Master Policy. Between. Bulstrad Life Vienna Insurance Group JSC (Hereinafter the Underwriter ) And

Transcription

1 Master Policy Between Bulstrad Life Vienna Insurance Group JSC (Hereinafter the Underwriter ) And ASSE International, Inc. (Hereinafter the Policyholder ) Policy Number: Purpose of Insurance 1.1. With this Contract the Policyholder, completes on its behalf with the Underwriter a Contract for group medical insurance for international travelers temporarily outside their home country while participating in a program sponsored by the Policyholder In exchange for payments of insurance premiums by the Policyholder, the Underwriter obligates itself to provide specially designated international medical insurance Insureds are international travelers, participating in programs of the Policyholder by point 1.2., and who are persons between 18 and 65 years. 2. Period of Coverage This Insurance Contract shall be effective upon execution by all the parties, and shall then be effective for a period of 18 months from said execution date. 3. Territorial Scope Benefits are payable under this Policy for Covered Expenses incurred by an Insured Person for the items stated in Section 7, Schedule of Benefits. Benefits shall be payable to either the Insured Person or the Service Provider for Covered Expenses incurred outside the Insured Person s Home Country. 4. Benefits Provisions 4.1. Occurrence of unexpected and urgent medically necessary medical expenses (including 100% of covered expenses for In-hospital Medical Services, 100% of covered expense for Inhospital Surgical Services and 100% for Out of Hospital Medical Services) which are a direct consequence of an accident or an illness of an Insured which are not an Exclusion from the Insurance Coverage, and are within the limits of insurance responsibility which have occurred during the term of the individual insurance coverage; 4.2. Dental treatment - relief of sudden and unexpected pain to sound natural teeth; 1

2 4.3. In the event of death of an Insured, the repatriation of the Insured s mortal remains, including transportation of the body from the site of death to the sending funeral home to the airport, minimally necessary casket or air tray for transport, coordination of consular services, procuring death certificate and transport of the remains from the airport to the receiving funeral home; 4.4 Expenses associated with medical evacuation to a medical facility that can provide appropriate care in the event of serious injury or sickness that cannot be adequately dealt with at the location where the illness or accident took place; 4.5 Accidental Death and Dismemberment in case of loss of life or limb* that occurs during the period of insurance Dependent upon the benefit levels selected under Medical Expense. The policy will pay according to the following scale provided it is a result of the Insured Person sustaining bodily injury caused by accidental, external, violent and visible means which shall solely and independently of any other cause occur within 12 calendar months from the date of the accident Age grouping 65 and older is excluded from all disability coverage under this policy. Coverage for Accidental Death is confined to public conveyance or common carrier which is defined as a scheduled public transportation service or air carrier and is limited to $10, Loss Description Percentage of Loss Description Principal Sum Loss of Life 100 Loss of Speech and Loss of Hearing 100 Loss of Speech and one of Loss of Hand, Loss of Foot or Loss of 100 Loss of Hearing and one of Loss of Hand, Loss of Foot or Loss of 100 Loss of Hands (Both), Loss of Feet (Both), Loss of Sight or a 100 combination of any two of Loss of Hand, Loss of Foot or Loss of Quadriplegia 100 Paraplegia 75 Hemiplegia 50 Loss of Hand, Loss of Foot or Loss of (any one of 50 each) Uniplegia 25 Loss of Thumb and Index Finger of the same hand Mental Health - For the purpose of this section, only such expenses, incurred as the result of Treatment or Medication for Mental Illness, which are specifically enumerated in the following list of charges, and which are not excluded, shall be considered as Covered Expenses: 1. Inpatient Care: a. Charges made by a Hospital or mental institution for room and board, floor nursing and other services inclusive of charges for professional service and with the exception of personal services of a non-medical nature, provided, however, that expenses do not exceed the Hospital s or mental institution s average charge for semi-private room and board accommodation. b. Charges made for diagnosis and Treatment by a Physician. c. Charges made for the cost and administration of anesthetics. 2

3 d. Charges for Medication, X-ray services, laboratory tests and services, oxygen, and medical Treatment. e. Drugs and Medicines that can only be obtained upon a written prescription from a Physician. 2. Outpatient care: a. Charges made for diagnosis and Treatment by a Physician. b. Charges made for the cost and administration of anesthetics. c. Charges for Medication, X-ray services, laboratory tests and services, oxygen, and medical Treatment. d. Drugs and Medicines that can only be obtained upon a written prescription from a Physician. Only those expenses specifically described above which are incurred within the following Limits from the onset of the Mental Illness and which are not excluded are considered Covered Expenses. Mental Illness must first manifest itself during the Period of Coverage. 5. Exclusions 5.1. The Underwriter shall not cover the benefits stated above if they are caused directly or indirectly by: Willful attempt at self-injury; suicide or attempted suicide; Criminal offense or attempted criminal offense by the Insured, death sentence execution, an accident occurred while the Insured is arrested or imprisoned; War or hostilities, rebellion, power usurpation, riot or other similar acts, terrorism or terrorist act, which include, but are not limited to the use of force or violence and/or the thereof, of any person or group/s/ of persons, whether acting alone or on behalf of or in connection with any organization/s/ or government/s/, committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public fear; Nuclear explosions, radioactive radiation, radioactive, chemical or biological contamination, natural catastrophes (which include, but not limited to storm, hurricanes, floods, lightings, earthquakes, tsunamis, avalanches etc. ), acts of God and all other similar events with or without mass consequences; AIDS, no matter how it is acquired or called, or HIV infection; Self- treatment or disobedience of a doctor s advice; Pregnancy (incl. tubal pregnancy), childbirth, abortion and any consequent complications or diseases; Fight provoked by the insured; Involvement in hazardous activities including motor sports, flying, hang-gliding, and underwater sports and hobbies, jumps from height, climbing requiring special equipment and speleology(spelunking) Consumption of alcohol, narcotics and other opiate or stimulative substances. In road accident with transportation vehicle, the stated by the law level of alcohol in the blood is taken into consideration, for the country where the accident has occurred; Injuries due to alcohol or drug consumption or accidents where the insured was operating a motor vehicle under the influence of drugs or alcohol; Swine flu (H1, N1) and any consequent complications of it; Use of weapon; Pre-existing disease or condition except of life-threatening situations Other events due to perilous or willful acts or gross negligence by the Insured; 5.2. The following expenses are not included in the scope of medical expenses coverage: Costs related to medical examination, treatment and surgical intervention which are not administered in a licensed healthcare institution; 3

4 Costs related to medical examination, where no illness has been diagnosed or accident has been ascertained; Cost related to venereal diseases, treatment of sterility, change of sex or implantation, transplantation of organs and the complications thereof; Costs for rehabilitation, kinesitherapy, all expenses for spas, hydrotherapeutic treatment or other such resorts and facilities; Costs for medical help administered by homeopathic doctors or natural doctors; Medical help administered by relatives or husband/ wife; Costs for medical repatriation or repatriation of remains, when it was not performed by the Assistance Company, and costs incurred after repatriation; Costs relative to cosmetic surgery for correction of the appearance; All costs relative to experimental or research services; All costs for medical examinations, or diagnostic examinations that are part of routine physical examination or health check, including vaccination, expenses for glasses, contact lenses, hearing-aids, prosthesis, artificial limbs, etc.; Costs for personal comfort during treatment such as: TV, radio, hairdresser or barber s services; Any part of the costs that exceeds the commonly necessary and inherent standard expenses that are covered in accordance with the conditions of the policy; All costs, which are a direct consequence of sunburn or burn in solarium, except for sunstroke; Costs for publication of certificates, and costs for translation of documents; 6. Schedule of Benefits for the Aspire International Coverage Plan Benefit Coverage Limit Maximum Overall policy maximum Limit per certificate $500,000 $50,000 per injury / illness Deductibles Per injury / illness $50 Emergency Room Deductible (for illness & not admitted) $350 1 Hospitalization 100% 2 Outpatient treatment by a doctor/specialist 100% 3 Ambulance transportation 100% 4 Prescriptions 100% 5 Dental treatment Accidents - 100% $200 Acute onset 6 Repatriation of mortal remains $7,500 7 Medical Evacuation $10,000 8 Accidental death and dismemberment $10,000 9 Worldwide Assistance Service included 4

5 7. Enrollment requirements 7.1. The Policyholder should upload the lists with insurances in Life Insurer s online enrollment system not later than the day before the program commencement date It is obligatory to be pointed the names of the insured persons, date of birth, gender of the participants, the addresses of the participants, the program in which they participate, and its beginning and end dates The insurance coverage for every individual policy, which starts within the period of the current contract and will end after its expiration, continues automatically after the expiration of the contract without the need of renewing. 8. General Terms of Cover 8.1. For the needs of this Contract, the services for Assistance will be provided by GBG Assist. During the term of this Agreement the Assistance company shall maintain a Call Centre at the Management Centre from which the assistance Services shall be provided and available seven (7) days a week, twenty-four (24) hours a day, 365 days a year In case of a claim, the insured person should contact the Assistance company at: Tel: (866) (U.S. and Canada, toll free) (905) (worldwide, collect) Fax: (949) All claims must be submitted within 60 days from date of incident. Any submissions after 90 days will not be processed and returned to the Insured Person If the Insured 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 amount or otherwise, then this Insurance shall become void and all claims hereunder shall be forfeited without refund of premium The underwriter may at their own expense take proceedings in the name of the Insured Person to recover compensation or secure an indemnity from any third party in respect of any expense covered by this Insurance and any amount so recovered or secured shall belong to the Insurer. 9. Contact information BULSTRAD Life Vienna Insurance Group registered office: 6, Sv. Sofia Str., Sofia 1301 Bulgaria Tel: / ; Fax: / ; bullife@bulstradlife.bg; ASSE International ASPIRE Worldwide Headquarters 228 North Coast Hwy. Laguna Beach, CA U. S. A. Tel: Fax: info@aspireww.com 5