Emergency Evacuation arranges to medically transport a patient to an appropriate medical facility. Medical Repatriation arranges for a patient to return home to receive care. Repatriation of Remains arranges for return of deceased remains back to the place of residence.
MEDICAL EVACUATION & REPATRIATION BENEFITS
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 Covered Trip.
Covered Expenses:
1. 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;
2. 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, when deemed medically necessary by the attending Physician, subject to the Program Medical Advisors prior approval;
3. 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;
4. expenses for transportation not to exceed the cost of one-way economy class air fare to your place of residence, 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;
5. expenses for one-way economy class air fare (or first class, if your original tickets were first class) to the your place of residence, 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 plan;
6. repatriation expenses for preparation and air transportation of your remains to your place of residence, or up to an equivalent amount for a local burial in the country where death occurred.
Your duties in the event of a Medical Expense:
1. You must provide us with all bills and reports for medical and/or dental expenses claimed.
2. You must provide any requested information, including but not limited to, an explanation of benefits from any other applicable insurance.
3. You must sign a patient authorization to release any information required by us, to investigate your claim.
In this Description of Coverage, “you”, “your” and “yours” refer to the Insured. “We”, “us” and “our” refer to the company providing the coverage. In addition certain words and phrases are defined as follows:
Accident means a sudden, unexpected, unintended and external event, which causes Injury.
Actual Cash Value means purchase price less depreciation.
Baggage means luggage, personal possessions and travel documents taken by you on the Covered Trip.
Common Carrier means any land, water or air conveyance operated under a license for the transportation of passengers for hire.
Covered Trip means: 1) a period of travel away from Home to a destination outside your city of residence and the Trip does not exceed 180 days.
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 affi davit 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.
Family Member includes your or the Traveling Companion’s dependent, spouse, child, spouse’s child, son-daughter-in-law, parent(s), sibling(s), brother-sister, 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.
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).
Injury means bodily harm caused by an Accident which: 1) occurs while your coverage is in effect under the plan; 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 Covered Trip, completes any required enrollment form, and pays any required plan payment.
Insurer means Stonebridge Casualty Insurance Company.
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 a 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 Benefit Schedule.
Schedule means the Benefit Schedule shown Description of Coverage for each Insured.
Scheduled Departure Date means the date on which you are originally scheduled to leave on your Covered Trip.
Scheduled Return Date means the date on which you are originally scheduled to return to the point where the Covered 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 plan 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 plan is not a Sickness as defined herein and is not covered by the plan.
Traveling Companion means a person whose name(s) appear(s) with you on the same Covered Trip arrangement.
Usual and Customary Charge means those charges for necessary treatment and services that are reasonable for the treatment of cases of comparable severity and nature. This will be derived from the mean charge based on the experience in a related area of the service delivered and the schedule of fees valued at the 100th percentile.
The following exclusion applies to the Accidental Death & Dismemberment coverage:
1. We will not pay for loss caused by or resulting from Sickness of any kind.
The following exclusion applies to all coverages:
We will not pay for any loss under the plan, caused by, or resulting from:
1. You the Insured, Your, Traveling Companions, Domestic Partner or Family Member’s suicide, attempted suicide, or intentionally self-inflicted injury, booked to travel with you, while sane or insane;
2. mental, nervous, or psychological disorders (does not apply to Medical Expense Benefits);
3. being under the influence of drugs or intoxicants, unless prescribed by a Physician;
4. normal pregnancy or resulting childbirth or elective abortion;
5. participation as a professional in athletics;
6. riding or driving in any motor competition;
7. declared or undeclared war, or any act of war;
8. civil disorder;
9. service in the armed forces of any country;
10. operating or learning to operate any aircraft, as pilot or crew;
11. 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;
12. any criminal acts, committed by you;
13. a loss or damage caused by detention, confiscation or destruction by customs;
14. Elective Treatment and Procedures;
15. medical treatment during or arising from a Covered Trip undertaken for the purpose or intent of securing medical treatment;
16. a loss that results from an illness, disease, or other condition, event or circumstance which occurs at a time when the plan is not in effect for you.
The following exclusion applies to the Baggage & Personal Effects and Baggage Delay coverages:
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.
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.