The Medical Deductible is a co-pay amount which is the responsibility of the insured. Options vary by plan and can range from $0 to $2500. Deductibles can be charged 1) per policy; or 2) per person; or 3) per occurrence, injury or illness; or 4) combination of the above. Most Long Term Plans require you to select a deductible option while most Vacation plans offer a zero deductible benefit.
There is no Medical Deductible with this plan.
The following are key words and phrases used in this certificate. When these words and phrases, or forms of them, are used, they are capitalized. As You read this certificate, refer back to these definitions.
Accident: means a sudden, unexpected, unusual, specific and abrupt event. Such event must occur by chance at an identifiable time and place while coverage is in force. Any loss caused by, or resulting from a sickness or disease is not an Accident.
TADEF-1AA
Actual Cash Value: means the original cost of Your Baggage and Personal Effects less any depreciation as determined by Us.
PCDEF-1AA
Additional Transportation Cost: means the actual cost incurred for one-way, Economy Transportation as charged by a Common Carrier, reduced by the value of an unused travel ticket.
PCDEF-2AA
Baggage and Personal Effects: means any luggage or goods being used by You during a Covered Trip.
PCDEF-3AA
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 U.S.C. Subsection 101 et seq.
PCDEF-4AA
Business Partner: means an individual who has at least a 20% ownership interest in a commercial enterprise in which You also have at least a 20% ownership interest; and You are both actively engaged in the daily management of the business.
TADEF-2AA
Commercial Rental Vehicle Agency: means an agency licensed under the laws of the jurisdiction of operation which rents vehicles for the personal use of its customers subject to the terms and conditions found within a rental agreement.
PCDEF-5AA
Common Carrier: means any public land, water, or air conveyance operated under a license for the transportation of passengers for hire.
TADEF-3AA
Confirmation of Coverage: means the coverage confirmation provided to You following enrollment and payment of the applicable premium as calculated on the enrollment form. The Confirmation of Coverage is attached to and made a part of this certificate.
TADEFC-4AA
Covered Trip: means scheduled trips, tours or cruises for which:
1) coverage is requested;
2) the required premium is paid prior to Your Effective Date of coverage; and
3) the trip exceeds 150 miles from Your Primary Residence.
TADEF-5AA
Default: means the inability to provide contracted services due to total cessation or complete suspension of operations due to financial insolvency, with or without the filing of a Bankruptcy petition, whether voluntary or involuntary, by a tour operator, cruise line, airline, or other Travel Supplier which is duly licensed in the states of operation other than the person, organization, agency or firm from whom You directly purchased or to whom You paid for Your Covered Trip.
PCDEF-6AA
Destination: means the place to which You expect to travel on Your Covered Trip.
TADEF-6AA
Economy Transportation: means transportation at the lowest published available rate for a ticket on a Common Carrier matching the original class of transportation that You purchased for the Covered Trip.
TADEF-7AA
Emergency: means an unforeseen Sickness or Injury that requires immediate Medical Treatment to prevent or alleviate existing danger to life or health. An Emergency no longer exists when medical evidence indicates that You are able to return to Your Point of Origin or to continue with the Covered Trip without endangering Your life or physical health.
TADEF-8AA
Emergency Medical Expenses: means expense incurred during Your Covered Trip for Emergency services and supplies listed below and ordered or prescribed by a Physician as Medically Necessary for diagnosis or treatment. Such Expenses are limited to:
1) the services of a Physician;
2) Hospital or ambulatory medical-surgical center services (this will also include expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a hospital room for recovery of an Injury or Sickness); and
3) transportation furnished by a professional ambulance company to and from a Hospital; and
4) prescribed drugs, prosthetics and therapeutic services and supplies.
TADEF-9AA
Family Member: means legal spouse or common-law spouse (where legal), legal guardian, legal ward, 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), great-grandparent, grandchild, great-grandchild, aunt, uncle, niece, nephew or Key Person provided such Family Member resides in the United States, Canada or Mexico.
TADEF-10AA
Hospital: means an institution established according to law which:
1) holds a license as a Hospital (if required in the state);
2) operates primarily for the reception, care and
treatment of sick or injured persons as in-patients;
3) provides 24-hour nursing service;
4) has a staff of one or more Physicians available at all times;
5) provides organized facilities for diagnosis and surgery;
6) is not primarily a clinic, nursing, rest or convalescent home or a skilled nursing facility or similar establishment; and
7) is not, other than incidentally, a place for treatment of alcoholism, drug addiction or mental or nervous disorders.
The nursing service must be by registered or graduate nurses on duty or call. Confinement in a special unit of a Hospital used primarily as a nursing, rest or convalescent home or skilled nursing facility will not be deemed to be a confinement in a Hospital.
TADEF-11AA
Host at Destination: means the person, at his or her usual place of residence, with whom You have arranged overnight accommodation for the majority of Your Covered Trip. A Host at Destination does not include any commercial facilities.
PCDEF-7AA
Inclement Weather: means any weather condition that delays the scheduled arrival or departure of a Common Carrier.
PCDEF-8AA
Injury: means bodily injury caused by an Accident: The injury must:
1) occur while Your coverage is in force;
2) result, directly and independently of all other causes; and
3) be certified by a local attending Physician.
TADEF-12AA
Insured: means the eligible person whose insurance is in force under terms of the Policy.
TADEFC-13AA
Key Person: means
1) an employed caregiver of Your legal dependent; or
2) a person to whom You are not married and with whom You have cohabited for 12 continuous months.
TADEF-14AA
Maximum Benefit Amount: means the maximum amount payable for each coverage as shown in Your Confirmation of Coverage.
TADEF-15AA
Maximum Waiver Amount: means the maximum limit of benefits for Trip Cancellation and Emergency Medical Expenses, as stated on Your Confirmation of Coverage, where the Pre-existing Exclusion is not applied.
TADEF-16AA
Medical Treatment: means treatment, advice or consultation by a Physician or care provided under a Physician’s supervision or direction.
TADEF-17AA
Medically Necessary: means an Emergency treatment, service or supply that is:
1) recommended by the local attending Physician;
2) performed under the Physician’s care, or supervision; and
3) determined by Us to be:
a) consistent with generally accepted medical practice for the Injury or Sickness;
b) could not have been omitted without adversely affecting Your condition or quality of medical care;
c) is delivered at the most appropriate level of care, and not primarily for the sake of convenience; and
d) is not considered experimental unless coverage for experimental service or supply is required by law.
TADEF-18AA
Natural Disaster: means a disaster resulting from natural causes including flood, hurricane, tornado, earthquake, volcanic eruption or blizzard.
PCDEF-9AA
Organized Labor Strike: means any stoppage of work:
1) as a result of the combined effect of workers which was unannounced and unpublished at the time coverage under the Policy was purchased;
and
2) that interferes with the normal departure and arrival of a Common Carrier.
It does not include a general strike whereby all or most of the workers of a country, province, state, city or town cease work.
PCDEFC-10AA
Physician: means a medical doctor or a Christian Science practitioner who is:
1) practicing within the scope of his or her license; and
2) recognized as a physician in the place where medical services are rendered. Physician does not include You, a Traveling Companion or a Family Member.
TADEF-20AA
Point of Origin: means Your original place of departure for Your Covered Trip. TADEF-21AA
Pre-existing Condition: means a condition occurring during the 60 day period immediately prior to Your Effective Date:
1) for which medical advice, care or treatment was received or recommended by a Physician regardless of whether or not a diagnosis was made and;
2) which produced symptoms or whose onset or manifestation occurred during such 60 day period. Such symptoms must have been significant enough to establish manifestation or onset which would have:
a) caused an ordinarily prudent person to seek diagnosis or treatment; or
b) enabled a Physician to diagnose such illness, disease, injury or other condition.
A Pre-existing Condition does not include any condition which is solely controlled through the taking of prescription medication and which has remained stable or controlled without any adjustment or change in the required prescription throughout the 60 day period immediately prior to Your Effective Date.
TADEF-22BA
Primary Residence: means Your principal domicile.
TADEF-23AA
Published Penalties: means any published cancellation penalties issued by Your travel agency or Travel Supplier that apply to all clients of the travel agency or Travel Supplier and can be documented at time of the Covered Trip sale. Published Penalties includes any penalties imposed by the travel agency or Travel Supplier of up to 10% of the Covered Trip Cost (excluding taxes and other non-commissionable items); or 10% of the amount You have paid towards the Trip, whichever is less.
PCDEF-11AA
Rental Vehicle: means any motor vehicle rented from a Commercial Rental Vehicle Agency as described in the rental agreement. A Rental Vehicle does not include trucks, vans, buses, motorcycles, mopeds, motorbikes, recreational all-terrain vehicles, campers, trailers, limousines, and vehicles 20 years of age or older, any vehicles specifically designed for off-road use and any exotic vehicles including, but not limited to Aston Martin, Bentley, Bricklin, Daimler, De Lorean, Excalibur, Ferrari, Jensen, Lamborghini, Lotus, Maserati, Mercedes Benz, Porsche, Rolls Royce, or any other similar vehicle.
PCDEF-12AA
Scheduled Departure Date: means the date on which You are originally scheduled to leave Your Point of Origin.
TADEF-24AA
Scheduled Return Date: means the date You are originally scheduled to return to the Point of Origin as shown in Your Confirmation of Coverage.
TADEF-25AA
Sickness: means an illness or disease which is diagnosed or treated by a Physician after Your Effective Date and while You are covered under the Policy.
TADEFC-26AA
Terrorist Incident: means the unsanctioned and illegal use of violence (excluding general civil disturbance, rioting, an act of war whether declared or undeclared or the intentional release of a biological material), which caused destruction of property, Injury, or death by an individual or group for the express or implied purpose of achieving a political, ethnic, or religious goal or result.
PCDEF-13BB
Transportation Expense: means
1) the cost of the conveyance of You and any medical
personnel (if Medically Necessary); and
2) Medically Necessary services and supplies
provided during Your conveyance.
TADEF-27AA
Travel Arrangements: means:
1) transportation;
2) travel accommodations; and
3) other specified services arranged by the Travel Supplier for the Covered Trip.
TADEF-29AA
Traveling Companion: means a person with whom You
1) have coordinated Travel Arrangements; and
2) intend to travel with during Your Covered Trip (up to a maximum of 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.
TADEF-30CC
Travel Supplier: means any entity or organization that coordinates or supplies travel services for You.
TADEF-31AA
Trip Cost: means all prepaid Covered Trip costs that are subject to cancellation penalties or restrictions including the cost of any subsequent arrangements added to Your Covered Trip.
TADEF-32AA
Usual and Customary Charges: means the amount charged for similar or comparable treatment, services and supplies in the geographic area where treatment is performed.
TADEF-33AA
We, Our and Us: mean Old Republic Insurance Company.
TADEF-34AA
You, Your and Yours: mean the Insured to whom this certificate is issued.
TADEFC-35AA
Some exclusions below may not apply or may differ in your state of residence. Please review your state specific Evidence of Coverage/Certificate for complete details.
Property and Casualty Benefits are Trip Cancellation, Trip Interruption, Trip Delay, Missed Connection, Itinerary Change, Baggage and Personal Effects, Baggage Delay and Rental Vehicle Damage Protection.
Accident and Health Benefi ts are Accidental Death and Dismemberment and Emergency Medical Benefits.
The Policy does not cover any loss caused by or resulting from:
1) suicide, attempted suicide, or any intentionally self infl icted Injury;
2) war or act of war (whether declared or undeclared);
3) service in the Armed Forces or units auxiliary thereto;
4) aviation, other than as a fare-paying passenger on a scheduled or charter fl ight operated by a scheduled airline;
5) intoxication or under the infl uence of any medication or drugs, unless taken as prescribed by a Physician. Intoxication means that which is defi ned and determined by the laws of the jurisdiction where the loss or cause of loss occurred;
6) participation in a felony;
7) participation in a riot or insurrection;
8) mental or emotional disorders unless hospitalized for 3 or more consecutive days after Your Effective Date;
9) a condition for which You have received advice from a Physician advising against travel 90 days prior to Your Effective Date;
10) any elective Medical Treatment;
11) pregnancy except complications of pregnancy;
12) travel to or through a city or country of Destination, as refl ected in Your travel itinerary, which is under a travel warning issued by the United States Department of State at the time this insurance is purchased and the loss or delay was a direct result of the incidents surrounding the travel warning, unless You are in the United States, its possessions or the countries of Canada and Mexico.
13) riding, driving or participating in races, or speed or endurance contests;
14) mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes or other special equipment);
15) participating as a member of a team in an organized sporting competition or as a professional in athletics;
16) participating in skydiving, hang gliding, bungee cord jumping, deep sea diving or scuba diving (unless You hold an open water diving certifi cate or You are accompanied by a dive master and not diving deeper than 130 feet);
17) a governmental regulation or prohibition (applies to Property and Casualty Benefi ts only);
18) a diagnosed sickness from which no recovery is expected and for which only palliative treatment is provided and which carries a prognosis of death within 12 months of Your Effective Date;
19) any sub-orbital or orbital space flights; or
20) travel for the purpose of receiving medical care, medication or treatment (applies to Property and Casualty Benefits only).
MAXIMUM LIMIT OF LIABILITY
(For Other Than Emergency Medical Evacuation/ Repatriation): All limits are applied per trip. Our maximum limit of liability resulting from the same occurrence will be $10,000,000. If the loss for all Insureds from such an occurrence exceeds $10,000,000, We will pay each Insured that proportion of the benefi ts stated which $10,000,000 bears to the total loss of all persons insured under all travel insurance in force with Us. We will pay no more than $1,000,000 per occurrence to or on account of any person insured.
PRE-EXISTING CONDITIONS EXCLUSION
The Policy does not cover Trip Cancellation/Interruption and Emergency Medical Benefi ts losses or expenses if they result from a Pre-existing Condition.
PRE-EXISTING CONDITIONS LIMITATION
If You have purchased a program where the Pre-existing Conditions Exclusion is waived, We cover these Pre-existing Conditions up to the Maximum Waiver Amount provided:
1) Your insurance was purchased within 21 days of the initial Covered Trip payment;
2) You had not fi led a claim with any insurer for Trip Cancellation/Interruption due to a sickness or injury within 90 days prior to the purchase of the Policy; and
3) the condition is not excluded by the
GENERAL EXCLUSIONS AND LIMITATIONS.
The Pre-Existing Conditions Exclusion applies to all amounts over the Maximum Waiver Amount shown on the Confi rmation of Coverage except for Medical Evacuation/Repatriation benefi ts which are not subject to the Maximum Waiver Amount.
If You do not meet the above criteria, You will still be covered for Trip Cancellation/Interruption and Emergency Medical Benefi ts caused by reasons other than those related to the Pre-existing Condition.
In addition to any other Exclusions listed in the Policy, no coverage is provided for any lost, stolen, damaged or delayed Baggage and Personal Effects for which You have been reimbursed:
1) by the Common Carrier, hotel or Travel Supplier, including any services rendered by such Common Carrier, hotel or Travel Supplier; or
2) as specified under any other insurance coverage You may have for the loss of or damage to property.
No coverage is provided under this benefit for any loss or damage to:
1) any animals;
2) automobile and automobile equipment, aircraft, bicycles, except when checked as baggage with a Common Carrier, boats or other vehicles or conveyances, trailers, motors;
3) the following personal items:
a) sunglasses (prescription or non-prescription), contact lenses;
b) artificial teeth, dental bridges, hearing aids, prosthetic limbs, or prescribed medications;
c) keys, money, credit cards, tickets and documents (except as coverage is otherwise specifically provided herein), stamps, securities;
d) sporting equipment if the loss results from the use thereof;
e) travel tickets for the Covered Trip, except for administrative fees required to reissue such tickets;
4) household effects and furnishings, antiques and collector’s items;
5) perishable or consumable items, including any tobacco products;
6) property used in trade, business or for the production of income;
7) computer software, including any expenses incurred for the restoration of any lost or corrupted data;
8) property shipped as freight or property shipped prior to Your Departure Date; or
9) any Baggage and Personal Effects determined to be contraband by Customs officials or other authorities.
In addition, no coverage is provided under this provision for loss caused by or resulting from:
1) theft from an unattended vehicle;
2) defective materials or craftsmanship; normal wear and tear, gradual deterioration, inherent vice;
3) electrical current, including electric arcing, that damages or destroys electrical devices or appliances;
4) the mysterious disappearance of Your Baggage and Personal Effects;
5) the confiscation, detention, requisition or destruction of Your Baggage and Personal Effects by Customs or other authorities.
Rental Vehicle Damage Protection
In addition to any other Exclusions listed in the Policy, no coverage is provided under this provision if:
1) the Commercial Rental Vehicle Agency waives or assumes responsibility for expenses incurred as a result of any physical loss or damage to the Rental Vehicle for which You may be liable;
2) any amounts are paid or payable under any other insurance coverage You might have.
No coverage is provided under this provision for physical loss of or damage to the Rental Vehicle caused by or resulting from:
1) driving the Rental Vehicle while You are:
a) using any medication which recommends abstinence from driving;
b) receiving compensation or hire;
c) participating in an illegal activity, or transporting contraband; or
d) in violation of the terms and conditions of the rental agreement;
2) mechanical failure or breakdown of the Rental Vehicle; wear and tear, gradual deterioration, corrosion, rust or freezing;
3) any neglect or abuse of the Rental Vehicle either by the Commercial Rental Vehicle Agency or You;
4) any conversion or modification to the Rental Vehicle by or at Your direction; or
5) contamination of the Rental Vehicle by radioactive material.