2023–2024

Student Accident &
Sickness Insurance

Enroll online at www.myers-stevens.com

Arranged and Administered by

WHY STUDENT INSURANCE IS IMPORTANT

Some families have little or no financial resources to fall back on during an unexpected emergency. Uncovered costs of medical care following an injury or illness may be a serious problem for families.

MYERS-STEVENS & TOOHEY CAN HELP!

Our plans can provide useful insurance protection for your children. They can even be used to assist with the high co-insurance, deductibles and other cost sharing requirements common to many of today’s health plans. To assist you during unforeseen emergencies and help expand your choice of provider, your school has partnered with us to offer voluntary coverage for accidents or illnesses.

WITH OUR PLANS:

• Use the doctor or hospital you want...no restrictions! • Enhanced Concussion Benefits added
• Enrollment is easy - online, mail and fax

• Every enrollee receives personalized ID cards as proof of coverage

Our Best Plan.........................................................4

Our Accident Plans..............................................5

Compare Plans......................................................5

Accident Plan Benefits.......................................6

Additional Plan & Features..............................7

How to Enroll..........................................................8

Frequently Asked Questions...........................9

How to File a Claim.............................................9

Exclusions & Limitations...................................10

OUR BEST PLAN

Student Accident & Sickness Plan

In these challenging times, we are pleased to offer your students 24-hour coverage anywhere in the world for bothaccidentalinjuriesAND sickness.

$50,000Maximum per Sickness        $200,000 Maximum per Accident $50 Deductible (Disappearing*) Per Condition

Students(Grades P-12) may enroll in this plan. Covers Injuries sustained and Sickness commencing anywherein the world, 24 hours a day, while your student is insured under this School Year’s plan (including interscholastic sports, except high school tackle football). This plan does not cover routine or preventative care.

NOTE – Participation in commercial camps or clinics may be covered under this plan.

Coverage begins

Coverage ends

at 11:59 pm on the day that Myers-Stevens & Toohey Co., Inc. (herein called the Company) receives a completed enrollment form and payment of premium.
at 11:59 pm on the last day of the month for which payment has been made. Coverage may be continued for up to 12 calendar months, or through September 30, 2024, whichever comes first, provided the required payments are made.

1st payment: $208

(Covers remainder of month in which you enroll and 1 additional month) Subsequent Payments: $169 a month, billed every 2 months.

Plan Benefits

We will pay benefits only for Covered Injuries sustained or Covered Sickness commencing while insured under this School Year’s plan. Benefits payable will be based on the Usual, Customary and Reasonable Charges incurred for covered medical and dental services, as defined by the Policy, subject to exclusions, requirements and limitations. We do not pay for a service or supply unless it is Medically Necessary and listed in the Description of Benefits below. Applicable benefits mandated by the state of residence will be included in the covered expenses.

You may take your child to any provider you choose; however, seeking Treatment through a First Health contracted provider may reduce your out-of-pocket costs- see page 10 for details. To find participating First Health medical providers nearest you, call 800-226-5116 or log on to www.myfirsthealth.com.

COVERED EXPENSES
	BENEFIT MAXIMUMS

Hospital Room & Board - Semi Private Room Rate
	
80%

Ancillary Hospital Expenses
	
80% to $4,000/Day

Intensive Care Unit
	
80%
	
Hospital Emergency Room (room & supplies)
	
100%
	
Emergency Room Physician Charges
	100%
	
Outpatient Surgical (room & supplies)
	80% to $5,000
	
Doctor Non-Surgical Treatment & Exam/ Telemedicine(excluding Physical Therapy) Including consultation (when referred by attending Doctor)
	
80%

Doctor’s Surgical Expense
	
80%
	
Assistant Surgeon Services
	80%
	
Anesthesiologist Services
	80%

* May be satisfied by other primary insurance.

COVERED EXPENSES
	BENEFIT MAXIMUMS
	
Physiotherapy (includes related office visits) when prescribed by a Physician
	
80% to $2,000
	
Diagnostic Testing, X-Ray Examinations, MRI and Cat Scans
	
80%
	
Ambulance Expenses Ground or Air (from site of an emergency directly to hospital)
	
100%
	
Registered Nurse Services and Laboratory Procedures
	
80%
	
Rehabilitative Braces and Appliances
	80%
	
Out-Patient Prescription Drugs (for Injuries only)
	80%
	
Dental Services (including dental x-rays) made necessary by Injury to whole, sound, and natural teeth for Treatment due to a covered Accident
	
80%
	
Eyeglass Replacement (for replacement of broken eyeglass frames or lenses resulting from a covered Accident requiring medical Treatment)
	
100% to $750
	
Aggravations or Re-Injury of an Injury
	$500
	
Medical Evacuation & Repatriation
	100% to $10,000

Additional benefits to this plan may be found on Page 7!

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OUR ACCIDENT PLANS* Premiums for these plans are paid only ONCE for the entire school-year.

Full-Time 24/7 Accident Plans cover injuries 3Both in and out of school
324hours a day, 7 days a week 3Anywhere in the world

3While participating in all interscholastic sports(except high school tackle football)

NOTE – Students (grades P-12) and school employees may enroll in these plans. Participation in commercial camps or clinics may be covered under these plans.

Benefit Levels:
Rates per School Year:

Low     High $225     $328

c Compare these levels on page 6

School-Time Accident Plans cover injuries

3On School premises during the hours and on days when the School’s regular classes are in session, including one hour immediately before and one hour immediately after regular classes, while continuously on the School premises

3While participating in or attending School-sponsored and directly supervisedSchool Activities** including interscholastic athletic activities and non-contact spring football (except interscholastic high schooltackle football)

3While traveling directly and without interruption to or from residence and School for regular attendance; or School and off campus site to participate in School-sponsored and directly supervisedSchool Activities; and while traveling in School Vehicles at any time

NOTE – Students (grades P-12) may enroll in these plans. Participation in commercial camps or clinics is not covered under these plans. See “Full-Time 24/7” plans.

Benefit Levels:
Rates per School Year:

Low     High $53      $79

c Compare these levels on page 6

Interscholastic High School Tackle Football Accident Plans cover injuries

3Caused by covered accidents occurring while practicing or playing in interscholastic high school tackle football activities which are School-sponsored and directly supervised, including spring practice and summer conditioning, weight training and passing league

3While traveling for football in a School Vehicle or traveling directly and without interruption between School and off-campus site for such activities provided travel is arranged by and is at the direction of the School

NOTE – Students (grades 9-12) may enroll in these plans. Participation in commercial camps or clinics is not covered under these plans. See “Full-Time 24/7” plans.

Benefit Levels:
Rates per School Year:

Low     High $235 $339

c Compare these levels on page 6

Additional benefits to these plans may be found on Page 7!

Coverage Beginsat 11:59 pm on the day that the Company receives a completed enrollment form and payment of premium.

Coverage Ends • Full-Time (24/7) at 12:01 am on the date School begins regularly scheduled classes for the 2024-2025 School Year.

• School-Timeand Interscholastic High School Tackle Footballat 11:59 pm on the closing date of regular classesfor the 2023-2024 School Year.

WHICH PLAN(S) BEST FITS YOUR NEEDS?
	Covers Sickness 24/7 anywhere in the world
	Covers Accidents in school, excluding Tackle Football grades
9-12
	Covers Accidents 24/7 anwhere in the world, excluding Tackle Football grades 9-12
	Covers Interscholastic Tackle Football grades P-8
	Covers Interscholastic Tackle Football grades 9-12
	
Student Accident & Sickness Plan
	3
	3
	3
	3
		
Full-Time (24/7) Accident Plan
		3
	3
	3
		
School-Time Accident Plan
		3
		3
		
Interscholastic High School Tackle Football Plan
					3

*Plans do not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and do not satisfy a person’s individual obligation to secure the requirement of minimum essential coverage under the Affordable Care Act (ACA).
**See Definitions on page 10 for more details concerning “School Activities”.	5

ACCIDENT PLAN BENEFITS- WHICH OPTION BEST FITS YOUR NEEDS?

We will pay benefits only for Covered Injuries sustained while insured under this School Year’s plan. Benefits payable will be based on the Usual, Customary and Reasonable Charges incurred for covered medical and dental services, as defined by the Policy, subject to exclusions, requirements and limitations. We do not pay for a service or supply unless it is Medically Necessary and listed in the Description of Benefits below. Applicable benefits mandated by the state of residence will be included in the covered expenses.

You may take your child to any provider you choose; however, seeking Treatment through a First Health contracted provider may reduce your out-of-pocket costs. To find participating First Health medical providers nearest you, call 800-226-5116 or log on to www.myfirsthealth.com.

Covered Benefit Levels
	Low Option
	High Option
	
Plan Name
	MAXIMUMS PER ACCIDENT
	
Tackle Football Accident Plan Full-Time 24/7 Accident Plan
School-Time Accident Plan
	$25,000 $50,000
$25,000
	$75,000 $150,000
$75,000
	
Deductible (disappearing*) - per condition
	$100
	$0
	
Covered Expenses
	BENEFIT MAXIMUMS
	
Hospital Room & Board - Semi Private Room Rate
	80%
	90%
	
Ancillary Hospital Expenses
	80% to $2,000/Day
	90% to $3,000/Day
	
Intensive Care Unit
	80%
	90%
	
Hospital Emergency Room (room & supplies)
	100%
	
Emergency Room Physician Charges
	100%
	
Outpatient Surgical (room & supplies)
	80% to $2,500
	90% to $5,000
	
Doctor Non-Surgical Treatment & Exam/Telemedicine
(excluding Physical Therapy) Including consultation (when referred by attending Doctor)
	
80%
	
90%
	
Doctor’s Surgical Expense
	80%
	90%
	
Assistant Surgeon Services
	80%
	90%
	
Anesthesiologist Services
	80%
	90%
	
Physiotherapy (includes related office visits) when prescribed by a Doctor
	80% to $500
	90% to $1,000
	
Diagnostic Testing, X-Ray Examinations, MRI and Cat Scans
	80%
	90%
	
Ambulance Expenses Ground or Air (from site of an emergency directly to hospital)
	100%
	
Registered Nurse Services and Laboratory Procedures
	80%
	100%
	
Rehabilitative Braces and Appliances
	80%
	100%
	
Out-Patient Prescription Drugs (for Injuries only)
	80%
	90%
	
Dental Services (including dental x-rays) made necessary by Injury to whole, sound, and natural teeth for Treatment due to a covered Accident
	
80%
	
90%
	
Eyeglass Replacement (for replacement of broken eyeglass frames or lenses resulting from a covered Accident requiring medical Treatment)
	
100% to $750
	
Aggravations or Re-Injury of an Injury
	$500

* May be satisfied by other primary insurance.

Even if your child has other coverage, our plans can expand the choice of providers and can be used to help with uncovered expenses and cost-sharing requirements (e.g. large deductibles, coinsurance and co-pays) common to many health plans today.
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ADDITIONAL PLAN AND FEATURES

Dental Accident Plan ($75,000 Maximum)

•	 Covers Injuries to teeth caused by covered Accidents occurring 24 hours a day, anywhere in the world, including participation in all sports and all forms of transportation.

•	Benefits are payable at 100% of the Usual, Customary and Reasonable charges for Treatment of Injured teeth, including repairor replacement of existing caps orcrowns. We do not pay for damage to or loss of dentures or bridges or damage to existing orthodontic equipment.
•	The coverage provides a “Benefit Period” of Accident dental benefits for up to one year from the date of first Treatment. The benefit period for an Injury may be extended each year, provided that: coverage is renewed prior to October 1, the student remains enrolled in grades P-12, and written notice is received by the Company at the time of Injury that further Treatment

will be deferred to a later date.

$16 purchased separately or $12 when added to any plan(s) purchased

Coverage Begins

Coverage Ends

at 11:59 pm on the day that the Company receives a completed enrollment form and payment of premium.

at 12:01 am on the date School begins regularly scheduled classes for the 2024-2025 School Year.

ENHANCED COVERAGE FOR CONCUSSION (Applies to all plans except Dental Accident)

If the Insured is diagnosed with a concussion as a result of an Injury received while participating in a Covered Activity, and the Insured is prohibited from participating in Interscholastic Sports as a result of the School’s formal concussion protocol, benefits for the treatment of that concussion will be paid at 100% of the Usual, Customary and Reasonable charges with no deductible, subject to all other terms and conditions of the Plan.

ACCIDENTAL DEATH, DISMEMBERMENT, LOSS OF SIGHT, PARALYSIS, COUNSELING, AND HEART OR CIRCULATORY MALFUNCTION

(Applies to all plans except Dental Accident)

In addition to medical benefits, if, within 365 days from the date of Accident covered by the policy, bodily Injuries result in any of the following losses, we will pay the benefit set opposite such loss. Only one such benefit (the largest) will be paid for all such losses due to any one Accident.

Accidental Death
	$10,000
	
Single dismemberment or entire loss of sight in one eye
	$25,000
	
Double dismemberment or entire loss of sight in both eyes, or paraplegia or hemiplegia or quadriplegia
	
$50,000
	
Counseling - In addition to the AD&D benefits, we will pay 100% of the Usual, Customary and Reasonable costs of psychiatric/psychological counseling needed after covered dismemberment, loss of sight or paralysis up to

$5,000
	
Heart or circulatory malfunction death benefit payable for Loss of Life due to Heart, Circulatory or Pulmonary Malfunction that occurs within 72 hours of participation in a covered activity that is causally connected to such Malfunction (not applicable in the State of Nevada)

$10,000

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HOW TO ENROLL

For IMMEDIATE confirmation of enrollment, skip the steps below and click here (or go to www.myers-stevens.com) to apply online

Thank you for enrolling your child! To avoid any delay in coverage, please follow these 3 easy steps below: Selectthe plan(s) you wish to purchase below:
• The Student Accident & Sickness Plan will provide our highest level of coverage.

• Our Accident Plans may be purchased on an individual basis or combined with additional coverage (for example, Full-Time Accident + Dental). Completethe enrollment form below. Please note, we are unable to accept enrollments over the phone.
Purchase and ReturnYou may either:

6
• Fax both sides of the completed Enrollment Form to(949) 348-2630. You must pay by credit card by completing the payment area below. Sorry, we cannot accept personal checks or Money Orders by fax.

+
• Mail both sides of the completed Enrollment Form to Myers-Stevens & Toohey, 26101 Marguerite Pkwy, Mission Viejo, CA 92692. You may pay by credit card by completing the payment area below or enclose a check or Money Order made payable to Myers-Stevens & Toohey.

PLEASE DO NOT SEND CASH

2023-2024 Enrollment FormComplete all information (please print) and return to Myers-Stevens & Toohey Co., Inc.

Our BEST Plan

Student Accident & Sickness -1st Payment	$208

You will be billed $338 every 2 months thereafter.
Coverage cannot exceed 12 calendar months or run past Sept. 30, 2024.

Our Accident Plans (One-Time Payment For Entire School Year)

PLANS:

Tackle Football Only

High Option

$339

Low Option	Student Name	First	Middle	Last $235

Full-Time (24/7) School-Time
Dental Accident

$328	$225
$79	$53	Student Birthdate	Month	Day	Year

$16 Purchased separately

$12 When added to any plan(s) purchased

Total Amount Due
	$

Print Parent or Guardian Name

Mailing Address

City

Apt. #

State	Zip Code

First Name	Last Name

I enroll for the coverage checked above. I understand premiums cannot be refunded or converted.

X _____________________________________________________

Parent Daytime Phone Number

Parent Email Address

Parent or Guardian Signature	Date

For Residents of California: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

For Residents of Arizona, Illinois, Indiana, Missouri: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, may be subject to prosecution for insurance fraud.

District Name

School Name	Grade

ALL PREMIUMS ARE FULLY EARNED UPON RECEIPT AND CANNOT BE REFUNDED OR CONVERTED

Method of PaymentNote: $25.00 service charge for Returned Checks and declined Credit Cards	Check/Money Order(Make payable to: Myers-Stevens & Toohey Co., Inc.) or	Mastercard® or Visa® Important: If paying by credit card, complete this form. Your amount of charge will appear as“MYERS-STEVENS & TOOHEY 800-827-4695 CA” on your statement.
$

Amount	Card Number	Exp. Date MO. YR.	3 Digit Control #

I authorize Myers-Stevens & Toohey Co. Inc. to deduct the premium payment, plus a 3% processing fee, from my credit card. If enrolling in the Student Accident & Sickness Plan, I am authorizing the initial premium payment and understand that I will be invoiced every 2 months for the subsequent payments.

X 	
Signature of Cardholder

Auto-Charge Option
	Available for your convenience is the option to have your bi-monthly payments automatically charged to your credit card.
By initialing here ______________, I hereby authorize Myers-Stevens & Toohey to charge the above credit card $338, plus a 3% processing fee, on the 5th of the month that my payment is due. This authorization will remain in effect for the 2023/2024 school year until I notify Myers-Stevens & Toohey in writing prior to the next payment date.

8

FREQUENTLY ASKED QUESTIONS

I'm in a hurry! What is the quickest way to enroll?
Click HERE (or visit www.myers-stevens.com) to enroll online, complete the enrollment process and your ID card will be emailed to you immediately!

If I have other insurance, why do I need this coverage?
Our plans can expand your choice of providers for your child and can be used to help cover high deductibles, high co-insurance and other cost-sharing obligations common to many of today’s health plans.

Can I take my child to any doctor or hospital?
YES! However, your out-of-pocket costs could be less using a First Health contracted provider. To find participating doctors/hospitals nearest you, call 800-226-5116 or log on to www.myfirsthealth.com

If my child has a covered injury or sickness, will benefits for that same injury or sickness be extended if they re-enroll next year? Once maximum benefits have been paid or the benefit period ends (generally, from one to two years depending on the plan) no further benefits for that injury or sickness will be made. The Dental Accident Plan is the only exception. See this brochure for details.

Are accident-only rates paid every month?
NO! Accident-only rates are one-time charges for the entire School Year.

Do the Interscholastic Tackle Football or School-Time plans cover camps and clinics sponsored and organized by groups other than my child's school?
NO! However, such camps and clinics may be covered under our Full-Time 24/7 or Student Accident & Sickness plans. Call us for guidance!

Can interscholastic high school tackle football be covered?
YES! But only under the Interscholastic Tackle Football Plan. “High Option” benefits are recommended.

Still need help or have questions?
Go to www.myers-stevens.com or call us for prompt, personalized assistance at (800) 827-4695.

HOW TO FILE A CLAIM

Each claim is assigned to one of our experienced examiners who will diligently guide family members, school staff, medical providers and any other parties involved throughout the entire process from A to Z. Our examiners

apply their specific and highly technical knowledge to ensure accurate and expedited processing.

Should an accident or sickness occur, please follow these 4 easy steps:

1.	Report School-related Injuries within 60 days if you reside in California or 72 hours if you reside in Arizona, Illinois, Indiana, or Missouri. 2.	Obtain a claim form from the School or the Company. Claim forms must be filed with the Company within 90 days after the date of loss. 3.	At the same time, please file a claim with any other applicable insurance or Health Care Plan.
4.	Follow ALL claim form instructions, attach all itemized bills and send to:

26101 Marguerite Parkway Mission Viejo, CA 92692-3203
Office 800-827-4695 | Fax 949-348-2630| claims@myers-stevens.com

CA License #0425842

The Insurance Company

Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services. For a list of these subsidiaries, please visit our website at http://www.chubb.com. Insurance provided by ACE American Insurance Company and its U.S. based Chubb underwriting company affiliates. All products may not be available in all states. This communication contains product summaries only. Coverage is subject to the language of the policies as actually issued. The terms and conditions of coverage are set forth in the policies issued in the states in which the policy is delivered under form number AH-57720. Surplus lines insurance sold only through licensed surplus lines producers. Chubb, 202 Hall’s Mill Road, Whitehouse Station, NJ 08889-1600.

9

EXCLUSIONS

1.	Routine physical examinations and routine testing; preventive testing or treatment; screening examinations or testing in the absence of Injury.

2.     Dental care or treatment including damage to or loss of dentures or bridges or damage to existing orthodontic equipment. This exclusion does not apply to care of sound, natural teeth and gums required due to an Injury resulting from an Accident while the Covered Person is insured under the Policy.

3.     War or any act of war, declared or undeclared

4.     Participation in a Riot; fighting or brawling, except in self-defense; commission of or attempt to commit a felony or violating or attempting to violate any duly enacted law. “Riot” means a public disturbance involving an assemblage of five (5) or more persons which by tumultuous and violent conduct or the threat thereof creates grave danger of damage or injury to property or persons. An exclusion for Riot shall apply only when a person willfully engages in a Riot or willfully incites or urges other persons to engage in a Riot.

5.	Intentionally self-inflicted Injury, suicide or attempted suicide.

6.     Injury or Sickness contributed to by the use of alcohol or drugs unless taken in the dosage and for the purpose prescribed by the Covered Person’s Doctor.

7.     Participation in or practice for interscholastic tackle football; intercollegiate sports; semi-professional sports; professional sports. (except as specified in the Coverage Descriptions) (does not apply to the Dental Accident Plan)

8.     Any Injury that is caused by: Flight in, boarding or alighting from an Aircraft, except as a fare-paying passenger or School chartered aircraft, Military Airlift Command or JROTC Program.

9.     Any elective treatment, surgery, health treatment, or examination, including any service, treatment or supplies that: (a) are deemed by Us to be experimental; and (b) are not recognized and generally accepted medical practices in the United States.

10. Treatment, care or services rendered for an Injury covered by Workers’ Compensation Employers’ Liability or similar occupational laws. Expenses payable by any automobile insurance policy without regard to fault. 11.     Covered medical expenses for which the Covered Person would not be responsible for in the absence of the Policy.
12. Treatment, services or supplies provided by the School’s infirmary or its employees, or by medical providers Doctors, or Other Medical Care Providers who work for the School or are contracted or retained by the School. Treatment by persons employed or retained by the Policyholder, or by any Immediate Family or member of the Covered Person’s household.

13. Treatment, services or supplies provided or paid for by any governmental program or law, except Medicaid, Medicare or Tricare. 14. Mental or Nervous Disorders.
15. Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food, except as provided by the Policy.

16. Supplies, except as otherwise provided in the Policy. 17. Treatment of osteomyelitis.
18. Treatment of hernia, Osgood-Schlatter’s Disease, osteochondritis, appendicitis, osteomyelitis, cardiac disease or conditions, pathological fractures, congenital weakness, hernia, detached retina unless caused by an Injury, or mental disorder or psychological or psychiatric care or treatment (except as provided in the Policy).

This insurance does not apply to the extent that trade or economic sanctions or regulations prohibit Us from providing insurance, including but not limited to, the payment of claims.

h
Requirements and Limitations
Aggravations of injuries w ich did not occur while insured under this plan are paid up to $500 maximum benefit per policy term.Injuries sustained as a result of riding in or on, entering or alighting from or being

struck by a Motor Vehicle are limited to a $25,000 maximum benefit. School-time and high schooltackle football injuries must be reported to the School within 72 hours (or 60 days if you live in California) of the date of Injury. The first Physician’s visit must be within 120 days after the Accident occurs.A claim form must be filed with Myers-Stevens & Toohey Co., Inc. withni 90 days after the date of loss. The School-Time, Tackle Football and Full-Time (24/7) plans pay for covered expenses incurred within up to 104 weeks from the date of injury. The StudentAccident & Sickness and Dental Accident plans pay for covered expenses incurred within up to 52 weeksfrom the date of first treatment, however, should the Injury sustained under the Student Accident & Sickness plan require the removalof surgical pins, continued Treatment for serious burns, or Treatment of anon-union or mal-union fracture, the benefit period will be extended to 104 weeks. Each covered condition may be subject to a deductible - see plan details.

Facility of Payment
Whenever payments that should have been made under the Policy are made by any other policy, the Company reserves the right to pay over to any plan making such other payments, any amounts the Company determines are warranted in order to satisfy the intent of this provision. The amounts paid are considered benefits paid under the Policy and, to the extent of such payments, the Company shall be fully discharged from liability under the Policy. In no event will the Company pay more than the benefits payable under the Policy for all policies providing the same or similar benefits issued to the Policyholder and underwritten by the Company.

Definitions
Accident means a sudden, unexpected and unintended incident. Covered Accident means an Accident that results in Injury or loss covered by the Policy. Coinsurance means the percentage of Covered Expenses after any Deductible is applied, that are payable under this Policy. Covered Expenses means expenses actually incurred by or on behalf of a Covered Person for treatment, services and supplies covered by the Policy. A Covered Expense is deemed to be incurred on the date such treatment, service or supply, that gave rise to the expense or the charge, was rendered or obtained. Covered Loss or “Covered Losses” means an accidental death, dismemberment or other Injury covered under the Policy. Disappearing Deductible means the dollar amount of Covered Expenses the Covered Person must incur before We pay any benefits. The Deductible may be satisfied by Other Valid and Collectible Insurance. The Disappearing Deductible is shown on the Schedule of benefits. Emergency Sickness means a Sickness of such a nature that failure to get immediate medical care couldput the person’s life in danger or cause serious harm to the person’s bodily functions.Injury means accidental bodily harmsustained by a Covered Person that results directly from an Accident (independently of all other causes) and occurs while coverage under the Policy is in force. The Injury must be caused solely through external, violent and accidental means. All injuries sustained by one person in any one Accident, including all related conditions and recurrent symptoms of these injuries, are considered a single Injury. Medically Necessary or Medical Necessity means the services or supplies provided by a Hospital, Doctor, or other provider that are required to identify or treat an Injury and that, as determined by The Company, are: (1) consistent with the symptom or diagnosis and treatment of Injury or Sickness; (2) appropriate with regard to standards of good medical practice; (3) not solely for the convenience of the Covered Person; and (4) the most appropriate supply or level of service that can be safely provided. When applied to the care of an Inpatient, it further means that the Person’s medical symptoms or condition requires that the services cannot be safely provided as an outpatient. The fact that a Doctor may prescribe, authorize, or direct a service does not of itself make it Medically Necessary or covered by the Policy. Other Valid and Collectible Insurance means any: 1) group plan, program, or insurance policy; 2) any other group hospital, surgical or medical benefit plan; or 3) union welfare plans or group employer or employee benefit programs. Other Valid and Collectible Insurance will not include benefits provided by the United States Social Security Act, any individual health insurance plans or any individual disability insurance plans. School Activity means any activity that is sponsored and supervised by the School. It does not include camps or clinics relating to athletics or cheerleading that are sponsored, controlled and, or organized by any non-School group. Sickness means an illness, disease or infection commencing while coverage under the Policy is in force. All related conditions and recurrent symptoms of the same or similar condition will be considered one Sickness. Usual, Customary and Reasonable Charge means the prevailing amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

Excess Provision:
In order to keep premiums as affordable as possible, these plans pay benefits on a non-duplicating basis. This means, if a person is covered by one or more of these plans and by any other valid insurance or health agreement, any amount payable or provided by the other coverages will be subtracted from the covered expenses and we will pay benefits based on the remaining amount. (In Arizona: Does not apply to the Sickness-Only coverage under the Student Accident & Sickness Plan.)

IMPORTANT NOTICE: This brochure contains a brief description of the benefits available under the insurance programs. It is not a contract of insurance. The terms and conditions of coverage are set forth in the policies delivered in the state under form numbers AH-57720. Complete details may be found in the policies. CERTAIN INSURANCE PLANS DESCRIBED HEREIN PROVIDE SHORT-TERM LIMITED DURATION SICKNESS BENEFITS. THEY DO NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS “MAJOR MEDICAL COVERAGE”) AND DO NOT SATISFY A PERSON’S INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). FOR MORE INFORMATION ABOUT THE ACA, PLEASE REFER TO WWW.HEALTHCARE.GOV.

ALL PREMIUMS ARE FULLY EARNED UPON RECEIPT AND CANNOT BE REFUNDED OR CONVERTED For a brochure in Spanish, or for assistance in Spanish, please call 800-827-4695 | Para un folleto en Español, o para asistencia en Español, por favor llame a 800-827-4695

AZ/CA/IL/IN/MO/NBP 640 04/23	10