MEMBER ELIGIBILITY

  1. Only individuals traveling outside of their home country who are at least 14 days of age are eligible for coverage under this plan. U.S. citizens must be traveling outside of the continental U.S., Alaska, Hawaii, Puerto Rico, and the U.S. Virgin Islands in order to be eligible. For individuals coming to the U.S. who are over age 65, coverage must be effective within 30 days of arrival.
  2. Individuals ages 80 and above must select Plan A. Individuals ages 70 to 79 may select Plan A or Plan B. Individuals age 69 and under may select any plan.

CERTIFICATE EFFECTIVE & TERMINATION DATES

CERTIFICATE EFFECTIVE DATE

Insurance hereunder is effective on the later of:

  1. The moment we receive an application and correct premium if the application and payment is made online or by fax;
  2. 12:01am U.S. Eastern Time on the date we receive an application and correct premium if the application and payment is made by mail;
  3. The moment you depart from your home country; or
  4. 12:01am U.S. Eastern Time on the date requested on the application

CERTIFICATE TERMINATION DATE

Insurance hereunder terminates on the earlier of:

  1. 11:59pm U.S. Eastern Time on the last day of the period for which premium has been paid
  2. 11:59pm U.S. Eastern Time on the date requested on the application; or
  3. The moment of arrival upon your return to your home country (unless you have started a benefit period or are eligible for home country coverage).

Coverage provided under this Master Policy is for a maximum duration of 364 days.

Notwithstanding the foregoing, coverage under all plans shall terminate on the date we, at our sole option, elect to cancel all members of the same sex, age, class or geographic location, provided we give no less than 30 days advance written notice by mail to your last known address.

Accident means a sudden, unintentional and unexpected occurrence caused by external, visible means and resulting in physical injury to you. The cause or one of the causes of such accident is external to your own body and occurs beyond your control.

Accidental Death means a sudden, unintentional and unexpected occurrence caused solely by external, visible means resulting in physical injury to you and your subsequent death. Death must occur within 30 days of the sudden, unintentional and unexpected occurrence and not be contributed to by illness or disease.

Accidental Dismemberment means a sudden, unintentional and unexpected occurrence caused solely by external, visible means and resulting in complete severance from the body of one or more limbs or eyes and not contributed to by illness or disease. For purposes of the Accidental Death and Dismemberment benefit, the term “limb” shall mean: the arm when the severance is at or above (toward the elbow) the wrist, or the leg when the severance is at or above (toward the knee) the ankle. Loss of eye(s) shall mean: complete, permanent, irrevocable loss of sight.

Beneficiary means the individual named in your application to be the recipient of any Accidental Death or Common Carrier Accidental Death benefit. If you do not designate a beneficiary on the application, the beneficiary is automatically as follows:

Members age 18 or older: 1. Spouse (if any), 2. Children (if any) equally, 3. Your estate.

Members under age 18: 1. Custodial Parent(s) (if any), 2. Siblings (if any) equally, 3. Your estate.

Certificate means the document issued to you that provides evidence of benefits payable under the Master Policy and that will confirm the plan type, period of cover, home country, certificate number, special terms and/or conditions, deductible, chosen benefit list, and geographical area of cover.

Certificate Period means the period of time beginning on the date and time of the certificate effective date and ending on the date and time of the certificate termination date. The maximum certificate period is 364 days.

Common Carrier means an airplane, bus, train or watercraft operating for commercial purposes and carrying fare-paying passengers on regularly scheduled and published routes. Custodial Care means that type of care or service, wherever furnished and by whatever name called, that is designed primarily to assist you in performing the activities of daily living. Custodial care also includes non- acute care for the comatose, semi-comatose, paralyzed or mentally incompetent patients

Cyber means the use or operations, as a means for inflicting harm, of any computer, computer software program, malicious code, computer virus or process or any other electronic system.

Deductible means the dollar amount of eligible expenses, specified in the Schedule of Benefits and Limits that you must pay per certificate period before eligible expenses are paid.

Durable Medical Equipment means a standard basic hospital bed and/or a standard basic wheelchair.

Educational or Rehabilitative Care means care for restoration (by education or training) of one’s ability to function in a normal or near normal manner following an illness or injury. This type of care includes, but is not limited to, vocational or occupational therapy and speech therapy.

Emergency means a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing your life or limb in danger if medical attention is not provided within 24 hours.

Extended Care Facility means an institution, or a distinct part of an institution, which is licensed as a hospital, extended care facility or rehabilitation facility by the state in which it operates; and is regularly engaged in providing 24-hour skilled nursing care under the regular supervision of a physician and the direct supervision of a registered nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation prescribed by a physician; and provides each patient with active treatment of an illnessor injury. Extended care facility does not include a facility primarily for rest, the aged, substance abuse treatment, custodial care, nursing care or for care of mental health disorders or the mentally incompetent.

Home Health Care Agency means a public or private agency or one of its subdivisions, which operates pursuant to law and is regularly engaged in providing home nursing care under the supervision of a registered nurse, and maintains a daily record on each patient, and provides each patient with a planned program of observation and treatment by a physician

Home Nursing Care means services provided by a home health care agency and supervised by a registered nurse, which are directed toward the personal care of a patient, provided always that such care is provided in lieu of medically necessary inpatient care in a hospital.

Hospital means an institution which operates as a hospital pursuant to law, and is licensed by the state or country in which it operates; and operates primarily for the reception, care and treatment of sick or injured persons as inpatients; and provides 24-hour nursing service by registered nurses on duty or call; and has a staff of one or more physicians available at all times; and provides organized facilities and equipment for diagnosis and treatment of acute medical conditions on its premises; and is not primarily a rehabilitation facility, long-term care facility, extended care facility, nursing, rest, custodial care or convalescent home, a place for the aged, drug addicts, alcoholics or runaways; or similar establishment.

Illness means a sickness, disorder, illness, pathology, abnormality, ailment, disease or any other medical, physical or health condition. For purposes of this insurance, illness includes Complications of Pregnancy during the first 26 weeks of pregnancy. Illness does not include learning disabilities, attitudinal disorders or disciplinary problems.

Injury means an unexpected and unforeseen harm to the body caused by an accident that requires medical treatment.

Inpatient means a patient who occupies a hospital bed for more than 24 hours for medical treatment and whose admission was recommended by a physician.

Intensive Care Unit means a cardiac care unit or other unit or area of a hospital that meets the required standards of the Joint Commission on Accreditation of Hospitals for Special Care Units.

Investigational, Experimental or for Research Purposes means procedures, services or supplies that are by nature or composition, or are used or applied, in a way which deviates from generally accepted standards of current medical practice.

Medically Necessary means a service or supply which is necessary and appropriate for the diagnosis or

treatment of an illness or injury based on generally accepted current medical practice as determined by us. A service or supply will not be considered medically necessary if is provided only as a convenience to you or the provider, and/or is not appropriate for your diagnosis or symptoms, and/or exceeds in scope, duration or intensity that level of care which is needed to provide safe, adequate and appropriate diagnosis or treatment of an illness or injury.

Member means an individual who is covered under this insurance.

Mental Health Disorder means a mental or emotional disease or disorder which generally denotes a disease of the brain with predominant behavioral symptoms; or a disease of the mind or personality, evidenced by abnormal behavior; or a disorder of conduct evidenced by socially deviant behavior. Mental health disorders include: psychosis, depression, schizophrenia, bipolar affective disorder, and those psychiatric illnesses listed in the current edition of the diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association.

Observation means the use of a bed and periodic monitoring and/or short term treatment by a hospital’s nursing or other staff. These services are considered reasonable and necessary to evaluate a patient’s condition to determine the need for possible inpatient admission. Observation care provides a method of evaluation and treatment as an alternative to inpatient hospitalization. The services may be considered eligible for coverage only when provided under a physician’s order or under the order of another person who is authorized by state statute and the hospital’s by laws to admit patients and order outpatient testing. The observation services must be patient-specific and not part of a standard operating procedure or facility protocol for a given diagnosis or service.

Outpatient means a member who receives medically necessary treatment by a physician for injury or illness that does not require overnight stay in a hospital.

Physician means a Doctor of Medicine (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DDM), Doctor of Podiatry (DPM), Doctor of Osteopathy (DO), a licensed Physical Therapist or Physiotherapist, and a Doctor of Psychiatry (Psy.D) and a Doctor of Psychology (Ph.D.). Physician also includes a Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Nurse Midwife or a Physician Assistant (PA) under the direction of a medical doctor. A physician must be currently licensed by the jurisdiction in which the services are provided, and the services must be within the scope of that license and covered under this Master Policy.

Relative means biological or step parent; biological or step child; current spouse; biological or stepsiblings; or parent, children, or sibling in law.

Routine Physical Exam means and examination of the physical body by a physician for preventative or informative purposes only, and not for the diagnosis or treatment of any condition.

Sexually Transmitted Diseases means diseases including but not limited to syphilis, gonorrhea, chlamydiosis, trichomoniasis, genital herpes, and Human Papillomavirus (HPV).

Specialist Physician means a doctor of medicine (MD) who has completed the training for and has become certified in a specialty or sub-specialty of the medical arts. Specialist Physician does not include a Doctor of Chiropractic (DC), a Doctor of Psychiatry (PsyD) or Doctor of Psychology (PhD). A physician must be currently licensed by the jurisdiction in which the services are provided, and the services must be within the scope of that license.

Substance Abuse means alcohol, drug or chemical abuse, overuse or dependency.

Surgery or Surgical Procedure means an invasive diagnostic procedure or the treatment of illness or injury by manual or instrumental operations performed by a Physician while the patient is under general or local anesthesia.

Urgent Care Center means a U.S. medical facility separate from a hospital emergency department where ambulatory patients can be treated on a walk-in basis without an appointment and receive immediate, non-routine urgent care for an injury or illness presented on an episodic basis.

Usual, Reasonable and Customary means the lesser of the following:

  1. One and a half times (150%) of the charges payable under the United States Medicare program, for claims incurred outside the PPO network within the U.S., or
  2. Most common charge for similar services, medicines or supplies within the area in which the charge is incurred, so long as those charges are reasonable. What is defined as usual, reasonable and customary charges will be determined by us. In determining whether a charge is usual, reasonable and customary, we may consider one or more of the following factors: the level of skill, extent of training, and experience required to perform the procedure or service; the length of time required to perform the procedure or services as compared to the length of time required to perform other similar services; the severity or nature of the illness or injury being treated; the amount charged for the same or comparable services, medicines or supplies in the locality; the amount charged for the same or comparable services, medicines or supplies in other parts of the country; the cost to the provider of providing the service, medicine or supply; such other factors we, in the reasonable exercise of discretion, determine are appropriate.

You/Your means each insured person named in the certificate.

We/Us/Our means WorldTrips.

Virtual Physician Visit means a live consultation conducted over the internet or phone between you and a physician.

SCHEDULE OF BENEFITS AND LIMITS

All benefits, except Emergency Medical Evacuation, Repatriation of Remains, and Common Carrier Accidental Death and Dismemberment, are subject to deductible and are per injury or illness, up to the overall policy maximum, unless stated otherwise

DEDUCTIBLE

Plan A

Plan B

Plan C

Plan D

Ages 14 days -59 years

$0, $50, or $100

 $0, $50, or $100

 $0, $50, or $100

 $0, $50, or $100

Ages 60- 69 years

$0, $50, or $100

 $0, $50, or $100

 $0, $50, or $100

 

Ages 70 – 79 years

$100 or $200

 $100 or $200

 

 

Ages 80 and above

$100 or $200

 

 

 

 

OVERALL POLICY MAXIMUM

Plan A

Plan B

Plan C

Plan D

Ages 14 days -59 years

$50,000

$75,000

$100,000

$130,000

Ages 60- 69 years

$50,000

$75,000

$100,000

 

Ages 70 – 79 years

$50,000

$75,000

 

 

Ages 80 and above

$10,000

 

 

 

INPATIENT TREATMENT
 Plan APlan BPlan CPlan D
Hospital Room &Board, including miscellaneous unless specified $1,450 per day,
30 days max
$1,725 per day,
30 days max
$2,000 per day,
30 days max
$2,585 per day,
30 days max
Intensive Care Unit, including miscellaneous unless specified $2,200 per day,
8 days max
$2,600 per day,
8 days max
$3,000 per day,
8 days max
$3,800 per day,
8 days max
Surgery $3,600 per session $4,800 per session $6,000 per session $7,800 per session
Consultant physician $450 $475 $500 $650
Private duty nurse $550 $550 $550 $700
Physician visits $60 per visit,
30 visits max
$75 per visit,
30 visits max
$90 per visit,
30 visits max
$115 per visit,
30 visits max
OUTPATIENT TREATMENT
 Plan APlan BPlan CPlan D
Surgery $3,300 per session $4,400 per session $5,500 per session $7,150 per session
Outpatient Surgical Facility $1,100 $1,150 $1,200 $1,500
Pre-admission Testing $1,100 $1,100 $1,100 $1,450
Diagnostic X-ray and Labs $500, plus $400 for one CAT Scan, MRI or PET $550, plus $450 for one CAT Scan, MRI or PET $600, plus $500 for one CAT Scan, MRI or PET $750, plus $650 for one CAT Scan, MRI or PET
Emergency Room (all expenses incurred therein) $375 $485 $600 $785
Observation Room Services (all expenses incurred therein) $355 $465 $575 $750
Outpatient Prescription Drugs $150 $200 $250 $300
Office Visits, including Urgent Care $70 per visit,
10 visits max
$85 per visit,
10 visits max
$100 per visit,
10 visits max
$130 per visit,
10 visits max
MISCELLANEOUS INPATIENT & OUTPATIENT TREATMENT
 Plan APlan BPlan CPlan D
Anesthesiologist $825 $1,110 $1,375 $1,775
Assistant Surgeon $825 $1,110 $1,375 $1,775
Local Ambulance $500 $500 $500 $500
Dental Accident $550 $550 $550 $550
Physical Therapy $40 per visit, 1 visit per day, maximum 12 visits
Mental & Nervous Disorder & Substance Abuse Same as any Illness Same as any Illness Same as any Illness Same as any Illness
Durable Medical Equipment $1,100 $1,200 $1,300 $1,700
Acute Onset of Pre-existing Condition See benefit description $50,000 Lifetime Maximum for Eligible Medical Expenses $75,000 Lifetime Maximum for Eligible Medical Expenses $100,000 Lifetime Maximum for Eligible Medical Expenses $100,000 Lifetime Maximum for Eligible Medical Expenses
  $25,000 Lifetime Maximum for Emergency Medical Evacuation
OTHER BENEFITS
Not subject to deductible or overall policy maximum
 Plan APlan BPlan CPlan D
Emergency Medical Evacuation $50,000 Lifetime Maximum, except as provided under Acute Onset of Pre-existing Condition. Available only to members under age 70.
Repatriation of Remains $25,000
Local Burial & Cremation $5,000
Common Carrier Accidental Death & Dismemberment $25,000 Lifetime Maximum Principal Sum
Death or Loss of Two Limbs – Principal Sum
Loss of One Limb – One-half the Principal Sum
Subject to a maximum of $125,000 any one family or group

General Exclusions

Excluded Conditions, Treatments (includes Diagnoses, Tests, and Examinations), Services, Supplies, Acts, Omissions, and/or Events:

1.  Illness that begins by occurrence of symptoms and/or receipt of treatment within the first two (2) days of coverage beginning with and including the certificate effective date, if coverage was purchased on the same day as the coverage effective date.
2.  Pre-existing Conditions, except charges resulting directly from an acute onset of pre-existing condition, as herein defined, subject to the limits set forth in the Schedule of Benefits and Limits.
3.  Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
4.   Pregnancy, termination of pregnancy, routine prenatal care, childbirth, postnatal care, and charges incurred by a child under the age of 14 days.
5.   Impotency or sexual dysfunction.
6.   All sexually transmitted diseases and conditions.
7.   HIV, AIDS, or ARC, and all diseases caused by and/or related to HIV.
8.   All forms of cancer / neoplasm.
9.   Acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, hypertrophic and atrophic conditions of skin, nevus.
10. Sleep apnea or other sleep disorders.
11. Obesity or weight modification, including but not limited to wiring of the teeth and all forms of intestinal bypass surgery.
12. Intentional self-inflicted injury or illness and/or suicide or attempted suicide whether sane or insane.
13. Injury sustained that is due wholly or partially to the effects of intoxication or drugs other than drugs taken in accordance with treatment prescribed by a physician and except drugs prescribed for the treatment of substance abuse.
14. Injury sustained while operating any motorized vehicle, aircraft or watercraft whether registered or not while under the influence of alcohol as defined under the law of the jurisdiction where the injury occurs or with a .08 Blood Alcohol Content (BAC), whichever is lower.
15. Routine medical examinations, including but not limited to vaccinations, immunizations, annual check- ups, the issue of medical certificates and attestations, and examinations as to the suitability of employment or travel.
16. Dental treatment and treatment of the temporomandibular joint, except for emergency dental
treatment necessary to replace natural teeth lost or damaged in an accident covered hereunder.
17. Promotion or prevention of conception including but not limited to: artificial insemination, treatment for infertility, sterilization or reversal of sterilization.
18. Organ or tissue transplants or related services.
19. Eye surgery, such as corrective refractory surgery, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
20.    Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and any examination or fitting related to these devices, dentures or dental appliances, and all vision and hearing tests and examinations.
21. Orthoptics and visual eye training.
22. Orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails.
23. Hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed.
24. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinesiotherapy.
25. Psychometric, intelligence, competency, behavioral and educational testing.
26. Cosmetic or aesthetic reasons, except for reconstructive surgery when the reconstructive surgery is directly related to and follows a surgery which was covered hereunder.
27. Modifications of the physical body intended to improve the psychological, mental or emotional well- being, including but not limited to sex-change surgery.
28. Exercise programs, whether or not prescribed or recommended by a physician.
29. Incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
30. Cryo preservation and implantation or re-implantation of living cells.
31. Genetic or predictive testing.
32. Investigational, experimental or for research purposes.
33. While confined primarily to receive custodial care, educational or rehabilitative care, or any medical
treatment in any establishment for the care of the aged.
34. Not medically necessary.
35. Not administered by or under the supervision of a physician, and products that can be purchased without a doctor's prescription.
36. Provided by a relative, family member or any person who ordinarily resides with you.
37. Provided by home nursing care.
38. Provided by a chiropractor.
39. Provided at no cost to you.
40. Failure to keep a scheduled appointment.
41. Payable under any government system, including the Australian Medicare system.
42. Payable under Worker’s Compensation or Employer’s Liability Laws, or by any coverage provided or required by law.
43. Charges exceeding usual, reasonable and customary.
44. Charges resulting from or occurring during the commission of a violation of law, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
45. Any illness or injury incurred as a result of epidemics, pandemics, public health emergencies, natural disasters, or other disease outbreak conditions that may affect a person’s health when, prior to your effective date, any of the following were issued:
a.   The United States Centers for Disease Control & Prevention had issued a Warning/Alert Level 3 or higher for a location or destination, including common carriers; or
b.   The United States Centers for Disease Control & Prevention had issued a Global or Worldwide Warning/Alert Level 3 or higher.
This exclusion is applicable when 1) any of the above were in effect within 6o days immediately prior to your effective date or 2) within 10 days following the date the alert/warning is issued you have failed to depart the country or location. This exclusion does not apply to charges resulting from COVID-19/SARS- CoV-2.
46. War, military action or while on duty as a member of a police or military force unit.
47. Travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, and Repatriation of Remains sections of this insurance.
48. Diagnosis, treatment, services, or supplies provided by Home Nursing Care.
49. Incurred within your home country.
50. Incurred outside your certificate period.
51. Submitted to us for payment more than 60 days after the last day of the certificate period.
52. When departure from the home country is to obtain treatment in the destination country/countries.
53. Complications or consequences of a treatment or condition not covered hereunder.
54. Not included as Eligible Expenses as described herein.

This coverage is only available for member under seventy (70) years of age.

  Plan A Plan B Plan C Plan D
Acute Onset of Pre-existing Condition(only available to members under age 70)
$50,000 Lifetime Maximum for Eligible Medical Expenses $75,000 Lifetime Maximum for Eligible Medical Expenses $100,000 Lifetime Maximum for Eligible Medical Expenses $100,000 Lifetime Maximum for Eligible Medical Expenses
Emergency Medical Evacuation for acute onset of Pre-existing condition $25,000 Lifetime Maximum for Emergency Medical Evacuation $25,000 Lifetime Maximum for Emergency Medical Evacuation $25,000 Lifetime Maximum for Emergency Medical Evacuation $25,000 Lifetime Maximum for Emergency Medical Evacuation

Acute Onset of Pre-Existing Condition

Subject to all other terms, conditions and limitations of this Master Policy, in the event you experience an acute onset of a pre-existing condition during the certificate period for which immediate treatment is essential and necessary to stabilize the pre-existing condition, this Master Policy will cover eligible medical expenses incurred during the certificate period with respect to an acute onset of the pre-existing condition provided that at the time of the acute onset of a pre-existing condition. The benefit will apply only if all of the following conditions are met:

(a) The Acute onset of a Pre-Existing Condition does not directly or indirectly relate to a chronic condition or congenital condition;

(b) Treatment must be obtained within twenty-four (24) hours of the sudden and unexpected outbreak or reoccurrence;

(c) You must be under seventy (70) years of age;

(d) You must not be traveling against or in disregard of the recommendations, established treatment programs, or medical advice of a physician or other healthcare provider;

(e) You must not be traveling with the intent or purpose to seek or obtain treatment for the pre- existing condition;

(f) You must be traveling outside your Home Country

Such coverage shall be subject to all other policy terms, conditions and exclusions, including the General Exclusions and the limits set forth in Schedule of Benefits and Limits.

Acute Onset of Pre-existing Condition means a sudden and unexpected outbreak or recurrence that is of short duration, is rapidly progressive, and requires urgent care. A pre-existing condition that is a chronic or congenital, or that gradually becomes worse over time is not acute onset of a pre-existing condition. An Acute Onset of Pre-existing Condition does not include any condition for which, as of the Effective date, the Insured Person (i) knew or reasonably foresaw he/she would receive, (ii) knew he/she should receive, (iii) had scheduled, or (iv) was told that he/she must or should receive, any medical care, drugs or treatment.

The coverage is the maximum certificate period is 364 days. Any extension of coverage is based upon the eligibility rules in force and is solely at our discretion.

Cancellation
We hope you are happy with the cover this policy provides. However, if after reading it, this insurance does not meet with your requirements, please notify us of your wish to cancel and we will refund your premium.
Premiums will be refunded in full if a cancellation request is received prior to the certificate effective date. Premiums may be refunded after the certificate effective date subject to the following provisions:

  1. A $25 cancellation fee will apply for administrative costs incurred by us; and
  2. Only the prorated portion of the premium will be refunded; and
  3. You cannot have filed any claims to be eligible for a premium refund.

Claims
This insurance policy has in it a Claims Procedure which tells you what steps you must take to file a claim, and explains our obligations to you. Beginning on the last day of your certificate period, you shall have 60 days to provide us proof of claim.


Appeals and Complaints
This insurance policy has in it an Appeals and Complaints Procedure which tells you what steps you can take if
you wish to make an appeal or complaint.

Claim Procedures
Claims Notification
All claims and related claim information, including a proof of claim, should be submitted to the Company at the contact information below, or online at http://service.worldtrips.com/ as soon as possible.

Online: http://service.worldtrips.com/
Postal Mail: WorldTrips
P O Box 240358,
Apple Valley,
MN 55124, USA

Proof of Claim
You must send proof of claim for any expenses that you are requesting to be paid by us. This includes treatment or services for which the medical provider bills us directly. No payments will be made by us without you first submitting a proof of claim.
We must receive proof of claim within 60 days of the last day of your certificate period (or for claims incurred during a benefit period, 60 days from the date the claim is incurred).
A proof of claim must include all of the following:
1.    A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments;
2.    Itemized bills from physicians, hospitals and other medical providers; and
3.    Receipts for any expenses which have already been paid by you or on your behalf.
Subsequent to receipt of proof of claim, we may, at our sole discretion, request and require additional information, including but not limited to medical records necessary to confirm whether coverage exists for any claim prior to payment thereof.

Claims Cooperation
You shall provide assistance and cooperate with us or our representatives in obtaining any other records we or they feel necessary to evaluate your claim or any incident giving rise to your claim. You shall provide, when asked, all authorizations necessary to obtain your medical records. If you do not fully cooperate with us and/or our investigation of the claim, we shall not be liable to pay any claim.

Access to Additional Materials
You shall provide us, or our designated representatives, all information, documentation and medical information that we or they may reasonably require during the term of this policy, or until all claims have been resolved, whichever is later.


Other Insurance
We shall not pay any claim if there is other insurance which would, or would but for the existence of this insurance, pay such claim. This insurance will apply with respect to expenses in excess of the amount paid or payable under such other insurance. We shall not pay any claim in respect to care, treatment, services or supplies furnished by any insurance, program or agency funded by any government.

Appeal and Complaints Procedure
Appealing a Claim
In the event we deny all or part of a claim under this insurance, you may file a written appeal with us. The written appeal must include sufficient information to identify the claim under appeal and must specify the reason(s) for the appeal with supporting documentation, if applicable.

Please submit your written appeal online, by email, or by postal mail at the following:

Online:    http://service.worldtrips.com/

Email:    appeals@worldtrips.com

Postal Mail: WorldTrips Appeals
P O Box 240358,
Apple Valley,
MN 55124, USA

When we receive the appeal, we will review the claim and a written response will be sent to you. After you receive our response to the appeal, you may initiate a second appeal. With our receipt of the second appeal, medical and/or claims personnel who were not involved in the original claim determination or the initial appeal will review the claim. A final determination will be made and a letter will be sent to you.

Please note that appealing a claim is not a requirement to following the complaints procedure detailed below.

Complaints Procedure
We are dedicated to providing a high-quality service and want to ensure that it is maintained at all times. If you feel that we or another party connected with this policy have not offered a first class service please contact us and we will do our best to resolve the problem.

Please send your written complaint online, by email, or by postal mail at the following:

Online: http://service.worldtrips.com/

Email: appeals@worldtrips.com

Postal Mail: WorldTrips Appeals
P O Box 240358,
Apple Valley,
MN 55124, USA
 
We will acknowledge receipt of your complaint promptly after receiving it.
If you are a UK citizen and you have not been given an answer within 8 (eight) weeks or should you remain dissatisfied, you may refer your complaint to Lloyd’s, who will investigate and assess your complaint. Lloyd’s contact details are as follows:

Complaints Lloyd’s
One Lime Street London EC3M 7HA
Email:    complaints@lloyds.com
Telephone:    +44 (0)20 7327 5693
Fax:    +44 (0)20 7327 5225
Web:    www.lloyds.com/complaints

This complaints procedure does not affect any legal right you have to take action. Once you have received your final response from Lloyd’s, and if you are still not satisfied you can contact the Financial Ombudsman Service:


Financial Ombudsman Service
Exchange Tower, Harbour Exchange Square, London, E14 9SR Phone: +44 (0) 20 7964 0500
Email: complaint.info@financial-ombudsman.org.uk


If you have purchased your policy online or by other electronic means within the European Union (EU) you may also make your complaint via the EU’s online dispute resolution (ODR) platform. The website for the ODR platform is: http://ec.europa.eu/odr

No coverage available for these countries when selected on application as home country, citizenship country or destination country.

  • Cuba
  • Iran
  • North Korea
  • Sudan