P. G. Umpnation Umpire Insurance Schedule Of Benefits

An Eligible Person is an individual who meets all of the requirements shown below:

Principal Sum: All registered umpires of the Policyholder $10,000

The benefits provided by this Policy will be paid, subject to applicable conditions, limitations and exclusions, under the following coverages:

Covered Activities:

While participating in all baseball officiating activities including but not limited to teaching baseball and officiating clinics. Participating is not limited to Policyholder sponsored and supervised events. Travel to and from the activities is not covered.


BENEFITS

Aggregate Limit of Indemnity

Applies to

Accidental Death and Dismemberment

Benefit Amount

$500,000

Not more than the Aggregate Limit of Indemnity specified above will be paid for all Covered Losses, Covered Accidents, Covered Injuries and Covered Expenses suffered by all Insured Persons as the result of any one Covered Loss that occurs under one of the Conditions of Coverage, as specified above. If this amount does not allow all Insured Persons to be paid the amounts this Policy otherwise provides, the amount paid will be the proportion of the Insured Person’s loss to the total of all losses, multiplied by the Aggregate Limit of Indemnity.

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS

Covered Loss must occur within

Benefit

Loss of Life

Loss of Two or More Hands or Feet Loss of Sight of Both Eyes

Loss of Speech and Hearing (in Both Ears) Loss of One Hand or Foot and Sight in One Eye Loss of One Hand or Foot

Loss of Sight in One Eye

Severance and Reattachment of One Hand or Foot Loss of Speech

Loss of Hearing (in Both Ears)

Loss of Thumb and Index Fingers of the Same Hand Loss of all Four Fingers of the Same Hand

Loss of all the Toes of the Same Foot

Exposure and Disappearance

365 days of the Covered Accident

Benefit Amount

100% of the Principal Sum 100% of the Principal Sum 100% of the Principal Sum 100% of the Principal Sum 100% of the Principal Sum 50% of the Principal Sum 50% of the Principal Sum 50% of the Principal Sum 50% of the Principal Sum 50% of the Principal Sum 25% of the Principal Sum 25% of the Principal Sum 25% of the Principal Sum

Included

ACCIDENT MEDICAL BENEFIT

Scope of Coverage Applicable to Accident Medical Benefits

Any benefit limits and benefit percentages apply, unless otherwise specified, on a per Insured Person – per Covered Loss basis. Any applicable Deductibles must be satisfied within the time periods specified before benefits are payable.

Full Excess Medical Expense Other Health Plan Reduction – 0%

Total Maximum for all Accident Medical Benefits- $10,000

First Covered Expenses must be incurred within – 90 days after the Covered Accident Benefit Period – 104 weeks from the date of the Covered Accident Deductible – $100, applies to – each Covered Loss

Covered Expenses                                                                  Benefit Percentage and Other Limits Determination of the amount of each Covered Expense, and where applicable, each Usual and Customary Charge will be made solely by the Company.

In-Patient Hospital Services

Room and Board Expenses, Intensive Care Unit, Semi-Private Room – 100% of Usual and Customary Charges

Inpatient X-ray, CT scan, MRI Laboratory Tests – 100% of Usual and Customary Charges

Miscellaneous Expenses

In-Hospital Physiotherapy, Nurse Services – 100% of Usual and Customary Charges

Outpatient Orthopedic Appliances – 100% of Usual and Customary Charges

Ambulatory Medical Center

100% of Usual and Customary Charges

Emergency Room Treatment

100% of Usual and Customary Charges

Physician Services

Surgery, Assistant Surgeon, Physician Assistant – 100% of Usual and Customary Charges

Use of Physician’s Surgical Facilities, Second Opinion or Consultation, Anesthesia and its Administration – 100% of Usual and Customary Charges

In-Hospital Visits Office Visits – 100% of Usual and Customary Charges

OUTPATIENT X-Ray, CT Scan, MRI and Laboratory Tests

100% of Usual and Customary Charges

Outpatient Physiotherapy, Outpatient Nursing Services, Ambulance Services 100% of Usual and Customary Charges

Medical Equipment Rental, Dental Services, Prescription Drugs

100% of Usual and Customary Charges

Expanded Medical Benefit for Covered Sports Conditions – Excluded

Heart and Circulatory Conditions, Covered Heart and Circulatory Conditions Included heat exhaustion; heart attack; stroke; burst aneurysm

HMO/PPO Denial Benefit

100% of Usual and Customary Charges

TOTAL DISABILITY WEEKLY INCOME BENEFIT

Weekly Benefit Maximum Benefit Period – $100

Maximum Benefit Period – 26 weeks

Total Disability must begin within – 30 days of the Covered Accident

Waiting  Period – 1 day

When Benefit Begin – End of the Waiting Period

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s