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Download & complete the form
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For further information,
please contact Carol Malouf:
Summit America Insurance
NIRSA Insurance Division
Services, L.C.
2180 South 1300 East, Suite 520
Salt Lake City, UT 84106
tel: 801-412-2622
fax: 801-412-2625
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This outline summarizes the provisions of the policies. Should there be any discrepancy between this outline and the policy, the policy provisions will prevail.
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Summit America Insurance
Accident Insurance Programs for Club Sports and Intramural Sports Participants.
Eligibility: All colleges/universities who are Institutional Members of the National Intramural-Recreational Sports Association.
Insured Person: The plans cover all student participants in an institution approved Club Sport or Intramural Sport Program.
Insured Activities:
CLUB SPORTS – The plans cover injuries that occur during play or practice of a Club Sports game, contest or match. Participants are covered while traveling as defined in the applicable Basic and/or Catastrophic policy.
INTRAMURAL SPORTS – The plans cover injuries that occur during play of insured Intramural games, contest or matches. Participants are covered while traveling as defined in the applicable Basic and/or Catastrophic policy.
BASIC ACCIDENT MEDICAL INSURANCE
Plan Highlights
A Medical/Dental benefit of $30,000 per person per covered accidental injury.
Benefits are payable for covered expenses which exceed the deductible and/or for expenses not recoverable from any other insurance policy, service contractor worker’s compensation coverage.
Benefits are payable for expenses incurred within TWO years from the date of injury.
Standard deductibles of $250, $500, $1,000 and $2,500 – with higher amounts available upon request.
$10,000 Accidental Death & Dismemberment Benefit.
CATASTROPHIC INJURY INSURANCE
Plan Highlights
LIFETIME Medical, Dental and Rehabilitation Benefits with a MAXIMUM of $5,000,000.
Monthly Benefits payable if Totally or Partially Disabled.
A Covered Accident Deductible of $25,000; $30,000 or $50,000 (as selected by school), for medical, dental or rehabilitation expenses which must be incurred within TWO years from the date of injury.
$10,000 Accidental Death & Dismemberment Benefit.
Benefits are payable for covered expenses which exceed the deductible and/or for expenses not recoverable from any other valid and collectible insurance or similar benefit program.
Additional Benefits for Total Disability
Up to $10,000 in the first ten years and $50,000 each subsequent ten years for special vehicle purchase and home remodeling or adaptation.
Up to $100,000 additional insurance coverage for other injuries or illnesses not related to the initial catastrophic injury; after the $5,000 Calendar Year deductible has been met.
This outline summarizes the provisions of the policies underwritten by Mutual of Omaha Insurance Company. Should there be any discrepancy between this outline and the policy, the policy provisions will prevail.
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