USASF.NET

Plan Summary

Aggregate Limit of Liability		$1,000,000.00
This is the maximum amount for which the Insurer is liable for an Insured Person for all benefits under this plan due to any one Accident.
		$25,000.00
Covered Accident Deductible:
Eligible medical expenses payable under any other insurance policy or service contract will be used to satisfy or reduce the Covered Accident Deductible

Full Excess* Medical, Dental, Rehabilitative and Custodial Care Expense Benefits:
Benefit Percentage		100%
Deductible Establishment Period		24 Months
Maximum Benefit Period		10 Years from accident date
Maximum Benefit Amount		$1,000,000.00
Maximum for Medically Necessary Hospital Inpatient Services and Supplies		Included in Medical Maximum
Maximum for confinement in an Extended Care Facility Per Calendar Year		$365,000.00
Daily Room And Board Limit For:
Private Or Semi-Private Room		Average Semi-Private Rate Of Hospital In Which Confined
Intensive Care		Reasonable and Customary Charges

Combined Home Health Care and Custodial Care Maximum
Benefit per Calendar Year		$100,000.00

Treatment Of Mental Or Nervous Disorders:
Doctor Fees-
Amount Per Visit		$90
Visits Per Day		One (1)
Visits Per Calendar Year		50
Inpatient Hospital		Up to 45 Days

Maximum Spinal Manipulative Services Benefit
Maximum Amount Per Calendar Year		$1,000.00

Maximum Outpatient Physical Therapy Benefit
Maximum Amount Per Calendar Year		$25,000.00

Maximum Prosthetic Limitation
Benefit Amount payable during the first two (2) years after Covered accident		$100,000.00
Benefit Amount payable for the remainder of the benefit Period immediately thereafter		$100,000.00 $200,000.00 If amputation of the leg above the knee.
Maximum Benefit Amount		$200,000.00 $300,000.00 If amputation of the leg above the knee.

Accidental Death, Dismemberment or Loss of Sight, Speech or Hearing Benefit:
Principal Sum		$10,000.00
Loss Establishment Period		365 Days

*Coverage is excess over any other valid and collectible insurance or similar benefit program available to the Insured Person for a Covered Loss.

This document is a summary of the U.S. All Star Federation (USASF) Catastrophic Injury Insurance Program. The
Memorandum of Coverage on file with USASF contains all of the provisions, exclusions, limitations and qualifications of the insurance benefits. If there is any conflict between the Memorandum of Coverage and this piece, Memorandum of Coverage provisions will prevail.