Participant Accident Insurance Coverage
Who Is Covered
All participants are covered while participating in
Policyholder sponsored and supervised mixed martial arts, kickboxing, boxing
or wrestling events. A participant is also covered while traveling, directly
and without interruption, to and from any Policyholder sponsored activity
and his or her home or place of residence.
Maximum Medical Expense Benefit
If the Covered Person incurs eligible expenses as the result
of a covered injury, the Company will pay the charges incurred for such
expense within 1 year, beginning on the date of accident. Payment will be
made for eligible expenses in excess of any other applicable insurance, not
to exceed the Maximum Medical Expense Benefit. The first such expense must
be incurred within 90 days after the date of the accident. “Eligible
Expenses” means charges for the necessary medical treatment and service, not
to exceed the Maximum Medical Expense Benefit as indicated on the following
pages.Excess Coverage: This plan does not cover treatment or service for
which benefits are payable or service is available under any other insurance
or medical service plan available to the Insured Person.
Accidental Death & Dismemberment
If a covered injury results in any of the losses specified
below within one year after the date of the accident, the company will pay
the applicable amount.
• Full Principal Sum for loss of life
•
Full Principal Sum for double dismemberment
•
Full Principal Sum for loss of sight of both
eyes
•
50% of the Principal Sum for loss of one hand,
one foot, or sight of one eye
•
25% of the Principal Sum for loss of index
finger and thumb of same hand
“Member” means hand, foot, or eye. Loss of hand or foot
means com plete severance above the wrist or ankle joint. Loss of eye means
the total, permanent loss of sight. If the Principal Sum is payable, no
indemnity will be paid for dismemberment. In any event, the Double
Dismemberment Indemnity is the maximum amount payable under this Benefit for
all losses resulting from one accident.
Exclusions and Limitations
This plan does not cover any loss to or resulting from:
• intentional self-inflicted injury,
suicide while sane or insane or any attempt thereat (in Missouri this
applies only while sane);
• voluntary
self-administration of any drug or chemical substance not prescribed by, and
taken according to the directions of the Insured Person’s Physician;
• participation in a riot or insurrection;
• an act of declared or
undeclared war;
• active duty service in
any Armed Forces of any country, and, in such event, the prorata unearned
premium will be returned upon proof of service. This does not include
Reserve or National Guard active duty or training unless it extends beyond
31 days;
• parachuting, except for
self preservation;
• bungee jumping, flight
in an ultralight aircraft, hang gliding;
• sickness, disease,
bodily or mental infirmity or medical or surgical treatment thereof,
bacterial infection, regardless of how contracted. This does not exclude
bacterial infection that is the natural and foreseeable result of an Injury
or accidental food poisoning;
• services or treatment
rendered by a Physician, Nurse, or any other person who is: employed or
retained by the Policyholder; or is the Insured Person or an Immediate
Family Member;
• flight in an aircraft,
except as a fare-paying passenger;
• dental treatment,
except as otherwise provided, and only when Injury occurs to sound natural
teeth;
• any loss for which
benefits are paid under state or federal worker’s compensation, employers
liability, or occupational disease law;
• treatment in any
Veteran Administration or Federal Hospital, except if there is a legal
obligation to pay;
• cosmetic surgery,
except for reconstructive surgery due to a covered injury;
• charges the Insured
Person would not have to pay if He did not have insurance;
• eyeglasses, contact
lenses, hearing aids;
• charges that are in
excess of Usual, Customary, and Reasonable charges.
