TABLE OF CONTENTS
Definitions ...................................................................................................3
Insured's Effective and Termination dates......................................................3
Benefits and Coverages................................................................................3
Principal Sum ..............................................................................................3
Reduction Schedule .....................................................................................4
Limitation on Multiple Benefits......................................................................4
Accidental Death Benefit..............................................................................4
Accidental Dismemberment Benefit ..............................................................5
Exposure and Disappearance .......................................................................5
Emergency Evacuation Benefit .....................................................................6
Paralysis Benefit...........................................................................................7
Repatriation of Remains Benefit.....................................................................7
Seat Belt Benefit ..........................................................................................8
Exclusions ....................................................................................................9
Claims Provisions..........................................................................................9
General Provisions ..................................................................................... 11
DEFINITIONS
Injury -means bodily injury caused by an accident occurring while the Policy is in force as to the
person whose injury is the basis of claim and resulting directly and independently of all other causes
in a covered loss.
Insured -means a member of an eligible class of persons as described in the Schedule and for whom
premium has been paid while covered under the Policy.
Immediate Family Member -means a person who is related to the Insured Person in any of the
following ways: spouse, brother-in-law, sister-in-law, son-in-law, daughter-in-law, mother-in-law,
father-in-law, parent (includes stepparent), brother or sister (includes stepbrother or stepsister), or
child (includes legally adopted or stepchild).
Insured Person - means an Insured.
Physician - means a licensed practitioner of the healing arts acting within the scope of his or her
license who is not: (1) the Insured Person; (2) an Immediate Family Member; or (3) retained by the
Policyholder.
Schedule - means the schedule found on the face page of this certificate.
INSURED'S EFFECTIVE AND TERMINATION DATES
Effective Date. The Insured's coverage under the Policy begins on the Effective Date of Coverage
as shown in the Schedule.
Termination Date. An Insured’s coverage under the Policy ends on the earliest of: (1) the date the
Policy is terminated; (2) the premium due date if premiums are not paid when due; (3) the date the
Insured requests, in writing, that his or her coverage be terminated; or (4) the date the Insured ceases
to be eligible for coverage under the Policy.
Termination of coverage will not affect a claim for a covered loss that occurred while the Insured’s
coverage was in force under the Policy.
BENEFITS AND COVERAGES
Principal Sum. As applicable to each Insured, Principal Sum means the amount of insurance in force
under the Policy as described in the Schedule.
Reduction Schedule
The amount payable for a loss will be reduced if an Insured Person is age 70 or older on the date of
the accident causing the loss with respect to any Benefit provided under the Policy where the amount
payable for the loss is determined as a percentage of his or her Principal Sum. The amount payable
for the Insured Person’s loss under that Benefit is a percentage of the amount that would otherwise
be payable, according to the following schedule:
AGE ON DATE OF ACCIDENT PERCENTAGE OF AMOUNT OTHERWISE PAYABLE
70 - 74 65%
75 - 79 45%
80 - 84 30%
85 and older 15%
Premium for an Insured Person age 70 or older is based on 100% of the coverage that would be in
effect if the Insured Person were under age 70.
“Age” as used above refers to the age of the Insured Person on the Insured Person's most recent
birthday, regardless of the actual time of birth.
Limitation on Multiple Benefits
If an Insured Person suffers one or more losses from the same accident for which amounts are
payable under more than one of the following Benefits provided under the Policy, the maximum
amount payable under all of the Benefits combined will not exceed the amount payable for one of
those losses, the largest: Accidental Death Benefit, Accidental Dismemberment Benefit, Paralysis
Benefit.
Accidental Death Benefit
If Injury to the Insured Person results in death within 365 days of the date of the accident that caused
the Injury, the Company will pay 100% of the Principal Sum.
Accidental Dismemberment Benefit
If Injury to the Insured Person results, within 365 days of the date of the accident that caused the
Injury, in any one of the Losses specified below, the Company will pay the percentage of the principal
Sum shown below for that Loss:
For Loss of Percentage of Principal Sum
Both Hands or Both Feet.................................................................. 100%
Sight of Both Eyes............................................................................ 100%
One Hand and One Foot...................................................................100%
One Hand and the Sight of One Eye.................................................. 100%
One Foot and the Sight of One Eye .................................................. 100%
Speech and Hearing in Both Ears ...................................................... 100%
One Hand or One Foot....................................................................... 50%
Sight of One Eye..................................................................................50%
Speech or Hearing in Both Ears .......................................................... 50%
Thumb and Index Finger of Same Hand .............................................. 25%
"Loss" of a hand or foot means complete severance through or above the wrist or ankle joint. "Loss"
of sight of an eye means total and irrecoverable loss of the entire sight in that eye. "Loss" of hearing
in an ear means total and irrecoverable loss of the entire ability to hear in that ear. "Loss" of speech
means total and irrecoverable loss of the entire ability to speak. "Loss" of thumb and index finger
means complete severance through or above the metacarpophalangeal joint of both digits.
If more than one Loss is sustained by an Insured Person as a result of the same accident, only one
amount, the largest, will be paid.
Exposure and Disappearance
If by reason of an accident occurring while an Insured Person's coverage is in force under the Policy,
the Insured Person is unavoidably exposed to the elements and as a result of such exposure suffers
a loss for which a benefit is otherwise payable under the Policy, the loss will be covered under the
terms of the Policy.
If the body of an Insured Person has not been found within one year of the disappearance, forced
landing, stranding, sinking or wrecking of a conveyance in which the person was an occupant while
covered under the Policy, then it will be deemed, subject to all other terms and provisions of the
Policy, that the Insured Person has suffered accidental death within the meaning of the Policy.
Emergency Evacuation Benefit
If the Insured Person suffers an Injury or Emergency Sickness that warrants his or her Emergency
Evacuation while he or she is outside a 100 mile radius from his or her current place of primary
residence, the Company will pay for Covered Emergency Evacuation Expenses reasonably incurred,
up to a maximum of $50,000 for all Emergency Evacuations due to all Injuries from the same accident
or all Emergency Sicknesses from the same or related causes.
The Physician ordering the Emergency Evacuation must certify that the severity of the Insured
Person's Injury or Emergency Sickness warrants his or her Emergency Evacuation. All Transportation
arrangements made for the Emergency Evacuation must be by the most direct and economical
conveyance and route possible.
AIG Assist must make all arrangements and must authorize all expenses in advance for any such
benefits to be payable. The Company reserves the right to determine the benefit payable, including
reductions, if it is not reasonably possible to contact AIG Assist in advance.
The Exclusions section of this Certificate does not apply with respect to this benefit(s).
"Covered Emergency Evacuation Expense(s)" -means an expense that: (1) is charged for a
Medically Necessary Emergency Evacuation Service; (2) does not exceed the usual level of charges
for similar Transportation, treatment, services or supplies in the locality where the expense is incurred;
and (3) does not include charges that would not have been made if no insurance existed.
"Emergency Evacuation" -means, if warranted by the severity of the Insured Person’s Injury or
Emergency Sickness: (1) the Insured Person's immediate Transportation from the place where he or
she suffers an Injury or Emergency Sickness to the nearest hospital or other medical facility where
appropriate medical treatment can be obtained; (2) the Insured Person's Transportation to his or her
current place of primary residence to obtain further medical treatment in a hospital or other medical
facility or to recover after suffering an Injury or Emergency Sickness and being treated at a local
hospital or other medical facility; or (3) both (1) and (2) above. An Emergency Evacuation also
includes medical treatment, medical services and medical supplies necessarily received in connection
with such Transportation.
"Emergency Sickness" -means an illness or disease, diagnosed by a Physician, which meets all of
the following criteria: (1) there is present a severe or acute symptom requiring immediate care and
the failure to obtain such care could reasonably result in serious deterioration of the Insured Person’s
condition or place their life in jeopardy; (2) the severe or acute symptom occurs suddenly and
unexpectedly; and (3) the severe or acute symptom occurs while the Policy is in force as to the
person suffering the symptom.
"Medically Necessary Emergency Evacuation Service" -means any Transportation, medical
treatment, medical service or medical supply that: (1) is an essential part of an Emergency
Evacuation due to the Injury or Emergency Sickness for which it is prescribed or performed; (2) meets
generally accepted standards of medical practice; and (3) either is ordered by a Physician and
performed under his or her care or supervision or order, or is required by the standard regulations of
the conveyance transporting the Insured Person.
"Transportation" -means moving the Insured Person during an Emergency Evacuation by a land,
water or air conveyance. Conveyances include, but are not limited to, air ambulances, land
ambulances and private motor vehicles.
Paralysis Benefit
If Injury to the Insured Person results, within 365 days of the date of the accident that caused the
Injury, in any one of the types of paralysis specified below, the Company will pay the percentage of
the Principal Sum shown below for that type of paralysis:
Type of Paralysis Percentage of Principal Sum
Quadriplegia..................................................................................... 100%
Paraplegia .......................................................................................... 75%
Hemiplegia ......................................................................................... 50%
Uniplegia ............................................................................................ 25%
“Quadriplegia” means the complete and irreversible paralysis of both upper and both lower limbs.
“Paraplegia” means the complete and irreversible paralysis of both lower limbs. “Hemiplegia” means
the complete and irreversible paralysis of the upper and lower limbs of the same side of the body.
"Uniplegia" means the complete and irreversible paralysis of one limb. “Limb” means entire arm or
entire leg.
If the Insured Person suffers more than one type of paralysis as a result of the same accident, only
one amount, the largest, will be paid.
Repatriation of Remains Benefit
If an Insured Person suffers loss of life due to Injury or Emergency Sickness while outside a 100 mile
radius from his or her current place of primary residence, the Company will pay for covered expenses
reasonably incurred to return his or her body to his or her current place of primary residence, up to a
maximum of $10,000.
Covered expenses include, but are not limited to, expenses for: (1) embalming or cremation; (2) the
most economical coffins or receptacles adequate for transportation of the remains; and (3)
transportation of the remains by the most direct and economical conveyance and route possible.
AIG Assist must make all arrangements and must authorize all expenses in advance for this benefit to
be payable. The Company reserves the right to determine the benefit payable, including any
reductions, if it was not reasonably possible to contact AIG Assist in advance.
"Emergency Sickness" – means an illness or disease, diagnosed by a Physician, which meets all of
the following criteria: (1) there is a present severe or acute symptom requiring immediate care and
the failure to obtain such care could reasonably result in serious deterioration of the Insured Person’s
condition or place his or her life in jeopardy; (2) the severe or acute symptom occurs suddenly and
unexpectedly; and (3) the severe or acute symptom occurs while the Policy is in force as to the
Insured Person suffering the symptom.
Exclusion 2 in the Exclusions section of this Certificate does not apply with respect to this benefit. In
addition to the Exclusions in the Exclusions section of this Certificate, Repatriation of Remains
benefits are not payable if loss of life is caused in whole or in part by, or results in whole or in part
from, any condition for which the Insured Person is entitled to benefits under any Workers’
Compensation Act or similar law.
Seat Belt Benefit
Seat Belt Benefit (Percentage of Principal Sum). If the Insured Person suffers accidental death
such that an Accidental Death benefit is payable under the Policy and the accident causing death
occurs while the Insured Person is operating, or riding as a passenger in, an Automobile and wearing
a properly fastened, original, factory-installed seat belt, or if the Insured Person is a child, a properly
installed and fastened child restraint device as defined by state law, the Company will pay this
additional benefit. The amount payable for this additional benefit is the lesser of: (1) $10,000 or (2)
10% of the Insured Person’s Principal Sum.
Verification of the actual use of the seat belt, at the time of the accident, must be a part of an official
report of the accident or be certified, in writing, by the investigating officer(s).
"Automobile" – means a self-propelled private passenger motor vehicle with four or more wheels
which is of a type both designed and required to be licensed for use on the highways of any state or
country. Automobile includes, but is not limited to, a sedan, station wagon, or jeep-type vehicle and a
motor vehicle of the pickup, panel, van, camper or motor home type. Automobile does not include a
mobile home or any motor vehicle which is used in mass or public transit.
EXCLUSIONS
The Policy does not cover any loss caused in whole or in part by, or resulting in whole or in part from,
the following:
1.
suicide or any attempt at suicide or intentionally self-inflicted injury or any attempt at
intentionally self-inflicted injury;
2.
sickness, disease or infections of any kind; except bacterial infections due to an accidental cut
or wound, botulism or ptomaine poisoning;
4.
declared or undeclared war, or any act of declared or undeclared war;
5.
full-time active duty in the armed forces, National Guard or organized reserve corps of any
country or international authority. (Unearned premium for any period for which the Insured
Person is not covered due to his or her active duty status will be refunded.) (Loss caused
while on short-term National Guard or reserve duty for regularly scheduled training purposes is
not excluded.); or
6.
the Insured Person being under the influence of drugs, unless taken under the advice of a
Physician.
CLAIMS PROVISIONS
Notice of Claim. Written notice of claim must be given to the Company within 20 days after an
Insured Person's loss, or as soon thereafter as reasonably possible. Notice given by or on behalf of
the claimant to the Company at American International Companiesâ, Accident and Health Claims
Division, P. O. Box 15701, Wilmington, DE 19850-5701, with information sufficient to identify the
Insured Person, is deemed notice to the Company.
Claim Forms. The Company will send claim forms to the claimant upon receipt of a written notice of
claim. If such forms are not sent within 15 days after the giving of notice, the claimant will be deemed
to have met the proof of loss requirements upon submitting, within the time fixed in the Policy for filing
proof of loss, written proof covering the occurrence, the character and the extent of the loss for which
claim is made. The notice should include the Insured's name, the Policyholder's name and the Policy
number.
Proof of Loss. Written proof of loss must be furnished to the Company within 90 days after the date
of the loss. If the loss is one for which the Policy requires continuing eligibility for periodic benefit
payments, subsequent written proofs of eligibility must be furnished at such intervals as the Company
may reasonably require. Failure to furnish proof within the time required neither invalidates nor
reduces any claim if it was not reasonably possible to give proof within such time, provided such proof
is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity
of the claimant, later than one year from the time proof is otherwise required.
Payment of Claims. Upon receipt of due written proof of death, payment for loss of life of an Insured
Person will be made to the Insured Person's beneficiary as described in the Beneficiary Designation
and Change provision of the General Provisions section.
Upon receipt of due written proof of loss, payments for all losses, except loss of life, will be made to
(or on behalf of, if applicable) the Insured. If an Insured dies before all payments due have been
made, the amount still payable will be paid to his or her beneficiary as described in the Beneficiary
Designation and Change provision of the General Provisions section.
If any payee is a minor or is not competent to give a valid release for the payment, the payment will be
made to the legal guardian of the payee's property. If the payee has no legal guardian for his or her
property, a payment not exceeding $1,000 may be made, at the Company's option, to any relative by
blood or connection by marriage of the payee, who, in the Company's opinion, has assumed the
custody and support of the minor or responsibility for the incompetent person's affairs.
Any payment the Company makes in good faith fully discharges the Company's liability to the extent
of the payment made.
Time of Payment of Claims. Benefits payable under the Policy for any loss other than loss for which
the Policy provides any periodic payment will be paid within forty-five (45) days after the Company's
receipt of due written proof of the loss. If payment of a valid claim is not made within this forty-five
(45) day period, interest will accrue on the amount payable by the Company at a rate of one and one-
half percent (1 1/2%) per month until the claim is settled. In addition, the claimant may bring action to
recover such benefits if benefits are not paid when due. Subject to the Company's receipt of due
written proof of loss, all accrued benefits for loss for which the Policy provides periodic payment will
be paid at the expiration of each month during the continuance of the period for which the Company is
liable and any balance remaining unpaid upon termination of liability will be paid immediately upon
receipt of such proof.
GENERAL PROVISIONS
Entire Contract; Changes. The Policy, the Master Application, and any attached papers make up
the entire contract between the Policyholder and the Company. In the absence of fraud, all
statements made by the Policyholder or any Insured Person will be considered representations and
not warranties. No written statement made by an Insured Person will be used in any contest unless a
copy of the statement is furnished to the Insured Person or his or her beneficiary or personal
representative.
No change in the Policy will be valid until approved by an officer of the Company. The approval must
be noted on or attached to the Policy. No agent may change the Policy or waive any of its provisions.
Incontestability. After an Insured Person has been insured under the Policy for two year(s) during
his lifetime, no statement made by the Insured Person, except a fraudulent one, will be used to
contest a claim under the Policy. The Company may only contest coverage if the misstatement is
made in a written instrument signed by the Insured Person and a copy is given to the Policyholder, the
Insured Person or the beneficiary.
Insured’s Beneficiary Designation and Change. The Insured’s designated beneficiary(ies) is (are)
the person(s) so named by the Insured for the Policyholder’s group life insurance policy as shown on
the Policyholder’s records kept on that policy, unless the Insured has named a beneficiary specifically
for the Policy as shown on the Policyholder’s records kept on the Policy.
An Insured over the age of majority and legally competent may change his or her beneficiary
designation at any time, unless an irrevocable designation has been made, without the consent of the
designated beneficiary(ies), by providing the Policyholder with a written request for change. When
the request is received by the Policyholder, whether the Insured is then living or not, the change of
beneficiary will relate back to and take effect as of the date of execution of the written request, but
without prejudice to the Company on account of any payment made by it prior to receipt of the
request.
If there is no designated beneficiary or no designated beneficiary is living after the Insured’s death,
the benefits will be paid, in equal shares, to the survivors in the first surviving class of those that
follow: the Insured’s (1) spouse; (2) children; (3) parents; or (4) brothers and sisters. If no class has a
survivor, the beneficiary is the Insured’s estate.
Physical Examination and Autopsy. The Company at its own expense has the right and opportunity
to examine the person of any individual whose loss is the basis of claim under the Policy when and as
often as it may reasonably require during the pendency of the claim and to make an autopsy in case
of death where it is not forbidden by law.
Legal Actions. No action at law or in equity may be brought to recover on the Policy prior to the
expiration of 60 days after written proof of loss has been furnished in accordance with the
requirements of the Policy. No such action may be brought after the expiration of three years after
the time written proof of loss is required to be furnished.
Noncompliance with Policy Requirements. Any express waiver by the Company of any
requirements of the Policy will not constitute a continuing waiver of such requirements. Any failure by
the Company to insist upon compliance with any Policy provision will not operate as a waiver or
amendment of that provision. Conformity With State Statutes. Any provision of the Policy which, on its effective date, is in conflict
with the statutes of the state in which the Policy is delivered is hereby amended to conform to the
minimum requirements of those statutes.
Workers' Compensation. The Policy is not in lieu of and does not affect any requirements for
coverage by any Workers' Compensation Act or similar law.
Clerical Error. Clerical error, whether by the Policyholder or the Company, will not void the insurance
of any Insured Person if that insurance would otherwise have been in effect nor extend the insurance
of any Insured Person if that insurance would otherwise have ended or been reduced as provided in
the Policy.
Assignment. An Insured may assign all of his or her rights, privileges and benefits under the Policy
without the consent of his or her designated beneficiary. The Company is not bound by an
assignment until the Company receives and files a signed copy. The Company is not responsible for
the validity of assignments. The assignee only takes such rights as the assignor possessed and such
rights are subject to state and federal laws and the terms of the Policy.
Misstatement of Age. If the benefits for which the Insured Person is insured are based on age and
the Insured Person has misstated his or her age, there will be an adjustment of said benefit based on
his or her true age. The Company may require satisfactory proof of age before paying any claim.
Policyholder: Alabama Conference of Educators
Policy Number: BSC 0009114914
INJURY DEFINITION AND EXCLUSIONS AMENDATORY ENDORSEMENT
This Endorsement is attached to and made part of this Certificate effective August 1, 2007. It applies
only with respect to accidents and Emergency Sicknesses and losses of life that occur on or after that
date. It is subject to all of the provisions, limitations and exclusions of this Certificate except as they
are specifically modified by this Endorsement.
1. The definition of Injury in the Definitions section of this Certificate is deleted and replaced by the
following:
Injury – means bodily injury: (1) which is sustained as a direct result of an unintended, unanticipated
accident that is external to the body and that occurs while the injured person’s coverage under this
Certificate is in force; and (2) which directly (independent of sickness, disease, mental incapacity,
bodily infirmity or any other cause) causes a covered loss.
2.
The Exclusions section of the Certificate is deleted and replaced by the following:
EXCLUSIONS
No coverage shall be provided under this Certificate and no payment shall be made for any loss
resulting in whole or in part from, or contributed to by, or as a natural and probable consequence of
any of the following excluded risks even if the proximate or precipitating cause of the loss is an
accidental bodily Injury.
1.
suicide or any attempt at suicide or intentionally self-inflicted Injury or any attempt at
intentionally self-inflicted Injury or auto-eroticism.
2.
sickness, disease, mental incapacity or bodily infirmity whether the loss results directly or
indirectly from any of these.
3.
travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial
navigation, if the Insured Person is:
a.
riding as a passenger in any aircraft not intended or licensed for the
transportation of passengers; or
b.
performing, learning to perform or instructing others to perform as a pilot or
crew member of any aircraft; or
c.
riding as a passenger in an aircraft owned, leased or operated by the
Policyholder or the Insured Person’s employer.
4.
declared or undeclared war, or any act of declared or undeclared war.
5.
infections of any kind regardless of how contracted, except bacterial infections that are directly
caused by botulism, ptomaine poisoning or an accidental cut or wound independent and in the
absence of any underlying sickness, disease or condition including but not limited to diabetes.
6.
full-time active duty in the armed forces, National Guard or organized reserve corps of any
country or international authority. (Unearned premium for any period for which the Insured
Person is not covered due to his or her active duty status will be refunded.) (Loss caused
while on short-term National Guard or reserve duty for regularly scheduled training purposes is
not excluded.)
7.
the Insured Person being under the influence of intoxicants while operating any vehicle or
means of transportation or conveyance.
8.
the Insured Person being under the influence of drugs unless taken under the advice of and
as specified by a Physician.
9.
the Insured Person's commission of or attempt to commit a crime.
10.
the medical or surgical treatment of sickness, disease, mental incapacity or bodily infirmity
whether the loss results directly or indirectly from the treatment.
11.
stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial
infarction or heart attack; coronary thrombosis; aneurysm.
The President and Secretary of National Union Fire Insurance Company of Pittsburgh, PA witness this
Endorsement:
President
Secretary
