Applicant Eligibility

  • Non-U.S. citizens who are at least fourteen (14) days of age are eligible for coverage outside of their home countries, except as provided under home country coverage
  • Plan not available for US green card holder.
  • Should you make a change to the location of your home country during the certificate period, you are no longer eligible for coverage in the new home country except as provided under home country coverage as of the date you establish the new home country.

Minimum Age

At least fourteen (14) days of age.

Maximum Age

80 and above.

Period of Coverage

maximum duration of twelve (12) months.

Destination Country

Traveling outside of Their Home Country. Also excluding restricted countries and US states given below.

Restriction Details

Restricted Countries

The following countries can NEVER be listed as Destination:

Iran
North Korea
Syria

The following country can NEVER be listed as Destination (Exception for U.S. Citizens) - U.S. Citizens must certify that they qualify for travel authorized under US Treasury's regulations and that they comply with the terms of such authorization

Cuba

The following countries are NOT available for selection at purchase as Destination:

Belarus
Lebanon
Russia
Ukraine

The following countries can NEVER be listed as Home Country:

Cuba
Iran
North Korea
Syria
Ukraine

The following countries can NEVER be listed as Citizenship:

Cuba
Ukraine

U.S. Territories and Outlying Areas - United States Citizen / Home Country cannot list the following as Destination:

Puerto Rico
U.S. Virgin Islands

U.S. Territories and Outlying Areas - United States Citizen / Home Country can list the following countries as Destination:

American Samoa
Guam
North Marina Islands

Location at Purchase - The proposed applicant cannot be located in the following locations at the time of purchase:

Australia
Canada
New York (US State) Washington (US State)

Location at Purchase - The proposed applicant and the purchaser cannot be located in the following location at the time of purchase:

Maryland (US State)

Member Eligibility
U.S. citizens and non-U.S. citizens who are at least fourteen (14) days of age are eligible for coverage outside of their home countries, except as provided under home country coverage. U.S. citizens and residents are not eligible for coverage within the U.S, except as provided under incidental home country coverage or an eligible benefit period. Should you make a change to the location of your home country during the certificate period, you are no longer eligible for coverage in the new home country except as provided under home country coverage as of the date you establish the new home country.
Individuals ages sixty-five (65) to seventy-nine (79) as of the certificate effective date are subject to a $100,000 overall maximum limit or less. Individuals ages eighty (80) and over as of the certificate effective date are subject to a $10,000 overall maximum limit.

Certificate Effective & Termination Dates
Certificate Effective Date
Insurance hereunder is effective on the later of:
a. The moment we receive an application and correct premium if the application and payment is made online or by fax; or
b. 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; or
c. The moment you depart from your home country; or
d. 12:01am U.S. Eastern Time on the date requested on the application if correct premium is received.

Certificate Termination Date
Insurance hereunder terminates on the earlier of:
a. 11:59pm U.S. Eastern Time on the last day of the period for which premium has been paid; or
b. 11:59pm U.S. Eastern Time on the date requested on the application; or
c. 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).

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.

Important Notice and Disclaimer Concerning the United States Patient Protection and Affordable Care Act
This insurance is not subject to, and does not provide certain insurance benefits required by the United States’ Patient Protection and Affordable Care Act (“PPACA”). PPACA requires certain U.S. citizens or U.S. residents to obtain PPACA compliant health insurance, or “minimum essential coverage.” PPACA also requires certain employers to offer PPACA compliant insurance coverage to their employees. Tax penalties may be imposed on U.S. residents or citizens who do not maintain minimum essential coverage, and on certain employers who do not offer PPACA compliant insurance coverage to their employees. In some cases, certain individuals may be deemed to have minimum essential coverage under PPACA even if their insurance coverage does not provide all of the benefits required by PPACA. You should consult your attorney or tax professional to determine whether this policy meets any obligations you may have under PPACA.

Benefits

Plan Details

Overall Maximum Limit Age 80 or older: $20,000.
Age 65 to 79: $50,000 or $100,000.
All others: $50,000, $100,000, $250,000, $500,000, $1,000,000 or $2,000,000
Maximum per Injury / Illness Age 80 or older: $20,000.
Age 65 to 79: $50,000 or $100,000.
All others: $50,000, $100,000, $250,000, $500,000, $1,000,000, or $2,000,000
Deductibles $0, $100, $250, $500, $1,000, $2,500, or $5,000 per certificate period
Coinsurance We will pay 100% of eligible expenses, after the deductible, to the overall maximum limit.
Eligible expenses are subject to deductible, overall maximum limit, and are per certificate period unless specifically indicated otherwise.
Benefit Limit
Hospital Room and Board Average semi-private room rate, including nursing services
Intensive Care Unit Up to the overall maximum limit
Local Ambulance Usual, reasonable and customary charges only, when covered illness or injury results in hospitalization as inpatient.
Emergency Room Co-payment Claims incurred in the U.S.
You shall be responsible for a $200 co-payment for each use of emergency room for an illness unless you are admitted to the hospital. There will be no co-payment for emergency room treatment of an injury.
Claims incurred outside the U.S.
No co-payment
Urgent Care Center Co-payment Claims incurred in the U.S.
For each visit, you shall be responsible for a $15 co-payment.
– Co-payment is waived for members with a $0 deductible.
– not subject to deductible
Claims incurred outside the U.S.
No co-payment
Outpatient Physical Therapy and Chiropractic Care Up to $50 maximum per day.
Emergency Dental Up to $300 - not subject to deductible
Emergency Eye Exam Copayment Up to $150. $50 deductible per occurrence (plan deductible is waived).
Acute Onset of Pre-existing Condition (See benefit description) Up to the overall maximum limit
Up to $25,000 lifetime maximum for Emergency Medical Evacuation
Terrorism Up to $50,000 lifetime maximum, eligible medical expenses only.
All Other Eligible Medical Expenses Up to the overall maximum limit
Emergency Travel Benefits Limit
Emergency Medical Evacuation Up to $1,000,000 lifetime maximum, except as provided under Acute Onset of Pre-existing Condition
- not subject to deductible or overall maximum limit
Repatriation of Remains Equal to the elected overall maximum limit - not subject to deductible or coinsurance. This limit is for this benefit only and is not included in or subject to the overall maximum limit.
Local Burial or Cremation Up to $5,000 lifetime maximum - not subject to deductible
Crisis Response - Ransom, Personal Belongings, Crisis Response Fees and Expenses, and Natural Disaster Evacuation Up to $100,000 per certificate period, with $10,000 maximum for Natural Disaster Evacuation - not subject to deductible or overall maximum limit.
Emergency Reunion Up to $150,000, subject to a maximum of 15 days - not subject to deductible
Bedside Visit Up to $1,500 - not subject to deductible
Return of Minor Children Up to $50,000 - not subject to deductible
Pet Return Up to $1,000 - not subject to deductible
Political Evacuation Up to $150,000 lifetime maximum - not subject to deductible
Trip Interruption Up to $15,000 - not subject to deductible
Accidental Death & Dismemberment (excludes loss due to Common Carrier Accident)  
Ages 18 through 69 Lifetime Maximum - $100,000
Death - $100,000
Loss of 2 Limbs - $100,000
Loss of 1 Limb - $50,000
Under age 18 Lifetime Maximum - $5,000
Death - $5,000
Loss of 2 Limbs - $5,000
Loss of 1 Limb - $2,500
Ages 70 through 74 Lifetime Maximum - $12,500
Death - $12,500
Loss of 2 Limbs - $12,500
Loss of 1 Limb - $6,250
Ages 75 and older Lifetime Maximum - $6,250
Death - $6,250
Loss of 2 Limbs - $6,250
Loss of 1 Limb - $3,125
$250,000 maximum benefit any one family or group.
- not subject to deductible or overall maximum limit
Common Carrier Accidental Death Ages 18 through 69
Under age 18
Ages 70 through 74
Ages 75 and older


$100,000
$10,000
$25,000
$12,500
Subject to a maximum of $250,000 any one family or group.
- not subject to deductible or overall maximum limit
Lost Checked Luggage Up to $2,000 - not subject to deductible
Travel Delay Up to $200 a day after a 12-hour delay period requiring an unplanned overnight stay. Subject to a maximum of 2) days.
- not subject to deductible
Lost or Stolen Passport/Travel Visa Up to $100 - not subject to deductible
Border Entry Protection Up to $500 if traveling on a valid B-2 visa and denied entrance at the U.S. border. - not subject to deductible
Natural Disaster - Replacement Accommodations Up to $500 a day for 5 days - not subject to deductible
Emergency Quarantine Indemnity – COVID-19 $50 per day for up to 10 days. Proof of quarantine mandated by a physician or governmental authority required. Quarantine must be due to you testing positive for COVID-19/SARS-CoV2, or because you are symptomatic and waiting on diagnostic test results. Not available while you are in your home country.
-not subject to deductible
Hospital Indemnity $100 per day of inpatient hospitalization - not subject to deductible
Personal Liability Up to:
$100,000 lifetime maximum
$100,000 third person injury
$100,000 third person property
$2,500 related third person property
- not subject to deductible or overall maximum limit

Benefit Period

While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate, including when you return to your home country, the benefit period applies for up to 90 days only to eligible medical expenses directly related to an injury or illness that was diagnosed or treated while the certificate was in effect. The benefit period begins on the first day of diagnosis or treatment of a covered injury or illness made while you are outside your home country. The benefit period applies whether or not you return to your home country.

Incidental Home Country Coverage

You must have purchased three months of coverage for the Incidental Home Country Coverage to be in effect.

U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in the U.S. are covered up to a maximum of 15 days.

Non-U.S. home country: For every three-month period during which you are covered, eligible medical expenses incurred in your home country are covered up to a maximum of 30 days.

Should you make a change to the location of your home country during the certificate period, you must notify us of such change within fifteen (15) days. Your new home country will govern the terms of any home country or incidental home country coverage.

Any benefit accrued under a single three-month period does not accumulate to another period. Failure to continue your international trip or your return to your home country for the sole purpose of obtaining treatment for an illness or injury that began while traveling shall void any incidental home country coverage.

Except for a benefit period, coverage provided under this Master Policy is for a maximum duration of 365 days for non-U.S. citizens or residents whose travel does not include the U.S. or U.S. Territories, and for all other members, 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.

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.

Medical & Repatriation Expenses

Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions and restrictions contained in this provision, we will pay the following expenses incurred while this insurance is in effect.

Medical Expenses

YOU ARE COVERED FOR:

  1. Charges made by a hospital for:
  2. Daily room and board and nursing services not to exceed the average semi-private room rate; and
  3. Daily room and board and nursing services in Intensive Care Unit; and
  4. Use of operating, treatment or recovery room; and
  5. Services and supplies which are routinely provided by the hospital to persons for use while inpatients; and
  6. Emergency treatment of an injury, even if hospital confinement is not required; and
  7. Emergency treatment of an illness; subject to emergency room co-pay as outlined in the Schedule of Benefits and Limits. ER co-payment is waived when you are directly admitted to the hospital as inpatient for further treatment of that illness.
  8. Surgery at an outpatient surgical facility, including services and supplies.
  9. Charges made by a physician for professional services, including virtual physician visits and surgery. Charges for an assistant surgeon are covered up to 20% of the usual, reasonable and customary charge of the primary surgeon, but standby availability will not be deemed to be aprofessional service and therefore is not covered hereunder.
  10. Dressings, sutures, casts or other supplies which are medically necessary and administered by or under the supervision of a physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except durable medical equipment.
  11. Diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included).
  12. Artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the replacement or repair thereof.
  13. Reconstructive surgery when the reconstructive surgery is directly related to a surgery which is covered hereunder.
  14. Hemodialysis and the charges by the hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components.
  15. Oxygen and other gasses and their administration by or under the supervision of a physician.
  16. Anesthetics and their administration by a physician.
  17. Drugs which require prescription by a physician for treatment of a covered injury or illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of 60 days per prescription.
  18. Care in a licensed extended care facility upon direct transfer from an acute care hospital.
  19. Home nursing care in bed by a qualified licensed professional, provided by a home health care agency upon direct transfer from an acute care hospital and only in lieu of medically necessary inpatient hospitalization.
  20. Emergency local ambulance transport necessarily incurred in connection with injury or illness resulting in inpatient hospitalization.
  21. Emergency dental treatment and dental surgery necessary to restore or replace natural teeth lost or damaged in an accident which was covered under this insurance.
  22. Emergency dental treatment necessary to resolve acute onset of pain, provided that initial treatment is obtained within seventy-two (72) hours of the acute onset of pain.
  23. Emergency Eye Exam if your prescription corrective lenses are lost or damaged due to a covered loss and an exam is required to obtain a lens prescription for medically necessary correction lenses, but not for the replacement cost of prescription corrective lenses or contact lenses.
  24. Medically necessary rental of durable medical equipment (consisting of a standard basic hospital bed and or a standard basic wheelchair) up to the purchase prices.
  25. Outpatient physical therapy or chiropractic care if prescribed by a physician who is not affiliated with the physical therapy or chiropractic practice, necessarily incurred to continue recovery from a covered injury or illness.
  26. Injury or illness resulting from participation in sports or athletic activities not otherwise excluded under this insurance.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Emergency Medical Evacuation

YOU ARE COVERED FOR:

  1. Emergency air transportation to a suitable airport nearest to the hospital where you will receive treatment; and
  2. Emergency ground transportation necessarily preceding emergency air transportation; and from the destination airport to the hospital where you will receive treatment.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The evacuation is recommended by the attending physician who certifies that it is medically necessary and that transportation by any other method would result in the loss of your life or limb;and
  2. The evacuation is agreed upon by you or your relative; and
  3. Travel arrangements, excluding Emergency Local Ambulance, are approved in advance and coordinated by us.

YOU ARE NOT COVERED IF:

  1. The illness or injury giving rise to the expense is not covered under this insurance; or
  2. Medically necessary treatment, services and supplies can be provided locally; or
  3. If transportation by any other method would not result in the loss of your life or limb; or
  4. The condition giving rise to the Emergency Medical Evacuation did not occur suddenly and unexpectedly and without advance warning, either in the form of physician recommendation orsymptoms which would have caused a prudent person to seek medical attention prior to the onset of the emergency; or
  5. Expenses arise directly or indirectly from anything in the General Exclusions.

We will provide Emergency Medical Evacuation only to the nearest hospital that is qualified to provide the medically necessary treatment, services and supplies to prevent your loss of life or limb.

The timeliness of arrangements can be affected by circumstances which are not within our control such as: availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems, weather and other acts of God. We shall not be held liable for any delays that are not within our direct and immediate control.

Notwithstanding the foregoing, and if you are visiting the U.S., we will pay for expenses to return you to your home country if the attending physician and our medical consultant agree that transfer to your home country is more appropriate than transfer to the nearest qualified hospital.

Trip Interruption

YOU ARE COVERED FOR:

  1. The cost of an economy one-way air or ground transportation ticket for you to the terminal serving the area of your principal residence; and/or
  2. The cost of an economy one-way air and/or ground transportation ticket for you from the area where you were hospitalized following an Emergency Medical Evacuation to the area where you were initially evacuated from or to the terminal serving the area of your principal residence.

 YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You provide written proof of one or more of the following events: destruction, after departure from home country, resulting from fire or weather of more than 40% of your principal residence, or death of a biological or stepparent, biological or step child/grandchild, current spouse, biological or stepsibling, or parent, children or sibling in law; or
  2. Following a covered Emergency Medical Evacuation, the attending physician states that it is medically necessary for you to return to your home country or to the area from which you wereinitially evacuated for continued treatment, recuperation and recovery.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Return of Minor Children

YOU ARE COVERED FOR:

  1. The cost of a one-way economy air and/or ground transportation ticket for each covered minor child to the terminal serving the area of the principle residence of each minor child.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You are the only person age 18 or older, traveling with one or more minor children under the age of 18 who are also covered hereunder; and
  2. You are hospitalized for treatment of a covered illness or injury, resulting in the children being left unattended for a period of time expected to exceed 36 hours; and
  3. The Return of Minor Children benefit must be agreed upon by you and/or by an authorized adult relative of the affected, covered minor children.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

The timeliness of arrangements can be affected by circumstances which are not within our control such as: availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems, weather and other acts of God. We shall not be held liable for any delays that are not within our direct and immediate control.

Political Evacuation

YOU ARE COVERED FOR:

  1. The cost of transportation by the most economical means possible for you to the nearest country of safety or to your home country. We will determine to which country you will be evacuated.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The U.S. Department of State has issued a level 3 or higher travel advisory after your arrival in the destination country; and
  2. Your coverage was effective prior to the advisory being issued; and
  3. You contact us within 10 days of the date the travel advisory is issued.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Repatriation of Remains

YOU ARE COVERED FOR:

  1. Air or ground transportation of bodily remains or ashes to the airport or ground transportation terminal nearest your principal residence; and
  2. Reasonable costs of preparation of the remains necessary for transportation.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The illness or injury giving rise to the expense are covered under this insurance; and
  2. Travel arrangements are approved in advance and coordinated by us.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

We are held harmless and shall not be held liable for loss of or any damage or other impairment to bodily remains incurred during the repatriation process or otherwise.

The timeliness of arrangements can be affected by circumstances which are not within our control such as: availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems, weather and other acts of God. We shall not be held liable for any delays that are not within our direct and immediate control.

Local Burial or Cremation

YOU ARE COVERED FOR:

  1. For you to be buried or cremated in the country of death in lieu of Repatriation of Remains up to the specified benefit maximum.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The illness or injury giving rise to the expense is covered under this insurance; and
  2. Travel arrangements are approved in advance and coordinated by us.

YOU ARE NOT COVERED IF:

  1. The death occurs in your home country; or
  2. The Emergency Medical Evacuation or Repatriation of Remains benefit is used; or
  3. Expenses arise directly or indirectly from anything in the General Exclusions.

The timeliness of arrangements can be affected by circumstances which are not within our control such as: availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems, weather and other acts of God. We shall not be held liable for any delays that are not within our direct and immediate control.

Indemnity Benefit & Visitation Expenses

Hospital Indemnity

YOU ARE COVERED FOR:

  1. The Hospital Indemnity benefit for each night you spend in the hospital.

YOU ARE NOT COVERED unless you fulfill the following conditions:

1.    You must provide verification of an eligible inpatient hospitalization.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Emergency Reunion

YOU ARE COVERED FOR:

  1. The cost of an economy round-trip air or ground transportation ticket for one relative for transportation to the terminal serving the area where you are hospitalized or are to be hospitalized following Emergency Medical Evacuation; and
  2. Reasonable expenses for lodging and meals for the relative, which are incurred in the area where you are hospitalized for a period not to exceed 15 days.

YOU ARE NOT COVERED unless you fulfill the following conditions:

1.    You have a covered Emergency Medical Evacuation.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Bedside Visit

YOU ARE COVERED FOR:

  1. The cost of an economy round-trip air or ground transportation ticket for one relative for transportation to the terminal serving the area where you are hospitalized or are to be hospitalized.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You are confined to a hospital intensive care unit following a covered life-threatening bodily injury or life-threatening illness.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Travel Assistance

Travel Delay

YOU ARE COVERED FOR:

  1. Reimbursement for reasonable accommodations and meals when your delay requires an unplanned overnight stay.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The delay must be twelve (12) hours or more and certified due to the following reasons:
  2. Delay of common carrier (which is certified by the common carrier); or
  3. A traffic accident while en route to the point of departure from an airport outside of your home country (substantiated by a police report); or
  4. Organized labor strike; or
  5. You being hijacked or quarantined; or
  6. Your passports or travel documents are stolen (substantiated by a police report).

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Lost Checked Luggage

YOU ARE COVERED FOR:

1.    Replacement of clothes and personal hygiene items, not to exceed $50 for any one item.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The lost checked luggage must have been checked, in accordance with routine luggage checking procedures, for transportation with you, on board a regularly scheduled commercial airline or cruise line, upon which you were a fare-paying passenger; and
  2. You must file a formal claim for lost luggage with the transportation provider, and follow all instructions and take all measures as directed by the transportation provider to locate and retrieve the lost checked luggage; and
  3. You must provide us with copies of all documentation of the claim filed with the transportation provider, and a written statement from the transportation provider confirming that the luggage was checked and after careful search, the luggage remains missing; and
  4. The lost checked luggage must be lost as of the date of our payment and as of that date, must have been lost for at least 10 days.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Lost or Stolen Passport/Travel Visa

YOU ARE COVERED FOR:

1.    Reimbursement for reasonable cost in replacing your passport or travel visa.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You exercise reasonable care for the safety and supervision of the passport or travel visa; and
  2. Loss or theft is reported to the police within 24 hours and a written police report is obtained; and
  3. You provide receipts for the costs associated with the passport or travel visa replacement.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Natural Disaster - Replacement Accommodations

YOU ARE COVERED FOR:

  1. Replacement accommodations in the event you are displaced from planned paid accommodations due to evacuation from forecasted natural disaster or following a natural disaster strike.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You provide a receipt of proof of payment for the accommodations from which you were displaced.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

The following definitions apply to Natural Disaster – Replacement Accommodations coverage:

Displaced means required to depart a destination due to an evacuation ordered by prevailing authorities.

Natural Disaster means an event of natural cause, including wildfire, earthquake, windborne dust or sand, volcanic eruption, tsunami, snow, rain or wind, that results in widespread and severe damage. Natural disaster does not include the direct or indirect effect of rain, wind or water associated with named storms meeting the definition of hurricane or typhoon, except in instances where:

  1. The path of the named storm deviates by a distance of greater than 200 miles within a 72-hour period from the path forecast by a nationally recognized meteorological service; or
  2. Less than 72 hours advance notice of a potential landfall for a named storm exists.

Emergency Quarantine Indemnity – COVID-19

YOU ARE COVERED FOR:

1.    The Emergency Quarantine Indemnity – COVID-19 benefit for each day you are quarantined.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The quarantine is mandated by a physician or governmental authority due to 1) you having tested positive for COVID-19/SARS-CoV2, or 2) you are symptomatic and waiting on diagnostic test results; and
  2. You are outside your home country while in quarantine.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Border Entry Protection

YOU ARE COVERED FOR:

If you are traveling on a Visitor Visa B-2 for tourism, for visiting family or friends, or on holiday, and you are denied entry to the United States at the border by customs officials:

  1. Reimbursement for the cost of an economy one-way air or ground transportation ticket to the original country of origin; or
  2. Common carrier change fee for transportation to the original country of origin less the amount credited for any unused portion of the return travel arrangements.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You must return to the country of origin; and
  2. You must not be a citizen or of the United States, have home country of the United States, and/or have permanent residency in the United States.

YOU ARE NOT COVERED IF:

  1. You are traveling to the United States without a Visitor Visa B-2, or you are travelling illegally; or
  2. You are from a country named on any active executive order at the time of purchase; or
  3. You are on the United States terror watch list; or
  4. You were denied entry to the United States upon arrival or while en route to the United States because you have violated any rule, law, condition of or guideline regarding the visa upon which you are traveling; or
  5. You are visiting the United States for medical treatment, participation by amateurs in musical, sports, or similar events or contests, if compensation is received; or
  6. You are visiting the United States for studies that receive credits towards a degree; or
  7. You committed a crime en route or upon entry to the United States which caused or would have caused you to be returned to your country of origin; or
  8. The United States government or the common carrier has paid, offered to pay, or will pay for your repatriation to your country of origin; or
  9. You have an unused return ticket or credit issued by the common carrier. If credit is not used, the amount reimbursed will be reduced by the amount of the credit.
  10. The following definitions apply to Border Entry coverage:

Country of Origin means the country you were in when you first departed for the United States.

Executive Order means a rule or order issued by the United States President on how federal agencies are to use their resources and having the force of law.

Pet Return

YOU ARE COVERED FOR:

  1. The cost of a one-way economy air and/or ground transportation ticket for a pet to be returned to the terminal serving the area of your principle residence.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You are the only person aged 18 or older traveling with the pet; and
  2. You are hospitalized for treatment of a covered illness or injury, resulting in the pet being left unattended for a period of time expected to exceed 36 hours.

YOU ARE NOT COVERED IF:

1.    Expenses arise directly or indirectly from anything in the General Exclusions.

Personal Accident

Accidental Death and Dismemberment

YOU ARE COVERED FOR:

  1. Death – we will pay the amount indicated in the Schedule of Benefits to the beneficiary: or
  2. Loss of 2 or more limbs or eyes – we will pay you the amount indicated in the Schedule of Benefits: or
  3. Loss of 1 limb or eye – we will pay you the amount indicated in the Schedule of Benefits.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The accident giving rise to the Accidental Death or Dismemberment must be covered under this insurance; and
  2. The accident giving rise to the accidental death must not be a common carrier accident; and
  3. Death must occur within 30 days of the sudden, unintentional and unexpected occurrence and not be contributed to by illness or disease.

YOU ARE NOT COVERED IF:

  1. Accident or loss is caused by or contributed to by any of the following:
  2. Terrorism, war or act of war, whether declared or undeclared:
  3. Your participation in a riot, insurrection or violent disorder:
  4. Your service in the armed forces of any country:
  5. Suicide or attempted suicide or intentional self-inflicted injury, while sane or insane:
  6. The voluntary use of any chemical compound, poison or drug, unless used according to the directions of a physician:
  7. Committing or attempting to commit a felony:
  8. Illness, mental health disorder, or pregnancy:
  9. As the result, directly or indirectly, of: i) intoxication as defined by the laws of the jurisdiction in which the accident or injury occurred, or ii) intoxication consistent with a .08 BAC (Blood Alcohol Content); whichever is lower;
  10. Myocardial infarction or cerebrovascular accident (CVA / Stroke):
  11. Infection, except infection through a wound that was caused solely by an accident:
  12. Injury while riding, boarding, or alighting from an aircraft if you were operating the aircraft, learning to operate the aircraft, serving as a member of the aircraft crew, or if the aircraft was being used for any purpose other than passenger transportation:
  13. Medical or surgical treatment for any of the above: or
  14. Any non-covered sports activities.
  15. Expenses arise directly or indirectly from anything in the General Exclusions.

In no event will our payment under this benefit total more than the principal sum. The maximum liability under Accidental Death and Dismemberment for any group or family is limited to $250,000.

Common Carrier Accidental Death Benefit

YOU ARE COVERED FOR:

1.    The amount indicated in the Schedule of Benefits to the beneficiary.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The accident giving rise to the accidental death must occur while you are a fare paying passenger on a regularly scheduled trip on board a commercial airline or cruise line;
  2. Death must occur within 30 days of the sudden, unintentional and unexpected occurrence and not be contributed to by illness or disease; and
  3. The maximum liability under this Common Carrier Accidental Death Benefit for a group or family is limited to $250,000.

YOU ARE NOT COVERED IF:

  1. Expenses arise directly or indirectly from anything in the General Exclusions. The following definitions apply to Personal Accident coverage:

Accidental Death means a sudden, unintentional and unexpected occurrence caused solely by external, visible means resulting in 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 in the order 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.

Sports and Activities

YOU ARE COVERED FOR:

  1. You are covered for taking part in amateur/non-professional sports and activities, unless it is excluded below. Coverage is for recreational purposes incidental to a trip.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You must ensure that appropriate safety equipment (such as protective headwear, life jackets etc.) are worn at all times.

YOU ARE NOT COVERED IF:

  1. The activity is organized athletics involving regular or scheduled practice and/or games; or
  2. The activity is performed in a professional capacity or for any wage, reward, or profit; or
  3. Expenses arise directly or indirectly from anything in the General Exclusions; or
  4. Any of the excluded items listed below:
  • All-Terrain Vehicles
  • American Football
  • Aussie Rules Football
  • Aviation (except when traveling solely as a passenger in a commercial aircraft)
  • Base Jumping
  • Big Game Hunting
  • Bobsleigh
  • Boxing
  • Cave Diving
  • Cliff Jumping
  • Hang-Gliding
  • Heli-Skiing
  • Hot Air Ballooning as a Pilot
  • Ice Hockey
  • Jousting
  • Kite-Surfing
  • Luge
  • Martial Arts
  • Modern Pentathlon
  • Motorized Dirt Bikes
  • Mountaineering at elevations of 4,500 meters or higher
  • Outdoor Endurance Events
  • Parachuting
  • Paragliding
  • Parasailing
  • Powerlifting
  • Quad Biking
  • Racing by any Animal, Motorized Vehicle, or BMX, and Speed Trials and Speedway
  • Rugby
  • Running with the Bulls
  • Skeleton
  • Sky Surfing
  • Snow Skiing and Snowboarding, except recreational downhill skiing, snowboarding and/or cross-country snow skiing (no cover provided for recreational downhill skiing or snowboarding while skiing away from prepared and marked in-bound territories and/or for any skiing or snowboarding against the advice of the local ski school or local authoritative body)
  • Snow Mobiles
  • Spelunking
  • Sub Aqua Pursuits involving underwater breathing apparatus unless accompanied by a certified instructor at depths less than 10 meters, or PADI/NAUI/SSI certified
  • Tractors
  • Whitewater Rafting
  • Wrestling

Crisis Response

YOU ARE COVERED FOR:

  1. Ransom; and/or
  2. Crisis Response Fees and Expenses; and/or
  3. Personal Belongings
  4. Natural Disaster Evacuation

Kidnapping and Express Kidnapping

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. Notification: Before surrendering a ransom, the person authorizing the surrender shall have notified or made every reasonable attempt to notify:
  2. The Federal Bureau of Investigation or local law enforcement agencies as soon as practicable bearing in mind the safety of the person(s) held or threatened; and
  1. Unity Advisory Group / On Call International via us.
  2. The surrender of a ransom must not be:
  1. Carried by, transported by or otherwise in your possession at the time that an express kidnapping or kidnapping first occurs; or
  2. At the location where an express kidnapping or kidnapping first occurs.
  3. Confidentiality: You must at all times use best efforts to ensure that knowledge of the existence of this insurance is restricted as far as possible.

YOU ARE NOT COVERED IF:

  1. Any kidnapping or express kidnapping first occurs in Afghanistan, Central African Republic, Democratic Republic of the Congo, Iraq, Libya, Mali, Niger, Nigeria, North Korea, Pakistan, Somalia, Sudan, South Sudan, Syria, Venezuela, Yemen, or any country for which we are prohibited from transaction due to sanctions by the United States Department of the Treasury’s Office of Foreign Assets Control (OFAC).
  2. Any express kidnapping or kidnapping is a result of fraudulent, dishonest or criminal act(s) by you or an authorized representative (whether acting alone or in collusion with others) unless the person authorizing the ransom payment had, prior to payment, made every reasonable attempt to determine that the ransom demand or threat was genuine.
  3. Expenses arise directly or indirectly from anything in the General Exclusions.

Limits of Liability:

  1. Certificate Period Aggregate: Our total liability for all insured losses shall not exceed the certificate period aggregate limit set forth herein.
  2. In the event that you are covered by two or more policies issued by us covering insured losses arising from a kidnapping or express kidnapping, it is agreed that our aggregate liability for insured losses sustained by you shall not be cumulative and shall in no event exceed the largest amount available under any one of the policies

The following definitions apply to Crisis Response coverage:

Valuation: We shall not be liable for more than the actual cash value of any consideration at the time of its surrender. If insured losses involve currency other than that of the United States of America, we shall not be liable for more than the United States Dollar equivalent of foreign currency based on the rate of exchange in the Wall Street Journal in effect on the day the monies are surrendered and/or expense incurred.

Crisis Response Fees and Expenses means all fees and expenses of Advisory Group / On Call International related to your kidnapping or express kidnapping.

Express Kidnapping means the actual abduction, transportation, and holding of you against your will for a minimum of one (1) hour where your personal belongings and/or readily available assets are surrendered by you in exchange for your release.

Kidnapping means the actual, alleged, or attempted abduction and holding of you against your will by a person or persons who demand a ransom specifically from your assets in exchange for your release.

Insured Losses means covered losses and expenses consisting of the following: ransom, personal belongings, and/or crisis response fees and expenses.

Personal Belongings means monies and/or property of monetary value that are:

  1. Being carried or transported by you when an express kidnapping or kidnapping first occurs; and
  2. Are surrendered during the course of an express kidnapping or kidnapping.

Ransom means monies and/or other consideration of monetary value that are surrendered or to be surrendered by you or on your behalf to meet an express kidnapping or kidnapping demand.

Natural Disaster Evacuation

We will provide evacuation due to a natural disaster which makes your host country location uninhabitable.

The method of transportation will be determined by us.

YOU ARE COVERED FOR:

  1. Transportation to the nearest safe location; and
  2. One-way economy airfare to return you to your home country following a Natural Disaster Evacuation; and
  3. A maximum of three (3) days for reasonable lodging accommodations if you are delayed at the safe location and unable to depart to your home country.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. Youcannot obtain commercial transportation to the nearest safe location within a time period:
    1. Enabling you to leave the host country in time to avert imminent bodily harm; or
  1. Complying with the time allowed to leave the host country pursuant to the orders of the recognized government of that host country; or
  1. Officials of the host country or the U.S. Embassy, have issued, for reasons due to the Natural Disaster situation, a recommendation that the categories of persons which include you should leave the host country;

OR

  1. Your location in the host country is deemed uninhabitable by us
  2. You must contact us as soon as possible after your host country issues the official disaster declaration; and
  3. Travel arrangements are approved in advance and coordinated by us.

YOU ARE NOT COVERED IF:

  1. You are able to leave your host country by normal means, such as changing a commercial airline ticket; we will assist in rebooking flights or other transportation. Such expenses for non-emergency transportation are your responsibility.
  2. Expenses are directly or indirectly from anything in the General Exclusions.

The timeliness of arrangements can be affected by circumstances which are not within our control such as: availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems, weather and other acts of God. We shall not be held liable for any delays that are not within our direct and immediate control, or your failure to comply with our recommendations, or where rendering of service is prohibited by local laws or regulatory agencies.

If evacuation becomes impractical due to hostile advise you until evacuation becomes viable or the or dangerous conditions, we will maintain contact with and natural disaster situation has been resolved.

We shall be under no obligation to provide the services to you, who in our sole opinion, are located in areas that represent conditions in which providing services is impossible, including without limitation geographical remoteness, war (declared or undeclared), civil or other hostilities or political unrest.

The following definitions apply to Optional Crisis Response Benefit Rider – Natural Disaster Evacuation:

Host Country means the country which you have traveled to and which is not your home country.

Imminent Bodily Harm means the existence of any condition or circumstance, which cannot be avoided through reasonable precautionary measures, and could be expected to cause death or serious physical harm to you, if you were to remain in the affected area where the natural disaster event has occurred.

Natural Disaster means an event of natural cause, including wildfire, earthquake, windborne dust or sand, volcanic eruption, tsunami, snow, rain or wind, that results in widespread and severe damage. Natural disaster does not include the direct or indirect effect of rain, wind or water associated with named storms meeting the definition of hurricane or typhoon, except in instances where:

  1. The path of the named storm deviates by a distance of greater than 200 miles within a 72-hour period from the path forecast by a nationally recognized meteorological service
  2. Or less than 72 hours advance notice of a potential landfall for a named storm exists.

Uninhabitable means your host country location is deemed unfit for residence, as determined by us in accordance with U.S. and local authorities, due to lack of habitable shelter, food, heat and/or potable water AND no suitable supplemental housing is available within 100 miles of the disaster site.

Personal Liability

YOU ARE COVERED FOR:

Up to the sum insured shown in the Schedule of Benefits and Limits (inclusive of legal costs and expenses) if you become legally liable to pay damages in respect of:

1.    Accidental bodily injury, including death, illness and disease of a third person; and/or

  1. Accidental loss of or damage to a third person’s material property (property that is both material and tangible); and/or
  2. Accidental loss of or damage to a related third person’s material property (property that is both material and tangible);

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. You or your legal representatives gives us written notice immediately if you have received notice of any prosecution or inquest in connection with any circumstances which may give rise to liability under this section.
  2. No admission, offer, promise, payment or indemnity shall be made by or on behalf of you without our prior written consent.
  3. Every claim notice, letter, writ or process or other document served on you shall be forwarded to us and immediately upon receipt.
  4. We shall be entitled to take over and conduct in your name the defense or settlement of any claim or to prosecute in your name for our own benefit any claim for indemnity or damages against all other parties or persons.
  5. We may at any time pay you in connection with any claim or series of claims the sum insured (after deduction of any sums already paid as compensation) or any lesser amount for which such claim(s) can be settled. Once this payment is made we shall relinquish the conduct and control and be under no further liability in connection with such claim(s) except for the payment of costs and expenses recoverable or incurred prior to the date of such payment.
  6. We will consider paying or advancing, but without any obligation or contractual duty to do so, up to $2,500 to you or for your benefit to settle and compromise an asserted claim against you so long as:
  7. The asserted claim is one that may be eligible for coverage under this insurance;
  8. A lawsuit has not yet been filed, or, if already filed, no response has been filed;
  9. You obtain a full written release and/or covenant-not-to-sue satisfactory to us; and
  10. A proof of claim and other necessary documentation is satisfactorily provided to us.

YOU ARE NOT COVERED FOR:

  1. Intentionally committed acts, or arising from the influence of alcohol or drugs not medically prescribed by a licensed physician;
  2. Bodily injury, illness or disease of any person under a contract of employment, service or apprenticeship with you when the bodily injury, illness or disease arises out of and in the course of their employment to you, or in connection with any trade, business or profession;
  3. Loss or damage to property belonging to or held in trust by or in the custody or control of you other than temporary accommodation occupied by you in the course of the trip;
  4. Bodily injury or damage caused directly or indirectly in connection with the ownership, possession or use by you or on behalf of you of: aircraft, hovercraft, watercraft, motorized vehicles, parachute, parasail, glider, firearms, fireworks, explosives, deadly weapons, or any racing activity;
  5. Any damages, losses or claims caused in whole or in part by you during any hunt or as a result of hunting;
  6. Bodily injury caused directly or indirectly in connection with the ownership, possession or occupation of land or buildings, immobile property or caravans or trailers;
  7. Damages resulting from any fire, flood, wind, hail, water leak, gas leak, explosion or other natural or man-made catastrophe;
  8. Fraudulent, dishonest or criminal acts of you or any person authorised by you to commit such acts;
  9. The consequences of any breach, violation or failure to perform any contractual undertakings or obligations, whether verbal or in writing;
  10. Punitive or exemplary damages, or fines, penalties, assessments or claims by any governmental authorities or regulatory bodies;
  11. Gambling, gaming, or betting of any kind;
  12. Animals or pets belonging to you, or in your care, custody or control;
  13. Expenses arising directly or indirectly from anything in the General Exclusions.

The following definitions apply to Personal Liability coverage:

Third Person means any individual, natural person, or other legal entity or person, other than you or a related third person.

Related Third Person means your relative, your traveling companion, your traveling companion’s relative, and any other person, individual or family member with whom you are residing or being hosted.

Terrorism

YOU ARE COVERED FOR:

  1. Eligible Medical Expenses for treatment of injuries and illnesses resulting from an Act of Terrorism, up to the limit set forth in the Schedule of Benefits and Limits, provided all of the following conditions are met.

YOU ARE NOT COVERED unless you fulfill the following conditions:

  1. The injury or illness does not result from the use of any biological, chemical, cyber, radioactive or nuclear agent, material, device or weapon;
  2. You have no direct or indirect involvement in the Act of Terrorism;
  3. The Act of Terrorism is not in a country or location where the U.S. Department of State has issued a level 3 or higher travel advisory that has been in effect within the 60 days immediately prior to your date of arrival; and
  4. You have not failed to depart a country or location within 10 days following the date a level 3 or higher advisory for that country or location is issued by the United States government.

YOU ARE NOT COVERED IF:

  1. Loss, damage, cost or expense directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss, damage, cost or expense:
  2. War, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; or
  3. The use of any biological, chemical, cyber, radioactive or nuclear agent, material, device or weapon; however, this exclusion shall not apply where you are exposed to nuclear radioactive and/or radioactive material for the purpose of medical treatment; or
  4. Any Act of Terrorism, not specifically covered above; or
  5. Coverage for loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to (a), (b) or (c) above; or
  6. Expenses arise directly or indirectly from anything in the General Exclusions.

For the purpose of this insurance, an “Act of Terrorism” means an act, including but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear. 

If we allege that by reason of this exclusion, any loss, damage, cost or expense is not covered by this insurance, the burden of proving the contrary shall be upon you.

In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect.

The following definitions apply to Terrorism:

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.

Acute Pre-Ex Coverage

Pre-Existing Medical Conditions

This policy does not cover charges, in whole or in part, resulting from, related to, arising from, or necessitated by a pre-existing condition(s), except and unless charges resulted directly from an acute onset of pre-existing condition in which case the charges will be covered only according to the Terms ofthe Acute Onset of Pre-existing Conditions provision.

Pre-existing Condition means any injury, illness, sickness, disease, or other physical, medical, mental, or nervous disorder, condition, or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the 2years prior to the effective date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, treated, or disclosed to us prior to the effective date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.

For the purposes of the Complications of Pregnancy coverage offered hereunder, pregnancy will not be included within the definition of a pre-existing condition.

Acute Onset of Pre-Existing Conditions

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:

  1. The Acute onset of a Pre-Existing Condition does not directly or indirectly relate to a chronic condition or congenital condition;
  2. Treatment must be obtained within twenty-four (24) hours of the sudden and unexpected outbreak or reoccurrence;
  3. You must be under eighty (80) years of age;
  4. 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;
  5. You must not be traveling with the intent or purpose to seek or obtain treatment for the pre-existing condition;
  6. You must be traveling outside your Home Country
  7. 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

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 conditions. Birth defects are deemed to include hereditary conditions.
4.    Mental health disorders.
5.    Pregnancy except 1) as covered under Complications of Pregnancy, as herein defined, termination of pregnancy except in connection with covered Complications of Pregnancy, all charges related to pregnancy after the 26th week of pregnancy, routine prenatal care, child birth, postnatal care, and charges incurred by a child under the age of fourteen (14) days, and 2) diagnostic testing related to a covered injury or illness.
6.    Impotency or sexual dysfunction.
7.    All sexually transmitted diseases and conditions except for diagnostic testing related to a covered injury
or illness.
8.    HIV, AIDS, or ARC, and all diseases caused by and/or related to HIV.
9.    All forms of cancer / malignant neoplasm.
10.    Substance abuse or addiction or conditions that may be attributed to substance abuse or addictions and direct consequences thereof.
11.    Acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, hypertrophic and atrophic conditions of skin, nevus.
12.    Sleep apnea or other sleep disorders.
13.    Obesity or weight modification, including but not limited to wiring of the teeth and all forms of intestinal bypass surgery.
14.    Intentional self-inflicted injury or illness and/or suicide or attempted suicide whether sane or insane.
15.    Injury or illness sustained that is due wholly or partially to the effects of alcohol, illegal , or drugs not taken in accordance with treatment prescribed by a physician and except drugs prescribed for the treatment of substance abuse, or injury sustained while under the influence of drugs or alcohol as (i) defined under the law of the jurisdiction, or (ii) with a .08 Blood Alcohol Content (BAC), whichever is lower; or (iii) an expert’s report, such as that of a medical practitioner or forensic expert; (iv) the witness report of a third party, or (v) your own admission; or (vi) the description of events you described to us or you had described to any treating medical professional (such as a paramedic, nurse, doctor) or attending emergency service member as documented in their records.
16.    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.
17.    Treatment of the temporomandibular joint.
18.    Promotion or prevention of conception including but not limited to: artificial insemination, treatment for infertility, sterilization or reversal of sterilization.
19.    Organ or tissue transplants or related services.
20.    Eye surgery, such as corrective refractory surgery, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
21.    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, except as provided for under Emergency Eye Exam.
22.    Orthoptics and visual eye training.
23.    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.
24.    Hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed, unless prescribed due to loss resulting from a covered injury or illness.
25.    Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinesiotherapy.
26.    Psychometric, intelligence, competency, behavioral and educational testing.
27.    Cosmetic or aesthetic reasons, except for reconstructive surgery when such surgery is directly related to and follows a surgery which was covered hereunder.
28.    Modifications of the physical body intended to improve the psychological, mental or emotional well- being, including but not limited to sex-change surgery.
29.    Exercise programs, whether or not prescribed or recommended by a physician.
30.    Incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
31.    Cryo preservation and implantation or re-implantation of living cells.
32.    Genetic or predictive testing.
33.    Investigational, experimental or for research purposes.
34.    While confined primarily to receive custodial care, educational or rehabilitative care, or any medical treatment in any establishment for the care of the aged, except rehabilitative care received upon direct transfer from an acute care hospital.
35.    Not medically necessary.
36.    Not administered by or under the supervision of a physician, and products that can be purchased without a doctor's prescription.
37.    Provided by a relative, family member or any person who ordinarily resides with you.
38.    Provided at no cost to you.
39.    Failure to keep a scheduled appointment.
40.    Payable under any government system, including the Australian Medicare system.
41.    Payable under Worker’s Compensation or Employer’s Liability Laws, or by any coverage provided or required by law.
42.    Charges exceeding usual, reasonable and customary.
43.    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.
44.    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 sixty (60) days immediately prior to your effective date or 2) within ten (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.
45.    War, military action or while on duty as a member of a police or military force unit.
46.    Travel or accommodations, except as provided or in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, Emergency Reunion, Natural Disaster, Return of Minor Children, Political Evacuation, Trip Interruption, Trip Delay, Emergency Quarantine Indemnity, and Border Entry Protection sections of this insurance.
47.    Incurred outside your certificate period.
48.    Submitted to us for payment more than sixty (60) days after the last day of the certificate period.
49.    When departure from the home country is to obtain treatment in the destination country/countries.
50.    Complications or consequences of a treatment or condition not covered hereunder.
51.    Not included as Eligible Expenses as described herein.

U.S. Preferred Provider Organization (PPO) Requirements

Within the USA - U.S. Preferred Provider Organization
When seeking treatment within the U.S., you may reduce your out-of-pocket costs by visiting a doctor within your preferred provider organization (PPO). A PPO is a network of hundreds of thousands of established, highly qualified medical practitioners and well-recognized hospitals in the U.S. Note that you may visit a doctor of your choosing outside the PPO, but billed charges for eligible expenses will not be eligible for a PPO discount. More details are available at https://www.worldtrips.com/find-a-doctor 

U.S. Preferred Provider Organization (PPO)
This insurance policy offers the option of a PPO network for medical treatment received in the United States. If you choose to seek treatment from a PPO provider, billed charges for eligible expenses may be reduced and we will remit payment directly to the provider.

You may review a listing of hospitals, physicians and other medical service providers included in the PPO Network for the area where you will be receiving treatment by accessing the Internet website for WorldTrips: www.worldtrips.com. For assistance locating a provider, contact us at 1-800-605-2282.

U.S. Preferred Provider Organization (PPO) Requirements
Nothing contained in this insurance restricts or interferes with your right to select the hospital, physician or other medical service provider of your choice. Nothing contained in this insurance restricts or interferes with the relationship between you and the hospital, physician or other providers with respect to treatment or care of any condition, nor your right to receive, at your own expense, services and/or supplies that are not covered under this insurance.
To comply with the United States Preferred Provider Organization (PPO) requirements, you must receive medical treatment from PPO providers while in the United States. If you receive treatment from a PPO provider, we will remit payment for eligible expenses directly to the provider.
You may review a listing of hospitals, physicians and other medical service providers included in the PPO Network for the area where you will be receiving treatment by visiting WorldTrips’ website located at: www.worldtrips.com. For assistance locating a provider, contact us at 1-800-605-2282.


Why should insured choose provider within PPO Network in United States?

Choosing Provider WITHIN PPO Network in United States

Choosing Provider OUTSIDE PPO Network in United States

Provider has option to bill directly to insurance company.

Provider will not bill directly to insurance company. Insured has to collect claim documents from provider and submit to insurance company.

Insurance company already has pre-negotiated rates with provider for services and that is lower than regular rates. The provider will not bill insured excessive charge for eligible services.

Insurance company will pay maximum as per Usual, Reasonable and Customary (URC). The provider may bill insured for excessive charge (more than URC charge) for eligible services. The insured will be responsible for paying excessive charge.

Direct billing will speed up claim process and save time.

This is time consuming process and requires more of insured time. Insured has to collect claim documents from the provider and submit to insurance company with all medical records for services received.

Definition
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 geographic 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 where the charges are incurred; 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.

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 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 unused 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 sixty (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. The written appeal must be submitted within ninety (90) days from the later of the date the claim was denied or the termination date of the policy.

Claim Procedures
Claims Notification
All claims and related claim information, including a proof of claim, should be submitted to WorldTrips at the contact information below, or online as soon as possible.
Online: https://www.worldtrips.com/customer-service 
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 for an incident within sixty (60) days of the last day of your certificate period
(or for claims incurred during a benefit period, sixty (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 be submitted within ninety (90) days from the later of the date the claim was denied or the termination date of the policy. The 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: https://www.worldtrips.com/customer-service 
Email: appeals@worldtrips.com
Postal Mail: WorldTrips Appeals - P.O. Box 241778, 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.

Misrepresentation or Fraud
Application
We rely on the statements made by you on the application in connection with the making of the application in determining whether or not the individual(s) included on the application meets the eligibility requirements for insurance hereunder. Any determination by us of a misstatement or misrepresentation (whether intentional or not), concealment or fraud in the member’s application, or in relation to any statement or warranty made by the member or their authorized representative, whether in writing or otherwise, to us or our representatives, on or in connection with the application shall immediately render this insurance null and void and all claims hereunder shall be deemed non-payable in addition to any and all other remedies available to us.

Claims
We rely on the statements made by the member on the claimant’s statement and in connection with the submission of any claim hereunder in determining whether or not and to what extent benefits under this insurance may be payable. Any misstatement or misrepresentation (whether intentional or not), concealment or fraud in the making of any claim hereunder shall immediately render this insurance null and void and all claims hereunder shall be deemed non-payable and we reserve our rights regarding any and all other remedies available to us. If any claim under this insurance shall be in any respect fraudulent or if any fraudulent means or devices are used by the member or anyone acting on their behalf, this insurance shall be null and void and all claims hereunder shall be deemed non-payable and we reserve our rights regarding any and all other remedies available to us.

Renewal

The coverage provided under this Master Policy is for a maximum duration of twelve (12) months. Any extension of coverage is based upon the eligibility rules in force and is solely at our
discretion.