Coverage Definition

• Pre-Existing Condition
  • No coverage
    Pre-existing look-back period 180 days
  
  
• What is Pre-Existing Condition?

  A pre-existing condition is an illness or medical condition that existed before a policy’s effective date, usually excluded from coverage. Travel Protection plans may include coverage provided you meet the condition of that insurance provider. Many providers offer coverage if the policy is purchased within a certain number of days after the initial trip deposit was made. A few providers offer coverage if the policy is purchased before the final payment date. Please refer to the policy summary to determine any conditions for coverage. Some Medical Plans may provide limited coverage; some may cover pre-existing conditions after a specified waiting period, while others do not provide any coverage.

• What am I covered for?

  PRE-EXISTING MEDICAL CONDITION EXCLUSION:

  The Insurer will not pay for any Loss or expense incurred as the result of an Injury, Sickness or other condition of an Insured, Traveling Companion, Business Partner, or Family Member which, within the 180 day period immediately preceding and including the Insured’s coverage effective date:
  a) first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment;
  b) for which care or treatment was given or recommended by a Physician;
  c) required taking prescription drugs or medicines, unless the condition for which the drugs or medicines are taken remains controlled without any change in the required prescription drugs or medicines.

• Definitions

  “Actual Cash Value” means purchase price less depreciation.
  “Baggage” means luggage and personal possessions, whether owned, borrowed, or rented, taken by the Insured on the Trip.
  “Business Partner” means an individual who:
  a) is involved with the Insured or the Insured’s Traveling Companion in a legal partnership; and
  b) is actively involved in the daily management of the business.
  “Common Carrier” means any conveyance operated under a license for the transportation of passengers for hire.
  “Complication of Pregnancy” means a condition whose diagnosis is distinct from pregnancy but adversely affected or caused by pregnancy. It does not include any condition associated with the management of a difficult pregnancy not consisting of a classifiable distinct Complication of Pregnancy.
  “Deductible” means the amount of charges that must be incurred by the Insured before benefits become payable. The amount of the Deductible is the Deductible shown in the Schedule of Benefits for each coverage to which a Deductible applies.
  “Destination” means the place where the Insured expects to travel on his/her Trip, as shown on the Enrollment Form.
  “Domestic Partner” means an opposite or a same-sex partner who is at least 18 years of age and has met all of the following requirements for at least 6 months:
  (1) resides with the Insured;
  (2) shares financial assets and obligations with the Insured; the Insurer may require proof of the Domestic Partner relationship in the form of a signed and completed Affidavit of Domestic Partnership.
  “Exotic Vehicle” means any vehicle with an original manufacturer’s suggested retail price greater than $50,000 and antique cars meaning cars that are over 20 years old or have not been manufactured for 10 or more years.
  “Experimental or Investigative” means treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device, or prescription medication is being used, including any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered.
  “Hospital” means a facility that:
  (1) is operated according to law for the care and treatment of injured people;
  (2) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis;
  (3) has 24- hour nursing service by registered nurses (R.N.’s); and
  (4) is supervised by one or more Physicians.
  A Hospital does not include:
  (1) a nursing, convalescent, or geriatric unit of a hospital when a patient is confined mainly to receive nursing care;
  (2) a facility that is, other than incidentally, a rest home, nursing home, convalescent home, or home for the aged; nor does it include any ward, room, wing, or other section of the hospital that is used for such purposes; or
  (3) any military or veterans hospital or soldiers home or any hospital contracted for or operated by any national government or government agency for the treatment of members or ex-members of the armed forces.
  “Immediate Family Member” means the Insured’s or Traveling Companion’s spouse or Domestic Partner, child, spouse’s child, daughter-in-law, son-in-law, brother, sister, mother, father, grandparents, grandchild, step-brother, stepsister, step-parents, parents-in-law, brother-in-law, sister-in-law, aunt, uncle, niece, nephew, legal guardian, caregiver, legal ward, or Domestic Partner of any of the above.
  “Inclement Weather” means any severe weather condition which delays the scheduled arrival or departure of a Common Carrier. With respect to an Insured who is traveling via private/non-commercial automobile transportation, any severe weather condition which prevents an Insured from reaching the Destination.
  “Injury” means a bodily injury caused by an accident occurring while the Insured’s coverage under the Policy is in force, and resulting directly and independently of all other causes of loss covered by the Policy. The Injury must be verified by a Physician.
  “Insured” means the person(s) named on the individual Enrollment Form and for whom the plan cost has been paid. “Insurer” means National Union Fire Insurance Company of Pittsburgh, PA.
  “Medically Necessary” means that a treatment, service, or supply:
  (1) is essential for diagnosis, treatment, or care of the Injury or Sickness for which it is prescribed or performed;
  (2) meets generally accepted standards of medical practice;
  (3) is ordered by a Physician and performed under his or her care, supervision, or order; and
  (4) is not primarily for the convenience of the Insured, Physician, other providers, or any other person.
  “Natural Disaster” means a flood, hurricane, tornado, earthquake, or blizzard that is due to natural causes.
  “Physician” means a licensed practitioner of the healing arts including accredited Christian Science Practitioners, acting within the scope of his/her license. The treating Physician may not be the Insured, Immediate Family Member, or a Traveling Companion.
  “Reasonable Additional Expenses” means any expenses for meals, taxi fares, essential telephone calls, and lodging which were necessarily incurred as the result of a Trip Delay and which are not provided by the Common Carrier or any other party free of charge.
  “Reasonable and Customary Charges” means an expense which:
  a) is charged for treatment, supplies, or medical services Medically Necessary to treat the Insured’s condition;
  b) does not exceed the usual level of charges for similar treatment, supplies, or medical services in the locality where the expense is incurred; and
  c) does not include charges that would not have been made if no insurance existed. In no event will the Reasonable and Customary Charges exceed the actual amount charged.
  “Return Destination” means the place to which the Insured expects to return from his/her Trip.
  “Sickness” means an illness or disease diagnosed or treated by a Physician.
  “Strike” means a stoppage of work
  a) announced, organized, and sanctioned by a labor union and
  b) which interferes with the normal departure and arrival of a Common Carrier. This includes work slowdowns and sickouts.
  “Terrorist Incident” 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 a person or persons with whom you have coordinated travel arrangements and intend to travel with during the Trip. A group or tour leader is not considered a Traveling Companion, unless you are sharing room accommodations with the group or tour leader.
  “Trip” means a period of travel away from home to a Destination outside the Insured’s city of residence; the purpose of the Trip is business or pleasure and is not to obtain health care or treatment of any kind; the Trip has defined departure and return dates specified when the Insured applies; the Trip does not exceed 365 days; travel is primarily by Common Carrier and only incidentally by private conveyance.
  “Unforeseen” means not anticipated or expected and occurring after the effective date of the policy.
  “Uninhabitable” means
  (1) the building structure itself is unstable and there is a risk of collapse in whole or in part;
  (2) there is exterior or structural damage allowing elemental intrusion, such as rain, wind, hail, or flood;
  (3) immediate safety hazards have yet to be cleared, such as debris on roofs or downed electrical lines; or
  (4) the rental is without electricity or water. An Insured’s Destination is inaccessible if he or she cannot reach the property by the original mode of transportation.

• Exclusions

  PRE-EXISTING MEDICAL CONDITION EXCLUSION:
  The Insurer will not pay for any loss or expense incurred as the result of an Injury, Sickness or other condition of you, traveling companion, business partner or Immediate Family Member which, within the 180 day period immediately preceding and including your coverage effective date: first manifested itself or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or for which care or treatment was given or recommended by a Physician; or required the taking of prescription drugs or medicines, unless the condition for which the drugs or medicines are taken remains controlled without any change in the prescription drugs or medicines.

  In addition to any exclusions which apply to a particular benefit (called “Additional Exclusions”), the policy does not cover any loss caused by:
  a) intentionally self-inflicted Injury or any attempt at an intentionally self-inflicted Injury, suicide, or attempted suicide by the Insured, Immediate Family Member, Traveling Companion or Business Partner; (while sane, in Colorado and Missouri);
  b) pregnancy or childbirth, or elective abortion, other than the Complications of Pregnancy;
  c) participation in professional athletic events, motor sport, or motor racing, including training or practice for the same;
  d) Mountain Climbing (meaning the ascent or descent of a mountain requiring the use of specialized equipment, including but not limited to pick-axes, anchors, bolts, crampons, carabineers and lead or top-rope anchoring equipment);
  e) war or act of war, whether declared or not, civil commotion, riot, or insurrection;
  f) operating or learning to operate any aircraft, as student, pilot, or crew;
  g) air travel on any air-supported device, other than a regularly scheduled airline or air charter company;
  h) loss or damage caused by detention, confiscation, or destruction by customs;
  i) any unlawful acts, committed by the Insured, Immediate Family Member, or a Traveling Companion, whether insured or not (not applicable in Florida);
  j) mental, psychological or nervous disorders including, but not limited to, anxiety, depression, neurosis or psychosis;
  k) if the Insured’s tickets do not contain specific travel dates (open tickets);
  l) alcohol or substance abuse or treatment for same;
  m) an Injury or Sickness which occurs at a time when this coverage is not in effect;
  n) elective or non-emergency treatment or surgery, except for any necessary treatment or surgery due to covered Injury or Sickness;
  o) Experimental or Investigative treatment or procedures.

  In addition to the General Exclusions, Trip Cancellation and Trip Interruption coverage is not provided for losses caused by or as a result of:
  (i) travel arrangements cancelled by an airline, cruise line, or tour operator, except as provided elsewhere in the policy;
  (ii) changes in plans by the Insured, an Immediate Family Member, or Traveling Companion, for any reason;
  (iii) financial circumstances of the Insured, an Immediate Family Member, or a Traveling Companion;
  (iv) any business or contractual obligations of the Insured, an Immediate Family Member, or Traveling Companion;
  (v) Default by the person, agency, or tour operator from whom the Insured bought his/her coverage and purchased his/her travel arrangements;
  (vi) any government regulation or prohibition;
  (vii) an event which occurs prior to the Insured’s coverage Effective Date for Trip Cancellation coverage, whether known to the Insured or not;
  (ix) financial default.

  Additional Exclusions to Loss of Baggage and Personal Effects: In addition to the General Exclusions, the Insurer will not pay for any loss due to:
  a) defective materials or craftsmanship;
  b) normal wear and tear;
  c) gradual deterioration; or
  d) rodents, animals, vermin, or insects.

  Additional Medical Expense Benefit Exclusions: In addition to the General Exclusions, coverage is not provided for:
  a) routine physical examinations;
  b) mental, psychological or nervous disorders including but not limited to: anxiety, depression, neurosis or psychosis, panic attacks and post-traumatic stress disorder;
  c) replacement of hearing aids, eye glasses, contact lenses, sunglasses, for the correction of vision or fitting of glasses;
  d) routine dental care, dentures, false teeth;
  e) alcohol or substance abuse or treatment for same;
  f) any service provided by the Insured, an Immediate Family Member, or Traveling Companion.

  Additional Optional Car Rental Collision Coverage Exclusions: In addition to the General Exclusions, coverage is not provided for loss due to:
  a) any loss which occurs if the Insured or his/her Traveling Companion is in violation of the rental agreement;
  b) rentals of trucks, campers, trailers, off-road vehicles, motor bikes, motorcycles, recreational vehicles, or Exotic Vehicles;
  c) any obligation the Insured or his or her Traveling Companion assumes under any agreement except insurance collision deductible;
  d) failure to report the loss to the proper local authorities and the rental car company;
  e) damage to any other vehicle, structure, or person as a result of a covered loss;
  f) driving under the influence of alcohol;
  g) Injury sustained while committing or attempting to commit a crime (not applicable in FL.)