Worldwide Trip Protector

WORLDWIDE TRIP PROTECTOR

Note: For residents of GA, KS, LA, MN, OR, SD, TX, UT, and WA, this is not Your Certificate of Insurance. Your coverage is under an individual policy and is based on the policy form TP-401-CW. 

 

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TRAVEL PROTECTION INSURANCE

Certificate of Insurance

This Certificate of Insurance describes all of the travel insurance benefits underwritten by United States Fire Insurance Company, herein referred to as the Company.  The insurance benefits vary from program to program.  Please refer to the accompanying Confirmation of Benefits.  It provides the Insured with specific information about the program he or she purchased.  The Insured should contact the Company immediately if he or she believes that the Confirmation of Benefits is incorrect.

 

Signed for the Company,

President,

Insurance provided by this Certificate is subject to all of the terms and conditions of the Group Policy.  If there is a conflict between the Policy and Certificate, the Policy will govern.

 

 

 

TABLE OF CONTENTS

I. SCHEDULE & COVERAGES

II. DEFINITIONS

III. INSURING PROVISIONS

IV. GENERAL LIMITATIONS AND EXCLUSIONS

V. GENERAL PROVISIONS

 

SECTION I.  SCHEDULE & COVERAGES

Listing of Benefits	Maximum Limit
Part A - Travel Protection
Trip Cancellation*	Trip Cost**
Trip Interruption ($500 Return Air Only if $0 displayed for Trip Cancellation on Your Confirmation of Benefits.)	150% of Trip Cost**
Missed Connection/Itinerary Change (3 hours)	$500
Trip Delay (6 hours)	$1,000($200/day)
Pet Care	$300($50/day)
Part B - Medical Protection
Emergency Accident and Sickness Medical Expense	$50,000 ($50 deductible)
Emergency Evacuation/Medically Necessary Repatriation/Repatriation of Remains	$500,000
Part C - Baggage Protection
Baggage/Personal Effects Per Article Limit Combined Articles Limit	$1,000 $250 $500
Baggage Delay (12 hours)	$300
Part D - Travel Accident Protection
Accidental Death & Dismemberment	$10,000
Optional Coverages Applicable only when specifically requested on the application and the appropriate additional premium has been paid and purchase confirmed on Your Confirmation of Benefits.
Accidental Death & Dismemberment Common Carrier (Air Only)	Up to Limit Purchased
Renters Collision Insurance	$50,000
Cancel for Any Reason*	Up to 75% of non-refundable Trip Cost**
Cancel for Work Reasons*	Up to Trip Cost**
Sports Coverage	$1,000
Medical Upgrade Excess Insurance Limitation does not apply and deductible is waived
Additional Medical Expense	$50,000 (For a total of $100,000)
Additional Emergency Evacuation/Medically Necessary Repatriation/Repatriation of Remains	$500,000 (For a total of $1,000,000)
Additional Accidental Death and Dismemberment	$15,000 (For a total of $25,000)
Baggage Upgrade
Baggage Delay	(6 hours) Business Equipment Coverage

*Not applicable when $0 Trip Cost displayed on Your Confirmation of Benefits.

**Up to the lesser of the Trip Cost paid or the limit of Coverage on Your Confirmation of Benefits

 

 

 

 

OPTIONAL CANCEL FOR ANY REASON/
OPTIONAL CANCEL FOR WORK REASONS

Optional Coverage: Applicable only when specifically requested on the original application and the appropriate additional premium has been paid and purchase confirmed on Your Confirmation of Benefits.

 

CANCEL FOR ANY REASON

Be advised that the Company requires You to purchase Cancel for any Reason coverage within 21 days of Your initial Covered Trip deposit.  If after 21 days from initial Covered Trip deposit, this coverage is not available.

The Company will pay a benefit, up to the maximum shown on Your Confirmation of Benefits, if You are prevented from taking Your Covered Trip for all reasons up to 48 hours prior to departure.

In no event shall the amount reimbursed exceed the lesser of the amount You prepaid for the Covered Trip or the maximum benefit shown on Your Confirmation of Benefits.

 

CANCEL FOR WORK REASONS

The Company will pay a benefit, up to the maximum shown on Your Confirmation of Benefits, if You are prevented from taking Your Covered Trip due to the following unforeseen events:

a) A transfer of You or Your Traveling Companion by the employer by whom You or Your Traveling Companion are employed on Your Effective Date which requires their principal residence to be relocated;

b) You or Your Traveling Companion are required to work during the scheduled Covered Trip. You or Your Traveling Companion must demonstrate proof of requirement to work, such as a notarized statement signed by an officer of Your or Your Traveling Companion’s employer;

c) You or Your Traveling Companion’s company is directly involved in a merger or acquisition. You or Your Traveling Companion must be an active employee of the company that is merging and You or Your Traveling Companion must be directly involved in such an event;

d) You or Your Traveling Companion’s company operations are interrupted by fire, flood, burglary, vandalism, product recall, Bankruptcy or financial Default.

Your application and plan cost must be received within 21 days of Your original Covered Trip deposit.

For the above Trip Cancellation, Trip Interruption, Cancel For Any Reason and Cancel For Work Reasons benefits the following applies:

All cancellations must be reported to the Travel Supplier within 72 hours of the event causing the need to cancel. If the event delays the reporting of the cancellation beyond the 72 hours, the event should be reported as soon as possible. All other delays of reporting beyond 72 hours will result in reduced benefit payments.

If Your Travel Supplier cancels Your Covered Trip, You are covered up to the cost of the ticket or the reissue fee charged by the airline for the tickets.  You must have covered the entire cost of the Covered Trip including the air.

The maximum payable under this benefit is the lesser of a) total cost of Your Covered Trip; or b) the total amount of coverage You purchased.

Single Supplement: Benefits will be paid, up to the Maximum Benefit Amount, for the additional cost incurred as a result of a change in the per person occupancy rate for prepaid Travel Arrangements if a Traveling Companion has Your Covered Trip delayed, canceled or interrupted for a covered reason and You do not cancel.

These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.

The Maximum Benefit Amount is shown in the Confirmation of Benefits.

 

 

 

COVERAGE C

ITINERARY CHANGE

 

This Coverage C Benefit is provided only if shown covered on the Confirmation of Benefits. 

In the event a cruise/tour supplier makes a change in Your Covered Trip itinerary after Your Scheduled Departure Date, which prevents You from participating in an event/activity pre-paid prior to departure and scheduled on Your Covered Trip itinerary, nonrefundable pre-paid event/activity expenses will be payable up to the Maximum Benefit Amount. 

Benefits will not be paid if a comparable event/activity of equivalent cost is rescheduled during the course of the Covered Trip.

The Maximum Benefit Amount is shown in the Confirmation of Benefits.

 

 

 

 

 

 

 

 

 

BAGGAGE UPGRADE

Optional Coverage: Applicable only when requested on the application and the appropriate additional premium has been paid and purchase is confirmed on Your Confirmation of Benefits.

The Excess Insurance Limitation does not apply.

Baggage Delay coverage is in effect if Your Checked Baggage is delayed or misdirected by a Common Carrier for more than six (6) hours, while on a Covered Trip, except for travel to final destination or place of residence.

 

BAGGAGE/PERSONAL EFFECTS – BUSINESS EQUIPMENT ONLY

If Your Business Equipment is damaged, lost, stolen or delayed by a Common Carrier for 6 hours or more, the Company will reimburse You on one-­time basis for the reasonable costs of renting Business Equipment during Your Covered Trip up the amount indicated on Your Confirmation of Benefits. A police report is required if Your Business Equipment is stolen. A Common Carrier report is required for proof of damage, delay, or loss by a Common Carrier. Original receipts and list of stolen, damaged or lost Business Equipment must be provided along with proof of loss providing amount of loss, date, time and cause of loss, and a repair estimate, if the Business Equipment is damaged.

 

These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.

The Maximum Benefit Amount is shown in the Confirmation of Benefits.

 

 

COVERAGE I

ACCIDENTAL DEATH AND DISMEMBERMENT –

AIR FLIGHT ONLY

Optional Coverage: Applicable only when specifically requested on the original application and the appropriate additional premium has been paid and purchase confirmed on Your Confirmation of Benefits

You are eligible for benefits, up to the Maximum Benefit Amount shown in the Confirmation of Benefits, when You sustain covered Injuries:  

a) while riding solely as a passenger in an aircraft on a regularly scheduled airline flight or regularly scheduled charter flight operated:

i) in scheduled air transportation pursuant to economic authority issued by the Civil Aeronautics Board;

ii) 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

iii) 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; or

b) while riding as a passenger in any land or water conveyance provided at the expense of the air carrier as a substitute for an aircraft covered by this Plan;

c) while riding as a passenger in a vehicle licensed to carry passengers for hire, but only when going to an airport to board an aircraft on which You are covered by this Plan or when leaving an airport after alighting from such an aircraft; or

d) while upon airport premises designated for passenger use immediately before boarding or immediately after alighting from an aircraft on which You are covered by this Plan.

that result in any of the following losses within 180 days from the date of the accident.

Type of Loss	Benefit Amount
Loss of Life	Principal Sum
Loss of Both Feet	Principal Sum
Loss of Both Hands	Principal Sum
Loss of Both Eyes	Principal Sum
Loss of One Hand and One Foot	Principal Sum
Loss of One Hand and One Eye	Principal Sum
Loss of One Foot and One Eye	Principal Sum
Loss of one hand	Half of the Principal Sum
Loss of one foot	Half of the Principal Sum
Loss of one eye	Half of the Principal Sum
Loss of thumb and index finger of the hand hand	Quarter of the Principal Sum
Loss of Speech	Half the Principal Sum
Loss of Hearing Both Ears	Half of the Principal Sum

 

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 one of the amounts shown above (the largest applicable) will be paid for Injuries resulting from one accident.

Loss of Speech means the loss of the ability to talk or speak as a result of a Covered Accident. The loss must be certified by a Legally Qualified Physician that the loss of speech is permanent with no reasonable expectation of recovery.

Loss of Hearing means the total and complete loss of the ability to hear any sound as a result of a Covered Accident. The loss must be certified by a Legally Qualified Physician that the loss of hearing is permanent with no reasonable expectation of recovery.

 

Only one of the amounts shown above (the largest applicable) will be paid for Injuries resulting from one accident.

The benefit for loss of: (a) two limbs; (b) both eyes; or (c) one limb and one eye is payable only when such loss results from the same accident.

These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.

The Principal Sum is shown in the Confirmation of benefits.

 

EXPOSURE AND DISAPPEARANCE

If, while insured under this Coverage I, You are unavoidably exposed to the elements because of a covered accident and suffer a loss for which benefits are payable under this Coverage I, such loss will be covered.

If, while insured under this Coverage I, You are in an accident resulting in the disappearance, sinking or damaging of an air or water conveyance on which You are covered by this Coverage I, and if Your body has not been found within 52 weeks from the date of the accident, it will be presumed, unless there is evidence to the contrary, that You suffered loss of life as a result of those Injuries.

These benefits will not duplicate any other benefits payable under the Plan or any coverage(s) attached to the Plan.

 

 

SECTION II.  DEFINITIONS

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

“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.

“Business Equipment” means property used in trade, business, or for the production of income; or offered for sale or trade or components of goods offered for sale or trade.

“Business Partner” means an individual who (a) is involved in a legal general partnership with You and or (b) is actively involved in the day to day management of Your business.

“Common Carrier” means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.

“Company” means United States Fire Insurance Company.

“Confirmation of Benefits” means the coverage confirmation provided to You following enrollment and payment of the applicable premium.

“Covered Trip” means scheduled trips, tours or cruises for which (a) coverage is requested: and (b) the required premium is submitted prior to the Scheduled Departure Date.

“Cruise” means any prepaid sea arrangements.

“Default” means a material failure or inability to provide contracted services.

“Dependent Child(ren)” means Your children, including an unmarried child, stepchild, legally adopted child or foster child who is:  (1) less than age 19 and primarily dependent on You for support and maintenance; or (2) who is at least age 19 but less than age 23 and who regularly attends an accredited school or college; and who is primarily dependent on You for support and maintenance

“Domestic Partner” means a person, at least 18 years of age, with whom You have been living in a spousal relationship with evidence of cohabitation for at least 10 continuous months prior to the Effective Date of coverage, or as otherwise defined according to the laws of Your state of residence.

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

“Effective Date” means the date and time Your coverage begins, as outlined in the General Provisions section of the policy.

“Family Member” means Your or a Traveling Companion’s: legal spouse or common-law spouse where legal; legal guardian; son or daughter (adopted, foster or step); son-in-law; daughter-in-law; grandmother; grandmother-in-law; grandfather; grandfather-in-law; grandchild; aunt; uncle; niece; or nephew; brother, step-brother; sister; step-sister; brother-in-law; sister-in-law; mother; mother-in-law; father; father in law; step-parent; Domestic Partner.

“Hospital” means (a) a place which is licensed or recognized as a general hospital by the proper authority of the state in which it is located: (b) a place operated for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility: (c) a place recognized as a general hospital by the Joint Commission on the Accreditation of Hospitals.  Not included is a hospital or institution licensed or used principally: (1) for the treatment or care of drug addicts or alcoholics: or (2) as a clinic continued or extended care facility, skilled nursing facility, convalescent home, rest home, nursing home or home for the aged.

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

“Injury” or “Injuries” means accidental bodily injuries: (a) received while insured under the Policy and any attached coverages: (b) resulting in loss independently of sickness and all other causes: and (c) not excluded from coverage.

“Insured” means the person(s) names on the Confirmation of Benefits who has paid the required premium. Also means “You” or “Your”.

“Intoxicated” mean a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where You are located at the time of an incident.

“Legally Qualified Physician” means a physician or a Christian Science Practitioner (a) other than You, a Traveling Companion or a Family Member: (b) practicing within the scope of Your license: and (c) recognized as a physician in the place where the services are rendered.

“Maximum Benefit Amount” means the maximum amount payable for coverage provided to an Insured as shown in the Confirmation of Benefits.

“Medical Treatment” means treatment advice or consultation by a Legally Qualified Physician.

“Medically Necessary” means a service or supply which: (a) is recommended by the attending Legally Qualified Physician: (b) is appropriate and consistent with the diagnosis in accord with accepted standards of community practice: (c) could not have been omitted without adversely affecting Your condition or quality of medical care: (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience: and (e) is not considered experimental unless coverage for experimental services or supplies is required by law.

“Natural Disaster” means flood, fire, hurricane, tornado, earthquake, volcanic eruption, blizzard or avalanche that is due to natural causes.

“Pre-existing Condition” means any injury, sickness or condition (including any condition from which death ensues) of the Insured, or Traveling Companion, or Your and/or Traveling Companion’s Family Member or Your Business Partner for which within the 180 day period prior to the effective date of Your Trip Cancellation coverage under the Policy which (a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or (c) required medical treatment or treatment was recommended by a Legally Qualified Physician.

“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 Covered Trip sale. 

“Scheduled Departure Date” means the date on which You are originally scheduled to leave on the Covered Trip.

“Scheduled Return Date” means the date on which You are originally scheduled to return to the point of origin or the original final destination.

“Sickness” means an illness or disease that is diagnosed or treated by a Legally Qualified Physician after the effective date of insurance and while You are covered under the Policy.

“Strike” means any stoppage of work: (a) as a result of a combined effort of workers which was unannounced and unpublished at the time travel services were purchased: and (b) which interferes with the normal departure and arrival of a Common Carrier.

“Terrorist Incident” means an incident deemed an act of terrorism by the U.S. Government.

“Third Party” means a person or entity other than You or the Company.

“Transportation Expense” means: (a) the cost of conveyance of You and any medical personnel (if Medically Necessary): and (b) Medically Necessary services or supplies.

“Travel Arrangements” means: (a) transportation: (b) accommodations: and (c) other specified services arranged by the Travel Supplier for the Covered Trip.

“Traveling Companion” means a person or persons with whom a covered person has coordinated travel arrangements and intends to travel with during the Covered Trip.

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

"Usual and Customary Charges” means those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.

 

SECTION III.  INSURING PROVISIONS

Insured’s Term of Coverage:

For Trip Cancellation: Coverage begins on the Effective Date and time specified in the Confirmation of Benefits.   Coverage ends at the point and time of departure on Your Scheduled Departure Date.

For Trip Delay: Coverage is in force while en route to and from the Covered Trip.

For all other coverages: Coverage begins at the point and time of departure on the Scheduled Departure Date.  Coverage ends at the point and time of return on Your Scheduled Return Date.

All coverage under the policy will be extended, if: (a) Your entire Covered Trip is covered by the policy; and (b) Your return is delayed by covered reasons specified under Trip Cancellation and Interruption or Travel Delay. If coverage is extended for the above reasons, coverage will end on the earlier of: (a) the date You reach Your Return Destination; or

(b) seven (7) days after the date the Covered Trip was scheduled to be completed

 

SECTION IV.   GENERAL LIMITATIONS AND EXCLUSIONS

Excess Insurance Limitation:  The Insurance provided by this policy shall be in excess of all other valid and collectible insurance or indemnity except Accidental Death & Dismemberment and Accidental Death & Dismemberment Common Carrier (air only), Emergency Accident and Sickness Medical Expense (if optional Medical Upgrade purchased) or as required by state law.  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.

Benefits are not payable for Sickness, Injuries or losses of You, Your Family Member, Your Traveling Companion or Your Traveling Companion’s Family Member, Your Business Partner or Your Traveling Companion’s Business Partner;

1. resulting from suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane;

2. resulting from an act of declared or undeclared war (does not apply to Cancel for Work Reasons coverage);

3. while participating in maneuvers or training exercises of an armed service (does not apply to Cancel for Work Reasons coverage);

4. while riding, driving or participating in races, or speed or endurance contests;

5. while mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes, or other special equipment)(mountaineering below 15,000 feet is covered while on Your Covered Trip if You purchase Sports Coverage);

6. while participating as a member of a team in an organized sporting competition;

7. while participating in skydiving, hang gliding, bungee cord jumping (Does not apply while on Your Covered Trip if You purchase Sports Coverage);

8. while piloting or learning to pilot or acting as a member of the crew of any aircraft; received as a result or consequence of being Intoxicated, as specifically defined  in the policy, or

9. under the influence of any controlled substance unless administered on the advise of a Legally Qualified Physician;

10. to which a contributory cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation;

11. due to normal childbirth, normal pregnancy (except for complications of pregnancy or as specifically provided under Trip Cancellation/Trip Interruption);

12. due to a mental or nervous condition, unless hospitalized;

13. for dental treatment (except as a result of Accidental Injury to sound natural teeth);

14. which exceed the Maximum Benefit Amount for each attached coverage as shown in the Confirmation of Benefits: or;

15. due to loss or damage (including death or injury) and any associated cost or expense resulting directly from the discharge, explosion or use of any device, weapon or material employing or involving chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act and regardless of any other sequence thereto;

16. due to a Pre-existing Condition, as defined in the Policy.  The Pre-existing Condition Limitation does not apply to: (a) Emergency Medical Evacuation, Medical Repatriation and Return of Remains coverage; or (b) to coverage purchased within 21 days of the initial Covered Trip deposit. The booking for the Covered Trip must be the first and only booking for this travel period and destination, You are not disabled from travel at the time You pay the premium, and You must purchase this policy for the full non-refundable cost of Your Covered Trip.

The following limitation applies to Trip Cancellation: All cancellations must be reported directly to the Travel Supplier within 72 hours of the event causing the need to cancel, unless the event prevents it, and then as soon as is reasonably possible.  If the cancellation is not reported within the specified 72 hour period, the Company will not pay for additional charges, which would not have, been incurred had You notified the Travel Supplier in the specified period.  If the event prevents You from reporting the cancellation, the 72 hour notice requirement does not apply; however, You must, if requested, provide proof that said event prevented him or her from reporting the cancellation within the specified period.

Additional Limitations and Exclusions Specific to Baggage and Personal Effects
Benefits are not payable for any loss caused by or resulting from:

a) breakage of brittle or fragile articles;

b) wear and tear or gradual deterioration;

c) confiscation or appropriation by order of any government or custom’s rule;

d) theft or pilferage while left in any unlocked vehicle;

e) property illegally acquired, kept, stored or transported;

f) Your negligent acts or omissions; or

g) property shipped as freight or shipped prior to the Scheduled Departure Date.

The following exclusions apply to loss or damage of Business Equipment: The Company will not pay for loss or damage for:

1) items other than Business Equipment;

2) intentional acts;

3) gross negligence or willful and wanton conduct;

4) Business Equipment shipped as freight or shipped prior to the Insured’s Scheduled Departure Date;

5) Business Equipment that is left in or on a vehicle or a car trailer;

6) Business Equipment that is lost by a Common Carrier and the loss is not reported to the Common Carrier within 24 hours after the loss and a claim is not filed with the Common Carrier;

7) Business Equipment that is stolen and the theft is not reported to the appropriate authorities; or

8) Damage to the Business Equipment resulting from defective materials or workmanship, ordinary wear and tear and normal deterioration.

 

SECTION V.  GENERAL PROVISIONS

Notice of Claim:  Notice of claim must be reported within 20 days after a loss occurs or as soon as is reasonably possible.  You or someone on Your behalf may give the notice.  The notice should be given to the Company or designated representative and should include sufficient information to identify You.

Claim Forms:  When notice of claim is received by the Company or designated representative, forms for filing proof of loss will be furnished.  If these forms are not sent within 15 days, the proof of loss requirements can be met by sending a written statement of what happened.   This statement must be received within the time given for filing proof of loss.

Proof of Loss: Proof of loss must be provided within 90 days after the date of the loss or as soon as is reasonably possible.  Proof must, however, be furnished no later than 12 months from the time it is otherwise required, except in the absence of legal capacity.

Time of Payment of Claims:  The Company or its designated representative will pay the claim after receipt of acceptable proof of loss.

Payment of Claims: Benefits for loss of life are payable to the Principal Insured, who is the beneficiary for all other Insureds.  If: (a) the Principal Insured predeceases You: and (b) a beneficiary is not otherwise designated by the Principal Insured benefits for loss of life will be paid to the first of the following surviving preference beneficiaries:

a) the Principal Insured’s spouse;

b) the Principal Insured’s child or children jointly;

c) Your parents jointly if both are living or the surviving parent if only one survives;

d) Your brothers and sisters jointly; or

e) the Principal Insured’s estate.

All or a portion of all other benefits provided by the Policy may, at the option of the Company, be paid directly to the provider of the service(s).  All benefits not paid to the provider will be paid to the Principal Insured.

Other than for loss of life, if any benefit is payable to: (a) You or the Principal Insured’s beneficiary who is minor or otherwise not able to give a valid release: or (b) the Principal Insured’s estate: the Company may pay up to $1,000.00 to the Principal Insured’s beneficiary or any relative to whom the Company finds entitled to the payment.  Any payment made in good faith shall fully discharge the Company to the extent of such payment.

Physician Examination and Autopsy: The Company, at the expense of the Company, may have You examined when and as often as is reasonable while the claim is pending.  The Company may have an autopsy done (at the expense of the Company) where it is not forbidden by law.

Legal Actions: No legal action for a claim can be brought against us until 60 days after we receive proof of loss.  No legal action for a claim can be brought against us more than 3 years after the time required for giving proof of loss.  This 3-year time period is extended from the date proof of loss is filed and the date the claim is denied in whole or in part.

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

Other Insurance with the Company: You may be covered under only one travel policy with the Company for each Covered Trip.  If You are covered under more than one such policy, You may select the coverage that is to remain in effect.  In the event of death, the selection will be made by the beneficiary or estate.  Premiums paid (less claims paid) will be refunded for the duplicate coverage that does not remain in effect.

Subrogation:  If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the Third Party responsible for the loss, the Company will be subrogated to that right.  You shall help the Company exercise the Company’s rights in any reasonable way that the Company may request: nor do anything after the loss to prejudice the Company’s rights: and in the event You recover damages from the Third Party responsible for the loss, You will hold the proceeds of the recover for the Company in trust and reimburse the Company to the extent of the Company’s previous payment for the loss.

Additional Claims Provisions Specific to Baggage

Insured’s Duties After Loss of or Damage to Property or Delay of Baggage:  In case of loss, theft, damage or delay of baggage or personal effects, and Insured must:

a) take all reasonable steps to protect, save or recover the property:

b) promptly notify, in writing, either the police, hotel proprietors, ship lines, airlines, railroad, bus, airport or other station authorities, tour operators or group leaders, or any Common Carrier or bailee who has custody of Your property at the time of loss:

c) produce records needed to verify the claim and its amount, and permit copies to be made:

d) provide to the Company, within 90 days from the date of loss, a detailed proof of loss signed and sworn to: and

e) be examined, if requested.

Reductions in the Amount of Insurance:  The applicable benefit amount will be reduced by the amount of benefits, if any, previously paid for any loss or damage under this coverage for this Covered Trip.

STATE EXCEPTIONS

ARKANSAS: The Provision entitled “Legal Actions” is amended so that the “three year” period reads “five years or within the time allowed by law”.

CONNECTICUT: The following provision is hereby added to the certificate:

THIS LIMITED HEALTH BENEFITS PLAN DOES NOT PROVIDE COMPREHENSIVE MEDICAL COVERAGE. IT IS A BASIC OR LIMITED BENEFITS POLICY AND IS NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS PLAN IS NOT DESIGNED TO COVER THE COSTS OF SERIOUS OR CHRONIC ILLNESS. IT CONTAINS SPECIFIC DOLLAR LIMITS THAT WILL BE PAID FOR MEDICAL SERVICES WHICH MAY NOT BE EXCEEDED. IF THE COST OF SERVICES EXCEEDS THOSE LIMITS, THE BENEFICIARY AND NOT THE INSURER IS RESPONSIBLE FOR PAYMENT OF THE EXCESS AMOUNTS. THE SPECIFIC DOLLAR LIMITS WILL BE PROVIDED TO YOU WHEN COVERAGE IS ELECTED.

Upon request, the master policy will be made available to any Certificateholder.

In the event of any cancellation of the master policy, adequate notice will be given to all certificateholders.

The Subrogation Provision is hereby revised as follows:

Subrogation: AS PERMITTED BY LAW:  If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the Third Party responsible for the loss, the Company will be subrogated to that right.  An Insured shall help the Company exercise the Company’s rights in any reasonable way that the Company may request: nor do anything after the loss to prejudice the Company’s rights: and in the event an Insured recovers damages from the Third Party responsible for the loss, You will hold the proceeds of the recover for the Company in trust and reimburse the Company to the extent of the Company’s previous payment for the loss.

Exclusion #9 is hereby deleted and replaced with the following:

received as a result or consequence of the voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless as prescribed by is physician for You.

Exclusion # 12 is hereby deleted in its entirety.

Exclusion # 15 is hereby deleted in its entirety.

The provision entitled “Excess Provision” has been deleted in its entirety.

The definition of Medical Necessity is hereby added as follows:

“Medical Necessity or Medically Necessary” means health care services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (1) In accordance with generally accepted standards of medical practice; (2) clinically appropriate, in terms of type, frequency, extent, site and duration and considered effective for the patient’s illness, injury or disease; and (3) not primarily for the convenience of the patient, physician or other health care provider and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease. For the purposes of this section, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community or otherwise consistent with the standards set forth in policy issues involving clinical judgment.

The definition of Pre-existing condition is amended to read:

“Pre-existing Condition” means coverage that is excluded for twelve months following Your effective date of coverage for conditions, whether physical or mental, for which medical advise, diagnosis, care or treatment was recommended or received during the six months immediately preceding the effective date of coverage.

The following additional benefits apply to Connecticut residents.  Benefits are subject to this Certificate’s Policy Year, and Lifetime Maximum Benefits, Exclusions, Limitations and all other certificate provisions.

1. Accidental Ingestion of Controlled Drugs  - Benefits will be paid for emergency medical care related to the accidental ingestion or consumption of a controlled drug for up to 30 inpatient hospital days and $500 of outpatient treatment each calendar year.

2. Emergency ambulance services Coverage- Coverage is provided for services whenever any person covered is transported when medically necessary by ambulance to a hospital. Such benefits shall be subject to any provision which applies to other services covered. Any payment for emergency ambulance services under coverage required by this section shall be paid directly to the ambulance provider rendering such service if such provider has complied with the provisions of this subsection and has not received payment for such service from any other source. Benefits payable will equal the lesser of: (1) Billed charges, or; (2) the applicable rate(s) published by the Connecticut Department of Public Health

FLORIDA:  The Provision, Legal Actions is deleted and replaced with the following: 

Legal Actions: No legal action for a claim can be brought against us until 60 days after we receive proof of loss.  No legal action for a claim can be brought against us more than 5 years after the time required for giving proof of loss.  This 5-year time period is extended from the date proof of loss is filed and the date the claim is denied in whole or in part.

HAWAII:  The provision entitled “Arbitration” is deleted in its entirety.

Exclusion # 15 is hereby deleted in its entirety.

IDAHO:   The definition of Hospital is amended to read:

Hospital means a provider that is a short-term, acute, general hospital that:

1. is a duly licensed institution;

2. in return for compensation from its patients, is primarily engaged in providing Inpatient diagnostic and therapeutic services for the diagnosis, treatment, and care of injured and sick person by or under supervision of Physicians;

3. has organized departments of medicine and major surgery;

4. provides 24-hour nursing service by or under the supervision of registered graduate nurses; and

5. is not other than incidentally:  a) a skilled nursing facility, nursing home, custodial care home, health resort, spa or sanatorium, place for rest, or place for the aged; b) a place for the treatment of mental Illness; c) a place for the treatment of alcoholism or drug abuse, place for the provision of hospice care; or d) a place for the treatment of pulmonary tuberculosis.

 ILLINOIS: 

1. The definition of Pre-existing Condition in the DEFINITIONS section is deleted and replaced with  the following:

 “Pre-existing Condition” means any disease, illness, sickness, malady or condition of an Insured, or Traveling Companion, or Your and/or Traveling Companion’s Family Member, or the Insured’s Business Partner for which Medical advice, diagnosis, consultation, or    treatment was received from a Legally Qualified Physician within 24-months prior to the effective date of coverage; or Symptoms existed within 12-months prior to the effective date of coverage which, in the opinion of a Legally Qualified Physician, would indicate that the disease, illness, sickness, malady or condition probably began and manifested itself prior to the effective date of coverage and would cause a reasonable person to seek diagnosis, care, or treatment.

2. The following statement is added to GENERAL CLAIM PROVISIONS, the section titled Time of Payment Of Claims: All claims will be paid within 30-days after receipt of due written proof of loss.  If we have not paid the claim within this timeframe, we will pay interest at the rate of 9% from the 30^th day after receipt of all necessary proof of loss, to the date of payment. We will not pay interest amounting to less than one dollar.

Except as stated herein, this Amendatory Endorsement does not change coverage in any other way and is subject to all provisions, terms, and conditions of the Policy.  If there is a conflict between the Policy and this Amendatory Endorsement, the terms of this Amendatory Endorsement will govern.

MAINE:  The exclusion related to Terrorist Events is deleted in its entirety.

Exclusion # 15 is hereby deleted in its entirety.

MISSISSIPPI:  The provision entitled “Legally Qualified Physician” is amended to read:

“Legally Qualified Physician” means a health care practitioner or a Christian Science Practitioner (a) other than an Insured, a Traveling Companion or a Family Member: (b) practicing within the scope of his or her license: and (c) recognized as a health care practitioner in the place where the services are rendered.

The provision entitled “Notice of Claim” is amended so that the “20 days” notice reads “30 days”.

The provision entitled “Time of Payment of Claims” is amended to read:

Benefits payable for any loss will be paid within 45 days after receipt of due written proof of such loss.  Benefits due are overdue if not paid within 45 days after the Company or We receive proof of loss and the necessary information to adjudicate the claim and the necessary medical information and other information essential for Us to administer any coordination of benefits and subrogation provisions.  If such information is not supplied as to the entire claim, the amount supported by reasonable proof is overdue if not paid within 45 days after the Company receives such proof.  Any part or all of the remainder of the claim that is later supported by such proof is overdue if not paid within 45 days after the Company receives such proof.  To calculate the extent to which any benefits are overdue, payment shall be treated as made on the date a draft or other valid instrument was placed in the United States mail to the last known address of the claimant or beneficiary in a properly addressed, postpaid envelope, or if not so posted, on the date of delivery. 

If the claim is not denied for valid and proper reasons by the end of such period of 45 days, the Company  must pay You interest on accrued benefits at the rate of one and one-half percent (1 ½ %) per month on the amount of such claim until it is finally settled or adjudicated.

In the event the Company fails to pay benefits when due, the person entitled to such benefits may bring action to recover such benefits, any interest that may accrue as provided above and any other damages as may be allowable by law.

The Provision entitled “Physical Examination and Autopsy” is re-titled “Physical Examination” and amended to read:

Physical Examination:  The Company has the right to physically examine You as often as reasonably needed while a claim is pending.  The Company will bear all costs for this.

The provision entitled “Subrogation” is amended to read:

Subrogation: To the extent the Company pays for a loss    suffered by You, the Company will take over the rights and remedies You had relating to the loss. This is known as subrogation. You must help the Company to preserve its rights against those responsible for the loss. This may involve signing any papers and taking any other steps the Company may reasonably require. If the Company takes over Your rights, You must sign an appropriate subrogation form supplied by the Company.  No subrogation will occur until You have been made whole for your damages.

MISSOURI:  The definition of Hospital is amended to read:

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 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.

Hospital also includes tax-supported institutions, which are not required to maintain surgical facilities.

The definition of Pre-existing Condition is amended to read:

Pre-Existing Condition means any injury, sickness or condition of You, Your Traveling Companion, You or Your Traveling Companion's Family Member for which within the 180 day period prior to the effective date under the Group Policy such person received diagnosis or treatment for such injury, sickness or condition.

The Pre-Existing Conditions exclusion is waived for You if You enroll in the Group Policy at the time You pay the deposit required for Your Covered Trip or within 21 days of the initial deposit) and You purchase the coverage under the Group Policy for the full cost of Your Covered Trip. Such an Injury or Sickness will continue to be a Pre- Existing Condition until the earlier of:

(a) the expiration of 12 consecutive months, beginning with the effective date of coverage for which You have not received any medical care, consultation, diagnosis, or treatment or have not taken any prescribed drug or medicine on account of such condition; or

(b) the expiration of 24 consecutive months, beginning with the effective date of coverage. Taking maintenance medications for a condition that is considered stable shall not be cause for Exclusion.

The Subrogation provision is deleted in its entirety.

The Legal Actions provision is amended to read: 

Legal Actions - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of loss. No legal action for a claim can be brought against the Company more than three (3) years after the time required for giving proof of loss.

The section entitled “General Limitations and Exclusions” is amended as follows:  The exclusions related to 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 or loss or damage (including death or injury) and any associated cost or expense resulting directly or indirectly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event contributing concurrently or in any other sequence thereto are amended so that they do not apply if considered a Terrorist Act.

Exclusion # 15 is hereby deleted in its entirety.

With regard to medical expenses, the “Payment of Claims” provision is amended by the addition of the following provision:

If You utilize a public hospital or clinic, and such hospital or clinic submits a claim for benefits, whether or not such person has made an assignment of benefits, the Company will pay the benefits provided by the policy directly to the hospital or clinic.  If, however, a claim for benefits provided by the policy is paid and then such public hospital or clinic files a claim for benefits, the Company will not be liable for the duplicate payment of such benefits to such hospital or clinic.

With regard to Proof of Loss for the medical expense and Accidental Death and Dismemberment benefits, the provision is amended to read:

Proof of Loss:  Written proof of loss must be furnished to the Company within 90 days after the date of such loss. Failure to furnish such proof within such time shall not invalidate nor reduce any claim if it was not reasonably possible to furnish such proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity of the claimant, later than one year from the time proof is otherwise required.

MONTANA: The definition of Sickness is amended to read:

Sickness means an illness or disease, including pregnancy that is diagnosed or treated by a Physician after the effective date of insurance and while You are covered under the Group Policy.

The following provision is added to the General Provisions section:

Conformity with Montana statutes:  The provisions of this certificate conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which You reside on or after the effective date of this certificate.

In the General Limitations and Exclusions section, the exclusion related to pregnancy and childbirth is deleted in its entirety.

NEW HAMPSHIRE: The definition of “Family Member” is amended to read: “Family Member” means an Insured’s or a Traveling Companion’s: legal spouse or common-law spouse where legal; legal guardian; son or daughter (adopted, foster or step); child placed for adoption with You or Traveling Companion; son-in-law; daughter-in-law; grandmother; grandmother-in-law; grandfather; grandfather-in-law; grandchild; aunt; uncle; niece; or nephew; brother, step-brother; sister; step-sister; brother-in-law; sister-in-law; mother; father; step-parent.”

The definition of “Hospital” is amended to read: 

“Hospital” means (a) a place that operates according to law in the state where it is located;  and b) a place operated for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility: Not included is a hospital or institution licensed or used principally: (1) for the treatment or care of drug addicts or alcoholics: or (2) as a clinic continued or extended care facility, skilled nursing facility, convalescent home, rest home, nursing home or home for the aged.

 “Proof of Loss” is amended to read:

Proof of Loss: Proof of loss must be provided within 90 days after the date of the loss or as soon as is reasonably possible. 

NEW YORK:  The following language is amended to read:

“Pre-Existing Condition” means the existence of symptoms in You, Your Traveling Companion, You or Your Traveling Companion's Family Member that would ordinarily cause a prudent person to seek diagnosis, care or treatment within a 180 day period preceding the effective date of Your coverage, or a condition for which medical advice or treatment was recommended by a Physician or received from a Physician within a 180 day period preceding the effective date of Your coverage. 

SOUTH CAROLINA: The provision entitled “Legal Actions” is amended so that the “three year” period reads “six years”.

The provision entitled “Subrogation is amended to read:

Subrogation:  If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the Third Party responsible for the loss, the Company will be subrogated to that right for not more than the amount of insurance benefits that the Company has paid previously in relation to Your Injury by the liable Third Party.  An Insured shall help the Company exercise the Company’s rights in any reasonable way that the Company may request: nor do anything after the loss to prejudice the Company’s rights: and in the event an Insured recovers damages from the Third Party responsible for the loss, You will hold the proceeds of the recover for the Company in trust and reimburse the Company to the extent of the Company’s previous payment for the loss. Attorneys' fees and costs must be paid by the Company from the amounts recovered.

The provision entitled “Time of Payment of Claims” is amended to read:

Time of Payment of Claims:  The Company or its designated representative will pay the claim within 60 days after receipt of acceptable proof of loss.

VERMONT: The following disclosure is added to the certificate as follows:

THIS TRAVEL PROGRAM IS A LIMITED BENEFIT PROGRAM.  READ YOUR CERTIFICATE CAREFULLY.

The following provision is added to the General Provisions section: Vermont law requires that insurance policies offered to married persons and their families be made available to parties to a civil union and their families.  In order to receive benefits in accordance with this endorsement, the civil union must be established in the state of Vermont according to Vermont law.

Exclusion # 15 is hereby deleted in its entirety.

It is understood that policy definitions and provisions designating

• an insured
• named insured
• who is insured
• who is a named insured
• covered person(s)
• you and/or your
• spouse

and any other policy or certificate definitions and provisions designating an insured under this certificate, are amended, wherever appearing, where terms denoting a marital relationship or family relationship arising out of a marriage are used, to indicate parties to a civil union and their families under Vermont law.

In the General Limitations and Exclusions section, the exclusion related to racing is amended to include “only when racing in a professional capacity”.

In the General Limitations and Exclusions section, the exclusions relating to mountaineering, skydiving, hang gliding, bungee cord jumping, scuba diving and the exclusion related to device, weapon or material employing or involving chemical, biological, radiological or similar agents are deleted in their entirety.

WEST VIRIGINIA: The following exclusions are amended to read as follows:

7.  while participating in skydiving, hang gliding, bungee cord jumping, scuba diving or deep sea diving;

14.due to a Pre-existing Condition, as defined in this policy.  The Pre-existing Condition Limitation does not apply to: (a) Emergency Medical Evacuation, Medical Repatriation and Return of Remains coverage; or (b) to coverage purchased within 21 days from the time the initial Covered Trip deposit is paid and if You are medically able to travel when payment is made for the insurance.

WISCONSIN: The provision entitled “Subrogation” is amended to read:

Subrogation:  If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the Third Party responsible for the loss, the Company will be subrogated to that right.  An Insured shall help the Company exercise the Company’s rights in any reasonable way that the Company may request: nor do anything after the loss to prejudice the Company’s rights: and in the event an Insured recovers damages from the Third Party responsible for the loss, the Insured will hold the proceeds of the recover for the Company in trust and reimburse the Company to the extent of the Company’s previous payment for the loss. No subrogation will take place until You are made whole.

In the General Limitations and Exclusions section, the exclusion related to device, weapon or material employing or involving chemical, biological, radiological or similar agents is deleted in its entirety.

WYOMING: The provision entitled “Legal Actions” is amended so that the “three year” period reads “four years”.
 

 

T-16000 11.1.2012

TP-401 CRT