
Vacation Travel Insurance Policy:
DESCRIPTION OF INCLUDED BASIC TRAVEL INSURANCE COVERAGE
Plan # 360AP
This Description of Coverage is a summary of the travel insurance benefits underwritten by United States Fire Insurance Company, herein referred to as the Company and also referred to as We, Us and Our. Notice: Provisions may vary by Your state of residence. Contact Travelex Customer Service if You have questions.
Insurance provided by this Description of Coverage is subject to all of the terms and conditions of the Group Policy. If there is a conflict between the Policy and this Description of Coverage, the Policy will govern.
Schedule of Benefits
Benefit Maximum Benefit Amount
Accidental Death and Dismemberment .............................. $25,000
Medical Expense/Emergency Assistance
Accident and Sickness Medical Expense ............................ $50,000
Emergency Evacuation and Repatriation .............................. $250,000
Trip Interruption ................................................................. $1,000
Missed Connection ............................................................. $1,000
Travel Delay ....................................................................... $1,000
Baggage and Personal Effects ............................................ $1,500
Baggage Delay .................................................................... $250
On Call 24-Hour Assistance Services .................................. Included
The travel insurance is underwritten by United States Fire Insurance Company under Form Series TP 401. In KS, LA, SD, TX, and UT Form #’s TP-401 CW. In WA under Form #TP-401-WA. In OR under Form #TP-401 OR.
Notice: If You are a resident of one of the following states (KS, LA, OR, SD, TX, UT, WA) Your coverage is provided on an individual policy form. Your policy number is Your complete name plus 360AP. If You live in any other state Your coverage is provided via a certificate. Your policy or certificate (including State Exceptions for AR, FL, ID, IL, KS, LA, ME, MS, MO, MT, NH, NY, OR, SD, TX, UT, VT, WA, WV, WI, and WY) and all General and “COB” Provisions are available at www.tripmate.com. You can also request this information by calling Travelex Customer Service at 1-800-965-8859.
SECTION I. Coverages
Accidental Death And DismembermentCIDENTAL DEATH AND DISMEMBERMENT
You are eligible for benefits 24 hours a day, up to the Maximum Benefit Amount, when You sustain an Injury during the Trip which results in any of the following losses within 180 days of the date of the Injury causing the Loss.
Benefits will be paid as follows:
Loss: Percentage of Principal Sum Payable:
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 ...................................... 100%
Loss of hand or hands, or foot or feet, means severance at or above the wrist joint or ankle joint, respectively.
Loss of eye or eyes means the total and irrecoverable loss of the entire sight thereof. Only one of the amounts shown above (the largest applicable) will be paid for Injuries resulting from one accident.
The benefit for loss of: (a) two limbs; (b) both eyes; or (c) one limb and one eye is payable only when such loss results from the same accident.
The Principal Sum is shown in the Schedule of Benefits.
Accident & Sickness Medical Expense i
ACCIDENT & SICKNESS MEDICAL EXPENSE
For the purpose of this benefit:
“Covered Expense” means expense incurred for services and supplies: (a) listed below; and (b) ordered or prescribed by a Legally Qualified Physician as Medically Necessary for diagnosis or treatment; which is limited to:
Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount, if You incur a Covered Expense as a result of a Sickness that first manifests itself during the Trip or Injury that occurs during the Trip. Only Covered Expenses incurred during the Trip will be reimbursed. Expenses incurred after the Trip ends are not covered.
Benefits will include expenses incurred during the Trip for emergency dental treatment due to Injury not to exceed $750. Expenses for emergency dental treatment incurred after the Trip are not covered.
Benefits will not be paid in excess of the Usual and Customary Charges.
Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed, to secure Your admission to a Hospital, because of a covered Sickness or Injury. The Program Medical Advisor will coordinate advance payment to the Hospital.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
Medical Evacuation and Repratriation of Remains
MEDICAL EVACUATION AND REPATRIATION OF REMAINS
When You suffer a loss of life for any reason or incur a Sickness or Injury during the course of a Trip, the following benefits are payable, up to the Maximum Benefit Amount.
If You are in the Hospital for more than 7 consecutive days and Your dependent children who are under 18 years of age and accompanying You on the Trip are left unattended, Economy Transportation will be paid to return the dependents to their home (with an attendant, if considered necessary by the Program Medical Advisor).
If You are traveling alone and will be hospitalized for more than 7 consecutive days and Emergency Evacuation is not imminent, benefits will be paid to transport one person, chosen by You, by Economy Transportation, for a single visit to and from Your bedside.
Benefits are paid less the value of Your original unused return travel ticket. If benefits are payable and You have other insurance that may provide benefits for this same loss, We reserve the right to recover from such other insurance. You shall: a) notify Us of any other insurance; b) help Us exercise the Company’s rights in any reasonable way that We may request, including the filing and assignment of other insurance benefits; c) not do anything after the loss to prejudice Our rights; and d) reimburse Us, to the extent of any payment We have made, for benefits received from such other insurance.
Trip Interruption And Travel Delay
Trip Interruption: Benefits will be paid, up to the Maximum Benefit Amount, for the non-refundable, unused portion of the prepaid expenses for land or water Travel Arrangements and the Additional Transportation Cost paid to return home or rejoin the Trip, when You are prevented from completing Your Trip due to:
Other Covered Reasons means:
Additional Trip Interruption Benefits: If Your Traveling Companion must remain hospitalized, benefits will also be paid for reasonable accommodation and transportation expenses incurred by You to remain with Your Traveling Companion up to $1,000.
If You cannot continue travel due to a covered Injury or Sickness not requiring hospitalization, and You must extend Your Trip due to medically imposed restrictions, as certified by a Legally Qualified Physician, benefits will be paid for additional hotel nights up to $1,000.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
Missed Connection: If You miss Your cruise or tour departure because Your arrival at Your Trip destination is delayed for 3 or more hours, benefits will be paid, on a one-time basis, up to the Maximum Benefit Amount, for a) the Additional Transportation Cost to join the Trip and b) the unused portion of the prepaid expenses for land or water Travel Arrangements, due to: a) any delay of a Common Carrier (the delay must be certified by the Common Carrier); b) a documented weather condition preventing You from getting to the point of departure; c) quarantine, hijacking, Strike, natural disaster, terrorism or riot.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
Travel Delay: Benefits will be paid for reasonable accommodation, meal, and local transportation expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, if You are delayed for 5 hours or more hours while en route to or from, or during a Trip, due to: a) any delay of a Common Carrier (the delay must be certified by the Common Carrier); b) a traffic accident in which You or Your Traveling Companion are not directly involved (must be substantiated by a police report); c) lost or stolen passports, travel documents or money (must be substantiated by a police report); d) quarantine, hijacking, Strike, natural disaster, terrorism or riot; e) a documented weather condition preventing You from getting to the point of departure.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
Baggage And Personal Effects and Baggage Delay
BAGGAGE AND PERSONAL EFFECTS AND BAGGAGE DELAY
Baggage and Personal Effects: Coverage will be provided to You: (a) against all risks of permanent loss, theft or damage to Your Baggage and Personal Effects; (b) subject to all Exclusions and Limitations in the policy; (c) up to the Maximum Benefit Amount; and (d) occurring while this coverage is in force.
The lesser of the following amounts will be paid: 1) the actual cash value (cost less proper deduction for depreciation) at the time of loss, theft or damage; 2) the cost to repair or replace the article with material of a like kind and quality; or 3) $300 per article.
A combined maximum of $600 will be paid for jewelry, watches, articles consisting in whole or in part of silver, gold or platinum, articles trimmed with fur, cameras and their accessories and related equipment.
A maximum of $50 will be paid for the cost of replacing a passport or visa. A maximum of $50 will be paid for the cost associated with the unauthorized use of lost or stolen credit cards, subject to verification that You have complied with all conditions of the credit card company.
Baggage and Personal Effects does not include:
1) animals; 2) automobiles and automobile equipment; 3) boats or other vehicles or conveyances; 4) trailers; 5) motors; 6) aircraft; 7) bicycles, except when checked as baggage with a Common Carrier; 8) household effects and furnishings; 9) antiques and collectors items; 10) sunglasses, contact lenses, artificial teeth, dental bridges or hearing aids; 11) prosthetic limbs; 12) prescribed medications; 13) keys, money, credit cards (except as coverage is otherwise specifically provided herein); 14) securities, stamps, tickets and documents (except as coverage is otherwise specifically provided herein); 15) professional or occupational equipment or property, whether or not electronic business equipment; or 16) telephones, computer hardware or software.
Additional Limitations and Exclusions Specific to Baggage and Personal Effects:
Benefits are not payable for any loss caused by or resulting from:
Baggage Delay: If, while on a Trip, Your checked baggage is delayed or misdirected by a Common Carrier for more than 12 hours from Your time of arrival at a destination other than at Your place of permanent residence, benefits will be paid, up to the Maximum Benefit Amount shown in the Schedule of Benefits, for the actual expenditure for necessary personal effects. You must be a ticketed passenger on a Common Carrier. The Common Carrier must certify the delay or misdirection. Receipts for the purchases must accompany any claim.
Additional Provisions applicable to Baggage and Personal Effects and Baggage Delay:
Benefits will not be paid for any expenses which have been reimbursed or for any services which have been provided by the Common Carrier, hotel or Travel Supplier; nor will benefits be paid for loss or damage to property specifically scheduled under any other insurance.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
ACCESS YOUR MEDICAL RECORDS ONLINE |
With our exclusive Free Global Xpi 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.globalxpi.com or call, toll free: 1-800-379-9887 Use Program Code 360AP These Services are Provided by: Global Xpi, Inc. |
SECTION II. Definitions
“Additional Transportation Cost” means the actual cost incurred for one-way Economy Transportation by a Common Carrier reduced by the value of an unused travel ticket.
“Baggage and Personal Effects” means luggage, personal possessions and travel documents taken by You during a Trip.
“Bankruptcy” means the filing of a petition for voluntary or involuntary bankruptcy in a court of competent jurisdiction under Chapter 7 or Chapter 11 of the United States Bankruptcy Code 11 L.S.C. Subsection 101 et seq.
“Business Partner” means an individual who (a) is involved in a legal general partnership with You and/or (b) is actively involved in the day to day management of Your business.
“Default” means a material failure or inability to provide contracted services.
“Common Carrier” means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
“Domestic Partner” means a person who is at least eighteen years of age and 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 continuous cohabitation throughout the 180 day period prior to Your Effective Date of the Plan; and 3) an affidavit of domestic partnership if recognized by the jurisdiction within which they reside.
“Economy Transportation” means the lowest published available transportation rate for a ticket on a Common Carrier matching the original class of transportation that You purchased for the Trip.
“Family Member” means any of the following who resides in the United States, Canada, or Mexico: Your or Your Traveling Companion’s: legal spouse (or common-law spouse where legal), legal guardian, son or daughter (adopted, foster, step or in-law), brother or sister (includes step or in-law), parent (includes step or in-law), grandparent (includes in-law), grandchild, aunt, uncle, niece or nephew, Domestic Partner, an employed caregiver who lives with You, or a person for whom You are the primary caregiver with whom You have lived for 12 continuous months prior to the effective date of Your Plan, whether or not they travel with You.
“Hospital” means: (a) a place which is licensed or recognized as a general hospital by the proper authority of the state in which it is located; (b) a place operated for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility; (c) a place recognized as a general hospital by the Joint Commission on the Accreditation of Hospitals. Not included is a hospital or institution licensed or used principally: (1) for the treatment or care of drug addicts or alcoholics; or (2) as a clinic, continued or extended care facility, skilled nursing facility, convalescent home, rest home, nursing home or home for the aged.
“Inclement Weather” means any weather condition that delays the scheduled arrival or departure of a Common Carrier.
“Injury” or “Injuries” means accidental bodily injuries: (a) received while insured under the Policy and any attached coverages; (b) resulting in loss independently of sickness and all other causes; and (c) not excluded from coverage.
“Intoxicated” means a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where You are located at the time of an incident.
“Insured” means the person who purchased the Trip and who has paid the required plan cost for the protection plan provided herein, and also referred to as You and Your.
“Legally Qualified Physician” means a physician or a Christian Science Practitioner: (a) other than You, a Traveling Companion or a Family Member; (b) practicing within the scope of his/her license; and (c) recognized as a physician in the place where the services are rendered.
“Maximum Benefit Amount” means the maximum amount payable for coverage provided to You as shown in the Schedule of Benefits.
“Medical Treatment” means treatment, advice or consultation by a Legally Qualified Physician.
“Medically Necessary” means a service or supply which: (a) is recommended by the attending Legally Qualified Physician; (b) is appropriate and consistent with the diagnosis in accord with accepted standards of community practice; (c) could not have been omitted without adversely affecting Your condition or quality of medical care; (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience; and (e) is not considered experimental unless coverage for experimental services or supplies is required by law.
“Pre-Existing Condition” means any injury, sickness or condition (including any condition from which death ensues) of You, Your Traveling Companion, or Your or Your Traveling Companion’s Family Member traveling with You which within the 60 day period prior to the effective date of Your Trip Cancellation coverage under the Policy: (a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or (c) required medical treatment or treatment was recommended by a Legally Qualified Physician.
“Program Medical Advisor” means On Call International, LLC.
“Scheduled Departure Date” means the date on which You are originally scheduled to leave on the Trip.
“Scheduled Return Date” means the date on which You are originally scheduled to return to the point of origin or the original final destination.
“Sickness” means an illness or disease that is diagnosed or treated by a Legally Qualified Physician after the effective date of insurance and while You are covered under the Policy.
“Strike” means any stoppage of work: (a) as a result of a combined effort of workers which was unannounced and unpublished at the time travel services were purchased; and (b) which interferes with the normal departure and arrival of a Common Carrier.
“Terrorist Incident” means an incident deemed a terrorist act by the United States Government that causes property damage and loss of life.
“Third Party” means a person or entity other than You or the Company.
“Transportation Expense” means: (a) the cost of conveyance of You and any medical personnel (if Medically Necessary); and (b) Medically Necessary services or supplies.
“Travel Arrangements” means: (a) transportation; (b) accommodations; and (c) other specified services arranged by the Travel Supplier for the Trip.
“Traveling Companion” means a person or persons with whom You have coordinated Travel Arrangements and intend to travel with during the Trip.
“Travel Supplier” means any entity or organization that coordinates or supplies travel services for You.
“Trip” means scheduled trips, tours or cruises for which: (a) coverage is requested; and (b) the required premium is submitted prior to the Scheduled Departure Date.
“Usual and Customary Charges” means those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.
SECTION III. When Coverage Begins and Ends
Your Term of Coverage:
For Travel Delay: Coverage is in force while en route to and from and during the Trip.
For all other coverages: All Other Benefits begin on 12:01 a.m. on Your Scheduled Departure Date. Coverage ends at the point and time of return on Your Scheduled Return Date.
In the event the Scheduled Departure Date and/or the Scheduled Return Date are delayed, or the point and time of departure and/or point and time of return are changed because of circumstances over which neither the Travel Supplier nor You have control, Your term of coverage shall be automatically adjusted in accordance with the Travel Supplier’s notice to Us of the delay or change.
SECTION IV. General Limitations and Exclusions
Benefits are not payable for any loss due to, arising or resulting from:
WAIVER OF THE PRE-EXISTING CONDITION EXCLUSION |
The Pre-Existing Condition Exclusion is waived if payment for this plan is received with or before the final payment for Your Trip. Please Note: This policy may not be purchased after You have made final payment for Your Trip. |
On Call International
24-Hour Medical Assistance
Contacting On Call’s 24-Hour Service Center When outside the USA or Canada, call us collect through a local operator (you will first have to enter the International Access Code of the country you are calling from). Within the USA or Canada, use the toll free number. Within U.S.A. & Canada Outside U.S.A. & Canada 1-800-784-0255 1-603-894-4710 YOUR PLAN NUMBER: 360AP |
Medical Assistance - Our multi-lingual professionals are available 24 hours a day to provide help, advice and referrals for medical emergencies. We will help you locate local physicians, dentists, or medical facilities.
Medical Consultation and Monitoring - If you are hospitalized, we will contact you and your treating physician to monitor your condition to assure you are receiving appropriate care and assess the need for further assistance. We will also contact your personal physician and family at home when necessary or requested to keep them informed of your situation.
Medical Evacuation - When medically necessary, we will arrange and pay for appropriate transportation, including an escort, if required, to a suitable hospital, treatment facility or home. Payment for Medical Evacuation is available only for covered claims and up to the amount of coverage provided in the policy. All medical transportation services must be authorized and arranged by On Call. In the event of an unauthorized Medical Evacuation, reimbursement may be limited or coverage may be invalidated.
Emergency Medical Payments - We will assist you in the advancement of funds or guarantee payments (up to the policy limits) to a hospital or other medical provider, if required, to secure your admission, treatment or discharge.
Prescription Assistance - We will assist you with replacing medications that are lost, stolen or spoiled during your Trip, either locally or by special courier.
Repatriation of Remains - In the event of death while on a Trip, we will arrange for the preparation and transportation required to return your remains to your Home.
24 Hour Legal Assistance - If while on your Trip you encounter legal problems, we will help you find a local legal advisor. If you are required to post bail or provide immediate payment of legal fees, we will assist you in arranging a funds transfer from family or friends.
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.
On Call Travel Solutions
24-Hour Worldwide Travel Services
Message Services - We will transmit emergency messages to family, friends or business associates and let you know that the message has been received.
Language Interpretation Services - We provide interpretation services in major languages and will refer you to appropriate local services, if needed.
Emergency Cash Transfer - We will help arrange an emergency cash transfer (wire transfer, travelers checks, etc.) of your funds from home or from friends or family in medical or travel emergency situations where additional funds are required.
Pre-Trip Travel Services - We provide 24-Hour information, help and advice for your planned Trip such as: passport and visa information, requirements and replacement; travel health information or advisories; vaccine recommendations and requirements; government agency contact information (i.e. embassies, consulates, and other departments or agencies); weather and currency information.
Travel Document and Ticket Replacement - When important travel documents (such as passports and visas) are lost or stolen, we will help you to secure replacements. We will also help you when airline or other travel tickets are lost or stolen. We will assist you with reporting your loss, reissuing tickets and obtaining the money required for this purpose (you are responsible for providing the funds).
On Call Concierge Services
While we strive to provide help and advice for problems encountered by travelers wherever or whenever they occur, situations may arise beyond our control when immediate resolution is not possible. We will make every reasonable effort to refer you to appropriate medical and legal providers, but neither the Insurer nor On Call Worldwide Travel Services Network may be held responsible for the availability, quality or results of any medical treatment or your failure to obtain medical treatment.
The 24-Hour Assistance Services are provided by: On Call International, LLC
WHERE TO PRESENT A CLAIM |
Present all claims to the Claims Administrator: Travelex 360° Claims P.O. Box 481127 Kansas City, Missouri 64148-1127 Tel: 1-800-965-8859 Plan Number: 360AP Claims may also be reported/completed online at: www.travelexinsurance.com |
SECTION V. General Provisions
Subrogation: If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the Third Party responsible for the loss, the Company will be subrogated to that right. You shall help the Company exercise the Company’s rights in any reasonable way that the Company may request; not do anything after the loss to prejudice the Company’s rights; and in the event You recover damages from the Third Party responsible for the loss, You will hold the proceeds of the recovery for the Company in trust and reimburse the Company to the extent of the Company’s previous payment for the loss.
Additional Claims Provisions Specific to Baggage: Your Duties after Loss of or Damage to Property or Delay of Baggage: In case of loss, theft, damage or delay of baggage or personal effects, You must: a) take all reasonable steps to protect, save or recover the property; b) promptly notify, in writing, either the police, hotel proprietors, ship lines, airlines, railroad, bus, airport or other station authorities, tour operators or group leaders, or any Common Carrier or bailee who has custody of Your property at the time of loss; c) produce records needed to verify the claim and its amount and permit copies to be made; d) provide to the Company, within 90 days from the date of loss, a detailed proof of loss signed and sworn to; and e) be examined, if requested.
SECTION VI. Coordination of Benefits
Applicability: The Coordination of Benefits (“COB”) provision applies to this Plan when You have health care coverage under more than one Plan.
Questions? Call 1800-965-8859
Please reference the following information when seeking travel assistance or reporting a claim:
Plan Number: 360AP
Location Number
END
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