Travel Visa Plus
InsureMyTrip Travel Visa Plus Certificate
TABLE OF CONTENTS
Accidental Death & Dismemberment
Accidental Death & Dismemberment – Common Carrier (Air Only)
Emergency Sickness Medical Expense
Emergency Accident Medical Expense
Repatriation of Remains
Optional – Collision Damage Waiver
Optional – Flight Accidental Death & Dismemberment
LIMITATIONS AND EXCLUSIONS
COORDINATION OF BENEFITS
InsureMyTrip Travel Visa Plus
Accident: means a sudden, unexpected, unusual, specific event that occurs at an identifiable time and place, but shall also include exposure resulting from a mishap to a conveyance in which You are traveling.
Accidental Injury: means Bodily Injury caused by an Accident (of external origin) being the direct and independent cause in the Loss.
Actual Cash Value: means purchase price less depreciation.
Additional Expense: means any reasonable expenses for meals and lodging which were necessarily incurred as the result of a Hazard and which were not provided by the Common Carrier or other party free of charge.
Bankruptcy: means the filing of a petition for voluntary or involuntary bankruptcy in a court of competent jurisdiction under Chapter 7 or Chapter 11 of the United States Bankruptcy Code 11 L.S.C. Subsection 101 et seq.
Bodily Injury: means identifiable physical injury which is caused by an Accident and is independent of disease or bodily infirmity.
Business Partner: means an individual who: (a) is involved in a legal partnership; and/or (b) is actively involved in the day-to-day management of the business.
Common Carrier: means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
Covered Expense: shall mean expenses incurred by You which are for medically necessary services, supplies, care, or treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician; reasonable and customary charges; incurred while insured under the Plan; and which do not exceed the maximum limits shown in the Confirmation of Coverage, under each stated benefit.
Cruise: means any prepaid sea arrangements made.
Default: means a material failure or inability to provide contracted services due to financial insolvency.
Economy Fare: means the lowest published rate for an economy ticket.
Effective Date: means the date and time Your coverage begins, as outlined in the General Provisions section of this Certificate.
Exotic Vehicles: includes Alfa Romeo, Aston Martin, Auburn, Avanti, Bentley, Bertone, BMC/Leyland, BMW M Series, Bradley, Bricklin, Cosworth, Citroen, Clenet, De Lorean, Excalibre, Ferrari, Fiat, Iso, Jaguar, Jensen, Jensen Healy, Lamborghini, Lancia, Lotus, Maserati, MG, Morgan, Pantera, Panther, Pininfarina, Rolls Royce, Rover, Stutz, Sterling, Triumph, TVR and Yugo.
Family Member: means Your or Your Traveling Companion’s legal or common law spouse, parent, legal guardian, step-parent, grandparent, parents-in-law, grandchild, natural or adopted child, step-child, children-in-law, brother, sister, step-brother, step-sister, brother-in-law, sister-in-law, aunt, uncle, niece or nephew, who reside in the United States, Canada or Mexico.
Hazard: means (a) any delay of a Common Carrier (including Inclement Weather); (b) any delay by a traffic accident en route to a departure, in which You or a Traveling Companion is not directly involved; (c) any delay due to lost or stolen passports, travel documents or money, quarantine, hijacking, unannounced strike, natural disaster, civil commotion or riot; (d) a closed roadway causing cessation of travel to the destination of the Trip (substantiated by the department of transportation, state police, etc.).
Hospital: means a facility that (a) holds a valid license if it is required by the law; (b) operates primarily for the care and treatment of sick or injured persons as in-patients; (c) has a staff of one or more Physicians available at all times; (d) provides twenty-four (24)-hour nursing service and has at least one registered professional nurse on duty or call; (e) has organized diagnostic and surgical facilities, either on the premises or in facilities available to the hospital on a pre-arranged basis; and (f) is not, except incidentally, a clinic, nursing home, rest home, or convalescent home for the aged, or similar institution.
Host at Destination: means a person with whom You are sharing pre-arranged overnight accommodations at the host’s usual principal place of residence.
Inclement Weather: means any severe weather condition that delays the scheduled arrival or departure of a Common Carrier.
Individual Coverage Term: means the period of time beginning when You have been enrolled for coverage under the Policy and for whom the required premium has been paid.
Insurance: means any one of the following types of policies or plans which provide benefits for hospital confinement, medical expenses for You on Your effective date of coverage, and such policy or plan requires You to pay a deductible and/or portion of coinsurance: individual, group or blanket insurance plans; group Blue Cross, Blue Shield, or other group prepayment coverage plans; coverage under labor management trustee plans, union welfare plans, employer organization plans, employee benefit organizational plans, or other arrangements of benefits for persons of a group. Insurance does not include Medicare or Medicaid.
Land/Sea Arrangements: means any activities undertaken by You while in the Individual Coverage Term.
Loss: means injury or damage sustained by You in consequence of happening of one or more of the occurrences against which the Company has undertaken to indemnify You.
Physician: means a licensed practitioner of medical, surgical or dental services acting within the scope of his/her license. The treating Physician may not be You, a Traveling Companion or a Family Member.
Scheduled Departure Date: means the date on which You are originally scheduled to leave on the Trip.
Scheduled Return Date: means the date on which You are originally scheduled to return to the point of origin or to a different final destination.
Sickness: means an illness or disease which is diagnosed or treated by a Physician after the Effective Date of insurance and while You are covered under the Policy. (sickness is defined as after the effective date, but pre-ex is sickness prior to Effective Date
Strike: means any unannounced labor disagreement that interferes with the normal departure and arrival of a Common Carrier.
Terrorist Incident: means an incident deemed a terrorist act by the United States Government that causes property damage or Loss of life.
Traveling Companion: means person(s) booked to accompany You on Your Trip (to a maximum or four (4) persons including You). Note, a group or tour leader is not considered a Traveling Companion unless You are sharing room accommodations with the group or tour leader.
Travel Supplier: means tour operator, cruise line, hotel, airline, etc., that has made the land and/or sea arrangements.
Trip: means prepaid Land/Sea Arrangements and shall include flight connections to join or depart such Land/Sea Arrangements provided such flights are scheduled to commence within one day of the Land/Sea Arrangements. Maximum Trip duration is 90 days.
You or Your: refers to all persons listed on the Confirmation of Coverage under the program purchased by You.
The following provisions apply to all coverages:
WHEN YOUR COVERAGE BEGINS
All coverage (except Trip Cancellation) will take effect at 12:01 A.M. local time, at Your location, on the Scheduled Departure Date provided:
(a)coverage has been elected; and
(b)the required premium has been paid
Trip Cancellation coverage will take effect at 12:01 A.M. local time at Your location, on the day after the required premium for such coverage is received by the Company or its authorized representative.
WHEN YOUR COVERAGE ENDS
Your coverage will end at 11:59 P.M. local time on the date that is the earliest of the following:
(a)the Scheduled Return Date as stated on Your Confirmation of Coverage;
(b)the date You return to Your origination point if prior to the Scheduled Return Date;
(c)the date You leave or change Your Trip (unless due to unforeseen and unavoidable circumstances covered by the Policy);
(d)if You extend the return date, Your coverage will terminate at 11:59 P.M., local time, at Your location on the Scheduled Return Date;
(e)the date You cancel the Trip;
(f)any Trip that exceeds 90 days.
EXTENDED COVERAGE - Coverage will be extended under the following conditions:
(a)When You commence air travel from Your origination point: within two (2) days before the commencement of the Land/Sea Arrangements, coverage shall apply from the time of departure from the origination point; or (ii) greater than two (2) days before the commencement of the Land/Sea Arrangements, the extension of coverage shall be provided only during his/her air travel.
(b)If You return to Your origination point: within two (2) days after the completion of the Land/Sea Arrangements, coverage shall apply until the time of return to the origination point; or (ii) greater than two (2) days after the completion of the Land/Sea Arrangements, the extension of coverage shall be provided only during his/her air travel.
(c)If You are a passenger on a scheduled common carrier that is unavoidably delayed in reaching the final destination coverage will be extended for the period of time needed to arrive at the final destination.
In no event will coverage be extended for unscheduled extensions to Your Trip for which premium has not been paid in advance.
1.Entire Contract; Changes: The Certificate, including the Application, Schedule of Benefits, Exclusionary Rider(s), endorsements and the attached papers, if any, constitutes the entire contract of Insurance. No change in the Certificate shall be valid until Approved by an executive officer of the Administrator and unless such Approval is endorsed hereon. No agent has authority to change this Certificate or to waive any of its provisions.
2.Notice of Claim: Written notice of claim must be given to the Company within thirty (30) days after the occurrence or commencement of any Covered Event(s) covered by the Certificate. If Notice cannot be given within 30 days because of incapacity or some similar reason, it must be given as soon thereafter as is reasonably possible. Notice given by or on behalf of the claimant to the Administrator, or to any authorized agent of the Company, with the name of the Insured Person(s) and the Certificate Number on the ID Cards to identify the Insured Person(s) shall be deemed notice to the Company.
3.Claim Forms: The Company, upon receipt of a Notice of Claim, will furnish to the claimant such forms as are usually furnished by it for filing Proofs of Loss. If such forms are not furnished within fifteen (15) days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of the Certificate as to Proof of Loss upon submitting, within the time fixed in the Certificate for filing Proofs of Loss, written proof covering the occurrence, the character and the extent of the Covered Event(s) for which claim is made.
4.Proof of Loss: Written Proof of Loss must be furnished to the Administrator, at its said office, within ninety (90) days after the date of such Covered Event(s). Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible. In any case, the proof required must be given no later than one year from the time specified except in the absence of legal capacity.
5.Payment of Claims: Subject to any written direction of the Insured Person(s) which is submitted within the time for filing the Proof of Loss, all or a portion of any indemnities provided by this Certificate for Hospital, nursing, medical or Surgical service may, at the Company's option, be paid directly to the Hospital or Service Provider rendering such services.
6.Physical Examination and Autopsy: The Company, at its own expense shall have the right and opportunity to examine the person of any individual whose Injury(ies) or Illness(es) is the basis of claim when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death, where it is not forbidden by law.
7.Legal Actions: It is agreed that in the event of the failure of the Company hereon to pay any amount claimed to be due hereunder, the Company hereon, at the request of the Insured Person, will submit to the jurisdiction of a Court of competent jurisdiction within the United States. Nothing in this Clause constitutes or should be understood to constitute a waiver of Company’s rights to commence an action in any Court of competent Jurisdiction in the United States, to remove an action to a United States District Court, or to seek a transfer of a case to another Court as permitted by the laws of the United States or of any State in the United States. It is further agreed that service of process in such suit may be made upon Mendes and Mount; 750 Seventh Avenue; New York, NY 10019-6829 USA, and that in any suit instituted against any one of them upon this contract, Company will abide by the final decision of such Court or of any Appellate Court in the event of an appeal.
The above-named are authorized and directed to accept service of process on behalf of Company in any such suite and/or upon the request of the Insured Person to give a written undertaking to the Insured Person that they will enter a general appearance upon Company’s behalf in the event that such a suit shall be instituted.
Further, pursuant to any statute of any state, territory or district of the United States which makes provision therefore, Company hereon hereby designate the Superintendent, Commissioner or Director of Insurance or other officer specified for that purpose in the statute, or his successor or successors in office, as their true and lawful attorney upon whom may be served any lawful process in any action, suit or proceeding instituted by or on behalf of the Insured Person or any beneficiary hereunder arising out of this contract of insurance, and hereby designate the above-named as the person to whom the said officer is authorized to mail such process or a true copy thereof.
8.Grace Period: A Grace Period of thirty-one (31) days will be granted for the payment of each Premium falling due after the first Premium, during which Grace Period the Certificate will continue in force, but the Insured Person(s) shall be liable to the Company for the payment of the Premium accruing for the period the Certificate continues to be in force.
9.Reinstatement: If the Company terminates Coverage for non-payment of Premium, the Company will consider reinstatement of Coverage only after receiving proof of good health and payment of Premium. The reinstated Certificate shall cover only Covered Event(s) resulting from Injury(ies) that are sustained after the date of reinstatement and those Covered Event(s) due to Illness(es) that manifests not less than ten (10) days after the date of reinstatement. No reinstatement will be considered by the Company sixty (60) days after the Certificate has been terminated for non-payment of Premium.
10.Effective Date of Individual Insurance: After review and Approval of each Applicant by the Administrator, Coverage will become effective on the later of the following dates: (1.) The date requested on the Application, (2.) The date the appropriate Premium and Application are received by the Administrator, or (3) The date the Applicant is Approved by the Administrator. The Insured’s ID Card will state the official Effective Date of Coverage, as issued by the Administrator.
11.Termination Date of Individual Insurance: Coverage will terminate upon the earlier of the following: (1.) The end of the period for which Premium has been paid, (2.) The date the Insured Person(s) fails to meet the Eligibility Requirements described in SECTION 3, A; (3.) The date the Company cancels Coverage for a specific Class(es) of Insured Person(s), which the individual Insured Person(s) may be included.
12.Not in Lieu of Worker's Compensation: This Insurance is not in lieu of and does not affect any requirements for Coverage by Worker's Compensation Insurance.
13.Certificate of Insurance: The Company shall issue to each Insured Person(s) an individual Certificate of Insurance, which shall state the essential features of Insurance to which such person is entitled and to whom benefits are payable, if required to do so by the laws of the state in which the Insured Person(s) resides when his Insurance becomes effective.
14.Data Furnished by Insured Person(s) or Applicant(s): Insured Person(s) or Applicant(s) shall furnish all information requested on the Application and/or Claim Form and any additional information requested by the Company.
Newborn Child(ren) born to the Primary Insured Person, after the Primary Insured Person’s Individual Effective Date of Coverage under this Certificate, cannot be added to this Certificate of Insurance, without a complete Application and Approval of Administrator. The birth of a Newborn Child(ren) to an Insured Person(s) shall not constitute valid Insurance under this contract for the Newborn Child(ren), except where provided under the Pregnancy Benefit.
The refusal or failure of the Insured Person(s)’s Relative, Employer, Insurance Company, Physician(s), Hospital or Service Provider to make all medical reports and records available to the Company could cause an otherwise valid claim or Application to be denied or the file to be closed due to lack of or limited reply from the above referenced individuals and entities. Failure on the part of the Insured Person(s) to maintain adequate documentation regarding travel history could cause an otherwise valid claim (where travel history is material to the benefit and claim) to be denied or the file to be closed.
The Company has the option whether or not to consider medical information provided by friends / Relatives of the Insured Person(s) as valid for underwriting or claim administration.
15.Cancellation: The Certificate is annually renewable for the life of the Insured Person(s) or until the Termination Date of Individual Insurance. The Company may cancel an entire Class(es) of Insured Persons based upon claims experience in a certain region or within a gender / age category.
NOTWITHSTANDING anything contained in this Insurance to the contrary this Insurance may be cancelled by the Insured Person at any time by written notice or by surrendering of this Certificate of Insurance. This Insurance may also be cancelled by or on behalf of the Company by delivering to the Insured Person or by mailing to the Insured Person, by registered, certified or other first class mail, at the Insured Person’s address as shown in this Insurance, written notice stating when, not less than 10 days thereafter, the cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice and this Insurance shall terminate at the date and hour specified in such notice.
If this Insurance shall be cancelled by the Insured Person the Company shall retain the customary short rate proportion of the premium heron, except that if this insurance is on an adjustable basis the Company shall receive the Earned Premium hereon or the pro rata proportion of any Minimum Premium stipulated herein whichever is the greater.
Payment or tender of any Unearned Premium by the Company shall not be a condition precedent to the effectiveness of Cancellation but such payment shall be made as soon as practicable.
If the period of limitation relating to the giving of notice is prohibited or made void by any law controlling the construction thereof, such period shall be deemed to be amended so s to be equal to the minimum period of limitation permitted by such law.
16.Renewal of Individual Insurance: The Certificate will be renewed each year on the anniversary of the Effective Date of Individual Insurance subject to the provisions of the Certificate in force at the time of the renewal. The initial Period of Coverage cannot exceed twelve (12) months. The Insured Person(s), however, may apply for renewal of Coverage. The renewal Period of Coverage may not total more than twelve (12) months. Renewal(s) will be contingent upon the Insured Person(s) submitting the applicable renewal Premiums for their Class(es), as determined by the Company. The Company can cancel an Insured Person(s), if the Insured Person(s) is included in a Class(es) that is canceled in its entirety by the Company or if the Insured Person(s)’s Coverage is Rescinded or Voided for misrepresentations. Additionally, the Company may make benefit modifications to the Certificate of an Insured Person(s), if the Insured Person(s) is included in a Class(es) that is modified in its entirety by the Company.
17.Excess Benefits: All Coverage shall be in excess of all other valid and collectible insurance and shall apply only when such benefits are exhausted.
Other valid and collectible insurance for which benefits may be payable are insurance programs provided by:
1.) Individual, group or blanket insurance or coverage;
2.) Other prepayment coverage provided on a group or individual basis;
3.) Any coverage under labor management trustee plans, union welfare plans, employer organizational plans, employee benefit organization plans, or other arrangement of benefits for individuals of a group;
4.) Any coverage required or provided by any statute, socialized insurance program; or
5.) Any no-fault automobile insurance;
6.) Any third party liability insurance.
18.Subrogation: The Company has the right to full subrogation and reimbursement of any and all amounts paid by the Company to or on behalf of, an Insured Person(s), if the Insured Person(s) receives any sum of money from any person, plan or legal entity which is legally obligated to make payments arising out of any act or omission of any person whether a third party or another covered person under the Certificate, which directly or indirectly caused a physical or mental condition, in connection with which payment of any benefits under the Certificate to, or on behalf of, such Insured Person(s) was made. The Certificate shall have a lien against such sum of money received from third parties or other persons described above or their insurers, or the insurer of the Insured Person(s), and shall be reimbursed there from. The Insured Person(s) further agrees to notify other persons described above in writing, of the Certificate's subrogation and lien rights before the receipt of any payment from said parties or other persons.
The Insured Person(s) shall be responsible for all expenses of recovery from such parties or other persons, including but not limited to, all attorneys' fees incurred in collection of such payments or payments by other persons, which fees and expenses shall not reduce the amount of reimbursement to the Certificate required of the Insured Person(s). The Insured Person(s) agrees to reimburse the Certificate for any benefit paid hereunder, out of any monies recovered from such party or other persons as a result of judgment, settlement or otherwise, even though such monies are not characterized as amounts paid for medical expenses or claims. The Insured Person(s) agrees to furnish such information and assistance, and to execute and deliver all necessary instruments, as the Company or its designee may request to facilitate the enforcement of these subrogation rights, including but not limited to the execution of a subrogation agreement prior to payments of benefits under the Certificate to, or on behalf of the Insured Person(s).
The Insured Person(s) shall not release or discharge any party from his or her obligation to the Insured Person or the Certificate or take any other action, which could impair the Certificate's subrogation rights. The Certificate's exercise of its rights, to take whatever action it sees fit against any third party or other persons, shall not affect the Insured Person(s)'s right to pursue other forms of recovery.
If the Insured Person(s), or any one acting on his or her behalf, has not taken action to pursue his or her rights against such parties or other persons to obtain a judgment, settlement or other recovery, the Company or its designee, upon giving thirty (30) days written notice to the Insured Person(s) shall have the right to take such action in the name of the Insured Person(s) to recover that amount of benefits paid under the Certificate; provided, however, that any action taken without the consent of the Insured Person(s) shall be without prejudice to such Insured Person(s).
The Certificate's right to reimbursement as set forth herein shall be payable first from sums received from the parties or other persons and such reimbursement shall continue until the Insured Person(s)'s obligations hereunder to the Certificate are fully discharged, even though the Insured Person(s) does not receive full compensation or recovery for his/her Injury(ies), damages loss or debt. This right to subrogation shall exist in all cases.
If an Insured Person(s) fails to comply with these requirements, the Insured Person(s) shall not be eligible to receive any benefits, services or payments under the Certificate until there is compliance, regardless of whether such benefits are related to the act or omission of such party or other persons.
19.Change of Residence: The Certificate will become null and Void, unless the Company is notified of any change in the Home Country of the Insured Person(s), within thirty (30) days of the change. All terms and conditions are subject to review and revision upon a change in the Insured Person(s)’s Home Country.
20.Monetary Limits: The monetary limits stated in this Certificate and the Premium shall be in United States dollars. For services outside of the territorial limits of the United States, the exchange rate used to determine the amount of United States dollars to be paid is the exchange rate effective for the date the claims expense was incurred.
21. Assignment: The Insurance provided hereunder is not assignable, but benefits may be assigned in accordance with #5, Payment of Claims.
22.Modification of Medical Condition Prior to Issuance of Certificate: Any conditions, which Manifest(ed) themselves between the date the Application is signed and the date the Coverage is issued, shall be considered Pre-Existing and not covered for the entire Certificate Period. Additionally, some conditions, which Manifest(ed) themselves between the date the Application is signed and the date the Coverage is issued, may affect your eligibility for Insurance.
23.Incontestability: After two (2) years from the Effective Date of Individual Insurance, only fraudulent misstatements in the Application may be used to Void the Certificate or deny any claim for Loss, Eligible Benefits or disability starting after the two (2) year period.
24.Representations in Application: Any statement or description made by or on behalf of the Insured Person(s) on the Application for Insurance Coverage is a representation and is not a warranty. A misrepresentation, omission, concealment of fact, or incorrect statement may prevent recovery under the Certificate only if any of the following apply; a.) the misrepresentation, omission, concealment, or statement is fraudulent or is material either to the Approval of the Coverage for the Insured Person(s) or payment of otherwise Eligible Benefits by the Company, b.) if the Administrator or Company had known the facts prior to issuance of Coverage, the Administrator or Company would not have issued Coverage, would not have issued Coverage at the same Premium, or would have issued an Exclusionary Rider(s) to the Coverage under this Certificate.
25.Patient Support: To ensure that Medically Necessary services, supplies and Treatment(s) are provided in the most cost effective and appropriate manner, the Company may determine that a particular claim or diagnosis occurring under this Insurance may be placed under the patient support program. Once the Insured Person(s) follows the Pre-Notification requirement and the Company determines that the condition (or diagnosis) qualifies for the patient support requirement, the Company will advise the Insured Person(s) that a Patient Support Specialist will be assigned to the Insured Person(s) for that particular condition. From that point forward, the Company’s Patient Support Specialist may make recommendations of alternative Treatment(s) in the form of other locations, other procedures, or other supplies that can be used that are more appropriate and/or cost effective for both the Insured Person(s) and the Company (and will result in the same or better care). The Insured Person(s) and the Insured Person(s)’s Physician(s) will have input in this evaluation. Should the recommendations be accepted by the Insured Person(s), the Insured Person(s) agrees to hold the Company harmless and the Company shall not be held liable or otherwise responsible for any Treatment(s), service, supply, procedure or care provided to the Insured Person(s) except for the payment of benefits under this Insurance. After the Insured Person(s) has been notified that the condition meets the Patient Support program requirements, the Company reserves the right to:
a. Generate payment for Treatment(s), services, and/or supplies which are excluded under this Insurance that would be beneficial to the Insured Person(s) and cost effective to the Company; and
b Decline payment for expenses that would otherwise be covered under this Insurance that exceed the amount the Company would have paid had the Insured Person(s) followed the recommended Treatment(s) program established by the patient support program.
26.Ten Day Right to Return Certificate: If for any reason you are not satisfied with this Certificate or any amendment/endorsement that has been added and made a part of this Certificate, you may return it to the Administrator within 10 days after you receive it. You must return it to the Administrator by mail or to the agent who sold it. Then we will refund any Premium paid and the Certificate will be deemed Void, just as though no Certificate had been issued.
27.Complaints: Any initial inquiry or compliant should be addressed to the Administrator, as defined herein. If the Insured Person(s) is not satisfied with the manner in which an inquiry or complaint has been managed by the Administrator, the Insured Person(s) may request in writing to the Complaints & Advisory Department at Lloyd's to review the case without prejudice to your rights in law.
Complaints and Advisory Department of Lloyd's
1 Lime Street
London EC3M 7HA
TRIP CANCELLATION & TRIP INTERRUPTION
The Company will pay a benefit, up to the maximum shown on the Confirmation of Coverage, if You are prevented from taking or unable to continue Your Trip due to:
(a)Sickness, Accidental Injury or death of You, Traveling Companion, or Family Member or Business Partner; which results in medically imposed restrictions as certified by a Physician at the time of Loss preventing Your continued participation in the Trip. A Physician must advise cancellation of the Trip on or before the Scheduled Departure Date.
(b)You or a Traveling Companion being hijacked, quarantined, required to serve on a jury, subpoenaed, the victim of felonious assault within ten (10) days of departure; or having his/her principal place of residence made uninhabitable by fire, flood or other natural disaster; or burglary of his/her principal place of residence within ten (10) days of departure.
(c)You or a Traveling Companion being directly involved in a traffic accident substantiated by a police report, while en route to departure.
(d) A transfer of You by the employer with whom You are employed on the Effective Date that requires Your principal residence to be relocated.
(e)The death or hospitalization of Your Host at Destination.
(g)Your Traveling Companion or Family Member, who are military personnel, and are called to emergency duty for a natural disaster other than war.
(h)Strike that causes complete cessation of services for at least forty-eight (48) consecutive hours.
(i)Weather that causes complete cessation of services of Your Common Carrier for at least forty-eight (48) consecutive hours.
(j)You are terminated, or laid off from employment subject to five (5) years of continuous employment at the place of employment where terminated.
(k)Natural disaster at the site of Your destination that renders the destination accommodations uninhabitable.
The Company will reimburse You for the following if Your Trip is cancelled for any of the reasons listed above under Trip Cancellation/Trip Interruption:
1.Non-refundable cancellation charges imposed by the Travel Suppliers, OR
2.If You must cancel Your Trip because you did not receive Your visa, You have the choice of one of the following exclusive options:
a)Upon written request, the Company will allow You to apply Your premium to a new Trip which commences within 18 months of Your initial policy effective date; OR
b)Upon submission of a copy of the denial letter from the embassy or consulate the Company will provide a $100 benefit for each airline ticket You purchased for Your Trip.
No other benefits will be payable for Cancellation.
SPECIAL CONDITIONS: You must advise the Travel Supplier and the Company as soon as possible in the event of a claim. The Company will not pay benefits for any additional charges incurred that would not have been charged had You notified the Travel Supplier as soon as reasonably possible.
SINGLE OCCUPANCY COVERAGE
The Company will reimburse You, up to the maximum shown on the Confirmation of Coverage for Trip Cancellation, for the additional cost incurred during the Trip as a result of a change in the per person occupancy rate for prepaid travel arrangements if a person booked to share accommodations with You has his/her Trip delayed, canceled, or interrupted for a covered reason and You do not cancel.
The Company will reimburse You for the following if Your Trip is cancelled for any of the reasons listed above under Trip Cancellation/Trip Interruption:
The Company will pay for the following:
(a)Unused, non-refundable land or sea expenses prepaid to the Travel Suppliers;
(b)The airfare paid less the value of applied credit from an unused travel ticket to return home, join or rejoin the original Land/Sea Arrangements limited to the cost of one-way economy airfare or similar quality as the originally issued ticket by scheduled carrier.
The Company will pay for reasonable additional accommodation and transportation expenses incurred by You (up to $100 a day) if a Traveling Companion must remain hospitalized, or if You must extend the Trip with additional hotel nights due to a Physician certifying that You cannot fly home due to an Accident or a Sickness but does not require hospitalization.
In no event shall the amount reimbursed exceed the maximum benefit shown on the Confirmation of Coverage.
The Company will reimburse You for Covered Expenses on a one-time basis, up to the maximum shown in the Confirmation of Coverage, if You are delayed en route to or from the Trip for twelve (12) or more hours due to a defined Hazard.
There will be a per day limit of $150.
Covered Expenses include:
(a)any prepaid, unused, non-refundable land and water accommodations;
(b)any reasonable Additional Expenses incurred;
(c)an Economy Fare from the point where You ended Your Trip to a destination where You can catch up to the Trip;
(d)a one-way Economy Fare to return You to Your originally scheduled return destination.
This benefit covers missed Cruise departures that result from cancellation or delay (for three (3) or more hours) of all regularly scheduled airline flights due to Inclement Weather or any Common Carrier caused delay. Maximum benefits of up to the amount shown in the Confirmation of Coverage are provided to cover additional transportation expenses needed for You to join the departed Cruise, reasonable accommodation and meal expenses and nonrefundable trip payments for the unused portion of Your Cruise. Coverage is secondary to any compensation provided by a Common Carrier. Coverage will not be provided to individuals who are able to meet their scheduled departure but cancel their Cruise due to Inclement Weather.
ACCIDENTAL DEATH & DISMEMBERMENT
The Company will pay the percentage of the Principal Sum shown in the Table of Losses when You, as a result of an Accidental Injury occurring during the Trip, sustain a Loss shown in the Table below. The Loss must occur within 181 days after the date of the Accident causing the Loss. The Principal Sum is shown on the Confirmation of Coverage. The Maximum Benefits for any one single Accident is limited to $15,000,000 for all persons insured under the Policy. If more than one Loss is sustained, as the result of an Accident, the amount payable shall be the largest amount of a sustained Loss shown in the Table of Losses.
TABLE OF LOSSES
|Loss of:||Percentage of Principal Sum:|
|Both hands or both feet||100%|
|Sight of both eyes||100%|
|One hand and one foot||100%|
|Either hand or foot and sight of one eye||100%|
|Either hand or foot||50%|
|Sight of one eye||50%|
|Speech and hearing in both ears||100%|
|Hearing in both ears||50%|
|Thumb and index finger of same hand||25%|
“Loss” with regard to:
1.Hand or foot means actual complete severance through and above the wrist or ankle joints;
2.Eye means an entire and irrecoverable Loss of sight;
3.Speech or hearing means entire and irrecoverable Loss of speech or hearing of both ears; and
4.Thumb and index finger means actual severance through or above the joint that meets the finger at the palm.
EXPOSURE: The Company will pay benefits for covered Losses that result from Your being unavoidably exposed to the elements due to an Accident. The Loss must occur within 365 days after the event that caused the exposure.
DISAPPEARANCE: The Company will pay benefits for Loss of life if Your body cannot be located one (1) year after Your disappearance due to an Accident.
The Company will pay benefits for Accidental Injuries resulting in a Loss as described in the Table of Losses above, that occurs while You are riding as a passenger in or on, boarding or alighting from, any Common Carrier conveyance operated under a license for the transportation of passengers for hire during the Trip. The Loss must occur within 181 days after the date of the Accident causing the Loss. The Principal Sum is shown on the Confirmation of Coverage. The Maximum Benefits for any one single Accident is limited to $15,000,000 for all persons insured under the Policy. If more than one Loss is sustained, as the result of an Accident, the amount payable shall be the largest amount of a sustained Loss shown in the Table of Losses above.
The Company will pay benefits up to the maximum shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip.
Emergency Treatment means necessary medical treatment, including services and supplies, which must be performed during the Trip due to the serious and acute nature of the Sickness.
Covered Medical Expenses are necessary services and supplies that are recommended by the attending Physician. They include but are not limited to:
(a)the services of a Physician;
(b)charges for Hospital confinement and use of operating rooms;
(c)charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
(d)ambulance service; and
(e)drugs, medicines, prosthetics and therapeutic services and supplies.
The Company will not pay benefits in excess of the reasonable and customary charges. Reasonable and customary charges means charges commonly used by Physicians in the locality in which care is furnished. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.
The Company will advance payment to a Hospital, up to the maximum shown on the Confirmation of Coverage, if needed to secure Your admission to a Hospital because of Sickness. If You are hospitalized due to a Sickness (which first occurred during the course of the scheduled Trip) beyond the date of the Scheduled Return Date, coverage will be extended until You are released from the Hospital or until maximum benefits under the Plan have been paid.
EMERGENCY ACCIDENT MEDICAL EXPENSE
The Company will pay benefits up to the maximum shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip. Emergency Treatment means necessary medical treatment, including services and supplies, which must be performed during the Trip due to the serious and acute nature of the Accidental Injury.
Covered Medical Expenses are necessary services and supplies that are recommended by the attending Physician. They include, but are not limited to:
(a)the services of a Physician;
(b)charges for Hospital confinement and use of operating rooms;
(c)charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
(d)ambulance service; and
(e)drugs, medicines, prosthetic and therapeutic services and supplies.
The Company will not pay benefits in excess of the reasonable and customary charges. Reasonable and customary charges means charges commonly used by Physicians in the locality in which care is furnished. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.
The Company will advance payment to a Hospital, up to the maximum shown on the Confirmation of Coverage, if needed to secure Your admission to a Hospital because of Accidental Injury.
If You are hospitalized due to an Accidental Injury which first occurred during the course of the scheduled Trip beyond the date of the Scheduled Return Date, coverage will be extended until You are released from the Hospital or until maximum benefits under the Plan have been paid.
The Company will pay benefits for Covered Expenses incurred, up to the maximum shown on the Confirmation of Coverage, if an Accidental Injury or Sickness commencing during the course of the Trip results in Your necessary Emergency Evacuation. An Emergency Evacuation must be ordered by a Physician who certifies that the severity of Your Accidental Injury or Sickness warrants Your Emergency Evacuation.
Emergency Evacuation means:
(a)Your medical condition warrants immediate transportation from the place where You are injured or sick to the nearest Hospital where appropriate medical treatment can be obtained;
(b)after being treated at a local Hospital, Your medical condition warrants transportation to where You reside, to obtain further medical treatment or to recover; or
(c)both (a) and (b), above.
Covered Expenses are Reasonable and Customary expenses for necessary transportation, related medical services and medical supplies incurred in connection with Your Emergency Evacuation. All transportation arrangements made for evacuating You must be by the most direct and economical route possible. Expenses for transportation must be:
(a)recommended by the attending Physician;
(b)required by the standard regulations of the conveyance transporting You; and
(c)authorized in advance by the authorized assistance company.
Transportation of Dependent Children: If You are in the Hospital for more than seven (7) days, the authorized assistance company will return Your dependents, who are under nineteen (19) years of age and accompanying You on the scheduled Trip, to the domicile of a person nominated by You or Your next of kin with an attendant if necessary.
Transportation to Join You: If You are traveling alone and in a Hospital alone for more than seven (7) consecutive days or if the attending Physician certifies that due to Your Injury or Sickness, You will be required to stay in the Hospital for more than seven (7) consecutive days, upon request the authorized assistance company will bring a person, chosen by You, for a single visit to and from Your bedside provided that repatriation is not imminent.
Transportation services are provided if authorized in advance by the authorized assistance company, and are limited to necessary Economy Fares less the value of applied credit from unused travel tickets, if applicable.
Transportation means any Common Carrier, or other land, water or air conveyance, required for an Emergency Evacuation and includes air ambulances, land ambulances and private motor vehicles. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.
EXCESS INSURANCE LIMITATION
The insurance provided by the Plan shall be in excess of all other valid and collectible insurance or indemnity. If at the time of the occurrence of any loss there is other valid and collectible insurance or indemnity in place, the Company shall be liable only for the excess of the amount of loss, over the amount of such other insurance or indemnity, and applicable deductible.
REPATRIATION OF REMAINS
The Company will pay the reasonable Covered Expenses incurred to return Your body to Your primary place of residence if You die during the Trip. This will not exceed the maximum shown on the Confirmation of Coverage. Covered Expenses include, but are not limited to, expenses for embalming, cremation, casket for transport and transportation.
The Company will reimburse You, up to the maximum shown on the Confirmation of Coverage, for Loss, theft or damage to baggage and personal effects, provided You have taken all reasonable measures to protect, save and/or recover Your property at all times. The baggage and personal effects must be owned by and accompany You during the Trip.
This coverage is secondary to any coverage provided by a Common Carrier.
There will be a per article limit of $300.
There will be a combined maximum limit of $1000 for the following: jewelry; watches; articles consisting in whole or in part of silver, gold or platinum; furs; articles trimmed with or made mostly of fur; cameras and their accessories and related equipment. Previously program summary had a $1,000 maximum for the above articles
The Company will pay the lesser of the following:
(a)Actual Cash Value at time of Loss, theft or damage to baggage and personal effects, less depreciation as determined by the Company; or
(b)the cost of repair or replacement.
EXTENSION OF COVERAGE: If You checked Your property with a Common Carrier and delivery is delayed, coverage for Baggage/Personal Effects will be extended until the Common Carrier delivers the property.
The Company will reimburse You for the expense of necessary personal effects, up to the maximum shown on the Confirmation of Coverage, if Your Checked Baggage is delayed or misdirected by a Common Carrier for more than twenty-four (24) hours, while on a Trip, except for travel to final destination or place of residence.
You must be a ticketed passenger on a Common Carrier.
Additionally, all claims must be verified by the Common Carrier who must certify the delay or misdirection and receipts for the purchases must accompany any claim.
The following exclusions apply to Trip Cancellation & Trip Interruption, Trip Delay, Missed Connection, Accidental Death & Dismemberment, Accidental Death & Dismemberment - Common Carrier, Emergency Sickness Medical Expense & Emergency Accident Medical Expense, Emergency Evacuation & Repatriation of Remains:
Loss caused by or resulting from:
1.Pre-Existing Conditions, as defined in the Definitions section (except Emergency Evacuation and Repatriation of Remains) unless the insurance is purchased within ten (10) days of the initial Trip deposit;
2.suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane (in Missouri, sane only) unless results in the death of a non-traveling immediate Family Member;
3.intentionally self-inflicted injuries;
4.war, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war;
5.participation in any military maneuver or training exercise any loss starting while You are in the service of the armed forces of any country. Orders to active military service for training purposes of two months or less will not constitute service in the armed forces. Upon notice to the Company of entering the armed forces, the Company will return to You pro-rata any premium paid, less any benefits paid, for any period during which You are in such service;
6.piloting or learning to pilot or acting as a member of the crew of any aircraft;
7.mental or emotional disorders, unless hospitalized;
8.participation as a professional in athletics;
9.participation in underwater activities;
10.being under the influence of drugs or intoxicants, unless prescribed by a Physician, unless results in the death of a non-traveling immediate Family Member;
11.commission or the attempt to commit a criminal act;
12.participating in bodily contact sports; skydiving; hang-gliding; parachuting; mountaineering; any race; bungee cord jumping; and speed contest (speed contest shall not include any of the following; regatta races, scuba diving, spelunking or caving, heliskiing, extreme skiing);
13.dental treatment except as a result of an injury to sound natural teeth within twelve (12) months of the Accidental Injury limited to $750;
14.any non-emergency treatment or surgery, routine physical examinations, hearing aids, eye glasses or contact lenses;
15.pregnancy and childbirth (except for complications of pregnancy) except if hospitalized;
16.curtailment or delayed return for other than covered reasons;
17.traveling for the purpose of securing medical treatment;
18.services not shown as covered;
19.directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination;
20.Confinement or treatment in a government Hospital; however the United States government may recover or collect benefits under certain conditions;
21.Care or treatment that is not medically necessary;
22.Care or treatment for which compensation is payable under Worker’s Compensation Law, any Occupational Disease law; the 4800 Time Benefit plan or similar legislation;
23.Care or treatment that is payable under any Insurance policy that does not require deductible and/or coinsurance payments by You;
24.Injury or Sickness when traveling against the advice of a Physician;
25.Cosmetic surgery except for: reconstructive surgery incidental to or following surgery for trauma, or infection or other covered disease of the part of the body reconstructed, or to treat a congenital malformation of a child.
26.Bankruptcy and/or Default of Your Travel Supplier which occurs more than ten (10) days following Your Effective Date. Coverage is not provided for the Bankruptcy or Default of the agency from whom You purchased the Land/Sea Arrangements. Your Scheduled Departure Date must be no more than fifteen (15) months beyond Your Effective Date. Benefits will be paid due to Bankruptcy or Default of an airline only if no alternate transportation is available. If alternate transportation is available, benefits will be limited to the change fee charged to allow You to transfer to another airline in order to get to Your intended destination.
The Company will not provide benefits for any Loss or damage to:
2.Automobiles and automobile equipment;
3.Boats or other vehicles or conveyances;
8.Bicycles (except when checked as baggage with a Common Carrier);
9.Household effects and furnishing;
10.Antiques and collectors’ items;
11.Eyeglasses, sunglasses or contact lenses;
12.Artificial teeth and dental bridges;
16.Keys, money, stamps, securities and documents;
19.Professional or occupational equipment or property, whether or not electronic business equipment;
20.Personal computers, telephones, computer hardware or software;
21.Sporting equipment if Loss or damage results from the use thereof
Any Loss caused by or resulting from the following is excluded:
1.Breakage of brittle or fragile articles;
2.Wear and tear or gradual deterioration;
3.Insects or vermin;
4.Inherent vice or damage while the article is actually being worked upon or processed;
5.Confiscation or expropriation by order of any government;
6.War or any act of war whether declared or not;
7.Theft or pilferage while left unattended in any vehicle;
9.Property illegally acquired, kept, stored or transported;
10.Insurrection or rebellion;
11.Imprudent action or omission;
12.Property shipped as freight or shipped prior to the Scheduled Departure Date.
OPTIONAL - FLIGHT ACCIDENTAL DEATH & DISMEMBERMENT
You are eligible for benefits as the result of an Accident:
1.Received while a passenger on a regularly scheduled airline flight or regularly scheduled charter operated; on scheduled air transportation pursuant to economic authority issued by the Civil Aeronautics Board; by an intrastate scheduled airline of United States registry maintaining regularly published schedules and licensed for the transportation of passengers by a duly constituted authority having jurisdiction over civil aviation in the state in which said airline operates; or by a scheduled airline of foreign registry maintaining regularly published schedules and licensed for transportation of passengers by the duly constituted governmental authority having jurisdiction over civil aviation in the country of registry of such airline;
2.Received while a passenger on any aircraft, other than a single-engine jet, which at the time is making a flight for the principal purchase of transporting passengers and not for any other operational, tactical or test purpose and which is operated by the Military Airlift Command of the United States, the Royal Canadian Air Force Air Transport Command, or the Royal Air Force Air Transport Command of Great Britain;
3.Received while a passenger on any land or water conveyance provided at the expense of the air carrier as a substitute for an aircraft covered by this Policy;
4.Received while a passenger on a vehicle licensed to carry passengers for hire, but only when:(a) going to an airport to board an aircraft on which You are covered by this Policy; or (b) when leaving an airport after alighting from such an aircraft;
5.Received while upon airport premises designated for passenger use immediately before boarding or immediately after alighting from an aircraft on which You are covered under this Policy.
Benefits will be paid equal to the amount purchased for accidental death or dismemberment when You sustain Injuries resulting in any of the following Losses within 181 days from the date of the Accident:
|Type of Loss||Percentage of Chose Benefit Paid|
|Loss of Life||100%|
|Loss of both feet||100%|
|Loss of both hands||100%|
|Loss of both eyes||100%|
|Loss of one hand and one foot||100%|
|Loss of one hand and one eye||100%|
|Loss of one foot and one eye||100%|
|Loss of one hand||50%|
|Loss of one foot||50%|
|Loss one eye||50%|
Loss of hand or hands, or foot or feet, means severance at or above the wrist joint or ankle joint, respectively. Loss of eye or eyes means the total and irrecoverable Loss of the entire sight thereof. Only the largest applicable amount shown above will be paid for the Injuries resulting from one Accident. The benefit for Loss of:
(b)both eyes; or
(c)one extremity and one eye is payable only when such Loss results from the same Accident.
If, while covered by this benefit, You are unavoidably exposed to the elements because of an eligible Accident and suffer a Loss for which benefits are payable under this benefit, such Loss will be payable under this Policy.
If, while eligible for this benefit, You are in an Accident resulting in the disappearance, sinking or damaging of an air or water conveyance on which You are scheduled under this Policy, and Your body has not been found within fifty-two (52) weeks from the date of the Accident, it will be presumed, unless there is evidence to the contrary, that You suffered a Loss of life as a result of those Injuries.
Flight Accident Option also includes a medical expense feature that pays Eligible Expenses up to $50 for each $1,000 of the chosen benefit amount. If medical expense occurs within fifty-two (52) weeks of an eligible Accident, You will be paid for Eligible Medical Expenses as well as home health care from a licensed home health agency, but only if continued Hospital care would have otherwise been required; attendance of a registered graduate nurse; X-ray examination; or, use of an ambulance.
Loss must occur within one hundred eighty-one (181) days of the Accident. To receive benefits, Loss must be independent of illness or disease and all other causes.
COORDINATION OF BENEFITS
The Coordination of Benefits (“COB”) provision applies to This Plan when You have health care coverage under more than one Plan. “Plan” and “This Plan” are defined below.
If this COB provision applies, the order of benefit determination rules should be looked at first. Those rules determine whether the benefits of This Plan are determined before or after those of another Plan.
The benefits of This Plan:
(a)will not be reduced when, under the order of benefit determination rules, This Plan determines its benefits before another Plan; but
(b)may be reduced when, under the order of benefit determination rules, another Plan determines its benefits first. This reduction is described further in the section entitled Effect on the Benefits of This Plan.
Plan is a form of written on an expense incurred basis that provides benefits or services for, or because of, medical or dental care or treatment. “Plan” includes:
(a)group insurance and group remittance subscriber contracts;
(b)uninsured arrangements of group coverage;
(c)group coverage through HMO’s and other prepayment, group practice and individual practice Plans; and
(d)blanket contracts, except blanket school accident coverages or a similar group when the Policyholder pays the premium.
“Plan” does not include individual or family:
(b)direct payment subscriber contracts;
(c)coverage through HMO’s; or
(d) coverage under other prepayment, group practice and individualpractice Plans.
This Plan is the parts of this blanket contract that provide benefits for health care expenses on an expense incurred basis.
Primary Plan is one whose benefits for a person’s health care coverage must be determined without taking the existence of any other Plan into consideration. A Plan is a Primary Plan if either:
(a)the Plan either has no order of benefit determination rules, or it has rules that differ from those in the contract; or
(b)all Plans that cover the person use the same order of benefits determination rules as in this contract, and under those rules the Plan determines its benefits first.
Secondary Plan is one that is not a Primary Plan. If a person is covered by more than one Secondary Plan, the order of benefit determination rules of this contract decide the order in which their benefits are determined in relation to each other. The benefits of each Secondary Plan may take into consideration the benefits of the Primary Plan or Plans and the benefits of any other Plan which, under the rules of this contract, has its benefits determined before those of that Secondary Plan.
Allowable Expense is the necessary, reasonable, and customary item of expense for health care; when the item of expense is covered at least in part under any of the Plans involved.
The difference between the cost of a private hospital room and a semi-private hospital room is not considered an Allowable Expense under the above definition unless the patient’s stay in a private hospital room is medically necessary in terms of generally accepted medical practice.
When a Plan provides benefits in the form of services, the reasonable cash value of each service will be considered both an Allowable Expense and a benefit paid.
Claim is a request that benefits of a Plan be provided or paid. The benefits claimed may be in the form of:
(a)services (including supplies);
(b)payment for all or a portion of the expenses incurred; or
(c)a combination of (a) and (b).
Claim Determination Period is the period of time, which must not be less than 12 consecutive months, over which Allowable Expenses are compared with total benefits payable in the absence of COB, to determine:
(a)whether overinsurance exists; and
(b)how much each Plan will pay or provide.
For the purposes of this contract, Claim Determination Period is the period of time beginning with the effective date of coverage and ending 12 consecutive months following the date of loss or longer as may be determined by the proof of loss provision.
Order of Benefit Determination Rules
When This Plan is a Primary Plan, its benefits are determined before those of any other Plan and without considering another Plan’s benefits.
When This Plan is a Secondary Plan, its benefits are determined after those of any other Plan only when, under these rules, it is secondary to that other Plan .
When there is a basis for a Claim under This Plan and another Plan, This Plan is a Secondary Plan that has its benefits determined after those of the other Plan, unless:
(a)the other Plan has rules coordinating its benefits with those of This Plan; and
(b)both those rules and This Plan’s rules, as described below, require that This Plan’s benefits be determined before those of the other Plan.
This Plan determines its order of benefits using the first of the following rules which applies:
(a)Nondependent/Dependent Rule. The benefits of the Plan that covers the person as an employee, member or subscriber (that is, other than as a dependent) are determined before those of the Plan that covers the person as a dependent.
(b)Longer/Shorter Length of Coverage Rule. The benefits of the Plan that covered an employee, member or subscriber longer are determined before those of the Plan that covered that person for the shorter time.
To determine the length of time a person has been covered under a Plan, two Plans shall be treated as one if the claimant was eligible under the second within 24 hours after the first ended. Thus, the start of a new Plan does not include: (a) a change in the amount or scope of a Plan’s benefits; (b) a change in the entity which pays, provides or administers the Plan’s benefits; or (c) a change from one type of Plan to another. The claimant’s length of time covered under a Plan is measured from the claimant’s first date of coverage under that Plan. If that date is not readily available, the date the claimant first became a member of the group shall be used as the date from which to determine the length of time the claimant’s coverage under the present Plan has been in force.
Effect on the Benefits of This Plan When it is Secondary
The benefits of This Plan will be reduced when it is a Secondary Plan so that the total benefits paid or provided by all Plans during a Claim Determination Period are not more than the total Allowable Expenses, not otherwise paid, which were incurred during the Claim Determination Period by the person for whom the Claim is made. As each Claim is submitted, This Plan determines its obligation to pay for Allowable Expenses based on all Claims that were submitted up to that point in time during the Claim Determination Period.
Right to Receive and Release Needed Information
Certain facts are needed to apply these COB rules. The Company has the right to decide which facts are needed. The Company may get needed facts from or give them to any other organization or person. The Company need not tell, or get the consent of, any person to do this. Each person claiming benefits under This Plan must give the Company any facts we need to pay the Claim.
Facility of Payment
A payment made under another Plan may include an amount that should have been paid under This Plan. If it does, the Company may pay that amount to the organization that made that payment. That amount will then be treated as though it were a benefit paid under This Plan. The Company will not have to pay that amount again. The term “payment made” includes providing benefits in the form of services, in which case “payment made” means reasonable monetary value of the benefits provided in the form of services.
Right of Recovery
If the amount of the payments made by the Company is more than the Company should have paid under this COB provision, the Company may recover the excess from one or more of: (a) the persons we have paid or for whom we have paid; (b) insurance companies; or (c) other organizations.
This Plan may coordinate its benefits with a Plan that is excess or always secondary or which uses order of benefit determination rules which are inconsistent with those of This Plan (non-complying Plan) on the following basis:
(a)If This Plan is the Primary Plan, This Plan will pay its benefits on a primary basis;
(b)if This Plan is the Secondary Plan, This Plan will pay its benefits first, but the amount of the benefits payable will be determined as if This Plan were the Secondary Plan. In this situation, our payment will be the limit of This Plan’s liability; and
(c)if the non-complying Plan does not provide the information needed by This Plan to determine its benefits within 30 days after it is requested to do so, the Company will assume that the benefits of the non-complying Plan are identical to This Plan and will pay benefits accordingly. However, the Company will adjust any payments made based on this assumption whenever information becomes available as to the actual benefits of the non-complying Plan.
The Travel Assistance feature provides a variety of travel related services. Services offered include:
Medical evacuation / repatriation
Repatriation of remains
Medical or legal referral
Hospital admission guarantee
Emergency cash advance*
Prescription drug / eyeglass replacement*
Passport / visa information
Lost Baggage retrieval
Payment reimbursement to the Assistance Company is Your responsibility.
For travel assistance services only
CALL TOLL FREE: 800-690-6295 (within the United States and Canada)
OR CALL COLLECT: 317-818-2808 (from all other locations)
Travel assistance services are provided by an independent organization and not by Lloyd’s of London or it’s affiliated companies or Seven Corners, Inc.
There may be times, when circumstances beyond the Assistance Company’s control, hinder their endeavors to provide travel assistance services. They will, however, make all reasonable efforts to provide travel assistance services and help you resolve your emergency situation.
FILING A CLAIM IS SIMPLE
To receive a claim form, contact Seven Corners Administrators, or send Your name, address, travel dates, confirmation number (provided on Your ID Card once You have purchased ), and details of Your loss within 30 days to:
Seven Corners Administrators
303 Congressional Blvd.
Carmel, IN 46032
IMPORTANT: To facilitate prompt claims settlement, You will be asked to provide proof of Your loss. Therefore, be sure to obtain the following as applicable:1.) For medical claims - detailed medical statements from treating physicians where and when the accident or Sickness occurred as well as receipts for medical services and supplies; 2.) For baggage and baggage delay claims - reports from parties responsible (i.e. airline, cruiseline, etc.) for loss, theft, damage or delay. Some claims may also require a police report. Please obtain receipts for lost or damaged items; 3.) For trip delay claims - a statement from party causing delay and receipts for expenses; 4.) For cancellation/interruption claims - Your travel invoice, the cancellation or interruption date, original unused tickets/vouchers, the travel organizer's cancellation clause with regard to nonrefundable losses. You will also be asked to provide proof of payment.
No benefits will be paid for any expenses reimbursed to You or services provided to You by any other source. Benefits cannot be duplicated under Your Protection Plan.
Unless You otherwise designate a beneficiary, or in the event the designated beneficiary predeceases You, indemnity for loss of life will be paid to the first of the following surviving beneficiaries: Your spouse; child or children, jointly; parents, jointly if both are living, or the surviving parent, if only one survives; brothers and sisters jointly; or Your estate.