Co-Insurance is the percentage of Eligible Expenses, after the deductible, which is the responsibility of the insured.
Co-Insurance is the percentage of Eligible Expenses, after the deductible, which is the responsibility of the insured.
There is no Co-Insurance with this plan.
In the Certificate, “you”, “your” and “yours” refer to the Insured. “We”, “us” and “our” refer to the company providing this coverage. In addition, certain words and phrases are defined as follows:
ACCIDENT: means a sudden, unexpected, unintended and external event, which causes Injury.
ACCOMMODATION: means any establishment used for the purpose of temporary, overnight lodging for which a fee is paid and reservations are required.
ACTUAL CASH VALUE: means purchase price less depreciation (for KS residents: current replacement cost for items of like kind and quality less depreciation).
BAGGAGE: means luggage, personal possessions and travel documents taken by you on the Covered Trip.
COMMON CARRIER: means any land, water or air conveyance operated under a license for the transportation of passengers for hire, not including taxicabs or rented, leased or privately owned motor vehicles.
COVERED TRIP (or TRIP): 1) A period of round-trip travel away from Home to a destination outside your city of residence; the purpose of the trip is business or pleasure and is not to obtain health care or treatment of any kind; the trip has defined departure and return dates specified when the Insured enrolls; the trip does not exceed 365 days; or 2) A period of one-way travel that starts in the U.S. (except U.S. citizens may begin their trip outside the U.S., if returning to the U.S.); the purpose of the trip is business or pleasure and is not to obtain health care or treatment of any kind; the trip has defined departure and arrival dates and defined departure and arrival places specified when the Insured applies; and the trip does not exceed 31 days in length.
DOMESTIC PARTNER: means a person who is at least eighteen years of age and you can show: 1) evidence of financial interdependence, such as joint bank accounts or credit cards, jointly owned property, and mutual life insurance or pension beneficiary designations; 2) evidence of cohabitation for at least the previous 6 months; and 3) an affidavit of domestic partnership if recognized by the jurisdiction within which they reside.
ELECTIVE TREATMENT AND PROCEDURES: means any medical treatment or surgical procedure that is not medically necessary including any service, treatment, or supplies that are deemed by the federal, or a state or local government authority, or by us to be research or experimental or that is not recognized as a generally accepted medical practice.
EXOTIC VEHICLE: includes Alfa Romeo, Aston Martin, Auburn, Avanti, Bentley, Bertone, BMC/Leyland, BMW M Series, Bradley, Bricklin, Cosworth, Citroen, Clenet, De Lorean, Excalibre, Ferrari, Fiat, Iso, Jaguar, Jensen Healy, Lamborghini, Lancia, Lotus, Maserati, Morgan, Pantera, Panther, Pininfarina, Rolls Royce, Rover, Stutz, Sterling, Triumph, TVR, Yugo, Corvette, Mercedes Benz, Porsche, and MG. You must contact CSA Travel Protection at (800) 348- 9505 before renting to obtain confirmation that the vehicle is covered.
FAMILY MEMBER: includes your or your Traveling Companion’s dependent, spouse, child, spouse’s child, son/daughter-in-law, parent(s), sibling(s), grandparent(s), grandchild, step-brother/sister, step-parent(s), parent(s)- in-law, brother/sister-in-law, aunt, uncle, niece, nephew, guardian, Domestic Partner, foster child, or ward.
FINANCIAL INSOLVENCY: means the total cessation or complete suspension of operations due to insolvency, with or without the filing of a bankruptcy petition, whether voluntary or involuntary, by a tour operator, cruise line, airline, rental car company, hotel, condominium, railroad, motor coach company, or other supplier of travel services which is duly licensed in the state(s) of operation other than the entity or the person, organization, agency or firm from whom you directly purchased or paid for your Covered Trip. There is no coverage for the total cessation or complete suspension of operations for losses caused by fraud or negligent misrepresentation by the supplier of travel services.
HOME: means your primary or secondary residence.
HOSPITAL: means an institution which meets all of the following requirements:
1. it must be operated according to law;
2. it must give 24-hour medical care, diagnosis and treatment to the sick or injured on an inpatient basis;
3. it must provide diagnostic and surgical facilities supervised by Physicians;
4. registered nurses must be on 24-hour call or duty; and
5. the care must be given either on the hospital’s premise or in facilities available to the hospital on a prearranged basis.
A Hospital is not: a rest, convalescent, extended care, rehabilitation or other nursing facility; a facility which primarily reats mental illness, alcoholism, or drug addiction (or any ward, wing or other section of the hospital used for such purposes); or a facility which provides hospice care (or wing, ward or other section of the hospital used for such purposes).
INJURY: means bodily harm caused by an Accident which: 1) occurs while your coverage is in effect under the plan; and 2) requires examination and treatment by a Physician. The injury must be the direct cause of loss and must be independent of all other causes and must not be caused by, or result from, Sickness.
INSURED: means an eligible person who arranges a Covered Trip, and pays any required plan payment.
INSURER: means Stonebridge Casualty Insurance Company.
OTHER VALID AND COLLECTIBLE GROUP INSURANCE: means any group policy or contract which provides for payment of medical expenses incurred because of Physician, nurse, dental or Hospital care or treatment; or the performance of surgery or administration of anesthesia. The policy or contract providing such benefits includes group or blanket insurance policies; service plan contracts; employee benefit plans; or any plan arranged through an employer, labor union, employee benefit association or trustee; or any group plan created or administered by the federal or a state or local government or its agencies. In the event any other group plan provides for benefits in the form of services in lieu of monetary payment, the usual and customary value of each service rendered will be considered a Covered Expense.
PHYSICIAN: means a person licensed as a medical doctor by the jurisdiction in which he/she is resident to practice the healing arts. He/she must be practicing within the scope of your license for the service or treatment given and may not be you, a Traveling Companion, or a Family Member.
PRE-EXISTING CONDITION: means an illness, disease, or other condition during the 180-day period immediately prior to your effective date for which you or your Traveling Companion or Family Member who is scheduled or booked to travel with you: 1) received, or received a recommendation for, a diagnostic test, examination or medical treatment; or 2) took or received prescription drugs or medicine. Item 2 of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the 180-day period before coverage is in effect under the Policy.
SCHEDULED DEPARTURE DATE: means the date on which you are originally scheduled to leave on your Covered Trip.
SCHEDULED RETURN DATE: means the date on which you are originally scheduled to return to the point where the Covered Trip started or to a different final destination.
SCHEDULED TRIP DEPARTURE CITY: means the city where the scheduled trip on which you are to participate originates.
SICKNESS: means an illness or disease of the body, which requires examination and treatment by a Physician.
TERRORIST ACT means an act of violence, other than civil disorder or riot, (that is not an act of war, declared or undeclared) that results in loss of life or major damage to property, by any person acting on behalf of or in connection with any organization which is generally recognized as having the intent to overthrow or influence the control of any government.
TRAVELING COMPANION: means a person whose name(s) appear(s) with you on the same Covered Trip arrangement and who, during the Covered Trip, will accompany you.
UNINHABITABLE: means the dwelling is not suitable for human occupancy in accordance with local public safety guidelines.
USUAL AND CUSTOMARY CHARGE: means those charges for necessary treatment and services that are reasonable for the treatment of cases of comparable severity and nature. This will be derived from the mean charge based on the experience in a related area of the service delivered and the MDR (Medical Data Research) schedule of fees valued at the 100th percentile and the Anesthesia Relative Value Guide.
The following exclusion applies to the Air Flight Accident coverage:
We will not pay for a loss caused by or resulting from Sickness of any kind.
The following exclusion applies to all coverages except Baggage Delay, Baggage and Personal Effects, and Rental Car Damage:
We will not pay for loss or expense caused by or incurred resulting from a Pre-Existing Condition, including death that results therefrom. This Exclusion does not apply to benefits under Covered Expenses item 1, 2 or 6 of the Emergency Assistance Benefits coverage. The following exclusions apply to all coverages:
We will not pay for any loss under the plan caused by, or resulting from:
1. your, your Traveling Companion’s, or Family Member’s suicide, attempted suicide, or intentionally self-inflicted injury, while sane or insane (while sane in CO & MO);
2. mental, nervous, or psychological disorders;
3. being under the influence of drugs or intoxicants, unless prescribed by a Physician (does not apply to WA or SD residents);
4. normal pregnancy or resulting childbirth or elective abortion;
5. participation as a professional in athletics;
6. participation in organized amateur and interscholastic athletic or sports competition or events;
7. riding or driving in any motor competition (does not apply to WA residents);
8. declared or undeclared war, or any act of war;
9. civil disorder (does not apply to Travel Delay);
10. service in the armed forces of any country (does not apply to #7 or #15 of Reasons for Cancellation and interruption);
11. nuclear reaction, radiation or radioactive contamination (except for involuntary exposure for NC) (does not apply to WA or KS residents);
12. operating or learning to operate any aircraft, as pilot or crew;
13. mountain climbing, bungee cord jumping, skydiving, parachuting, hang gliding, parasailing or travel on any air supported device, other than on a regularly scheduled airline or air charter company (does not apply to WA residents);
14. any unlawful acts, committed by you, a Traveling Companion or Family Member traveling with you (whether insured or not);
15. any amount paid or payable under any Worker’s Compensation, disability benefit or similar law;
16. a loss or damage caused by detention, confiscation or destruction by customs;
17. Elective Treatment and Procedures;
18. medical treatment during or arising from a Trip undertaken for the purpose or intent of securing medical treatment;
19. Financial Insolvency of the person, organization or firm from whom you directly purchased or paid for your Covered Trip, Financial Insolvency which occurred, or for which a petition for bankruptcy was filed by a travel supplier;
20. business, contractual or educational obligations of you, a Family Member or a Traveling Companion (does not apply to #12, #14, or #16 of Reasons for Cancellation and interruption);
21. failure of any tour operator, Common Carrier, or other travel supplier, person or agency to provide the bargained-for travel arrangements;
22. a loss that results from an illness, disease, or other condition, event or circumstance which occurs at a time when the plan is not in effect for you.