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.
“Accidental or Accident” means an unexpected and unforeseen event or incident, including a Terrorist Incident.
“Amateur Athletics” means any amateur or non- professional sporting, recreation or athletic activity that is organized, sponsored and/or sanctioned, and/ or involves regular or scheduled practices, games and/or competitions (collectively, “organized athletic activities”). This definition does not include non- organized athletic activities that are engaged in by You solely for recreational, entertainment or fitness purposes.
“Certificate” means this document issued by Us. As the underwriting insurance carrier, We are solely liable and responsible for the coverage and benefits provided under the Certificate.
“Civil Disorder or Civil Unrest” means a symptom of, and a form of protest against, political or major socio-political problems. Civil Disorder or Civil Unrest includes, but is not limited to illegal parades, sit-ins and other forms of obstructions, riots, sabotage and other forms of crime which is intended to be a demonstration to the public and the government, but can escalate into general chaos.
“Coverage Verification Letter” means the letter that accompanies the Certificate of Coverage from Our program manager.
“Covered Trip” means any travel and sojourn to a Destination more than 120 miles from the starting point of the Covered Trip and not exceeding the maximum Covered Trip Duration shown in Your Coverage Verification Letter.
“Departure Date” means the scheduled date to begin the Covered Trip as referenced in Your Coverage Verification Letter for this Certificate.
“Destination” means one or more cities to which You are scheduled to travel on a Covered Trip.
“Emergency” means a sudden, unexpected, unforeseen occurrence demanding immediate action.
“Family Member” means Your spouse, children (including step children and those adopted and placed for adoption), brothers or sisters (including in- laws and steps), parents (including in-laws and steps), grandparents (including in-laws), grandchildren, aunts, uncles, nieces, nephews, legal guardians and legal wards.
“Hospital” means an institution or medical facility that meets all of the following requirements:
1. Properly accredited and where required by law, holds a license as a Hospital;
2. Operates mainly for the care and Treatment of sick or injured persons as inpatients;
3. Provides twenty-four hours a day nursing care by registered nurses;
4. Has a staff of one or more Physicians available at all times;
5. Provides organized facilities for diagnosis and surgical procedures or has them available on a pre-arranged basis;
6. Not primarily a clinic, nursing home or convalescent home or similar place of business; and
7. Not mainly a place for treating alcoholics or drug addicts.
With respect to outpatient surgery or diagnostic testing, an ambulatory surgical center or a clinic will be considered a Hospital. Such facility must be properly accredited and, where required by law, hold a license allowing the facility to operate as such.
“Illness” means an Emergency sickness, impairment or physical condition that involves inpatient care in a Hospital, or requires Emergency Treatment by a qualified Physician.
“Injury” means trauma or damage to any part of the body caused solely by Accident, independent of disease or bodily infirmity.
“Insured” means the Member who arranged to take the Covered Trip, completed the application, paid the premium in full, and whose coverage under the Certificate has become effective and has not terminated.
“Insured” includes any other Member listed in the Coverage Verification Letter whose coverage has become effective and has not terminated.
“Locality” means an area large enough to represent a reasonable cross section of providers giving the type of service or supplies for which the charge was made.
“Medically Able To Travel” means that You are 100% able to travel on the day You purchased Your Certificate.
“100% able to travel” means that You have no medical condition that requires Treatment, or prevents You from traveling, or will cause You to return home early from Your Covered Trip.
“Member” means any person who belongs to the Policyholder’s association.
“Mental, Nervous or Psychological Disorder” means a mental or nervous health condition including, but not limited to; anxiety, depression, neurosis, phobia, psychosis; or any related physical manifestation as defined in the most current edition of Diagnostic and Statistical Manual of Mental Disorders as published by the American Psychiatric Association.“Natural Disaster” means a flood, mudslide, hurricane, tornado, earthquake, volcanic eruption, wildfire or blizzard that is due to natural causes.
“Necessary” means medical Treatment that is vital and required for the Treatment of a covered Injury or Illness.
“Physician” means a person, other than You, a Travel Companion or a Family Member, who is licensed as a medical doctor in the healing arts, and acting within the scope of his or her license for the service or Treatment given.
“Policy” means the Group Travel Insurance Policy issued to the Policyholder by Us. As the underwriting insurance carrier, We are solely liable and responsible for the coverage and benefits provided under the Policy.
“Policyholder” means the National Small Business Travel & Health Association.
“Pre-Existing Condition” means an Injury or Illness or condition during the 60 days immediately before and including the date Your coverage became effective which:
1. Manifested itself, became acute or exhibited symptoms which would have caused a reasonably prudent person to seek diagnosis, care or Treatment; or
2. Required taking prescription drugs or medicine, unless the condition for which the prescribed drug or medicine is being taken remains controlled without any change in the required prescription; or
3. Was diagnosed, or required Treatment or Treatment was recommended by a Physician.
“Professional Athletics” means an athletic or sporting activity, including practice, preparation, and actual sporting events for any individual of an organized team that is a member of a recognized professional sports organization, is directly supported or sponsored by a professional team or professional sports organization, is a member of a playing league that is directly supported or sponsored by a professional team or professional sports organization; or has any athlete receiving for his or her participation any kind of payment or compensation, directly or indirectly, from a professional team or professional sports organization.
“Reasonable Expenses” means the normal and customary charge of the provider, incurred by You for a service or supply, but not more than the prevailing charge in the Locality for a like service by a provider with similar training or experience; or for a supply which is identical or substantially equivalent.
“Return Date” means the scheduled date on which You are to arrive at Your Return Destination as shown in the Coverage Verification Letter for the Certificate.
“Return Destination” means the place to which You are scheduled to return from a Covered Trip.
“Scheduled Airline” (including scheduled charters) means an airline with a license for civil scheduled air transport issued by the country in which its aircraft
“Travel Companion” means a person who accompanies and shares a room or cabin with You on a Covered Trip, and a physical cross-reference entry exists within a computerized reservation system, a global distribution system or Travel Supplier reservation system that references Travel Companions to each other.
“Travel Companion’s Family Member” means a Travel Companion’s spouse, children, parents or grandparents.
“Travel Supplier” means a travel agent, Scheduled Airline, cruise line, tour operator, bus line or other licensed provider of travel.
“Treatment” means any and all undertakings, services and/or procedures rendered or employed with respect to the management and/or care of You for the purpose of identifying, testing for, analyzing, diagnosing, treating, curing, resolving, preventing, monitoring, attending to, caring for, controlling and/ or combating any Illness or Injury or the symptoms or manifestations thereof, including without limitation: verbal or written advice, consultation, examination, discussion, diagnostic or laboratory testing or evaluation of any kind, pharmacotherapy or other medication and/or surgery.
“We, Us, Our” means Sirius America Insurance Company.
“You or Your” means the Insured.
These exclusions apply to all program benefits and services. In addition to any exclusion that applies to a particular benefit, no coverage is provided for any loss arising directly or indirectly out of, related to or as a result of the following:
1. Intentionally self-inflicted harm, suicide or attempted suicide, by You, a Family Member, a Travel Companion or a Travel Companion’s Family Member;
2. Pregnancy, fertility Treatments, childbirth or elective abortion, other than unforeseen complications of pregnancy, of You, a Family Member, a Travel Companion or a Travel Companion’s Family Member;
3. Any Mental, Nervous or Psychological disorders or physical complications related thereto, of You, a Family Member, a Travel Companion or a Travel Companion’s Family Member;
4. You being under the influence of intoxicating liquor (as determined by the jurisdiction where the loss occurred) or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician;
5. War (whether declared or undeclared), acts of war, military duty (unless specifically covered), or voluntary participation in a Civil Disorder or unrest;
6. Participation in Professional or Amateur Athletics (including training);
7. Participation in any sporting, recreational, or adventure activity where such activity is undertaken against the advice or direction of any local authorities or any qualified instructor or contrary to the rules, regulations, recommendations and procedures of the recognized governing body of the area where such activity takes place;
8. All extreme, high risk sports including but not limited to: bodily contact sports; skydiving; hang gliding; bungee jumping; parachuting; mountain climbing or other high altitude activities, caving, heli-skiing, extreme skiing, or any skiing outside marked trails;
9. Scuba diving (unless accompanied by a dive master and not deeper than 130 feet);
10. Operating or learning to operate any aircraft as pilot or crew;
11. Nuclear reaction, radiation or radioactive contamination;
12. Natural Disasters (unless specifically covered);
14. Pollution or threat of pollutant release;
15. Commission of a violation of law by You, a Family Member, a Travel Companion or a Travel Companion’s Family Member whether they are Insured or not, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations;
16. Any known, expected or reasonably foreseeable events or conditions that would cause a loss or claim under this Certificate.
This program does not cover You:
1. If the purpose of the travel is to receive medical care, medication or Treatment;
2. If the Travel Supplier’s tickets do not indicate the travel dates;
3. If You give incorrect data or facts; or
4. If the loss is not submitted to Us within 90 days from the date of loss, except as otherwise prohibited by law.
PRE-EXISTING CONDITIONS EXCLUSION
This exclusion applies to Emergency Medical/Dental and Emergency Medical Evacuation/Repatriation and Emergency Reunion benefits.
This program does not cover losses or expenses if they result from:
1. Any Injury occurring to You, a Family Member, a Travel Companion or a Travel Companion’s Family Member prior to and including the Effective Date of insurance.
2. Any Illness occurring to You, a Family Member, a Travel Companion or a Travel Companion’s Family Member who resides in Your household during the 60 days prior to and including the Effective Date of Your insurance for which: a) medical diagnosis or Treatment by a Physician has been sought or recommended or for which symptoms exist which would cause a reasonably prudent person to seek diagnosis, care or Treatment; or b) require taking prescription drugs or medicine unless the Illness remains controlled without any change in the required prescription.
For the purposes of determining any Pre-existing Condition, the Effective Date of Your insurance will be the date You purchased this coverage.