The following information describes benefits and exclusions for the Accident Medical Benefits, Accidental Death & Dismemberment Benefits, Air Evacuation/Repatriation Benefits and our Travel Assistance Benefit and Services. This is a breif desciption only. For full plan details, please refer to the insurance policy posted on our member only website or request a copy which is kept on file with the association.

Accident Insurance Protection

(Accident Plans are underwritten by United States Fire Insurance Company. These plans are not available in AK, ME, NC & VT)

2 membership levels (Basic and Plus) and 4 plans that offer 24 hour, worldwide accident insurance: (Please refer to the Certificate of Coverage on file with the association for full plan details. Benefits are provided for accidental injuries up to 52 weeks from the date of injury and treatment must be sought within 90 days of the initial injury.)

Members Insured
All members of the Adventure Advocates Association who purchased a Gold, Silver, Bronze or Core Membership.

When Coverage Applies
Blanket Accident Insurance provides coverage when accidental bodily injury causes a covered loss 24 hours a day – worldwide -- while on business or pleasure. Coverage becomes effective the 1st day of the month after becoming a member.

Basic Level (Skiing/Snowboarding excluded) – In addition to the standard exclusions and limitations below, the Basic Level accident medical insurance benefit excludes skiing/snowboarding related accidents.

Plus Level (Skiing/Snowboarding covered) – The Plus Level accident medical insurance benefit includes coverage for skiing/snowboarding but is subject to the standard exclusions and limitations below.

Accident Medical - Schedule of Benefits

Accident Medical – Basic and Plus Level Benefits (see exclusions above/below)
Gold Plan Accident Medical: $10,000 with a per occurrence deductible of $500
Silver Plan Accident Medical: $5,000 with a per occurrence deductible of $250
Bronze Plan Accident Medical: $2,500 with a per occurrence deductible of $100
Core Plan Accident Medical: $1,000 with a per occurrence deductible of $100

Accident Medical Plans provide coverage for the following based on URC: Usual, Reasonable & Customary (see definitions below):

Hospital Room & Board	URC
Intensive Care Room & Board	URC
Outpatient Pre-Admission Testing	URC
Outpatient Hospital Emergency Room Treatment	URC
Surgical Benefits	URC
X-ray and Laboratory	URC
Nursing	URC
Physiotherapy	URC
Ambulance	URC
Dental Treatment For Injury Only - Maximum Benefit Amount: $100.00	$100

Accidental Death and Dismemberment

Gold, Silver, Bronze & Core Plans

Principal Sum: Eligible Member: $25,000

Eligible Spouse: $10,000

Eligible Child: $ 2,000

AGGREGATE LIMIT OF INDEMNITY: $50,000 per accident

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

Accidental Loss of	Benefit Amount
Loss of Life	100%
Loss of Both Hands	100%
Loss of Both Feet	100%
Loss of Entire Sight of Both Eyes	100%
Loss of One Hand and One Foot	100%
One Hand or One Foot and Entire Sight of One Eye	100%
Loss of Speech and Hearing (Both Ears)	100%
Quadriplegia (total Paralysis of both upper and lower limbs)	100%
Paraplegia (total Paralysis of both lower limbs	50%
Loss of One Hand OR One Foot	50%
Loss of Entire Sight of One Eye	50%
Loss of Speech	50%
Loss of Hearing (both ears)	50%
Hemiplegia (total Paralysis of upper and lower limbs on one side of body)	50%
Uniplegia (total Paralysis of one lower or upper limb)	25%
Loss of 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, the plan will pay only the single largest Benefit Amount applicable.

Please Click here for Healthcare Services & Product Details for detailed definitions of terms

United States Fire Insurance Company Exclusions & Limitations

Benefits will not be paid for a Covered Person's loss which:

EXCLUSIONS

Benefits will not be paid for a Covered Person's loss which:

(1) Is caused by or results from the Covered Person’s own:

(a) Intentionally self‑inflicted Injury, suicide or any attempt thereat;

(b) Voluntary self‑administration of any drug or chemical substance not prescribed by, and taken according to the directions of, a doctor (Accidental ingestion of a poisonous substance is not excluded.);

(d) Participation in a riot or insurrection;

(e) Driving under the influence of a controlled substance unless administered on the advice of a doctor; or

(f) Driving while Intoxicated. “Intoxicated” will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs;

(2) Is caused by or results from:

(a) Declared or undeclared war or act of war;

(b) An Accident which occurs while the Covered Person is on active duty service in any Armed Forces. (Reserve or National Guard active duty for training is not excluded unless it extends beyond 31 days.);

(d) Sickness, disease, bodily or mental infirmity or medical or surgical treatment thereof, bacterial or viral infection, regardless of how contracted. This does not include bacterial infection that is the natural and foreseeable result of an accidental external bodily injury or accidental food poisoning.

(e) Nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained within 180 days of the initial incident and:

(i) The loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear energy; and

(ii) The Covered Person was within a 25‑mile radius of the site of the release either:

1) At the time of the release; or

2) Within 24 hours of the start of the release.

ADDITIONAL EXCLUSIONS

Benefits will not be paid for:

1. Normal health checkups;

2. Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury resulting from an Accident while the Covered Person is covered under this Certificate, and rendered within 6 months of the Accident;

3. Services or treatment rendered by a doctor, nurse or any other person who is:

(a) Employed or retained by the Certificateholder; or

(b) Who is the Covered Person or a member of his immediate family;

4. Charges which:

(a) The Covered Person would not have to pay if he did not have insurance; or

(b) Are in excess of Usual, Reasonable and Customary charges.

5. An Injury that is caused by flight in:

(a) An aircraft, except as a fare‑paying passenger;

(b) A space craft or any craft designed for navigation above or beyond the earth's atmosphere; or

6. Travel in or upon:

(a) A snowmobile;

(b) Any two or three wheeled motor vehicle;

7. Any Accident where the Covered Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator's license;

8. That part of medical expense payable by any automobile insurance policy without regard to fault. (Does not apply in any state where prohibited);

9. Injury that is:

(a) The result of the Covered Person being Intoxicated. (“Intoxicated” will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs); or

(b) Caused by any narcotic, drug, poison, gas or fumes voluntarily taken, administered, absorbed or inhaled, unless prescribed by a doctor;

10. Any Sickness, except infection which occurs directly from an Accidental cut or wound or diagnostic tests or treatment, or ingestion of contaminated food, unless a Sickness Expense Rider is inforce under this Certificate;

11. Expenses to the extent that they are paid or payable under other valid and collectible medical insurance or medical prepayment plan;

12. Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood;

13. Elective treatment or surgery, health treatment, or examination where no Injury is involved;

14. Injury sustained while in the service of the armed forces of any country. When the Covered Person enters the armed forces of any country, we will refund the unearned pro rata premium upon request;

15. Eyeglasses, contact lenses, hearing aids, braces, appliances, or examinations or prescriptions therefore;

16. Treatment in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay;

17. Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy;

18. Cosmetic surgery, except for reconstructive surgery on a diseased or injured part of the body;

19. Any loss which is covered by state or federal worker's compensation, employers’ liability, occupational disease law, or similar laws;

20. The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices;

21. Rest cures or custodial care;

22. The repair or replacement of existing dentures, partial dentures, braces or fixed or removable bridges;

23. Expenses incurred for an Accident or Sickness after the Benefit Period shown in the Schedule of Benefits;

24. Orthopedic appliances which are used mainly to protect an Injury so that a covered student can take part in interscholastic or intercollegiate sports;

25. Services and supplies furnished by the Student Camp Daycare Policyholder’s infirmary, its employees, or doctors who work for the School Camp Daycare Policyholder’s;

26. Hernia of any kind; or any bacterial infection that was not caused by an Accidental cut or wound;

27. Prescription medicines unless specifically provided for under this Certificate.

LIMITATIONS

Any benefits payable under this Certificate will be limited to the following:

(1) The medical benefits otherwise payable under this Certificate will be reduced by 50% if:

(a) Excess insurance is provided under this Certificate; and

(b) The Covered Person has coverage under another plan providing medical expense benefits; and

(c) The other plan is an HMO, PPO or similar arrangement ("PPO‑Preferred Provider Organization" means an Organization offering health care services through designated health care providers who agree to perform these services at rates lower than nonpreferred providers.); and

(d) The Covered Person does not use the facilities or services of the HMO, PPO or similar arrangement for the provision of benefits.

The Covered Person’s limitation does not apply to emergency treatment required within 24 hours after an Accident which occurred outside the geographic area serviced by the HMO, PPO or similar arrangement.

(2) In the event no consenting surgical opinion is obtained for those procedures that mandate such second surgical opinion, benefits payable for all Eligible Expenses associated with the procedure will be reduced by 50%. This limitation will apply whether the surgery is performed on an in‑patient or out‑patient basis. We will not cover a second opinion given more than 6 months after surgery was first recommended.

(3) Costs that exceed the Usual, Reasonable and Customary charges in the area where the services are furnished or supplies provided. Services, supplies and equipment must be:

a) Medically necessary for the care or treatment of a covered Injury;

b) Received while coverage is in force under this Certificate; and

c) Rendered and/or prescribed by a licensed Doctor other than the Covered Person (or a member of his

household or immediate family) in accordance with current medical standards and practices.

(4) The application of the Coordination of Benefits or Non-Duplication of Benefits provision.

(5) If the Covered Person is admitted into the Hospital on a Friday or a Saturday on a non‑emergency basis and the procedure for which he is admitted is not performed on the day of or the day after admission, we will not pay the Hospital charges for room and board or miscellaneous Hospital charges for the initial Friday or Saturday preceding the procedure.

Membership Cost Details
There are multiple insurance products and premiums included as part of membership. The Insurance Premium related to coverage underwritten by United States Fire Insurance Company as part of your membership is as follows:

Total Cost	Membership Name	Insurance Premium*	Membership Cost
$46.00	Individual Basic Gold	$34.55	$11.45
$53.00	Family Basic Gold	$41.95	$11.05
$99.00	Individual Plus Gold	$83.37	$15.63
$109.00	Family Plus Gold	$91.00	$18.00
$35.00	Individual Basic Silver	$23.40	$11.60
$42.00	Family Basic Silver	$30.70	$11.30
$39.00	Individual Plus Silver	$28.00	$11.00
$49.00	Family Plus Silver	$35.00	$14.00
$27.00	Individual Basic Bronze	$15.58	$11.42
$31.00	Family Basic Bronze	$19.47	$11.53
$29.00	Individual Plus Bronze	$17.00	$12.00
$33.00	Family Plus Bronze	$23.00	$10.00
$15.00	Individual Basic Core	$8.50	$6.50
$19.00	Family Basic Core	$12.00	$7.00
$18.00	Individual Plus Core	$11.50	$6.50
$25.00	Family Plus Core	$15.00	$10.00

*The above Insurance Premium reflects only the coverage underwritten by United States Fire Insurance Company. It does not include the association’s costs for other coverage, programs and services; including but not limited to member discount and savings related programs and services, administration and maintenance of association information and awareness benefits, websites, enrollment, fulfillment and any other costs related to administration of association membership.

Emergency Helicopter Rescue – Provided by Lifeguard

In the event that an eligible member suffers from a life threatening “certified injury” as a result of an accident that requires emergency medical transportation by helicopter in accordance with EMS protocols, the program will reimburse the participant or their provider up to a maximum of $7,000.00 per occurrence. Reimbursement includes expenses incurred from the cost of a “Medically Necessary” or “Life Threatening” situation for helicopter transportation from the scene of an accident to the nearest medical facility capable of treating the injuries, or from one medical facility to another medical facility. Claims for “Medically Necessary” transports from one medical facility to another medical facility are subject to review by Lifeguard’s Medical Officer. This benefit is included with the Gold plan and optional on Silver, Bronze, Core & Standard plans.

Provisions
• One benefit will be paid per occurrence
• Benefit in excess of all other valid collectable insurance
• Coverage is worldwide
• Transportation by helicopter only

How To Use This Benefit
Call 911 or the local equivalent. Local EMS protocols will make the determination for necessity and type of medical transportation that best fits each situation.
To file a claim, please call Lifeguard at 800-446-7142. Certain terms and conditions apply.
THIS BENEFIT IS NOT AVAILABLE IN FLORIDA OR FOR RESIDENTS OF FLORIDA.

Travel Assistance Services – Provided by On-Call International

While traveling away from home, Insured members can have the confidence that comes from knowing there’s someone who can assist in the event of a travel-related emergency. On-Call International, a leading traveler’s 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 coverage 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.

On-Call International Travel Assistance 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.

This benefit is included with the Gold, Silver, Bronze & Core plans.

Medical Evacuation / Repatriation – Provided by On-Call International

Medical Air Evacuation / Repatriation: $4,000 for Gold, Silver, Bronze & Core Plans - Provided by On-Call International
If accidental bodily injury, disease or illness causes an Insured Member to require a physician ordered medical evacuation and/or repatriation, On-Call 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. The term, “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. 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.