exclusion, means intoxicated, as defined by the law of the state in which the Covered Injury or Covered Illness occurred.
b) The following exclusion is modified as shown below:
• voluntary commission or attempt to commit a felony; •
voluntary participant in the commission of or active participation in a riot, insurrection, rebellion or unlawful police action;
• services or treatment rendered by a Physician, Nurse or any other person who is: a. employed or retained by the Policyholder/Subscriber; b.
providing homeopathic, aroma-therapeutic or herbal therapeutic services;
c.
a parent, sibling, spouse or child of the Covered Person;
10) Under the Claim Provisions section the following changes are made:
a) The Proof of Loss provision is revised as follows:
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 a claim is or could have been 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 if it is shown that such notice was given as soon as was reasonably possible. Failure to give notice or file proof of loss as required by the provision does not bar recovery under the Policy if the Insurer fails to show it was prejudiced by failure.
b) The Time of Payment of Claims is revised as follows:
We will pay benefits due under this Policy for any loss other than a loss for which this Policy provides any periodic payment not more than 60 days upon Our receipt of due written or authorized electronic proof of such loss. Due proof of loss means all essential information needed to make a determination on the claim. 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. Failure to pay a claim in accordance with the time periods stated in this provision will require the payment of interest at a rate not to exceed 10% per annum on all benefits due and unpaid.
c) The Payment of Claims provision is revised to not permit reduction of benefits by outstanding premium due as well as paying $1,000 to a relative.
d) The Recovery of Overpayment the first sentence is revised as follows:
If benefits are overpaid, We have the right to recover the amount overpaid by either of the following methods, due to fraud, or within 12 months of the overpayment for any other reason.
e) The following Grievance Procedure is added:
Grievance Procedure When a claim is denied the claimant will receive a written statement containing the exact reason(s) for the claim denial.
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