MEDJET Select a service provided by MEDJET Assistance, LLC. A Travel Assistance
Membership Program.
Subject to the definitions, general provisions, exclusions and limitations
stated herein MEDJET ASSISTANCE, LLC will provide Services to each Participant
while traveling more than one hundred fifty miles (150) from his or her
Permanent Residence. All Services in connection with this Agreement must be
pre-approved and arranged by MEDJET ASSISTANCE-.
SECTION I. SERVICES
1 a. Emergency Medical Evacuation. In the event a Participant suffers from a
Certified Illness or Injury that requires medical transportation of that sick
or injured Participant, MEDJET ASSISTANCE will provide medical transportation
from the attending Hospital to the nearest appropriate Hospital capable of
providing such treatment. Such transportation will be provided upon
certification by the MEDJET ASSISTANCE Medical Director, liaising with the
attending Physician, that the Participant's severity of Illness or Injury
Necessitates medical transportation to the nearest appropriate Hospital. b.
Medically Necessary Repatriation. In the event the MEDJET ASSISTANCE Medical
Director, liaising with the attending Physician, determine it is Medically
Necessary to bring the Participant from the attending Hospital to a Hospital or
nursing home nearer his/her Permanent Residence, subsequent to receiving
Emergency Medical Evacuation Services provided under this .Agreement, MEDJET
ASSISTANCE will provide flight by common carrier or air ambulance, and ground
ambulance, if necessary, by the most direct and economical route. All Services
in connection with an Emergency Medical Evacuation or Medically Necessary
Repatriation must be preapproved and arranged by MEDJET ASSISTANCE [Eligible
Emergency Medical Evacuation/Medically Necessary Repatriation - Limit of
US$100,000 per Participant.]
2. Transportation of Mortal Remains. In the event of death of a Participantã
caused by a Certified Illness or Injury, MEDJET ASSISTANCE will arrange to have
the Participant's remains returned to a location nearest the Participant's
Permanent Residence, including but not limited to, preparation, transportation.
All Services in connection with a Return of Mortal Remains must be pre-approved
and arranged by MEDJET Assistance. [Eligible Return of Mortal Remains - Limit
of US $20,000 per Participant.]
3. Transportation of Escort. In the event a Participant requires Emergency
Medical Evacuation by air ambulance or Repatriation by commercial airline
provided in this Agreement, air transport of the Participant's Spouse or other
Family Member or traveling companion will be provided so that person may
accompany the Participant in flight, subject to space availability, giving
priority to medical equipment and medical personnel aboard and for the welfare
and safety of the Participant receiving Services in this Agreement. All
Services in connection with the Transportation of an Escort must be
pre-approved and arranged by MEDJET Assistance.
4. Family Visitation. In the event a Participant, who is traveling alone, is
expected to be Hospitalized for more than seven (7) days, round trip economy
transportation on a regularly scheduled airline or equivalent will be provided
for one Family Member or relative from the commercial airport nearest the
Family Member's Permanent Residence to the Hospital where the Participant is
confined so the Family Member may attend the Participant during the
Hospitalization. All Services in connection with Family Visitation must be
pre-approved and arranged by MEDJET Assistance. [Eligible Family Visitation -
Limit of $5,000 to include Round Trip Economy Airfare and Food and Lodging of
$100 per Day/ 10 day maximum per Participant.]
5. Minor Child(ren) Return/Escort. In the event a Participant's Minor
Child(ren) are left unattended as a result of a Participant's Emergency Medical
Evacuation, being Hospitalized for more than 24 hours due to Illness or Injury,
or in the event of death, one way economy transportation on a regularly
scheduled airline, or the equivalent, will be provided to return the Minor
Child(ren) to the Participant's Permanent Residence. A qualified attendant will
also be provided by MEDJET Assistance to accompany the Minor Child(ren) under
the age of 16 when necessary. All Services in connection with Minor Child(ren)
Return/Escort must be pre-approved and arranged by MEDJET Assistance. [Eligible
Return of Minor Child(ren) - Limit of one, One Way Economy Airfare to a Maximum
Limit of $5,000 per Participant per Agreement Period.]
6. Vehicle Return. In the event a Participant should suffer from a Certified
Illness, Injury or death which requires Emergency Medical Evacuation/ Medically
Necessary Repatriation or Transportation of Mortal Remains and the Participant
is thereby unable to drive his/her vehicle, MEDJET Assistance will provide
vehicle return service for ground vehicles such as cars, trucks, vans travel
trailers or motor homes, operated by the Participant, to the Participant's
Permanent Residence. This benefit will pay the cost, up to $1,000 for fuel,
oil, driver and tolls to affect such vehicle return. The Participant will bear
the cost of any repair due to mechanical breakdown en route, as well as, costs
for food and accommodations during the trip. The vehicle must be in a condition
capable of being safely operated on the highway. All Services in connection
with Vehicle Return must be pre-approved and arranged by MEDJET Assistance.
[Eligible Return of Vehicle - Limit of $1,000 per Participant.]
7. 24-Hour Information Service. Should the Participant need information before
and/or during travel he/she may call MEDJET Assistance 24 hours a day to obtain
help. The Membership Services staff is prepared to assist and coordinate the
management of a wide variety of travel related situations. Services include but
are not limited to information on required documents, immunization
requirements; State Department Travel Advisory warnings on travel to certain
locations; weather and hazard information about foreign locations; suggested
medical exams or treatment before departure and medical care en route.
8. Medical Monitoring. Should the Participant need to be medically monitored,
MEDJET Assistance's duty Physician will monitor the case while liaising with
the Participant, the local attending Physician, the family Physician and the
medical director of MEDJET Assistance.
9. Medical Referral. Should the Participant need help locating a Physician or
Hospital, MEDJET Assistance will provide referrals to a local Physician and/or
Hospital.
10. Guarantee of Medical Expenses. Should the Participant need help for
overseas medical payments, MEDJET Assistance will arrange for payment or
guarantee of payment to medical providers, with appropriate repayment
guarantees to MEDJET Assistance.
11. Insurance Coordination. Should the Participant need help for overseas
medical claims, MEDJET Assistance will assist him/her in coordinating the
claims procedure with the Participant's insurance program.
12. Lost Document Service. Should the Participant need help to replace lost or
stolen travel documents (i.e. passport, baggage, tickets, credit cards, etc.),
MEDJET Assistance will advise and assist where possible regarding their
replacement.
13. Legal Assistance. Should the Participant need help arranging local
attorneys, embassies and consulates, arranging bail, or coordination of payment
for legal Services, MEDJET Assistance will provide referrals and payments, from
available resources of the Participant.
14. Emergency Delivery of Prescription Items. Should the Participant need
prescription medication or lenses not available locally, MEDJET Assistance will
organize the delivery of the prescribed item to the Participant upon written
authorization from the prescribing Physician when possible and legally
permissible.
15. Emergency Cash Transfers and Advance. Should the Participant need cash as a
result of loss or theft, MEDJET Assistance will arrange for emergency cash
transfers and advances through additional sources, including hotels, banks,
Consulates and Western Union, up to a limit of $500 per transaction. All
transactions are subject to any government regulation and to the availability
of the Participant's confirmed personal credit.
16. Language Assistance. Should the Participant need help communicating in a
foreign country, MEDJET Assistance will provide telephone interpretation.
SECTION II. DEFINITIONS
1. Accident or Accidental shall mean an event, independent of Illness or
self-inflicted means, which is the direct cause of bodily Injury to the
Participant.
2. Administrator shall mean MEDJET Assistance, LLC
3. AIDS shall mean Acquired Immune Deficiency Syndrome, as that term is defined
by the United States Centers for Disease Control.
4. MEDJET Assistance shall mean the contracted service organization that
provides 24 hour availability to Services in this Agreement.
5. Services shall mean Services and expenses provided on behalf of the
Participant which are for Medically Necessary B Services, supplies, care or
treatment; due to Illness or Injury; prescribed, performed or ordered by a
Physician; incurred while provided under this Agreement; and which do not
exceed the maximum limits shown.
6. Agreement shall mean the description of Services provided herein.
7. Complications of Pregnancy shall mean any or all of the following conditions
which are mad worse by, occur during, or are caused by pregnancy; acute
nephritis nephritis, cardiac compensation missed abortion, hyper-emensis
gravidarum, ectopic pregnancy that is ended; non-elective cesarean section,
pre-eclampsia, gestational diabetes, spontaneous end of pregnancy which occurs
when a viable birth is not possible, and other medical problems of similar
severity.
8. Certified Illness shall mean sickness or disease of any kind contracted and
commencing after the Effective Date of this Agreement and causing loss provided
by this Agreement.
9. Dependent shall mean the spouse who is legally married to the Primary
Participant; the Primary Participant's unmarried Children) who is over 19 years
old but not older than 23 years old and is enrolled as a full-time student at
an accredited school or college and/or is not employed one full-time basis.
10. Effective Date shall mean the date the Primary Participant became the
recipient of Services, which made him/her eligible for the Services provided in
the Agreement.
11. Emergency shall mean a medical condition manifesting itself by acute; signs
or symptoms, which could reasonably result in placing the Participant's life or
limb in danger if medical attention is not provided within 24 hours.
12. Family Member shall mean a spouse, parent, sibling or Children) of the
Participant.
13. HIV Positive shall mean laboratory evidence defined by the United States
Center for Disease Control as being positive for human immunodeficiency virus
infection.
14. Home Country shall mean the country where the Participant has his or her
true, fixed and Permanent Residence and principal establishment.
15. Hospital shall mean except as may otherwise be provided, a Hospital (other
than an institution for the aged, chronically ill or nursing homes) operated
pursuant to law for the care and treatment of sick of Injured persons with
organized facilities for diagnosis and surgery and having 24-hour nursing
service and medical supervision.
16. Host Country shall mean any country other than the country where a
Participant has his or her true, fixed and Permanent Residence and principal
establishment.
17. Injury shall mean bodily Injury caused solely and directly by violent,
Accidental, external and visible means occurring while this Agreement is
inforce and resulting directly and independently of all other causes in Loss
provided by this Agreement.
18. Medically Necessary or Medical Necessity shall mean Services or supplies
received while the Participant is eligible that are determined by MEDJET
Assistance and MEDJET Assistance's program medical director to be 1.)
Appropriate and necessary for the symptoms, diagnosis, or direct care and
treatment of the Participant's medical condition, 2.) Within the standards the
organized medical community deems good medical practice for the Participant's
condition; 3.) Not primarily for the convenience of the Participant, the
Participant's Physician or other Service Provider or person; 4.) Not
Experimental/Investigational or unproven, as recognized by the organized
medical community, or which are used for any type of research program or
protocol; and 5.) Not excessive in scope, duration, or intensity to provide
safe and adequate, and appropriate treatment. For Hospital stays, this means
that acute care as an Inpatient is necessary due to the kinds of Services the
Participant is receiving or the severity of the Participant's condition, in
that safe and adequate care cannot be received as an Outpatient or in a less
intensified medical setting. The fact that any particular Physician may
prescribe, order, recommend, or approve a service, supply, or level of care
does not, of itself, make such treatment Medically Necessary or make the charge
of a Benefit or Service provided under this Agreement.
19. Medicine or Medication shall mean the drugs prescribed or dispensed to the
Participant, by a licensed Physician, as a result of a Benefits and Services
provided under this Agreement. Medicine or Medication shall mean the generic
equivalent of a drug, or if the generic equivalent is not available, the brand
name drug.
20. Mental Illness shall mean any condition or disease listed in the most
recent edition of the International Classification of Diseases as a mental
disorder, which clinically significant behavioral or psychological disorder
marked by a pronounced deviation from a normal healthy state and associated
with a present painful symptom or impairment in one or more important areas of
functioning. This disease must not be merely an expectable response to a
particular stimulus. Mental Illness does not mean learning disabilities,
attitudinal disorders or disciplinary problems.
21. Minor Child(ren) shall mean the Primary Participant's stepChild(ren) or
Child(ren) under the Primary Participant's legal guardianship, but only if such
Child(ren) depends on the Primary Participant's support and maintenance and
lives with the Primary Participant in a parent-Children) relationship. The term
Minor Child(ren) does not include a foster Child (ren) who is eligible for
benefits provided by a governmental program or law, unless required by the law
of the State. The age limits that apply to Dependent Child(ren) will not apply
to any Participating Child(ren) of the Primary Participant who remains
dependent on the Primary Participant for support and maintenance because he or
she becomes incapable or working dice to a physical handicap or retardation
which occurs: before reaching the age limit and while being a Participant under
this Agreement or any prior program, provided such Child(ren) was Participating on
the date of termination of the prior program.
22. Participant shall mean a person who is eligible for Services provided in
this Agreement.
23. Permanent Residence shall mean the country where a Participant has his or
her true, fixed and permanent home and principal establishment, and to which he
or she has the intention of returning.
24. Physician shall mean a licensed practitioner of the healing arts acting
within the scope of his or her license. The attending Physician may not be (a)
the Participant; (b) the Participant's Spouse; (c) a person booked to accompany
the Participant on the trip; or (d) a person who is related to the Participant,
or a person booked to accompany the Participant on the trip in any of the
following ways: child, parent, or sibling. Such definition will exclude
chiropractors and physiotherapists.
25. Preexisting Condition shall mean 1.) a condition that would have caused an
ordinarily prudent person to seek medical advise, diagnosis, care or treatment
during the 90 days prior to the Effective Date of this Agreement, 2.) a
condition for which medical advise, diagnosis, care or treatment was
recommended or received during the 90 days prior to the Effective Date of this
Agreement; 3.) Conditions or complications of pregnancy in the third trimester.
26. Pregnancy shall mean the physical condition of being pregnant, including
Complications of Pregnancy.
27. Primary Participant shall mean the person who is the recipient of benefits
which mad him/her eligible for the Services provided in this Agreement, and
whom may have Dependents who are Participants.
28. Registered Nurse shall mean a graduate nurse who has been registered or
licensed to practice by a State Board of Nurse Examiners or other
jurisdictional authority, and who is legally entitled to place the letters
"R.N." after his or her name.
29. Relative shall mean spouse, parent, sibling, Child(ren), grandparent.,
grandchild, step-parent, step-child, step-sibling, in-laws, (parent, son,
daughter, brother, or sister), aunt, uncle, niece, nephew, legal guardian,
ward, or cousin of the Participant.
30. Repatriation shall mean the transportation of the Participant to his/her
Home Country.
31. Service Provider shall mean a Hospital, convalescent/skilled nursing
facility, ambulatory surgical center, psychiatric Hospital, community mental
health center, residential treatment facility, psychiatric treatment facility,
alcohol or drug dependency treatment center, birthing center, Physician,
dentist, chiropractor, licensed medical practitioner, nurse, medical
laboratory, assistance service company, air/ground ambulance firm, or any
other such facility that MEDJET Assistance approves. 32. Substance Abuse shall
mean alcohol, drug, or chemical abuse, overuse or dependency.
SECTION III. GENERAL PROVISIONS
1. Access of Services All arrangements for transportation or Services under
this Agreement must be made by MEDJET Assistance. The Participant agrees to
notify MEDJET Assistance promptly of the need for Emergency Medical Evacuation
specifying the nature of the Injury or Illness requiring air transportation.
MEDJET Assistance will require a reasonable period of time to confirm
Participant's benefits and to initiate the Participant's Medically Necessary
transportation. The Participant must recognize that diligence is necessary to
properly accommodate a medical emergency; therefore, MEDJET Assistance requires
notice at the earliest possible moment to secure MEDJET Assistance's Program
Medical Director's consent and to allow proper time to prepare the
Participant's transportation.
2. Authorization. The Participant does hereby authorize any Physician,
Hospital, medical attendant or others to furnish to MEDJET Assistance any and
all information regarding the Participant's physical condition including x-rays
acquired in the course of examinations and treatment. The Participant hereby
further agrees to authorize MEDJET Assistance's medical team or MEDJET
Assistance's authorized affiliate medical team authority to perform those
procedures deemed necessary.
3. Assignment. The Services provided in this Agreement cannot be assigned by
the Participant.
4. Death, Disability and Injury. MEDJET Assistance and/or Administrator shall
not be liable to any person for the death, disability or Injury of the
Participant, the Patient, or any other person accompanying the patient unless
such Injury is caused by the sole negligence of MEDJET Assistance and/or the
Administrator, its agents, servants and employees. It is understood and agreed
that MEDJET Assistance and/or the Administrator may enter into Agreements with
regional air ambulance carriers and that MEDJET Assistance and/or the
Administrator shall not be liable under any circumstances in the event of any
Injury or death to the Participant which might occur during the course of
transport by such agreement carrier.
5. Eligibility. Guarantee issue to all eligible Primary Participants and
dependents over the age of 14 days and under the age of 80 years old and as
described in the Participant's membership program.
6. Entire Agreement. All provisions of this Agreement, Participant's
identification card, or other Agreements to provide Services, constitute the
entire Agreement between the Administrator and the Participant. If any
provision is declared void under the law, that provision is severable and the
remainder of this Agreement shall remain in full force and effect.
7. Excess Benefits. All Services shall be in excess of all other valid and
collectible Insurance Indemnity and shall apply only when such benefits are
exhausted. Other valid and collectible Insurance Indemnity for which benefits
may be payable are Insurance programs provided by:
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Individual, group or blanket Insurance or coverage.
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Other prepayment coverage provided on a group or individual basis;
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Any coverage under labor management trusted programs, union welfare programs,
employer organizational programs, employee benefit organization programs, or other
arrangement of benefits for individuals of a group;
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Any coverage required or provided by any statute, socialized Insurance program;
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Any no-fault automobile Insurance; or
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Any third party liability Insurance
8.
Impossibility of Performance. MEDJET Assistance and/or the Administrator shall
not be liable for failure to perform under this Agreement if such failure is
caused by rebellion riot, military upresing, war, terrorism, labor disturbance,
strikes nuclear accidents, acts of God, fire flood, war or any other cause
beyond the control of MEDJET Assistance and/or the Administrator. Nothing
herein contained shall require MEDJET Assistance and/or the .Administrator to
take any action contrary to law or to any order or regulation of any
governmental agency or officer or contrary to any authorization granted to
MEDJET Assistance and/or the Administrator by any governmental agency.
9.
Liability. MEDJET Assistance and/or the Administrator shall use all reasonable
diligence in selecting persons, companies and equipment to provide the
described Services. If companies outside of those contracted through MEDJET
Assistance are used to provide any Services, MEDJET Assistance and/or the
Administrator shall not be liable for any negligence or tortuous acts resulting
from such Services. MEDJET Assistance and/or the Administrator are not liable
for departures or arrivals delayed in transport when deemed unsafe by airport
authorities or by pilot due to operational conditions, Acts of God, or
mechanical failure.
10.
Monetary Limits. The monetary limits stated in this Agreement shall be in US
dollars. For Services outside of the territorial limits of the United States,
the exchange rate date used to determine the amount of US dollars to be paid is
the date the Services in this Agreement were provided to the eligible
Participant.
11.
Not in Lieu of Worker's Compensation. This Agreement is not in lieu of and does
not affect any requirements for coverage by Worker's Compensation Insurance.
12.
Service Agreement. The Participant shall not make Agreement, authorize or
engage any service or expense in the name of or on behalf of MEDJET Assistance
and/or the Administrator. The obligations of MEDJET Assistance and/or the
Administrator in this Agreement are limited to providing the various Services
described herein. MEDJET Assistance and/or Administrator are under no
obligation to reimburse the Participant should the Participant independently
authorize, Agreement, or make payment for any service.
13.
Trip Duration. The benefits provided by this Agreement cover trips up to ninety
(90) consecutive days or less.
SECTION IIV. EXCLUSIONS
Benefits will not be provided for any loss, cost or expense resulting, in whole
or in part from:
1. Any Injury or Illness, which meets the following criteria:
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a condition that would have caused an ordinarily prudent person to seek medical
advise, diagnosis, care or treatment during the 90 days prior to the Effective
Date this Agreement;
-
a condition for which medical advice, diagnosis, care or treatment as
recommended or received during the 90 days prior to the Effective Date this
Agreement;
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Conditions or complications of pregnancy in the third trimester;
2. Charges for treatment, which is not Medically Necessary or exceeds
Reasonable and Customary charges.
3. Charges provided at no cost to the Participant;
4. Charges incurred during any period of Hospital confinement;
5. Charges for services, supplies or treatment, which were not recommended,
approved and certified as Medically Necessary and reasonable by a Physician;
6. Suicide or any attempt there at, while sane or self destruction or any
attempt there at, while insane;
7. War, declared or undeclared, or any act thereof;
8. Injury Sustained while participating in professional, amateur or
interscholastic athletics;
9. services or supplies performed or provided by a Relative of the Participant;
10. Elective Surgery, which can be postponed until the Participant returns to
his/her Home Country;
11. Treatment in connection with alcoholism and drug addiction, or use of any
drug or narcotic agent, or Injury sustained while under the influence of or
disablement due to alcohol or drugs;
12. Congenital anomalies and conditions arising out of or resulting there from;
13. Expenses, which are non-medical in nature;
14. Expenses as a result or in connection with intentionally self-inflicted
Injury or Illness;
15. Expenses as a result or in connection with the commission of a felony
offense;
16. Injury sustained while taking part in mountaineering where ropes or guides
are normally used, hang gliding and parachuting, racing by horse, motor or
motorcycle, and scuba diving involving underwater breathing apparatus (unless PADI certified);
17. Treatment paid for or furnished under any other individual or group policy
or other service or medical pre-payment program arranged through the Participant's
employer to the extent so furnished or paid, or under any mandatory government
program or facility set up for treatment without cost to any individual.
18. Injuries for which benefits are payable under any no-fault automobile
Insurance Agreement;
19. Charges for treatment which is incurred by Participants who were HIV
Positive or afflicted with Venereal disease at the time of application for this
Agreement and Testing for the following: HIV, seropositivity to the AIDS virus,
AIDS related Illnesses, ARC Syndrome, AIDS. AIDS virus, AIDS related Illness,
ARC Syndrome, AIDS, and/or any Illness arising as complications from these
conditions;
20. Any Mental or nervous disorders or rest cures.