Accident Medical Insurance
Underwritten by U.S. Fire Insurance Company and/or Fairmont Premier Insurance Company.

DESCRIPTION OF BENEFIT

• Your membership includes an Accident Medical Insurance Coverage that will pay up to $2,000 per occurrence to reimburse you for medical expenses resulting from an injury caused by a covered accident. A $100 Deductible must be met before reimbursements will be paid. Your entire family is covered.
   

• Covered Expenses Include: emergency room, doctor bills, ambulance, hospital room and board, ancillary hospital expenses including operating room, lab tests & anesthesia, registered nurse services for private duty nursing while confined in a hospital, x-ray expenses, prescription drug expenses, dental expenses include dental x-ray.
   

• Eligibility and Effective Dates: The insured benefit is effective on the first day of the month following the date your completed application for Membership is received and processed. Coverage for Legal Dependents you acquire after your coverage is effective will be effective on the first day of the month following the date you acquire the Legal Dependent.
   

• Accident Medical Expense Benefit: If, while insured for this benefit, a covered person suffers accidental bodily injury, this plan will pay a Medical Expense Benefit, after the deductible has been paid, if covered. The Medical Expense Benefit is $2,000 per incident with a $100 deductible per incident.
   

• Exclusions and Limitations and Restrictions: Benefits will not be paid for a covered person's loss which: (1) is caused by or results from the covered person's own: intentional self-inflicted injury, suicide or any attempt thereat; voluntary self-administration of any drug or chemical substance not prescribed by, and taken according to the directions of a doctor (Accidental ingestion of a poisonous substance is not excluded); commission or attempt to commit a felony; participation in a riot or insurrection; driving under the influence of a controlled substance unless administered on the advice of a doctor; or driving while intoxicated as determined by the laws in the jurisdiction of the geographical area where the loss occurs; (2) is caused by or results from: the covered person being intoxicated as determined by the laws in the jurisdiction of the geographical area where the loss occurs); Any narcotic, drug, poison, gas or fumes voluntarily taken, administered, absorbed or inhaled, unless prescribed by a doctor; Declared or undeclared war or act of war; injury sustained while in the service of the armed forces of any country; aviation, except as specifically provided in this Policy; Sickness, disease, bodily or mental infirmity or medical or surgical treatment thereof, bacterial or viral infection, regardless of how contracted. This does not include bacterial infection that is the natural and foreseeable result of an accidental external bodily injury or accidental food poisoning.