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As a member, you receive the following benefits through the Travel Assistance Program when traveling more than one hundred (100) miles from your permanent place of Residence, and the trip duration is ninety (90) consecutive days or less if an accidental injury or sickness commences during the course of the covered trip. The following is a summary description only of the program's services. If you have any questions, please call the customer service number provided with your benefit information.
ALL BENEFITS AND SERVICES MUST BE PRE-ARRANGED
BY THE ASSISTANCE PROVIDER COMPANY
BY CALLING THE NUMBER IN YOUR GUIDE.
If an insured incurs an accidental injury or sickness and adequate medical facilities are not available locally in the opinion of the assistance company physician, the assistance company will arrange an emergency medical evacuation (under medical supervision if necessary) by whatever means necessary to the nearest facility capable of providing adequate care. Covered expenses include transportation and related medical services (including cost of medical escort) and medical supplies necessarily incurred in connection with the emergency evacuation. All transportation arrangements made for the emergency evacuation must be made by the most direct and economical route possible.
After initial treatment and stabilization for the accidental injury or sickness suffered by the insured, if the attending physician deems it medically necessary, and the assistance company physician agrees, the assistance company will arrange transport for the insured back to his or her permanent place of residence for further medical treatment or to recover. Covered expenses include transportation and related medical services (including escort if necessary) and medical supplies necessarily incurred in connection with the repatriation. All transportation cost made for repatriation must be by the most direct and economical route possible. Emergency Evacuation and Medically Necessary Repatriation Total Combined Limit up to USD $100,000.
OF MORTAL REMAINS
In the event of death of an insured, the assistance company will provide for the return of mortal remains. Covered expenses are the following: locating a sending funeral home, transportation of the body from the site of death to the sending funeral home; preparation of the remains for either burial or cremation; transportation of the remains from the funeral home to the airport; providing the minimum necessary casket or air tray for transport; consular services (in case of death overseas); procuring death certificate; transport of the remains from the airport to the receiving funeral home. Once the insured's body has been delivered to the receiving funeral home, this coverage ends. Up to USD $20,000.
In the event an insured requires emergency medical evacuation by air ambulance or repatriation by commercial airlines provided in this agreement, air transport of the insured spouse or other family member or traveling companion will be provided so that person may accompany the insured in flight, subject to space availability, giving priority to medical equipment and medical personnel aboard and for the welfare and safety of the insured receiving services in this agreement. All services in connection with transportation of traveling companion must be preapproved and arranged by the assistance company. Up to USD $5,000.
When a member is traveling alone and is hospitalized for more than seven (7) consecutive days, the assistance company will arrange transportation to the place of hospitalization for a chosen person by the insured, provided repatriation is not imminent. Covered expenses include the cost of the most direct economy round trip common carrier ticket to the place of hospitalization. Up to USD $5,000.
When dependent children, traveling on a covered trip with the insured, are left unattended as the result of an insured's injury or sickness, the assistance company will arrange to transport such minors to the domicile of a person nominated by the insured or next of kin. Covered expenses include a one way common carrier economy ticket by the most direct route. Attendants will be provided if necessary. Up to USD $5,000.
Should the participant need help with overseas medical claims, the Assistance Provider will assist him / her in coordinating the claims procedure with the Participant's insurance program.
Should the participant need to be medically monitored, the assistance provider's duty physician will monitor the case, while liaising with the participant, the local attending physician, the family physician and the medical director of the assistance provider.
Should the participant need help locating a physician or hospital, the assistance provider will provide referrals to a local prequalified physician and / or hospital.
Should the participant need help for overseas medical payments the assistance provider will assist in the arrangement of payment or guarantee of payment to medical providers. Subject to the quality of the participant's confirmed personal credit.
Should the participant need help communicating in a foreign country, the assistance provider will provide telephone interpretation.
Should the participant need help to replace lost or stolen travel documents (i.e., passport, baggage, tickets, credit cards, etc.), the assistance provider will advise and assist where possible regarding their replacement.
Should the participant need help arranging local attorneys, embassies and consulates, arranging bail, or coordination of payment for legal services the assistance provider will provide referrals and payments, from available resources of the participant.
EMERGENCY DELIVERY OF
Should the participant need prescription medication or lenses not available locally, the assistance provider will organize the delivery of the prescribed item to the participant upon written authorization from the prescribing physician when possible and legally permissible.
TRANSFER & ADVANCES
Should the participant need cash as a result of loss or theft, the assistance provider will arrange for emergency cash transfers and advances through additional sources, including hotels, banks, Consulates and Western Union, up to a limit of $500 per transaction. All transactions are subject to any government regulation and to the availability of the participant's confirmed personal credit.
Should the participant need information before and or during travel he / she may call the assistance provider 24 hours a day to obtain help. The multilingual staff is prepared to assist and coordinate the management of a wide variety of travel related situations. Services include but are limited to information on required documents, immunization requirements, State Department travel advisory warnings on travel to certain locations, suggested medical exams or treatment before departure and medical care en route.
In the event an insured should suffer from a certified illness, injury or death which requires emergency medical evacuation / medical necessary repatriation or transportation of mortal remains and the insured is thereby unable to drive his / her vehicle, this assistance will provide vehicle return service for ground vehicles such as cars, trucks, vans, travel trailers or motor homes, operated by the insured, to the insured permanent residence. This benefit will pay the cost, up to USD $1,000 for fuel, oil, driver, and tolls to affect such return. The insured will bear the cost of any repair due to mechanical breakdown, en route, as well as cost of food and accommodations. The vehicle must be in condition capable of being safely operated on the highway. All services in connection with vehicle return must be preapproved and arranged by the assistance company. All coverages apply only when the insured is traveling more than 100 miles from the insured permanent place of residence and the trip is 90 consecutive days or less. Covered expenses are reasonable and customary expenses for necessary transportation, related medical services and medical supplies incurred in connection with the coverage's listed above. All transportation arrangements made must be by the most direct route. Covered expenses for transportation must be recommended by the attending physician, required by the standard regulations of the conveyance transporting the insured and arranged by the assistance company. Up to $1,000 USD.
LIMITATIONS & EXCLUSIONS
The following conditions represent coverage exclusions:
- Suicide or attempted suicide;
- Intentionally self-inflicted injuries;
- War, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war;
- Participation in any military maneuver or training exercise;
- Mental or emotional disorders, unless hospitalized;
- Being under the influence of drugs or intoxicants, unless prescribed by a Physician;
- Commission or the attempt to commit a criminal act;
- Participation as a professional in athletics;
- Pregnancy and childbirth (except for complications of pregnancy);
- Travel undertaken for the specific purpose of securing medical treatment; and
- Bodily Injury or Sickness which can be treated locally and does not prevent the Insured from continuing his or her journey or from returning home.
This benefit is NOT available to residents of CT, FL or NY.
Terms, Conditions, & Disclosures
NURSELINE, DIRECT LABS, EMERGENCY TRAVEL & ROADSIDE ASSISTANCE
This plan is not insurance. This is your agreement as Cardholder with Coverdell & Company, Inc. (a "discount medical plan organization", "DMPO"). It is effective on the date of acceptance of Carholder's application for enrollment in the UBA Membership ("Program") and for the period of your plan. DMPO shall provide Cardholder with a listing of participating providers. Cardholder shall excuse DMPO from any liability for errors in such listing. Providers are subject to change without notice. Cardholder is responsible for choice of provider, verification that the provider is a current participant and for payment for goods and services. No portion of any provider's fee will be reimbursed or otherwise paid by Coverdell. You are solely responsible for payment. Savings are based on the provider's usual fees or on national or regional fees for the service or product. Actual savings will vary depending upon your location and the specific products or services purchased. Providers may offer certain products or services purchased. Providers may offer certain products or services to the general public at prices lower than the Program price. In that event, members will always be charged the lower price. This is a discount program and not insurance. Program discounts cannot be used in conjunction with any other network based program.
Although DMPO screens participating providers to ensure appropriate credentials and qualifications to provide goods and services, DMPO does not otherwise guarantee nor is responsible for the quality of such service or product purchased by Cardholder. Coverdell reserves the right to modify any benefits included in Your Program, but will make every attempt to replace any benefits with a comparable benefit. If your state requires that we notify you of changes to your benefits, Coverdell will do so.
Payment of membership fee is made by the billing source authorized by You in accordance with the payment terms to which You agreed. DMPO reserves the right to increase or decrease the membership fee for each renewal of Your membership. Membership is not transferable. You have a family membership, only you and your immediate family may use the membership. "Immediate Family" means, you, your spouse, and children living in your home. Should a single member wish to add family members on a family plan, call the customer service number shown on the membership I.D. Card.
General Complaint Procedure. Complaints of any nature may be filed with Coverdell & Company, Inc. the discount medical plan organization at 8770 W Bryn Mawr, Suite 1000, Chicago, IL 60631. Complaints will be acknowledged in writing within 5 business days and will be resolved in writing to you within 30 calendar days. Should you remain dissatisfied with the results from your complaint with the discount medical plan organization, you may contact the Commissioner of Insurance, Division of Insurance, the insurance department or other agency which regulates this product in your state. Contact us at 1-800-308-0374 to obtain state complaint contact information.
Termination and Cancellation. You may terminate Your membership at any time by logging into www.ubamembers.com - select the billing link and submit a cancellation request or by calling us at 866-438-4274. You can also notify us in writing at 409 W Vickery Blvd, Fort Worth, TX 76104. Your cancellation will be effective promptly upon the receipt of Your cancellation notice and You will no longer be billed for Your membership.
THIS IS NOT INSURANCE
Governing Law and Arbitration. Your membership is governed and controlled by the laws of the State of Illinois. Any dispute arising from or related to Your membership shall be resolved by binding, non-appealable private arbitration conducted in accordance with the Rules of American Arbitration Association in Chicago, Illinois, unless required by a member's individual state laws to resolve in a different location. This provision shall survive the termination of Your membership and shall be subject to the Federal Arbitration Act.
Governing Law and Arbitration for Montana Residents. Your membership is governed and controlled by the laws of the State of Montana. Any dispute arising from or related to Your membership shall be resolved by a voluntary private arbitration conducted in accordance with the Rules of the American Arbitration Association in the State of Montana. This provision shall survive the termination of Your membership and shall be subject to the Federal Arbitration Act.
South Dakota Residents. If you cancel the program you are not obligated to make any further payments under the program, nor are you entitled to any benefits under the program for any period of time after the last month for which payment has been made.
Disclosure. This plan is NOT insurance. This plan is not a qualified health plan under the Affordable Care Act (ACA). Some services may be covered by a qualified health plan under the ACA. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This is not a Medicare prescription drug plan. The plan provides discounts at certain health care providers of medical services. The plan does not make payments directly to the providers for medical services. The plan member is obligated to pay for all health services but will receive a discount from those health care providers who have contracted with the discount medical plan organization. The range of discounts will vary depending on the provider type and services provided. This plan is administered by Coverdell & Company, Inc., a licensed discount medical plan organization at 8770 W. Bryn Mayr, Suite 1000, Chicago, IL 60631, 1-800-308-0374. To view a list of participating providers visit: http://www.gapplusplan.com/ubalabs.html. This plan is provided to you at no cost and you may cancel at any time.