Terms And Conditions
MEDICAL TREATMENTS ARE ONLY COVERED WITHIN THE STATE OF ISRAEL *
With the AIM GOLD PLAN and AIM PLATINUM PLAN, the registrant receives the following:
- Unlimited visits to the AIM Medical Center for examinations and treatments by the staff of General
Practitioners. Office hours at the center are Sundays to Thursdays 9:00am to 5:00pm and Fridays 9:00am
to 12:00 noon, There is no billing to the family for these visits, however, outside services will have a
$10.00 service charge applied. AIM reserves the option to settle all claims with the registrant’s primary or
Israeli insurance carrier.
- Emergency room and hospitalization coverage throughout Israel. Provides for emergency non-elective
expenses, for all illnesses or injuries that occur within the State of Israel during the registered period. ( See
- Emergency local ambulance transport necessarily incurred in connection with illness or injury resulting in hospitalization.
- Acute and urgent medical care for problems that arise during registrants stay in Israel. Coverage on the AIM Gold Plan up to $100,000 for the year and $200,000 for the AIM PLATINUM PLAN for the year. *
- Doctors are available at the AIM Healthnet Center on Sundays through Fridays.
- 24 hour hotline with a physician on duty seven days a week. Nurse visits to selected schools.
- The AIM Gold and Platinum Plans, provide routine medical checkups for universities or summer camps.
The following statements herein and the Master Agreement are an integral part of the AIM Registration Agreement*.
1. MEDICATIONS: Prescriptions issued by AIM participating physicians, for acute or urgent care, shall be generic and furnished by authorized pharmacies. All medications shall have a maximum limit of $500.00 for the year. Over the counter medications and medications for non-covered conditions, are excluded*. Does not cover medications taken on a regular basis or for preventive treatment*.
2. EMERGENCY DENTAL care consists of initial evaluation and palliative treatment for immediate relief of pain up to $400 for the year.
2.1 All registrants are covered for first aid emergency treatments by AIM referral only; e.g.: replacing lost fillings, draining an acute abscess, stabilizing acute traumatic events, etc. Not included are root canal, fillings, wisdom teeth extraction, TMJ disorders, bondings, orthodontics, broken or chipped teeth and
cosmetic dentistry, cleaning, etc. and as defined by the AIM Medical Director.
2.2 No benefits are available to replace or repair existing dental prosthesis even if damaged in an eligible accidental injury.
2.3 Dental care other than First Aid is only available upon receipt of written consent and payment*.
3. MEDICAL SERVICES: Referrals to hospitals, urgent care centers, specialists, dentists and other physicians and/or diagnostic services for acute or urgent care, must be authorized by the Medical Director or the AIM physician on duty. A referral slip will be issued in each case. The member is responsible for payment of non-authorized visits*. In instances where medical care is urgently needed – the AIM emergency hotline must be used to receive instructions from the physician on duty. Only when authorized in writing, will AIM reimburse the registrant on the strength of the following documents being displayed: a. Medical
documentation. b. A tax invoice (chesbonit) of the provider of the services, stating the amount of the payment. c. The refund level shall be up to a maximum of $100 per illness. In the absence of these documents AIM shall be released from refunding payment.
3.1 PRE-EXISTING CONDITIONS and/or SYMPTOMS THEREOF: Medical, surgical or dental illness or injury and/or symptoms thereof, that, with reasonable medical certainty, existed on and/or originated at anytime prior to the registration date and Effective Date of Coverage (including any recurrence of a previous condition or complications of a pre-existing condition or symptom) and treatment of pre-existing or chronic conditions of any kind, or conditions that are deemed to have been present and/or treated prior to arrival in Israel, whether or not previously diagnosed, treated or disclosed on the Application or otherwise, including any chronic, subsequent or recurring complications or consequences associated therewith or arising or resulting there from, are not covered by the AIM GOLD Plan or AIM PLATINUM Plan. Illness or injury occurring in a prior registration is considered pre-existing and is not covered in a current registration period.
In these situations, upon written approval and payment received, AIM will make all necessary arrangements for care and provide invoices to the family for the services.
4. GENERAL CONDITIONS
4.1 The medical coverage in terms of this agreement is effected on the basis of the knowledge and written declarations which were provided to the American Israel Medi-Plan, Inc. (AIM).Their accuracy constitutes a principal condition for the existence of the medical coverage. In the event of an answer/s or declarations which is/are not complete and accurate having been given by the registrant to the questions relating to the state of health of the registrant, AIM reserves the right to decline or cancel the registration at any time.You can receive a credit for the unused portion of the registration, less the $100. administrative charge.
4.2 Validity of the agreement: This agreement shall be valid from the date of the commencement of the medical coverage period but not prior to the date on which all the pre-conditions have been complied with including payment and delivery of all required documents within 14 days from the date of commencement of the medical coverage period. In the event of such documents not having been delivered within the said time, the agreement can be automatically cancelled. In the event the agreement being cancelled, the registrant shall return the photo ID card and in such case a credit will be issued in respect of the period following the return of the ID card, as per 5.1 to 5.6 below.
4.3 Every extension or renewal of the medical coverage requires the written consent of AIM. It is hereby clarified that that upon termination of the medical coverage, the agreement shall not be extended automatically and not be extended by virtue of silence or any other action other than by written consent.
4.4 Effective Date of Coverage – Will be 14 days after the registrant arrives in Israel and is eligible for coverage as per 5.1 to 5.6 below.
4.4.1 Charges for Treatment of the following Illnesses or Surgeries which manifest themselves and/or involve procedures which take place and/or are recommended during the coverage period under the AIM Medical Plans: asthma, allergies, any condition of the breast, any condition of the prostate, any condition of the heart, kidney, lung or liver, tonsillectomy, adenoidectomy, hemorrhoids, disorders of the reproductive system, seizure disorders, diverticulitis, hysterectomy, hernia, intervertebral disc disease, gall stones, kidney
stones, anemia, colitis or irritable bowel disease and transplants of any kind are excluded from coverage.
These conditions are excluded, regardless of whether the conditions were previously diagnosed or not.
Note: Coverage and/or benefits for these Illnesses or Surgeries (or for similar or different Illnesses or Surgeries) may be separately or further limited and/or excluded under the Pre-existing Conditions
4.5 Termination of registration – The registration and Master Agreement can be terminated at anytime by the AIM Administrator by giving at least 30 days written notice to the participating member. Such termination will have no effect on the eligible coverage or benefits accrued prior thereto. No coverage or renewals will be accepted after the date the registration and Master Agreement are terminated.
4.6 Cooperation – The participating member and his/her physicians hospitals and other healthcare and medical service providers and suppliers shall cooperate fully with the AIM Administrator in reviewing,
investigating, adjudicating and/or administering any claim for benefits under this coverage, including granting full right of access to all relevant or related medical documentation, medical histories, reports, lab or test results, x-rays and other available evidence relating to or affecting the investigation, adjudication or administration of the claim. The AIM Administrator may deny coverage for a claim when there has been a refusal or material failure to cooperate.
4.7 Emergency Room and Hospitalization coverage: AIM reserves the right to review and deny claims for non-covered conditions or when not medically necessary. In the event of hospitalization, hospitalization is limited to a cumulative maximum total of 15 days. The registrant agrees and authorizes AIM to receive payment for all medical services from the patient’s primary insurance carrier.
4.8 AIM Gold and Platinum Plans only provide for acute and urgent medical care for problems that arise solely during the registrants stay in Israel*. Injuries sustained outside of Israel during the registration period are not covered. For example: if someone goes home for Pesach, is injured and then returns to Israel, follow up treatment is not a covered expense. Acute and urgent care is defined as conditions that require medical attention and intervention within 12-24 hours by an AIM Israeli affiliated physician. Elective or investigative evaluations as determined solely by the AIM Medical Director, are excluded from coverage.
4.9 This agreement covers acute and urgent care for problems such as pneumonia, dysentery, appendicitis, fractures and sore throat. It does not cover investigational studies to evaluate and treat subacute or chronic conditions such as celiac disease, inflammatory bowel disease, thyroid conditions, carpel tunnel syndrome or neurologic disorders.
4.10 The Policy of AIM is that the Medical Director will determine and approve all referrals to doctors and hospitals based on his knowledge, experience and prior arrangements. In the event patients elect to choose doctors other than those referred by the Medical Director, AIM will be released from all responsibilities
5. Eligibility – In order to be eligible and qualified for coverage under the AIM Medical Plans, a participating member must:
5.1 Complete and sign a current application by the adult member, parent or guardian or successfully register on the AIM website on-line and
5.2 Complete, sign and submit a full disclosure Medical History form and
5.3 Pay the required amount by check, money order or valid credit card and
5.4 AIM reserves the right to decline or cancel the registration at any time if 5.1 through 5.3 are not completed or in the event of a discovery of a case of fraud, deception or concealment relating to any matter influencing a medical claim, or if your medical history is materially different from the information you
provided in your application.
5.5 Coverage is effective 14 days after receipt of the signed application, Medical History form and payment.
6. AIM PLATINUM PLAN
6.1 SUDDEN ONSET OF PRE-EXISTING CONDITIONS: The AIM PLATINUM PLAN provides coverage for the sudden onset of pre-existing conditions, if fully disclosed on the required Medical History form. There is a limited amount of coverage provided for conditions which have not required ongoing or intermittent treatment (includes medications, surgery, physiotherapy or similar modalities), over the past eighteen (18) months.
6.1.1 The registrant must not be receiving any treatment or taking any medications thereof for any condition during the past 18 months, related to the Sudden Onset of the Pre-Existing Condition. The AIM PLATINUM Plan provides a limited amount of coverage to help mitigate this unpleasant surprise. For U.S. citizens
there is coverage up to $10,000. As a non-US citizen, you have up to $1,000. of coverage for medical expenses only.*
6.1.2. AIM Platinum Plan is not meant to provide coverage for continuing medical care of an illness or symptoms that with reasonable medical certainty existed on and/or originated at any time prior to the
effective Date of Coverage. AIM provides coverage for acute and urgent medical care; only for problems that arise during the registrants stay in Israel.*
6.1.3 If a person has a pre-existing condition or symptoms which have been stable for the past eighteen (18) months and has not been receiving medications or treatment, that person will be covered during
his/her registration period for a sudden onset.*
184.108.40.206 A few examples of those conditions that would be covered:
220.127.116.11. Someone with a history of asthma and who has not required medications or treatment during the past 18 months, but as a result of differences in pollen, altitude. etc. has an asthma attack he/she would be covered by the Sudden Onset benefit for the asthma attack. If the registrant is periodically using an inhaler, that would be considered ongoing treatment and therefore would not be covered.
18.104.22.168 Someone has torn a knee ligament, which was repaired a few years ago. They step the wrong way off of a curb and they tear it again. Obviously, they are unlikely to have had ongoing treatment, the Sudden Onset benefit would apply. .
6.2 AIM Complimentary Medicine: On the AIM Platinum Plan only. Similar treatment must not have been rendered during the last 18 months. When referred in advance by an AIM physician, the AIM Complimentary Medicine available, consists of only one of the modalities listed in 6.2.1 through to 6.2.4. and is available for 12 month registrants, in the amounts listed below:
6.2.1 Traditional Chinese Medicine: Up to $175 per registered period of 12 months..
6.2.2 Acupuncture: Up to $175. per registered period of 12 months.
6.2.3 Herbal Therapy: Up to $175. per registered period of 12 months.
6.2.4 Massage Therapy: Up to $175. per registered period of 12 months.
6.3 Physical Therapy: On the AIM Platinum Plan only. When ordered in advance by an AIM Physician, Physical Therapy is available for 12 month registrants, up to 8 visits per year. Outside visits for Physical Therapy are limited to 4 visits per year.(6.1.2 is applicable)*
6.4 Chiropractic Care: On the AIM Platinum Plan only. When ordered in advance by an AIM Physician, Chiropractic Care is available for 12 month registrants, up to 8 visits per year.(6.1.2 is applicable)*
6.5 In order to be eligible for referral to only one of the medical services described in 6.2 to 6.4 above, there must be Medically Necessary Treatment for a specific illness which has been diagnosed and is being treated by an AIM physician.
6.6 For the optional Sports Rider contact the AIM Administrator.
6.7 Airline Trip Delay/Missed Connection: Maximum Limit of $100. a day to help defray unexpected expenses as a result of such a delay, for a maximum of 48 hours or two (2) days, after a minimum of 12 hour delay period with a purchase of a full years coverage on the AIM Platinum Plan only*.
6.8 Lost Checked Luggage: The AIM Administrator will consider paying for the replacement of clothing and hygiene items not to exceed $250 with a purchase of a full years coverage on the AIM Platinum Plan only*.
The AIM Administrator will consider paying for the replacement of clothing and hygiene items not to exceed $100 for any one item if the following provisions are met:
6.8.1 The Registered Member(s) must be in compliance with all conditions and restrictions of this coverage.
6.8.2 Lost checked luggage must have been checked, in accordance with routine luggage checking
procedures of the carrier, for transportation with the member(s), on board a regularly scheduled commercial airline, upon which the Registered Member(s) was a fare-paying passenger
6.8.3 The Registered Member(s) must file a formal claim for lost checked luggage with the transportation carrier, and follow all instruction and take all measures as directed by the transportation carrier to locate and retrieve all lost checked luggage.
6.8.4 The Registered Member(s) must provide the AIM Administrator with copies of all documentation of the claim filed with the transportation carrier, and a written statement from the transportation carrier that the luggage was checked and after careful search, the luggage remains missing.
6.8.5 The Lost Checked Luggage must be lost as of the date of payment by the Scheme Administrator and as of that date must have been lost for 10 days.
6.9 Eating Disorders Counseling: On the AIM Platinum Plan only.The AIM Platinum Plan provides for an initial consultation by the AIM Medical Director. The physician’s report with recommendations will be
prepared and furnished to the patient. The AIM student and family can then make a decision to participate in any of the various treatment plan if needed.. Contact the AIM administrator for details and prices.
6.10. Hepatitis and flu shots are administered without charge, however the costs of the vaccines (serums) are not covered. Vaccination of any kind- including Rabies vaccination are not covered. There is a $15.
charge for allergy shots for members on the AIM Gold Plan. Allergy shots on the AIM Platinum Plan are
administered at no charge.
7.0 AIM BASIC PLAN
7.1 The AIM BASIC PLAN provides for emergency room and hospitalization coverage only, free
examinations and treatment at the AIM Medical Center and the doctor that visits the Seminary.
IMPORTANT: Referrals to specialists, laboratory tests or outside services such as X-rays or ultrasound if
any, will be billed to the parents directly.
8. WHAT IS NOT COVERED
8.1 Pre-existing conditions – Except for sudden onset of Pre-existing condition, (Platinum Plan only) charges resulting directly or indirectly from or relating to any pre-existing condition or symptom, are excluded from coverage.
8.2 The AIM Plans do not cover medical expenses with respect to hormonal imbalances, menstrual
irregularities, pregnancy, prevention of/or pregnancy related problems, preservation of pregnancy, childbirth or miscarriage.
8.3 Does not include services and expenses with respect to eating disorders, nutritional counseling, weight loss/gain, diet control, dyspepsia, GE reflux, irritable bowel syndrome, mental illnesses, anxiety disorders, psychological disturbances, learning disabilities, ADD, any sleep disorders, headaches, or migraine headaches.
8.3.1 Podiatric treatment is only covered under the AIM Platinum Plan.
8.3.2 Nutritional Counseling is only covered under the AIM Platinum Plan when prescribed by the AIM physician, up to a maximum of $175 per year.
8.4. Does not include expenses due to alcohol intoxication, substance abuse, medical treatment for the purpose of drugs and/or alcohol rehabilitation, or consequences , injuries as a result of brawls, self-inflicted injury, attempt at suicide or consequences related to the influence of any of the above.
8.5. Does not include coverage for sexual related illnesses, AIDs or malignant conditions.
8.6. The AIM GOLD and PLATINUM plans do not cover expenses with respect to optometry, treatment,
supply, examination or fitting of glasses or eye infections or eye inflammations in contact lens users, for any
reason. Vision care is available under the AIM PLATINUM Plan. with $100. maximum limit per coverage period for exams and materials after 12 months of continuous coverage, when referred by the AIM physician for medical reasons.
8.7. The AIM GOLD PLAN does not include services and expenses with respect to alternative medicine, acupuncture, chiropractic or non-conventional medicine, rehabilitation or Physical Therapy, whereas the AIM PLATINUM Plan does include coverage for Traditional Chinese Medicine, acupuncture, herbal therapy and massage therapy when prescribed by the AIM physician up to a maximum of $175 per year.
8.8. Does not include coverage for cosmetic or plastic treatments, warts, previous skin lesions, acne, nevi, eczema, asthma, psoriasis, seborrhea dermatitis, anti-viral medication, herpes, treatment for allergies, removal of skin lesions and fungal infection of skin or nails.
8.9. AIM does not cover the following orthopedic problems e.g. scoliosis, back pain or low back pain, flat feet, posture related problems, problems with arches and recurrent orthopedic problems, whether previously diagnosed or not. Physiotherapy, when prescribed under the AIM PLATINUM Plan is limited to 8 sessions*.
8.9.1 AIM does not cover orthopedic shoes; orthopedic prescription devices to be attached to or placed in shoes; Treatment of weak, strained, flat, unstable or unbalanced feet; metatalgia, bone spurs, hammertoes or bunions; and any treatment or supplies for corns, calluses or toenails; provided, however, that treatment or supplies may be eligible for coverage at the sole option of the AIM Administrator for an injury to the foot arising from an accident covered hereunder..
8.9.2 Plaster casts are used for treating broken bones and immobilizing the injured area. AIM does not cover the cost of air casts, knee supports or similar prosthetics and if elected will be charged to the patient.
8.10. AIM does not cover expenses related to elective surgery, private surgeon’s fees or conditions which require elective or not urgent treatments. Treatment or evaluations of H. pylori, chronic disorders e.g. polycystic ovary syndrome, hypertension, chronic fatigue syndrome, celiac disease, diabetes, neurological disorder, Tourette syndrome, Crohn’s disease, hair loss, hearing loss, hernias, cysts, biopsies, etc. or transplants of any kind are not covered
8.11. AIM does not cover injuries associated with an event connected with professional and organized competitive sports. Flag Football and hazardous sporting activities such as bungee jumping, motorcycles, jet skis, bicycling, tractoring, scuba diving, wrestling, martial arts and other unnecessary risks deemed by the AIM Medical Director, are not covered. Practice or training for any excluded activity which results in injury will be considered as taking part in such activity.
8.12. The AIM Gold Plan does not cover podiatric treatments, CAT scans, Bone scans, Endoscopy, MRI, mammography, serological and metabolic tests eg: EBV, CMV blood test or celiac anti-bodies, B12, folate and Vitamin D*.
8.13 The AIM PLATINUM Plan covers EBV, CMV blood tests, endoscopy, colonoscopy, and podiatric
treatments( subject to 8.9.1). AIM will only cover 50% of the cost of MRI’s, bone scans and CAT scans.
8.14. Does not include coverage for earthquakes, volcanic explosions, nuclear fission, meltdowns or radioactive contamination.
8.15. Road accidents are covered by no-fault Israeli insurance. Work accidents are covered by the National Health Insurance. AIM shall not compensate or cover expenses for an event in which a medical body,
insurance, government body or other institute in Israel is said to cover such expenses.
8.16. Does not include coverage for medical care or hospitalization with respect to active participation by the registrant in warlike, military, underground activities, revolution, revolt, riots, civil commotion, strikes, illegal activities, reckless behavior, intentional physical injury by the registrants exposing themselves to danger-except for the purpose of saving lives.
8.17. Shall not compensate or cover expenses in the event of a discovery of a case of fraud, deception or concealment relating to any matter influencing the presentation of a claim*.
8.18. Visits to emergency or urgent care centers after office hours requires a $10. or 40 shekel service charge. Visits to emergency or urgent care centers without referrals from the 24 hr. hotline physician on
duty, shall be reviewed and if deemed by the AIM Medical Director not to have been urgent, the individual or family will be responsible for the billing. The 24 hr. hotline is for emergencies only. Non-emergency phone calls will be billed to the family at the rate of $10. per call.
8.19. Acute and urgent care are defined as conditions that require medical attention and intervention within 12-24 hours.
8.20. AIM does not cover surgeries or treatments and testing which are deemed to be investigational, experimental for evaluation or for genetic testing or genetic counseling.
8.21 AIM does not cover immune-regulatory treatments i.e.: remicade,IV Gamma Globulin or rabies shots.
8.22. In events where the family is responsible for payments, when possible, the family will be contacted for consent and to arrange payments, prior to performance of services. In the event of emergencies or at any time after services are rendered, if services are determined to have been a pre-existing condition or excluded from coverage, the family will be responsible for payment without the prior consent and authorization for such service. In the event of any question, the decision of the AIM Administrator will be final.
8.23. The AIM Administrator reserves the right to challenge, dispute and/or revoke a prior determination of Medical Necessity based upon subsequent information obtained. The fact that treatment or supplies have been administered is not a guarantee of payment or eligibility of benefits. The AIM Administrator’s subsequent review shall remain subject to all Terms & Conditions, including exclusions for pre-existing conditions.
8.24. American Israel Medi-Plan is not an insurance plan but provides coverage through the AIM Healthnet Center and a group of participating physicians providing comprehensive private medical services in Israel.
8.25. Emergency Hospitalization and Emergency Medical care, subject to exclusions elsewhere in this agreement, means hospital or medical care that is provided for an injury or a sickness condition manifesting itself by acute symptoms of sufficient severity including without limitation sudden and unexpected severe pain for which the absence of immediate medical attention could reasonably result in:
a. Permanently placing the registrant’s health in jeopardy, or
b. Causing other serious consequences, or
c. Causing serious impairment to bodily functions.
8.26 Claims Procedures: When the AIM administrator receives notice of a claim it will provide the Registered Member with a claim form for filing Proof of Claim. The following items must be submitted to be
considered a complete Proof of Claim eligible for consideration of coverage
a. A duly completed and signed Claim Form; and
b. All original itemized bills from all physicians, Hospitals and other healthcare or medical service providers involved with respect to the claim; and
c. All original receipts for medical expenses with respect to the claim.
All items to be mailed to:
American Israel Medi-Plan, Inc.
75 N. Woodward Ave. #88294 Tallahassee, FL. 32313
The Registered Member shall have ninety (90) days from the date a claim is incurred to submit a complete Proof of Claim, and the AIM Administrator may deny coverage for Proofs of Claim submitted thereafter or for incomplete Proofs of Claims. No provider or other third party shall have any direct or indirect claim against AIM or the AIM Administrator
8.26.1 Fraudulent Claims: If any claim or request for benefits under this coverage shall be in any respect fraudulent or deceitful, or if the Registered Member or anyone acting for or on their behalf uses any
fraudulent or deceitful means or devices, all benefits and claims under this coverage shall be forfeited and waived, and the AIM Administrator, shall have no liability for such benefits or claims. No claim for benefits for which liability, eligibility, or coverage under this insurance has been denied in whole or in part by the AIM Administrator nor any other dispute or controversy arising under or related to this insurance shall be subject to arbitration under any circumstances or for any reason.
9. TERMINATION OF MEMBER REGISTRATION– The Member registration can be terminated at anytime by the AIM Administrator by giving at least thirty (30) days written notice to the registrant or the family member, also providing the same such notice to the School, or Yeshiva. Such termination will have no effect on the coverage prior to the date of the termination. No Evidence of coverage will be issued or renewals accepted after the date the Member registration is terminated.
10. OTHER INSURANCE– The American Israel Medi-Plan and the AIM Administrator shall not be obligated to provide any benefits or to pay any claim under the registered coverage, if there is any other
insurance, membership benefit, government program, reimbursement or indemnification coverage, recoupment or recovery, contract, or other third-party obligation or (“Other Coverage”) which would, or would but for the existence of the AIM coverage, be available or obligated to provide such benefit or to pay such claim, had the AIM coverage not been effected. The AIM Administrator shall not be obligated to provide any benefit or to pay any claim in respect to Treatment or supplies furnished by any program or agency funded by any government.
11. Cancellation: The date of cancellation will be the date AIM receives written confirmation the registrant has left Israel. In cases where students or tourists have left Israel, prior to the expiration date of the application, we try to accommodate and there are two options.
- You can receive a credit for the unused portion of the registration, less the administrative charge, and utilize this credit whenever the student returns to Israel.
- In the event you opt for a refund, for any reason, there is a $100.administrative processing charge and for each additional month of coverage there will be an additional charge of $65. for each month of coverage under the AIM Gold Plan and $85. for each month of coverage under the AIM Platinum Plan.
- In cases where Travel registrants decide to cancel the AIM Medical coverage there will be a 10% cancellation charge.
12. Explanation or verification of benefits – In the event of any verbal or telephone inquiry, every attempt will be made to help the participating member and his/her parents or guardian understand the status, scope and extent of available benefits and coverage under each of the AIM Medical Plans: provided, however, that no statement made by any employee or representative of AIM or the AIM Administrator, be deemed or construed to bind the AIM Administrator or to modify, replace, waive, extend or amend any of the terms and conditions and those of the Master Agreement unless expressly set forth in writing If a definite answer to a specific benefits or coverage question is required for any reason, the participating member may submit a written request to the AIM Administrator, including all pertinent information and a written reply will be sent by the AIM Administrator and kept on file.
If a definite answer to a specific benefits or coverage question is required for any reason, the participating member may submit a written request to the AIM Administrator, including all pertinent information and a written reply will be sent by the AIM Administrator and kept on file.
13. Renewal or extension of the medical coverage requires the written consent of AIM. It is hereby clarified that that upon termination of the medical coverage, the agreement shall not be extended automatically and not be extended by virtue of silence or any other action other than by written consent.The AIM Administrator reserves the right in its sole discretion to make changes additions and/or deletions to the Terms and Conditions and the Master Agreement, (including the issuance of Riders to effectuate same) at any time or from time to time, after the Effective Date of Coverage of the Master Agreement.
14. PRE-CERTIFICATION PROVISIONS/REQUIREMENTS- Pre-certification is a general determination of Medical Eligibility only, and all such determinations are made by the AIM Administrator in reliance and based upon the completeness and accuracy of the information provided by the Participating Member and/or his/her relatives, guardians and/or healthcare providers at the time of Pre-certification. The AIM Administrator reserves the right to challenge, dispute and/or revoke a prior determination of Medical Necessity based upon subsequent information obtained. Pre-certification is not an assurance, authorization, or verification of coverage, a verification of benefits, or a guarantee of payment. The fact that Treatment or supplies are Pre-certified by the AIM Administrator does not guarantee the payment of benefits or the amount or eligibility of benefits. The AIM Administrator’s consideration and determination of a Precertification request, as well as any subsequent review or adjudication of all medical claims submitted in connection therewith, shall remain subject to all Terms and Conditions of this Master Agreement, including exclusions for Pre-existing Conditions and other designated exclusions, benefit limitations, and the requirement that claims be Usual, Reasonable and Customary. Also, any consideration or determination of a Pre-certification request shall not be deemed or considered as the AIM Administrator’s approval, authorization or ratification of, recommendation for, or consent to any diagnosis or proposed course of Treatment. If the Participating Member complies with the Pre-certification requirements of this Master Agreement, and the Treatment or supplies are Pre-certified as Medically Necessary, the AIM Administrator will reimburse the Participating Member for Eligible Medical Expenses incurred in relation thereto, subject to all Terms of this coverage.
14.1 When requested by the AIM Administrator, registrants will first submit any claims to their primary insurnace carrier. Pre-certification by the primary insurance carrier is required for hospitalization, surgery, emergency medical, CAT scans and MRI’s. AIM reserves the option to settle all claims with the registrants primary or Israeli insurance carrier…
15. The Master Agreement can be terminated at anytime by giving at least thirty (30) days written notice to the participating member. Such termination shall have no effect on the coverage prior to the date of termination. No medical coverage will be issued or renewals accepted after the date the Master Agreement is terminated.
* This medical coverage is provided in accordance with the Terms and Conditions on the application and on www.aim.co.il and of this Master Agreement. The Terms and Conditions and the Master Agreement will determine what doctors’ visits and medical conditions will be covered. Perhaps more importantly, it will detail which visits and conditions will not be paid for. In all cases, the AIM Administrator will make the final determination of coverage and such decisions will be final. The Master Agreement is available upon request at any time by contacting the AIM Administrator at email@example.com.
* You, the enrolling member and AIM hereto expressly agree, that any and all disputes, claims or litigation arising from, or related in any way to this Agreement or any of its provisions shall be resolved, in the sole discretion of AIM, either by the Courts of the State of Israel or by the Courts of the State of New York, County of New York, U.S.A., in accordance with substantive law of the State of Israel or the State of New York, U.S.A., as the case may be. Under such circumstances, both parties waive any objections against and expressly agree to submit to the personal jurisdiction of the Courts of the State of Israel and the State of New York.The unsuccessful party in any such litigation will be responsible for court costs and reasonable attorney’s fees relating to such litigation.
MEDICAL COVERAGE IS ONLY FOR ILLNESSES OR INJURIES OCCURRING WITHIN THE STATE OF ISRAEL DURING THIS REGISTERED PERIOD.
REMEMBER: You are only covered for services authorized by your primary care physician at the AIM Healthnet Center or the physician on duty. Office hours at the center are Sundays to Thursdays 9:00am to 5:00pm and Fridays 9:00am to 12:00 noon. There is no billing for these visits, however, outside GP visits during office hours will have a $10.00 service charge applied. A physician is on duty for assistance and referrals each day at the 24 hour emergency hot-line:
Emergency Hot-line: 053-753-7111
This Terms & Conditions Statement was last updated on January 10, 2018. Please check back frequently to ensure you stay current in terms of your rights and our obligations pursuant to this Policy.