Pays for the cost of treatment associated with a medical emergency incurred while traveling.
$50,000 per person
Pays for the cost of treatment associated with a medical emergency incurred while traveling.
MEDICAL EXPENSE BENEFITS
We will pay this benefit, up to the amount on the Schedule for the following Covered Expenses incurred by you, subject to the following: 1) Covered Expenses will only be payable at the Usual and Customary level of payment; 2) benefits will be payable only for Covered Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on a Covered Trip; 3) benefits payable as a result of incurred Covered Expenses will only be paid after benefits have been paid under any Other Valid and Collectible Group Insurance in effect for you. We will pay that portion of Covered Expenses which exceed the amount of benefits payable for such expenses under your Other Valid and Collectible Group Insurance.
1. expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you during a Covered Trip;
2. expenses for emergency dental treatment incurred by you during a Covered Trip.
Please refer to the Definitions for an explanation of Pre-Existing Conditions which are excluded under the Medical Expense/Emergency Assistance Benefits.
Your duties in the event of a Medical Expense:
1. You must provide us with all bills and reports for medical and/or dental expenses claimed.
2. You must provide any requested information, including but not limited to, an explanation of benefits from any other applicable insurance.
3. You must sign a patient authorization to release any information required by us, to investigate your claim.
In this Description of Coverage, “you”, “your” and “yours” refer to the Insured. “We”, “us” and “our” refer to the company providing the coverage. In addition certain words and phrases are defined as follows:
Accident means a sudden, unexpected, unintended and external event, which causes Injury.
Actual Cash Value means purchase price less depreciation.
Baggage means luggage, personal possessions and travel documents taken by you on the Covered Trip.
Business Partner means an individual who is involved, as a partner, with you in a legal general partnership and shares in the management of the business.
Common Carrier means any land, water or air conveyance operated under a license for the transportation of passengers for hire.
Covered Trip means a period of travel away from Home to a destination outside your city of residence and the Trip does not exceed 180 days.
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.
Family Member includes your or the Traveling Companion’s dependent, spouse, child, spouse’s child, son-daughter-in-law, parent(s), sibling(s), brother-sister, 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 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 other than the person, organization, agency or firm from whom you directly purchased or paid for your Covered Trip provided the Financial Insolvency occurs more than 14 days following your effective date for the Trip Cancellation Benefits. There is no coverage for the 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 premises or in facilities available to the hospital on a pre-arranged basis.
A Hospital is not: a rest, convalescent, extended care, rehabilitation or other nursing facility; a facility which primarily treats 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 a 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, completes any required enrollment form, 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.
Payments or Deposits means the amount actually paid for the Insured’s Covered Trip. Payments or Deposits may be made by cash, check, credit card, prepaid vouchers, incurred change fees, administrative fees, and Currency Units. Payments made in the form of a non-paid certificate, non-paid voucher or discount are not Payments or Deposits as defined herein.
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 his/her license for the service or treatment given and may not be you, a Traveling Companion, or a Family Member of yours.
Policy means the contract issued to the Policyholder providing the benefits specified herein.
Policyholder means the legal entity in whose name this Policy is issued, as shown on the Benefit Schedule.
Pre-existing Condition means an illness, disease, or other condition during the 120 day period immediately prior to your effective date for which you or your Traveling Companion, Domestic Partner, Business Partner or Family Member 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 a prescription for 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 120 day period before coverage is effective under this Policy.
Schedule means the Benefit Schedule shown on the Description of Coverage for each Insured.
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 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: 1) requires examination and treatment by a Physician, and 2) commences while the plan is in effect. An illness or disease of the body which first manifests itself and then worsens or becomes acute prior to the effective date of this plan is not a Sickness as defined herein and is not covered by the plan.
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 alone or 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.
Please note, a group or tour leader is not considered a Traveling Companion unless you are sharing room accommodations with a the group or tour leader.
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 schedule of fees valued at the 100th percentile.
The following exclusion applies to the Accidental Death & Dismemberment coverage:
1. We will not pay for loss caused by or resulting from Sickness of any kind.
The following exclusion applies to the Medical Expense, Trip Cancellation, Trip Interruption, and Trip Delay coverages:
We will not pay for loss or expense caused by or incurred resulting from
1. a Pre-Existing Condition, as defined in the plan, including death that results therefrom. This Exclusion does not apply to benefits under covered expenses for emergency medical evacuation or repatriation of remains of the Medical Expense Benefits coverage.
The following exclusion applies to all coverages:
We will not pay for any loss under the plan, caused by, or resulting from:
1. suicide, attempted suicide, or intentionally self- inflicted injury of you, your Traveling Companion or Family Member booked to travel with you, while sane or insane (while sane in CO and MO);
2. mental, nervous, or psychological disorders (does not apply to Medical Expense Benefits), unless hospitalized;
3. being under the influence of drugs or intoxicants, unless prescribed by a Physician;
4. normal pregnancy or resulting childbirth or elective abortion;
5. participation as a professional in athletics;
6. riding or driving in any motor competition;
7. declared or undeclared war, or any act of war;
8. civil disorder (does not apply to Trip Delay);
9. service in the armed forces of any country;
10. operating or learning to operate any aircraft, as pilot or crew;
11. mountain climbing, bungee cord jumping, skydiving, parachuting, scuba diving, skin diving, hang gliding, parasailing or travel on any air supported device, other than on a regularly scheduled airline or air charter company;
12. any criminal acts, committed by you;
13. a loss or damage caused by detention, confiscation or destruction by customs;
14. Elective Treatment and Procedures;
15. medical treatment during or arising from a Covered Trip undertaken for the purpose or intent of securing medical treatment;
16. 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.
Waiver of the Pre-Existing Condition Exclusion
The Pre-Existing Condition Exclusion is waived provided you meet all of the following requirements:
1. the payment for this plan and enrollment form is received within 14 days of the initial Covered Trip deposit/payment for your Covered Trip; and
2. you are not disabled from travel at the time you makes your plan payment.
The following exclusion applies to the Baggage & Personal Effects and Baggage Delay coverages:
We will not pay for damage to or loss of:
2. property used in trade, business or for the production of income, household furniture, musical instruments, brittle or fragile articles, or sporting equipment if the loss results from the use thereof;
3. boats, motors, motorcycles, motor vehicles, aircraft, and other conveyances or equipment, or parts for such conveyances;
4. artificial limbs or other prosthetic devices, artificial teeth, dental bridges, dentures, dental braces, retainers or other orthodontic devices, hearing aids, any type of eyeglasses, sunglasses or contact lenses;
5. documents or tickets, except for administrative fees required to reissue tickets;
6. money, stamps, stocks and bonds, postal or money orders, securities, accounts, bills, deeds, food stamps or credit cards, except as noted above;
7. property shipped as freight or shipped prior to the Scheduled Departure Date;
We will not pay for loss arising from:
1. defective materials or craftsmanship; or
2. normal wear and tear, gradual deterioration, inherent vice; or
3. rodents, animals, insects or vermin; or
4. theft or pilferage from an unattended vehicle; or
5. mysterious disappearance; or
6. electrical current, including electric arcing that damages or destroys electrical devices or appliances.