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.
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 b) is actively involved in the day-to- day management of Your business.
Common Carrier means any public land, air or water conveyance operating under a valid license providing for the transportation of passengers for hire.
Default means the inability to provide contracted services due to a material financial failure.
Economy Transportation means the lowest published available transportation rate for a ticket on a Common Carrier matching the original class of transportation that You purchased for the Trip, reduced by the value of an unused return travel ticket.
Eligible Medical Emergency Expense means expense incurred for services and supplies: a) listed below; and b) ordered or prescribed by a Legally Qualified Physician as Medically Necessary for diagnosis or treatment; which are limited to: the services of a Legally Qualified Physician; 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 of Injury or Sickness); and transportation furnished by a professional ambulance company to or from a Hospital
Family Member means any of the following who resides in Your country of residence: You or Your Traveling Companion’s: legal spouse (or common-law spouse where legal), legal guardian, son or daughter (adopted, foster, step or in-law), brother or sister (includes step or in- law), parent (includes step or in-law), and grandparent (includes in-law), grandchild, aunt, uncle, niece or nephew.
Home Country / Country of Residence shall mean the country where You have Your true, fixed and permanent home and principal establishment. Any other country where an Insured Person also has other temporal home or secondary establishment by more than 6 months also will be consider as other country of residence.
Hospital means: a) a place which is licensed or recognized as a general hospital by the proper authority of the state or country 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; and c) a place recognized as a general Hospital by the Joint Commission on the Accreditation of Hospitals.
Hospital does not include an institution licensed or used principally: a) for treatment or care of drug addicts or alcoholics; or b) as a clinic, continued or extended care facility, skilled nursing facility, convalescent home, rest home, nursing home or home for the aged.
Injury/Injuries means accidental bodily injury received after the Effective Date of Your Protection Plan and prior to Your Scheduled Return Date and in loss independently of Sickness and all other causes and certified by a Legally Qualified Physician.
Intoxicated means a blood alcohol level which 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 his or her license; and c) recognized as a physician in the place where the services are rendered.
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 accordance 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 law requires payment of benefits for experimental service or supplies.
Medical Emergency means a serious dysfunction or impairment to a bodily organ or part or to vital bodily functions, caused by Injury or the sudden or unexpected onset of Sickness of such a severe nature that immediate medical care must be given to the Covered Person. A Medical Emergency ends when, as a result of a Medically Necessary treatment, service or supply rendered to a Covered Person, the symptoms and/or the physical condition that caused the Medical Emergency no longer constitute a serious dysfunction or impairment to a bodily organ or part or to vital bodily function, and the Covered Person’s physical condition has been stabilized to the extent of allowing him/her to continue his/her trip or return to the Country of Residence for further care or treatment.
Pre-existing Condition means any Injury, Sickness, condition or related condition (including any condition from which death ensues) of You, or Your Traveling Companion, Your or Your Traveling Companion’s Family Member or Your Business Partner which within the 6 month period (for Age 70+ 12 month period) prior to the Effective Date of Your Protection Plan: a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment, whether such diagnosis care or treatment were seek or not; or 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.
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 the sale of the Trip. The loss must occur within the Travel Supplier’s penalty period. The maximum amount reimbursable under the travel agencies Published Penalties is 10% of the Trip cost (excluding taxes and other non-commissionable items) or 10% of the amount You have paid, whichever is less. Maximum payable under any one claim is the Trip cost, excluding taxes and other non-commissionable items.
Reasonable, Usual and Customary Charges shall mean the maximum amount that the Company determines is Reasonable and Customary for Covered Expenses the Insured Person receives, up to but not to exceed charges actually billed. The determination considers: a) amounts charged by other Service Providers for the same or similar treatment, services and supplies in the geographic area where received, considering the nature and severity of the bodily Injury or Illness in connection with which such services and supplies are received; b) any usual medical circumstances requiring additional time, skill or experience; and c) other factors the Company determines are relevant, including but not limited to, a resource based relative value scale.
Scheduled Departure Date means the date on which You are originally scheduled to leave on Your 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.
Sickness means an illness or disease which is diagnosed or treated by a Legally Qualified Physician after the Effective Date of Your Protection Plan and prior to Your Scheduled Return Date.
Strike means any stoppage of work: a) As a result of a combined effect 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.
Transportation Expense means: a) The cost of conveyance of You and any medical personnel (if Medically Necessary); and b) The cost of Medically Necessary services or supplies.
Travel Arrangements mean: a) transportation; b) accommodations; and c) other specified services arranged by the Travel Supplier for the Trip.
Traveling Companion means a person or persons with whom You a) have coordinated Travel Arrangements and b) intend to travel with during the Trip. Note: a group or tour leader is not considered a Traveling Companion unless You are sharing room accommodations with the group or tour leader.
Travel Supplier means any entity or organization that coordinates or supplies travel services for You.
Trip means scheduled trips, tours or cruises for which: a) benefits are requested; and b) the required plan cost is submitted prior to the Scheduled Departure Date.
Trip Cost is the full cost of the trip that must be declared and informed in the purchase form. If Airline tickets are paid with award miles or points, the cost of issuing the ticket and taxes paid must be included in the full declared cost of the trip. In case of a Trip Cancellation or Trip Interruption claim, if the trip cost is not informed and declared as stated above, benefit will be settled proportionally to the declared trip cost amount(pro-rata).
You/Your means the individual named on the enrollment form who has purchased a Trip and who has paid the required cost for Your Protection Plan.
Benefits are not payable for Sickness, Injuries or losses of You or Your Traveling Companion:
1. Due to or related to a Pre-Existing Condition and/or arising complications of a Pre- Existing Condition. (Pre-existing Condition limitation is automatically waived for emergency Medical Evacuation / Repatriation benefits);
2. Resulting from or in connection with suicide, attempted suicide, or any illness or intentionally self-inflicted Injury while sane or insane;
3. Any Mental or Nervous disorders or rest cures;
4. Received as a result or consequence of being completely or partially Intoxicated with drugs or alcohol as defined by the laws of the state in which the injury occurred; or under the influence of any narcotic unless administered on medical prescription;
5. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent;
6. To which a contributory cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation;
7. Due to normal childbirth, normal pregnancy (except complications of pregnancy) or voluntarily induced abortion;
8. For pain management or treatments for chronic pain;
9. Congenital abnormalities, genetic disorders, chronic, evolutive or degenerative diseases, and/or conditions arising out or resulting there from;
10. Treatment of venereal or sexually transmitted disease;
11. Expenses resulting from Acquired Immune Deficiency Syndrome (AIDS), Aids-Related Complex (ARC) or the Human Immunodeficiency Virus (HIV);
12. Sex change operations, or for treatment of sexual dysfunction or sexual inadequacy;
13. For dental treatment (except as otherwise specifically provided herein);
14. Treatment of the temporomandibular joint;
15. Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or for the fitting thereof;
16. Treatment for human organ tissue transplants and their related treatment;
17. Cosmetic or plastic Surgery, except as the result of a covered Accident; for the purposes of this plan, treatment of a deviated nasal septum shall be considered a cosmetic condition;
18. Weight reduction programs or the surgical treatment of obesity;
19. Normal ear tests and the provision of hearing aids;
20. Vocational, speech, recreational or music therapy;
21. For physiotherapy treatments;
22. Due to or related to: a) Routine physicals, inoculations, or other examinations where there are no objective indications or impairment in normal health; b) laboratory diagnostic or X-ray exams, except in case of disability/illness established by previous communication or Legally Qualified Physician.
23. When any Legally Qualified Physician advised You or Your Traveling Companion not to travel due to Sickness or Injury;
24. Expenses which were not recommended, approved and certified as Medically Necessary and Reasonable by a Physician;
25. Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
26. Expenses incurred for which travel was undertaken to seek medical treatment for a condition;
27. Expenses incurred for which travel was undertaken after the insured Person’s physician has limited or restricted travel;
28. Service or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the insured person;
29. Expenses incurred in your country of residence;
30. Treatment paid for or furnished under any other individual, government or group policy or charged provided at no cost to Insured Person;
31. Charges for Treatments which exceed Reasonable and Customary Charges;
32. Ambulance expenses incurred when are not for Medical Emergency or are not Medically Necessary.
33. Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes;
34. Elective or scheduled Surgery or treatments which can be postponed until You return to Your Home Country;
35. Charges do not correspond to the treatment received and/or for Treatments which are not Medically Necessary;
36. Expenses incurred due to treatments that do not correspond to the nature of the emergency or admission diagnostic;
37. Expenses incurred to detect causes or unknown diagnostics when this is not of emergency nature or no precise result is reached;
38. Charges for medicines: a) that have not been prescribed by a Legally Qualified Physician; or b) that have not been prescribed during the declared travel period; or c) that are sold over the counter without a medical prescription;
39. Injury sustained while or resulting from taking part in mountaineering; parachuting, hang gliding or paragliding; bungee jumping; scuba diving or deep sea diving; water-ski; snowmobiling, ski o snowboard; speleology and parasailing;
40. Occurring while or resulting from: a) riding, driving or participating in races, or speed or endurance contests; or b) driving motorcycles/mopeds/scooters (whether as driver or passenger);
41. Occurring while or resulting from participating as a member of a team in professional, sponsored, amateur and/or organized sporting competition;
42. Occurring while or resulting from piloting or learning to pilot or acting as a member of the crew of any aircraft;
43. Loss or damage (including death or injury) or any other expense associated with the discharge, explosion, or use of war weapons or weapons of mass destruction or nuclear, chemical, biological or similar weapons howsoever these may be distributed or combined and used at times of peace, war or terrorism; regardless of who commits the act. regardless of who commits the act.
44. When claims are filed after 30 days from the date of occurrence;
45. Expenses which are not presented to the Company for payment within 3 months of receiving Treatment;
46. When the Declared Trip Dates do not correspond to the itinerary of the trip made or the dates were rescheduled and this change was not duly notified;
47. When at the claim process a) fraudulent, adulterated and/or misleading information is presented; or b) relevant and/or decisive information is omitted or concealed.
For Trip Cancellation / Interruption claims, Benefits are not payable:
1. If Your Protection Plan has been purchased after a storm has been named;
2. A Pre-existing Condition existing prior to the Effective Date from their Home Country that has the likelihood of causing death or impediment for traveling or interrupt the travel;
3. Being unable to obtain necessary travel documents (passports, visas, etc.);
4. Prohibition or regulatory by any government.
For Baggage Delay claims, Benefits are not payable for any delay of the following:
2. Automobile or automobile equipment, boats or other vehicles or conveyances, trailers, motors, aircraft, bicycles (except when checked as baggage with a Common Carrier);
3. Household effects and furnishings, antiques or collectors items;
4. Sunglasses (prescription or non- prescription) or contact lenses;
5. Artificial teeth or dental bridges;
6. Hearing aids;
7. Prosthetic limbs;
8. Prescribed medications;
10. Money, credit cards, tickets, documents (except as otherwise specified under the benefit description) or securities;
12. Professional or occupational equipment or property (whether or not electronic business equipment), telephones or computer hardware or software.