Members Insured

Class 1: All members of the Adventure Advocates Association who purchased Gold, Silver or Bronze Membership.

When Coverage Applies

Blanket Accident Insurance provides coverage when accidental bodily injury causes a covered loss.

Class	1	:24 hours a day – worldwide -- while on business or pleasure.

Schedule of Benefits

Accidental Death and Dismemberment                                                         Up to $25,000 for Gold, Silver & Bronze Plans

Accident Medical                                                                                                  Gold Plan Accident Medical: $25,000 with a per occurrence deductible of $500                             Silver Plan Accident Medical: $10,000 with a per occurrence deductible of $250                         Bronze Plan Accident Medical: $2,500 with a per occurrence deductible of $100

Air Evacuation / Repatriation*: $4,000 for Gold, Silver & Bronze Plans

Assistance Services*:

*Provided by On-Call International

Accidental Death and Dismemberment

If accidental bodily injury causes the following losses within one year of the date of the accident which are not otherwise excluded, FSG* will pay the following benefits:

Accidental Loss of	Benefit Amount
Life	100%
Speech and Hearing	100%
Speech and one of: Hand, Foot or Sight of an Eye	100%

 

Accidental Loss of	Benefit Amount
Hearing and one of: Hand, Foot or Sight of an Eye	100%
Both Hands, Both Feet, Sight of Both Eyes or a combination of any two of a Hand, a Foot, or Sight of an Eye	100%
One Hand, One Foot, or Sight of an Eye	50%
Speech or Hearing	50%
Thumb and Index Finger of the same hand	25%

If an Insured Person suffers more than one loss under the Schedule of Benefits as the result of one Accident, FSG* will pay only the single largest Benefit Amount applicable.

Additional Benefits

• The following benefits are payable in addition to all other benefits payable under the policy.

Excess Accident Medical Expense                                                                                                                                                                                               

FSG* will pay up to the Medical Expense Benefit Amount shown above if the Insured Member suffers a Loss, requires medical care and treatment and incurs Medical Expenses.

Medical Expense means the Reasonable and Customary charges for Medical Services that are Medically Necessary for the care and treatment of Accidental Bodily Injuries sustained in a covered Accident.

Medically Necessary means any medical or dental service, supply or course of treatment which

1) is ordered or prescribed by a Physician or a dentist;

2) is appropriate and consistent with the patient’s diagnosis;       

3) is in accord with current accepted medical or dental practice; and

4) could not be eliminated without adversely affecting the patient’s condition or quality of medical or dental care.

Medical Services means the costs for the following Medically Necessary services:

1) medical care and treatment by a Physician or a dentist;

2) hospital room and board and hospital care, both inpatient and outpatient;

3) drugs and medicines prescribed by a Physician or a dentist;

4) diagnostic tests and x-rays;

5) use of a professional ambulance;

6) dental care due to injury of functional, natural teeth.

Other Plan means any: group medical plan; group blanket plan, governmental plan or program; or coverage provided or required by any law or statute, including automobile "fault " and "no-fault" coverage and Workers’ Compensation.

Reasonable and Customary means the lesser of:

1) the usual charge made by Physicians or other health care providers for a given service or supply; or

2) the charge we determine to be the prevailing charge made by Physicians or other health care providers for a given service or supply in the geographical area where it is furnished; or

3) the amount negotiated by the insurer and the health care provider.

The Medical Expense Benefit Amount is payable excess of any valid or collectable insurance. FSG* will determine the Reasonable and Customary charge for the covered Medical Expense. We will then reduce that amount by amounts already paid or payable by any Other Plan from which the Insured Person is entitled to receive benefits. FSG* will pay the resulting amount, plus amounts paid by the Insured Member to satisfy cash deductibles or coinsurance amounts. In no event will FSG* pay more than the benefit amount shown above.

If, as a result of the excess calculation a Benefit Amount is not payable under this Medical Expense coverage, FSG* will reimburse the Insured Person, any amount the Insured Member may have paid to satisfy cash deductibles, or coinsurance amounts. In no event will we pay more than the benefit amount shown above.

Exclusions

The Medical Expense Benefit does not apply to the following charges and services:

1) charges for which the Insured Member has no obligation to pay;

2) eyeglasses, contact lenses and other vision or hearing aids and artificial limbs;

3) any injury for which Worker’s Compensation benefits or occupational injury benefits are payable.

4) Sickness of any kind

This Medical Expense coverage applies only to Medically Necessary charges, as defined above.

Medical Evacuation / Repatriation

If accidental bodily injury, disease or illness causes an Insured Member to require a physician ordered medical evacuation and/or repatriation, FSG* will pay for covered expenses incurred up to the specified benefit amount.  The Assistance Services Administrator – On-Call International, must approve the evacuation/repatriation.  Covered expenses include costs for evacuation, transportation, medical supplies and services.  Covered expenses does not include expenses incurred if travel is against the advice of a physician, for the purpose of obtaining medical treatment or due to normal pregnancy or resulting child birth.

On-Call International Assistance Service

• While traveling away from home, Insured members can have the peace of mind that comes from knowing there’s someone who can assist in the event of a travel-related emergency.  On-Call International, a leading travelers assistance provider that specializes in worldwide assistance, operates a twenty-four hour, seven days a week, toll-free emergency telephone assistance service.  In the event of a travel-related emergency, On-Call will provide the following emergency assistance services:
• Special assistance in replacing lost or stolen travel documents, including passports.
• Emergency funds transfer.
• Special assistance in locating the nearest, most appropriate medical care.
• Verification of insurance coverages facilitating entry and admissions into hospitals and other medical care providers.
• Assistance in establishing contact with family, personal physician, and employer as appropriate.
• Special assistance in the coordination of direct claims payment.
• Management, arrangement, and coordination of emergency medical transportation and evacuation as necessary.
• Translation services and referrals to local interpreters as necessary.
• Knowledgeable legal referral assistance.
• Courtesy assistance in securing incidental aid and other travel-related services.
• Coordination of securing bail bonds and other legal instruments.

Maximum Limit of Insurance/Aggregate

A maximum limit of insurance of 5 lives applies per accident.

Exclusions

• Loss occurring while the insured is in, entering or exiting any aircraft that is owned, leased or operated by his or her employer or on behalf of the employer.
• Loss occurring while the insured is in any aircraft while acting or training as a pilot or crew member.
• Loss caused by or resulting from the insured's emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection or bodily malfunctions.
• Loss resulting from suicide, attempted suicide or loss that is intentionally self-inflicted.
• Loss caused by or resulting from a declared or undeclared war, but war does not include acts of terrorism.
• While an Insured Person is participating in military action in the Armed Forces of any country or established international authority. However, orders to active military service  for sixty (60) consecutive days or less shall not constitute service in the Armed Forces.

Loss caused by or resulting from, directly or indirectly, an Insured Person’s commission or attempted commission of any illegal act including but not limited to any felony.

Loss caused by or resulting from an Insured Person being intoxicated, as defined by laws of  the jurisdiction where the loss occurred, or under the influence of any narcotic unless taken on the advice of a Physician and used in accordance with the prescription.

• Nuclear reaction or the release of nuclear energy.
• Dental Care unless required on the account of an injury caused by a covered accident.
• Any accident where the Insured Member is the operator of a motor vehicle and does not possess a current and valid motor operator’s license.
• Blood or plasma.
• Cosmetic surgery.
• Artificial limbs.
• Hernia of any kind.
• Prescription medicines unless specifically provided for under this Plan.

Please note, that this is a description of coverage only. For a full review of the Plan’s benefits and exclusions, a copy of the full policy will be on file with the Association.

* Products underwritten by: Fairmont Premier Insurance Company & Fairmont Specialty Insurance Company under the management of Fairmont Specialty Group.

Please note that Fairmont’s “Privacy Policy & Practices” and “Grievance Procedures” apply to the Plan You have purchased. If You would like to receive a copy of this information, please contact Coordinated Benefit Plans

 

 

Adventure Advocates strives to serve a dual mission: 1. Encourage Responsible Outdoor Recreation by providing a host of benefits which protect our member’s health and welfare while leading their active lives. 2. Promote Environmental Conservation by donating 100% of its net (after expenses and taxes) membership dues towards environmental and outdoor recreational causes. Adventure Advocates is an Illinois incorporated and Colorado based Not-For-Profit organization, created out of the understanding that lovers and users of the natural world owe a large debt and carry a responsibility to protect the wellbeing of our natural surroundings.