RB | Drive America Repair Assist Program

Enrollment - Repair Banc

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Billing Term Coverage

FOR BASIC

Chevron Travel Basic membership includes four categories of Accidental Loss of Life Insurance Coverage at affordable group rates! No health questions! No medical examination! See category section below. Full details of coverage limitations and exclusions will be provided with your membership kit. The availability of this offer may change; not available in all states.

Category 1.1:

$4.25 Monthly Dues. Member and covered family enjoy all Travel Club benefits, except the accidental-loss-of-life insurance, which applies to member only. Member's benefit is $20,000*.

Category 2.1:

$4.50 Monthly Dues. Member and covered family enjoy all Travel Club benefits, except the accidental-loss-of-life insurance, which applies to member and legally married spouse only. Member's benefit is $20,000, the same as under Category 1.1; spouse's benefit is $10,000*.

Category 3.1:

$5.00 Monthly Dues. Member and covered family enjoy all Travel Club benefits, except the accidental-loss-of-life insurance, which applies to member and Covered Children** only. Member's benefit is $20,000, the same as under Category 1.1; children's are $5,000 each.

Category 4.1:

$5.50 Monthly Dues. Member and covered family enjoy all Travel Club benefits. Insurance applies to member, legally married spouse and Covered Children**. Member's benefit is $20,000, the same as under Category 1.1; spouse's is $10,000*, children's are $5,000 each.

Extra indemnity:

If you and your spouse should die in a common accident, Membership Category 4.1 pays a single benefit of $30,000, plus $100 a month to each covered child until the child's death or twenty-first birthday, whichever occurs first.

*A member or a member's legally married spouse shall have their benefits reduced by 50% upon becoming age 75 and another 50% upon becoming age 80. A member or member's legally married spouse who has attained membership at age 75 or age 80 shall immediately have their benefit reduced to the amount applicable to their attained age.

** Covered Children: The Member's unmarried child (includes stepchild, legally adopted and foster children) who lives at the same permanent address as the Member, who is dependent on the Member for support, and who is under age 21 or who is under age 23 and is a full time student at an accredited school or college. If, while insured, an injury of a Member of Covered Dependent results in loss of life within 365 days of the date of the accident that caused the injury, the full benefit stated in the applicable Membership Category will be paid.

Exclusions:

The Group Policy does not cover loss-of-life caused by or resulting from: A. Intentionally self-inflicted injuries, suicide, self-destruction or any attempt thereat, while sane or insane; B. Declared or undeclared war, or any act thereof; C. Travel or flight in any vehicle or device for: (1) Navigation beyond the earth's atmosphere, or (2) Aerial navigation, including boarding or alighting therefrom: a. While being used for any test or experimental purpose, or b. While operating, learning to operate or serving as a member of the crew thereof, or c. While being operated by, or for, or under the direction of any military authority except any transport aircraft operated by or for the Air Mobility Command (AMC) of the United States of America or by the similar air transport service of any other country; D. Hernia of any kind, except as a result of an accident; E. Illness, disease, pregnancy, childbirth, miscarriage, or any bacterial infection not occurring in consequence of an accidental cut or wound; being legally intoxicated or under the influence of any narcotic, barbiturate or hallucinatory drug unless administered under the advice of a licensed physician and taken in accordance with the prescribed dosage. Coverage for the Member will continue as long as dues are paid, until the Group Policy is terminated or the date you are no longer a Chevron Travel Club member, whichever occurs first.

Coverage for Covered Dependents will end when your coverage ends or they no longer qualify. Terms and conditions of coverage are set forth in The Group Policy issued by the Life Insurance Company of North America to the Chevron Travel Club (Policy Number GA5144-B, Rev. 1/96). Additional information is contained in the Certificate of Insurance issued to persons enrolling in the plan. The availability of this offer may change. Offered and underwritten by the Life Insurance Company of North America as a service to Chevron Travel Club Members.

personal information

First Name*

Last Name*

Email Address*

Street Address*

City*

State*

ZIP Code*

Home Phone*

Cell Phone*

*Required Field

Vehicle Information

Primary Vehicle VIN*

Primary Vehicle Year*

Primary Vehicle Make*

Primary Vehicle Model*

Primary Vehicle Mileage*

*Required Field

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