Silver

Underwritten by Old Republic Insurance Company

Distributed by John Hancock Insurance Agency, Inc.
 
John Hancock Insurance Agency, Inc. Travel Insurance

 

 

Evidence of Coverage

 

 

IMPORTANT

 

Take Your Confirmation of Coverage and this Evidence of Coverage with You on Your trip. Refer to Your Confirmation of Coverage for Your specific plan benefits and limits.

 

Certificate of Insurance

Old Republic Insurance Company hereby certifies that You are insured under the Policy provided that You qualify under the Eligibility and Enrollment provision, become insured and remain insured in accordance with the terms of the Policy.  Your insurance is subject to all of the definitions, limitations, exclusions and conditions of the Policy.

This certificate is not the entire contract of insurance.  It is a part of the Policy and is evidence of Your insurance.  It takes effect at 12:01 A.M. Standard Time on the Effective Date stated in the Confirmation of Coverage.  We and the Old Republic Travel Insurance Trust can agree to amend the Policy at any time.

This certificate is not valid unless the Confirmation of Coverage is attached.

 

10-DAY RIGHT TO EXAMINE YOUR CERTIFICATE

It is important that You understand the coverage described in this certificate and are satisfied with it. You should read it carefully.  If You have any questions, You should contact Us.  If You are not satisfied with the coverage, this certificate should be returned to Us within 10 days after receipt.  We will then refund the premium paid, and this certificate will be considered never to have been issued.  All premiums and fees are nonrefundable after the 10-day review period.

TAC-1AA

 

This Evidence of Coverage describes the benefits and provisions of coverage under the following: Group Master Policy TA02012011, form number ORTA-GP (ORTA-C24 for residents of MO)

 

 

 

LIMITED BENEFIT SHORT TERM GROUP TRAVEL CERTIFICATE

 

TRIP CANCELLATION / TRIP INTERRUPTION

TRIP DELAY

MISSED CONNECTION

ITINERARY CHANGE

BAGGAGE AND PERSONAL EFFECTS / BAGGAGE DELAY
RENTAL VEHICLE DAMAGE PROTECTION

TRAVEL ACCIDENT COVERAGE

COMMON CARRIER ACCIDENT COVERAGE

FLIGHT ACCIDENT COVERAGE

 EMERGENCY MEDICAL EXPENSES

EMERGENCY MEDICAL EVACUATION/REPATRIATION

 

 

TABLE OF CONTENTS

PROVISIONS                                                                                                         

Definitions

Your Coverage Period

Extension of Your Coverage

PROPERTY AND CASUALTY

     Trip Cancellation – Trip Interruption

     Trip Delay

     Missed Connection

     Itinerary Change

     Baggage and Personal Effects

     Baggage Delay

     Rental Vehicle Damage Protection

TRAVEL ACCIDENT AND HEALTH

     Accidental Death & Dismemberment

        Travel Accident Coverage

        Common Carrier Travel Accident

        Flight Accident Coverage

     Emergency Medical Benefits

        Emergency Medical Expenses

        Emergency Medical Evacuation/Repatriation

General Exclusions and Limitations

      Maximum Limit of Liability

     Pre-Existing Conditions Exclusion

     Pre-Existing Conditions Limitation

General Provisions

Uniform Provisions

State Exceptions

Travel Assistance & Concierge Services

Filing a Claim

TOC-C

 

DEFINITIONS

The following are key words and phrases used in this certificate.  When these words and phrases, or forms of them, are used, they are capitalized.  As You read this certificate, refer back to these definitions.

Accident means a sudden, unexpected, unusual, specific and abrupt event. Such event must occur by chance at an identifiable time and place while coverage is in force.  Any loss caused by, or resulting from a sickness or disease is not an Accident.

TADEF-1AA

Actual Cash Value means the original cost of Your Baggage and Personal Effects less any depreciation as determined by Us.

PCDEF-1AA

Additional Transportation Cost means the actual cost incurred for one-way, Economy Transportation as charged by a Common Carrier, reduced by the value of an unused travel ticket.

PCDEF-2AA

Baggage and Personal Effects means any luggage or goods being used by You during a Covered Trip.

PCDEF-3AA

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 U.S.C. Subsection 101 et seq.

PCDEF-4AA

Business Partner means an individual who has at least a 20% ownership interest in a commercial enterprise in which You also have at least a 20% ownership interest; and You are both actively engaged in the daily management of the business.

TADEF-2AA

Commercial Rental Vehicle Agency means an agency licensed under the laws of the jurisdiction of operation which rents vehicles for the personal use of its customers subject to the terms and conditions found within a rental agreement.

PCDEF-5AA

Common Carrier means any public land, water, or air conveyance operated under a license for the transportation of passengers for hire.

TADEF-3AA

Confirmation of Coverage means the coverage confirmation provided to You following enrollment and payment of the applicable premium as calculated on the enrollment form.  The Confirmation of Coverage is attached to and made a part of this certificate.

TADEFC-4AA

Covered Trip means scheduled trips, tours or cruises for which: 1) coverage is requested; 2) the required premium is paid prior to Your Effective Date of coverage; and 3) the trip exceeds 150 miles from Your Primary Residence.

TADEF-5AA

Destination means the place to which You expect to travel on Your Covered Trip.

TADEF-6AA

Economy Transportation means transportation at the lowest published available rate for a ticket on a Common Carrier matching the original class of transportation that You purchased for the Covered Trip.

TADEF-7AA

Emergency means an unforeseen Sickness or Injury that requires immediate Medical Treatment to prevent or alleviate existing danger to life or health. An Emergency no longer exists when medical evidence indicates that You are able to return to Your Point of Origin or to continue with the Covered Trip without endangering Your life or physical health.

TADEF-8AA

Emergency Medical Expenses means expense incurred during Your Covered Trip for Emergency services and supplies listed below and ordered or prescribed by a Physician as Medically Necessary for diagnosis or treatment. Such Expenses are limited to:

1)       the services of a Physician;

2)       Hospital or ambulatory medical-surgical center services (this will also include expenses for a cruise ship cabin or hotel room, not already     included in the cost of Your Covered Trip, if recommended as a substitute for a hospital room for recovery of an Injury or Sickness); and

3)       transportation furnished by a professional ambulance company to and from a Hospital; and

4)       prescribed drugs, prosthetics and therapeutic services and supplies.

TADEF-9AA

 

 

TADEF-10AA

Hospital means an institution established according to law which:

1)     holds a license as a Hospital (if required in the state);

2)     operates primarily for the reception, care and treatment of sick or injured persons as in-patients;

3)     provides 24-hour nursing service;

4)     has a staff of one or more Physicians available at all times;

5)     provides organized facilities for diagnosis and surgery;

6)     is not primarily a clinic, nursing, rest or convalescent home or a skilled nursing facility or similar establishment; and

7)     is not, other than incidentally, a place for treatment of alcoholism, drug addiction or mental or nervous disorders.

The nursing service must be by registered or graduate nurses on duty or call.  Confinement in a special unit of a Hospital used primarily as a nursing, rest or convalescent home or skilled nursing facility will not be deemed to be a confinement in a Hospital.

TADEF-11AA

Host at Destination means the person, at his or her usual place of residence, with whom You have arranged overnight accommodation for the majority of Your Covered Trip.  A Host at Destination does not include any commercial facilities.

PCDEF-7AA

Inclement Weather means any weather condition that delays the scheduled arrival or departure of a Common Carrier.

PCDEF-8AA

Injury means bodily injury caused by an Accident.  The injury must:

1)       occur while Your coverage is in force;

2)       result, directly and independently of all other causes; and

3)       be certified by a local attending Physician.

TADEF-12AA

Insured means the eligible person whose insurance is in force under terms of the Policy.

TADEFC-13AA

Key Person means 1) an employed caregiver of Your legal dependent; or 2) a person to whom You are not married and with whom You have cohabited for 12 continuous months.

TADEF-14AA

Maximum Benefit Amount means the maximum amount payable for each coverage as shown in Your Confirmation of Coverage.

TADEF-15AA

Maximum Waiver Amount means the maximum limit of benefits for Trip Cancellation/Trip Interruption and Emergency Medical Expenses, as stated on Your Confirmation of Coverage, where the Pre-existing Conditions Exclusion is not applied.

TADEF-16BB 

Medical Treatment means treatment, advice or consultation by a Physician or care provided under a Physician’s supervision or direction.

TADEF-17AA

Medically Necessary means an Emergency treatment, service or supply that is:

1)     recommended by the local attending Physician;

2)     performed under the Physician’s care, or supervision; and

3)     determined by Us to be:

        a)     consistent with generally accepted medical practice for the Injury or Sickness;

        b)     could not have been omitted without adversely affecting Your condition or quality of medical care;

        c)     is delivered at the most appropriate level of care, and not primarily for the sake of convenience; and

        d)     is not considered experimental unless coverage for experimental service or supply is required by law.

TADEF-18AA

Natural Disaster means a disaster resulting from natural causes including flood, hurricane, tornado, earthquake, volcanic eruption or blizzard.

PCDEF-9AA

Organized Labor Strike means any stoppage of work:

1)     as a result of the combined effect of workers which was unannounced and unpublished at the time coverage under the Policy was purchased; and

2)     that interferes with the normal departure and arrival of a Common Carrier.

It does not include a general strike whereby all or most of the workers of a country, province, state, city or town cease work.

PCDEFC-10AA

Physician means a medical doctor or a Christian Science practitioner who is: 1) practicing within the scope of his or her license; and 2) recognized as a physician in the place where medical services are rendered.  Physician does not include You, a Traveling Companion or a Family Member.

TADEF-20AA

Point of Origin means Your original place of departure for Your Covered Trip.

TADEF-21AA

Primary Residence means Your principal domicile.

TADEF-23AA

Published Penalties means any published cancellation penalties issued by Your travel agency or Travel Supplier that apply to all clients of the travel agency or Travel Supplier and can be documented at time of the Covered Trip sale. Published Penalties includes any penalties imposed by the travel agency or Travel Supplier of up to 10% of the Covered Trip Cost (excluding taxes and other non-commissionable items); or 10% of the amount You have paid towards the Covered Trip, whichever is less.

PCDEF-11AA

Scheduled Departure Date means the date on which You are originally scheduled to leave Your Point of Origin.

TADEF-24AA

Scheduled Return Date means the date You are originally scheduled to return to the Point of Origin as shown in Your Confirmation of Coverage.

TADEF-25AA

Sickness means an illness or disease which is diagnosed or treated by a Physician after Your Effective Date and while You are covered under the Policy. 

TADEFC-26AA

Transportation Expense means: 1) the cost of the conveyance of You and any medical personnel (if Medically Necessary); and 2) Medically Necessary services and supplies provided during Your conveyance.

TADEF-27AA

Travel Arrangements means: 1) transportation; 2) travel accommodations; and 3) other specified services arranged by the Travel Supplier for the Covered Trip.

TADEF-29AA

Traveling Companion means a person with whom You: 1) have coordinated Travel Arrangements; and 2) intend to travel with during Your Covered Trip (up to a maximum of 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.

TADEF-30CC

Travel Supplier means any entity or organization that coordinates or supplies travel services for You.

TADEF-31AA

Trip Cost means all prepaid Covered Trip costs that are subject to cancellation penalties or restrictions including the cost of any subsequent arrangements added to Your Covered Trip.

TADEF-32AA

Usual and Customary Charges means the amount charged for similar or comparable treatment, services and supplies in the geographic area where treatment is performed.

TADEF-33AA 

We, Our and Us mean Old Republic Insurance Company.

TADEF-34AA

You, Your and Yours mean the Insured to whom this certificate is issued.

TADEFC-35AA

 

 

YOUR COVERAGE PERIOD

 

Effective Dates

1)       Trip Cancellation: Coverage shall take effect at 12:01 a.m. on the date stated on Your Confirmation of Coverage.

2)       All Coverages Other Than Trip Cancellation: Coverage shall take effect at 12:01 a.m. on:  a) the date You start Your Covered Trip; or b) Your Scheduled Departure Date, whichever is later.

Termination Dates

1)       Trip Cancellation: coverage ends the earlier of:  a) the point and time of departure on Your Scheduled Departure Date; or b) cancellation of Your Covered Trip.

2)       All Coverages Other Than Trip Cancellation and Rental Vehicle Damage Protection: Coverage ends the earlier of:  a) the point and time You return from Your Covered Trip; or b) on Your Scheduled Return Date.

 

3)       Rental Vehicle Damage Protection coverage ends on the earliest of the following:

        a)     the Rental Vehicle return date as shown on Your enrollment form;

        b)     the date You return the Rental Vehicle to the Commercial Rental Vehicle Agency; or

        c)     the date the Rental Vehicle was scheduled to be returned to the Commercial Rental Vehicle Agency as stipulated in the rental agreement.

TACP-1BB

Maximum Covered Trip Length

Coverage is provided for any one Covered Trip up to a maximum period of 365 days. For longer trips, You may apply for an extended period of coverage subject to Our approval.

MCTL-1AA

 

EXTENSION OF YOUR COVERAGE

Automatic Extension of Coverage

In the event a trip delay, affecting a Common Carrier on which You are or You were scheduled to travel, results in Your Covered Trip being prolonged beyond Your Scheduled Return Date, We will automatically extend coverage under the Policy for an additional 3 days.  In addition, if You are Hospitalized due to a covered Injury or Sickness, We will automatically extend coverage for the period of Hospital confinement for You and one covered Traveling Companion, and for an additional 5 days following Your release.

This automatic extension of coverage is provided as long as:

1)       the trip delay was beyond the control of any person covered under the Policy;

2)       You were originally scheduled to arrive at Your Point of Origin within the coverage period;

3)       Your Covered Trip was ultimately completed within a reasonable period of time; and

4)       coverage under the Policy was in force at the time of the trip delay or Your hospitalization.

The automatic extension of coverage will not be subject to the payment of any additional premium.

TAAEC-1AA

 

Optional Extension of Coverage

If, while traveling on Your Covered Trip, You decide, after departure, to extend such trip beyond Your Scheduled Return Date You may obtain an extension of coverage, subject to Our approval, by contacting Us before Your coverage is scheduled to end.

We will extend Your coverage under the Policy for up to an additional 30 days from Your Scheduled Return Date, as long as:

1)       You have not experienced an Injury or Sickness, or have not had Medical Treatment during Your Covered Trip;

2)       coverage under the Policy is in force at the time You request an extension; and

3)       You pay any additional required premium for such extension.

Failure to make medical information known will render this coverage extension null and void.

TAOEC-1AA

 

PROPERTY AND CASUALTY

 

 

 

 

BAGGAGE AND PERSONAL EFFECTS/BAGGAGE DELAY

 

 

TRAVEL ACCIDENT AND HEALTH COVERAGE

 

ACCIDENTAL DEATH & DISMEMBERMENT BENEFIT

DESCRIPTION OF COVERAGE

 

GENERAL EXCLUSIONS and LIMITATIONS

Property and Casualty Benefits are Trip Cancellation, Trip Interruption, Trip Delay, Missed Connection, Itinerary Change, Baggage and Personal Effects, Baggage Delay and Rental Vehicle Damage Protection.

Accident and Health Benefits are Accidental Death and Dismemberment and Emergency Medical Benefits.

The Policy does not cover any loss caused by or resulting from:

1)       suicide, attempted suicide, or any intentionally self-inflicted Injury;

XLPA-1AA

2)       war or act of war (whether declared or undeclared);

XLPA-2AA

3)       service in the Armed Forces or units auxiliary thereto;

XLPA-3AA

4)       aviation, other than as a fare-paying passenger on a scheduled or charter flight operated by a scheduled airline;

XLPA-4AA

5)       intoxication or under the influence of any medication or drugs, unless taken as prescribed by a Physician.  Intoxication means that which is defined and determined by the laws of the jurisdiction where the loss or cause of loss occurred;

XLPA-5AA

6)       participation in a felony;

XLPA-7AA

7)       participation in a riot or insurrection;

XLPA-8AA

8)       mental or emotional disorders unless hospitalized for 3 or more consecutive days after Your Effective Date;

XLPA-9AA

9)       a condition for which You have received advice from a Physician advising against travel 90 days prior to Your Effective Date;

XLPA-11AA

10)    any elective Medical Treatment;

XLPA-12AA

11)    pregnancy except complications of pregnancy;

XLPA-13AA

12)    travel to or through a city or country of Destination, as reflected in Your travel itinerary, which is under a travel warning issued by the United States Department of State at the time this insurance is purchased and the loss or delay was a direct result of the incidents surrounding the travel warning, unless You are in the United States, its possessions or the countries of Canada and Mexico.

XLPA-14AA

13)   riding, driving or participating in races, or speed or endurance contests;

XLPA-15AA

14)   mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes or other special equipment);

XLPA-16AA

15)   participating as a member of a team in an organized sporting competition or as a professional in athletics;

XLPA-17AA

16)   participating in skydiving, hang gliding, bungee cord jumping, deep sea diving or scuba diving (unless You hold an open water diving certificate or You are accompanied by a dive master and not diving deeper than 130 feet);

XLPA-18AA

17)   a governmental regulation or prohibition (applies to Property and Casualty Benefits only);

XLPA-19AA

18)   a diagnosed sickness from which no recovery is expected and for which only palliative treatment is provided and which carries a prognosis of death within 12 months of Your Effective Date;

XLPA-20AA

19)   any sub-orbital or orbital space flights; or

XLPA-29BA

20)   travel for the purpose of receiving medical care, medication or treatment (applies to Property and Casualty Benefits only).

XLPA-23AA

MAXIMUM LIMIT OF LIABILITY (For Other Than Emergency Medical Evacuation/Repatriation) All limits are applied per trip.  Our maximum limit of liability resulting from the same occurrence will be $10,000,000.  If the loss for all Insureds from such an occurrence exceeds $10,000,000, We will pay each Insured that proportion of the benefits stated which $10,000,000 bears to the total loss of all persons insured under all travel insurance in force with Us.  We will pay no more than $1,000,000 per occurrence to or on account of any person insured.

TAML-1AA

 

GENERAL PROVISIONS

Any statement made by You, in the absence of fraud, will be deemed a representation and not a warranty.  No statement will be used to void or reduce benefits, or be used in defense to a claim unless:

1)       it is in writing;

2)       it was signed by You; and

3)       a copy has been given to You, Your beneficiary or Your personal representative.

TAGPC-1AA

Medical Records: In the event of a claim, We reserve the right to review any and all medical records relating to Your claim(s).

TAGP-2AA

Subrogation for Property and Casualty Benefits (Trip Cancellation/Trip Interruption, Trip Delay, Baggage and Personal Effects, Baggage Delay, Missed Connection, Itinerary Change and Rental Vehicle Damage Protection): We will, upon making any payment or assuming liability thereon under the Policy, be subrogated to all rights of recovery against any person or corporation and may bring action in Your name to enforce such rights.

TAGPC-3AA

Errors or Mis-payments: If any benefit is paid in error or payment is made in excess of the amount allowed under the provisions of the Policy, We reserve the right to recover the excess or ineligible payment from You, Your estate, any institution, insurer or person to whom the payment was made.

 TAGPC-4AA

Currency: All monies described in the Policy are expressed in United States of America currency.

TAGPC-5AA

Conformity With State Statutes:  Any provision of the Policy which, on its effective date, is in conflict with the statutes of the state in which You reside on such date is hereby amended to conform to the minimum requirements of such laws.

TAGPC-6AA

Clerical Error:  Clerical Error on Our part or that of a Travel Supplier in keeping records or furnishing information will not void coverage if it is otherwise validly in force; nor will it continue coverage if it is otherwise validly terminated under the terms of the Policy.

TAGPC-7AA

Misstatement of Age: In the event Your age has been misstated, and the premium paid for insurance is less than the required premium for coverage at the correct age benefits will be paid in direct proportion of the actual premium paid to the required premium due.

TAGP-8AA

Sworn Statements:  At Our expense, We have the right to have You examined under oath with respect to any claim documents submitted.  We also have the right to require a sworn statement be submitted before any loss under the Policy is payable.

TAGPC-10AA

Assistance Provision: We and our contracted suppliers are not responsible for the availability, quality or results of any treatment or transportation, or failure of You to obtain treatment.

TAGP-9AA

 

UNIFORM PROVISIONS

Notice of Claim:  Written notice of claim must be given to Us within 20 days after any loss covered by the Policy. If notice cannot be given within that time, it must be given as soon as reasonably possible.

Notice should identify You and Your beneficiary, if applicable, and provide the identification number as stated on Your Confirmation of Coverage. Notice must be sent to Us at 4600 Witmer Industrial Estates- Suite 6, Niagara Falls, NY 14305, or given to Our agent.

TAUPC-1AA

Claim Forms: When We receive written notice of claim, We will furnish claim forms within 15 days.  If We do not, You will be considered to have met the requirements for written proof of loss if We are sent written proof as described below. The proof must describe the occurrence, extent and nature of the loss.

TAUP-2AA

Written Proof of Loss:  Written proof of loss must be given to Us within 90 days after the date of such loss.  If it is not reasonably possible to give the proof within that time frame, the claim is not affected if the proof is given as soon as possible.  Unless You are legally incapacitated, written proof must be given within one year of the time it is otherwise due.

TAUP-3AA

Time of Payment of Claims:  Benefits payable under the Policy for any loss will be paid immediately upon receipt of due written proof of such loss.

TAUPC-4AA

Payment of Claims: Benefits for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at time of payment. If no such designation or provision is then effective, such benefit shall be payable to Your estate.

Any other accrued benefits unpaid at Your death may, at Our option, be paid either to such beneficiary or to such estate. All other benefits will be payable to You.

If any benefit of the Policy shall be payable to Your estate, or to You or Your beneficiary who is a minor or otherwise not competent to give a valid release, We may pay such benefit, up to an amount not exceeding $1,000, to any relative by blood or connected to You by marriage or Your beneficiary who is deemed by Us to be equitably entitled thereto. Any payment made by Us in good faith pursuant to this provision shall fully discharge Us to the extent of such payment.

Subject to Your written direction, all or a portion of the benefits payable for any Hospital nursing, medical, or surgical services may, at Our option and unless You request otherwise in writing not later than the time of filing proofs of loss, be paid directly to the Hospital or person rendering such services; but is not required that the service be rendered by a particular Hospital or person.

TAUPC-5AA

No Benefit to Bailee: The Policy shall not benefit any Common Carrier or bailee.

TAUPC-6AA

Physical Examination and Autopsy: At Our expense, We have the right to have You examined as often as is reasonable while the claim is pending.  We have the right to have an autopsy performed at the Our expense, unless forbidden by law.

TAUP-7AA

Legal Actions: No legal action at law or in equity can be brought against Us until after 60 days after written proof of loss was given. No such action can be brought after 3 years after the date written proof of loss is required.

TAUP-8AA

Concealment and Misrepresentation: The entire coverage will be void, if before, during or after a loss, any material fact or circumstance relating to the Policy has been concealed or misrepresented.

TAUPC-9AA

Other Insurance With Us:  Insurance effective at any one time on You under a like policy with Us, is limited to one such policy as elected by You, Your beneficiary or Your estate.  We will then return all premium paid (less claims paid) for all other such policies.

TAUP-10AA

Coverage/Recovery From Other Sources: Unless stipulated otherwise, if benefits are payable under the Policy and coverage is available from any other source, coverage under the Policy is supplemental to coverage or recovery available from any other source.

TAUPC-11AA

Insurance With Other Insurers:  If You have other valid coverage, not with Us, which:

1)     provides benefits for the same loss on a “per service” or an “expense incurred” basis; and

2)     have not been given written notice prior to the time the loss occurred of the existence of such coverage; then

Our only liability under any “expense incurred” coverage provision of Our Policy shall be for:

1)     such proportion of the loss as the amount which would otherwise have been payable under Our Policy; and

2)     the total of the like amounts under all such other valid coverages for the same loss of which We had notice bears to the total like amount under all valid expense incurred coverages under Our Policy for such loss, and

3)     the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined under Our Policy.

For the purpose of applying this provision when other coverage is on a ”per service” basis, the “like amount” of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such other valid coverage.

TAUP-12AA

 

 

 

 

STATE EXCEPTIONS

 

CONNECTICUT

Changes applicable to residents of the Connecticut:

 

General Exclusion and Limitations “5)” is replaced with: 

5A) voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as amended, unless as prescribed by a Physician;

XLPA-5AA-06

 

5B) alcoholism or drug addiction;

XLPA-6AA-06

 

MAXIMUM LIMIT OF LIABILITY (Applicable to Trip Cancellation, Trip Interruption, Trip Delay, Missed Connection, Itinerary Change, Baggage and Personal Effects, Baggage Delay, and Rental Vehicle Damage Protection) All limits are applied per trip. Our maximum limit of liability resulting from the same occurrence will be $10,000,000. If the loss for all Insureds from such an occurrence exceeds $10,000,000, We will pay each Insured that proportion of the benefits stated which $10,000,000 bears to the total loss of all persons insured under all travel insurance in force with Us. We will pay no more than $500,000 per occurrence to or on account of any person insured.

TAML-1AA-06

 

Under UNIFORM PROVISIONS

Coverage/Recovery From Other Sources (Applicable to Trip Cancellation, Trip Interruption, Trip Delay, Missed Connection, Itinerary Change, Baggage and Personal Effects, Baggage Delay, and Rental Vehicle Damage Protection): If benefits are payable under the Policy and coverage is available from any other source, coverage under the Policy is supplemental to coverage or recovery available from any other source.

TAUPC-11AA-06

 

Insurance With Other Insurers (Applicable to Trip Cancellation, Trip Interruption, Trip Delay, Missed Connection, Itinerary Change, Baggage and Personal Effects, Baggage Delay, and Rental Vehicle Damage Protection): If You have other valid coverage, not with Us, which:

1) provides benefits for the same loss on a “per service” or an “expense incurred” basis; and

2) have not been given written notice prior to the time the loss occurred of the existence of such coverage; then

Our only liability under any “expense incurred” coverage provision of Our Policy shall be for:

1) such proportion of the loss as the amount which would otherwise have been payable under Our Policy; and

2) the total of the like amounts under all such other valid coverages for the same loss of which We had notice bears to the total like amount under all valid expense incurred coverages under Our Policy for such loss, and

3) the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined under Our Policy.

For the purpose of applying this provision when other coverage is on a ”per service” basis, the “like amount” of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such other valid coverage.

TAUP-12AA-06

 

DISTRICT of COLUMBIA 

Changes applicable to residents of the District of Columbia:

 

Medically Necessary  means an Emergency treatment, service or supply that is:

1)     recommended by the local attending Physician;

2)     performed under the Physician’s care, or supervision; and

3)     determined by Us to be:

     a)     consistent with generally accepted medical practice for the Injury or Sickness;

     b)     could not have been omitted without adversely affecting Your condition or quality of medical care;

     c)     is delivered at the most appropriate level of care, and not primarily for the sake of convenience; and

     d)     is not considered experimental unless coverage for experimental service or supply is required by law.

The fact that a Physician may prescribe, authorize or direct a service does not of itself make it Medically Necessary or covered by the Policy.

TADEF-18AA-99

Pre-existing Condition means a condition occurring during the 60 day period immediately prior to Your Effective Date:

1)     for which medical advice, care or treatment was received or recommended by a Physician regardless of whether or not a diagnosis was made and;

2)     which produced symptoms or whose onset or manifestation occurred during such 60 day period. Such symptoms must have been significant enough to establish manifestation or onset, which would have: a) caused a person to seek diagnosis or treatment; or, b) enabled a Physician to diagnose such illness, disease, injury or other condition.

A Pre-existing Condition does not include any condition which is solely controlled through the taking of prescription medication and which has remained stable or controlled without any adjustment or change in the required prescription throughout the 60 day period immediately prior to Your Effective Date.

TADEF-22BA-99

 

FLORIDA 

Changes applicable to residents of Florida:

 

Notice to Florida Residents: The benefits of the Policy providing Your coverage are governed by the law of a state other than Florida.

TAC-1AA-09

 

MISSISSIPPI 

Changes applicable to residents of Mississippi:

 

Under UNIFORM PROVISIONS

Time of Payment of Claims:

For Property and Casualty Benefits:  Benefits payable under the Policy for any loss will be paid immediately upon receipt of due written proof of such loss.

For Accident and Health Benefits: Benefits payable under the Policy for any loss will be paid:

      1.  within 25 days after receipt of due written proof of such loss when such written proof:

          a) constitutes a clean claim; and

          b) is submitted electronically; or

      2.  within 35 days after receipt of due written proof of loss when such written proof:

           a) constitutes a clean claim; and

           b) is submitted in paper format.

Benefits due under the Policy are overdue if not paid within 25 or 35 days, as applicable, after We receive a clean claim containing the necessary medical and other information essential to adjudicate the claim according to the provisions of the Policy.  A “clean claim” means a claim We receive which requires no further information, adjustment or alteration by the provider of the services or the Insured in order for Us to process and pay such claim.  A claim is considered clean if it has no defect or impropriety, including any lack of substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made.  A clean claim includes resubmitted claims with previously identified deficiencies corrected.

A “clean claim” does not include any of the following:

1. A duplicate claim where the original and the duplicate claim is filed within 30 days of each other;
2. Claims which are submitted fraudulently or that are based upon material misrepresentations;
3. Claims that require information essential for Us to administer the provisions of the Policy; or
4. Claims submitted by a provider more than 30 days after the date of service.  If the provider does not submit the claim on behalf of the Insured, then a claim is not considered clean when submitted more than 30 days after the date of billing to Insured.

No later than 25 days after the date We actually receive an electronic claim, or no later than 35 days after the date We actually receive a claim submitted in paper format, will We pay the appropriate benefit in full, or any portion of the claim that is clean.  We will notify the provider (where the claim is owed to the provider) or the Insured (where the claim is owed to the Insured) of the reasons why the claim or portion thereof is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean.

Any claim or portion thereof submitted with the supporting documentation and information requested by Us will be paid within 20 days after the date of receipt.

For the purposes of this provision, the term “pay” means that We will either send cash or a cash equivalent by United States mail, or send cash equivalent by other means such as electronic transfer, in full satisfaction of the appropriate benefit due the provider (where the claim is owed to the provider) or the Insured (where the claim is owed to the Insured).

To calculate the extent to which any benefits are overdue, payment will be treated as made on the date a draft or other valid instrument was placed in a properly addressed, postpaid envelope and put in the United States mail to the last known address of the provider (where the claim is owed to the provider) or the Insured (where the claim is owed to the Insured) or, if not so posted or not sent by United States mail, on the date of delivery of payment to the provider or the Insured.

If the claim is not denied for valid and proper reasons by the end of the applicable time period prescribed in this provision, We must pay the provider (where the claim is owed to the provider) or the Insured (where the claim is owed to the Insured) interest on the accrued benefits at the rate of 1½ % per month accruing from the day after payment was due on the amount of benefits that remain unpaid until the claim is finally settled or adjudicated.  Whenever interest due pursuant to this provision is less than One Dollar, such amount will be credited to the account of the person or entity to whom such account is owed.

In the event We fail to pay benefits when due, the person entitled to such benefits may bring action to recover such benefits, and interest which may accrue as provided in this provision and any other damages as may be allowable by law.

TAUPC-5AA-23

Physical Examination: At Our expense, We have the right to have You examined as often as is reasonable while the claim is pending.

TAUP-7AA-23

 

MISSOURI 

Changes applicable to residents of Missouri:

 

General Exclusions and Limitations “1)” is replaced with:

1A) suicide, attempted suicide, or any intentionally self-inflicted Injury while sane;

XLPA-1AA-24

Under Uniform Provisions:

Notice of Claim: Written notice of claim must be given to Us within 20 days after any loss covered by the Policy. If notice cannot be given within that time, it must be given as soon as reasonably possible. No claim will be denied for failure to report a loss within the time specified unless this failure operates to prejudice Our rights.  Notice should identify You and Your beneficiary, if applicable, and provide the identification number as stated on Your Confirmation of Coverage. Notice must be sent to Us at 4600 Witmer Industrial Estates- Suite 6, Niagara Falls, NY 14305, or given to Our agent.

TAUPC-1AA-24 

 

Written Proof of Loss:  Written proof of loss must be given to Us within 90 days after the date of such loss.  If it is not reasonably possible to give the proof within that time frame, the claim is not affected if the proof is given as soon as possible.  Unless You are legally incapacitated, written proof must be given within one year of the time it is otherwise due.  No claim will be denied for failure to report a loss within the time specified unless this failure operates to prejudice Our rights.

TAUP-3AA-24

 

Legal Actions: No legal action at law or in equity can be brought against Us until after 60 days after written proof of loss was given. No such action can be brought after 10 years after the date written proof of loss is required.  This 10-year period is extended from the date proof of loss is filed and the date the claim is denied in whole or in part.

TAUP-8AA-24

 

 

OKLAHOMA 

Changes applicable to residents of Oklahoma:

 

General Exclusions and Limitations “15)” is replaced with:

15A) participating as a member of a team in an interscholastic sporting competition;

XLPA-17AA-35

 

 

 

SOUTH CAROLINA 

Changes applicable to residents of South Carolina:

 

Under “Your Coverage Period”

“Automatic Extension of Coverage” is replaced with:

In the event a trip delay, affecting a Common Carrier on which You are or You were scheduled to travel, results in Your Covered Trip being prolonged beyond Your Scheduled Return Date, We will automatically extend coverage under the Policy for an additional 3 days. In addition, if You are hospitalized due to an injury or sickness, We will automatically extend coverage for the period of hospital confinement for You and one covered Traveling Companion, and for an additional 5 days following Your release.

This automatic extension of coverage is provided as long as:

1) any trip delay was beyond the control of any person covered under the Policy;

2) You were originally scheduled to arrive at Your Point of Origin within the coverage period;

3) Your Covered Trip was ultimately completed within a reasonable period of time; and

4) coverage under the Policy was in force at the time of the trip delay or Your hospitalization.

The automatic extension of coverage will not be subject to the payment of any additional premium.

TAAEC-1AA-39

 

Under “Your Duties in the event of Trip Cancellation or Trip Interruption”, item “6)    detailed medical documentation if the trip cancellation or trip interruption was caused by or resulted from a serious Injury or serious Sickness” is not applicable.

TADCI-1AA-39

Under GENERAL PROVISIONS

Property & Casualty

Medical Records is not applicable.

 

Under UNIFORM PROVISION

Property & Casualty:

Payment of Claims: All benefits will be payable to You. Any accrued benefits unpaid at Your death may, at Our option, be paid either to Your beneficiary or to Your estate.

If any benefit of the Policy shall be payable to Your estate, or to You or Your beneficiary who is a minor or otherwise not competent to give a valid release, We may pay such benefit, up to an amount not exceeding $1,000, to any relative by blood or connected to You by marriage or Your beneficiary who is deemed by Us to be equitably entitled thereto. Any payment made by Us in good faith pursuant to this provision shall fully discharge Us to the extent of such payment.

TAUPC-5AA-39

Physical Examination and Autopsy and Insurance With Other Insurers is not applicable to Property & Casualty.

 

Travel Accident & Health:

Physical Examination and Autopsy: At Our expense, We have the right to have You examined as often as is reasonable while the claim is pending. We have the right to have an autopsy performed at the Our expense, unless forbidden by law. Such autopsy will be performed in the state of South Carolina.

TAUP-7AA-39

Legal Actions: No legal action at law or in equity can be brought against Us until after 60 days after written proof of loss was given. No such action can be brought after 6 years after the date written proof of loss is required.

TAUP-8AA-39

 

 

VERMONT 

Changes applicable to residents of Vermont:

 

Accident means a sudden, unexpected, specific and abrupt event. Such event must occur by chance at an identifiable time and place while coverage is in force.  Any loss caused by, or resulting from a sickness or disease is not an Accident.

TADEF-1AA-44

Family Member means: legal spouse or common-law spouse (where legal), or a person with whom You have a civil union as defined under Vermont law, legal guardian, legal ward, son or daughter (adopted, foster, step or in-law), brother or sister (includes step or in-law), parent (includes step or in-law), grandparent (includes in-law), great-grandparent, grandchild, great-grandchild, aunt, uncle, niece, nephew or Key Person provided such Family Member resides in the United States, Canada or Mexico.

TADEF-10AA-44

Injury means bodily injury caused by an Accident.  The injury must:

1)       occur while Your coverage is in force;

2)       result, directly and independently of any disease or bodily infirmity; and

3)       be certified by a local attending Physician.

TADEF-12AA-44

Key Person means 1) an employed caregiver of Your legal dependent; or 2) a person to whom You are not married and with whom You have cohabited for 12 continuous months or a person with whom You have a civil union as defined under Vermont law.

TADEF-14AA-44

Physician means a medical doctor who is: 1) practicing within the scope of his or her license; and 2) recognized as a physician in the place where medical services are rendered.  Physician does not include You, a Traveling Companion or a Family Member.

TADEF-20AA-44

Under EMERGENCY MEDICAL BENEFITS

Conditions For Emergency Medical Benefits item “1)” is changed to read:

1)     You, or someone acting on Your behalf, must immediately contact the travel assistance company at the telephone number listed on Your Confirmation of Coverage.  We can locate the nearest and most appropriate medical resource.  We can also arrange direct payment to the medical provider, where possible.  Advance payment, up to a maximum of $5,000, will be made to a Hospital if needed to secure Your admission. Contact must be made within 24 hours after a life or organ-threatening Emergency.

TAMEC-1AA-44

 

General Exclusions and Limitations “1)” is replaced with:

1)Your suicide, attempted suicide, or any intentionally self-inflicted Injury;

XLPA-1AA-44

General Exclusions and Limitations “3)” is replaced with:

3) service in the Armed Forces or units auxiliary thereto. If coverage under the Policy is denied as a result of the application of this exclusion, upon Your written request, We will refund the pro-rata portion of any unearned premium paid;

XLPA-3AA-44

General Exclusions and Limitations “5)”  is replaced with:

5) treatment for alcohol or drug addiction;

XLPA-6AA-44

General Exclusions and Limitations “8) mental or emotional disorders unless hospitalized for 3 or more consecutive days after Your Effective Date;

XLPA-9AA” – is deleted.

General Exclusions and Limitations “13)” is replaced with:

13) riding, driving or participating in races, or speed or endurance contests (Property and Casualty Only);

XLPA-15AA-44

General Exclusions and Limitations “14)” to “19)” inclusive are applicable only to Property and Casualty Benefits.

 

 

FILING A CLAIM

 

To receive a claim form please call 877-617-2832 or download the form at: www.johnhancocktravel.com/claims.

 

Please submit your claim to:

 

                                Old Republic Insurance Company

                                Claims Department

                                4600 Witmer Industrial Estates, Suite 6

                                Niagara Falls, NY 14305

 

Along with the required claim form, you must submit the following documentation:

Trip Cancellation claims:  a copy of your trip itinerary; copies of all invoices; proof of payment for the trip (including initial and final payment dates); original unused non-refundable tickets; a copy of the travel supplier's cancellation terms and conditions; copies of any refunds; and any documentation substantiating the reason for the cancellation.  

Trip Interruption claims:  a copy of your trip itinerary; copies of all invoices; proof of payment for the trip (including initial and final payment dates); original unused non-refundable tickets; a copy of the travel supplier's cancellation terms and conditions; copies of any refunds; any documentation substantiating the reason for the interruption; copies of new tickets; new invoices; proof of payment; and original receipts.

Trip Delay/Missed Connection/Itinerary Change claims:  a copy of your trip itinerary; copies of all invoices; proof of payment for the trip; original unused non-refundable tickets; copies of new travel tickets; new invoices; original receipts; and documentation substantiating the reason for the delay (i.e. documentation from the airline or other carrier detailing the cause of your delay).

Medical claims: detailed medical statements from the treating physician and medical facility; original receipts for medical services and supplies.

For Baggage Loss and Baggage Delay claims: reports from parties responsible (i.e. airline, cruise line, etc.) for loss, theft, damage or delay; original receipts; and if applicable, a police report will be required.

Rental Vehicle Damage Protection claim: copy of rental agreement; a copy of the written record of any pre-existing damages to the rental vehicle prior to rental; proof of physical damage or loss to the rental vehicle; copy of police report documenting any accident, theft or malicious act to the vehicle; and any estimates/costs to repair the rental vehicle.

Travel, Common Carrier and Flight Accidental Death & Dismemberment claims – contact our claims department directly to obtain instruction.

 

ORTA-C

ORTA-C24

JH-EOC-IMT-NATC-0811