Coverage Description

The Participant Accident Medical Plan pays the reasonable and customary charges for a covered injury to an insured if that injury requires treatment by a legally qualified physician, dentist or graduate nurse; confined in a hospital; ambulance service from the site of injury to the initial treatment facility; and services and supplies ordered by a physician.

Covered Person

All players and coaches for whom premium has been paid.

Covered Activity

Coverage is provided for a Covered Person while:

Participant Accident Benefit

• Up to $100,000 limit for Eligible Expenses (applicant will select the desired limit)
• Eligible Expense means charges for the following necessary treatment and service, not to exceed the usual and customary charges in the area where provided.
• Medical and surgical care by a physician
• Radiology (X-rays)
• Dental treatment of sound natural teeth
• Hospital care and service in semi-private accommodations, or as an outpatient
• Ambulance service from the scene of the accident to the nearest hospital
• Orthopedic appliances necessary to promote healing
• Excess Coverage: This policy does not cover treatment or services which are payable or available under other health benefit plans.
• Deductible ranging from $0 - $250 (applicant will select the desired deductible)

Accidental Death and Dismemberment Benefit

• Up to $10,000 limit (applicant will select the desired limit)
• “Member” means hand, foot, or eye. Loss of hand or foot means complete severance above the wrist or ankle joint. Loss of eye means the total and permanent loss of sight
• If a covered injury results in any of the losses specified below within 1 year (not applicable in Pennsylvania) after the date of the accident, the Company will pay the applicable amount:
• Full Principal Sum for loss of life
• Full Principal Sum for double dismemberment
• Full Principle Sum for loss of sight of both eyes
• 50% of the Principal Sum for loss of one hand, one foot, or sight of one eye
• 25% of the Principal Sum for the loss of index finger and thumb of the same hand
• If the Principal Sum is payable, no indemnity will be paid for dismemberment. In any event, the Double Dismemberment Indemnity is the maximum amount payable under this Benefit for all losses resulting from one accident.

Program Insurer

Member companies of Aegis Group, rated "A" (Excellent) with a financial size category of "VI." by A.M. Best.

Benefits will not be paid for a loss due to:

1. Intentionally self-inflicted Injury, suicide while sane or insane or any attempt there at (in Missouri this applies only while sane);
2. Voluntary self‑administration of any drug or chemical substance not prescribed by, and taken according to the directions of the Covered Person's Doctor;
3. Committing or attempting to commit a felony;
4. Participation in a riot or insurrection;
5. An act of declared or undeclared war (not including terrorism);
6. Active duty service in any Armed Forces of any country and, in such event, the pro-rata unearned premium will be returned upon proof of service. This does not include Reserve or National Guard active duty or training unless it extends beyond 31 days ;
7. Practice or play in any sports activity, including travel to and from the activity and practice, unless specifically provided for in the Policy;
8. Parachuting, except for self preservation;
9. Bungee jumping, flight in an ultralight aircraft, hang-gliding;
10. Sickness, disease, bodily or mental infirmity or medical or surgical treatment thereof, bacterial infection, regardless of how contracted. This does not exclude bacterial infection that is the natural and foreseeable result of an Injury or accidental food poisoning;
11. Services or treatment rendered by a Doctor, Nurse or any other person who is:
• (a) Employed or retained by the Policyholder; or
• (b) is the Covered Person, His spouse, parent, child or sibling;
12. Flight in an aircraft, except as a fare-paying passenger;
13. Dental treatment or dental X‑rays, except as otherwise provided, and only when Injury occurs to sound natural teeth;
14. Any loss for which benefits are paid under state or federal workers' compensation, employers liability, or occupational disease law;
15. Treatment in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay;
16. Cosmetic surgery, except for reconstructive surgery due to a covered Injury;
17. Charges which the Covered Person would not have to pay if He did not have insurance;
18. Eyeglasses, contact lenses, hearing aids; and
19. Charges which are in excess of Usual and Customary charges.

The information in this brochure is a summary of the benefits provided. It is NOT a complete explanation of all policy provisions or specifics of the policy benefits. No coverage is extended, and no representations are made, other than what is stated in the policy. Please refer to the policy for a complete, detailed description of program coverages, exclusions, and benefits.