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Student Insurance

MABE Insurance

Protection when your child needs it most.  Student Accident Insurance is designed to help your family with the financial burdens that may arise from an
accident. While in class, on a field trip, or participating in school-sponsored sports, your child may be exposed to many risks. Our insurance plans give you the opportunity to ensure they are covered if the unexpected occurs.


HIGHLIGHTS
• Accidental Death & Dismemberment coverage if your child is injured in a serious accident.
• Accident Medical Expense benefits help alleviate costs of injuries that may land your child in the hospital.
• School Coverage option allows for coverage while on school premises and while participating in school-sponsored activities.
• 24 Hour Coverage option allows for the coverage to expand 24 hours a day, anywhere in the world.
• Sports Coverage for Interscholastic Football protects high-risk sports activities.

CHOOSE THE PLAN THAT IS RIGHT FOR YOU:

Coverage Descriptions

24-Hour Coverage (Students & Employees)
Around the clock/anywhere in the world. Before, during and after school.
Weekends, vacations, and all summer, including summer school. School-sponsored
and extracurricular sports, excluding High School Football.  Premium: $82.00


24-Hour Coverage (Summer Only Coverage, Students Only)
Summer begins on the first day after the school year ends. Summer ends on the first
day of the next school year.  Premium: $27.00


24-Hour Coverage (High School Football)
Around the clock/anywhere in the world. Before, during and after school.
Weekends, vacations, and all summer, including summer school. School-sponsored
and extracurricular sports, including High School Football.  Premium: $216.00


School Time Coverage (Students & Employees)
During the regular school term, on school premises, while school is in session,
including direct and uninterrupted travel to and from home and scheduled classes.
School-sponsored and supervised activities and sports, excluding High School
Football. Travel to and from school-sponsored and supervised activities and
sports while in a school-furnished or approved vehicle. Premium: $26.00

School Time Coverage (High School Football)
During the regular school term, on school premises, while school is in session,
including direct and uninterrupted travel to and from home and scheduled classes.
School-sponsored and supervised activities and sports, including High School
Football. Travel to and from school-sponsored and supervised activities and
sports while in a school-furnished or approved vehicle. Premium: $160.00


High School Football (Full Year)
High School Football (Spring only Rates)

While participating in a school-sponsored play and practice of regularly scheduled
football. Premium: $134.00


While participating in a school-sponsored and regularly scheduled football, spring
training, and conditioning. Premium: $59.00

BENEFITS


ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS:
We will pay the applicable Benefit Amount if an Accident results in a covered loss not otherwise excluded. The Accident must result from an insured hazard and occur while an Insured Person is insured under this policy, while it is in force. The covered loss must occur within one (1) year after the accident. If an Insured Person has multiple losses as the result of one accident, then we will pay only the single largest benefit amount applicable to the losses suffered.

Loss of Foot
Loss of foot means the complete severance of a foot through or above the ankle joint. We will consider such severance a loss of foot even if the foot is later reattached. If the reattachment fails and amputation becomes necessary, then we will not pay an additional Benefit Amount for such amputation.


Loss of Hand
Loss of hand means complete severance, as determined by a physician, of at least four (4) fingers at or above the metacarpal phalangeal joint on the same hand or at least three (3) fingers and the thumb on the same hand. We will consider such severance a loss of hand even if the hand, fingers, or thumb are later reattached. If the reattachment fails and amputation becomes necessary, then we will not pay an additional Benefit Amount for such amputation.


Loss of Hearing
Loss of Hearing means permanent, irrecoverable, and total deafness, as determined by a Physician, with an auditory threshold of more than 90 decibels in each ear. The deafness cannot be corrected by any aid or device, as determined by a physician.


Loss of Life
Loss of Life means death, including clinical death, as determined by the local governing medical authority where such death occurs within 365 days after an Accident.


Loss of Sight
Loss of Sight means permanent loss of vision. The remaining vision must be no better than 20/200 using a corrective aid or device, as determined by a physician.


Loss of Sight of One Eye
Loss of Sight of One Eye means permanent loss of vision of one eye. Remaining vision in that eye must be no better than 20/200 using a corrective aid or device, as determined by a physician.

Loss of Speech
Loss of Speech means the permanent, irrecoverable, and total loss of the capability of speech without the aid of mechanical devices, as determined by a physician.


Loss of Thumb and Index Finger
Loss of Thumb and Index Finger means complete severance, through the metacarpal phalangeal joints, of the thumb and index finger of the same hand, as determined by a physician. We will consider such severance a loss of the thumb and index finger even if a thumb, an index finger, or both are later reattached. If the reattachment fails and amputation becomes necessary, then we will not pay an additional Benefit Amount for such amputation.


ACCIDENT MEDICAL EXPENSE BENEFIT
We will reimburse up to the Maximum Benefit Amount for Accident Medical Expense if Accidental Bodily Injury causes an Insured Person to first incur Medical Expenses for care and treatment of the Accidental Bodily Injury within sixty (60) days after an Accident. The Benefit Amount for Accident Medical Expense is payable only for Medical Expenses incurred within 52 weeks after the date of the Accident causing the Accidental Bodily Injury. The Benefit Amount for Accident Medical Expense is payable in addition to any other applicable Benefit Amounts under this policy.


MAXIMUM BENEFIT FOR ACCIDENT MEDICAL EXPENSES
Maximum Benefit & Deductible
$25,000 Maximum Benefit Amount
$0 deductible
Co-insurance is 100% of Reasonable and Customary (R&C) Charges up to the Benefit Maximum

COVERED MEDICAL SERVICES (including but not limited to)                                                                                                                                                                                                                  Medical Care and Treatment by a Physician 100% of R&C Charges up to the Maximum Benefit Amount, 
Hospital Room and Board and Hospital Care (inpatient and outpatient) 100% of R&C Charges up to the Maximum Benefit Amount                                                                                                        Drugs and Medicines Required and Prescribed by a Physician, 100% of R&C Charges up to the Maximum Benefit Amount
Diagnostic Tests and X-Rays Prescribed by a Physician 100% of R&C Charges up to the Maximum Benefit Amount
Treatment Performed by a Licensed Medical Professional when Prescribed by a Physician if Hospitalization would have been Otherwise Required 100% of R&C Charges up to the Maximum Benefit Amount
Rental of Durable Medical Equipment 100% of R&C Charges up to the Maximum Benefit Amount


ACCIDENTAL DEATH & SPECIFIC LOSS BENEFITS (PRINCIPAL SUM - $10,000)
Loss of Life 100% of Principal Sum
Loss of Speech and Loss of Hearing 100% of Principal Sum
Loss of Speech and one of Loss of Hand, Loss of Foot or
Loss of Sight of One Eye 100% of Principal Sum
Loss of Hearing and one of Loss of Hand, Loss of Foot or
Loss of Sight of One Eye 100% of Principal Sum
Loss of Hands (Both), Loss of Feet (Both), Loss of Sight or
a combination of any two of Loss of Hand, Loss of Foot or
Loss of Sight of One Eye
100% of Principal Sum
Loss of Hand, Loss of Foot, or Loss of Sight of One Eye
(Any one of each) 75% of Principal Sum
Loss of Speech or Loss of Hearing 50% of Principal Sum
Loss of Thumb and Index Finger of the same hand 25% of Principal Sum
Artificial Limbs and Other Prosthetic Devices 100% of R&C Charges up to the Maximum Benefit Amount
Eyeglasses, Contact Lenses, and Other Vision
or Hearing Aids 100% of R&C Charges up to the Maximum Benefit Amount
Outpatient Physical Therapy 100% of R&C charges up to $220 maximum
Outpatient Orthopedic Appliance 100% of R&C charges up to $140 maximum
Transportation in an Emergency Transportation Vehicle from Location of Injury to Nearest Hospital 100% of R&C charges up to $800 maximum
Dental (from Injury) 100% of R&C charges up to $10,000 maximum

DEFINITIONS
ACCIDENT OR ACCIDENTAL
Accident or Accidental means a sudden, unforeseen, and unexpected event which:
1) happens by chance;
2) arises from a source external to an Insured Person;
3) is independent of illness, disease, or other bodily malfunction or medical or surgical treatment thereof;
4) occurs while the Insured Person is insured under this policy which is in force; and
5) is the direct cause of loss.

ACCIDENTAL BODILY INJURY
Accidental Bodily Injury means bodily injury, which:
1) is Accidental;
2) the direct cause of a loss; and
3) occurs while an Insured Person is insured under this policy, which is in force.
Accidental Bodily Injury does not include conditions caused by repetitive motion injuries or cumulative
trauma not a result of an accident, including, but not limited to:
1) Osgood-Schlatter's Disease;
2) bursitis;
3) Chondromalacia;
4) shin splints;
5) stress fractures;
6) tendinitis; and
7) Carpal Tunnel Syndrome.

MEDICAL EXPENSE
Medical Expense means the Reasonable and Customary Charges for Medical Services for the care and
treatment of Accidental Bodily Injuries sustained in an accident.

MEDICALLY NECESSARY
Medically Necessary means a medical or dental service, supply, or course of treatment which:
1) is ordered or prescribed by a physician;
2) is appropriate and consistent with the patient's diagnosis;
3) is in accord with current accepted medical or dental practice; and
4) could not be eliminated without adversely affecting the patient's condition.

REASONABLE AND CUSTOMARY CHARGE
Reasonable and Customary Charge means the lesser of:
1) the usual charge made by physicians or other health care providers for a given service or supply;
or
2) the charge we reasonably determine to be the prevailing charge made by physicians or other
health care providers for a given service or supply in the geographical area where it is furnished

IMPORTANT FACTS
1) The accident policy on file with the school is a non-renewable, one-year term policy.
2) EFFECTIVE DATE OF COVERAGE: Insurance is effective on the latest of the following dates:
• the Policy Effective Date;
• the date the Insured Person is first eligible;
• the date we receive the completed enrollment form; or
• the date the required premium is paid.
3) EVIDENCE OF COVERAGE: Verification of online payment and a copy of this brochure is your
evidence of coverage under the School Sponsored Accident Policy.
4) STUDENT TRANSFER: Coverage under the policy continues in force anywhere in the world if the
Covered Person should relocate prior to the expiration of coverage.
5) CANCELLATION: Coverage under the Policy will not be canceled, and accordingly, premiums may not
be refunded after acceptance by the Company. However, a pro-rata refund of premium shall be made in
the event a Covered Person enters the Military Service.
6) LATE ENROLLMENT: There is no premium reduction for any individual who enrolls late in the year.

PAYMENT CLAUSES & EXCLUSIONS
The Benefit Amount for covered Loss of Life will be paid to the beneficiary designated by an Insured Person.
Any Benefit Amount payable due to the Loss of Life of a Dependent Child will be paid to the Primary Insured
Person, absent any beneficiary designation by the Dependent Child.
If an Insured Person has not chosen a beneficiary or if there is no beneficiary alive when the Insured
Person dies, then We will pay the Benefit Amount for Loss of Life to the first surviving party in the following
order:
1) the Insured Person's Spouse;
2) in equal shares to the Insured Person's surviving children;
3) in equal shares to the Insured Person's surviving parents;
4) in equal shares to the Insured Person's surviving brothers and sisters;
5) the Insured Person's estate.
All other Benefit Amounts are paid to the Insured Person unless otherwise directed by an Insured Person
or an Insured Person's designee, or unless otherwise noted in this policy.
If any beneficiary has not reached the legal age of majority, then we will pay such beneficiary's legal guardian.
The Benefit Amount for Accident Medical Expense is payable on an excess basis. The Reasonable and Customary
Charge for a covered medical expense will be reduced by amounts paid or payable by other insurance. In no
event will payment exceed the Maximum Benefit Amount.

PLAN EXCLUSIONS
This insurance does not apply to any Accident, Accidental Bodily Injury, or loss caused by or resulting from,
directly or indirectly:
• an Insured Person being in, entering, or exiting any aircraft:
1) owned, leased, or operated by the Policyholder or on the Policyholder's behalf; or
2) operated by an employee of the Policyholder on the Policyholder's behalf.
• an Insured Person riding as a passenger in, entering, or exiting any aircraft while acting or training as a
pilot or crew member. This exclusion does not apply to passengers who temporarily perform pilot or
crew functions in a life-threatening emergency.
• an Insured Person's emotional trauma, mental or physical illness, disease, pregnancy, childbirth or
miscarriage, bacterial or viral infection, bodily malfunctions, or medical or surgical treatment thereof. This
exclusion does not apply to an Insured Person's bacterial infection caused by an accident or by Accidental
consumption of a substance contaminated by bacteria.
• any occurrence while an Insured Person is incarcerated after conviction.
• an Insured Person being intoxicated at the time of an accident. Intoxication is defined by the laws of the
jurisdiction where such Accident occurs.
• an Insured Person being under the influence of any narcotic or other controlled substance at the time of
an accident. This exclusion does not apply if any narcotic or other controlled substance is taken and used
as prescribed by a physician.
• an Insured Person participating in military action while in active military service with the armed forces of
any country or established international authority. However, this exclusion does not apply to the first sixty
(60) consecutive days of active military service with the armed forces of any country or established
international authority.
• an Insured Person's suicide, attempted suicide, or intentionally self-inflicted injury.
• a declared or undeclared War.
The Benefit Amount for Accident Medical Expense does not apply to charges and services:
1) for which an Insured Person has no obligation to pay;
2) for any injury where worker's compensation benefits or occupational injury benefits are
payable;
3) for treatment that is educational, experimental, or investigational in nature or that does not
constitute accepted medical practice;
4) for treatment by a person employed or retained by the Policyholder;
5) for treatment involving conditions caused by repetitive motion injuries, or cumulative trauma
and not as the result of an Accidental Bodily Injury.
This insurance applies only to medical necessary charges and services.

CLAIMS
How to File a Claim:
1. Obtain a claim form from your school office or BMI Benefits, and answer all questions in detail on the
front of the claim form.
2. The claim form should identify the student’s name, school name, or district, and the date of the accident.
3. Make sure the claim form is signed and submitted to BMI within 90 days from the date of the accident.
4. Attach all itemized bills to the completed claim form and mail to Bob McCloskey Insurance at the
address provided on the claim form.
5. Bills that cannot be attached to the initial form must be submitted within 90 days of the date of service.
P.O. Box 511
Matawan, NJ 07747
Phone: 800.445.3126
Fax: 732.583.9610
E-mail: BMI@bobmccloskey.com
www.bobmccloskey.com
This information is a brief description of the important features of the insurance plan underwritten by Federal
Insurance Company. It is not a contract of insurance and may be subject to change based on the underwriting
requirements of the company. Coverage may not be available in all states or certain terms may be different
where required by state law.
Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related
services. For a list of these subsidiaries, please visit our website at www.chubb.com. Insurance provided by U.S.
based Chubb underwriting companies.