| |
Printer-Friendly Document
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 Travelex 360° Claims
at 1-800-965-8859. Claims may
also be reported online and claim forms downloaded at: www.travelexinsurance.com Plan
Number: 725C
Schedule
|
| Benefit |
| Pre-Departure Trip Cancellation |
Trip Cost* |
| Post-Departure Trip Interruption |
150% of Trip Cost* |
| Travel Delay (Up to $100 Per Day) |
$500 |
Accidental Death & Dismemberment
|
$25,000 |
| Baggage and Personal Effects |
$1,000 |
| Baggage Delay |
$100 |
Medical Expense/Emergency
Assistance
|
|
| Accident and Sickness Medical Expense
|
$25,000 |
| Emergency Evacuation and Repatriation
|
$50,000 |
* The Pre-Departure Trip Cancellation and
Post-Departure Trip Interruption Benefits are optional benefits
that are included only if elected and the appropriate premium
paid. If you elect these benefits and insure an amount less
than your total prepaid Trip costs that are subject to cancellation
penalties or restrictions, the maximum benefit for Pre-Departure
Trip Cancellation and Post-Departure Trip Interruption will
be limited to the amount of coverage you purchased. |
A person who has arranged to take
a Trip, and pays the required premium, and is a citizen or
resident of the U.S.A. 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; 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. 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.
|
Please see 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 the 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 of Coverages.
|
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. |
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 $50 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:
“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 an
airline, cruise line, or tour operator, 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 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 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 $500.
3. arrangements canceled by an airline,
cruise line, or tour operator resulting from Financial
Insolvency as defined.
Item #3 above is subject to your
premium being received within 14 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 14 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, LLC.
“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
up to six persons whose names appear with yours on the
same Trip arrangement and who, during the Trip, will
accompany you.
“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.
|
|
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. (Unless
this exclusion is waived, see below for details)
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.
Waiver
of the Pre-Existing Condition Exclusion
The Pre-Existing Condition Exclusion is waived
provided you meet the following requirements: 1) the
premium for the coverage is received within 14 days
of the initial deposit/payment for your Trip and 2)
you are not disabled from travel at the time you pay
your premium.
|
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. |
All claims should be presented to the Claims Administrator,
Trip Mate*, at the following address:
Travelex 360° Claims
P.O. Box 481127
Kansas City, Missouri 64148-1127
1-800-965-8859
Plan Number: 725C
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 725C. Additional forms complete
your policy and are available at www.travelexinsurance.com/tmforms.
You can also request these forms by calling Travelex
Customer Service at 1-800-965-8859.
Travelex 360° claims are
administered by: Trip Mate*
*In CA, dba Trip Mate Insurance Agency
|
24 Hour Worldwide Assistance Service
Travelex Travel Assistance helps you find your way more easily whether
you are traveling domestically or internationally. You can access a wide
range of services on a 24/7 basis both before you go and during your
trip. Services include:
• 24-hour
medical assistance helpline
• Medical evacuation/repatriation
• Baggage tracking
• Lost/stolen passport/card assistance
• Emergency air/hotel/car rental bookings
• Destination information and advice
• International dining recommendations
• Hospitality & event ticketing
All Travelex Travel Assistance Services are included with
this travel protection plan purchase. There are charges associated
with some services.
|
Customers can call
toll-free for travel assistance by calling:
|
Within
USA & Canada
|
1-800-784-0255
|
Outside USA & Canada |
1-603-894-4710* |
*When outside the United States & Canada,
you will first have to call the local telephone operator
for help in placing your collect call, or if dialing direct,
enter the International Access Code of the country you are
calling from.
Refer to Plan Number: 725C |
|
The Travelex Travel
Assistance is provided by:
ON CALL International, LLC.
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! Use Program
Code 725C
The Traveler PDQ Service is provided
by: Worldwide PDQ, a division of Cargril Corporation
|
Questions? Call 1-800-965-8859
Please reference the the following
information when seeking travel assistance or reporting
a claim:
PLAN
NUMBER: 725C
LOCATION NUMBER:
|
|
|
|
