Attachment J.docx

EVEREST REINSURANCE COMPANY

Statutory Office: 251 Little Falls Drive, Wilmington, DE, 19808 Administrative Office: 100 Everest Way, Warren, NJ 07059 800-438-4375

BLANKET ACCIDENT ONLY POLICY

This Policy describes the terms and conditions of insurance. This Policy goes into effect subject to its applicable terms and conditions at 12:01 A.M. on the Policy Effective Date shown above at the Policyholder’s address. It will remain in effect for the duration of the Policy Term shown above if the premium is paid according to the agreed terms. This Policy terminates at 12:00 A.M., on the day following the last day of the Policy Term unless the Policyholder and We agreed to continue coverage under this Policy for an additional Policy Term. The laws of the State of Issue govern this Policy. The Policy describes the essential features of the insurance coverage. All benefits are paid according to the terms of the Policy. The Policy is on file with the Policyholder and may be examined at any reasonable time.

30 DAY RIGHT TO EXAMINE THIS POLICY

Within 30 days after the Policyholder received the Policy, or notice electronically that the Policy is available, it may be returned in person or by regular mail to the Company, its agency office, or the agent who sold it to the Policyholder for any reason. The Company will return the premium to the payee. Then the Policyholder will be in the same position as if the Policy had never been issued.

THIS IS ACCIDENT ONLY COVERAGE. READ IT CAREFULLY.

BENEFITS ARE NOT PAYABLE FOR LOSS DUE TO SICKNESS.

THIS POLICY PAYS BENEFITS FOR SPECIFIC LOSSES FROM ACCIDENTS ONLY. THIS POLICY IS RENEWABLE.

Signed for Everest Reinsurance Company By:

EBAP 00 001 0924 SC

TABLE OF CONTENTS

The following provisions appear within this Policy in the following order:

Page Number

SCHEDULE OF BENEFITS

The Schedule of Benefits provides a brief outline of the coverage and benefits provided by this Policy. Please read the Description of Hazards section and the Description of Benefits section for full details.

AGGREGATE LIMIT OF LIABILITY

Class(es) of Eligible Persons

A person may be insured only under one Class of Eligible Persons even though They may be eligible under more than one class.

While participating in the following Covered Activities:

Men’s – Baseball, Basketball, Cheerleading, Cross Country, Golf, Soccer, Tennis, Track and Field.

Women’s – Basketball, Cheerleading, Cross Country, Golf, Lacrosse, Soccer, Softball, Tennis, Track and Field, Volleyball.

HAZARDS

BENEFITS

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

ACCIDENT MEDICAL EXPENSE BENEFIT

Any benefit limits and benefit percentages for Accident Medical Expense Benefits apply, unless otherwise specified, on a per Covered Person – per Covered Accident basis. Any applicable Deductibles must be satisfied within the time periods specified before benefits are payable.

Accident Medical Expense benefits may be available on an allocated or unallocated basis as shown. That is to say there may be specific limits or out of pocket expenses on certain Covered Expenses (allocated) or all Covered Expenses may be subject to the same maximum limit and out of pocket expenses (unallocated).

Any Deductibles, Benefit Periods, and Maximum Benefit Amounts apply on a per Covered Person, per Covered Accident basis.

Any Deductibles apply to all of the below Accident Medical Expense Benefits unless otherwise indicated in the Schedule below.

Benefit Period

ACCIDENT MEDICAL EXPENSE BENEFIT

Hospital Miscellaneous Benefit

In-Patient Surgical Benefits

Outpatient Surgery Benefits

Physician’s Visits

X-Ray Benefit

Laboratory Benefit

Dental Treatment for Injury Only

DEFINITIONS

The terms shown below shall have the meaning given in this section whenever they appear in this Policy. Additional terms may be defined within the provision to which they apply.

Aircraft means a vehicle which:

1. has a valid Certificate of Airworthiness; and

2. is being flown by a pilot with a valid license appropriate to the Aircraft.

Aggregate Deductible means the amount, shown as the Aggregate Deductible in the Schedule of Benefits, being applied to all the benefit amounts under Accident Medical Expense Benefits, by all Covered Persons insured under this Policy and paid by the Policyholder, before any benefits become payable by Us.

Benefit Period means the period of time from the date of Covered Injury, as shown in the Schedule of Benefits.

Child (Children) means the Covered Person’s children all of whom are not yet age 26, including:

1. a natural Child from the moment of birth, stepchild, foster, or legally adopted Child; or

2. a Child in the process of adoption (including the Covered Person’s adopted Child from the date the Covered Person is a party to a proceeding in which the adoption of such Child is sought); or

3. a Child for whom the Covered Person is required by a court order to provide medical support; and

4. grandchildren who are dependent on the Covered Person for federal income tax purposes at the time of application.

Certificate of Airworthiness means the standard airworthiness certificate issued by the Federal Aviation Administration of the United States or its foreign equivalent.

Coinsurance means the ratio by which We and the Covered Person share in the payment of Usual and Customary charge for medical treatment. The coinsurance percentage that We will pay is stated in the Schedule of Benefits.

Company or We, Us, Our means Everest Reinsurance Company, domiciled in Delaware.

Corridor Deductible means the dollar amount of the Covered Expenses the Covered Person must pay towards the policy before We pay any benefits regardless of what any other Insurance Plan or other Insurance Carrier has paid. It applies separately for each Covered Person.

Covered Accident means a sudden, unforeseeable external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and meets all the following conditions:

1. occurs while the Covered Person is insured under this Policy;

2. is not contributed to by disease, sickness, or mental or bodily infirmity;

3. is not otherwise excluded under the term of this Policy.

Covered Activity means any recurring activity or event that is shown in the Schedule of Benefits and:

1. takes place under one of the Conditions of Coverage specified in the Schedule of Benefits; and

2. is sponsored, organized, scheduled or otherwise provided by the Policyholder.

Covered Expenses means expenses actually incurred by or on behalf of a Covered Person for the Usual and Customary charges for the Medically Necessary treatment, services and supplies covered by the Policy and which is performed or given under the direction of a Physician for treatment of a Covered Injury. Coverage under the Policy must remain continuously in force from the date of the Accident until the date treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date such treatment, service, or supply, that gave rise to the expense or the charge, was rendered or obtained. A Covered Expense for a Covered Injury cannot be in excess of the Maximum Benefit Amount payable per service as shown in the Schedule and cannot be for medical services and supplies that are excluded under the Policy.

Covered Injury means any bodily harm that results, directly and independently of all other causes, from a Covered Accident. All injuries to the same Covered Person sustained in one Covered Accident, including all related conditions and recurring symptoms of the injuries, will be considered one Covered Injury.

Covered Loss means a loss:

1. which is the result of a Covered Injury to a Covered Person;

2. for which benefits are payable under this Policy; and

3. which is not otherwise excluded under the terms of this Policy.

Covered Person means an Insured Person eligible for coverage as identified in the Schedule of Benefits, for whom proper premium payment has been made when due, and who is therefore insured under the Policy.

Deductible means the amount of Covered Expenses that each Covered Person must Incur, as applicable, before benefits are paid under this Policy. The Deductible may apply to each Covered Accident or each Policy Term, as shown in the Schedule of Benefits.

Dependent means an Insured Person’s:

1. lawful Spouse, if not legally separated or divorced, or Domestic Partner.

2. unmarried Children under the age of 26.

Domestic Partner means an opposite or same sex partner who, for at least 12 consecutive months, has resided with the Covered Person and shared financial assets/obligations with the Covered Person. Both the Covered Person and the Domestic Partner must: (1) intend to be life partners; (2) be at least the age of consent in the state in which they reside; and (3) be mentally competent to contract. Neither the Covered Person nor the Domestic Partner can be related by blood to a degree of closeness that would prohibit a legal marriage, be married to anyone else, or have any other Domestic Partner. The Company requires proof of the Domestic Partner relationship in the form of a signed and completed Affidavit of Domestic Partnership.

Emergency Room means a trauma center or special area in a Hospital that is equipped and staffed to give people emergency treatment on an outpatient basis. An Emergency Room is not a clinic or Physician’s office. Emergency Room treatment includes all Hospital related services including Physician, x-ray and lab services shown in the Schedule of Benefits.

Health Care Plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

1. group or blanket insurance, whether on an insured or self-funded basis;

2. hospital or medical service organizations on a group basis;

3. Health Maintenance Organizations on a group basis.

4. group labor management plans;

5. employee benefit organization plan;

6. professional association plans on a group basis; or

7. any other group employee welfare benefit plan as defined in the Employee Retirement Income Security Act of 1974 as amended.

Home means the primary residence, structure, or land on which the Covered Person permanently resides.

Hospital means an institution which:

1. is operated pursuant to law;

2. is primarily and continuously engaged in providing medical care and treatment to sick and injured persons on an inpatient basis;

3. is under the supervision of a staff of Physicians;

4. provides 24-hour nursing service by or under the supervision of a graduate registered nurse, (R.N.);

5. has medical, diagnostic and treatment facilities, with major surgical facilities;

a. On its premises; or

b. Available to it on a prearranged basis; and

6. charges for its services.

7. Is a duly licensed Rehabilitation Facility.

Hospital does not include:

1. a clinic or facility for:

a. Convalescent, custodial, educational or nursing care;

b. The aged, drug addicts or alcoholics;

2. a military or veterans’ hospital or a hospital contracted for or operated by a national government or its agency unless:

a. the services are rendered on an emergency basis; and

b. a legal liability exists for the charges made to the individual for the services given in the absence of insurance.

Insured Person means a member, as defined under the Schedule of Benefits, who is eligible and for whom the required premium is made making insurance in effect for that person under the Policy. A Dependent covered under the Policy is not an Insured Person.

Medically Necessary or Medical Necessity means a treatment, service, or supply that is:

1. required to treat a Covered Injury; and

2. prescribed or ordered by a Physician or furnished by a Hospital;

3. performed in the least costly setting required by the condition;

4. consistent with the medical and surgical practices prevailing in the area for treatment of the condition at the time rendered.

The purchasing or renting of air conditioners, air purifiers, motorized transportation equipment, escalators or elevators in private homes, swimming pools or supplies for them, and general exercise equipment are not considered Medically Necessary.

The fact that a Physician may prescribe, authorize, or direct a service does not in and of itself make it Medically Necessary or covered by the Group Policy.

A service or supply may not be Medically Necessary if a less intensive or more appropriate diagnostic or treatment alternative could have been used. We may, at Our discretion, consider the cost of an alternative to be the Covered Expense.

Nurse means either a professional, licensed, graduate Registered Nurse (R.N.) or a professional, Licensed Practical Nurse (L.P.N.).

Physician means a person who is a qualified practitioner of medicine. As such, They must be acting within the scope of Their license and under the laws in the state in which They practice and providing only those medical services which are within the scope of Their license or certificate. It does not include a Covered Person, a Covered Person’s Spouse, son, daughter, father, mother, brother, or sister or other relative.

Policyholder means the entity, in whose name the Policy is issued, as identified on the Policy’s face page.

Principal Sum means the largest amount payable under the benefit for all losses resulting from any one Accident.

Spouse means the lawful Spouse, if not legally separated or divorced, or Domestic Partner.

Supervised and Sponsored Activity means a Policyholder-authorized function:

1. in which the Covered Person participates;

2. that is organized and approved by the Policyholder; and

3. that is within the scope of the activities provided by the Policyholder.

Their, Them, They refers to male, female, or nonbinary individuals.

Usual Reasonable and Customary (URC) means:

1. with respect to fees or charges, fees for medical services, or supplies which are;

a. usually charged by the provider for the service or supply given; and

b. the average charged for the service or supply in the locality in which the service or supply is received; or

2. with respect to treatment or medical services, treatment which is reasonable in relationship to the service or supply given and the severity of the condition.

EFFECTIVE DATES OF INSURANCE

Policyholder Effective Date The Policy begins on the Policy Effective Date shown in the Schedule of Benefits at 12:01 A.M. at the address of the Policyholder.

Covered Person’s Effective Date A Covered Person will become an insured under this Policy, provided proper premium payment is made, on the latest of:

1. the Effective Date of the Policy; or

2. the day They become eligible according to the referenced date shown in the Schedule of Benefits.

TERMINATION DATE OF INSURANCE

Policy Termination Date Termination takes effect at 12:01 A.M. time at the address of the Policyholder on the date of termination. Termination by the Policyholder or by Us will be without prejudice to any claims originating prior to the date of termination.

The Policy terminates automatically on the earlier of:

1. the Policy Termination Date shown in the Policy; or

2. the premium due date if premiums are not paid when due subject to any Grace Period.

Failure by the Policyholder to pay all required premiums due by the last day of the Grace Period shall be deemed notice by the Policyholder to Us to terminate this Policy on the last day of the period for which premiums have been paid.

The Policy may be terminated by the Policyholder or by Us as of any premium due date or Policy Anniversary Date by giving written notice to the other at least 60 days prior to such date.

We or the Policyholder may terminate the Policy at any time by written mutual consent.

If premiums have been paid beyond the termination date, We will refund the excess; or if premiums have been paid short of the termination date, the Policyholder will owe Us the difference.

Insured Person’s Termination Insurance for an Insured Person will end on the earliest of:

1. the date the Insured Person is no longer in an Eligible Class.

2. the date the Insured Person reports for active duty in any Armed Forces, according to the referenced date shown in the Application. We will refund, upon receipt of proof of service, any premium paid, calculated from the date active duty begins until the earlier of:

a. the date the premium is fully earned; or

b. the Expiration Date of this Policy.

This does not include Reserve or National Guard duty for training;

3. the end of the period for which the last premium contribution is made; or

4. the date this Policy is terminated.

SCOPE OF COVERAGE

We will provide the benefits described in this Policy to all Covered Persons who suffer a Covered Loss which:

1. is within the scope of the Description of Benefits and results, directly and independently of disease or bodily infirmity, from a Covered Injury which is suffered in a Covered Accident;

2. occurs while the person is a Covered Person under this Policy; and

3. is within the scope of the risks set forth in the Description of Hazards provisions.

Full Excess Accident Medical Expense:

If an injury to the Covered Person occurs while They are in the United States and results in Them incurring Covered Expenses for any of the services in the Schedule of Benefits, We will pay the Covered Expenses incurred, subject to the Deductible Amount (if any), that are in excess of Expenses payable by any other Health Care Plan, regardless of any Coordination of Benefits provision contained in such Health Care Plan.

The Covered Person must be under the care of a Physician when the Covered Expenses are incurred. The Expense must be incurred solely for the treatment of a Covered Injury:

1. while the person is insured under this Policy; or

2. during the Benefit Period stated in the Schedule of Benefits.

The first Expense must be incurred within the time frame shown in the Schedule of Benefits.

The total of all medical benefits payable under this Policy is shown in the Schedule of Benefits: and

1. subject to the specific maximums shown in the Schedule of Benefits; and

2. subject to compliance with the requirement, set forth in the Limitations section of this Policy.

Any Covered Expenses payable under this provision will be reduced by the amount the Health Care Plan would have paid had its services or facilities been utilized if:

1. the Covered Person has coverage under another Health Care Plan; and

2. the other Health Care Plan is an HMO, PPO or similar arrangement; and

3. the Covered Person does not use the facilities or services of the HMO, PPO or similar arrangement.

Non-Duplication of Benefits Provision:

This provision applies if a Covered Person:

1. is covered by any other blanket or group health care plan; and

2. would, as a result, receive total medical expense or service benefits in excess of the expenses actually incurred.

In this case, the Medical Expense Benefits We will pay under this Policy will be reduced by such excess. This provision does not apply if We would be primary under any coordination of benefit guidelines contained in the other Health Care Plans.

Coordination of Benefits Provision:

If a Covered Person is also covered under one or more other Plans, the benefits payable under this Policy will be coordinated with the benefits payable under all other Plans.

Coordination of Benefits will be used to determine the benefits payable for a Covered Person for any Claim Determination Period if, for the Allowable Expenses incurred in that period, the sum of 1. and 2. below would exceed those Allowable Expenses:

1. the benefits that would be payable under this Policy without coordination; and

2. the benefits that would be payable under all other Plans without the coordination of benefits provisions in those Plans.

The benefits that would be payable under this Policy for Allowable Expenses incurred in any Claim Determination Period without Coordination of Benefits will be reduced to the extent required so that the sum of:

1. those required benefits; and

2. all the benefits payable for those Allowable Expenses from all other Plans will not exceed the total of those Allowable Expenses.

Benefits payable under all other Plans include the benefits that would have been payable had proper claim been made for them.

However, the benefits of another Plan will be ignored when the benefits of this Policy are determined if:

1. the Benefit Determination Rules would require this Policy to determine its benefits before that Plan; and

2. the other Plan has a provision that coordinates its benefits with those of this Policy and would, based on its rules, determine its benefits after this Policy.

When Coordination of Benefits reduces the total amount otherwise payable in a Claim Determination Period for a Covered Person, each benefit that would be payable in the absence of Coordination of Benefits will be reduced in proportion. The reduced amount will be charged against any applicable benefit limit of this Policy.

We reserve the right to release to or obtain from any other insurance company or other organization or person, any information that, in Our opinion, We or it needs for the purpose of the Coordination of Benefits. When payments that should have been made under this Policy based on the terms of this provision have been made under any other Plans, We have the right to pay to any other organization making these payments the amount it determines to be warranted. Amounts paid in this manner will be considered benefits paid under this Policy. We will be released from all liability under this Policy to the extent of these payments. When an overpayment has been made by Us, at any time, We will have the right to recover that payment, to the extent of the excess, from the person to whom it was made or any other insurance company or organization, as We may determine.

Benefit Determination Rules - The rules below establish the order in which benefits will be determined:

1. Benefits not as a Dependent:

The benefits of a Plan that covers the person for whom claim is made other than as a Dependent will be determined before a Plan that covers that person as a Dependent.

2. Dependent Benefits under Different Parent Plans:

The benefits of a Plan that covers the person for whom claim is made as a Dependent of the parent whose birthday falls earlier in the year will be determined before the benefits that covers that person as a Dependent under the other parent’s Plan.

When both parents have the same birthday, the benefits of the Plan which covered the parent longer are determined before those of the Plan which covered the other parent for a shorter period of time.

However, if the other Plan does not have the rule described immediately above, but instead has a rule based upon the gender of the parent, and if, as a result, the Plans do not agree on the order of benefits, the rule in the other Plan will determine the order of benefits.

Notwithstanding the foregoing, in the case of a Dependent Child of divorced or separated parents, the following rules will apply:

1. if there is a court decree that establishes financial responsibility for medical, dental or other health care of the Child, the benefits of the Plan that covers the child as a Dependent of the parent so responsible will be determined before any other Plan, otherwise:

2. the benefits of a Plan that covers the Child as a Dependent of the parent with custody will be determined before a Plan that covers the Child as a Dependent of a step-parent or a parent without custody;

The benefits of a Plan that covers the Child as a Dependent of a step-parent will be determined before a Plan that covers the Child as a Dependent of the parent without custody.

3. Benefits for Person Longest Covered:

When the above rules do not establish the order, the benefits of a Plan that has covered the person for whom claim is made for the longer period of time will be determined before a Plan which has covered the person for the shorter period of time.

Whenever used in this provision:

Plan means any:

1. group, blanket or franchise insurance coverage;

2. service plan contracts, group or individual practice or other prepayment plans;

3. coverage under any labor management trusteed Plans, union welfare plans, employer organization plans, self-funded plans or employee benefit organization plans which provides medical or dental benefits or services; or

4. Medicare plan or similar governmental plan offering benefits.

It does not include coverage under individual policies or contracts. Each Plan or part of a Plan that has a right to coordinate benefits will be considered a separate Plan.

Allowable Expense means any necessary, Usual and Customary item of expense at least a part of which is covered by any one of the Plans that covers the person for whom claim is made. When benefits from a Plan are in the form of services, not cash payments, the reasonable cash value of each service is both an Allowable Expense and a benefit paid.

Claim Determination Period means a calendar year or that part of a calendar year in which the person has been covered under this Policy.

HMO/PPO PROVISION

In the event that Covered Expenses are denied under a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or other group medical plan the Covered Person has in force, and such denial is because care or treatment was received outside of the network’s geographic area, benefits will be payable under this coverage, provided the expense is a Covered Expense.

DESCRIPTION OF HAZARDS

Coverage will be provided for the Insured Person only when the Insured Person is engaged in a Hazard as described below and experiences a Covered Loss. Each Hazard is subject to the terms, conditions, limitations, and exclusions contained in this Policy.

Note that the Hazard(s) may be different for each class of Eligible Persons. The Hazard(s) applicable to each Class of Eligible Persons is shown in the Schedule of Benefits.

Unless otherwise specified, We pay benefits only once for any one Covered Accident, even if it is covered by more than one Hazard.

SPORTS COVERAGE HAZARD

This Hazard applies to the Covered Person when They suffer a Covered Injury resulting from a Covered Accident that occurs while They are participating in or attending one of the following Sports Covered Activities:

1. regularly-scheduled practice or training;

2. regularly-scheduled competition or exhibition game;

3. a scheduled tryout, workout session, or team meeting;

4. a Supervised and Sponsored Sports Activity; or

5. Covered Sports Travel.

Covered Sports Travel includes travel, only within the contiguous United States, including Alaska and Hawaii and only directly and without interruption:

1. between Home and the premises of the Sports Organization;

2. between Home and another meeting place designated by the Sports Organization;

3. between Home and another site designated by the Sports Organization, where a Supervised and Sponsored Sports Activity is scheduled;

4. between the premises of the Sports Organization or other meeting place it designates, and another site where a Supervised and Sponsored Sports Activity is scheduled.

Travel Coverage for Overnight Supervised and Sponsored Sports Activities Covered Sports Travel also includes travel to a Supervised and Sponsored Sports Activity, within the contiguous United States, including Alaska and Hawaii, when Covered Person’s participation or attendance requires Them to be away from Their Home for a stay of one or more nights. Coverage for travel to any Supervised and Sponsored Sports Activity that takes place outside the contiguous United States, including Alaska and Hawaii will be covered only if We have agreed to it in writing.

Definitions: For the purpose of this Hazard:

Covered Sports Travel means transportation on a bus or Private Passenger Automobile driven by an adult with a valid drivers' license whom the Sports Organization has specifically designated to transport Them to a Supervised and Sponsored Activity.

Sports Organization means a School, college or university, team, league or other organization, as named in the Schedule of Benefits, that organizes, sponsors, supervises schedules or otherwise provides Sports Covered Activities.

Supervised and Sponsored Sports Activity means a Covered Activity that:

1. takes place:

a. on a Sports Organization's premises during scheduled hours;

b. at another site at which the Covered Activity is scheduled; and

2. is sponsored, organized or otherwise provided by the Sports Organization; and

3. is supervised by a coach, referee, or by another adult specifically assigned supervisory duties and authority for that Covered Activity by the Sports Organization.

Exclusions

1. This coverage will not be in effect during any sports activity unless it is sponsored, organized, supervised, scheduled or otherwise provided by the Sports Organization named in the Schedule of Benefits.

2. This coverage will not be in effect during travel to or from any Supervised and Sponsored Sports Activity if:

a. the Sports Organization provides transportation to and from it for a group of two or more persons; and

b. the Covered Person is travelling to or from it by another means of transportation.

3. This coverage will not be in effect during travel to any Supervised and Sponsored Sports Activity that takes place outside the contiguous United States, including Alaska and Hawaii unless We have agreed in advance to provide it.

4. This coverage will not be in effect during Their Personal Deviation.

No benefits are payable for an Injury sustained while traveling or flying in or on (including getting in or out of, or on or off of) any Aircraft while it is being used for any Specialized Aviation Activity(ies).

Any Exclusions contained in the General Exclusions section pertaining to air travel is(are) waived only to the extent of the specific circumstances contained in this Hazard.

DESCRIPTION OF BENEFITS

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

If, within 1 year(s) from the date of a Covered Accident by this Policy, Covered Injury from such Covered Accident, results in Covered Loss listed in the Schedule of Benefits, We will pay the percentage of the Principal Sum set opposite the loss in the table below. If the Covered Person sustains more than one such Covered Loss as the result of one Covered Accident, We will pay only one amount, the largest to which They are entitled. This amount will not exceed the Principal Sum which applies for the Covered Person.

Definitions: For the purpose of this benefit:

Loss of a hand or foot means complete Severance through or above the wrist or ankle joint.

Loss of sight means the total, permanent loss of sight of the eye. The loss of sight must be irrecoverable by natural, surgical or artificial means.

Loss of speech means total, permanent and irrecoverable loss of audible communication.

Loss of hearing means total and permanent loss of hearing in one or both ears which cannot be corrected by any means.

Loss of a thumb and index finger means complete Severance through or above the metacarpophalangeal joints (the joints between the fingers and the hand).

Severance means the complete separation and dismemberment of the part from the body.

ACCIDENT MEDICAL EXPENSE BENEFITS

We will pay Accident Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident. These benefits are subject to the Deductibles, Benefit Periods, Maximum Benefit Amounts and other terms or limits shown below and in the Schedule of Benefits.

Accident Medical Expense Benefits are only payable:

1. for Usual and Customary charges incurred after the Deductible has been met;

2. for those Medically Necessary Covered Expenses incurred by or on behalf of the Covered Person;

3. for Covered Expenses incurred within 180 days after the date of the Covered Accident.

No benefits will be paid for any expenses incurred that are in excess of Usual and Customary charges. Benefits will be payable for:

1. Hospital semi-private room and board (or, when Medically Necessary, room and board in an intensive care or cardiac care unit); Hospital miscellaneous ancillary services (miscellaneous services include services and supplies such as: the cost of the operating room; laboratory tests; X-ray examinations; anesthesia; drugs (excluding take-home drugs) or medicines; therapeutic services; and supplies. Miscellaneous services do not include charges for telephone, radio or television, extra beds or cots, meals for guests, take-home items, or other convenience items.); Emergency room; or use of an ambulatory medical center;

2. Observation room;

3. Services of an In-Hospital and/or Emergency Room Physician or a registered nurse (R.N.);

4. Air and Ground Ambulance service to or from a Hospital;

5. Pre-Admission Testing;

6. Outpatient Physiotherapy including physical therapy and occupational therapy;

7. Rental of Durable Medical Equipment;

8. Artificial limbs, artificial eyes or other prosthetic appliances (not including the replacement of these items);

9. Medicines or drugs administered by a Physician or that can be obtained only with a Physician’s written prescription;

10. Dental charges for injury to sound, natural tooth;

11. Medical emergency care (room and supplies) expenses: incurred within 72 hours of an Accident and including: the attending Physician’s charges; X-rays; laboratory procedures; use of the Emergency Room; and supplies;

12. Inpatient and/or Outpatient surgical room and supply expenses for use of the surgical facility; Services of Inpatient and/or Outpatient Primary and Assistant surgeons;

13. Outpatient: diagnostic X-rays; MRI/CAT scans; laboratory procedures; diagnostic imaging services; and tests;

14. Inpatient and/or Outpatient Physician non-surgical treatment/examination expenses (excluding medicines) including: the Physician’s initial visit; each Medically Necessary follow-up visit; and consultation visits when referred by the attending Physician;

15. Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a surgical procedure whether on an inpatient or outpatient basis;

16. Chiropractic expenses on an outpatient basis limited to one visit per day;

17. Eyeglasses; contact lenses; and hearing aids; when damage occurs in a Covered Accident that requires medical treatment;

18. Injections;

19. In-Patient Rehabilitative Services, including Skilled Nursing and Sub-Acute Facility Care.

20. Home Health Care;

21. Motor Vehicle Accidents;

22. Orthopedic braces and appliances.

23. Expenses due to an aggravation or re-Injury of a pre-existing condition;

24. Expenses for treatment of heat stroke, heart attack, stroke, and burst aneurysm if the condition occurs as the result of a Covered Accident.

25. Expenses for treatment of the following conditions resulting from the play or practice of Intercollegiate sports: repetitive motion injuries; strains; sprains; hernia; tennis elbow; tendonitis; bursitis; and muscle tears

26. Non-ambulance transportation expenses to or from a Physician’s office or Hospital.

Excluded Expenses The following will not be considered Covered Expenses unless coverage is specifically provided.

1. Any service, treatment or supply that is not considered appropriate treatment as defined in this Policy.

2. Expenses Incurred after the end of the Benefit Period, even if Incurred for continuing services or treatment of a Covered Injury.

3. cosmetic surgery or care, or treatment solely for cosmetic purposes, or complications therefrom. This exclusion does not apply to:

a cosmetic surgery resulting from a Covered Accident, if initial treatment of the Covered Person is begun within 12 months of the date of the Covered Accident;

b reconstruction incidental to or following surgery resulting from a Covered Accident;

c. any unplanned and unintended adverse consequences that may result during the treatment of a Covered Accident.

4. Any elective or routine treatment, surgery, health treatment, or examination, including any service, treatment or supplies that: (a) are deemed to be experimental or investigational; and (b) are not recognized and generally accepted medical practice in the United States.

5. Services or treatment provided by persons who do not normally charge for their services, unless there is a legal obligation to pay.

6. Rest cures or custodial care.

7. Personal services such as television and telephone.

8. 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 foreseeable result of an accidental external bodily injury or accidental food poisoning.

Other Exclusions that apply to this benefit are in the General Exclusions Section.

GENERAL LIMITATIONS

Limitation on Multiple Covered Losses: If a Covered Person suffers more than one Covered Loss as a result of the same Covered Accident, We will pay only one benefit, the largest benefit.

GENERAL EXCLUSIONS

This Policy does not cover any loss resulting in whole or part from, or contributed to by, or as a natural or probable consequence of any of the following even if the immediate cause of the loss is an Accidental bodily Injury, unless otherwise covered under this Policy by Additional Benefits:

1. Suicide, self-destruction, attempted self-destruction or intentional self-inflicted Injury while sane or insane.

2. War or any act of war, declared or undeclared.

3. An Accident which occurs while the Insured Person is on Active Duty in any Armed Forces, National Guard, military, naval or air service or organized reserve corps:

4. Injury sustained while in the service of the armed forces of any country. When the Insured Person enters the armed forces of any country, We will refund the unearned pro-rata premium upon request;

5. Participation in a riot or insurrection.

6. Any Injury requiring treatment which arises out of, or in the course of fighting, brawling, assault or battery.

7. 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 foreseeable result of an Accidental external bodily injury or accidental food poisoning.

8. Disease or disorder of the body or mind.

9. Mental or Nervous disorders, except as specifically provided in the Policy.

10. Asphyxiation from voluntarily or involuntarily inhaling gas and not the result of the Insured Person’s job.

11. Injury caused by, contributed to or resulting from the Insured Person’s use of alcohol, illegal drugs or medicines that are not taken in the dosage or for the purpose as prescribed by the Insured Person’s Physician.

12. Driving under the influence of a controlled substance unless administered on the advice of a Physician.

13. Driving while Intoxicated. Intoxicated will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs.

14. Violation or in violation or attempt to violate any duly-enacted law or regulation, or commission or attempt to commit an assault or felony, or that occurs while engaged in an illegal occupation.

15. Regular health checkups.

16. Travel or activity outside the United States.

17. Any Accident where the Insured Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator’s license.

18. Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from:

a. While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or

b. While being used for any test or experimental purpose; or

c. While piloting, operation, learning to operate or serving as a member of the crew thereof; or

d. While traveling in any such Aircraft or device which is owned or leased by or on behalf of the Policyholder of any subsidiary or affiliate of the Policyholder, or by the Insured Person or any member of Their household.

e. A space craft or any craft designed for navigation above or beyond the earth’s atmosphere; or

f. an ultralight hang-gliding, parachuting, or bungee-cord jumping

g. Except as a fare paying passenger on a regularly scheduled commercial airline or as a passenger in a non-scheduled, private Aircraft used for business or pleasure purposes.

19. Rest cures or custodial care.

20. Elective or Cosmetic surgery, except for reconstructive surgery on an injured part of the body.

21. Massage Therapy. Physical Therapy or Acupuncture/Acupressure Services, unless otherwise specifically allowed for in the Schedule of Benefits.

22. Services rendered for detection and correction by manual or mechanical means (including x-rays incidental thereto of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column.

23 Pregnancy (except complications of pregnancy); childbirth; miscarriage; abortion; or any complications of childbirth, miscarriage or abortion. This does not apply if treatment is required as a result of a Covered Accident.

AGGREGATE LIMIT

The maximum amount payable under this Policy may be reduced if more than one Covered Person suffers a loss as a result of the same accident, and if amounts are payable for those losses under one or more of the following Hazards and Benefits provided by this Policy: Accidental Death and Dismemberment Benefit. The maximum amount payable for all such losses for all Covered Persons under all those Benefits combined will not exceed the amount shown as the Aggregate Limit in the Schedule of Benefits. If the combined maximum amount otherwise payable for all Covered Persons must be reduced to comply with this provision, the reduction will be taken by applying the same percentage of reduction to the individual maximum amount otherwise payable for each Covered Person for all such losses under all those Benefits combined.

PREMIUM PROVISIONS

GRACE PERIOD:

A grace period of 31 days is granted for each premium due after the first premium due date. Coverage will stay in force during this period unless notice has been sent, in accordance with the Policy Termination provision, of the intent to terminate coverage under this Policy. Coverage will end if the premium is not paid by the end of the Grace Period.

PREMIUMS:

Premium due dates are the first of every month. Premium payment made in advance or for more than a one month period will not affect any provisions of this Policy with regard to change. Failure by the Policyholder to pay premiums when due or within the grace period shall be deemed notice to Us to terminate coverage at the end of the period for which premium was paid.

CHANGES IN RATES:

We have the right to change the premium rates on any premium due date:

1. after the first 12 months insurance is in effect;

2. coinciding with a change in the coverage provided or classes eligible; or

3. coinciding with a change in the risks We have assumed.

We will give 60 days written notice of any change under 1. above. Notice will be sent to the Policyholder's most recent address in Our records.

REINSTATEMENT

This Policy may be reinstated within 60 days if it lapsed for nonpayment of premium. Requirements for reinstatement are Your written application and payment of all overdue premiums. Any premium accepted in connection with a reinstatement will be applied to the earliest period for which premium was not previously paid.

GENERAL PROVISIONS

ENTIRE CONTRACT

The entire contract consists of the Policy, the Application, Riders, and any other documents requested and accepted by Us. No change in this Policy is valid unless approved by an officer of the Company. Such approval must be signed by Our officer and attached to this Policy. No broker, agent or producer can change or waive any provision of this Policy.

AMENDMENTS

Any change in this Policy will be made by amendment and approved by Us. Such amendment will not require the consent of any Covered Person. The effective time for any amendments shall be 12:01 A.M. Standard Time at the address of the Insured.

TIME LIMITS ON CERTAIN DEFENSES

All statements made by the Policyholder or by a Covered Person are deemed representations and not warranties. No such statement will cause Us to deny or reduce benefits or be used as a defense to a claim unless a copy of the instrument containing the statement is or has been furnished to such person; or, in the event of Their death or incapacity, Their beneficiary or representative. After 2 years from the Covered Person's Effective Date of coverage, no such statement, except in the case of fraud or with respect to eligibility for coverage, will cause such coverage to be contested.

MISSTATEMENT OF AGE

If the age of the Covered Person is incorrectly stated, We will make a fair adjustment of the premiums, benefits, or both. The adjustment will be based on the premiums and benefits that would have been payable had We known the correct information.

WORKERS' COMPENSATION INSURANCE:

This Policy is not in lieu of and does not affect any requirement for coverage under any Workers' Compensation Insurance.

POLICY TERMINATION:

We may terminate coverage on or after the anniversary of any premium due date. The Policyholder may terminate its coverage on any premium due date. Written notice must be given at least 31 days prior to such premium due date.

CONFORMITY WITH STATE STATUTES:

Any provision of this Policy in conflict, on the Effective Date of this Policy, with the laws of the state where it is delivered, is amended to conform to the minimum requirements of such laws.

CLERICAL ERROR

Clerical errors that We or Our authorized Administrator make in Your Schedule of Benefits, the issuance of a Policy, or in record keeping will not afford You benefits or validate insurance for which You have not applied and paid the appropriate premium and been approved by Us. We have the right to offset or recover from You any overpayment of benefits made due to such errors.

NON-WAIVER

If We or You fail to enforce or to insist on strict compliance with any of the terms, conditions, limitations or exclusions of this Policy, that will not be considered a waiver of any rights under the Policy. . A past failure to strictly enforce the Policy will not be a waiver of any rights in the future, even in the same situation or set of facts.

ADVISORY NOTICE TO POLICYHOLDERS REGARDING TRADE OR ECONOMIC SANCTIONS

This Notice supersedes any provision in the Policy pertaining to Trade or Economic Sanctions.

No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of…