GlobeHopper Platinum Travel Medical Cover
If an Insured Person is not eligible, this Plan is void ab initio and all premium paid will be refunded. This Plan is available to eligible persons of any nationality worldwide. In order to be eligible and qualified for coverage under this Plan, a person must:
- complete and sign an Application as the Insured Person (or be listed thereon by proxy as an applicant and proposed Insured Person), and/or as the Insured Person’s spouse and/or Dependent Child;
- be at least 15 days or more at the Effective Dateand not be a citizen of the Host Country;
- have an Effective Date which is on or after the date they legally departed their Home Country and legally entered the Host Country; and (i) for Insured Persons under 65 years of age visiting the United States of America (USA), Your initial Period of Insurance must begin within six months of arrival in the USA; ii) for Insured Persons aged 65 years and older visiting the USA, initial Period of Insurancemust begin within 30 days of arrival in the USA or must have proof of valid international travel insurance coverage expiring no more than 30 days prior to initial Effective Date of Coverage. Prior USA domestic health care coverage does not meet this eligibility requirement;
- pay the required Premium on or before the Effective Date of coverage;
- USA Citizens, in addition to the above; i) must depart the USA on, or be located outside of the USA, as of the Effective Date(or date of extension, or Renewal Date);
Usual, reasonable and customary charges. Subject to Excess and Co-Insurance when applicable
|Hospital Room & Board||Up to Maximum Limit|
|Intensive Care||Up to Maximum Limit|
|Medical Expenses||Up to Maximum Limit|
|Out-Patient Medical Expenses||Up to Maximum Limit|
|Emergency Local Ambulance||Injury: Up to Maximum Limit Illness resulting in In-patient Admission: Up to Maximum Limit|
|Prescription Drugs||Up to Maximum Limit|
|Emergency Room Accident||Up to Maximum Limit|
|Emergency Room Illness with In-Patient Admission||Up to Maximum Limit|
|Emergency Room Illness without In-Patient Admission||Up to Maximum Limit with an additional $250 / £150 / €200 Excess|
|Dental – Injury due to Accident||Up to Maximum Limit|
|Sudden Dental Pain||Up to $250 / £150 / €200|
|State Hospital Cash Benefit||$100 / £60 / €75 Per night up to a maximum of 14 nights|
|Reciprocal Health Agreement Benefit||Nil Excess When a claims saving is made due to a European Health Insurance Card (EHIC) or Reciprocal Health Agreement|
|Hospital Income Benefit||Up to $250 / £150 / €200 Per night up to a maximum of 10 nights|
|Sudden and Unexpected Recurrence of a Pre-Existing Conditions||Under Age 65 Lifetime Limit Up to $20,000 /£12,500 / €15,000 Medical Coverage $20,000/ £12,500/ €15,000 Emergency Medical Evacuation|
International Emergency Care & Assistance
When co-ordinated through the Plan Administrator
|24 Hour Emergency Medical Help Line||Included|
|Medical Information Service||Included|
|Global Concierge & Assistance Services||Included|
|Emergency Medical Evacuation||Up to Maximum Limit|
|Emergency Reunion||Up to $100,000 / £60,000 / €75,000|
|Cremation/Burial, or Repatriation of Remains||Up to $100,000 / £60,000 / €75,000|
|Return of Minor Children||Up to $100,000 / £60,000 / €75,000|
|Identity Theft Assistance||Up to $500 / £300 / €400 Per Period of Insurance|
|Security and Political Evacuation||Up to $100,000 / £60,000 / €75,000|
|Natural Disaster Evacuation & Accommodation||$250/ £150/ €200 Per day for up to five days|
|Lost or Stolen Checked-In/Stored Baggage/Travel Documents||Up to $500/ £300/ €400
Unreceipted Item(s) Total Limit $100/£60/€75
Single Item, Pair or Set Limit $100/£60/€75
Valuables Limit in total $100/£60/€75
Alcohol and Tobacco Limit $25/£15/€20
|Trip Interruption||Up to $10,000 / £6,000 / €7,500|
|Terrorism Coverage||Up to Maximum Limit|
|Common Carrier Accidental Death||Up to $100,000/ £60,000/ €75,000 per adult
$25,000/ £16,000/ €20,000 per child
Maximum Per Family $250,000/ £160,000/ €200,000
|Accidental Death and Dismemberment (AD&D)||Up to $50,000 / £30,000 / €40,000 principle sum|
|Citizenship Return Coverage||You are covered for trips to Your Country of Citizenship provided it is within Your Area of Cover. For USA Citizens: Cover is provided for up to 60 days per 12 month Period of Insurance for brief returns to the USA.|
|Incidental Home Trip Coverage||Up to a cumulative of two weeks during the Period of Insurance|
|Remote Transportation||$5,000 / £3,000 / €4,000 per Period of Insurance $20,000 /£12,500 / €15,000 Lifetime Maximum|
|Criminal Assault Benefit When admitted to Hospital for 48 hours or more.||$1,000 / £600 / €750 per admitted night Up to $10,000 / £6,000 / €7,500|
|Small Pet Common Air Carrier Accidental Death||Up to $500/ £300/ €400|
We will not pay any charges, fees, costs, expenses and/or claims (collectively called “charges”) Youincur which directly or indirectly relate to, or arise from, or are in connection with any of the following acts, omissions, events, conditions, charges, consequences, claims, Treatments (including diagnosis, consultations, tests, examinations, and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this Plan, and We shall provide no benefits or reimbursements and shall have no liability or obligation for any coverage thereof or herefor:
War; Military Action
Subject to the Terms of Section C3 above and Section D item 2 below, We shall not be liable for and will provide coverage or benefits for any claim or charges incurred with respect to any Illness, Injury or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising or incurred in connection with or as a result of any of the following acts or events (collectively, “Occurrences”):
- War or any act of war (whether declared or not), invasion, act of foreign enemy hostilities, warlike operations, civil war;
- Mutiny, riot, strike, military or popular uprising, insurrection, rebellion, revolution, military or usurped power;
- Attempted overthrow of government, any act of any person acting on behalf of or in connection with any organisation with activities directed towards the overthrow by force of the government de jure or de facto or to the influencing of it by violence of any type;
- Martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege; or
- Any use of any radiological, chemical, nuclear or biological weapons or any other radiological, chemical, nuclear or biological events of any type (including in connection with an act of Terrorism).
Any claim, charges, Illness, Injury or other consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether or not directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Occurrences shall be deemed and considered to be consequences for which We shall not be liable under this Plan, except to the extent that You shall prove that such claim, charges, Illness, Injury or other consequence happened independently of the existence of such abnormal conditions and/or Occurrences
We shall not be liable for and will not provide any coverage or benefits for any claim, charges, Illness, Injury or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising in connection with the following:
- the Insured Person’s active and voluntary planning or coordination of or participation in any act of Terrorism; and/or
- any act of Terrorism that takes place in a location, post, area, territory or country for which the United States Department of State, Bureau of Consular Affairs and/or the Government of Your Country of Citizenship, issued a Travel Warning that was in effect on or within six (6) months prior to the Insured Person’s date of arrival in said location, post, area, territory or country; and/or
- any act of Terrorism that takes place in a location, post, area, territory or country for which the United States Department of State, Bureau of Consular Affairs and/or the Government of Your Country of Citizenship, issues a Travel Warning that becomes effective or is in effect on or after the Insured Person’s date of arrival in said location, post, area, territory or country, and the Insured Person unreasonably fails or refuses to heed such warning and thereafter remains in said location, post, area, territory or country.
Any Pre-Existing Condition other than as specifically provided herein under the Terms of SectionA15: Sudden and Unexpected Recurrence of a Pre-Existing Condition.
Any charges incurred by You for Treatment or supplies within Your Home Country, or whilst outside the Area of Cover are excluded, other than as expressly provided for under Section C6 Citizenship Return Coverage, or Section C7 Incidental Home Trip Coverage and/or Section E17 (c). End of Trip Home Country Coverage.
Maternity, Pregnancy and Newborn care, including charges for pre-natal care, delivery, post-natal care, and care of Newborns, including complications of Pregnancy, miscarriage, complications of delivery and/or complications of Newborns.
Treatment of Mental or Nervous Disorders.
Charges for any Treatment, service or supply that is:
- not incurred, obtained or received by an Insured Person during the Period of Insurance;
- not presented to Us for payment by way of a complete Proof of Claim within ninety (90) days of the date such Charges are incurred;
- not administered or ordered by a Medical Practitioner;
- not Medically Necessary;
- provided at no cost to the Insured Person or for which the Insured Person is not otherwise liable;
- in excess of Reasonable and Customary Charges;
- incurred by an Insured Person who was HIV + on or before the Effective Date of this Plan relating to or arising or resulting directly or indirectly from HIV, AIDS virus, AIDS related Illness, ARC Syndrome, AIDS and/or any other Illness arising or resulting from any complications or consequences of any of the foregoing conditions; whether or not the Insured Person had knowledge of their HIV status prior to the Effective Date, and whether or not the Charges are incurred in relation to or as a result of said status;
- provided by or at the direction or recommendation of a Chiropractor, unless ordered in advance by a Medical Practitioner;
- performed or provided by a Relative of the Insured Person;
- not expressly included as Eligible Charges within a Section of Cover of this Plan, above;
- provided by a person who resides or has resided with the Insured Person or in the Insured Person's home;
- Required or recommended as a result of complications or consequences arising from or related to any Treatment, Injury, Illness or supply which is excluded from cover or which is otherwise not insured under Your Plan;
- Any In-Patient Treatment which could have been provided on a Day-Patient basis or as an Out-Patient.
for Congenital Disorders and conditions arising out of or resulting there from.
Charges for Telephone consultations except Telemedicine consultations through an established Telemedicine protocol system will be considered individually based on medical necessity and appropriateness as determined by Us under the Plan; completion of Treatment; completion of claim forms; or Your failure to keep a scheduled appointment.
Charges incurred for Surgeries or Treatment or supplies which are:
- Investigational, Experimental, or for research purposes, and/or
- related to genetic medicine, genetic testing, surveillance testing and/or wellness screening procedures for genetically predisposed conditions indicated by genetic medicine or genetic testing, including, but not limited to amniocentesis, genetic screening, risk assessment, preventive and prophylactic surgeries recommended by genetic testing, and/or any procedures used to determine pre-disposition, provide genetic counseling, or administration of gene therapy.
Rest cures, institutionalisation, isolation, quarantine, or sanatorium care.
Confinement primarily to receive Custodial Care, Educational or Rehabilitative Care.
Education or training aimed at restoring Your ability to function in a normal or near normal manner following a Medical Condition; including, but not limited to, vocational therapy, occupational therapy, and speech therapy.
Treatment or supply received in a health hydro, nature cure clinic, spa, health farm or similar establishment, or private bed registered as a nursing home attached to such establishment or a Hospital where the Hospital has effectively become Your home or permanent abode or where admission is arranged wholly or partly for domestic reasons.
Charges incurred for any Surgery, Treatment or supplies relating to, arising from or in connection with, for, or as a result of:
- weight loss or weight modification, obesity (including without limitation morbid obesity), including without limitation wiring of the teeth and all forms or procedures of bariatric Surgery by whatever name called, or reversal thereof, including without limitation intestinal bypass, gastric bypass, gastric banding, vertical banded gastroplasty, biliopancreatic diversion, duodenal switch, or stomach reduction or stapling; or the reversal by Surgery of any such Treatment; or removal of fat or other surplus tissue from any part of the body, whether or not for medical or psychological purposes, and any associated consequent Treatment;
- Any medical prescription relating to a special diet, weight control, children's food, baby supplies or vitamin/mineral supplements (unless expressly covered herein); or any alternative medicine (such as chiropodists, optometrists and podiatrists, non- prescription medicines, vitamins, food extracts, or nutritional supplements); vitamin or herbal therapy; Drugs not approved by the U.S. Food and Drug Administration, European Medicines Agency, or which are considered "off label" use; non-Drugs or medicines, or Drugs or medicines not prescribed by a Medical Practitioner;
- modification of the physical body in order to change or improve or attempt to change or improve the physical appearance or psychological, mental or emotional well-being of the Insured Person (such as but not limited to sex-change Surgery or Surgeryrelating to sexual performance or enhancement thereof);
- Treatment to correct or deal with a problem that arises out of any Treatment You receive if the charges incurred by You for that Treatment were not covered under the Terms of Your Plan;
- elective Surgery or Treatment of any kind;
- cosmetic or aesthetic reasons, whether or not for psychological purposes, except for reconstructive Surgery when such Surgery is Medically Necessary and is directly related to and follows a Surgery which was covered under this Plan; or ear or body piercing;
- any Illness or Injury sustained while taking part in: Amateur Athletics, Professional Athletics, athletic activity that is sponsored or sanctioned by any collegiate sanctioning or governing body, or the International Olympic Committee, and adventure sports and activities, including, without limitation the following (including any combination or derivative of the following): abseiling; mountaineering activities where specialised climbing equipment, ropes or guides are normally or reasonably should have been used; athletic or sporting activities (except for activities that are non-contact, non-professional, and engaged in by You solely for recreational, entertainment or fitness purposes); aviation (except when travelling solely as a passenger in a commercial aircraft); motocross (MOTO-X); BMX; BASE jumping; bobsledding; bungee jumping; canyoning; caving; hang gliding; heli-skiing; high diving; hot air ballooning; inline skating; jet skiing; jungle zip lining; kiteboarding; kayaking; luge; mountain biking; parachuting; paragliding; parascending; rappelling; racing of any kind including without limitation by horse, motor or other vehicle (of any type) or motorcycle; rock climbing; any rodeo activity; ski jumping; sky diving; snow skiing except for recreational downhill and/or cross country snow skiing (provided that there is no coverage for any Illness or Injury sustained while skiing in violation of applicable laws, rules or regulations, away from prepared and marked in-bound territories, and/or against the advice of the local ski school or local authoritative body); snowboarding; snowmobiling; spelunking; surfing; trekking; whitewater rafting; windsurfing; wildlife safaris; and subaqua pursuits involving underwater breathing apparatus below a depth of 10 meters. Practice or training in preparation for any excluded activity which results in Illness or Injury will be considered as activity while taking part in such activity; and/or
- any Medical Condition sustained while participating in any sporting, recreational or adventure activity where such activity is undertaken against the advice or direction of any local authority or any qualified instructor or contrary to the rules, recommendations and procedures of a recognised governing body for the sport or activity;
- any Medical Condition sustained while participating in any activity where such activity is undertaken in disregard of or against the recommendations, Treatment programs, or medical advice of a Medical Practitioner or other healthcare provider;
- Treatment of Alcohol and Substance Abuse;
- any Medical Condition sustained as a result of being under the influence of or due wholly or partly to the effects of alcohol, liquor, intoxicating substances, narcotics or Drugs, other than Drugs taken in strict accordance with Treatment prescribed and directed by a Medical Practitioner, but not for the Treatment of Substance Abuse;
- any Medical Condition sustained while operating a moving vehicle after consumption of intoxicating liquor or Drugs other than Drugs taken in strict accordance with Treatment prescribed and directed by a Medical Practitioner. For purposes of this exclusion, “vehicle” shall include both motorised devices regardless of whether or not a driver or operator license is required (including watercraft and aircraft) and non- motorized bicycles and scooters for which no permit or license is required;
- Suicide or attempted suicide, or any wilfully Self-inflictedInjury or Illness, or wilful exposure to danger (other than in an attempt to save human life);
- any venereal disease or any other sexually transmitted disease;
- any testing for the following: HIV, seropositivity to the AIDS virus, AIDS related Illnesses, ARC Syndrome, AIDS;
- any Medical Condition resulting from or occurring during the commission of a violation of law by the Insured Person, including, without limitation, the engaging in an illegal or malicious occupation or act, but excluding minor traffic violations;
- Professional services performed by a psychotherapist, psychologist, family therapist or bereavement counsellor for the Treatment for learning difficulties, hyperactivity, attention deficit disorder, developmental or behavioural problems in children; or speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy;
- orthoptics, visual therapy or visual eye training;
- any Illness or Treatment of the feet, including without limitation: orthopaedic shoes; orthopaedic prescription devices to be attached to or placed in shoes; Treatment of weak, strained, flat, unstable or unbalanced feet; metatarsalgia, bone spurs, hammer toes or bunions; and any Treatment or supplies for corns, calluses or toenails; provided, however, that claims for Treatment or supplies for the feet may be eligible for coverage under this insurance at Our sole option and subject to all other Terms of this Plan when related to:
- an Injury to the foot arising from an Accident covered hereunder;
- an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment;
- hair loss, including without limitation wigs, hair Treatments, hair transplants or any Drug that promises to promote hair growth, whether or not prescribed by a Medical Practitioner;
- Any sleep disorder, including sleep apnoea (temporarily stopping breathing during sleeping), snoring, fatigue, jet lag or work related stress;
- any exercise program, whether or not prescribed or recommended by a Medical Practitioner;
- Exposure to any non-medical nuclear or atomic radiation, and/or radioactive material(s), chemical contamination or contamination by radioactivity from any nuclear material whatsoever or from the combustion of nuclear fuel, asbestosis or any related condition;
- any organ or tissue or other transplant or related services, Treatment or supplies;
- any artificial or mechanical devices designed to replace human organs temporarily or permanently;
- any efforts to keep a donor alive for a transplant procedure;
Charges incurred for any Treatment or supply that either promotes or prevents or attempts to promote or prevent conception or birth; including but not limited to: birth control, sterilisation (or its reversal), vasectomy (or its reversal), contraception, infertility, fertility, surrogacy or abortion, oral contraceptives, artificial insemination, Treatment for infertility or any form of assisted conception or assisted reproduction or any complication thereof including but not limited to premature or multiple births following assisted conception.
Charges incurred for any Treatment or supply that either promotes, enhances, prevents or corrects or attempts to promote, enhance, prevent or correct impotency, sexual performance or sexual dysfunction or any consequence thereof.
Charges incurred for Dental Treatment (except as provided for under Sections A10 Dental – Injury due to Accident and A11 Sudden Dental Pain); Orthodontic Treatment, gingivitis, gum disease of any kind, or periodontitis; damage to dentures whilst not being worn; dental veneers (unless as a result of damage to existing veneers as a result of an Accident); tooth whitening of any kind; missed dental appointments; Charges for services and supplies (to include crowns, dentures and bridges) to replace extracted or missing teeth prior to coverage.
Treatment, supplies, examination or fitting related to vision correcting spectacles, eyeglasses or contact lenses; eye refraction for any reason; non-medical or natural degenerative eye defects, including but not limited to myopia, presbyopia and astigmatism; or any corrective Surgery for non-medical or natural degenerative sight defects and eye Surgery, such as but not limited to radial keratotomy, when the primary purpose is to correct or attempt to correct nearsightedness, farsightedness, or astigmatism. However, We will pay Eligible Charges for corrective sight Surgery consequent of an Injury.
Treatment, supplies, examination or fitting related to hearing aids; providing, maintaining or fitting any hearing implants or hearing transplants; or any corrective Surgery for non-medical or natural degenerative hearing defects.
Charges incurred for Treatment of the temporomandibular joint, unless required as a result of an Accident.
Charges incurred for any immunisations and/or Routine Physical Exams.
Charges incurred for Illness or Injury where the trip to the Host Country is undertaken for the purpose of securing medical treatment or advice for such Illness or Injury.
Charges incurred for any travel, meals, transportation and/or accommodations, except as otherwise expressly provided for in this Plan.
Any taxes, involuntary or forced contributions, assessments, charges, fees or surcharges imposed by any governmental agency or authority;
- arising out of or as a result of any Treatment or supplies received by the Insured Person;
- based upon Our election hereunder, if any, to pay benefits directly to providers as an accommodation to the Insured Person;
- for any other reason.
Serving in the military, navy or air force in time of declared war, or while under orders for war-like operations, or restorations of public orders, or any Medical Conditions sustained whilst on military, naval or air force training exercise.
Travelling against the advice of a Medical Practitioner.
Treatment or supplies obtained or received after the expiry date of Your Plan or after termination of Your Plan for whatever reason including non-renewal and non-payment of Premium.
Any second or subsequent medical opinion from a Medical Practitioner or Specialist which is not required by Us.
Any Treatment or Surgery which We think You do not need immediately and can wait until You return home at the end of Your Trip. Our decision is final.
Anycharges that are as a result of a tropical disease, if You have not had the recommended vaccinations or taken the recommended medication.
Any claim if You refuse disclosure of the data to a third party, which in turn prevents Us from providing cover under this Plan.
Loss or theft of cash, money, travellers cheques or other financial documents.
Any infection of the urinary tract (including, without limitation, infection of the kidney, ureter, bladder, prostate or urethra) and any complication, medical condition or other Illness directly or indirectly arising therefrom, that occurs within ninety (90) days of the Effective Date of this Plan and that requires Treatment of the Insured Person in a Hospital; provided that any such Illness, infection, complication or condition shall be deemed by Us to be a Pre- existing Condition and eligible for coverage as otherwise provided herein.
Acute Pre-Ex Coverage
Acute Onset of Pre-existing Condition: Pay up to $20,000 / £12,500 / €15,000 lifetime for medical expenses and emergency medical evacuation. For those up to age 65, GlobeHopper Platinum will pay the Usual, Reasonable and Customary charges of a Sudden and Unexpected Recurrence of a Pre-existing Condition (defined on page 21) when the insured persons are travelling outside their home country. The Pre-existing Condition must have stabilised for at least 30 days prior to the effective date.
Acute Onset of Pre-existing Condition means a sudden and unexpected outbreak or recurrence of a pre-existing condition(s) which occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent care.
You are free to choose the provider and location for Your Treatment within Your Area of Cover. It is not a requirement of Your Plan that You seek Treatment or supplies exclusively from a provider within Our Plan Administrator’s network of providers. However, Your use or non-use of Our Plan Administrator’s network of providers may affect the scope and extent of benefits available under Your Plan, including the applicable Co-Insurance, as set forth below:
(i) Special benefit When Using the United States PPO Network
If Treatment or supplies eligible for coverage under this Plan are received directly from Ourapproved list of independent PPO providers while You are in the USA:
- We will pay eligible expenses at 100% Co-Insurance (up to the maximum as indicated in the Schedule of Cover and Plan Highlights) to such claim for Outpatient and any In-Patient Treatment.
However,all Eligible Charges received in the USA from a provider that is not within Our Plan Administrators United States PPO will remain subject to the 90% Co-Insurance as stated in the Schedule of Cover and Plan Highlights
(ii) Utilisation of the Provider Network
You may contact Our Plan Administrator and request a directory of providers within the USA PPO Network, or within the network for the area where You will be receiving Treatment (therein listing the Medical Practitioners, Hospitals and other healthcare providers within the provider network by location and speciality), or You may obtain such information by accessing the website www.imglobal.com
We, through the Plan Administrator, endeavor to maintain a contractual arrangement with independent Preferred Provider Organisations (PPOs) that have established and maintained networks of U.S. and Non-US based Medical Practitioners, Hospitals and other healthcare and health service providers who are contracted separately and directly with the PPO and who may provide re-pricings, discounts or reduced charges for Treatment or supplies provided to You. Neither Us nor the Plan Administrator, or Plan Manager have any authority or control over the operations or business of the PPO, or over the operations or business of any provider within the independent PPO network. Neither the PPO nor any provider within the PPO network nor any of their respective agents, employees or representatives has or shall have any power or authority whatsoever to act for or on behalf of Us, the Plan Administrator or the Plan Manager in any respect, including without limitation no power or authority to:
- approve applications or enrollments for initial, renewal or reinstated coverage under this insurance plan or to accept Premium payments,
- accept risks for or on behalf of Us,
- act for, speak for, or bind Us or the Plan Administrator in any way,
- waive, alter or amend any of the Terms of this Plan or waive, release, compromise or settle any of Our rights, remedies, or interests thereunder or hereunder, or
- determine Pre-Certification, eligibility for coverage, verification of benefits, or make any coverage, benefit or claim adjudications or decisions of any kind.
If your initial Period of Insurance is one month or more, thenyou can request YourPlan be renewed for extended Periods of Insurance from 5 days to 12 months up to a maximum total of thirty-six (36) continuous months and will be renewed subject to the Terms in force at each Renewal Date. Any one Period of Insurance may not exceed twelve (12) months. If any Period of Insurance under this Planhas lapsed or terminated for any reason, coverage under this Plan cannot be renewed, but may be separately written under a new Plan (only after all applicable eligibility guidelines are met). A new Application with Premium must be received by Us in order to effect newly written coverage, and upon acceptance, a new Plan and Policy Wording will be issued and a new initial Period of Insurance will be established. New Excesses, Schedule of Cover including benefit limits and sub-limits, Terms and conditions of coverage, eligibility requirements, and Pre-Existing Condition exclusions will apply to any separately written and non-continuous Periods of Insurance.
- At the time of any request for renewal, the Insured Person must satisfy all of the then current eligibility requirements for this Plan, as established by Us at Our sole discretion (see e.g., Section E General Conditions 7 - Eligibility); and
- The maximum period of continuous coverage under this Plan, including the initial Period of Insurance and any renewed and extended Period(s) of Insurance, may not exceed a total of thirty-six (36) continuous months; and
- After the first twelve (12) months of continuous coverage under this Plan, a new Excess and Co- Insurance requirement will apply for each period of twelve (12) months of continuous coverage thereafter, under this Plan,
- Upon Our acceptance of a renewal Application, a new Certificate of Insuranceand the then current form of Policy Wording for this Plan will be issued to the Insured Person by Us and will supersede and replace all previously issued Policy Wordings
We will write to You and/or Your Intermediary through whom You applied for cover,with Our renewal Terms and provide You with a renewal Premium notice prior to each Renewal Date. Our commitment and the Insured Person’s ability to renew is also subject to termination upon thirty (30) days written notice to the other party prior to the expiration date of the then existing Period of Insurance.
The renewal Premium must be received by Us prior to the Renewal Date, and no cover is in effect until We have received Your Premium and such time as We have confirmed Your renewal has been accepted in writing by Us.
If You cancel or fail to renew Your Plan upon renewal, You cannot make a claim under it and neither You nor Us shall have any further rights, liabilities or obligations under Your Plan.
We reserve the right, at our sole discretion to alter, amend or discontinue the benefits, and/or other make other changes to the Terms of Your Plan, renewals or replacement of either (including issuing Endorsements to effect such change) at any time or from time to time after the Effective Date of this Plan, upon no less than ninety (90) days prior written notice to You (Notice of Endorsement). The Notice of Endorsement shall include a complete description of the changes, additional and/or deletions to be made, the effective date thereof (the Change Date), and the notice of Your cancellation rights as set forth below, and shall be sent to your last known mailing address. Failure to receive notice for whatever reason shall not invalidate the change.
Upon issuance of the Notice of Endorsement You shall have the right to request cancellation of Your Plan at any time prior to the Change Date; provided, however that cancellation under this Section E19 shall be at Your option and coverage under this Plan shall terminate with effect from the cancellation date specified by You (subject to the provisions of Section E17 (a-f)). If You do not elect to cancel this Plan, the changes, additions and/or deletions We made and specified in the Notice of Amendment shall take effect as of the Change Date and this Plan shall thereafter continue in effect as amended and modified.
How to Make a Claim
Please follow the guidelines below to help Us process Your claims promptly and efficiently.
- All claims should be submitted to Us with a fully completed claim form, original invoices, receipts and all other supporting documentation within 90 days of Your initial Treatment. We may deny cover for any claim submitted thereafter.
- Before You make a claim, it is important for You to review the Terms of this Policy Wording with respect to covers for the Treatment You are seeking and Pre-Certification requirements. You must follow any and all Pre-Certification procedures.
- We supply a personalised membership card to You, which contains essential contact numbers and addresses. We therefore suggest You keep this card with You at all times and that You also take a printed copy of this Policy Wording with You on Your trip.
In the event of Emergency admissions, You should contact the Pre-Certification helpline as soon as possible after admission, giving full details of the Medical Condition and Treatment (including dates and name of procedure if known) together with the name of the Specialist and Hospital details. (The telephone number is provided on the back of Your membership card and below). Please do not delay obtaining Emergency Treatment.
Planned In-Patient & Day-Patient Treatment
In the event of a planned admission on an In-Patient or Day-Patient basis to a Hospital, You should contact Our Pre-Certification helpline as soon as possible prior to Your admission, giving full details of the Medical Condition, proposed Treatment (including dates and name of procedure if known) together with the name of the Specialist and Hospital details. (The telephone number is provided on the back of Your membership card and below).
Where possible We will make arrangements with the Hospital or Treatment provider for all Eligible Charges to be settled directly (Direct Settlement). Where this has been arranged, You should send the original claim form and the unpaid invoices (if given to You by the Hospital) to Us. You are responsible for paying any Excess and Co-Insurance to the Treatment provider. If Direct Settlementhas not been arranged, You should pay all of the charges and submit the originals to Us, together with the claim form
You should pay for any Treatment You receive as an Out-Patient and then submit Your charges, as per the cover and instructions in this Policy Wording.
- Whenever You visit a Medical Practitioner or Specialist on an Out-Patient basis, please make sure You take Our claim form with You.
- Fill in the section that is assigned to You, then date and sign the claim form. Make sure that Your Medical Practitioner or Specialist provides all relevant medical information in the specified section and then dates, signs and stamps the claim form
- Attach all original supporting documentation, invoices and receipts to the claim form (e.g. Medical Practitioner invoices, pharmacy receipts with related prescriptions), and post to Us at the address below.
ALL CLAIM FORMS SHOULD BE SENT TO:
IMG Europe Ltd
36-38 Church Road
Tel : +44 (0) 1444 46 55 88
Fax : +44 (0) 1444 46 55 50
E-mail : email@example.com
The above numbers are for the Claims Department only and should be used to discuss claims submitted and on-going issues. The emergency medical assistance helpline number can be found on the back of Your membership card.
Cancellation and Premium Refunds
You may cancel Your Plan, by providing written cancellation instructions (by e-mail, fax or post) and return the Policy Wording with the Certificate of Insurance within 14 days after receipt to the Plan Manager:
- For Plans cancelled within 14 days of Application, and prior to the Effective Date: - You will receive a full refund;
- For Plans cancelled after 14 days from the date of Application, but prior to the Effective Date: - You will receive a full refund of the premium paid less a $50/£30/€40 cancellation fee;
- For Plans that are cancelled after the Effective Date, and provided no claims have been paid or are in progress:
- For Plans with less than full one months Period of Insurance remaining: - there will be no refund payable;
- For Plans with one or more full months Periods of Insurance remaining: - You will receive a full refund of each complete full months coverage remaining, less a $50/£30/€40 cancellation fee.
Of course, if You cancel Your Plan You cannot make a claim under it and neither You nor Us will have any further rights, liabilities or obligations under the Plan.
Your request for cancellation will be dealt with promptly and Your Plan will be retroactively cancelled.
If You have any doubts regarding the Terms of Your Plan, please contact the Plan Manager directly for clarification, otherwise it shall be assumed that all Terms are understood and acceptable to You.
We reserve the right to require You to execute a release of claims as a condition to granting such refund. Upon cancellation and refund, neither We nor You shall have any further rights, liabilities or obligations under this Plan.