All-Inclusive Package
Plan Details
All-Inclusive Package
Nationwide Mutual Insurance CompanyPO Box 2399
Columbus OH 43216-2399
Mail Code C0-03-24
TRAVEL PROTECTION CERTIFICATE
TABLE OF CONTENTS
GENERAL DEFINITIONSGENERAL PROVISIONS
COVERAGES:
Trip Cancellation
Trip Interruption
Trip Delay
Missed Connection
Accidental Death & Dismemberment
Emergency Sickness Medical Expense
Emergency Accident Medical Expense
Emergency Evacuation
Repatriation of Remains
Baggage/Personal Effects
Baggage Delay
LIMITATIONS AND EXCLUSIONS
COORDINATION OF BENEFITS
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, and (b) solely and independently of any other cause, except illness resulting from, or medical or surgical treatment rendered necessary by such injury, is the direct cause of Your death or dismemberment 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 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 You request coverage and remit the required premium.
Cruise means any prepaid sea arrangements made by the Participating Organization.
Default means a material failure or inability to provide contracted services due to financial insolvency.
Dependent Child(ren) means the Insured's 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 the Insured for support and maintenance; or (2) who is at least age 19 but less than age 23 and who regularly attends an institution of learning an accredited school or college; and who is primarily dependent on the Insured for support and maintenance.
Dependent means the Insured's lawful spouse and/or unmarried children under 19 years of age.
Economy Fare means the lowest published rate for a one-way 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.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.
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 Yours, an Insured's Traveling Companion for which within the sixty (60) day period prior to the effective date 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 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.
Scheduled Departure Date means the date on which You are originally scheduled to leave on the 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 the Insured. Note, a group or tour leader is not considered a Traveling Companion unless the Insured is 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 will take effect at 12:01 A.M. local time, at the location of the Insured, on the Scheduled Departure Date provided:
(a) coverage has been elected; and
(b) the required premium has been paid.
WHEN YOUR COVERAGE ENDS - Your coverage will end at 11:59 PM local time on the date that is the earliest of the following:
(a) the date the Group Policy is terminated or the date the Travel Supplier no longer participates in the program, unless the Insured purchased insurance prior to the date of termination. If insurance was purchased prior to the date of termination, insurance will continue to the end of the Covered Trip;
(b) the Scheduled Return Date as stated on the travel tickets;
(c) the date the Insured returns to his/her origination point if prior to the Scheduled Return Date;
(d) the date the Insured leaves or changes his/her Covered Trip (unless due to unforeseen and unavoidable circumstances covered by the Policy);
(e) the time the Group Policy terminates. If insurance was purchased prior to the date of termination, insurance will continue to the end of the Individual Coverage Term;
(f) If the Insured extends the return date, Your coverage will terminate at 11:59 P.M., local time, at the location of the Insured on the Scheduled Return Date;
(g) The date the Insured cancels the Covered Trip;
(h) Any Trip that exceeds 150 days.
EXTENDED COVERAGE - Coverage will be extended under the following conditions:
(a) If the Insured is 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 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. 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.
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 Interruption, Trip Delay, Missed Connection, 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 Insured's beneficiary. If a beneficiary is not otherwise designated by the Insured, benefits for loss of life will be paid to the first of the following surviving preference beneficiaries:
a) the Insured's spouse:
b) the Insured's child or children jointly:
c) an Insured's parents jointly if both are living or the surviving parent if only one survives:
d) an Insured's brothers and sisters jointly: or
e) the Insured's estate.
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 the Insured.
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 the Insured for an amount greater than the amount paid by the Insured.
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 Participating Organization'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 reasonable 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.
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 CANCELLATION
The 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 Trip. A Physician must advise cancellation of the 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) A Terrorist Incident that occurs in a city listed on Your 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 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 Trip and for the full cost of the Trip.
(g) The Insured's Traveling Companion or Family Member, who are military personnel, and are called to emergency duty for a natural disaster other than war.
(h) Strike that causes complete cessation of services for at least 24 consecutive hours.
(i) Weather that causes complete cessation of services of the Common Carrier for at least 24 consecutive hours.
(j) 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 the Insured purchased the Land/Sea Arrangements. The Insured's Scheduled Departure Date must be no more than 15 months beyond the Insured's 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.
(k) An Insured is terminated, or laid off from employment subject to three years of continuous employment at the place of employment where terminated.
(l) Natural disaster at the site of Your destination that renders their destination accommodations uninhabitable.
The Company will reimburse the Insured for the following:
a) non-refundable cancellation charges imposed by the Travel Suppliers.
In no event shall the amount reimbursed exceed the amount the Insured 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 the Insured notified the Travel Supplier as soon as reasonable possible.
SINGLE OCCUPANCY COVERAGE
The 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 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 Trip. A Physician must advise cancellation of the 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) A Terrorist Incident that occurs in a city listed on Your 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 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 Trip and for the full cost of the Trip.
(g) The Insured's Traveling Companion or Family Member, who are military personnel, and are called to emergency duty for a natural disaster other than war.
(h) Strike that causes complete cessation of services for at least 24 consecutive hours.
(i) Weather that causes complete cessation of services of the Common Carrier for at least 24 consecutive hours.
(j) 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 the Insured purchased the Land/Sea Arrangements. The Insured's Scheduled Departure Date must be no more than 15 months beyond the Insured's 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.
(k) An Insured is terminated, or laid off from employment subject to three years of continuous employment at the place of employment where terminated.
(l) Natural disaster at the site of Your destination that renders their destination accommodations uninhabitable.
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 Insured (up to $100 a day) if a Traveling Companion must remain hospitalized or if You must extend the 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 the 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.
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.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 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.
EXPOSURE
The 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.
DISAPPEARANCE
The Company will pay benefits for loss of life if Your body cannot be located one year after Your disappearance due to an Accident.
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 means 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 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 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 Policy have been paid
Under New York Law, certain mandated benefits are required to be provided under a hospital/medical expense policy. We will pay benefits as applicable to this policy for such mandates as they apply to the benefits provided under the Policy.
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 means 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 Trip.The Company will pay benefits, up to $750.00, 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 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 Policy have been paid.
Under New York Law, certain mandated benefits are required to be provided under a hospital/medical expense policy. We will pay benefits as applicable to this policy for such mandates as they apply to the benefits provided under the Policy.
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 the 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.
(a) recommended by the attending Physician;
(b) required by the standard regulations of the conveyance transporting You; and
(c) authorized in advance by the Company or its authorized representative.
Transportation to Join the Insured: If the Insured is traveling alone and is in a Hospital alone for more than seven (7) consecutive days or if the attending Physician certifies that due to the Insured's Injury or Sickness, the Insured will be required to stay in the Hospital for more than seven (7) consecutive days, upon request the Company will bring a person, chosen by the Insured, for a single visit to and from the Insured's 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 the Insured or already included within the cost of the Trip.
REPATRIATION OF REMAINS
The Company will pay the reasonable Covered Expenses incurred to return Your body to the Insured's primary place of residence if You die during the 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 the Insured has taken all reasonable measures to protect, save and/or recover his/her 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.
LIMITATIONS AND EXCLUSIONS
The following exclusions apply to Trip Cancellation, Trip Interruption, Trip Delay, 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 Trip deposit;
1. 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;
2. intentionally self-inflicted injuries;
3. war, invasion, 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;
8. participation in underwater activities;
9. 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;
10. commission or the attempt to commit a felony;
11. 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;
12. dental treatment except as a result of an injury to sound natural teeth limited to $750;
13. any non-emergency treatment or surgery, routine physical examinations, hearing aids, eye glasses or contact lenses;
14. pregnancy and childbirth (except for complications of pregnancy) except if hospitalized;
15. curtailment or delayed return for other than covered reasons;
16. traveling for the purpose of securing medical treatment;
17. services not shown as covered;
18. Confinement or treatment in a government Hospital; however the United States government may recover or collect benefits under certain conditions;
19. Care or treatment that is not medically necessary;
20. 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;
21. Injury or Sickness when traveling against the advice of a Physician;
22. 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 BENEFITS
ApplicabilityThe 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 RulesWhen 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.
Form SRTC 2500 NY
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.
Confidentiality and security
We follow all data security laws. We protect your information by using physical, technical, and procedural safeguards. We limit access to your information to those who need it to do their jobs. Our business partners are legally bound to use your information for permissible purposes.
Collecting and using your personal information
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
•Account and policy information
•Credit reports and other consumer report information
•Family member and beneficiary information
•Public information
Sharing your information for business purposes
We share your information with other Nationwide companies and business partners. When you buy a product, we share your personal information for everyday purposes. Some examples include mailing your statements or processing transactions that you request. You cannot opt out of these. We also share your information where federal and state law requires.
Sharing your information for marketing purposes
We don't sell your information for marketing purposes. We have chosen not to share your personal information with anyone except to service your product. So there's no reason for you to opt out. If we change our policy, we'll tell you and give you the opportunity to opt out before we send your information.
Using your medical information
We sometimes collect medical information. We may use this medical information for a product or service you're interested in, to pay a claim, or to provide a service. We may share this medical information for these business purposes if required or permitted by law. But we won't use it for marketing purposes unless you give us permission.
Accessing your information
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.We can't update information that other companies, like credit agencies and third parties, provide to us. So you'll need to contact these other companies to change and correct your information.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