Travel Insurance - Description of Coverage

 

Part A: Travel Arrangement Protection

TRIP CANCELLATION AND TRIP INTERRUPTION BENEFITS

Pre-Departure Trip Cancellation

We will pay a Pre-Departure Trip Cancellation Benefit, up to the amount in the Schedule if you are prevented from taking your Covered Trip due to your, an Immediate Family Member’s, or Traveling Companion’s, Sickness, Injury, or death or Other Covered Events as defined, that occur(s) before departure on your Covered Trip. The Sickness or Injury must: a) commence while your coverage is in effect under the Plan; b) require the examination and treatment by a Physician at the time the Covered Trip is canceled; and c) in the written opinion of the treating Physician, be so disabling as to prevent you from taking your Covered Trip.

Pre-Departure Trip Cancellation Benefits

We will reimburse you, up to the amount in the Schedule for the amount of prepaid, non-refundable, and unused Payments or Deposits that you paid for your Covered Trip. We will pay your additional cost as a result of a change in the per person occupancy rate for prepaid travel arrangements if a Traveling Companion’s Covered Trip is canceled for a covered reason and your Covered Trip is not canceled.

Post-Departure Trip Interruption

We will pay a Post-Departure Trip Interruption Benefit, up to the amount in the Schedule, if: 1) your arrival on your Covered Trip is delayed beyond the Scheduled Departure Date; or 2) you are unable to continue on your Covered Trip after you have departed on your Covered Trip due to your, an Immediate Family Member’s, or Traveling Companion’s, Sickness, Injury, or death or Other Covered Events as defined. For item 1) above, the Sickness or Injury must: a) commence while your coverage is in effect under the Plan; b) for item 2) above, commence while you are on your Covered Trip and your coverage is in effect under the Plan; and c) for both items 1) and 2) above, require the examination and treatment by a Physician at the time the Covered Trip is interrupted or delayed; and d) in the written opinion of the treating Physician, be so disabling as to delay your arrival on your Covered Trip or to prevent you from continuing your Covered Trip.

Post-Departure Trip Interruption Benefits

We will reimburse you, less any refund paid or payable, for unused land or water travel arrangements and/or the following: 1) the additional transportation expenses by the most direct route from the point you interrupted your Covered Trip: a) to the next scheduled destination where you can catch up to your Covered Trip; or b) to the final destination of your Covered Trip; 2) the additional transportation expenses incurred by you by the most direct route to reach your original Covered Trip destination if you are delayed and leave after the Scheduled Departure Date. However, the benefit payable under 1) and 2) above will not exceed the cost of a one-way economy airfare by the most direct route less any refunds paid or payable for your unused original tickets. 3) your additional cost as a result of a change in the per person occupancy rate for prepaid travel arrangements if a Traveling Companion’s Covered Trip is interrupted and your Covered Trip is continued. 4) reasonable additional accommodation and transportation expenses (up to $100 per day) incurred to remain near a covered traveling Immediate Family Member or Traveling Companion who is hospitalized during your Trip.

In no event shall the amount reimbursed under Trip Cancellation or Trip Interruption exceed the amount you prepaid for your Trip.

Important: You, your Traveling Companion and your Immediate Family Member booked to travel with you must be medically capable of travel on the day you purchase this coverage. The covered reason for cancellation or interruption of your Trip must occur after your effective date of Trip Cancellation coverage. In all circumstances, coverage does not apply for Financial Insolvency if Financial Insolvency occurred, or a petition for bankruptcy was filed by the travel supplier, before your effective date of coverage or a Financial Insolvency occurs within 7 days following your effective date of coverage.

“Other Covered Events” means only the following unforeseeable events or their consequences which occur while coverage is in effect under this Policy: 1) arrangements canceled by a tour operator, cruise line, or airline, resulting from Financial Insolvency; Item #1 above is subject to your plan payment being received within 14 days of the initial deposit payment for your Covered Trip; 2) a change in plans by you, an Immediate Family Member traveling with you, or Traveling Companion resulting from one of the following events which occurs while coverage is in effect under this Policy: a) being directly involved in a documented traffic accident while en route to departure; b) being hijacked, required to serve on a jury, or required by a court order to appear as a witness in a legal action, provided you, an Immediate Family Member traveling with you or a Traveling Companion is not: 1) a party to the legal action, or 2) appearing as a law enforcement officer; c) having your Home made uninhabitable by fire, flood, volcano, earthquake, hurricane or other natural disaster; d) a Terrorist Act which occurs in your departure city or in a foreign city which is a scheduled destination for your Covered Trip provided: 1) The Terrorist Act occurs within 30 days of the Scheduled Departure Date for your Covered Trip; 2) Your payment for the plan is received within 14 days of the initial deposit payment for your Covered Trip. e) Your involuntary termination of employment or layoff which occurs after your effective date of coverage and was not under your control. This provision is not applicable to temporary employment, independent contractors or self-employed persons. f) being unable to undergo an injection, due to a medical reason, which is unexpectedly and suddenly required for entry into a country of destination, provided that such a requirement was unknown at the time travel arrangements were made; g) are required to take an academic examination on a date that has been fixed after travel arrangements were made, and the date falls within the period of travel; h) scheduled public transportation is cancelled as a result of riot, civil commotion, strikes, hijacking, natural disasters, motor or railway accidents, not reasonably expected at the time coverage is purchased; i) becomes legally separated or divorced after the purchase of insurance and prior to your scheduled departure date provided the insurance was purchased within 14 calendar days of the date of your Initial Trip Payment or Deposit date.

Trip Delay

If your Covered Trip is delayed for 12 hours or more, we will reimburse you, up to the amount shown in the Schedule for unused land and water travel arrangements, less any refund paid or payable and reasonable additional expenses incurred by you for hotel accommodations, meals, telephone calls and economy transportation to catch up to your Trip, or to return Home. We will not pay benefits for expenses incurred after travel becomes possible. Trip Delay must be caused by or result from: 1) Common Carrier delay; 2) loss or theft of your passport(s), travel documents or money; 3) natural disaster; 4) unannounced strike.

Part B: Medical Protection

Medical Expense/Emergency Assistance Benefits

We will pay this benefit, up to the amount on the Schedule for the following Covered Expenses incurred by you, subject to the following: 1) Covered Expenses will only be payable at the Usual and Customary level of payment; 2) benefits will be payable only for Covered Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on a Covered Trip; 3) benefits payable as a result of incurred Covered Expenses will only be paid after benefits have been paid under any Other Valid and Collectible Group Insurance in effect for you. We will pay that portion of Covered Expenses which exceed the amount of benefits payable for such expenses under your Other Valid and Collectible Group Insurance. We will advance payment to a Hospital, up to $25,000, if needed to secure your medically necessary admission.

Covered Expenses:

Accident Medical Expense/Sickness Medical Expense:

1) expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you within one year from the date of your Sickness or Injury;

2) expenses for emergency dental treatment incurred by you during a Covered Trip;

Emergency Evacuation:

3) expenses incurred by you for Physician-ordered emergency medical evacuation, including medically appropriate transportation and necessary medical care en route, to the nearest suitable Hospital, when you are critically ill or injured and no suitable local care is available, subject to the Program Medical Advisors prior approval;

4) expenses incurred for non-emergency medical evacuation, including medically appropriate transportation and medical care en route, to a Hospital or to your place of residence, when deemed medically necessary by the attending Physician, subject to the Program Medical Advisors prior approval;

5) expenses for transportation not to exceed the cost of one round-trip economy class air fare to the place of hospitalization for one person chosen by you, provided that you are traveling alone and are hospitalized for more than 7 days;

6) expenses for transportation not to exceed the cost of one-way economy class air fare to your place of residence, including escort expenses if you are 18 years of age or younger and left unattended due to the death or hospitalization of an accompanying adult(s), subject to the Program Medical Advisors prior approval;

7) expenses for one-way economy class air fare to your place of residence, from a medical facility to which you were previously evacuated, less any refunds paid or payable from your unused transportation tickets, if these expenses are not covered elsewhere in the Plan.

Repatriation:

8) repatriation expenses for preparation and air transportation of your remains to your place of residence, if you die while on your Covered Trip.

Losses Not Covered:

We will not pay Medical Expense/Emergency Assistance Benefits if your Covered Trip destination is traveling to your Home and the Covered Trip is longer than 396 days.

Please Note: In no event will all benefits paid for Emergency Evacuation and Repatriation expenses exceed the coverage limit of $250,000.

Please note: Benefits under Parts A & B (except Emergency Evacuation and Repatriation) are subject to the Pre-Existing Condition Exclusion as defined below.

“Pre-Existing Condition” means an illness, disease, or other condition during the 60 day period immediately prior to your effective date for which you your Traveling Companion or Immediate Family Member who is scheduled or booked to travel with you:

1.) received or received a recommendation for a diagnostic test, examination, or medical treatment; or

2.) took or received a prescription for drugs or medicine Item 2) of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the 60 day period before coverage is effective under this Policy.

Waiver of the Pre-Existing Condition Exclusion

The Pre-Existing Condition Exclusion is waived provided you meet all of the following requirements:

1.) the payment for this plan and enrollment form is received within 14 days of the initial Trip deposit for your Covered Trip;

2.) you are not disabled from travel at the time you make your plan payment;

3.) the amount of Trip Cancellation coverage purchased at the time equals the full duration of the Covered Trip. The duration of any subsequent arrangements added to your Covered Trip (or any other arrangements not made through your travel agent) must be insured within 7 days of the payment for those arrangements; and

4) the Covered Trip cost per person is no more than $20,000.

If you have any questions concerning this exclusion, please call BerkelyCare at 1-800-387-2427 for further clarification.

Part C: Baggage Protection

Baggage and Personal Effects Benefit

We will reimburse you, less any amount paid or payable from any other valid and collectible insurance or indemnity, up to the amount shown in the Schedule, for direct loss, theft, damage or destruction of your Baggage during your Covered Trip.

Valuation and Payment of Loss

Payment of loss under the Baggage and Personal Effects Benefit will be calculated based upon an Actual Cash Value basis. For items without receipts, payment of loss will be calculated based upon 80% of the Actual Cash Value at the time of loss. At our option, we may elect to repair or replace your Baggage. We will notify you within 30 days after we receive your proof of loss. We may take all or part of a damaged Baggage as a condition for payment of loss. In the event of a loss to a pair or set of items, we will: 1) repair or replace any part to restore the pair or set to its value before the loss; or 2) pay the difference between the value of the property before and after the loss.

Items Subject to Special Limitations

We will not pay more than $500 (or the Baggage and Personal Effects limit, if less) on all losses to jewelry; watches; precious or semi-precious gems; decorative or personal articles consisting in whole or in part of silver, gold, or platinum; cameras, camera equipment; digital or electronic equipment and media; and articles consisting in whole or in part of fur.

Baggage Delay Benefit

We will reimburse you, less any amount paid or payable from any other valid and collectible insurance or indemnity, up to the amount shown in the Schedule for the cost of reasonable additional clothing and personal articles purchased by you, if your Baggage is delayed by a Common Carrier for 24 hours or more during the Covered Trip. You must be a ticketed passenger on a Common Carrier. This coverage terminates upon your arrival at the return destination of your Covered Trip.

Part D: Travel Accident Protection

Accidental Death and Dismemberment

We will pay this benefit up to the amount on the Schedule if you are injured in an Accident which occurs while you are on a Covered Trip and covered under the Plan, and you suffer one of the losses listed below within 365 days of the Accident. The Principal Sum is the benefit amount shown on the Schedule.

Loss: Percentage of Principal Sum Payable:

Life..........................................................................................100%

Both Hands; Both Feet or Sight of Both Eyes.............................100%

One Hand and One Foot..........................................................100%

One Hand and Sight of One Eye.............................................100%

One Foot and Sight of One Eye..............................................100%

One Hand; One Foot or Sight of One Eye..................................50%

If you suffer more than one loss from one Accident, we will pay only for the loss with the larger benefit. Loss of a hand or foot means complete severance at or above the wrist or ankle joint. Loss of sight of an eye means complete and irrecoverable loss of sight.

Exposure and Disappearance

If by reason of an Accident covered by the Plan, you are unavoidably exposed to the elements and as a result of such exposure suffer a loss for which benefits are otherwise payable, such loss shall be covered hereunder. If you are involved in an Accident which results in the sinking or wrecking of a conveyance in which you were riding and your body is not located within one year of such Accident, it will be presumed that you suffered loss of life resulting from Injury caused by the Accident.

Air Common Carrier Benefits

The benefits provided by the Plan for air flight applies only if you sustain a covered loss in an Accident which occurs 1) while a passenger in or on, boarding or alighting from an Air Common Carrier; or 2) being struck or run down by an Air Common Carrier of a regularly scheduled airline or an air charter company that is licensed to carry passengers for hire.

Part E: Worldwide Emergency Assistance (AIG Assist)

Not a care in the world… when you have our 24/7 global network to assist you on your travels.

• CareFree™ Travel Assistance
• Medical Assistance
• Emergency Services

CareFreeTM Travel Assistance

Travel Arrangements

• Arrangements for last-minute flight and hotel changes
• Luggage Locator (reporting/tracking of lost, stolen or delayed baggage)
• Hotel finder and reservations
• Airport transportation
• Rental car reservations and automobile return
• Coordination of travel for visitors to bedside
• Return travel for dependent/minor children
• Assistance locating the nearest embassy or consulate
• Cash transfers
• Assistance with bail bonds

Pre-Trip Information

• Destination guides (hotels, restaurants, etc.)
• Weather updates and advisories
• Passport requirements
• Currency exchange
• Health and safety advisories

Documents and Communication

• Assistance with lost travel documents or passports
• Live email and phone messaging to family and friends
• Emergency message relay service
• Multilingual translation and interpretation services

Medical Assistance Services

• Medical case management, consultation and monitoring
• Medical Transportation
• Dispatch of a doctor or specialist
• Referrals to local medical and dental service providers
• Worldwide medical information, up-to-the-minute travel medical advisories, and immunization requirements
• Prescription drug replacement
• Replacement of eyeglasses, contact lenses and dental appliances

Emergency Services

• Emergency evacuation
• Repatriation of mortal remains
• Emergency medical and dental assistance
• Emergency legal assistance
• Emergency medical payment assistance
• Emergency family travel arrangements

CareFree™ Travel Assistance, Medical Assistance and Emergency Services can be accessed by calling On Call International at 1-800-618-0692 or, from outside the U.S. or Canada, call collect*: 1-603-898-2679.

* If you have any difficulty making this collect call, contact the local phone operator to connect you to a US-based long-distance service. In this case, please let the Assistance Provider answering the phone know the number you are calling from, so that he/she may call you back. Any charges for the call will be considered reimbursable benefits.

Note that the problems of distance, information, and communications make it impossible for Stonebridge Casualty Insurance Company, BerkelyCare, STA Travel, or On Call International to assume any responsibility for the availability, quality, use, or results of any emergency service. In all cases, you are still responsible for obtaining, using, and paying for your own required services of all types.

DEFINITIONS

In the certificate, “you”, “your” and “yours” refer to the Insured. “We”, “us” and “our” refer to the company providing the coverage. In addition certain words and phrases are defined as follows:

“Accident” means a sudden, unexpected, unintended and external event, which causes Injury.

“Actual Cash Value” means purchase price for items of like kind and quality less depreciation.

“Air Common Carrier” means any air conveyance operated under a license for the transportation of passengers for hire.

“Baggage” means luggage, personal possessions and travel documents taken by you on the Covered Trip.

“Common Carrier” means any land, water or air conveyance operated under a license for the transportation of passengers for hire, not including taxicabs or rented, leased or privately-owned motor vehicles.

“Covered Trip” means: a period of round-trip travel away from Home to a destination outside your city of residence; the purpose of the Trip is business or pleasure and is not to obtain health care or treatment of any kind; the Trip does not exceed 396 days.

“Domestic Partner” means a person who is at least eighteen years of age and you can show: 1) evidence of financial interdependence, such as joint bank accounts or credit cards, jointly-owned property, and mutual life insurance or pension beneficiary designations; 2) evidence of cohabitation for at least the previous 6 months; and 3) an affidavit of domestic partnership if recognized by the jurisdiction within which they reside.

“Elective Treatment and Procedures” means any medical treatment or surgical procedure that is not medically necessary including any service, treatment, or supplies that are deemed by the federal, or a state or local government authority, or by us to be research or experimental or that is not recognized as a generally accepted medical practice.

“Financial Insolvency” means the complete suspension of operations due to insolvency, with or without the filing of a bankruptcy petition, whether voluntary or involuntary, by a tour operator, cruise line, or airline other than STA Travel or the person, organization, agency or firm from whom you directly purchased or paid for your Covered Trip, provided the Financial Insolvency occurs more than 7 days following your effective date for the Trip Cancellation Benefits. There is no coverage for the complete suspension of operations for losses caused by fraud or negligent misrepresentation by the supplier of travel services.

“Home” means your primary or secondary residence.

“Hospital” means an institution, which meets all of the following requirements:1) it must be operated according to law; 2) it must give 24 hour medical care, diagnosis and treatment to the sick or injured on an inpatient basis; 3) it must provide diagnostic and surgical facilities supervised by Physicians; (4) registered nurses must be on 24 hour call or duty; and (5) the care must be given either on the hospital’s premises or in facilities available to the hospital on a prearranged basis. A Hospital is not: a rest, convalescent, extended care, rehabilitation or other nursing facility; a facility which primarily treats mental illness, alcoholism, or drug addiction (or any ward, wing or other section of the hospital used for such purposes); or a facility which provides hospice care (or wing, ward or other section of a hospital used for such purposes).

“Immediate Family Member” includes your or the Traveling Companion’s spouse, child, son-daughter-in-law, parent(s),

sibling(s), grandparent(s), grandchild, step brother-sister, stepparent(s), parent(s)-in-law, brother-sister-in-law, aunt, uncle, niece, nephew, guardian, Domestic Partner, or ward.

“Injury” means bodily harm caused by an accident which: 1) occurs while your coverage is in effect under the Plan; and 2) requires examination and treatment by a Physician. The Injury must be the direct cause of loss and must be independent of all other causes and must not be caused by, or result from, Sickness.

“Insured” means an eligible person who arranges a Covered Trip, completes any required enrollment form, and pays any required plan payment.

“Insurer” means Stonebridge Casualty Insurance Company.

“Other Valid and Collectible Group Insurance” means any group policy or contract which provides for payment of medical expenses incurred because of Physician, nurse, dental or Hospital care or treatment; or the performance of surgery or administration of anesthesia. The policy or contract providing such benefits includes group or blanket insurance policies; service plan contracts; employee benefit plans; or any plan arranged through an employer, labor union, employee benefit association or trustee; or any group plan created or administered by the federal or a state or local government or its agencies. In the event any other group plan provides for benefits in the form of services in lieu of monetary payment, the usual and customary value of each service rendered will be considered a Covered Expense.

“Payments or Deposits” means the cash, check, or credit card amounts actually paid to the travel supplier for your Covered Trip.

“Physician” means a person licensed as a medical doctor by the jurisdiction in which he/she is resident to practice the healing arts. He/she must be practicing within the scope of his/her license for the service or treatment given and may not be you, a Traveling Companion, or an Immediate Family Member of yours.

“Policy” means the contract issued to the Policyholder providing the benefits specified herein.

“Policyholder” means the legal entity in whose name this Policy is issued, as shown on the Benefit Schedule.

“Program Medical Advisors” means On Call International.

“Schedule” means the Benefit schedule shown on the Certificate for each Insured.

“Scheduled Departure Date” means the date on which you are originally scheduled to leave on your Covered Trip.

“Scheduled Return Date” means the date on which you are originally scheduled to return to the point where the Covered Trip started or to a different final destination.

“Scheduled Departure City” means the city where the scheduled Trip on which you are to participate originates.

“Sickness” means an illness or disease of the body which:

1) requires examination and treatment by a Physician, and

2) commences while the plan is in effect. An illness or disease of the body which first manifests itself and then worsens or becomes acute prior to the effective date of this plan is not a Sickness as defined herein and is not covered by the Plan.

“Terrorist Act” means an act of violence, other than civil disorder or riot, (that is not an act of war, declared or undeclared) that results in loss of life or major damage to property, by any person acting alone or on behalf of or in connection with any organization which is generally recognized as having the intent to overthrow or influence the control of any government.

“Traveling Companion” means a person whose name(s) appear(s) with you on the same Trip arrangement and who, during the Trip, will accompany you.

“Trip” means a scheduled round-trip for which coverage has been elected and the plan payment paid, and all travel arrangements are arranged prior to the Scheduled Departure Date of the trip. Also covered by this definition are any direct round trip air flights booked by others, to and from the scheduled Covered Trip departure and return cities, provided the dates of travel for the air flights are within 1 total day of the scheduled land tour or cruise dates.

“Usual and Customary Charge” means those charges for necessary treatment and services that are reasonable for thetreatment of cases of comparable severity and nature. This will be derived from the mean charge based on the experience in a related area of the service delivered and the MDR (Medical Data Research) schedule of fees valued at the 90th percentile.