Mutual of Omaha Insurance Company
Catastrophic Athletic Injury
Accident Insurance
for College Club and
Intramural Sports
MC26012_0406
NAIA Lifetime Catastrophic Athletic Injury Insurance
BENEFIT SUMMARY
THE NAIA COUNCIL OF PRESIDENTS is responsible for supervising the Association’s membership insurance programs. It is dedicated
to the development and continued availability of quality insurance coverages for member institutions and their student athletes.
In 1985 a unique insurance program approved by the NAIA became available for the first time to NAIA member institutions. It
offered significant and continuing benefits to student athletes who suffer catastrophic injuries while participating in intercollegiate
athletics. In 1995 the program was reevaluated by the NAIA, benefits were enhanced, and Mutual of Omaha Insurance Company
became the insurer of the program.
ELIGIBILITY
All Student Athletes participating in Club or Intramural sports.
COVERAGE
Coverage for Club sports is provided for participation in
scheduled games, supervised practice sessions and during
authorized group or team travel that is paid for or reimbursed
by the participating school in connection with such games or
practice sessions.
Coverage for Intramural sports is provided for participation in
scheduled intramural games only.
BENEFITS
Accidental Death, Dismemberment,
or Loss of Sight, Speech or Hearing
We will pay the benefit amounts shown below, based upon the
Principal Sum shown in the Plan of Insurance, for Accidental
Death, Dismemberment or Loss of Sight, Speech or Hearing
which results solely from an Injury to the Insured which occurs
during a covered event, and from no other contributory cause,
and is sustained within the Loss Establishment Period of 365
days after the date of the Injury.
If an Insured sustains more than one such loss as the result of
one Accident, we will pay only one amount, the largest to which
he or she is entitled. This amount will not exceed the Principal
Sum that applies for the Insured.
Loss
Loss of Life
Loss of Both Hands
Loss of Both Feet
Loss of Entire Sight of Both Eyes
Loss of One Hand and One Foot
Loss of One Hand and
Entire Sight of One Eye
Loss of Speech and Hearing (Both Ears)
Loss of Speech or Hearing (Both Ears)
Loss of One Hand
Loss of One Foot
Loss of Entire Sight of One Eye
Loss of Thumb and Index Finger
of the Same Hand
Benefit Amount
$10,000
$10,000
$10,000
$10,000
$10,000
$10,000
$10,000
$5,000
$5,000
$5,000
$5,000
$2,500
Loss of a hand or foot means complete severance through or
above the wrist or ankle joint. Loss of sight means the total,
permanent loss of sight of the eye. The loss of sight must be
irrecoverable by natural, surgical or artificial means. Loss of a
thumb and index finger means complete severance through
or above the metacarpophalangeal joints (the joints between
the fingers and the hand). Loss of speech or hearing means
their total and irrecoverable loss. Loss of hearing that can be
corrected by the use of any hearing aid or device shall not be
considered an irrecoverable loss.
ACCIDENT MEDICAL EXPENSE
We will pay benefits for Medical Expenses incurred by an
Insured within 24 months following a Covered Accident that
are in excess of the Covered Accident Deductible. Benefits will
not exceed the Maximum Benefit Limit shown in the Schedule
of Benefits. Medical Expense means the Reasonable and
Customary charges: (a) of a professional ambulance service
for Medically Necessary transportation to and from a Hospital;
(b) of a Doctor for Medically Necessary care and treatment; (c) of
a Hospital for Medically Necessary inpatient services, including
room and board (not exceeding the semi-private room rate for
each day of confinement unless a private room is Medically
Necessary); (d) for Medically Necessary inpatient services and
supplies, including intensive care services, and daily Hospital
charges for personal Hospital services (including television,
radio, telephone, barber, and beauty services); (e) for Medically
Necessary outpatient and emergency room care and treatment;
(f) for confinement in an Extended Care Facility; (g) for Home
Health Care; (h) for medical or surgical services, prescription
drugs, and other medical supplies commonly used for
therapeutic or diagnostic services, which are Medically
Necessary and prescribed by a Doctor operating within the
scope of his or her license; (i) for care and treatment of mental
and nervous disorders by a Doctor; (j) for treatment of
subluxation or dislocation of the spine or treatment for the
general purpose of correction of nerve interference and its
effects, by manual or mechanical means when interference
results from or is related to distortion or misalignment of
or in the vertebral column; (k) physical therapy; and
(l) prosthetic devices.
Questions should be directed to the Administrator,
Summit America Insurance Services, LC
1-800-955-1991
DISABILITY BENEFITS
Total Disability Benefit: If an Insured Person becomes Totally
Disabled and has satisfied the Covered Accident Deductible,
We will pay Total Disability Benefits as shown in the Schedule of
Benefits. Thereafter, as shown in the Schedule of Benefits,
we will pay a Total Disability Benefit for each subsequent
month which will be increased by a percentage, as shown in
the Schedule of Benefits, after the benefit has been paid for
12 months and after each subsequent 12-month period while
the Insured Person remains Totally Disabled. Benefits will begin
on the later of: (a) the date the Insured Person’s Academic
Class graduates; or (b) the end of the Academic Year in which
the Insured Person became Totally Disabled; or (c) the date the
Covered Accident Deductible is satisfied. Payment of the Total
Disability Benefit will continue for so long as the Insured Person
remains so disabled or the end of the Maximum Period Payable
shown in the Schedule of Benefits; whichever is later.
Partial Disability Benefit: If an Insured Person becomes
Partially Disabled immediately following a period of Total
Disability for which Total Disability Benefits were paid, We will
pay the Partial Disability Benefit shown in the Schedule of
Benefits. The monthly Partial Disability Benefit amount will be
increased by a percentage shown in the Schedule of Benefits
after that benefit has been paid for 12 months and after
each subsequent 12-month period while the Insured Person
remains Partially Disabled. Partial Disability will end when the
Insured Person is no longer Partially Disabled; or the Insured
Person’s average gross monthly earnings exceed $2,500 for six
consecutive months.
Resumption of Disability: If Total Disability or Partial Disability
Benefits as provided herein cease and the Insured Person again
becomes Totally Disabled or Partially Disabled as a result of the
same Covered Accident which caused the earlier period of
disability, benefits will resume after the new period of disability
has persisted three consecutive months.
ADJUSTMENT EXPENSE BENEFITS
We will pay the Adjustment Expense Incurred on behalf of the
Totally Disabled Insured Person after the Covered Accident
Deductible is satisfied, subject to the maximum benefit shown
in the Schedule of Benefits. Adjustment Expenses are the
Reasonable and Customary Expenses Incurred for (benefit
amounts are shown in the Schedule of Benefits): (a) Medically
Necessary Family Counseling for the Immediate Family of the
Insured Person. (b) The training of a member of the Immediate
Family of the Insured Person to perform rehabilitative or
custodial functions necessary to the care of the Insured Person.
(c) Travel by the Insured Person’s Immediate Family members
between their home and the Insured Person’s place of
treatment. Travel is limited to not more than two members of
the Insured Person’s Immediate Family at one time. (d) Lost
earnings by the Insured Person’s parents, guardians or spouse,
due to, and in connection with, a Covered Accident. Lost
earnings will be reimbursed for one parent/guardian or the
spouse of the Insured Person.
SPECIAL EXPENSE BENEFIT
We will pay for those Reasonable and Customary Expenses
Incurred, after the Covered Accident Deductible has been
satisfied, by an Insured Person who is Totally Disabled as a
result of a Covered Accident for special items approved by the
Insured Person’s Doctor to accommodate his or her physical
disability. Benefits will not exceed the Maximum Benefit Amount
shown in the Schedule of Benefits. Special Expense items or
modifications must be approved by the Doctor as being
appropriate and as being Medically Necessary to accommodate
the physical disability of the Insured Person.
ANCILLARY ILLNESS OR INJURY EXPENSE BENEFIT
We will pay benefits for the Medically Necessary Medical
Expenses and Dental Expenses Incurred, after the Covered
Accident Deductible has been satisfied, as a result of an
accidental bodily Injury or Illness to a Totally Disabled Person
which occurs during the period he or she is receiving benefits
in connection with a Covered Accident. Benefits will not
exceed the Maximum Benefit Amount shown in the Schedule
of Benefits.
COLLEGE EDUCATION BENEFIT
The College Education Benefit provides payment for the full
cost of attendance for a Totally Disabled Insured Person to
complete his or her undergraduate degree: (a) at the school or
alternate institution such person was attending at the time of
the Covered Accident; or (b) for other covered persons, at the
school or alternate institution such person will be attending;
however, the amount of the College Education Benefit payable
shall not exceed the lesser of the comparable full cost of
attendance or the Maximum Aggregate Lifetime Benefit Amount
as shown in the Schedule of Benefits. The full standard cost of
attendance shall be as determined by the financial aid office at
the particular school net of any other financial aid received by
the Insured Person.
To qualify for the College Education Benefit, the Totally Disabled
Insured Person must commence or recommence undergraduate
study within the Loss Establishment Period, after the Covered
Accident occurred, as shown in the Schedule of Benefits.
The College Education Benefit will terminate
at the earlier of: (a) the date the Insured
Person completes the requirements for any
undergraduate degree; (b) the twentieth (20th)
anniversary of the date of the commencement or
recommencement of undergraduate study; and
(c) the date the Maximum Aggregate Lifetime
Benefit has been met.
OTHER INSURANCE/EXCESS
NATURE OF POLICY
This insurance is excess over any other valid and
collectible insurance or similar benefit program
available to the Insured Person for a Covered
Loss. If an Insured Person receives or is entitled
to receive benefits or services from any source
described in the policy for any benefit category
of a Covered Loss for which he or she is entitled,
such benefit will be in excess of the amount of
such Other Insurance.
EXCLUSIONS
In all states the following general exclusions
will apply: (a) Illness or disease or medical or
surgical treatment thereof, including diagnosis,
except as may be specifically provided for in the
policy; as may result from an Injury sustained
in a Covered Accident; the aggravation of a
condition such as tendonitis, strains, sprains and other similar
conditions caused by exertion while participating in a Covered
Event; (b) bacterial infection, except infection of and through
a wound accidentally sustained infection, except bacterial
infection which results from the accidental ingestion of a
contaminated substance or pyogenic infection which results
from an accidental bodily Injury; (c) suicide or intentionally
self-inflicted Injury while sane; (d) an act of declared or
undeclared war; (e) participation in a riot or engagement in
or attempt to commit a felony or being engaged in an illegal
activity; (f) travel or flight in or descent from any aircraft, unless
the Insured Person is a passenger for authorized group or
team travel on a regularly scheduled flight on a commercial
airline; or is a passenger on an aircraft chartered solely for the
purpose of travel which has a valid airworthiness certificate
from the jurisdiction in which operated and which is being
operated by a duly licensed pilot; (g) charges which exceed the
Reasonable and Customary charges; (h) charges Incurred for
dental work unless the Insured Person sustains a Disablement
which results in damage to his or her teeth; (i) charges Incurred
for television, telephone, water pitcher, and other personal
convenience items, or expenses for other persons, except as
may be specifically provided for elsewhere; (j) charges Incurred
for services or supplies not specifically provided for in the
policy; (k) charges which would not have been made in the
absence of insurance or which the Insured Person is not legally
obligated to pay; (l) charges Incurred for cosmetic procedures,
unless made necessary by a Disablement; (m) charges Incurred
for eyeglasses, contact lenses or hearing aids or for any
examination or fitting related to these devices unless made
necessary by a Disablement; (n) charges
Incurred for care, treatment or service,
which is not Medically Necessary to the
diagnosis or treatment of a Disablement;
(o) charges Incurred for the professional
services of a person who either resides
with or is an Immediate Family member;
(p) charges Incurred for experimental or
investigational treatment or procedures;
(q) charges Incurred for articles of clothing
which are intended for use more than once;
(r) treatment of a Disablement sustained
during the commission of a felony as a
result or consequence of being Intoxicated,
as specifically defined in the policy, or under
the influence of any controlled substance
unless administered on the advice of a
Doctor; (s) the use by the Insured of drugs
or narcotics during the commission of
a felony unless used as prescribed by a
Doctor for a condition other than drug
addiction; (t) routine medical examination
and related medical services.
In NC, in addition to the general exclusions
shown above, the following will apply:
(u) charges Incurred which have been paid
under any other insurance policy, service
contract, or other arrangements of insured
or self-insured group coverage; (v) charges
Incurred which have been paid under any
other insurance policy, service contract, or other arrangements
of insured or self-insured group coverage; charges Incurred for
claims that are subject to the Workmen’s Compensation Act,
Article 1 of Chapter 97 of the General Statutes, but only to
the extent of any specific medical charges for which the
employee, employer, or carrier is liable or responsible and
which were paid according to a final adjudication of the claim
under that Article, or an order of the North Carolina Industrial
Commission approving a settlement agreement entered into
under that Article.
In CA, ID, OR, SC, SD, TX and VT, in addition to the general
exclusions shown above, the following will apply: (u) charges
which are paid from any other insurance policy, service contract,
workers’ compensation or other arrangements of insured or
self-insured group coverage.
NONDUPLICATION OF BENEFITS
If any item of expense is payable under more than one provision
of this policy, payment will be made only under the provision
providing the greater benefit.
DEFINITIONS
Covered Accident, with respect to all benefits under this policy,
except death benefits, means an accident which directly results
in bodily Injury (not excluded from coverage by the policy
Exclusions and Limitations) to the Insured Person as a result of
which the Insured Person incurs a Covered Loss in excess of the
Covered Accident Deductible, and which occurs to an Insured
Person while this policy is in effect and between the Policy
Dates and while he or she is participating in a Covered Event
or performing directly assigned duties in connection with the
Covered Event; and (a) which occurs during Covered Travel to
and from the location of a Covered Event; (b) which occurs
during a temporary stay at the location of a Covered Event held
away from the location of the Insured Person’s Participating
School while the Insured Person is engaged in an activity or
travel authorized by the Insured Person’s Participating School.
With respect only to death benefits (not excluded from coverage
by the policy Exclusions and Limitations), Covered Accident
means an accident which occurs to an Insured Person while this
policy is in effect and between the Policy Dates and while he or
she is participating in a Covered Event or during Covered Travel.
Covered Event means those activities and events specified in
the Schedule of Benefits.
Covered Loss means Reasonable and Customary: (a) Medical
Expense; (b) Dental Expense; (c) Rehabilitation Expense;
(d) Custodial Care Expense; (e) Adjustment Expense; (f) Special
Expense; (g) Ancillary Illness or Injury Benefit.
An expense will be a Covered Loss under this policy only to
the extent that it is for Medically Necessary services, and not
excluded under Exclusions and Limitations. Further, for those
Insured Persons who have satisfied the Covered Accident
Deductible, Covered Loss shall not include any expenses
Incurred after the respective Date of Recovery. Covered Loss
also means Disability Benefits as described herein payable as a
result of a Covered Accident.
Hospital means an institution which meets all of the following
requirements: (a) It is licensed (if required) as a Hospital by
applicable licensing authorities; (b) It is open at all times;
(c) It is operated mainly to diagnose and treat Illnesses and
Injuries on an inpatient basis; (d) It has a staff of one (1) or
more Doctors on call at all times; (e) It has twenty-four (24) hour
nursing services by registered nurses on duty or call; (f) It is not
mainly a skilled nursing facility, clinic, nursing home, rest home,
convalescent home, or like place; and (g) It has organized
facilities for surgery or provides for such facilities for its patients
through formal written agreement with other Hospitals.
Injury or Injuries means bodily Injury which results directly from
an accident and which is independent from disease, sickness or
other bodily functions.
Partial Disability or Partially Disabled means the inability as
the direct result of Total/Catastrophic Disability of an Insured
Person who, following a period of Total/Catastrophic Disability
for which Total/Catastrophic Disability Benefits were paid under
this policy, is engaged in an occupation, to perform all of the
important duties of such occupation, and to earn a Partial
Disability Gross Earnings Amount per month, or more, as shown
in the Plan of Insurance.
Total/Catastrophic Disability or Totally/Catastrophically
Disabled means for the first 12 months: (a) the inability of
the Insured Person, due to a Covered Accident, to engage in
substantially the same activities as the Insured Person had
engaged in immediately prior to the Covered Accident; and
(b) the irrecoverable loss suffered by the Insured Person, due
to a Covered Accident, of: (1) speech; (2) hearing of both
ears; (3) sight in both eyes; (4) use of both arms; (5) use of
both legs; (6) use of one arm and one leg; or (7) severely
diminished mental capacity due to brain stem or other
neurological Injury such that the Insured Person is unable to
perform normal daily functions.
For any period thereafter, Total/Catastrophic Disability or
Totally/Catastrophically Disabled means: (a) the inability of
the Insured Person, due to a Covered Accident, to engage in
any gainful occupation or employment for compensation or
profit for which he or she is or may become reasonably fitted by
education, training, or experience; and (b) the irrecoverable loss
suffered by the Insured Person, due to a Covered Accident, of:
(1) speech; (2) hearing of both ears; (3) sight in both eyes;
(4) use of both arms; (5) use of both legs; (6) use of one arm
and one leg; or (7) severely diminished mental capacity due to
brain stem or other neurological Injury such that the Insured
Person is unable to perform normal daily functions.
This brochure illustrates the highlights of this insurance.
All information herein is subject to the provisions of Policy Form
SB20CC, underwritten by Mutual of Omaha Insurance Company.
If there is any conflict between the brochure and the policy,
policy provisions will prevail.
This coverage is not available in Connecticut, Maryland or
New York.
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Aggregate Limit of Indemnity:
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$5,000,000
This is the maximum amount for which We are liable for an
Insured Person for all benefits under this plan due to any one Accident.
Covered Accident Deductible:
$25,000*
*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
Deductible Establishment Period
Maximum Benefit Period
Maximum Benefit Amount
Maximum for Medically Necessary Hospital Inpatient Services and Supplies
Maximum for Confinement in an Extended Care Facility per Calendar Year
Daily Room and Board Limit for:
Private or Semi-Private Room
Intensive Care
Combined Home Health Care and Custodial Care Maximum Benefit per Calendar Year
Custodial Care Maximum Benefit per Calendar Year Subject to the Combined
Home Health Care and Custodial Care Maximum Benefit per Calendar Year
Home Health Care Maximum Benefit per Calendar Year Subject to the Combined
Home Health Care and Custodial Care Maximum Benefit per Calendar Year
Treatment of Mental or Nervous Disorders
Doctor Fees –
Amount per Visit/Visits per Day/Visits per Calendar Year
Inpatient Hospital
Maximum Spinal Manipulative Services Benefit
Maximum Amount per Calendar Year
Maximum Visits per Calendar Year
Maximum Physical Therapy Benefit Amount per Calendar Year
Physical Therapy includes, but is not limited to, heat treatment,
diathermy, microtherm, ultrasonic, adjustment, manipulation,
massage therapy and acupuncture.
**Payment for all prosthetic devices/limbs, including adjustments, replacements, refittings and
supplies, in combination, shall not exceed $100,000 during the first two (2) years after the
Covered Accident. Payment shall not exceed $100,000 ($200,000, if the Covered Accident
results in an amputation of the leg above the knee) during each consecutive ten- (10) year
period immediately thereafter, not to exceed a $500,000 maximum ($750,000 maximum, if
the Covered Accident results in an amputation of the leg above the knee) for the duration of the
Insured’s life, subject to all terms and conditions of the Policy including, without limitation, the
Date of Recovery definition.
100%
24 Months
Lifetime
$5,000,000**
Included in Medical Maximum
$365,000
Average Semi-Private Rate of Hospital in
Which Confined
Usual and Customary Charges
$250,000
$100,000
$250,000
$50/1/50
Up to 45 Days
$1,000
N/A
$25,000
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Total Disability Benefit:
Total Disability Benefit for the First 12 Months
Total Disability Benefit After First 12 Months
Percentage Increase After First 12 Months
Maximum Period Payable
$1,500 per Month
$1,500 per Month
4%
Lifetime
Partial Disability Benefit:
Percentage Increase After First 12 Months
Average Gross Monthly Earnings Limit for Partial Disability
After-Tax Monthly Compensation
Partial Disability Maximum Period Payable
$1,000 per Month
4%
$2,500 for 6 Months
$500
Lifetime
Adjustment Expense Benefit:
Family Counseling
Maximum Number of Visits
Maximum Amount per Visit
Training of Family Member
Maximum Expense for Training
Travel for Immediate Family Members
Maximum Expense for Travel per Family Member
Lost Earnings
% of Gross Lost Earnings
Maximum Lost Earnings per Week
Maximum Number of Weeks
Maximum Lifetime Benefit
Special Expense Benefit:
Limit During First 10 Years Following the Date of the Covered Accident
Limit for Each 10-Year Period Thereafter
Ancillary Illness or Injury Benefit:
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Must be rendered within 24 months after
the Covered Accident
20
$70
Must be rendered within 24 months after
the Covered Accident
$2,500
Must occur within 24 months after the
Covered Accident
$2,000
75%
$500
13 within a 24-month period after the
Covered Accident
$40,000
$125,000
$50,000
$2,000 per Calendar Year Deductible;
not to Exceed a Combined Maximum
Lifetime Benefit for all Injuries and
Illnesses of $100,000
College Education Benefit:
Loss Establishment Period
Maximum Aggregate Lifetime Benefit
20 Years
$60,000
Accidental Death, Dismemberment, Loss of Sight/Speech or Hearing Benefit:
Principal Sum
Loss Establishment Period
$10,000
365 Days
Questions should be directed to the Administrator,
Summit America Insurance Services, LC
(800) 955-1991
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Underwritten by:
Mutual of Omaha Insurance Company
Home Office: Mutual of Omaha Plaza
Omaha, NE 68175
mutualofomaha.com
Policy Form SB20CC Series 8342S
ID Policy Form SB20CC Series 8365S
OK Policy Form SB20CC Series 8342S
TX Policy Form SB20CC Series 8352S
Questions should be directed to the Administrator,
Summit America Insurance Services, LC
7400 College Blvd., Suite 100
Overland Park, KS 66210
1-800-955-1991
Summit America Insurance Services, LC
2180 South, 1300 East, Suite 520
Salt Lake City, UT 84106
1-800-955-1991, ext. 198
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