 |
 |
|
 |
 |
 |
|
 |
 | Health Insurance and Limited Medical Plans | |  | Guarantee Issue Limited Medical Plans | |  | Dental Insurance Plans | |  | 24 Hour Accident Coverage | |
|

|
 |
| "We really enjoy working with GAC. The VBA Association plans are just what our customers need. A combination of affordability, easy issue, and generous hospital, medical and surgical benefits. I appreciate their customer service, they are professional and always responsive." |
Wayne Schellhaas, LUTCF
NAIM Regional Director
Schellhaas & Acssociates
Metairie, LA |
|
 |
| "General Agent Center has great health products and their staff is so helpful. I can't tell you how much it is appreciated." |
Lynette K. Azar
Individual Product Marketing
George W. Evans & Associates, Inc.
Houston, TX |
|
 |
| "My clients want it simple,
and GAC makes it easy for them. They just apply online, and get covered. The rates are great too." |
Chris Boyett
Insurance Agent
Houston, Texas |
|
| |
|
|
|
|
| |
|
VBA Truckers Occupational Accident Insurance Program |
| |
VBA Truckers Occupational Accident
Insurance Program |
|
Motor carriers and the independent owner-operators who contract with them face specialized financial risks.
An accident can have a serious economic impact on an owner-operator and his/her family and can leave a motor carrier liable for the losses. Truckers Occupational Accident Insurance covers injuries that result from eligible on-the-job accidents that owner-operators or contract drivers sustain. |
| |
| Value Benefits of America, Inc. along with the Domestic Accident & Health Division of the AIG Companies are providing members with Truckers Occupational Accident Insurance. |
| |
| Benefit Coverage Highlights: |
|
| • Truckers Occupational Accident Insurance pays benefits for injuries sustained in a covered accident |
| • Up to $1,000,000 Accident Medical Expense, there is no deductible |
| • Up to either $150,000 or $250,000 Accident Dismemberment or Paralysis |
| • $25,000 Accidental Death |
| • $125,000 or $225,000 Survivors Benefit paid in monthly installments |
|
• $500 per week Temporary Total Disability for 104 weeks
(7 day waiting period up to 70% of income up to $500 weekly)
|
• $500 per week Continuous Total Disability to age 70
(up to 70% of income up to $500 weekly)
|
| • Up to $5,000 Hernia Coverage |
| • Up to $5,000 Hemorrhoid Coverage |
|
|
| |
|
| |
| Benefits |
Plan A |
Plan B |
| Accidental Death Benefits |
|
|
| Principal Sum |
$25,000 |
$25,000 |
| Survivor's Benefit * |
$125,000 |
$225,000 |
| |
$1,250/month for 100 months |
$2,250/month for 100 months |
| Incurral Period ** |
365 days |
365 days |
|
| Accidental Dismemberment |
$150,000 |
$250,000 |
| Principal Sum |
365 Days |
365 Days |
| Percentage of Principal Sum Paid for Loss of: |
|
|
| Life |
100% |
100% |
| Both Hands or Feet |
100% |
100% |
| or Sight of Both Eyes |
100% |
100% |
| One Hand and One Foot |
100% |
100% |
| One Hand or Foot and One Eye |
100% |
100% |
| One Hand, One Foot or One Eye |
50% |
50% |
| Thumb & Index Finger |
25% |
25% |
|
| Paralysis |
|
|
| Principal Sum |
$150,000 |
$250,000 |
| Incurral Period ** |
365 Days |
365 Days |
| Percentage of Principal Sum Paid for Paralysis of: |
|
|
| Quadriplegia |
100% |
100% |
| Paraplegia |
75% |
75% |
| Hemiplegia |
50% |
50% |
| Uniplegia |
25% |
25% |
|
| Temporary Disability |
|
|
| Commencement Period ** |
90 Days |
90 Days |
| Waiting Period |
7 Days |
7 Days |
| Participation Percentage |
70 |
70 |
| Maximum Weekly Benefit |
$500 |
$500 |
| Maximum Benefit Period |
104 Weeks |
104 Weeks |
|
| Continuous Total Disability |
|
|
| Participation Percentage |
70% |
70% |
| Maximum Weekly Benefit |
$500 |
$500 |
| Maximum Benefit Period |
To Age 70 |
To Age 70 |
|
| Accident Medical Expense (Primary) |
$1,000,000 |
$1,000,000 |
| Incurral Period ** |
90 Days |
90 Days |
| Deductible Amount |
No Deductible |
No Deductible |
| Commencement Period ** |
2 Years |
2 Years |
| Dental Benefit |
$1,000 |
$1,000 |
|
| Hernia Coverage |
|
|
| Lifetime Maximum Benefit Period |
90 Days |
$5,000 |
| Lifetime Maximum Benefit |
90 Days |
$5,000 |
|
| Hemorrhoid Coverage |
|
|
| Lifetime Maximum Benefit Period |
90 Days |
90 Days |
| Lifetime Maximum Benefit |
$5,000 |
$5,000 |
|
| Combined Single Limit |
$1,000,000 |
$1,000,000 |
| Aggregate per Occurrence |
$2,000,000 |
$2,000,000 |
| Monthly VBA Membership Fee |
$10.00 |
$10.00 |
| Monthly Premium Rates - Per Person |
$126.00 |
$131.00 |
| Total Monthly Cost |
$136.00 |
$141.00 |
|
|
* Survivor's Benefit provides $1,250 per month for 100 months for Plan A and $2,250 per month for 100 months for Plan B to an eligible spouse and/or dependent child(ren).
** All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury.
|
|
| IMPORTANT INFORMATION: The Policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical, major medical or sickness coverage. This is only a brief description of the coverage(s) available under policy series C22382DBG(rev.11-99). The Policy contains reductions, limitations, exclusions and termination provisions. Full details of the coverage are contained in the Policy. If there are any conflicts between this document and the Policy, the Policy shall govern. Not all coverages are available in every state. Insurance is underwritten by National Union Fire Insurance Company of Pittsburgh, PA, with its principal place of business in New York, NY. This coverage is not a substitute for Workers Compensation Coverage. 0701.010c |
|
| |
VALUE BENEFITS OF AMERICA MEMBERSHIP
ALSO INCLUDES DISCOUNTS AND DIVIDENDS * |
|
| The Dividend Club: Members will earn Dividends (paid quarterly to you) on Merchandise, Services, Travel & Entertainment
when you shop from our On-line Mall and make a purchase. Choose from retailers like these, just to name a few,
and get the dividends: Walmart.com, Target.com, BestBuy.com, CircuitCity.com, CompUSA.com, DisneyStore.com,
OfficeMax.com, BrooksBrothers.com, Brookstone.com, Buy.com, EddieBauer.com, LizClairborne.com, FOA.com, FOSSIL.
com, HotelDiscounts.com, Jcrew.com, etc. |
|
| Refund Sweepers: Free Merchandise, Bargains, On-line Coupons, Rebates, Sweepstakes & more |
|
| Car Rental Services: Provides discounts at Alamo, National, Hertz and Avis |
|
| Rewards Network: America’s Premier Dining Rewards Program and Hotel Discounts. Save up to 20% off every meal
plus up to 15% off your hotel room rate |
|
| Included at no charge: discounts at over 55,000 pharmacies for your prescription drugs as well as lab tests and x-ray
imaging services |
| |
| Discounts and Dividends are not insurance |
| |
|
| |
|
|
| Benefits Details |
| |
| BENEFITS DETAILS |
| |
Truckers Occupational Accident Insurance Program
Solutions for Motor Carriers, Owner-Operators, and Contract Drivers |
| |
| Motor carriers and the independent owner-operators who contract with them face specialized financial risks. An accident can have a serious economic impact on an owner-operator and his/her family and can leave a motor carrier liable for the losses. Truckers Occupational Accident Insurance (TOAI) is part of an effective, affordable and reliable solution for motor carriers and truckers alike. |
| |
| Value Benefits of America, Inc. along with the Domestic Accident & Health Division of the AIG Companies are providing you with the opportunity to purchase Truckers Occupational Accident Insurance. |
| |
| Eligibility for Truckers Occupational Accident Insurance |
| All Owner-Operators of the Participating Organization, who are under age 65, and who are under a long-term lease agreement of 30 days or more, or who have entered into a contract, to provide Occupational services for the Participating Organization. |
| |
| Effective Date |
| An Owner-Operator's or Contract Driver's coverage under the Policy begins on the latest of: |
| 1. |
the Policy Effective Date; |
| 2. |
the date the person becomes a member of an eligible class of persons as described in the Description of Eligible Persons section of the Master Application; |
| 3. |
if individual enrollment is required, the date written enrollment is received by the Policyholder; or |
| 4. |
the date on which the first premium payment is paid when due. |
|
| |
| Termination Date |
| An Owner-Operator's or Contract Driver's coverage under the Policy ends on the earliest of: |
| 1. |
the date the Policy is terminated; |
| 2. |
the premium due date if premiums are not paid when due; |
| 3. |
the date the Owner-Operator requests, in writing, that his or her coverage be terminated; or |
| 4. |
the date the Owner-Operator ceases to be a member of any eligible class(es) of persons as described in the Description of Eligible Persons section of the Master Application. In addition, a Contract Driver's coverage under the Policy will also end on the earliest of the date the Owner-Operator with respect to whom the Contract Driver is under contract ceases to be a member of any eligible class(es) of persons as described in the Schedule of the Master Application. |
|
| |
| Grace Period |
| A Grace Period of 31 days will be provided for the payment of the required premium. The Policy and effected coverage will remain in force during the Grace Period. This Grace Period does not apply to the first premium or the last premium when the Policyholder intends to terminate coverage |
| |
| Benefits Overview |
| |
| Accidental Death, Dismemberment and Paralysis Benefit: If Injury to the Insured Person directly results in death within the 365 day Incurral Period, the Company will pay the Principal Sum shown on page 4. When Injury directly results in any of the losses/paralysis within 365 days of the accident causing the loss/paralysis, the Program will pay in one payment the indicated percentage of the Principal Sum. If more than one Loss/paralysis is sustained by an Insured as a result of the same accident, only one amount, the largest, will be paid. All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury. |
| |
| Survivor's Benefit: If the Accidental Death Benefit is payable, the Company will pay a monthly Survivor's Benefit to the surviving Spouse, up to the Principal Sum. If the Insured Person is not survived by a Spouse, or if the Insured Person's Spouse dies or remarries, the Company will pay or continue to pay the Survivor's Benefit to the Insured Person's surviving Dependent Children, if any. If there is more than one surviving Dependent Child, the Survivor's Benefit will be distributed equally among the surviving Dependent Children. The payment of the monthly Survivor's Benefit will end on the earliest of the following dates: 1. the date the Spouse dies or remarries, if there are no Dependent Children; 2. the date the last Dependent Child dies or is no longer eligible; or 3. the date the Principal Sum has been paid. All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury. |
| |
| Temporary Total Disability (TTD) Benefit: If Injury to the Insured Person results in TTD within the Commencement Period and if the Insured Person is under age 65 on the day the TTD begins, the Company will pay the TTD Benefit subject to the 7-day waiting period. The TTD benefit with respect to each week of an Insured Person's TTD during a Single Period of Total Disability is equal to the lesser of: a) the Participation Percentage of the Insured Person's Average Weekly Earnings; or b) the Maximum Weekly Benefit Amount, subject to satisfaction of any applicable Waiting Period. The Commencement Period starts on the date of the accident that caused such Injury. All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury. |
| |
| Continuous Total Disability (CTD) Benefit: If Injury to the Insured Person, resulting in TTD, subsequently results in CTD, the Company will pay the $500 CTD Maximum Weekly Benefit provided: a) benefits payable for a TTD Covered Loss ceased solely because the 104 week Maximum Benefit Period for TTD has been reached, but the Insured Person remains disabled; b) the Insured Person is under age 65 on the day after the 104 week Maximum Benefit Period for TTD has been reached; c) the Insured Person has been granted a Social Security Disability Award for their disability; and d) their disability is reasonably expected to continue without interruption until the Insured Person dies. The CTD Benefit with respect to each month of an Insured Person's CTD is equal to four and three-tenths (4.3) times the weekly benefit for TTD, less the Insured Person's primary Social Security Disability Award. The CTD Benefit with respect to less than a full Benefit Week of CTD equals 1/7th of the weekly Benefit for TTD for each day of CTD. All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury. |
| |
| Accident Medical Expense Benefit: If an Insured Person suffers an Injury that requires him or her to be treated by a Physician within the 90 day Commencement Period, the Company will pay the Usual and Customary Charges4 incurred for Medically Necessary5Covered Accident Medical Services6 received due to that Injury, up to the $1,000,000 Maximum Benefit Amount and the 104 week Maximum Benefit Period per Insured Person for all Injuries caused by a single accident, subject to any applicable Deductible Amount. All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury. |
| |
| Hernia Coverage: Benefits will be payable for a Covered Loss caused in whole or in part by, contributed to in whole or in part by, or resulting in whole or in part from, the Insured Person's Hernia, provided such Hernia is surgically repaired while the Insured Person's coverage is in force under the Policy, subject to the following: 1. With respect to the TTD Benefit, the period for which such indemnity shall be payable for all periods of disability, subject to the TTD Benefit Waiting Period, shall not exceed the $5,000 Hernia Lifetime Maximum Benefit Period; 2. With respect to the AME Benefit, benefits payable for or in connection with the Insured Person's Hernia, shall not exceed the $5,000 Hernia Lifetime Maximum Benefit Amount. All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury. Exclusion # 7 is waived. |
| |
| Hemorrhoid Coverage: Benefits will be payable for a Covered Loss caused in whole
or in part by, contributed to in whole or in part by, or resulting in whole or in part from, the Insured Person's Hemorrhoids, provided such Hemorrhoids are surgically repaired while the Insured Person's coverage is in force under the Policy, subject to the following: 1. With respect to the TTD Benefit the period for which such indemnity shall be payable for all periods of disability, subject to the TTD Benefit Waiting Period, shall not exceed the $5,000 Hemorrhoids Lifetime Maximum Benefit Period; 2. With respect to the AME Benefit, benefits payable for or in connection with the Insured Person's Hemorrhoids, shall not exceed the $5,000 Hemorrhoids Lifetime Maximum Benefit Amount. All Incurral Periods and Commencement Periods start on the date of the accident that caused such Injury. Exclusion # 7 is waived. |
| |
| Limits of Liability |
| |
| Per-Insured Person Limit of Liability: The Per-Insured Person Limit of Liability (Combined Single Limit) stated in the Schedule will be the total limit of the Company's liability for all benefits payable as described in the Benefits section of this Description of Coverage with respect to any one Insured Person arising out of Injury sustained by such individual as the result of any one accident. |
| |
| Aggregate Limit of Liability: The Aggregate Limit of Liability stated in the Schedule will be the total limit of the Company's liability for all benefits payable as described in the Benefits section of this Description of Coverage with respect to all Insured Persons arising out of Injury sustained by one or more Insured Person(s) as the result of any one accident. |
| |
| If the total of such benefits exceeds the Aggregate Limit of Liability, the Company shall not be liable to any Insured Person for a greater proportion of such Insured Person's benefits than said Aggregate Limit of Liability bears to the total benefits afforded all such Insured Persons by all coverages listed in the Benefits section of this Description of Coverage. |
| |
| Footnotes: |
| |
| 1. |
For Losses: "Loss" of a hand or foot means complete severance through or above the wrist or ankle joint; "Loss" of sight of an eye means total and irrecoverable loss of the entire sight in that eye; "Loss" of hearing in an ear means total and irrecoverable loss of the entire ability to hear in that ear; "Loss" of speech means total and irrecoverable loss of the entire ability to speak; and "Loss" of thumb and index finger means complete severance through or above the metacarpophalangeal joint of both digits. For Paralysis, "Quadriplegia" means the complete and irreversible paralysis of both upper and both lower limbs; "Paraplegia" means the complete and irreversible paralysis of both lower limbs; "Hemiplegia" means the complete and irreversible paralysis of the upper and lower limbs of the same side of the body and "Uniplegia" means the complete and irreversible paralysis of one limb. "Limb" means entire arm or entire leg. |
| 2. |
Temporary Total Disability means disability that: (1) prevents an Insured Person from performing the duties of his or her regular, primary occupation; and (2) requires that, and results in, the Insured Person receiving Continuous Care. |
| 3. |
Continuous Total Disability means disability that: (1) prevents an Insured Person from performing the duties of any occupation for which he or she is qualified by reason of education, training or experience; and (2) requires that, and results in, the Insured Person receiving Continuous Care. |
| 4. |
In addition to the Exclusions, Usual and Customary Charges for Covered Accident Medical Services do not include, and benefits are not payable with respect to, any expense for or resulting from: (1) repair or replacement of existing artificial limbs, artificial eyes or other prosthetic appliances or repair of existing Durable Medical Equipment unless for the purpose of modifying the item because Injury has caused further impairment in the underlying bodily condition; (2) new, or repair or replacement of, dentures, bridges, dental implants, dental bands or braces or other dental appliances, crowns, caps, inlays or onlays, fillings or any other treatment of the teeth or gums; (3) new eye glasses or contact lenses or eye examinations related to the correction of vision or related to the fitting of glasses or contact lenses, unless Injury has caused impairment of sight; or repair or replacement of existing eyeglasses or contact lenses unless for the purpose of modifying the item because Injury has caused further impairment of sight; (4) new hearing aids or hearing examinations unless Injury has caused impairment of hearing; or repair or replacement of existing hearing aids unless for the purpose of modifying the item because Injury has caused further impairment of hearing; (5) rental of Durable Medical Equipment where the total rental expense exceeds the usual purchase expense for similar equipment in the locality where the expense is incurred (but if, in the Company's sole judgment, Accident Medical Expense Benefits for rental of Durable Medical Equipment are expected to exceed the usual purchase expense for similar equipment in the locality where the expense is incurred, the Company may, but is not required to, choose to consider such purchase expense as a Usual and Customary Covered Accident Medical Expense Benefit in lieu of such rental expense); (6) Custodial Services; or (7) Personal Comfort or Convenience Items. |
| 5. |
Medically Necessary means that a Covered Accident Medical Service: (1) is essential for diagnosis, treatment or care of the Occupational Injury for which it is prescribed or performed; (2) meets generally accepted standards of medical practice; and (3) is ordered by a Physician and performed under his or her care, supervision or order. |
| 6. |
Covered Accident Medical Service(s) means any of the following services: (1) Hospital semiprivate room and board (or room and board in an intensive care unit); Hospital ancillary services (including, but not limited to, use of the operating room or emergency room); or use of an Ambulatory Medical Center; (2) services of a Physician or a registered nurse (RN); (3) ambulance service to or from a Hospital; (4) laboratory tests; (5) radiological procedures: (6) anesthetics and the administration of anesthetics; (7) blood, blood products and artificial blood products, and the transfusion thereof; (8) rental of Durable Medical Equipment, up to the actual purchase price of such equipment; (9) artificial limbs, artificial eyes or other prosthetic appliances; or (10) medicines or drugs administered by a Physician or that can be obtained only with a Physician's written prescription; or (11). repair or replacement of Sound Natural Teeth damaged or lost as a result of Injury, up to the Dental Maximum, if any, shown in the Benefit Plan. |
| 7. |
Hernia means a protrusion of an organ or part through connective tissue or through a wall of
the cavity in which it is normally enclosed. Hernia does not include diaphragmatic (hiatal) hernia.
|
| 8. |
Hemorrhoid(s) means a mass of dilated veins in swollen tissue at the margin of the anus or nearby within the rectum. |
|
| |
| |
|
|
| |
|
|
| Exclusions and Limitations |
| |
| Exceptions |
|
The Policy does not cover any losses caused in whole or in part by, or resulting in whole or in part from, the following:
| 1. |
suicide or any attempt at suicide; intentionally self-inflicted injury or any attempt at intentionally self-inflicted injury; |
| 2. |
sickness, disease or infections of any kind, except bacterial infections due to an accidental cut or wound, botulism or ptomaine poisoning; |
| 3. |
any Pre- Existing Condition; |
| 4. |
Occupational Cumulative Trauma, unless (and to the extent as) specifically provided by the Policy; |
| 5. |
Occupational Disease, unless (and to the extent as) specifically provided by the Policy; |
| 6. |
hernia of any kind, unless (and to the extent as) specifically provided by the Policy; |
| 7. |
hemorrhoids of any kind, unless (and to the extent as) specifically provided by the Policy; |
| 8. |
performing, learning to perform or instructing others to perform as a master or crew member of any vessel while covered under the Jones Act or the United States Longshore and Harbor Workers' Act, or similar coverage; |
| 9. |
declared or undeclared war, or any act of declared or undeclared war; |
| 10. |
full-time active duty in the armed forces, National Guard or organized reserve corps of any
country or international authority. (Unearned premium for any period for which the Insured Person is not covered due to his or her active duty status will be refunded.) (Loss caused while on short-term National Guard or reserve duty for regularly scheduled training purposes is not excluded.);
|
| 11. |
any Injury for which the Insured Person is entitled to benefits pursuant to any workers compensation law or other similar legislation;
|
| 12. |
any loss insured by employers' liability insurance; |
| 13. |
accidents occurring while the Insured is working for or under contract with an entity other than the Contractee; |
| 14. |
the Insured Person being under the influence of drugs or intoxicants, unless taken under the advice of his or her Physician; |
| 15. |
the Insured Person's commission of or attempt to commit a felony; |
| 16. |
travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the Insured Person is: a. riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or b. performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or c. riding as a passenger in an aircraft owned, leased or operated by the Contractee; or |
| 17. |
any union "stop work" action. |
|
| |
| Additional Exclusions: Usual and Customary Charges for Covered Accident Medical Services do not include, and benefits are not payable with respect to, any expense for or resulting from: repair or replacement of existing artificial limbs, artificial eyes or other prosthetic appliances or repair of existing Durable Medical Equipment unless for the purpose of modifying the item because Injury has caused further impairment in the underlying bodily condition; new, or repair or replacement of, dentures, bridges, dental implants, dental bands or braces or other dental appliances, crowns, caps, inlays or onlays, fillings or any other treatment of the teeth or gums; new eye glasses or contact lenses or eye examinations related to the correction of vision or related to the fitting of glasses or contact lenses, unless Injury has caused impairment of sight; or repair or replacement of existing eyeglasses or contact lenses unless for the purpose of modifying t he item because Injury has caused further impairment of sight; new hearing aids or hearing examinations unless Injury has caused impairment of hearing; or repair or replacement of existing hearing aids unless for the purpose of modifying the item because Injury has caused further impairment of hearing; rental of Durable Medical Equipment where the total rental expense exceeds the usual purchase expense for similar equipment in the locality where the expense is incurred (but if, in the Company's sole judgment, Accident Medical Expense Benefits for rental of Durable Medical Equipment are expected to exceed the usual purchase expense for similar equipment in the locality where the expense is incurred, the Company may, but is not required to, choose to consider such purchase expense as a Usual and Customary Covered Accident Medical Expense Benefit in lieu of such rental expense); Custodial Services; or Personal Comfort or Convenience Item(s). |
| |
| IMPORTANT NOTICE |
|
| The Policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical, major medical or sickness coverage. This is only a brief description of the coverage(s) available under policy series C22382DBG(rev.11-99). The Policy contains reductions, limitations, exclusions and termination provisions. Full details of the coverage are contained in the Policy. If there are any conflicts between this document and the Policy, the Policy shall govern. Not all coverages are available in every state. Insurance is underwritten by National Union Fire Insurance Company of Pittsburgh, PA, with its principal place of business in New York, NY. This coverage is not a substitute for Workers Compensation Coverage. 0701.010c |
| |
| Comprehensive Strength, Innovative SolutionsSM |
| |
| Domestic Accident & Health Division |
| |
AIG Companies |
|
Administrator:
Value Benefits of America
15575 N. 79th Place, Suite 100
Scottsdale, AZ 85260
1-800-366-2467
|
| |
|
| |
|
|
| DEFINITIONS |
| |
| DEFINITIONS: |
|
| Administrator means the Administrator named in the Schedule. |
| |
| Ambulatory Medical Center means a licensed public establishment with an organized staff of Physicians and permanent facilities that are equipped and operated primarily for the purpose of providing medical services or performing surgical procedures. Such establishment must provide continuous Physician and registered nursing (RN) services whenever a patient is in the facility. An Ambulatory Medical Center does not include a Hospital, a Physician's office, or a clinic. |
| |
| Co-Owner means a person who has partial ownership of a vehicle which is being operated by an Owner-Operator for the purpose of performing Occupational services in the course and scope of contractual obligations for the Policyholder |
| |
| Combined Single Limit means, with respect to any one Insured Person, the total amount of benefits that are payable under the Policy for or in connection with Injury sustained as the result of any one accident. When the Combined Single Limit has been reached, no further benefits shall be payable under the Policy, with respect to that Insured Person, for or in connection with Injury sustained as the result of that one accident. |
| |
| Contract Driver means a person who: (1) drives a vehicle owned or leased by an Owner-Operator for the purpose of performing Occupational services; (2) who is on file with the Company; and (3) who is not an employee of the Policyholder or Owner-Operator. |
| |
| Covered Loss(es) means one or more of the losses or expenses described in the Benefits section of this Description of Coverage. |
| |
| Covered Accident Medical Service(s) means any of the following services: |
| |
Hospital semi-private room and board (or room and board in an intensive care unit); Hospital ancillary services (including, but not limited to, use of the operating room or emergency room); or use of an Ambulatory Medical Center;
services of a Physician or a registered nurse (R.N.);
ambulance service to or from a Hospital;
laboratory tests;
radiological procedures;
anesthetics and the administration of anesthetics;
blood, blood products and artificial blood products, and the transfusion thereof;
physical therapy, Occupational therapy, and chiropractic care, up to the Physical Therapy, Occupational Therapy and Chiropractic Care Maximum, if any, shown in the Schedule;
rental of Durable Medical Equipment, up to the actual purchase price of such equipment;
artificial limbs, artificial eyes or other prosthetic appliances; or
medicines or drugs administered by a Physician or that can be obtained only with a Physician's written prescription; or repair or replacement of Sound Natural Teeth damaged or lost as a result of Injury, up to the Dental Maximum shown in the Schedule.
|
| |
| Custodial Services means any services which are not intended primarily to treat a specific Injury. Custodial Services include, but shall not be limited to services: (1) related to watching or protecting the Insured Person; (2) related to performing or assisting the Insured Person in performing any activities of daily living, such as: (a) walking; (b) grooming; (c) bathing; (d) dressing; (e) getting in or out of bed; (f) toileting; (g) eating; (h) preparing foods; or (i) taking medications that can usually be self-administered; and (3) that are not required to be performed by trained or skilled medical or paramedical personnel. |
| |
| Dependent Child(ren) means the Insured Person's unmarried children, including natural children from the moment of birth, step or foster children, or adopted children, from the moment of placement in the home of the Insured Person, under age 19 (25 if attending an accredited institution of higher learning on a full-time basis) and primarily dependent on the Insured Person for support and maintenance. It also includes any unmarried Dependent Children of the Insured Person who are incapable of self-sustaining employment by reason of mental or physical incapacity, and who are primarily dependent on the Insured Person for support and maintenance. The Company may require proof of the Dependent Child(ren)'s incapacity and dependency within 60 days before the Dependent Child(ren) reach the age limit specified above. The Company may request that satisfactory proof of the Dependent Child(ren)'s continued incapacity and dependency be submitted to the Company on an annual basis. If the requested proof is not furnished within 31 days of the request, such child(ren) shall no longer be considered Dependent Child(ren) as of the end of that 31 day period. |
| |
| Dispatch means the period of time during which an Insured operates his or her vehicle or performs vehicle repair while being en route to pick up a load, picking up a load, en route to deliver a load, and unloading a load. |
| |
| Durable Medical Equipment refers to equipment of a type that is designed primarily for use, and used primarily, by people who are injured (for example, a wheelchair or a hospital bed). It does not include items commonly used by people who are not injured, even if the items can be used in the treatment of injury or can be used for rehabilitation or improvement of health (for example, a stationary bicycle or a spa). |
| |
| Functional Capacity Examination (FCE) means a test performed by a physical therapy professional to evaluate and estimate physical limitations. |
| |
| Hospital means a facility that: (1) is operated according to law for the care and treatment of injured people; (2) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis; (3) has 24-hour nursing service by registered nurses (R.N.), on duty or on call; and (4) is supervised by one or more Physicians. A Hospital does not include: (1) a nursing, convalescent or geriatric unit of a hospital when a patient is confined mainly to receive nursing care; (2) a facility that is, other than incidentally, a rest home, nursing home, convalescent home or home for the aged; nor does it include any ward, room, wing or other section of the hospital that is used as such; or (3) any military or veterans hospital or soldiers home or any hospital contracted for or operated by any national government or government agency for the treatment of members or ex-members of the armed forces. |
| |
| Immediate Family Member means a person who is related to the Insured Person in any of the following ways: Spouse, brother-in-law, sister-in-law, son-in-law, daughter-in-law, mother-in-law, father-in-law, parent (includes stepparent), brother or sister (includes stepbrother or stepsister), or child (includes legally adopted or placed for adoption, or stepchild).
Injury means bodily Injury to an Insured Person caused by an Occupational accident while coverage is in force under the Policy, which results directly from and independently of all other causes in a Covered Loss. All Injuries sustained by an Insured Person in any one accident shall be considered a single Injury.
|
| |
| Injury - All Injuries sustained by an Insured Person in any one accident shall be considered a single Injury. |
| |
| Insured means a person who: (1) is a member of an eligible class as described in the Schedule of this Description of Coverage; (2) has enrolled for coverage; and (3) has paid the required premium. |
| |
Insured Person means an Insured.
Maximum Benefit Period means, with respect to Accident Medical Expense, the maximum period for which benefits shall be payable for Covered Accident Medical Services for or in connection with a single Accident Medical Expense Covered Loss. The length of the Maximum Benefit Period for Accident Medical Expense is shown in the Schedule. |
| |
| Medically Necessary means that a Covered Accident Medical Service: (1) is essential for diagnosis, treatment or care of the Occupational Injury for which it is prescribed or performed; (2) meets generally accepted standards of medical practice; and (3) is ordered by a Physician and performed under his or her care, supervision or order. |
| |
| Occupational means, with respect to an activity, accident, incident, circumstance or condition involving an Insured, that the activity, accident, incident, circumstance or condition occurs or arises out of or in the course of the Insured performing services within the course and scope of contractual obligations for the Policyholder while under Dispatch. Occupational does not encompass any period of time during the course of everyday travel to and from work.
Occupational Assessment means a test of vocational capabilities. The process includes a review of medical records, Injury and treatment, history and background (education, military, previous occupation(s)), evaluation of basic skills such as reading, understanding, spelling and/or math capabilities, and vocational alternatives.
|
| |
| Occupational Cumulative Trauma means bodily Injury to an Insured caused by the combined effect of repetitive physical Occupational activities extending over a period of time, where: (1) such condition is diagnosed by a Physician; (2) the Insured's last day of last performance of the activities causing the Injury occurred during the Policy Period; and (3) such activities resulted directly and independently of all other causes in a Covered Loss. |
| |
| Occupational Disease means a sickness which results in disability or death, and is caused by exposure to environmental or physical hazards during the course of the Insured's Occupational activities, where: (1) such condition is diagnosed by a Physician, and is generally accepted by the National Centers for Disease Control to be a disease caused by such hazards; (2) exposure to such hazards is not an accident but is caused or aggravated by the conditions under which the Insured Person performs Occupational services; (3) the Insured's last day of last exposure to the environmental or physical hazards causing such condition occurs during the Policy Period; and (4) such exposure results directly and independently of all other causes in a Covered Loss. |
| |
| Owner-Operator means a person who: (1) owns or leases a vehicle which he or she is operating for the purpose of performing Occupational services in the course and scope of contractual obligations for the Policyholder; (2) is an independent contractor as defined by law; and (3) is not an employee of the Policyholder. The term Owner-Operator will include a Co-Owner if the Co-Owner otherwise meets the definition of Owner-Operator. |
| |
| Personal Comfort or Convenience Item(s) means those items that are not Medically Necessary for the care and treatment of the Insured Person's Occupational Injury. The term Personal Comfort or Convenience Item(s) includes, but is not limited to: (1) a private Hospital room, unless Medically Necessary; (2) television rental; and (3) Hospital telephone charges. |
| |
| Physician means a practitioner of the healing arts acting within the scope of his or her license who is not: (1) the Insured Person; or (2) an Immediate Family Member; or (3) a practitioner retained by the Policyholder. |
| |
| Pre-Existing Condition means a condition for which an Insured Person has sought or received medical advice or treatment preceding his or her effective date of coverage under the Policy. |
| |
| Schedule means the Schedule of Benefits shown in this Description of Coverage. |
| |
| Sound Natural Teeth means natural teeth that either are unaltered or are fully restored to their normal function and are disease-free, have no decay and are not more susceptible to injury than unaltered natural teeth. |
| |
| Spouse means the Insured Person's legal spouse. |
| |
| Usual and Customary Charge(s) means a charge that: (1) is made for a Covered Accident Medical Service; (2) does not exceed the usual level of charges for similar treatment, services or supplies in the locality where the expense is incurred (for a Hospital room and board charge, other than for a Medically Necessary stay in an intensive care unit, does not exceed the Hospital's most common charge for semi-private room and board); and (3) does not include charges that would not have been made if no insurance existed. |
| |
|
| |
|
|
| VBA TERMS |
| |
| VBA TERMS AND CONDITIONS |
|
| 1. |
Member understands that VBA is not an insurance company or program. Insurance coverage is provided by National Union Fire Insurance Company of Pittsburgh, Pa, with its principal place of business in New York, NY. |
| 2. |
VBA provides savings to its members through a number of sources. The current list of benefits may be modified through additions or deletions. A quarterly newsletter, posted on our website or sent via email, will keep members up-to-date on benefits and other pertinent information. |
| 3. |
Payments for VBA Programs are due in advance. Payments will be drafted on or about 15 days before the due date. If you choose to cancel your program, it is your responsibility to make sure that your membership card and a written request for cancellation are sent to VBA at least 15 days prior to the anniversary of your effective date in order for your account to not be charged for additional fees. |
| 4. |
Member hereby appoints, Value Benefits of America Association (VBA) President, or failing this person, a VBA Director, as proxy holder for and on behalf of the member with the power of
substitution to attend, act and vote for and on behalf of the member in respect of all matters that may properly come before the meeting of the members of VBA and at every adjournment thereof, to the same extent and with the same powers as if the undersigned member
were present at the said meetings or any adjournment thereof. Annual meetings are to be held in Arizona the second Tuesday of August.
|
| 5. |
VBA reserves the right to terminate any enrollment or deny eligibility in the program for lack of payment to VBA, Returned checks or insufficient notices on bank drafts for payment of the membership fee is deemed to be evidence of non-payment by a member. There will be a $10.00 charge to be reinstated in the program after such denial. If reinstatement for non-payment happens more than once, a $20.00 reinstatement will apply. |
| 6. |
In the event of any dispute, member agrees to resolve said dispute solely by binding arbitration that shall be governed by the laws of the state of Arizona and enforceable at Scottsdale, Maricopa County, |
| 7. |
Membership cancelled within the first 30 days of the enrollment date may be eligible for refund if the membership card and written cancellation request are sent to VBA, The administrative fee is nonrefundable. Approved refunds will be processed approximately 30 days after cancellation. |
| 8. |
Membership is effective on the 1st of the month following enrollment acceptance by VBA. |
|
| |
| Member Agreement: |
| By signing the enrollment form, the member expresses the desire to become a member of Value Benefits of America. Member acknowledges that the discount plans are NOT INSURANCE, but membership includes the option to purchase certain limited supplemental insurance coverages. Membership fees may be changed for all members, but not individually, with notification. In addition, by signing below, the member acknowledges that they have read, understand, and agree to the terms and conditions of membership as they have been presented to them in this brochure. |
| |
| Discounts and Dividends are not insurance |
| |
|
| |
|
|
| SECURITY & PRIVACY STATEMENT |
| |
When you become a GACquote.com customer, you entrust us with your personal data. We consider your data to be private and confidential, and we hold ourselves to the highest standards of trust and fiduciary duty in their safekeeping and use.
General Agent Center (GAC) and our partners will not release information about you or your application, policy or claims information, unless one or more of the following conditions are met:
- We receive your prior written consent.
- We believe the prospective recipient to be you or your authorized representative.
- We are required by law to release information to the recipient.
Questions about your medical history and physical condition are required by our insurance carrier partners and will be released to the insurer so that they may underwrite your insurance application. GAC will not give or sell information about you to any other company, individual, or group without your prior authorization.
GAC will only use information about you to help us better serve your insurance needs or to suggest GAC services or insurance materials that may be of interest to you.
To further protect your privacy, our web site uses the highest levels of Internet security, including data encryption, user names and passwords, and other security tools.
Occasionally, GAC may conduct marketing surveys or research to help us evaluate products, services, and the changing needs of our customers. It is GAC's policy to keep this information confidential.
We will not share individual marketing data gathered from our web site with individuals or business entities not affiliated with GAC.
We know that the privacy of your personal information is important to you. In order to provide you with insurance products of the highest quality and with the service you deserve, it may be necessary for us from time to time to collect nonpublic personal and financial information about you (the "Information") and, in certain situations, to share that Information with others. The following notice describes our policies and practices with regard to your Information. |
| |
| HOW WE PROTECT YOUR INFORMATION |
| We maintain physical, electronic and procedural safeguards to protect the Information against unauthorized access and use. We restrict access to the Information to those employees who need access to provide products and services to you and your dependents. The personnel who have access are trained in the proper handling of the Information. Employees who violate this strict level of confidentiality are subject to our disciplinary process. |
| |
| CATEGORIES OF INFORMATION THAT WE COLLECT |
In the normal course of business we may collect the following types of Information:
- Information you provide on applications and other forms (including name and address)
- Data about your transactions with us (such as types of products you have purchased and your account status)
- Information gathered on our Web sites through online forms, site visit data and online information-collecting devices known as "cookies"
|
| |
| HOW WE USE YOUR INFORMATION |
- We may share your information among the Insurance Companies as permitted by law, including for routine business administration.
- We may share information with non-affiliated companies as allowed by law, such as firms that perform services on our behalf, including the administration and marketing of our products. We require these companies to meet strict privacy standards.
- We may disclose information to non-affiliated entities when required by law, such as to respond to a subpoena, to prevent fraud or to comply with an inquiry by a government agency.
|
| |
| ACCURACY OF YOUR INFORMATION |
| We strive to maintain the accuracy of Information that is in our possession about you. In order to help us maintain accuracy, you have the right to reasonably access your information. If you believe any information in our possession is inaccurate, a request can be made to amend or delete the information that you believe to be erroneous. If we concur with the request, we will amend or delete the information in question. You may write our Privacy Office at the address below to receive our complete policy on accessing and amending the Information. |
| |
| CHANGES TO THIS NOTICE |
| We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for the Information we already have about you as well as any Information we receive in the future. If we make any material changes to our policies or practices, we will provide you with a copy of a revised Notice. We will post a copy of the current Notice on our websites. The Notice will contain in the top right-hand corner, the effective date. |
| |
| You may contact our Privacy Office at: |
General Agent Center
15575 North 79th Place, Suite 100
Scottsdale, AZ 85260 |
| |
|
| |
| |
|
©2006-07 GACQuote.com
Security & Privacy | Legal Notice |
|