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We agree to pay benefits subject to the provisions,
definitions, limitations, and conditions of the group Policy issued by
MEDICAL LIFE INSURANCE COMPANY to the Maine Snowmobile Association
(herein called the Association), Group Number G13497. The Policy is a
legal contract between the Association and Medical Life, and it may be
changed at any time by a written agreement between Medical Life
Insurance Company and the Association.
This is your certificate of coverage. It is not a
contract or a part of one. Your benefits are described in plain
English, but a few terms and provisions are written as required by
insurance law.
PLEASE
READ CAREFULLY
If you have any questions, please contact the
Benefits Administrator at the Association or write to us. We will
assist you in any way we can to help you understand your benefits.
DEFINITIONS
This section tells you the meaning of special words
and phrases used in this certificate. In addition, special words and
phrases used only in specific sections of this certificate are
defined in those sections. To help you recognize these special words
and phrases, the first letter of each word, or each word in the
phrase, is capitalized wherever it appears.
Accident or Accidental
means an event that is sudden, unexpected, and unintended and over
which you have no control.
Insured means any Member or Dependent covered under the
Policy.
Male Pronoun whenever used includes the female.
Member means a person whose membership application has been
accepted by the Association and who has paid the annual dues.
Policy means the group insurance contract between the
Association and Medical Life which provides your insurance benefits.
Policyholder means
the Maine Snowmobile Association (herein called the Association).
We, Us, or Our means Medical Life Insurance Company. You or Your
means the insured Member to whom this certificate has been issued.
ELIGIBILITY, EFFECTIVE DATE AND TERMINATION
PROVISIONS
This section tells you: Who is eligible for
insurance, when insurance coverage will be effective, and when your
insurance will end.
ELIGIBILITY
All Members of the Association and their Dependents
are eligible for coverage. For the purpose of this coverage, Dependent
means the Member's spouse and any unmarried child who is:
1. at least 14 days but less than 19 years of age;
and
2. not in active military service.
Child(ren)
includes natural, step, foster or adopted children.
EFFECTIVE DATE
OF COVERAGE
Coverage will be effective on the first of the month
which coincides with or next follows the day you enroll, provided you
have paid your annual dues to the Association.
TERMINATION OF
COVERAGE
Insurance coverage will end on the earliest of:
1.
the date you are no longer a member of the Association; or
2. the date the Policy is cancelled; or
3. (with respect to Dependent children) the date the Dependent
reaches the limiting age.
BENEFICIARY PROVISIONS
BENEFICIARY
DESIGNATION
You and each insured Dependent must name a
beneficiary on a form which We provide or on a form approved by Us. If
two or more beneficiaries are named, payment of proceeds will be
equally apportioned unless you specify otherwise. The Policyholder may
not be named as beneficiary.
Unless provided otherwise, if a beneficiary dies
before the Insured, We will divide that beneficiary's share equally
between any remaining named beneficiaries.
If no named beneficiary survives the Insured, We will
pay the amount of insurance:
1. to his spouse, if living; if not,
2. in equal shares to his then living children, if
any if none,
3. in equal shares to his father and mother, if
living; it not,
4. in
equal shares to his brother(s) and sister(s), if any; if none,
5. to his estate.
If the beneficiary is a minor, or is not able to give
a valid release for any payment of benefits made, We will not make
payment until a claim is made by the person or entity, which by court
order, has been granted control of the estate of such beneficiary.
This provision does not prevent Us from making payment to or for the
benefit of a minor beneficiary in accordance with applicable state
law.
If any benefits under this provision are to be paid
to an Insured's estate, We may pay an amount not greater than $1,000
to any person We deem to be entitled to such funds. Any and all
payments made by Us shall fully discharge Us in the amount of such
payment.
CHANGE OF
BENEFICIARY
An Insured may change his beneficiary at any time by
completing a change form, or a form approved by Us, and
sending it to Our Home Office. The written request
for change of
beneficiary will not be effective until it is recorded
in Our Home Office. After it has been so recorded, it
will take effect as of the date the form was signed. If death
occurs before We receive the change form, We will not
alter any payment that We have already made. Any prior
payment shall fully discharge Us from further
liability in that amount.
ACCIDENTAL
DEATH, DISMEMBERMENT, AND LOSS OF SIGHT BENEFIT
BENEFIT
The Principal Sum is equal to $2,000. We will pay up
to the Principal Sum if you or your Dependent suffers loss of life or
loss of a member of the body while insured under the Policy. The loss
must occur within 365 days of an Accident and must be the direct and
sole result of the Accident and independent of all other causes. The
amount payable is listed in the table below.
TABLE OF
LOSSES
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Principal
Sum for Loss of:
Life
Both Hands
Both Feet
One
Hand and One Foot
Sight of Both Eyes
One
Hand and the Sight of One Eye
One
Foot and the Sight of One Eye
Loss of
a hand or foot means cut or broken apart at or above the wrist or
ankle joint, as applicable. Loss of sight means sight in at least
one eye is completely gone and cannot be recovered.
The
total amount of benefits payable for all losses to any one person
resulting from any one Accident will not be greater than the
Principal Sum.
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One-half of the Principal Sum for Loss of:
Sight of One Eye
One Hand
One Foot
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PAYMENT OF
BENEFITS
Accidental Death: We will pay benefits for the loss
of life to the Insured's designated beneficiary. Payment will be in one lump sum.
Accidental Dismemberment or Loss of Sight: If you
and/or your Dependent spouse are the claimant(s), We will pay benefits for these losses to the claimant. If the
claimant is a Dependent child, we will pay benefits for these losses to you. Payment
will be in one lump sum.
LIMITATIONS
We will not pay any benefits for a loss caused by or connected with:
-
suicide or attempted suicide; or
- intentionally self-inflicted injury; or
- disease or mental infirmity or from the medical or surgical
treatment or diagnosis of such disease or infirmity; or
- ptomaines; or
-
bacterial infection except pyogenic infection which occurs
through or with an Accidental cut or wound; or
-
war or any act of war, whether declared or undeclared; or
-
travel or flight in an aircraft while a member of the
crew, or while engaged in the operation of the aircraft, or giving or
receiving training or instruction in such aircraft; or
-
your being under the influence of any drug, except those
prescribed by a physician, including alcohol, narcotics, hallucinogens
and gas or fumes, which are taken or inhaled voluntarily; or
- by voluntary poisoning.
GENERAL
PROVISIONS
This section tells you: The documents that form the
master policy; your basic rights and obligations; and the rights
and obligations of
Medical Life.
ENTIRE CONTRACT
The Policy and the Application of the Policyholder
are considered to be the entire contract.
STATEMENTS
We consider any statements made by you or the
Policyholder, in the absence of fraud, to be representations and not
warranties. No statement will be used to void the insurance, reduce
benefits, or deny a claim unless:1. the statement is in writing; and 2. a copy of that statement is given to you or to your
beneficiary.
We will not contest the validity of the Policy,
except for nonpayment of premium, after it has been in force for two
(2) years from its effective date. We will not contest the validity of
an Insured's insurance after his insurance has been in force for two
(2) years during his lifetime.
MISSTATEMENT OF AGE
If you
have misstated your age or the age of a Dependent, the true age will
be used to determine:
1.
the effective date or termination date of insurance; and
2. any other rights or benefits.
Premiums will be
adjusted to reflect the premiums that would have been paid if the true
age had been known.
PHYSICAL EXAMINATION/AUTOPSY
Upon receipt of a
claim, We may examine you, at Our expense, at any reasonable time. We
reserve the right to perform an autopsy, at Our expense, if it is not
prohibited by any applicable law.
LEGAL ACTION
No
action at law or in equity may begin prior to 60 days after We receive
valid written proof of loss. No such action may begin after three (3)
years from the day written proof of loss was required.
CONFORMITY WITH
STATE LAW
If
any part of the Policy does not conform to a state statute in the
state in which it is issued or delivered, it is amended to conform
with the minimum requirements of the statutes of that state.
ASSIGNMENT
You may assign to
anyone other than the Policyholder any incident of ownership you may
possess. We are not responsible for the validity or legal effect of
any assignment.
NOTICE OF CLAIM
If you or your Dependent(s) have an Accident that may
result in a claim for benefits under the Policy, written notice must
be given to Us at Our Home Office. This must be done within 30 days
after the covered loss occurs. If notice cannot be given within that
time, it must be given as soon as reasonably possible. This notice
must contain enough information to identify the claimant.
CLAIM FORMS
When We receive written notice of a claim, We will
send you forms with which to file proof of loss. If you do not receive
these forms within 15 days, you will be excused from filing the forms
provided you send Us written proof of loss which describes the
occurrence, the character and extent of the loss for which claim is
made.
At a minimum, the
description should tell Us such things as: your name and address; the
type of benefits you are claiming; the name(s) and address(es) of your
physician(s); the date and nature of the Accident.
PROOF OF LOSS
We must receive written proof of loss within 90 days
after the date of the loss for which claim was made. If it can be
shown that it was not reasonably possible to furnish such proof, and
that such proof was furnished as soon as reasonably possible, failure
to furnish proof of loss within 90 days will not invalidate or reduce
any claim. However, except in the absence of legal capacity, proof of
loss must be furnished no later than one (1) year from the date such
proof is required.
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