Cancel For Any Reason - Platinum - Coverage Details - Travel Insurance

The below are only a selection of terms, conditions, and exclusions under the policy certificate. For an entire list of terms, conditions, and exclusions applicable to you, please see the policy certificate.

Accident means a sudden, unexpected, or unintended event that occurs at a single, identifiable time and place, and that causes Accidental Death, Dismemberment, or Accidental Injury. An Accident may not be caused by Sickness or other conditions, or by the voluntary ingestion, injection, or inhalation of any substance.

Accidental Death means the death of a Covered Person as a direct result of an Accident.

Accidental Injury means bodily injury to a Covered Person as a direct result of an Accident.

Account means the credit, charge, prepaid, or debit card account issued to the Enrollee in his or her name to which premiums will be billed. The Account must be listed on the enrollment form or provided to a representative by phone to be considered an eligible enrolled Account to which premium can be billed.

Ambulance means a vehicle equipped for transporting the injured and sick, staffed by trained personnel and is operated and duly licensed through a hospital, municipality or independent ambulance service.

American Express Card means for the purpose of this Certificate, any card bearing an American Express trademark or logo issued by American Express Travel Related Services, Inc. or its subsidiaries and affiliates.

American Express Membership Rewards Points or Membership Rewards Points means credits obtained through the Membership Rewards program available with most American Express Cards, which are earned when making certain purchases with such cards.

Attending Physician means the Physician from whom treatment is sought for a Sickness or Accidental Injury.

Baggage means each Covered Person’s suitcases or traveling bags, the contents of each, and the Covered Person’s personal effects that the Covered Person brings on a Covered Trip.

Beneficiary means the person or entity designated on forms and in a manner approved by Us to receive benefits in the event of Accidental Death. If no person or entity is designated, the Beneficiary will be determined by the terms of the Certificate.

Boarding means engaging, by a Covered Person, in the direct and immediate act of getting on and entering into a Scheduled Airline or Common Carrier Conveyance to begin, or while on, a Covered Trip.

Business Effects means property owned by the Covered Person or used in conjunction with the Covered Person’s employment for which the safekeeping is the Covered Person’s responsibility.

Common Carrier Conveyance means any land, water or air vehicle operated by a licensed common carrier and offered to the public to carry passengers for hire on a regularly scheduled basis. (A rental or personal vehicle is not a Common Carrier Conveyance.)

Commutation means travel between an individual’s residence, whether Permanent or Temporary, and the individual’s routine place of daily employment.

Company means AMEX Assurance Company and its duly authorized agents or subcontractors.

Company Officer means, in regards to the employer of a Covered Person, a person who acts in an official capacity in a company.

Company Officers include, but may not be limited to directors, managers and corporate secretaries.

Complications of Pregnancy means conditions whose diagnoses are distinct from pregnancy, but are adversely affected by pregnancy or caused by pregnancy. Such conditions include, but are not limited to:
1. Acute nephritis;
2. Nephrosis;
3. Cardiac decompensation;
4. Missed abortion and similar medical and surgical conditions of comparable severity;
5. Non-elective cesarean section;
6. Ectopic pregnancy which is terminated;
7. Hyperemesis gravidarum and preeclampsia; or
8. Spontaneous termination of pregnancy that occurs during a period of gestation in which a viable birth is not possible.

Complications of Pregnancy shall not include:
1. False labor;
2. Occasional spotting;
3. Physician-prescribed rest during the period of Pregnancy;
4. Morning sickness; and
5. Similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy.

Coverage Effective Date is the date shown on the Schedule of Benefits identifying the date coverage under the Certificate begins.

Covered Person means You or Your Traveling Companions who have met the enrollment requirements of the Plan, and for whom all premiums have been paid. If You pay for coverage on behalf of another person(s), but do not accompany the person(s) on the Covered Trip, You are not a Covered Person.

Covered Trip is defined in the Description Of Benefits section in connection with each type of benefit provided by Us under this Certificate.

Covered Trip Conclusion Date means the date on which the Covered Person is originally scheduled to return to the point where the Covered Trip started or to the Covered Person’s final destination.

Covered Trip Departure Date means the date on which the Covered Person is originally scheduled to leave on the Covered Trip.

Dentist means a Doctor of Dental Surgery or Doctor of Dental Medicine as defined and licensed by the jurisdiction in which the Dentist is practicing, and who is providing dental services authorized by his or her license. The treating Dentist may not be a Covered Person, Spouse or Domestic Partner of the Covered Person, other Family Member of the Covered Person or anyone else related to the Covered Person by blood.

Dependent means
1. Your lawful Spouse or Domestic Partner;
2. Your unmarried, dependent children under 26 years of age who rely on You for financial support and maintenance; and
3. Your unmarried dependent children 26 years or older who because of a handicap condition that occurred before the attainment of the limiting age, are incapable of self-sustaining employment and dependent upon You for lifetime care and supervision. Coverage will be extended for as long as such child is incapacitated, unmarried and dependent.

Deplaning means engaging, by a Covered Person, in the direct and immediate act of moving down, out, or off of the Scheduled Airline while on a Covered Trip. Once the Covered Person’s body has completely exited the Scheduled Airline, he or she is no longer Deplaning.

Designated Trip Payment Plan means a selected option of premium payment whereby You enroll for coverage and pay a premium for benefits selected under the Certificate for each Covered Person and Covered Trip. Re-enrollment is required for each Covered Trip.

Dismemberment means, with reference to hand or foot, complete and permanent severance through or above the wrist or ankle joint as a result of an Accident, and as used with reference to eye, means the irrecoverable loss of the entire sight thereof as a result of an Accident.

Domestic Partner means persons who either,
1. Can provide documentation of registration of the Domestic Partner relationship pursuant to a state, county or municipal provision, or
2. Can meet all of the following qualifications:
a. Have resided with each other continuously for at least 12 months in a sole-partner relationship that is intended to be permanent;
b. Are not married to any other person;
c. Are at least 18 years old;
d. Are not related to each other by blood closer than would bar marriage per state law; and
e. Are financially interdependent as can be documented by copies of joint home ownership or lease, common bank accounts, credit cards, investments or insurance.

Enrollee means the person who authorizes completion of the enrollment form, who pays the required premium and, if applicable, takes a Covered Trip and enrolls eligible Traveling Companion(s).

Exceptional Danger means a circumstance in which a reasonably prudent person, using ordinary caution, would realize that he or she was at substantial risk of serious injury or death.

Family Member means the Covered Person’s Dependent, son or daughter (including adopted and those who are in the process of becoming adopted, foster, step or in-law), Domestic Partner’s son or daughter (including adopted and those who are in the process of becoming adopted, foster, step or in-law), brother or sister (including step or in-law), parent (including step or in-law), grandparent (including step or in-law), grandchild (including adopted and those who are in the process of becoming adopted, foster or step), aunt, uncle, niece, nephew, guardian, or ward.

Felonious Assault means an act of violence against a Covered Person, or the Covered Person’s Family Member or Traveling Companion requiring medical treatment in a Hospital.

Financial Default means the complete suspension of operations due to financial situations, whether or not a bankruptcy petition is filed, or partial suspension of operations after the filing of a bankruptcy petition.

High-Risk Articles means the following personal property of a Covered Person:
1. Jewelry;
2. Sporting equipment;
3. Photographic or electronic equipment;
4. Computers and audio/visual equipment;
5. Items consisting in whole or in part of gold, silver or platinum; and
6. Furs or articles made mostly with fur or trimmed or lined with fur.

Hospital means an institution which meets all of the following requirements:
1. It is properly accredited and where required by law, holds a license as a Hospital;
2. It operates mainly for the care and treatment of sick or injured persons as inpatients;
3. It provides 24 hours a day nursing care by registered nurses;
4. It has staff of one or more Physicians available at all times; and
5. It provides organized facilities for diagnosis and surgical procedures.

Hospital does not include any of the following:
1. A facility used primarily for the care of the aged;
2. A mental institution or sanitarium;
3. A facility used primarily as a clinic, nursing home, hospice or similar place of business;
4. A long term nursing unit or geriatric ward;
5. A rehabilitative facility or extended care facility for convalescent patients; or
6. A military or veterans hospital, soldier’s home or any hospital that is contracted for or operated by the federal government or any of its agencies for members or former members of the armed forces, unless You are legally required to pay for the services.

With respect to outpatient surgery or diagnostic testing, an ambulatory surgical center or a clinic will be considered a Hospital.

Master Policyholder means the trustee of the AMEX Assurance Travel Group Trust and any successors of such trustee that may serve in the future.

Medically Necessary means a service, supply, drug, or article that is:
1. Recommended and approved by a Physician or Dentist or acting within the scope of his or her license;
2. Consistent with the Covered Person’s condition or accepted standards of good medical practice;
3. Medically proven to be effective for the Sickness or Accidental Injury for which it is recommended or approved;
4. Not performed mainly for the convenience of the Covered Person or the Physician or Dentist;
5. Not considered experimental or conducted for research purposes; and
6. The most appropriate level of services which can be safely provided to the Covered Person.

Occurrence means a single instance or a continuous or repeated exposure to conditions during the Period of Coverage which results in eligibility for payment of a Policy benefit. The loss shall be deemed one Occurrence if it is attributable directly or indirectly to one cause or to one series of similar causes.

Participating Organization means the organization of which You are a member that has completed a Participating Organization Application under the Master Policy and has been accepted by the Company.

Pay with Points is a process that may be available to an individual who accrues American Express Membership Rewards Points and then uses the Membership Rewards Points to pay for travel by converting them to statement credits to off-set some or all of the expense of that travel reflected on the individual’s American Express Card Account statement.

Period of Coverage means that period of time during which a Covered Person is covered under the Policy. This period begins on the Coverage Effective Date, which is variable by coverage, and ends at 12:01 a.m. on the date immediately following the Covered Trip Conclusion Date.

Permanent Residence means the one primary dwelling place where the Covered Person resides and to which he or she intends to return.

Physician means a Medical Doctor or Doctor of Osteopathy as defined and licensed by the jurisdiction in which the Physician is practicing, and who is providing medical services authorized by his or her license. For the purposes of this Certificate, Physician also means an advanced practitioner licensed in the applicable jurisdiction to provide medical services under the direct supervision of a Medical Doctor or Doctor of Osteopathy, such as an advanced practice nurse or a physician’s assistant, and who is providing medical services authorized by his or her license. The treating Physician may not be a Covered Person, Spouse or Domestic Partner of the Covered Person, other Family Member of the Covered Person or anyone else related to the Covered Person by blood.

Plan means the Policy and the benefits described therein.

Policy means the Group Insurance Master Policy AX0126 issued to the Master Policyholder and includes a copy of this Certificate, which is attached to the Policy issued to the Master Policyholder.

Preexisting Condition is a Sickness or Accident that existed, or for which a Covered Person, Traveling Companion or Family Member of a Covered Person or Traveling Companion was treated or received medical advice, before the Coverage Effective Date. The existence of a Preexisting Condition may cause certain benefits to be excluded, as explained in the section Terms That Apply To All Benefits, in the subsection on the Certificate’s Preexisting Condition Exclusion.

Reasonable and Customary means the usual fee charged by a Physician or Dentist or by a provider of medical transportation services, or by a mortician, within a certain geographic area. The locality where the charge is made also will be considered. Locality means a county or such greater area as is needed to represent a cross section of providers giving the type of service or supplies for which the charge was made. If the fees charged are higher than the average amounts, the individual receiving the service is responsible for paying the difference.

Replacement Cost means the lesser of the cost to repair or replace Baggage with new material or property of like kind and quality as a result of physical loss, theft, pilferage, and significant damage to or destruction of the Baggage. Deduction for depreciation of the item will also be taken into consideration.

Residence means either the Covered Person’s Permanent Residence or Temporary Residence.

Schedule of Benefits means the summary of benefits for all Covered Persons under the Certificate.

Scheduled Airline means a commercial airline that publishes schedules and fares for regular passenger service between cities and which is:
1. Of United States registry and certified for civil scheduled air transport by the United States government to carry passengers on a regularly scheduled basis; or
2. Of foreign registry and approved by the United States government or the appropriate foreign authority where the aircraft is registered; or
3. A Scheduled Charter, defined as an airline charter service that meets all of the following qualifications:
a. It is operated by a Scheduled Airline;
b. It is licensed to carry passengers for hire;
c. It is available to the public; and
d. It is not hired, owned or leased by a Covered Person’s employer.

Sickness means an illness or disease.

Spouse means a person to whom the Covered Person is married.

Temporary Residence means a dwelling place where the Covered Person intends to reside for a limited time during a Covered Trip, and which is occupied or intended to be occupied by the Covered Person for 45 days or more.

Terrorist Incident means an act, outside the context of declared or undeclared war or of any form of unrest or civil disturbance, committed by one or more persons, neither enlisted nor commissioned in the armed forces of any nation state, for the express or implied purpose of achieving a political, ethnic, or religious goal which causes physical damage to humans, property or infrastructure.

Traveling Companion means a person enrolled by You or enrolled under a separate American Express Travel Insurance Certificate or American Express Award Travel Insurance Certificate who participates in the entire Covered Trip.

Unforeseeable means incapable of being anticipated with ordinary diligence.

Unused Airfare means the nonrefundable expense for a portion of the Covered Trip not taken through a Scheduled Airline.

We, Us, Our means the Company.

You, Your means, or refers to, the Enrollee.

1. Excess Coverage

If any loss under this Policy and Certificate is insured under any other valid and collectible policy, this Policy shall cover such loss, subject to its exclusions, conditions, provisions and other terms herein, only to the extent that the amount of such loss is in excess of the amount of such other insurance which is payable or paid. This limitation applies to all benefits unless otherwise provided above in regards to a specific benefit in the Description Of Benefits section.

2. When a Covered Person has Coverage under similar American Express Products

A Covered Person may be covered for similar benefits under different American Express Products. If both products state that the similar benefits are either primary or that the benefits are excess, the product with the lower level of benefits will pay first and the other product will provide excess coverage.

3. When a Covered Person purchases a Covered Trip with Frequent Flyer Points or other travel credits

Benefits under this Certificate are available only for travel expenses paid for in cash or the equivalent to cash, such as through use of a credit or debit card, or when American Express Membership Rewards Points are used in the Pay with Points program. Benefits are not available for travel purchased with travel award credits such as frequent flyer points issued by Scheduled Airlines, vouchers or coupons issued by hotels or rental car companies or similar programs, including such credits purchased by exchanging American Express Membership Rewards Points for such credits.

4. Multiple Certificates of Insurance under this Policy for a Covered Trip

This Certificate takes the place of any Certificate of Insurance previously issued to You under the Policy. You or any Covered Person may qualify under only one Certificate of Insurance issued under the Policy for each Covered Trip. If any Covered Person is insured at the same time under more than one Certificate, We will consider that person to be insured under the Certificate that provides the greatest amount of coverage as shown on the Schedule of Benefits for the Certificate. Upon discovery of the duplication, We will refund any duplicated premium payments that may have been made on behalf of a Covered Person. The records maintained by the Master Policyholder shall determine the insurance provided under the Policy for any Covered Person. The maximum amount We will pay for any one benefit is that which provides the greatest amount of coverage, as shown on the Schedule of Benefits.

5. Preexisting Condition Exclusion

There is no coverage for losses under this Certificate incurred because of a condition of a Covered Person, Family Member, Traveling Companion or Family Member of a Traveling Companion if, during the 90 days preceding and including the Coverage Effective Date:
a. There was medical advice or treatment received or recommended by a Physician or Dentist for the condition;
b. Symptoms of the condition were present which would have caused a prudent person to seek medical consultation, dental treatment, advice, examination or treatment; or
c. If during such 90 day period the condition required taking newly prescribed medication or adjusted medication.

The exclusion does not apply to congenital anomalies of Dependent children who are Covered Persons, Family Members or Family Members of Traveling Companions. Routine examinations for physicals, dental check-ups or similar wellness care visits do not trigger the Preexisting Condition exclusion unless the treating Physician or Dentist diagnoses an injury from an Accident or a Sickness during the examination.

We will waive this Preexisting Condition exclusion in relation to a Covered Person if the Covered Person meets all of the following requirements:
a. The Covered Person must be medically able to travel at the time the Policy premium is paid; and
b. The premium under the Policy is paid within 14 days of making the first Covered Trip deposit;

If the Covered Person does not qualify to have the Preexisting Conditions exclusion waived, any Sickness that arises during the Covered Trip that is NOT related to a Preexisting Condition will be eligible for coverage under this Plan.

This exclusion is applicable to all Covered Persons, Traveling Companions, Family Members and Family Members of Traveling Companions, whether or not they are traveling.

6. Exclusions That Apply To All Benefits

Benefits are not payable if the loss for which coverage is sought was directly or indirectly, wholly or partially, contributed to or caused by:
a. War or any act of war, whether declared or undeclared, or any other activity directly related to and occurring while in the service of any armed military force of any nation state recognized by the United Nations;
b. Participation in a riot, civil disturbance, protest or insurrection;
c. Violation of a criminal law, offense or infraction, whether cited or charged, by or on behalf of the Covered Person or Beneficiary;
d. Being engaged or committing fraud, abuse, or illegal activity of any kind by the Covered Person or Family Member;
e. Suicide or any attempt at suicide, intentionally self-inflicted injury or any attempt at intentionally self-inflicted injury, or autoeroticism;
f. Being under the influence of any drug, unless taken as prescribed or administered on the advice of a Physician;
g. Consumption of alcohol at or in excess of the legal blood alcohol level in the state or locality in which the Accident occurred;
h. Riding in any capacity in an aircraft other than as a fare-paying passenger on a Scheduled Airline or Common Carrier Conveyance;
i. Riding or driving in any kind of race for prize money or profit;
j. Participation in professional sporting events (including training);
k. Pregnancy, resulting childbirth or abortion except to the extent coverage is required for Complications of Pregnancy;
l. Cosmetic surgery, except surgery that is reconstructive, incidental and related to an Accidental Injury;
m. Accidental Injury or Sickness covered under any state or federal workers’ compensation, employer’s liability or occupational disease law;
n. Any mental or emotional condition, whether diagnosed or undiagnosed;
o. Any addiction to drugs, alcohol, prescribed or non-prescribed medication, or any other substance;
p. Voluntary ingestion, injection, or inhalation of any substance;
q. Fighting, brawling, or injury from a firearm or knife or any other lethal instrument during a fight or brawl unless acting in self defense;
r. Intentional exposure to Exceptional Danger except in an attempt to save human life;
s. Confiscation by any governmental authority, public authority, or customs official; or
t. Any injury received during or as a result of Commutation.

Coverage Definition