Definitions
“ADMINISTRATOR” - means LegalEASE; or its subsidiary.
“COMPLEX WILL” - means the Member has a significant net worth and will benefit from tax planning, or the estate is subject to current state or federal estate taxation; the Member owns a business that will continue in operation after death; the Member wants to put restrictions on what heirs may do with the property; the Member wants to leave money to someone in a trust because the person cannot manage his or her own affairs (such as a mentally handicapped child), or wants the property to be managed by a trustee for a period of time past the child’s age of majority, to age 25 or 30, for example; the Member thinks that someone will challenge the will; and/or the Member wants to exclude any lawful dependents.
“EFFECTIVE DATE” - means the date coverage hereunder begins.
“FAMILY MEMBER” - means the Member’s lawful spouse and children. Eligible Family Members are the Member’s spouse and Member’s unmarried dependent children, including stepchild, legally adopted child, child placed in the home for adoption and foster child, up to age 19, and from age 19 up to 26 years if they are enrolled in an accredited school or college as full-time student(s) and are primarily dependent upon the Member for support.
“MEMBER” - refers to the individual who is associated with the Policyholder and who has paid or a premium has been paid on their behalf and who meets the eligibility requirements for Covered Services in the Policy.
“MEMBER SERVICE CENTER” - means the service location established to help make full use of the Policy.
“NON-PARTICIPATING ATTORNEY” - means an attorney not retained by Administrator who is selected and paid by the Member to provide services covered under the Policy up to the maximum amount as shown in the Schedule of Benefits.
“PAID IN FULL” - means complete payment to a Participating Attorney for covered legal services.
“PARTICIPATING ATTORNEY” - means an attorney retained by the Administrator to provide covered legal services at the amount shown in the Schedule of Benefits.
“PLAN” ATTORNEY” - means an attorney associated with a private law firm, who is licensed to practice law in the Member’s state. These attorneys have been contracted to provide legal advice and simple service by telephone to Members.
“PLAN SPONSOR” - means an organization other than the Policyholder or the Member’s employer which makes coverage hereunder available.
“POLICYHOLDER” - means the organization named in the declarations page.
“WE”, “US”, “OUR” AND “COMPANY” - means the name of the underwriter indicated on the declarations page of this Policy.
Covered Services
In consideration of payment and receipt by Us of the applicable premium, all Covered Services are available to a Member and the Member’s spouse and eligible dependents. Except as noted below, the following Covered Services are provided to the Member when the Member uses a Participating Attorney. The Schedule of Benefits chart shows the reimbursement schedule when the Member uses a Non-Participating Attorney.
Advice and Consultation
LegalEASE Helpline:
Advice and consultation by toll-free telephone with a Plan Attorney. Services are available during normal business hours (EST). Calls can relate to any personal legal matter, civil or criminal, except those specifically excluded.
Financial and Tax Helpline:
Consultation by toll-free telephone during normal business hours (EST). Calls can relate to investment strategies, debt matters, taxes or any personal financial planning question.
Initial Law Office Consultation
Up to the maximum as shown in the Schedule of Benefits for office consultations with a Participating Attorney on any personal legal problem, civil or criminal, except those specifically excluded. See Miscellaneous Law Office Services.
Miscellaneous Law Office Services
Benefits not specifically covered or excluded hereunder to be provided at an amount shown in the Schedule of Benefits.
This benefit is limited to one use per year and is subject to Managed Case Rules.
Review of Simple Document
The Plan Attorney will verbally explain the meaning or impact of any form or document, or make suggestions for changes to a form or document being drafted of up to the maximum number of pages as shown in the Schedule of Benefits. This benefit does not include a written analysis of any form or document.
OnLine Legal Access
Internet access to legal information and documents for many common legal situations. This feature is designed for Members and/or Family Members who wish to independently research legal issues either before or after contacting an Plan Attorney. OnLine Legal Access can be activated through the internet by contacting the following website:
www.legalease.com.
Document Preparation
Preparation of any of the following documents: simple deed (excluding those reviewed or prepared under the real estate benefit), promissory note, consumer dispute correspondence, installment sales agreement, general power of attorney, lease agreement (tenant only), time share agreement, and simple affidavit.
This benefit is limited to one use per year.
Consumer Dispute
Consultation or representation in a dispute relating to consumer goods and services (not involving real estate construction, landlord/tenant disputes or renovation).
This benefit is limited to one use per year.
Small Claims Court Representation
Consultation and/or representation for a consumer dispute filed in small claims court.
This benefit is limited to one use per year.
Will and Codicil Preparation
Preparation of one simple will or codicil (an amendment to an existing will) for the Member and spouse only, including the preparation of a simple testamentary support trust for the dependent children:
Simple Will Preparation: Plan Attorney shall prepare a simple will or codicil for Member and Family Member and discuss the legal requirements for signing the will.
Living Will and/or Health Care Power of Attorney
Preparation of living will and/or health care power of attorney for Member and/or Family Member as authorized by state law. A living will expresses an individual’s wishes as to the use or withdrawal of life support systems. A health care power of attorney appoints another to make medical decisions if the individual is unable to do so him/her self.
This benefit is limited to one use per year.
Living Trust Document
Preparation of living trust documents. This benefit does not include services related to transactions to fund the trust or transfer assets into it.
This benefit is limited to one use per year.
Probate of Small Estate
The service of an attorney for the probate of a small estate (an estate that is not subject to current state or federal estate taxation) up to the maximum as shown in Schedule of Benefits.
Real Estate Sale, Purchase or Refinancing of Primary Residence
The services of an attorney for the purchase, sale, or refinancing of a Member’s primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes the review or preparation of closing documents and/or attendance by the Member’s attorney at closing in situations when it is customary to do so. This benefit does not include services performed by or for a title company, or for an attorney acting on behalf of a lending institution. Home equity loans and the sale or purchase of unimproved or rental properties are not included.
This benefit is limited to one closing per year and is subject to a waiting period, if any, as shown in the Schedule of Benefits.
Landlord/Tenant Disputes
Representation of the Member and/or Family Member as a tenant in a dispute with his/her landlord.
This benefit is limited to one use per year and is subject to Managed Case Rules.
Debt Collection Defense
The defense of any dispute involving personal (non-business related) debt. This benefit includes correspondence, negotiating with creditors to arrange a repayment schedule, assistance in limiting harassment by bill collectors, and negotiating settlement after a complaint is filed. This service does not include defense against execution of a court-ordered judgment or efforts to vacate or set aside a judgment.
This benefit is limited to one use per year. Trial defense benefit is subject to Managed Case Rules.
Bankruptcy
Representation on behalf of the Member or Family Member for personal (non-business related) bankruptcy protection under Chapter 7 or 13 of the Internal Revenue Code.
This benefit is limited to one use per year and is subject to a waiting period, if any, as shown in the Schedule of Benefits.
Foreclosure
Defense of the Member in an action to foreclose on the Member’s primary residence (where Member has resided or intends to reside twenty-seven (27) weeks or more per year.)
This benefit is limited to one use per year and is subject to Managed Case Rules.
Tax Audits
Includes the services of an attorney (but not accounting services) during a personal (non-business related) tax audit process required by federal and state tax authorities and negotiations relating to it. This benefit does not include a defense against criminal charges nor the defense of civil tax litigation in any tax court.
This benefit is limited to one use per year and is subject to a waiting period, if any, as shown in the Schedule of Benefits. This benefit is subject to Managed Case Rules.
Separation, Divorce, Annulment
Legal representation of the Member only for up to 10 hours in an uncontested separation, divorce, civil annulment, consent or default divorce. An uncontested separation, divorce or civil annulment does not involve significant disputed issues and the parties resolve any issues prior to any court supervised proceeding. A consent or default divorce does not involve any disputed issues and the opposing party is not represented by counsel. The benefit for uncontested matters does not provide any coverage of an attorney’s fee for: (1) services in excess of 10 hours; the Member must pay the attorney’s fee for services in excess of 10 hours; (2) services relative to post-decree representation; or, (3) contested matters in which case the Member must pay the attorney’s fee for services, unless this Policy provides coverage of contested matters and the benefit shall be in accordance with the Schedule of Benefits. A contested separation, divorce or civil annulment requires more than five (5) hours of attorney time, involves disputed issues and both parties are represented by an attorney.
This benefit is limited to one use per year ( representation seeking or defending against interim or subsequent-to-decree order shall constitute a separate use) and applies to the Member only. This benefit is subject to a waiting period, if any, as shown in the Schedule of Benefits. Contested divorce is subject to the Managed Case Rules.
Name Change
Services required to accomplish a legal name change for a Member or Family Member.
This benefit is limited to one use per year.
Guardianship/Conservatorship
Services required to establish a Member and/or Family Member as the guardian(s) or conservator(s) of another. This benefit does not include contested matters.
This benefit is limited to one use per year.
Uncontested Adoption
Legal representation for a Member and/or Family Member of up to five (5) hours in an uncontested governmental agency or stepparent adoption. An uncontested adoption does not involve significant disputed issues. This benefit does not include: (1) contested termination of parental rights; (2) fees for a court-appointed attorney for the child; or (3) adoptions(s) made through any agency other than a governmental agency. A contested adoption requires more than five (5) hours of attorney time and involves disputed issues. If the amount of an attorney’s times for uncontested adoption exceeds five (5) hours, or if the adoption becomes contested, coverage will terminate and the Member and/or Family Member will be responsible for any additional legal fees.
This benefit is limited to one use per year.
Juvenile Court Matters
Services related to the representation of the dependent child of a Member and/or Family Member in any juvenile court proceeding, provided the child’s interest is not in conflict with the Member’s and/or Family Member’s interest. This benefit does not cover any matter that falls outside the jurisdiction of juvenile court.
This benefit is limited to one use per year.
Civil Litigation Defense
Services related to the representation of a Member and/or Family Member who is a named defendant in a civil lawsuit (non-business related), up to and including the trial thereof. This benefit does not include: (1) any debt collection or family law matters; (2) lawsuits normally handled on a contingent fee basis; or (3) matters for which the Member has or is required by law to have insurance.
This benefit is limited to one use per year and is subject to a waiting period, if any, as shown in the Schedule of Benefits. This benefit is subject to the Managed Case Rules.
Traffic Defense
Services related to the representation of a Member and/or Family Member who is charged by governing authorities with moving traffic violation(s) and conviction could result in suspension or revocation of Member’s and/or Family Member’s drivers’ license.
This benefit is limited to one use per year.
Administrative Proceeding
Services related to the representation of a Member and/or Family Member in an administrative proceeding relating to the suspension or revocation of driving privileges.
This benefit is limited to one use per year.
Misdemeanor Defense
Defense of a Member and/or Family Member in connection with criminal misdemeanor charges (not associated with any felony charge). This benefit does not include defense of moving traffic violations.
This benefit is limited to one use per year. This benefit is subject to Managed Case Rules.
Elder Law Services
Your benefits package includes Elder Law Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1) Eligibility of Parents
a) Parents of the Plan Member and the Member’s Spouse, regardless of age, are eligible for benefits under the Elder Law coverage described herein.
b) The benefits specified below extend not only to the Member’s Parents and the Member’s Spouse’s Biological Parents, but their Step-Parents and Adoptive Parents as well.
2) Benefits for Elder Parents
a) Advice and Consultation
1. LegalADVISOR Helpline:
Member may receive advice and consultation by toll-free telephone with a Plan Attorney. Services are available during normal business hours. Calls can relate to any personal legal matter, civil or criminal.
2. Financial Helpline:
Member will receive consultation by toll-free telephone during normal business hours. Calls can relate to investment strategies, debt matters or any personal financial planning question
b) Free Simple Wills & Living Wills
1. Simple Will Preparation:
Each Eligible Parent, as defined above, may receive one Simple Will per year at no charge. Plan Attorney will prepare the document and discuss the legal requirements for executing the Will.
Simple Will means the will maker does not have a significant net worth and will not benefit from tax planning, or the estate is not subject to current state or federal estate taxation; the will maker does not own a business that will continue in operation after death; the will maker does not want to put restrictions on what heirs may do with the property; the will maker does not want to leave money to someone in a trust because the person cannot manage his or her own affairs (such as a mentally handicapped child), or does not want the property to be managed by a trustee for a period of time past the child’s age of majority, to age 25 or 30, for example; the will maker does not think that someone will challenge the will; and/or the will maker does not want to exclude any lawful dependents.
2. Living Will Preparation:
Eligible Parents, as defined above, may request one Living Will per year at no charge. Plan Attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Living Will. A Living Will expresses an individual’s wishes as to the use or withdrawal of life support systems.
d) Additional documents may be prepared for a minimal charge:
1. Additional documents may be prepared for a minimal charge, up to once per year per Eligible Parent, as described above:
- Healthcare Directive - $45 fee per document
- Financial Power of Attorney - $45 fee per document
- Durable Power of Attorney - $45 fee per document
- Healthcare Durable Power of Attorney - $45 fee per document
Any 3 or more of the above documents may be prepared for a package cost of $115 per set.
Identity Theft Prevention/Recovery Assistance
Coverage includes a basic Identity Theft HelpLine Service as well as a comprehensive Online Identity Theft Prevention and Assistance Service for covered members.
1) Advice and Consultation
a) Free ½ hour telephonic consultations (10 per year) with a Trained Identity Theft Recovery Specialist (consultations can also be online – member’s choice)
b) Online Assistance in understanding identity theft prevention
c) Unlimited access to complete identity theft legal issue law libraries
2) Additional Benefits
a) Personal Recovery Kit – designed to walk a victim of identity theft step-by-step through the process of recovery (designed to be utilized in conjunction with the free consultations with the Recovery Specialist).
b) Free Simple Recovery Letter preparation by plan attorney – a plan attorney will draft the simple affidavits to submit to specific agencies and organizations needed to establish the theft of your identity and prevent further loss of your identity and credit rating.
c) Free Review of necessary recovery legal documents (up to 6 pages each)
d) Up to $25,000 Expense Reimbursement for Identity Theft Losses That Cannot Be Recovered
Mediation Services
Your benefits package includes Mediation Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1. Consultation Services:
a) Plan members receive unlimited access to online information including domestic disputes, divorce or child custody proceedings, consumer problems, medical bill, warranties, loan disputes, auto accidents, etc.
b) Members receive one free thirty minute consultation with a licensed mediator every quarter.
2. Mediation Counseling Assistance:
a) Assistance is available to assist members with understanding mediation and alternative dispute resolution. Examples of some topics are; charting projected lawsuit expenses, understanding when mediation might work, managing legal expenses in mediation, educational tools to make an informed decision, and advice on selecting mediator or other options.
b) These services are designed to help members deal with the increase in resolution pace.
3. Additional Mediation Services:
a) Plan members receive a 10% discount on Plan Mediators’ normal fees. This includes hourly rates and flat fees. However, this does not apply to Contingency Fees.
Savings Assistance Services
Your benefits package includes a Savings Assistance Plan as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1. Consultation Services:
a) Plan members are entitled to an initial consultation with one of our Savings Coaches for savings information including how to get started, how much is the right amount, how can I possibly save, how can I create a savings plan, can I save while I am in debt, and similarly related topics.
2. Creation of Savings Plan Assistance:
a) Counselor assistance to help members with creating their own personal savings plan is also included in the Saving Assistance Coverage. This service will include charting projected income and expenses, helping the member understand when savings might work, managing expenses in debt, educational tools to make an informed decision, and advice on selecting savings amounts options. This section of the plan is designed to help members deal with their increasing debt and need to save.
3. Additional Follow-up Services:
a) Plan members may utilize one, free, thirty minute telephone consultation per year.
b) Follow-up consultations and help from Savings Coaches are also available to each plan member.
Immigration Services
Your benefits package includes Immigration Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage. The services below are provided for up to one Eligible Family Member, as described below, per year. Eligible Family Members include spouse, children up to any age, parents of member and spouse and siblings of member and spouse.
1. Advice and Consultation:
a) Plan Member or Eligible Family Member will receive up to one-half hour office consultation per issue with a participating attorney on any personal immigration matter.
2. Review of Immigration Documents:
a) A Plan Attorney will review and explain the meaning or impact of any immigration form or document, or make suggestions for changes to a form or document being drafted that is up to six (6) pages.
3. Discounted Rate:
a) Plan Member or Eligible Family Member receives a discounted hourly rate, up to a 25% discount from the Plan Attorney’s normal hourly rate, for additional representation. Flat fees may not be discounted.
4. Preparation for Hearings:
a) Plan Member or Eligible Family Member will receive up to two hours of general preparation for immigration hearings.
5. Preparation of Documents:
a) A Plan Attorney will prepare necessary affidavits and powers of attorney for the Plan Member or Eligible Family Member at no charge.
To access services, Plan Member or Spouse must call the Member Service Center and identify the family member for whom services are requested.
Flat Rate Benefits
Your benefits package includes benefits that will be covered at a flat rate charged to the member as described below. These benefits are in addition to plan services described in your Certificate of Coverage. Eligible Family Members include spouse and unmarried dependent children, including stepchild, legally adopted child, child placed in the home for adoption and foster child, up to age 19, and from age 19 up to 25 years if they are enrolled in an accredited school or college as full-time student(s) and are primarily dependent upon the Member for support.
1. Traffic Ticket Defense Flat Rate of $89:
a) Traffic defense generally includes the preparation of court documents and attendance at on a one-time only court hearing to settle the issue. Does not include court costs, fines, additional hearings or other related expenses. Does not apply in jurisdictions that consider traffic offenses to be criminal matters.
2. Preparation of Prenuptial Agreement Flat Rate of $239:
a) This service covers the preparation of an agreement by a Plan Member and his or her fiancé/partner prior to their marriage or legal union (where allowed by law), outlining how property is to be divided in the event of separation, divorce or death of a spouse. Representation is provided only to the Plan Member. The fiancé/partner must have separate counsel or must waive representation.
To access services, Plan Member or Spouse must call the Member Service Center.
Obtaining Policy Benefits
Telephone Advice and Consultation on Legal and Financial Matters
Consultation by toll-free telephone with an attorney. Services are available during normal business hours (EST). Calls can relate to any personal legal matter, civil or criminal, except those specifically excluded herein.
Financial and Tax Helpline:
Consultation by toll-free telephone during normal business hours (EST). Calls can relate to investment strategies, debt matters, taxes or any personal financial planning question.
Claim for Benefits
1. Members must call the Member Service Center to confirm eligibility and coverage prior to consulting with any attorney. The Member Service Center will assign a Participating Attorney to provide services relative to the matter. Failure to notify the Member Service Center within thirty (30) days following consultation with an attorney may result in a denial of benefits.
2. To obtain benefits under the Managed Case Rules:
Members and/or Family Member must secure a confirmation letter from the Member Service Center prior to proceeding with an attorney.
The attorney must provide a written estimate of fees reflecting his or her best judgment as to the likely conduct of the case.
We will set a maximum attorney fee that takes into account the reasonable level of reimbursement for the proceeding and the proposed litigation strategy. Fees as a result of services in excess of the maximum attorney fee are the responsibility of the Member and/or Family Member.
3. Members actively receiving services under this Policy must remain enrolled and continue to pay premium hereunder. All Policy benefits will be subject to subrogation and coordination of benefit rules.
4. Upon completion of a Covered Service, the Member and/or Family Member will be required by the Participating Attorney to sign a confirmation of completion.
5. If the Member and/or Family Member pays for pre-authorized services provided by a Non-Participating Attorney, the Member must submit a reimbursement form (provided by Member Service Center) accompanied by an original itemized bill within sixty (60) days after incurring the legal fees. Benefits provided to the Member and/or Family Member for Covered Services are subject to the maximum as shown in the Schedule of Benefits.
Disputes Between Member and Family Member
In the event that the Member and one of the Family Members are involved as adversaries in a dispute that is a Covered Service, the Policy will cover the Member only.
If two or more Family Members are involved in a dispute that is otherwise covered under the Policy, the Policy will provide no coverage.
If two Members are involved as adversaries in a dispute that is a Covered Service, the Policy will provide separate coverage for each Member.
Exclusions
This Policy excludes benefits for the following:
Appellate court proceedings, class actions, interventions, derivative action and amicus curiae filings.
The preparation and filing of individual, partnership or estate tax returns, appellate or administrative proceedings related to tax returns, litigation before the U.S. Tax Court, U.S. Court of Claims or any other federal, state or other courts with respect to tax matters.
Matters relating to securities, trademark or patent matters; business or commercial interests, including, but not limited to, professional, partnership and/or corporate matters; matters involving the law or laws of jurisdictions other than the United States and its territories and Canada; any matters involving a government (domestic or foreign) entity or agency; farm related issues; matters involving commercial or rental property transactions, including the purchase, sale or lease of investment or income-producing property. A two-family house, whether or not used by the Member as his or her primary residence, is deemed an investment or income-producing property
Legal services which are fully paid for or provided at no cost by any governmental agency, organization or insurance company.
Matters that the attorney deems frivolous, spurious, harassing, or unethical (collectively referred to as “frivolous”) or otherwise prohibited by the Model Rules of Professional Conduct of the state in which the attorney is licensed.
Costs associated with covered legal services, including but not limited to, all fines, court costs, penalties, sanctions, expert witness fees, bonds, bail bonds, attorney fees, exhibits, deposition costs, filing fees, transcripts, postage, telephone, photocopying, recording fees, messengers, judgements, jury fees, court reporter fees, investigative costs and all other incidental and out-of-pocket legal and litigation costs.
Any services on behalf of a Family Member against the interests of the Member.
Any employment-related matter. This includes, but is not limited to, any dispute involving the Member’s employer or its affiliates, their officers or directors, the Member’s employee benefit plans, credit unions, programs or arrangements sponsored by an employer, or cases involving workers’ compensation, unemployment compensation, sex harassment, age discrimination, etc.
Any dispute or proceeding against the following persons or entities, their officers, directors, employees, or agents: any person or entity involved in the sale of the Policy; Administrator or its subsidiaries; Policyholder; Member’s employer; Virginia Surety Company, Inc. it’s parents, subsidiaries or any affiliated or successor company, plan underwriter or reinsurer; Plan Sponsor; or any Participating and/or Non-Participating Attorney, if the dispute or proceeding pertains to services provided under the Policy.
Except regarding LegalEASE Helpline and Financial and Tax Helpline services, the Policy will not provide benefits in connection with pre-existing matters, which includes any matter where the Member and/or Family Member is on notice as to a pending legal dispute or has previously contacted an attorney.
General Provisions
Attorney-Client Relationship
All attorneys are subject to the authority of the State Supreme Court and the State Bar of the state where they are licensed to practice. The Member’s relationship with an attorney is privileged and strictly confidential. We will not interfere in the attorney-client relationship, nor in the attorney’s independent exercise of his or her professional judgment. Attorneys are not certified specialists.
Member shall authorize Participating Attorney to provide the Administrator with anonymous statistical reports on the number and type of services provided to Member.
By using legal services benefits for which are provided under the Policy, the Members agree that neither We, nor the Policyholder, nor any other person involved in the marketing or administration of the Policy, shall have any liability for the acts, errors or omissions of an attorney providing services, in whole or in part, under the Policy.
Non-Participating Attorney Services
If the Member already has an attorney, the Member may prefer to use her/him as a Non-Participating Attorney. To do so, the Member must first contact the Member Service Center and notify the representative of his/her intention to use a Non-Participating Attorney for a Covered Service. The Member Service Center will send the Member a claim form to request reimbursement from the Policy. The Member’s reimbursement will be based on the reimbursement schedule as shown in the Schedule of Benefits.
Legal Terminology
The Member or Family Member may call the Member Service Center to obtain a definition or explanation of any term used herein.
Coverage Period
The coverage period is automatically renewable upon receipt of appropriate premium unless terminated in accordance with the terms hereof.
Coverage Territory
The coverage territory includes the states identified in Schedule A attached hereto.
Premium Refund Provision
In the event that the premium mode is other than monthly and the Policy is terminated or the Member elects to terminate the coverage, a prorata premium refund will be made in accordance with the insurance laws of the Policyholder’s state.
Termination and Cancellation of Coverage
Coverage provided to Member shall terminate upon the first of the following to occur:
a. Cancellation or termination of this Policy;
b. If applicable, the Member fails to re-enroll;
c. The Member is no longer associated with Policyholder; or
d. The Member fails to remit premium when due, subject to the statutory grace period.
Coverage provided to Family Member of a Member shall terminate upon the first of the following to occur:
a. The Member’s coverage is cancelled or terminated; or
b. The Family Member ceases to be an eligible Family Member of the Member’s coverage.
When coverage for a Member and/or Family Member terminates and a matter is unresolved when coverage terminated, then any further legal work between said Member and/or Family Member and the Plan Attorney shall be outside the scope and coverage of the Policy. The Plan Attorney shall not be obligated to provide any benefits under the Policy and any further legal services shall be based upon an independent and separate fee agreement entered into, if at all, between the former Member and/or Family Member and the attorney. If such an agreement is not entered into, then the Plan Attorney may withdraw from any further representation in accordance with applicable law and State Bar standards.
If this Policy has been in effect ninety (90) days or less, we may cancel this Policy by mailing or delivering to the Policyholder written notice of cancellation, including the specific reason(s) for cancellation, at least:
1. Ten (10) days before the effective date of cancellation if We cancel for nonpayment of premium; or
2. Twenty (20) days before the effective date of cancellation if We cancel for any other reason, except We may cancel immediately if there has been:
(a) A material misstatement or misrepresentation; or
(b) A failure to comply with underwriting requirements established by the insurer.
If this Policy has been in effect ninety (90) days or more, we may cancel this Policy only for one or more of the following reasons by mailing or delivering to the Policyholder forty-five (45) days written notice of cancellation:
1. The Policy was obtained by a material misstatement;
2. There has been a failure to comply with established underwriting requirements within ninety (90) days of the effective date of coverage;
3. There has been a substantial change in the risk covered for a given class of insureds.
Additionally, we retain the right to terminate the Policy upon ten (10) days written notice for the following reason:
1. Nonpayment of premium.
The Policyholder is responsible for notifying the Members of cancellation.
Premium Remittance
Policyholder shall remit premium to Company no later than the 10th calendar day following the month for which Policy coverage is provided.
Grace Period
The Policy provides Policyholder a grace period of thirty-one (31) days after the premium for covered Members due date to remit the premium that is due and unpaid. During the grace period, this Policy will continue in effect. If the premium for covered Members remains unpaid at the end of the grace period, the Policy will terminate. Termination will be effective at 12:01 a.m. on the thirty-second (32nd) day following the due date for which premium for covered Members remains unpaid. Policyholder shall remain liable for the prorata portion of all premiums that accrue for the period this Policy is in effect.
Amendment of the Policy
The Policy may be amended or changed at any time by the Company upon written notice thereof and signed by a duly authorized representative. No agent, broker or sales representative may make any change in this Policy or waive any of its provisions.
Notice of Policy Provisions
Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or change any part of the Policy or stop Us from asserting any right under the terms of the Policy; nor shall terms of the Policy be waived or changed except as stated above.
Change in Premium
We shall provide the Policyholder written notice within thirty (30) days prior to the anniversary date of the Policy for any change in premium to be implemented. Any such change shall apply to the Policyholder on the anniversary date of the Policy. The Policyholder is responsible for notifying the Members of the change in premium.
Arbitration
This provision is voluntary and binding. All disputes and controversies of every kind and nature between the parties hereto arising out of or in connection with this Policy and the Policy application, the subject matter thereof, the negotiation thereof, the existence, construction, validity, interpretation, or meaning, performance, non-performance, enforcement, operation, breach of contract, continuation or termination thereof or any claim alleging fraud in fact, fraud in the inducement, deceit, or suppression of any material fact, bad faith may be submitted to binding arbitration pursuant to the provisions of the Federal Arbitration Act and according to the Commercial Rules of the American Arbitration Association. Such proceedings may be initiated by either party by notice in writing to the other and to the American Arbitration Association. Each party shall bear its own arbitration costs and expenses.
Conversion
The Member may continue this insurance by converting to an individual policy subject to state availability when the Member no longer qualifies as an employee of the Policyholder or as a Member of the group to which this Policy is issued. The Member must notify us within thirty-one (31) days of this disqualifying event to make arrangements for premium payment.
Policy Conformed to Statute
Any terms of the Policy which are in conflict with the statutes of the jurisdiction where issued, are amended to conform to the statutes.
Assignment of Benefits
The benefits provided under this Policy are not assignable.
Entire Contract
This Policy, including the application and endorsements, if any, constitutes the entire contract of insurance.