IMPORTANT
The Pre-Existing Condition Exclusion is waived provided you meet the
following requirements: 1) the premium for the coverage is received
by Tourlite International, Inc. within 7 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.
Schedule: Tourlite International, Inc.
|
| Benefit |
Accidental Death
and Dismemberment
|
$25,000 |
Medical Expense/Emergency
Assistance
|
$25,000 |
| Accident and Sickness Medical
Expense
|
Included |
| Emergency Evacuation and Repatriation
|
Included |
Pre-Departure Trip
Cancellation
|
Up To Trip Cost |
Post-Departure Trip
Interruption
|
Up To Trip Cost |
Travel Delay (Up
to $100 Per Day)
|
$500 |
| Baggage and Personal Effects
|
$1,000 |
| Baggage Delay
|
$100 |
|
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.
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 by Tourlite International, Inc.; 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.
Pre-Departure Trip Cancellation coverage will take effect on the date
your premium is received by Tourlite International, Inc.
Post-Departure Trip Interruption coverage will take effect on the Scheduled
Departure Date of your Trip if the required premium payment is received.
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.
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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) |
|
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.
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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. |
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.
(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. |
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. |
Travel Delay
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.
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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.
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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. |
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:
“Accident” means a
sudden, unexpected, unintended and external event, which causes
Injury.
“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.
“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 inclement weather, mechanical breakdown
of the aircraft on which you are scheduled to travel or organized labor
strikes that affect public transportation;
2. arrangements canceled by an airline, cruise line or tour operator
resulting from inclement weather, mechanical breakdown of the aircraft
on which you are scheduled to travel or organized labor strikes that
affect public transportation;
Items #1 and #2 above apply only to Post-Departure
Trip Interruption benefits and are subject to a limit of $100
per day to a maximum of $500.
3. 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.
“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 Benefit Schedule.
“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.
“Scheduled Trip Departure City” means
the city where the scheduled trip on which you are to participate
originates.
“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.
“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 by Tourlite
International, Inc. prior to the Scheduled Departure Date of
the Trip. Air arrangements covered by this definition also include
any direct round trip air flights booked by others, to and from
the Scheduled Trip Departure and return cities, provided the
dates of travel for the air flights are within 7 total days of
the scheduled land tour or cruise dates.
“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.
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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.
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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) bankruptcy,
financial insolvency, default or failure to supply services
by a travel supplier u) failure of any
tour operator, Common Carrier, or other travel supplier,
person or agency to provide the bargained-for travel
arrangements; 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. |
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| International Travelers Assistance |
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.
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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.
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Within U.S.A. & Canada Outside
U.S.A. & Canada
1-800-555-9095 1-603-894-4710*
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*From outside the United States & Canada,
you will first have to enter the International Access
Code of the country you are calling from.
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PLAN
NUMBER: 427R
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PLEASE NOTE: Neither the
Insurer 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 assure that your important medical records are available to you or
any Physician chosen by you, at any time, anywhere in the world, quickly,
wherever there is internet access available. Register at www.travelerpdq.com
or call, toll free 1-800-379-9887. It’s
free during your insured Trip!
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Please
read this Insurance Certificate/brochure carefully,
as it is your evidence of coverage under the policy
(once you have paid the appropriate premium). If
you have any questions about the coverages offered
or to report a claim, please contact Trip Mate at
1-800-888-7292. Claims may also be reported online
and claim forms downloaded at www.tripmate.com Plan
Number 427R. |
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All claims should be presented to the Program Administrator:
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Trip Mate*
9225 Ward Parkway, Suite 200
Kansas City, Missouri 64114
1-800-888-7292
Plan Number: 427R
* In CA, dba Trip Mate Insurance Agency
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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.
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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 427R.
Additional information about your policy is available at
www.tripmate.com. You can also request this information by
calling Trip Mate at 1-800-888-7292.
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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