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Concierge Services Coverage
Many companies offer additional services that differentiate them against their competitors. We have listed some of these services on the providers page under the “why buy” heading.
• Restaurant referrals and reservations
• Ground transportation arrangements
• Event ticketing arrangements
• Tee times and course recommendations
• Floral service
“Actual Cash Value” means purchase price less depreciation.
“Baggage” means luggage, travel documents, and personal possessions, whether owned, borrowed, or rented, taken by the Insured on the Trip.
“Business Partner” means a person who: (1) is involved with the Insured or the Insured’s Traveling Companion in a legal partnership; and (2) is actively involved in the daily management of the business.
“Caregiver” means an individual employed for the purpose of providing assistance with activities of daily living to the Insured or to the Insured’s Family Member who has a physical or mental impairment. The Caregiver must be employed by the Insured or the Insured’s Family Member. A Caregiver is not a babysitter; childcare service, facility or provider; or persons employed by any service, provider or facility to supply assisted living.
“Children” /“Child” means, with respect to Medical Expense and Emergency Evacuation benefits, unmarried children of the Insured, including natural children from the moment of birth, and step, foster or adopted children from the moment of placement in the Insured’s home, under age 25 and primarily dependent on the Insured for support and maintenance. However, the age limit does not apply to a child who: (1) otherwise meets the definition of Children; and (2) is incapable of self-sustaining employment by reason of mental or physical incapacity.
“City” means an incorporated municipality having defined borders and does not include the high seas, uninhabited areas or airspace.
“Common Carrier” means an air, land, or sea conveyance operated under a license for the transportation of passengers for hire.
“Complications of Pregnancy” means conditions whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy. These conditions include acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity. Complications of Pregnancy also include nonelective cesarean section, ectopic pregnancy which is terminated, and spontaneous termination of pregnancy which occurs during a period of gestation in which a viable birth is not possible. Complications of Pregnancy do not include false labor, occasional spotting, Physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, preeclampsia and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy.
“Departure Date” means the date on which the Insured is originally scheduled to leave on his/her Trip. This date is specified in the travel documents.
“Destination” means any place where the Insured expects to travel to on his/her Trip other than Return Destination as shown on the travel documents.
“Domestic Partner” means an opposite or a same-sex partner who is at least 18 years of age and has met all of the following requirements for at least 6 months: (1) resides with the Insured; (2) shares financial assets and obligations with the Insured; The Insurer may require proof of the Domestic Partner relationship in the form of a signed and completed Affidavit of Domestic Partnership.
“Eligible Person” means a person who is a member of an eligible class of persons as described in the Description of Eligible Persons section of the Master Application.
“Experimental or Investigative” means a treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used. This includes any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered.
“Family Member” means the Insured’s or Traveling Companion’s spouse, Domestic Partner, Child, daughter-in-law, son-in-law, brother, sister, mother, father, grandparents, grandchild, step-child, step-brother, step-sister, step-parents, parents-in-law, brother-inlaw, sister-in-law, aunt, uncle, niece, nephew, legal guardian, Caregiver, foster child, ward, or legal ward, or spouse or Domestic Partner of any of the above.
“Hospital” means a facility that: (1) is operated according to law for the care and treatment of sick or Injured people; (2) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis; (3) has 24 hour nursing service by registered nurses (R.N.’s); and (4) is supervised by one or more Physicians available at all times. A Hospital does not include: (1) a nursing, convalescent or geriatric unit of a hospital when a patient is confined mainly to receive nursing care; (2) a facility that is, other than incidentally, a clinic, a rest home, nursing home, convalescent home, home health care, or home for the aged; nor does it include any ward, room, wing, or other section of the hospital that is used for such purposes; or (3) any military or veterans hospital or soldiers home or any hospital contracted for or operated by any national government or government agency for the treatment of members or exmembers of the armed forces.
“Individual Coverage Term” means the period of time beginning on the date insurance coverage begins and ending on the date insurance coverage ends as specified in the Effective and Termination Dates section.
“Injury/Injured” means a bodily Injury caused by an accident occurring while the Insured’s coverage under this Policy is in force and resulting directly and independently of all other causes of Loss covered by the Policy. The Injury must be verified by a Physician.
“Insured” means an Eligible Person for whom: (a) any required enrollment form has been completed; (b) any required plan cost has been paid; © while covered under the Policy.
“Insurer” means National Union Fire Insurance Company of Pittsburgh, Pa.
“Loss” means Injury or damage sustained by the Insured as a consequence of one or more of the events against which the Insurer has undertaken to compensate the Insured.
“Medically Necessary” means that a treatment, service, or supply: a) is essential for diagnosis, treatment, or care of the Injury or Sickness for which it is prescribed or performed; b) meets generally accepted standards of medical practice; c) is ordered by a Physician and performed under his or her care, supervision, or order; and d) is not primarily for the convenience of the Insured, Physician, other providers, or any other person.
“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.
“Necessary Personal Effects” means items such as clothing and toiletry items, which were included in the Insured’s Baggage and are required for the Insured’s Trip.
“Physician” means a licensed practitioner of the healing arts including accredited Christian Science Practitioners, medical, surgical, or dental services acting within the scope of his/her license. The treating Physician may not be the Insured, a Traveling Companion, a Family Member or a Business Partner.
“Primary Residence” means a person’s fixed, permanent and principal home for legal and tax purposes.
“Reasonable and Customary Charges” means an expense which: a) is charged for treatment, supplies, or medical services Medically Necessary to treat the Insured’s condition; b) does not exceed the usual level of charges for similar treatment, supplies or medical services in the locality where the expense is incurred; and c) does not include charges that would not have been made if no insurance existed. In no event will the Reasonable and Customary Charges exceed the actual amount charged.
“Return Date” means the date on which the Insured is scheduled to return to the point where the Trip started or to a different specified Return Destination. This date is specified in the travel documents.
“Return Destination” means the place to which the Insured expects to return from his/her Trip.
“Schedule” means the Schedule of Benefits. “Sickness” means an illness or disease diagnosed or treated by a Physician.
“Transportation” means any land, sea or air conveyance required to transport the Insured during an Emergency Evacuation. Transportation includes, but is not limited to, air ambulances, land ambulances and private motor vehicles.
“Traveling Companion” means a person or persons with whom the Insured has coordinated travel arrangements and intends to travel with during the Trip. A group or tour leader is not considered a Traveling Companion, unless the Insured is sharing room accommodations with the group or tour leader.
“Travel Supplier” means the tour operator, hotel, rental company, cruise line, and/or airline that provides pre-paid travel arrangements for the Insured’s Trip.
“Trip” means a period of travel away from home to a Destination outside the Insured’s 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 does not exceed 90 days; the Trip must be more than 100 miles from the Insured’s Primary Residence. For annual plans, any Trip taken during the Individual Coverage Term.
This plan does not cover any loss caused by or resulting from:
a) intentionally self-inflicted Injury, suicide, or attempted suicide of the Insured, Family Member, Traveling Companion or Business Partner while sane or insane;
b) pregnancy, childbirth, or elective abortion, other than Complications of Pregnancy;
c) participation in professional athletic events, motor sport, or motor racing, including training or practice for the same (does not apply if Adventure Sports Coverage is purchased);
d) mountaineering where ropes or guides are normally used. The ascent or descent of a mountain requiring the use of specialized equipment, including but not limited to pick-axes, anchors, bolts, crampons, carabineers, and lead or top-rope anchoring equipment (does not apply if Adventure Sports Coverage is purchased);
e) war or act of war, whether declared or not, civil disorder, riot, or insurrection;
f) operating or learning to operate any aircraft, as student, pilot, or crew (does not apply if Adventure Sports Coverage is purchased);
g) air travel on any air-supported device, other than a regularly scheduled airline or air charter company (does not apply if Adventure Sports Coverage is purchased);
h) loss or damage caused by detention, confiscation, or destruction by customs;
i) any unlawful acts, committed by the Insured, a Family Member, a Traveling Companion, or Business Partner whether insured or not;
j) Mental, Nervous or Psychological Disorder;
k) if the Insured’s tickets do not contain specific travel dates (open tickets);
l) use of drugs, narcotics, or alcohol, unless administered upon the advice of a Physician;
m) any failure of a provider of travel related services (including any Travel Supplier) to provide the bargained-for travel services or to refund money due the Insured;
n) Experimental or Investigative treatment or procedures;
o) any loss that occurs at a time when this coverage is not in effect;
p) traveling for the purpose of securing medical treatment;
q) care or treatment which is not Medically Necessary;
r) any Trip taken outside the advice of a Physician;
s) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Insurer will not pay for any loss or expense incurred as the result of an Injury, Sickness or other condition of an Insured, Traveling Companion, Business Partner or Family Member which, within the 90 day period immediately preceding and including the Insured’s coverage effective date: a) first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; b) for which care or treatment was given or recommended by a Physician; c) required taking prescription drugs or medicines, unless the condition for which the drugs or medicines are taken remains controlled without any change in the required prescription drugs or medicines.
The following exclusions apply to Baggage/Personal Effects Loss and Baggage Delay:
Benefits will not be provided for any loss or damage to or resulting (in whole or in part) from:
a) animals, rodents, insects or vermin;
b) bicycles (except when checked with a Common Carrier);
c) motor vehicles, aircraft, boats, boat motors, ATV’s and other conveyances;
d) artificial prosthetic devices, false teeth, any type of eyeglasses, sunglasses, contact lenses, or hearing aids
e) tickets, keys, notes, securities, accounts, bills, currency, deeds, food stamps or other evidences of debt, credit cards and other travel documents (except passports and visas);
f) money, stamps, stocks and bonds, postal or money orders;
g) property shipped as freight, or shipped prior to the Departure Date;
h) contraband, illegal transportation or trade;
i) items seized by any government, government official or customs official;
j) defective materials or craftsmanship;
k) inherent vice or damage;
l) normal wear and tear;
The following exclusions apply to the Medical Expense Benefit:
Benefits will not be provided for any loss resulting (in whole or in part) from:
a) routine physical examinations;
b) mental health care;
c) replacement of hearing aids, eye glasses; contact lenses and sunglasses;
d) routine dental care;
e) any service provided by the Insured, a Family Member, or Traveling Companion or Traveling Companion of Family Member;
f) alcohol or substance abuse or treatment for the same.
The following exclusion applies to Accidental Death and Dismemberment:
a) the Insurer will not pay for loss caused by or resulting from Sickness or disease of any kind.
EXCESS INSURANCE LIMITATION
The insurance provided by this Policy for all coverages except Medical Expense 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 the Policy there is other valid and collectible insurance or indemnity in place, the Insurer shall be liable only for the excess of the amount of Loss, over the amount of such other insurance or indemnity, and applicable deductible.