Access America
Travel Insurance & Assistance

Certificate of Insurance

For Emergency Assistance During Your Trip Call:

1-800-654-1908
(From U.S.)
1-804-281-5700
(Collect)

Access America branded plans are underwritten by Jefferson Insurance Company, and administered by World Access Service Corp., a company of Mondial Assistance.
Form No. 101-C-XX-01 JIC_DL_C
©2008 World Access Service Corp.

Your Travel Insurance Certificate

Thank you for buying a travel insurance plan from Access America!

Your plan is described in the following documents:

• This certificate, which explains how our travel insurance works.
• The letter of confirmation that came with your package, which tells you what coverage your plan includes and the limits.
• Any other information you receive with your package, including riders or other forms.

Please make sure you read these documents carefully. This certificate may describe coverage your plan doesn't include. Make sure you refer to all of these documents to understand what your plan covers. Contact us immediately if you think there's a mistake on your letter of confirmation.

All dollar amounts in these documents are in US dollars.

We can help!
Our assistance team can help you with problems 24 hours a day, almost anywhere in the world.
In the United States, Canada, Puerto Rico and the U.S. Virgin Islands 1-800-654-1908
All other locations, call collect 1-804-281-5700

California Residents: Please note that we are doing business in California as WASC Insurance Agency and our California License # is OBO1400.

Notice for Florida Residents: The benefits of the policy providing your coverage are governed primarily by the law of a state other than Florida

SECTION 1: OUR AGREEMENT WITH YOU

Your travel insurance plan (your plan) includes both insurance coverage and assistance services.

Throughout this document:

• we, us and our mean World Access Service Corp., Access America and Jefferson Insurance Company. Access America branded plans are underwritten by Jefferson Insurance Company and administered by World Access Service Corp., a company of Mondial Assistance.
• Jefferson means Jefferson Insurance Company
• you and your mean the people listed on your letter of confirmation

All of the information about travel insurance in this document is subject to the terms and conditions of the Group Policy underwritten by Jefferson. No one has the right to describe this travel insurance any differently than it has been described in this document, or to change or waive any of its provisions. Our coverage may be broader than described in the policy. If there is a discrepancy between the Group Policy and the certificate, the Group Policy governs.

About this agreement
It is important that you read the certificate carefully. You have a duty to make all reasonable effortsto minimize any loss.
We have issued the certificate and any attached riders based on your payment of the premium and on the information you included in your enrollment or other form. The statements you made in your enrollment or other form are representations and not warranties. We may use this information to void insurance, reduce benefits or defend our decision about a claim.

The headings in this certificate are for convenience only.

Satisfaction Guarantee
We will refund your insurance premium if you cancel your plan within 10 days of purchase and you haven't started your trip or filed a claim.

Signed for Jefferson Insurance Company
Jon Ansell, President
Fred Faett, Secretary
Jefferson Insurance Company
2805 North Parham Road, Richmond, VA 23294

SECTION 2: WHAT THIS CERTIFICATE INCLUDES

This is a named perils travel insurance certificate, which means it covers only the specific situations, events and losses included in this document, and only under the conditions we describe.

The plan you purchased may not include all the coverage described here. Make sure you check your letter of confirmation to confirm your coverage and limits.

Your plan also includes assistance services, which are described in Section 5, Help while traveling.

How to read Section 2

When it applies
Tells you when you're eligible to make a claim. These situations and events are called covered reasons.

What it covers
Tells you the kinds of things you can be reimbursed for. You'll find out more in Section 6, Claims information.

We can help!
Tells you about related assistance services that are available to you worldwide. You'll find a complete list in Section 5, Help while traveling.

Important
Travel insurance doesn't cover everything. It's designed to protect you when there's a sudden, unexpected problem or event. Please see Section 3, What this certificate excludes, for more information.

YOUR TRIP IS CANCELED OR INTERRUPTED

Important
You need to contact your travel suppliers within 72 hours of canceling or interrupting your trip to qualify for the largest reimbursement possible. If you notify your suppliers later and get a smaller refund, we will not cover the difference. If you're seriously ill or injured, contact your travel suppliers as soon as you can.

We can help!
Need help sending an emergency message or getting flight information? See Section 5, Help while traveling, for a complete list of ways we can help.

Trip cancellation and Trip interruption

When it applies

Your trip is canceled before you get started, or interrupted after you've left, for one of the following covered reasons:
Health
Injury, illness or medical condition
You or a traveling companion are seriously ill or injured.

Specific requirement
The injury, illness or medical condition must be disabling enough to make a reasonable person delay, cancel or interrupt their trip.

• A doctor must examine you or a traveling companion and advise you or a traveling companion to cancel or interrupt your trip before you cancel or interrupt it. If that isn't possible, a doctor must examine you within 72 hours of your cancellation or interruption.

A family member who isn't traveling with you is seriously ill or injured.

Specific requirement

• The injury, illness or medical condition must be considered life threatening, require hospitalization, or he or she must require your care.

Death
You, a traveling companion or family member dies.

Specific requirement

• A traveling companion or family member's death must occur before or during your trip.

Quarantine
You or a traveling companion are quarantined.

Pregnancy
You become pregnant (trip cancellation coverage only).

Childbirth
You need to attend the birth of an immediate family member's child (trip cancellation coverage only).
Transportation and accommodation
Financial default
Your tour operator, airline or cruise line ceases operations due to financial default.

Specific requirements (all must apply)

• You purchased this insurance within 14 days of making your first trip deposit or first trip payment.
• The financial default happens more than seven days after your plan's effective date.
• The tour operator, airline or cruise line isn't the entity you purchased your plan or your travel services from, or an affiliate of that entity, and was included in our List of covered suppliers on your plan's effective date.

Please note that Jefferson can choose to give you a trip of similar value instead of cash.

Traffic accident
You or a traveling companion are in a traffic accident on the way to your point of departure.

Family or friends can't accommodate you as planned
Family or friends outside the United States can't accommodate you as planned because someone in the household has died or been diagnosed with a serious illness or injury.

Legal
Jury duty or court-ordered appearance
You're summoned by a court order or subpoena to serve on a jury or appear in court.

Legal separation or divorce
You or a traveling companion legally separate or divorce after your plan's effective date but before your scheduled departure date.

Specific requirement

• You purchased your plan within 14 days of making your first trip deposit or first trip payment.

Environment
Home uninhabitable
Your primary residence is uninhabitable because of a natural disaster, fire, flood, burglary or vandalism.

Destination uninhabitable
Your destination is uninhabitable because of a natural disaster, fire,flood, burglary or vandalism.

Canceled services
Your airline, cruise line, or tour operator or travel supplier stops offering all services for at least 24 consecutive hours where you're departing, arriving or making a connection because of:

• a natural disaster
• severe weather
• a strike
• a Federal Aviation Administration (FAA) mandate

Specific requirements (all must apply)

• Your travel supplier doesn't offer you a substitute itinerary.
• The striking workers aren't employed by the supplier you purchased your plan or travel services from, or an affiliate of that supplier.

Politics and violence
Hijacking
You or a traveling companion is hijacked.

Terrorism
A terrorist event happens at your U. S. or foreign destination within 30 days of the day you're scheduled to arrive.

Specific requirement

• For locations outside the United States, you're not covered if there's been a terrorist event at your destination in the 30 days before your plan's effective date.

Work
Termination or layoff
You or a traveling companion are terminated or laid off from a company after your plan's effective date.

Specific requirements (all must apply)

• The termination or layoff isn't your fault.
• You worked for this employer for at least 12 months.

U.S. Armed Forces
You or a traveling companion serving in the U.S. Armed Forces are reassigned, or have your personal leave revoked, except because of war, the War Powers Act, base or unit mobilization, unit reassignment or disciplinary action.

Other
Extended travel delay
You miss more than half of the total length of your trip because your travel is delayed.

Specific requirements (all must apply)

• Your plan must include travel delay coverage.
• You must be delayed for a covered reason listed under travel delay coverage.

Additional coverage

BizPack coverage
The following covered reasons are included:

Place of work unsuitable for business
The place where you work is unsuitable for business because of a natural disaster, fire, flood, burglary or vandalism, and you're required to work as a result.

Work obligation
You or a traveling companion are required to work during the time you're scheduled to travel.

Specific requirement

• You didn't know you'd be required to work when you purchased your plan.

Merger or acquisition
You're required to work during the time you're scheduled to travel because your employer is merging with another company or being acquired.

Specific requirements (all must apply)

• You're directly involved in the merger or acquisition.
• You didn't know you'd be required to work when you purchased your plan.

What it covers

Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

Trip cancellation coverage
Non-refundable payments and deposits
Payments and deposits you made before your trip was canceled, less any published refunds you're entitled to receive.

Accommodation
The extra cost of single accommodation if you prepaid for shared accommodation and a traveling companion canceled or interrupted their trip for a covered reason or was delayed for a covered reason.

Trip interruption coverage
Prepaid expenses
The unused part of your prepaid expenses, less any refunds you receive.

Accommodation
The extra cost of single accommodation if you prepaid for shared accommodation and a traveling companion canceled or interrupted their trip for a covered reason or was delayed for a covered reason.

Transportation
Reasonable transportation expenses for getting to:

• your final destination or a place where you can continue your trip, or
• your original destination another way, if your travel is delayed for 24 hours or more at the start of your trip.

Expenses for the cost of staying longer than you planned
Extra accommodation and transportation expenses because a traveling companion is hospitalized.

Special limit

• Maximum of $100 a day for up to five days

YOU CAN GET SICK OR HURT WHILE TRAVELING

We can help!
Need help finding a doctor or getting emergency cash from home to pay for treatment? See Section 5, Help while traveling, for a complete list of ways we can help.

Emergency medical/dental

When it applies

You have to pay for emergency medical or dental care for one of the following covered reasons:

• you have a sudden, unexpected illness or injury during your trip that's either life threatening or could cause serious and irreparable harm if it isn't treated
• you have an injury or infection, a lost filling or a broken tooth during your trip that requires immediate treatment by a dentist

Specific requirement

• The treatment is medically necessary and is provided by a doctor, dentist, hospital or other licensed provider during your trip.

What it covers

Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

Reasonable and customary costs
Reasonable and customary costs for supplies and services from a doctor, dentist, hospital or other licensed provider.

California Residents: If you are purchasing a plan that includes emergency medical/dental coverage, please note the following:
This plan contains disability insurance benefits or health insurance benefits, or both, that only apply during the covered trip. You may have coverage from other sources that already provides you with these benefits. You should review your existing policies. If you have any questions about your current coverage, call your insurer or health plan.

Important
This is primary coverage.

Travel accident

When it applies

You're in an accident during your trip that results in:

• your death
• total and permanent loss of sight in one or both of your eyes
• permanent loss of one or both of your hands or feet when they aresevered at or above the wrist or ankle

Specific requirement

• The loss is a direct result of the accident and happens within 365 days of the accident.

What it covers

Please refer to your letter of confirmation to confirm the coverage and limits in your plan.

Death benefit
In the event of your death, we will pay 100% of the travel accident benefit shown in your letter of confirmation.

Dismemberment benefit
If you lose one eye, hand or foot, you're eligible for 50% of the travel accident benefit shown on your letter of confirmation. If you lose more than one eye, hand or foot, in any combination, you're eligible for 100% of the benefit.

Benefits are payable for only one loss and are paid in a lump sum.

YOU'RE DELAYED OR YOU MISS YOUR FLIGHT OR CRUISE

Important
You need to make reasonable efforts to continue your trip if you're delayed or you miss your flight or cruise. The coverage described here can help. Any refunds you receive from your travel suppliers will be deducted from your claim.

We can help!
Need help rebooking your flight or arranging for alternative transportation? See Section 5, Help while traveling, for a complete list of ways we can help.

Travel delay

When it applies

Your travel is delayed for six or more consecutive hours for one of the following covered reasons.

Strike or common carrier delay

• Your departure is delayed by a common carrier.
• Your departure is delayed by an unannounced strike.

Quarantine

• You are quarantined.

Natural disaster

• There's a natural disaster.

Politics, violence or theft

• Your passports, money or other travel documents are lost or stolen.
• Your travel is delayed by a hijacking.
• Your travel is delayed by civil disorder or unrest.

What it covers

Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

You can claim on of the following:

Prepaid expenses

The unused part of your prepaid expenses, less any refunds you receive.

or

Meals, accommodation and transportation

• Reasonable expenses for meals and accommodation while you're delayed.
• Reasonable additional transportation expenses.

Special limit

• Maximum of $150 per person per day, up to the limit shown on your letter of confirmation.

Benefits are payable under travel delay or missed connection coverage, not both.

Missed connection

When it applies

You miss your connecting flight or cruise for one of the following covered reasons:

• you're involved in or delayed by a traffic accident
• severe weather cancels one of your flights en route to the connection or cruise, or delays it for at least three hours

Specific requirements (all must apply)

• You allowed enough time in your itinerary to reach your flight or cruise on time.
• You aren't able to reach your connecting flight or cruise another way.

What it covers

Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

Prepaid expenses
The unused part of your prepaid expenses if you miss at least 24 hours of your trip, less any refunds you receive.

Meals, accommodation and transportation

• Reasonable additional expenses for meals and accommodation related to your missed connection or cruise.
• Reasonable additional transportation expenses to get to your original destination or to a place where you can continue your trip.

Benefits are payable under only one of missed connection or travel delay coverage.

YOUR BAGGAGE IS LOST, DAMAGED, STOLEN OR DELAYED

Important
Any refunds you receive will be deducted from your claim.

We can help!
Need help contacting local authorities or getting emergency cash from home? See Section 5, Help while traveling, for a complete list of ways we can help.

Lost, damaged or stolen baggage

When it applies

Your baggage is lost, damaged or stolen while you're traveling.

Specific requirements (all must apply)

• You take reasonable steps to keep your baggage safe and intact, and to recover it.
• You file a report giving a description of the property and its value with the appropriate local authorities, common carrier, hotel or tour operator within 24 hours of the loss.

What it covers

Please refer to your letter of confirmation to confirm your coverage and limits in your plan.
Actual price, actual cash value, repair or replacement (whichever is less)

• actual price is the amount it would cost to buy a similar item
• actual cash value is the amount the item is worth based on its current market value. If you don't have an original receipt, we'll cover up to 75% of its current market value
• repair or replacement is the cost to repair or replace the item

Special limit

• Maximum $500 in total for all jewelry, watches, gems, furs, camerasand camera equipment, camcorders, sporting equipment, computers, radios and other electronic items. You need to provide original receipts for these items or they won't be covered.

Delayed baggage

When it applies

A common carrier, hotel or tour operator delays your baggage for 24 hours or more.

Specific requirement

• You report the loss and file a claim with the common carrier, hotelor tour operator.

What it covers

Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

Reasonable essential items
Reasonable essential items for you to use until your baggage arrives.

Lost, damaged or stolen electronic or sporting equipment

When it applies
Your electronic or sporting equipment is:

lost or damaged by a common carrier

stolen while you're traveling

Specific requirements (all must apply)

You take reasonable steps to keep your equipment safe and intact, and to recover it.

You file a report giving a description of the property and its value with the appropriate local authorities or common carrier within 24 hours of the loss.

What it covers
Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

Repair or reimbursement (whichever is less)

• the cost to repair a damaged item, or
• a portion of the original cost, based on the age of the item: 12 months old or less    90%
  13-24 months old    50%
  25-48 months old    25%
  More than 48 months old    no benefit
  

Electronic or sporting equipment rental

When it applies
You have to rent electronic or sporting equipment because yours is:

lost or delayed by a common carrier for 12 hours or more on your outbound trip

damaged by a common carrier on your outbound trip

stolen during your outbound trip

Specific requirement

• You file a report giving a description of the property and its value with the appropriate local authorities or common carrier within 24 hours of the loss

What it covers
Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

Rental costs
Reasonable costs for renting replacement equipment to use during your trip.

YOUR RENTAL CAR IS DAMAGED OR STOLEN

Collision, loss or damage

When it applies

A car you're renting is stolen or is damaged in an accident or while it's left unattended.

Specific requirements

• The driver is listed on the rental car agreement.
• You file a report with the rental car company, either within 24 hours of the loss or damage or when you return the rental car (whichever comes first).

What it covers

Please refer to your letter of confirmation to confirm your coverage and limits in your plan.

Repair or replacement
The cost to repair or replace the car (whichever is less)

• repair costs include only reasonable and customary costs to repair physical damage to the car and reasonable loss of use fees the rental car company charges while it's being repaired
• replacement cost is the car's current market value

Important
This is primary coverage.

OTHER COVERAGE

Important
Please check your letter of confirmation to confirm your coverage and limits.

Existing medical condition coverage

If your plan includes this coverage, you, a traveling companion or family member can have an existing medical condition and you will still be eligible for all coverage and assistance services, as long as:

• you purchased your plan within 14 days of making your first trip payment or first trip deposit
• you purchased trip cancellation coverage that covers the full cost of all your nonrefundable trip arrangements
• you were a U.S. resident and medically able to travel on the day you purchased the plan, and
• the total cost of your trip is $50,000 per person or less.

SECTION 3: WHAT THIS CERTIFICATE EXCLUDES

GENERAL EXCLUSIONS

You aren't covered for any loss that results directly or indirectly from any of the following general exclusions, unless they're included in Section 2, What this certificate includes.

The following things if they affect you, a traveling companion or an immediate family member, whether the immediate family member is traveling with you or not:

• existing medical conditions (unless you have existing medical condition coverage)
• intentional self-harm or attempting or committing suicide (only applies to you)
• pregnancy, unless there are unforeseen complications or problems with the pregnancy
• fertility treatments, childbirth or elective abortion
• a mental or nervous health disorder (like anxiety, depression, neurosis, psychosis and others), or any related physical complications (physical complication means any physical symptom)
• the use or abuse of alcohol or drugs, or any related physical complications (physical complication means any physical symptom)

The following activities if you, a traveling companion or a family member participates in them, whether the family member is traveling with you or not:

• flying or learning to fly an aircraft as a pilot or crew member
• participating in or training for any professional or amateur sporting competition
• participating in extreme, high-risk sports like:
• skydiving, hang gliding or parachuting
• bungee jumping
• caving
• extreme skiing, heli-skiing or skiing outside marked trails
• body contact sports (meaning any sport where the objective is to physically render an opponent unable to continue with the competition such as boxing and full contact karate)
• mountain climbing or any other high altitude activities
• scuba diving below 120 feet (40 meters) or without a dive master

The following events:

• any problem or event that could have reasonably been foreseen or expected when you purchased your plan
• an epidemic or pandemic
• natural disasters like hurricanes, earthquakes, fires and floods
• air, water or other pollution, or the threat of a pollutant release
• nuclear reaction, radiation or radioactive contamination
• war (declared or undeclared), acts of war, military duty, civil disorder or unrest
• terrorist events
• financial default
• unlawful acts

You aren't eligible for reimbursement under any coverage if:

• your common carrier tickets don't show departure and return dates
• the departure and return dates on your enrollment or other form don't represent when you actually intended to travel

SPECIFIC EXCLUSIONS

You aren't covered for any loss that results directly or indirectly from any of the following specific exclusions unless they're included in Section 2, What this certificate includes.

Trip cancellation and trip interruption coverage

• travel bulletins or alerts
• government prohibitions or regulations

Lost, damaged or stolen baggage coverage

• intentional loss of or damage to equipment
• defective materials or workmanship
• ordinary wear and tear

These items aren't covered:

• animals
• cars and accessories, motorcycles and motors, aircraft, boats and other vehicles
• bicycles, skis and snowboards (unless they're checked with a common carrier)
• eyeglasses, sunglasses and contact lenses
• hearing aids, artificial teeth and limbs
• wheelchairs and other mobility devices
• consumables, medicines, perfumes, cosmetics and perishables
• tickets, passports, deeds and other documents
• money, credit cards, securities, bullion, stamps and keys
• rugs and carpets
• property for business or trade
• baggage when it is:
  • shipped as freight
  • sent before your scheduled departure date
  • left in or on a car trailer
  • left in an unlocked car

Lost, damaged or stolen electronic or sporting equipment coverage

• intentional loss of or damage to equipment
• defective materials or workmanship
• ordinary wear and tear

Also doesn't cover equipment when it is:

• shipped as freight
• sent before your departure date
• left in or on a car or car trailer

Collision, loss or damage coverage

• any obligation you assume under any agreement, except a collision or comprehensive deductible for your primary insurance
• violating the rental car agreement

Also doesn't cover:

• leases or rentals for 45 consecutive days or longer
• cars rented in or driven through:
  • Israel
  • Jamaica
  • Republic of Ireland
  • Northern Ireland
  • jurisdictions where the law doesn't allow this coverage

SECTION 4: WHO IS COVERED AND WHEN

WHO IS COVERED BY YOUR PLAN

Your plan covers the people listed on your letter of confirmation.

WHEN YOUR COVERAGE BEGINS AND ENDS

You're only eligible for coverage if we accept your request for insurance.

Your plan's effective date depends on how you purchased it.

if you purchased ... it's effective:
in person: the day and time you purchase your plan
by mail: the day after your enrollment or other form is postmarked
over the phone: the day after you place your telephone order
by fax: the day after we receive your fax
online: the day after we receive your online order

Trip cancellation coverage begins on your plan's effective date, as long as we receive your premium before you cancel your trip or make a claim.

All other coverage begins on your scheduled departure date, as long as we've received your payment. Your departure and return dates are counted as two separate days of travel when we calculate the duration of your trip.

Your coverage ends on the earliest of:

• the day you're scheduled to return
• the day you actually return, if you come back earlier
• the day and time you cancel your trip

If your return travel is delayed for a covered reason, we'll extend your coverage until you can get home.

Your plan can't be renewed.

SECTION 5: HELP WHILE TRAVELING

If you need help while traveling, our assistance team is available 24 hours a day.

Our services are here to help make challenging situations a little easier. With our global reach, we can get you in touch with licensed medical and legal professionals and other kinds of help.

Important
Please note that the General exclusions for your plan also apply to our assistance services. You'll find the list of these exclusions in Section 3, What this certificate excludes.

HOW TO REACH US

In the United States, Canada, Puerto Rico and U.S. Virgin Islands, call 1-800-654-1908
All other locations, call collect 1-804-281-5700
If you can't call collect, we'll call you back.

Please have this information ready when you call:

• your name, location and phone number
• your policy identification number

MEDICAL ASSISTANCE

Finding a doctor, dentist or medical facility
If you need care from a doctor, dentist or medical facility while you're traveling, we can help you find one.

Paying or guaranteeing your hospital bill
If you need to be admitted to a hospital as an inpatient for longer than 24 hours, we can guarantee or advance payments up to the limit of your emergency medical/dental coverage (described in Section 2).

Monitoring your care
If you're hospitalized, our medical staff will stay in contact with you and the doctor caring for you.
We can also notify your family and your doctor back home of your illness or injury and update them on your status.

EMERGENCY MEDICAL TRANSPORTATION

Important
If your emergency is immediate and life threatening, seek local emergency care at once.

Your emergency medical transportation limit is the total amount available for all covered services described below. Please check your letter of confirmation to confirm that you have this benefit in your plan and your total dollar limit.

You must make all emergency medical transportation arrangements described below through us. We can deny a claim for emergency transportation if we didn't authorize and arrange it.

Moving you to a hospital or medical clinic (Emergency medical evacuation)
If our medical team and the doctor caring for you agree that a local care facility can't treat your injury or illness, we'll identify the nearest appropriate facility that can provide the care you need.

We'll only cover the cost of your emergency medical evacuation if we authorize and arrange:

• your transportation, and
• the medical escort (if you need one).

Bringing a friend or family member to you or getting your children home (transport to bedside or return of dependents)
If you're told you will be hospitalized for more than seven days, we'll arrange for and cover the cost of an economy class round-trip ticket to bring a friend or family member to you if you're alone, or to send children under the age of 23 who are traveling with you home.

Getting you home after your care (medical repatriation)
Once you've recovered enough to return home, we'll arrange for and cover the cost of an economy class ticket to get you home (less any refunds from your unused return trip tickets).

We'll only cover the cost of your medical repatriation if we authorize and arrange your transportation.

Transporting your remains (repatriation of remains)
We'll cover the cost of reasonable and necessary services to transport your remains to your place of residence. We can also help the sending and receiving funeral homes coordinate with each other.

LEGAL ASSISTANCE

Finding a legal advisor
We can help you find local legal advice if you need it while you're traveling.

Arranging a cash transfer
If you need to pay legal fees, we can arrange to transfer funds from your family or friends.

TRAVEL AND DOCUMENT ASSISTANCE

Replacing lost travel tickets
If your tickets are lost or stolen, we can contact the airline or other common carrier, and can help you with your travel arrangements if your trip is interrupted.

Replacing lost passports and other travel documents
If your passport or other travel documents are lost or stolen, we can help you reach the appropriate authorities, contact your family or friends, and assist you in getting your documents replaced.

OTHER ASSISTANCE SERVICES

Getting flight information
If you miss your flight or it's canceled, we can give you arrival and departure times for other flights that will get you to your connecting flight or final destination.

Getting emergency cash
If your cash is lost or stolen or you need extra money to pay for unexpected expenses, we can arrange to transfer funds from your family or friends.

Delivering emergency messages
We can help you get an urgent message to someone back home. We'll try calling up to three times within 24 hours and confirm whether we were able to reach the person you asked us to contact.

CONCIERGE SERVICES

If you are in need of assistance 24 hours a day, any day of the year, please call the phone number printed on your letter of confirmation, or the hotline at:

1-800-654-1908 when in the U.S., Canada, Puerto Rico and U.S. Virgin Islands
1-804-281-5700 collect
When you call, have the following information ready for the hotline coordinator:

• Your name and confirmation or identification number; and
• Your location and local telephone number.

The hotline coordinator will confirm your enrollment and connect you with a Concierge associate.

Note: It may not be possible to call collect. If you must phone the hotline directly, give your location and phone number to the hotline coordinator who will call you back.

Our goal is to make your travels more enjoyable and hassle free. Our Concierge associates can assist you with many requests from the routine to the extraordinary. The following are types of services you can contact us for assistance with:

• Restaurant and local event information
• Emergency and after hours hotel information and reservations
• Golf tee times, information, referrals and reservations

All of our concierge benefits are service benefits, not financial benefits. Any costs associated with the services are paid by you.

About our assistance services
Our goal is to help you with your problem no matter where you're traveling.

We'll make all reasonable efforts to help you as we've described, but there may be times when we aren't able to resolve your problem for reasons that are beyond our control.

We will always do our best to refer you to appropriate professionals, but please be aware that they are independent providers and we can't be held responsible for the results of any services they provide.

SECTION 6: CLAIMS INFORMATION

HOW TO MAKE A CLAIM

Making a claim is easy - just visit www.accessamerica.com/claims, email or call us and we'll be happy to help.

Go online to:

• find out what forms and documentation you need
• download a claims form and mail it in
• file a claim electronically and track its progress

Email or call to:

• find out what forms and documentation you need
• file a claim and check its progress

Claims inquiry:

• Website: www.accessamerica.com/claims
• Email: claimsinquiry@accessamerica.com
• Telephone: 1-800-334-7525

IMPORTANT INFORMATION ABOUT CLAIMS

You have 90 days from the date of your loss to submit your claim to us, except as otherwise provided by law.

Assignment
You can assign your rights under your plan by notifying us in writing.

About beneficiaries
If you named a beneficiary on your enrollment or other form, travel accident benefits will be paid to your beneficiary if you die. All other benefits will be paid to your estate.

Duplicate coverage
If you're covered by another certificate or policy that we've issued with the same or similar coverage, we'll use the terms and conditions of the certificate or policy that pays the most. We'll also refund any premium you've paid for duplicate coverage.

Maximum coverage
The most that will be paid per trip for all losses resulting from the same event or problem is:

• $500,000 to a single person
• $10,000,000 in total for all people we cover who are affected by the same event or problem. If the combined loss is more than this amount, we'll divide the $10,000,000 among the people affected in proportion to each person's share of the combined loss.

Medical examinations and autopsy
We have the right to have you medically examined as reasonably necessary to make a decision about your medical claim. If someone covered by your plan dies, we may also require an autopsy (except where prohibited by law). We will cover the cost of these medical examinations or autopsies.

Recovery
We have the right to recover any amount you receive that exceeds the total amount of your loss.

Subrogation
When someone is responsible for your loss, we have the right to recover any payments we've made to you or someone else in relation to your claim, as permitted by law. Everyone eligible to receive payment for a claim submitted to us must cooperate with this process, and must refrain from doing anything that would adversely affect our rights or the rights of Jefferson to recover payment.

About fraud
Fraud is illegal. We will deny your claim if:

• what you told us on your enrollment or other form is deliberately misleading or inaccurate
• you intentionally file a claim that includes false information or deliberately conceals material facts. This may be a crime subject to criminal prosecution and civil penalties, and you may be liable for the stated value of the claim.

Resolving disputes
If you disagree with our decision about a claim, you can request to go to arbitration through the American Arbitration Association. If we agree, you can submit a dispute to desk arbitration, as long as:

• you submit it at least 60 days, but no more than three years, after you've filed your entire claim with us, and
• it complies with the American Arbitration Association's rules at the time you submit it.

Important

This is a named perils travel insurance certificate, which means it covers only the specific situations, events and losses included in this document, and only under the conditions we describe.

We'll only pay for reasonable, appropriate expenses that are covered by the plan you purchased. Please check your letter of confirmation to confirm your coverage and limits in your plan.

SECTION 7: DEFINITIONS

Accident An unexpected and unintended event that causes injury, property damage or both.

Accommodation A hotel or other kind of lodging where you make a reservation and pay a fee.

Assault Physical assault that requires treatment in a hospital.

Baggage Personal property you take on your trip and the suitcases or other kinds of containers you use to carry them.

Car or rental car A car or other vehicle designed for use on public roads that you own or that you've rented for the period of time shown in a rental car agreement. Rental cars don't include:

• trucks
• campers, trailers and recreational vehicles
• motorcycles, motorbikes and all-terrain vehicles
• off-road vehicles
• vehicles that are older than 20 years
• vehicles that haven't been manufactured in the last 10 years
• vehicles that don't have to be licensed
• vehicles that are rented for commercial or livery purposes, including limousines
• vehicles that have a manufacturer's suggested retail price of more than $75,000
• other conveyances

Common carrier A company that's licensed to carry passengers on land, water or in the air for a fee, not including car rental companies.

Covered reasons The specific situations and events that are covered by this certificate.

Current market value The dollar amount an item could reasonably be sold for, based on its original price, age and current condition.

Deductible The dollar amount you must contribute to the loss.

Dentist Someone who is licensed and legally entitled to practice dentistry or dental surgery. This can't be you, a traveling companion, any member of either of your immediate families, or any member of the sick or injured person's immediate family.

Destination A place more than 100 miles from your primary residence where you spend more than 24 hours of your trip.

Doctor Someone who is legally entitled to practice medicine, and is licensed if required. This can't be you, a traveling companion, any member of either of your immediate families, or any member of the sick or injured person's immediate family.

Domestic partner A person you've lived with in a spousal relationship for at least 12 consecutive months who is 18 years or older. You must be able to show evidence that you've lived together for 12 consecutive months.

Emergency medical and/or dental care
Medical and dental services, supplies and charges that are for a health emergency. It doesn't include things like:

• elective cosmetic surgery or cosmetic foot care
• physical exams
• allergy treatments (unless life threatening)
• hearing aids, eyeglasses and contact lenses
• palliative care
• experimental treatment

Epidemic An outbreak of a contagious disease that spreads rapidly and widely and that is identified as an epidemic by The Centers for Disease Control and Prevention (CDC).

Existing medical condition
An illness or injury that you, a traveling companion or family member were seeking or receiving treatment for or had symptoms of on the day you purchased your plan, or at any time in the 120 days before you purchased it.

You, a traveling companion or family member are considered to have an existing medical condition if you, a traveling companion or family member:

• saw or were advised to see a doctor
• had symptoms that would cause a prudent person to see a doctor
• were taking prescribed medication for the condition or the symptoms, unless the condition or symptoms are effectively controlled by the prescription, and the prescription hasn't changed

Family member Any of the following people, whether or not they're traveling with you:

• spouses and common-law, civil union and domestic partners
• parents and step-parents
• children and step-children (including adopted or soon to be adopted children)
• siblings
• grandparents and grandchildren
• the following in-laws: mother, father, son, daughter, brother, sister
• aunts, uncles, nieces and nephews
• legal guardians and wards
• business partners
• paid, live-in caregivers
• service animals (as defined by the Americans with Disabilities Act)

Immediate family members are:

• spouses and common-law, civil union and domestic partners
• parents and step-parents
• children and step-children (including adopted or soon to be adopted children)
• siblings
• grandparents and grandchildren

Financial default A complete cessation of operations because of financial circumstances, with or without filing for bankruptcy protection.

Hospital A facility whose primary function is to diagnose and treat sick and injured people under the supervision of doctors. It must:

• have organized departments of medicine and major surgery, on site or off site through a pre-arranged contract provide 24 hour nursing service supervised or provided by registered nurses
• be compensated by patients or their insurance providers for performing these services, and
• be licensed where required.

Illness Sickness, infirmity or disease. It doesn't include conditions you already had or knew about when you purchased your plan (see existing medical condition).

Injury Physical harm directly caused by an accident or assault, without other contributing causes.

Inpatient Someone who receives medical or dental treatment while registered as a bed patient in a hospital or other licensed provider. Room and board is charged for the patient's stay, in addition to charges for medical treatment and care.

Medical condition A physical condition you have, or have symptoms of, that you:

• have seen or been advised to see a doctor about
• have symptoms of that would cause a prudent person to see a doctor
• are taking prescribed medication for

Medically necessary Treatment that's appropriate for your illness or injury, consistent with your symptoms, and that can safely be provided to you. It meets the standards of good medical practice and isn't for your convenience or the provider's convenience.

Natural disaster A large-scale extreme weather or environmental event that damages property, disrupts transportation or endangers people. Examples include: earthquake, fire, flood, hurricane, or volcanic eruption.

Other licensed provider
A person or entity that isn't a doctor or hospital but provides medical or dental services, and is licensed where required.

Outpatient Someone who receives medical or dental treatment but doesn't have to stay at a hospital for overnight care.

Pandemic An epidemic over a wide geographic area that affects a large portion of the population.

Primary residence Your permanent, fixed address and primary residence for legal and tax purposes. We call the place your primary residence is located your place of residence.

Quarantine Mandatory isolation or restrictions on where you can go, intended to stop a contagious disease from spreading.

Reasonable and customary costs
What customers would usually be charged for a specific service in a particular geographic area. The charges are appropriate to the availability of the service, and of skilled and licensed service providers.

For collision, loss or damage coverage, the charges are also appropriate to the availability of parts, the difficulty or complexity of the job, and the effort needed to repair the damaged vehicle.

Refund Cash or a credit or voucher for future travel that you get from a travel agent, tour operator, airline, cruise line or other travel supplier, or any credit, recovery or reimbursement you get from your employer, another insurance company, a credit card issuer or any other entity.

Rental car agreement The contract that describes all of the terms and conditions of renting a car, including your responsibilities and the responsibilities of the rental car company.

Scheduled departure date
The day and time you listed on your enrollment or other form as the day and time you plan to start your trip. You have paid for travel that starts on this date.

Severe weather Hazardous weather conditions, like fog, a hailstorm or severe rainstorm, a blizzard, or an ice storm.

Terrorist event When an organized terrorist group, as defined by the U.S. State Department, injures or kills people or damages property to achieve a political, ethnic or religious goal or result. Terrorist events don't include general civil protest, unrest, rioting or acts of war.

Travel supplier A travel agent, tour operator, airline, cruise line or other travel service provider.

Traveling companion A person traveling with you whose name appears with yours on the same trip arrangement and who will accompany you on your trip. A group or tour leader is not considered a traveling companion unless you are sharing the same room with the group or tour leader.

Trip Round-trip or one-way travel to and from a place at least 100 miles from your home. It can't include travel to receive health care or medical treatment of any kind, or commuting to and from work.

Unlawful acts Felonies committed by you, a traveling companion or a family member, even if the family member isn't covered by your plan.

Uninhabitable A natural disaster, fire, flood, burglary or vandalism causes enough damage to make a reasonable person find their home other accommodation unfit for use.

Unsuitable for business
A natural disaster, fire, flood, burglary or vandalism causes enough damage to make a reasonable person find their workplace unfit for use.

JIC_DL_C
Form No. 101-C-XX-01 07/08

State Exceptions:

JEFFERSON INSURANCE COMPANY
(A Stock Company)
ALASKA AMENDATORY RIDER
Form 101-R-AK-01 The certificate to which this rider is attached is amended as follows:

1. In the section entitled What this certificate excludes, the exclusion related to terrorism is deleted.
2. In the section entitled Claims information, the following is added:
Undisputed portions of claims will be paid within 30 business days.
3. The provision entitled Resolving disputes is amended to read:
Resolving disputes
If you disagree with our decision about a claim, you can request to go to arbitration through the American Arbitration Association if all parties mutually agree to such arbitration. If we agree, you can submit a dispute to desk arbitration, as long as:

• you submit it at least 60 days, but no more than three years, after you've filed your entire claim with us and we have either denied such claim or there is a breach of contract, and
• It complies with the American Arbitration Association's rules at the time you submit it.

There are no other changes to the certificate.

JIC_RAK

JEFFERSON INSURANCE COMPANY
(A Stock Company)
KENTUCKY AMENDATORY RIDER
Form 101-R-KY-01 The certificate to which this rider is attached is amended as follows:

In the section entitled Our agreement with you, the third paragraph is amended to read:

All of the information about travel insurance in this document is subject to the terms and conditions of the Group Policy underwritten by Jefferson. No one has the right to describe this travel insurance any differently than it has been described in this document, or to change or waive any of its provisions. Our coverage may be broader than described in the policy. If there is a discrepancy between the Group Policy and the certificate, the certificate governs.

There are no other changes to the certificate.

JIC_RKY

JEFFERSON INSURANCE COMPANY
(A Stock Company)
MAINE AMENDATORY RIDER
Form 101-R-ME-01

The certificate to which this rider is attached is amended as follows:
1. In the section under What this certificate excludes, the exclusion related to Terrorist Events is deleted in its entirety.
2. The provision entitled Resolving disputes is amended to include the following: Maine courts will have jurisdiction if applicable.

There are no other changes to the certificate.

JIC_RME

JEFFERSON INSURANCE COMPANY
(A Stock Company)
MISSISSIPPI AMENDATORY RIDER
Form 101-R-MS-01

The certificate to which this rider is attached is amended as follows:
In the section entitled Claims Information the following changes are made:
How to make a claim is amended to read:

How to make a claim
Making a claim is easy - just visit www.accessamerica.com, email or call us and we'll be happy to help. Notice of claim with information sufficient to identify you must be given to us within 30 days after a loss covered under your certificate or as soon as reasonably possible.
Email or call to:

• find out what forms and documentation you need
• file a claim and check its progress

Claims inquiry
Website: www.accessamerica.com/claims
Email: claimsinquiry@accessamerica.com
Telephone: 1-800-334-7525

Important information about claims
You have 90 days from the date of your loss to submit your claim to us. Failure to furnish such proof within the time required shall not invalidate or reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one (1) year from the time proof is otherwise required.

The following provision is added to the section entitled Claims Information:
Time of Payment of Claim
All benefits payable under this certificate, for any loss will be paid within 25 days after receipt of due written proof of such loss in the form of a clean claim where claims are submitted electronically, and within 35 days after where claims are submitted in paper format. We will pay the appropriate benefit in full, or any portion of the claim that is clean, and notify you of the reasons why the claim or portion thereof is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean. Any claim or portion thereof resubmitted with the supporting documentation and information requested by us shall be paid within twenty (20) days after receipt.

A "clean claim" means a claim received by us for adjudication and which requires no further information, adjustment or alteration by you in order to be processed and paid by us. A claim is clean if it has no defect or impropriety, including any lack of substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this provision. A clean claim includes resubmitted claims with previously identified deficiencies corrected.

A clean claim does not include any of the following:

• A duplicate claim, which means an original claim and its duplicate when the duplicate is filed within 30 days of the original claim;
• Claims which are submitted fraudulently or that are based upon material misrepresentations; or
• Claims that require information essential for us to administer existing medical condition, coordination of benefits or subrogation provisions.

Benefits due under the certificate and claims are overdue if not paid within the applicable timeframe. If the claim is not denied for valid and proper reasons by the end of the applicable time period, we must pay you interest on accrued benefits at the rate of one and one-half percent (1 1/2 %) per month accruing from the day after payment was due on the amount of the benefits that remain unpaid until the claim is finally settled or adjudicated.

If we fail to pay benefits when due, the person entitled to such benefits may bring action to recover such benefits, any interest which may accrue as provided above and any other damages as may be allowable by law.

The provision entitled Maximum Coverage is amended so that the maximum coverage limit does not apply to the Flight Accident or Travel Accident benefits.

The provision entitled Medical examinations and autopsy is amended to read:
Medical examinations
We have the right to have you medically examined as reasonably necessary to make a decision about your medical claim. We will cover the cost of these medical examinations.

The provision entitled Subrogation is amended to read:
Subrogation
When someone is responsible for your loss, we have the right to recover any payments we've made to you or someone else in relation to your claim, as permitted by law. Everyone eligible to receive payment for a claim submitted to us must cooperate with this process, and must refrain from doing anything that would adversely affect our rights or the rights of Jefferson to recover payment. No subrogation will occur until you have been made whole for your damages.

There are no other changes to the certificate.

JIC_RMS

JEFFERSON INSURANCE COMPANY
(A Stock Company)
MISSOURI AMENDATORY RIDER
Form 101-R-MO-01

The certificate to which this rider is attached is amended as follows:

In the section entitled What this certificate excludes, the suicide provision is amended to read:
Intentional self-harm or attempting or committing suicide (only applies to you). In Missouri, suicide is excluded only if the person was sane at the time of the suicide.

In the section entitled Claims information, the provision, Important information about claims, is amended to read:
IMPORTANT INFORMATION ABOUT CLAIMS
you have 90 days from the date of your loss to submit your claim to us, except as otherwise provided by law. Notwithstanding, we shall not deny a claim based on your failure to submit a written notice of loss within a specified time following any loss, unless this failure operates to prejudice our rights.

There are no other changes to the certificate.

Signed For Jefferson Insurance Company
Jon Ansell, President
Fred Faett, Secretary

JIC_RMO

JEFFERSON INSURANCE COMPANY
(A Stock Company)
MONTANA AMENDATORY RIDER
Form 101-R-MT-01

The certificate to which this rider is attached is amended as follows:

The following provision is added:
Conformity with Montana statutes: The provisions of this certificate conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of this certificate.
The definition of Sickness is amended to read: Sickness, infirmity or disease, including pregnancy. It doesn't include conditions you already had or knew about when you purchased your plan (see existing medical condition).

The pregnancy exclusion is deleted in its entirety.

There are no other changes to the certificate.

JIC_RMT

JEFFERSON INSURANCE COMPANY
(A Stock Company)
NORTH CAROLINA AMENDATORY RIDER
Form 101-R-NC-01

The certificate to which this rider is attached is amended as follows:

1. The provision entitled Subrogation is amended by the addition of the following sentence: This provision does not apply to the Emergency medical/dental benefit or the Travel Accident benefit.


2. The provision entitled Resolving disputes is amended to read:
   Resolving disputes
   If you disagree with our decision about a claim, you can request to go to arbitration through the American Arbitration Association. If we agree, you can submit a dispute to desk arbitration, as long as: 1) you submit it at least 60 days, but no more than three years, after you've filed your entire claim with us, and 2) it complies with the American Arbitration Association's rules at the time you submit it. If you disagree with the decision, you may seek a decision from a jury trial as long as you file the suit at least 60 days but not more than three years after you field your entire claim with us.


3. In the provision entitled Important Information about claims the first sentence is amended to read: You have 180 days from the date of your loss to submit your claim to us, except as otherwise provided by law.

There are no other changes to the certificate.

JIC_RNC

JEFFERSON INSURANCE COMPANY
(A Stock Company)
OKLAHOMA AMENDATORY RIDER
Form 101-R-OK-01

The certificate to which this rider is attached is amended as follows:

The following is added:
FRAUD STATEMENT
Warning: Any person who knowingly, and with intent to injure, defraud, or deceive any insurer, makes any claim for proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of felony.

In the section entitled What this certificate excludes, General exclusions is amended to read:
The following events:

• any problem or event that could have reasonably been foreseen or expected when you purchased your plan
• an epidemic or pandemic
• natural disasters like hurricanes, earthquakes, fires and floods
• air, water or other pollution, or the threat of a pollutant release
• nuclear reaction, radiation or radioactive contamination, except related to terrorism acts
• war (declared or undeclared) or acts of war while serving in military service or any auxiliary thereto;
• financial default
• unlawful acts

The section entitled Who is covered and when is amended to include the following:

The effective time for coverage under the policy is 12:01 a.m. Standard Time

In the section entitled Claims Information the following provisions are added:
Conformity with State Statutes
Any part of the certificate that conflicts with the state law of Oklahoma is changed to meet the minimum requirements of that law.

Payment of Loss Time Period
We will notify you of acceptance or denial of a claim within 45 days of receipt of proof of loss. We shall inform you if the claim has been accepted, if it has been denied, or if further investigation is necessary.

There are no other changes to the certificate.

JIC_ROK

JEFFERSON INSURANCE COMPANY
(A Stock Company)
SOUTH CAROLINA AMENDMENT RIDER
Form 101-R-SC-01

With regard to South Carolina residents, the policy and certificate are amended as follows:

Under the section entitled, Claims information, the provision Medical examinations and autopsy is amended to read:
We have the right to have you medically examined as reasonably necessary to make a decision about your medical claim. If someone covered by your plan dies, we may also require an autopsy (except where prohibited by law). We will cover the cost of these medical examinations or autopsies. Any autopsy must be performed in South Carolina.

The provision entitled Resolving disputes is amended to read:
If you disagree with our decision about a claim, you can request to go to arbitration through the American Arbitration Association. If we agree, you can submit a dispute to desk arbitration, as long as:

• you submit it at least 60 days, but no more than six years, after you've filed your entire claim with us, and
• it complies with the American Arbitration Association's rules at the time you submit it.

There are no other changes to the policy or certificate.

JIC_RSC

JEFFERSON INSURANCE COMPANY
(A Stock Company)
TENNESSEE AMENDATORY RIDER
Form 101-R-TN-01

With regard to Tennessee residents, the policy and certificate to which this rider is attached is amended as follows:

In the section entitled What this certificate excludes, under General Exclusions, the fourth paragraph beginning with "The following events" is amended as follows:

The following events:

• any problem or event that could have reasonably been foreseen or expected
• when you purchased your plan
• an epidemic or pandemic
• natural disasters like hurricanes, earthquakes, fires and floods
• air, water or other pollution, or the threat of a pollutant release
• nuclear reaction, radiation or radioactive contamination (this exclusion does not apply to medical/dental, flight accident or travel accident benefits.)
• war (declared or undeclared), acts of war, military duty, or participation in civil disorder or unrest
• terrorist events (for medical/dental, flight accident or travel accident benefits, the exclusion applies only due to intentional participation in terrorist events)
• financial default
• unlawful acts

There are no other changes to the policy or certificate.

JIC_RTN

JEFFERSON INSURANCE COMPANY
(A Stock Company)
VIRGINIA AMENDATORY RIDER
Form 101-R-VA-01
The certificate to which this rider is attached is amended as follows:
The provision entitled Subrogation is deleted for Virginia residents.

There are no other changes to the certificate.

JIC_RVA

JEFFERSON INSURANCE COMPANY
(A Stock Company)
WISCONSIN AMENDATORY RIDER
Form 101-R-WI-01

The certificate to which this rider is attached is amended as follows:
The provision entitled Subrogation is amended to read:

Subrogation
When someone is responsible for your loss, we have the right to recover any payments we've made to you or someone else in relation to your claim, as permitted by law. Everyone eligible to receive payment for a claim submitted to us must cooperate with this process, and must refrain from doing anything that would adversely affect our rights or the rights of Jefferson to recover payment. Subrogation does not take place until you have been made whole.

There are no other changes to the certificate.

JIC_RWI