Co-Insurance is the percentage of Eligible Expenses, after the deductible, which is the responsibility of the insured.
Co-Insurance is the percentage of Eligible Expenses, after the deductible, which is the responsibility of the insured.
There is no Co-Insurance with this plan.
Accident: means a sudden, unexpected, unusual, specific event that occurs at an identifiable time and place, but shall also include exposure resulting from a mishap to a conveyance in which You are traveling.
Accidental Injury: means Bodily Injury caused by an Accident (of external origin) being the direct and independent cause in the Loss.
Actual Cash Value: means purchase price less depreciation.
Additional Expense: means any reasonable expenses for meals and lodging which were necessarily incurred as the result of a Hazard and which were not provided by the Common Carrier or other party free of charge.
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.
Bodily Injury: means identifiable physical injury which is caused by an Accident and is independent of disease or bodily infirmity.
Business Partner: means an individual who: a) is involved in a legal partnership; and/or b) is actively involved in the day-to-day management of the business.
Common Carrier: means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
Company: means Nationwide Mutual Insurance Company.
Covered Expense: shall mean expenses incurred by You which are for medically necessary services, supplies, care, or treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician; reasonable and customary charges; incurred while insured under the Plan; and which do not exceed the maximum limits shown in the Confirmation of Coverage, under each stated benefit.
Cruise: means any prepaid sea arrangements made.
Default: means a material failure or inability to provide contracted services due to financial insolvency.
Dependent: means Your lawful spouse and/or unmarried children under 19 years of age.
Economy Fare: means the lowest published rate for an economy ticket.
Effective Date: means the date and time Your coverage begins, as outlined in the General Provisions section of this Certificate.
Exotic Vehicles: includes Alfa Romeo, Aston Martin, Auburn, Avanti, Bentley, Bertone, BMC/Leyland, BMW M Series, Bradley, Bricklin, Cosworth, Citroen, Clenet, De Lorean, Excalibre, Ferrari, Fiat, Iso, Jaguar, Jensen, Jensen Healy, Lamborghini, Lancia, Lotus, Maserati, MG, Morgan, Pantera, Panther, Pininfarina, Rolls Royce, Rover, Stutz, Sterling, Triumph, TVR and Yugo.
Family Member: means Your or Your Traveling Companion’s legal or common law spouse, parent, legal guardian, step-parent, grandparent, parents-in-law, grandchild, natural or adopted child, step-child, children-in-law, brother, sister, step-brother, step-sister, brother-in-law, sister-in-law, aunt, uncle, niece or nephew, who reside in the United States, Canada or Mexico.
Hazard: means a) any delay of a Common Carrier (including Inclement Weather); b) any delay by a traffic accident en route to a departure, in which You or a Traveling Companion is not directly involved; c) any delay due to lost or stolen passports, travel documents or money, quarantine, hijacking, unannounced strike, natural disaster, civil commotion or riot; d) a closed roadway causing cessation of travel to the destination of the Trip (substantiated by the department of transportation, state police, etc.).
Hospital: means a facility that a) holds a valid license if it is required by the law; b) operates primarily for the care and treatment of sick or injured persons as in-patients; c) has a staff of one or more Physicians available at all times; d) provides twenty-four (24)-hour nursing service and has at least one registered professional nurse on duty or call; e) has organized diagnostic and surgical facilities, either on the premises or in facilities available to the hospital on a pre-arranged basis; and f) is not, except incidentally, a clinic, nursing home, rest home, or convalescent home for the aged, or similar institution.
Host at Destination: means a person with whom You are sharing pre-arranged overnight accommodations at the host’s usual principal place of residence.
Inclement Weather: means any severe weather condition that delays the scheduled arrival or departure of a Common Carrier.
Individual Coverage Term: means the period of time beginning when You have been enrolled for coverage under the Policy and for whom the required premium has been paid.
Insurance: means any one of the following types of policies or plans which provide benefits for hospital confinement, medical expenses for You on Your effective date of coverage, and such policy or plan requires You to pay a deductible and/or portion of coinsurance: individual, group or blanket insurance plans; group Blue Cross, Blue Shield, or other group prepayment coverage plans; coverage under labor management trustee plans, union welfare plans, employer organization plans, employee benefit organizational plans, or other arrangements of benefits for persons of a group. Insurance does not include Medicare or Medicaid.
Land/Sea Arrangements: means any activities undertaken by You while in the Individual Coverage Term.
Loss: means injury or damage sustained by You in consequence of happening of one or more of the occurrences against which the Company has undertaken to indemnify You.
Physician: means a licensed practitioner of medical, surgical or dental services acting within the scope of his/her license. The treating Physician may not be You, a Traveling Companion or a Family Member.
Pre-Existing Condition: means any injury, sickness or condition of You, or Your Traveling Companion, Your Family Member booked to travel with You for which within the sixty (60) day period prior to the Effective Date of Trip Cancellation coverage under the Policy a) first manifested itself 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 Physician. The Pre-Existing Conditions exclusion is waived for You if You enroll in the Plan at the time You pay the deposit required for the Trip (or within ten (10) days of the initial deposit) and You purchase the coverage under the Plan for the full cost of the Trip.
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 to a different final destination.
Sickness: means an illness or disease which is diagnosed or treated by a Physician after the Effective Date of insurance and while You are covered under the Policy. (sickness is defined as after the effective date, but pre-ex is sickness prior to Effective Date
Strike: means any unannounced labor disagreement that 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 or Loss of life. Traveling Companion: means person(s) booked to accompany You on Your Trip (to a maximum or four (4) persons including You). Note, a group or tour leader is not considered a
Traveling Companion unless You are sharing room accommodations with the group or tour leader.
Travel Supplier: means tour operator, cruise line, hotel, airline, etc., that has made the land and/or sea arrangements.
Trip: means prepaid Land/Sea Arrangements and shall include flight connections to join or depart such Land/Sea Arrangements provided such flights are scheduled to commence within one day of the Land/Sea Arrangements. Maximum Trip duration is 90 days.
You or Your: refers to all persons listed on the Confirmation of Coverage under the program purchased by You.
LIMITATIONS AND EXCLUSIONS
The following exclusions apply to Trip Cancellation & Trip Interruption, Trip Delay, Missed Connection, Accidental Death & Dismemberment, Accidental Death & Dismemberment – Common Carrier, Emergency Sickness Medical Expense & Emergency Accident Medical Expense, Emergency Evacuation & Repatriation of Remains:
Loss caused by or resulting from:
1. Pre-Existing Conditions, as defined in the Definitions section (except Emergency Evacuation and Repatriation of Remains) unless the insurance is purchased within ten (10) days of the initial Trip deposit;
2. suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane (in Missouri, sane only) unless results in the death of a non-traveling immediate Family Member;
3. intentionally self-inflicted injuries;
4. war, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war;
5. participation in any military maneuver or training exercise any loss starting while You are in the service of the armed forces of any country. Orders to active military service for training purposes of two months or less will not constitute service in the armed forces. Upon notice to the Company of entering the armed forces, the Company will return to You pro-rata any premium paid, less any benefits paid, for any period during which You are in such service;
6. piloting or learning to pilot or acting as a member of the crew of any aircraft;
7. mental or emotional disorders, unless hospitalized;
8. participation as a professional in athletics;
9. participation in underwater activities;
10. being under the influence of drugs or intoxicants, unless prescribed by a Physician, unless results in the death of a non-traveling immediate Family Member;
11. commission or the attempt to commit a criminal act;
12. participating in bodily contact sports; skydiving; hang-gliding; parachuting; mountaineering; any race; bungee cord jumping; and speed contest (speed contest shall not include regatta races); scuba diving; spelunking or caving; heliskiing; extreme skiing;
13. dental treatment except as a result of an injury to sound natural teeth within twelve (12) months of the Accidental Injury limited to $750;
14. any non-emergency treatment or surgery, routine physical examinations, hearing aids, eye glasses or contact lenses;
15. pregnancy and childbirth (except for complications of pregnancy) except if hospitalized;
16. curtailment or delayed return for other than covered reasons;
17. traveling for the purpose of securing medical treatment;
18. services not shown as covered;
19. directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination;
20. Confinement or treatment in a government Hospital; however the United States government may recover or collect benefits under certain conditions;
21. Care or treatment that is not medically necessary;
22. Care or treatment for which compensation is payable under Worker’s Compensation Law, any Occupational Disease law; the 4800 Time Benefit plan or similar legislation;
23. Care or treatment that is payable under any Insurance policy that does not require deductible and/or coinsurance payments by You;
24. Injury or Sickness when traveling against the advice of a Physician;
25. Cosmetic surgery except for: reconstructive surgery incidental to or following surgery for trauma, or infection or other covered disease of the part of the body reconstructed, or to treat a congenital malformation of a child.
The following exclusions apply to Baggage/Personal Effects, Baggage Delay:
The Company will not provide benefits for any Loss or damage to:
2. Automobiles and automobile equipment;
3. Boats or other vehicles or conveyances;
8. Bicycles (except when checked as baggage with a Common Carrier);
9. Household effects and furnishing;
10. Antiques and collectors’ items;
11. Eyeglasses, sunglasses or contact lenses;
12. Artificial teeth and dental bridges;
13. Hearing aids;
14. Prosthetic limbs;
15. Prescribed medications;
16. Keys, money, stamps, securities and documents;
18. Credit cards;
19. Professional or occupational equipment or property, whether or not electronic business equipment;
20. Personal computers, telephones, computer hardware or software;
21. Sporting equipment if Loss or damage results from the use thereof.
Any Loss caused by or resulting from the following is excluded:
1. Breakage of brittle or fragile articles;
2. Wear and tear or gradual deterioration;
3. Insects or vermin;
4. Inherent vice or damage while the article is actually being worked upon or processed;
5. Confiscation or expropriation by order of any government;
6. War or any act of war whether declared or not;
7. Theft or pilferage while left unattended in any vehicle;
8. Mysterious disappearance;
9. Property illegally acquired, kept, stored or transported;
10. Insurrection or rebellion;
11. Imprudent action or omission;
12. Property shipped as freight or shipped prior to the Scheduled Departure Date.