Group Accident Insurance Certificate

commission of a felony;

b) The following exclusions are removed:

• bungee jumping; parachuting; skydiving; parasailing; hang-gliding; • crop dusting, spraying or seeding, giving and receiving flying instruction, fire fighting, sky writing, sky diving or hang-gliding, pipeline or power line inspection, aerial photography or exploration, racing, endurance tests, stunt or acrobatic flying; or • being used for the purpose of parachuting or skydiving;

9) Under the Claim Provisions section, the following changes are made:

a) Under the Proof of Loss provision, the provision is replaced with the following:

Written or authorized electronic proof of loss satisfactory to Us must be given to Us at Our office, within 90 days of the loss for which claim is made. If (a) benefits are payable as periodic payments and (b) each payment is contingent upon continuing loss, then proof of loss must be submitted within 90 days after the termination of each period for which We are liable. If written or authorized electronic notice is not given within that time, no claim will be invalidated or reduced if it is shown that such notice was given as soon as was reasonably possible.

b) The Payment of Claims provision is replaced with the following:

Time of Payment of Claims We will pay benefits due under this Policy for any loss other than a loss for which this Policy provides any periodic payment immediately upon receipt of due written or authorized electronic proof of such loss. Subject to due written or authorized electronic proof of loss, all accrued benefits for loss for which this Policy provides periodic payment will be paid monthly unless otherwise specified in the benefits descriptions and any balance remaining unpaid at the termination of liability will be paid immediately upon receipt of proof satisfactory to Us.

c) Under the Payment of Claims provision, reference to ‘‘$1,000’’ is changed to read ‘‘up to an amount not exceeding $1,000’’.

d) The Recovery of Overpayment provision is replaced with the following:

If benefits are overpaid, We have the right to recover the amount overpaid by either of the following methods after We identify the reasons for the overpayment.

1. A request for lump sum payment of the overpaid amount. 2. A reduction of any amounts payable under this Policy.

Our right to recover is only from amounts that would be payable directly to the Covered Person, and only if the discovery of the overpayment and request for recovery occurs within one year after the overpayment.

If We reduce any amounts payable under this Policy, the Covered Person has the right to appeal the claim adjudication and the amount. If the overpayment is in dispute, the reduction of subsequent claims will be suspended until the dispute is resolved.

If there is an overpayment due when the Covered Person dies, We may recover the overpayment from the Covered Person’s estate.

10) Under the Administrative Provisions section, the Payment of Premium provision for the Covered Person does not apply.

11) Under the General Provisions section, the following changes are made:

a) The following sentence has been added to the Assignment provision:

The rights and benefits under this Policy may not be assigned to a healthcare provider.

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