ST. GEORGE'S UNIVERSITY STUDENT Stand Alone Emergency Medical Evacuation Coverage

Transcription

1 ST. GEORGE'S UNIVERSITY STUDENT Stand Alone Emergency Medical Evacuation Coverage 1 SGU

2 ST. GEORGE'S UNIVERSITY STUDENT Stand Alone Emergency Medical Evacuation Coverage ELIGIBILITY AND TERMINATION PROVISIONS Eligibility: Any St. George s University student who belongs to one of the "Classes of Persons to Be Insured" as set forth in the application is eligible to be insured under this plan. The (student) Named Insured must be enrolled in a minimum of 5 credit hours and actively attend classes for at least the first 31 days after the date for which coverage is purchased. Home study, correspondence, and television (TV) courses do not fulfill the Eligibility requirements that the student actively attend classes. The Company maintains its right to investigate student status and attendance records to verify that the policy Eligibility requirements have been met. Students on an approved leave of absence are eligible to enroll as long as the premium is paid on or before the policy effective date (first day of the term). Members of faculty who are also students are not eligible to enroll in the student insurance plan. If the Company discovers the Eligibility requirements have not been met, its only obligation is to refund premium. Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the spouse and children up to the age of 26. Dependent Eligibility expires concurrently with that of the Named Insured. *Note: any Named Insured on an approved Leave of Absence commencing after the first 31 days for which they were originally eligible for coverage, may continue coverage under this plan until the end of the Term for which they were originally eligible. (For the purpose of eligibility and Open Enrollment: Fall Term is defined as August, 1 through December, 31; Spring Term as January 1 through July 31 of any calendar year). The eligibility date for Dependents of the Named Insured (as defined) shall be determined in accordance with one of the following qualifying events: 1. If a Named Insured has Dependents on the date he or she is eligible for insurance; or 2. If a Named Insured acquires a Dependent after the Effective Date, such Dependent becomes eligible: a. On the date the Named Insured marries the Dependent; or b. On the date the Named Insured acquires a dependent child who is within the limits of a dependent, unmarried child set forth in the "Definitions" section of this policy. Eligible persons may be insured under this policy subject to the following: 1. Payment of premium as set forth on the policy application; and, 2. Application to the Company for such coverage within 31 days of the qualifying event outlined above in 2) (a) and (b). Effective Date: Insurance under this policy shall become effective on the effective date of the policy. Dependent coverage will not be effective prior to that of the Named Insured. 2

3 Termination Date: The coverage provided with respect to the Named Insured shall terminate on the earliest of the following dates: 1. The last day of the period through which the premium is paid; or 2. The date the policy terminates; or 3. The date the Named Insured is withdrawn from the University. The coverage provided with respect to any Dependent shall terminate on the earliest of the following dates: 1. The last day of the period through which the premium is paid; 2. The date the policy terminates; or 3. The date the Named Insured's coverage terminates. Conditions of Coverage: 1. Coverage under this plan is secondary to any other coverage. 2. All services provided under this plan must be coordinated and approved in advance by Lyncpay. 3. Coverage is limited to life threatening conditions, to the closest country with a medical facility capable of providing the adequate level of treatment. (This policy does not cover for extended evacuation - which is to evacuate the member to the hospital of his/her choice or family choice). Coverage is to the nearest hospital and not necessarily to the state or country of residence of the member or member s family. Lyncpay in connection with our medical team reserve the right to the most appropriate means of transportation. 4. Evacuation must be recommended by a treating physician or specialist physician. 5. Evacuation must be incurred during the period of coverage or the benefit period. 6. Claims must be presented to Lyncpay for payment within 90 days from the date of the evacuation. SCHEDULE OF BENEFITS Maximum Aggregate Benefit: $100,000 per policy period Emergency Medical Evacuation: The plan includes coverage for emergency medical evacuation to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred up to the Policy Maximum. Emergency Medical Evacuation is subject to pre-certification by Lyncpay prior to travel and certified instructions from the attending physician or specialist physician, including confirmation that the required treatment is unavailable at the place of incident. Our Medical Advisors will decide the most 3

4 appropriate method of transportation for the evacuation and the most appropriate Medical Facility to which the Named Insured will be evacuated. Emergency Reunion: The plan provides emergency reunion coverage up to $15,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an emergency medical evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured. Return of Mortal Remains: If a covered illness/injury results in death, expenses for repatriation of bodily remains or ashes to the home country will be covered up to a maximum of $20,000. Exclusions and Limitations: Charges for the following services, treatments and/or conditions are excluded from coverage under the Emergency Medical Evacuation Policy: 1. War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for Political Evacuations. 2. AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured. 3. Charges, injuries and/or illness resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations. 4. Bodily injury or Illness sustained directly or indirectly as a result of the enrolled person committing a criminal offence. 5. Treatment required as a result of or arising from complications from a treatment or condition not covered under your current health care policy. 6. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured. 7. Charges incurred for any travel, meals, transportation and/or accommodations, unless previously approved in writing by Lyncpay as per the schedule of benefits. 8. Any taxes, involuntary or forced contributions, assessments, charges, fees or surcharges imposed by any governmental agency or authority. 9. Cosmetic procedures, except that cosmetic procedures does not include reconstructive surgery when such surgery is incidental to or follows surgery resulting from trauma, infection or other disease of the involved part and reconstructive surgery because of a congenital disease or anomaly of a covered Dependent child which has resulted in a functional defect. It also does not include breast reconstructive surgery after a mastectomy; 10. Pregnancy terminations and subsequent complications. 4

5 11. No coverage will be provided when services are obtained solely for outpatient treatment(s) or purposes. 12. Treatment directly or indirectly arising from or required as a result of chemical contamination or contamination by radioactivity from any nuclear material whatsoever or from the combustion of nuclear fuel, asbestosis or any related condition. 13. Treatment related to malpractice. 14. Any Cost or expenses where an Insured person has traveled against medical advice. 15. Any Cost or expenses not coordinated and approved in advance by Lyncpay or the Company. 5