Common use of BENEFITS PROVISIONS Clause in Contracts

BENEFITS PROVISIONS. 1. Occurrence of unexpected and urgent medically necessary medical expenses (including 100% of covered expenses for In-hospital Medical Services, 100% of covered expense for In- hospital Surgical Services and 100% for Out of Hospital Medical Services) which are a direct consequence of an accident or an illness of an Insured which are not an Exclusion from the Insurance Coverage, and are within the limits of insurance responsibility which have occurred during the term of the individual insurance coverage; 2. Casual/Leisure Sports: The following is included in your coverage for non-school sponsored events: aerobics, baseball, basketball, calisthenics, cycling, dancing, diving above 15M, Frisbee, horseback riding (trail only - no jumping, competition or dressage), hiking/trekking below 3500M, jogging/running, roller (in-line) skating, rollerblading, sailing, sea kayaking/canoeing, soccer, squash, surfing, tennis, swimming, volleyball, whitewater rafting up to and including Class 3 level. Any other sport not requiring a high degree of risk or training and will be evaluated at the insurer’s discretion whose decisions are final.