TRAVEL INSURANCE CERTIFICATE
Who is Eligible for Coverage
A person who has arranged to take a Trip and pays the required premium
and is a citizen or resident of the United States of America.
When Coverage Begins and Ends
All coverages will take effect on the later of: 1) the date the premium
has been received; 2) the date and time you start your Trip; or 3) 12:01
A.M. Standard Time on the Scheduled Departure Date of your Trip. Your coverage automatically ends on the earlier of: 1) the date the Trip is completed; 2) the Scheduled Return Date; 3) your arrival at the return destination on a round-trip, or the destination on a one-way trip; 4) cancellation of the Trip covered by the policy.
All coverages under the policy will be extended if your entire Trip is covered by the policy and your return is delayed by unavoidable circumstances beyond your control. If coverage is extended for the above reasons, coverage will end on the earlier of the date you reach your originally scheduled return destination or 7 days after the Scheduled Return Date.
Summary of Coverages
Medical Expense/Emergency Assistance
We will pay this benefit, up to the amount on the Schedule, for the following Covered
Expenses incurred by you, subject to the following:
- Covered Expenses will only be payable at the Usual and Customary level of
payment;
- benefits will be payable only for Covered Expenses resulting from a Sickness
that first manifests itself or an Injury that occurs while on a Trip;
- benefits payable as a result of incurred Covered Expenses will only be paid after
benefits have been paid under any Other Valid and Collectible Group Insurance
in effect for you.
We will pay that portion of benefits payable for Covered Expenses which exceed the amount of benefits payable for such expenses under your Other Valid and Collectible Group Insurance.
Covered Expenses include: expenses for the following Physician-ordered medical services: services of
legally qualified Physicians and graduate nurses, charges for Hospital
confinement and services, local ambulance services, prescription drugs and
medicines, and therapeutic services, incurred by you within one year from
the date of your Sickness or Injury; expenses for emergency dental treatment incurred by you during a Trip; expenses incurred by you for Physician-ordered emergency medical
evacuation, including medically appropriate transportation and necessary
medical care en route, to the nearest suitable Hospital, when you
are critically ill or injured and no suitable local care is available, subject
to the Program Medical Advisors prior approval; expenses incurred for non-emergency
medical evacuation, including medically appropriate transportation and medical care en route, to a
Hospital or to your place of residence in the United States of America or Canada, when deemed
medically necessary by the attending Physician, subject to the Program
Medical Advisors prior approval; repatriation expenses for preparation and air transportation of your remains to your place of residence in the United States of America or Canada, or up to an equivalent amount for a local burial in the country where death occurred, if you die while outside the United States of America or Canada.
MEDEX WORLDWIDE ASSISTANCE SERVICE-Multi-lingual professionals are available 24 hours a day to provide help and advice with a medical or legal emergency.
Policy Definitions
The words, "you", "your" and "yours" refer to the Insured. "We", "us" and "our" refer to company providing the insurance. In addition certain words and phrases are defined as follows:
"Elective Treatment and Procedures" means any medical treatment or
surgical procedure that is not medically necessary including any service, treatment,
or supplies that are deemed by the federal, or a state or local government
authority, or by us to be research or experimental or that is not recognized as a
generally accepted medical practice.
"Hospital" means an institution which meets all of the following requirements: 1)
it must be operated according to law; 2) it must give 24 hour medical care, diagnosis
and treatment to the sick or injured on an inpatient basis; 3) it must provide
diagnostic and surgical facilities supervised by Physicians; 4) registered nurses
must be on 24 hour call or duty; and 5) the care must be given either on the
hospitals premises or in facilities available to the hospital on a pre-arranged basis.
A Hospital is not: a rest, convalescent, extended care, rehabilitation, or other
nursing facility; a facility which primarily treats mental illness, alcoholism, or drug
addiction (or any ward, wing or other section of the hospital used for such
purposes); or a facility which provides hospice care (or wing, ward or other section
of a hospital used for such purposes).
"Immediate Family Member" includes your or the Traveling Companions,
spouse, child, spouse's child, son-daughter-in-law, parent(s), sibling(s),
grandparent(s), grandchild, step brother-sister, step-parent(s), parent(s)-inlaw,
brother-sister-in-law, aunt, uncle, niece, nephew, guardian, Domestic
Partner, foster-child, or ward.
"Injury" means bodily harm caused by an accident which 1) occurs while
your coverage is in effect under the policy and 2) requires examination and
treatment by a Physician. The injury must be the direct cause of loss and
must be independent of all other causes and must not be caused by, or
result from, Sickness.
"Insured" means an Eligible Person who arranges a Trip and pays any required premium.
"Insurer" means Stonebridge Casualty Insurance Company.
"Other Valid and Collectible Group Insurance"means any group policy
or contract which provides for payment of medical expenses incurred because
of Physician, nurse, dental or Hospital care or treatment; or the performance
of surgery or administration of anesthesia. The policy or contract providing
such benefits includes group or blanket insurance policies; service plan
contracts; employee benefit plans; or any plan arranged through an employer,
labor union, employee benefit association or trustee; or any group plan created
or administered by the federal or a state government or its agencies. In the
event any other group plan provides for benefits in the form of services in lieu
of monetary payment, the Usual and Customary value of each service rendered
will be considered a Covered Expense.
"Physician" means a person licensed as a medical doctor by the jurisdiction
in which he/she is resident to practice the healing arts. He/she must be
practicing within the scope of his/her license for the service or treatment given
and may not be you, a Traveling Companion or an Immediate Family Member
of yours.
"Policy" means the contract issued to the Policyholder providing the benefits
specified herein.
"Policyholder" means the legal entity in whose name this Policy is issued, as
shown on the Declarations.
"Pre-Existing Condition" means an illness, disease, or other condition
during the 60 day period immediately prior to your effective date for which
you, your Traveling Companion, or Immediate Family
Member scheduled or booked to travel with you: 1) received or received
a recommendation for a diagnostic test, examination, or medical treatment;
or 2) took or received a prescription for drugs or medicine.
Item 2) of this definition does not apply to a condition which is treated or
controlled solely through the taking of prescription drugs or medicine and
remains treated or controlled without any adjustment or change in the required
prescription throughout the 60 day period before coverage is effective under
this policy.
"Program Medical Advisors" means MEDEX Assistance Corporation.
"Scheduled Departure Date" means the date on which you are originally
scheduled to leave on your Trip.
"Sickness"means an illness or disease of the body which: 1) requires
examination and treatment by a Physician, and 2) commences while the
insurance is in effect. An illness or disease of the body which first manifests
itself and then worsens or becomes acute prior to the effective date of this
insurance is not a Sickness as defined herein and is not covered by the policy.
"Trip" means a scheduled trip for which coverage has been elected and the premium paid prior to the Scheduled Departure Date of the Trip.
"Usual and Customary Charge" means those charges for necessary
treatment and services that are reasonable for the treatment of cases of
comparable severity and nature. This will be derived from the mean charge based
on the experience in a related area of the service delivered and the MDR (Medical
Data Research) schedule of fees valued at the 90th percentile.
Policy Exclusions
The following exclusions apply to all coverages:
- We will not pay for loss or expense caused by or incurred resulting from a Pre-Existing Condition, as defined, including death that results therefrom.
Exclusion #1 will be waived: if 1) the premium for the coverage is received by or before the final payment due date for your Trip; and 2) are not disabled from travel at the time you pay your premium.
- We will not pay for any loss under the policy caused by, or resulting from:
- suicide, attempted suicide, or intentionally self-inflicted injury of you, a Traveling Companion, Immediate Family Member, or Business Partner booked to travel with you, while sane or insane (while sane in CO & MO);
- mental, nervous, or psychological disorders;
- being under the influence of drugs or intoxicants unless prescribed by a Physician;
- normal pregnancy, resulting childbirth, or elective abortion;
- participation as a professional in athletics;
- participation in organized amateur and interscholastic athletic or sports competition or events;
- riding or driving in any motor competition;
- declared or undeclared war, or any act of war;
- civil disorder;
- service in the armed forces of any country;
- nuclear reaction, radiation or radioactive contamination;
- operating or learning to operate any aircraft, as pilot or crew;
- mountain climbing, bungee cord jumping, skydiving, parachuting, hang gliding, parasailing or travel on any air supported device, other than on a regularly scheduled airline or air charter company;
- any unlawful acts, committed by you or a Traveling Companion (whether insured or not);
- any amount paid or payable under any Worker's Compensation, Disability Benefit or similar law;
- a loss or damage caused by detention, confiscation or destruction by customs;
- Elective Treatment and Procedures;
- medical treatment during or arising from a Trip undertaken for the purpose or intent of securing medical treatment;
- a loss that results from an illness, disease, or other condition, event or circumstance which occurs at a time when the policy is not in effect for you.
IMPORTANT NOTE: Exclusion 2, Item s above applies to you, an Immediate Family Member, Traveling Companion, or Business Partner.
Insurance Company
This Insurance is Underwritten By:
Stonebridge Casualty Insurance Company, Columbus, OH.
Notice: If you are a resident of one of the following states (IL,IN,KS,LA,OH,OR,VT,WA,WY) your
coverage is provided on an individual policy form. Your policy number is your complete
Name plus 925M. Additional forms complete your policy and are available at
www.tripmate.com. You can also request these forms by calling TravelSafe at 1-888-
-885-7233.
In Canada: Life Investors Insurance Company of America.
Your Duties in the Event of a Loss
In the event of a Medical or Dental Expense: You must provide us with
all bills and reports for medical and/or dental expenses claimed; you must
provide any requested information, including but not limited to, an explanation
of benefits from any other applicable insurance; and you must sign a
patient authorization to release any information required by us, to investigate
your claim.
Where to Present a Claim
All claims should be presented to the Program Administrator,
use Plan # 925M.
The address and telephone number are as follows:
Trip Mate*
9225 Ward Parkway
Kansas City, Missouri 64114
1-888-411-5378
*In CA, dba Trip Mate Insurance Agency
Please read this Insurance Certificate/brochure carefully, as it is your evidence of coverage under the policy (once you have paid the appropriate premium). If you have any questions about the coverages offered or to report a claim, please contact Trip Mate at 1-888-411-5378. Claims may also be reported online and claim forms downloaded at www. tripmate.com
Plan Number: 925M
MEDEX Travelers Assistance Service
24-hour Telephone Service- Multi-lingual professionals are available 24 hours a day to provide help and advice with a medical or legal emergency.
International Medical Assistance- If you are in need of medical attention, MEDEX will help you locate local physicians, dentists, or medical facilities. MEDEX will also monitor your condition and contact your personal physician and family, if requested.
Medical Evacuation*- If you need to be transported to a different hospital or treatment facility, or back home, MEDEX will arrange and pay for transportation and a special medical escort if required.
Telephone Interpretation Service- In a medical emergency, MEDEX provides interpretation services in major languages and will transmit urgent messages to family, friends, and business, if requested.
*Payment for these services is available only for covered claims and up to the amount of coverage provided in the policy.
Failure to call MEDEX may invalidate your Medical Expense claim.
The MEDEX Assistance Network extends worldwide. If you are outside the United States or Canada, call the local telephone operator for help in placing your
collect call. Within the United States and Canada, use the toll free number.
Give MEDEX the following Plan Number: 925M
Within U.S.A & Canada: 1-800-527-0218
Outside U.S.A. & Canada: 1-410-453-6330*
From outside the United States & Canada, you will first have to enter the International Access Code of the country you are calling from.
NOW! Access Your Medical Records Online
With Traveler PDQ, you can assure that your important medical records are available to you or any Physician chosen by you, anytime, anywhere in the world, quickly, wherever internet access is available. The registration process takes just a few minutes. Register at your convenience at www.travelerpdq.com* or call, toll free 1-800-379-9887. It's free during your insured Trip! *
Program Code 925M
Travel PDQ Service is provided by: Worldwide PDQ, a division of Cargril Corporation
24 Hour Assistance is provided by MEDEX Assistance Corporation.