ACCIDENT INSURANCE COVERAGE TERMS

SECTION I - SCHEDULE OF BENEFITS

CLASSES OF ELIGIBLE PERSONS

A person may be insured only under one Class of Eligible Persons even though he or she may be eligible under more than one class. Also, a person may not be insured as a Dependent and an Insured at the same time.


Class 1	All registered participants of Polaris Adventures Elite locations of the Policyholder, for whom require premium has been paid.
Class 2	All registered participants of Polaris Adventures Elite locations of the Policyholder that have also elected the Upgrade Coverage Option, and paid the required premium for the additional Accident Medical and Dental Expense Benefit.

AGGREGATE LIMIT OF LIABILITY


Benefit Maximum	$1,000,000
Applies During	per Covered Accident.
Applies To	Accidental Death & Dismemberment benefits only

COVERED ACTIVITIES

The following are the Covered Activities for which insurance applies:

Class	Covered Activity
Class 1	Supervised and Sponsored Activities
Class 2	Supervised and Sponsored Activities

Covered Activities:

While participating in an eligible Polaris Adventures activity.

Subject to all the terms and conditions of the Policy, benefits described in the Policy are payable when an Insured suffers a Covered Loss or Injury as a result of a Covered Accident during one of the Covered Activities listed above. Benefits are payable only once for any Covered Accident even if it is covered by more than one Covered Activity. The benefit amount will be the largest benefit amount applicable under all such Covered Activities.

Class 1 Schedule of Benefits

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS


Class 1 Principal Sum:
Accidental Death and Dismemberment	$25,000
Time Period for Loss:	365 days
Exposure and Disappearance	Included

Loss of:	Benefit: (Percentage of Principal Sum)
Life	100%
Quadriplegia	100%
Two or More Members	100%
One Member	50%
Hemiplegia	50%
Paraplegia	50%
Uniplegia	25%
Thumb and Index Finger of the Same Hand	25%

ACCIDENT MEDICAL and DENTAL EXPENSE BENEFIT


Total Benefit Maximum for all Accident Medical and Dental Expense Benefits	$25,000 per Covered Accident
Loss Period First Covered Expenses must be incurred within	90 days after the covered Accident
Benefit Period	1 year from the date of the covered Accident
Scope of Coverage	Full Excess

Any Deductibles; Coinsurance; Benefit Periods; and Benefit Maximums apply on a per Insured, per Covered Accident basis.

Covered Expense	Benefit Amount
Daily Hospital Room and Board	100% of U&C not to exceed the daily semi-private room rate
Daily Intensive Care Unit	100% of U&C
Ancillary Hospital Expenses	100% of U&C
Physician Office Visit	100% of U&C
Physician Surgical Expenses	100% of U&C
Assistant Surgeon Expenses	100% of U&C
Emergency Room and Supplies	100% of U&C
Ambulance	100% of U&C
Outpatient Surgery Visit	100% of U&C
Outpatient Surgical Room and Supplies	100% of U&C
Outpatient Laboratory Tests and X-Rays	100% of U&C
Physical Medicine	100% of U&C
Anesthesiologist Expenses	100% of U&C
Dental Expenses	100% of U&C
Rehabilitative Braces and Appliances	100% of U&C
Prescription Drugs	100% of U&C
Medical Equipment Rental	100% of U&C
Medical Services and Supplies	100% of U&C

ADDITIONAL ACCIDENT BENEFITS

Any benefits payable under these additional accident benefits shown below are paid in addition to any other

Accidental Death and Dismemberment benefits payable, unless specifically noted otherwise.


Accidental Burn and Disfigurement Benefit	75-100% Body Disfigurement 100% of the Principal Sum
	50-74% Body Disfigurement 50% of the Principal Sum
	25-49% Body Disfigurement 25% of the Principal Sum
	Burn Classification third degree
Time Period for Loss:	365 days from the date of the Covered Accident
Coma Benefit	1% of the principal sum (up to a maximum of $25,000). occurs within 30 days from the date of the Covered Accident
Hospital Stay Benefit
Benefit Amount	$250 per day
Maximum Benefit Period	15 days per Hospital Stay per Covered Accident
Benefit Waiting Period	3 days
Physical Therapy Benefit
Benefit Amount	$50 per visit
Maximum Number of Visits	10
Emergency Evacuation Rider Benefits:
Emergency Medical Evacuation Benefit
Maximum Benefit per Insured per Covered Accident	$50,000
Repatriation of Mortal Remains Benefit
Maximum Benefit	$10,000

Class 2 Schedule of Benefits

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS


Class 2 Principal Sum:
Accidental Death and Dismemberment	$25,000
Time Period for Loss:	365 days
Exposure and Disappearance	Included
Loss of:	Benefit: (Percentage of Principal Sum)
Life	100%
Quadriplegia	100%
Two or More Members	100%
One Member	50%
Hemiplegia	50%
Paraplegia	50%
Uniplegia	25%
Thumb and Index Finger of the Same Hand	25%

ACCIDENT MEDICAL and DENTAL EXPENSE BENEFIT


Total Benefit Maximum for all Accident Medical and Dental Expense Benefits	$75,000 per Covered Accident
Loss Period First Covered Expenses must be incurred within	90 days after the covered Accident
Benefit Period	1 year from the date of the covered Accident
Scope of Coverage	Full Excess

Any Deductibles; Coinsurance; Benefit Periods; and Benefit Maximums apply on a per Insured, per Covered Accident basis.

Covered Expense	Benefit Amount
Daily Hospital Room and Board	100% of U&C not to exceed the daily semi-private room rate
Daily Intensive Care Unit	100% of U&C
Ancillary Hospital Expenses	100% of U&C
Physician Office Visit	100% of U&C
Physician Surgical Expenses	100% of U&C
Assistant Surgeon Expenses	100% of U&C
Emergency Room and Supplies	100% of U&C
Ambulance	100% of U&C
Outpatient Surgery Visit	100% of U&C
Outpatient Surgical Room and Supplies	100% of U&C
Outpatient Laboratory Tests and X-Rays	100% of U&C
Physical Medicine	100% of U&C
Anesthesiologist Expenses	100% of U&C
Dental Expenses	100% of U&C
Rehabilitative Braces and Appliances	100% of U&C
Prescription Drugs	100% of U&C
Medical Equipment Rental	100% of U&C
Medical Services and Supplies	100% of U&C

ADDITIONAL ACCIDENT BENEFITS

Any benefits payable under these additional accident benefits shown below are paid in addition to any other

Accidental Death and Dismemberment benefits payable, unless specifically noted otherwise.


Accidental Burn and Disfigurement Benefit	75-100% Body Disfigurement 100% of the Principal Sum
	50-74% Body Disfigurement 50% of the Principal Sum
	25-49% Body Disfigurement 25% of the Principal Sum
	Burn Classification third degree
Time Period for Loss:	365 days from the date of the Covered Accident
Coma Benefit	1% of the principal sum (up to a maximum of $25,000). occurs within 30 days from the date of the Covered Accident
Hospital Stay Benefit
Benefit Amount	$250 per day
Maximum Benefit Period	15 days per Hospital Stay per Covered Accident
Benefit Waiting Period	3 days
Physical Therapy Benefit
Benefit Amount	$50 per visit
Maximum Number of Visits	10
Emergency Evacuation Rider Benefits:
Emergency Medical Evacuation Benefit Maximum Benefit per Insured per Covered Accident	$50,000
Repatriation of Mortal Remains Benefit Maximum Benefit	$10,000

SECTION II – DESCRIPTION OF COVERED ACTIVITIES

We will pay benefits if the Insured is engaged in one of the Covered Activities described below, as listed in the Schedule of Benefits and when the Covered Loss occurs. Unless otherwise specified, We pay benefits only once for any one Covered Loss, even if covered by more than one Covered Activity. We shall pay the single largest benefit amount applicable under all such Covered Activities.

Supervised and Sponsored Activities

We will pay benefits as shown in the Schedule of Benefits for any Covered Loss while the Insured is engaged in this Covered Activity:

The Covered Loss must take place:

while participating in Policyholder activities or
on the premises of the Policyholder during other periods if attending or participating in a Covered Activity; or
away from the premises of the Policyholder while attending or participating in a Covered Activity at its scheduled site.

Unless otherwise stated in the Schedule of Benefits, We will pay benefits for a Covered Loss, only once, even if coverage was provided under more than one Covered Activity.

SECTION III - DEFINITIONS

For the purposes of this Policy, certain words with specific meanings are capitalized throughout the document. The definition of any word, if not defined in the text where it is used, may be found in the Schedule of Benefits or in this Definitions Section.

ACCIDENT means a sudden, unexpected event happening by chance that arises from an external source to the Insured and occurs at an identifiable time and place.

AGGREGATE LIMIT OF LIABILITY means the maximum amount We will pay for all Covered Losses resulting from the same Covered Accident.

BENEFIT PERIOD means the period of time, as stated on the Schedule of Benefits, between the date of the Accident causing the Injury for which benefits are payable and the date after which no further benefits will be paid.

CONVEYANCE means any motorized craft, vehicle or mode of transportation licensed or registered by a governmental authority with competent jurisdiction.

COVERED ACCIDENT means an Accident that occurs while coverage is in force for an Insured and for which benefits are payable.

COVERED ACTIVITY means any activity that the Policyholder requires the Insured to attend, or that is under its supervision and control listed in the Schedule of Benefits and insured under the Policy.

COVERED EXPENSES means expenses actually incurred by or on behalf of an Insured for Treatment, services and supplies covered by this Policy. Coverage under the Policyholder’s Policy must remain continuously in force from the date of the Covered Loss until the date Treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date such Treatment, service or supply, that gave rise to the expense or the charge, was rendered or obtained.

COVERED LOSS or COVERED LOSSES means a loss which meets the requisites of one or more benefits, results from a Covered Accident or Injury and for which benefits are payable under the Policy.

DEPENDENT means an Insured’s:

lawful Spouse, if not legally separated or divorced,
children under age26.

The age limitations will not apply to an Insured’s unmarried child who is incapable of self-support due to a mental disability or physical handicap. Proof of such incapacity must be furnished to Us immediately upon enrollment or within 31 days of the child reaching the age limitation. Thereafter proof will be required whenever reasonably necessary, but not more often than once a year after the 2-year period following the age limitation.

The term child as used herein means the Insured’s natural child, adopted child (or child placed in the Insured’s home for purposes of adoption), foster child, stepchild, or other child for whom the Insured has legal guardianship.

DOMESTIC PARTNER means an opposite or same sex partner who, for at least 12 consecutive months, has resided with the Insured and shared financial assets/obligations with the Insured. Both the Insured and the Domestic Partner must: (1) intend to be life partners; (2) be at least the age of consent in the state in which they reside; and (3. be mentally competent to contract. Neither the Insured nor the Domestic Partner can be related by blood to a degree of closeness that would prohibit a legal marriage, be married to anyone else, or have any other Domestic Partner. We require proof of the Domestic Partner relationship in the form of a signed and completed Affidavit of Domestic Partnership.

EMERGENCY ROOM means a trauma center, urgent care facility or special area in a Hospital that is equipped and staffed to give people emergency Treatment on an outpatient basis. An Emergency Room is not a clinic or Physician’s office.

HOME COUNTRY means a country from which the Insured holds a passport. If the Insured holds passports from more than one country, his or her Home Country will be that country which the Insured has been residing for the last 12 months declared to Us in writing as his or her Home Country.

HOSPITAL means an institution that:

operates as a Hospital pursuant to law for the care, Treatment and providing in-patient services for sick or Injured persons; and is a duly licensed institution, operated lawfully in its area;
provides 24-hour nursing service by Registered Nurses on duty or call;
has a staff of one or more licensed Physicians available at all times;
provides organized facilities for diagnosis, Treatment and surgery, either

a. on its premises; or
b. in facilities available to it, on a pre-arranged basis;

is not primarily a nursing care facility, rest home, convalescent home or similar establishment, or any separate ward, wing or section of a Hospital used as such; and
is not a facility for the Treatment of drug addiction, alcoholism, Treatment of the aged.

We will not deny a claim for services rendered in a Hospital having one or more of the following accreditations solely because the Hospital lacks major surgical facilities and is primarily of a rehabilitative nature, if such rehabilitation is specifically for the Treatment of a physical disability:

the Joint commission of Accreditation of Hospitals; or
the American Osteopathic Association; or
the Commission on the Accreditation of Rehabilitative Facilities.

HOSPITAL CONFINED means a stay of 24 or more consecutive hours as a registered resident bed-patient in a Hospital.

IMMEDIATE FAMILY means the Insured’s parent, legal guardian, grandparent, Spouse, child(ren) (includes legally adopted or step child(ren), brother, sister, grandchild(ren), or in-laws.

INJURY or INJURED means bodily injury caused by the direct result of an Accident occurring while the Policy is in force as to the person whose injury is the basis of the claim which results directly and independently of all other causes in a Covered Loss.

INSURED means an eligible person who is within the covered class(es) listed in the Policy, and for whom the required premium is paid when due. An Insured is not a Dependent covered under this Policy.

MAXIMUM BENEFIT means the largest total amount of Covered Expenses that We will pay for the Insured.

MEDICAL EMERGENCY means a condition which meets all of the following criteria:

there is present a severe or acute symptom requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of the Insured’s condition or place his or her life in jeopardy;
the severe or acute symptom occurs suddenly and unexpectedly; and
the severe or acute symptom occurs while the Policy is in force as to the person suffering the symptom and under the circumstances described in a Covered Activity:

a) applicable to that person; and
b) to which this Policy applies.

MEDICALLY NECESSARY means a determination by the Insured’s Physician that Treatment, service or supply provided to treat an Injury is:

appropriate and consistent with the diagnosis and does not exceed in scope, duration, or intensity the level of care needed to provide safe, adequate, and appropriate Treatment;
is commonly accepted as proper care or Treatment in accordance with the medical practices of the United States and federal guidelines;
can reasonably be expected to result in or contribute to the improvement of the Injury; and
is provided in the most conservative manner or in the least intensive setting without adversely affecting the condition of the Injury or the quality of the medical care provided.

The fact that a Physician may prescribe, order, recommend, or approve a Treatment, service or supply does not, of itself, make the Treatment, service, or supply medically necessary for the purpose of determining eligibility for coverage under this Policy.

The Physician must be acting within the scope of his/her license. A Physician does not include an Insured or any Immediate Family member.

PHYSICIAN means a licensed health care provider practicing within the scope of his or her license and rendering care and Treatment to the Insured that is appropriate for the condition and locality, and who is not:

the Insured;
Immediate Family of either the Insured or the Insured's Spouse;
a person living in the Insured's household;
a person employed or retained by the Policyholder; or
a person providing homeopathic,aroma-therapeutic,or herbal therapeutic services.

PLAN YEAR means the 12-month period defined for the Policyholder.

POLICYHOLDER means an organization as shown in the Schedule of Benefits in the Policy.

PRE-EXISTING CONDITION means an illness, disease or other condition of the Insured, that in the 12 month period before the Insured’s coverage became effective under this Policy:

first manifested itself, worsened, became acute or exhibited symptoms that would have caused an ordinary prudent person to seek diagnosis, care or Treatment; or
required taking prescribed drugs or medicines, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or
was treated by a Physician or Treatment had been recommended by a Physician.

SICKNESS means an illness, disease or condition that impairs an Insured Person ’s normal functioning of mind or body and which is not the direct result of an Injury or Accident.

TREATMENT means medical advice, diagnosis, care or services (including diagnostic measures. received by a person, or the use of drugs or medicines by a person.

SPOUSE means an Insured’s legal Spouse. Spouse will also include a Domestic Partner or civil union partner as determined by any controlling legal authority or, in the absence of such authority, by agreement between Us and the Policyholder.

USUAL AND CUSTOMARY CHARGES (U&C. means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

WE, OUR, US means Arch Insurance Company or its authorized agent.

YOU, YOUR, YOURS means the Insured who meets the eligibility requirements of the Policy and whose insurance under the Policy is in force.

SECTION IV - ELIGIBILITY FOR INSURANCE

A person is eligible for insurance under this Policy when he or she meets the definition of eligible person shown in the Schedule of Benefits. An eligible person may be covered under only one Class, even though he or she may be eligible under more than one Class.

SECTION V - EFFECTIVE DATE OF INSURANCE

Policy Effective Date. This Policy begins on the Policy Effective Date shown in the Schedule of Benefits at 12:01 A.M. at the address of the Policyholder.

Insured’s Effective Date

(Text for Non-Contributory Plan) An Insured’s coverage under this Policy begins on the later of:

the Policy Effective Date; or
the date such person becomes eligible, subject to any required waiting period; as described in the Schedule of Benefits.

(Text for Voluntary or Contributory Plan) If the Insured is required to contribute to the cost of this insurance, the insurance is effective on the latest of the following dates:

the Policy Effective Date;
the date the Insured is first eligible;
the first date of the Plan Year;
the date We receive the completed enrollment form;
the date the required premium is paid; or
the date payroll or account deduction is authorized for this insurance.

SECTION VI - TERMINATION DATE OF INSURANCE

Policy Termination Date

Termination takes effect at 12:01 A.M. time at the address of the Policyholder on the date of termination. Termination by the Policyholder or by Us will be without prejudice to any claims originating prior to the date of termination.

This Policy terminates automatically on the earlier of:

The Policy Termination Date shown in this Policy; or
The premium due date if premiums are not paid when due; subject to the grace period provided in the section of this Policy entitled Premium.

Failure by the Policyholder to pay all required premiums due by the last day of the grace period shall be deemed notice by the Policyholder to Us to terminate this Policy on the last day of the period for which premiums have been paid.

This Policy may be terminated by the Policyholder or Us as of any premium due date or Policy Anniversary Date by giving written notice to the other at least 31 days prior to such date; unless such longer notice period is required pursuant to applicable insurance regulations. Any unearned premium, calculated on a pro-rata basis, and will be returned to the Policyholder as soon as reasonably possible.

We and the Policyholder may terminate this Policy at any time by written mutual consent. If premiums have been paid beyond the termination date, We will refund the excess; or if premiums have been paid short of the termination date, the Policyholder will owe Us the difference.

Insured’s Termination Date

An Insured’s coverage under this Policy ends on the earliest of:

The date this Policy terminates;
The date the Insured requests, in writing, that his or her coverage be terminated;
The date the Insured enters full-time active duty in the armed forces of any country or international authority;
The date the Insured ceases to be eligible as described in this Policy provided all required premiums are paid; or
The last day of the period for which premiums have been paid

SECTION VII - DESCRIPTION OF BENEFITS

The following provisions explain the benefits available under the Policy. All benefits payable are shown in the Schedule of Benefits. (These benefits may vary on a class level.)

AGGREGATE LIMIT OF LIABILITY

The maximum amount We will pay for all Covered Losses resulting from the same Covered Accident will not exceed the Aggregate Limit of Liability as described in the Schedule of Benefits.

If the total amount payable for all Covered Losses in any one Accident exceeds the Aggregate Limit of Liability, each Insured’s Covered Loss will be paid at the same ratio that the Aggregate Limit of Liability has to the total amount of all Covered Losses. We shall not be liable for amounts in excess of the Aggregate Limit of Liability.

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

If Injury to the Insured results in any of the Covered Losses shown below, within the Time Period for Loss as shown in Schedule of Benefits from the date of the Covered Accident that caused the Injury, We will pay the percentage of the Principal Sum shown on the Schedule of Benefits for that loss. The Principal Sum is shown in the Schedule of Benefits. If multiple losses occur, only one benefit, the largest, will be paid for all losses due to the same Covered Accident.

Exposure and Disappearance includes unavoidable exposure to the elements following a Covered Accident or disappearance of the Insured after the forced landing; stranding; sinking; or wrecking of a Conveyance in which the Insured was traveling in during the course of a Trip which would otherwise be covered under the Policy. Additionally, Disappearance means an Insured is presumed dead as a result of a Covered Accident and the body is not found within one year of the Covered Accident.

Member means Loss of Hand or Foot, Loss of Sight, Loss of Speech and Loss of Hearing.

Loss of a hand or foot means complete severance through or above the wrist or ankle joint.

Loss of sight means total and permanent loss of sight of one or both eyes that is irrecoverable, including by surgical and artificial means.

Loss of speech means total and permanent loss of coherent audible communication that is irrecoverable by natural, surgical or artificial means.

Loss of hearing means permanent total deafness in one or both ears such that it cannot be corrected by any aid or device.

Loss of thumb and index finger of the same hand means complete severance of each through or above the metacarpophalangeal joint of both digits of the same hand. Severance means the complete separation and dismemberment of the part from the body.

Loss of Use means loss of functional, normal, or characteristic use or paralysis; which continues without interruption for a period of 12 consecutive months and at the end of such period is determined by a Physician to be continuous, permanent and irrecoverable.

Paralysis means total Loss of Use.

Hemiplegia means total Paralysis of the upper and lower limbs on one side of the body.

Paraplegia means total Paralysis of both lower limbs.

Quadriplegia means total Paralysis of both upper and lower limbs.

Uniplegia means total Paralysis of one lower limb or one upper limb.

ACCIDENT MEDICAL AND DENTAL EXPENSE BENEFIT

We will pay Accident Medical and Dental Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident. These benefits are subject to the Deductibles; Coinsurance Factors; Benefit Periods; Benefit Maximums; and other terms or limits shown in the Schedule of Benefits.

Accident Medical Expense Benefits are only payable:

for Usual and Customary Charges incurred after the Deductible has been met;
for those Medically Necessary Covered Expenses incurred by or on behalf of the Insured;
for charges incurred within the timeframe shown on the Schedule of Benefits after the date of the Covered Accident.

No benefits will be paid for any expenses incurred that are, in Our judgment, in excess of Usual and Customary Charges.

Covered Medical Expenses, from a Covered Accident, include:

Daily Hospital room and board expenses; the daily room rate when an Insured is Hospital confined and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted, but not the date of discharge.
Daily Intensive Care Unit or Cardiac Care Unit Expenses; the daily room rate when an Insured is Hospital confined in a bed in the Intensive Care Unit or Cardiac Care Unit and nursing services other than private duty nursing services.
Ancillary Hospital expenses; services and supplies including operating room; laboratory tests; anesthesia and medicines when Hospital confined.
Physician Office Visit; non-surgical Treatment or examination expenses (excluding medicines) including the Physician’s initial visit; each necessary follow-up visit; and consultation visits when referred by the attending Physician.
Physician surgical expenses. If an injury requires multiple surgical procedures through the same incision, We will pay only one benefit, the largest of the procedures performed. If multiple surgical procedures are performed during the same operative session, but through different incisions, We will pay for the most expensive procedure and 50% of Covered Expenses for the additional surgeries.
Assistant Surgeon
Emergency Room or emergency care facility and Supplies expense incurred within 72 hours of a Covered Accident and including the attending Physician’s charges; x-rays; laboratory procedures; use of the Emergency Room and supplies.
Ambulance expenses for transportation from the emergency site to the Hospital.
Outpatient surgery visit; office visits connected with such Treatment when prescribed by a Physician.
Outpatient surgical room and supply expenses for use of the surgical facility. Second surgical opinion expense.
Outpatient diagnostic x-rays; laboratory procedures; and test expenses. Diagnostic imaging expenses including: magnetic resonance imaging (MRI) and CAT scans. Does not include dental x-rays.
Physical Medicine (Physiotherapy) expenses on an inpatient or outpatient basis limited to one visit per day; expenses include Treatment and office visits connected with such Treatment when prescribed by a Physician, including: diathermy; ultrasonic; whirlpool; heat Treatments; adjustments; manipulation; massage or any form of physical therapy.
Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a surgical procedure whether on an inpatient or outpatient basis.
Dental expenses including dental x-rays for the repair or Treatment of each Injured tooth that is whole, sound and a natural tooth at the time of the Covered Accident. Dental expenses related to the installation of crowns; caps; bridges and dentures; oral surgery and endodontics as a result of a Covered Accident. Repair or replacement of caps and crowns that existed prior to the Covered Accident.
Rehabilitative braces or appliances prescribed by a Physician. It must be durable medical equipment that is primarily and customarily used to serve a medical purpose and can withstand repeated use and generally is not useful to a person in the absence of injury. No benefits will be paid for rental charges in excess of the purchase price.
Prescription drug expenses prescribed by a Physician .
Medical equipment rental expenses for a wheelchair or other medical equipment that has therapeutic value for the Insured. We will not cover computers; motor vehicles or modifications to a motor vehicle; ramps and installation costs.
Medical services and supplies for blood and blood transfusions; oxygen and its administration.

ADDITIONAL ACCIDENT BENEFITS

Accidental Burn & Disfigurement Benefit

We will pay this benefit shown in the Schedule of Benefits if the Insured suffers burns that leave him or her Disfigured as defined below. The burns must result directly; and independently of all other causes; from a Covered Accident. The Disfigurement must satisfy all of the conditions below:

reconstructive or cosmetic surgery is required to restore the Insured’s physical abilities or correct Disfigurement and must commence within the time period of loss noted on the Schedule of Benefits; and
If occupational coverage is provided to the Insured, the Covered Accident must occur while the Insured is on the Policyholder’s premises and engaged in the course of his or her job; and
a Physician must determine that the burn involves the minimum percentage required, be classified as defined herein and results in Disfigurement or loss of physical abilities.

Disfigurement or Disfigured, as it pertains to this benefit, means spoiled or deformed appearance caused by burns that can be corrected by means of reconstructive or cosmetic surgery.

Coma Benefit

If a Insured suffers an Injury caused by a Covered Accident which results in such person being in a Coma within 30 days of the Accident and if the Coma continues for at least 30 consecutive days, the Company will pay a monthly benefit equal to 1% of the Insured’s Principal Sum as shown in the Schedule of Benefits.

No benefit is provided for the first 30 days of Coma. The benefit is paid monthly, beginning on the 31st day of the Coma and ends on the earliest of:

the date the Coma ends, whether by death, recovery, or any other change of condition; or
after 11 continuous months of benefit payments by the Company, or the date the total amount of monthly Coma benefits paid for all Injuries caused by the same accident equals 100% of the Insured’s Principal Sum.

If the Insured suffers loss of life for which benefits are payable under this Policy as a result of the same Covered Accident which caused the Coma, or if he or she remains in a Coma at the end of 11 continuous months, an additional benefit will be paid equal to the Insured’s Principal Sum as shown on the Schedule of Benefits; less any Coma Benefits paid or other benefits payable under this Policy for any other losses incurred as a result of the same Covered Accident.

Under no circumstances will the Company pay more than the Insured’s Principal Sum as shown on the Schedule of Benefits for all Covered Losses combined, including this Coma Benefit, which are incurred as the result of the same Covered Accident.

The Insured’s designated beneficiary is responsible for providing the Company proof of continuing Coma. The Company reserves the right, at the end of the first 30 consecutive days of Coma and as often as it may reasonably require thereafter, to determine, on the basis of all the facts and circumstances, that the Insured is in a Coma, including, but not limited to, requiring an independent medical examination provided at the expense of the Company.

Coma means being in a state of profound unconsciousness which resulted directly, and independently from all other causes, from a Covered Accident, and from which the Insured is not likely to be aroused through powerful stimulation. This condition must be diagnosed and treated regularly by a Physician. Coma does not mean any state of unconsciousness intentionally induced during the course of Treatment of an Injury unless the state of unconsciousness results from the administration of anesthesia in preparation for surgical Treatment of that Covered Accident.

Hospital Stay Benefit

We will pay this benefit shown in the Schedule of Benefits subject to the following conditions, if the Insured requires a Hospital Stay due to a Covered Loss resulting directly; and independently of all other causes; from a Covered Accident.

The Hospital Stay must meet all of the following:

be at the direction and under the care of a Physician; and
begin within the timeframe shown on the Schedule of Benefits; and
begin while the Insured is covered under this Policy.

The benefit will be paid for each day of continuous Hospital Stay that continues after the end of the Benefit Waiting Period if any as shown in the Schedule of Benefits. Benefits will be paid retroactively to the first day of the Hospital Stay.

Physical Therapy Benefit

We will pay this benefit as shown in the Schedule of Benefits subject to the following conditions, if the Insured requires Physical Therapy to treat an Injury resulting directly; and independently of all other causes; from a Covered Accident.

Physical Therapy must:

be received on an outpatient basis;
commence within 30 days of a Hospital stay that was for Treatment of the same Injury; and
be given by a licensed physical therapist upon the recommendation of the attending Physician.

Physical Therapy means manipulation by physical and mechanical means including heat Treatment or diathermy; ultrasonic; microtherm; manipulation; adjustment; massage therapy; and acupuncture.

SECTION VIII – SCOPE OF COVERAGE

Benefits will be paid according to the following basis.

Full Excess Benefits

If an Insured incurs Covered Expenses, We will pay the applicable benefit, subject to any applicable Deductible; Coinsurance Factor; and Benefit Period shown on the Schedule of Benefits that are in excess of amounts payable by any other Health Care Plan; regardless of any Coordination of Benefits provision contained in such Health Care Plan. The first expense must be incurred within the Loss Period stated on the Schedule of Benefits. The Total Benefit Maximum payable and sub-limits under the Policy are shown on the Schedule of Benefits.

Failure by an Insured to follow the terms and conditions of his or her primary coverage will result in a benefit reduction of Covered Expense to 50% of the amount otherwise payable under the Policy. This limitation will not apply to emergency Treatment required within 24 hours after a Covered Accident. Such Covered Accident must occur outside the geographic area served by the primary plan’s HMO, PPO or other similar arrangement for provision of benefits or services, if applicable.

Health Care Plan means any contract, policy or other arrangement for benefits or services for medical or dental care or Treatment under:

group or blanket insurance, whether on an insured or self-funded basis;
hospital or medical service organizations on a group basis;
Health Maintenance Organizations on a group basis;
group labor management plans;
employee benefit organization plan;
professional association plans on a group basis;
any other group employee welfare benefit plan as defined in the Employee Retirement Income Security Act of 1974 as amended; or
automobile no-fault coverage (unless prohibited by law).

SECTION IX - PREMIUM

We provide insurance in return for premium payments. The premium showed in the Schedule of Benefits is payable to Us in the manner described in the schedule; and is based on: rates currently in force; the plan; and the amount of insurance in force.

We have the right to rely upon the accuracy of the Policyholder’s calculations; and require the Policyholder to furnish a census from time to time but not more than twice in a 12-month period. If, at any time, it is determined that additional premium or a premium credit is due, the Policyholder will pay the additional premium or apply the premium credit at the next premium due date.

If any premium payment is not paid when due, the Policy will be cancelled as of the premium due date; except as provided under the Grace Period section.

Grace Period

After the payment of the first premium, this Policy will have a 31 day grace period. This means that if premium is not paid on or before the date it is due, it may be paid during the 31 day grace period. During this time, this Policy will stay in force provided the Policyholder pays all the premiums due by the last day of the grace period; unless the Policyholder gives Us written notice of the discontinuance of the coverage in advance of the date of discontinuance and in accordance with the terms of the Policy. This Policy will terminate on the last day of the period for which all premiums have been paid if the Policyholder fails to pay all premiums due by the last day of the grace period.

Changes in Premium Rate

We may change the premium rates from time to time with at least 31 days advanced written or authorized electronic notice.

However, We reserve the right to change rates at any time including during any rate guarantee period if any of the following events occur:

A change in the terms of the Policy.
A subsidiary; division; affiliated organization; or eligible class is added or deleted to the Policy.
A change in any federal; or state law; or regulation affecting this Policy and Our benefit obligation.
A change in the factors bearing on the risk assumed.
A misrepresentation in the information relied on in establishing the rate for this Policy.
The number of Insured’s or persons eligible for coverage or Estimated Volume of Insurance increases or decreases by more than 10% since the later of the Policy Effective Date or the date of the last renewal of this Policy.
The Policyholder fails to provide sufficient information, as required by Us, to confirm adequacy and accuracy of premiums and rates being paid.

If an increase or decrease in rates takes place on a date that is not a Premium Due Date, a prorated adjustment will apply from the date of the change to the next Premium Due Date.

Premium Audit

We may examine the Policyholder's books and records relating to this Policy at any reasonable time during the Policy Term and up to three (3) years after expiration of this Policy or until final adjustment and settlement of all claims under this Policy, whichever is later.

The Policyholder must maintain information pertaining to the Insureds, but not limited to each Insured's Benefit Amount, Class, salary, enrollment form, if any, and beneficiary designations or assignments.

New Subsidiary or affiliate company

The premium for this Policy applies only to the Policyholder’s organization as composed on the Policy Effective Date as described in the Application; or as thereafter amended.

The eligible persons of any corporation; partnership; or sole proprietorship acquired by the Policyholder after the Policy Effective Date through merger; stock purchase; exchange of stock; or otherwise may be covered under this Policy subject to the following conditions:

the Policyholder must report, in writing, the name of the newly acquired entity and all underwriting information necessary to determine any additional premium required; and
Underwriting and acceptance of the new entity by Us and
the Policyholder must agree to, and must pay, any required additional premium.

Newly Acquired Corporations, Partnerships, or Sole Proprietorships

The Premium for this Policy applies only to the Policyholder as constituted on the Policy Effective Date (or any renewal date of this Policy). However, any corporation, partnership, or sole proprietorship acquired by the Policyholder after the Policy Effective Date (or the renewal date) will be considered a covered affiliate or subsidiary, as of the date of the acquisition, but only if the following conditions are both met by the Policyholder within a reasonable time after the acquisition date: (1) it must report to Us , in writing, the name of the newly acquired entity and all underwriting information We deem necessary to determine any additional premium required; and (2) it must agree to, and must pay, any required additional premium (or an appropriate portion thereof as agreed upon with Us . If both conditions are not met within a reasonable time after the acquisition date, the newly acquired entity will not be considered a covered affiliate or subsidiary, and the employees/members from the newly acquired entity will not be eligible for coverage, until the date both conditions are met.

Schedule of Affiliates and Subsidiaries

Eligible persons employed by or a member of an affiliate or subsidiary of the Policyholder as of the Policy Effective Date are covered under the Policy. The coverage will begin and end in accordance with the Effective Date of Insurance and Termination Date of Insurance in the Policy. A list of these affiliates and subsidiaries must be kept on file with Us.

Reinstatement

The Policy may be reinstated within 31 days of lapse if it has lapsed for nonpayment of premium, if: the Policyholder submits written application to Us ; We accept the application; and the Policyholder makes payment of all overdue premiums.

SECTION X - CLAIMS PROVISIONS

Notice of Claim

Written notice of claim; death; or injury must be given to Us or Our designated representative within 20 days after the date of the Covered Loss or as soon as reasonably possible. Failure to give notice within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably practicable.

Notice should include the Insured’s name, address, Policyholder name and Policy Number.

Claim Forms

When We receive a notice of claim, We will send forms for filing proof of loss. If claim forms are not sent within 15 days the claimant will satisfy the requirements of written proof of loss by sending the written proof as shown below. Proof of loss must describe the occurrence, extent and nature of the loss.

Proof of Loss

Written proof of loss, including a loss of time for disability, must be given to Us within 90 days after the date of the Covered Loss, or after the commencement of the period for which We are liable. If the proof of loss is not submitted within 90 days, it should be sent as soon as reasonably possible; otherwise the claim may be reduced or invalidated. In no event, except in the absence of legal capacity, should proof of loss be sent later than one year from the time proof is otherwise required. We may require subsequent proofs of loss for the continuance of the disability and these should be provided at reasonable intervals.

Beneficiary

The Insured may designate a beneficiary. The primary Insured shall have the sole right to designate a beneficiary for any Dependent child who is a minor. All beneficiary designations must be 1) in writing; 2) filed with the Policyholder; and 3) provided to Us at the time of claim; or 4) at such other time as We may require.

The Insured, and no one else, unless there is an irrevocable assignment, has the right to change the beneficiary except as set forth above. The Insured does not need the consent of anyone to do so.

All beneficiary changes must be 1) in writing; 2) filed with the Policyholder; and 3) provided to Us at the time of claim or such other time as We may require. If it is necessary to designate a beneficiary for a minor, the parent or guardian may exercise that right. The change will be effective when received by the Policyholder. When received, the effective date is the date the notice was signed. We are not liable for any payments made before the change was received. We cannot attest to the validly of a change.

Payment of Claims

We or Our designated representative, will pay a claim after receipt of acceptable proof of loss. Benefits for loss of life are payable to the Insured’s beneficiary. The designation shall be as follows:

Beneficiaries designated in writing by the Insured for this Policy on file with the Policyholder, if any, otherwise;
Beneficiaries as designated in writing for any group life insurance plan or its renewals in force for the Policyholder, if any, otherwise;
If a beneficiary is not otherwise designated by the Insured, benefits for loss of life will be paid to the first of the following surviving preference beneficiaries surviving party in the following order:
the Insured’s Spouse/Domestic Partner;
in equal shares to the Insured’s child or children jointly;
in equal shares to the Insured’s surviving parents jointly if both are living or the surviving parent if only one survives;
in equal shares to the Insured’s surviving brothers and sisters jointly; or
the Insured’s estate.

All other claims will be paid to (or on behalf of, if applicable) the Insured suffering the loss. In the event the Insured is a minor, incompetent or otherwise unable to give a valid release for the claim, We may make arrangement to pay claims to the Insured's legal guardian, committee or other qualified representative. All or a portion of all other benefits provided by this Policy may, at the option of Us, be paid directly to the provider of the service(s). All benefits not paid to the provider will be paid to the Insured.

Any payment made in good faith will discharge Our liability to the extent of the claim.

Recovery of Overpayment

If benefits are overpaid; or paid in error We have the right to recover the amount overpaid; or paid in error by any of the following methods:

A request for lump sum payment of the amount overpaid; or paid in error; or
Offset or reduction of any proceeds payable under this Policy by the amount overpaid; or paid in error.

Right of Recovery

An Insured may incur charges due to an Injury for which benefits are paid by this Policy. The injury may be caused by the act or omission of another person. If so, the Insured may have a claim against that other person for payment of expense-incurred charges. If Recovery under the claim is made, the Insured must repay Us the Recovery made from: 1) another person; 2) insurance companies; or 3) other organizations.

Recovery means monies paid to the Insured through judgment, settlement or otherwise to compensate for all losses caused by the Injury.

Net Recovery means the Insured’s Recovery less attorney’s fees and court costs incurred in making the Recovery. Refund means repayment to Us for benefits paid.

Timely Payment of Claims

Benefits for loss covered by this Policy, other than benefits that require periodic payment, will be paid immediately after We receive due written proof of such loss. Subject to due proof of loss, all benefits for loss covered by this Policy that require periodic payment shall be paid on a monthly basis during the continuance of the period for which We are liable, and. any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of such proof.

Newly Acquired Organizations

The Premium shown on the Schedule of Benefits applies only to the Policyholder and any affiliates or subsidiaries covered on the Policy Effective Date. However, eligible employees/individuals of organizations acquired by the Policyholder during the Policy Term may be covered based on the Policyholder:

Reporting to Us within 60 days of the acquisition, the name of the newly acquired organization; and
Providing any underwriting information We may need to calculate the premium; and
Paying the required additional premium, if any to Us.

Newly Acquired Corporations, Partnerships, or Sole Proprietorships

(1) it must report to Us , in writing, the name of the newly acquired entity and all underwriting information We deem necessary to determine any additional premium required; and

(2) it must agree to, and must pay, any required additional premium (or an appropriate portion thereof as agreed upon with Us ). If both conditions are not met within a reasonable time after the acquisition date, the newly acquired entity will not be considered a covered affiliate or subsidiary, and the employees/individuals from the newly acquired entity will not be eligible for coverage, until the date both conditions are met.

Schedule of Affiliates

Eligible persons employed by ay affiliate or subsidiary of the Policyholder as of the Policy Effective Date are covered under the Policy. The coverage will begin and end in accordance with the Effective Date of Insurance and Termination Date of Insurance in the Policy. A list of these affiliates and subsidiaries must be kept on file with Us.

Physical Examination and Autopsy

We have the right to have a Physician of Our choice examine the Insured as often as is reasonably necessary. This section applies when a claim is pending or while benefits are being paid.

We also have the right to request an autopsy in the case of death, unless the law forbids it. We will pay the cost of the examination or autopsy.

Subrogation

To the extent We for a loss suffered by an Insured, We will take over the rights and remedies the Insured had relating to the loss. This is known as subrogation. The Insured must help Us to preserve its rights against those responsible for the loss.

This may involve signing any papers and taking any other steps We may reasonably require. If We take over an Insured 's rights, the Insured must sign an appropriate subrogation form supplied by Us. We have the right to offset future benefits payable to the Insured under this Policy against any such Recovery.

SECTION XI - GENERAL POLICY PROVISIONS

Assignment

This Policy is not assignable, whether by operation of law or otherwise. Benefits may be assigned. No assignment of interest in loss of life benefits shall be binding on Us until the original or duplicate thereof is received by Us . We assume no responsibility for the validity of such assignment.

Certificates of Insurance

Where it is required by law, or upon request of the Policyholder, We will make available to all Insured’s certificates outlining the benefits; conditions; exclusions; and limitations of this Policy.

Clerical Error

Clerical error in keeping any records pertaining to the coverage, whether by the Policyholder or by Us , will not invalidate coverage otherwise validly in force; nor continue coverage otherwise validly terminated, provided such clerical error is not prejudicial to Us and is rectified promptly upon discovery. No error will continue the insurance of an Insured beyond the date it should end under the Policy terms. After an error is found, We will take appropriate action, which may include adjusting, collecting or refunding premium.

Conformity with State Laws

On the effective date of this Policy, any provision of this Policy in conflict with the laws of the state where it is issued is amended to conform to the minimum requirements of such laws.

Entire Contract/Changes

This Policy, including any endorsements; amendments; and attached papers; the signed application of the Policyholder; and any individual applications of Insured’s is the entire contract between the Policyholder and Us. A copy of the application, if any, of the Policyholder shall be attached to the Policy when issued. All statements made by the Policyholder or by an Insured are in the absence of fraud, deemed representations and not warranties. No such statement will cause Us to void the insurance under this Policy or be used as a defense of a claim, unless it is contained in a written application.

An Insured, his/her beneficiary, or assignee, shall have the right to make written request to Us for a copy of such application and We shall, within 15 days after the receipt of such request at its home office or any of Our branch offices, deliver or mail to the person making such request a copy of such application. Such written request shall provide Us with the full name and address of the Insured, the policy owner and the policy number if known, or the written request shall contain such information that We can reasonably be expected to locate the application. If such copy is not so delivered or mailed, We shall be precluded from introducing such application as evidence in any action based upon or involving any statements contained therein.

Valid changes to this Policy may be made at any time by an endorsement or amendment signed by Us, provided that any such amendment which reduces or eliminates coverage was either requested in writing by the Policyholder or signed by the Policyholder. We may also, upon 31 days written notice to the Policyholder, change or modify the provisions of this Policy to comply with any applicable requirements of the Internal Revenue Service and any state or other federal law or regulation. No agent may change this Policy or waive any of its provisions.

Electronic Delivery of Documents

The Policyholder agrees to receive, accept, obtain or submit any and all documentation including the policy in electronic form e.g. via email and agrees that electronic communications is a reasonable and proper form of communication that fully satisfies any requirement that communications be provided in writing.

Insolvency

The insolvency; bankruptcy; financial impairment; receivership; voluntary plan of arrangement with creditors; or dissolution of the Policyholder will not impose upon Us any liability other than the liability defined in this Policy. The insolvency of the Policyholder will not make Us liable to the creditors of the Policyholder, including insured’s under this Policy.

Incontestability

Except for nonpayment of premiums, We will not contest the validity of an Insured’s coverage after it has been in force for two years from its date of issue. No statement made by an Insured relating to his or her insurability shall be used to contest the validity of his insurance after the insurance has been in force for two years during his or her lifetime, exclusive of any period of disability; nor unless it is contained in a written application signed by him or her.

Legal Action

No legal action may be brought to recover on this Policy until there has been full compliance with all the terms of this Policy. All Policy terms will be interpreted under the laws of the state in which this Policy was issued. No legal action may be brought to recover on this Policy before 60 days following the date written Proof of Loss was given to Us. No legal action may be brought against Us more than three (3) years after the time required for written Proof of Loss.

Misrepresentation and Fraud

This entire Policy will be void, whether before or after a loss, if We determine that the Policyholder; Insured; or its agent has concealed or misrepresented any material fact or circumstance concerning this Policy, including any claim or any case of fraud by the Policyholder; Insured; Third Party Administrator; or other agent relating to this Policy.

Misstated Data

We have relied upon the underwriting information provided by the Policyholder; its Third Party Administrator; or other Agent in the issuance of this Policy. Should subsequent information become known which, if known prior to issuance of this Policy, would have affected the rates; deductibles; terms; or conditions for coverage, We will have the right to revise the rates; deductibles; terms; or conditions as of the Effective Date of issuance, by providing written notice to the Policyholder.

Payment of Premium

We provide insurance in return for the payment of premiums. The Premiums are to be paid to Us by the Policyholder. The first Premium is due on or before the Policy Effective Date. After that premiums will be due monthly unless shown otherwise in the Schedule of Benefits. If any premium is not paid when due, the Policy will be cancelled as of the Premium Due Date; except as provided in the Policy Grace Period provision.

Waiver

Our failure to strictly enforce Our rights under this Policy at any time or under any circumstance shall not constitute a waiver of such rights by Us at any time under the same or different circumstances.

Workers’ Compensation

This Policy is not a Workers’ Compensation policy. It does not provide Workers’ Compensation benefits; and does not satisfy any requirements for coverage by any Workers' Compensation Act or similar law.

SECTION XII – GENERAL EXCLUSIONS

Unless specifically covered by this Policy, We do not provide coverage for any loss or Injury resulting or caused, in whole or part, from:

Insured’s Suicide or attempted suicide; self-destruction or attempted self-destruction while sane or insane.
Insured’s Intentionally self-inflicted injury.
War or any act of war or invasion; declared or undeclared.
Insured’s full-time active duty in the armed forces; National Guard; military; naval; or air service; or organized reserve corps of any country or international organization.
Sickness; disease; bodily or mental infirmity; or any bacterial or viral infection; or medical or surgical Treatment thereof, except for any bacterial infection that results from: an accidental external cut; or wound; or pyogenic infections that result from accidental ingestion of contaminated food substances, unless otherwise covered by this Policy.
Insured’s piloting or serving as a crewmember or riding in any aircraft except as a fare-paying passenger on a regularly scheduled or charter airline.
Insured’s voluntarily taking any drug or narcotic unless the drug or narcotic is prescribed by a Physician.
Insured being intoxicated while operating any vehicle, means of transportation or Conveyance. Intoxication is defined by the laws of the jurisdiction where such Accident occurs.
Insured’s violation of or attempt to violate any duly-enacted law or regulation; or commission or attempt to commit an assault; felony; or other illegal activity.
Injuries paid under Workers’ Compensation, Employer’s liability laws; or similar occupational Benefits.
Aggravation or re-injury of a prior Injury that the Insured suffered prior to coverage effective date, unless We receive and approve a written medical release from the Insured’s Physician.
To the extent We are prohibited from providing coverage or making payment by any type of travel restriction; trade restriction; economic sanction; or embargo imposed by the U.S. government.
Insured’s active participation in acts of terrorism, civil commotion or riots of any kind.
Travel arrangements that were neither coordinated by nor approved by Us in advance, unless otherwise specified.
Insured’s travel or flight in or on any aircraft or , including entering or exiting from:

a. while riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or
b. while being used for any test or experimental purpose; or
c. while piloting; operating; learning to operate; or serving as a member of the crew thereof; except as covered in this Policy; or
d. while traveling in any such aircraft or device which is owned; controlled; or leased by or on behalf of the Policyholder of any subsidiary or affiliate of the Policyholder, or by the Insured or any member of his or her household, except as covered in this Policy; or
e. being flown by the Insured or which the Insured is a member of the crew; or
f. being used for: i) crop dusting; spraying or seeding; giving and receiving flying instructions; fire fighting; sky writing; sky diving or hang gliding; pipeline or power line inspection; bungee-cord jumping; mountaineering; parasailing; aerial photography or exploration; racing; endurance tests; stunts or acrobatic flying; or ii) any operation that requires a special permit from the FAA, even if it is granted. (This does not apply if the permit is required solely because of the territory flown over or landed on.);
g. designed for flight above or beyond the earth’s atmosphere;
h. which is an ultra light; or glider;
i. being used for the purpose of skydiving; or parachuting;
j. being used by any military authority; except an aircraft used by the Air Mobility Command or its foreign equivalent.

In addition to the exclusions above, We will not pay Accident Medical and Dental Expense Benefits or Additional Accident Benefits for any loss, Treatment or services resulting from or contributed to by:

Pre-Existing Conditions.
Treatment by persons employed or retained by a Policyholder; or by any Immediate Family member of the Insured's household.
Treatment of Sickness; disease; or infections except pyogenic infections or viral or bacterial infections that result from the accidental ingestion of contaminated food substances.
Treatment of hernia; Osgood-Schlatter's Disease; osteochondritis; appendicitis; osteomyelitis; cardiac disease or conditions; pathological fractures; congenital weakness; detached retina unless caused by an Injury; or mental disorder; or psychological or psychiatric care or Treatment (except as provided in the Policy); whether or not caused by a Covered Accident.
Mental and Nervous Disorders (except as provided in the Policy).
Damage to or loss of dentures or bridges; or damage to existing orthodontic equipment (; except as specifically covered by the Policy.
Expense incurred for Treatment of temporomandibular; or craniomandibular joint dysfunction; and associated myofacial pain (except as provided by the Policy).
Any elective Treatment; surgery; health Treatment; or examination; including any service; Treatment; or supplies that: (a) are deemed by Us to be experimental; and (b) are not recognized and generally accepted medical practices in the United States.
Replacement of artificial limbs; eyes; and larynx.
Cosmetic surgery; except for reconstructive surgery needed as the result of an Injury.
Charges for Treatment which are not Medically Necessary.