susa_DOC_1210 - Study USA-HealthCare Description of...

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Study USA-HealthCare™ Description of Coverage The Insurance Company of the State of Pennsylvania with its principal place of business in New York, NY Having issued the Policy to SunTrust Bank as Trustee of the Group Insurance Trust (District of Columbia) (Herein called the Policyholder). Limits of Coverage Emergency Medical Assistance Service TO OBTAIN ASSISTANCE IN THE EVENT OF A MEDICAL EMERGENCY OR TO FACILITATE MEDICAL CARE, contact the insurance company’s 24-hour assistance service, Travel Assist, located in Houston, Texas. Travel Assist can recommend a local doctor or hospital, verify coverage, organize all emergency medical transportations, and provide multilingual assistance. Call toll free in the U.S. and Canada 1-800-626-2427 or call 0-715-295-9817. If outside the U.S. call collect 0-715-295-9817. Identify yourself as a Study USA-HealthCare™ insured and refer to the Policy Number and Travel Assist numbers on your confi rmation. ALL EMERGENCY MEDICAL EVACUATIONS AND REPATRIATIONS ARE TO BE ARRANGED BY TRAVEL ASSIST. How to File a Claim You will need to save copies of all receipts. All itemized bills must be submitted to the Insurance Company with a Claim Form. To request a claim form, please contact: Chartis, Accident & Health Claims, Travel Insurance Services Claims Unit, P.O. Box 25987, Shawnee Mission, KS 66225-5987 or call toll free 1-800-551-0824. Written notice of a claim must be made to the Claims Unit within twenty (20) days after the occurrence or commencement if any loss covered by the Policy, or as soon thereafter as is reasonably possible. THE COMPANY HEREBY CERTIFIES that the person(s) named in the Schedule (herein called Insured Person) is insured under and subject to all defi nitions, exceptions, limitations, and provisions of said Policy; to the extent provided in the Master Policy on fi le with the Company. The Master Policy constitutes the only agreement under which payments are made. Refund of Premium Premiums received by the Program Marketer/Insurance Company will be considered fully earned and non-refundable. Coverage under this program terminates if a covered Person enters military service and a pro-rata refund will be made from the date a written request is received. Otherwise, no refunds will be made. 12/10 This is a brief description of the Accident and Illness In sur ance Program. The exact pro vi sions gov ern ing this insurance are contained in the Master Policy underwritten by the Insurance Company of the state of Pennsylvania. A Blan ket Accident and Illness Master Policy is on fi le with the Program Marketer, Travel Insurance Services. The Master Policy shall control in the event of any confl ict between this brochure and the Program. Eligibility of Coverage
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This note was uploaded on 02/24/2012 for the course ECON 180364203 taught by Professor Edwardmcdevitt during the Spring '09 term at UCLA.

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susa_DOC_1210 - Study USA-HealthCare Description of...

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