MEMBER ELIGIBILITY

Non-U.S. Citizens who are at least 14 days of age that are traveling outside of their home countries. Individuals age 80 and over as of the certificate effective date are subject to a $20,000 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;

 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;

c. The moment you depart from your home country; or

d. 12:01am U.S. Eastern Time on the date requested on the application.

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;

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).

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 US citizens or US 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.

DESCRIPTION OF COVERAGE SUMMARY

This Description of Coverage is a summary of the provisions contained in Master Policy No.181920- 2.1. For a complete copy of the Master Policy, please contact Tokio Marine HCC Medical Insurance Services Group.

This Description is to help you understand the insurance that your certificate provides. It details the key features, benefits, limitations, exclusions, definitions, Schedule of Benefits and Limits, and any endorsements, applying to your certificate.

The levels of coverage which apply to your coverage are detailed in the Schedule of Benefits and Limits.

IMPORTANT FEATURES OF YOUR TRAVEL INSURANCE

DEFINITIONS

This insurance policy has defined terms, indicated by bolded words (excluding headers). The defined terms may be found in the relevant benefit section or in the general definitions.

PRE-EXISTING CONDITIONS

This insurance policy excludes coverage for pre-existing conditions, except as provided for under the Acute Onset of Pre-existing Conditions benefit. This policy defines a pre-existing condition and provides the description of the Acute Onset of Pre-Existing Conditions benefit.

DATA PROTECTION

We respect individual privacy and value your confidence. We restrict access to personal information to employees/partners who need to know that information in order to perform their jobs. Any employee that we determine is in violation of this policy will be subject to disciplinary action, up to and including termination and criminal prosecution.

We will not disclose your personal information to third parties outside Tokio Marine HCC and our partners unless ordered to do so to comply with the law of the countries in which we do business or when complying with the legal process.

RIGHTS OF THIRD PARTIES

 You may assign benefits under this insurance to a hospital, physician or other provider. Any assignment shall not confer upon such hospital, physician or other provider, any right or privilege granted to you under this insurance except for the right to receive benefits, if any, which are determined to be due and payable hereunder. No hospital, physician or other provider shall have any direct or indirect claim or right of action against us.

LAW AND JURISDICTION

No action of law or equity may be brought to recover benefits under this insurance until 60 days after written proof of claim has been provided to us. No such action may be brought after the end of three (3) years after the time written proof of claim is required to be furnished. The validity, interpretation, and performance of this agreement shall be governed by and construed in accordance with the laws of Bermuda.

TOKIO MARINE HCC MEDICAL INSURANCE SERVICES GROUP (“MIS GROUP”)

 A subsidiary of Tokio Marine HCC, HCC Lloyd’s Syndicate 4141 is managed by HCC Underwriting Agency Ltd which is authorized by the Prudential Regulation Authority (PRA) and regulated by the Financial Conduct Authority (FCA) and the PRA. Registered in England and Wales No. 04632146. Registered office: 1 Aldgate, London EC3N 1RE, United Kingdom. Lloyd’s is authorised as an insurer in Spain by the Spanish insurance regulatory authority (Dirección General de Seguros y Fondos de Pensiones) under reference L0017.

These details can be checked on the Financial Services Register by visiting: www.fca.org.uk or contacting the Financial Conduct Authority on 0800 111 6768

DEFINITIONS

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

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

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

Acute Onset of Pain (Emergency Dental) means a sudden and unexpected occurrence of pain which occurs spontaneously and without advance warning, either in the form of physician or dentist recommendation or symptoms, including pain, which would have caused a prudent person to seek medical or dental attention prior to the onset of pain. Treatment must be obtained within 24 hours of the sudden and unexpected occurrence of pain.

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. The Acute Onset of a Pre-existing Condition(s) must occur after the certificate effective date. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A pre-existing condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute Onset. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the certificate effective date.

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

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

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

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

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

Coinsurance means your payment of eligible expenses at the percentage specified in the Schedule of Benefits and Limits.

Complications of Pregnancy means illnesses whose diagnoses are distinct from pregnancy, but are adversely affected by pregnancy or caused by pregnancy and not associated with a normal pregnancy. This includes: ectopic pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed abortion and conditions of comparable severity. Complications of Pregnancy does not include: false labor, edema, prolonged labor, prescribed rest during the period of pregnancy, morning sickness and conditions of comparable severity associated with management of a difficult pregnancy, and not constituting a medically distinct condition.

Crisis Response Fees and Expenses means all fees and expenses of Unity Resources Group related to your kidnapping or express kidnapping.

Custodial Care means that type of care or service, wherever furnished and by whatever name called, that is designed primarily to assist you in performing the activities of daily living. Custodial care also includes non-acute care for the comatose, semi-comatose, paralyzed or mentally incompetent patients.

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

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

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

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

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

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

Express Kidnapping means the actual or attempted abduction and holding of you against your will where your personal belongings and/or readily available assets are surrendered by you in exchange for your release.

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

Home Country means the country where you principally reside and receive regular mail.

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

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

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

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

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

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

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

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

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

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.

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

Member means an individual who is covered under this insurance.

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

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

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

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.

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

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.

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.

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

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

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

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

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

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

Urgent Care Center means a U.S. medical facility separate from a hospital emergency department

where ambulatory patients can be treated on a walk-in basis without an appointment and receive

immediate, non-routine urgent care for an injury or illness presented on an episodic basis.

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

1. One and a half times (150%) of the charges payable under the United States Medicare program, for claims incurred outside the PPO network within the U.S., or

2. Most common charge for similar services, medicines or supplies within the area in which the chargeis incurred, so long as those charges are reasonable. What is defined as usual, reasonable and

customary charges will be determined by us. In determining whether a charge is usual, reasonable

and customary, we may consider one or more of the following factors: the level of skill, extent of

training, and experience required to perform the procedure or service; the length of time required to Perform the procedure or services as compared to the length of time required to perform other similar services; the severity or nature of the illness or injury being treated; the amount charged for the same or comparable services, medicines or supplies in the locality; the amount charged for the same or comparable services, medicines or supplies in other parts of the country; the cost to the provider of providing the service, medicine or supply; such other factors we, in the reasonable exercise of discretion, determine are appropriate.

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

We/Us/Our means Tokio Marine HCC - Medical Insurance Services Group.

SCHEDULE OF BENEFITS AND LIMITS

Plan Details
Overall Maximum Limit	Age 80 or older: $20,000 Age 65 to 79: $100,000 All others: $250,000
Maximum per Injury / Illness	Age 80 or older: $20,000 Age 65 to 79: $100,000 All others: $250,000
Deductibles	$0, $250, $500, or $1,000 per certificate period
Coinsurance – Claims incurred outside U.S.	We will pay 100% of eligible expenses after the deductible up to the overall maximum limit.
Coinsurance – Claims incurred in U.S.
In-Network Payment	Within the PPO: We will pay 100% of eligible expenses, after the deductible, to the overall maximum limit
Out-of-Network Payment	Outside the PPO: Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount.

Eligible expenses are subject to deductible, coinsurance, 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, when covered illness or injury results in hospitalization as inpatient.
Emergency Room Co-payment	Claims incurred outside the U.S. No co-payment   Claims incurred in 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.
Urgent Care Center Co-payment	Claims incurred outside the U.S.  No co-payment   Claims incurred in U.S.  For each visit, you shall be responsible for a $50 co-payment, after which coinsurance will apply. – Co-payment is waived for members with a $0 deductible. – not subject to deductible
Outpatient Physical Therapy and Chiropractic Care	Usual, reasonable and customary charges. Must be ordered in advance by a physician.
Mental Health Disorders	Up to $5,000
Emergency Dental Treatment due to Accident	Up to $1,000
Emergency Dental (Acute Onset of Pain)	Up to $100 - not subject to deductible or coinsurance
Acute Onset of Pre-existing Condition (excludes chronic and congenital conditions)	Ages 65 and above: $2,500 All others: $25,000
Terrorism	Up to $50,000 lifetime maximum, eligible medical expenses only
Optional Hazardous Activities Rider	Up to the overall maximum limit
Optional Intercollegiate or Interscholastic Sports Rider	Up to $20,000
All Other Eligible Medical Expenses	Up to the overall maximum limit
Emergency Travel Benefits	Limit
Emergency Medical Evacuation	Up to $500,000 lifetime maximum - not subject to deductible, coinsurance, 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 - not subject to deductible or coinsurance
Crisis Response - Ransom, Personal Belongings, and Crisis Response Fees and Expenses	Up to $10,000 - not subject to deductible, coinsurance, or overall maximum limit
Emergency Reunion	Up to $15,000, subject to a maximum of 15 days - not subject to deductible or coinsurance
Bedside Visit	Up to $1,500 - not subject to deductible or coinsurance
Return of Minor Children	Up to $50,000 - not subject to deductible or coinsurance
Pet Return	Up to $1,000 - not subject to deductible or coinsurance
Political Evacuation	Up to $50,000 lifetime maximum - not subject to deductible or coinsurance
Trip Interruption	Up to $5,000 - not subject to deductible or coinsurance
Accidental Death & Dismemberment   Ages 18 through 69       Under age 18         Ages 70 through 74         Ages 75 and older	Lifetime Maximum - $50,000 Death - $50,000 Loss of 2 Limbs - $50,000  Loss of 1 Limb - $25,000   Lifetime Maximum - $5,000 Death - $5,000 Loss of 2 Limbs - $5,000  Loss of 1 Limb - $2,500   Lifetime Maximum - $20,000 Death - $20,000  Loss of 2 Limbs - $20,000 Loss of 1 Limb - $10,000   Lifetime Maximum - $10,000 Death - $10,000 Loss of 2 Limbs - $10,000 Loss of 1 Limb - $5,000 $250,000 maximum benefit any one family or group. - not subject to deductible, coinsurance, or overall maximum limit
Optional Enhanced Accidental Death & Dismemberment Rider (only available to members under age 70)	Lifetime Maximum - $50,000 Death - $50,000 Loss of 2 Limbs - $50,000 Loss of 1 Limb - $25,000 - not subject to deductible, coinsurance, or overall maximum limit
Lost Checked Luggage	Up to $500 - not subject to deductible or coinsurance
Travel Delay	Up to $100 a day after a 12-hour delay period requiring an unplanned overnight stay. Subject to a maximum of 2 days. - not subject to deductible or coinsurance
Lost or Stolen Passport/Travel Visa	Up to $100 - not subject to deductible or coinsurance
Natural Disaster - Replacement Accommodations	Up to $100 a day for 5 days - not subject to deductible or coinsurance
Hospital Indemnity	$100 per day for 5 days for inpatient hospitalization - not subject to deductible or coinsurance
Personal Liability	Up to: $10,000 lifetime maximum $10,000 third person injury $10,000 third person property $2,500 related third person property - not subject to deductible, coinsurance, or overall maximum limit

GENERAL EXCLUSIONS

Excluded Conditions, Treatments (includes Diagnoses, Tests, and Examinations), Services, Supplies, Acts, Omissions, and/or Events:
1. 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.
2. Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
3. Pregnancy except 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 14 days.
4. Impotency or sexual dysfunction.
5. All sexually transmitted diseases and conditions.
6. HIV, AIDS, or ARC, and all diseases caused by and/or related to HIV.
7. All forms of cancer / neoplasm.
8. Substance abuse or addiction or conditions that may be attributed to substance abuse or addictions and direct consequences thereof.
9. Acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, hypertrophic and atrophic conditions of skin, nevus.
10. Sleep apnea or other sleep disorders.
11. Obesity or weight modification, including but not limited to wiring of the teeth and all forms of intestinal bypass surgery.
12. Self-inflicted injury or illness and/or suicide or attempted suicide whether sane or insane.
13. Injury sustained that is due wholly or partially to the effects of intoxication or drugs other than drugs taken in accordance with treatment prescribed by a physician and except drugs prescribed for the treatment of substance abuse.
14. Injury sustained while operating any motorized vehicle, aircraft or watercraft whether registered or not while under the influence of alcohol as defined under the law of the jurisdiction where the injury occurs or with a
.08 Blood Alcohol Content (BAC), whichever is lower.
15. Routine medical examinations, including but not limited to vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to the suitability of employment or travel.
16. Dental treatment and treatment of the temporomandibular joint, except for emergency dental treatment necessary to replace sound natural teeth lost or damaged in an accident covered hereunder or for the emergency relief of acute onset of pain.
17. Promotion or prevention of conception including but not limited to: artificial insemination, treatment for infertility, sterilization or reversal of sterilization.
18. Organ or tissue transplants or related services.
19. Eye surgery, such as corrective refractory surgery, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
20. Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and any examination or fitting related to these devices, dentures or dental appliances, and all vision and hearing tests and examinations.
21. Orthoptics and visual eye training.
22. Orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails.
23. Hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed.
24. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinesiotherapy.
25. Psychometric, intelligence, competency, behavioral and educational testing.
26. Cosmetic or aesthetic reasons, except for reconstructive surgery when such surgery is directly related to and follows a surgery which was covered hereunder.
27. Modifications of the physical body intended to improve the psychological, mental or emotional well-being, including but not limited to sex-change surgery.
28. Exercise programs, whether or not prescribed or recommended by a physician.
29. Incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
30. Cryo preservation and implantation or re-implantation of living cells.
31. Genetic or predictive testing.
32. Investigational, experimental or for research purposes.
33. While confined primarily to receive custodial care, educational or rehabilitative care, or any medical treatment in any establishment for the care of the aged, except rehabilitative care received upon direct transfer from an acute care hospital.
34. Not medically necessary.
35. Not administered by or under the supervision of a physician, and products that can be purchased without a doctor's prescription.
36. Provided by a relative, family member or any person who ordinarily resides with you.
37. Provided at no cost to you.
38. Failure to keep a scheduled appointment.
39. Payable under any government system, including the Australian Medicare system.
40. Payable under Worker’s Compensation or Employer’s Liability Laws, or by any coverage provided or required by
law.
41. Charges exceeding usual, reasonable and customary.
42. 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.
43. 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 6 months immediately prior to your effective date or 2) within 10 days following the date the alert/warning is issued you have failed to depart the country or location. This exclusion does not apply to charges resulting from COVID-19/SARS-CoV-2.
44. War, military action or while on duty as a member of a police or military force unit.
45. Travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, Emergency Reunion, Natural Disaster, Return of Minor Children, Political Evacuation, Trip Interruption, and Trip Delay sections of this insurance.
46. Incurred outside your certificate period.
47. Submitted to us for payment more than 60 days after the last day of the certificate period.
48. When departure from the home country is to obtain treatment in the destination country/countries.
49. Complications or consequences of a treatment or condition not covered hereunder.
50. Not included as Eligible Expenses as described herein.

Acute Onset of Pre-existing Condition (excludes chronic and congenital conditions)

Ages 65 and above: $2,500  All others: $25,000

ACUTE ONSET OF PRE-EXISTING CONDITION

YOU ARE COVERED:

1. Charges for a sudden and unexpected outbreak or recurrence of a pre-existing condition(s) which:

a. Occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms; and

b. Is of short duration; and

c. Is rapidly progressive; and

d. Requires urgent care.

YOU ARE NOT COVERED unless you fulfill the following condition:

 1. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

YOU ARE NOT COVERED IF:

1. The Acute Onset of a Pre-existing Condition(s) occurs before the certificate effective date; or

2. The pre-existing condition is

• a chronic or congenital condition; or
• a complication or consequence of a chronic or congenital condition; or
• a condition that gradually becomes worse over time; or

 3. The charges are for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the certificate effective date; or

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

Definitions
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. The Acute Onset of a Pre-existing Condition(s) must occur after the certificate effective date. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A pre-existing condition that is a chronic or congenital condition, or a complication or consequence of a chronic or congenital condition, or a condition that gradually becomes worse over time will not be considered Acute Onset. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the certificate effective date.

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. Additionally, we will apply the in-network coinsurance applicable to the expenses.

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 choose to seek treatment from a PPO provider, we will remit payment for eligible expenses directly to the provider and we will waive the coinsurance applicable to the expenses.
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 at: www.worldtrips.com.  For assistance locating a provider, contact us at 1-800-605-2282.

Cancellation

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

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

CLAIMS

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

APPEALS AND COMPLAINTS

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

CLAIM PROCEDURES

You must submit a claim for any expenses to be paid by us. This includes treatment or services for which the medical provider will bill us directly. No payments will be made by us without you first submitting a claim.

Notice of claim, Claimant’s Statement and Authorization, and proof of claim must be mailed to:

WorldTrips
P.O. Box 2005
Farmington Hills, MI 48333-2005 USA

PROOF OF CLAIM

When we receive notice of a claim, we will provide you with forms for filing proof of claim. The following is considered to be proof of claim:

1. A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments;

2. Original itemized bills from physicians, hospitals and other medical providers; and

 3. Original receipts for any expenses which have already been paid by you or on your behalf.

Beginning on the last day of your certificate period, you shall have 60 days to provide us proof of claim (unless medical services were rendered after the certificate termination date, in which case you shall have 60 days from the date the claim is incurred). 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 the validity of 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 the incident or claim. Following notification of a claim, you shall provide, when asked, all authorizations necessary to obtain your medical records. If you do not 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, 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 program or agency funded by any government.

APPEAL AND COMPLAINTS PROCEDURE

APPEALING A CLAIM

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

Please provide your written appeal online or by postal mail at the following:

Online: http://service.worldtrips.com/
Email: appeals@worldtrips.com
Postal Mail:    WorldTrips Appeals
P.O. Box 2058
Farmington Hills, MI 48333
USA

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

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

COMPLAINTS PROCEDURE

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

Please provide your written complaint online or by postal mail at the following:

Online: http://service.worldtrips.com/
Email: appeals@worldtrips.com
Postal Mail: WorldTrips Appeals
P.O. Box 2058
Farmington Hills, MI 48333
USA

You will be contacted within 3 (three) business days of receiving your complaint to inform you of what action is being taken. We will try to resolve the problem and give you an answer within four weeks. If it will take longer than four weeks we will tell you when you can expect an answer.

If you are a UK citizen and you have not been given an answer within 8 (eight) weeks or should you remain dissatisfied, you may if you wish, refer your complaint to Lloyd’s, who will investigate and assess your complaint. Lloyd’s contact details are as follows:

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

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

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

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