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.
“Additional Transportation Cost” means the actual cost incurred for one-way Economy Transportation by Common Carrier reduced by the value of an unused travel ticket.
“Allowable Expense” is the necessary, reasonable, and customary item of expense for health care; when the item of expense is covered at least in part under any of the Plans involved. The difference between the cost of a private hospital room and a semi-private hospital room is not considered an Allowable Expense under the above definition unless the patient’s stay in a private hospital room is medically necessary in terms of generally accepted medical practice. When a Plan provides benefits in the form of services, the reasonable cash value of each service will be considered both an Allowable Expense and a benefit paid.
“Bankruptcy” means the filing of a petition for voluntary or involuntary bankruptcy in a court of competent jurisdiction under Chapter 7 or Chapter 11 of the United States Bankruptcy Code 11 L.S.C. Subsection 101 et seq.
“Business Partner” means an individual who a) is involved in a legal general partnership with You and or b) is actively involved in the day to day management of Your business.
“Claim” is a request that benefits of a Plan be provided or paid. The benefits claimed may be in the form of: a) services (including supplies); b) payment for all or a portion of the expenses incurred; or c) a combination of a) and b).
“Claim Determination Period” is the period of time, which must not be less, than 12 consecutive months, over which Allowable Expenses are compared with total benefits payable in the absence of COB, to determine: a) whether over insurance exists; and b) how much each Plan will pay or provide. For the purposes of this contract, Claim Determination Period is the period of time beginning with the effective date of coverage and ending 12 consecutive months following the date of loss or longer as may be determined by the proof of loss provision.
“Common Carrier” means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
“Confirmation of Benefits” means the coverage confirmation provided to You following enrollment and payment of the applicable premium.
“Covered Trip” means scheduled trips, tours or cruises for which a) coverage is requested: and b) the required premium is submitted prior to the Scheduled Departure Date.
“Default” means a material failure or inability to provide contracted services.
“Economy Transportation” means the lowest published available transportation rate for a ticket on a Common Carrier matching the original class of transportation that the Insured purchased for the Covered Trip.
“Exotic Vehicles” includes Alfa Romeo, Aston Martin, Auburn, Avanti, Bentley, Bertone, BMC/Leyland, BMW M Series, Bradley, Bricklin, Clenet, Corvette, Cosworth, De Lorean, Excalibre, Ferrari, Iso, Jaguar, Jensen Healy, Lamborghini, Lancia, Lotus, Maserati, Mercedes Benz, MG, Morgan, Pantera, Panther, Pininfarina, Porsche, Rolls Royce, Rover, Stutz, Sterling, Triumph, and TVR. The Insured must call the Company’s authorized administrator before renting to obtain confirmation that the vehicle is covered.
“Family Member” means Your or a Traveling Companion’s: legal spouse or common-law spouse where legal; legal guardian; son or daughter (adopted, foster or step); son-in-law; daughter-in-law; grandmother; grandmother-in-law; grandfather; grandfather-in-law; grandchild; aunt; uncle; niece; or nephew; brother, step-brother; sister; step-sister; brother-in-law; sister-in-law; mother; father; step-parent.
“Hospital” means a) a place which is licensed or recognized as a general hospital by the proper authority of the state in which it is located: b) a place operated for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility: c) a place recognized as a general hospital by the Joint Commission on the Accreditation of Hospitals. Not included is a hospital or institution licensed or used principally: (1) for the treatment or care of drug addicts or alcoholics: or (2) as a clinic continued or extended care facility, skilled nursing facility, convalescent home, rest home, nursing home or home for the aged.
“Inclement Weather” means any weather condition that delays the scheduled arrival or departure of a Common Carrier.
“Injury” or “Injuries” means accidental bodily injuries: a) received while insured under the Policy and any attached coverages: b) resulting in loss independently of sickness and all other causes: and c) not excluded from coverage.
“Insured” means the person(s) named on the enrollment form or Roster as the Principal Participant, participant’s spouse or participant’s child.
“Intoxicated” mean a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where You are located at the time of an incident.
“Legally Qualified Physician” means a physician or a Christian Science Practitioner a) other than You, a Traveling Companion or a Family Member: b) practicing within the scope of Your license: and c) recognized as a physician in the place where the services are rendered.
“Maximum Benefit Amount” means the maximum amount payable for coverage provided to an Insured as shown in the Confirmation of Benefits.
“Medical Treatment” means treatment advice or consultation by a Legally Qualified Physician.
“Medically Necessary” means a service or supply which: a) is recommended by the attending Legally Qualified Physician: b) is appropriate and consistent with the diagnosis in accord with accepted standards of community practice: c) could not have been omitted without adversely affecting Your condition or quality of medical care: d) is delivered at the most appropriate level of care and not primarily for the sake of convenience: and e) is not considered experimental unless coverage for experimental services or supplies is required by law.
“Plan” is a form of coverage written on an expense incurred basis that provides benefits or services for, or because of, medical or dental care or treatment.
“Plan” includes: a) group insurance and group remittance subscriber contracts; b) uninsured arrangements of group coverage; c) group coverage through HMO’s and other prepayment, group practice and individual practice Plans; and d) blanket contracts, except blanket school accident coverages or a similar group when the Policy:
“Plan” does not include individual or family: a) insurance contracts; b) direct payment subscriber contracts; c) coverage through HMO’s; or d) coverage under other prepayment, group practice and individual practice Plans.
“Pre-existing Condition” means any injury, sickness or condition (including any condition from which death ensues) of the Insured, or Traveling Companion, or Your and/or Traveling Companion’s Family Member or Your Business Partner for which within the 60 day period prior to the effective date of Your Trip Cancellation coverage under the Policy which a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or c) required medical treatment or treatment was recommended by a Legally Qualified Physician.
“Primary Plan” is one whose benefits for a person’s health care coverage must be determined without taking the existence of any other Plan into consideration. A Plan is a Primary Plan if either: a) the Plan either has no order of benefit determination rules, or it has rules which differ from those in the contract; or b) all Plans that cover the person use the same order of benefits determination rules as in this contract, and under those rules the Plan determines its benefits first.
“Published Penalties” means any published cancellation penalties issued by Your travel agency or travel supplier that apply to all clients of the travel agency or travel supplier and can be documented at time of trip sale. The maximum amount reimbursable under the travel agencies published penalties is 10% of the total trip cost excluding taxes and other non-commissionable items.
“Scheduled Departure Date” means the date on which You are originally scheduled to leave on the Covered Trip.
“Scheduled Return Date” means the date on which You are originally scheduled to return to the point of origin or the original final destination.
“Secondary Plan” is one that is not a Primary Plan. If a person is covered by more than one Secondary Plan, the order of benefit determination rules of this contract decides the order in which their benefits are determined in relation to each other. The benefits of each Secondary Plan may take into consideration the benefits of the Primary Plan or Plans and the benefits of any other Plan, which, under the rules of this contract, has its benefits, determined before those of that Secondary Plan.
“Sickness” means an illness or disease that is diagnosed or treated by a Legally Qualified Physician after the effective date of insurance and while You are covered under the Policy.
“Strike” means any stoppage of work: a) as a result of a combined effort of workers which was unannounced and unpublished at the time travel services were purchased: and b) which interferes with the normal departure and arrival of a Common Carrier.
“Third Party” means a person or entity other than You or the Company.
“This Plan” is the parts of this blanket contract that provide benefits for health care expenses on an expense incurred basis.
“Transportation Expense” means: a) the cost of conveyance of You and any medical personnel (if Medically Necessary): and (b) Medically Necessary services or supplies.
“Travel Arrangements” means: a) transportation: b) accommodations: and c) other specified services arranged by the Travel Supplier for the covered trip.
“Traveling Companion” means a person or persons with whom a covered person has coordinated travel arrangements and intends to travel with during the trip.
“Travel Supplier” means any entity or organization that coordinates or supplies travel services for You.
“Usual and Customary Charges” means those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.
Benefits are not payable for Sickness, Injuries or losses of You, Your Traveling Companion or Your Traveling Companion’s Family Member, or Your Business Partner:
1. resulting from suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane (in Missouri, sane only);
2. resulting from an act of declared or undeclared war;
3. while participating in maneuvers or training exercises of an armed service;
4. while riding, driving or participating in races, or speed or endurance contests;
5. while mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes, or other special equipment);
6. while participating as a member of a team in an organized sporting competition;
7. while participating in skydiving, hang gliding, bungee cord jumping, scuba diving or deep sea diving;
8. while piloting or learning to pilot or acting as a member of the crew of any aircraft;
9. received as a result or consequence of being Intoxicated, as specifically defined in the policy, or under the influence of any controlled substance unless administered on the advise of a Legally Qualified Physician;
10. to which a contributory cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation;
11. due to normal childbirth, normal pregnancy through the first 9 months of pregnancy or voluntarily induced abortion;
12. for dental treatment (except as coverage is otherwise specifically provided herein);
13. which exceed the Maximum Benefit Amount for each attached coverage as shown in the Confirmation of Benefits: or;
14. due to a Pre-existing Condition, as defined in the Policy. The Pre-existing Condition Limitation does not apply to: a) Emergency Medical Evacuation, Medical Repatriation and Return of Remains coverage; or b) to coverage purchased within 21 days from the time the initial Covered Trip deposit is paid.
The following limitation applies to Trip Cancellation: All cancellations must be reported directly to the Travel Supplier within 72 hours of the event causing the need to cancel, unless the event prevents it, and then as soon as is reasonably possible. If the cancellation is not reported within the specified 72 hour period, the Company will not pay for additional charges, which would not have, been incurred had You notified the Travel Supplier in the specified period. If the event prevents You from reporting the cancellation, the 72-hour notice requirement does not apply; however, You must, if requested, provide proof that said event prevented him or her from reporting the cancellation within the specified period.
Additional Limitations and Exclusions Specific to Baggage and Personal Effects Benefits are not payable for any loss caused by or resulting from:
a) breakage of brittle or fragile articles;
b) wear and tear or gradual deterioration;
c) confiscation or appropriation by order of any government or custom’s rule;
d) theft or pilferage while left in any unlocked vehicle;
e) property illegally acquired, kept, stored or transported;
f) Your negligent acts or omissions; or
g) property shipped as freight or shipped prior to the Scheduled Departure Date.