Valley Regional Hospital

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Benefits Proudly Offered to Valley Regional Hospital Employees

Be fully prepared and confident

with LegalEASE

Learn about legal benefits, a smart option for your protection.

LegalEASE can help ease the two biggest stresses -finding and paying for an attorney.

Nobody likes to be caught off guard, especially when it comes to legal matters. Life can be complicated. Finding a good attorney doesn’t have to be. With LegalEASE, it’s easy to choose the best attorney, because you get assistance from highly trained and qualified personal specialists who review the details of local attorneys and help you find your best source for legal advice. Being a LegalEASE member saves you time and costly legal fees. But most importantly, it gives you confidence and provides coverage for common legal matters.

With a LegalEASE plan, you get:

An attorney with expertise specific to your legal matter
Access to a national network of attorneys with exceptional experience that are matched to meet your needs
Coverage for in and out-of-network
Concierge help finding a better attorney and navigating common individual or family legal issues
Hours of financial counseling and coaching

We all make some sort of plan in life. But have you ever considered the possibility of a legal problem?

You've graduated from college and are planning for your future - where to get hired, which company will put you on the path to success. Whether to be single or date or settle down, and with the right person. Legal problems can be unexpected and interrupt your plans. LegalEASE provides coverage for your specific legal matter so you won't be caught off guard.

Protect your family’s future, with LegalEASE.

You work hard to make the right choices for your loved ones, especially when it comes to legal and financial matters. Get the peace of mind you want and the protection you need with a LegalEASE Plan. LegalEASE offers valuable benefits to shield your family and savings from unexpected legal issues.

According to the American Bar Association, more than 70 percent of U.S. households will have the need for a lawyer in the next 12 months. And the same study found most consumers feel uncertain about how to tell a good lawyer from a bad one. With LegalEASE you have access to a national network of credentialed attorneys and the help you need to find the best attorney for your legal matter with its concierge service.

Coverage

The Value of a LegalEASE Benefits Plan.

Being a LegalEASE benefits plan member saves you time and costly legal fees. But most importantly, it gives you confidence and provides coverage for:

Home and Residential
Financial and Money Matters
Consumer
Auto and Driving
Family and Personal
Civil Lawsuits
Estate planning and wills

LegalEASE Benefits Plan Coverage

Benefits are designed to meet the typical needs of a colleague and their family. There are no deductibles to worry about for covered services. Benefits cover the attorney’s time. Other costs such as filing fees or court costs are not covered. Listed below are the types of matters that are covered by the LegalEASE benefits plan. This plan offers the convenience of in-network and out-of-network benefits. Many of the below areas are fully covered in-network.

Plan Cost

The LegalEASE Plan is $8.96 per pay-period, via payroll deduction, based on a 26 pay-period deduction schedule.

Who's Covered?

The Member’s Covered Spouse and the Member’s children, including stepchildren, legally adopted children, children placed in the home for adoption and foster children, up to age 26.

Schedule of Benefits
Advice and Consultation	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
LegalEASE Helpline	Covered	Not Applicable
Initial Law Office Consultation - one hour per calendar quarter	Covered	Not Applicable
Review of Simple Documents - Review of documentation up to 6 pages	Covered	Not Applicable
Financial Advisor	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Financial Helpline	Covered	Not Applicable
Identity Theft Assistance	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Advice and Consultation	Covered	Not Applicable
Miscellaneous Services	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Legal Services for any non-excluded legal matter not specifically covered in the Schedule of Benefits up to 10 hours per year	Covered	$60/hour
Discounted Legal Services for any non-excluded legal matter	25% Discount on Participating Attorney's Hourly Rates	Not Applicable
Consumer Matters	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Document Preparation: Simple Deed Promissory Note Consumer Dispute Correspondence Installment Sales Agreement Simple Affidavit General Power of Attorney: Member & Family Member Lease Agreement - Tenant only Time Share Agreement	Covered	$65 $55 $55 $55 $55 $55 $65 $55
Consumer Dispute	Covered	$595
Small Claims Court Reprsentation	Covered	$300
Mail Order or Internet Purchase Dispute	Covered	$300
Bank Fee Dispute	Covered	$300
First-time Vehicle Buyer	Covered	$300
Vehicle Repair and Lemon Law Litigation	Covered	$300
Cell Phone Contract Dispute Contract review up to 6 pages Representation	Covered	$300
Personal Property Protection	Covered	$300
Warranty Dispute Warranty review up to 6 pages Representation	Covered	$300
Healthcare Coverage Disputes and Records Office consultation up to 5 hours Review of Health Care Policy Review/preparation of document up to 5 pages	Covered	$300
Identity Theft Defense	Covered	$850
Estate Planning	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Simple Will or Codicil for: Member Spouse Family Member	Covered	$80
Complex Will	Covered	$310
Living Will/Health Care or Advance Directive	Covered	$55
Health Care or Medical Power of Attorney	Covered	$55
Revocable or Irrevocable Living Trust Document	Covered	$310
Probate of Small Estate	Covered subject to Managed Case Rules*	$1,275 maximum subject to Managed Case Rules*
Elder Law	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Will Preparation	Covered	$80
Living Will/Health Care or Advanced Directive	Covered	$55
Durable Financial Power of Attorney	Member co-pay $45 per document	Not Applicable
Health Care or Medical Power of Attorney	Member co-pay $45 per document	Not Applicable
Elder Law Matters	Covered	$425
Residential Matters	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Purchase of Primary Residence	Covered	$490
Sale of Primary Residence	Covered	$365
Refinancing of Primary Residence	Covered	$385
Vacation or Investment Home Sale/Purchase/Refinancing	Covered	$425
Home Equity Loan Assistance	Covered	$360
Property Tax Assessment	Covered	$360
Tenant Dispute	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
Tenant Security Deposit Dispute	Covered	$850
Landlord Dispute with Tenant Pre-litigation Trial	Pre-litigation: Covered up to 10 hours with remainder at 25% discount Trial: Covered up to 10 hours with remainder at 25% discount	Pre-litigation: $595 Trial: $595
Security Deposit Dispute with Tenant	Covered up to 10 hours with remainder at 25% discount	$595
Construction Defect Dispute	Covered	$425
Neighbor Dispute	Covered	$765
Noise Reduction Dispute	Covered	$765
Boundary or Title Dispute	Covered	$595 maximum subject to Managed Case Rules*
Zoning Application	Covered	$595
Financial Matters	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Debt Collection Defense Pre-litigation defense activities Trial defense	Covered	$425 $850
Garnishment Defense	Covered	$850
Bankruptcy (chapter 7 or 13)	Covered	$935
Foreclosure	Covered	$680
Tax Audit	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
Tax Defense	Covered	$850
Student Loan Refinancing/Collection Defense	Covered up to 7 hours with remainder at 25% discount	$420
Repossession Defense	Covered	$850
Family	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Separation, Divorce, Civil Annulment Uncontested Separation Consent/default Divorce Uncontested Divorce	Covered	$595
Contested Divorce	Covered up to 28.5 hours with remainder at 25% discount	$1,700 maximum subject to Managed Case Rules*
Post-Divorce Proceedings	Covered up to 28.5 hours with remainder at 25% discount	$1,700 maximum subject to Managed Case Rules*
Prenuptial Agreement	Covered	$680
Name Change	Covered	$255
Guardianship/Conservatorship	Uncontested: Covered Contested: Covered	$365 $765
Governmental Agency Adoption	Uncontested: Covered Contested: Covered	$365 $765
Stepparent Adoptions	Uncontested: Covered Contested: Covered	$365 $765
Child Custody/Support Involving Never-Married Parents of a Child	Covered up to 28.5 hours with remainder at 25% discount	$1,700 maximum subject to Managed Case Rules*
Protection from Domestic Violence	Covered	$595
Juvenile Court Proceedings	Covered	$470
School Administrative Proceeding	Covered	$425
Immigration Assistance	Covered up to 10 hours with remainder at 25% discount	$595
Parental Responsibility Matters	Covered	$595
Civil	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Civil Litigation Defense	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
Incompetency Defense	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
Administrative Hearing Representation	Covered subject to Managed Case Rules*	$1,275 maximum subject to Managed Case Rules*
Discounted Contingency Fees	10% discount on state maximum, or a maximum of 29% pre-trial, 36% at trial, or 40% in an appeal	Not Applicable
Mediation	10% discount on Mediator’s hourly rates	Not Applicable
Criminal Defense	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Traffic Ticket	Covered	$215
Serious Traffic Matters (resulting in suspension or revocation of license)	Covered	$425
Administrative Proceeding (Regarding Suspension or Revocation of License)	Covered	$255
Habeas Corpus Proceedings	Covered	$850
Misdemeanor Defense	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
DUI/DWI Defense	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*

Limitations apply.

The policy language listed herein is intended to provide a general overview of a typical LegalEASE policy. Please see your LegalEASE policy for specific coverage amounts and exclusions.

* Managed Case Rules

In cases deemed by Us to be complex, Managed Case Rules may be used to approve additional coverage beyond the standard Participating Attorney maximum fees or to ensure that Non-Participating Attorney fees are reasonable and customary. Managed Case Rules provide protection for Members by limiting or preventing additional charges that Members would otherwise be responsible for. Managed Case Rules may be enacted prior to or after the initial consultation. Managed Case Rules require the following:

1. The Member should contact the Member Service Center prior to proceeding with an attorney. If the Member understands from the attorney that there may be additional charges beyond the covered charges under the Contract and the Member does not contact the Member Service Center prior to proceeding with the attorney, then the Member may be responsible for those additional charges beyond the covered charges under the Contract, even on a Paid In Full benefit.

2. If it is determined that the complexity of the case may require additional hours beyond the standard Participating Attorney maximum, or that the Non-Participating Attorney charges are higher than reasonable and customary fees, the attorney must provide a written estimate of fees reflecting his or her best judgment as to the likely cost of legal services based on the expected conduct of the case.

3. We will set a maximum attorney fee that takes into consideration the reasonable level of reimbursement of 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.

Exclusions

The following benefits are excluded:

Appellate court proceedings, class actions, interventions, malpractice proceedings, actions in which punitive damages are being sought, derivative actions 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 arising out of a Member/Covered Family Member’s role as an officer or director of an organization 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-

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producing property. A multi-family residence, whether or not used by the Member/Covered Family Member as his or her primary residence, is deemed an investment or income-producing property.

Legal services that 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 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 awarded as part of a judgment, exhibits, deposition costs, filing fees, transcripts, postage, telephone, photocopying, recording fees, messengers, judgments, jury fees, court reporter fees, investigative costs, arbitrator fees, and all other incidental and out-of-pocket legal and litigation costs.

Any services on behalf of a Covered 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, and age discrimination.

Any dispute or proceeding against the following persons or entities, their officers, directors, employees, or agents: any person or entity involved in the sale, marketing, administration or other processes related to the Contract; Legal Plan Administrator or its subsidiaries; Contractholder; Member’s employer; Virginia Surety Company, Inc. and it’s parents, subsidiaries or any affiliated or successor company, plan underwriter or reinsurer; or any Participating and/or Non-Participating Attorney, if the dispute or proceeding pertains to services provided under the Contract.

Except for consultation, the Contract will not provide benefits in connection with pre-existing matters, which includes any matter where the Member/Covered Family Member is on notice as to a pending legal dispute or has previously contacted an attorney.

The Contract does not allow benefits listed under the Covered Services section to be combined for one legal matter.

Where there are specific hours or dollar amounts provided in the Contract, or where a maximum is set under the Managed Case Rules, the Member will be responsible for all attorney fees incurred which exceed the maximum. Additional exclusions related to each benefit are included in the Covered Services.

Definitions

Definitions

“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; or the Member owns a business that will continue in operation after death; or the Member wants to put restrictions on what heirs may do with the property; or 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; or the Member thinks that someone will challenge the will; or the Member wants to exclude any lawful dependents.

“CONTESTED DIVORCE” - refers to a divorce proceeding that requires more than 5 hours of attorney time, and involves disputed issues and both parties are represented by an attorney.

“CONTRACT” - means the Legal Expense Service Contract and the Certificate of Coverage.

“CONTRACTHOLDER” - means the organization named in the declarations page.

“COVERED FAMILY MEMBER” – means the Member’s Covered Spouse and the Member’s children, including stepchildren, legally adopted children, children placed in the home for adoption and foster children, up to age 26.

“COVERED SPOUSE” - means the Member’s lawful spouse at the time the coverage is in effect.

“DURABLE FINANCIAL POWER OF ATTORNEY” –a legal document that allows an individual to appoint another person to manage the individual’s finances in the event that he/she is unable to do so him/her self.

“EFFECTIVE DATE” - means the date the Member’s coverage hereunder begins.

“ELIGIBLE PARENT” – means the parents of the Member or Covered Spouse, regardless of age, and includes, biological parents, step-parents and adoptive parents.

“HEALTH CARE COVERAGE” – means coverage of a Member under any health care or health insurance policy or any policy that covers as its primary function any aspect of an individual’s health.

“HEALTH CARE OR MEDICAL POWER OF ATTORNEY” – A legal document that allows an individual to appoint another person to make medical decisions in the event the individual is unable to do so him/her self.

“INTERNET PURCHASE” - A purchase of goods or services whose cost is over $200.00 at the time of purchase by a Member from a website on the Surface Web, as defined.

“LEGAL PLAN ADMINISTRATOR” – LegalEASE, its affiliates, officers, directors, employees, and/or agents, including third party organizations and their affiliates, officers, directors, employees, and/or agents, hired by LegalEASE to perform services under the Contract.

“LIVING WILL/ HEALTH CARE OR ADVANCE DIRECTIVE” – A legal document that outlines an individual’s preferences for medical treatment and which takes effect only when the individual becomes incapacitated and can no longer express his or her wishes.

“MEMBER” - refers to the individual who (a) is associated with the Contractholder, (b) has either made a payment or had payment made on his or her behalf, and (c) meets the eligibility requirements for Covered Services as defined by the Contractholder.

“MEMBER SERVICE CENTER” - means the service location established to assist Members/Covered Family Members in making full use of the coverage.

“NEIGHBOR” – A person whose residence is located on a property that directly abuts the property on which a Member’s residence is located.

“NON-PARTICIPATING ATTORNEY” - means an attorney not contracted by the Legal Plan Administrator who is selected and paid by the Member to provide covered legal services up to the maximum amount shown under the Non-Participating Attorney column of the Schedule of Benefits.

“PAID IN FULL” - means complete payment in full to a Participating Attorney for covered legal services.

“PARTICIPATING ATTORNEY” - means an attorney contracted by the Legal Plan Administrator to provide covered legal services at the amount shown under the Participating Attorney column of the Schedule of Benefits.

“PERSONAL PROPERTY” – means any property that is not Real Property and which does not produce income.

“REAL PROPERTY” – means land and all permanent structures attached thereto.

“SURFACE WEB” – means the portion of the World Wide Web that is readily available to the general public and searchable via standard web search engines.

“WAITING PERIOD” – means the period after the Effective Date during which certain benefits as shown in the Schedule of Benefits may not be used. This includes any matter that arises prior to the end of the Waiting Period.

“WE”, “US”, “OUR” AND “COMPANY” - means Virginia Surety Company, Inc.

Covered Services

In consideration of payment and receipt by Us of the applicable payments, all Covered Services are available to the Member and all Covered Family Members, except as specifically noted below. The following Covered Services are provided 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 telephone with a Participating Attorney. Services are available during normal business hours. Calls can relate to any personal legal matter, civil or criminal, except those specifically excluded.

Initial Law Office Consultation:

Up to the maximum as shown in the Schedule of Benefits for office consultations with an attorney on any personal legal problem, civil or criminal, except those specifically excluded.

Review of Simple Documents:

This benefit includes attorney review, verbal explanations of the meaning or impact of any form or document, or suggestions for changes to a form or proposed 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.

Miscellaneous Law Office Services

Legal Services for any Non-Excluded Legal Matter:

This benefit will cover any legal services to review and/or prepare documents, or any other service required on any legal matters not listed as a Covered Service or Exclusion.

This benefit is limited to the maximum number of hours shown on the Schedule of Benefits per year.

Discounted Legal Services for any Non-Excluded Legal Matter:

This benefit will cover any legal services to review and/or prepare documents, or any other service required on any legal matters not listed as a Covered Service or Exclusion.

Consumer Matters

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
Simple Affidavit.
General Power of Attorney
Lease Agreement (for the Member/Covered Family Member as a tenant only)
Time Share Agreement

This benefit is limited to one use per year per document per Member/Covered Family Member.

Consumer Dispute:

Consultation or representation in a dispute relating to consumer goods and services (not directly or indirectly related to real estate construction or renovation, or landlord/tenant disputes).

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. (Attorney may not be permitted to attend court hearings in some jurisdictions).

This benefit is limited to one use per year.

Mail Order or Internet Purchase Dispute:

The services of an attorney to review the nature of any mail order or Surface Web Internet Purchase dispute involving the purchaser prior to the commencement of litigation. This service includes the consultation with the attorney and review and/or preparation of purchase documents and/or dispute letters. If litigation is commenced in this matter, the benefit will cover up to the maximum shown on the Schedule of Benefits.

This benefit is limited to one dispute per year.

Bank Fee Dispute:

The services of an attorney to review the nature of any (non-business related) bank fee dispute between the Member and their bank prior to the commencement of litigation. This service includes the consultation with the attorney and review and/or preparation of purchase documents and/or dispute letters. If litigation is commenced in this matter, the benefit will cover up to the maximum shown on the Schedule of Benefits.

This benefit is limited to one dispute per year.

First-time Vehicle Buyer:

The services of an attorney for the purchase of a first vehicle. This service includes the consultation with the attorney at or before closing and/or review and/or preparation of purchase and finance documents.

This benefit is limited to one vehicle purchase per year and must be the first vehicle purchase of the Member/Covered Family Member.

Vehicle Repair and Lemon Law Litigation:

Services related to the representation of a Member who is entitled under the applicable state “lemon” law to bring a civil lawsuit (non-business related), up to and including the trial thereof related to a defective car as defined in the applicable state law. This benefit does not apply to: (1) any lawsuit related to matters that are not specifically listed under the provisions of the applicable state fraud laws; (2) lawsuits normally handled on a contingent fee basis; (3) any action for or defense against a collection or related matter; or (4) matters for which the Member has or is required by law to have insurance.

This benefit is limited to one use per year.

Cell Phone Contract Dispute:

Review of the cell phone contract where the 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 maximum number of pages shown on the Schedule of Benefits. This benefit does not include a written analysis or explanation of any form or document.

In the event of a dispute over the terms of the agreement between the cell phone company and the Member, this benefit provides for representation in a dispute relating to the cell phone contract only if the Member has been sued or named in a small claims court action. This service covers counseling on prosecuting a small claims court action; helping the Member prepare documents; advising on evidence, documentation and witnesses; and preparing the Member for trial. The service does not include the attorney’s attendance or representation at a small claims trial, collection activities after a judgment or any services relating to post-judgment actions.

This benefit is limited to one use per year.

Personal Property Protection:

Services cover counseling over the phone or in the office on any Personal Property issue, including consumer credit reports, contracts for the purchase of Personal Property, consumer credit agreements or installment sales agreements. Counseling on pursuing or defending small claims actions is included. The benefit includes reviewing personal legal documents and preparing promissory notes, affidavits and demand letters.

This benefit is limited to one use per year.

Warranty Dispute:

Review of the warranty policy or service contract where the 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, up to the maximum number of pages shown on the Schedule of Benefits. This benefit does not include a written analysis or explanation of any form or document.

In the event of a dispute over the terms of the agreement between the warranty company and the Member, this benefit provides representation in a dispute relating to the warranty or service contract

only if the Member has been sued or named in a small claims court action. This service covers counseling on prosecuting a small claims court action; helping the Member prepare documents; advising on evidence, documentation and witnesses; and preparing the Member for trial. The service does not include the attorney’s attendance or representation at a small claims trial, collection activities after a judgment or any services relating to post-judgment actions.

This benefit is limited to one use per year.

Health Care Coverage Dispute and Records:

Up to the maximum as shown in the Schedule of Benefits for office consultations with an attorney on any Health Care Coverage dispute, civil or criminal, involving a coverage, benefits, or privacy matter that arose while the health care or health insurance policy was in effect (as defined by the terms of that health care or health insurance policy). For a definition of Health Care Coverage, please see the Definitions section.

This benefit is designed to help the Member understand health care law provisions and coverages based on the federal and/or state version of this law AAPACA, and to prepare a bona fide defense to any denials in coverage valued at more than $1,000.00 in covered medical services under the policy in dispute. This benefit is not intended to provide representation in litigation and does not include collection defense or other actions related to medical bills or payments.

This benefit also includes the review of simple health care policy coverage documents and the attorney will verbally explain the meaning or impact of any policy or related document, or make suggestions for dispute letters or documents 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 or explanation of any form or document but does include the preparation of any of the following documents, up to the maximum number of pages shown on the Schedule of Benefits: policyholder dispute correspondence, and simple affidavit. Partial documents cannot be reviewed or prepared, and if the document other than the actual health care coverage policy is more than the maximum number of pages shown in the Schedule of Benefits, the benefit does not apply.

This benefit is limited to one use per year.

Identity Theft Defense:

Services related to the representation of a Member regarding potential creditor actions resulting from identity theft, and attorney services as needed to contact creditors, credit bureaus and financial institutions. It also provides defense services for specific creditor actions over disputed accounts.

This benefit is limited to one use per year.

Estate Planning

Will or Codicil Preparation:

Preparation of one will or codicil (an amendment to an existing will), including the preparation of a simple testamentary support trust for the dependent children:

Will Preparation: Attorney shall prepare a will or codicil and discuss the legal requirements for signing the will. This benefit does not cover Complex Wills, as defined in the Definitions section. This benefit is limited to one use per year per Member/Covered Family Member.

Complex Will Preparation: Attorney shall prepare a Complex Will or codicil.

This benefit shall be limited to one Complex Will prepared per year.

Living Will/Health Care or Advance Directive/Health Care or Medical Power of Attorney:

This benefit covers the preparation of up to 2 of any of the following documents as defined in the Definitions section per Member/Covered Family Member:

Living Will
Health Care Directive
Advance Directive
Health Care Power of Attorney
Medical Power of Attorney

The titles of the above documents may vary by state

This benefit is limited to one use document/set of documents per year per Member/Covered Family Member.

Revocable or Irrevocable Living Trust Document:

Preparation of a revocable or irrevocable living trust for the Member and/or Covered Spouse. This benefit does not include services related to transactions to fund the trust or transfer assets into it. This benefit does not include tax planning or tax advice.

This benefit is limited to one use per year per Member/Covered Spouse

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.

Elder Matters

Elder Parent Will Preparation:

Each Eligible Parent may receive one Simple Will per year at no charge. The attorney will prepare the document and discuss the legal requirements for signing the will. This benefit does not cover Complex Wills, as defined in the Definitions section.

This benefit is limited to one use per year per Eligible Parent.

Elder Parent Living Will/Health Care or Advance Directive:

Each Eligible Parent may request one Living Will/Health Care or Advance Directive, as they are defined in the Definitions section, per year at no charge. The attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Living Will/Health Care or Advance Directive. The titles of the above documents may vary by state.

This benefit is limited to one use document/set of documents per year per Eligible Parent.

Elder Parent Durable Financial Power of Attorney:

Each Eligible Parent may request one Durable Financial Power of Attorney, as defined in the Definitions section, per year at the co-pay rate shown in the Schedule of Benefits. The attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Durable Financial Power of Attorney. The titles of the above documents may vary by state.

This benefit is limited to one use document/set of documents per year per Eligible Parent.

Elder Parent Health Care or Medical Power of Attorney:

Each Eligible Parent may request one Health Care or Medical Power of Attorney, as they are defined in the Definitions section, per year at the co-pay rate shown in the Schedule of Benefits. The attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Health Care or Medical Power of Attorney. The titles of the above documents may vary by state. This benefit is limited to one use document/set of documents per year per Eligible Parent.

Elder Law Matters:

This service covers counseling the Member over the phone or in the office on any personal issues relating to the Eligible Parents as they affect the Member. This benefit includes reviewing documents of the Eligible Parents to advise the Member of the legal effect on the Member. The documents include Medicare or Medicaid materials, prescription plans, leases, nursing home agreements, powers of attorney, living wills and wills. The benefit also includes preparing deeds involving the Eligible Parents when the Member and/or Covered Spouse is either the grantor or grantee; and preparing promissory notes involving the parents when the Member and/or Covered Spouse is either the payor or payee.

This benefit is limited to one use per year.

Residential Matters

Real Estate Sale, Purchase or Refinancing of Primary Residence:

The services of an attorney for the sale, purchase or refinancing of a primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes the review and/or preparation of closing documents and/or attendance by the attorney at closing in situations when it is customary for the attorney 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.

Vacation or Investment Home Purchase, Sale or Refinancing:

The services of an attorney for the purchase, sale, or refinancing of a vacation or investment residence (where Member has not resided or does not intend to reside for twenty-seven (27) weeks or more per year). This service includes the review and/or preparation of closing documents and/or attendance by the attorney at closing in situations when it is customary for the attorney 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 properties are not included.

This benefit is limited to one closing per year.

Home Equity Loan Assistance for Primary Residence:

The services of an attorney for the review and/or preparation of a home equity loan on a primary residence, or second or vacation home. This benefit does not include services performed by or for a title company, or for an attorney acting on behalf of a lending institution.

This benefit is limited to one closing per year.

Property Tax Assessment:

The services of an attorney for review and advice on a property tax assessment on a primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This benefit includes filing the paperwork, gathering the evidence, negotiating a settlement, and attending the hearing necessary to seek a reduction of the assessment.

This benefit is limited to one use per year.

Tenant Dispute:

Representation of the Member as a tenant in a dispute with his/her landlord. This benefit does not include representation for a tenant in a dispute with other tenants or for a tenant acting in his/her capacity as sublessee or sublessor.

This benefit is limited to one use per year.

Tenant Security Deposit Dispute:

The services of an attorney to assist the Member as a tenant in recovering a security deposit from the residential landlord for the primary residence; reviewing the lease and other relevant documents; and preparing a demand letter to the landlord for the return of the deposit. This benefit covers preparation for prosecuting a small claims action; helping prepare documents; advising on evidence, documentation and witnesses; and preparing the Member for the small claims trial. The service does not include the attorney’s attendance or representation at the small claims trial, collection activities after a judgment or any services relating to post-judgment actions.

This benefit is limited to one use per year.

Landlord Dispute with Tenant:

This benefit covers the Member where he/she is a landlord, but where the regular business or livelihood of the Member is that other than a landlord, for matters involving evictions, leases, or disputes with a residential tenant. The service includes advice and representation if a lawsuit is filed up to the maximum shown on the Schedule of Benefits. This benefit does not include representation for a tenant in disputes with other tenants or for a tenant acting in his/her capacity as sublessee or sublessor. If a lawsuit is required in order for the landlord to recover his or her damages, then representation will be provided up to the maximum shown in the Schedule of Benefits and the Member will be responsible for paying all fees for any additional services required.

This benefit is limited to one use per year.

Security Deposit Dispute with Tenant:

This benefit covers the Member where he/she is a landlord, but where the regular business or livelihood of the Member is that other than a landlord, in defending against the recovery of a security deposit from the Member’s residential tenant for any residence owned and leased by the Member; reviewing the lease and other relevant documents; and preparing a letter to the tenant specifying what part of the deposit, if any, will not be returned. It also covers assisting the Member in defending a small claims action; helping prepare documents; advising on evidence, documentation and witnesses; and preparing the Member for the small claims trial. The service does not include the attorney’s attendance or representation at the small claims trial, collection activities after a judgment or any services relating to post-judgment actions.

This benefit is limited to one use per year.

Construction Defect Dispute:

The services of an attorney in a dispute relating to a defect or damage caused by the construction of the Member’s new primary residence (where Member has resided or intends to reside for twenty- seven (27) weeks or more per year), purchased within the past five (5) years up to the maximum shown in the Schedule of Benefits.

This benefit is limited to one use per year.

Neighbor Dispute:

The services of an attorney in a dispute relating to a Member’s Neighbor up to the maximum shown in the Schedule of Benefits. For a definition of Neighbor, please see the Definitions section. Advice and/or preparation and assistance for a dispute filed in court is covered, although representation in small claims court is not covered.

This benefit is limited to one use per year.

Noise Reduction Dispute:

The services of an attorney in a dispute relating to a Member’s enjoyment of his/her residence, where any activity related to noise affecting the Member’s enjoyment of their home is prohibited by federal, state or local law, up to the maximum shown in the Schedule of Benefits. Advice and/or preparation and assistance for a dispute filed in court is also covered, although representation in small claims court is not covered.

This benefit is limited to one use per year.

Boundary or Title Dispute:

Services needed to negotiate and/or litigate matters arising from boundary or Real Property title disputes involving the Member’s primary or secondary or vacation residence and where coverage is not available under the Member’s homeowner or title insurance policies. This benefit includes filing to remove a mechanic’s lien. This benefit does not include boundary or title issues related to business assets or property. This benefit does not include boundary or title issues arising from the assertion of Eminent Domain.

This benefit is limited to one use per year.

Zoning Application:

Services needed to negotiate and/or litigate the change of zoning or variance for the Member’s primary or secondary or vacation residence. This benefit applies to the Member as a plaintiff or defendant. This benefit includes research and review of the law, surveys, advising the Member, preparing applications, and preparing for and attending the hearing. This benefit does not include zoning or variance issues related to business assets or property.

This benefit is limited to one use per year.

Financial Matters

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.

Garnishment Defense:

The defense of any dispute involving wage or earnings garnishment to collect on a court-ordered judgment related to personal (non-business related) goods or services. This benefit includes correspondence, negotiating with the court or opposing party to arrange a repayment schedule, assistance in limiting harassment by bill collectors, negotiating settlement after a complaint is filed, and representation at trial, if necessary. This service does not include efforts to vacate or set aside a judgment. This service does not include counter, cross or third-party claims; bankruptcy; any action arising out of family law matters, including support and post-decree matters; or any matter where the creditor is affiliated with the Contractholder.

This benefit is limited to one use per year.

Bankruptcy:

Representation on behalf of the 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.

This benefit applies to the Member/Covered Spouse only.

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.

This benefit applies to the Member/Covered Spouse only.

Tax Audit:

Includes the services of an attorney (but not accounting services) during a personal (non-business related) tax audit 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.

Tax Defense:

The defense of any dispute involving the collection of personal (non-business related) debt by a state or federal tax agency. This benefit includes correspondence, negotiating with the creditor tax agency to arrange a repayment schedule, assistance in limiting harassment by bill collectors, negotiating settlement after a complaint is filed, and representation at trial, if necessary. This service does not include defense against execution of a court-ordered judgment or efforts to vacate or set aside a judgment. This service does not include counter, cross or third-party claims; bankruptcy; any action arising out of family law matters, including support and post-decree matters; or any matter where the creditor is affiliated with the Contractholder.

This benefit is limited to one use per year.

Student Loan Refinancing/Collection Defense:

The services of an attorney up to the maximum shown in the Schedule of Benefits for a student loan refinancing or collection dispute proceeding. This benefit includes negotiation with creditors for a repayment schedule and to limit creditor harassment, and representation in defense of any action for personal debt collection, tax agency debt collection, foreclosure, repossession or garnishment, all related to one or more school loans up to and including trial if necessary.

This benefit does not include: vacating a judgment; counter, cross or third-party claims; bankruptcy, any action arising out of family law matters, including support and post decree issues; or any matter where the creditor is affiliated with the sponsor or employer.

This benefit is limited to one use per year. This service covers the Member only, not a Covered Family Member, and/or Covered Family Member when there is an issue regarding a student loan in the name of the Member

Repossession Defense:

The defense of any dispute involving the repossession of personal (non-business related) property by a private (non-governmental) party. This benefit includes correspondence, negotiating with the opposing party to arrange a repayment schedule, assistance in limiting harassment by bill or property repossession collectors, negotiating settlement after a complaint is filed, and representation at trial, if necessary. This service does not include defense against execution of a court-ordered judgment or efforts to vacate or set aside a judgment. This service does not include counter, cross or third-party claims; bankruptcy; any action arising out of family law matters, including support and post-decree matters; or any matter where the creditor is affiliated with the Contractholder. This benefit is limited to one use per year.

Family Matters

Separation, Divorce, Civil Annulment:

Legal representation of the Member for up to the maximum shown on the Schedule of Benefits in an uncontested separation or civil annulment; consent or default divorce, uncontested divorce or Contested 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 the maximum shown on the Schedule of Benefits; the Member must pay the attorney’s fee for services in excess of the maximum; or (2) contested matters in which case the Member must pay the attorney’s fee for services, unless the coverage includes 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 hours of attorney time, and involves disputed issues and requires that both parties be represented by an attorney.

This benefit is limited to one use per year (representation seeking or defending against interim order shall constitute a separate use). This benefit applies to the Member only and Covered Family Members only for actions not involving the Member as an opposing party.

Post-Divorce Proceedings:

Legal representation of the Member for up to the maximum listed on the Schedule of Benefits in a contested or uncontested post-divorce proceeding. An uncontested post-divorce proceeding does not involve significant disputed issues and the parties resolve any issues prior to any court supervised proceeding. The benefit for uncontested matters does not provide any coverage of an attorney’s fee for: (1) services in excess of the maximum listed on the Schedule of Benefits; the Member must pay the attorney’s fee for services in excess of the maximum; (2) contested matters in which case the Member must pay the attorney’s fee for services, unless the coverage includes contested matters and the benefit shall be in accordance with the Schedule of Benefits. A contested post-divorce proceeding requires more than five hours of attorney time, involves disputed issues and requires that both parties be represented by an attorney. This benefit includes custody, support and alimony proceedings.

This benefit is limited to one use per year. This benefit applies to the Member only and Covered Spouse only for actions not involving the Member as an opposing party.

Prenuptial Agreement:

This service covers the preparation of an agreement by a 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 Member. The fiancé/partner must have separate counsel or must waive representation.

This benefit is limited to one use per year. This benefit applies to the Member only.

Name Change:

Services required to accomplish a legal name change for a Member/Covered Family Member.

This benefit is limited to one use per year per Member/Covered Family Member.

Guardianship/Conservatorship:

Services required to establish a Member/Covered Family Member as the guardian(s) or conservator(s) of a family member of either the Member or Covered Spouse another. This benefit does not include fees for a court-appointed attorney for the child/conservatee.

This benefit is limited to one use per year.

Government Agency/Stepparent Adoption:

Legal representation up to the maximum shown in the Schedule of Benefits in a 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 hours of attorney time and involves disputed issues. If the amount of an attorney’s time for uncontested adoption exceeds the maximum shown in the Schedule of Benefits, or if the adoption becomes contested, then coverage will terminate and the Member will be responsible for any additional legal fees.

This benefit is limited to one use per year.

Child Custody/Support Proceeding Involving Never-Married Parents:

Legal representation up to the maximum shown in the Schedule of Benefits in a child custody/support proceeding. This service covers the Member and/or Covered Family Member, when there is an issue of child custody/support of a child parented by a person with the Member/Covered Family Member, but never married to the Member/Covered Family Member. This service covers representation to obtain a support order, including all required paperwork and attendance at all court appearances. The service does not include representation in suits for damages, defense of any action,

representation for the opposing parent, or any paternity proceeding. If the amount of an attorney’s time for an uncontested or contested child custody/support proceeding exceeds the maximum shown in the Schedule of Benefits, then coverage will terminate and the Member will be responsible for any additional legal fees.

This benefit is limited to one use per year.

Protection from Domestic Violence:

Services needed to assist the Member only, in obtaining a protective order arising from a domestic violence or abuse matter, including all required paperwork and attendance at all court appearances. This benefit does not include representation in suits for damages, defense of any action, or representation of the offender.

This benefit is limited to one use per year. This benefit applies to the Member only.

Juvenile Court Proceeding:

Services related to the representation of the dependent child of a Member/Covered Family Member in any juvenile court proceeding, provided the child’s interest is not in conflict with the Member’s and/or Covered Family Member’s interest. This benefit does not cover any matter that falls outside the jurisdiction of juvenile court or any matter that may be considered a felony.

This benefit is limited to one use per year.

School Administrative Proceeding:

Services needed for a dependent child of a Member/Covered Family Member for consultations, and review or help with preparation of documents prior to the representation of the dependent child in any school administrative proceeding (not including expulsion), provided the child’s interest is not in conflict with the Member’s and/or Covered Family Member’s interest. This benefit does not cover any matter that falls outside the jurisdiction of the school in which the child is officially enrolled. This benefit does not contemplate any attendance or representation by the attorney at or prior to any administrative hearing or appearance.

This benefit is limited to one use per year

Immigration Assistance:

This service covers advice and consultation, preparation of affidavits and powers of attorney, review of any immigration documents, and helping the Member prepare for hearings. This benefit also extends to the Member’s Covered Family Members and non-covered family members who are attempting to become US citizens in the manner prescribed by law.

This benefit is limited to proceedings involving one covered immigration applicant per year.

Parental Responsibility Matters:

Representation of the Member/Covered Spouse in juvenile court proceedings (except those involving traffic matters) where the State has brought an action against the Member/Covered Spouse relating to his or her parental responsibilities for a Covered Family Member.

This benefit is limited to one use per year. This benefit applies to the Member/Covered Spouse only.

Civil Matters

Civil Litigation Defense:

Services related to the representation of a Member who is a named defendant in a filed 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.

Incompetency Defense:

Services related to the representation of a Member in the defense of any incompetency action, including court hearings when there is a proceeding to find the Member incompetent.

This benefit is limited to one use per year.

Administrative Hearing Representation:

Services needed to defend the Member from civil proceedings before a municipal, county, state, or federal administrative board, agency or commission. It includes the hearing before an administrative

board or agency regarding an adverse governmental action. It does not apply where services are available or are being provided by virtue of an insurance policy. It does not include family law matters, post judgment matters or litigation of a job-related incident.

This benefit is limited to one use per year.

Discounted Contingency Fees:

Participating Attorneys will handle the matter at a maximum percentage of the gross award. It is the

Member’s responsibility to pay this fee and all costs.

When state laws set contingency fees: Lesser of 10% less than state law maximum fee or the

Participating Attorney’s usual fee.

When state laws do not set contingency fee: Maximum of 29% if settled before trial, 36% if trial is conducted, or 40% after an appellate brief is filed.

Contingency rate discount applies in those cases where attorneys customarily take a case on a contingency fee, (an agreed upon portion of any recovery), depending on the outcome of the case.

Mediation:

The services of an attorney for representation at a mediation. This benefit does not include the cost

of the mediator’s services.

This benefit is limited to one use per year. This benefit applies to the Member only.

Criminal Defense

Traffic Ticket:

Services related to the representation of the Member in defense of any traffic ticket except driving under influence or vehicular homicide, including court hearings, negotiation with the prosecutor, trial, and counseling and preparing Member for self-representation at any hearings if chosen. This benefit does not cover violations related to a commercial driver’s license.

This benefit is limited to one use per year. This benefit applies to the Member only.

Serious Traffic Matter:

Services related to the representation of a Member who is charged by governing authorities with moving traffic violation(s) and conviction could result in suspension or revocation of a state-issued license permitting a person to drive a motor vehicle. This benefit does not cover violations related to a commercial driver’s license.

This benefit is limited to one use per year.

Administrative Proceeding:

Services related to the representation of a Member in an administrative proceeding relating to the suspension or revocation of driving privileges. This benefit does not cover suspension or revocation of a commercial driver’s license.

This benefit is limited to one use per year.

Habeas Corpus Proceeding:

Services related to the representation in a Habeas Corpus proceeding.

This benefit is limited to one use per year.

Misdemeanor Defense:

Defense of a Member in connection with criminal misdemeanor charges (not associated with any felony charge).

This benefit is limited to one use per year.

DUI/DWI Defense:

Defense of a Member in connection with Driving Under the Influence (DUI) or Driving While Intoxicated (DWI) violations/citations misdemeanor charges (not associated with any felony charge). This benefit does not include employment related DUI/DWI charges. This benefit does not include misdemeanors relating to a commercial driver’s license. This benefit does not include adjustments to probation or parole.

This benefit is limited to one use per year. This benefit applies to the Member only.

The following is a list of Covered Services available, in addition to the services described in your Certificate of Coverage.

FINANCIAL ADVISOR

Coverage includes a financial counseling Service for Member, and Covered Family Members.

Financial Helpline

Consultation with legal or financial professionals by toll-free telephone during normal business hours. Calls can relate to investment strategies, debt matters, budgeting or any personal financial planning question.

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 Member, and Covered Family Members.

Advice and Consultation

Telephone consultations (10 per year) with a Trained Identity Theft Recovery Specialist.

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 consultations with the Recovery Specialist).

b) 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) Review of necessary recovery legal documents (up to 6 pages each).

Obtaining Benefits

Reimbursement for Benefits

1. Members should call the Member Service Center to confirm the potentially applicable benefit(s) 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 confirm coverage for matters to which Managed Case Rules apply reference Managed Case Rules in the Schedule of Benefits.

3. Members and/or Covered Family Members who are requesting services must remain enrolled and continue to make payment hereunder.

4. Upon completion of a Covered Service, the Member/Covered Family Member may be required by the Participating Attorney to sign a confirmation of completion. Failure to sign the confirmation may result in denial of the reimbursement and the Member/Covered Family Member will be responsible for all legal fees.

5. If the Member/Covered 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, proof of payment and supporting documentation sufficient to demonstrate the work completed in the matter within sixty (60) days after incurring the legal fees. Benefits provided to the Member/Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule of Benefits.

6. Payment by Us for Covered Services does not preclude the attorney (whether Participating or Non-Participating) from seeking and recovering attorney’s fees from an opposing party, where authorized by law, court rule, or contract, at the attorney’s customary or prevailing rate. If the Member/Covered Family Member receives reimbursement of attorney’s fees, then the Member/Covered Family Member agrees to reimburse Us for payments issued.

Disputes Between Member and Covered Family Member

In the event that the Member and one of the Covered Family Members are involved as adversaries in a dispute that is a Covered Service, only the Member will be covered.

If two or more Covered Family Members are involved in a dispute that is otherwise covered, no coverage will be provided.

If two Members are involved as adversaries in a dispute that is a Covered Service, separate coverage for each Member will be provided.

Exclusions

The following benefits are excluded:

Appellate court proceedings, class actions, interventions, malpractice proceedings, actions in which punitive damages are being sought, derivative actions and amicus curiae filings.

producing property. A multi-family residence, whether or not used by the Member/Covered Family Member as his or her primary residence, is deemed an investment or income-producing property.

Legal services that 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 or otherwise prohibited by the Model Rules of Professional Conduct of the state in which the attorney is licensed.

Any services on behalf of a Covered Family Member against the interests of the Member.

The Contract does not allow benefits listed under the Covered Services section to be combined for one legal matter.

General Provisions

Attorney-Client Relationship

All attorneys are subject to the authority of the state Supreme Court and the state bar association of the state(s) where they are licensed to practice. The Member has the unrestricted right to choose an attorney. The Member’s relationship with an attorney is privileged and strictly confidential. We will not interfere in the attorney-client relationship or in the attorney’s independent exercise of his or her professional judgment. Participating Attorneys are not certified specialists. Participating Attorneys are not agents or employees of either the Legal Plan Administrator or Us.

The Member shall authorize the Participating Attorney to provide the Legal Plan Administrator with information and supporting documentation on the number and type of services provided to the Member.

By using legal services benefits that are provided under the Contract, the Member agrees that neither We, nor the Contractholder, nor any other person involved in the marketing or administration of the Contract, shall have any liability for the acts, errors or omissions of an attorney providing services, in whole or in part.

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 form which must be completed and returned in order to request reimbursement. The Member’s reimbursement will be based on the reimbursement schedule shown under the Non-Participating Attorney column of the Schedule of Benefits. If a Member has a Non-Participating Attorney he or she would prefer to work with, the Legal Plan Administrator may elect to offer to negotiate with the attorney on behalf of the Member, but cannot guarantee the Non-Participating Attorney will accept the Plan Discounted Rate.

Subrogation and Coordination of Benefits

All benefits will be subject to subrogation and coordination of benefit rules. For the purpose of subrogation, We may require the Member/Covered Family Member to assign all rights of recovery of legal fees to the extent that payment is made by Us. If an assignment is sought, the Member/Covered Family Member must cooperate in providing the assignment.

Legal Terminology

The Member or Covered Family Member may call the Member Service Center to obtain a definition or explanation of any term used herein.

Coverage Territory

The coverage territory includes the United States and United States territories and Canada.

Payment Refund Provision

In the event that the mode of payment is other than monthly and the Group Contract is terminated or the Member elects to terminate the coverage, a pro-rata refund will be made to the Member.

Secondary Coverage

If the Member/Covered Family Member is entitled to receive legal services or reimbursement for legal services from any other person or organization, the coverage available under the Contract would be considered excess as defined in the National Association of Insurance Commissioners Model Coordination of Benefits Provisions.

Termination and Cancellation of Coverage

Coverage provided to the Member shall terminate upon the first of the following to occur:

a. Cancellation or termination of the Group Contract;

b. If applicable, the Member fails to re-enroll;

c. The Member is no longer associated with Contractholder; or

d. The Member fails to remit payment when due, subject to the statutory grace period.

Coverage provided to a Covered 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 qualify as a Covered Family Member as defined.

When coverage for a Member/Covered Family Member terminates and a matter is unresolved when coverage terminated, then any further legal work between said Member/Covered Family Member and the Participating Attorney shall be outside the scope and coverage of the Contract. The Participating Attorney shall not be obligated to provide any services under the Contract and any further legal services shall be based upon an independent and separate fee agreement entered into, if at all, between the former Member/Covered Family Member and the attorney. If such an agreement is not entered into, then the Participating Attorney may withdraw from any further representation in accordance with applicable law and State Bar standards.

Illegal Activity, Misrepresentation and Fraud

We will not provide coverage if the Member/Covered Family Member has intentionally concealed or misrepresented any material fact or circumstances or been involved in any illegal activity related to the Contract or reimbursement. We will not provide coverage if doing so would be in violation of any United States economic or trade sanction.

Portability

The Member may continue this coverage by electing the option of portability when the Member no longer qualifies as an employee of the Contractholder or as a Member of the group to which the Group Contract is issued. The Member must apply for portability within sixty (60) days of this disqualifying event and make arrangements for payment. Portability coverage will take effect, subject to receipt of the initial payment, as of the date the Member’s coverage under the Group Contract terminates. Credit will be given for any applicable Waiting Period based upon the number of months coverage was in force for the Member under the Group Contract.

Waiver of Payment

Upon the death of the Member, coverage for the surviving Covered Family Members continues for the remainder of the current Group Contract term. We waive further payments during this time.

Upon the Member being called to active duty for a period of more than thirty (30) consecutive days for the purposes of military service or of responding to a declared national emergency, coverage for the Covered Family Members will continue, without the payment, for the length of the Member’s absence and for so long as the Member remains eligible for benefits through the Contractholder.

Conformed to Statute

Any terms herein that conflict with the statutes of the jurisdiction where issued are amended to conform to the statutes.

Assignment of Benefits

The benefits provided herein are not assignable.

Network

About the Network of Attorneys

When going in for surgery, you don’t want a surgeon that has a poor track record or only a couple years experience. We feel that a legal need is just as important.

Help Focus Infrastructure

When it comes to finding an attorney, an employee can waste days looking for the right one, even with a legal plan. Our process has a Help Focus Infrastructure. We focus on our relationships with our Providers to help us help your employees, faster. Our Attorney Match Technology and dialogue with attorneys and members ensures the right help the first time. Matching an employee to the right help expedites solutions while saving time and stress.

Standards and Qualifications

The credentialing standards that we utilize to vet our providers is the most stringent in the country. We focus on years of experience, as well as insurance and discipline, as well as penalty of perjury submissions with extensive back ground checks.

Under the Provider Network, your employees will receive legal help from professionals with many of these service characteristics:

Experience in the Legal Matter Needed
Quality Time Spent in Consultations
Years of Legal Training and Experience
Up-to-date Legal Training Each Year
Lawyers Who are Service-Oriented
Lawyers Who Have a Solid Local Reputation in their Communities
Exceptional Backgrounds
Years of Courtroom and Trial Experience

Provider Standards of Care

The Network Provider shall strive to provide the highest quality of legal representation and service to Plan Members.

Plan Providers agree to the following:

To comply at all times with the Rules of Civil Procedure and Criminal Procedure and the Rules of Professional Conduct applicable to the jurisdiction.
To return member's calls promptly, within one business day, and communicate with members such that a member and the member's family do not voice substantiated concerns over promptness or frequency of your or your firm's communication.
To not enter continuances, adjournments, or the like without the member's comfort and consent.
To not arrange for substitutions or stand-ins unless the member has been previously advised and that the member understands that you remain responsible for the case and to contact you if there is any concern or if proceedings do not go as planned.
To always respect a member, their needs and family.
To maintain a professional office, in staffing and appearance.
To fully explain yourself such that a member has an understanding for the reasons behind your recommendations and suggestions, even if a member may not hire your firm.
To not complete any additional work that will result in a fee to the member, where not covered by the member's plan, until a fee arrangement is fully understood by the member and there is a written agreement.
To help each member individually and ensure that everything you do is in the interest of the member.
To notify LegalEASE if there is or may be the possibility of a conflict of interest or violation of ethical codes.
To notify LegalEASE if there may be a misunderstanding or potential service issue where there may be a complaint without breaking any client confidences.
To direct any grievances or concerns, such as process procedure or billing, to Legal Access and not a member.
To not refer any member to another attorney without the knowledge and consent of Legal Access if you cannot assist.
To take responsibility and uphold the highest standards of customer service delivered by any and all firm staff or employees that have interaction with members.
To communicate and cooperate with LegalEASE on any concern, inquiry or issue and return any communication from Legal Access within one business day.

About

We are here to serve you...

We believe people deserve to have a sense of safety and security, a peace of mind, when it comes to being protected in legal matters that they may not be the experts in. To have access to legal professionals that can ease and solve their legal burdens. We are here to serve you.

How we do it is by providing an in-depth pool of resources to accommodate all your legal needs. Legal Access and LegalEASE have broad experiences with employees in small, medium and large companies in the public and private sectors, local, state and federal government offices, unions, employee assistance plans, work-life companies, and organizations, when it comes to solving your legal matters.

What we do is provide value by creating unparalleled access to a network of skilled attorneys to cover your legal needs with options in convenient plans. We are a diversified employee benefits company engaged in administration, network development, technology management and insurance, based in Houston, Texas. Since 1971, we have grown from five attorneys in Los Angeles providing services to a modest amount of companies into a company with the strongest attorney network across America. We provide assistance to members over half of a million times each year throughout the United States and the world.

Legal Access Companies consists of several companies and brands to best meet customer needs, including but not limited to: Legal Plans USA, Legal Access Plans, LegalEASE, and LAMG. Legal Access Plans has a wide array of products across several market segements, including worksite, employee assistance and worklife. LegalEASE is the group's primary insurance brand and focuses primarily in the worksite market. LegalEASE products are underwritten and presented by Virginia Surety Company, part of the Warranty Group.

The Legal Corner

The Legal Corner

To visit The Legal Corner, CLICK HERE

The Legal Corner offers valuable resources like:

Articles with valuable information you may need in order to handle several legal issues.

Articles
Featured Attorneys
News Updates

Help Center

Our guide to common legal matters will help you understand court cases and what you will typically see.

Legal Blog

Articles over laws, court decisions and more for all readers.

Non-Member Online Directory

The ability to find attorneys near you, with the expertise in the area of law for your legal matter.

For all this and more, visit https://legalcorner.legaleaseplan.com/