Jones Birdsong | Insurance Services

AMA RAMP Insurance Program Enrollment

Annual Accident Insurance Plan Cost
& Benefit Amounts

Plan 1 ($155.00)

$15,000 - Accidental Death & Dismemberment Principal Sum

$5,000 - Excess Accident Medical Expense Benefit

$2,500 - Medical Expense Deductible

Plan 2 ($210.00)

$20,000 - Accidental Death & Dismemberment Principal Sum

$10,000 - Excess Accident Medical Expense Benefit

$2,500 - Medical Expense Deductible

Plan 3 ($345.00)

$25,000 - Accidental Death & Dismemberment Principal Sum

$20,000 - Excess Accident Medical Expense Benefit

$2,500 - Medical Expense Deductible

Rider Accident Medical Plan

Accident Insurance Offered and Administered by Jones Birdsong LLP.

Please click on the link below to see the detailed information of the AMA RAMP Insurance Program.

>> AMA RAMP Program Information <<

Eligibility

All members of the AMA are eligible for coverage. Benefits are paid when a member has elected coverage and paid the required premium and then suffers a covered loss while taking part as a registered rider in an AMA amateur or road sanctioned event.

Member Information

AMA Member Number

Name

Select a Choice

Male Female

Date of Birth

Address

Phone Number - -

Beneficiary Designation

Beneficiary Name

Relationship

If you do not select a beneficiary, your accidental death benefits will be paid as shown in your Certificate of Insurance.

Terms and Signature

I hereby enroll in the Rider Accident Medical Plan underwritten by Federal Insurance Company a member insurer of the Chubb Group of Companies. I understand that my insurance coverage will be effective on the first day following the receipt of my enrollment form and initial premium. I have read the product brochure Description of Coverage and understand the terms, conditions, limitations and exclusions of the accident insurance program. Coverage is only in effect while I am participating in an event sanctioned by the AMA and the coverage is in force.

I, the undersigned, agree to the terms above.