Acute Plus Promotions, LLC AcutePlus™ Equine Membership Program
Brazos Valley Equine Hospitals, Navasota PLLC This is not insurance.
MEMBER TERMS AND CONDITIONS
The Plan will provide the following benefits:
Membership Plans
The Plan will provide for each of Your Horses listed on the Horse Ownership Schedule one of the following:
Core Medical Care, Surgical and Final Expense for horses between one (1) and eighteen
(18) years of age, (“Core Plan”). The Core Plan will credit the Owner for Medical Care and Surgery(ies) as set-forth on Exhibit A up to an aggregate annual amount of Five Thousand Dollars ($5,000) for each of Your Horses listed for the Core Plan during the applicable Coverage Period. In addition, the Core Plan will credit an Owner One Thousand Dollars ($1,000) for each of Your Horses listed for the Core Plan that dies during said Coverage Period; provided, however, that (i) any Plan death benefit shall be excess of any other equine mortality insurance in full force and effect for such horse at the time of its death; (ii) there shall be a no death benefit for any horse whose death arises out of or is in any way whatsoever related to a Chronic Condition and (iii) no Plan death payment will be made that would result in an Owner receiving a double benefit of any type whatsoever for the death of Your Horse.
Premier Medical Care, Surgical and Final Expense for horses between one (1) and eighteen (18) years of age. (“Premier Plan”). The Premier Plan will credit the Owner for Medical Care and Surgery(ies) as set-forth on Exhibit A up to an aggregate annual amount of Ten Thousand Dollars ($10,000) for each of Your Horses listed for the Premier Plan during the applicable Coverage Period. In addition, the Premier Plan will credit an Owner the lesser of Twenty Thousand Dollars ($20,000) or the fair market value of each of Your Horses listed for the Premier Plan that dies during said Coverage Period; provided, however, that (i) any Plan death benefit shall be reduced by and payable after any amount that the Owner receives from equine mortality insurance or any other benefit plan in full force and effect for such horse at the time of its death; (ii) there shall be no death benefit for any horse whose death arises out of or is in any way whatsoever related to a Chronic Condition and (iii) no Plan death payment will be made that would result in an Owner receiving a double benefit of any type whatsoever for the death of Your Horse.
Senior Medical Care, Surgical and Final Expense for horses between nineteen (19) and twenty-five (25) years of age (“Senior Plan”). The Senior Plan will credit the Owner for Medical Care and Surgery(ies) as set-forth on Exhibit A up to an aggregate annual amount of Five Thousand Dollars ($5,000) for each of Your Horses listed for the Senior Plan during the applicable Coverage Period. In addition, the Senior Plan will credit an Owner the lesser of One Thousand Dollars ($1,000) for each of Your Horses listed for the Senior Plan that dies during said Coverage Period; provided, however, that (i) any Plan death benefit shall be excess of any other equine mortality insurance in full force and effect for such horse at the time of its death; (ii) there shall be no benefit for any horse whose medical care, surgical care or death arises out of or is in any way whatsoever related to (1) a Chronic Condition, (2) Equine Cushings or (3) Equine Metabolic Syndrome and
(iii) no Plan death payment will be made that would result in an Owner receiving a double benefit of any type whatsoever for the death of Your Horse.
Membership Plan Benefits
The Core, Premier and Senior Plans will provide an Owner with the benefits set forth on Exhibit
B. Utilization through the Plan or provided proof of the current status of the Minimum Routine Benefits, as defined below, is a prerequisite for all Medical Care, Surgical and Final Expense credits under the Plan unless a medical waiver issued in writing by a licensed veterinarian is provided that prohibits adherence to the Minimum Routine Benefits for medical reasons.
Notwithstanding the foregoing and subject to all other terms and conditions herein, so long as Your Horse is current on Minimum Routine Benefits as provided by a licensed, In-Network Veterinarian, or within the past thirteen (13) months Your Horse has received the Minimum Routine Benefits from any licensed veterinarian that is not an In-Network Veterinarian and You can provide written proof thereof, Your Horse shall be eligible for Medical Care, Surgical and Final Expense credits under the Plan. A Vet Report must be provided before Medical Care, Surgical and Final Expense credits can be given.
How to access Your Benefits:
veterinary clinic account; no action is required by You.
CONSIDERATION EXCHANGE.
In return for receiving the applicable annual Core, Premier or Senior fee payment for each of Your Horses listed on the Horse Ownership Schedule, the Plan will credit You as explained in the below Plan terms, conditions, exclusions and limitations. Any failure to pay the Plan fee, however invoiced (either monthly or annually) and at the discretion of the Plan Administrator, may be considered a material breach and Your Horse may become ineligible for the Plan Benefits as a result of such breach.
DEFINITIONS.
Defined terms are in bold print throughout the Plan for ease of reading.
Set forth on the Member Benefits Schedule;
Consistent with symptoms or diagnoses;
Appropriate and meets generally accepted veterinary practice standards; 4. Not for the convenience of an Owner, a veterinarian or other provider; and
Consistent with the most appropriate supply or level of services which can safely be provided to the horse.
Traumatic Injury defined as an acute concussive Injury or Accident that effectively interferes with the normal biomechanics of the horse.
CREDITS.
Medical Care and Surgical
In the event Your Horse requires Medical Care and/or Surgery(ies) during the Plan Period, the Plan will credit You for all Reasonable and Customary Fees including Medication rendered as part of Acute Care by a licensed veterinarian and Hospitalization up to the applicable limit of credits set-forth on the Member Credit Schedule. However, any credit for Medical Care and/or Hospitalization shall be a maximum of 1) eighty percent (80%) if provided by an In-Network Veterinarian; 2) seventy percent (70%) if provided by an Out-of-Network Veterinarian and 3) forty percent (40%) for Diagnostic Test(s) including Bone scan, MRI and CT scan.
For Owners or Authorized Parties with three (3) or more concurrent member horses actively enrolled in the Premier plan, up to twenty-five (25%) of Medical Care and Surgical benefits may be stacked. Stacked Medical Care and Surgical benefits may only
be used for follow-up treatment associated with an approved incident that exceeds the individual plan limits for one of the active Premier plan member horses.
Final Expense
For members enrolling a new horse into one of the Plans, Your Horse must have received the Minimum Routine Benefits either from an In-Network Veterinarian or Out Of Network Veterinarian within thirty (30) days prior to the first day of the Plan Period or within the first thirty (30) days of the Plan Period. For any horse that received its Minimum Routine Benefits from an Out Of Network Veterinarian before the Plan Period started supporting documentation of the Minimal Routine Benefits must be provided. You shall be eligible to receive the equine Final Expense benefit pursuant to the Member Credit Schedule in the event of the death of Your Horse resulting from any Accident, Illness or Injury occurring after the first thirty (30) days of the Plan Period. No new horse enrolled in any Plan shall be eligible for a Final Expense benefit during its initial thirty (30) days of a Plan Period (this shall be known as the “Waiting Period”). Uninterrupted, consecutive renewal Plan Periods are not subject to the Waiting Period.
It is a condition precedent to any equine Final Expense benefit, however, that in the event of the death of Your Horse other than by euthanasia as set forth above that the Plan shall be given the opportunity at its own expense to arrange for and conduct a postmortem and necropsy examination of the deceased horse by a veterinarian chosen by the Plan.
EXCLUSIONS – MEDICAL CARE, SURGICAL AND FINAL EXPENSE.
Credit requests in any way arising from:
Any death, Injury or Illness of Your Horse intentionally caused by You or any agent of You.
Any treatments and/or elective procedures, Vaccinations, cosmetic procedures, preventive procedures, performance enhancing treatments or procedures, joint injections, or procedures normally associated with the maintenance of a healthy animal.
Any diseases (such as internal parasites) preventable by Vaccination or deworming.
Any complications of Conditions excluded or limited by this Plan.
Abnormalities where Clinical Symptoms were apparent prior to the applicable Coverage Period. This includes Conditions that are or would be detectable by a routine physical examination by a licensed veterinarian.
Arising from the lack of use and/or implementation of preventive health care products
and/or methods where such products and/or methods would be in accordance with generally accepted veterinary standards. Preventive healthcare includes: Vaccinations, deworming, dental care, regular farrier services, grooming and prudent regular care.
Arising from special diets, horse foods, vitamins, supplements, grooming, farrier, shampoo and bathing (including medicated baths) not at the direction of any veterinarian.
Arising out of nuclear fission, nuclear fusion, or radioactive contamination.
Any experimental or investigational treatments or Medications.
Breeding, castration, or postoperative complications associated with any aspect of breeding or foaling, or any Condition relating to breeding.
Feeding or housing.
Any Illness or Injury arising from Your decision to not follow any veterinarian’s advice.
Any Core, Premier or Senior Membership Plan benefit that arises out of Your Horse being entered or raced in any claiming, selling, or combination race at any time during the applicable Plan Period.
Any birth defects, developmental conditions, growth conditions, nutritional conditions, and congenital conditions, including but not limited to, undescended testicles, umbilical hernia, epilepsy, glaucoma, cataracts, and blindness, irrespective of whether said defects and conditions are evident or have manifested themselves prior to the Plan Period.
Any intentional destruction of Your Horse other than as provided for in the Core, Premier or Senior Membership Plan.
GENERAL CONDITIONS.
The applicable Plan fee payment for each of Your Horses listed on the Horse Ownership Schedule is due and payable monthly by credit or debit card through the Plan website. The Plan Period shall commence upon the payment of the first month’s fee and shall be for a term of one (1) year, subject to the Member’s payment of the Plan fee and all other terms and conditions described herein. However, the Plan shall only credit for Medical Care and Surgeries arising out of any Accident, Injury or Illness that first occurs thirty (30) days after the Plan Period commences. Uninterrupted, consecutive renewal Plan Periods are not subject to an additional waiting period. In addition, any failure to pay in full the applicable monthly Plan fee for any of Your Horses listed on the Horse Ownership Schedule will result in no further Plan benefits of any type whatsoever for said horse unless the Plan Sponsor, in its sole discretion and upon terms and conditions acceptable to the Plan Sponsor, agrees to reinstate the applicable Plan for the horse.
You must be the Owner of Your Horse. If an Owner dies, becomes unable to care for his/her horse(s) or ownership or medical responsibility of Your Horse passes to another, the Plan will continue without interruption, if, and only if, (i) the Plan Administrator and Plan Sponsor are notified in writing of the transfer of ownership (or the owner’s incapacitation) and are able to verify such prior to the administration of any additional benefits, and (ii) payment for the Plan is current. Should payment for the Plan not be current at the time ownership or medical responsibility for Your Horse changes hands, Your successor may bring payment current within thirty (30) days from the date of the transfer of ownership or medical responsibility at which point your successor shall be deemed the Owner of Your Horse and eligible for all benefits under the Plan. Should your successor fail to bring the account current within the first thirty (30) days of the successor’s ownership of Your Horse, Your Horse will not be eligible for any benefits under the Plan. Any transfer of ownership or change in ownership representation or change in medical responsibility that is recognized by the Plan Administrator and Plan Sponsor is subject to all other terms and conditions of this Plan.
A horse is covered under this Plan only (i) if it is listed on the Horse Ownership Schedule, (ii) during the applicable Plan Period for said horse, and (iii) the applicable monthly Plan fee has been paid for said horse.
During the Plan Period you must implement all reasonable means possible in the care and protection of Your Horse(s), and undertake all necessary means to protect Your Horse(s) from aggravation and/or recurrence of any Injury, Illness or disease after onset of any Injury, Illness or disease.
A condition precedent to any credit under the Plan is that Your Horse is in sound health and free from any Illness, disease, lameness, Injury, or disability of any type whatsoever at the start of the Plan Period.
Notice of a credit request for Medical Care and Surgical under this Plan must be given by You or Your agent to the Plan Administrator as soon as practicable, but in no event later than thirty (30) days after the Medical Treatment is rendered.
As a condition precedent to any Final Expense benefit, you or your agent must have
called, regardless of day or time, the Plan Administrator at 1-855-502-7587. In the event of unexplained death of Your Horse you must notify the Plan Administrator within three (3) hours. In the event that euthanasia is required you must call the Plan Administrator prior to euthanasia, approval from the Plan Administrator is required. Failure to provide this notice may result in the denial of a Final Expense benefit.
Any credit under the terms and conditions of the Plan will be made either at the time of service, but not later than ninety (90) days after submission of the request unless applicable state law provides for a shorter period.
In order to process a request for a credit, You must allow the Plan Sponsor or Plan Administrator to contact any of Your previous veterinarians and provide the Plan Sponsor or Plan Administrator with the necessary written authorization to obtain all information and/or documentation the Plan Sponsor or Plan Administrator may reasonably require. In the event information/documentation relating to the history of the horse is missing or incomplete, the request for a credit will not be processed.
In the event of any disagreement between You and the Plan Sponsor with regards to a credit request, the matter will be referred to an independent third-party veterinarian selected by the Plan Sponsor. This independent third-party veterinarian’s decision shall be final and binding on all parties.
Every action or proceeding of any type whatsoever against the Plan Sponsor and/or Plan Administrator for a benefit by virtue of these Terms is absolutely barred unless commenced within ninety (90) days after the end of the last Plan Period set forth on the Horse Ownership Schedule unless applicable state law requires a longer period.
The Plan is excess and non-contributory over any other plan or insurance of any type whatsoever available to Your Horse for any Medical Care that is covered by both the Plan and any other plan or insurance.
ADDITIONAL CONDITIONS.
Misrepresentation and Fraud. This Plan is null and void if You intentionally or negligently have concealed or misrepresented any material fact or circumstance of any type whatsoever concerning this Plan or Your Horse(s). The Plan does not provide any credits or benefits for any Owner who has concealed or misrepresented any such material facts or circumstances at any time whatsoever. The Plan Administrator and/or Plan Sponsor have the right to reject any membership or benefits should such person or entity have a history of misrepresentation, fraud, or animal neglect or abuse.
State Law/Dispute Resolution. This Plan shall be governed by the laws of the State of Florida. Any dispute arising out of or related to these Terms shall be resolved solely via arbitration conducted pursuant to the Commercial Rules of the American Arbitration Association. Exclusive venue for any hearing or proceeding shall be in Palm Beach County, Florida. Each Member, Veterinarian, the Plan Administrator, and Plan Sponsor consents to Palm Beach County as its sole venue.
Entire Contract. This Plan contains the full and complete agreement between You and the Plan Sponsor.
Limitation of Liability. TO THE MAXIMUM EXTENT PERMITTED BY LAW, THE PLAN SPONSOR AND PLAN ADMINISTRATOR SHALL NOT BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, INDIRECT, PUNITIVE, INCIDENTAL, OR SPECIAL DAMAGES, LOSS OF PROFITS, DATA OR REVENUES, OR OTHER INTANGIBLE LOSSES, ARISING OUT OF OR RELATED TO ONE’S MEMBERSHIP, USE OF THE WEBSITE, OR MAINTENANCE OF ONE’S PERSONAL INFORMATION.
Other Websites. The Plan Administrator’s website may contain links to third-party websites or services that are not owned or controlled by the Plan Administrator. The Plan Administrator has no control over, and assumes no responsibility for, the content, privacy policies, or practices of any third-party websites or services. Thus, You agree that the Plan Administrator shall not be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with use of or reliance on any such content, goods or services available on or through any such websites or services.
Changes. The Plan Administrator reserves the right, in its sole discretion, to modify or replace these Terms at any time. If a revision is material, the Plan Administrator will try to provide at least 30 days’ notice prior to any new terms taking effect. What constitutes a material change will be determined in the Plan Administrator’s sole discretion.
Exhibit A: Membership Credit Schedule
|
Core |
Premier |
Senior |
Annual Per Horse Aggregate Limits of Liability |
$5,000 |
$10,000 |
$5,000 |
Annual Per Horse Fee if Paid Annually |
$1,282 |
$3,163 |
$1,987 |
Monthly Per Horse Fee if Not Paid Annually |
$109 |
$269 |
$169 |
Covered Illness / Injuries / Services - Membership Plan Limits per Occurrence up to Annual Per Horse Aggregate Limits of Liability |
|||
Colic - Surgical |
$5,000 |
$10,000 |
$5,000 |
Colic – Non-Surgical |
$2,500 |
$5,000 |
$2,500 |
Traumatic Injury |
$5,000 |
$10,000 |
$5,000 |
Fracture |
$5,000 |
$10,000 |
$5,000 |
Upper Respiratory Infection / Pneumonia |
$1,250 |
$2,500 |
$1,250 |
Lacerations / Abrasions / Punctures / Wounds Requiring Sutures |
$750 |
$1,500 |
$750 |
Subsolar Abscess |
$500 |
$1,000 |
$500 |
Acute Onset Laminitis |
$750 |
$1,500 |
$750 |
Enteritis / Colitis |
$1,000 |
$2,000 |
$1,000 |
Choke / Esophageal Obstruction |
$750 |
$2,000 |
$750 |
Tendon or Ligament Tear / Structural Damage |
$1,000 |
$2,000 |
$1,000 |
Ophthalmic Injury – Non-Surgical |
$500 |
$1,000 |
$500 |
Ophthalmic Surgery |
$1,500 |
$3,000 |
$1,500 |
Barn call fees associated with an approved medical incident. |
$50 |
$50 |
$50 |
Medically Necessary Diagnostics that are part of immediate care* |
$2,000 |
$4,000 |
$2,000 |
* Bone Scan, MRI and CT Scan require pre-approval from Plan Sponsor. The maximum credit is forty percent (40%) of the actual reasonable and necessary scan charge up to the maximum diagnostic benefit listed in Schedule A. Credit will be applied to diagnostics directly related to new Illness, Injury or Accident. No credit will apply to diagnostics directly related to imaging of an existing Chronic Condition.
Exhibit B: Membership Routine Care Schedule
Member Routine Benefits |
Core Plan |
Premier Plan |
Senior Plan |
In-Network Veterinarian |
Out-Of-Network Veterinarian* |
Loyalty Points |
Yes |
Yes |
Yes |
1 pt per $1 spent; $0.02 per pt redemption |
No Benefit |
Digital Records |
Yes |
Yes |
Yes |
Full Benefit |
Limited Benefit |
Microchip |
1 |
1 |
1 |
Up to $100 |
No Benefit |
Exam - Physical Exam |
1 |
1 |
1 |
Up to $105 |
Up to $95 |
Vaccine - Flu/Rhino |
2 |
2 |
2 |
Up to $40 |
Up to $37 |
Vaccine - EEE/WEE/WN |
1 |
1 |
1 |
Up to $85 |
Up to $60 |
Vaccine - Tetanus |
1 |
1 |
1 |
Up to $12 |
Up to $12 |
Vaccine - Rabies |
1 |
1 |
1 |
Up to $20 |
Up to $15 |
Vaccine - Herpes |
1 |
1 |
0 |
Up to $32 |
Up to $28 |
Vaccine - Strep |
1 |
1 |
0 |
Up to $48 |
Up to $40 |
Test - Coggins Test |
1 |
1 |
1 |
Up to $50 |
Up to $45 |
Test - Endocrine (CBC, Chemistry, Insulin and Fasting ACTH) |
0 |
0 |
1 |
Up to $350 |
Up to $300 |
Test - Fecal Egg Count |
1 |
1 |
1 |
Up to $35 |
Up to $30 |
Dental Float (Tranquilization) |
0 |
1 |
0 |
Up to $65 |
Up to $50 |
Dental Float |
0 |
1 |
0 |
Up to $186 |
Up to $150 |
Barn Call for Routine Care - Up to $50** |
1 |
2 |
1 |
Up to $50 |
No Benefit |
* Lesser of actual charge or amount set-forth above.
** Only applies to Barn Calls for Routine Care performed by Plan Sponsor.
Exhibit C: In-Network Veterinarian List In-Network Veterinarians:
All veterinarians who are employed by:
Brazos Valley Equine Hospitals, Navasota PLLC 6999 Hwy 6
Navasota, TX 77868
(936) 825-2197
All veterinarians who offer the AcutePlus program Plans to their customers and have an executed administration agreement with the Plan Administrator that is in full force and effect.
Doctors:
Ben Buchanan, DVM, DACVIM, DACVECC Terrell “T-Bone” Buchanan, DVM
Ricci Karkula, DVM, MS, cVMA Weston Warnock, DVM, DACVS-LA Ted Kellerman, DVM
Kyle Grogger, DVM Meghan Murphy, DVM Sara Nerz, DVM Natalie Heite, DVM Jon Johnson, DVM
Exhibit C: Horse Ownership Schedule
Owner |
Horse Name |
Age |
Plan Period Plan |
Fee |
Paid |
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