Policy terms and conditions

All benefits payable are subject to the Maximum Benefit Limits, and any applicable sub-limits, listed in the Schedule of Benefits.

MEDICAL EXPENSE BENEFIT

If a covered Sickness or Injury occurs during the Policy Period, and the Covered Person requires medical or surgical treatment, benefits are payable for the following covered expenses. The first charges must be incurred within 90 days after the date of the covered Sickness or Injury or the treatment must occur within 24 hours of the Unexpected Recurrence of a Pre-existing Condition.

No benefits will be paid for any expenses incurred which are in excess of usual and customary charges.

1. Hospital Room and Board Expenses: the average daily rate for a semi-private room when a Covered Person is Hospital Confined, and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge. All charges in excess of the allowable semiprivate rate are the responsibility of the Covered Person.

2. Hospital Emergency Room Visits. Emergency Room Visit for an Illness with no direct Hospital Admittance will be subject to an additional deductible as outlined in the schedule of benefits.

3. Ancillary Hospital Expenses: Services and supplies as Medically Necessary and approved and covered by the Policy including meals and special diets (only for the Covered Person), use of operating room and related facilities, use of intensive care and related services to include x-ray (including reading charges) , laboratory and other diagnostic tests, drugs, medications, biological anesthesia and oxygen services, and administration of blood products. This does not include personal services of a non-medical nature.

4. Intensive Care Unit Expenses: Room and Board: 3 times the average semiprivate room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.

5. Medical Emergency Care Expenses incurred within 24 hours of Unexpected Recurrence of a Pre-existing Condition. These expenses include the attending Physician’s charges, x-rays, laboratory procedures, use of the emergency room and supplies.

6. Physician non-surgical treatment and examination expenses including the Physician’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Physician.

7. Physician’s Surgical Expenses.

8. Assistant Physician Surgical Expenses when Medically Necessary.

9. Anesthesiologist expenses for pre-operative screening and administration of anesthesia during a surgical procedure on an outpatient basis.

10. Outpatient Medical expenses.

11. Physician Visits

12. Physiotherapy Physical Medicine/Chiropractic Expenses on an Inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Physician, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy.

13. X-rays

14. Emergency dental treatment and restoration of sound natural teeth, including x-rays, required as a result of an Accident or to relieve pain.

15. Ambulance Service Benefits are provided for medically necessary emergency ground ambulance transportation from the emergency site to the nearest Hospital able to provide the required level of care.

16. Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Physician.

17. Emergency medical treatment of pregnancy.

18. Mental or nervous disorders.

19. Medically Necessary treatment for COVID-19, SARS-CoV-2, and any mutation or variation of SARS-CoV-2.

 

ADDITIONAL MEDICAL TREATMENT AND SERVICES

Unexpected Recurrence of a Pre-Existing Condition - Benefits are payable for Covered Expenses resulting from a sudden, Unexpected Recurrence of a Pre-Existing Condition while traveling outside the Covered Person’s Home Country. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage.

TRANSPORTATION BENEFITS

AMBULANCE SERVICE BENEFITS

Ambulance Service Benefits are provided for medically necessary emergency ground or air ambulance transportation as required from the emergency site to the nearest Hospital able to provide the required level of care.

EMERGENCY MEDICAL EVACUATION

Benefits are payable if a Covered Person suffers a Sickness or Injury during the course of the Trip which requires Emergency Medical Evacuation from the place where the Covered Person suffers a Sickness or Injury to the nearest Hospital or other medical facility where appropriate medical treatment can be obtained; or transportation to the Covered Person’s Home Country to obtain further medical treatment in a Hospital or other medical facility or to recover after suffering a Sickness or Injury. An Emergency Medical Evacuation includes Medically Necessary medical treatment, medical services and medical supplies necessarily received in connection with such transportation. If after hospitalization or treatment for a covered Sickness or Injury, the Covered Person is unable to continue Their journey, Our designated Assistance Provider, in conjunction with the local attending Physician, will organize the Covered Person’s return to Their Home Country. If the gravity of the situation so dictates, Our designated Assistance Provider will ensure that appropriate medical care is provided to the Covered Person during the return journey. If Our designated Assistance Provider and the local attending medical practitioner consider the Covered Person stable enough to be medically repatriated, without endangering Their health, and They refuse repatriation, We will continue to pay medical expense benefits incurred after the date repatriation was recommended only up to the amount that would have been payable for the medical repatriation.

Benefits will not be payable unless We authorize in writing or by an authorized electronic or telephonic means all expenses in advance. Benefits will not be payable unless: 1. the Physician ordering the Emergency Medical Evacuation certifies the severity of the Covered Person’s Sickness or Injury requires an Emergency Medical Evacuation; 2. all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible; 3. the charges incurred are Medically Necessary and do not exceed the usual level of charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred ; and 4. do not include charges that would not have been made if there were no insurance.

NATURAL DISASTERS, POLITICAL EVACUATION

Benefits are payable for the Covered Person’s extrication from the Host Country due to an Occurrence which could result in grave physical harm or death. The Occurrence must take place while coverage is in effect, and while the Covered Person is traveling outside of Their Home Country. Benefits will be paid for: 1. Transportation and Related Costs to the Nearest Place of Safety, necessary to ensure the Covered Person’s safety and well-being as determined by the Designated Security Consultant. 2. Transportation and Related Costs within 14 days of the Political Evacuation to either to the country in which the Covered Person is traveling while covered by the Policy; or the Covered Person’s Home Country; or 3. consulting services by a Designated Security Consultant for seeking information on a Missing Person or kidnapping cases, if the Covered Person is kidnapped or reported as a Missing Person to local or international authorities. Benefits will not be payable unless We (or Our authorized Assistance Provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by the Assistance Provider. The Assistance Provider is not responsible for the availability of transport services. Where a Political Evacuation becomes impractical due to hostile or dangerous conditions, a Designated Security Consultant will endeavor to maintain contact with the Covered Person until a Political Evacuation occurs. Political Evacuation Benefits are payable only once for any one Occurrence. If, after a Political Evacuation is completed, it becomes evident that the Covered Person was an active participant in the events that led to the Occurrence, We have the right to recover all Transportation and Related costs from the Covered Person. Benefits will be payable for evacuation during a period of civil unrest, insurrection or natural disasters that could not have been foreseen prior to the Covered Person’s departure from Their Home Country of origin.

EMERGENCY REUNION

Benefits are payable for the cost of one economy airfare ticket and other local travel related expenses including the reasonable expenses incurred for lodging and meals of a Covered Person’s Immediate Family Member for a period of up to 10 days, to join the Covered Person at the Hospital where the Covered Person is confined and to accompany the Covered Person back to their Home Country, if needed, provided: 1. the Emergency Medical Evacuation Benefit is payable under the Policy; 2. the Covered Person is alone outside of Their Home Country; 3 . the place of confinement is more than 100 miles from the Covered Person’s Home Country; and 4. expenses were authorized in advance by the Company.

RETURN OF MINOR CHILDREN OR TRAVELING COMPANION

If the Covered Person is the only person traveling with minor Dependent children who are under the age of 21, or with a Travel Companion, and the Covered Person suffers a Sickness or Injury and must be Hospital Confined for at least 48 consecutive hours, or are medically evacuated to another location, benefits are payable for the cost of the Dependent or Travel Companion’s one way economy airfare ticket and/or ground transportation ticket to Their Home Country. All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the usual level of charges for similar transportation in the locality where the expense is incurred. Benefits will not be paid unless all expenses are approved in advance by Us, and services are rendered by the Assistance Provider.

REPATRIATION OF MORTAL REMAINS

Benefits are payable for preparation and return of a Covered Person’s body to Their Home Country if they die due to a Sickness or Injury. Covered Expenses include: Expenses for embalming or cremation; The least costly coffin or receptacle adequate for transporting the remains; Transporting the remains by the most direct and least costly conveyance and route possible. Expenses must be approved in advance and coordinated by the Assistance Provider. This benefit excludes fees for return of personal effects, religious or secular memorial services, clergymen, flowers, music, announcements, guest expenses and similar personal burial preferences.

ADDITIONAL BENEFITS

HOSPITAL CONFINEMENT

Benefits are payable, if the Covered Person is confined to a Hospital provided; 1. The Hospital stay is the direct result, from no other causes, of Injuries sustained in a Covered Accident or Sickness that occurs while the Policy is in effect; and 2. The Hospital say begins within 3 days of a Covered Accident or Sickness and lasts for at least 3 days. The benefit will be paid retroactive to the first day of the Hospital stay. Benefit payments will end on the first of the following: 1. The date the Hospital Stay ends; 2. The date the Covered Person dies; 3. The 15th day of hospitalization; or 4. The date the coverage terminates.

FELONIOUS ASSAULT ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)

We will pay the Benefit Amount for felonious assault, if Accidental Bodily Injury that results from felonious assault causes a Covered Person to suffer one of the losses shown below within 365 days from the felonious assault. The Benefit Amount for felonious assault is payable in addition to any other applicable Benefit Amounts under this policy. Any assault by a family member is not covered under this benefit.

COVERED LOSS

BENEFIT AMOUNT

Loss of Life

100% of Principal Sum

Loss of Hands (Both), Loss of Feet (Both), or Loss of Sight of One Eye

100% of Principal Sum

Quadriplegia

100% of Principal Sum

Paraplegia

75% of Principal Sum

Hemiplegia

75% of Principal Sum

Loss of Hand, Loss of Foot or Loss of Sight of One Eye (any one of each)

50% of Principal Sum

Uniplegia

25% of Principal Sum

Loss of Thumb and Index Finger of the same hand

25% of Principal Sum

 

ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)

Accidental Death and Dismemberment will apply to Covered Accidents incurred by a Covered Person. If Injury to the Covered Person results in any one of the losses shown below within 365 days from date of the Covered Accident, We will pay the Benefit Amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.

COVERED LOSS

BENEFIT AMOUNT

Loss of Life

100% of Principal Sum

Loss of Hands (Both), Loss of Feet (Both), or Loss of Sight of One Eye

100% of Principal Sum

Quadriplegia

100% of Principal Sum

Paraplegia

75% of Principal Sum

Hemiplegia

75% of Principal Sum

Loss of Hand, Loss of Foot or Loss of Sight of One Eye (any one of each)

50% of Principal Sum

Uniplegia

25% of Principal Sum

Loss of Thumb and Index Finger of the same hand

25% of Principal Sum

Exposure and Disappearance Benefit – Benefits are payable if a Covered Person is exposed to the elements after the forced landing, stranding, sinking, or wrecking of a vehicle in which They were traveling. The Covered Person is presumed dead if They are in a vehicle that disappears, sinks or is stranded or wrecked and Their body is not found within six (6) months of the Covered Accident.

HIJACKING AND AIR OR WATER PIRACY

Benefits are payable if a Covered Person suffers an Injury during 1. the hijacking of an Aircraft; 2. air or water piracy; or 3. unlawful seizure or attempted seizure of an aircraft or watercraft.

COMA BENEFIT

Benefits are payable if the Covered Person becomes comatose within 31 days of a Sickness or Injury and remain in a coma for at least 31 days.

SEATBELT AND AIRBAG ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D)

Benefits are payable if a Covered Person dies or is dismembered directly and independently from Injuries sustained while wearing a seatbelt and operating or riding as a passenger in an Automobile.

ADAPTIVE HOME AND VEHICLE

Benefits are payable if the Covered Person has an Injury which results in a Covered Loss under the Accidental Death and Dismemberment Benefit, We will pay an additional benefit equal to the least of the actual cost of the alterations for the one-time cost of alterations to the Covered Person’s principal residence and/or private Automobile to make the residence accessible and/or the private Automobile drivable or rideable.

LOST BAGGAGE

Up to $1,000 maximum for the replacement costs of Necessities, up to $75 per article. Benefits are payable if a Covered Person’s luggage is checked onto a Common Carrier, and is then lost, stolen or damaged beyond use. Replacement costs are calculated on the basis of the depreciated standard and its average usable period. The Covered Person must file a formal claim with the transportation provider and provide Us with copies of all claim forms and proof that the transportation provider has paid the Covered Person its normal reimbursement for the lost, stolen or damaged luggage.

TRIP INTERRUPTION

Benefits are payable for reimbursement of the cost of a one-way economy air and/or ground transportation ticket if the Covered Person’s Trip is interrupted as the result of:

  1. 1. the death of an Immediate Family Member; or
  2. 2. the Covered Person’s unforeseen Sickness or Injury or, the Sickness or Injury of a Traveling Companion or Immediate Family Member. The Sickness or Injury must be so disabling as to reasonably cause a Trip to be interrupted; or
  3. 3. substantial destruction of the Covered Person’s principal residence by fire or weather-related activity; or
  4. 4. a Medically Necessary covered Emergency Medical Evacuation to return the Covered Person to Their Home Country or to the area from which They were initially evacuated for continued treatment, recuperation and recovery.

TRIP DELAY

The Company will reimburse You for Covered Trip Delay Expenses, up to the Maximum Benefit shown on the Schedule of Benefits, if You are delayed, while coverage is in effect, en-route to or from the Trip for six (6) or more hours due to a defined Hazard.

Covered Trip Delay Expenses:

  • (a) Any pre-paid, unused, non-refundable land and water accommodations;
  • (b) Any Reasonable Expenses incurred;
  • (c) An Economy Fare from the point where You ended Your Trip to a destination where You can catch up to the Trip;
  • (d) A one-way Economy Fare to return You to Your originally scheduled return destination.

OPTIONAL ATHLETIC SPORTS COVERAGE- IF PURCHASED

Coverage for injuries incurred during Amateur, Club, Intramural, Interscholastic, Intercollegiate activities.

Professional and Semi Professional Sports are always excluded.

  • Class 1 - includes Archery, Tennis, Swimming, Cross Country, Track, Volleyball and Golf
  • Class 2 - includes Ballet, Basketball, Cheerleading, Equestrian, Fencing, Field Hockey, Football (no division 1), Gymnastics, Hockey, Karate, Lacrosse, Polo, Rowing, Rugby and Soccer

Any Athletic Sport not expressly covered hereunder is excluded from this policy unless the activity is non-contact and engaged in by You solely for leisure, recreation, entertainment, or fitness purposes only.

OPTIONAL 24 HOUR Accidental Death and Dismemberment Upgrade - IF PURCHASED

Increase to $50,000 maximum AD&D benefit - All Ages

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