ANDRA Fastlane ANDRA_FASTLANEED26 - Page 43

43 fastlane • Option available for upgrade to Personal Accident cover at the Category Two level for the period of the event, on payment of the $5.00 fee (inc GST) to venue prior the commencement of the event. • Upgrades to Category One or Category Two insurance to be discussed with Venue prior to commencement of event. BENEFITS Non-Medicare Medical Expenses (including Out of Pocket and emergency transport) • 100% of eligible expenses, as defined, after reimbursement from a recognised private health fund to a maximum of $10,000 any one period of insurance. An excess of $50 applies per claim. OUT OF POCKET EXPENSES • Up to $250 for any one insured person • Please note, all invoices for Out of Pocket expenses and Emergency Transport costs must be paid in full by the claimant. A copy of the invoice and receipt are to be submitted with the Claim Form to ANDRA. ACCIDENTAL DEATH • $75,000 (Category One) • $30,000 (Category Two - Driver/Rider Only) • $20,000 Persons under 18 years and over 75 years FUNERAL BENEFIT • Up to $10,000 for any one person. STUDENT TUTORIAL • Maximum weekly benefit of $500 per week; limited to 52 weeks. • Excess period of seven days applies • (Not payable if claiming under Temporary Total Disablement) DOMESTIC HELP • Reimburse the cost of hiring domestic help from a recognised and licensed domestic help agency provided that: - - TEMPORARY TOTAL DISABLEMENT • 100% of weekly earnings or $1,000 per week whichever is the lesser; limited to 104 weeks (Category One) • 100% of weekly earnings or $250 per week whichever lesser; limited to 52 weeks (Category Two -Drivers/Riders Only) • Excess period of seven days applies to both categories. • $250 per week (Non-Earning); limited to 52 weeks (Category Two - Drivers/riders only) • Excess period of seven days applies to both categories. PERMANENT TOTAL DISABLEMENT • $75,000 (Category One) • $30,000 (Category Two - Driver/Rider Only) LOSS OF LIMB/S, EYE/S • Up to $75,000 (Category One) • Up to $30,000 (Category Two -Driver/Rider Only) Up to 80 percent of actual and reasonable expenses up to a maximum benefit of $1,000 per week. Benefit Period limited to 26 weeks and a 7 Day Deferral period HOME AND OR MOTOR VEHICLE MODIFICATION BENEFIT • Up to $20,000 for any one insured person (Payable for home and vehicle modification expenses). Provided that: - - DISABLEMENT – NON-INCOME EARNERS • $250 per week (Non-Earning); limited to 52 weeks (Category One) The domestic help is certified by a Medical Practitioner as being necessary and hiring of family members of the insured persons family or other relatives are not included; All modifications are certified necessary by the INSURED PERSON’S treating doctor or rehabilitation provider. NOTE: Death and Capital Benefits listed may be increased through extra cost options available through ANDRA. Professional Players/Competitors: It is hereby noted and agreed that the excess period under the Weekly BENEFITS - INJURY Section will be increased to 28 says for any claims received under this BENEFIT. Except as otherwise provided in this endorsement, the Insuring Clause and all other POLICY terms and conditions shall have full force and effect. CONDITIONS • No person other than registered Officials/ Competitors/Crew shall be eligible to make application. • Only accidents occurring during official ANDRA Drag Racing events, or related activities in the case of Officials, can be considered. • Payments shall be made at the discretion of the Insurer, and all paperwork must be in order, as with any compensation claim. • Applications for compensation shall be on the official form provided by ANDRA, accompanied by a copy of the relevant ANDRA Incident Report. • The Insurer will not pay accounts but will reimburse genuine out of pocket expenses to the level stated under Benefits. Attach all accounts when paid, with a summary sheet clearly showing details. • Completed forms must reach ANDRA within twenty-one (21) days of the incident. • First Certificate must show anticipated period of Temporary Disablement, if any. • Written confirmation must be provided to show the Claimant is employed. • If self-employed, a Statutory Declaration, duly signed, must be provided with the claim. This is a summary of the insurance only and is not the policy document. Please contact ANDRA for further information. PLEASE NOTE: In the Event of an Accident or Injury If an ANDRA Steward is not present at the scene of your accident or injury, the incident should be reported to the Meeting Director before leaving the track. A claim Form should be requested from ANDRA on (08) 82715355 or info@andra.com.au immediately after the event