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Benefits and Exclusions

Summary of Benefits

 Agile One 750Agile One 1000
ACCIDENT AND SICKNESS HOSPITAL INDEMNITY BENEFITS
Hospital Indemnity

Pays a daily benefit for each day a Covered Person is Confined to a Hospital due to a Sickness or Accident. The first day of a Hospital stay must occur within 30 days of the Accident, causing the Injury.
$750 per day$1,000 per day
Max Days per Confinement1010
Max Benefit Amount per Plan Year$22,500$30,000
Physician Office Visit

Benefit pays for a Physician office visit as a result of an Accident or Sickness. The visit must be made to the Physician’s office or clinic. The visit to a Physician’s office must occur within 30 days of the Accident, causing an Injury.
$75 per visit$75 per visit
Max Visit per Plan Year36
Surgical Indemnity
Pays the Surgical Indemnity Benefit if a Covered Person has a Major or Minor Surgical Procedure performed while In-Hospital or on an outpatient basis in an Outpatient Unit.
Inpatient Major$1,000 per procedure$1,000 per procedure
Outpatient Major$1,000 per procedure$1,000 per procedure
Max Inpatient Procedures per Plan Year22
Max Outpatient Procedures per Plan Year11
Anesthesia
Pays the Anesthesia Indemnity Benefit for the administration of anesthesia related to a covered surgical procedure, if the Surgical Indemnity Benefit is payable.
Inpatient Major$200 per procedure$200 per procedure
Outpatient Major$200 per procedure$200 per procedure
Max Inpatient Procedures per Plan Year22
Max Outpatient Procedures per Plan Year11
Advanced Diagnostic

Pays the Advanced Diagnostic Test Indemnity Benefit when a Covered Person has one of the following tests performed: Angiogram /Arteriogram, EEG, Myelogram, CT Scan, MRI Scan, or PET Scan when ordered by a Physician and be related to an Accident or Sickness. Benefits are not payable for tests performed while Confined in a Hospital.
$100 per test$200 per test
Max Tests per Plan Year11
Diagnostic X-Ray and Lab

Pays the Diagnostic X-Ray and Laboratory Indemnity Benefit when a Covered Person has diagnostic x-ray and laboratory tests performed when ordered by a Physician and related to an Accident or Sickness. Benefits are not payable for tests performed while Confined in a Hospital or if payable under the Advanced Diagnostic Test Indemnity Benefit. Tests performed due to Accident must be done within 30 days of the Accident causing an Injury.
$50 per test$50 per test
Wellness
Pays benefits if the Covered Person has one of the screening tests, as shown in the Description of Coverage, performed while coverage under the Policy which is in force. If the benefit is payable under the Diagnostic X-Ray and Laboratory Indemnity Benefit or the Surgical Indemnity Benefits as it relates to an Accident or Sickness, it will be paid under that benefit and not the Wellness Indemnity Benefit.
$50 per test$75 per test
Max Screening Tests per Plan Year
11
ACCIDENT BENEFITS
Accident Medical Expense

Reimburses up to the Maximum Benefit Amount for Accident Medical Expense if Accidental Bodily Injury causes an Insured Person to first incur Medical Expenses for care and treatment of the Accidental Bodily Injury within ninety (90) days after an Accident. The Benefit Amount for Accident Medical Expense is payable only for Medical Expenses incurred within 52 weeks after the date of the Accident causing the Accidental Bodily Injury. The Benefit Amount is subject to the Deductible
up to $10,000up to $10,000
AME Deductible per Accident$250$250
Accidental Death and Dismemberment

Benefit pays if a covered Accident results in a covered Loss within one year after the Accident.
up to $1,000up to $1,000
CRITICAL ILLNESS BENEFITS
Critical Illness Coverage

After a 30-day waiting period, benefits are paid per category for each Critical Condition suffered by the Insured Person. Benefits are paid one time for each category of Critical Condition.
up to $10,000up to $10,000
Category 1 – Cancers/Tumors
Skin Cancer$2,500$2,500
Type 1 Cancer$10,000$10,000
Type 2 Cancer$5,000$5,000
Category 2 – Heart & Circulatory
Heart Attack$10,000$10,000
Stroke$10,000$10,000

Agile One Limitations & Exclusions

Accident & Sickness Hospital Indemnity Insurance Plan

Underwritten by: Federal Insurance Company, a member insurer of the Chubb Companies

Alcoholism and Drug or Substance Abuse

This insurance does not apply to alcoholism or drug or substance abuse. In addition, the insurance does not apply to any confinement in a detoxification facility or drug or alcohol rehabilitation facility that is not also a Hospital or part of a Hospital.

Intoxication Exclusion Vehicular

This insurance does not apply to any Accident caused by or resulting from, directly or indirectly, the Covered Person being intoxicated, while operating a motorized vehicle at the time of an Accident. Intoxication is defined by the laws of the jurisdiction where such Accident occurs.

Operating an Aircraft

This insurance does not apply to any Accident caused by or resulting from, directly or indirectly, the Covered Person entering, flying or exiting any aircraft while acting or training as a pilot or crew member. This exclusion does not apply to passengers who temporarily perform pilot or crew functions in a life-threatening emergency.

Pre-existing Condition

This insurance does not any benefits for Sickness caused by or resulting from a covered Person’s Pre-existing Condition if the Sickness occurs during the first 12 months that a Covered Person is insured under this policy

A Pre-existing Condition means an Accident or a Sickness for which, in the 6-months before the Covered Person becomes insured under the policy, medical advice, treatment or care was sought by a Covered Person, or was recommended by, prescribed by or received from a Physician.

Pregnancy

This insurance does not apply to normal pregnancy. Complications of Pregnancy are covered as any other Sickness.

Pregnancy of a Dependent Child

This insurance does not apply to pregnancy of a Dependent Child, unless required by law.

Service in the Armed Forces

This insurance does not apply to any Accident or Sickness 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 established international authority.

Suicide or Intentional Injury

This insurance does not apply to, and no benefits are payable related to the Covered Person’s suicide, attempted suicide or intentionally self-inflicted injury.

Voluntary Abortion

This insurance does not apply to voluntary abortion, except with respect to the Insured Person or his or her covered Spouse or Domestic Partner where such person’s life would be endangered if the fetus were carried to term.

War

This insurance does not apply to any Accident or Sickness caused by or resulting from, directly or indirectly, war, undeclared war, civil war, insurrection, rebellion, revolution, warlike acts by a military force or personnel, any action taken in hindering or defending against any of these or any consequences of any of these acts regardless of any other direct or indirect caused or event, whether covered or not, contributing in any sequence to the loss.

Critical Illness Benefits Exclusions

(a) Alcoholism, Drug or Substance Abuse: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, the Insured Person’s alcoholism or drug or substance abuse. In addition, the insurance does not apply to any confinement in a detoxification facility or drug or alcohol rehabilitation facility that is not also a Hospital or part of a Hospital.

(b) Congenital Conditions: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly a congenital condition as Diagnosed by a licensed Physician.

(c) Cosmetic Surgery: This insurance does not apply to cosmetic surgery or care or treatment solely for cosmetic purposes or complications therefrom. This exclusion does not apply to cosmetic surgery resulting from an Accident if initial treatment of the Insured Person is begun within twelve (12) months of the date of the Accident or to treat congenital defects in covered newborns.

(d) Experimental or Investigational: This insurance does not apply to any service, supply or Covered Condition that is experimental or investigational.

(e) Incarceration: This insurance does not apply to any Sickness or Accident caused by or resulting from, directly or indirectly any occurrence while the Insured Person is incarcerated.

(f) Illegal Acts: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, the Insured Person’s commission or attempted commission of a felony or being engaged in an illegal activity or occupation.

(g) Participation in a Riot: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, an Insured Person’s voluntary participation in a riot.

(h) Participation in Extreme Sports: This insurance does not apply to any Covered Condition caused by or resulting from, directly or indirectly, an Insured Person’s participation in scuba diving to depths of more than 100 feet; skydiving; hang- gliding or para-gliding; parascending other than over water; bungee jumping; mountaineering or rock climbing normally requiring the use of guides or ropes; or caving.

(i) Pregnancy: This insurance does not apply to normal pregnancy. Complications of Pregnancy are covered as any other Sickness.

(j) Pregnancy of a Dependent Child: This insurance does not apply to pregnancy of a Dependent Child, unless required by law.

(k) Professional Sporting Activity: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, the Insured Person participating in any professional sporting activity for which the Insured Person received a salary or prize money.

(l) Pre-Existing Condition: No Benefit Amount will be paid under the policy for a Covered Condition caused by or resulting from, directly or indirectly, a Pre-Existing Condition.

(m) Procedures and Diagnosis Outside the US or its Territories: This insurance does not apply to a Covered Condition that has been Diagnosed or to any surgical procedures that have been performed outside of the United States or its Territories, unless the Diagnosis can be verified by a Physician licensed to practice within the United States or its Territories.

(n) Race or Speed Contest: This insurance does not apply to any Covered Condition caused by or resulting from, directly or indirectly, the Insured Person being engaged in or participating in a motorized vehicular race or speed contest.

(o) Rest care or custodial care and treatment: This insurance does not apply to any rest care or custodial care or treatment for any Sickness or Accident.

(p) Refusal of Medical Treatment: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, the Insured Person’s refusal of the following recommended medical treatment: a. a Physician has recommended treatment with angioplasty or Coronary Artery By-Pass Graft for coronary artery disease, the Insured Person refuses treatment, and the Insured Person suffers a Heart Attack; or b. a Physician has recommended treatment for a brain aneurysm or carotid artery stenosis, the Insured Person refuses treatment, and the Insured 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 Insured refuses and the Insured Person develops Type 1 Cancer, Skin Cancer, or Type 2 Cancer.

(q) Rocket Propelled or Rocket Launched Conveyance: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, the Insured Person traveling or flying on any rocket propelled or rocket launched conveyance.

(r) Service in the Armed Forces: This insurance does not apply to any Sickness or Accident caused by or resulting from, directly or indirectly, the Insured Person participating in military action while in active military service with the armed forces of any country or established international authority.

(s) Suicide or Intentional Injury: This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, an Insured Person’s suicide, or attempted suicide or intentionally self-inflicted injury while the Insured Person is sane or insane.

(t) War: This insurance does not apply to any Covered Condition caused by or resulting from, directly or indirectly,war, undeclared war, civil war, insurrection, rebellion, revolution, warlike acts by a military force or personnel, any action taken in hindering or defending against any of these, the destruction or seizure of property for a military purpose or any consequences of any of these acts regardless of any other direct or indirect cause or event, whether covered or not, contributing in any sequence to the loss.

(u) Workers Compensation: This insurance does not cover Sickness or Accident arising out of and in the course of any occupation for compensation, wage or profit or which are payable under Occupational Disease Law, Workers Compensation or similar law, whether or not application for such benefits have been made.

This Policy does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit the provision of insurance, including but not limited to the payment of claims.

Accident Benefit Exclusions

This policy does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing the insurance. In addition, not benefits will be paid for any Accident caused by or resulting from any of the following:

1 .an insured Person entering, or existing any aircraft while acting or training as a pilot or crew member. (This exclusion does not apply to passengers who temporarily perform pilot or crew functions in a life-threatening emergency.);

2. an insured Person’s emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions or medical or surgical treatment thereof. (This exclusion does not apply to an Insured Person’s bacterial infection caused by an Accident or by Accidental consumption of a substance contaminated by bacteria.);

3. an Insured Person’s commission or attempted commission of any illegal act, including but not limited to any felony;

4. an Insured Person being intoxicated is defied by the laws of the jurisdiction where such Accident occurs;

5. an Insured Person being under the influence of any narcotic or other controlled substance at the time of an Accident. (This exclusion does not apply if any narcotic or other controlled substance is taken an used as prescribed by a Physician.);

6. an Insured Person participating in military action while in active military service with the armed forces of any country or established international authority. (This exclusion does not apply to the first 60 consecutive days of active military service with the armed forces of any country or established international authority. (This exclusion does not apply to the first 60 consecutive days of active military service with the armed forces of any country or established international authority.);

7. an Insured Person’s suicide, attempted suicide or intentionally self-inflicted injury;

8. a declared or undeclared War.