1. MEMBERSHIP: UCA Membership is mission oriented, dedicated to helping members live a life filled with more caring and happiness. In a desensitized and challenging world, the UCA is committed to increasing emotional awareness in support of a more loving and caring environment through the provision of information, education, inspirational materials, and programs. As part of its ongoing mission, UCA sponsors caring initiatives in the developing and developed world by teaming with projects that help Children, Animals, Reforestation and the Elderly. Member means a person whose membership has been accepted by the UCA.
2. MEMBERSHIP PLAN COST: You hereby authorize the UCA or its designated membership administrator to charge your credit card or bank account using the billing information supplied by you for the Membership charges selected by you every month. Your initial membership plan cost will be processed immediately upon enrollment. Membership is automatically renewed monthly and your recurring payment will routinely draw from your specified account each month thereafter. Non-payment of monthly membership plan cost will result in cancellation of monthly Membership benefits included in those costs. It is your responsibility to make sure that you are being charged each month. If you fail to make a payment or your payment is declined, your monthly membership benefits will cease, and unfortunately no benefits will be available to you. Visit www.UnifiedCaring.org for more details on your UCA Base Membership Benefits. The UCA Base Membership does not include any insurance benefits and can be purchased by visiting www.UnifiedCaring.org.
3. CANCELLATION: If you are not completely satisfied, you may call the Member Services phone number on the back of your ID Card or e-mail to support@asureconnect. com to cancel at any time. You will be sent a full refund of the first monthly plan cost (which includes association membership costs, non-insurance services costs and insurance premium costs) only if cancellation is received within thirty (30) days from your effective date. The Member Lifetime Association Fee is non-refundable, except where refund provisions for such are specified by state law. Prorated refunds are not offered. Refunds can take up to five (5) business days to process. When insurance claims are submitted during the first thirty (30) days of membership you agree that such a submission constitutes acceptance of the membership, the products and their terms and submission of such a claim constitutes a waiver of any and all refund rights. For cancellations after the first 30 days, you must provide notification in writing, by fax, phone or e-mail prior to your next monthly payment due date to prevent another automatic bill from occurring. If you cancel, monthly membership benefits will terminate at the end of the billing cycle for which you have paid. Please call to confirm your request for cancellation was received.
4. THIRD PARTY INSURANCE DISCLAIMER: UCA is not an insurance company and does not sell insurance. All insurance matters are handled directly with licensed companies. UCA assumes no liability or risk with regard to insurance services and neither receives nor processes premiums or claims and receives no commission with regard to insurance processed. Any insurance coverage is made available by licensed insurance companies which issued policies to the UCA. Classes of membership that include insurance benefits may be subject to age, limitations, conditions and exclusions. If any such benefits are no longer available to member, membership class may be changed or cancelled at member discretion. Policies included in the UCA membership are not Major Medical or Comprehensive Medical Insurance coverage. Policies included in the UCA membership are not Minimum Essential Health Benefit Plans under Affordable Care Act nor Policies of Workers’ compensation Insurance under state law.
5. THIRD PARTY DISCLAIMER: UCA is not a merchant, manufacturer, or a provider of any savings programs or Services included in membership. UCA may change service providers at its sole discretion. Providers of services at discounted pricing receive no reimbursement from UCA. UCA assumes no liability or risk for payment for services to these providers. Discount medical plans are included at no extra charge as part of membership and are administered by a licensed Discount Medical Plan provider.
6. CONSENT TO ELECTRONIC DELIVERY: Membership materials can be downloaded electronically, including instruction guides, certificates, and ID cards. Important notifications regarding memberships will be delivered by email and the privacy policy and terms and conditions can be viewed by logging into www.member.asureconnect. com. You are consenting to accept electronic delivery of your membership materials. Your electronic membership documents have the same effect, validity, and enforceability as paper copies. You also have the right at any time to receive a paper copy of any document that was provided to you electronically, at no charge by calling member services. You are responsible for providing updated contact information should your information change from what was previously provided. Please call member services or email support@asureconnect.com to make changes to your contact information.
7. COMMUNICATIONS: You may be contacted via text message and/or telephone at the number you provided using automated technologies and/or prerecorded messages. You may opt-out from receiving text messages and automated calls by calling the member services telephone number listed on your welcome email and membership materials.
8. RELEASE: Benefits are to be used at your sole discretion. Each Member, for himself/ herself, or Family Member (“Membership Participant”) who uses any information, programs, services or benefits included in membership (hereafter “Membership Benefits”), hereby forever releases, acquits, and discharges each of the UCA and its employees, officers, directors, agents, affiliates and third party providers from any and all liabilities, claims, demands, actions, and causes of action that such Member, Membership Participant, or Member’s legal representative(s) may have by reason of any damage or personal injury sustained as a result of or during the course of the use of any Membership Benefits. The sole recourse available to a Member, Membership Participant, or Member’s legal representative(s) against the UCA will be cancellation of the Program membership as provided in Paragraph 3 of this Agreement.
9. ENTIRE AGREEMENT: All provisions under this Agreement constitute the entire Agreement between the UCA and the Member. If any provision is declared void under the law, that provision is severable and the remainder of this Agreement shall remain in full force and effect.
10. HEADINGS. The headings or captions provided throughout this Agreement are for reference purposes only, and will in no way affect the meaning or interpretation of this Agreement.
11. WAIVER OF BREACH. A waiver by the UCA of a breach of any provision of this Agreement will not be deemed a waiver by the UCA of any other breach of the same or different provision(s). These terms and conditions are subject to change without notice. Ocean Consulting Group, Inc.* is the third-party administrator collecting your association fees and remitting the premium to the carriers providing insurance coverage as part of your association membership. *Otherwise known as “Ocean Consulting Group Administrators, Inc.” in the state of New Jersey and OCG Administrators and OCG Insurance Services in the state of California and Oregon GROUP FIXED INDEMNITY INSURANCE LIMITATIONS AND EXCLUSIONS: Underwritten By Everest Reinsurance Company. For complete listing of limitations and exclusions please see the policy. Expenses for any services, supplies, and Treatment as described below will not be considered Covered Benefits or Covered Services or a Covered Loss and no benefits will be payable for such expenses, unless expressed otherwise. 1. Breast Surgery – Capsular contraction, augmentation or reduction mammoplasty, except for all stages and revisions of reconstruction of the breast following a Medically Necessary mastectomy occurring while covered under this Certificate for Treatment of Cancer, including reconstruction of the other breast to produce a symmetrical appearance and Treatment of lymphedemas. 2. Certain services or treatment - No benefits are payable if provided by persons who do not normally charge for their services, unless there is a legal obligation to pay. 3. Cosmetic Surgery - No benefits are payable, except for reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or other disease of the involved part and reconstructive surgery because of Congenital Condition of a covered Dependent Child which has resulted in a functional defect. 4. Dental care and treatment - No benefits are payable, except for dental care or treatment due to accidental injury to Sound Natural Teeth within 12 months of a Covered Accident and except for dental care or treatment necessary due to congenital disease or anomaly. Sound Natural Teeth means teeth that are free of active or chronic clinical decay, have at least 50% bone support and are functional in the arch. 5. Elective treatment or surgery - No benefits are payable. 6. Experimental or Investigational treatment - No benefits are payable. 7. Extreme Sports - No benefits are payable for any Accident caused by or resulting from, directly or indirectly, a Covered Person’s participation in a sport featuring speed, height, danger, a high level of physical exertion, highly specialized gear, or spectacular stunts, including but not limited to: scuba diving; skydiving; hang-gliding, parachuting, paragliding or parascending; bungee jumping; mountaineering or rock climbing normally requiring the use of guides or ropes; caving; flight in an aircraft other than a regularly scheduled flight by an airline; entering, flying or exiting any aircraft while acting or training as a pilot or crew member; participation in a rodeo; operating or riding in or on any motorized or non-motorized vehicle engaged in acrobatic tricks/ stunts, off-road activities or racing; parkour; or free running. 8. Family Member - No benefits are payable for Treatment, services or supplies which are received from a Family Member. 9. Foreign Travel - No benefits are payable for Treatment, services or supplies received or purchased outside the United States unless the charges are incurred while traveling on business or for pleasure, for a period not to exceed 30 days, and the charges are incurred for an Emergency, provided the treatment, services or supplies used in connection with the Emergency are approved for use in the United States. 10. Gender – No benefits are payable for Treatment, services, and supplies related to the following conditions, regardless of underlying causes: sex transformation; gender dysphoric disorder; gender reassignment; treatment of sexual function, dysfunction or inadequacy; Treatment to enhance, restore or improve sexual energy, performance or desire. 11. Hazardous Activity Occupation - No benefits are payable for Treatment or services required due to Injury received while engaging in any hazardous occupation or other 19 Citadel One Health activity for which compensation is received in any form, including sponsorship, salary or prize money, such as, but not limited to: Participating, instructing, demonstrating, guiding or accompanying others in skiing, horse riding, rodeo activities, professional or semiprofessional contact sports and adult sporting competition at a national or international level.
12. Illegal Acts – No benefits are payable for loss caused by or resulting from, directly or indirectly, the Covered Person’s commission or attempted commission of a criminal act or being engaged in an illegal occupation.
13. Incarceration - No benefits are payable for loss caused by or resulting from, directly or indirectly any occurrence while the Covered Person is incarcerated.
14. Intoxication Exclusion - No benefits are payable for loss caused by or resulting from, directly or indirectly, the Covered Person being intoxicated. The Insured Person is conclusively deemed to be intoxicated if the level in his blood exceeds the amount at which a person is presumed, under the law of the state in which loss occurred, to be under the influence of alcohol if operating a motor vehicle, regardless of whether he or she is in fact operating a motor vehicle. An autopsy report from a licensed medical examiner, law enforcement officer’s report, toxicology test results or similar items will be considered proof of the Covered Person’s intoxication.
15. Not Medically Necessary - No benefits are payable.
16. Mental Illness/Substance Abuse - No benefits are payable for Mental Illness or Substance Abuse, whether organic or non-organic, chemical or non-chemical, biological or non-biological in origin and irrespective of cause, basis or inducement, including, but not limited to, Prescription Drugs, except as provided under the Mental Health Facility Confinement Benefit, Substance Abuse Facility Confinement Benefit, Mental Health Outpatient Benefit, or Substance Abuse Outpatient Benefit provisions if listed in PART VI – BENEFIT PROVISIONS.
17. Narcotic Exclusion - No benefits are payable for loss caused by or resulting from, directly or indirectly, the Covered Person being under the influence of any narcotic or other controlled substance at the time of the loss. This exclusion does not apply if any narcotic or other controlled substance is taken and used as prescribed by a Physician.
18. Overdose – No benefits are payable for a Medical Condition resulting from abuse or overdose of any illegal or controlled substance, except when administered in accordance with the advice of the Covered Person’s Physician.
19. Pregnancy - No benefits are payable for Treatment, services, and supplies related to: maternity; Pregnancy; childbirth; voluntary or elective abortion, except with respect to where a Covered Person’s life would be endangered if the fetus were carried to term, except as provided under the Newborn Indemnity Benefit if listed in PART VI – BENEFIT PROVISIONS. Complications of Pregnancy are covered as any other Sickness.
20. Service in the Armed Forces - No benefits are payable for loss caused by or resulting from, directly or indirectly, the Covered Person participating in military action while in active military service with the armed forces of any country or international organization, including non-military units supporting such forces.
21. Manipulations of the Musculoskeletal System or Acupuncture – No benefits are payable for care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of the vertebral column. No benefits are payable for Meridian therapy or acupuncture.
22. Sports – No benefits are payable for loss resulting from participation in intercollegiate sports, interscholastic sports, organized competitive sports (i.e., travel teams or club sports) or professional athletics. This does not include dependent children participating in local recreational community sports activities.
23. Suicide or Intentional Injury – No benefits are payable for loss caused or aggravated by suicide, attempted suicide or a self-inflicted Medical Condition, even if the Covered Person did not intend to cause the harm which resulted from the action which led to the self-inflicted Medical Condition.
24. Unlicensed Driver - No benefits are payable for an Accident if the Covered Person is the operator of a motor vehicle and does not possess a valid motor vehicle operator's license, unless: (a) the Covered Person holds a valid learner’s permit and (b) the Covered Person is receiving instruction from a driver's education instructor.
25. War - No benefits are payable for War or Act of War, Riot, Insurrection, Service in Armed Forces. War or act of war (whether declared or undeclared); participation in a riot or insurrection; service in the Armed Forces or units auxiliary thereto. Loss resulting from acts of terrorism committed by individuals or groups will not be excluded from coverage unless the Covered Person who suffered the loss committed the act of terrorism.
26. Weight - No benefits are payable for any Treatment, services, supplies, diagnosis, drugs, medications or regimen, whether medical or surgical, for purposes of controlling the Covered Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is Medically Necessary or appropriate or regardless of potential benefits for comorbid conditions; weight reduction or weight control surgery, treatment or programs; any type of gastric bypass surgery; suction lipectomy; physical fitness programs, exercise equipment or exercise therapy, including health club membership visits or services; nutritional counseling.
27. Workers Compensation - No benefits are payable for a Medical Condition arising out of, or is the result of, any work for wage or profit; a work-related condition that is eligible for benefits under worker’s compensation, employers’ liability, occupational disease law or act, or similar laws even when the Covered Person does not file a claim for benefits.
28. Pre-existing Condition Limitation - No benefits are payable for a Pre-Existing Condition for a continuous period of months, as outlined in PART II - SCHEDULE OF BENEFITS, following the effective date of a Covered Person’s coverage under the Certificate. This exclusion does not apply to a newborn child or newborn adopted child who is added to coverage in accordance with PART II – ELIGIBILITY AND EFFECTIVE DATE OF INSURANCE.
IMPORTANT: This program provides Group Fixed Indemnity insurance only. It does not provide basic hospital, basic medical, or comprehensive/major medical coverage, and does not satisfy the “minimum essential coverage” requirements of the Patient Protection and Affordable Care Act.
Everest Insurance® markets property, casualty, specialty and other lines of admitted and non-admitted direct insurance on behalf of Everest Group, Ltd., and its affiliated companies. Additional information about Everest, our people, and our products can be found on our website at www.everestglobal.com. This accident product is underwritten by Everest Reinsurance Company (or Everest Denali Insurance Company), depending on jurisdiction. All issuing companies may not do business in all jurisdictions. This literature is descriptive only. All coverage is subject to the language of the policy as issued. Not all products and product features may be available in all jurisdictions and availability may be subject to business and regulatory approval in each jurisdiction
Policy terms, conditions, exclusions and limitations may vary by state. This product may not be available in all states. Benefits will not be provided under the Policy for any Illness or Injury that is caused.
The Insurance Rate related to coverage underwritten by Everest Reinsurance Company, as part of your membership is as follows: Foundation Plan: Individual = $47.84, Individual Plus Spouse = $95.67, Individual Plus Child(ren) = $86.10, Family = $129.17; Guardian Plan: Individual = $76.00, Individual Plus Spouse = $152.01, Individual Plus Child(ren) = $136.81, Family = $205.22; Sovereign Plan: Individual = $123.90, Individual Plus Spouse = $247.81, Individual Plus Child(ren) = $223.02, Family = $334.54
SECURITY SERIES
Critical Illness Insurance Exclusions and Limitations:
Underwritten by Everest Reinsurance Company.
Benefits will not be provided for a Critical Illness if it is caused by, contributed to or results from:
1. suicide or attempted suicide while sane or insane or from intentionally self-inflicted injury.
2. from a Pre-existing Condition.
3. war or any act of war, whether declared or undeclared.
4. involvement in any type of active military service. Reserve or National Guard active duty training is not excluded, unless it extends beyond thirty-one (31) consecutive days.
5. refusing certain types of recommended medical treatment, as follows: a) a Physician has recommended treatment with angioplasty or Coronary Artery ByPass Graft for coronary artery disease, the Covered Person refuses this treatment, and the Covered Person suffers a Heart Attack; or b) a Physician has recommended treatment for a brain aneurysm or carotid artery stenosis, the Covered Person refuses treatment, and the Covered Person suffers a Stroke; or c) a Physician has recommended a diagnostic biopsy or diagnostic/therapeutic excision of a mass or lesion suspected of being cancer, the Covered Person refuses, and the Covered Person develops Type 1 Cancer, Skin Cancer, or Type 2 Cancer. Benefits are payable for the First Occurrence in a Covered Person’s lifetime. First Occurrence means, subject to any Pre-existing Condition limitation period, the first time that a Diagnosis is made or a Procedure is recommended for a Critical Illness in a Covered Person’s lifetime covered under the Policy. A Diagnosis made or Procedure recommended for a Critical Illness after satisfaction of the Pre-existing Condition limitation period is considered a First Occurrence.
Pre-existing Condition Limitation
No benefits are payable for a Pre-existing Condition. Once a Critical Illness is no longer considered a Pre-existing Condition as defined herein due to satisfaction of the time period below, the exclusion for that Critical Illness as a Pre-existing Condition no longer applies. A condition will no longer be considered a Pre-existing Condition after the Covered Person’s coverage under the Policy has been in effect for 12 consecutive months.
Major Organ Transplant means human to human organ transplant from a donor to the Covered Person of transplant of an entire liver, lung, small intestine, kidney or pancreas that is required due to clinical evidence of a major organ’s irreversible failure which requires that the malfunctioning organ or tissue of the Covered Person be replaced with an organ or tissue from a suitable human donor, excluding the Covered Person. The Covered Loss will be deemed to have occurred on the date the Covered Person is listed on the United Network for Organ Sharing (UNOS).
Major Organ Transplant does not include an organ transplant involving organs other than an entire kidney, liver, small intestine, lung, or pancreas;
1. involving transplants of parts of organs, tissues or cells;
2. involving organs transplanted from the same Covered Person;
3. involving organs received from non-human donors;
4. involving implantation of mechanical devices or mechanical organs; or
5. involving islet cell transplant. Citadel One Health 20 Type 1 Cancer means a malignant neoplasm, which is characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue, and which is not specifically hereafter excluded. Leukemia, Hodgkin’s disease, carcinoma, sarcoma, malignant tumor and lymphomas are included. Type 1 Cancer does not include:
1. any benign tumor, dysplasia, intraepithelial neoplasia or pre-malignant growth;
2. any papillary tumor of the bladder classified as Ta under TNM Classification;
3. any tumor of the prostate classified as T1N0M0 under TNM Classification;
4. any papillary tumor of the thyroid that is classified as T1N0M0 or less under TNM Classification and is one centimeter or less in diameter;
5. any tumor in the presence of human immuno-deficiency virus;
6. any Skin Cancers, unless there is metastasis and the tumor is a malignant melanoma of greater than 1.0 millimeters maximum thickness (regardless of Clark level of ulceration) as determined by a histological examination using the Breslow method;
7. Type 2 Cancer; and
8. chronic Lymphocytic Leukemia (CLL), less than or equal to Stage I, as defined by RAI classification.
Type 1 Cancer must be Diagnosed according to a Pathological Diagnosis or Clinical Diagnosis of Type 1 Cancer.
Type 2 Cancer means a Diagnosis of cancer where the tumor cells still lie within the tissue of origin without having invaded neighboring tissue. It also includes:
1. any malignant melanoma less than or equal to 1.0 millimeters maximum thickness (regardless of Clark level of ulceration) as determined by a histological examination using the Breslow method;
2. any melanoma not invading the dermis classified as T1N0M0 under TNM Classification;
3. any tumor of the prostate classified as T1N0M0 under TNM Classification;
4. any papillary tumor of the bladder classified as Ta under TNM Classification;
5. any papillary tumor of the thyroid that is classified as T1N0M0 or less under TNM Classification and is one centimeter or less in diameter;
6. chronic Lymphocytic Leukemia (CLL), less than or equal to Stage I, as defined by RAI classification.
Type 2 Cancer does not include:
1. any benign tumor, dysplasia, intraepithelial neoplasia or pre-malignant growth;
2. any tumor in the presence of human immuno-deficiency virus;
3. any non-melanoma Skin Cancer;
4. any melanoma in situ classified as TisN0M0 under TNM Classification
5. other skin malignancies; and
6. any carcinoid tumor.
Type 2 Cancer must be Diagnosed pursuant to a Pathological Diagnosis or Clinical Diagnosis. The Insurance Rate related to coverage underwritten by Everest Reinsurance Company, as part of your membership is as follows: Security 2500: Individual=$3.13, Individual Plus Spouse = $6.24, Individual Plus Child(ren) = $3.15, Family = $6.28. Security 5000: Individual=$6.24, Individual Plus Spouse = $12.48, Individual Plus Child(ren) = $6.28, Family = $12.52. Security 7500: Individual=$9.37, Individual Plus Spouse = $18.73, Individual Plus Child(ren) = $9.42, Family = $18.78. Security 10000: Individual=$12.48, Individual Plus Spouse = $24.97, Individual Plus Child(ren) = $12.56, Family = $25.05. Security 20000: Individual=$24.97, Individual Plus Spouse = $49.95, Individual Plus Child(ren) = $25.11, Family = $50.09.
Per Person Lifetime Benefit Maximum: 100% of the Benefit Amount for all occurrences combined for all Critical Illnesses. Benefit Waiting Period: 30 Days
LEGACY SERIES
GROUP ACCIDENT ONLY INSURANCE LIMITATIONS & EXCLUSIONS:
Underwritten by Guarantee Trust Life Insurance Company
The Policy does not provide benefits for:
• Treatment, services or supplies which:
• Are not Medically Necessary;
• Are not prescribed by a Doctor as necessary to treat an Injury;
• Are determined to be Experimental/Investigational in nature;
• Are received without charge or legal obligation to pay;
• Are received from persons employed or retained by any Family Member, unless otherwise specified; or
• Are not specifically listed as Covered Charges in the Policy.
• Injury by acts of war, whether declared or not.
• Injury received while traveling or flying by air, except as a fare-paying passenger and not as a pilot or crew member, on a regularly scheduled commercial airline.
• Injury covered by Worker’s Compensation, Employer Liability law or Occupational Disease Act or Law.
• Dental treatment, except as specifically stated.
• Injury sustained while committing or attempting to commit a felony.
• Prescription Drugs except as specifically stated.
• Suicide or attempted suicide while sane or insane.
• Intentionally self-inflicted Injury.
• Loss resulting from being legally intoxicated or under the influence of alcohol as defined by the laws of the state or jurisdiction in which the Injury occurs.
• Loss resulting from being under the influence of any drugs or narcotic unless administered on the advice of a Doctor.
• Injury sustained while participating in or practicing for any professional, intercollegiate or club sports activity, except as specifically provided.
• Injury which occurs while a Covered Person is on active duty service in any armed forces. Reserve or National Guard active duty for training is not excluded unless it extends beyond 31 days.
• Injury sustained flying in an ultra light, hang gliding, parachuting or bungee-cord jumping, by flight in a space craft or any craft designed for navigation above or beyond the earth’s atmosphere.
• Injury sustained while driving or riding on vehicles for off-road use including but not limited to all-terrain vehicles (ATV’s).
• Injury sustained where a Covered Person is the operator and does not possess a current and valid motor vehicle operator’s license, except in a Driver’s Education Program.
• Treatment in any Veteran’s Administration or federal Hospital, except if there is a legal obligation to pay;
• Cosmetic surgery, except for reconstructive surgery on an injured part of the body.
• Covered Charges incurred outside of the United States or its possessions
• Competing in motor sports races or competitions;
• Competing in water sports races or competitions;
• Testing cars/trucks on any racetrack or speedway;
• Handling, storing or transporting explosives;
• Scaling up cliffs or mountain walls;
• Spelunking (exploring caves);
• Handling or working with dangerous animals.
• Injury sustained while water skiing or surfboarding;
• Injury sustained while snow skiing or snowboarding;
• Injury sustained while roller blading or skateboarding;
• Injury sustained while participating in a rodeo.
• Repetitive motion injuries, strains, hernia, tendonitis, bursitis and heat exhaustion not related to a specific Injury.
The Insurance Rate related to coverage underwritten by Guarantee Trust Life Insurance Company as part of your membership is as follows: Legacy 50: Individual=$2.00, Individual Plus Spouse = $2.99, Individual Plus Child(ren) = $2.39, Family = $3.39; Legacy 100: Individual=$3.99, Individual Plus Spouse = $5.97, Individual Plus Child(ren) = $4.77, Family = $6.76; Legacy 200: Individual=$7.97, Individual Plus Spouse = $11.94, Individual Plus Child(ren) = $9.54, Family = $13.54
Notice of Claim: Written notice of claim must be given to the claims administrator within 60 days after a covered loss starts, or as soon thereafter as is reasonably possible. Notice should include information sufficient to identify the Covered Person.
PROTECT SERIES
GROUP ACCIDENT ONLY INSURANCE LIMITATIONS & EXCLUSIONS:
Underwritten by Guarantee Trust Life Insurance Company The Policy does not provide benefits for:
• Treatment, services or supplies which:
• Are not Medically Necessary;
• Are not prescribed by a Doctor as necessary to treat an Injury;
• Are determined to be Experimental/Investigational in nature;
• Are received without charge or legal obligation to pay;
• Are received from persons employed or retained by any Family Member, unless otherwise specified; or
• Are not specifically listed as Covered Charges in the Policy.
• Injury by acts of war, whether declared or not.
• Injury received while traveling or flying by air, except as a fare-paying passenger and not as a pilot or crew member, on a regularly scheduled commercial airline.
• Injury covered by Worker’s Compensation, Employer Liability law or Occupational Disease Act or Law.
• Dental treatment, except as specifically stated.
• Injury sustained while committing or attempting to commit a felony.
• Prescription Drugs except as specifically stated.
• Suicide or attempted suicide while sane or insane.
• Intentionally self-inflicted Injury.
• Loss resulting from being legally intoxicated or under the influence of alcohol as defined by the laws of the state or jurisdiction in which the Injury occurs.
• Loss resulting from being under the influence of any drugs or narcotic unless administered on the advice of a Doctor.
• Injury sustained while participating in or practicing for any professional, intercollegiate or club sports activity, except as specifically provided.
• Injury which occurs while a Covered Person is on active duty service in any armed forces. Reserve or National Guard active duty for training is not excluded unless it extends beyond 31 days.
• Injury sustained flying in an ultra light, hang gliding, parachuting or bungee-cord jumping, by flight in a space craft or any craft designed for navigation above or beyond the earth’s atmosphere.
• Injury sustained while driving or riding on vehicles for off-road use including but not limited to all-terrain vehicles (ATV’s).
• Injury sustained where a Covered Person is the operator and does not possess a current and valid motor vehicle operator’s license, except in a Driver’s Education Program.
• Treatment in any Veteran’s Administration or federal Hospital, except if there is a legal obligation to pay;
• Cosmetic surgery, except for reconstructive surgery on an injured part of the body. 21 Citadel One Health
• Covered Charges incurred outside of the United States or its possessions
• Competing in motor sports races or competitions;
• Competing in water sports races or competitions;
• Testing cars/trucks on any racetrack or speedway;
• Handling, storing or transporting explosives;
• Scaling up cliffs or mountain walls;
• Spelunking (exploring caves);
• Handling or working with dangerous animals.
• Injury sustained while water skiing or surfboarding;
• Injury sustained while snow skiing or snowboarding;
• Injury sustained while roller blading or skateboarding;
• Injury sustained while participating in a rodeo.
• Repetitive motion injuries, strains, hernia, tendonitis, bursitis and heat exhaustion not related to a specific Injury.
The Insurance Rate related to coverage underwritten by Guarantee Trust Life Insurance Company as part of your membership is as follows; Protect 5000: Individual =$4.09, Individual Plus Children = $10.23, Individual Plus Spouse = $10.23, Family = $10.23. Protect 7500: Individual =$5.40, Individual Plus Children = $13.51, Individual Plus Spouse = $13.51, Family = $13.51. Protect 10000: Individual =$7.69, Individual Plus Children = $19.20, Individual Plus Spouse = $19.20, Family = $19.20.
Notice of Claim: Written notice of claim must be given to the claims administrator within 60 days after a covered loss starts, or as soon thereafter as is reasonably possible. Notice should include information sufficient to identify the Covered Person.
RENAISSANCE – UCA SMILES DENTAL PLAN LIMITATIONS
LIMITATIONS TO COVERED SERVICES
If a description of Limitations to Covered Services in this Summary conflicts with a statement elsewhere in the Certificate, the statement in this Summary applies to you and you should ignore the conflicting statement in the remainder of the Certificate.
FRESH PLAN:
i. Topical fluoride treatments are payable two times in any Benefit Year for Children under age 19;
ii. Oral examinations submitted as a consultation or evaluation are payable two times in any Benefit Year, whether provided under one or more RLHICA Plans;
iii. Prophylaxes, including periodontal maintenance procedures, are payable two times in any Benefit Year;
iv. Bitewing X-rays are payable one time in any three-year period;
v. Sealants are payable only for the occlusal surface of first permanent molars for Children under the age of 16 and second permanent molars for Children under the age of 16. The surface must be free from decay and restorations. Sealants are a Benefit payable once in any 3 year period;
vi. Full mouth X-rays (which include bitewing X-rays) or a panoramic X-ray (with or without bitewing X-rays) are payable once in any three-year period;
vii. Periodontal maintenance following active periodontal therapy procedures to treat diseases of the gums and supportive structures of the teeth along with benefits for prophylaxes, including periodontal maintenance procedures are payable two times in any Benefit Year;
viii. Veneers are not a covered service;
ix. A reline or a complete replacement of denture base material is not a covered service;
x. Inlays are not a covered service;
xi. Indirect restorations including porcelain/ceramic substrate, porcelain/resin processed to metal and cast restorations (including crowns and onlays) and associated procedures such as cores and post and core substructures on the same tooth are payable once in any 5 year period;
xii. RLHICA will not make payment for fixed or removable bridges and all charges for the same will be your responsibility.
GLEAM PLAN:
i. Topical fluoride treatments are payable two times in any Benefit Year for Children under age 19;
ii. Oral examinations submitted as a consultation or evaluation are payable two times in any Benefit Year, whether provided under one or more RLHICA Plans;
iii. Prophylaxes, including periodontal maintenance procedures, are payable two times in any Benefit Year;
iv. Bitewing X-rays are payable one time in any one-year period;
v. Sealants are payable only for the occlusal surface of first permanent molars for Children under the age of 16 and second permanent molars for Children under the age of 16. The surface must be free from decay and restorations. Sealants are a Benefit payable once in any 3 year period;
vi. Full mouth X-rays (which include bitewing X-rays) or a panoramic X-ray (with or without bitewing X-rays) are payable once in any five-year period;
vii. Periodontal maintenance following active periodontal therapy procedures to treat diseases of the gums and supportive structures of the teeth along with benefits for prophylaxes, including periodontal maintenance procedures are payable two times in any Benefit Year;
viii. Veneers are limited to permanent anterior and bicuspid teeth when necessary due to decay or injury and only when the tooth cannot be restored with amalgam or resin-based compositing filling material. A veneer is payable once on the same tooth in any 5-year period;
ix. An Athletic mouth guard is payable once per lifetime;
x. Initial installation of dentures to replace teeth missing is covered provided the teeth were extracted after the Effective Date of coverage. xi. A reline or a complete replacement of denture base material is limited to once in any 5 year period per appliance;
xii. Inlays will be payable once every 5 years, subject to any other limitations set forth in this Certificate;
xiii. Indirect restorations including porcelain/ceramic substrate, porcelain/resin processed to metal and cast restorations (including crowns and onlays) and associated procedures such as cores and post and core substructures on the same tooth are payable once in any 5 year period;
xiv. RLHICA will not make payment for fixed or removable bridges and all charges for the same will be your responsibility.
SPARKLE PLAN:
i. Topical fluoride treatments are payable two times in any Benefit Year for Children under age 19;
ii. Oral examinations submitted as a consultation or evaluation are payable two times in any Benefit Year, whether provided under one or more RLHICA Plans;
iii. Prophylaxes, including periodontal maintenance procedures, are payable two times in any Benefit Year;
iv. Bitewing X-rays are payable one time in any one-year period;
v. Sealants are payable only for the occlusal surface of first permanent molars for Children under the age of 16 and second permanent molars for Children under the age of 16. The surface must be free from decay and restorations. Sealants are a Benefit payable once in any 3 year period;
vi. Full mouth X-rays (which include bitewing X-rays) or a panoramic X-ray (with or without bitewing X-rays) are payable once in any five-year period;
vii. Periodontal maintenance following active periodontal therapy procedures to treat diseases of the gums and supportive structures of the teeth along with benefits for prophylaxes, including periodontal maintenance procedures are payable two times in any Benefit Year;
viii. Veneers are limited to permanent anterior and bicuspid teeth when necessary due to decay or injury and only when the tooth cannot be restored with amalgam or resin-based compositing filling material. A veneer is payable once on the same tooth in any 5-year period;
ix. An Occlusal guard and athletic mouth guard is payable once per lifetime;
x. A reline or a complete replacement of denture base material is limited to once in any 5 year period per appliance;
xi. Inlays will be payable once every 5 years, subject to any other limitations set forth in this Certificate;
xii. Indirect restorations including porcelain/ceramic substrate, porcelain/resin processed to metal and cast restorations (including crowns and onlays) and associated procedures such as cores and post and core substructures on the same tooth are payable once in any 5 year period; The Insurance Rate related to dental coverage underwritten Renaissance Dental as part of your membership is as follows: Fresh Plan: Individual: $16.76, Individual Plus Spouse: $33.53, Individual Plus Child(ren): $43.16, Family: $70.46. Sparkle Plan: Individual: $26.39, Individual Plus Spouse: $52.77, Individual Plus Child(ren): $55.67, Family: $94.01. Gleam Plan: Individual: $31.41, Individual Plus Spouse: $62.84, Individual Plus Child(ren): $71.11, Family: $119.09. The Insurance Rate related to vision coverage underwritten Renaissance Dental as part of your membership is as follows: Individual: $4.99, Individual Plus Spouse: $9.96, Individual Plus Child(ren): $10.66, Family: $17.04. Citadel One Health 22 LIMITATIONS AND EXCLUSIONS FOR ACCIDENT DENTAL EXPENSE INSURANCE UNDERWRITTEN BY GUARANTEE TRUST LIFE INSURANCE COMPANY (GTL) EXCLUSIONS The Policy does not provide benefits for:
• Treatment, services or supplies which:
i. Are not Medically Necessary;
ii. Are not prescribed by a Doctor as necessary to treat an Injury;
iii. Are determined to be Experimental/Investigational in nature;
iv. Are received without charge or legal obligation to pay;
v. Are received from persons employed or retained by any Family Member, unless otherwise specified; or vi. Are not specifically listed as Covered Charges in the Policy.
• Injury by acts of war, whether declared or not.
• Injury received while traveling or flying by air, except as a fare-paying passenger and not as a pilot or crew member, on a regularly scheduled commercial airline.
• Injury covered by Worker’s Compensation, Employer Liability law or Occupational Disease Act or Law.
• Dental treatment, except as specifically stated.
• Injury sustained while committing or attempting to commit a felony.
• Prescription Drugs except as specifically stated.
• Suicide or attempted suicide while sane or insane.
• Intentionally self-inflicted Injury.
• Loss resulting from being legally intoxicated or under the influence of alcohol as defined by the laws of the state or jurisdiction in which the Injury occurs.
• Loss resulting from being under the influence of any drugs or narcotic unless administered on the advice of a Doctor.
• Injury sustained while participating in or practicing for any professional, intercollegiate or sports activity, except as specifically provided.
• Injury which occurs while a Covered Person is on active duty service in any armed forces. Reserve or National Guard active duty for training is not excluded unless it extends beyond 31 days.
• Injury sustained flying in an ultra-light, hang gliding, parachuting or bungee-cord jumping, by flight in a space craft or any craft designed for navigation above or beyond the earth’s atmosphere.
• Injury sustained while driving or riding on vehicles for off-road use including but not limited to all-terrain vehicles (ATV’s).
• Injury sustained where a Covered Person is the operator and does not possess a current and valid motor vehicle operator’s license, except in a Driver’s Education Program.
• Treatment in any Veteran’s Administration or federal Hospital, except if there is a legal obligation to pay.
• Cosmetic surgery, except for reconstructive surgery on an injured part of the body.
• Covered Charges incurred outside of the United States or its possessions
• Competing in motor sports races or competitions;
• Competing in water sports races or competitions;
• Testing cars/trucks on any racetrack or speedway;
• Handling, storing or transporting explosives;
• Scaling up cliffs or mountain walls;
• Spelunking (exploring caves);
• Handling or working with dangerous animals.
• Injury sustained while water skiing or surfboarding;
• Injury sustained while snow skiing or snowboarding;
• Injury sustained while roller blading or skateboarding;
• Injury sustained while participating in a rodeo.
• Reinjury or complications of an Injury caused or contributed to by a condition that existed before the Accident.
• Repetitive motion injuries, strains, hernia, tendonitis, bursitis and heat exhaustion not related to a specific Injury.
Cancellation/Termination of Benefits/Renewability: Coverage terminates when UCA terminates the policy, your membership ceases, insurance ceases for your class, for non-payment of premium by UCA, or the date of fraud or misrepresentation of a material fact. The group policy terminates for non-payment of premium, if group participation requirements are not met or on any premium due date for any of the following reasons: fraud or misrepresentation of a material fact; failure of UCA to provide required information; or at GTL’s option with 30 days notice. Notice of termination provided to UCA is considered notice of termination to all members and will not be sent to you individually by GTL. The policy automatically renews each policy anniversary until cancellation/termination.
GTL does not provide nor is affiliated with the other insurance/discount programs provided as a part of membership in UCA. The Insurance Rate related to coverage underwritten GTL as part of your membership is as follows: Fresh Plan: Individual: $0.67, Individual Plus Spouse: $1.36, Individual Plus Child(ren): $1.01, Family: $2.03. Sparkle Plan: Individual: $0.67, Individual Plus Spouse: $1.36, Individual Plus Child(ren): $1.01, Family: $2.03. Gleam Plan: Individual: $0.67, Individual Plus Spouse: $1.36, Individual Plus Child(ren): $1.01, Family: $2.03.
