2009 Group Accident Insurance Program

Eligibility

USA Track & Field, in an effort to promote the sport of Track & Field, Long Distance Running and Race Walking has purchased an Excess Accidental Medical Expense and Accidental Death and Dismemberment Insurance policy for its athlete members and registered officials.  This insurance coverage is secondary to other insurance such as health coverage, disability or similar, governmental plan or program; or coverage provided or required by any law or statute and Workers’ Compensation.  Covered persons must first submit their claim to all other insurance companies before claims on this policy will be processed.

Covered Activities

Coverage is provided for excess accidental medical expense incurred (and accidental death and dismemberment) as the result of an accidental bodily injury occurring while you are participating in sanctioned events and registered practices scheduled by USATF member Clubs. Practices must be under the supervision of your Club's coaches or managers. Coverage includes travel directly to and from such sanctioned events and practices. Coverage is also provided while you are competing as a member of USA National Teams in international competition, while training at USOC training centers, and while participating in USATF Committee activities.

Schedule of Benefits

Excess Accidental Medical Expense Benefit

If you suffer an accidental bodily injury covered by the terms of this plan, which requires medical care and treatment this plan will pay up to a maximum benefit amount of $10,000:

1. The first $5,000 benefit amount is subject to a 20% co-pay.
2. The remaining benefit amount is subject to no co-pay.

The plan deductible of $200 will be deducted from the amount paid.  The deductible applies separately to each person and each accident.  In addition, the Excess Accidental Medical Expense Benefit is payable on an excess basis.  The insurance company will determine the reasonable and customary charge for the covered medical expense, and then reduce that amount by amounts already paid or payable by any other plan.   Other plan means any other insurance or other payment source for medical services including but not limited to health coverage; disability or similar; governmental plan or program; or coverage provided or required by any law or statute, including automobile “fault” and “no-fault” coverage and Workers’ Compensation.

Benefits are payable for expenses incurred within 52 weeks of the date of the accident up to the Maximum Benefit of $10,000. The first medical expense for a covered injury must be incurred within 30 days from the date of the accident, otherwise no benefits are payable. All claims must be filed within 90 days of the injury or as soon as reasonably possible.

Other Medical Provisions

Medical services are the costs for the medically necessary services of medical care and treatment by a physician or a dentist; hospital room and board and hospital care, both inpatient and outpatient; drugs and medicines required and prescribed by a Physician or a dentist; diagnostic tests and x-rays prescribed by a Physician or a dentist; transporting in an emergency transportation vehicle from the location where the person becomes injured to the nearest hospital where appropriate medical treatment can be obtained; dental care and treatment due to injury; treatment performed by a licensed medical professional when prescribed by a physician, if hospitalization would have been otherwise required; rental of durable medical equipment designed primarily for use, and used primarily, by people who are injured, such as a wheelchair or a hospital bed; artificial limbs and other prosthetic appliances.

No payment will be made for treatment of services rendered at a facility provided by USA Track & Field or by its staff members, employees and designated sports medicine volunteers (doctors, trainers, chiropractors, etc.). No payment will be made for physical therapy or chiropractic services.

The dental benefit is $250 per tooth, payable for expenses incurred for the necessary care and treatment of sound natural teeth resulting from injury due to an accident. Such care and treatment must be recommended and given by a licensed dentist and incurred within 52 weeks of the date of the accident.

Accidental Death and Dismemberment

If an accidental bodily injury results in a loss specified below within one year after the date of the accident, the policy provides the following benefits:

Loss of Speech means the permanent and irrecoverable total loss of the capability of speech without the aid of mechanical devices.  Loss of Hearing means the permanent and irrecoverable loss of hearing in both ears.  Loss of Hand means complete severance through or above the knuckle joints of at least 4 fingers on the same hand or at least 3 fingers and the thumb on the same hand. Loss of Foot means complete severance through or above the ankle joint. Loss of Sight means the permanent loss of vision in the eye. Remaining vision must be no better than 20/200 using a corrective aid or device. Loss of Thumb and Index Finger means complete severance through or above the knuckle joints of the thumb and index finger of the same hand.

Exclusions

Benefits will not be paid for any loss:

Benefits will not be paid for any loss:

1. for which the Insured Person has no obligation to pay;
2. for eyeglasses, contact lenses and other vision or hearing aids;
3. for any injury for which Worker’s Compensation benefits or occupational injury benefits are payable;
4. for treatment by a person employed or retained by the Policyholder;
5. for any injury occurring while fighting, except in self defense;
6. for treatment required for conditions caused by repetitive motion injuries and not as a result of an Accident, including but not limited to: Osgood-Schlatter’s Disease, bursitis, chondromalacia, shin splints, and tendinitis.
7. occurring while the insured is in, entering or exiting any aircraft that is owned, leased or operated by his or her employer or on behalf of the employer.  This exclusion does not apply to aircraft chartered with a pilot or crew on a one time charter basis.
8. occurring while the insured is in any aircraft while acting or training as a pilot or crew member.  This does not apply to passengers who temporarily perform pilot or crew functions in a life threatening emergency.
9. caused by or resulting from the insured’s emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection or bodily malfunctions.  This does not apply to loss resulting from bacterial infection caused by an Accident or from Accidental consumption of a substance contaminated by bacteria.
10. resulting from suicide, attempted suicide or loss that is intentionally self-inflicted.
11. caused by or resulting from an insured being intoxicated or under the influence of any narcotic, unless taken on the advice of a physician and used in accordance with the prescription.
12. caused by or resulting from a declared or undeclared war, but war does not include acts of terrorism.

 Eligible expenses resulting from re-injury or aggravation or an Injury that occurred prior to the effective date of the Covered Person's coverage are not covered.

Effective Date of Coverage

The effective date of your coverage will be from the date of your membership until the expiration date shown on your membership card, or the date the policy ends or the date you are no longer a member of USA Track & Field, whichever is earlier.

Beneficiary Designation

You may elect a beneficiary to whom any death benefits shall be payable by submitting written notification to the Plan Administrators on a form approved by the insurance company. The Plan Administrators will provide these forms on request. If you have not elected a beneficiary the proceeds will be paid in the following descending order: your spouse, your surviving children in equal shares, your parents in equal shares, your siblings in equal shares, or your estate.

To File A Claim

If you suffer an accident while covered by the terms of this policy, you must send all related medical bills to your employer's (or yours parent's/guardian's) insurance company for payment, if you have coverage. Claim forms for USATF Group Accident Insurance can be downloaded or obtained by calling 317-713-4665.

Completed claim forms and other information must be sent to: American Specialty Insurance, PO Box 459, Roanoke, IN 46783.  Do not send claim forms, medical bills or related insurance claim information to USA Track & Field or your local Association.

This program is underwritten by:
Federal Insurance Company

This program has been arranged by:
ESIX
Brown & Brown Insurance of Georgia
PO Box 889009
Atlanta, GA 30356
770-512-5000 - Phone

Federal Insurance Company is a member insurer of the Chubb Group of Insurance Companies.  The coverage and services described are descriptive only.  Actual coverage is subject to the language of the policy as issued under Policy number 9906-20-44