Volunteer Insurance

Granite State Ambassadors carries Volunteer Accident coverage for all of our active volunteers. It is not an insurance substitute for any insurance you may now carry, and only applies while you are performing your assignment as a volunteer in the GSA program.

Prior to submitting a claim, you must send a report to NHGSA about your accident / incident right away. If you have any questions, please contact Kelly at kelly@nhgsa.com.

LINKS:  CIMA VIS Accident Policy MHH 010303Claim forms | Printable Information Sheet


Principal Sum $2,500
Loss must occur within 365 days of the Covered Accident

Schedule of Covered Losses
Covered Loss / Benefit
Loss of Life / 100% of the Principal Sum
Loss of Two or More Hands or Feet  / 100% of the Principal Sum
Loss of Sight of Both Eyes / 100% of the Principal Sum
Loss of One Hand or Foot and Sight in One Eye / 100% of the Principal Sum
Loss of One Hand or Foot / 50% of the Principal Sum
Loss of Use of One Hand or Foot / 50% of the Principal Sum
Loss of Sight in One Eye / 50% of the Principal Sum
Loss of Thumb and Index Finger of the Same Hand / 25% of the Principal Sum

Any benefit limits and Benefit Percentages for Accident Medical Expense Benefits apply, unless otherwise specified, on a per Covered Person – per Covered Accident basis. Any applicable Deductibles must be satisfied within the time periods specified before benefits are payable.

Scope of Coverage Applicable to Accident Medical Benefits

Full Excess Medical Expense
Other Health Plan Reduction / 50%

Medical Expense Benefits
Benefit Limit for all Covered
• Expenses for any one Covered Accident – $50,000
• First Covered Expenses must be Incurred within 60 days after a Covered Accident
• Benefit Period – 365 days from the date of the Covered Accident
• Deductible – None

Covered Expense / Benefit Amount, Percentage, Other Limits
In-Patient Hospital Services
• Daily ICU or CCU Benefit 100%, up to two times the average semi-private room rate
• Daily In-Hospital Benefit 100% of the average semi-private room rate
• Miscellaneous Services 100%

Ambulatory Medical Center 100%
Emergency Room Treatment 100%

Physician Services
• Surgery Benefit 100%
• Assistant Surgeon 100%
• Physician’s Surgical Facilities 100%
• Second Opinion or Consultation 100%
• Physician’s Assistant 100%
• Anesthesia Benefit 100%
• Inpatient Visits 100%
• Office Visits 100%

Outpatient X-ray, CT Scan, MRI and Laboratory Tests 100%
Outpatient Physiotherapy 100%
Nursing Services 100%
Ambulance Services 100%; limited to $5,000 for air ambulance
Medical Equipment Rental 100%
• Initial artificial limbs, eyes and larynx, including fitting 100%

Replacement or repair of eyeglasses, contact lenses or hearing aids 100%; limited to $50 for repair or replacement of eyeglass frames; $50 for replacement of prescription lenses; and $50 for repair or replacement of hearing aids.

Medical Services and Supplies 100%
Dental Services (including $900, up to $500 per tooth, for a maximum of replacement or repair of dentures) 3 teeth
Prescription Drug Benefit 100%

Home Health Care Benefit 100%
• Minimum Hospital Stay: Not Applicable
Home Health Care must begin within: Not Applicable
• Maximum Number of Home Health Care Visits 30

Rehabilitation and Extended Care Facility
• Rehabilitation Care Facility 100%
• Extended Care Facility 100%
• Minimum Hospital Stay 3 consecutive days
• Extended Care must begin within 7 consecutive days after the Minimum Hospital Stay