Out-of-Country Insurance Package
THE EMPLOYER PACKET
An insurance package for employers and volunteer-coordinating organizations that have
workers (employees or volunteers) serving out of country. The package is designed to
provide key coverages for these workers and their families while they serve.
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
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Overview
This package contains valuable information on the insurance policies
available to the approved worker.
Table of Contents
Out-of-Country Insurance Package Summary 3
Insurance Coverages 4
Checklist 4
How to File a Claim 5
Emergency Assistance Program 6
Accident & Sickness Insurance Plan Claim Application 7
Accident and Sickness Medical 9
• Accident and Sickness Medical 10
• How to File a Claim for Policy Number: GLM N01060995 12
• International SOS 13
Life Insurance 15
• Life Insurance Summary 16
Personal Eects Baggage (PEB) 17
• Personal Eects Baggage Summary 18
International Workers’ Comp 19
• International Workers’ Comp Summary 20
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 3 of 20
Out-of-Country_Insurance_Pkg_2019_NADENG
Out-of-Country Insurance Package
Summary
Policy Period: January 1 thru December 31
TYPE OF COVERAGE COMPANY/POLICY NO. BENEFITS & LIMITS
Accident and Sickness
Medical (ASM)
ACE American Insurance Co
Policy #: GLM N01060995
Medical Expense Benet up to $50,000
• $0 Deductible per policy term
• Your rst $3,500 of expenses will be reimbursed at
90%, thereafter at 100% per person
Accidental Death & Dismemberment up to $50,000
Emergency Evacuation and Repatriation: 100% of
covered expenses not to exceed the Usual and Customary
Charges for similar transportation, treatment, services or
supplies in the locality where the expense is incurred.
Pre-existing Condition: Exclusion applicable except as
provided by the policy.
Life Insurance Global Benets Group
Policy #: LIS-6497
Benets:
• Employee — $5,000 • Spouse — $2,500
Personal Eects & Baggage
(PEB)
GENCON
Policy #: PR102193-03
Benet:
Up to $3,000
International Workers
Comp (WC)
Chubb
Policy #: PHFD37987621002
Benets:
This insurance applies only in the event a covered individual
suers bodily injury by accident or disease, including
death resulting from or arising out of and in the course of
employment in the business operations of the world church.
For medical referrals, evacuation, repatriation or other services, please call
International SOS: +1 (215) 942-8226 (Outside the USA, Call Collect)
Member #: 11BCAM749125 (Reference Seventh-day Adventist Church)
Policy Number: GLM N01060995
Organization Name: General Conference Corp. of Seventh-day Adventists
This summary has been prepared for the convenience of the Insured and is not an exact and binding analysis of the coverages. Even though care has been taken in
preparing this summary, in the event there is a discrepancy, the original policies will prevail as the sole binding documents. This document is based upon general
limits, deductibles, terms and conditions shown on the policy, and may vary from the actual policy.
The Out-of-Country Insurance Package is comprised of several insurance policies
from various companies to meet the needs of workers around the world.
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 4 of 20
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◯ Submit a completed application before departure. Be sure to include date of birth and
beginning and ending dates of assignment (format: mm/dd/yyyy).
◯ Ensure you provide your worker with their Certificate and ID Card regarding emergency
evacuation procedures.
◯ Ensure you provide your worker with their insurance summary package.
◯ Notify ARM if there is a change in the itinerary: new start date or change in end date.
◯ Inform ARM of a childbirth or marriage.
Checklist
Accident and Sickness
Medical (ASM)
Workers’
Compensation (WC)
Personal Eects
Baggage (PEB)
Life Insurance
Medical Evacuation X X
Medical Repatriation X X
Medical Guarantee 10K X
AD&D X
Trip Cancellation/Interruption X
Political Risk X
Salary X
Healthcare
Dental and Vision
Personal Property X
Accident Medical X X
Sickness Medical X X
War Risk X
Death X
COVERAGES BY POLICY
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 5 of 20
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While each type of claim form may have dierent questions and require additional
documentation or information, the steps below provide simple guidance for the employee/
volunteer through the claim process:
1. Be sure to complete all sections of the claim form including accurate contact
information; typed or clearly written.
2. Most claims require additional documentation to be attached to the claim form. This
may include: medical bills and receipts, police report, death certicate, or medical
report stating the cause of death, depending on the type of claim. Each claim form will
provide guidance for what is needed.
3. Send the completed and signed claim form and attached documentation to the email
address (preferred), insurance address, or fax number listed on the claim form.
4. Retain a copy of the claim form and attached documentation for your records.
5. A claims examiner or claims assistant will contact you if additional information or
documentation is required.
Do not hesitate to reach out to Adventist Risk Management, Inc. with questions about which
claim form to use, or how to ll it out. We are available at:
How to File a Claim
Email: claims@adventistrisk.org
Phone: 1 (888) 951-4ARM (4276)
Fax: (301) 453-7060
Adventist Risk Management, Inc.
Claims and Legal Services
12501 Old Columbia Pike
Silver Spring, MD 20904 USA
In many cases the claim will be initially paid to the employer/volunteer coordinating
organization and passed to the employee/volunteer through internal channels.
Please encourage employees/volunteers to familiarize themselves with the summary of
benets. There are provisions, limitations, and exclusions in the policy. The insurance company
makes the nal determination on payment or denial of all claims.
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
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International SOS provides an emergency assistance program available for your employees
and volunteers while outside their home country. This service should be utilized when
emergency hospitalization, medical evacuation, political evacuation, repatriation is required, or
when you need to guarantee payment for emergency medical expenses. International SOS is
our emergency assistance provider.
If you need these services, please contact International SOS.
International SOS Phone:
+1 (215) 942-8226 (Outside the USA Call Collect)
Member #: 11BCAM749125 (Reference the Seventh-day Adventist Church)
ARM Contact: Joni Dreher-Smith, Senior Claims Examiner; jdreher@adventistrisk.org
(888) 951-4276, option #2 (Inside the USA); 1 (301) 453-7400 (Outside the USA Call Collect)
When you contact Adventist Risk Management, Inc. and International SOS for emergency
assistance, please provide:
• Name of caller, email address, phone number, and relationship to patient.
• Contact name, email address, and phone number of your employer/sponsoring
organization.
• Name of point of contact with the patient (if different from caller), email address,
phone number.
• Patient’s name, age, gender, and policy number.
• A description of the patient’s condition and, if it was an accident, how it occurred.
Emergency Assistance Program
Out-of-Country Insurance Package Application
Policyholder: General Conference of the Seventh-day Adventists
Underwritten by ACE American Insurance Company, a Chubb Company
Global Benets Group, and GENCON Insurance Company of Vermont
Adventist Risk Management, Inc.
119 St. Peters Street, St. Albans, Hertsfordshire AL1,
3EY, England
Email: [email protected]
Classication of Eligible Persons:
Class 1 Relief Doctors, Relief Workers, Pilots, Workers including Relief Missionaries, Student Missionaries and Adventist Volunteer Service Workers,
Sustentation Volunteer Workers who are serving outside the United States and who are approved by the Participating Organization.
Class 2 All regular missionaries of the Participating Organization (not Classes 1 or 3) who are serving outside of the United States.
Class 3 All participants (not Classes 1 or 2) authorized by the Participating Organization for special short term trips.
Dependents of Class 1 and Class 3 are eligible for Coverage under this Policy.
Adventist Risk Management, Inc.
12501 Old Columbia Pike, Silver Spring, MD 20904
Email: [email protected]
An application must be made and accepted by the insurance company prior to the eective date
If Yes, complete separate application
Optional Benet: Trip Cancellation Benet
Approved by:
Benet Amount per Policy Term
Title of Division, Union or Authorized Entity Representative Signature Date Signed
Cost of Trip Cancellation
& Trip Interruption Benet
If Yes, list specialty:
$500
$1,000
$1,500
COMPLETE THE FOLLOWING: SPONSORING ORGANIZATION RESPONSIBLE FOR PAYMENT:
DIVISION, UNION, CONFERENCE OR ENTITYNEW APPLICATION EARLY RETURN EXTENSION
CITY
PLACE OF SERVICE
INSURED’S LAST NAME
DEPENDENT’S LAST NAME
COUNTRY
STREET ADDRESS
INSURED’S FIRST NAME
DEPENDENT’S FIRST NAME
DIVISION UNION
DOB
DOB SPOUSE COVERAGE DEPENDENT CHILDREN COVERAGE
YOUR COUNTRY OF RESIDENCE
EFFECTIVE DATEPRIMARY OCCUPATION
YOUR COUNTRY OF CITIZENSHIP
EXPIRATION DATE
DO YOU EXPECT TO TRAVEL ON BUSINESS WHILE THE PROVIDED COVERAGE IS IN FORCE? IF YES, HOW MANY DAYS?
PILOT COVERAGE
IS SPOUSE A VOLUNTEER ALSO?
IS VOLUNTEER A MEDICAL PROFESSIONAL?
TYPE OF TRANSPORTATIONYES
YES
YES
YES
AUTONO
MM/DD/YY
MM/DD/YY
MM/DD/YY
MM/DD/YY
NO
NO
NO
$12.57 PER TRIP
$25.13 PER TRIP
$50.26 PER TRIP
DECLINE
SHIP PLANE TRAIN
Eective Date: 1/1/2019–12/31/2019
Covered Activities for Accident and Sickness Medical (A&S) - Underwritten by ACE American Insurance Company, a Chubb Company
Policy Number: GLM N01060995
Classes 1 and 2 and Dependents of Class 1: Travel Coverage, Exposure & Disappearance
Class 3 and Dependents of Class 3: Specied Trip Coverage, Exposure & Disappearance
Benets Class 1
Class 2
Dependent Spouse &
Child(ren)
Class 3
Dependent Spouse & Child(ren)
of Class 1 and 3
Medical Expense Benet Covered Covered Covered Covered
Emergency Reunion Benet Covered Covered Covered Covered
Repatriation of Remains Benet Covered Covered Covered Covered
Accidental Death & Dismemberment Benet Covered n/a Covered Covered
Disability Benet (Permanent Total Disability) Covered n/a Covered n/a
Owned, Leased, or Controlled Aircraft Benet Covered n/a Covered Covered
Home Country Extension Benet Covered Covered Covered Covered
War Risk Benet Covered Covered Covered Covered
Trip Cancellation Covered Covered Covered Covered
Trip Interruption Covered Covered Covered Covered
Monthly Rate/Age
<40 40–49 50–59 60–64 65–69 70–79 80–100
Medical Insured Only:*
$33.06 $52.08 $63.99 $73.40 $84.47 $107.07 $24.24
Medical Insured + One Dependent:*
$70.66 $89.00 $104.69 $131.14 $167.81 $191.70 $37.69
Medical Insured + Family:*
$76.93 $137.46 $140.89 $164.03 $200.68 $224.47 $70.51
Life Insured:**
$1.38 $1.38 $1.38 $1.38 NA NA NA
Life Spouse:**
$0.69 $0.69 $0.69 $0.69 NA NA NA
PEB Insured Only:
$4.02 $4.02 $4.02 $4.02 $4.02 $4.02 $4.02
Life Insurance
Policy Holder: General Conference of the Seventh-day Adventists
Policy Number: LIS-6497
Underwritten by Global Benets Group of GBG Insurance Limited
Class 1 Benet: $5,000 Insured $2,500 Spouse $0 Child
Annual Premium: $16.50 $8.25 n/a
Coverage: Accident and Sickness Medical*
*Medical Benets end at age 80
REFER TO THE SUMMARY OF BENEFITS FOR A DESCRIPTION OF THE IMPORTANT FEATURES OF THESE INSURANCE PLANS.
**Life Insurance ends at age 65
Class 1
See separate summary of coverage
Personal Eects & Baggage
Policy Holder: General Conference of the Seventh-day Adventists
Policy Number: PR102193-02
Underwritten by GICV
Benet Limit: $3,000
Annual Premium: $48.22
* Coverage not available in home country.
Eective Date: 1/1/2019–12/31/2019
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
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Accident and Sickness
Medical (ASM)
General Conference of Seventh-Day Adventists
Accident and Sickness Medical
General Conference of Seventh-Day Adventists is making a variety of travel benets available
for you while you are traveling on behalf of the General Conference of Seventh-Day Adventists
and its aliates. Below is a brief overview of the travel benets being oered and contact
information in the event of an emergency.
Who is eligible for coverage?
You are eligible for coverage if you are an approved relief doctor, relief worker, pilot, relief missionary, student
missionary, Adventist volunteer service worker, a sustentation volunteer worker or regular missionary serving
outside of the United States or an authorized participant on a specied short-term trip and eligible dependents.
When is coverage in eect?
Coverage will begin on the actual start of a covered trip. It will end when you return to your home, home country,
place of work or other place.
Accidental Death & Dismemberment Benets*:
If, within 365 days of a covered accident, injury
results in any one of the losses shown, the benet
amount shown opposite the loss will be paid. If
multiple losses occur, only one benet amount—
the largest—will be paid for all losses due to the
same accident.
Medical Expense Benets:
We will pay up to $50,000 for medically necessary expenses incurred for hospital and medical care, treatment or
services within 30 days of a covered accident or sickness. Coverage may vary for regular missionaries serving outside
the United States. Deducibles*: $0 per Policy Term. Co-insurance Rate: 90% of Usual & Customary Charges up to
$3,500; 100% thereafter. Maximum co-insurance out-of-pocket expense is $350 per Policy Term.
COVERED LOSS BENEFIT AMOUNT**
Life, Two or More Members, Quadriplegia $50,000
Hemiplegia, One Member, Paraplegia $25,000
Thumb & Index Finger of the Same Hand, Uniplegia $12,500
**Benet Amounts for eligible Spouses and Dependent Children vary.
Additional Benets: Benet Maximums:
Emergency Hotel Convalescence $200 per day, maximum of 5 days
Emergency Medical (Guarantee of Payment for Hospital Admission) $10,000
Emergency Medical Evacuation 100% of Covered Expenses
Emergency Reunion $5,000, subject to $300 per day for 10 days
Home Country Extension Up to $50,000
Permanent Total Disability* 1% of $50,000 per month, up to 365 days
Repatriation of Remains 100% of Covered Expenses
Trip Cancellation $750 with options to purchase additional amounts of $500, $1,000 or $1,500
Trip Interruption $750 with options to purchase additional amounts of $500, $1,000 or $1,500
War Risk Provides accident benets as the result of a war if you are traveling outside of the United
States or your Home Country
*Not applicable to regular missionaries serving outside the United States.
What’s Not Covered?
No accident benets are payable for any loss or Injury
that is caused by or results from:
♦ intentionally self-inicted injury; suicide or
attempted suicide; war or any act of war, whether
declared or not*
♦ a Covered Accident that occurs while on active duty
service in the military, naval or air force of any
country or international organization
♦ sickness, disease, bodily or mental inrmity,
bacterial or viral infection, or medical or surgical
treatment thereof, except forany bacterial infection
resulting from an accidental external cut or wound
oraccidental ingestion of contaminated food
♦ piloting or serving as a crewmember in any
aircraft*
♦ commission of or attempt to commit a felony
In addition, medical expense benets will not be paid
for any loss, treatment, orservices resulting from, or
contributed to by:
♦ routine physicals and care of any kind
♦ mental and nervous disorders*
♦ routine dental care and treatment, damage
to dentures and bridges*; treatment of
temporomandibular joint dysfunction and
associated myofascial pain
♦ cosmetic surgery or plastic surgery, including but
not limited to, breast implants and breast reduction
surgery, except as the result of an injury
♦ eye refractions or eye examinations for the purpose
of prescribing corrective lenses or for the tting
thereof; eyeglasses, contact lenses, and hearing aids
♦ services, supplies, or treatment including any period
of Hospital connement which is not recommended,
approved and certied as Medically Necessary and
reasonable by a Doctor, or expenses which are non-
medical in nature
♦ treatment or service provided by a private duty
nurse
♦ treatment by any Immediate Family Member or
member of your household
♦ any expense paid or payable by any other valid and
collectible group insurance plan
♦ expenses incurred as the result of Injury or Sickness
for which benets are paid or payable under any
Workers’ Compensation or Occupational Disease
Law or Act, or similar legislation, whether United
States federal or foreign law
♦ Injury or sickness where your trip to the host
country is undertaken for treatment or advice for
such injury or sickness
♦ medical expenses for which you would not be
responsible to pay for in the absence of the Policy
♦ injury or sickness that occurs while you are under
the inuence of any drug unless administered
under the advice and consent of a Doctor
♦ for expenses as a result of, or in connection with,
the commission or attempt to commit an assault or
felony
♦ injury resulting from mountain climbing (where
ropes or guides are used), amateur and professional
racing, racing or speed contests and bungee jumping
♦ custodial care
♦ services incurred in your Home Country*
♦ services provided by any government hospital or
agency; any expense covered by another employer
or government-sponsored plan for which, and to the
extent that you are eligible
♦ elective treatment, exam or surgery, including
those deemed to be experimental and which are not
recognized and generally accepted medical practices
in the United States
♦ expenses payable by any automobile insurance
policy without regard to fault
♦ organ or tissue transplants and related services
♦ injury sustained while participating in professional,
intercollegiate, or interscholastic sports
♦ expenses incurred for services related to the
diagnostic treatment of infertility or other problems
related to the inability to conceive a child, including
but not limited to, fertility testing and in-vitro
fertilization
♦ birth defects and congenital anomalies, or
complications which arise from such conditions
♦ pre-existing conditions (please contact claims@
adventistrisk.com for full details of this exclusion).
*Except as provided in the Policy.
This insurance does not apply to the extent that trade or economic
sanctions or other laws or regulations prohibit us from providing
insurance, including, but not limited to, the payment of claims.
General Conference of Seventh-Day Adventists
Accident and Sickness Medical
Chubb NA is the U.S.-based operating division of the Chubb Group of Companies, headed by Chubb Ltd.
(NYSE:CB) Insurance products and services are provided by Chubb Insurance underwriting
companies and not by the parent company itself. This information is a brief description of the
important features of this insurance plan. It is not an insurance contract. Insurance benets are
underwritten by ACE American Insurance Company. Coverage may not be available in all states
or certain terms may be dierent where required by state law.
Program sponsored by: Adventist Risk Management,
®
Inc.
How to File a Claim for Policy Number: GLM N01060995
You will need to submit a completed claim form for any covered accident or eligible
expense in order to receive reimbursement under the policy. If you have suered a
covered loss or incurred a covered expense, please contact claims@adventistrisk.org
for the appropriate claim form. The instructions for the claim form will detail any
supporting documentation you will need to submit with your claim.
How can I ensure the timely processing of my claim?
Be sure to provide the requested documentation when submitting a claim. Also, be
sure to provide a diagnosis or suitable explanation for the loss you are claiming.
When receiving care from doctors outside of the United States, an explanation of the
occurrence may help to clarify your claim and help to facilitate the claim process.
For access to your assistance services, please contact
International SOS at:
Philadelphia Assistance Center: +1-215-942-8226 | +1-800-523-6586
Philadelphia@internationalsos.com
Membership #: 11BCAM749125 (Reference Seventh-day Adventist Church)
www.internationalsos.com
Member Log-in: 11BCAM749125
Adventist Risk Management
& International SOS
A partnership that supports you
Adventist Risk Management has partnered with International SOS to oer our sta medical, safety and security advice, referrals
and routine & emergency assistance when travelling or living abroad. We strongly recommend that you follow the steps below to
familiarise yourself with this new partnership and the services available to you in preparation of your next trip and while overseas.
YOU
PRIOR TO DEPARTURE
International SOS will assist you no matter how big or small your request might be and we encourage you to call for help any time,
day or night. Whether you have lost your wallet, need medical advice or assistance, a referral to a doctor, or require a full scale
evacuation, International SOS can assist you.
1 2 3
Read your organization’s travel
guidelines and ensure you are
compliant.
READ YOUR
TRAVEL
GUIDELINES
DOWNLOAD THE
ASSISTANCE APP
CALL OR
GO ONLINE
The mobile app provides immediate
access to the assistance centre where
medical, security or logistical experts
are on hand to provide routine advice or
support in an emergency. You will nd
up-to-date advice and real-time alerts
for the locations you are travelling to.
1. Download the App on your mobile.
2. Select ’Yes’ when you run the app
to make it a trusted application.
3. Enter our membership number:
11BC AM749125
There are many questions you should
ask before you depart. International
SOS medical and security specialists
are on hand 24 hours a day to answer
your queries and concerns.
Save the assistance centre number to
your mobile now:
Philadelphia Assistance Center:
+1 215 942 8226
Before departing on your overseas
assignment, a great place to start you
pre-trip preparation is the online portal
(internationalsos.com). Using our
membership number (11BCAM749125)
you can log into the portal and view
up-to-date medical and security
information and receive alerts to your
email or smartphone.
Philadelphia Assistance Center: +1 215 942 8226 www.internationalsos.com
Adventist Risk Management
& International SOS
A partnership that supports you
Contact International SOS anytime, anywhere when you venture out of the country as your representative. Consider them your
reliable, virtual advisor for both critical and routine questions.
PRE-DEPARTURE
No matter how small your concern may feel, when in doubt, call International SOS for support.
With a global network of medical and security specialists, International SOS is well equipped to support you.
• As soon as you know you are
tra veling, sign yourself up for
email alerts for each of the
countries/cities you will travel to
or through
• Review the country guides
• Contact the assistance center
(available 24/7) to get a travel
brief ov er the phone
• Ensure your International SOS
App is active – allowing you
access to medical and security
alerts while you’re away
Call an assistance center 24/7 if you:
• Are not feeling well
• Need a referral for a doctor, dentist
or other care
• Need emotional support
• Hear of travel disruption aecting
your itinerary
• Hear of adverse weather or a
natural disaster that impacts your
itinerary
• Feel unsafe, hear of riots or protests
outside your hotel or place of
business
• Require a language translator, even
in a cab
• Need prescriptive medication
• Your wallet /passport/ identication
documents are lost or stolen
• Require a cash advance
• Are the victim of a theft or assault
Call an assistance center 24/7 in any
emergency situation. International SOS
will assist you and your managers with:
• Hospitalization and medical
monitoring (including upfront
payment to ensure emergency
admission)
• Step-by-step security instructions
and advice to ensure your safety
• Operational and logistical
management of your medical and/
or security evacuation
• Liaising with your family members
and ARM with updates on your
situation
• Post-incident follow-up and return
to work assistance
Philadelphia Assistance Center: +1 215 942 8226 www.internationalsos.com
DURING TRAVEL
OR EXCHANGE
IN AN
EMERGENCY
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
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Life
Insurance
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 16 of 20
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Life Insurance
Summary
Life Insurance provides financial assistance to the workers and
their families in the event of an untimely death.
This policy pays for death by any cause.
Normal Retirement Age: 65
th
birthday attained
EXCLUSIONS
Nuclear, Chemical and Biological (NCB) weapons, or warfare (applies to all benet amounts).
For Benet Amounts in excess of $100,000, the following exclusions will apply:
1. Suicide, attempted suicide or self‐inicted injury in the rst two years an insured is covered under
this program;
2. HIV/AIDS;
3. Misuse of drugs or alcohol;
4. Regularly and/or extensively practiced professional or hazardous sports or pursuits.
CLAIMS
To le a claim, ll out the claim form related to your type of loss and email it to claims@adventistrisk.org.
A nal death certicate is needed to accompany the signed claim form.
This is a brief overview of the policy and is not intended to replace policy terms and conditions.
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 17 of 20
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Personal Eects
& Baggage (PEB)
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 18 of 20
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Personal Eects Baggage
Summary
All Employees approved by the participating Seventh-day
Adventist organization are eligible for this coverage.
PROPERTY COVERED
Personal eects belonging to and usually carried or worn by the covered individual. Coverage is available only
for business travel or while engaged in business activities away from the place of permanent residence, and
subject to all the provisions of the policy.
LIMITS
US$1,000 | US$2,000 | US$3,000 | US$4,000 US$5,000
PROPERTY NOT COVERED
1. Bicycles or other conveyances or their equipment
2. Motor vehicle equipment including installed audio and/or
electronic equipment; CB radios, Radar Detectors & Car Phones.
3. Travelers checks, securities or documents (other than travel
tickets, birth certicates, Government-issued identication
cards, visas, passports, or drivers’ licenses.)
4. Animals, household furnishings, salesmen’s samples.
5. Medical instruments, medical devices or prescription items which
may be recoverable from a Medical Company.
6. Property for sale or exhibitions.
7. Contraband or illegal items.
8. Property specically or otherwise insured
9. Any loss or damage resulting from the activity of fungi, wet or dry
rot or bacteria.
GICV—Policy PR102193-03 | Policy Period: January 1 – December 31, 2019
LIMITATIONS
1. Loss or damage to any one item shall be limited to 35% of the limit.
2. Loss or damage caused by war or warlike action shall be limited to 25% of the limit.
3. The indemnity for loss or damage to property specially or otherwise insured shall be limited to the amount not covered by other insurance,
within the scheduled limit.
4. Loss of money or securities in any one occurrence shall be limited as follows:
• US $200 insured limit of $1,000 • US $400 insured limit of $3,000 • US $600 insured limit of $5,000
• US $300 insured limit of $2,000 • US $500 insured limit of $4,000
EXCLUSIONS
1. The residence or domicile of the covered individual.
2. While in storage or while in the custody of students.
3. Theft or pilferage due to negligence while left unattended in
or on any automobile unless the loss is a direct result of visible,
forcible entry into a securely locked automobile.
4. Wear and tear.
5. Breakage, marring or scratching of articles of brittle or fragile nature.
6. Radioactivity.
7. Due to conscation or destruction under quarantine or
government authority.
This is a brief overview of the policy and is not intended to replace policy terms and conditions.
CLAIMS
To le a claim, ll out the claim form related to your type of loss and email it to claims@adventistrisk.org.
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 19 of 20
Out-of-Country_Insurance_Pkg_2019_NADENG
International
Workers’ Comp
Providing Risk Management Solutions
for the Seventh-day Adventist® Church
12501 Old Columbia Pike | Silver Spring, MD 20904
Phone: (301) 453-7400 | Toll free: 1-888-951-4276
Page 20 of 20
Out-of-Country_Insurance_Pkg_2019_NADENG
International Workers’ Comp
Summary
International Workers’ Compensation is an insurance in place
for workers who travel outside of the United States. Workers’
Compensation insurance compensates workers for losses
suffered as a result of a work related injury or illness.
Compensation can include:
• Medical and hospital costs
• Rehabilitation
• Death benets
• Loss wages
• Lump sum or single payments for certain injuries
• Prosthetic devices
CLAIMS
Claim reporting should be sent via email directly to Chubb at:
This is a brief overview of the policy and is not intended to replace policy terms and conditions.
