Not applicable to Washington Residents.
DESCRIPTION OF COVERAGE
Please keep this document with you while you travel
A comprehensive program providing you with 24/7 emergency medical,
security, and travel assistance - including emergency medical
evacuation and repatriation - when you are 100 or more miles away from
your permanent residence in your home country.(Expatriates are
eligible regardless of distance from your expatriate home.)
Schedule of Basic Coverages and Services
Maximum Benefit for all Coverages..........$100,000
Emergency Accident and Sickness Medical Expense
Deductible per Injury or Sickness..........$25
Emergency Dental sublimit..........$200
Deductible per occurrence..........$25
Emergency Evacuation and Repatriation of Remains
Schedule of Optional Coverages and Services
(can only be purchased with basic plan)
|Optional Lost Baggage....................||$1,000
|Deductible per occurrence...............||$100
|Maximum limit per single article.......||$250
Optional Trip Cancellation/Trip Interruption..........$5,000
Actual limit is based upon the coverage amount You chose during enrollment:
From______ to _______
Level of Coverage $________________
If You need medical attention:
Call the 24-hour MEDEX Emergency Response Center. Telephone numbers
are listed on Your I.D. card. The multilingual coordinators will
provide direct access to MEDEX Physician Advisors, approved hospitals,
and other service providers around the world. Be prepared to give Your
name, I.D. number, and a brief description of Your problem. MEDEX
Assistance will immediately take appropriate action to assist You and
monitor Your care until the situation is resolved. Trained
multilingual assistance coordinators are available 24 hours a day, to
make the necessary arrangements on Your behalf.
In the case of an emergency go IMMEDIATELY to the nearest
Physician or hospital without delay, then notify MEDEX Assistance of
REMEMBER to call MEDEX Assistance. The traveler's assistance
services are provided to help You and provide the skilled professional
assistance necessary. Please do not attempt to provide Your own
solutions to Your problems and subsequently ask us to pay for all of
the expenses incurred. MEDEX Assistance is there to provide You with
the skilled professional assistance necessary.
Payments arranged by MEDEX Assistance:
Most Physicians and hospitals will provide you with the necessary
medical treatment and will either send their bill directly to MEDEX
Insurance Services, or in the case of small dollar amounts, may ask
You to pay at time services are rendered. Ask the hospital or
Physician to contact MEDEX Assistance. MEDEX Assistance will confirm
Your protection plan coverage and arrange for prompt payments. You
will be asked to pay for any deductible amount or items not covered by
Payments made by You:
If You are required to pay for medical treatment, obtain a signed
receipt and a signed statement by a Physician describing the problem
and the treatment. Once Your other insurance has processed Your claim,
submit a copy of their final disposition along with a MEDEX Insurance
Services claim form and a copy of Your receipts to:
MEDEX Insurance Services
8501 LaSalle Road, Suite 200
Baltimore, MD 21286
1-800-732-5309 or 1-410-453-6380
For claim forms or questions, call between 8:00 A.M. and 5:00
P.M. Monday through Friday Eastern Time.
EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE
Emergency Accident and Sickness Medical Expense: The Insurer
will pay benefits up to the maximum shown on the Schedule of Coverages
and Services, subject to a $25 deductible, if You incur Covered
Medical Expenses as a result of an Accidental Injury or a Sickness
which occurs on the covered Trip outside the United States. You must
receive Emergency Treatment while on the covered Trip outside the
Emergency Treatment means necessary medical treatment, including
services and supplies, which must be performed during the covered Trip
due to the serious and acute nature of the Accidental Injury or
Covered Medical Expenses are necessary services and supplies which are
recommended by the attending Physician. They include, but are not
limited to: the services of a Physician; charges for Hospital
confinement and use of operating rooms; charges for anesthetics
(including administration); x-ray examinations or treatments, and
laboratory tests; ambulance service; and drugs, medicines, prosthetic
and therapeutic services and supplies.
The Insurer will not pay benefits in excess of the reasonable and
customary charges. Reasonable and customary charges means charges
commonly used by Physicians in the locality in which care is
furnished. The Insurer will not cover any expenses provided by another
party at no cost to You or already included within the cost of the
The Insurer will pay benefits, up to $200.00, for emergency dental
treatment for Accidental Injury to sound natural teeth.
If the Insured is hospitalized due to an Accidental Injury or Sickness
which first occurred during the course of the scheduled Trip) beyond
the date of the Scheduled Return Date, coverage will be extended until
the Insured is released from the hospital or until maximum benefits
under the policy have been paid.
The Insurer will pay, subject to the limitations set out herein, for
Covered Emergency Evacuation Expenses reasonably incurred if You
suffer an Injury or Emergency Sickness that warrants Your Emergency
Evacuation while You are on a Trip. Benefits payable are subject to
the maximum amount per person shown on the Schedule for all Emergency
Evacuations due to all Injuries from the same Accident or all
Emergency Sicknesses from the same or related causes.
A legally licensed Physician, in coordination with the Assistance
Company, must order the Emergency Evacuation and must certify that the
severity of Your Injury or Emergency Sickness warrants Your Emergency
Evacuation to the closest adequate medical facility. It must be
determined that such Emergency Evacuation is required due to the
inadequacy of local facilities.
The certification and approval for Emergency Evacuation must be
coordinated through the most direct and economical conveyance and
route possible, such as air or land ambulance, or commercial airline
Covered Emergency Evacuation Expenses are those for Medically
Necessary Transportation, including Reasonable and Customary medical
services and supplies incurred in connection with Your Emergency
Evacuation. Expenses for Transportation must be: (a) recommended by
the attending Physician; and (b) required by the standard regulations
of the conveyance transporting You and (c) reviewed and pre-approved
by the Assistance Company;
The Insurer will also pay reasonable and customary charges, up to the
maximum limit shown on the policy, for escort expenses required by
You, if You are disabled during a Trip and an escort is recommended in
writing, by the Insurer's attending Physician and must be
pre-approved by the Assistance Company. The Company will pay for the
services and transportation expenses for a qualified escort.
The Insurer will pay the expenses incurred to return to where they
reside, with an attendant if necessary, any of Your Dependent Children
who were accompanying You when the Injury or Emergency Sickness
occurred but not to exceed the cost of a single one-way economy
airfare ticket less the value of applied credit from any unused return
travel tickets per person.
If You are hospitalized for more than 7 days, the Company will pay
subject to the limitations set out herein, for expenses to bring one
person chosen by You to and from the Hospital or other medical
facility where You are confined if You are alone; but not to exceed
the cost of one round-trip economy airfare ticket.
In addition to the above covered expenses, if the Company has
previously evacuated You to a medical facility, the Company will pay
Your airfare costs from that facility to Your primary residence, less
refunds from Your unused transportation tickets. Airfare costs will be
economy, or first class if Your original tickets are first class or in
business or first class as in compliance to Your medical necessities
and requirements upon the discharge, less refunds from Your unused
All transportation must be authorized and arranged by the Assistance
To access Emergency Assistance, call the Assistance Company's
operation center collect at:
REPATRIATION OF REMAINS
The Insurer will pay reasonable Covered Expenses incurred to return
Your body to Your primary residence if You die during the covered
Trip. This will not exceed the maximum shown on the Schedule of
Coverages and Services. Covered Expenses include, but are not limited
to, expenses for embalming, cremation, minimally necessary coffins for
transport, and transportation.
Trip Cancellation/Trip Interruption:
The Insurer will pay a
benefit, up to the maximum shown on Your Confirmation Letter, if You
are prevented from taking Your covered Trip due to the following
Sickness, Accidental Injury, or death of You, Your Traveling
Companion, or Family Member. which results in medically imposed
restrictions as certified by a Physician at the time of loss
preventing Your continued participation in the Trip. A Physician
must advise cancellation of the Trip on or before the Scheduled
You and/or Your Traveling Companion being hijacked, quarantined,
required to serve on a jury, subpoenaed, or having his/her
principal place of residence made uninhabitable by fire, flood or
other natural disaster;
You or Your Traveling Companion being directly involved in a
traffic accident substantiated by a police report, while en route
You are transferred by the employer with whom You are employed on
Your Effective Date which requires Your principal residence to be
The death or hospitalization of Your host at destination;
If within 30 days of the departure of an Insured, a politically
motivated terrorist attack occurs within a 50 mile radius of the
territorial city limits of the foreign city to be visited by the
program for which the Insured has registered and if the United
States government issues a travel advisory indicating that
Americans should not travel to a city named on the itinerary;
Your Traveling Companion or Family Member, who are military
personnel, and are called to emergency duty for a natural disaster
other than war
Contact MEDEX as soon as You know the Trip is going
to be canceled or interrupted. Failure to do so may affect coverage.
Trip Cancellation: non-refundable cancellation charges imposed
by Your Travel Supplier.
Trip Interruption: the airfare paid, to return home or rejoin
the original Trip (limited to the cost of one-way Economy Fare by
scheduled carrier, from the point of destination to the point of
origin shown on the original travel tickets) less the value of applied
credit from an unused return travel ticket. In no event shall the
amount reimbursed exceed the lesser of the amount You pre-paid for
Your Trip, or the maximum benefit shown on the Schedule of Coverages
Lost Baggage: The Insurer will pay benefits if Your Checked
Baggage is lost due to theft or misdirection or damaged by a Common
Carrier while You are on a Covered Trip and are a ticketed passenger
on the Common Carrier.
Benefits will also be paid for Carry-On Baggage that is lost or stolen
while You are on a Covered Trip and are a ticketed passenger on a
The Insurer will reimburse You for the cost of replacement of the
baggage and its contents up to the maximum shown on Your Confirmation
Letter. There is a $100 deductible per occurrence. Per article, there
is a limit of $250. There will also be a combined maximum limit of
$500 for the following: jewelry; watches; articles consisting in
whole or in part of silver, gold or platinum; furs; articles trimmed
with or made mostly of fur; personal computers, cameras and their
accessories and related equipment.
All claims must be verified by the Common Carrier who must certify the
loss or theft occurred while in possession of the Common Carrier or
while the Insured was riding in the Common Carrier for Carry on
The Insurer will pay the lesser of the following: actual cash value at
time of loss, theft or damage to baggage and personal effects, less
depreciation as determined by the Insurer; or the cost of repair or
EXCESS INSURANCE PROVISION
This coverage is secondary to any coverage provided by a Common
Carrier and all other valid and collectible insurance indemnity and
shall apply only when such other benefits are exhausted.
"Pre-Existing Condition" means any Injury, Sickness or condition of
Yourself, a Traveling Companion or You and/or Your Traveling
Companion's Family Member for which medical advice, diagnosis, care
or treatment was recommended or received within the 6 month period
ending on the Effective Date. Conditions are not considered
pre-existing if the condition for which prescribed drugs or medicine
is taken remains controlled without any change in the required
The following exclusions apply. This plan does not cover any loss
caused by or resulting from:
Pre-Existing Conditions (except for Emergency Evacuation and
Repatriation of Remains);
Injury or Sickness when traveling against the advice of a Physician;
Traveling for the purpose of securing medical treatment;
Suicide, attempted suicide, or any intentionally self-inflicted Injury
while sane or insane;
War, invasion, acts of foreign enemies, hostilities between nations
(whether declared or not), civil war;
Participation in any military maneuver or training exercise;
Service of the armed forces of any country;
Piloting or learning to pilot or acting as a member of the crew of
Mental or emotional disorders;
Participation as a professional in athletics;
Being under the influence of drugs or intoxicants unless
prescribed by a Physician;
Commission or the attempt to commit a criminal act;
Participating in bodily contact sports; skydiving; hang gliding;
parachuting; mountaineering; any race; bungee cord jumping; scuba
diving, and speed contest;
Any non-emergency treatment or surgery, routine physical
examinations, hearing aids, eye glasses or contact lenses;
Pregnancy and childbirth (except for Complications of Pregnancy)
The following exclusions apply to Baggage/Personal Effects Coverage
only in the Optional Coverages section:
ANY LOSS OR DAMAGE TO: animals; automobiles and their
equipment; boats; trailers, motors; motorcycles; other conveyances and
their equipment (except bicycles while checked as Baggage with a
Common Carrier); household effects and furnishings; antiques and
collectors items; eyeglasses, sunglasses, and contact lenses;
artificial teeth and dental bridges; hearing aids; prosthetic limbs;
keys, money, securities, and documents; tickets; credit cards;
professional or occupational equipment or property; personal
computers; sporting equipment if loss or damage result from the use
ANY LOSS CAUSED BY OR RESULTING FROM:
Breakage of brittle or fragile articles; wear and tear, gradual
deterioration; insects or vermin; inherent vice or damage while the
article is actually being worked upon or processed; confiscation or
expropriation by order of any government; radioactive contamination;
war or any act of war whether declared or not; theft or pilferage
while left unattended in any vehicle; mysterious disappearance;
property illegally acquired, kept, stored or transported; insurrection
or rebellion; imprudent action or omission; and property shipped as
freight or shipped prior to the Scheduled Departure Date.
"Accident" means a sudden, unexpected, unusual, specific event
which occurs at an identifiable time and place, but shall also
include exposure resulting from a mishap to a conveyance in which
You are traveling.
"Accidental Injury" means Bodily Injury caused by an Accident (of
external origin) being the direct and independent cause in the
"Assistance Company" means MEDEX
"Bodily Injury" means identifiable physical Injury which: (a) is
caused by an Accident, and (b) solely and independently of any
other cause, except illness resulting from, or medical or surgical
treatment rendered necessary by such Injury, is the direct cause
of death or dismemberment of You within twelve months from the
date of the Accident.
"Carry On Baggage" means a piece of baggage that has not been
checked and is owned by and accompanies the Insured while
traveling on a Common Carrier.
"Checked Baggage" means a piece of baggage for which a claim
check has been issued to the Insured by a Common Carrier.
"Common Carrier" means any land, sea, and/or air conveyance
operating under a license for the transportation of passengers
"Complication of Pregnancy" means a condition whose diagnosis is
distinct from pregnancy but is adversely affected or caused by
"Dependent Child(ren)" means Your child (or children), including
an unmarried child, stepchild, legally adopted child or foster
child who is: (1) less than age 19 and primarily dependent on You
for support and maintenance; or (2) who is at least age 19 but
less than age 23 and who regularly attends an accredited school or
college; and who is primarily dependent on You for support and
"Economy Fare" means the lowest published rate for a one-way ticket.
"Effective Date" means the date and time Your coverage begins, as
outlined in the General Provisions section of this policy.
"Emergency Evacuation" means Your medical condition warrants
immediate transportation from the place where You are injured or
sick to the nearest Hospital where appropriate medical treatment
can be obtained;
"Emergency Sickness" means an illness or disease, diagnosed by a
legally licensed Physician, which meets all of the following
criteria: (1) there is a present severe or acute symptom requiring
immediate care and the failure to obtain such care could
reasonably result in serious deterioration of Your condition or
place Your life in jeopardy; (2) the severe or acute symptom
occurs suddenly and unexpectedly; and (3) the severe or acute
symptom occurs while Your coverage is in force and during Your
"Family Member" means You or Your Traveling Companion's legal
spouse, parent, legal guardian, step-parent, grandparent,
parents-in-law, grandchild, natural or adopted child, step-child,
children-in-law, ward, brother, sister, brother-in-law,
sister-in-law, aunt, uncle, niece, or nephew.
"Injury" means Bodily Injury caused by an Accident occurring while
this policy is in force, and resulting directly and independently
of all other causes in loss covered by the policy. The Injury must
be verified by a Physician.
"The Insurer" means Arch Insurance Company.
"Medically Necessary" means that a treatment, service, or supply:
(1) is essential for diagnosis, treatment, or care of the Injury
or Sickness for which it is prescribed or performed; (2) meets
generally accepted standards of medical practice; and (3) is
ordered by a Physician and performed under his or her care,
supervision, or order.
"Physician" means a licensed practitioner of medical, surgical, or
dental services acting within the scope of his/her license. The
treating Physician may not be Yourself, a Traveling Companion, or
a Family Member.
"Scheduled Departure Date" means the date on which You are
originally scheduled to leave on the Trip.
"Sickness" means illness or disease which is diagnosed and treated
by a Physician on or after the Effective Date of the protection
plan and while You are covered under this plan.
"Transportation" means any land, sea or air conveyance required to
transport You during an Emergency Evacuation. Transportation
includes, but is not limited to, Common Carrier, air ambulances,
land ambulances and private motor vehicles.
"Travel Supplier" means tour operator, cruise line, hotel, etc.,
who has made the land and/or sea arrangements.
"Traveling Companion" means a person who is sharing travel
arrangements with You to a maximum of 4 persons including You.
Companion unless You are sharing room accommodations with the
group or tour leader.
"Trip" means prepaid land/sea arrangements and shall include
flight connections to join and depart such land/sea arrangements
"Unforeseen" means not anticipated or expected and occurring after
the Effective Date of the policy.
"You," "Your," or "the Insured" means a person who has purchased a
Trip and who has paid the required plan cost for the protection
plan provided herein.
To facilitate prompt claims settlement:
TRIP CANCELLATION CLAIMS:
IMMEDIATELY Call Travel Supplier and
MEDEX Insurance Services to report Your cancellation and avoid
non-covered expenses due to late reporting. MEDEX Insurance Services
will then advise You on how to obtain the appropriate form to be
completed by You and the attending Physician.
Immediately call the Assistance Company and
obtain medical statements from the doctors in attendance in the
country where Sickness or Accident occurred. These statements should
give complete diagnosis, stating that the Sickness or Accident
prevented traveling on dates contracted. Provide all unused
transportation tickets, official receipts, etc.
Obtain receipts from the providers of
service, etc., stating the amount paid and listing the diagnosis and
Obtain a statement from the Common Carrier that Your
Baggage was delayed or a police report showing Your Baggage was stolen
along with copies of receipts for Your purchases.
TO OBTAIN CLAIM FORMS AND ANY ADDITIONAL INFORMATION ON HOW TO REPORT
A CLAIM,CALL OR WRITE MEDEX INSURANCE SERVICES AND REFER TO THE
TRAVMED ABROAD PRODUCT
The policy, applications, riders, and endorsements,
if any, make up the entire contract. No change in the policy is valid
unless it is signed by an executive officer of the Insurer. No agent
has the power to change this policy.
As required by the Insurer, the participating
organization must keep a record of the insurance for all Insureds. The
Insurer can inspect these records while coverage is in effect and for
one year after it ends or until final adjustment and settlement of
claims hereunder, whichever is later.
The Insurer will not deny or cancel coverage
on an Insured because of clerical error by the participating
organization or by the Insurer. After an error is found, the Insurer
will take appropriate action. This may include adjusting, collecting,
or refunding premium.
CONTESTING THIS POLICY.
The Insurer relies on statements made
by the participating organization in the application. If there is no
fraud, the participating organization's statements: (a) are
considered representations and not warranties; and (b) will not be
Used to void the policy or reduce any claim. The Insurer will not
contest the policy after it has been in effect for two (2) years,
except for fraud.
No legal action for a claim can be brought
against us until sixty (60) days after we receive proof of loss. No
legal action for a claim can be brought against us more than two (2)
years after the time required for giving proof of loss.
Any part of this policy that conflicts with
the state law where the policy is issued is changed to meet the
minimum requirements of that law.
MISREPRESENTATION AND FRAUD.
Coverage as to an Insured shall be
void if, whether before or after a loss, the Insured has concealed or
misrepresented any material fact or circumstance concerning this
policy or the subject thereof, or the interest of the Insured therein,
or if the Insured commits fraud or false swearing in connection with
any of the foregoing.
To the extent the Insurer pays for a loss suffered
by an Insured, the Insurer will take over the rights and remedies the
Insured had relating to the loss. This is known as subrogation. The
Insured must help the Insurer to preserve its rights against those
responsible for the loss. This may involve signing any papers and
taking any other steps the Insurer may reasonable require. If the
Insurer takes over an Insured's rights, the Insured must sign an
appropriate subrogation form supplied by the Insurer.
This policy is not assignable but benefits may be assigned.
CANCELLATION AND NON-RENEWAL.
Cancellation by the participating organization or Insured: The
participating organization or Insured has the right to cancel this
policy at any time by giving advance notice to the Insurer (stating
when thereafter the cancellation shall be effective). Cancellation by
the Insurer: The Insurer has
the right to cancel this policy at any time and for any reason within
the first sixty (60) days. The Insurer will mail all notice of
cancellation thirty (30) days prior to the Effective Date of
cancellation on a policy which has been in force sixty (60) days or
less. A specific explanation for cancellation will be given. On a
policy which has been in force sixty-one (61) days or more, the
Insurer will mail advance notice of cancellation sixty (60) days prior
to cancellation. After this policy has been in effect for sixty (60)
days, it may be cancelled only for one of the following reasons: (a)
Non-payment of premium; (b) The policy was obtained through a material
misrepresentation; (c) Any participating organization or Insured
violating any of the terms and conditions of the policy; (d) The risk
originally accepted has measurably increased; The Insurer will mail
all notices of cancellation for nonpayment of premium ten (10) days in
advance prior to cancellation.
Non-renewal by the Insurer:
The Insurer has the right to non-renew this policy effective on any
annual policy anniversary date. All notices of non-renewal will be
mailed to the participating organization or Insured at the last
mailing address known to the Insurer, at least sixty (60) days prior
to the Effective Date of non-renewal and shall provide a specific
explanation of the reasons for non-renewal.
The period beginning on the Effective Date and
continuing or a period indicated in the policy. The policy term shall
automatically renew continuously for successive one-year periods
(policy anniversary date), thereafter until cancelled or non-renewed
pursuant to the terms of this policy.
WHEN AN INSURED'S COVERAGE BEGINS.
All coverage (except Trip
Cancellation) will take effect at 12:01 A.M. local time, at the
location of the Insured, on the Scheduled Departure Date provided: (a)
coverage has been elected; and (b) the required premium has been
paid. Trip Cancellation coverage will take effect at 12:01 A.M. local
time at the location of the Insured, on the day after the required
premium for such coverage is received by the Company or its authorized
WHEN AN INSURED'S COVERAGE ENDS.
An Insured's coverage will
end at 11:59 local time on the date which is the earliest of the
following: (a) the date the policy is terminated, unless the Insured
purchased insurance prior to the date of termination; (b) the
Scheduled Return Date as stated on the travel tickets; (c) the date
the Insured returns to his/her origination point if prior to the
Scheduled Return Date; (d) the date the Insured leaves or changes
his/her Covered Trip (unless due to Unforeseen and unavoidable
circumstances covered by the policy); (e) the time the policy
terminates; (f) If the Insured extends the return date, coverage will
terminate at 11:59 P.M., local time, at the location of the Insured on
the Scheduled Return Date; (g) The date the Insured cancels their
covered Trip; (h) When the Insured is less than 100 miles from their
primary residence; (i) Any Trip that exceeds 365 days.
The Insurer provides insurance in return for premium
payments. Premium must be remitted on behalf of the Insureds to the
Insurer or to its authorized representative.
AMOUNT OF PREMIUM.
The amount of premium due from the
participating organization is calculated by multiplying the number of
Insureds in each class by the amounts due for the benefits for that
class and adding the total amounts due for each class. The amount of
premium due for each Insured is obtained by adding the total rate
charged for each benefit provided for that Insured.
MODE OF PREMIUM:
The required premium must be paid to the
participating organization or its authorized representative prior to
the Scheduled Departure Date of the Covered Trip.
Organization will pay the premium according to the schedule noted in
the travel protection policy application.
PREMIUM RATE CHANGE.
The Insurer has the right to change
premium rates on any premium due date. The Insurer will give the
participating organization thirty-one (31) days advance notice in
writing of any such change. The Insurer can also change the rates when
any change affecting rates is made in the policy.
Notwithstanding anything in this policy to the
contrary, any claim arising out of or relating to this contract, or
its breach, will be settled by arbitration administered by the
American Arbitration Association in accordance with its Commercial
rules except to the extent provided otherwise in this clause. Judgment
upon the award rendered in such arbitration may be entered in any
court having jurisdiction thereof. All fees and expenses of the
arbitration shall be borne by the parties equally. However, each party
will bear the expense of its own counsel, experts, witnesses, and
preparation and presentation of proofs. The arbitrators are precluded
from awarding punitive, treble, or exemplary damages, however so
denominated. If more than one Insured is involved in the same dispute
arising out of the same policy and relating to the same loss or claim,
all such Insureds will constitute and act as one party for the
purposes of the arbitration. Nothing in this clause will be construed
to impair the rights of the Insureds to assert several, rather than
joint, claims or defenses. This section does not apply to Kansas
NOTICE OF CLAIM.
Written notice of claim must be given to the
Insurer or its designated representative within twenty (20) days after
a covered loss first begins or as soon as reasonably possible. Notice
should include the Insured's name and policy number.
PROOF OF LOSS.
The claimant must send the Insurer, or its
designated representative, proof of loss with ninety (90) days after a
covered loss occurs or as soon as reasonably possible.
PAYMENT OF CLAIMS.
The Insurer, or its designated
representative, will pay a claim after receipt of acceptable proof of
loss. All other claims will be paid to the Insured. In the event the
Insured is a minor, incompetent, or otherwise unable to give a valid
release for the claim, the Insurer may make arrangement to pay claims
to the Insured's legal guardian, committee, or other qualified
representative. All or a portion of all other benefits provided by
this policy may, at the option of the Insurer, be paid directly to the
provider of the service(s). All benefits not paid to the provider will
be paid to the Insured. Any payment made in good faith will discharge
the Insurer's liability to the extent of the claim. The applicable
benefit amount will be reduced by the amount of benefits, if any,
previously paid by other Insurance Policies. In no event will the
Insurer reimburse the Insured for an amount greater than the amount
paid by the Insured.
PHYSICAL EXAMINATION AND AUTOPSY.
The Insurer, or its
designated representative, at their own expense, have the right to
have the Insured examined as often as reasonably necessary while a
claim is pending.
The Insurer, or its designated representative, also have the right to
have an autopsy made unless prohibited by law.
The following provisions apply to Lost Baggage coverage only:
NOTICE OF LOSS.
If the Insured's property covered under this
policy is lost, stolen, or damaged, the Insured must: (a) notify the
Insurer, or its authorized representative as soon as possible; (b)
take immediate steps to protect, save, and/or recover the covered
property; (c) give immediate notice to the carrier or bailee who is or
may be liable for the loss or damage; (d) notify the police or other
authority in the case of robbery or theft within twenty-four (24)
PROOF OF LOSS.
The Insured must furnish the Insurer, or its
designated representative, with proof of loss. This must be a detailed
sworn statement. It must be filed with the Insurer, or its designated
representative within ninety (90) days from the date of loss. Failure
to comply with these conditions shall invalidate any claims under this
SETTLEMENT OF LOSS.
Claims for damage and/or destruction shall
be paid after acceptable proof of the damage and/or destruction is
presented to the Insurer and the Insurer has determined the claim is
covered. Claims for lost property will be paid after the lapse of a
reasonable time if the property has not been recovered. The Insured
must present acceptable proof of loss and the value involved to the
The Insurer will not pay more than the Actual Cash
Value of the property at the time of loss. Damage will be estimated
according to Actual Cash Value with proper deduction for
depreciation. At no time will payment exceed what it would cost to
repair or replace the property with material of like kind and quality.
DISAGREEMENT OVER SIZE OF LOSS.
If there is a disagreement
about the amount of the loss, either the Insured or the Insurer can
make a written demand for an appraisal. After the demand, the Insured
Insurer will each select their own competent appraiser. After
examining the facts, each of the two appraisers will give an opinion
on the amount of the loss. If they do not agree, they will select an
arbitrator. Any figure agreed to by 2 of the 3 (the appraisers and the
arbitrator) will be binding. The appraiser selected by the Insured is
paid by the Insured. The Insurer will pay the appraiser they
choose. The Insured will share equally with the Insurer the cost for
the arbitrator and the appraisal process.
BENEFIT TO BAILEE.
This insurance will in no way inure directly
or indirectly to the benefit of any carrier or other bailee.
CALIFORNIA RESIDENTS: 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.
The following definitions are revised:
"Accidental Injury" means Bodily Injury caused by an
accident being the direct and independent cause in the loss.
"Bodily Injury" means identifiable physical injury
which: (a) is caused by an Accident, and (b) solely and independently
of sickness, disease, or bodily infirmity, except illness resulting
from, or medical or surgical treatment rendered necessary by such
injury, is the direct cause of Your death or dismemberment within
twelve months from the date of the Accident.
Letter (b) is deleted from the definition of "Pre-Existing Conditions"
The following definition is added:
"Intoxication" is that which is defined by the laws of
the state where the loss or cause of loss was incurred.
The following sections are added to General Provisions:
INSURANCE WITH OTHER COMPANIES. If there is other valid
coverage, not with this company, providing benefits for the same loss
on other than an expense-incurred basis and of which this company has
not been given written notice prior to the occurrence or commencement
of loss, the only ability for such benefits under this policy shall be
for such proportion of the indemnities otherwise provided hereunder
for such loss as the like indemnities of which the company had notice
(including the indemnities under this policy) bear to the total amount
of all like indemnities for such loss, and for the return of such
portion of the premium paid as shall exceed the pro-rata portion for
the indemnities thus determined.
ARBITRATION. An arbitration provision is not a substitute for a
person's right to maintain a legal action if they so desire; and in
no way affects or limits a person's ability to take legal action in a
court of law, prior to voluntarily agreeing to enter into an
arbitration proceeding. Any controversy or claim arising out of or
relating to this contract, or the breach thereof, may be settled by
arbitration. The arbitration will be conducted pursuant to the
applicable rules of the American Arbitration Association and in
accordance with the Uniform Arbitration Act within reasonable time
limit (30 days after the parties agree to arbitrate their dispute is a
reasonable time limit for selected and appointing independent
arbitrators, 15 days is a reasonable time limit for an expedited
review provision). The arbitration may be binding on both parties, but
in all instances must be entered into on a voluntary
basis. Arbitrators must be fair, impartial, and free of any conflicts
of interest or the appearance of a conflict of interest. By
voluntarily agreeing to enter into an arbitration proceeding, the
parties should be aware and understand that they may be giving up
certain rights to have their dispute settled in a court of law, except
to the extent that Illinois law may provide for judicial review of
TIME PAYMENT OF CLAIMS. Claims payable under this policy shall
begin to be paid in period payments no later than the 30th day after
the Insured received notice of a health care selection. All subsequent
payments will be made in accordance with the monthly periodic
cycle. Failure to pay within such period shall entitle the payee to
interest at the rate of 9% per annum from the 30th day after receipt
of such proof of loss to the date of late payment, provided that
interest amounting to less than one dollar need not be paid. Any
required interest payments shall be made within 30 days after the
The following Exclusion is deleted (13) participating in
bodily contact sports.
Exclusion (5) shall read: "War, invasion, hostilities between nations (whether declared or not), civil war;
The Subrogation provision does not apply to medical, surgical,
Hospital, or funeral expenses.
Legal Actions is revised as follows: "No legal action
for a claim can be brought against us more than five (5) years after
the time required for giving proof of loss."
A Claim Forms provision was added: "The Insurer, upon
receipt of a notice of claim, will furnish to the claimant such forms
as are usually furnished by it for filing proofs of loss. If such
forms are not furnished within 15 days after the giving of such notice
the claimant shall be deemed to have complied with the requirements of
this policy as to proof of loss upon submitting within the time fixed
in the policy for filing proofs of loss, written proof covering the
occurrence, the character, and the extent to the loss for which claim
A Time of Payment of Claims provision was added to the policy:
"Indemnities payable under this policy for any loss other than loss
for which this policy provides any periodic payment will be paid
immediately upon receipt of due written proof of such loss. Subject to
due written proof of loss, all accrued indemnities for loss for which
this policy provides periodic payment will be paid monthly, and any
balance remaining unpaid upon the termination of liability will be
paid immediately upon receipt of due written proof."
A definition of "Usual, Customary, and Reasonable" was added to
the policy: "charges commonly Used by Physicians in the locality in
which care is furnished, as determined by the Administrator's
database (Ingenix, Medicaid, other) and updated at least every 6
The definition of Family Member is revised to read "Family
Member" means Your legal or common law spouse, Domestic
Partner, parent, legal guardian, step-parent, grandparent,
parents-in-law, grandchild, natural or adopted child, foster child,
ward, step-child, children-in-law, brother, sister, step-brother,
step-sister, brother-in-law, sister-in-law, aunt, uncle, niece, or
If this policy is financed by a premium finance company and we (the
Insurer) or the premium finance company or the first-named insured
cancels the policy, the refund will be pro rata excluding any expense
constant, administrative fee, or nonrefundable charge filed with and
approved by the insurance commissioner.
Legal Actions provision in the policy was revised to provide 3 years
(not 2) for an insured to file a legal action against the insurance
company. The Cancellation and Nonrenewal provision in the policy is
revised to provide at least 45 days notice of cancellation by the
company for any reason other than non-payment of premium. The
provision is also revised to state that "All notices will be sent to
the insured by certificate of mailing."
"Bodily Injury" means identifiable physical Injury
which: (a) is caused by an Accident, and (b) solely and independently
of Sickness, disease, or bodily infirmity, except illness resulting
from, or medical or surgical treatment rendered necessary by such
Injury, is the direct cause of death or dismemberment of the Insured
within twelve months from the date of the Accident. Subrogation is not
permitted in Missouri.
NEW YORK RESIDENTS:
The definition of "Complication of Pregnancy" is revised to read:
"Complication of Pregnancy" means: (1) conditions
requiring Hospital stays (when the pregnancy is not terminated) whose
diagnoses are distinct from pregnancy but are adversely affected by
pregnancy or are caused by pregnancy, such as acute nephritis,
nephrosis, cardiac decompensation, missed abortion and similar medical
and surgical conditions of comparable severity, and shall not include
false labor, occasional spotting, Physician-prescribed rest during the
period of pregnancy, morning Sickness, hyperemesis gravidarum,
preeclampsia and similar conditions associated with the management of
a difficult pregnancy not constituting a nosologically distinct
Complication of Pregnancy; and (2) nonelective caesarean section,
ectopic pregnancy which is terminated and spontaneous termination of
pregnancy, which occurs during a period of gestation in which a viable
birth is not possible. The Repatriation benefit is limited to the cost
of transporting the body. Coverage for "embalming, cremation, and
casket for transport" is deleted.
The following exclusions are deleted: (10) Participation
as a professional in athletics; (11) Being under the influence of
drugs or intoxicants, unless prescribed by a Physician; (12)
Commission or the attempt to commit a criminal act; (13) Participating
in bodily contact sports; skydiving; hang-gliding; parachuting;
mountaineering; any race; bungee cord jumping; and speed contests.
The following definition is deleted: "Unforeseen".
Exclusion #5 is revised to read:
"War or act of war (whether declared or not);"
The following General Provisions sections are deleted:
Records, Clerical Errors, Contesting This Policy, Legal Actions,
Controlling Law, Cancellation and Non-Renewal, Policy Term, Premium,
Amount of Premium, Mode of Premium, Premium Rate Change, and Claims.
The following General Provisions sections have been revised:
MISREPRESENTATION AND FRAUD: All statements and descriptions in
any enrollment form for this policy by or in behalf of You or any
other Insured, shall be deemed to be representations and not
warranties. Misrepresentations, omissions, concealments of facts and
incorrect statements shall not prevent a recovery under the policy
unless the misrepresentations, omissions, concealments of fact, and
incorrect statements: (a) Are contained in a written statement for the
insurance policy, and a copy of such statement is attached to the
insurance policy when issued; (b) Are shown by the Insurer to be
material, and the Insurer also shows reliance thereon; and (c) Are
either fraudulent or material either to the acceptance of the risk or
to the Hazard assumed by the Insurer.
ARBITRATION: Notwithstanding anything in this policy to the
contrary, any claim arising out of or relating to this contract, or
its breach, may be settled by arbitration administered by the American
Arbitration Association in accordance with its commercial rules except
to the extent provided otherwise in this clause. Arbitration is by
mutual consent by all parties and Oregon courts will have jurisdiction
over such arbitration. All fees and expenses of the arbitration shall
be borne by the parties equally. However, each party will bear the
expense of its own counsel, experts, witnesses, and preparation and
presentation of proofs. The arbitrators are precluded from awarding
punitive, treble, or exemplary damages, however so denominated. If
more than one covered person is involved in the same dispute arising
out of the same policy and relating to the same loss or claim, all
such covered persons will constitute and act as one party for the
purposes of the arbitration. Nothing in this clause will be construed
to impair the rights of the covered persons to assert several, rather
than joint, claims or defenses.
NOTICE OF CLAIM: Written notice of claim must be given by the
Claimant (either You or someone acting on Your behalf) to the Insurer
or its designated representative within fifteen (15) days after a
covered loss first begins or as soon as reasonably possible. Notice
should include Your name and the plan number. Notice should be sent to
the Insurer's administrative office, at the address shown on
the cover page of the policy, or to the Insurer's designated
DISAGREEMENT OVER SIZE OF LOSS: If there is a disagreement
about the amount of the loss either You or the Insurer can make a
written demand for an appraisal. Such request for appraisal will be by
mutual consent and take place in Oregon according to Oregon law. After
the demand, You and the Insurer will each select Your own competent
appraiser. After examining the facts, each of the two appraisers will
give an opinion on the amount of the loss. If they do not agree, they
will select an arbitrator. Any figure agreed to by 2 of the 3 (the
appraisers and the arbitrator) will be binding. You pay for the
appraiser selected by You. The Insurer will pay the appraiser they
choose. You will share equally with the Insurer the cost for the
arbitrator and the appraisal process.
The Legal Actions provision is revised to permit suits against the
insurers within 2 years and one day after the loss.
The Cancellation and Nonrenewal provision is revised so that it
states "The Insurer cannot cancel or refuse to renew a policy
or contract of insurance based solely on the fact that the
policyholder in question is an elected official."
The following definitions are revised as follows:
"Physician" means a licensed practitioner of medical,
surgical, the healing arts, or dental services acting within the scope
of his/her license. The treating Physician may not be the Insured, a
Traveling Companion, or a Family Member.
Medical Evacuation/Repatriation benefit has been revised so that
pre-approval is not required and cannot be a reason for denial of the
benefit, but a 50% or $500 penalty is permitted.
Plan is designed by MEDEX
This Insurance, under policy #AIC-TRVL-P (2/03)
is underwritten by: Arch Insurance Company, with its principal place
of business in New York, NY
Policy terms and conditions are briefly outlined in this Description
of Coverage. Complete provisions pertaining to this insurance are
contained in the Master Policy on file with American Group Travel
Trust, BankNewport as Trustee. The use of a Trustee is not permitted
in Kansas, New York, Oregon, Texas or Washington. In the event of any
conflict between this Description of Coverage and the Master Policy,
the Master Policy will govern.