Preferred Benefits
IMPORTANT
The Pre-Existing Condition Exclusion is waived
provided you meet the following requirements: 1) premium for this coverage
is received within 15 days of the initial deposit/payment for your Trip
and 2) you are not disabled from travel at the time you pay your premium. Please
note: This policy may not be purchased
after you have made final payment for your Trip. Exception: If
you make only one payment in full for your Trip, your premium must
be received no later than 15 days after your Trip payment.
Part A - Schedule
| Benefit | Maximum Benefit
Amount |
Pre-Departure Trip
Cancellation
|
Amount Purchased * |
| Post-Departure Trip Interruption | Amount Purchased * |
Part B - Schedule
| Benefit | Maximum
Benefit Amount |
Medical Expense/Emergency Assistance |
|
| Accident & Sickness Medical Expense | $50,000 |
| Emergency Evacuation and Repatriation | $100,000 |
Travel Delay (Up to $100 Per
Day)
|
$500 |
| Baggage and Personal Effects | $1,000 |
| Baggage Delay |
$100 |
Accidental Death
and Dismemberment |
$25,000 |
* The maximum amount payable for Pre-Departure
Trip Cancellation or Post-Departure Trip Interruption will be the lesser
of the amount of coverage purchased or the Trip cost.
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 or Canada.
When Coverage Begins
The Pre-Departure Trip Cancellation Benefit is
effective on the earlier of:
1) at 12:01 A.M. Standard Time on the day after the date the premium is received; or
2) if mailed, at 12:01 A.M. Standard Time on the day after the postmark date.
Post-Departure Trip Interruption coverage will take effect on the Scheduled Departure Date. All coverages (except Pre-Departure Trip Cancellation and Post-Departure Trip Interruption) 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.
When Coverage Ends
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.
Termination of the policy will not affect a claim for loss that occurs
after premium has been paid.
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 seven (7) days after the Scheduled Return
Date.
Please
see the Definitions for an explanation of Pre-Existing
Conditions which are excluded under the Pre-Departure Trip Cancellation,
Post-Departure Trip Interruption, Travel Delay and Medical Expense/Emergency
Assistance Benefits. (Unless this exclusion is waived, see
Waiver of the Pre-Existing Condition Exclusion for details) |
Part A - Summary of Coverages
Pre-Departure Trip Cancellation
We will pay a Pre-Departure Trip Cancellation Benefit, up to the amount in the Schedule, if you are prevented from taking your Trip due to your, an Immediate Family Member’s, Traveling Companion’s, or Business Partner’s Sickness, Injury, or death, that occurs before departure on your Trip. The Sickness or Injury must: a) commence while your coverage is in effect under the policy; b) require the examination and treatment by a Physician at the time the Trip is canceled; and c) in the written opinion of the treating Physician, be so disabling as to prevent you from taking your Trip. We will pay a benefit if you are prevented from taking your Trip due to Other Covered Events, as defined, that occur before departure on your Trip.
Pre-Departure Trip Cancellation Benefits: We will reimburse you, up to the amount in the Schedule for the amount of prepaid, forfeited, non-refundable Payments or Deposits that you paid for your Trip. We will pay your additional cost as a result of a change in the per person occupancy rate for prepaid travel arrangements if a Traveling Companion’s Trip is canceled and your Trip is not canceled.
Post-Departure Trip Interruption
We will pay a Post-Departure Trip Interruption Benefit, up to the amount in the Schedule, if: 1) your arrival on your Trip is delayed beyond the Scheduled Departure Date or 2) you are unable to continue on your Trip after you have departed on your Trip due to your, an Immediate Family Member’s, Traveling Companion’s, or Business Partner’s Sickness, Injury, or death.
For item 1) above, the Sickness or Injury must: a) commence while your coverage is in effect under the policy; b) for item 2) above, commence while you are on your Trip and your coverage is in effect under the policy; and c) for both items 1) and 2) above, require the examination and treatment by a Physician at the time the Trip is interrupted or delayed; and d) in the written opinion of the treating Physician, be so disabling as to delay your arrival on your Trip or to prevent you from continuing your Trip.
We will pay a benefit if: 1) your arrival on your Trip is delayed beyond the Scheduled Departure Date or 2) you are unable to continue on your Trip after you have departed on your Trip due to Other Covered Events, as defined.
Post-Departure Trip Interruption Benefits: We will reimburse you, less any refund paid or payable, for unused land or water travel arrangements, plus one of the following:
(1) the additional transportation expenses by the most direct route from the point you interrupted your Trip: a) to the next scheduled destination where you can catch up to your Trip; or b) to the final destination of your Trip; or
(2) the additional transportation expenses incurred by you by the most direct route to reach your original Trip destination if you are delayed and leave after the Scheduled Departure Date.
However, the benefit payable under (1) and (2) above will not exceed the cost of a one-way economy air fare (or first class, if the original tickets were first class) by the most direct route less any refunds paid or payable for your unused original tickets.
(3) your additional cost as a result of a change in the per person occupancy rate for prepaid travel arrangements if a Traveling Companion’s Trip is interrupted and your Trip is continued.
Part B - 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:
1) Covered Expenses will only be payable at the Usual and Customary
level of payment;
2) 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;
3) 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 Covered
Expenses which exceed the amount of benefits payable for such expenses
under your Other Valid and Collectible Group Insurance provisions.
Covered
Expenses:
(1) 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
during a Trip;
(2) expenses for emergency dental treatment incurred by you during a
Trip;
(3) 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;
(4) 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;
(5) expenses for transportation not to exceed the cost of one round-trip
economy class air fare to the place of hospitalization for one person
chosen by you, provided that you are traveling alone and are hospitalized
for more than 7 days;
(6) expenses for transportation not to exceed the cost of one-way economy
class air fare to your place of residence in the United States of America
or Canada, including escort expenses, if you are 18 years of age or younger
and left unattended due to the death or hospitalization of an accompanying
adult(s), subject to the Program Medical Advisors’ prior approval;
(7) expenses for one-way economy class air fare (or first class, if your
original tickets were first class) to your place of residence in the
United States of America or Canada, from a medical facility to which
you were previously evacuated, less any refunds paid or payable from
your unused transportation tickets, if these expenses are not covered
elsewhere in the policy;
(8) 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.
If your Trip is delayed for 12 hours or more, we will reimburse you, up to the amount shown in the Schedule for reasonable additional expenses incurred by you for hotel accommodations, meals, telephone calls and local transportation while you are delayed. We will not pay benefits for expenses incurred after travel becomes possible.
Travel Delay must be caused by or result from: 1) Common Carrier delay; or 2) loss or theft of your passport(s), travel documents or money; or 3) quarantine; or 4) hijacking; or 5) natural disaster or closure of public roadways by government authorities due to adverse weather; or 6) Injury or Sickness of you, an Immediate Family Member traveling with you, or a Traveling Companion; or 7) death of you, an Immediate Family Member traveling with you, or a Traveling Companion.
Baggage and Personal Effects
We will reimburse you, less any amount paid or payable from any other valid and collectible insurance or indemnity, up to the amount shown in the Schedule, for direct loss, theft, damage or destruction of your Baggage, passports or visas during your Trip. We will also pay for loss due to unauthorized use of your credit cards, if you have complied with all of the credit card conditions imposed by the credit card companies.
Valuation and Payment of Loss: Payment of loss under the Baggage and Personal Effects Benefit will be calculated based upon an Actual Cash Value basis. For items without receipts, payment of loss will be calculated based upon 75% of the Actual Cash Value at the time of loss. At our option, we may elect to repair or replace your Baggage. We will notify you within 30 days after we receive your proof of loss. We may take all or part of a damaged Baggage as a condition for payment of loss. In the event of a loss to a pair or set of items, we will: 1) repair or replace any part to restore the pair or set to its value before the loss; or 2) pay the difference between the value of the property before and after the loss.
Items Subject to Special Limitations: We will not pay more than $500 (or the Baggage and Personal Effects limit, if less) on all losses to jewelry; watches; precious or semi-precious gems; decorative or personal articles consisting in whole or in part of silver, gold, or platinum; cameras, camera equipment; digital or electronic equipment and media; and articles consisting in whole or in part of fur. Items not included above are subject to a $250 per item limit.
Items Not Covered: We will not pay for damage to or loss of: 1) animals; 2) property used in trade, business or for the production of income, household furniture, musical instruments, brittle or fragile articles, or sporting equipment if the loss results from the use thereof; 3) boats, motors, motorcycles, motor vehicles, aircraft, and other conveyances or equipment, or parts for such conveyances; 4) artificial limbs or other prosthetic devices, artificial teeth, dental bridges, dentures, dental braces, retainers or other orthodontic devices, hearing aids, any type of eyeglasses, sunglasses or contact lenses; 5) documents or tickets, except for administrative fees required to reissue tickets; 6) money, stamps, stocks and bonds, postal or money orders, securities, accounts, bills, deeds, food stamps or credit cards, except as noted above; 7) property shipped as freight or shipped prior to the Scheduled Departure Date; 8) contraband.
Losses Not Covered: We will not pay for loss arising from: 1) defective materials or craftsmanship; or 2) normal wear and tear, gradual deterioration, inherent vice; or 3) rodents, animals, insects or vermin; or 4) theft or pilferage from an unattended vehicle; or 5) mysterious disappearance; or 6) electrical current, including electric arcing that damages or destroys electrical devices or appliances.
Notice to Florida Residents: Your homeowners policy, if any, may provide coverage for loss of personal effects. You are not required to purchase baggage insurance in connection with purchase of tickets or with the lease or rental of a motor vehicle.
Baggage Delay
We will reimburse you, less any amount paid or payable from any other
valid and collectible insurance or indemnity, up to the amount shown
in the Schedule for the cost of reasonable additional clothing and personal
articles purchased by you, if your Baggage is delayed for 24 hours or
more during your Trip. We will also reimburse you up to $25 for expenses
incurred during your Trip to expedite the return of your delayed Baggage.
This coverage terminates upon your arrival at the return destination
of your Trip.
Accidental
Death and Dismemberment
We will pay this benefit up to the amount on the Schedule if you are
injured in an Accident which occurs while you are on a Trip and covered
under the policy, and you suffer one of the losses listed below within
365 days of the Accident.
The Principal Sum is the benefit amount shown on the Schedule.
|
|||
Life
|
100% |
||
Both Hands; Both Feet or Sight
of Both Eyes
|
100% |
||
| One Hand and One Foot | 100% |
||
| One Hand and Sight of One Eye | 100% |
||
One Foot and Sight of One Eye
|
100% |
||
One Hand; One Foot or Sight of
One Eye
|
50% |
||
If you suffer more than one loss from one Accident, we will pay only for the loss with the larger benefit. Loss of a hand or foot means complete severance at or above the wrist or ankle joint. Loss of sight of an eye means complete and irrecoverable loss of sight.
Definitions
In this Policy, “you”, “your” and “yours”
refer to the Insured. “We”, “us” and “our”
refer to the company providing this insurance. In addition certain words
and phrases are defined as follows:
“Actual Cash Value” means current
replacement cost for items of like kind and quality less depreciation.
“Air Carrier” means any air
conveyance operated under a license for the transportation of passengers
for hire.
“Baggage” means luggage, personal possessions and travel
documents taken by you on the Trip.
“Business Partner” means an
individual who is involved, as a partner, with you in a legal general
partnership and shares in the management of the business.
“Common Carrier” means any land,
water or air conveyance operated under a license for the transportation
of passengers for hire, not including taxicabs or rented, leased or privately
owned motor vehicles.
“Domestic Partner” means a person
who is at least eighteen years of age and you can show: 1) evidence of
financial interdependence, such as joint bank accounts or credit cards,
jointly owned property, and mutual life insurance or pension beneficiary
designations; 2) evidence of cohabitation for at least the previous 6
months; and 3) an affidavit of domestic partnership if recognized by the
jurisdiction within which they reside.
“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.
“Financial Insolvency”
means the total cessation of operations due to insolvency, with or without
the filing of a bankruptcy petition, or the total cessation of operations
following the filing of a bankruptcy petition, by a tour operator, cruise
line or airline, other than the person, organization, agency or firm from
whom you directly purchased or paid for your Trip provided the Financial
Insolvency occurs more than 15 days following your effective date for
the Trip Cancellation Benefits.
“Home” means your primary or
secondary residence.
“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 hospital’s 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 Companion’s spouse, child, spouse’s
child, son-daughter-in-law, parent(s), sibling(s), grandparent(s), grandchild,
step brother-sister, step-parent(s), parent(s)-in-law, 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 Covered Events” means only
the following unforeseeable events or their consequences which occur while
coverage is in effect under this Policy:
1. Air Carrier delays resulting from organized labor strikes that affect
public transportation;
2. arrangements canceled by an airline, cruise line, or tour operator,
resulting from inclement weather or organized labor strikes that affect
public transportation;
3. arrangements canceled by an airline, cruise line,
or tour operator, resulting from Financial Insolvency.
Item #3 above is subject to your premium being
received within 15 days of the initial deposit/payment for your Trip.
4. a change in plans by you, an Immediate Family Member traveling with
you, or Traveling Companion resulting from one of the following events
which occurs while coverage is in effect under this Policy: a) being directly
involved in a documented traffic accident while en route to departure;
b) being hijacked, quarantined, required to serve on a jury, or required
by a court order to appear as a witness in a legal action, provided you,
an Immediate Family Member traveling with you or a Traveling Companion
is not 1) a party to the legal action, or 2) appearing as a law enforcement
officer; c) your Home is made uninhabitable by fire, flood, volcano, earthquake,
hurricane or other natural disaster; d) being called into active military
service to provide aid or relief in the event of a natural disaster; e)
a documented theft of passports or visas; f) a transfer of employment
of 250 miles or more;g)
a Terrorist Act which occurs in your departure city
or in a city which is a scheduled destination for your Trip provided:
1) the Terrorist Act occurs within 30 days of the Scheduled Departure
Date for your Trip; and 2) your premium is received within 15 days of
the initial deposit/payment for your Trip.
“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 or local 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.
“Payments or Deposits” means the cash, check, or credit
card amounts actually paid for your Trip. Payments made in the form of
a certificate, voucher or discount are not Payments or Deposits as defined
herein.
“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 or 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
ON CALL INTERNATIONAL.
“Scheduled Departure Date” means
the date on which you are originally scheduled to leave on your Trip.
“Scheduled Return Date” means the date on which you
are originally scheduled to return to the point where the Trip started
or to a different final destination.
“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.
“Terrorist Act” means
an act of violence, other than civil disorder or riot, (that is not an
act of war, declared or undeclared) that results in loss of life or major
damage to property, by any person acting on behalf of or in connection
with any organization which is generally recognized as having the intent
to overthrow or influence the control of any government.
“Traveling Companion” means a person whose name appears
with yours on the same Trip arrangement and who, during the Trip, will
share accommodations with you in the same room, cabin, condominium unit,
apartment unit, or other lodging.
“Trip” means
a scheduled trip for which coverage has been elected and the premium paid,
and all travel arrangements are arranged 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.
The following exclusion applies to the Accidental Death and Dismemberment
coverage:
1. We will not pay for loss caused by or resulting from Sickness of any
kind.
The following exclusion applies to the Medical Expense/Emergency Assistance,
Pre-Departure Trip Cancellation, Post-Departure Trip Interruption, and Travel
Delay coverages:
2. We will not pay for loss or expense caused
by or incurred resulting from a Pre-Existing Condition, as defined in the
policy, including death that results therefrom. This Exclusion does not
apply to benefits under covered expenses item #3 (emergency medical evacuation)
or item #8 (repatriation of remains) of the Medical Expense/Emergency Assistance
Benefits coverage.
The following exclusion applies
to all coverages:
3. We will not pay for any loss under the policy, caused by, or resulting
from: a) 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); b) mental, nervous, or psychological disorders; c) being under the influence
of drugs or intoxicants, unless prescribed by a Physician; d) normal pregnancy
or resulting childbirth or elective abortion; e) participation as a professional
in athletics; f) participation in organized amateur and interscholastic
athletic or sports competition or events; g) riding or driving in any motor
competition; h) declared or undeclared war, or any act of war; i) civil
disorder; j) service in the armed forces of any country; k) nuclear reaction,
radiation or radioactive contamination; l) operating or learning to operate
any aircraft, as pilot or crew; m) 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; n) any unlawful acts, committed by you or a Traveling Companion
(whether insured or not); o) any amount paid or payable under any Worker’s
Compensation, Disability Benefit or similar law; p) a loss or damage caused
by detention, confiscation or destruction by customs; q) Elective Treatment
and Procedures; r) medical treatment during or arising from a Trip undertaken
for the purpose or intent of securing medical treatment; s) business, contractual
or educational obligations of you, an Immediate Family Member, Business
Partner, or Traveling Companion; t) Financial Insolvency of the person,
organization or firm from whom you directly purchased or paid for your
Trip, Financial Insolvency which occurred before your effective date for
the Trip Cancellation Benefits, or Financial Insolvency which occurs within
15 days following your effective date for the Trip Cancellation Benefits;
u) failure of any tour operator, Common Carrier, or other travel supplier,
person or agency to provide the bargained-for travel arrangements other
than Financial Insolvency; v) 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 3, Item v above, applies to you, an Immediate Family Member, Traveling Companion, or Business Partner. |
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,
ON CALL will help you locate local physicians, dentists, or medical facilities.
ON CALL will also monitor your condition and contact your personal physician
and family, if requested.
Nurse Helpline–Registered nurses are available 24 hours a day before
and during your trip to provide general health information, clinical assessment,
and health counseling to give you assistance in making appropriate healthcare
decisions.
Medical Evacuation–If you need to be transported to a different hospital
or treatment facility, or back home, ON CALL will arrange and pay for transportation
and a special medical escort if required. Payment is available only for
covered claims and up to the amount of coverage provided in the policy.
Telephone Interpretation Service–In a medical emergency, ON CALL
provides interpretation services in major languages and will transmit urgent
messages to family, friends, and business, if requested.
Failure to call ON CALL may invalidate your Medical Expense and/or Trip
Interruption or Delay claim.
HOW
TO CONTACT ON CALL INTERNATIONAL
|
|
The ON CALL 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.
Phone answered 24 hours daily. |
|
Within U.S.A. & Canada Outside
U.S.A. & Canada 1-800-555-9095 1-603-894-4710* |
| *From outside the United States & Canada,
you will first have to enter the International Access Code of the
country you are calling from.
|
| PLAN
NUMBER : 905
|
PLEASE NOTE: Neither the Insurer(s) nor
ON CALL INTERNATIONAL shall be responsible for the availability, quality
or results of any medical treatment or your failure to obtain medical treatment.
Access Your Medical Records Online
With our exclusive free Traveler PDQ Service, you can ensure 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. Register at your convenience at www.travelerpdq.com or call, toll free 1-800-379-9887.
Program Code: 905
The Traveler PDQ Service is provided by:
Worldwide PDQ, a division of Cargril Corporation
Please read this Insurance Certificate/brochure carefully, as it is your evidence of coverage under the policy (once you have paid the appropriate premium). Important - You are eligible only for the benefits of the Part(s) you purchase; Part A and/or Part B. If you have any questions about the coverages offered or to report a claim, please contact Trip Mate at 1-800-996-5378. Claims may also be reported online and claim forms downloaded at www.tripmate.com Plan Number: 905 |
All claims should be presented to the Program Administrator:
Trip Mate (In CA, dba Trip Mate Insurance Agency)
9225 Ward Parkway, Suite 200
Kansas City, Missouri 64114
1-800-996-5378
Plan Number: 905
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.
In case of loss, theft or damage to Baggage and
Personal Effects you should: immediately report the situation to the hotel manager, tour guide or representative,
transportation official, local police or other local authorities and obtain
their written report of your loss; take reasonable steps to protect your
Baggage from further damage; and make necessary, reasonable and temporary
repairs. We will reimburse you for these expenses. We will not pay for
further damage if you fail to protect your Baggage.
The Travel Insurance is Underwritten
By: Stonebridge Casualty Insurance Company, Columbus, Ohio;
(all states except as otherwise noted) under Policy/Certificate Form series
TAHC5000. In CA, CT, HI, NE, NH, PA, TN and TX Policy/Certificate Form
series TAHC5100 and TAHC5200. In IL, IN, KS, LA, OH, OR, VT, WA and WY
Policy Form #’s TAHC5100IPS and TAHC5200IPS.
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 905. Additional forms
complete your policy and are available at www.tripmate.com. You can also
request these forms by calling Trip Mate at 1-800-996-5378.
Note: This policy contains disability insurance benefits or health insurance
benefits, or both, that apply only during a covered Trip. You may have
coverage from other sources that already provides you with these benefits.
You should review your existing policies. If you have any questions about
your current coverage, call your insurer or health plan.
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