• No results found

Accident & Sickness Insurance Information

N/A
N/A
Protected

Academic year: 2021

Share "Accident & Sickness Insurance Information"

Copied!
14
0
0

Loading.... (view fulltext now)

Full text

(1)

Accident & Sickness Insurance Information

CIEE is pleased to provide all CIEE program participants with the iNext Travel Card. Among its many benefits, the iNext card includes insurance coverage under the group sickness, accident, and travel insurance policy maintained by CIEE and administered by CHARTIS Travel Guard, the industry’s leading provider of travel insurance plans. The policy is designed to supplement your private insurance by providing additional coverage for the costs of accidents and routine sicknesses while you are abroad. Additionally, the policy offers Emergency Evacuation and Emergency Medical Transportation coverage, 24-hour Medical, Legal, and Travel Assistance Services, Travel Document Replacement, as well as limited Travel Delay, Baggage Delay, and Baggage and Personal Effects coverage.

SHOULD I PURCHASE OR MAINTAIN MY U.S. HEALTH INSURANCE PLAN?

Before you depart for your program it is important that you understand that the coverage provided by CHARTIS Travel Guard begins only when you leave the U.S., and ends immediately upon your return to the U.S. For coverage in the U.S., you must purchase or maintain a separate plan. CIEE strongly recommends that you consider retaining your U.S. health insurance, including hospitalization, even while abroad. This will cover you both before you leave and after you return from your program; and should you have an accident or illness abroad that requires long term care, you will have insurance upon your return to cover these expenses. You may find it difficult to purchase a health plan if you return to the U.S. with what an insurance company considers to be a pre-existing condition.

HOW DOES SUPPLEMENTAL INSURANCE WORK?

Like all travel insurance policies, the coverage provided by CHARTIS Travel Guard is

supplemental or secondary to any other coverage that you may have. In other words, if you are

covered by another insurance policy – e.g., a personal policy, college/university policy, or a policy

maintained by your parents – then that policy is your primary policy. Prior to departure, you

should contact your primary insurance carrier concerning coverage for accidents, illnesses, and liability cases that occur outside the U.S. Check your policy’s limitations before making any assumptions about coverage.

In the event that you must file a claim for reimbursement of medical expenses incurred while you are abroad, please note that you must file a claim with your primary insurance carrier FIRST to determine what, if any, portion of those medical expenses are reimbursable through your primary policy. Subsequently, you should file a claim with CHARTIS Travel Guard for any amount that was not covered by your primary insurance carrier.

IMPORTANT!

While abroad, you should have your primary insurance carrier and policy information readily available. During the CHARTIS Travel Guard claim process, you will be asked to submit the following:

o Name of Primary Insurance Carrier

o Complete Street Address of Primary Insurance Carrier

o Telephone Number of Primary Insurance Carrier

(2)

HOW LONG AM I COVERED BY THE CHARTIS TRAVEL GUARD POLICY?

You are covered for 365 days from the start date of coverage – regardless of the length of your CIEE program. Generally, the start date of coverage is two weeks prior to the date that your CIEE program begins. The dates of coverage are noted on the front of your iNext card.

AM I COVERED IN COUNTRIES OTHER THAN MY CIEE PROGRAM COUNTRY?

Yes. Your insurance coverage is valid in any country outside the 50 United States and District of

Columbia. This is particularly beneficial should you require medical care when traveling independently during holidays, semester break, or after your CIEE program has ended.

IS IT POSSIBLE TO GET REFERRALS TO LOCAL DOCTORS OR HOSPITALS ABROAD? CHARTIS Travel Guard maintains a fairly extensive database of licensed medical providers and is available 24/7 to offer referrals over the telephone. Simply call CHARTIS Travel Guard collect at the number provided on the back of your iNext Travel Card.

It should be noted that CHARTIS Travel Guard is only able to offer referrals to medical providers. There is no list of preferred providers with which CHARTIS Travel Guard has an established “financial” relationship. Unlike in the United States, most medical providers abroad are not set up, or even willing, to bill an overseas insurance company directly. In addition, no insurance company can force any doctor or medical facility to bill insurance rather than the patient. As with most travel insurance, the customary procedure with CHARTIS Travel Guard is for you to pay for medical treatment received, and then submit a claim for reimbursement.

IS PRE-APPROVAL REQUIRED BEFORE I RECEIVE MEDICAL TREATMENT?

No. You do not have to contact CHARTIS Travel Guard before receiving any medicaltreatment

aside from hospitalization or surgery. Treatment by any doctor or medical facility that is licensed to practice medicine will be covered. Simply go to a doctor, get a prescription, pay the doctor, and then submit a claim for reimbursement.

Exception:

You MUST call CHARTIS Travel Guard before being admitted to a hospital or prior to a scheduled surgery unless it is an emergency situation and a call is not possible, in which case CHARTIS Travel Guard should be notified as soon as possible.

IMPORTANT!

In the event of an emergency, if it is possible to contact CHARTIS Travel Guard immediately (available 24/7), CHARTIS Travel Guard may be able to arrange direct payment with the hospital or coordinate payment guarantees for serious and/or expensive cases. In addition, CHARTIS Travel Guard will attempt to facilitate contact between your family members and the attending doctor to help evaluate the best possible treatment. This service will begin without first checking for other insurance coverage, which obviously is a secondary concern compared to your wellbeing. Instead CHARTIS Travel Guard will get involved immediately and, afterwards, seek reimbursement from any other insurance company that may be in existence (i.e., subrogate against your primary insurer).

WHAT IS THE PROCESS FOR FILING A CLAIM?

You should telephone CHARTIS Travel Guard as soon as possible after receiving treatment to initiate the claim process. When calling, you should have the following information available:

o Policy Number (listed on the back of your iNext Travel Card)

o What coverage type or benefit category the claim is under (e.g. Medical Expense,

Baggage or Personal Effects, Travel Document Replacement, etc.)

(3)

o The amount that you paid (if applicable)

During the phone call, a claim form will be completed by the CHARTIS Travel Guard

representative based on your responses. The completed form will be mailed or faxed to you or to a recipient in the U.S. designated by you (e.g. parent or family member). Upon receipt or upon return to the U.S., review the claim form for accuracy, sign the form, and return it to CHARTIS Travel Guard along with any requested supporting documentation, such as original receipts, primary insurance information, proof of travel (e.g. a copy of your flight itinerary), etc.

In order to avoid lengthy bank processing times and finance charges associated with cashing an international check, it may be advantageous for you to request that CHARTIS Travel Guard send the reimbursement check to a recipient in the U.S. (e.g. parent or family member).

Telephone Protocol:

When calling from abroad, place a collect call (reverse charge) to CHARTIS Travel Guard at the number indicated on the back of your iNext Travel Card. If, for whatever reason, a collect call is not possible and you must dial CHARTIS Travel Guard directly, you should ask the answering CHARTIS Travel Guard representative to call you back, hang up, and then wait for the call.

WHAT ARE THE POLICY EXCLUSIONS?

The policy does not include coverage for pre-existing conditions; mental, psychological, or nervous disorders; routine physical or dental examinations; or preventative medicine. For a complete list of exclusions, please refer to the policy description online (see below).

WHAT IS A PRE-EXISTING CONDITION?

Any injury, sickness, or other condition identified within 90 days before the start date of coverage. For additional information, please refer to the policy description online (see below).

SCHEDULE OF BENEFITS & PROVISIONS AT A GLANCE

Below is a list of the maximum limits of the benefits available under your CHARTIS Travel Guard policy. A comprehensive description of the benefits and basic provisions of the policy is available

online at http://www.travelguard.com/partners/EducationalExchange.pdf.

Deductible $0

Accident Medical Expense $100,000

Sickness Medical Expense $20,000

Emergency Evacuation $1,000,000

Mental Health Coverage $10,000

Repatriation of Remains $50,000

Accidental Death & Dismemberment $10,000

Trip Delay $200

Baggage Delay $200

Baggage and Personal Effects Loss $500

Travel Document Replacement $1,000

24-hour Medical Assistance Services Included

24-hour Legal Assistance Services Included

(4)

ASSISTANCE SERVICES AT A GLANCE

The following Assistance Services, provided by CHARTIS Travel Guard Assist, are included with the iNext Travel Card. All benefits provided are service benefits. Any costs associated with benefits that are not specifically listed in the policy’s Schedule of Benefits will be paid by the named Insured.

Travel Medical Assistance

o Emergency medical transportation assistance.

o Physician/hospital/dental/vision referrals.

o Repatriation of mortal remains assistance.

o Emergency prescription replacement assistance.

o Dispatch of doctor or specialist.

o Medical evacuation quote.

o In-patient and out-patient medical case management.

o Arrangements of visitor to bedside of hospitalized Insured.

o Eyeglasses and corrective lens replacement assistance.

o Medical payment arrangements.

o Medical cost containment/expense recovery and overseas investigation.

o Shipment of medical records.

o Medical equipment rental/replacement.

Worldwide Travel Assistance

o Lost baggage search; stolen luggage replacement assistance.

o Lost passport/travel documents assistance.

o ATM locator

o Emergency cash transfer assistance

o Travel information including visa/passport requirements

o Emergency telephone interpretation assistance

o Urgent message relay to family, friends or business associates

o Up-to-the-minute travel delay reports

(5)

1

DEFINITIONS

(Capit

alized terms within this

Description of Coverage are defined herein)

“Actual Cash V

alue”

means purchase price less depreciation.

“Baggage”

means luggage, travel document

s, and personal

possessions whether owned, borrowed, or rented, t

aken by the

Insured on the

Trip.

“Business Partner”

means a person who: (1) is involved with the

Insured or the Insured’

s

T

raveling Comp

anion in a legal

partnership; and (2) is actively involved in the daily management of

the business.

“Children”/“Child”

means, with respect to Medical Expense and

Emergency Evacuation benefit

s, unmarried children of the Insured,

including natural children from the moment of birth, and step, foster

or adopted children from the moment of placement in the Insured’

s

home, under age 25 and primarily dependent on the Insured for

support and maintenance. However

, the age limit does not apply

to a child who: (1) otherwise meet

s the definition of Children; and

(2) is incap

able of self-sust

aining employment by reason of ment

al

or physical incap

acity

.

“City”

means an incorporated municip

ality having defined borders

and does not include the high seas, uninhabited areas or airsp

ace.

“Common Carrier”

means an air

, land, or sea conveyance

operated under a license for the transport

ation of p

assengers for

hire.

“Complications of Pregnancy”

means conditions whose

diagnoses are distinct from pregnancy but are adversely af

fected

by pregnancy or are caused by pregnancy

.

These conditions

include acute nephritis, nephrosis, cardiac decompensation,

missed abortion and similar medical and surgical conditions of

comp

arable severity

. Complications of Pregnancy also include

nonelective cesarean section, ectopic pregnancy which is

terminated and spont

aneous termination of pregnancy

, which

occurs during a period of gest

ation in which a viable birth is not

possible.

Complications of Pregnancy do not include false labor

, occasional

spotting, Physician-prescribed rest during the period of pregnancy

,

morning sickness, hyperemesis gravidarum, preeclamp

sia and

similar conditions associated with the management of a dif

ficult

pregnancy not constituting a nosologically distinct complication of

pregnancy

.

“Deductible”

means the amount of charges that must be incurred

by an Insured before benefit

s become p

ayable.

The amount of the

Deductible is shown in the Schedule for each coverage to which a

Deductible applies.

“Departure Date”

means the date on which the Insured is originally

scheduled to leave on his/her

Tr

ip.

This date is specified in the travel

document

s.

“Destination”

means any place where the Insured expect

s to travel

to on his/her

Trip other than Return Destination as shown on the

travel document

s.

“Domestic Partner”

means an opposite or a same-sex p

artner

who is at least 18 years of age and has met all of the following

requirement

s for at least 6 months: (1) resides with the Insured; (2)

shares financial asset

s and obligations with the Insured;

The

Insurer may require proof of the Domestic Partner relationship in

the form of a signed and completed

Af

fidavit of Domestic

Partnership.

“Eligible Person”

means a person who is a member of an eligible

class of persons as described in the Description of Eligible Persons

section of the Master

Application.

“Experimental or Investigative”

means treatment, a device or

prescription medication which is recommended by a Physician, but

is not considered by the medical community as a whole to be safe

and ef

fective for the condition for which the treatment, device or

prescription medication is being used.

This includes any treatment,

procedure, facility

, equipment, drugs, drug usage, devices, or

supplies not recognized as accepted medical practice, and any of

those items requiring federal or other government

al agency

approval not received at the time services are rendered.

“Family Member”

means the Insured’

s or

Traveling Comp

anion’

s

spouse, Domestic Partner

, Child, daughter-in-law

, son-in-law

,

brother

, sister

, mother

, father

, grand

parent

s, grandchild, step-child,

step-brother

, step-sister

, step-p

arent

s, p

arent

s-in-law

,

brother-in-law

, sister-in-law

, aunt, uncle, niece, nephew

, legal guardian, foster

Child, ward, or legal ward.

“Hospital”

means a facility that: (1) is operated according to law

for the care and treatment of sick or Injured people; (2) has

organized facilities for diagnosis and surgery on it

s premises or in

facilities available to it on a prearranged basis; (3) has 24 hour

nursing service by registered nurses (R.N.’

s); and (4) is supervised

by one or more Physicians available at all times.

A

Hospit

al does not include:

(1) a nursing, convalescent or geriatric unit of a hospit

al when a

patient is confined mainly to receive nursing care; (2) a facility that

2

3

DESCRIPTION OF COVERAGE

iNext Platinum

Annual

S

tudent Insurance Plan

SCHEDULE OF BENEFITS

All coverages are aggregate amounts which will diminish in

value per paid claim during the individual coverage term.

All coverages are per person MAXIMUM LIMIT

Trip Delay

...

$200

Baggage & Personal Ef

fect

s Loss

...$2,000

Baggage Delay

...$200

Travel Document Replacement

...$1,000

(Covers Administrative

Fees)

Accident Medical Expense

...$100,000

Sickness Medical Expense

...$20,000

Dent

al

...$500

Ment

al Health Coverage

...$10,000

Emergency Evacuation

...$1,000,000

Rep

atriation of Remains

...$50,000

Accident

al Death & Dismemberment

...$20,000

Accident

al Death & Dismemberment

(Common Carrier

Air Only)

...$100,000

The following non-insurance services

are provided by T

ravel Guard.

Travel Medical

Assist

ance

W

orldwide T

ravel

Assist

ance

LiveT

ravel

®

Emergency Assist

ance

Concierge Services

T30337NUFIC-TG-DOC

008078 P3 9/09

S

tate Notice

This document is not applicable to resident

s of all st

ates. Resident

s

of Florida, Georgia, Indiana, New Hamp

shire, Pennsylvania, Ut

ah,

and W

ashington can obt

ain their st

ate specific document

s by visiting

www

.travelguard.com/fulfillment or by calling 1.866.385.4839.

PLEASE READ THIS

DOCUMENT CAREFULL

Y!

The Policy will cont

ain reductions, limit

ations, exclusions and

termination provisions. Full det

ails of coverage are cont

ained in the

Policy

. If there are any conflict

s between the content

s of this

document and the Policy (form series

T30337NUFIC), the Policy will

govern in all cases. Insurance underwritten by National Union Fire

Insurance Comp

any of Pitt

sburgh, Pa., with it

s princip

al place of

business in New

York, NY

. Coverage may not be available in all

st

ates.

IMPORT

ANT

This coverage is valid only if the appropriate plan cost has been

paid. Please keep this document as

Your record of coverage

(6)

Insured. Owned or Rented V

ehicle includes, but is not limited to, a

sedan, st

ation wagon, jeep-type vehicle pickup, van, camper or

motor home type. Owned or Rented V

ehicle does not include a

mobile home or any motor vehicle which is used in mass or public

transit.

“Physician”

means a licensed practitioner of the healing art

s

including accredited Christian Science Practitioners, medical,

surgical, or dent

al, services acting within the scope of his/her

license.

The treating Physician may not be the Insured, a

Traveling

Comp

anion, a Family Member

, or a Business Partner

.

“Primary Residence”

means a person's fixed, permanent and

princip

al home for legal and t

ax purposes.

“Reasonable Additional

Expenses”

means expenses for meals

and lodging which were necessarily incurred as the result of a

Trip

Delay and which are not provided by the Common Carrier or any

other p

arty free of charge.

“Reasonable and Customary Charges”

means an expense

which:

(1) i

s

charged for treatment, supplies, or medical services

Medically Necessary to treat the Insured’

s condition;

(2)

does not exceed the usual level of charges for similar

treatment, supplies or medical services in the locality where

the expense is incurred; and

(3)

does not include charges that would not have been made if no

insurance existed. In no event will the Reasonable and

Customary Charges exceed the actual amount charged.

“Return Date”

means the date on which the Insured is scheduled

to return to the point where the

Trip st

arted or to a dif

ferent

specified Return Destination.

This date is specified in the travel

document

s.

“Return Destination”

means the place to which the Insured

expect

s to return from his/her

Trip.

“Schedule”

means the Schedule of Benefit

s.

“Sickness”

means an illness or disease diagnosed or treated by

a Physician.

“S

trike”

means a stopp

age of work:

(1)

announced, organized, and sanctioned by a labor union and

(2)

which interferes with the normal dep

arture and arrival of a

Common Carrier

.

This includes work slowdowns and sickout

s.

The Insured’

s

Trip

cancellation coverage must be ef

fective prior to when the S

trike is

foreseeable.

A

S

trike is foreseeable on the date labor union

members vote to approve a S

trike.

“T

ransportation”

means any land, sea or air conveyance required

to transport the Insured during an Emergency Evacuation.

Transport

ation includes, but is not limited to, air ambulances, land

ambulances and private motor vehicles.

“T

ravel Supplier”

means the tour operator

, rent

al comp

any

, cruise

line, and/or airline that provides pre-p

aid travel arrangement

s for

the Insured’

s

Trip.

is, other than incident

ally

, a clinic, a rest home, nursing home,

convalescent home, home health care, or home for the aged; nor

does it include any ward, room, wing, or other section of the

hospit

al that is used for such purposes; or (3) any milit

ary or

veterans hospit

al or soldiers home or any hospit

al contracted for or

operated by any national government or government agency for

the treatment of members or ex-members or the armed forces.

“Inclement W

eather”

means any severe weather condition which

delays the scheduled arrival or dep

arture of a Common Carrier or

prevent

s the Insured from reaching his/her Destination when

traveling by an Owned or Rented V

ehicle.

“Individual Coverage T

erm”

means the period of time beginning

on the date insurance coverage begins and ending on the date

insurance coverage ends as specified in the Ef

fective and

Termination Dates section.

“Injury/Injured”

means a bodily injury caused by an accident

occurring while the Insured’

s coverage under the Policy is in force,

and resulting directly and independently of all other causes of Loss

covered by the Policy

. The injury must be verified by a Physician.

“Insured”

means an Eligible Person for whom: (a) any required

enrollment form has been completed; (b) any required plan cost

has been p

aid; (c) while covered under the Policy

.

“Insurer”

means National Union Fire Insurance Comp

any of

Pitt

sburgh, Pa.

“Loss”

means Injury or damage sust

ained by the Insured as a

consequence of one or more of the event

s against which the

Insurer has undert

aken to compensate the Insured.

“Medically Necessary”

means that a treatment, service, or

supply:

(1)

is essential for diagnosis, treatment, or care of the Injury or

Sickness for which it is prescribed or performed;

(2)

meet

s generally accepted st

andards of medical practice;

(3)

is ordered by a Physician and performed under his or her care,

supervision, or order; and

(4)

is not primarily for the convenience of the Insured, Physician,

other providers, or any other person.

“Mental, Nervous or Psychological Disorder”

means a ment

al

or nervous health condition including, but not limited to: anxiety

,

depression, neurosis, phobia, p

sychosis; or any related physical

manifest

ation.

“Natural Disaster”

means a flood, hurricane, tornado,

earthquake, fire, wildfire, volcanic eruption, or blizzard that is due

to natural causes.

“Necessary Personal Ef

fects”

means items such as clothing and

toiletry items, which were included in the Insured’

s Baggage and

are required for the Insured’

s

Trip.

“Owned or Rented V

ehicle”

means a self-propelled private

passenger motor vehicle with four or more wheels which is of a

type both designed and required to be licensed for use on the

highways of any st

ate or country that is rented or owned by the

“T

raveling Companion”

means a person or persons with whom

the Insured has coordinated travel arrangement

s and intends to

travel with during the

Trip.

A

group or tour leader is not considered

a

Traveling Comp

anion, unless the Insured is sharing room

accommodations with the group or tour leader

.

“T

rip”

means a period of travel away from home to a Destination

out

side the Insured’

s City of residence; the purpose of the

Trip is

business or pleasure and is not to obt

ain health care or treatment

of any kind; the

Trip has defined Dep

arture and Return dates

specified when the Insured applies; travel is primarily by Common

Carrier and only incident

ally by private conveyance.

The

Trip does

not exceed 180 days.

Travel must be more than 100 miles from

the Insured’

s Primary Residence. For annual plans, any

Trip t

aken

during the Individual Coverage

Term.

“T

rip Cost”

means the dollar amount of

Trip p

ayment

s or deposit

s

reflected on any required enrollment form which are subject to

cancellation penalties or restrictions p

aid by the Insured prior to the

Insured’

s

Trip Dep

arture Date.

Trip Cost will also include the cost

of any subsequent pre-p

aid p

ayment

s or deposit

s p

aid by the

Insured for the same

Trip, af

ter enrollment for coverage under this

plan provided the Insured amends their enrollment form to add

such subsequent p

ayment

s or deposit

s and p

ays any required

additional plan cost prior to the Insured’

s Dep

arture Date.

“Unforeseen”

means not anticip

ated or expected and occurring

af

ter the ef

fective date of the coverage.

“Uninhabitable”

means (1) the building structure it

self is unst

able

and there is a risk of collap

se in whole or in p

art; (2) there is

exterior or structural damage allowing element

al intrusion, such as

rain, wind, hail or flood; (3) immediate safety hazards have yet to

be cleared, such as debris on roofs or downed electrical lines; or

(4) the rent

al property is without electricity or water

.

ELIGIBILITY

, EFFECTIVE &

TERMINA

TION DA

TES

Eligibility

Persons eligible for insurance under the policy are: (a)

resident

s of the United S

tates; (b) who have enrolled through

the Council on International Educational Exchange or one of

its appointed institutional or organizational of

fices; (c) who

have or will purchase travel arrangement

s from a travel

supplier or arranger while covered under the policy

.

This

insurance coverage is valid out

side of the 50 United S

tates

and District of Columbia.

Insurance Ef

fective Date:

Insurance elected or provided for an Insured will t

ake ef

fect on

the latest of:

1.

The Policy ef

fective date;

2.

the day af

ter any required plan cost has been p

aid.

4

5

(7)

Coverage Ef

fective Date:

All coverages will begin on the later of:

(a)

12:01 a.m. S

tandard

T

ime on the scheduled Dep

arture

Date shown on the travel document

s or

(b)

the date and time the Insured st

art

s a

T

rip, t

aken during the

Individual Coverage

Term

provided any required plan cost has been p

aid.

Insurance T

ermination Date:

Insurance elected by an Insured will end

o

n

the earliest of (a)

365 days from the date of the Insured’

s Ef

fective Date of

insurance or (b) the date the Insured request

s, in writing, that

his or her insurance be terminated.

Coverage T

ermination Date:

All coverage ends on the earlier

of:

(a)

the scheduled Return Date for a

T

rip;

(b)

the Insured’

s arrival at the Return Destination on a round

T

rip;

(c)

the date the Insured’

s Insurance terminates.

Extension of Coverage:

All coverages will be extended for a

T

rip covered by this plan,

if:

(a)

the Insured's entire

T

rip is covered by the plan; and

This extension of coverage will end on the earlier of:

(a)

the date the Insured reaches his/her Return Destination; or

(b) 7

days af

ter the date a

T

rip was scheduled to be

completed.

Baggage Continuation of Coverage:

If an Insured’

s

Baggage, p

assport

s, and visas are in the charge of a charter or

Common Carrier and delivery is delayed, coverage for

Baggage and Personal Ef

fect

s travel document

s will be

extended until the Common Carrier delivers the property to the

Insured.

This Extension does not include Loss caused by the

delay

.

GENERAL

EXCLUSIONS

This plan does not cover any loss caused by or resulting from:

(a)

intentionally self-inflicted Injury

, suicide, or attempted suicide of

the Insured, Family Member

,

T

raveling Comp

anion or

Business Partner while sane or insane;

(b)

pregnancy

, childbirth, or elective abortion, other than

Complications of Pregnancy;

(c)

particip

ation in professional athletic event

s, motor sport, or

motor racing, including training or practice for the same;

(d)

mount

aineering where ropes or guides are normally used.

The

ascent or descent of a mount

ain requiring the use of

specialized equipment, including but not limited to pick-axes,

anchors, bolt

s, crampons, carabineers, and lead or top-rope

anchoring equipment;

(e)

war or act of war

, whether declared or not, civil disorder

, riot, or

insurrection;

(f)

operating or learning to operate any aircraf

t, as student, pilot, or

crew;

(g)

air travel on any air-supported device, other than a regularly

scheduled airline or air charter comp

any;

(h)

loss or damage caused by detention, confiscation, or

destruction by customs;

(i) any

unlawful act

s, committed by the Insured, a Family

Member

, or a

Traveling Comp

anion, or Business Partner

whether insured or not;

(j)

Ment

al, Nervous or Psychological Disorder in excess of the

Maximum Limit shown in the Schedule;

(k)

if the Insured’

s ticket

s do not cont

ain specific travel dates (open

ticket

s);

(l)

use of drugs, narcotics, or alcohol, unless administered upon

the advice of a Physician;

(m)

any failure of a provider of travel related services (including

any

Travel Supplier) to provide the bargained-for travel

services or to refund money due the Insured;

(n)

Experiment

al or Investigative treatment or procedures;

(o)

any loss that occurs at a time when this coverage is not in

ef

fect;

(p)

traveling for the purpose of securing medical treatment;

(q)

care or treatment which is not Medically Necessary;

(r)

any

Trip t

aken out

side the advice of a Physician;

(s)

financial default;

(t)

PRE-EXISTING MEDICAL

CONDITION EXCLUSION:

The

Insurer will not p

ay for any Loss or expense incurred as the

result of an Injury

, Sickness or other condition of an Insured,

Traveling Comp

anion, Business Partner

, or Family Member

which, within the 90 day period immediately preceding and

including the Insured’

s coverage ef

fective date: (a) first

manifested it

self, worsened or became acute or had symptoms

which would have prompted a reasonable person to seek

diagnosis, care or treatment; (b) for which care or treatment

was given or recommended by a Physician; (c) required t

aking

prescription drugs or medicines, unless the condition for which

the drugs or medicines are t

aken remains controlled without

any change in the required prescription drugs or medicines.

The following exclusions apply to Baggage, T

ravel Document,

and Personal Ef

fects Loss:

Benefit

s will not be provided for any loss or damage to or resulting

(in whole or in p

art) from:

(a)

animals, rodent

s, insect

s or vermin;

(b)

bicycles (except when checked with a Common Carrier);

(c)

motor vehicles, aircraf

t, boat

s, boat motors,

ATV’

s and other

conveyances;

(d)

artificial prosthetic devices, false teeth, any type of eyeglasses,

sunglasses, cont

act lenses, or hearing aids;

(e

)

ticket

s, keys, notes, securities, account

s, bills, currency

,

deeds, food st

amp

s, credit cards or other evidences of debt,

and other travel document

s (except p

assport

s and visas);

(f) money

, st

amp

s, stocks and bonds, post

al or money orders;

(g)

property shipped as freight, or shipped prior to the Dep

arture

Date;

(h) contraband, illegal transport

ation or trade;

(i)

items seized by any government, government of

ficial or customs

of

ficial;

(j)

defective materials or craf

tsmanship;

(k)

normal wear and tear;

(l) deterioration.

The following exclusions apply to the Medical Expense

Benefit:

Benefit

s will not be provided for any loss resulting (in whole or in

part) from:

(a)

routine physical examinations;

(b)

ment

al health care;

(c)

replacement of hearing aids, eye glasses, cont

act lenses and

artificial teeth;

(d)

routine dent

al care;

(e)

any service provided by the Insured, a Family Member

, or

Traveling Comp

anion or

Traveling Comp

anion of Family

Member;

(f)

alcohol or subst

ance abuse or treatment for the same.

The following exclusion applies to

Accidental Death &

Dismemberment:

(a)

the Insurer will not p

ay for Loss caused by or resulting from

Sickness or disease of any kind.

The following exclusions apply to

Accidental Death &

Dismemberment (Common Carrier

Air Only):

(a)

Sickness or disease whether the Loss result

s directly or

indirectly from any of these;

(b)

stroke or cerebrovascular accident or event; cardiovascular

accident or event; myocardial infarction or heart att

ack;

coronary thrombosis; aneurysm.

EXCESS INSURANCE LIMIT

A

TION

The insurance provided by the Policy for all coverages shall be in

excess of all other valid and collectible insurance or indemnity

. If at

the time of the occurrence of any Loss p

ayable under the Policy there

is other valid and collectible insurance or indemnity in place, the

Insurer shall be liable only for the excess of the amount of Loss, over

the amount of such other insurance or indemnity

, and applicable

Deductible.

TRIP

DELA

Y

The Insurer will reimburse the Insured up to the Maximum Limit(s)

shown on the Schedule for Reasonable

Additional Expenses until

travel becomes possible if the Insured’

s

Trip is delayed 12 or more

9

8

(8)

consecutive hours from reaching their intended Destination as a

result of a cancellation or delay of a regularly scheduled airline

flight for one of the Unforeseen event

s listed below:

(a) Common Carrier delay;

(b)

S

trike; or

(c)

Inclement W

eather which prohibit

s Insured’

s dep

arture.

Incurred expenses must be accomp

anied by receipt

s.

This benefit is p

ayable for only one delay per Insured, per

Trip.

If the Insured incurs more than one delay in the same

Trip the

Insurer will p

ay for the delay with the largest benefit up to the

Maximum Limit

s shown on the Schedule.

The Insured Must:

Cont

act

Travel Guard as soon as he/she

knows his/her

Trip is going to be delayed more than 12 hours.

BAGGAGE & PERSONAL

EFFECTS LOSS

The Insurer will reimburse the Insured, up to the Maximum Limit

shown in the Schedule subject to the special limit

ations shown

below

, for Loss, thef

t or damage to the Insured’

s Baggage and

personal ef

fect

s during the Insured’

s

Trip.

Special Limitations:

The Insurer will not p

ay more than:

$750 for the first item and

thereaf

ter

, no more than $250 per each additional item

$500 aggregate on all Losses to: jewelry

, watches, furs,

cameras and camera equipment, camcorders, computers, and

other electronic devices, including but not limited to: port

able

personal computers, cellular phones, electronic organizers

and port

able CD players.

Items over $150 must be accomp

anied by original receipt

s.

The Insurer will p

ay the lesser of:

(1) the cash value (original cash value less depreciation) as

determined by the Insurer or

,

(2) the cost of replacement.

The Insurer may t

ake all or p

art of the damaged Baggage at the

appraised or agreed value. In the event of a Loss to a p

air or set of

items, the Insurer may at it

s option:

(1)

rep

air or replace any p

art to restore the p

air or set to it

s value

before the Loss; or

(2)

pay the dif

ference between the value of the property before

and af

ter the Loss.

TRA

VEL DOCUMENT REPLACEMENT

While the Insured is on a

Trip out

side the United S

tates and his or

her p

assport is lost, stolen or damaged, the Insurer will reimburse

the cost

s up to the Lost, S

tolen Passport Replacement Maximum

Limit shown in the Schedule.

The Loss, thef

t or damage must be

documented by a police report.

BAGGAGE DELA

Y

If the Insured’

s Baggage is delayed or misdirected by the Common

Carrier for more than 24 hours while on a

Trip, the Insurer will

reimburse the Insured up to the Maximum Limit shown on the

Schedule for the purchase of Necessary Personal Ef

fect

s. Incurred

expenses must be accomp

anied by receipt

s.

This benefit does not

apply if Baggage is delayed af

ter the Insured has reached his/her

Return Destination.

MEDICAL

EXPENSE BENEFIT

The Insurer will reimburse the Insured up to the Maximum Limit(s)

shown on the Schedule if, while on a

Trip, an Insured suf

fers an

Injury or a Sickness that requires him or her to be treated by a

Physician during the course of the

Trip.

The Sickness or Injury

must first manifest it

self during the course of the

Trip.

The Insurer

will p

ay the Reasonable and Customary Charges incurred for

Medically Necessary Covered Expenses received due to that Injury

or Sickness incurred by the Insured within one year from the date

of Injury or Sickness provided initial treatment was received during

the

Trip.

The Injury must occur or Sickness must begin while the

Insured is covered by the plan.

Covered Expenses:

The Insurer will p

ay for:

services of a Physician or Registered Nurse (R.N.);

Hospit

al charges;

X-ray(s);

local ambulance services to or from a Hospit

al;

artificial limbs, artificial eyes, artificial teeth, or other prosthetic

devices;

the cost of emergency dent

al treatment only during a

Trip

limited to a Maximum Limit shown in the Schedule. Coverage

for emergency dent

al treatment does not apply if treatment or

expenses are incurred af

ter the Insured has reached his/her

Return Destination, regardless of the reason.

The treatment

must be given by a Physician or dentist;

Advance Payment:

If an Insured requires admission to a Hospit

al,

Tr

avel Guard will arrange advance p

ayment, if required. Hospit

al

confinement must be certified as Medically Necessary by the

attending Physician.

EMERGENCY

EV

ACUA

TION

& REP

A

TRIA

TION OF REMAINS

The Insurer will p

ay for Covered Emergency Evacuation Expenses

incurred if an Insured suf

fers an Injury or Sickness while he or she

is on a

Trip that warrant

s his or her Emergency Evacuation.

Benefit

s p

ayable are subject to the Maximum Limit shown on the

Schedule for all Emergency Evacuations due to all Injuries from the

same accident or all Sicknesses from the same or related causes.

Covered Emergency Evacuation Expenses

are the Reasonable

and Customary Charges for necessary

Transport

ation, related

medical services and medical supplies incurred in connection with

the Emergency Evacuation of the Insured.

All

Transport

ation

arrangement

s made for evacuating the Insured must be by the

most direct and economical route possible. Expenses for

Transport

ation must be:

(a)

ordered by the attending Physician who must certify that the

severity of the Insured’

s Injury or Sickness warrant

s his or her

Emergency Evacuation and adequate medical treatment is not

locally available;

(b)

required by the st

andard regulations of the conveyance

transporting the Insured; and

(c

)

authorized in advance by

Travel Guard. In the event the

Insured’

s Injury or Sickness prevent

s prior authorization of the

Emergency Evacuation,

Travel Guard (1.866.385.4839 or collect

1.715.295.5452) must be notified as soon as reasonably

possible.

Special Limitation:

In the event

Travel Guard could not be

cont

acted to arrange for emergency

Transport

ation, benefit

s are

limited to the amount the Insurer would have p

aid had the Insurer

or their authorized represent

ative been cont

acted.

The Insurer will also p

ay a benefit for Reasonable and Customary

Charges incurred for an escort’

s transport

ation and

accommodations if an attending Physician recommends in writing

that an escort accomp

any the Insured.

Emergency Evacuation means:

(a)

the Insured's medical condition warrant

s immediate

Transport

ation from the place where the Insured is injured or

sick to the nearest adequate

licensed medical

facility where

appropriate medical treatment can be obt

ained;

(b)

af

ter being treated at a local licensed medical facility

, the

Insured's medical condition warrant

s transport

ation to the

Insured’

s home, or adequate licensed medical facility nearest

the Insured’

s home to obt

ain further medical treatment or to

recover; or

(c)

both (a) and (b) above.

LIMIT

A

TIONS:

1)

Benefit

s are only available under Emergency Evacuation if

they are not provided under another coverage in the plan.

2)

The Maximum Limit p

ayable for both Emergency Evacuation

and Rep

atriation of Remains is shown in the Schedule.

ADDITIONAL

BENEFIT

In addition to the above covered expenses, if the Insurer has

previously evacuated an Insured to a medical facility

, the Insurer

will p

ay his/her airfare cost

s from that facility to the Insured’

s

Return Destination, within one year from the Insured’

s original

10

11

(9)

P

A

YMENT OF CLAIMS

Claim Procedures: Notice of Claim:

The Insured must call

Travel

Guard as soon as reasonably possible, and be prep

ared to

describe the Loss, the name of the comp

any that arranged the

Trip

(i.e., tour operator

, cruise line, or charter operator), the

Trip dates,

and the amount that the Insured p

aid.

Travel Guard will fill in the

claim form and forward it to the Insured for his or her review and

signature.

The completed form should be returned to

Travel Guard,

PO Box 47, S

tevens Point, Wisconsin 54481 (telephone

1.866.385.4839).

All claims of California resident

s will be

administered by Mercury Claims

Administrator Services, LLC.

All

accident, health, and life claims will be administered by Mercury

Claims &

Assist

ance of WI, LLC, in those st

ates where it is

licensed.

Claim Procedures: Proof of Loss:

The claim forms must be sent

back to Insurer no more than 90 days af

ter a covered Loss occurs

or ends, or as soon af

ter that as is reasonably possible.

All claims

under the policy must be submitted to

Travel Guard no later than

one year af

ter the date of Loss or insured occurrence or as soon

as reasonably possible. If Insurer has not provided claim forms

within 15 days af

ter the notice of claim, other proofs of Loss should

be sent to

Travel Guard by the date claim forms would be due.

The

proof of Loss should include written proof of the occurrence, type

and amount of Loss, the Insured’

s name, the p

articip

ating

organization name, and the policy number

.

Payment of Claims: When Paid:

Claims will be p

aid as soon as

Travel Guard receives complete proof of Loss and verification of

age.

Payment of Claims: T

o

Whom Paid:

Benefit

s are p

ayable to the Insured who applied for coverage and

paid any required plan cost.

Any benefit

s p

ayable due to that

Insured’

s death, will be p

aid to the survivors of the first surviving

class of those that follow:

(1)

the Beneficiary named by that Insured and on file with

Travel

Guard

(2)

to his/her spouse, if living. If no living spouse, then

(3)

in equal shares to his/her living children. If there are none, then

(4)

in equal shares to his/her living p

arent

s. If there are none, then

(5)

in equal shares to his/her living brothers and sisters. If there

are none, then

(6)

to the Insured’

s est

ate.

If a benefit is p

ayable to a minor or other person who is incap

able

of giving a valid release, the Insurer may p

ay up to $3,000 to a

relative by blood or connection by marriage who has assumed care

or custody of the minor or responsibility for the incompetent

person’

s af

fairs.

Any p

ayment Insurer makes in good faith fully

discharges Insurer to the extent of that p

ayment.

Return Date, less refunds from the Insured’

s unused transport

ation

ticket

s.

Airfare cost

s will be economy

, or same class as the

Insured’

s original ticket

s.

REP

A

TRIA

TION OF REMAINS

The Insurer will p

ay Rep

atriation Covered Expenses up to the

Maximum Limit shown on the Schedule to return the Insured's

body to city of burial if he/she dies during the

Trip.

Repatriation Covered Expenses

include, but are limited to, the

reasonable and customary expenses for transport

ation, according

to airline t

arif

fs, of the remains by the most direct and economical

conveyance and route possible.

Travel Guard must make all arrangement

s and authorize all

expenses in advance for this benefit to be p

ayable.

Special Limitation:

In the event the Insurer or the Insurer

’s

authorized represent

ative could not be cont

acted to arrange for

Rep

atriation Covered Expenses, benefit

s are limited to the amount

the Insurer would have p

aid had the Insurer or their authorized

represent

ation been cont

acted.

ACCIDENT

AL

DEA

TH & DISMEMBERMENT

If, while on a

Trip, Injury to an Insured result

s within 180 days of the

date of the accident which caused Injury

, in one of the losses

shown in the

Table of Losses below

, the Insurer will p

ay the

percent

age shown below of the Maximum Limit shown in the

Schedule.

The accident must occur while the Insured is on the

Trip

and is covered under the Policy

.

If more than one Loss is sust

ained by an Insured as a result of the

same accident, only one amount, the largest applicable to the

Losses incurred, will be p

aid.

The Insurer will not p

ay more than

100% of the Maximum Limit for all Losses due to the same

accident.

Table of Losses

Loss of

% of Maximum Limit

Life

...100%

Both Hands or Both Feet

...100%

Sight of Both Eyes

...100%

One Hand and One Foot

...100%

Either Hand or Foot and Sight of One Eye

...100%

Either Hand or Foot

...50%

Sight of One Eye

...50%

"Loss"

with regard to:

(a)

hand or foot means actual severance through or above the

wrist or ankle joint

s;

(b)

eye means entire and irrecoverable Loss of sight in that eye.

EXPOSURE

The Insurer will p

ay a benefit for covered Losses as specified

above which result from an Insured being unavoidably exposed to

the element

s due to an accident

al Injury during the

Trip.

The Loss

must occur within 180 days af

ter the event which caused the

exposure.

DISAPPEARANCE

The Insurer will p

ay a benefit for loss of life as specified above if

the Insured’

s body cannot be located one year af

ter disappearance

due to an accident

al Injury during the

Trip.

ACCIDENT

AL

DEA

TH & DISMEMBERMENT

(COMMON CARRIER ONL

Y)

The Insurer will p

ay this benefit if the Insured is Injured while riding

as a p

assenger in or boarding or alighting from or struck or run

down by a certified p

assenger aircraf

t provided by a regularly

scheduled airline or charter and operated by a properly certified

pilot.

The Insurer will p

ay up to the Maximum Limit shown in the

Schedule for which premium has been p

aid for Loss of life, both

hands or feet, sight of both eyes, or Loss of one hand or foot and

the sight of one eye when such double losses are the result of the

same accident. One-half of the benefit is p

ayable for the Loss of

one hand or foot or the sight of one eye. If the Insured suf

fers more

than one Loss from an accident, the Insurer will p

ay only for the

Loss with the larger benefit. Loss of hand or foot means complete

severance at or above the wrist or ankle joint.

The Insurer will not

pay more than 100% of the Maximum Limit for all losses due to the

same accident. Loss of sight of an eye means complete and

irrecoverable Loss of sight.

Loss must occur within 365 days of the accident.

If an Insured suf

fers one or more losses from the same accident for

which amount

s are p

ayable under both

AD&D benefit

s shown

above, the Maximum Limit p

ayable under that benefit combination

will not exceed the applicable Combined Maximum Limit shown on

the Schedule.

EXPOSURE

The Insurer will p

ay a benefit for covered losses as specified above

which result from an Insured being unavoidably exposed to the

element

s due to an aAccident

al Injury during the

Trip.

The Loss

must occur within 365 days af

ter the event which caused the

exposure.

DISAPPEARANCE

The Insurer will p

ay a benefit for loss of life as specified above if an

Insured’

s body cannot be located one year af

ter disappearance

due to an

Aaccident

al Injury during the

Trip.

13

14

(10)

V

aluation.

The Insurer will not p

ay more than the

Actual Cash

V

alue of the property at the time of Loss.

At no time will p

ayment

exceed what it would cost to rep

air or replace the property with

material of like kind and quality

.

Disagreement Over Size of Loss.

If there is a disagreement

about the amount of the Loss either the Insured or the Insurer can

make a written demand for an appraisal.

Af

ter the demand, the

Insured and the Insurer each select their own competent appraiser

.

Af

ter examining the fact

s, each of the two appraisers will give an

opinion on the amount of the Loss. If they do not agree, they will

select an arbitrator

.

Any figure agreed to by 2 of the 3 (the

appraisers and the arbitrator) will be binding.

The appraiser

selected by the Insured is p

aid by the Insured.

The Insurer will p

ay

the appraiser it chooses.

The Insured will share with us the cost

for the arbitrator and the appraisal process.

Benefit to Bailee.

This insurance will in no way inure directly or

indirectly to the benefit of any carrier or other bailee.

The following provision applies to Medical Expense, Baggage,

T

ravel Document, and Personal Ef

fects Loss, Emergency

Evacuation, and Repatriation of Remains,

Accidental Death &

Dismemberment and

Accidental Death &

Dismemberment

(Common Carrier

Air

Only):

Subrogation.

To

the extent the Insurer p

ays for a Loss suf

fered

by an Insured, the Insurer will t

ake over the right

s and remedies the

Insured had relating to the Loss.

This is known as subrogation.

The Insured must help the Insurer preserve it

s right

s against those

responsible for it

s Loss.

This may involve signing any p

apers and

taking any other step

s the Insurer may reasonably require. If the

Insurer t

akes over an Insured's right

s, the Insured must sign an

appropriate subrogation form supplied by the Insurer

.

As a condition to receiving the applicable benefit

s listed above, as

they pert

ain to this Subrogation provision, the Insured agrees,

except as may be limited or prohibited by applicable law

, to

reimburse the Insurer for any such benefit

s p

aid to or on behalf of

the Insured, if such benefit

s are recovered, in any form, from any

Third Party or Coverage.

Coverage –

as used in this Subrogation section, means no fault

motorist coverage, uninsured motorist coverage, underinsured

motorist coverage, or any other fund or insurance policy (except

coverage provided under the Policy to which this Description of

Coverage is att

ached) and any fund or insurance policy providing

the Policyholder with coverage for any claims, causes of action or

right

s the Insured may have against the Policyholder

.

Third Party –

as used in this Subrogation section, means any

person, corporation or other entity (except the Insured, the

Policyholder and the Insurer).

GENERAL

PROVISIONS

Physical Examination and

Autopsy

.

The Insurer at it

s own

expense has the right and opportunity to examine the person of

Benefit

s for Medical Expense/Emergency Evacuation services

may be p

ayable directly to the provider of the services. However

,

the provider: (a) must comply with the st

atutory provision for direct

payment, and (b) must not have been p

aid from any other sources.

Baggage and Personal Ef

fects Loss Payment of Loss:

The

Insured Must: (a) report thef

t Losses to police or other local

authorities as soon as possible; (b) t

ake reasonable step

s to

protect his/her Baggage from further damage and make necessary

and reasonable temporary rep

airs; (The Insurer will reimburse the

Insured for those expenses.

The Insurer will not p

ay for further

damage if the Insured fails to protect his/her Baggage); (c) allow

the Insurer to examine the damaged Baggage and/or the Insurer

may require the damaged item to be sent in the event of p

ayment;

or (d) send sworn proof of Loss as soon as possible from date of

Loss, providing amount of Loss, date, time, and cause of Loss, and

a complete list of damaged/lost items.

Baggage Delay Payment of Loss:

The Insured must provide

document

ation of the delay or misdirection of Baggage by the

Common Carrier and receipt

s for the Necessary Personal Ef

fect

s

purchases.

Medical Expense Payment of Loss:

The Insured must provide

Travel Guard with: (a) all medical bills and report

s for medical

expenses claimed; and (b) a signed p

atient authorization to release

medical information to

Travel Guard.

The following provisions apply to Baggage Delay and

Baggage, T

ravel Document, and Personal Ef

fects Loss:

Notice of Loss.

If the Insured's property covered under the Policy

is lost or damaged, the Insured must:

(a)

notify

Travel Guard as soon as possible;

(b)

take immediate step

s to protect, save and/or recover the

covered property;

(c)

give immediate notice to the carrier or bailee who is or may be

liable for the loss or damage;

(d)

notify the police or other authority in the case of robbery or thef

t

within 24 hours.

Proof of Loss.

The Insured must furnish the Insurer with proof of

Loss. Proof of Loss includes police or other local authority report

s

or document

ation from the appropriate p

arty responsible for the

Loss. It must be filed within 90 days from the date of Loss. Failure

to comply with these conditions shall not invalidate any claims

under the Policy

.

Settlement of Loss.

Claims for damage and/or destruction shall

be p

aid immediately af

ter proof of the damage and/or destruction

is presented to the Insurer

. Claims for lost property will be p

aid

af

ter the lap

se of a reasonable time if the property has not been

recovered.

The Insured must present accept

able proof of Loss and

the value.

any individual whose Loss is the basis of claim under the Policy

when and as of

ten as it may reasonably require during the

pendency of the claim and to make an autop

sy in case of death

where it is not forbidden by law

.

Beneficiary Designation and Change.

The Insured’

s

beneficiary(ies) is (are) the person(s) designated by the Insured

and on file with

Travel Guard.

An Insured over the age of majority and legally competent may

change his or her beneficiary designation at any time, unless an

irrevocable designation has been made, without the consent of the

designated beneficiary(ies), by providing

Travel Guard with a

written request for change. When the request is received, whether

the Insured is then living or not, the change of beneficiary will relate

back to and t

ake ef

fect as of the date of execution of the written

request, but without prejudice to the Insurer on account of any

payment made by it prior to receipt of the request.

Assignment.

An Insured may not assign any of his or her right

s,

privileges or benefit

s under the Policy

.

Misst

atement of

Age.

If premiums for the Insured are based on

age and the Insured has misst

ated his or her age, there will be a

fair adjustment of premiums based on his or her true age. If the

benefit

s for which the Insured is insured are based on age and the

Insured has misst

ated his or her age, there will be an adjustment

of said benefit based on his or her true age.

The Insurer may

require satisfactory proof of age before p

aying any claim.

Legal Actions.

No action at law or in equity may be brought to

recover on the Policy prior to the expiration of 60 days af

ter written

proof of Loss has been furnished in accordance with the

requirement

s of the Policy

. No such action may be brought af

ter

the expiration of 3 years af

ter the time written proof of Loss is

required to be furnished.

Concealment or Fraud:

The Insurer does not provide coverage if

the Insured has intentionally concealed or misrepresented any

material fact or circumst

ance relating to the policy or claim.

Payment of Premium:

Coverage is not ef

fective unless all premium

due has been p

aid to

Tr

avel Guard prior to a date of Loss or insured

occurrence.

Termination of the Policy:

Termination of the policy will not af

fect

a claim for Loss which occurs while the policy is in force.

Transfer of Coverage:

Coverage under the policy cannot be

transferred by the Insured to anyone else.

ST

A

TE SPECIFIC NOTICES

Notice to Colorado Residents:

T30341NUFIC-CO

The phrase “or insane” is deleted from the intentionally self-inflicted

Injury

, suicide or attempted suicide exclusion when it applies to

Medical Expense Benefit and Emergency Evacuation.

16

17

References

Related documents

The information you have supplied on this form and subsequent information and documentation provided in relation to this claim will be used in. the administration of your

I authorize any person or organizati on who has relevant informati on pertaining to this claim, including any medical practi ti oner, health care provider or insti tuti on,

- that in case of medical treatment, hospitalisation and or repatriation, he/she will – insofar necessary - offer the medical adviser(s) of SOS International permission to give

medical practitioner to see the report. It will not be sent to you automatically). The medical practitioner will be informed that you wish to have access to the report and will allow

Note : Please submit all relevant documents such as traveling schedule airticket, police report, property report, photos, purchase invoice, repair or replacement quotation

 If a claim is submitted on behalf of a deceased insured, We will require certified copies of the death certificate. If the insured passed away due to illness rather than as a

When you give Lloyd's and its agents personal information about other individuals, we rely on you to have made or make them aware that you will or may provide their

If these expenses were incurred as a result of Injury or Sickness to any other person, please give details of cause, name, address, age of person and relationship to you. Name