WHAT ARE THE POLICY EXCLUSIONS? - AAA

1 what ARE THE POLICY EXCLUSIONS? This insurance does not apply to any accident resulting from: 1). an Insured Person riding as a passenger in, entering, or exiting any aircraft while acting or training as a pilot or crew member. (This exclusion does not apply to passengers who temporarily perform pilot or crew functions in a life threatening emergency); 2). an Insured Person's emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions or medical or surgical treatment ACCIDENT MEDICAL PLAN. thereof. (This exclusion doesn't apply to bacterial infection caused THREE EASY WAYS TO ENROLL by an Accident or by accidental consumption of a substance contaminated by bacteria); 3) an Insured Person's commission 1.

2 Call 1-800-352-5382 or attempted commission of a felony or being engaged in an (Select option 3, then 5.) illegal occupation; 4) an Insured Person being incarcerated after conviction; 5) an Insured Person being intoxicated while driving a vehicle at the time of an Accident. Intoxication is defined by 2. Stop by your local AAA office the laws of the jurisdiction where such Accident occurs; 6) an Insured Person being under the influence of any narcotic unless 3. Mail completed Coverage Activation Form administered on the advice of a Physician; 7) an Insured Person participating in military action while in active military service and premium to: with the armed forces of any country or established international AAA. Arizona authority. (This exclusion does not apply to the first sixty (60).

3 Dept. 510 consecutive days of active military service with the armed forces of Box 10370 any country or established international authority); 8) an Insured Phoenix, AZ 85064-0370 Person's suicide, attempted suicide or intentionally self-inflicted injury; 9) a declared or undeclared War. Insurance is Underwritten by FEDERAL INSURANCE COMPANY, a member insurer of the Chubb Group of Insurance Companies PLAN ADMINISTRATOR & SPONSOR. The POLICY provides limited accident insurance only. The POLICY does not provide coverage for legal liability. It does not provide basic hospital, basic medical or major medical insurance. HELPING YOU PREPARE FOR THE UNEXPECTED. The coverage described in this literature may not be available in all Guaranteed Acceptance jurisdictions. This literature is descriptive only.

4 Actual coverage is subject to the language of the POLICY as written, POLICY #9907-17- No Medical Exam 58. Exclusions and limitations apply. Chubb, Box 1615, Warren, AAA. No Health Questions Special $7. NJ 07061-1615. Rate Any person knowingly and with intent to defraud any insurance per company or other person, files an application for insurance or year statement of claim containing any materially false information or conceals for the purpose of misleading information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and/or civil penalties.. 51-0000-036. 1 5/6/14 9:09 AM. what IS THE ACCIDENT MEDICAL PLAN? what ARE THE COVERED ACTIVITIES? COVERAGE ACTIVATION FORM. Th The Accident Medical Plan reimburses medical expenses for Accident Medical Expense and accidental Death &.

5 Care and treatment of an accidental bodily injury for members Dismemberment benefit amounts are only payable if the Please complete for AAA members to be covered in the Accident Medical Plan. engaged in a wide variety of travel and sporting activities. accident occurs while you are: Entering, exiting, driving or riding in a Private Passenger _____. Primary Membership Number Automobile; or _____. In, entering or exiting a common carrier; or what ARE THE TYPES OF Primary Member Name MEDICAL EXPENSES COVERED? Involved in a Private Passenger Automobile accident as a _____. pedestrian or bicyclist; or Associate Member Name They include, but are not limited to: Involved in the wrecking of a motor-driven farm machine Emergency Room _____. or implement which the member is operating while engaged in Associate Member Name Hospital Room the performance of farm duties; or Prescription Drugs Being accidentally shot while hunting in a field; or Please add _____ members at $ to my X-rays and Diagnostics Being struck by a golf ball or golf club while playing golf or as membership for a total of $_____.

6 Ambulance a spectator on a golf course; or Physical Therapy While ice skating, snow-skiing, snowboarding, or water-skiing;. Medical Equipment Rental or METHOD OF PAYMENT. Swimming at a public beach or pool during the time the lifeguard ___ Check enclosed payable to AAA Arizona. Casts and Splints is on duty; or Dental Work Due to Bodily Injury (Sorry, no cash, partial payment or post-dated checks.). Engaged in non-commercial fishing or boating; or ___ Visa ___ MasterCard ___ Amex ___ Discover Being struck by a baseball while a spectator at an organized professional baseball game; or By checking a card type and providing the card number you authorize AAA to charge the insurance premium to your credit card. what ARE THE BENEFITS FOR Operating a motorcycle that complies with safety standards, is COVERED ACTIVITIES?

7 Street legal and operated by a properly licensed insured. _____. Coverage also includes while getting on or off of a motorcycle. Credit Card Number Pays $5,000 accidental Death and up to $5,000. While in, entering or exiting a golf cart as a driver or passenger _____. Dismemberment. The amount payable for dismemberment varies Name on Credit Card based on the injury suffered. when on a public or private golf course Expiration Date: _____/_____/_____. Pays an additional $2,500 accidental Death when wearing a For full coverage details, and to obtain a copy of the insurance seat belt in a private passenger automobile accident certificate with claims information: _____. Pays an additional $2,500 accidental Death when protected by Visit Signature an air bag in a private passenger automobile accident Stop by your local AAA office.

8 To find a AAA office near you, Date: _____. Pays up to $2,500 to reimburse necessary home and vehicle visit Once you enroll and pay the initial premium, the annual $ per person modifications All claims must be reported to the Plan Administrator within 90 days of the renewal premium will automatically be included on your AAA membership Pays up to $1,200 to reimburse covered medical expenses accident. The benefit amount is payable only if treatment is first incurred dues statement each year. When you provide a check as payment, you within 90 days after the accident. Accident Medical Expense is payable authorize us to either use information from your check to make a one-time only for medical expenses incurred within 52 weeks after the date of the electronic fund transfer from your account or to process the payment as a accident causing the accidental bodily injury.

9 Check transaction. 2 5/6/14 9:09 AM.