All-Inclusive Package
Plan Details
All-Inclusive Package
TRAVEL PROTECTION PLAN
CERTIFICATE OF INSURANCE
Nationwide Mutual Insurance Company
This Certificate of Coverage describes all of the travel insurance benefits, underwritten by Nationwide Mutual Insurance Company and herein referred to as the Company, and assistance services provided by On Call International. The insurance benefits and assistance services vary from program to program. Please refer to the accompanying Confirmation of Coverage. It provides You with specific information about the program You purchased. Please contact the Plan Administrator immediately if You believe that the Confirmation of Coverage is incorrect.This Certificate of Coverage is issued in consideration of the enrollment form and payment of any premium due. All statements in the enrollment forms are representations and not warranties. Only statements contained in a written enrollment form will be used to void insurance, reduce benefits or defend a claim.
NO DIVIDENDS WILL BE PAYABLE UNDER THE GROUP POLICY.
The President and Secretary of Nationwide Mutual Insurance Company witness the Group Policy. This program contains a pre-existing conditions limitation. Please read the Definitions and Exclusions carefully.
NATIONWIDE MUTUAL INSURANCE COMPANY
PASSENGER PROTECTION INSURANCE POLICY
GENERAL DEFINITIONS
Accident means a sudden, unexpected, unusual, specific event that 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 loss.
Actual Cash Value means purchase price less depreciation.
Additional Expense means any reasonable expenses for meals and lodging which were necessarily incurred as the result of a Hazard and which were not provided by the Common Carrier or other party free of charge.
Bankruptcy means the filing of a petition for voluntary or involuntary bankruptcy in a court of competent jurisdiction under Chapter 7 or Chapter 11 of the United States Bankruptcy Code 11 L.S.C. Subsection 101 et seq.
Bodily Injury means identifiable physical injury which: (a) is caused by an Accident, (b) is independent of disease or bodily infirmity, and (c) is the direct cause of death or dismemberment of the Insured within twelve months from the date of the Accident.
Business Partner means an individual who: (a) is involved in a legal partnership; and (b) is actively involved in the day-to-day management of the business.
Checked Baggage means a piece of baggage for which a claim check has been issued to You by a Common Carrier.
Common Carrier means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
Company means Nationwide Mutual Insurance Company.
Covered Expenses shall mean expenses incurred by You which are for Medically Necessary services, supplies, care, or treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician; reasonable and customary charges; incurred while You are insured under the Group Policy; and which do not exceed the maximum limits shown in the Confirmation of Coverage, under each stated benefit.
Covered Trip means any class of scheduled trips, tours or cruises for which You request coverage and remit the required premium.
Cruise means any prepaid sea arrangements made by the Travel Supplier.
Default means a material failure or inability to provide contracted services due to financial insolvency.
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 maintenance.
Dependent means Your lawful spouse and/or unmarried children under 19 years of age.
Economy Fare means the lowest published rate for a round trip economy ticket.
Effective Date means the date and time Your coverage begins, as outlined in the General Provisions section of this Certificate.
Family Member means You or Your Traveling Companion's legal or common law spouse, parent, legal guardian, step-parent, grandparent, parents-in-law, grandchild, natural or adopted child, step-child, children-in-law, brother, sister, step-brother, step-sister, brother-in-law, sister-in-law, aunt, uncle, niece or nephew, who reside in the United States, Canada or Mexico.
Hazard means:a) Any delay of a Common Carrier (including Inclement Weather).b) Any delay by a traffic accident en route to a departure, in which You or a Traveling Companion is not directly involved.c) Any delay due to lost or stolen passports, travel documents or money, quarantine, hijacking, unannounced strike, natural disaster, civil commotion or riot.d) A closed roadway causing cessation of travel to the destination of the Covered Trip (substantiated by the department of transportation, state police, etc.)
Hospital means a facility that:
(a) holds a valid license if it is required by the law;
(b) operates primarily for the care and treatment of sick or injured persons as in-patients;
(c) has a staff of one or more Physicians available at all times;
(d) provides 24 hour nursing service and has at least one registered professional nurse on duty or call;
(e) has organized diagnostic and surgical facilities, either on the premises or in facilities available to the hospital on a pre-arranged basis; and
(f) is not, except incidentally, a clinic, nursing home, rest home, or convalescent home for the aged, or similar institution.
Host at Destination means a person with whom You are sharing pre-arranged overnight accommodations at the host's usual principal place of residence.Inclement Weather means any severe weather condition that delays the scheduled arrival or departure of a Common Carrier.
Individual Coverage Term means the period of time beginning when You have been enrolled for coverage under the Group Policy and for whom the required premium has been paid.
Insured means the person who has enrolled for and paid for coverage under the Group Policy.
Land/Sea Arrangements means any activities undertaken by You while in the Individual Coverage Term.
Loss means injury or damage sustained by You in consequence of happening of one or more of the occurrences against which the Company has undertaken to indemnify You.
Maximum Benefit means the largest total amount of Covered Expenses that the Company will pay for Your covered losses.
Medically Necessary means a service or supply which: (a) is recommended by the attending Physician; (b) is appropriate and consistent with the diagnosis in accord with accepted standards of community practice; (c) could not have been omitted without adversely affecting an Insured's condition or quality of medical care; (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience; and (e) is not considered experimental unless coverage for experimental services or supplies is required by law.
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 You, a Traveling Companion or a Family Member.
Pre-Existing Condition means any injury, sickness or condition of You, or Your Traveling Companion for which within the sixty (60) day period prior to the effective date of Trip Cancellation coverage under the Group Policy (a) first manifested itself or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or (c) required medical treatment or treatment was recommended by a Physician.
The Pre-Existing Conditions exclusion is waived for You if You enroll in the Group Policy at the time You pay the deposit required for the Covered Trip (or within 10 days of the initial deposit) and You purchase the coverage under the Group Policy for the full cost of the Covered Trip.
Scheduled Departure Date means the date on which You are originally scheduled to leave on the Covered Trip.
Scheduled Return Date means the date on which You are originally scheduled to return to the point of origin or to a different final destination.
Sickness means an illness or disease which is diagnosed or treated by a Physician after the effective date of insurance and while You are covered under the Group Policy.
Strike means any unannounced labor disagreement that interferes with the normal departure and arrival of a Common Carrier.
Terrorist Incident means an incident deemed a terrorist act by the United States Government that causes property damage or loss of life.
Traveling Companion means person(s) named and traveling under the same reservation as You during the Covered Trip. Note, a group or tour leader is not considered a Traveling Companion unless You are sharing room accommodations with the group or tour leader.
Travel Supplier means tour operator, cruise line, hotel etc. who has made the land and/or sea arrangements.
You or Your refers to all persons listed on the Confirmation of Coverage under the program purchased by the Insured.
GENERAL PROVISIONS
The following provisions apply to all coverages:
WHEN YOUR COVERAGE BEGINS - All coverage (except Trip Cancellation) will take effect at 12:01 A.M. local time, at Your location, 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 Your location, on the date the required premium for such coverage is received by the Company or its authorized representative.
WHEN YOUR COVERAGE ENDS - Your coverage will end at 11:59PM local time on the date that is the earliest of the following:
(a) the Scheduled Return Date as stated on the travel tickets;
(b) the date You return to Your origination point if prior to the Scheduled Return Date;
(c) the date You leave or change Your Covered Trip (unless due to unforeseen and unavoidable circumstances covered by the Policy);
(d) the time the Group Policy terminates. If insurance was purchased prior to the date of termination, insurance will continue to the end of the Individual Coverage Term;
(e) If You extend the return date, Your coverage will terminate at 11:59 P.M., local time, at Your location on the Scheduled Return Date;
(f) The date You cancel the Covered Trip;
(g) Any Covered Trip that exceeds 150 days.
EXTENDED COVERAGE - Coverage will be extended under the following conditions:(a) If You are a passenger on a scheduled common carrier that is unavoidably delayed in reaching the final destination coverage will be extended for the period of time needed to arrive at the final destination.
In no event will coverage be extended for unscheduled extensions to Your Covered Trip for which premium has not been paid in advance.
ARBITRATION - 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 the Uniform Arbitration Act (710 ILCS 5/1 et seq.) 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. Such arbitration will be voluntary, will be by mutual consent by all parties, and may be binding upon all parties or non-binding on the Insured. Nothing in this clause will be construed to impair the rights of the Insureds to assert several, rather than joint, claims or defenses.
LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of loss. No legal action for a claim can be brought against the Company more than two (2) years after the time required for giving proof of loss.
CONTROLLING LAW - Any part of the Group Policy that conflicts with the state law where the Group Policy is issued is changed to meet the minimum requirements of that law.
SUBROGATION - To the extent the Company pays for a loss suffered by You, the Company will take over the rights and remedies You had relating to the loss. This is known as subrogation. You must help the Company to preserve its rights against those responsible for the loss. This may involve signing any papers and taking any other steps the Company may reasonably require. If the Company takes over Your rights, You must sign an appropriate subrogation form supplied by the Company.
The following provisions will apply to Trip Cancellation, Trip Interruption, Trip Delay, Accidental Death & Dismemberment, Emergency Sickness Medical Expense, Emergency Accident Medical Expense, Emergency Evacuation, Repatriation of Remains:
PAYMENT OF CLAIMS - The Company, or its designated representative, will pay a claim after receipt of acceptable proof of loss. Benefits for loss of life are payable to Your beneficiary. If a beneficiary is not otherwise designated by You, benefits for loss of life will be paid to the first of the following surviving preference beneficiaries:a) Your spouse:b) Your child or children jointly:c) Your parents jointly if both are living or the surviving parent if only one survives:d) Your brothers and sisters jointly: ore) Your estate.All other claims will be paid to You. In the event You are a minor, incompetent or otherwise unable to give a valid release for the claim, the Company may make arrangement to pay claims to Your legal guardian, committee or other qualified representative.
All or a portion of all other benefits provided by the Group Policy may, at the option of the Company, be paid directly to the provider of the service(s). All benefits not paid to the provider will be paid to You.
Any payment made in good faith will discharge the Company'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 Company reimburse You for an amount greater than the amount paid by You.
NOTICE OF CLAIM - Written notice of claim must be given by the Claimant (either You or someone acting for You) to the Company or its designated representative within twenty (20) days after a covered loss first begins or as soon as reasonably possible. Notice should include Your name, the Travel Supplier's name and the Group Policy number. Notice should be sent to the Company's administrative office, at the address shown on the cover page of the Group Policy, or to the Company's designated representative.
PROOF OF LOSS - The Claimant must send the Company, or its designated representative, proof of loss within ninety (90) days after a covered loss occurs or as soon as reasonably possible.
PHYSICAL EXAMINATION AND AUTOPSY - The Company, or its designated representative, at their own expense, have the right to have You examined as often as reasonably necessary while a claim is pending. The Company, or its designated representative, also has the right to have an autopsy made unless prohibited by law.
TIME OF PAYMENT OF CLAIMS: Benefits 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.
All claims shall be paid within 30 days following receipt by the Company of due proof of loss. Failure to pay within such period shall entitle the claimant to interest at the rate of 9 percent 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. You or Your assignee shall be notified by the Company or designated representative of any known failure to provide sufficient documentation for a due proof of loss within 30 days after receipt of the claim. Any required interest payments shall be made within 30 days after the payment.
The following provisions apply to Baggage/Personal Effects and Baggage Delay coverages:
NOTICE OF LOSS - If Your property covered under the Group Policy is lost, stolen or damaged, You must:(a) notify the Company, 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) hours.
PROOF OF LOSS - You must furnish the Company, or its designated representative, with proof of loss. This must be a detailed sworn statement. It must be filed with the Company, or its designated representative within ninety (90) days from the date of loss. Failure to comply with these conditions shall invalidate any claims under the Group Policy.
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 Company and the Company 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. You must present acceptable proof of loss and the value involved to the Company.
VALUATION - The Company 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 as determined by the Company. 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 You or the Company can make a written demand for an appraisal. After the demand, You and the Company 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. The appraiser selected by You is paid by You. The Company will pay the appraiser they choose. You will share equally with the Company the cost for the arbitrator and the appraisal process.
BENEFITS
TRIP CANCELLATIONThe Company will pay a benefit, up to the maximum shown on the Confirmation of Coverage, if You are prevented from taking Your Covered Trip due to:
(a) Sickness, Accidental Injury or death of You, Traveling Companion, or Family Member or Business Partner; which results in medically imposed restrictions as certified by a Physician at the time of loss preventing Your continued participation in the Covered Trip. A Physician must advise cancellation of the Covered Trip on or before the Scheduled Departure Date.
(b) You or a Traveling Companion being hijacked, quarantined, required to serve on a jury, subpoenaed, the victim of felonious assault within 10 days of departure; or having his/her principal place of residence made uninhabitable by fire, flood or other natural disaster; or burglary of his/her principal place of residence within 10 days of departure.
(c) You or a Traveling Companion being directly involved in a traffic accident substantiated by a police report, while en route to departure.
(d) A transfer of You by the employer with whom You are employed on the Effective Date that requires Your principal residence to be relocated.
(e) The death or hospitalization of Your Host at Destination.
(f) Your Traveling Companion or Family Member, who are military personnel, and are called to emergency duty for a natural disaster other than war.
(g) Strike that causes complete cessation of services for at least 24 consecutive hours.
(h) You are terminated, or laid off from employment subject to three years of continuous employment at the place of employment where terminated.
(i) Natural disaster at the site of Your destination that renders the destination accommodations uninhabitable.
(j) Weather that causes complete cessation of services of Your Common Carrier for at least 24 consecutive hours.
(k) You are required to take an academic examination on a date that has been fixed after travel arrangements were made, and the date falls within the period of travel.
(l) A Terrorist Incident that occurs in a city listed on Your Covered Trip itinerary and within 30 days prior to your Scheduled Departure Date. This same city must not have experienced a Terrorist Incident within the 90 days prior to the Terrorist Incident that is causing the cancellation of Your Covered Trip. Benefits are not provided if the Travel Supplier offers a substitute itinerary. Your Scheduled Departure Date must be no more than 15 months beyond Your Effective Date. This benefit only applies if the policy has been purchased within 10 days of Your initial payment for the Covered Trip and for the full cost of the Covered Trip.
(m) Bankruptcy and/or Default of Your Travel Supplier which occurs more than 10 days following Your Effective Date. Coverage is not provided for the Bankruptcy or Default of the agency from whom You purchased the Land/Sea Arrangements. Your Scheduled Departure Date must be no more than 15 months beyond Your Effective Date. Benefits will be paid due to Bankruptcy or Default of an airline only if no alternate transportation is available. If alternate transportation is available, benefits will be limited to the change fee charged to allow You to transfer to another airline in order to get to Your intended destination.
The Company will reimburse You for the following:
a) Non-refundable cancellation charges imposed by the Travel Suppliers;
If the Travel Supplier cancels Your Covered Trip, You are covered up to $100 for the reissue fee charged by the airline for the tickets or up to $200 for the cost charged by the airline to retain Your frequent flyer miles if You had used them to purchase the airline ticket in conjunction with this Trip. You must have covered the entire cost of the Covered Trip including the airfare.
In no event shall the amount reimbursed exceed the amount You prepaid for the Covered Trip or the maximum benefit shown on the Confirmation of Coverage.
SPECIAL CONDITIONS: You must advise the Travel Supplier and the Company as soon as possible in the event of a claim. The Company will not pay benefits for any additional charges incurred that would not have been charged had You notified the Travel Supplier as soon as reasonably possible.
SINGLE OCCUPANCY COVERAGEThe Company will reimburse You, up to the maximum shown on the Confirmation of Coverage, for the additional cost incurred during the Covered Trip as a result of a change in the per person occupancy rate for prepaid travel arrangements if a person booked to share accommodations with You has his/her Covered Trip delayed, canceled, or interrupted for a covered reason and You do not cancel.
TRIP INTERRUPTION
The Company will pay a benefit, up to the maximum shown on the Confirmation of Coverage, if You are unable to continue on Your Covered Trip due to:
(a) Sickness, Accidental Injury or death of You, Traveling Companion, or Family Member or Business Partner; which results in medically imposed restrictions as certified by a Physician at the time of loss preventing Your continued participation in the Covered Trip.
(b) You or a Traveling Companion being hijacked, quarantined, required to serve on a jury, subpoenaed, the victim of felonious assault within 10 days of departure; or having his/her principal place of residence made uninhabitable by fire, flood or other natural disaster; or burglary of his/her principal place of residence within 10 days of departure.
(c) You or a Traveling Companion being directly involved in a traffic accident substantiated by a police report, while en route to departure.
(d) A transfer of You by the employer with whom You are employed on the Effective Date which requires Your principal residence to be relocated.
(e) The death, or hospitalization of Your Host at Destination.
(f) Your Traveling Companion or Family Member, who are military personnel, and are called to emergency duty for a natural disaster other than war
(g) Strike that causes complete cessation of services for at least 24 consecutive hours.
(h) You are terminated, or laid off from employment subject to three years of continuous employment at the place of employment where terminated.
(i) Natural disaster at the site of Your destination that renders the destination accommodations uninhabitable.
(j) Weather that causes complete cessation of services of Your Common Carrier for at least 24 consecutive hours.
(k) You are required to take an academic examination on a date that has been fixed after travel arrangements were made, and the date falls within the period of travel.
(l) A Terrorist Incident that occurs in a city listed on Your Covered Trip itinerary and within 30 days prior to your Scheduled Departure Date. This same city must not have experienced a Terrorist Incident within the 90 days prior to the Terrorist Incident that is causing the cancellation of Your Covered Trip. Benefits are not provided if the Travel Supplier offers a substitute itinerary. Your Scheduled Departure Date must be no more than 15 months beyond Your Effective Date. This benefit only applies if the policy has been purchased within 10 days of Your initial payment for the Covered Trip and for the full cost of the Covered Trip.
(m) Bankruptcy and/or Default of Your Travel Supplier which occurs more than 10 days following Your Effective Date. Coverage is not provided for the Bankruptcy or Default of the agency from whom You purchased the Land/Sea Arrangements. Your Scheduled Departure Date must be no more than 15 months beyond Your Effective Date. Benefits will be paid due to Bankruptcy or Default of an airline only if no alternate transportation is available. If alternate transportation is available, benefits will be limited to the change fee charged to allow You to transfer to another airline in order to get to Your intended destination.
The Company will pay for the following:
a) unused, non-refundable land or sea expenses prepaid to the Travel Suppliers;
b) the airfare paid less the value of applied credit from an unused return travel ticket, to return home or rejoin the original Land/Sea Arrangements limited to the cost of one-way economy airfare or similar quality as originally issued ticket by scheduled carrier, from the point of destination to the point of origin shown on the original travel tickets;
The Company will pay for reasonable additional accommodation and transportation expenses incurred by You (up to $100 a day) if a Traveling Companion must remain hospitalized or if You must extend the Covered Trip with additional hotel nights due to a Physician certifying that You cannot fly home due to an Accident or a Sickness but does not require hospitalization.
In no event shall the amount reimbursed exceed the maximum benefit shown on the Confirmation of Coverage.
TRIP DELAY
The Company will reimburse You for Covered Expenses on a one-time basis, up to the maximum shown in the Confirmation of Coverage, if You are delayed en route to or from the Covered Trip for twelve (12) or more hours due to a defined Hazard:
Covered Expenses include:
(a) Any prepaid, unused, non-refundable land and water accommodations;
(b) Any reasonable additional expenses incurred;
(c) An Economy Fare from the point where You ended Your Covered Trip to a destination where You can catch up to the Covered Trip; or
(d) A one-way Economy Fare to return You to Your originally scheduled return destination.
Hazard means:
a) Any delay of a Common Carrier (including Inclement Weather).
b) Any delay by a traffic accident en route to a departure, in which You or a Traveling Companion is not directly involved.
c) Any delay due to lost or stolen passports, travel documents or money, quarantine, hijacking, unannounced strike, natural disaster, civil commotion or riot.
d) A closed roadway causing cessation of travel to the destination of the Covered Trip (substantiated by the department of transportation, state police, etc.)
MISSED CONNECTION
This benefit covers missed Cruise departures that result from cancellation or delay (for three or more hours) of all regularly scheduled airline flights due to Inclement Weather or any Common Carrier caused delay. Maximum benefits of up to the amount shown in the Confirmation of Coverage are provided to cover additional transportation expenses needed for You to join the departed Cruise, reasonable accommodation and meal expenses (up to the per day amount shown in the Confirmation of Coverage) and nonrefundable trip payments for the unused portion of Your Cruise. Coverage is secondary to any compensation provided by a Common Carrier. Coverage will not be provided to individuals who are able to meet their scheduled departure but cancel their Cruise due to Inclement Weather.
EMERGENCY SICKNESS MEDICAL EXPENSE
The Company will pay benefits up to the maximum shown on the Confirmation of Coverage if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that first manifests itself during the Covered Trip.
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 Sickness.
Covered Medical Expenses are necessary services and supplies that are recommended by the attending Physician. They include but are not limited to:
(a) the services of a Physician;
(b) charges for Hospital confinement and use of operating rooms;
(c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
(d) ambulance service; and
(e) drugs, medicines, prosthetics and therapeutic services and supplies.
The Company will not pay benefits in excess of the reasonable and customary charges. Reasonable and customary charges mean charges commonly used by Physicians in the locality in which care is furnished. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Covered Trip.
The Company will advance payment to a Hospital, up to the maximum shown on the Confirmation of Coverage, if needed to secure Your admission to a Hospital because of Sickness.
If You are hospitalized due to a Sickness which first occurred during the course of the scheduled Covered Trip beyond the date of the Scheduled Return Date, coverage will be extended until You are released from the Hospital or until maximum benefits under the Group Policy have been paid.
EMERGENCY ACCIDENT MEDICAL EXPENSE
The Company will pay benefits up to the maximum shown on the Confirmation of Coverage if You incur Covered Medical Expenses for Emergency Treatment of an Accidental Injury that occurs during the Covered Trip.
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.
Covered Medical Expenses are necessary services and supplies that are recommended by the attending Physician. They include, but are not limited to:
(a) the services of a Physician;
(b) charges for Hospital confinement and use of operating rooms;
(c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
(d) ambulance service; and
(e) drugs, medicines, prosthetic and therapeutic services and supplies.
The Company will not pay benefits in excess of the reasonable and customary charges. Reasonable and customary charges mean charges commonly used by Physicians in the locality in which care is furnished. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Covered Trip.
The Company will pay benefits, up to $750, for emergency dental treatment for Accidental Injury to sound natural teeth.
The Company will advance payment to a Hospital, up to the maximum shown on the Confirmation of Coverage, if needed to secure Your admission to a Hospital because of Accidental Injury.
If You are hospitalized due to an Accidental Injury which first occurred during the course of the scheduled Covered Trip beyond the date of the Scheduled Return Date, coverage will be extended until You are released from the Hospital or until maximum benefits under the Group Policy have been paid.
EMERGENCY EVACUATION AND REPATRIATION OF REMAINS
EMERGENCY EVACUATION
The Company will pay benefits for Covered Expenses incurred, up to the maximum shown on the Confirmation of Coverage, if an Accidental Injury or Sickness commencing during the course of the Covered Trip results in Your necessary Emergency Evacuation. An Emergency Evacuation must be ordered by a Physician who certifies that the severity of Your Accidental Injury or Sickness warrants Your Emergency Evacuation.
Emergency Evacuation means:
(a) 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;
(b) after being treated at a local Hospital, Your medical condition warrants transportation to the United States where You reside, to obtain further medical treatment or to recover; or
(c) both (a) and (b), above.
Covered Expenses are reasonable and customary expenses for necessary transportation, related medical services and medical supplies incurred in connection with Your Emergency Evacuation. All transportation arrangements made for evacuating You must be by the most direct and economical route possible. Expenses for transportation must be:
(a) recommended by the attending Physician;
(b) required by the standard regulations of the conveyance transporting You; and
(c) authorized in advance by the authorized assistance company.
Transportation of Dependent Children: If You are in the Hospital for more than seven (7) days, the authorized assistance company will return Your dependents, who are under 18 years of age and accompanying You on the scheduled Covered Trip, to the domicile of a person nominated by You or Your next of kin with an attendant if necessary.
Transportation to Join You: If You are traveling alone and in a Hospital alone for more than seven (7) consecutive days or if the attending Physician certifies that due to Your Injury or Sickness, You will be required to stay in the Hospital for more than seven (7) consecutive days, upon request the authorized assistance company will bring a person, chosen by You, for a single visit to and from Your bedside provided that repatriation is not imminent.
Transportation services are provided if authorized in advance by the assistance provider, and are limited to necessary economy fares less the value of applied credit from unused travel tickets, if applicable.
Transportation means any Common Carrier, or other land, water or air conveyance, required for an Emergency Evacuation and includes air ambulances, land ambulances and private motor vehicles.
The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Covered Trip.
REPATRIATION OF REMAINS
The Company will pay the reasonable Covered Expenses incurred to return Your body to Your primary place of residence if You die during the Covered Trip. This will not exceed the maximum shown on the Confirmation of Coverage.
Covered Expenses include, but are not limited to, expenses for embalming, cremation, casket for transport and transportation.
BAGGAGE/PERSONAL EFFECTS
The Company will reimburse You, up to the maximum shown on the Confirmation of Coverage, for loss, theft or damage to baggage and personal effects, provided You have taken all reasonable measures to protect, save and/or recover Your property at all times. The baggage and personal effects must be owned by and accompany You during the Covered Trip.
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.
There will be a per article limit shown on the Confirmation of Coverage.
There will be a combined maximum limit shown on the Confirmation of Coverage 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.
The Company will pay the lesser of the following:
(a) Actual Cash Value at time of loss, theft or damage to baggage and personal effects,less depreciation as determined by the Company; or
(b) the cost of repair or replacement.
EXTENSION OF COVERAGEIf You checked Your property with a Common Carrier and delivery is delayed, coverage for Baggage/Personal Effects will be extended until the Common Carrier delivers the property.
BAGGAGE DELAY (Outward Journey Only)
The Company will reimburse You for the expense of necessary personal effects, up to the maximum shown on the Confirmation of Coverage, if Your Checked Baggage is delayed or misdirected by a Common Carrier for more than twelve (12) hours, while on a Covered Trip, except for travel to final destination or place of residence.
You must be a ticketed passenger on a Common Carrier.
Additionally, all claims must be verified by the Common Carrier who must certify the delay or misdirection and receipts for the purchases must accompany any claim.
ACCIDENTAL DEATH AND DISMEMBERMENT
The Company will pay the percentage of the Principal Sum shown in the Table of Losses when You, as a result of an Accidental Injury occurring during the Covered Trip, sustain a loss shown in the Table below. The loss must occur within 180 days after the date of the Accident causing the loss. The Principal Sum is shown on the Confirmation of Coverage. The maximum benefits for any one single Accident is limited to $15,000,000 for all persons insured under the Group Policy. If more than one loss is sustained, as the result of an Accident, the amount payable shall be the largest amount of a sustained loss shown in the Table of Losses.
TABLE OF LOSSES
| Loss of | Percentage of Principal Sum |
| Life | 100% |
| Both hands or both feet | 100% |
| Sight of both eyes | 100% |
| One hand and one foot | 100% |
| Either hand or foot and sight of one eye | 100% |
| Either hand or foot | 50% |
| Sight of one eye | 50% |
| Speech and hearing in both ears | 100% |
| Speech | 50% |
| Hearing in both ears | 50% |
| Thumb and index finger of same hand | 25% |
"Loss" with regard to:
1. hand or foot means actual complete severance through and above the wrist or ankle joints;
2. eye means an entire and irrecoverable loss of sight;
3. speech or hearing means entire and irrecoverable loss of speech or hearing of both ears; and
4. thumb and index finger means actual severance through or above the joint that meets the finger at the palm.
EXPOSUREThe Company will pay benefits for covered losses that result from Your being unavoidably exposed to the elements due to an Accident. The loss must occur within 365 days after the event that caused the exposure.
DISAPPEARANCEThe Company will pay benefits for loss of life if Your body cannot be located one year after Your disappearance due to an Accident.
LIMITATIONS AND EXCLUSIONS
The following exclusions apply to Trip Cancellation, Trip Interruption, Trip Delay, Accidental Death & Dismemberment, Emergency Sickness Medical Expense, Emergency Accident Medical Expense, Emergency Evacuation, Repatriation of Remains:Loss caused by or resulting from:
1. Pre-Existing Conditions, as defined in the Definitions section (except Emergency Evacuation and Repatriation of Remains) unless the insurance is purchased within 10 days of the initial Covered Trip deposit;
2. Suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane (in Missouri, sane only) unless results in the death of a non-traveling immediate Family Member;
3. Intentionally self-inflicted injuries;
4. War, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war;
5. Participation in any military maneuver or training exercise or any loss starting while You are in the service of the armed forces of any country. Orders to active military service for training purposes of two months or less will not constitute service in the armed forces. Upon notice to the Company of entering the armed forces, the Company will return to You pro-rata any premium paid, less any benefits paid, for any period during which You are in such service;
6. Piloting or learning to pilot or acting as a member of the crew of any aircraft;
7. Mental or emotional disorders, unless hospitalized;
8. Participation as a professional in athletics;
9. Participation in underwater activities;
10. Being under the influence of drugs or intoxicants, unless prescribed by a Physician or unless results in the death of a non-traveling immediate Family Member;
11. Commission or the attempt to commit a criminal act;
12. Participating in bodily contact sports; skydiving; hang-gliding; parachuting; mountaineering; any race; bungee cord jumping; and speed contest (speed contest shall not include any of the regatta races), scuba diving, spelunking or caving heliskiing or extreme skiing;
13. Dental treatment except as a result of an injury to sound natural teeth limited to $750;
14. Any non-emergency treatment or surgery, routine physical examinations, hearing aids, eye glasses or contact lenses;
15. Pregnancy and childbirth (except for complications of pregnancy)except if hospitalized;
16. Curtailment or delayed return for other than covered reasons;
17. Traveling for the purpose of securing medical treatment;
18. Services not shown as covered;
19. Directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination;
20. Confinement or treatment in a government Hospital; however the United States government may recover or collect benefits under certain conditions;
21. Care or treatment that is not medically necessary;
22. Care or treatment for which compensation is payable under Worker's Compensation Law, any Occupational Disease law; the 4800 Time Benefit plan or similar legislation;
23. Care or treatment that is payable under any Insurance policy that does not require deductible and/or coinsurance payments by You;
24. Injury or Sickness when traveling against the advice of a Physician;
25. Cosmetic surgery except for: reconstructive surgery incidental to or following surgery for trauma, or infection or other covered disease of the part of the body reconstructed, or to treat a congenital malformation of a child.
The following exclusions apply to Baggage/Personal Effects, Baggage Delay:
The Company will not provide benefits for any loss or damage to:
1. Animals;
2. Automobiles and automobile equipment;
3. Boats or other vehicles or conveyances;
4. Trailers;
5. Motors;
6. Motorcycles;
7. Aircraft;
8. Bicycles (except when checked as baggage with a Common Carrier);
9. Household effects and furnishing;
10. Antiques and collectors items;
11. Eye glasses, sunglasses or contact lenses;
12. Artificial teeth and dental bridges;
13. Hearing aids;
14. Prosthetic limbs;
15. Prescribed medications;
16. Keys, money, stamps, securities and documents;
17. Tickets;
18. Credit cards;
19. Professional or occupational equipment or property, whether or not electronic business equipment;
20. Personal computers, telephones, computer hardware or software;
21. Sporting equipment if loss or damage results from the use thereof.
Any loss caused by or resulting from the following is excluded:1. Breakage of brittle or fragile articles;
2. Wear and tear or gradual deterioration;
3. Insects or vermin;
4. Inherent vice or damage while the article is actually being worked upon or processed;
5. Confiscation or expropriation by order of any government;
6. War or any act of war whether declared or not;
7. Theft or pilferage while left unattended in any vehicle;
8. Mysterious disappearance;
9. Property illegally acquired, kept, stored or transported;
10. Insurrection or rebellion;
11. Imprudent action or omission;
12. Property shipped as freight or shipped prior to the Scheduled Departure Date.
COORDINATION OF BENEFITSApplicability
The Coordination of Benefits ("COB") provision applies to This Plan when You have health care coverage under more than one Plan. "Plan" and "This Plan" are defined below.If this COB provision applies, the order of benefit determination rules should be looked at first. Those rules determine whether the benefits of This Plan are determined before or after those of another Plan. The benefits of This Plan:(a) will not be reduced when, under the order of benefit determination rules, This Plan determines its benefits before another Plan; but(b) may be reduced when, under the order of benefit determination rules, another Plan determines its benefits first. This reduction is described further in the section entitled Effect on the Benefits of This Plan.
Definitions
Plan is a form of written on an expense incurred basis that provides benefits or services for, or becauseof, medical or dental care or treatment. "Plan" includes:(a) group insurance and group remittance subscriber contracts;(b) uninsured arrangements of group coverage;(c) group coverage through HMO's and other prepayment, group practice and individual practice Plans; and(d) blanket contracts, except blanket school accident coverages or a similar group when the Policyholder pays the premium."Plan" does not include individual or family: (a) insurance contracts; (b) direct payment subscriber contracts;(c) coverage through HMO's; or (d) coverage under other prepayment, group practice and individual practice Plans.
This Plan is the part of this blanket contract that provides benefits for health care expenses on an expense incurred basis.
Primary Plan is one whose benefits for a person's health care coverage must be determined without taking the existence of any other Plan into consideration. A Plan is a Primary Plan if either:(a) the Plan has no order of benefit determination rules, or it has rules that differ from those in the contract; or(b) all Plans that cover the person use the same order of benefits determination rules as in thiscontract, and under those rules the Plan determines its benefits first.
Secondary Plan is one that is not a Primary Plan. If a person is covered by more than one Secondary Plan, the order of benefit determination rules of this contract decide the order in which their benefits are determined in relation to each other. The benefits of each Secondary Plan may take into consideration the benefits of the Primary Plan or Plans and the benefits of any other Plan which, under the rules of this contract, has its benefits determined before those of that Secondary Plan.
Allowable Expense is the necessary, reasonable, and customary item of expense for health care; whenthe item of expense is covered at least in part under any of the Plans involved.
The difference between the cost of a private hospital room and a semi-private hospital room is not considered an Allowable Expense under the above definition unless the patient's stay in a private hospital room is medically necessary in terms of generally accepted medical practice.
When a Plan provides benefits in the form of services, the reasonable cash value of each service will beconsidered both an Allowable Expense and a benefit paid.
Claim is a request that benefits of a Plan be provided or paid. The benefits claimed may be in the form of:(a) services (including supplies); (b) payment for all or a portion of the expenses incurred; or (c) a combination of (a) and (b).
Claim Determination Period is the period of time, which must not be less than 12 consecutive months, over which Allowable Expenses are compared with total benefits payable in the absence of COB, to determine: (a) whether overinsurance exists; and (b) how much each Plan will pay or provide.
For the purposes of this contract, Claim Determination Period is the period of time beginning with the effective date of coverage and ending 12 consecutive months following the date of loss or longer as may be determined by the proof of loss provision.
Order of Benefit Determination Rules
When This Plan is a Primary Plan, its benefits are determined before those of any other Plan and without considering another Plan's benefits.When This Plan is a Secondary Plan, its benefits are determined after those of any other Plan only when, under these rules, it is secondary to that other Plan .When there is a basis for a Claim under This Plan and another Plan, This Plan is a Secondary Plan that has its benefits determined after those of the other Plan, unless:(a) the other Plan has rules coordinating its benefits with those of This Plan; and(b) both those rules and This Plan's rules, as described below, require that This Plan's benefits bedetermined before those of the other Plan.
Rules
This Plan determines its order of benefits using the first of the following rules which applies:(a) Nondependent/Dependent Rule. The benefits of the Plan that covers the person as an employee, member or subscriber (that is, other than as a dependent) are determined before those of the Plan that covers the person as a dependent.(b) Longer/Shorter Length of Coverage Rule. The benefits of the Plan that covered an employee,member or subscriber longer are determined before those of the Plan that covered that person for the shorter time.To determine the length of time a person has been covered under a Plan, two Plans shall be treated as one if the claimant was eligible under the second within 24 hours after the first ended. Thus, the start of a new Plan does not include: (a) a change in the amount or scope of a Plan's benefits; (b) a change in the entity which pays, provides or administers the Plan's benefits; or (c) a change from one type of Plan to another. The claimant's length of time covered under a Plan is measured from the claimant's first date of coverage under that Plan. If that date is not readily available, the date the claimant first became a member of the group shall be used as the date from which to determine the length of time the claimant's coverage under the present Plan has been in force.
Effect on the Benefits of This Plan When it is Secondary
The benefits of This Plan will be reduced when it is a Secondary Plan so that the total benefits paid or provided by all Plans during a Claim Determination Period are not more than the total Allowable Expenses, not otherwise paid, which were incurred during the Claim Determination Period by the person for whom the Claim is made. As each Claim is submitted, This Plan determines its obligation to pay for Allowable Expenses based on all Claims that were submitted up to that point in time during the Claim Determination Period.
Right to Receive and Release Needed Information
Certain facts are needed to apply these COB rules. The Company has the right to decide which facts are needed. The Company may get needed facts from or give them to any other organization or person. The Company need not tell, or get the consent of, any person to do this. Each person claiming benefits under This Plan must give the Company any facts needed to pay the Claim.
Facility of Payment
A payment made under another Plan may include an amount that should have been paid under This Plan. If it does, the Company may pay that amount to the organization that made that payment. That amount will then be treated as though it were a benefit paid under This Plan. The Company will not have to pay that amount again. The term "payment made" includes providing benefits in the form of services, in which case "payment made" means reasonable monetary value of the benefits provided in the form of services.
Right of Recovery
If the amount of the payments made by the Company is more than the Company should have paid under this COB provision, the Company may recover the excess from one or more of: (a) the persons we have paid or for whom we have paid; (b) insurance companies; or (c) other organizations.
Non-complying Plans
This Plan may coordinate its benefits with a Plan that is excess or always secondary or which uses order of benefit determination rules which are inconsistent with those of This Plan (non-complying Plan) on the following basis:(a) If This Plan is the Primary Plan, This Plan will pay its benefits on a primary basis;(b) if This Plan is the Secondary Plan, This Plan will pay its benefits first, but the amount of the benefits payable will be determined as if This Plan were the Secondary Plan. In this situation, our payment will be the limit of This Plan's liability; and(c) if the non-complying Plan does not provide the information needed by This Plan to determine its benefits within 30 days after it is requested to do so, the Company will assume that the benefits of the non-complying Plan are identical to This Plan and will pay benefits accordingly. However, the Company will adjust any payments made based on this assumption whenever information becomes available as to the actual benefits of the non-complying Plan.
STATE EXCEPTIONS
If you reside in the state of CONNECTICUT Form SRTC 2200-1 CT:
With regard to the Emergency Accident and Sickness Medical Expense Benefits, Emergency Evacuation and Repatriation of Remains Benefits, and the Accidental Death and Dismemberment Benefits ONLY, the certificate to which this rider is attached is amended as follows:
1. In the Definitions section:
a) the definition of "Insurance" is amended to read:
Insurance means any one of the following types of policies or plans which provide benefits for hospital confinement medical expenses for You on Your effective date of coverage, and such policy or plan requires You to pay a deductible and/or portion of coinsurance: group or blanket insurance plans; group Blue Cross, Blue Shield, or other group prepayment coverage plans; coverage under labor management trustee plans, union welfare plans, employer organization plans, employee benefit organizational plans, or other arrangements of benefits for persons of a group. Insurance does not include Medicare or Medicaid.
b) the definition of "Pre-existing Condition" is amended to read:
Pre-Existing Condition means any injury, sickness or condition of Yours, Your Traveling Companion, Your Family Member booked to travel with You for which any medical advice, diagnosis, care or treatment was recommended or received, within the sixty (60) day period prior to the effective date of Trip Cancellation coverage under the Group Policy. Routine follow-up care to determine whether a breast cancer has reoccurred in a person who has been previously determined to be breast cancer free shall not be considered as medical advice, diagnosis, care or treatment for purposes of this section unless evidence of breast cancer is found during or as a result of such follow-up. Genetic information shall not be treated as a condition in the absence of a diagnosis of the condition related to such information. Pregnancy shall not be considered a preexisting condition with regard to the accident and sickness medical expense benefits only.
2. In the Accidental Death and Dismemberment Benefit, the following is eliminated.
"The maximum benefits for any one single accident is limited to $15,000,000 for all persons insured under the Group Policy".
3. The following is added to the Benefits Section
Coverage for treatment of Lyme disease will include at least thirty (30) days of intravenous antibiotic therapy, sixty (60) days of oral antibiotic therapy, or both and shall provide further treatment if recommended by a board certified rheumatologist, infectious disease specialist or neurologist licensed in accordance with Connecticut requirements or licensed in another state or jurisdiction whose requirements for practicing in such capacity are substantially similar to or higher than those of the State of Connecticut
4. In the General Provisions section:
a) The provision entitled "Arbitration" is amended to read:
ARBITRATION - Notwithstanding anything in the Group 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. Such arbitration will be by mutual consent by all parties and is non-binding. 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 Group 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.
b) The provision entitled "Subrogation" is amended by the addition of the following sentence: "Subrogation will take place only as provided by law".
5. In the Exclusions Section, exclusion 10 related to drugs and intoxicants as it applies to the accidental death benefit under the Accidental Dismemberment Benefit is amended to read: No indemnity will be paid for loss caused by the voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless as prescribed by Your physician. Exclusion 11 is amended to read: 11. commission or the attempt to commit a felony. Exclusion 14 is amended to read: 14. any non-emergency treatment or surgery, routine physical examinations, hearing aids (except to the extent otherwise specifically covered under the certificate), eye glasses or contact lenses Exclusion 20 is amended to read: 20. Confinement or treatment in a government Hospital, except for a Veterans Administration hospital; however the United States government may recover or collect benefits under certain conditions.
The following exclusions are deleted in their entirety: Exclusion 7 related to mental or emotional disorders; Exclusions [19] that states: "directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination"; Exclusion [23] 23. Care or treatment that is payable under any Insurance policy that does not require deductible and/or coinsurance payments by You;] and exclusion [26] loss or damage (including death or injury) and any associated cost or expense resulting directly or indirectly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event contributing concurrently or in any other sequence thereto.
6. The following is added to the General Provisions.
"THIS LIMITED HEALTH BENEFITS PLAN DOES NOT PROVIDE COMPREHENSIVE MEDICAL COVERAGE. IT IS A BASIC OR LIMITED BENEFITS POLICY AND IS NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS PLAN IS NOT DESIGNED TO COVER THE COSTS OF SERIOUS OR CHRONIC ILLNESS. IT CONTAINS SPECIFIC DOLLAR LIMITS THAT WILL BE PAID FOR MEDICAL SERVICES WHICH MAY NOT BE EXCEEDED. IF THE COST OF SERVICES EXCEEDS THOSE LIMITS, THE BENEFICIARY AND NOT THE INSURER IS RESPONSIBLE FOR PAYMENT OF THE EXCESS AMOUNTS. THE SPECIFIC DOLLAR LIMITS FOR EACH COVERAGE PROVIDED ARE OUTLINED IN THE SCHEDULE OF BENEFITS.
If you reside in the state of FLORIDA Form SRTC 2200 FL:
This policy is an Individual Policy underwritten by Allied Property Casualty Insurance Company.
In the section entitled General Provisions, the provision entitled "Arbitration" is amended to read as follows:
ARBITRATION - Notwithstanding anything in the 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. Judgment upon the award rendered in such arbitration may be entered in any court having jurisdiction thereof. Any arbitration will be by mutual agreement by all parties. 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 Group 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.
If you reside in the state of GEORGIA Form SRTC 2200 (GA):
1.The second paragraph on page 1 is amended to read:This Policy is issued in consideration of the enrollment form and payment of any premium due. All statements in the enrollment forms are representations and not warranties. Only statements contained in a written enrollment form will be used to cancel insurance, reduce benefits or defend a claim. The entire coverage will be cancelled, if before, during or after a loss, any material fact or circumstance relating to this insurance has been concealed or materially misrepresented.
If you reside in the state of HAWAII Form SRTC-2200-HI:
1.In the section entitled General Provisions, the provision entitled "Arbitration" is deleted in its entirety.
2.In the section entitled LIMITATION AND EXCLUSIONS, the exclusions related to the actual, alleged, or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination or loss or damage (including death or injury) and any associated cost or expense resulting directly or indirectly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion, or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event contributing concurrently or in any other sequence thereto, are hereby deleted from the certificate.
If you reside in the state of IDAHO Form SRTC-2200-ID:The definition of Hospital is amended to read:Hospital means a provider that is a short-term, acute, general hospital that:
1.is a duly licensed institution;
2.in return for compensation from its patients, is primarily engaged in providing Inpatient diagnostic and therapeutic services for the diagnosis, treatment, and care of injured and sick person by or under supervision of Physicians;
3.has organized departments of medicine and major surgery;
4.provides 24-hour nursing service by or under the supervision of registered graduate nurses; and
5.is not other than incidentally: a) a skilled nursing facility, nursing home, custodial care home, health resort, spa or sanatorium, place for rest, or place for the aged; b) a place for the treatment of mental Illness; c) a place for the treatment of alcoholism or drug abuse, place for the provision of hospice care; or d) a place for the treatment of pulmonary tuberculosis.
If you reside in the state of KANSAS Form SRTC 2200 KS:
1.Please note that: THIS IS A LIMITED POLICY - READ IT CAREFULLY
2.The provision entitled "Subrogation" does not apply to medical or dental expense benefits payable under the policy.
3.The provision entitled "Legal Actions" is amended to read: LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of Loss. No legal action for a claim can be brought against the Company more than five (5) years after the time required for giving proof of Loss.
4.The "Payment of Claims" provision is amended to state: The Company or its designated representative will pay the claim immediately after receipt of due and acceptable proof of Loss.
5.The provision entitled "Arbitration" is amended to read: After a dispute has arisen, an appraisal or arbitration may take place if You and the Company fail to agree on the amount of the Loss. However, an appraisal or arbitration will take place only if both You and the Company agree, voluntarily, to have the Loss appraised or arbitrated.
If you reside in the state of LOUISIANA Form SRTC 2000 (LA) 07/04:
1.This policy is an Individual Policy underwritten by Nationwide Casualty Company
2.INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this Company, providing benefits for the same Loss on a provision of service basis or on 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 liability under any expense incurred coverage of this policy shall be for such proportion of the Loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same Loss of which this insurer had notice bears to the total like amounts under all valid coverages for such Loss, and for the return of such portion of the premiums paid as shall exceed the pro-rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the "like amount" of such other coverage shall be taken, as the amount which the services rendered would have cost in the absence of such coverage.
If you reside in the state of MAINE Form SRTC 2200-1 ME:
The following warnings apply:
With regard to the accidental death and dismemberment benefits and the emergency medical expense benefits: This certificate excludes the following hazardous activities: participating in bodily contact sports; skydiving; hang-gliding; parachuting; mountaineering; any race; bungee cord jumping; and speed contest (speed contest shall not include any of the regatta races), scuba diving, spelunking or caving, heliskiing, or extreme skiing.
With regard to the emergency medical expense benefits: THIS IS A LIMITED BENEFIT CERTIFICATE. THIS PROGRAM PROVIDES SHORT-TERM LIMITED MEDICAL EXPENSE BENEFITS AND IS NOT A COMPREHENSIVE HEALTHCARE PLAN. YOU SHOULD READ YOUR CERTIFICATE CAREFULLY.
In the Definitions Section:
• The definition of accidental injury is amended to read: Accidental Injury means Bodily Injury caused by an accident (of external origin) being the direct and independent cause in the loss.
• The definition of dependent is amended to read: Dependent Child(ren) means children who: (1) are under 19 years of age and are Your children, stepchildren or are adopted children of, or children placed for adoption with You; or (2) a child who is at least age 19 but less than age 23 and who either regularly attends an institution of learning or an accredited school or college or if the child would otherwise be a student but due to a mental or physical illness or an accidental injury cannot attend such institution, school or college. We will require written documentation from a health care provider and the student's school that the student is no longer enrolled in school on a full-time basis due to a mental or physical illness or accidental injury. With regard to item (2) the child must be primarily dependent on the Insured for support and maintenance.
• The definition of sickness is amended to read: Sickness means illness or disease of an insured person and is subject to any pre-existing condition limitations.
The following exclusions apply to Accidental Death & Dismemberment, Emergency Sickness Medical Expense, Emergency Accident Medical Expense; Loss caused by or resulting from:1. Pre-Existing Conditions, as defined in the Definitions section (except Emergency Evacuation and Repatriation of Remains) unless the insurance is purchased within 10 days of the initial Trip deposit;
2. suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane unless results in the death of a non-traveling immediate Family Member. This exclusion does not apply to the medical expense benefits;
3. war, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war;
4. participation in any military maneuver or training exercise or any loss starting while the Insured is in the service of the armed forces of any country. Orders to active military service for training purposes of two months or less will not constitute service in the armed forces. Upon notice to the Company of entering the armed forces, the Company will return to the Insured pro-rata any premium paid, less any benefits paid, for any period during which the Insured is in such service;
5. piloting or learning to pilot or acting as a member of the crew of any aircraft;
6. mental or emotional disorders, unless hospitalized;
7. participation as a professional in athletics or interscholastic sports;
8. being under the influence of drugs or intoxicants, unless prescribed by a Physician][unless results in the death of a non-traveling immediate Family Member;
9. commission or the attempt to commit felony or participating in a riot;
10. dental treatment except as a result of an injury to sound natural teeth limited to $750;
11. any non-emergency treatment or surgery, routine physical examinations, hearing aids, eye glasses or contact lenses;
12. participating in bodily contact sports; skydiving; hang-gliding; parachuting; mountaineering; any race; bungee cord jumping; and speed contest (speed contest shall not include any of the regatta races), scuba diving, spelunking or caving, heliskiing, or extreme skiing.
13. pregnancy and childbirth (except for complications of pregnancy) except if hospitalized;
14. traveling for the purpose of securing medical treatment;
15. services not shown as covered;
16. Confinement or treatment in a government Hospital; however the United States government may recover or collect benefits under certain conditions;
17. Care or treatment that is not medically necessary;
18. Care or treatment for which compensation is payable under Worker's Compensation Law, any Occupational Disease law; the 4800 Time Benefit plan or similar legislation;
19. Injury or Sickness when traveling against the advice of a Physician;
20. Cosmetic surgery except for: reconstructive surgery incidental to or following surgery for trauma, or infection or other covered disease of the part of the body reconstructed, or to treat a congenital malformation of a child;
If you reside in the state of MINNESOTA Form SRTC 2200 (MN):
1.The definition of Pre-existing Condition is amended so that the phrase: "or exhibited symptoms which would have caused one to seek diagnosis, care or treatment" in item (a) does not apply to the section Emergency Accident & Sickness Medical Expense provided under this Plan.
2.In the section entitled "General Exclusions"
a)The following exclusion: "being under the influence of drugs or intoxicants unless prescribed by a licensed Physician" is amended for the following benefits only: Emergency Accident & Sickness Medical Expense and Accidental Death & Dismemberment (24 Hour) to read as follows: "substance abuse and related illnesses and intoxication (blood alcohol level over the legal limit) while operating a motorized vehicle." The exclusion remains as stated under General Exclusions for all other benefits.
b)The following exclusion: "participating in bodily contact sports;" includes the following: "Bodily contact sports means any sport where the objective is to physically render an opponent unable to continue with the competition such as boxing and full contact karate".
3.In the General Provisions section, the provision entitled "Payment of Claims" is amended by the addition of the following sentence: The Company will pay the claim within 5 business days after agreement with You as to the amount of Loss.
4. In the General Provisions section, the provision entitled "Subrogation" is amended by the addition of the following sentence: The Company's rights do not apply against any person insured under this or any other policy/coverage part the Company issues with respect to the same occurrence or Loss.
5.In the General Provisions section, the provision entitled "Notice of Claim" is amended to provide for oral notification of claims, losses, or suits under the policy.
If you reside in the state of MISSISSIPPI Form SRTC-2200 MS:
1.A provision entitled TIME OF PAYMENT OF CLAIM is amended to read:Benefits payable for any loss will be paid within 35 days after receipt of due written proof of such loss. Benefits due are overdue if not paid within 35 days after the Company or We receive proof of loss and the necessary information to adjudicate the claim and the necessary medical information and other information essential for Us to administer any coordination of benefits and subrogation provisions. If such information is not supplied as to the entire claim, the amount supported by reasonable proof is overdue if not paid within 35 days after the Company receives such proof. Any part or all of the remainder of the claim that is later supported by such proof is overdue if not paid within 35 days after the Company receives such proof. To calculate the extent to which any benefits are overdue, payment shall be treated as made on the date a draft or other valid instrument was placed in the United States mail to the last know address of the claimant or beneficiary in a properly addressed, postpaid envelope, or if not so posted, on the date of delivery. If the claim is not denied for valid and proper reasons by the end of such period of 35 days, the Company must pay You interest on accrued benefits at the rate of one and one-half percent (1.5%) per month on the amount of such claim until it is finally settled or adjudicated.In the event the Company fails to pay benefits when due, the person entitled to such benefits may bring action to recover such benefits, any interest that may accrue as provided above and any other damages as may be allowable by law.
2.The provision entitled Physical Examination and Autopsy is re-titled Physical Examination and amended to read:Physical Examination: The Company has the right to physically examine You as often as reasonably needed while a claim is pending. The Company will bear all costs for this.
3.The provision entitled Subrogation is amended to read:
SUBROGATION - To the extent the Company pays for a loss suffered by You, the Company will take over the rights and remedies You had relating to the loss. This is known as subrogation. You must help the Company to preserve its rights against those responsible for the loss. This may involve signing any papers and taking any other steps the Company may reasonably require. If the Company takes over Your rights, You must sign an appropriate subrogation form supplied by the Company. No subrogation will occur until You have been made whole for Your damages.
If you reside in the state of MONTANA Form SRTC 2200-MT:
1.The definition of sickness is amended to read:Sickness means an illness or disease, including pregnancy, that is diagnosed or treated by a Physician after the effective date of insurance and while You are covered under the Group Policy.
2.The provision entitled Controlling Law is amended to read: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.
3.The exclusion related to pregnancy and childbirth is deleted in its entirety.
If you reside in the state of NEVADA Form SRTC-2200-NV:
1.For effective dates of coverage and termination dates of coverage, the references to 12:01 A.M and 11:59 PM are amended to read "12:00 midnight".
2.The definition of Pre-existing Condition is amended to read:Pre-Existing Condition means any injury, sickness or condition of You, an Insured's Traveling Companion, an Insured's Family Member booked to travel with him or her, You or an Insured's Traveling Companion's Family Member for which, within the 60 day period prior to the effective date of Trip Cancellation coverage under the Group Policy, medical advice, diagnosis, care or treatment was recommended or received.Such an Injury or Sickness will continue to be a Pre- Existing Condition until the expiration of 12 consecutive months, beginning with the effective date of coverage.The Pre-Existing Conditions exclusion is waived for You if the Insured enrolls You in the Group Policy at the time the Insured pays the deposit required for his or her Trip (or within 10 days of the initial deposit) and the Insured purchases the coverage under the Group Policy for the full cost of their Trip.
If you reside in the state of NEW JERSEY Form SRTC 2500 IL:
1.This policy is underwritten by Nationwide Life Insurance Company
If you reside in the state of NEW MEXICO Form SRTC-2200-NM:
1.The definition of Physician is amended to read:Physician means a licensed practitioner of the healing arts acting within the scope of his/her license. The treating Physician may not be You, a Traveling Companion or a Family Member.
2.The provision entitled Arbitration is deleted in its entirety.
If you reside in the state of NORTH CAROLINA Form SRTC-2200 NC:1. The provision entitled Arbitration is amended to read:
ARBITRATION - Notwithstanding anything in the Group 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. Arbitration will take place in the county and state where You reside, unless otherwise agreed to by you and the Company. 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 Group 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.2. In the Section entitled GENERAL PROVISIONS, the following apply to the Emergency Sickness Medical Expense, and Emergency Accident Medical Expense Benefits.
a. "Legal Actions" is amended to read: LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of loss. No legal action for a claim can be brought against the Company more than three (3) years after the time required for giving proof of loss.
b. "Proof of Loss" is amended to read: PROOF OF LOSS - The Claimant must send the Company, or its designated representative, proof of loss within 180 days after a covered loss occurs or as soon as reasonably possible.
c. The "Subrogation" provision does not apply to the above mentioned accident and sickness benefits.
3. In the Section entitled EXCLUSIONS, the following exclusions are deleted:
19. directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination; and
4. The Section entitled COORDINATION OF BENEFITS is amended as follows:
a. Any reference to blanket insurance is deleted from the coordination of benefits provisions.b. The provision entitled "Right of Recovery" is deleted in its entirety.
If you reside in the state of NORTH DAKOTA Form SRTC-2200-ND:
1.Under the section entitled GENERAL PROVISIONS, Arbitration and Legal Actions are amended to read:
ARBITRATION - Notwithstanding anything in the Plan 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. 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. Arbitration will be by mutual consent by all parties and the local courts must have jurisdiction.
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 Plan 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.
LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of loss. No legal action for a claim can be brought against the Company more than three (3) years after the time required for giving proof of loss.
If you reside in the state of OHIO Form SRTC-2200-OH:
1.The following Notices are added:
FRAUD STATEMENT
Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact materiel thereto, commits a fraudulent insurance act which is a crime.
COORDINATION OF BENEFITS
Notice: if you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans. Each plan may require you to follow its rules or use specific doctors and hospitals, and it may be impossible to comply with both plans at the same time. Read all of the rules very carefully, including the coordination of benefits section, and compare them with the rules of any other plan that covers you or your family.
2.Item 2 under Part VII entitled "General Provisions Related to Insurance Benefits" is amended to read:
ARBITRATION - Notwithstanding anything in the Plan 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. Judgment upon the award rendered in such arbitration may be entered in any Ohio court having jurisdiction thereof. All fees and expenses of the arbitration shall be borne by the parties equally. In addition, such arbitration must be by mutual consent by all parties.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 Plan 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.
3.The provision entitled "Legal Actions" is amended to read:
LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of loss. No legal action for a claim can be brought against the Company more than three (s) years after the time required for giving proof of loss.
4.In the section entitled COORDINATION OF BENEFITS, the following changes are made:The definition of Plan is amended to read:
"Plan" means a form of coverage with which coordination is allowed. The following will be considered in applying this COB provision.
"Plan" includes group insurance and group subscriber contract, an uninsured arrangement of group or group-type coverage, group or group-type coverage through a health insuring corporation or other prepayment, group practice or individual practice plan, group-type contracts, the amount by which group-type hospital indemnity benefits exceed one hundred dollars per day, medical benefits coverage under a group or group-type automobile "no fault" and traditional "fault" type contract, and Medicare or other governmental benefits, Medicaid or other plan when, by law, its benefits are in excess of those of any private insurance plan or other non-governmental plan.
The term "plan" shall not include an individual insurance contract, whether single or family coverage, an individual subscriber contract, whether single or family coverage, an individual contract with a health insuring corporation, whether single or family coverage, an individual contract under any other prepayment, group practice or individual practice plan, whether single or family coverage, group or group-type hospital indemnity benefits of one hundred dollars per day or less, a supplemental sickness and accident policy excluded from coordination of benefits because of the limited nature of the program pursuant to law, school accident-type coverage, a state plan under Medicaid, or other plan when, by law, its benefits are in excess of those of any private insurance plan or other non-governmental plan.
The definition of Allowable Expense is amended to read:
Allowable Expense is the necessary, reasonable, and customary item of expense for health care; when the item of expense is covered at least in part under any of the Plans involved.The difference between the cost of a private hospital room and a semi-private hospital room is not considered an Allowable Expense under the above definition unless the patient's stay in a private hospital room is medically necessary in terms of generally accepted medical practice. When a Plan provides benefits in the form of services, the reasonable cash value of each service will be considered both an Allowable Expense and a benefit paid.When plans have differing allowable expenses, the larger allowable expense shall be used for purposes of coordination. When benefits paid by a primary plan are less than the allowable expenses, the secondary plan shall pay or provide its benefits toward any remaining balance otherwise payable by You. A secondary plan will not be required to make a payment of an amount that exceed the amount it would have paid if it were the primary plan, but in no event, when combined with the amount paid by the primary plan, shall payments by the secondary plan exceed 100% of the larger of the expenses allowable under the provisions of the applicable policies.
Under the section entitled "Rules", items (c) and (d): (c) Children (Parents Divorced or Separated). If the court decree makes one parent responsible for health care expenses, that parent's plan is primary. If the court decree gives joint custody and does not mention health care, we follow the birthday rule. (d) Children and the Birthday Rule. When your children's health care expenses are involved, we follow the "birthday rule." The plan of the parent with the first birthday in a calendar year is always primary for the children.
COORDINATION DISPUTESIf you believe that we have not paid a claim properly, you should first attempt to resolve the problem by contacting us. (For health maintenance organizations, reference certificate's description of appeal procedures). If you are still not satisfied, you may call the Ohio Department of Insurance for instructions on filing a consumer complaint. Call (614) 644-2673 or 1-800-686-1526.
5.If you have a complaint related to a claim, You should contact the Company or its Agent at 877-266-0741. If you disagree with the company's decision, you have the right to file a complaint with the Ohio Department of Insurance, Consumer Services Division, 2100 Stella Court, Columbus, Ohio 43215-1067, (614)-644-2673, toll free in Ohio 1-800-686-1526.
If you reside in the state of OREGON Form SRTC 2000 (OR) 04/05:
1.Please note that: In Oregon this is an individual policy.
2.The exclusion "being under the influence of drugs or intoxicants unless prescribed by a licensed Physician" is amended to read as follows: "being under the influence of drugs, unless such drug is prescribed by a Physician or while intoxicated according to the legal limits where the Loss takes place."
If you reside in the state of RHODE ISLAND Form SRTC-2200-RI:
1.Under the section entitled GENERAL PROVISIONS, the provision entitled "Arbitration" is deleted in its entirety.
2.Under the section entitled GENERAL PROVISIONS, the provisions entitled proofs of loss are amended to read: PROOF OF LOSS - The Claimant must send the Company, or its designated representative, proof of loss within ninety (90) days after a covered loss occurs. Failure to furnish such proof within the time required shall not invalidate nor 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 year from the time proof is otherwise required.
If you reside in the state of SOUTH CAROLINA Form SRTC -2200-SC (for Emergency Accident Medical Expense, Emergency Sickness Medical Expense, Accidental Death and Dismemberment benefits only):
1.The Excess Insurance Limitations provisions are deleted in their entirety. The reference to "Excess Insurance" on page 1 is deleted.
2.The Legal Action provision is amended to read:
LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of loss. No legal action for a claim can be brought against the Company more than six (6) years after the time required for giving proof of loss.
3.The Physical Examinations and Autopsy provision is amended to read:
Physical Examinations and Autopsy: The Company, or its designated representative, at its own expense, has the right to have You examined as often as reasonable necessary while a claim is pending. The Company, or its designated representative, also has the right to have an autopsy made at its own expense unless prohibited by law. The autopsy will be performed in South Carolina.
4.The provision entitled Arbitration is deleted in its entirety.
5.The provision entitled Subrogation is amended to read:
SUBROGATION - To the extent the Company pays for a loss suffered by You, the Company will take over the rights and remedies You had relating to the loss. This is known as subrogation. You must help the Company to preserve its rights against those responsible for the loss. This may involve signing any papers and taking any other steps the Company may reasonably require. If the Company takes over Your rights, You must sign an appropriate subrogation form supplied by the Company. We may not subrogate for more than the amount of insurance benefits that We have previously paid in relation to Your loss by the liable third party. Subrogation is not permitted if the Director of Insurance determines that the exercise of subrogation by Us is inequitable and commits an injustice to You. Attorneys' fees and costs must be paid by Us from the amounts recovered. Subrogation only applies to injury, the insured has the right to petition the Administrative Law Judge Division and it applies to liable third parties only.
6.The Definition of Pre-existing conditions is amended to read:
Pre-Existing Condition means any injury, sickness or condition of You, an Insured's Traveling Companion, an Insured's Family Member booked to travel with him or her for which within the sixty (60) day period prior to the effective date under the Group Policy such person received medical advice or treatment or medical advice or treatment was recommended.
Such an Injury or Sickness will continue to be a Pre- Existing Condition and excluded until the first to occur of the expiration of 12 consecutive months for which You have not received any medical care, consultation, diagnosis, or treatment or the expiration o f 12 months from the effective date of coverage.
The Pre-Existing Conditions exclusion is waived for You if the Insured enrolls You in the Group Policy at the time the Insured pays the deposit required for his or her Trip (or within 10 days of the initial deposit) and the Insured purchases the coverage under the Group Policy for the full cost of their Trip.
7.The Exclusions section is amended to delete exclusions 16, 19 and 23.
8.The Coordination of Benefits Provision is amended to read:
I. COORDINATION OF BENEFITS
A. This Coordination of Benefits ("COB") provision applies to This Plan when You have health care coverage under more than one Plan. "Plan" and "This Plan" are defined below. B. If this COB provision applies, the order of benefit determination rules should be looked at first. Those rules determine whether the benefits of This Plan are determined before or after those of another plan. The benefits of This Plan:
1)Shall not be reduced when, under the order of benefit determination rules, This Plan determines its benefits before another plan; but
2)May be reduced when, under the order of benefits determination rules, another plan determines its benefits first. The above reduction is described in Section IV "Effect on the Benefits of This Plan."
II. DEFINITIONS
A. "Plan" is any of these which provides benefits or services for, or because of, medical or dental care or treatment:
1)Group insurance coverage, whether insured or uninsured. This includes prepayment, group practice or individual practice coverage.
2)Coverage under a governmental plan, or coverage required or provided by law. This does not include a state plan under Medicaid (Title XIX, Grants to States for Medical Assistance Programs, of the United States Social Security Act, as amended from time to time).
Each contract or other arrangement for coverage under (1) or (2) is a separate plan. Also, if an arrangement has two parts and COB rules apply only to one of the two, each of the parts is a separate plan.
B. "This Plan" is the part of the group contract that provides benefits for health care expenses.
C. "Primary Plan/Secondary Plan:" The order of benefit determination rules state whether This Plan is a Primary Plan or Secondary Plan as to another plan covering the person.
When This Plan is a Primary Plan, its benefits are determined before those of the other plan and without considering the other plan's benefits.
When This Plan is a Secondary Plan, its benefits are determined after those of the other plan and may be reduced because of the other plan's benefits.
When there are more than two plans covering the person, This Plan may be a Primary Plan as to one or more other plans, and may be a Secondary Plan as to a different plan or plans.
D. "Allowable Expense" means a necessary, reasonable and customary item of expense for health care, when the item of expense is covered at least in part by one or more plans covering the person for whom the claim is made. The difference between the cost of a private hospital room and the cost of a semi-private hospital room is not considered an Allowable Expense under the above definition unless the patient's stay in a private hospital room is medically necessary either in terms of generally accepted medical practice, or as specifically defined in the plan. When a plan provides benefits in the form of services, the reasonable cash value of each service rendered will be considered both an Allowable Expense and a benefit paid.
NOTE: When benefits are reduced under a Primary Plan because covered person does not comply with the plan provisions, the amount of such reduction will not be considered an Allowable Expense Examples of such provisions are those related to second surgical opinions, pre-certification of admissions or services, and preferred provider arrangements.
E. "Claim Determination Period" means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.
III. ORDER OF BENEFIT DETERMINATION RULES
A) General. When there is a basis for a claim under This Plan and another plan, This Plan is a Secondary Plan which has its benefits determined after those of the other plan, unless:
1) The other plan has rules coordinating its benefits with those of This Plan; and
2) Both those rules and This Plan's rules, in Subsection B below, require that This Plan's benefits be determined before those of the other plan.
B Rules. This Plan determines its order of benefits using the first of the following rules which applies:
1) Non-Dependent/Dependent. The benefits of the plan which covers the person as an employee, member or subscriber (that is, other than as a dependent) are determined before those of the plan which covers the person as a dependent.
2) Dependent Child/Parents Not Separated or Divorced. Except as stated in Paragraph (B)(3) below, when This Plan and another plan cover the same child as a dependent of different persons, called "parents:"
a) The benefits of the plan of the parent whose birthday falls earlier in a year are determined before those of the plan of the parent whose birthday falls later in that year; but
b) If both parents have the same birthday, the benefits of the plan which covered a parent longer are determined before those of the plan which covered the other parent for a shorter period of time.
c) However, if the other plan does not have the rule described in (a) immediately above, but instead has a rule based upon the gender of the parent, and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan will determine the order of benefits.
3) Dependent Child/Separated or Divorced Parents. If two or more plans cover a person as adependent child of divorced or separated parents, benefits for the child are determined in this order:
a) First, the plan of the parent with custody of the child;
b)Then, the plan of the spouse of the parent with the custody of the child; and
c) Finally, the plan of the parent not having custody of the child.
However, if the specific terms of a court decree state that one of the parents is responsible for the health care expenses of the child, and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. The plan of the other parent shall be the Secondary Plan. This paragraph does not apply with respect to any Claim Determination Period or Plan year during which any benefits are actually paid or provided before the entity has that actual knowledge.
4) Joint Custody. If the specific terms of a court decree state that the parents shall share joint custody, without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child shall follow the order of benefit determination rules outlined in Paragraph III B(2).
5)Active/Inactive Employee. The benefits of a plan which covers a person as an employee who is neither laid off nor retired (or as that employee's dependent) are determined before those of a plan which covers that person as a laid off or retired employee (or as that employee's dependent). If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this Rule (5) is ignored.
6) Longer/Shorter Length of Coverage. If none of the above rules determines the order of benefits, the benefits of the plan which covered an employee, member or subscriber longer are determined before those of the Plan which covered that person for the shorter term.
IV. EFFECT ON THE BENEFITS OF THIS PLAN
A)When This Section Applies. This Section IV applies when, in accordance with Section III "Order of Benefit Determination Rules," This Plan is a Secondary Plan as to one or more other plans. In that event the benefits of This Plan may be reduced under this section. Such other plan or plans are referred to as "the other plans" in B immediately below.
B)Reduction in this Plan's Benefits. The benefits of This Plan will be reduced when the sum of:
1)The benefits that would be payable for the Allowable Expense under This Plan in the absence of this COB provision; and
2)The benefits that would be payable for the Allowable Expenses under the other plans, in the absence of provisions with a purpose like that of this COB provision, whether or not claim is made, exceeds those Allowable Expenses in a Claim Determination Period. In that case, the benefits of This Plan will be reduced so that they and the benefits payable under the other plans do not total more than those Allowable Expenses.
3)When the benefits of This Plan are reduced as described above, each benefit is reduced in proportion. It is then charged against any applicable benefit limit of This Plan.
V. RIGHT TO RECEIVE AND RELEASE NEEDED INFORMATION Certain facts are needed to apply these COB rules. Insurer has the right to decide which facts it needs. It may get needed facts from or give them to any other organization or person. Insurer need not tell, or get the consent of, any person to do this. Each person claiming benefits under This Plan must give Insurer any facts it needs to pay the claim. VI. FACILITY OF PAYMENT A payment made under another plan may include an amount which should have been paid under This Plan. if it does, Insurer may pay that amount to the organization which made that payment. That amount will then be treated as though it were a benefit paid under This Plan. Insurer will not have to pay that amount again. The term "payment made" includes providing benefits in the form of services, in which case "payment made" means reasonable cash value of the benefits provided in the form of services. VII. RIGHT OF RECOVERY If the amount of the payments made by Insurer is more than it should have paid under this COB provision, it may recover the excess from one or more of: A. The persons it has paid or for whom it has paid; B. Insurance companies; or C. Other organizations. The "amount of the payments made" includes the reasonable cash value of any benefits provided in the form of services.
If you reside in the state of SOUTH CAROLINA Form SRTC-2200-SC (P&C): (for Trip Cancellation, Trip Interruption, Trip Delay, Emergency Evacuation, Repatriation of Remains, Baggage Personal Effects, and Baggage Delay benefits only)1. The Physical Examinations and Autopsy provision is deleted in its entirety. 2. The provision entitled Arbitration is deleted in its entirety. 3. The provision entitled Subrogation is amended to read:
SUBROGATION To the extent the Company pays for a loss suffered by You, the Company will take over the rights and remedies You had relating to the loss. This is known as subrogation. You must help the Company to preserve its rights against those responsible for the loss. This may involve signing any papers and taking any other steps the Company may reasonably require. If the Company takes over Your rights, You must sign an appropriate subrogation form supplied by the Company. We may not subrogate for more than the amount of insurance benefits that We have previously paid in relation to Your loss by the liable third party. Subrogation is not permitted if the Director of Insurance determines that the exercise of subrogation by Us is inequitable and commits an injustice to You. Attorneys' fees and costs must be paid by Us from the amounts recovered. 4. The Exclusions section is amended as follows: The Exclusions related any associated cost or expense resulting directly or indirectly from the discharge, explosion or use of any device. weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event contributing concurrently or in any other sequence thereto or directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination are deleted in their entirety.
If you reside in the state of SOUTH DAKOTA Form SRTC 2200 SD:In the GENERAL PROVISIONS:
1.The provision entitled Arbitration is amended to read:
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 will be by mutual consent by all parties and any determination will not be binding on any party. 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 Plan 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.
2.The provision entitled Disagreement Over Size of Loss is amended to read:
DISAGREEMENT OVER SIZE OF LOSS: If there is a disagreement about the amount of the Loss either You or the Company may make a written demand for an appraisal. After the demand, You and the Company 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. The appraiser selected by You is paid by You. The Company will pay the appraiser they choose. You will share equally with the Company the cost for the arbitrator and the appraisal process. Such action must be mutually agreed to by all parties and any determination made is not binding on either party.
3.The provision entitled "Legal Actions" is amended to read:
LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of Loss. No legal action for a claim can be brought against the Company more than six (6) years after the time required for giving proof of Loss.
Under the EMERGENCY SICKNESS MEDICAL EXPENSE provision, the first paragraph is amended to read:
The Company will pay benefits up to the maximum shown on the Confirmation of Coverage, if You incur Covered Medical Expenses as a result of Emergency Treatment of a Sickness that manifests itself during the Trip.
The paragraph under the EMERGENCY SICKNESS MEDICAL EXPENSE provision that begins with "If You are hospitalized due to a Sickness" is amended to read: "If You are hospitalized due to a Sickness (which occurred during the course of the scheduled Trip) beyond the date of the Scheduled Return Date, coverage will be extended until You are released from the Hospital or until maximum benefits under this Policy have been paid."
The paragraph under the EMERGENCY ACCIDENT MEDICAL EXPENSE provision that begins with "If You are hospitalized due to an Accidental Injury" is amended to read: If You are hospitalized due to an Accidental Injury (which occurred during the course of the scheduled Trip) beyond the date of the Scheduled Return Date, coverage will be extended until You are released from the Hospital or until maximum benefits under this Policy have been paid.
Under the section entitled LIMITATIONS AND EXCLUSIONS:Exclusion 10 is amended to read: "10. being under the influence of drugs or intoxicants, unless prescribed by a Physician and only if You are committing felony at the time of the Loss unless results in the death of a non-traveling immediate Family Member."
If you reside in the state of TEXAS 2 Forms apply:
Form SRTC 2200 TX:
1.In the provision entitled WHEN YOUR COVERAGE ENDS, the following sentence is added:Coverage will not end solely because a person becomes an elected official in Texas.
2. In the provision entitled LEGAL ACTIONS in the GENERAL PROVISION, the reference to "2 years" is amended to read "2 years and one day".
3.The provision entitled NOTICE OF CLAIM in the GENERAL PROVISIONS is amended by the addition of the following paragraphs:The Company shall, not later than the 15th day after receipt of such notice of a claim:
a)acknowledge receipt of the claim;
b) commence any investigation of the claim; and
c) request from the Claimant all items, statements, and forms that the Company reasonably believes, at that time, will be required from the claimant. Additional requests may be made if during the investigation of the claim such additional requests are necessary.
If the acknowledgement of the claim is not made in writing, the insurer shall make a record of the date, means, and content of the acknowledgement. The Company shall notify a claimant in writing of the acceptance or rejection of the claim not later than the 15th business day after the date the Company receives all items, statements, and forms required by the Company, in order to secure final proof of Loss. If the company rejects the claim, the Company will inform the Claimant of the reasons for the rejection. If the Company is unable to accept or reject the claim within 15 business days after the date the Company receives all items, statements, and forms required by the Company, the Company shall notify the claimant within such 15 business day period. The notice provided must give the reasons that the Company needs additional time. Not later than the 45th day after the date the Company notifies a Claimant of the need for additional time to investigate a claim, the Company shall accept or reject the claim.Except as otherwise provided, if the Company delays payment of a claim following its receipt of all items, statements, and forms reasonably requested and required for more than 60 days, the Company shall pay, in addition to the amount of the claim, 18 percent per annum of the amount of such claim as damages, together with reasonable attorney fees. If suit is filed, such attorney fees shall be taxed as part of the costs in the case.
4. The provision entitled PAYMENT OF CLAIM in the GENERAL PROVISION is amended by the addition of the following paragraph: If the Company notifies a claimant that the insurer will pay a claim or part of a claim, the Company shall pay the claim not later than the fifth business day after the notice has been made. If payment of the claim or part of the claim is conditioned on the performance of an act by the claimant, the Company shall pay the claim not later than the fifth business day after the date the act is performed.
5. The PROOF OF LOSS provision in the GENERAL PROVISIONS is amended to read:The Claimant must send the Company, or its designated representative, proof of Loss within ninety-one (91) days after a covered Loss occurs or as soon as reasonably possible.
6. The following provision is added to the policy:You may cancel the policy by giving the Company or its agent written notice within either 10 days from the date of issuance of Your policy, or Your Departure Date, whichever occurs first. If You do this, the Company will refund Your plan cost in full, excluding the administrative fee.
Form SRTC 2200 TX (A&H):
1. In the section entitled GENERAL DEFINITIONS:
The definition of Family Member is amended to read: Family Member means Your or Your Traveling Companion's spouse, parent, legal guardian, step-parent, grandparent, parents-in-law, grandchild, natural or adopted child, step-child, children-in-law, brother, sister, step-brother, step-sister, brother-in-law, sister-in-law, aunt, uncle, niece or nephew, [who reside in the United States, Canada or Mexico.
The definition of Hospital is amended to read: Hospital means:
a) is licensed as a hospital and operated pursuant to law; and b) is primarily engaged in providing or operating (either on its premises or in facilities available to the hospital on a contractual prearranged basis and under the supervision of a staff of one or more duly licensed physicians), medical, diagnostic, and major surgery facilities for the medical care and treatment of sick or injured persons on an inpatient basis for which a charge is made; and c) provides 24-hour nursing service by or under the supervision of a registered graduate professional nurse (RN); and d) is an institution which maintains and operates a minimum of five beds; and e) has x-ray and laboratory facilities either on the premises or available on a contractual prearranged basis; and f) maintains permanent medical history records.
Hospital does not include:
a) the federal government or any agency thereof for the treatment of members or ex-members of the armed forces; or b) convalescent homes, convalescent facilities, rest facilities, or nursing facilities; or c) home or facilities primarily for the aged, drug addicts, alcoholics, those primarily affording custodial care, educational care or those primarily affording care for mental and nervous disorders.
The definition of Pre-existing Condition, with regard to the Emergency Accident Medical Expense and Emergency Sickness Medical Expense benefits is amended to read:
Pre-Existing Condition means any injury, sickness or condition of Yours for which within the sixty (60) day period prior to the effective date of such Benefits under this Policy: (a) first manifested itself or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or (c) required medical treatment or treatment was recommended by a Physician. The Pre-Existing Conditions exclusion is waived for You if You enroll You in this Policy at the time You pay the deposit required for Your Trip (or within 10 days of the initial deposit) and You purchase the coverage under this Policy for the full cost of their Trip.
2. In the section entitled LIMITATIONS AND EXCLUSIONS, exclusion 7 is amended to read: mental, emotional, or functional disorder without demonstrable organic disease;
3. The following provisions are added to the section entitled GENERAL PROVISIONS:Entire Contract; Changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. A change in this policy is not valid until the change is approved by an executive officer of the insurer and unless the approval is endorsed on or attached to the policy. An agent does not have authority to change this policy or to waive any of its provisions
Change of Beneficiary: Unless You make an irrevocable designation of beneficiary, the right to change a beneficiary is reserved for You, and the consent of the beneficiary or beneficiaries is not required for the surrender or assignment of this policy, for any change of beneficiary or beneficiaries, or for any other changes in this policy.
4. The provision entitled Arbitration is amended to read:
ARBITRATION - 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 you reside in the state of UTAH Form SRTC 2200 (UT):
•In the General Provisions section, both provisions entitled Proof of Loss are deleted and replaced with the following:PROOF OF LOSS - The Claimant must send the Company, or its designated representative, proof of loss within ninety (90) days after a covered loss occurs or as soon as reasonably possible.
•In the section entitled Limitations and Exclusions, the exclusions related to excluding loss or damage (including death or injury) and any associated cost or expense resulting directly or indirectly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event contributing concurrently or in any other sequence thereto or losses directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination are not excluded to the extent that they are caused by terrorism.
If you reside in the state of VERMONT Form SRTC-2200 VT P&C:In the GENERAL PROVISIONS section, the first sentence of the provision entitled "When Your Coverage Ends" is amended to read:
WHEN YOUR COVERAGE ENDS - Your coverage will end at 11:59 P.M. local time on the date that is the earliest of the following:1. The following disclosure is added to the certificate:
THIS TRAVEL PROGRAM IS A LIMITED BENEFIT PROGRAM. READ YOUR CERTIFICATE CAREFULLY.
2. This endorsement is part of the certificate to which it is attached and provides benefits under the certificate for parties to a civil union. Vermont law requires that insurance policies offered to married persons and their families be made available to parties to a civil union and their families. In order to receive benefits in accordance with this endorsement, the civil union must be established in the state of Vermont according to Vermont law.It is understood that policy definitions and provisions designating
•an insured
•named insured
•who is insured
•who is a named insured
•covered person(s)
•you and/or your
•spouse
•family member
and any other policy or certificate definitions and provisions designating an insured under this certificate, are amended, wherever appearing, where terms denoting a marital relationship or family relationship arising out of a marriage are used, to indicate parties to a civil union and their families under Vermont law.3. The provision entitled "Arbitration" is amended to read:
ARBITRATION - Notwithstanding anything in the Group 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. All parties must mutually agree to such arbitration. 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 Group 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.4. The following items apply to the Accidental Death and Dismemberment and Medical Expense benefits ONLY:a. The definition of Accidental Injury is amended to read:
Accidental Injury means Bodily Injury caused by an accident being the direct and independent cause in the loss.b. The section entitled exclusions is amended to read: (4) Exclusions:With regard to the Accidental Death and Dismemberment benefits and the Accident and Sickness Medical Expense benefits, if provided, no benefits are payable due to loss caused by or resulting from:
1.Pre-Existing Conditions, as defined in the Definitions section unless the insurance is purchased within 10 days of the initial Trip deposit
2.Suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane unless results in the death of a non-traveling immediate Family Member;
3.Intentionally self-inflicted injuries;
4.War, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war;
5.Participation in any military maneuver or training exercise. Orders to active military service for training purposes of two months or less will not constitute service in the armed forces. Upon notice to the Company of entering the armed forces, the Company will return to the Insured pro-rata any premium paid, less any benefits paid, for any period during which the Insured is in such service;
6.Piloting or learning to pilot or acting as a member of the crew of any aircraft;
7.Participation as a professional in athletics;
8 Being under the influence of drugs or intoxicants, unless prescribed by a Physician unless results in the death of a non-traveling immediate Family Member;
9.Commission or the attempt to commit a criminal act;
10.Dental treatment except as a result of an injury to sound natural teeth limited to $750;
11.Any non-emergency treatment or surgery, routine physical examinations, hearing aids, eye glasses or contact lenses;
12.Pregnancy and childbirth (except for complications of pregnancy) except if hospitalized;
13.Curtailment or delayed return for other than covered reasons;
14.Traveling for the purpose of securing medical treatment;
15.Services not shown as covered;
16.Confinement or treatment in a government Hospital; however the United States government may recover or collect benefits under certain conditions;
17.Care or treatment that is not medically necessary;
18.Care or treatment for which compensation is payable under Worker's Compensation Law, any Occupational Disease law; the 4800 Time Benefit plan or similar legislation;
19.Injury or Sickness when traveling against the advice of a Physician; or
20.Cosmetic surgery except for: reconstructive surgery incidental to or following surgery for trauma, or infection or other covered disease of the part of the body reconstructed, or to treat a congenital malformation of a child.
If you reside in the state of WYOMING Form SRTC 2200-1 WY:Under the section entitled "General Provisions" the following changes are made:
The provision entitled "Arbitration" is amended to read:
ARBITRATION -Notwithstanding anything in the Group 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. 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. In addition, such arbitration must be by mutual consent by all parties.
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 Group 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.
The provision entitled "Legal Actions" is amended to read:
No legal action for a claim can be brought against the company until 60 days after the Company received proof of loss. No legal action for a claim can be brought against the Company more than 48 months after the time for giving proof of loss.
WORLDWIDE EMERGENCY ASSISTANCE SERVICES
Worldwide Emergency Assistance
A 24-hour emergency telephone assistance service is available for Your benefit so that, in the event of an emergency while on the Trip, English speaking help and advice may be furnished to You.PART I - TRAVELER'S ASSISTANCE
The Assistance Company's multilingual staff can assist You in solving a variety of unexpected complications during the Trip such as lost tickets or belongings. If necessary, the Assistance Company may also help locate legal counsel. Pre-Trip information such as cultural, visa requirements and exchange rates can also be provided.
PART II - MEDICAL ASSISTANCE
If a medical emergency arises during travel, the Assistance Company may help You find local medical care. Physicians and hospitals worldwide can contact the Assistance Company to confirm coverage and, if required, help You arrange immediate settlement of medical expenses resulting from an Injury during the covered Trip. The Assistance Company will coordinate emergency medical situations, with Your home Physician and arrange Emergency Evacuation services.
PART III - EMERGENCY CASH TRANSFER
the Assistance Company can help arrange a fund transfer through Your credit cards, family, friends, employer or similar source if You need cash while on the Trip.
Note Assistance Services are provided by an independent organization and not by Nationwide Mutual Insurance Company, Nationwide Casualty Insurance Company, Nationwide Life Insurance Company. There may be times when circumstances beyond the Assistance Company's control hinder their endeavors to provide travel assistance services. They will, however, make all reasonable efforts to provide travel assistance services and help You resolve Your emergency situation.
For Travel Assistance Only
CALL TOLL FREE:
1-877-318-6895
OR CALL COLLECT
1-603-328-1905
(From all other locations)
Nationwide® Privacy StatementThank you for choosing Nationwide
Our privacy statement explains how we collect, use, share, and protect your personal information. So just how do we protect your privacy? In a nutshell, we respect your right to privacy and promise to treat your personal information responsibly. It's as simple as that. Here's how.
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We collect personal information about you when you ask about or buy one of our products or services. The information comes from your application, business transactions with us, consumer reports, medical providers, and publicly available sources. Please know that we only use that information to sell, service, or market products to you.
We may collect and use the following types of information:
•Name, address, and Social Security number
•Assets and income
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You can ask us for a copy of your personal information. Please call the number on your insurance ID card if applicable, contact your customer service representative, or send a letter to the address below and have your signature notarized. This is for your protection so we may prove your identity. We don't charge a fee for giving you a copy of your information now, but we may charge a small fee in the future.
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Send your privacy inquiries to the address below. Please include your name, address, and policy number. If you know it, include your agent's name and number.
Nationwide Claims AdministrationP.O. Box 23802Tampa, FL 33632-3802
NationwideClaimServices@cbpinsure.com
A parting word
These are our privacy practices. They apply to all current and former clients of Nationwide health plans. They also apply to joint policy or contract holders. This includes the following companies:
Nationwide Better Health, Inc.Nationwide Life Insurance Company Nationwide Mutual Insurance Company National Casualty Company