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SPECIMENCONTENTS ACCESS TO ADDITIONAL MATERIALS ................. 11
OTHER INSURANCE ............................................... 11
PATIENT PROTECTION AND AFFORDABLE CARE ARBITRATION.......................................................... 11
ACT (“PPACA”) DISCLOSURE STATEMENT.................3 APPEAL AND COMPLAINTS PROCEDURE................ 11
DESCRIPTION OF COVERAGE SUMMARY..................3 APPEALING A CLAIM .............................................. 11
IMPORTANT FEATURES OF YOUR TRAVEL COMPLAINTS PROCEDURE................................... 12
INSURANCE....................................................................3 PRE-EXISTING MEDICAL CONDITIONS .................... 12
ACUTE ONSET OF PRE-EXISTING CONDITION ... 12
CANCELLATION .........................................................3 MEDICAL & REPATRIATION EXPENSES ................... 13
U.S. PREFERRED PROVIDER ORGANIZATION MEDICAL EXPENSES.............................................. 13
(PPO) ..........................................................................3 EMERGENCY MEDICAL EVACUATION.................. 14
CLAIMS .......................................................................4 REPATRIATION OF REMAINS ................................ 15
APPEALS AND COMPLAINTS ...................................4 EMERGENCY REUNION ......................................... 15
PRE-EXISTING CONDITIONS....................................4 ACCIDENTAL DEATH AND DISMEMBERMENT ......... 15
DATA PROTECTION ..................................................4 SPORTS AND ACTIVITIES .......................................... 16
RIGHTS OF THIRD PARTIES.....................................4 A. INTERCOLLEGIATE, INTERSCHOLASTIC,
LAW AND JURISDICTION ..........................................4 INTRAMURAL, OR CLUB SPORTS ......................... 17
TOKIO MARINE HCC MEDICAL INSURANCE B. LEISURE, RECREATIONAL, ENTERTAINMENT,
SERVICES GROUP (“MIS GROUP”) ..........................4 OR FITNESS SPORTS & ACTIVITIES..................... 17
MEMBER ELIGIBILITY ....................................................5 PERSONAL LIABILITY ................................................. 18
ELIGIBILITY ................................................................5 TERRORISM................................................................. 19
CERTIFICATE EFFECTIVE & TERMINATION DATES...5 GENERAL EXCLUSIONS ............................................. 20
CERTIFICATE EFFECTIVE DATE..............................5 DEFINITIONS ............................................................... 21
CERTIFICATE TERMINATION DATE .........................5 OPTIONAL ACCIDENTAL DEATH & DISMEMBERMENT
BENEFIT PERIOD & HOME COUNTRY COVERAGE ....5 BENEFIT RIDER........................................................... 25
BENEFIT PERIOD.......................................................5 OPTIONAL CRISIS RESPONSE BENEFIT RIDER ...... 26
INCIDENTAL HOME COUNTRY COVERAGE............6
SCHEDULE OF BENEFITS AND LIMITS........................6
U.S. PREFERRED PROVIDER ORGANIZATION (PPO)
REQUIREMENTS ..........................................................10
CLAIM PROCEDURES..................................................10
PROOF OF CLAIM....................................................10
CLAIMS COOPERATION..........................................11
2 StudentSecure Description of Coverage | Tokio Marine HCC – MIS Group
OTHER INSURANCE ............................................... 11
PATIENT PROTECTION AND AFFORDABLE CARE ARBITRATION.......................................................... 11
ACT (“PPACA”) DISCLOSURE STATEMENT.................3 APPEAL AND COMPLAINTS PROCEDURE................ 11
DESCRIPTION OF COVERAGE SUMMARY..................3 APPEALING A CLAIM .............................................. 11
IMPORTANT FEATURES OF YOUR TRAVEL COMPLAINTS PROCEDURE................................... 12
INSURANCE....................................................................3 PRE-EXISTING MEDICAL CONDITIONS .................... 12
ACUTE ONSET OF PRE-EXISTING CONDITION ... 12
CANCELLATION .........................................................3 MEDICAL & REPATRIATION EXPENSES ................... 13
U.S. PREFERRED PROVIDER ORGANIZATION MEDICAL EXPENSES.............................................. 13
(PPO) ..........................................................................3 EMERGENCY MEDICAL EVACUATION.................. 14
CLAIMS .......................................................................4 REPATRIATION OF REMAINS ................................ 15
APPEALS AND COMPLAINTS ...................................4 EMERGENCY REUNION ......................................... 15
PRE-EXISTING CONDITIONS....................................4 ACCIDENTAL DEATH AND DISMEMBERMENT ......... 15
DATA PROTECTION ..................................................4 SPORTS AND ACTIVITIES .......................................... 16
RIGHTS OF THIRD PARTIES.....................................4 A. INTERCOLLEGIATE, INTERSCHOLASTIC,
LAW AND JURISDICTION ..........................................4 INTRAMURAL, OR CLUB SPORTS ......................... 17
TOKIO MARINE HCC MEDICAL INSURANCE B. LEISURE, RECREATIONAL, ENTERTAINMENT,
SERVICES GROUP (“MIS GROUP”) ..........................4 OR FITNESS SPORTS & ACTIVITIES..................... 17
MEMBER ELIGIBILITY ....................................................5 PERSONAL LIABILITY ................................................. 18
ELIGIBILITY ................................................................5 TERRORISM................................................................. 19
CERTIFICATE EFFECTIVE & TERMINATION DATES...5 GENERAL EXCLUSIONS ............................................. 20
CERTIFICATE EFFECTIVE DATE..............................5 DEFINITIONS ............................................................... 21
CERTIFICATE TERMINATION DATE .........................5 OPTIONAL ACCIDENTAL DEATH & DISMEMBERMENT
BENEFIT PERIOD & HOME COUNTRY COVERAGE ....5 BENEFIT RIDER........................................................... 25
BENEFIT PERIOD.......................................................5 OPTIONAL CRISIS RESPONSE BENEFIT RIDER ...... 26
INCIDENTAL HOME COUNTRY COVERAGE............6
SCHEDULE OF BENEFITS AND LIMITS........................6
U.S. PREFERRED PROVIDER ORGANIZATION (PPO)
REQUIREMENTS ..........................................................10
CLAIM PROCEDURES..................................................10
PROOF OF CLAIM....................................................10
CLAIMS COOPERATION..........................................11
2 StudentSecure Description of Coverage | Tokio Marine HCC – MIS Group
