2020–2021 Plan Benefi ts
Revised 09/10/2020 10:08 AM
Underwritten by:Liberty Insurance Underwriters Inc.
Blanket Policy Number:SCH-40000267-00
LOURDES UNIVERSITYACCIDENT ONLY INSURANCE PLANwww.4studenthealth.com/lourdes
Important Contact Information and ResourcesPlan AdministrationBenefits & ClaimsRelation Insurance ServicesP.O. Box 25936Overland Park, Kansas 66225(877) [email protected]–Friday, 8:30 a.m. to 5:00 p.m. Central Time
Underwritten byLiberty Insurance Underwriters Inc.175 Berkeley Street, Boston, Massachusetts 02116
What’s InsideGeneral Information
Notice of Coverage ..........................................................3Eligibility ..............................................................................3Eff ective and Termination Date ....................................3ID Card ................................................................................4Heart and Circulatory Malfunction Benefi t ................4Limited Primary Excess Medical Expense..................4
Filing a Claim ........................................................................4Confi dential Communication Request ........................4
Plan Benefi tsSchedule of Benefi ts .......................................................6Additional Accident Benefi ts ......................................... 7Accidental Death & Dismemberment Benefi t ........... 7
Exclusions and Limitations ...............................................9
Defi nitions ........................................................................... 10
Privacy Notice & Consent ................................................ 11
2020–2021 Plan Benefi ts / Lourdes University / 3 /
NoticeThis Plan Summary provides a brief summary of your coverage under the Policy of blanket accident insurance of which your school is the Policyholder. Your school’s blanket accident Policy does not provide major medical or comprehensive medical coverage, and does not satisfy the standards of minimum essential coverage under the Patient Protection and Affordable Care Act. Your coverage under the Policy is not designed to serve as a replacement to or an alternative to major medical insurance. Rather, coverage under the Policy is intended to supplement comprehensive health insurance coverage. Coverage is for accidents only. Sicknesses are not covered by the Policy.
This Plan Summary is not a contract of insurance. Your coverage is governed by a Policy underwritten by Liberty Insurance Underwriters Inc. under form LIUI BACC P001 OH (Ed. 12 13), and is subject to the terms, conditions, limitations and exclusions of the Policy. You may ask your school for a copy of the Policy. Any discrepancy between this Plan Summary and the Policy will be governed by the Policy.
The following is a brief description of the Accident Only medical expense benefits for students attending Lourdes University. Complete details of coverage are in the Policy issued to the University. It may be inspected during business hours at the business office of the University.
Notice of CoverageThe Policy is issued to Lourdes University (“the Policyholder”). The Policy is a legal contract between the Policyholder and Liberty Mutual (“the Company”). It is issued in consideration of payment of premiums. The Policy is issued in and will be interpreted by the laws of the State of Ohio, without giving effect to the principles of conflicts of law of that State or any other state. Any part of the Policy which is in conflict with the laws of the State of Ohio is changed to conform to the minimum requirements of that State’s laws.The Company agrees to pay the benefits described in the Policy for any Accident that occurs while the Policy is in force, subject to the terms, conditions, and limitations of the Policy.
EligibilityAll full-time registered students enrolled in twelve (12) credits or more are eligible and automatically covered under this Plan. Students must actively attend classes for at least the first 31 days beginning with the first day for which coverage is purchased.Coverage is provided 24 hours a day during the policy term. No coverage is provided for intercollegiate, club, or intramural sports.
Eff ective and Termination DateAn Eligible Person becomes eligible for insurance under the Policy on the date he meets all of the requirements of one of the Covered Classes. An Eligible Person may be insured under only one Covered Class, even though he may be eligible under more than one Covered Class.The Policy is on file at the University and is effective August 26, 2020. Insurance for an Eligible Person is effective on the date stated in the Schedule of Benefits.1. the effective date of the Policyholder’s participation under
the Policy; and2. the date the Eligible Person becomes eligible based on
Policyholder requirements.The Policy terminates August 26, 2021. Insurance for the Insured Person will end on the earliest of:1. the date the person is no longer in an Eligible Class;2. the date the person enters full time active duty in any
Armed Forces. The Company will refund any premium paid for any period of active duty when the Company receives proof of active duty. Active duty does not include Reserve or National Guard duty for training;
3. the end of the period for which the last premium is made; or4. the date this Policy ends.Termination does not affect a claim for a Covered Loss due to an Accident that occurs before the termination date. However, in no instance will benefits extend beyond the earlier of: 1. the end of the Benefit Period; and2. the date benefits equal to any applicable Benefit Limit,
as shown in the Schedule of Benefits, have been paid.
General Information
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General Information (continued)
ID CardYou may pick up your insurance ID card from Office of the Vice President, Finance and Administration. No other card will be mailed to you.Carry your ID card with you at all times! Upon an accident, if you go to a physician’s office, urgent care center, hospital, or pharmacy, you will be asked for your ID card.
Heart and CirculatoryMalfunction Benefi tThe Company will pay the Benefit Amount shown in the Schedule of Benefits, if an Insured Person suffers a sudden Heart and Circulatory Malfunction that results in death as a direct result of participating in a Covered Activity, and the first symptoms of the malfunction are medically diagnosed while the Insured Person is covered under the Policy.
Filing a ClaimIn the event of Injury, the student should:1. Report to a Physician or Hospital.2. Obtain a claim form from the office of the Vice President, Finance and Administration. You must complete the claim form and
return it to the same office. They will submit the claim form to Relation Insurance Services.3. Once the school submits the claim form, you can forward the detailed billing statements and primary insurance explanation
of benefits to:Relation Insurance Services
P.O. Box 25936Overland Park, Kansas 66225
Fax: (913) 327-7520
Bills will not be processed without a properly submitted claim form.Keep copies of all the documents you submit. To check the status of a claim you submitted, contact Relation at (877) 246-6997 or email [email protected]. It is advisable to wait 10 business days after the submission of your claim before making an inquiry.
Confi dential Communication RequestIf you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with the school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available from www.4studenthealth.com/lourdes in the Claims section, under USE YOUR INSURANCE.
Limited Primary Excess Medical ExpenseIf an Injury to the Covered Person results in his incurring Covered Expenses, the Company will pay Covered Expenses, subject to the Limited Primary Benefit shown in the Schedule of Benefits:1. after the Insured Person satisfies any Deductible; and2. subject to the Non-Duplication of Benefits provision in the Limitations Section.The Company will pay the benefits shown in Schedule of Benefits for the Insured Person’s Necessary Treatment Covered Expenses, subject to all applicable conditions and exclusions, for treatment of a Covered Injury.Benefits will be paid:• When Covered Expenses exceed any applicable Deductible within the number of days from the date of the Covered Injury
specified in the Schedule of Benefits; and• The Company shall not pay more than the Maximum Benefit Amount shown in the Schedule of Benefits.• The Covered Expenses must be provided within the Maximum Benefit Period shown in the Schedule of Benefits.• The Company will multiply the Covered Expenses by the Coinsurance percentage contained in the Schedule of Benefits to
determine the amount payable.• The Company may impose limits on certain types or categories of Covered Expenses. These limits are contained in the Schedule
of Benefits.
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Plan Benefi ts
(CONTINUED)
Schedule of Benefi tsThe Schedule of Benefits provides a brief outline of the coverage and benefits provided by the Policy. Please read the Conditions of Coverage and Description of Benefits sections for full details.
ACCIDENT MEDICAL AND DENTAL EXPENSES
Full Excess
Full Excess Accident Expense Benefi t Maximum $25,000
Limited Primary $50
Deductible $250
First Covered Expenses must be received within 180 days after the Covered Injury
Benefi t Period Two (2) years from the date of the Covered Injury
Coinsurance 100% of Usual and Customary (U&C)Covered unless otherwise specifi ed below
Heart and Circulatory Malfunction Benefit Maximum $10,000
INPATIENT HOSPITAL SERVICES
Room & Board ExpensesSemi-Private Room 100% of U&CIntensive Care Unit/Critical Care Unit 100% of U&CHospital Miscellaneous Expenses 100% of U&CEmergency Room Treatment (must occur within 72 hours) 100% of U&CRegistered Nursing Services 100% of U&C
Physician ServicesSurgery 100% of U&CAssistant Surgeon 100% of U&CAnesthesia and its Administration 100% of U&C
OUTPATIENT SERVICES
Physician Offi ce Non- Surgical Visits 100% of U&C
Combined Maximum for CT scan, MRI 100% of U&C
X-Ray 100% of U&C
Lab Tests 100% of U&C
Outpatient PhysiotherapyIncludes acupuncture, microthermy, manipulation, diathermy, massage therapy, heat treatment, and ultrasonic treatment.
100% of U&C
Outpatient Orthopedic Appliances 100% of U&C
Hospital Outpatient Surgery Facilities Payment 100% of U&C
Ambulance Services/One (1) Trip to Nearest Hospital 100% of U&C
Medical Equipment Rental 100% of U&C
Dental Services 100% of U&C
Outpatient Prescription Drugs 100% of U&C
2020–2021 Plan Benefi ts / Lourdes University / 7 /
Plan Benefi ts (continued)
ADDITIONAL BENEFITS
HMO/PPO Denial Included
Heart and Circulatory MalfunctionCovered Conditions: heat exhaustion; heart attack; stroke; burst aneurysm. Included
Expanded MedicalCovered Conditions: bursitis; sprains; hernia; muscle tears; tendonitis; and repetitive motion injuries.
Included
Pre-Existing Sports Injury Included
Additional Accident Benefi tsThe total of all benefits payable under the Policy, including all Additional Accident Benefits paid for all Injuries caused by the same Covered Accident, shall not exceed the Principal Sum indicated in the Schedule of Benefits unless otherwise excluded or indicated under the terms, conditions, and exclusions of the Policy.
Accidental Death & Dismemberment Benefi tPrincipal Sum: $25,000Time Period for Loss: 365 Days
The Company will pay the Benefit Amount for any one of the Covered Losses listed in the Schedule of Benefits, subject to all applicable conditions and exclusions, if the Insured Person suffers a Covered Loss within the applicable time period specified in the Schedule of Benefits.
Loss Percentage of Principal Sum
Loss of Life 100%
Loss of Two or More Hands or Feet 100%
Loss of Sight of Both Eyes 100%
Loss of Speech and Hearing (in Both Ears) 100%
Loss of One Hand or Foot and Sight in One Eye 100%
Loss of One Hand or Foot 50%
Loss of Speech 50%
Loss of Hearing (in Both Ears) 50%
Loss of Thumb and Index Finger of Same Hand 25%
Loss of Hand or Foot means complete Severance through or above the wrist or ankle joint.Loss of Hearing means total and permanent loss of ability to hear any sound in both ears which is irrecoverable by natural, surgical or artificial means.Loss of Sight means the total, permanent Loss of Sight of one eye. The Loss of Sight must be irrecoverable by natural, surgical or artificial means.Loss of Speech means total and permanent loss of audible communication which is irrecoverable by natural, surgical or artificial means.Loss of Thumb and Index Finger of Same Hand means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the hand).Severance means the complete separation and dismemberment of the part from the body.
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2020–2021 Plan Benefi ts / Lourdes University / 9 /
In addition to any benefit or coverage specific exclusion, benefits will not be paid for any loss which directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in the policy.
1. Intentionally self-inflicted injury, suicide, or any attempt while sane or insane.
2. Commission or attempt to commit a felony or an assault.
3. Commission of or active participation in a riot or insurrection.
4. Declared or undeclared war or act of war or any act of declared or undeclared war unless specifically provided by the Policy.
5. The Insured Person’s intoxication as determined according to the laws of the jurisdiction in which the Covered Loss occurred or the laws of the Home Country.
6. Release, whether or not Accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release.
7. Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage.
8. A Covered Loss that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon the Company’s receipt of proof of service, the Company will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days.
9. Travel outside the United States, to any country for which a travel warning has been issued or renewed by the U.S. State Department within 60 days prior to date of departure and any country to which travel by U.S. citizens is restricted or prohibited.
10. Flight in, boarding or alighting from an Aircraft, except as: a fare-paying passenger on a regularly scheduled commercial airline.
11. Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, including exposure, whether or not accidental, to viral, bacterial or chemical agents whether the loss results directly or non-directly from the treatment except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food.
12. Participation in any motorized race or contest of speed or stunt show.
13. Occupational injuries for which benefits are not paid under the Workers’ Compensation Law or any similar law.
14. Participation in any sports activity not specifically authorized, sponsored and supervised by the Policyholder whether or not it takes place on Policyholder premises or during a Covered Activity, including but not limited to snowboarding, skateboarding, motorcycle racing, racing rocket-powered, jet propelled or nuclear-powered vehicles (or any other activity to be excluded).
In addition, benefits will not be paid for services or treatment rendered by any person who is:
1. Employed or retained by the Policyholder.
2. A Resident of the Same Household.
3. An Immediate Family Member including Domestic Partner of either the Insured Person or the Insured Person’s Spouse.
4. The Insured Person.
The following will not be considered Covered Expenses unless coverage is specifically provided:
1. Injury sustained while participating in professional athletics.
2. Routine physical and care of any kind.
3. Routine dental care and treatment.
4. Immunizations of any kind.
5. Cosmetic or plastic surgery, except as the result of a Covered Injury.
6. Routine nursery or routine child care.
7. Any mental or nervous disorders.
8. Eye refractions or eye examinations for the purpose of prescribing corrective lenses or for the fitting thereof; eyeglasses, contact lenses, and/or hearing aids unless Necessary Treatment t of a Covered Injury.
9. Services, supplies, or treatment including any period of Hospital Confinement which is not recommended, approved, and certified as Necessary Treatment and reasonable by a Physician, or expenses which are non-medical in nature.
10. In connection with alcoholism and drug addiction, or use of any drug or narcotic agent.
11. Expenses incurred during holiday travel, or travel for the purposes of seeking medical care or treatment.
12. Charges for Covered Medical Expenses for which the Insured Person would not be responsible in the absence of this Policy.
13. Injury or Sickness for which benefits are payable under any worker’s compensation or occupational disease law or act, or similar legislation, whether Unites Stated federal or foreign law.
14. Any elective or routine treatment, surgery, health treatment, or examination, including any service, treatment of supplies that: (a) are deemed by the Company to be experimental or investigational; and (b) are not recognized and generally accepted medical practice in the United States.
15. Services or treatment provided by persons who do not normally charge for their services, unless there is a legal obligation to pay.
16. Rest cures or custodial care.
17. Repair or replacement of existing dentures, partial dentures, braces or bridgework.
18. Personal services such as television and telephone or transportation.
19. Expenses payable by any automobile insurance policy without regard to fault.
20. Repair or replacement of existing artificial limbs, eyes and larynx.
Exclusions and Limitations
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Accident or Accidental means a sudden, unexpected, specific and abrupt event that occurs by chance at an identifiable time and place while the Insured Person is covered under the Policy.
Benefit Period means the maximum period that benefits are payable under the Catastrophic Accident Expense benefit.
Condition of Coverage means the circumstances under which the Policy provides benefits as stated in the Schedule of Benefits.
Covered Accident means a sudden, unexpected, specific and abrupt event that results directly and independently of all other causes, in a Covered Injury or Covered Death and meets all of the following conditions:
1. occurs while the Insured Person’s coverage under the Policy is in force;
2. occurs while the Insured Person is attending, participating in or traveling to and from a Covered Activity; and
3. is not otherwise excluded under the terms of the Policy.
Covered Death means Accidental death:
1. which is the direct result of a Covered Accident;
2. which results directly and independently from all other causes from a Covered Accident and independent of Sickness, disease, mental incapacity, bodily infirmity or any other cause; and
3. suffered by the Insured Person within the applicable time period specified in the Schedule of Benefits.
Covered Injury means Accidental bodily injury:
1. which is sustained by an Insured Person as a direct result of a Covered Accident that is external to the body;
2. which results directly and independently from all other causes from a Covered Accident (independent of Sickness, disease, mental incapacity, bodily infirmity or any other cause) that causes a Covered Loss; and
3. suffered by the Insured Person within the applicable time period specified in the Schedule of Benefits.
The Covered Injury must be caused through Accidental means. All injuries sustained by an Insured Person in any one Accident, including related conditions and recurrent symptoms of these injuries, are considered a single injury.
Covered Expenses means the Usual and Customary Charges for the following services, provided such following services are Necessary Treatment of a Covered Injury:
Inpatient Hospital services
• Room and board in a semi-private room;
• Intensive Care Unit (Critical Care Unit);
• Hospital Miscellaneous Services;
• Inpatient medical and surgical services, physiotherapy prescription drugs and other medical supplies commonly used for therapeutic or diagnostic services;
• Inpatient X-Ray, CT Scan, MRI and Lab Test includes charges for reading;
• Ambulatory Medical Center;
• Physician services, Surgery, Assistant Surgeon, Physician’s Surgical Facilities, Second Opinion, or consultation, Anesthesia and it administration, In Physician Hospital Visits, Physician Office visits;
• Emergency Room;
• Outpatient Services;
• Outpatient X Ray, CT Scan, MRI, and Laboratory Test includes charges for reading;
• Outpatient physiotherapy;
• Outpatient Nursing services;
• Chiropractic Treatments;
• Medical Equipment;
• Artificial limbs;
• Medical equipment rental or if less than the purchase of equipment;
• Expanded Medical Benefit for Covered Sports Injuries as shown in the Schedule of Benefits;
• Heart and Circulatory Condition Benefit, Covered Heart and Circulatory Conditions included are shown in the Schedule of Benefits;
• Hernia;
• HMO/PPO Denial, when benefits are denied or reduced by an HMO or PPO plan because services provided to treat a Covered Injury were rendered by a Non-Preferred Provider; or received outside of the network’s service area. If benefits are reduced rather than denied by an HMO or PPO for the reasons described above, the Company will pay an amount equal to the Covered Expense less the amount paid by the HMO or PPO;
• Pre-existing Condition Injury Aggravation or re-injury of a Pre-existing Condition Injury.
Covered Loss means a loss which results from a Covered Injury or Covered Death, and for which benefits are payable under the Policy. Covered Loss includes any expenses arising from services or supplies rendered or obtained by the Insured Person when such services and supplies are covered by the Policy.
Eligible Person means an individual as defined in the Schedule of Benefits.
Heart and Circulatory Condition or Malfunction means heat exhaustion, heart attack, stroke, burst aneurysm and dehydration.
Hospital means an institution that meets all of the following:
1. it is licensed as a Hospital pursuant to applicable law;
2. it is primarily and continuously engaged in providing medical care and treatment to sick and injured persons;
3. it is managed under the supervision of a staff of medical doctors;
4. it provides 24-hour nursing services by or under the supervision of a graduate registered nurse (R.N.);
5. it has medical, diagnostic and treatment facilities, with major surgical facilities on its premises, or available on a prearranged basis;
6. it charges for its services.
Hospital shall include a Veteran’s Administration Hospital or Federal Government.
The term Hospital does not include a clinic, facility, or unit of a Hospital for:
1. rehabilitation, convalescent, custodial, educational or nursing care; or
2. the aged, drug addicts or alcoholics.
Hospital Miscellaneous Expenses mean the Necessary Treatment expenses charged by a Hospital or Ambulatory Surgical Center for Outpatient surgery. The Miscellaneous Expenses include, but are not limited to, the expenses shown in the Schedule of Benefits and all necessary charges other than room and board, for services received during a Hospital stay.
Integrated Deductible means the amount that must be paid for Covered Medical Services by the Insured Person before benefits will become payable under the Benefit. A separate Deductible shall apply to each Covered Injury. The Deductible shall be reduced by the amount of medical expenses paid or payable under another Other Insurance for medical expenses arising out of the Covered Injury that gave rise to the claim under the Benefit. Benefits are not payable for charges applied to the Deductible.
Heart or Circulatory Malfunction means a disease or illness of the heart or circulatory system which:
1. appears on the list of Heart and Circulatory Conditions shown in the Schedule of Benefits; and
2. occurs during a Covered Activity while the Policy is in force.
Hospital Confinement or Confined means a Necessary Treatment stay of 96 or more consecutive hours as a registered resident bed patient in a Hospital. Hospital Confinements due to the same Covered Injury will be treated as one Hospital Confinement unless separated by at least 180 days.
Immediate Family Member means a person who is related to the Insured Person or Insured Dependent in any of the following ways: Spouse, Domestic Partner, brother-in-law, sister-in-law, daughter–in-law, son-in-law, mother-in-law, father-in-law, parent (includes stepparent), brother or sister (includes stepbrother or stepsister), or child (includes legally adopted or stepchild).
Defi nitions
(CONTINUED)
The terms shown below shall have the meaning given in this section whenever they appear in this Policy. Additional terms may be defined within the provision to which they apply.
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Injury means Accidental bodily injury:
1. That is the direct result of an Accident that is external to the body;
2. Which results directly and independently from all other causes of an Accident (independent of Sickness, disease, mental incapacity, bodily infirmity or any other causes).
Inpatient means confined overnight as a registered bed patient in a Hospital or other medical facility where at least one day’s room and board is charged. The confinement must be on the advice of a Physician.
Insured Person means an Eligible Person, as defined in the Schedule of Benefits, for whom the required premium has been paid when due and for whom coverage under the Policy remains in force.
Health Maintenance Organization (HMO) means any organized system of health care that provides health maintenance and treatment services for a fixed sum of money agreed and paid in advance to the provider of service.
Necessary Treatment means medical services that:
1. are essential for diagnosis, treatment or care for which it is prescribed or performed;
2. meets generally accepted standards of medical practice; and
3. are ordered by a Physician and performed under his care, supervision or order.
Other Insurance means any reimbursement for or recovery of any element of Covered Injury as a result of an Accident available from any other source whatsoever, except gifts and donations, but including without limitations:
• any individual, group, blanket or franchise policy of Accident, disability or health insurance or any similar type of arrangement that provides for payments or reimbursement of medical expenses or disability payments;
• Social Security Disability Benefits; and
• any benefits payable under any program provided or sponsored solely or primarily by and federal, state or local governmental unit or agency or subdivision or through operation of law or regulation; except Medicaid.
Outpatient means an Insured Person who is a patient and is not hospitalized overnight but who visits a Hospital, clinic, or associated facility for diagnosis or treatment.
Physical Therapy means a branch of rehabilitative health care that uses specially designed exercises and equipment to help patients regain or improve their physical abilities. Physical Therapy must be prescribed by a Physician and performed by a licensed physical therapist practicing within the scope of his license.
Physician means a licensed health care provider practicing within the scope of his license and rendering care and treatment to the Insured Person that is appropriate for the condition and locality, and who is not:
1. the Insured Person;
2. an Immediate Family Member of either the Insured Person or the Insured Person’s Spouse;
3. a Resident of the Same Household;
4. a person employed or retained by the Policyholder; or
5. a person providing homeopathic, aroma-therapeutic, or herbal therapeutic services.
Preferred Provider Organization (PPO) means an organization offering health care services through designated health care providers who agree to perform these services at rates lower than Non-Preferred Providers.
Sickness means a physical or mental illness including pregnancy.
Usual and Customary Charges means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.
We, Us, Our means Liberty Insurance Underwriters Inc.
You, Your means the person to whom the Certificate is issued.
Defi nitions (continued)
Privacy Notice & ConsentTo provide our services as an administrator, Relation Insurance Services will collect and use personal information about you, such as your name, age and contact details so that we can arrange insurance cover for you. During the period of your insurance you may also provide special personal information (e.g. about your health) that may be used by Relation Insurance Services, and by us, so that we can process your insurance and deal with any claim you make.We may pass your personal information to third parties such as medical emergency providers, reinsurers, loss adjusters, subcontractors and affiliates, who will use your personal information for processing your insurance and handling claims, as well as for the purposes described in our Privacy Notice. Certain regulators may also require your personal information for their own purposes which are also described in our Privacy Notice.We may transfer your personal information to other countries which have limited or no data protection laws. Any transfer will be made with appropriate safeguards in place to ensure your personal information is held securely.Any information you provide may be used by Relation Insurance Services and by us for crime prevention. We will not share your personal information with third parties for marketing purposes.
You have the right to see the personal information we hold about you, and you must make this request in writing and give your full name and address. You should send your request to:
Marcos Rolon, Privacy Officer Relation Insurance Administrators
P.O. Box 6040Agoura Hills, California 91376-6040
Your consent to our processing of your personal information in the way described in this Notice is necessary for us to be able to provide you with insurance cover, and the services required to fulfill our obligations to you, and you hereby consent to such processing. You may withdraw your consent at any time, but if you do, we may be unable to provide services to you, or process any claim, and your insurance cover will come to an end. Where you are providing personal information about anyone other than yourself, you must provide them with this Notice and obtain their explicit consent as set out above.More information about how we use your personal information is set out in our Privacy Notice which can be found at www.4studenthealth.comYou can also request a copy of our Privacy Notice by contacting [email protected].
Plan Administered ByRelation Insurance Services
EDUCATION SOLUTIONS
