Insurance At Need Copy

INSURANCE AT NEED COPY

Issuer:    Policy Number:

Applicant / Insured Information

Policy Details

Policy Type: Life Funeral Expense Accidental Death Repatriation

Policy Period Effective Date:   to  

Coverage Selections

Select specific coverages applicable under this policy. Coverage commencement is subject to payment and issuance terms set forth in the policy contract.

Funeral expense coverage (costs for funeral goods and services)
Burial plot / interment allowance
Cremation services and container allowance
Accidental death benefit
Repatriation and transportation of remains
Other (specify)

Exclusions and Limitations

This copy summarizes material exclusions and limitations. The policy does not cover loss, expense or liability arising from:

• Death by suicide within the contestability period as defined in the issued policy;
• Loss resulting directly or indirectly from war, declared or undeclared acts of war, or participation in a riot or insurrection;
• Death or injury sustained while committing or attempting to commit a felony or illegal act;
• Claims based upon material misrepresentation, omission or fraud in the application for coverage; and
• Services, goods, or fees that exceed the coverage limits or are otherwise excluded by endorsement.

The insurer's obligation to pay is subject to proof of loss, compliance with claims procedures, and the terms and conditions of the issued policy. Any amounts payable may be reduced by outstanding premiums or indebtedness owed under the policy.

Beneficiary Designation

Designate primary beneficiaries. Percentages must total 100% unless contingent beneficiaries are specified below.

Claims and At-Need Provisions

Claims must be filed with the insurer within the time specified in the policy. The insurer requires satisfactory proof of loss, including certified death certificate and such documentation as reasonably requested. When benefits are assigned to a funeral provider in writing, payments will be made in accordance with the assignment up to the covered limits.

Declaration and Authorization

I certify that the information provided on this At Need Copy is true and complete to the best of my knowledge. I acknowledge that this document is a copy of the policy summary issued at the time of need and does not supersede the full policy contract. I authorize the insurer to obtain and verify information necessary to underwrite and administer this policy, including medical, vocational and claims history. I understand that any material misstatement may render coverage voidable or result in denial of benefits in accordance with the policy provisions.

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