleged violation of the laws of the country You are visiting, unless We determine such allegations to be fraudulent; or c) failure to maintain required documents or visas;
9.    We will not pay any costs or expenses arising from
a) Natural Disaster Evacuation from Your Home Country.
b) Natural Disaster Evacuation when the Natural Disaster Event precedes Your arrival in the Host Country.

CLAIMS ADMINISTRATOR
Surego Administrative Services on Behalf of Crum & Forster PO Box 2069 Fairhope AL 36533
Click here to Submit Your Claim Online
For claim status or questions please call: Toll Free: 866-696-0409 Direct 251-928-0939 Email claims@mysurego.com

PLAN ADMINISTRATOR
Trawick International
PO Box 2284 Fairhope AL 36533
Toll Free: 888-301-9289 Direct: 251-661-0924
Email: info@trawickinternational.com

CLAIM PROCEDURES
All claims must be submitted within 90 days of the date of service. All claims MUST BE ON A FULLY COMPLETED claim form including medical history sections. A claim form must be completed and provided for each medical condition.
Governing Jurisdiction: All claims arising under this insurance shall be governed by the Laws of Cayman Islands whose courts alone shall have jurisdiction in any dispute arising hereunder.

Notice of Claim: A claimant must give Us or Our authorized representative written (or authorized electronic or telephonic) notice of claim within 90 days after any loss covered by the Policy occurs. If the claimant or Covered Person is incapacitated within the 90 days after the loss, must be given as soon as reasonably possible. This notice should identify the Covered Person and the Policy Number. All claims must be submitted within 90 days from date of incident, or they will be denied. Circumstances may exist in which this is not always possible. Any submissions after 90 days will be considered based on those circumstances.

Claim Forms: Upon receiving written notice of claim, We will provide claim forms to the claimant within 15 days. If We do not furnish such claim forms, the claimant will satisfy the requirements of written proof of loss by sending the written (or authorized electronic or telephonic) proof as shown below. The proof must describe the occurrence, extent and nature of the loss and give authorization to release medical records.

Proof of Loss: Written (or authorized electronic or telephonic) proof of loss must be sent to the agent authorized to receive it. Written (or authorized electronic or telephonic) proof must be given within 90 days after the date of loss. If it cannot be provided within that time, it should be sent as soon as reasonably possible. In no event, except in the absence of legal capacity, will proof of loss be accepted if it is sent later than one year from the time proof is otherwise required.

Proof of Eligibility: A claimant must provide Us or Our authorized representative with written proof of eligibility as outlined in this policy, at time of Claim. Proof of Eligibility is required prior to any payment of a Claim.
Claimant Cooperation Provision: Failure of a claimant to cooperate with Us in the administration of a claim may result in the delay or termination of a claim. Such cooperation includes, but is not limited to, providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due.

Time Payment of Claims: Benefits for loss covered by the Policy, other than benefits that require periodic payment, will be paid not more than 60 days after We receive proper written proof of such loss.

Payment of Claims: If the Covered Person dies, any death benefits or other benefits unpaid at the time of the Covered Person’s death will be paid to the beneficiary. If no beneficiary is on record with Us or Our authorized agent, payment will be made to the first surviving class of the following to the Covered Person’s: 1. spouse; 2. children, in equal shares (If a child is a minor, benefits will be paid to the legal guardian); 3. mother or father; 4. estate. All other benefits due and not assigned will be paid to the Covered Person if living. Otherwise, the benefits may, at our option, be paid: 1. according to the beneficiary designation; or 2. to the Covered Person’s estate. If a benefit due is payable to: 1.the Covered Person’s estate; or 2. the Covered Person or a beneficiary who is either a minor or is not competent to give a valid release for the payment, We may pay any amount due to some other person. The other person will be one who we believe is entitled to the payment and who is related to the Covered Person or the beneficiary by blood or marriage. We will be relieved of further responsibility to the extent of any payment made in good faith. We may pay benefits directly to any Hospital or person rendering covered services, unless the Covered Person requests otherwise in writing. The Covered Person must make the request no later than the time he or she files a written proof of loss.

Recovery of Overpayment or Error: If benefits are overpaid, or paid in error, We have the right to recover the amount overpaid, or paid in error, by any or all of the following methods: 1. a request for lump sum payment of the amount overpaid or paid in error. 2. Reduction of any proceeds payable under the Policy by the amount overpaid or paid in error. 3. Taking any other action available to Us. We may at Our own expense take proceedings in the name of the Covered Person to recover compensation or secure an indemnity fromany third party in respect of any loss, damage or expense covered by this Insurance and any amount so recovered or secured shall belong to Us.

Assignment: At the request of the Covered Person or his or her parent or guardian, if the Covered Person is a minor, medical benefits may be paid to the provider of service. Any payment made in good faith will end our liability to the extent of the payment.

Beneficiary: The Insured may designate a beneficiary. The Insured has the right to change the beneficiary at any time by written (or electronic and telephonic) notice. If the Insured is a minor, his or her parent or guardian may exercise this right for him or her. The change will be effective when We or Our authorized agent receive it. When received, the effective date is the date the notice was signed. We are not liable for any payments made before the change was received. We cannot attest to the validity of a change. The Insured is the beneficiary for any covered Dependent.

Physical Examinations and Autopsy: We have the right to have a Physician of Our choice examine the Covered Person as often as is reasonably necessary. This section applies when a claim is pending or while benefits are being paid. We also have the right to request an autopsy in the case of death, unless the law forbids it. We will pay the cost of the examination or autopsy.
Legal Actions: No lawsuit or action in equity can be brought to recover on the Policy: 1. before 60 days following the date proof of loss was given to Us; or 2. After 3 years following the date proof of loss is required.

Not in Lieu of Workers’ Compensation: The Policy is not a Workers’ Compensation Policy. It does not provide
Workers’ Compensation benefits.

Economic or Trade Sanctions: Any payments under this policy will only be made in full compliance with all United States of America economic or trade sanction laws or regulations, including, but not limited to, sanctions, laws, and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”). Therefore, any expenses incurred, or claims made involving travel that is in violation of such sanctions, laws and regulations will not be covered under this policy. For more information, You may consult the OFAC internet website at https://www.treasury.gov/about/organizational-structure/offices/Pages/Office-of-Foreign-Assets-Control.aspx

Electronic Communication: 1. Consent to receive insurance related documents and communications, including but not limited to, your policy documents, disclosures, notices, explanation of benefits (EOB), claims documentation, as well as termination and cancellation or non-renewal notices, electronically to the email address you provide to us through the online application process instead of receiving these records in a paper format from us. 2. Agree and acknowledge that your consent is provided and/or obtained in connection with a transaction affecting interstate commerce subject to the Electronic Signatures in Global and National Commerce Act and the Uniform Electronic Transactions Act, or a similar electronic transactions law, as adopted by state law. 3. Agree that the document(s) delivered to you electronically shall have the same meaning and effect as if you were provided a paper document, whether or not you choose to view the document(s), unless you previously withdrew your consent to receive documents via electronic means as provided below. Electronic document(s) are considered received by you at the time you complete your purchase, unless we receive notice that the email notification was not delivered to you at the email address you provided.

Fraud Warning: If the Covered Person or any person acting on his/her behalf shall make any claim or statement knowing the same to be false or fraudulent as regards to amount or otherwise, then this Insurance shall become void and all claims here under shall be forfeited without refund of premium.