Page 4 - AtlasGroup_Specimen
P. 4
SPECIMENCLAIMS
This insurance policy has in it a Claims Procedure which tells you what steps you must take to file a
claim, and explains our obligations to you. Beginning on the last day of your certificate period, you
shall have 60 days to provide us proof of claim.
APPEALS AND COMPLAINTS
This insurance policy has in it an Appeals and Complaints Procedure which tells you what steps you
can take if you wish to make an appeal or complaint.
DEFINITIONS
This insurance policy has defined terms, indicated by bolded words (excluding headers). The defined
terms may be found in the relevant benefit section or in the general definitions.
PRE-EXISTING CONDITIONS
This insurance policy excludes coverage for pre-existing conditions, except as provided for under the
Acute Onset of Pre-existing Conditions benefit. This policy defines a pre-existing condition and
provides the description of the Acute Onset of Pre-Existing Conditions benefit.
DATA PROTECTION
We respect individual privacy and value your confidence. We restrict access to personal information
to employees/partners who need to know that information in order to perform their jobs. Any employee
that we determine is in violation of this policy will be subject to disciplinary action, up to and including
termination and criminal prosecution.
We will not disclose your personal information to third parties outside Tokio Marine HCC and our
partners unless ordered to do so to comply with the law of the countries in which we do business or
when complying with the legal process.
RIGHTS OF THIRD PARTIES
You may assign benefits under this insurance to a hospital, physician or other provider. Any
assignment shall not confer upon such hospital, physician or other provider, any right or privilege
granted to you under this insurance except for the right to receive benefits, if any, which are
determined to be due and payable hereunder. No hospital, physician or other provider shall have
any direct or indirect claim or right of action against us.
LAW AND JURISDICTION
No action of law or equity may be brought to recover benefits under this insurance until 60 days after
written proof of claim has been provided to us. No such action may be brought after the end of three
(3) years after the time written proof of claim is required to be furnished. The validity, interpretation,
and performance of this agreement shall be governed by and construed in accordance with the laws
of Bermuda.
TOKIO MARINE HCC MEDICAL INSURANCE SERVICES GROUP (“MIS GROUP”)
A subsidiary of Tokio Marine HCC, HCC Lloyd’s Syndicate 4141 is managed by HCC Underwriting
Agency Ltd which is authorized by the Prudential Regulation Authority (PRA) and regulated by the
Financial Conduct Authority (FCA) and the PRA. Registered in England and Wales No. 04632146.
Registered office: 1 Aldgate, London EC3N 1RE, United Kingdom. Lloyd’s is authorised as an insurer
in Spain by the Spanish insurance regulatory authority (Dirección General de Seguros y Fondos de
Pensiones) under reference L0017.
These details can be checked on the Financial Services Register by visiting: www.fca.org.uk or
contacting the Financial Conduct Authority on 0800 111 6768.
4 Atlas Group Description of Coverage | Tokio Marine HCC - MIS Group
This insurance policy has in it a Claims Procedure which tells you what steps you must take to file a
claim, and explains our obligations to you. Beginning on the last day of your certificate period, you
shall have 60 days to provide us proof of claim.
APPEALS AND COMPLAINTS
This insurance policy has in it an Appeals and Complaints Procedure which tells you what steps you
can take if you wish to make an appeal or complaint.
DEFINITIONS
This insurance policy has defined terms, indicated by bolded words (excluding headers). The defined
terms may be found in the relevant benefit section or in the general definitions.
PRE-EXISTING CONDITIONS
This insurance policy excludes coverage for pre-existing conditions, except as provided for under the
Acute Onset of Pre-existing Conditions benefit. This policy defines a pre-existing condition and
provides the description of the Acute Onset of Pre-Existing Conditions benefit.
DATA PROTECTION
We respect individual privacy and value your confidence. We restrict access to personal information
to employees/partners who need to know that information in order to perform their jobs. Any employee
that we determine is in violation of this policy will be subject to disciplinary action, up to and including
termination and criminal prosecution.
We will not disclose your personal information to third parties outside Tokio Marine HCC and our
partners unless ordered to do so to comply with the law of the countries in which we do business or
when complying with the legal process.
RIGHTS OF THIRD PARTIES
You may assign benefits under this insurance to a hospital, physician or other provider. Any
assignment shall not confer upon such hospital, physician or other provider, any right or privilege
granted to you under this insurance except for the right to receive benefits, if any, which are
determined to be due and payable hereunder. No hospital, physician or other provider shall have
any direct or indirect claim or right of action against us.
LAW AND JURISDICTION
No action of law or equity may be brought to recover benefits under this insurance until 60 days after
written proof of claim has been provided to us. No such action may be brought after the end of three
(3) years after the time written proof of claim is required to be furnished. The validity, interpretation,
and performance of this agreement shall be governed by and construed in accordance with the laws
of Bermuda.
TOKIO MARINE HCC MEDICAL INSURANCE SERVICES GROUP (“MIS GROUP”)
A subsidiary of Tokio Marine HCC, HCC Lloyd’s Syndicate 4141 is managed by HCC Underwriting
Agency Ltd which is authorized by the Prudential Regulation Authority (PRA) and regulated by the
Financial Conduct Authority (FCA) and the PRA. Registered in England and Wales No. 04632146.
Registered office: 1 Aldgate, London EC3N 1RE, United Kingdom. Lloyd’s is authorised as an insurer
in Spain by the Spanish insurance regulatory authority (Dirección General de Seguros y Fondos de
Pensiones) under reference L0017.
These details can be checked on the Financial Services Register by visiting: www.fca.org.uk or
contacting the Financial Conduct Authority on 0800 111 6768.
4 Atlas Group Description of Coverage | Tokio Marine HCC - MIS Group
