What is Covid-19 Medical?

Covid-19 Medical can reimburse the medical costs a traveler incurs in the event they contract the virus during a trip.

Covid-19 Medical is included within some policies under the Emergency Medical benefit. This benefit is designed to cover treatment specifically for travelers who unexpectedly contract Covid-19 while traveling. Squaremouth recommends a policy with at least $50,000 in coverage for international travel, and at least $100,000 for cruises or travel to a remote location.

Please be aware that coverage and eligibility requirements for this benefit differ by policy. The tables below show the providers that offer Covid-19 Medical coverage.

Search & Compare Travel Insurance Policies
All policies provide worldwide coverage unless stated prior to purchase.
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April Travel Protection
April Travel Protection
Policy Name and Summary of Coverage
1

Trip Cancellation Plan

No coverage

There is no Covid-19 Medical coverage with this plan.

2

Choice

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL AND DENTAL COVERAGE

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; and

2. Benefits will be payable only for covered expense resulting from a Sickness that first manifests itself or an Injury that occurs while on a Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you while on your Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental 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 related to the claimed expense(s), 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.

Please refer to the Definitions, for an explanation of PreExisting Conditions, which are excluded under the Medical or Dental Expense Benefits.

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3

Choice

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL AND DENTAL COVERAGE

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; and

2. Benefits will be payable only for covered expense resulting from a Sickness that first manifests itself or an Injury that occurs while on a Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you while on your Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental 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 related to the claimed expense(s), 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.

Please refer to the Definitions, for an explanation of PreExisting Conditions, which are excluded under the Medical or Dental Expense Benefits.

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4

Annual Plan

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL AND DENTAL COVERAGE

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; and

2. Benefits will be payable only for covered expense resulting from a Sickness that first manifests itself or an Injury that occurs while on a Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your
primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician‐ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you while on your Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental 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 related to the claimed expense(s), 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. Please refer to the Definitions, for an explanation of Pre‐Existing Conditions, which are excluded under the Medical or Dental Expense Benefits.

Coordination of Benefits

If you reside in CT, ID, IL, and excess coverage for Medical and Dental Expense Benefits is not permitted, then coordination of benefit provisions in accordance with the laws and regulations in your state will apply in lieu of the excess coverage provisions.

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5

Pandemic Plus

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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AXA Assistance USA
AXA Assistance USA
Policy Name and Summary of Coverage
6

Silver

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip. Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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7

Gold

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip. Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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8

Platinum

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip. Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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battleface
battleface
Policy Name and Summary of Coverage
9

Travel Medical Single Trip

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

TRAVEL MEDICAL EXPENSE

We will pay a benefit to reimburse you for the reasonable and customary charges, up to the maximum limit shown in the schedule of benefits (and after satisfaction of the deductible) if you suffer an injury or sickness during the covered trip that requires treatment by a physician. The injury must occur or the sickness must first begin while on a covered trip. The initial documented treatment must be given by a physician during the covered trip.

Travel Medical Covered Expenses:

We will pay a benefit to reimburse you the medically necessary expenses incurred for:

a. Services of a physician or registered nurse (R.N.), and related tests or treatment;

b. Hospital charges or ambulatory medical-surgical center services (this may 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 from an injury or sickness;

c. Prescription medication to treat the injury or sickness;

d. Charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;

e. Local ambulance services to and from a hospital;

f. Hospital room and board subject to the daily limit shown in the schedule of benefits;

g. Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;

h. The cost of emergency dental treatment for accidental injury to sound natural teeth that occurs during a covered trip limited to the Maximum Limit shown in the schedule of benefits.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after you have reached your return destination, regardless of the reason. The treatment must be given by a physician or dentist.

We will pay a benefit to reimburse you for these expenses for all treatment related to the initial injury or sickness for thirty (30) days from the date of the first treatment during the covered trip, or until the return date, whichever is later. Otherwise, we will not pay for any expenses incurred after the Coverage Termination Date as shown in the Effective and Termination Dates section of this policy, regardless of the reason.

We will not pay benefits in excess of the reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or already included within the cost of the covered trip.

Advance Payment: If you require admission to a hospital during a covered trip for an injury or sickness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. Hospital confinement must be certified as medically necessary by the onsite attending physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the schedule of benefits. You agree to reimburse this payment to us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or

b. It is determined that your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by you. However:

a. We reserve the right to deny a request for advance payment if we confirm that your claim is not covered under the Policy; and

b. An advance payment made by us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the policy.

Travel Medical Expense Exclusions:

In addition to the General Limitations and Exclusions, the following exclusions apply to the Travel Medical Expense Benefit. No benefits will be paid for any loss for, caused by, or resulting from:

a. Any service provided by you, a family member, or your traveling companion;
b. Alcohol or substance abuse or treatment for the same;
c. Experimental or investigative treatment or procedures;
d. Expenses incurred by any child born during the covered trip;
e. Care or treatment which is not medically necessary, except for related reconstructive surgery resulting from trauma, infection or disease;
f. Mental health care; or
g. Physical therapy or occupational therapy.

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10

Explorer

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

TRAVEL MEDICAL EXPENSE

We will pay a benefit to reimburse you for the reasonable and customary charges, up to the maximum limit shown in the schedule of benefits (and after satisfaction of the deductible) if you suffer an injury or sickness during the covered trip that requires treatment by a physician. The injury must occur or the sickness must first begin while on a covered trip. The initial documented treatment must be given by a physician during the covered trip.

Travel Medical Covered Expenses:

We will pay a benefit to reimburse you the medically necessary expenses incurred for:

a. Services of a physician or registered nurse (R.N.), and related tests or treatment;
b. Hospital charges or ambulatory medical-surgical center services (this may 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 from an injury or sickness;
c. Prescription medication to treat the injury or sickness;
d. Charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;
e. Local ambulance services to and from a hospital;
f. Hospital room and board subject to the daily limit shown in the schedule of benefits;
g. Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices; and
h. The cost of emergency dental treatment for accidental injury to sound natural teeth that occurs during a covered trip limited to the Maximum Limit shown in the schedule of benefits.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after you have reached your return destination, regardless of the reason. The treatment must be given by a physician or dentist.

We will pay a benefit to reimburse you for these expenses for all treatment related to the initial injury or sickness for thirty (30) days from the date of the first treatment during the covered trip, or until the return date, whichever is later. Otherwise, we will not pay for any expenses incurred after the Coverage Termination Date as shown in the Effective and Termination Dates section of this policy, regardless of the reason.

We will not pay benefits in excess of the reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or already included within the cost of the covered trip.

Adventure Sports Coverage: Benefits will be paid up to the limit shown in the schedule of benefits, if you suffer an injury while participating adventure activities.

Advance Payment: If you require admission to a hospital during a covered trip for an injury or sickness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. Hospital confinement must be certified as medically necessary by the onsite attending physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the schedule of benefits. You agree to reimburse this payment to us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or
b. It is determined that your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by you. However:

a. We reserve the right to deny a request for advance payment if we confirm that your claim is not covered under the Policy; and
b. An advance payment made by us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the policy.

Travel Medical Expense Exclusions:

In addition to the General Limitations and Exclusions, the following exclusions apply to the Travel Medical Expense Benefit. No benefits will be paid for any loss for, caused by, or resulting from:

a. Any service provided by you, a family member, or your traveling companion;
b. Alcohol or substance abuse or treatment for the same;
c. Experimental or investigative treatment or procedures;
d. Expenses incurred by any child born during the covered trip;
e. Care or treatment which is not medically necessary, except for related reconstructive surgery resulting from trauma, infection or disease;
f. Mental health care; or
g. Physical therapy or occupational therapy.

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Berkshire Hathaway Travel Protection
Berkshire Hathaway Travel Protection
Policy Name and Summary of Coverage
11

ExactCare

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre‐existing medical conditions will be covered if the Pre‐ existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:
● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X‐rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Berkshire Hathaway Specialty Concierge will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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12

ExactCare Value

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Berkshire Hathaway Specialty Concierge will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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13

LuxuryCare

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Preexisting Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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14

ExactCare Lite

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason.

The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Berkshire Hathaway Specialty Insurance will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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Cat 70
Cat 70
Policy Name and Summary of Coverage
15

Travel Plan

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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Generali Global Assistance
Generali Global Assistance
Policy Name and Summary of Coverage
16

Standard

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL AND DENTAL COVERAGE

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; and

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 Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you within one year from the date of your Sickness or Injury during a Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental 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 related to the claimed expense(s), 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.

Please refer to the Definitions, for an explanation of Pre- Existing Conditions, which are excluded under the Medical or Dental Expense Benefits.

Coordination of Benefits

If you reside in CT, ID, IL, and excess coverage for Medical and Dental Expense Benefits is not permitted, then coordination of benefit provisions in accordance with the laws and regulations in your state will apply in lieu of the excess coverage provisions.

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17

Preferred

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL AND DENTAL COVERAGE

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; and

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 Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you within one year from the date of your Sickness or Injury during a Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental 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 related to the claimed expense(s), 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.

Please refer to the Definitions, for an explanation of Pre- Existing Conditions, which are excluded under the Medical or Dental Expense Benefits.

Coordination of Benefits

If you reside in CT, ID, IL, and excess coverage for Medical and Dental Expense Benefits is not permitted, then coordination of benefit provisions in accordance with the laws and regulations in your state will apply in lieu of the excess coverage provisions.

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18

Premium

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL AND DENTAL COVERAGE

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; and

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 Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you within one year from the date of your Sickness or Injury during a Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental 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 related to the claimed expense(s), 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.

Please refer to the Definitions, for an explanation of Pre- Existing Conditions, which are excluded under the Medical or Dental Expense Benefits.

Coordination of Benefits

If you reside in CT, ID, IL, and excess coverage for Medical and Dental Expense Benefits is not permitted, then coordination of benefit provisions in accordance with the laws and regulations in your state will apply in lieu of the excess coverage provisions.

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GeoBlue
GeoBlue
Policy Name and Summary of Coverage
19

Voyager Choice

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

*Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing or expenses for quarantining (confinement outside of a hospital setting) are not covered under this Plan.

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate including for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Note: Injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United State government.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture

Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Choice of Hospital and Physician: Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan.

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

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20

Voyager Essential

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

*Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing or expenses for quarantining (confinement outside of a hospital setting) are not covered under this Plan.

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate including for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Note: Injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United State government.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture

Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Choice of Hospital and Physician: Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

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21

Trekker Choice excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

*Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing or expenses for quarantining(confinement outside of a hospital setting) are not covered under this Plan

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate other than for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture
Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Note: For existing and/or perspective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or travel to that country or location is issued by the United State government.

Choice of Hospital and Physician:

Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan.

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

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22

Trekker Essential excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

*Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing or expenses for quarantining (confinement outside of a hospital setting) are not covered under this Plan.

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate other than for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Note: Injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United State government.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture
Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Choice of Hospital and Physician: Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan.

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

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Global Underwriters
Global Underwriters
Policy Name and Summary of Coverage
23

Diplomat America

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT and SICKNESS MEDICAL EXPENSE BENEFIT

We will pay Usual Reasonable and Customary charges for Eligible Expenses, excess of the chosen Deductible and Coinsurance up to the selected Medical Maximum (age 60-69, medical maximum limited to $250,000 unless reduced maximum amount selected; age 70-79, medical maximum limited to $100,000 unless reduced maximum amount selected; age 80+ medical maximum limited to $20,000), incurred by You due to an accidental Injury or Sickness which occurred during the period of coverage inside the USA except as provided under the Incidental Trips benefit. All bodily disorders existing simultaneously which are due to the same or related causes will be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement, the Disablement will be considered a continuation of the prior Disablement and not a separate Disablement. The initial treatment of an Injury or Sickness must occur within 30 days of the date of Injury or onset of Sickness. For a covered disablement, after you pay the per person deductible, the plan pays 80% up to $5,000 of eligible costs, then 100% to the Medical Maximum. There will be an additional $250 deductible for each emergency room visit as a result of an Illness. The emergency room deductible will be waived if hospital admittance is within 12 hours of the incident.

We will pay Accident and Sickness Medical Expense Benefits for Eligible Expenses. These benefits are subject to the Deductibles, Coinsurance Factors, Benefit Maximums and other terms or limits shown below and in the Schedule of Benefits. Only such Expenses that are specifically enumerated in the following list of charges that are incurred for the medical care and supplies which are incurred within: 26 weeks from the date of the disablement will be considered.

Accident and Sickness Medical Expense Benefits are only payable:

1) for Usual, Reasonable and Customary Charges incurred after the Deductible has been met;

2) for those Medically Necessary Eligible Expenses incurred by or on behalf of the Plan Participant; No benefits will be paid for any expenses incurred that are in excess of Usual, Reasonable and Customary Charges.

Eligible Expenses include:

1) Hospital Admission Expenses: Charges for each hospital admission.

2) Outpatient Pre-Surgical Testing benefit – charges for Pre-surgical testing. A scheduled surgical procedure must occur within 7 days of the testing.

3) Nursing Services – Outpatient Charges for nursing services by a Registered Nurse or Licensed Professional.

4) Dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon.

5) Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.

6) In-Patient Hospital Room & Board Benefit, Intensive Care Unit Benefit, Hospital Miscellaneous Expense Benefit, Day Surgery Miscellaneous, Surgeon (In or Outpatient) Benefits, Assistant Surgeon Benefit (In or Outpatient).

7) Pre-Admission Testing Benefit, Anesthesia Benefit, Diagnostic X-Ray and Laboratory Benefit

8) Ambulance Benefit

9) Physician Visit Benefit (Inpatient or Outpatient), Consultant Physician Benefit.

10) Emergency Room Benefit, Physiotherapy Expense Benefit (In / URC) or (Outpatient / Chiropractic Care subject to $50 per visit 10 visits maximum), Durable Medical Equipment Expense Benefit

11) Out-Patient Prescription Drug Benefit; 30-day supply per prescription.

ADDITIONAL BENEFITS

Emergency Dental Treatment (Accident) – We will pay benefits as described in the Schedule of Benefits for expenses incurred during the Plan Participant’s Trip for emergency dental treatment. Only expenses for emergency dental treatment to natural teeth incurred during the Trip will be reimbursed. Expenses incurred after the Trip are not cover.

Emergency Dental Treatment (Palliative) – We will pay benefits as described in the Schedule of Benefits for eligible expenses for Palliative Dental; an eligible Dental condition will mean emergency pain relief treatment to natural teeth.

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24

Diplomat LT excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT and SICKNESS MEDICAL EXPENSE BENEFIT:

We will pay Usual Reasonable and Customary charges for Eligible Expenses, excess of the chosen Deductible and Coinsurance up to the selected Medical Maximum (age 70-79, medical maximum limited to $100,000 unless reduced maximum amount selected; age 80+ medical maximum limited to $20,000), incurred by You due to an accidental Injury or Sickness which occurred during the period of coverage outside your Home Country (except as provided under the Home Country Coverage). All bodily disorders existing simultaneously which are due to the same or related causes will be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement, the Disablement will be considered a continuation of the prior Disablement and not a separate Disablement. The initial treatment of an Injury or Sickness must occur within 30 days of the date of Injury or onset of Sickness.

We will pay Accident and Sickness Medical Expense Benefits for Eligible Expenses. These benefits are subject to the Deductibles, Coinsurance Factors, Benefit Maximums and other terms or limits shown below and in the Schedule of Benefits. Only such Expenses that are specifically enumerated in the following list of charges that are incurred for the medical care and supplies which are incurred within: i) 52 weeks for US Citizens; or ii) 26 weeks for Non US Citizens from the date of the disablement will be considered.

Accident and Sickness Medical Expense Benefits are only payable:

1) for Usual, Reasonable and Customary Charges incurred after the Deductible has been met;
2) for those Medically Necessary Eligible Expenses incurred by or on behalf of the Plan Participant;

No benefits will be paid for any expenses incurred that are in excess of Usual, Reasonable and Customary Charges.

Eligible Expenses include:

1) Hospital Admission Expenses: Charges for each hospital admission.

2) Outpatient Pre-Surgical Testing benefit – charges for Pre-surgical testing. A scheduled surgical procedure must occur within 7 days of the testing.

3) Nursing Services – Outpatient Charges for nursing services by a Registered Nurse or Licensed Professional.

4) Dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon.

5) Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.

6) In-Patient Hospital Room & Board Benefit, Intensive Care Unit Benefit, Hospital Miscellaneous Expense Benefit, Day Surgery Miscellaneous, Surgeon (In or Outpatient) Benefits, Assistant Surgeon Benefit (In or Outpatient).

7) Pre-Admission Testing Benefit, Anesthesia Benefit, Diagnostic X-Ray and Laboratory Benefit

8) Ambulance Benefit

9) Physician Visit Benefit (Inpatient or Outpatient), Consultant Physician Benefit.

10) Emergency Room Benefit, Physiotherapy Expense Benefit (In / URC) or (Outpatient / Physiotherapy Care subject to $50 per visit 10 visits maximum), Durable Medical Equipment Expense Benefit

11) Out-Patient Prescription Drug Benefit; 30-day supply per prescription.

Emergency Dental Treatment (Accident) -We will pay benefits as described in the Schedule of Benefits for expenses incurred during the Plan Participant’s Trip for emergency dental treatment. Only expenses for emergency dental treatment to natural teeth incurred during the Trip will be reimbursed. Expenses incurred after the Trip are not cover.

Emergency Dental Treatment (Palliative) – We will pay benefits as described in the Schedule of Benefits for eligible expenses for Palliative Dental; an eligible Dental condition will mean emergency pain relief treatment to natural teeth.

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25

Diplomat LT incl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT and SICKNESS MEDICAL EXPENSE BENEFIT:

We will pay Usual Reasonable and Customary charges for Eligible Expenses, excess of the chosen Deductible and Coinsurance up to the selected Medical Maximum (age 70-79, medical maximum limited to $100,000 unless reduced maximum amount selected; age 80+ medical maximum limited to $20,000), incurred by You due to an accidental Injury or Sickness which occurred during the period of coverage outside your Home Country (except as provided under the Home Country Coverage). All bodily disorders existing simultaneously which are due to the same or related causes will be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement, the Disablement will be considered a continuation of the prior Disablement and not a separate Disablement. The initial treatment of an Injury or Sickness must occur within 30 days of the date of Injury or onset of Sickness.

We will pay Accident and Sickness Medical Expense Benefits for Eligible Expenses. These benefits are subject to the Deductibles, Coinsurance Factors, Benefit Maximums and other terms or limits shown below and in the Schedule of Benefits. Only such Expenses that are specifically enumerated in the following list of charges that are incurred for the medical care and supplies which are incurred within: i) 52 weeks for US Citizens; or ii) 26 weeks for Non US Citizens from the date of the disablement will be considered.

Accident and Sickness Medical Expense Benefits are only payable:

1) for Usual, Reasonable and Customary Charges incurred after the Deductible has been met;
2) for those Medically Necessary Eligible Expenses incurred by or on behalf of the Plan Participant;

No benefits will be paid for any expenses incurred that are in excess of Usual, Reasonable and Customary Charges.

Eligible Expenses include:

1) Hospital Admission Expenses: Charges for each hospital admission.

2) Outpatient Pre-Surgical Testing benefit – charges for Pre-surgical testing. A scheduled surgical procedure must occur within 7 days of the testing.

3) Nursing Services – Outpatient Charges for nursing services by a Registered Nurse or Licensed Professional.

4) Dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon.

5) Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.

6) In-Patient Hospital Room & Board Benefit, Intensive Care Unit Benefit, Hospital Miscellaneous Expense Benefit, Day Surgery Miscellaneous, Surgeon (In or Outpatient) Benefits, Assistant Surgeon Benefit (In or Outpatient).

7) Pre-Admission Testing Benefit, Anesthesia Benefit, Diagnostic X-Ray and Laboratory Benefit

8) Ambulance Benefit

9) Physician Visit Benefit (Inpatient or Outpatient), Consultant Physician Benefit.

10) Emergency Room Benefit, Physiotherapy Expense Benefit (In / URC) or (Outpatient / Physiotherapy Care subject to $50 per visit 10 visits maximum), Durable Medical Equipment Expense Benefit

11) Out-Patient Prescription Drug Benefit; 30-day supply per prescription.

Emergency Dental Treatment (Accident) -We will pay benefits as described in the Schedule of Benefits for expenses incurred during the Plan Participant’s Trip for emergency dental treatment. Only expenses for emergency dental treatment to natural teeth incurred during the Trip will be reimbursed. Expenses incurred after the Trip are not cover.

Emergency Dental Treatment (Palliative) – We will pay benefits as described in the Schedule of Benefits for eligible expenses for Palliative Dental; an eligible Dental condition will mean emergency pain relief treatment to natural teeth.

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HTH Travel Insurance
HTH Travel Insurance
Policy Name and Summary of Coverage
26

TravelGap Voyager excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, subject to any Deductible shown on the Schedule of Benefits if You incur Covered Medical Expenses for Necessary Treatment as a result of an Accidental Injury or Sickness that occurs during the Trip. You must receive initial treatment for Accidental Injuries within thirty (30) days of the Accident that caused them or the onset of the Sickness and while on the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services; and
f) emergency and palliative dental treatment (limited to expenses incurred while on Your Trip).

The Company will not reimburse benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or Sickness which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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27

TripProtector Preferred

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Treatment of an Accidental Injury that occurs during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, overage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Treatment of a Sickness that first manifests itself during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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28

TravelGap Excursion excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, subject to any Deductible shown on the Schedule of Benefits if You incur Covered Medical Expenses for Necessary Treatment as a result of an Accidental Injury or Sickness that occurs during the Trip. You must receive initial treatment for Accidental Injuries within thirty (30) days of the Accident that caused them or the onset of the Sickness and while on the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services; and
f) emergency and palliative dental treatment (limited to expenses incurred while on Your Trip).

The Company will not reimburse benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or Sickness which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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29

TripProtector Economy

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Treatment of an Accidental Injury that occurs during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, overage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Treatment of a Sickness that first manifests itself during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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30

TripProtector Classic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Treatment of an Accidental Injury that occurs during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, overage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Treatment of a Sickness that first manifests itself during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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iTravelInsured
iTravelInsured
Policy Name and Summary of Coverage
31

Travel Lite

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL AND DENTAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a) benefits will be payable only for Medical Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on Your Trip (of a duration of one hundred eighty (180) days or less for Sickness) and requires treatment in person by a Physician;

b) only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy. An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

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32

Travel SE

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL AND DENTAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a) benefits will be payable only for Medical Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on Your Trip (of a duration of one hundred eighty (180) days or less for Sickness) and requires treatment in person by a Physician;

b) only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits. Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered. We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy. An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

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33

Travel LX

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL AND DENTAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a) benefits will be payable only for Medical Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on Your Trip (of a duration of one hundred eighty (180) days or less for Sickness) and requires treatment in person by a Physician;
b) only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits. Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;
2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;
3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental expenses incurred after Your Trip is completed are not covered;
4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy.

An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

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34

Travel LX Basic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL AND DENTAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a) benefits will be payable only for Medical Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on Your Trip (of a duration of one hundred eighty (180) days or less for Sickness) and requires treatment in person by a Physician;
b) only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits. Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;
2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;
3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental expenses incurred after Your Trip is completed are not covered;
4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy.

An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

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John Hancock Insurance Agency, Inc.
John Hancock Insurance Agency, Inc.
Policy Name and Summary of Coverage
35

Bronze

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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36

Silver

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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37

Gold

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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Nationwide Mutual Insurance Company
Nationwide Mutual Insurance Company
Policy Name and Summary of Coverage
38

Essential

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; 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 Trip, if recommended as a substitute for a Hospital room for recovery from a Sickness);

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; 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 Trip, if recommended as a substitute for a Hospital room for recovery from an Accidental Injury);

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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39

Prime

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.
Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; 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 Trip, if recommended as a substitute for a Hospital room for recovery from an Accidental Injury);

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; 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 Trip, if recommended as a substitute for a Hospital room for recovery from a Sickness);

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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Seven Corners Inc
Seven Corners Inc
Policy Name and Summary of Coverage
40

RoundTrip Choice

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT & SICKNESS MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip;
b. only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered;
c. benefits payable as a result of incurred Medical Expenses will only be paid after benefits have been paid under any other valid and collectible insurance in effect for You or in accordance with a provision in jurisdictions where excess coverage provisions are not permitted.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury, Sickness or Emergency Condition;

3. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Emergency Condition means an Injury or Sickness diagnosed by a Physician for which You have sudden and unexpected severe or acute symptoms requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of Your condition or place Your life in jeopardy. The severe or acute symptoms must occur while on Your Trip.

We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy. An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

Emergency Dental Expense Benefit

Benefits will be paid for Emergency Dental Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

1. benefits will be payable only for Emergency Dental Expenses resulting from an Injury to sound natural teeth that occurs while on Your Trip and requires treatment in person by a Physician;

2. only Emergency Dental Expenses incurred by You during Your Trip will be reimbursed. Dental Expenses incurred after You return from Your Trip are not covered;

3. benefits payable as a result of incurred Emergency Dental Expenses will only be paid after benefits have been paid under any other valid and collectible insurance in effect for You or in accordance with a provision in jurisdictions where excess coverage provisions are not permitted.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental Expenses incurred after Your Trip are not covered.

We will not pay benefits in excess of the Usual and Customary level of charges.

We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

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41

RoundTrip Economy

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 for expenses for emergency dental treatment due to Injury to natural teeth.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, prosthetics, and therapeutic services and supplies ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

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42

RoundTrip Elite

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 expenses for emergency dental treatment due to Injury to natural teeth.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, prosthetics, and therapeutic services and supplies ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

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43

Liaison Travel Plus excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

3.11 COVID-19 Treatment. – URC up to Medical Maximum or $100,000; whichever is less.

Subject to the terms of the Certificate, the Company will reimburse You for Expenses listed under Section 3.2, up to the amount set forth in the Schedule of Benefits, for Medically Necessary Treatment only for the following:

(i) COVID-19;
(ii) SARS-Cov-2; and
(iii) Any mutation or variation of SARS-CoV-2.

The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this Section 3.11.

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44

Wander Frequent Traveler Plus excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

COVID-19 Treatment – Age 14 days to 64 years: $100,000, Age 65 to 74 years: $50,000

Subject to the terms of the Certificate, the Company will reimburse You for Expenses listed under Section 3.2, up to the amount set forth in the Schedule of Benefits, for Medically Necessary Treatment only for the following:

(i) COVID-19;
(ii) SARS-Cov-2; and
(iii) Any mutation or variation of SARS-CoV-2.

The exclusions set forth in Section 8 apply to the coverage provided by the Certificate under this Section.

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45

RoundTrip Basic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT & SICKNESS
MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip;
b. only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered;
c. benefits payable as a result of incurred Medical Expenses will only be paid after benefits have been paid under any other valid and collectible insurance in effect for You or in accordance with a provision in jurisdictions where excess coverage provisions are not permitted.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us
or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury, Sickness or Emergency Condition;

3. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Emergency Condition means an Injury or Sickness diagnosed by a Physician for which You have sudden and unexpected severe or acute symptoms requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of Your condition or place Your life in jeopardy. The severe or acute symptoms must occur while on Your Trip.

We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy. An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

Emergency Dental Expense Benefit – up to $750

Benefits will be paid for Emergency Dental Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

1. benefits will be payable only for Emergency Dental Expenses resulting from an Injury to sound natural teeth that occurs while on Your Trip and requires treatment in person by a Physician;

2. only Emergency Dental Expenses incurred by You during Your Trip will be reimbursed. Dental Expenses incurred after You return from Your Trip are not covered;

3. benefits payable as a result of incurred Emergency Dental Expenses will only be paid after benefits have been paid under any other valid and collectible insurance in effect for You or in accordance with a provision in jurisdictions where excess coverage provisions are not permitted.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental Expenses incurred after Your Trip are not covered.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

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Tin Leg
Tin Leg
Policy Name and Summary of Coverage
46

Economy

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Covered Expenses:

The Company will reimburse the Insured for:

- services of a Physician or registered nurse (R.N.);
- Hospital charges;
- X-rays;
- local ambulance services to or from a Hospital;
- artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
- the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Tin Leg will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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47

Standard

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for reasonable and customary charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Preexisting Medical Condition Waiver is in effect.

Covered Expenses: The Company will reimburse the Insured for:

- services of a Physician or registered nurse (R.N.);
- Hospital charges;
- X-rays;
- local ambulance services to or from a Hospital;
- artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
- the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Tin Leg will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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48

Luxury

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Tin Leg will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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49

Adventure

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Preexisting Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EXCESS INSURANCE LIMITATION

The insurance provided by this Policy for all coverages except Baggage Delay, shall be in excess of all other valid and collectible insurance or indemnity. If at the time of the occurrence of any Loss payable under this Policy there is other valid and collectible insurance or indemnity in place, the Company shall be liable only for the excess of the amount of Loss, over the amount of such other insurance or indemnity, and applicable deductible. Medical Expense will become Primary if this plan is purchased within 15 days of Initial Trip Payment.

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50

Gold

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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51

Basic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

TRAVEL MEDICAL EXPENSE

We will pay a benefit to reimburse you for the reasonable and customary charges, up to the maximum limit shown in the schedule of benefits (and after satisfaction of the deductible) if you suffer an injury or sickness during the covered trip that requires treatment by a physician. The injury must occur or the sickness must first begin while on a covered trip. The initial documented treatment must be given by a physician during the covered trip.

Travel Medical Covered Expenses:

We will pay a benefit to reimburse you the medically necessary expenses incurred for:

a. Services of a physician or registered nurse (R.N.), and related tests or treatment;
b. Hospital charges or ambulatory medical-surgical center services (this may 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 from an injury or sickness;
c. Prescription medication to treat the injury or sickness;
d. Charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;
e. Local ambulance services to and from a hospital;
f. Hospital room and board subject to the daily limit shown in the schedule of benefits;
g. Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices; and
h. The cost of emergency dental treatment for accidental injury to sound natural teeth that occurs during a covered trip limited to the Maximum Limit shown in the schedule of benefits.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after you have reached your return destination, regardless of the reason. The treatment must be given by a physician or dentist.

We will not pay benefits in excess of the reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or already included within the cost of the covered trip.

Advance Payment: If you require admission to a hospital during a covered trip for an injury or sickness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. Hospital confinement must be certified as medically necessary by the onsite attending physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the schedule of benefits. You agree to reimburse this payment to us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or

b. It is determined that your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by you. However:

a. We reserve the right to deny a request for advance payment if we confirm that your claim is not covered under the Policy; and

b. An advance payment made by us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the policy.

Travel Medical Expense Exclusions:

In addition to the General Limitations and Exclusions, the following exclusions apply to the Travel Medical Expense Benefit. No benefits will be paid for any loss for, caused by, or resulting from:

a. Any service provided by you, a family member, or your traveling companion;
b. Alcohol or substance abuse or treatment for the same;
c. Experimental or investigative treatment or procedures;
d. Expenses incurred by any child born during the covered trip;
e. Care or treatment which is not medically necessary, except for related reconstructive surgery resulting from trauma, infection or disease;
f. Mental health care; or
g. Physical therapy or occupational therapy.

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52

Platinum

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

TRAVEL MEDICAL EXPENSE

We will pay a benefit to reimburse you for the reasonable and customary charges, up to the maximum limit shown in the schedule of benefits (and after satisfaction of the deductible) if you suffer an injury or sickness during the covered trip that requires treatment by a physician. The injury must occur or the sickness must first begin while on a covered trip. The initial documented treatment must be given by a physician during the covered trip.

Travel Medical Covered Expenses:

We will pay a benefit to reimburse you the medically necessary expenses incurred for:

a. Services of a physician or registered nurse (R.N.), and related tests or treatment;
b. Hospital charges or ambulatory medical-surgical center services (this may 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 from an injury or sickness;
c. Prescription medication to treat the injury or sickness;
d. Charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;
e. Local ambulance services to and from a hospital;
f. Hospital room and board subject to the daily limit shown in the schedule of benefits;
g. Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices; and
h. The cost of emergency dental treatment for accidental injury to sound natural teeth that occurs during a covered trip limited to the Maximum Limit shown in the schedule of benefits.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after you have reached your return destination, regardless of the reason. The treatment must be given by a physician or dentist.

We will not pay benefits in excess of the reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or already included within the cost of the covered trip.

Advance Payment: If you require admission to a hospital during a covered trip for an injury or sickness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. Hospital confinement must be certified as medically necessary by the onsite attending physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the schedule of benefits. You agree to reimburse this payment to us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or
b. It is determined that your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by you. However:

a. We reserve the right to deny a request for advance payment if we confirm that your claim is not covered under the Policy; and
b. An advance payment made by us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the policy.

Travel Medical Expense Exclusions:

In addition to the General Limitations and Exclusions, the following exclusions apply to the Travel Medical Expense Benefit. No benefits will be paid for any loss for, caused by, or resulting from:

a. Any service provided by you, a family member, or your traveling companion;
b. Alcohol or substance abuse or treatment for the same;
c. Experimental or investigative treatment or procedures;
d. Expenses incurred by any child born during the covered trip;
e. Care or treatment which is not medically necessary, except for related reconstructive surgery resulting from trauma, infection or disease;
f. Mental health care; or
g. Physical therapy or occupational therapy.

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53

USA Only

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Covered Expenses:

The Company will reimburse the Insured for:

- services of a Physician or registered nurse (R.N.);
- Hospital charges;
- X-rays;
- local ambulance services to or from a Hospital;
- artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
- the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Tin Leg will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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54

Silver

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

TRAVEL MEDICAL AND DENTAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits if You incur necessary Covered Expenses while on Your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip and the initial documented treatment is given by a Physician during this Trip.

Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for You. This coverage is in excess of any other health insurance You have available to You at the time of the loss. You must submit Your claim to that provider first. Any benefits You receive from Your primary or supplementary insurance providers will be deducted from Your claim with Us.

Covered Expenses for this benefit include but are not limited to:
a. The services of a Physician or registered nurse (R.N), and related test or treatment;
b. Charges for Hospital confinement and use of operating rooms;
c. Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel/Motel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);
d. Charges for anesthetics (including administration);
e. X-ray examinations or treatments, and laboratory tests;
f. Ambulance service;
g. Drugs, medicines, prosthetics and therapeutic services and supplies; and
h. Emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth while on Your Trip.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

Dental Covered Expenses

If You suffer an Injury or a Sickness that requires emergency dental treatment by a Dentist, We will reimburse You, up to the amount shown in the Schedule of Benefits, for the following emergency dental expenses:

a. Services and supplies for the relief of dental pain; and
b. The repair or replacement of teeth or dental implants.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after You have reached Your Return Destination, regardless of the reason.

Your duties in the event of a Loss:

a. You must provide Us with all bills and reports for medical and/or dental expenses claimed;
b. You must provide any requested information related to the claimed expense(s), including but not limited to, an explanation of benefits from any other applicable insurance;
c. You must sign a patient authorization to release any information required by Us, to investigate Your claim.

Travel Medical and Dental Expense Exclusions:

In addition to the General Limitations and Exclusions, the following exclusions apply to the Travel Medical and Dental Expense Benefit. No benefits will be paid for any loss for, caused by, or resulting from:

1. Any service provided by You, a Family Member, or Your Traveling Companion;
2. Alcohol or substance abuse or treatment for the same;
3. Experimental or Investigative treatment or procedures;
4. Expenses incurred by any Child born during the Covered Trip;
5. Care or treatment which is not Medically Necessary, except for related reconstructive surgery resulting from trauma, infection or disease;
6. Routine physical examinations;
7. Repair or replacement of hearing aids, any type of eye glasses, contact lenses, or sunglasses;
8. Mental health care; or
9. Physical therapy or occupational therapy.

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Travel Insured International
Travel Insured International
Policy Name and Summary of Coverage
55

Worldwide Trip Protector Plus

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Confirmation of Benefits as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 expenses for emergency dental treatment due to Injury to natural teeth.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, prosthetics, and therapeutic services and supplies ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

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56

Worldwide Trip Protector

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS
MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip (of a duration of 180 days or less for Sickness);

b. only Medical Expenses incurred by You during Your Trip (of a duration of 180 days or less for Sickness) will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital. We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

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Travelex Insurance Services
Travelex Insurance Services
Policy Name and Summary of Coverage
57

Travel Basic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● local ambulance services to or from a Hospital;

● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;

● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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58

Flight Insure Plus

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● local ambulance services to or from a Hospital;

● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;

● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

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TravelSafe
TravelSafe
Policy Name and Summary of Coverage
59

Basic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Confirmation of Benefits, as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of a duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 for expenses incurred during Your Trip for emergency dental treatment. Only expenses for emergency dental treatment to natural teeth incurred during Your Trip will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness.

The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, therapeutic services ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

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60

Classic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Confirmation of Benefits, as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of a duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 for expenses incurred during Your Trip for emergency dental treatment. Only expenses for emergency dental treatment to natural teeth incurred during Your Trip will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, therapeutic services ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

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61

Classic Plus

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Confirmation of Benefits, as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of a duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 for expenses incurred during Your Trip for emergency dental treatment. Only expenses for emergency dental treatment to natural teeth incurred during Your Trip will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, therapeutic services ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

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Trawick International
Trawick International
Policy Name and Summary of Coverage
62

Safe Travels International excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If a covered Sickness or Injury occurs during the Policy Period, and the Covered Person requires medical or surgical treatment, benefits are payable for the following covered expenses. The first charges must be incurred within 90 days after the date of the covered Sickness or Injury or the treatment must occur within 24 hours of the Unexpected Recurrence of a Pre-existing Condition.

No benefits will be paid for any expenses incurred which are in excess of usual and customary charges.

1. Hospital Room and Board Expenses: the average daily rate for a semi-private room when a Covered Person is Hospital Confined, and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge. All charges in excess of the allowable semiprivate rate are the responsibility of the Covered Person.

2. Hospital Emergency Room Visits. Emergency Room Visit for an Illness with no direct Hospital Admittance will be subject to an additional deductible as outlined in the schedule of benefits.

3. Ancillary Hospital Expenses: Services and supplies as Medically Necessary and approved and covered by the Policy including meals and special diets (only for the Covered Person), use of operating room and related facilities, use of intensive care and related services to include x-ray (including reading charges) , laboratory and other diagnostic tests, drugs, medications, biological anesthesia and oxygen services, and administration of blood products. This does not include personal services of a non-medical nature.

4. Intensive Care Unit Expenses: Room and Board: 3 times the average semiprivate room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.

5. Medical Emergency Care Expenses incurred within 24 hours of Unexpected Recurrence of a Pre-existing Condition. These expenses include the attending Physician’s charges, x-rays, laboratory procedures, use of the emergency room and supplies.

6. Physician non-surgical treatment and examination expenses including the Physician’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Physician.

7. Physician’s Surgical Expenses.

8. Assistant Physician Surgical Expenses when Medically Necessary.

9. Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an outpatient basis.

10. Outpatient Medical expenses.

11. Physician Visits

12. Physiotherapy Physical Medicine/Chiropractic Expenses on an Inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy.

13. X-rays

14. Emergency dental treatment and restoration of sound natural teeth, including x-rays, required as a result of an Accident or to relieve pain.

15. Ambulance Service Benefits are provided for medically necessary emergency ground ambulance transportation from the emergency site to the nearest Hospital able to provide the required level of care.

16. Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Physician.

17. Emergency medical treatment of pregnancy.

18. Mental or nervous disorders.

19. Medically Necessary treatment for COVID-19, SARS-CoV-2, and any mutation or variation of SARS-CoV-2.

ADDITIONAL MEDICAL TREATMENT AND SERVICES

Unexpected Recurrence of a Pre-Existing Condition – Benefits are payable for Covered Expenses resulting from a sudden, Unexpected Recurrence of a Pre-Existing Condition while traveling outside the Covered Person’s Home Country. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage.

TRANSPORTATION BENEFITS
AMBULANCE SERVICE BENEFITS

Ambulance Service Benefits are provided for medically necessary emergency ground or air ambulance transportation as required from the emergency site to the nearest Hospital able to provide the required level of care.

HOSPITAL CONFINEMENT – $150 per night up to a maximum of 15 nights

Benefits are payable, if the Covered Person is confined to a Hospital provided; 1. The Hospital stay is the direct result, from no other causes, of Injuries sustained in a Covered Accident or Sickness that occurs while the Policy is in effect; and 2. The Hospital say begins within 3 days of a Covered Accident or Sickness and lasts for at least 3 days. The benefit will be paid retroactive to the first day of the Hospital stay. Benefit payments will end on the first of the following: 1. The date the Hospital Stay ends; 2. The date the Covered Person dies; 3. The 15th day of hospitalization; or 4. The date the coverage terminates.

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63

Safe Travels International Cost Saver excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If a covered Sickness or Injury occurs during the Policy Period, and the Covered Person requires medical or surgical treatment, benefits are payable for the following covered expenses. The first charges must be incurred within 90 days after the date of the covered Sickness or Injury or the treatment must occur within 24 hours of the Unexpected Recurrence of a Pre-existing Condition.

No benefits will be paid for any expenses incurred which are in excess of usual and customary charges.

1. Hospital Room and Board Expenses: the average daily rate for a semi-private room when a Covered Person is Hospital Confined, and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge. All charges in excess of the allowable semiprivate rate are the responsibility of the Covered Person.

2. Hospital Emergency Room Visits. Emergency Room Visit for an Illness with no direct Hospital Admittance will be subject to an additional deductible as outlined in the schedule of benefits.

3. Ancillary Hospital Expenses: Services and supplies as Medically Necessary and approved and covered by the Policy including meals and special diets (only for the Covered Person), use of operating room and related facilities, use of intensive care and related services to include x-ray (including reading charges) , laboratory and other diagnostic tests, drugs, medications, biological anesthesia and oxygen services, and administration of blood products. This does not include personal services of a non-medical nature.

4. Intensive Care Unit Expenses: Room and Board: 3 times the average semiprivate room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.

5. Medical Emergency Care Expenses incurred within 24 hours of Unexpected Recurrence of a Pre-existing Condition. These expenses include the attending Physician’s charges, x-rays, laboratory procedures, use of the emergency room and supplies.

6. Physician non-surgical treatment and examination expenses including the Physician’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Physician.

7. Physician’s Surgical Expenses.

8. Assistant Physician Surgical Expenses when Medically Necessary.

9. Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an outpatient basis.

10. Outpatient Medical expenses.

11. Physician Visits

12. Physiotherapy Physical Medicine/Chiropractic Expenses on an Inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy.

13. X-rays

14. Emergency dental treatment and restoration of sound natural teeth, including x-rays, required as a result of an Accident or to relieve pain.

15. Ambulance Service Benefits are provided for medically necessary emergency ground ambulance transportation from the emergency site to the nearest Hospital able to provide the required level of care.

16. Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Physician.

17. Emergency medical treatment of pregnancy.

18. Mental or nervous disorders.

19. Medically Necessary treatment for COVID-19, SARS-CoV-2, and any mutation or variation of SARS-CoV-2.

ADDITIONAL MEDICAL TREATMENT AND SERVICES

Unexpected Recurrence of a Pre-Existing Condition – Benefits are payable for Covered Expenses resulting from a sudden, Unexpected Recurrence of a Pre-Existing Condition while traveling outside the Covered Person’s Home Country. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage.

TRANSPORTATION BENEFITS AMBULANCE SERVICE BENEFITS

Ambulance Service Benefits are provided for medically necessary emergency ground or air ambulance transportation as required from the emergency site to the nearest Hospital able to provide the required level of care.

HOSPITAL CONFINEMENT – $150 per night up to a maximum of 15 nights

Benefits are payable, if the Covered Person is confined to a Hospital provided; 1. The Hospital stay is the direct result, from no other causes, of Injuries sustained in a Covered Accident or Sickness that occurs while the Policy is in effect; and 2. The Hospital say begins within 3 days of a Covered Accident or Sickness and lasts for at least 3 days. The benefit will be paid retroactive to the first day of the Hospital stay. Benefit payments will end on the first of the following: 1. The date the Hospital Stay ends; 2. The date the Covered Person dies; 3. The 15th day of hospitalization; or 4. The date the coverage terminates

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64

Safe Travels USA Cost Saver

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If a covered Sickness or Injury occurs during the Policy Period, and the Covered Person requires medical or surgical treatment, benefits are payable for the following covered expenses. The first charges must be incurred within 90 days after the date of the covered Sickness or Injury or the treatment must occur within 24 hours of the Unexpected Recurrence of a Pre-existing Condition.

No benefits will be paid for any expenses incurred which are in excess of usual and customary charges.

• Hospital Room and Board Expenses: the average daily rate for a semi-private room when a Covered Person is Hospital Confined, and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge. All charges in excess of the allowable semiprivate rate are the responsibility of the Covered Person.

• Hospital Emergency Room Visits. Emergency Room Visit for an Illness with no direct Hospital Admittance will be subject to an additional deductible as outlined in the schedule of benefits.

• Ancillary Hospital Expenses: Services and supplies as Medically Necessary and approved and covered by the Policy including meals and special diets (only for the Covered Person), use of operating room and related facilities, use of intensive care and related services to include x-ray (including reading charges) , laboratory and other diagnostic tests, drugs, medications, biological anesthesia and oxygen services, and administration of blood products. This does not include personal services of a non-medical nature.

• Intensive Care Unit Expenses: Room and Board: 3 times the average semiprivate room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.

• Medical Emergency Care Expenses incurred within 24 hours of Unexpected Recurrence of a Pre-existing Condition. These expenses include the attending Physician’s charges, x-rays, laboratory procedures, use of the emergency room and supplies.

• Physician non-surgical treatment and examination expenses including the Physician’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Physician.

• Physician’s Surgical Expenses.

• Assistant Physician Surgical Expenses when Medically Necessary.

• Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an outpatient basis.

• Outpatient Medical expenses.

• Physician Visits

• ** Telemedicine (see benefit at https://trawickinternational.com/telemedicine)

• Physiotherapy Physical Medicine/Chiropractic Expenses on an Inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy.

• X-rays

• Emergency dental treatment and restoration of sound natural teeth, including x-rays, required as a result of an Accident or to relieve pain.

• Ambulance Service Benefits are provided for medically necessary emergency ground ambulance transportation from the emergency site to the nearest Hospital able to provide the required level of care.

• Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Physician.

• Emergency medical treatment of pregnancy.

• Mental or nervous disorders.

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65

Safe Travels USA Comprehensive

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

MEDICAL EXPENSE BENEFIT

If a covered Sickness or Injury occurs during the Policy Period, and the Covered Person requires medical or surgical treatment, benefits are payable for the following covered expenses. The first charges must be incurred within 90 days after the date of the Covered Accident or Sickness or the treatment must occur within 24 hours of the Acute Onset of a Pre-Existing Condition. No benefits will be paid for any expenses incurred which are in
excess of Usual and Customary Charges.

1. Hospital Room and Board Expenses: the average daily rate for a semi-private room when a Covered Person is Hospital Confined, and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge. All charges in excess of the allowable semiprivate rate are the responsibility of the Covered Person.

2. Hospital Emergency Room Visits. Emergency Room Visit for an Illness with no direct Hospital Admittance will be subject to an additional deductible as outlined in the schedule of benefits.

3. Ancillary Hospital Expenses: Services and supplies as Medically Necessary and approved and covered by the Policy including meals and special diets (only for the Covered Person), use of operating room and related facilities, use of intensive care and related services to include x-ray (including reading charges) , laboratory and other diagnostic tests, drugs, medications, biological anesthesia and oxygen services, and administration of blood products. This does not include personal services of a non-medical nature.

4. Intensive Care Unit Expenses: Room and Board: 3 times the average semiprivate room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.

5. Medical Emergency Care Expenses incurred within 24 hours of Unexpected Recurrence of a Pre-existing Condition. These expenses include the attending Physician’s charges, x-rays, laboratory procedures, use of the emergency room and supplies.

6. Physician non-surgical treatment and examination expenses including the Physician’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Physician.

7. Physician’s Surgical Expenses

8. Assistant Physician Surgical Expenses when Medically Necessary

9. Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an outpatient basis

10. Outpatient Medical expenses

11. Physician Visits

12. ** Telemedicine (see benefit at https://trawickinternational.com/telemedicine)

13. Physiotherapy Physical Medicine/Chiropractic Expenses on an Inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy

14. X-rays

15. Emergency dental treatment and restoration of sound natural teeth, including x-rays, required as a result of an Accident or to relieve pain

16. Ambulance Service Benefits are provided for medically necessary emergency ground ambulance transportation from the emergency site to the nearest Hospital able to provide the required level of care.

17. Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Physician.

18. Emergency medical treatment of pregnancy

19. Mental or nervous disorders

20. Cardiac Treatment up to $25,000 for ages up to 69 or $15,000 for ages 70 and over per Policy Period.

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66

Safe Travels Single Trip

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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67

Safe Travels First Class

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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68

Safe Travels Outbound excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Treatment of an Accidental Injury that occurs during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, overage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Treatment of a Sickness that first manifests itself during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services;
f) emergency dental treatment for the relief of pain.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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69

Safe Travels Outbound Cost Saver excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses for Treatment of an Accidental Injury that occurs during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service; and
e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Treatment must occur during the Trip.

If You are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, overage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage subject to any Deductible shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Treatment of a Sickness that first manifests itself during the Trip.

Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services;

f) emergency dental treatment for the relief of pain.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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70

Safe Travels Annual Executive

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You or a Traveling Companion incurs Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or a Traveling Companion already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You or a Traveling Companion are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You or a Traveling Companion are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You, or a Traveling Companion incurs Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or the Traveling Companion or already included within the cost of the Trip.

If You or the Traveling Companion are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You, and/or the Traveling Companion are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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71

Safe Travels Annual Deluxe

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You or a Traveling Companion incurs Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service; and
e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or a Traveling Companion already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You or a Traveling Companion are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You or a Traveling Companion are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You, or a Traveling Companion incurs Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: a) listed below; and b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service; and
e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or the Traveling Companion or already included within the cost of the Trip.

If You or the Traveling Companion are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You, and/or the Traveling Companion are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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72

Safe Travels Annual Basic

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You or a Traveling Companion incurs Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Accidental Injury.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or a Traveling Companion already included within the cost of the Trip.

The Company will pay benefits up to the Maximum Benefit shown on the Confirmation of Coverage for dental Emergency Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Emergency Treatment must occur during the Trip.

If You or a Traveling Companion are Hospitalized due to an Accidental Injury that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You or a Traveling Companion are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

EMERGENCY SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Confirmation of Coverage, if You, or a Traveling Companion incurs Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Trip.

Emergency Treatment means necessary medical treatment that must be performed during the Trip due to the serious and acute nature of the Sickness.

Covered Medical Expenses are expenses incurred for necessary services and supplies: (a) listed below; and (b) ordered or prescribed by the attending Physician as Medically Necessary for treatment, that are limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service; and

e) drugs, medicines and therapeutic services.

The Company will not pay benefits in excess of the Reasonable and Customary Charges. The Company will not cover any expenses provided by another party at no cost to You or the Traveling Companion or already included within the cost of the Trip.

If You or the Traveling Companion are Hospitalized due to a Sickness that first occurred during the course of the Trip beyond the Scheduled Return Date, coverage under this benefit will be extended until You, and/or the Traveling Companion are released from the Hospital or until Maximum Benefits under this Certificate have been paid.

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73

Safe Travels Explorer

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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74

Safe Travels Journey

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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75

Safe Travels Voyager

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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76

Safe Travels Explorer Plus

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

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USI Affinity Travel Insurance Services
USI Affinity Travel Insurance Services
Policy Name and Summary of Coverage
77

Ruby

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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78

Diamond

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may 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 from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;(g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

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WorldTrips
WorldTrips
Policy Name and Summary of Coverage
79

Atlas International excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions and restrictions contained in this provision, we will pay the following expenses incurred while this insurance is in effect.

MEDICAL EXPENSES

YOU ARE COVERED:

1. Charges made by a hospital for:

a. Daily room and board and nursing services not to exceed the average semi-private room rate; and

b. Daily room and board and nursing services in Intensive Care Unit; and

c. Use of operating, treatment or recovery room; and

d. Services and supplies which are routinely provided by the hospital to persons for use while inpatients; and

e. Emergency treatment of an injury, even if hospital confinement is not required; and

f. Emergency treatment of an illness; subject to emergency room co-pay as outlined in the Schedule of Benefits and Limits. ER co-payment is waived when you are directly admitted to the hospital as inpatient for further treatment of that illness.

2. Surgery at an outpatient surgical facility, including services and supplies.

3. Charges made by a physician for professional services, including surgery. Charges for an assistant surgeon are covered up to 20% of the usual, reasonable and customary charge of the primary surgeon, but standby availability will not be deemed to be a professional service and therefore is not covered hereunder.

4. Dressings, sutures, casts or other supplies which are medically necessary and administered by or under the supervision of a physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except durable medical equipment.

5. Diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included).

6. Artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the replacement or repair thereof.

7. Reconstructive surgery when the surgery is directly related to surgery which is covered hereunder.

8. Hemodialysis and the charges by the hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components.

9. Oxygen and other gasses and their administration by or under the supervision of a physician.

10. Anesthetics and their administration by a physician.

11. Drugs which require prescription by a physician for treatment of a covered injury or illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of 60 days per prescription.

12. Care in a licensed extended care facility upon direct transfer from an acute care hospital.

13. Home nursing care in bed by a qualified licensed professional, provided by a home health care agency upon direct transfer from an acute care hospital and only in lieu of medically necessary inpatient hospitalization.

14. Emergency local ambulance transport necessarily incurred in connection with injury or illness resulting in inpatient hospitalization.

15. Emergency dental treatment and dental surgery necessary to restore or replace sound natural teeth lost or damaged in an accident which was covered under this insurance.

16. Emergency dental treatment necessary to resolve acute onset of pain, provided treatment is obtained within 24 hours of the acute onset of pain.

17. Emergency Eye Exam if your prescription corrective lenses are lost or damaged due to a covered loss and an exam is required to obtain a lens prescription for medically necessary correction lenses, but not for the replacement cost of prescription corrective lenses or contact lenses.

18. Medically necessary rental of durable medical equipment (consisting of a standard basic hospital bed and or a standard basic wheelchair) up to the purchase prices.

19. Outpatient physical therapy or chiropractic care if prescribed by a physician who is not affiliated with the physical therapy or chiropractic practice, necessarily incurred to continue recovery from a covered injury or illness.

20. Injury or illness resulting from participation in sports or athletic activities not otherwise excluded under this insurance.

YOU ARE NOT COVERED IF:

1. Expenses arise directly or indirectly from anything in the General Exclusions.

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80

Atlas America incl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions and restrictions contained in this provision, we will pay the following expenses incurred while this insurance is in effect.

MEDICAL EXPENSES

YOU ARE COVERED:

1. Charges made by a hospital for:

a. Daily room and board and nursing services not to exceed the average semi-private room rate; and

b. Daily room and board and nursing services in Intensive Care Unit; and

c. Use of operating, treatment or recovery room; and

d. Services and supplies which are routinely provided by the hospital to persons for use while inpatients; and

e. Emergency treatment of an injury, even if hospital confinement is not required; and

f. Emergency treatment of an illness; subject to emergency room co-pay as outlined in the Schedule of Benefits and Limits. ER co-payment is waived when you are directly admitted to the hospital as inpatient for further treatment of that illness.

2. Surgery at an outpatient surgical facility, including services and supplies.

3. Charges made by a physician for professional services, including surgery. Charges for an assistant surgeon are covered up to 20% of the usual, reasonable and customary charge of the primary surgeon, but standby availability will not be deemed to be a professional service and therefore is not covered hereunder.

4. Dressings, sutures, casts or other supplies which are medically necessary and administered by or under the supervision of a physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except durable medical equipment.

5. Diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included).

6. Artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the replacement or repair thereof.

7. Reconstructive surgery when the surgery is directly related to surgery which is covered hereunder.

8. Hemodialysis and the charges by the hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components.

9. Oxygen and other gasses and their administration by or under the supervision of a physician.

10. Anesthetics and their administration by a physician.

11. Drugs which require prescription by a physician for treatment of a covered injury or illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of 60 days per prescription.

12. Care in a licensed extended care facility upon direct transfer from an acute care hospital.

13. Home nursing care in bed by a qualified licensed professional, provided by a home health care agency upon direct transfer from an acute care hospital and only in lieu of medically necessary inpatient hospitalization.

14. Emergency local ambulance transport necessarily incurred in connection with injury or illness resulting in inpatient hospitalization.

15. Emergency dental treatment and dental surgery necessary to restore or replace sound natural teeth lost or damaged in an accident which was covered under this insurance.

16. Emergency dental treatment necessary to resolve acute onset of pain, provided treatment is obtained within 24 hours of the acute onset of pain.

17. Emergency Eye Exam if your prescription corrective lenses are lost or damaged due to a covered loss and an exam is required to obtain a lens prescription for medically necessary correction lenses, but not for the replacement cost of prescription corrective lenses or contact lenses.

18. Medically necessary rental of durable medical equipment (consisting of a standard basic hospital bed and or a standard basic wheelchair) up to the purchase prices.

19. Outpatient physical therapy or chiropractic care if prescribed by a physician who is not affiliated with the physical therapy or chiropractic practice, necessarily incurred to continue recovery from a covered injury or illness.

20. Injury or illness resulting from participation in sports or athletic activities not otherwise excluded under this insurance.

YOU ARE NOT COVERED IF:

1. Expenses arise directly or indirectly from anything in the General Exclusions.

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81

Atlas Premium International excl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions and restrictions contained in this provision, we will pay the following expenses incurred while this insurance is in effect.

MEDICAL EXPENSES

YOU ARE COVERED:

1. Charges made by a hospital for:

a. Daily room and board and nursing services not to exceed the average semi-private room rate; and

b. Daily room and board and nursing services in Intensive Care Unit; and

c. Use of operating, treatment or recovery room; and

d. Services and supplies which are routinely provided by the hospital to persons for use while inpatients; and

e. Emergency treatment of an injury, even if hospital confinement is not required; and

f. Emergency treatment of an illness; subject to emergency room co-pay as outlined in the Schedule of Benefits and Limits. ER co-payment is waived when you are directly admitted to the hospital as inpatient for further treatment of that illness.

2. Surgery at an outpatient surgical facility, including services and supplies.

3. Charges made by a physician for professional services, including surgery. Charges for an assistant surgeon are covered up to 20% of the usual, reasonable and customary charge of the primary surgeon, but standby availability will not be deemed to be a professional service and therefore is not covered hereunder.

4. Dressings, sutures, casts or other supplies which are medically necessary and administered by or under the supervision of a physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except durable medical equipment.

5. Diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included).

6. Artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the replacement or repair thereof.

7. Reconstructive surgery when the surgery is directly related to surgery which is covered hereunder.

8. Hemodialysis and the charges by the hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components.

9. Oxygen and other gasses and their administration by or under the supervision of a physician.

10. Anesthetics and their administration by a physician.

11. Drugs which require prescription by a physician for treatment of a covered injury or illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of 60 days per prescription.

12. Care in a licensed extended care facility upon direct transfer from an acute care hospital.

13. Home nursing care in bed by a qualified licensed professional, provided by a home health care agency upon direct transfer from an acute care hospital and only in lieu of medically necessary inpatient hospitalization.

14. Emergency local ambulance transport necessarily incurred in connection with injury or illness resulting in inpatient hospitalization.

15. Emergency dental treatment and dental surgery necessary to restore or replace sound natural teeth lost or damaged in an accident which was covered under this insurance.

16. Emergency dental treatment necessary to resolve acute onset of pain, provided treatment is obtained within 24 hours of the acute onset of pain.

17. Emergency Eye Exam if your prescription corrective lenses are lost or damaged due to a covered loss and an exam is required to obtain a lens prescription for medically necessary correction lenses, but not for the replacement cost of prescription corrective lenses or contact lenses.

18. Medically necessary rental of durable medical equipment (consisting of a standard basic hospital bed and or a standard basic wheelchair) up to the purchase prices.

19. Outpatient physical therapy or chiropractic care if prescribed by a physician who is not affiliated with the physical therapy or chiropractic practice, necessarily incurred to continue recovery from a covered injury or illness.

20. Injury or illness resulting from participation in sports or athletic activities not otherwise excluded under this insurance.

YOU ARE NOT COVERED IF:

1. Expenses arise directly or indirectly from anything in the General Exclusions.

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82

Atlas Premium America incl US

Included in Emergency Medical

Included in Emergency Medical benefit. The policy certificate includes the following language:

Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions and restrictions contained in this provision, we will pay the following expenses incurred while this insurance is in effect.

MEDICAL EXPENSES

YOU ARE COVERED:

1. Charges made by a hospital for:

a. Daily room and board and nursing services not to exceed the average semi-private room rate; and

b. Daily room and board and nursing services in Intensive Care Unit; and

c. Use of operating, treatment or recovery room; and

d. Services and supplies which are routinely provided by the hospital to persons for use while inpatients; and

e. Emergency treatment of an injury, even if hospital confinement is not required; and

f. Emergency treatment of an illness; subject to emergency room co-pay as outlined in the Schedule of Benefits and Limits. ER co-payment is waived when you are directly admitted to the hospital as inpatient for further treatment of that illness.

2. Surgery at an outpatient surgical facility, including services and supplies.

3. Charges made by a physician for professional services, including surgery. Charges for an assistant surgeon are covered up to 20% of the usual, reasonable and customary charge of the primary surgeon, but standby availability will not be deemed to be a professional service and therefore is
not covered hereunder.

4. Dressings, sutures, casts or other supplies which are medically necessary and administered by or under the supervision of a physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except durable medical equipment.

5. Diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included).

6. Artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the replacement or repair thereof.

7. Reconstructive surgery when the surgery is directly related to surgery which is covered hereunder.

8. Hemodialysis and the charges by the hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components.

9. Oxygen and other gasses and their administration by or under the supervision of a physician.

10. Anesthetics and their administration by a physician.

11. Drugs which require prescription by a physician for treatment of a covered injury or illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of 60 days per prescription.

12. Care in a licensed extended care facility upon direct transfer from an acute care hospital.

13. Home nursing care in bed by a qualified licensed professional, provided by a home health care agency upon direct transfer from an acute care hospital and only in lieu of medically necessary inpatient hospitalization.

14. Emergency local ambulance transport necessarily incurred in connection with injury or illness resulting in inpatient hospitalization.

15. Emergency dental treatment and dental surgery necessary to restore or replace sound natural teeth lost or damaged in an accident which was covered under this insurance.

16. Emergency dental treatment necessary to resolve acute onset of pain, provided treatment is obtained within 24 hours of the acute onset of pain.

17. Emergency Eye Exam if your prescription corrective lenses are lost or damaged due to a covered loss and an exam is required to obtain a lens prescription for medically necessary correction lenses, but not for the replacement cost of prescription corrective lenses or contact lenses.

18. Medically necessary rental of durable medical equipment (consisting of a standard basic hospital bed and or a standard basic wheelchair) up to the purchase prices.

19. Outpatient physical therapy or chiropractic care if prescribed by a physician who is not affiliated with the physical therapy or chiropractic practice, necessarily incurred to continue recovery from a covered injury or illness.

20. Injury or illness resulting from participation in sports or athletic activities not otherwise excluded under this insurance.

YOU ARE NOT COVERED IF:

1. Expenses arise directly or indirectly from anything in the General Exclusions.

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