Club Accident Medical

Club Accident Medical  

Overview

Program Overview

 

As an Optimist International Club leader you can purchase a policy customized to the specific needs of your Club.  Coverage is structured to respond to individuals injured while participating in scheduled youth games and practice sessions.

With no deductible, and negotiated pricing, protection is benefit rich at an affordable cost. High Limits of coverage are available upon request, and coverage extends for a 1 year maximum benefit period.

The Optimist International program includes a number of benefits not typically available in the standard marketplace, including:

 
  • Dental
  • Laboratory Tests
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  • Prescriptions
  • Air Ambulance
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  • Ground Ambulance
  • X-rays
  •  

     

  • *Replacement of:
    • -Eyeglasses
    • -Hearing Aids
    • -Contacts
  •  

  • Durable Medical Equipment
  •    
  • Diagnostic Imaging
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    *If medical treatment is also received for the covered injury

     
    $100,000 Accident Medical Enrollment Form
     

    Remember always refer to your policy for coverage limits, exclusions, terms and conditions.

    Contacts

     Address
    Special Markets Insurance Consultants, Inc.
    1055 Main Street, Suite 101
    Stevens Point, WI 54481
     Phone
    1-800-727-7642
     Email
    smic_information@amwins.com

    FAQ's

    Answers about the plan, including eligibility, options, enrollment, customer service and more.

    More Information

    Accident Medical Coverage protects all Optimist Club sponsored activities including participating in scheduled youth games and practice sessions.

     

    Hospital and Professional Services

     

    Injury must be treated within 60 days after the Accident occurs.
    Benefit Period: Services must be received within 1 year from the date of the Injury. Expenses incurred after 1 year from the date of the Injury are not covered even though the service is a continuing one or one that is necessarily delayed beyond 1 year from the date of the Injury.

     

    Maximums and Benefit Period (All maximums are subject to the COVERAGE and LIMITATIONS as stated below.)

     

    Maximum Medical Expense for each Injury: $100,000
    Maximum Medical Expense for Injuries involving motor vehicles: $100,000
    Accidental Death, Dismemberment and Loss of Sight Benefit: $10,000
    Deductible is: $0
    Coverage is: Full Excess

     

    COVERAGE AND LIMITATIONS (All limitations are stated per Injury.)

     

    Hospital/Facility Services

    Inpatient

    1. HOSPITAL ROOM AND BOARD: 100% of Reasonable Expenses up to the semi-private room rate
    2. HOSPITAL INTENSIVE CARE: 100% of Reasonable Expenses
    3. INPATIENT HOSPITAL MISCELLANEOUS: 100% of Reasonable Expenses


    Outpatient

    1. OUTPATIENT HOSPITAL MISCELLANEOUS (Except Physician’s services and x-rays paid as below):100% of Reasonable Expenses
    2. HOSPITAL EMERGENCY ROOM: 100% of Reasonable Expenses
    3. FREE -STANDING AMBULATORY SURGICAL FACILITY: 100% of Reasonable Expenses
    4. HOSPITAL EMERGENCY ROOM PHYSICIAN: 100% of Reasonable Expenses


    Physician's Services

    1. SURGICAL:100% of Reasonable Expenses
    2. ASSISTANT SURGEON: 100% of Reasonable Expenses
    3. ANESTHESIOLOGIST: 100% of Reasonable Expenses
    4. PHYSICIAN'S NON-SURGICAL TREATMENT (EXCEPT AS IN 5. BELOW): 100% of Reasonable Expenses
    5. PHYSICIAN'S OUTPATIENT TREATMENT IN CONNECTION WITH PHYSICAL THERAPY AND/OR SPINAL MANIPULATION: 100% of Reasonable Expenses to a maximum of $1,000


    Other Services

    1. REGISTERED NURSES' SERVICES: 100% of Reasonable Expenses
    2. PRESCRIPTIONS(DISPENSED BY A LICENSED PHARMACIST) - OUTPATIENT: 100% of Reasonable Expenses
    3. LABORATORY TESTS -OUTPATIENT: 100% of Reasonable Expenses
    4. X-RAYS (INCLUDES INTERPRETATION) - OUTPATIENT: 100% of Reasonable Expenses
    5. DIAGNOSTIC IMAGING (MRI, CAT SCAN, ETC.) - INCLUDES INTERPRETATION: 100% of Reasonable Expenses
    6. GROUND AMBULANCE: 100% of Reasonable Expenses
    7. AIR AMBULANCE: 100% of Reasonable Expenses
    8. DURABLE MEDICAL EQUIPMENT - INCLUDES ORTHOPEDIC BRACES AND APPLIANCES: 100% of Reasonable Expenses to a maximum of $1,000
    9. DENTAL TREATMENT: 100% of Reasonable Expenses for the treatment, repair or replacement of injured natural teeth,includes initial braces when required for treatment of a covered injury, as well as examination, x-rays, restorative treatment, endodontics, oral surgery and treatment for gingivitis resulting from trauma
    10. REPLACEMENT OF EYEGLASSES, HEARING AIDS, CONTACT LENSES, IF MEDICAL TREATMENT IS ALSO RECEIVED FOR THE COVERED INJURY: 100%of Reasonable Expenses to a maximum of $500

     

    This description has been designed to illustrate the highlights of this insurance and it does not include all coverage details and Exclusions.  All information in this description is subject to all other provisions of the insurance Policy, including all Coverage and Limitations, Maximums and Exclusions. If there is any conflict between this description and the insurance Policy, the insurance Policy will prevail. NOTE: Please see the insurance Policy for complete and individual state details.