| India Network Health Insurance, USA | Toll Free: 877-204-0222 | Members Area | Contact Us | |
| Telephone: 408-850-2154 |   
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| Visitor Medical Insurance - Standard Coverage $50,000 Program |
| Program Home Page | Comprehensive Coverage |
Standard $150,000 with Pre Existing Coverage |
Standard $100,000 with Pre Existing Coverage |
Standard $150,000 |
Standard $100,000 |
Standard $50,000 |
SCHEDULE OF BENEFITS IN-PATIENT, OUT-PATIENT, AND OTHER
SCHEDULE OF BENEFITS PART A
When your covered Injury or Sickness requires treatment by a Physician, the Policy will provide benefits while your coverage is in force for the charges subject to the maximums which exceed the deductible Per Person for each Injury and each Sickness. Payment for any Covered Service will be no more than the Benefit Limit. The total payable by all Benefits will be no more than the stated policy maximum for each Injury and each Sickness. The $250 deductible and $500 deductible options include the same Covered Services and Benefit Limits as described below for 70 plus visitors.
For the following conditions, whether the condition caused the admission or during your inpatient stay at the Hospital, the maximum amount payable for all benefits combined is $3,500:
- Stroke or Cerebrovascular accident or event
- Cardiovascular accident or event
- Myocaridal infraction or heart attack
- Coronary thrombosis
- Aneurysm
COVERED SERVICES |
$50,000 Policy Reimbursement Coverage |
Hospital Room (average semi-private) and Board and Miscellaneous |
Charges up to $1,300 maximum a day, to 30 days |
Hospital Intensive Care Unit |
Up to $525 maximum additional a day, to 8 days |
Surgeon |
Charges up to $3,000 maximum |
Anesthetist |
Charges up to $750 maximum |
Assistant Surgeon |
Charges up to $750 maximum |
Physician’s Non-Surgical Visits |
Charges up to $60 a visit, 1 visit a day, to 30 visits |
Consultant Physician, when requested by attending physician |
Charges up to $400 maximum |
Pre-Admission Tests within 7 days before hospital admission |
Charges up to $1,000 maximum |
COVERED SERVICES |
$50,000 Policy Reimbursement Coverage |
Day Surgery Miscellaneous, related to major scheduled surgery performed at a hospital or licensed outpatient surgery center, including the cost of; operating room’ anesthesia drugs and medicines; and medical supplies used there: |
Charges up to $1,000 maximum |
Surgeon: |
Charges up to $3,000 maximum |
Anesthetist: |
Charges up to $750 maximum |
Assistant Surgeon: |
Charges up to $750 maximum |
Physician’s Non-Surgical Visits: |
Charges up to $60 a visit, 1 visit a day, to 10 visits |
Diagnostic X-rays and Lab Services: |
Charges up to $400 maximum |
CAT Scan, PET Scan or MRI: |
Charges up to $400 additional |
Hospital Emergency Room: |
75% charges to maximum $350 |
Prescription Drugs: |
Up to $100 maximum |
COVERED SERVICES |
$50,000 Policy Reimbursement Coverage |
Ambulance Services: |
Charges up to $400 maximum |
Initial Orthopedic Prosthesis or Brace: |
Charges up to $1,000 maximum |
Dental Treatment injury to sound, natural teeth- due to accident |
Charges up to $450 maximum. There are no benefits for dental services for immediate relief of pain. |
Chemotherapy and/or Radiation Therapy: |
Charges up to $1,000 maximum |
Physical and Occupational Therapy: |
Charges up to $35 a visit maximum, 1 visit a day to 12 visits |
Private Duty Nurse |
Charges up to $400 maximum |
Maternity Benefit (conception to occur after 120 days of cont coverage) |
Charges up to $4,500 maximum |
Medical Evacuation* |
$15,000 maximum |
Repatriation of Remains* |
$10,000 maximum |
Intercollegiate Sports |
No Benefits |
PERIODS OF COVERAGE & PREMIUM RATES
Premium Rates in all tables are per month (30 days coverage) and any single days premium is prorated based on 30 day monthly premium.
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Enrollment is subject to the following rules: |
A $5 service fee will be charged for each enrollment/renewal and is non-refundable even if insurance is cancelled. A premium notice reminder e-mail will be sent before period of coverage ends. Renewal is available for a minimum period of one day and a maximum of 12 months at a time. |
PROGRAM ELIGIBILITY
Only dues-paying members of India Network and their non-U.S. citizen visitors and their Eligible Dependents (if coverage has been purchased), while visiting the USA or another country outside their country of residence, excluding those countries identified on the OFAC list of excluded countries.
Eligible dependents are any of the following persons: the insured's legal spouse, and their unmarried dependent children under 18 years of age (unless incapable of self-sustaining employment due to physical or mental handicap).
If adoption, birth or marriage occurs while the Insured is covered by this program, the insured will have 31 days within which to pay the required additional premium to enroll any newly eligible dependents for the remainder of the period of coverage.
INSURANCE ENROLLMENT
ONLINE:
To enroll in the India Network Accident & Sickness Medical Insurance Program, the procedure is to complete online insurance forms:
1. Complete the India Network Membership Form (1st Form under Online Forms Link)
2. Complete the Insurance Enrollment Form (2nd Form under Online Forms Link)
FAX:
Fax the membership and enrollment forms (fax versions of the forms are available under download link) with charge authorization to 407-479-3289
MAIL:
Mail a check for the exact amount with completed enrollment forms: the membership form & insurance form. Prepare two checks:
(i) Membership fee of $10 made payable to India Network Foundation, and
(ii) Premium amount made payable to 'India Network Services' and mail the package to:
India Network Services
7065 Westpointe Blvd, Suite 209
Orlando, FL 32835-8758
Processing of an insurance enrollment may take up to 2 working days; when processing is complete, India Network office will mail an insurance ID card and brochure to the USA/Canada address of the member if the insurance coverage duration is more than 1 month.
NOTE: For coverage of less than one month, print the brochure and keep the ID card generated after online submission form as proof of coverage.
COVERAGE
Coverage of Insured and their eligible dependents who enroll in this program will begin at 12:01 a.m. on the latest of the following dates, whichever is applicable:
Insured’s Effective Date:
Insurance under this Policy shall become effective on the latest of the following dates:
1.) The Effective Date of the Policy;
2.) The date the Insured leaves their Country of Residence;
3.) The date the Insured’s enrollment form is received by the India Network Foundation;
4.) The date the Insured’s premium is received by the India Network Foundation; or
5.) The date the Insured requested on the Application.
Subject to the Exception for Sickness:
Exception for Sickness: If coverage is purchased after the Insured Person's arrival in the United States, coverage under the Policy will be limited to Accident only during an Insured Person's first seven (7) days of coverage, commencing as of the Insured Person's Effective Date. In this case, Full Policy coverage will take effect after seven (7) days.
Dependent's Effective Date:
Insurance under this Policy shall become effective on the latest of the following dates:
1) the date the Insured’s coverage becomes effective;
2) the date the dependent leaves their Country of Residence; or
3) the date the person becomes a dependent as defined in Item 3 of the Declarations section.
Insured’s Termination Date:
The coverage provided with respect to the Insured shall terminate on the latest of the following dates:
1) The last day of the period for which the premium is paid;
2) The date the Insured returns to their Country of Residence;
3) The expiration of the maximum period coverage as shown on the premium section, Page 13 of this Policy; or
4) The date the Policy terminates.
Termination of Coverage will not affect a claim for a covered loss that occurred while the Dependent ‘s coverage was in force under this policy.
Dependent’s Termination Date:
The coverage provided with respect to the Insured shall terminate on the latest of the following dates:
1) The last day of the period for which the premium is paid;
2) The date the Insured returns to their Country of Residence;
3) The expiration of the maximum period coverage as shown on the premium section, Page 13 of this Policy; or
4) The date the Policy terminates.
This coverage will not duplicate benefits available from other valid and collectible insurance. If an Insured’s injury or sickness is due to act or omission of another, benefits payable by this program are subject to recovery from amounts eventually paid to the Insured by, or on behalf of, the other person.
CONTINUOUS COVERAGE
Coverage for an Insured individual will be considered as continuous during consecutive periods of insurance under this Policy when premium payment is received by the Policyholder or Administrator within the Enrollment Period specified in the Policy Schedule.
This Continuous Coverage provision will not establish a new benefit period, nor affect any lifetime or specifically stipulated benefits shown herein for an incurred loss existing during any preceding coverage period.
DEFINITIONS
COMPLICATIONS OF PREGNANCY means conditions whose diagnoses are distinct from pregnancy but are adversely affected by or are caused by pregnancy. Such complications include, but are not limited to: a) acute nephritis; b) Nephrosis, c) Cardiac decompensation; d) missed abortion; e) hyperemesis gravidarum; f) preeclampsia; and g) similar medical and surgical conditions of comparable severity. Complications of Pregnancy also includes: a) non-elective Cesarean section; b) ectopic pregnancy which is terminated; and c) spontaneous termination of pregnancy which occurs during a period of gestation which is viable birth is not possible. Complications of Pregnancy shall not mean: a) false labor; b) occasional spotting; c) Doctor prescribed rest during the period of pregnancy; d) morning Sickness; or e) similar conditions associated with the management of difficult pregnancy but not constituting a distinct Complication of Pregnancy.
COUNTRY OF RESIDENCE means the country where the Insured Person maintains his or her primary permanent residence.
COVERED MEDICAL EXPENSES means reasonable charges which are: 1) not in excess of Usual and Customary Charges; 2) not in excess of the maximum benefit amount payable per service as specified in the Schedule of Benefits; 3) made for services and supplies not excluded under the policy; 4) made for services and supplies which are a Medical Necessity; 5) made for services included in the Schedule of Benefits; and 6) in excess of the amount stated as a deductible, if any. Covered medical expenses will be deemed “incurred” only: 1) when the covered services are provided; and 2) when a charge is made to the Insured Person for such services.
DEDUCTIBLE means the amount stated in the Schedule of Benefits or any endorsement to this policy as a deductible. Such amount will be subtracted from the amount or amounts otherwise payable as Covered Medical Expenses before payment of any benefit is made. The deductible will apply per policy year or per occurrence (for each Injury or Sickness) as specified in the Schedule of Benefits.
DEPENDENT means the spouse (husband or wife) of the Named Insured, and their dependent, unmarried children living with the Named Insured. This includes stepchildren, legally adopted children and children of adopting parents pending adoption procedures. Children shall cease to be dependent on the first to occur of:
1) the end of the month in which they marry; or
2) the end of the month in which they attain the age of nineteen (19) years.
The attainment of the limiting age will not operate to terminate the coverage of such child while the child is and continues to be both:
1) incapable of self-sustaining employment by reason of mental retardation or physical handicap; and
2) chiefly dependent upon the Insured Person for support and maintenance.
Proof of such incapacity and dependency shall be furnished to the Company: 1) by the Named Insured; and 2) within 31 days of the child’s attainment of the limiting age. Subsequently, such proof must be given to the Company upon request following the child’s attainment of the limiting age.
If a claim is denied under the policy because the child has attained the limiting age for dependent children, the burden is on the Insured Person to establish that the child is and continues to be handicapped as defined by subsection (1) and (2).
EXCESS PROVISION means the plan benefits are payable for covered expenses not covered and payable by any other plan providing medical expense benefits. If there is no other valid and collectible benefits available from any other source, this plan will pay the covered expenses up to the limits of the policy.
HOSPITAL means a licensed or properly accredited general hospital which; 1) is open at all times; 2) is operated primarily and continuously for the treatment of and surgery for sick and injured person as inpatients; 3) is under the supervision of a staff of one or more legally qualified Physicians available at all times; 4) continuously provides on the premises 24 hour nursing service by Registered Nurses; 5) provides organized facilities for diagnosis and major surgery on the premises; and 6) is not primarily a clinic, nursing, rest or convalescent home, or an institution specializing in or primarily treating Mental and Nervous Disorders.
HOSPITAL CONFINED/HOSPITAL CONFINEMENT means confined in a hospital for at least 18 hours by reason of an Injury or Sickness for which benefits are payable.
INJURY means bodily injury: 1) directly and independently caused by specific accident which is unrelated to any pathological, functional, or structural disorder or injury; 2) treated by a Physician within 30 days after the date of accident; and 3) which causes loss during the term of the policy.
INSURED PERSON means: 1) the Named Insured; and 2) Dependents of the Named Insured, if: 1) the Dependent is properly enrolled in the program; and 2) the appropriate dependent premium has been paid. The term “insured” also means Insured Person.
INTENSIVE CARE means:
1) a specifically designated facility of the Hospital that provides the highest level of medical care; and
2) which is restricted to those patients who are critically ill or injured.
Such facility must be separate and a part from the surgical recovery room and from rooms, beds and wards customarily used for patient confinement.
MEDICAL EMERGENCY means the occurrence of a sudden, serious and unexpected sickness or injury. In the absence of immediate medical attention, a reasonable person could believe this condition would result in:
1) Death;
2) Permanent placement of the Insured’s health in jeopardy;
3) Serious impairment of bodily functions; or
4) Serious and permanent dysfunction of any body organ or part.
Expenses incurred for “Medical Emergency” will be paid only for sickness or injury which fulfills the above conditions. These expenses will not be paid for minor injuries or minor sicknesses.
MEDICAL NECESSITY means those services or supplies provided or prescribed by a hospital or physician which are:
1) Essential for the symptoms and diagnosis or treatment of the Sickness or Injury;
2) Provided for the diagnosis, or the direct care and treatment of the sickness or injury;
3) In accordance with the standards of good medical practice;
4) Not primarily for the convenience of the Insured, or the Insured’s Physician; and
5) The most appropriate supply or level of service which can safely be provided to the Insured.
The Medical Necessity of being hospital confined means that: 1) the Insured requires acute care as a bed patient; and 2) the Insured cannot receive safe and adequate care as an outpatient. This policy only provides payment for services, procedures and supplies which in the judgment of the Company are a Medical Necessity. No benefits will be paid for expenses which are determined not to be a Medical necessity, including any or all days of Hospital Confinement.
MENTAL AND NERVOUS DISORDER means a Sickness that is a mental, emotional or behavioral disorder.
NAMED INSURED means an eligible, registered or non-registered, student of the Policyholder if : 1) the student is properly enrolled in the program; an d2) the appropriate premium for coverage has been paid.
NEWBORN INFANT means any child born of an Insured while that person is insured under this policy. Newborn infants will be covered under the policy for the first 31 days after birth. Coverage for such child will be for Injury or Sickness, including medically diagnosed congenital defects, birth abnormalities, prematurity and nursery care; benefit swill be the same as for the Insured Person who is the child’s parent.
The Insured will have the right to continue such coverage for the child beyond the first 31 days. To continue coverage the insured must, within the 31 days after the child’s birth: 1) apply to us; and 2) pay the required additional premium for the continued coverage. If the Insured does not use this right as stated here, all coverage as to that child will terminate at the end of the first 31 days after the child’s birth.
PHYSICIAN means a person, other than the Insured or a member of the Insured’s family, who holds a medical license or medical certificate.
PHYSIOTHERAPY means any form of the following: physical or mechanical therapy; diathermy; ultra-sonic therapy; heat treatment in any form; manipulation or massage administered by a physician.
PRE-EXISTING CONDITION means any Injury or Sickness that manifested itself, whether known or unknown or where there have been prior manifestation of systems, for which a Physician was consulted, or for which treatment or medication was prescribed prior to the effective date of an Insured Person's coverage.
PRESCRIPTION DRUGS means: 1) prescription legend drugs; 2) compound medications of which at least one ingredient is a prescription legend drug; 3) any other drugs which under the applicable state or federal law may be dispensed only upon written prescription of a physician; and 4) injectable insulin.
SICKNESS means sickness or disease of the Insured Person which causes loss, and originates while the Insured Person is covered under this policy. All related conditions and recurrent symptoms of the same or similar condition will be considered one sickness.
SOUND, NATURAL TEETH means natural teeth, the major portion of the individual tooth is present, regardless of fillings or caps; and is not carious, abscessed or defective.
USUAL AND CUSTOMARY CHARGES means a reasonable charge which is : 1) usual and customary when compared with the charges made for similar services and supplies; and 2) made to persons having similar medical conditions in the locality of the Provider. No payment will be made under this policy for any expenses incurred which in the judgment of the Company are in excess of Usual and Customary Charges.
EXCLUSIONS
No benefits will be paid for loss or expense caused by contributed to, or resulting from:
1) Pre-existing Conditions;
2) No benefits will be paid for loss or expense caused by, contributed to, or resulting any loss that occurs while traveling or enrolling solely for the purpose of obtaining medical treatment, while on a waiting list for a specific treatment, or while traveling against the advice of a Physician;
3) Expense incurred within the Insured Person’s Home Country or country of regular domicile;
4) Routine physical or other examinations where there are no objective indications of impairment of normal health, or well baby care;
5) Eye examinations; prescriptions or fitting of eyeglasses and contact lenses; or other treatment for visual defects and problems. "Visual defects: means any physical defect of the eye which does or can impair normal vision;
6) Hearing examinations or hearing aids; or other treatment for hearing defects and problems. "Hearing defects: means any physical defect of the ear which does or can impair normal hearing;
7) Dental treatment, except as the result of injury to sound, natural teeth as stated in the Schedule of Benefits;
8) Professional services rendered by a Member of the Insured Person’s immediate family, or anyone who lives with the Insured Person;
9) Services or supplies not necessary for the medical care of the patient’s injury or sickness;
10) Weak, strained or flat feet, corns, calluses, or toenails;
11) Cosmetic surgery, or treatment for congenital anomalies, except reconstructive surgery as the result of a covered Injury or Sickness. Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or covered Sickness;
12) Elective Surgery and Elective Treatment;
13) Diagnostic or surgical procedures in connection with infertility unless infertility is a result of a covered Injury or covered Sickness;
14) Birth control, including surgical procedures and devices;
15) Injury or Sickness for which benefits are paid or payable under any Worker’s Compensation or Occupational Disease Law or Act, or similar legislation;
16) Organ transplants;
17) War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period not covered);
18) Participation in a riot or civil disorder, commission of or attempt to commit a felony in the country in which it was attempted or committed;
19) Suicide or attempted suicide (including drug overdose), while sane or insane (while sane in Missouri), or intentionally self-inflected Injury;
20) Charges of an institution, health service, or infirmary for whose service payment is not required in the absence of insurance;
21) Loss incurred from riding in any aircraft, other than as a passenger in an aircraft licensed for the transportation of passengers;
22) Treatment services, supplies or facilities in a hospital owned or operated by: a) The Veteran’s Administration; or b) A national government or any of its agencies. (This exclusion does not apply to treatment when a charge is made which the Insured is required by law to pay);
23) Duplicate services actually provided by both a certified nurse-midwife and Physician;
24) Expenses payable under any prior policy which was in force for the person making the claim;
25) Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
26) Expenses incurred for outpatient treatment in connection with the detection or correction by manual or mechanical means of structural imbalance, distortion or sublimation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column;
27) Medical expense resulting from a motor vehicle accident in excess of that which is payable under any valid and collectible insurance;
28) Voluntary or elective abortion except as specifically provided;
29) Expense covered by any other valid and collectible medical, health or accident insurance;
30) Expense incurred after the date insurance terminates for an Insured Person except as may be specifically provided in the Extension of Benefits Provision;
31) Expenses incurred for injuries resulting from the use of alcohol or intoxicants, or any drugs unless prescribed by a Physician;
32) Sexually transmitted diseases, including AIDS.
33) For Injury sustained while participating in professional, interscholastic, sponsored scholastic or intercollegiate sports.
THERE ARE NO BENEFITS PROVIDED FOR THE FOLLOWING:
Elective Surgery and Elective Treatment: including but is not limited to surgery and/or treatment for acne; acupuncture; allergy; including allergy testing; alopecia; biofeedback-type services; birth control; breast implants; breast reduction; circumcision; corns, calluses and bunions; cosmetic procedures, except cosmetic surgery required to correct an Injury for which benefits are otherwise payable under this Policy; family planning; fertility tests; gynecomatia; hirsutism; impotence, organic or otherwise; infertility (male or female), including any services or supplies rendered for the purpose or with the intent of inducing conception; learning disabilities; nasal and sinus surgery; nicotine addition; nonmalignant warts, moles and lesions; obesity and any condition resulting therefrom (including hernia of any kind); patient controlled anesthesia treatment of a covered Injury; sexual reassignment surgery; skeletal irregularities of one or both jaws, including orthognathia and mandibular retrognathia; sleep disorders, including testing thereof; temporomandibular joint dysfunction, tubal ligation; vasectomy; and weight reduction. Elective surgery and elective treatment includes any service, treatment; or supplies that: 1) are deemed by the company to be researched or experimental; or 2) are not recognized and generally accepted medical practices in the United States.
CLAIM PROCEDURE
Report at once to the nearest physician or hospital. Generally, claims are submitted by service providers directly to Chartis Claims Service office using the claim form found under print forms section. All claims must be submitted using the Claim Form found on the web. The first part should be completed by the Policy Holder and section 2 should be completed by the Provider/Hospital.
Completed claim forms must be furnished to the Chartis Claims Office within 90 days after the date of such loss. Failure to furnish such proof within the time required will not invalidate or reduce any claim if it was not reasonably possible to furnish proof.
Claims Office
Chartis Insurance
A & H Claims Division
P.O. Box 25987
Shawnee Mission, KS 66225
(877) 204-0222 or (302) 661-4176
Should it become necessary to check upon the status of your filed claim, or claims related questions you may call the claims office at the above number during business hours 7 AM to 7 PM (CST).
Questions about the brochure or insurance program are answered by India Network. They can be reached by phone at 407-243-8760. Questions are answered from 9:00 AM to 6:00 PM (EST) during week days, Monday through Friday.
ASSISTANCE SERVICES (HEALTH PROGRAM PARTICIPANTS ONLY)
Non-Insurance Services Provided by Chartis International Services
Chartis International Services, Inc. can help travelers with medical emergencies by:
1) Helping to obtain local medical care;
2) Monitoring hospitalizations and maintaining contact between attending physicians and family physicians;
3) Arranging medical evacuations and treatment en-route if necessary;
4) Arranging family, business associates, or friends to join the ill traveler;
5) Arranging repatriation of remains in the event of the insured's death.
Up-to-the-minute information available on:
1) U.S. State Department and private service warnings about travel to certain locations.
2) Immunizations requirements;
3) Passport and Visa requirements;
4) Emergency transfer of funds;
5) Weather conditions and hazards particular to certain locations.
Chartis Assist provides:
1) Emergency registry services for vital, confidential, personal, and medical information;
2) 24-hours emergency travel service for airline and hotel reservations;
3) Help in replacing lost baggage and lost passports.
Chartis Assist can also:
1) Arrange for local legal assistance;
2) Act as a 24-hour toll free/collect emergency message center;
3) Assist with emergency cash transfers and credit card advances based on the insured's resources;
4) Co-ordinate insurance documents and claims submissions.
OTHER POLICY FEATURES
Benefits |
|
Accidental Death and Dismemberment** |
$25,000 Maximum |
Pre-certification |
Not Required |
Type of Coverage |
Excess |
Benefit Period |
36 Months |
MEDICAL EVACUATION AND REPATRIATION*
EVACUATION: If an injury or sickness occurs during the period of coverage, evacuation is recommended and approved by the attending physician; and all procedures of the evacuation provider are followed, benefits will be paid for the evacuation of the insured to his/her natural country, or nearest appropriate location at the Insurer's discretion. No additional benefits will be paid under the basic or major medical coverage.
REPATRIATION: If an injury or sickness results in the loss of life during the period of coverage, the Insurer will pay the expenses for the preparation and transportation of the body to the Insured Person's home country up to a maximum as specified above.
ACCIDENTAL DEATH DISMEMBERMENT of $25,000**
ACCIDENTAL DEATH AND DISMEMBERMENT INDEMNITY
Definition of Injury and Scope of Coverage – 24 Hour Coverage
Principal sum for Covered Injury: $25,000
The Company shall pay to the member an indemnity determined from the Table of Losses if an Insured Person sustains a loss stated therein resulting from injury, provided that:
(a) such loss occurs (1) within 365 days after the date of accident causing such loss; or (2) if Weekly Accident Indemnity is provided under the Policy with respect to an Insured Person, within a period of continuous total disability resulting from such injury and for which indemnities are payable with respect to such person under such provision, but within fifty-two weeks after the date of accident causing such loss; and
(b) the indemnity payable for any such loss shall be the amount stated opposite such loss in said Table and the Principal Sum stated therein shall be the amount stated as Principal Sum in Item 4 of Section I, Declarations, as applicable to such person and this Coverage; and
(c) if more than one loss stated in said Table is sustained as the result of one accident, only one of the amounts so stated in said Table, the largest, shall be payable.
Table of Losses
For Loss of: Indemnity
Life................................................................................................ Principal Sum
Both Hands or Both Feet or Sight of Both Eyes....................................... Principal Sum
One Hand and One Foot..................................................................... Principal Sum
Either Hand or Foot and Sight of One Eye.............................................. Principal Sum
Either Hand or Foot........................................................................... One-Half the Principal Sum
Sight of One Eye.............................................................................. One-Half the Principal Sum
The term "loss" as used herein shall mean with regard to hands and feet, actual severance through or above wrist or ankle joints, and with regard to eyes, entire irrecoverable loss of sight.
COVERED SERVICES INJURY AND SICKNESS BENEFIT LIMITS. See the definition above for triggering the benefits under this option.
CANCELLATION POLICY
Refund of premium, less a $25 processing fee, will be considered only if Cancellation Form is received by the India Network Services prior to the effective date of coverage. After that date, the premium is considered fully earned and non-refundable. All cancellation requests should be submitted by completing the Cancellation Form found under 'Members Area' section of the web pages. The form can be faxed to 407-479-3289. Policy changes can not be made under any circumstances once the policy becomes effective.
INDIA NETWORK ACCIDENT AND SICKNESS MEDICAL INSURANCE PROGRAM
This is a brief description of the coverage available under the policy. The policy contains reductions, limitations, exclusions, and termination provisions. If there are any conflicts between this document and the master policy, the policy will govern in all cases. The master policies are held by the SunTrust Bank as Trustee of the AIU Group Insurance Trust on behalf of the India Network Foundation:
Standard Coverage Maximum $50,000 - GLB 9493298
Standard Coverage Maximum $100,000 - GLB 9493299
Standard Coverage Maximum $150,000 - GLB 9493300
Standard Coverage Maximum $100,000 with Pre-Existing Conditions - GLB 9493301
Standard Coverage Maximum $150,000 with Pre-Existing Conditions - GLB 9493302
Comprehensive Coverage - GLB 9493303
The program is underwritten by The Insurance Company of the State of Pennsylvania, a Pennsylvania insurance company, which has its principal place of business at 70 Pine Street, New York, New York, 10270. It is currently authorized to transact business in all states and the District of Columbia, NAIC No. 19429.
INCIDENTAL SIDE TRIPS
Coverage is provided worldwide, outside the Insured Person's County of Residence. Coverage to the following countries is excluded: Balkans, Belarus, Burma, Ivory Coast, Cuba, Democratic Republic of the Congo, Iran, Iraq, Lebanon, Liberia, North Korea, Sudan (Darfur), Syria, and Zimbabwe