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T ERMS
&
CONDI T I ONS
A SSI ST A NCE P ROGRA M ST A NDA RD T ERMS & CONDI T I ONS
This is to certify that in accordance with the authorisation granted by the Insurers and in
consideration ofthe paymentof premium specified herein or hereon, the Insurers agree to provide cover as set outin this certificate ofinsurance. The Insurers are certain syndicates atLloyd’s as detailed in the schedule retained by All Seasons Underwriting Insurance Agency Ltd.
Evacuation& RepatriationC over will provide limited medical,evacuation and repatriationcover subjectto the terms, conditions and exclusions detailed herein subjectto pre-authorisationonly. CONDI T I ONS:
A n ins ur e d p e r s o n is o nly e lig ib le f o r b e ne f its und e r this ins ur a nc e if the y a r e :
1. Hospitalised as an inpatientas a resultof an insured accidentor illness occurring more than 99 miles from your primary country of residence as itappears in their application and need to be admitted as an in-patientat the hospital to which they are beingevacuated or
repatriated subjectto the medical treatmentnotbeing available in your primary country of residence.
2. Medically unfitto travelas a normally seated passenger withoutmedical assistance. EvacuationC over will make allarrangements for medical evacuationand repatriation wherever possible butcannotguarantee the quality,availability or supply of servicesoutside ofour
immediate control.
Boththe originating and receiving hospital mustbe reasonably accessible by ground ambulance to transportthe insuredto and from an airfield capable of accommodating an authorised aircraft. If the medical condition allows,you will be transported by the means provided by our 24 hour emergency medical service while in the care of the Evacuation C over medicalproviders.
Emergency Evacuation will be provided if you need to be hospitalised due to injury or illness from the place of the incident to the nearestmedicalfacility outside ofyour primary country of residence if the medicaltreatmentwhich you require isnote available in your primary country of residence. Decisions concerningthe urgency, timing and mostsuitable means of transportationwill be made by the emergency assistance company afterconsultation with the localattending physicianand the receiving physician.
REST RI CT I ONS:
Due to the high risk of sendingregistered aircraftand personnel into countries where travel restrictions have beenissued, services are subject to exclusion in these areas.
Boththe originating and receiving hospital mustbe reasonably accessible by ground ambulance to transportthe insuredto and from an airfield capable of accommodating an authorised aircraft.
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SECT I ON A I S COVERED UNDER I NSURA NCE B – OUT BOUND ONLY
In the eventyou fall illor are injured in an area with no suitable medical facilities to treatyour condition,we will provide Emergency medical,hospitaland treatmentexpenses limitedsolely to necessary and unavoidable treatmentas an in-patientthat are required to stabilise your medical conditionin order to make you fit to be medically transported by our 24 hour emergency medical service while in the care of the evacuation and repatriation cover medicalproviders.
Itisa condition of thisinsurance that approval mustbe obtained for suchmedical evacuation from our 24 hour emergency medical service who mustbe contacted as soon as possible. We will
arrange for directsettlement with the transportation providers where possible.
Please note that if you are fit to travelnormally seatedand withoutmedicalassistance then no benefitwill be paidby us.
B - EMERGENCY EVA CUA T I ON F ROM P LA CE OF I NJURY
In the eventyou fall illor are injured in an area with no suitable medical facilities to treatyour conditionwe will pay reasonable and necessary expenses to transportyou to the nearestmedical facility available.
Itisa condition of thisinsurance that approval mustbe obtained for suchmedical evacuation from our 24 hour emergency medical service who mustbe contacted as soon as possible. We will
arrange for directsettlement with the transportation providers where possible.
Please note that if you are fit to travelnormally seatedand withoutmedicalassistance then no benefitwill be paidby us.
C - REP A T RI A T I ON F ROM HOSP I T A L
Once your medicalcondition is stabilised and you are fit to be transported we will arrange a
medicaltransfer to a hospitalof your choice near your home as declared to us on your application. Itisa condition of thisinsurance that approval mustbe obtained for suchmedical evacuation from our 24 hour emergency medical service who mustbe contacted as soon as possible. We will
arrange for directsettlement with the transportation providers where possible.
Please note that if you are fit to travelnormally seatedand withoutmedicalassistance then no benefitwill be paidby us.
D - REP A T RI A T I ON OF MORT A L REMA I NS
In the eventof your death we will arrange the transportation ofyour mortalremains to a funeral home near your place of residence or in your place of residence as declared to us.C osts are limited to a standard air transportation casketor Urn and do notinclude ornamental caskets or ornamental urns or funeral,burial or cremationcosts.
GENERA L NOT ES
One Family member, business associate,and/or travelling companionmay accompany the patient atno additionalcoston Evacuation C over authorised aircraftduring transport, provided space is available and the patient care is notcompromised. On scheduled commercialaircraft, companions will be responsible for their own airfare.
While Evacuation C over makesevery effort to accommodate its insured’s,the patientand any accompanyingpassenger islimited to one small carry-on bag each due to limited space available on medicalaircraft. Evacuation C over will arrange for additional luggage to be forwarded at the insured’s expense.
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n. Murderor Assaultsubsequently proved beyond reasonable doubtto have beenthe act of agentsof a state foreignto the nationality of the insuredperson whether war be declared with thatstate or not,
o. Terroristactivity.
F o r the p ur p o s e o f this e x c lus io n;
1. Terroristactivity meansan act, or acts, of any person, or group(s) of persons,committed for political,religious, ideologicalor similarpurposes with the intention to influence any governmentand/or to putthe public,or any section of the public,in fear. Terrorist activity caninclude, butnotbe limited to,the actual use of force or violence and/or the threatof suchuse. Furthermore,the perpetrators ofterrorist activity can either be acting alone, or on behalfof, or in connection with any organisation(s)or governments(s).
2. Utilisationof Nuclear weapons of mass destruction means the use ofany explosive nuclear weaponor device or the emission, discharge, dispersal, release or escape of fissile material emitting a level of radioactivity capable of causing incapacitating disablement or death amongstpeople or animals.
3. Utilisationof C hemicalweapons ofmass destruction means the emission, discharge,
dispersal,release or escape ofany solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing incapacitating disablementor death amongst people or animals.
4. Utilisationof Biological weapons of mass destruction means the emission, discharge, dispersal,release or escape ofany pathogenic (disease producing) micro-organism(s) and/orbiologically producedtoxin(s) (including genetically modified organisms and
chemically synthesised toxins) which are capable of causing incapacitating disablement or death amongst people or animals.
Also excluded hereon is any loss or expense of whatsoever nature directly or indirectly arising out of,contributed to,caused by, resulting from,or in connection with any action taken in controlling, preventing, or suppressing any, or all, of(a) to (o)above.
In the eventany portion of thisexclusion is found to be invalid or unenforceable, the remainder shallremain in full force and effect.
15.
Sa nc tio n Lim ita tio n a nd Ex c lus io n Cla us e . No (re)insurer shall be deemed to provide cover and no (re)insurer shallbe liable to pay any claim or provide any benefit hereunder to the extentthatthe provision of suchcover, payment ofsuch claim or provision of such benefitwould expose that (re)insurer to any sanction, prohibitionor restrictionunder United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States ofAmerica.
16.
All claims notsubmitted within 90 days ofthe expiry date of the insurance will notbe covered.
Jur is d ic tio n
Any dispute arisingbetween the parties shallcome under the exclusive jurisdiction ofthe C ourts of England.This Policy shall be consideredin accordance with EnglishLaw and if any difference shall arise as to the amountto be paid under this Policy (liability beingotherwise admitted)such
difference shall be referredto an arbitrator to be appointed by the parties in accordancewith the Statutory provisions in England in thatbehalf for the time beingin force where any difference isby thiscondition to be referred to arbitration the makingof an award shallbe a condition precedentto
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Be ne f its will no t b e p r o v id e d in c a s e s whe r e a n ins ur e d :
1. is suffering from tuberculosis or other chronic airborne pathogens;
2. is suffering with mildlesions, simple injuries such as sprains, simple fractures or mildillness which canbe treated by localdoctors and do notpreventthe member from continuinghis or her trip or returning home as a normally seated passenger notrequiring medicalassistance 3. has a primary admitting diagnosis of a psychiatric disorder;
4. is medically discharged (or leaves the hospitalagainstmedical advice)and is fitto travel on their own withoutmedical assistance as a normally seated passenger;
5. is travelling following a terminal prognosis; 6. Pre-Existing MedicalC ondition(s) Exclusion
7. The Underwriters shall notbe liable for any claim directly or indirectly consequentupon or contributed to by any physicaldefect, infirmity or medicalcondition knownto an Insured Person atthe inception date of this Insurance or date of their addition whichever is the later. The exclusionshall notapply if such conditionhas beenwithout the necessity of medical consultation or treatmentfor 24 consecutive months prior to the original inceptiondate or any subsequentrenewal date ofthis Insurance;
8. Suicide or attempted suicide or intentional self injury; 9. Alcohol or Drug abuse;
10. An insured’s own criminal or felonious act, or sustained while the insuredis in a state of insanity;
11. An insured with an infectious disease under treatmentat the time of enrolmentwillnotbe transported for any condition relatedto that infection;
12. An insured on an organtransplant listprior to enrolmentwill notbe entitled to a transport for that transplant;
13. Insured’s will notbe entitledto air medicaltransportbenefits if their illness or injury is a result ofor is contributed to by the following:
14. War, Terrorism and Mass Destruction Exclusion:
Notwithstanding any provision to the contrary within thisinsurance, or any endorsementthereto, it is agreed that thisinsurance excludes any loss or expense ofwhatsoever nature directly or
indirectly arisingoutof, contributed to, caused by,resulting from, or in connection with any of the following regardlessof any other cause or event contributingconcurrently or in any other sequence to the loss or expense;
a. War, hostilities or warlike operations (whether war be declared or not), b. Invasion,
c. Actof an enemy foreign to the nationality of the insuredperson or the country in, or over, which the act occurs,
d. C ivil war, e. Riot,
f. Rebellion, g. Insurrection, h. Revolution,
i. Overthrow of the legally constituted government,
j. C ivil commotion assuming the proportions of, or amounting to,an uprising, k. Military or usurped power,
l. Explosions of war weapons,
m. Utilisation of Nuclear, C hemicalor Biological weapons ofmass destruction howsoever these may be distributedor combined,
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Cla im s P r o c e d ur e
In the eventofan emergency please contact:
A MA A SSI ST A NCE
24 Ho ur e m e r g e nc y Me d ic a l He lp line T e l:+91 124 4688444
F a x :+91 124 4014728
Em a il:o p s ind ia @a s ia m e d a s s is t.o r g
To obtaina claims form please e-mail us or contactus at the address below. Please send all claims directly to:
The above numbers are for the C laims Departmentonly and should be used to discuss claims submitted and on-going issues.
Co m p la ints P r o c e d ur e
If you are nothappy with our service please write to:
Ma na g ing Dir e c to r A SUI A Lim ite d
Office 206, 2nd Floor, 10 LloydsAvenue, London. EC 3N 3AJ. United Kingdom
Our aim is to provide you with a first class standard of service at alltimes. Nevertheless, there may be an occasionwhen you may feel this objective has notbeenachieved by us.In the unlikely event ofthis happening, should you have any complaint or query regarding the service provided by us under Your Plan, then please contactus.
Please quote Your C ertificate ofInsurance number and give full information regarding the query or complaint. Also include details of where you can be contacted. We aim to send a written
acknowledgmentwithin 5 business days ofreceipt and give you details of who is handling your complaint and how to contacthim or her. We aim to resolve or respond to your complaintwithin 4 weeks of receiving the complaint.
If we are unable to resolve this situation and you wish to take your complaintfurther, please write, detailing why you feel our decisionis incorrectin relation to the Terms and benefits under Your Plan to: The C omplaints Department. Lloyd’s. One Lime Street,London. EC 3M7HA. United Kingdom.
Should the matternotbe resolved to your satisfaction, you may be entitled to refer the matterto The FinancialOmbudsman Servicesin the UnitedKingdom at: The Financial Ombudsman Services. South Quay Plaza, 183 Marsh Wall,London E14 9SR, United Kingdom.
