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IMPORTANT
The Pre-Existing Condition Exclusion is waived provided you
meet the following requirements: 1) premium for this coverage is received
within 15 days of the initial deposit/payment for your Trip and 2) you are
not disabled from travel at the time you pay your premium. Please note: This policy may
not be purchased after you have made final payment for your Trip.
Exception: If you
make only one payment in full for your Trip, your premium must be received
no later than 15 days after your Trip payment. |
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Part A - Schedule
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Pre-Departure Trip Cancellation |
Amount Purchased * |
| Post-Departure Trip Interruption |
Amount Purchased * | |
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Part B - Schedule
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Medical Expense/Emergency Assistance |
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| Accident & Sickness Medical Expense |
$50,000 |
| Emergency Evacuation and Repatriation |
$100,000 |
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Travel Delay (Up to $100 Per Day) |
$500 |
| Baggage and Personal Effects |
$1,000 |
| Baggage Delay |
$100 |
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Accidental Death and Dismemberment |
$25,000 |
* The maximum amount payable for Pre-Departure Trip
Cancellation or Post-Departure Trip Interruption will be the lesser of the
amount of coverage purchased or the Trip cost.
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A person who has arranged to take a Trip and pays the
required premium, and is a citizen or resident of the United States of
America or Canada.
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The Pre-Departure Trip Cancellation
Benefit is effective on the earlier of:
1) at 12:01 A.M. Standard Time on the day after the date
the premium is received; or
2) if mailed, at 12:01 A.M. Standard Time on the day
after the postmark date.
Post-Departure Trip Interruption coverage will take
effect on the Scheduled Departure Date. All coverages (except
Pre-Departure Trip Cancellation and Post-Departure Trip Interruption) will
take effect on the later of: 1) the date the premium has been received; 2)
the date and time you start your Trip; or 3) 12:01 A.M. Standard Time on
the Scheduled Departure Date of your Trip. |
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Your coverage
automatically ends on the earlier of: 1) the date the Trip is completed;
2) the Scheduled Return Date; 3) your arrival at the return destination on
a round-trip, or the destination on a one-way trip; 4) cancellation of the
Trip covered by the Policy.
Termination of the policy will not
affect a claim for loss that occurs after premium has been
paid.
All coverages under the policy will be extended if your
entire Trip is covered by the policy and your return is delayed by
unavoidable circumstances beyond your control.
If coverage is extended for the above reasons,
coverage will end on the earlier of the date you reach your originally
scheduled return destination or seven (7) days after the Scheduled Return
Date.
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Please see the Definitions for an
explanation of Pre-Existing Conditions which are excluded under the
Pre-Departure Trip Cancellation, Post-Departure Trip Interruption,
Travel Delay and Medical Expense/Emergency Assistance Benefits.
(Unless this exclusion is waived, see Waiver
of the Pre-Existing Condition Exclusion for
details) |
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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 Trip due to your, an Immediate
Family Member’s, Traveling Companion’s, or Business Partner’s Sickness,
Injury, or death, that occurs before departure on your Trip. The Sickness
or Injury must: a) commence while your coverage is in effect under the
policy; b) require the examination and treatment by a Physician at the
time the Trip is canceled; and c) in the written opinion of the treating
Physician, be so disabling as to prevent you from taking your Trip. We
will pay a benefit if you are prevented from taking your Trip due to Other
Covered Events, as defined, that occur before departure on your
Trip.
Pre-Departure Trip Cancellation
Benefits: We will reimburse you, up to the
amount in the Schedule for the amount of prepaid, forfeited,
non-refundable Payments or Deposits that you paid for your 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
Trip is canceled and your 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 Trip is delayed beyond the Scheduled
Departure Date or 2) you are unable to continue on your Trip after you
have departed on your Trip due to your, an Immediate Family Member’s,
Traveling Companion’s, or Business Partner’s Sickness, Injury, or
death.
For item 1) above, the Sickness or Injury must: a) commence
while your coverage is in effect under the policy; b) for item 2) above,
commence while you are on your Trip and your coverage is in effect under
the policy; and c) for both items 1) and 2) above, require the examination
and treatment by a Physician at the time the 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 Trip or to prevent you from
continuing your Trip.
We will pay a benefit if: 1) your arrival on
your Trip is delayed beyond the Scheduled Departure Date or 2) you are
unable to continue on your Trip after you have departed on your Trip due
to Other Covered Events, as defined.
Post-Departure Trip Interruption Benefits: We will reimburse you, less any refund paid or payable,
for unused land or water travel arrangements, plus one of the
following:
(1) the additional transportation expenses by the most
direct route from the point you interrupted your Trip: a) to the next
scheduled destination where you can catch up to your Trip; or b) to the
final destination of your Trip; or
(2) the additional
transportation expenses incurred by you by the most direct route to reach
your original 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 air fare (or
first class, if the original tickets were first class) 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 Trip is interrupted and your Trip is continued.
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Medical Expense/Emergency
Assistance
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 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 provisions.
(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 during a Trip;
(2) expenses for emergency
dental treatment incurred by you during a Trip;
(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 in the United States of America or Canada, 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 in the United States of America
or Canada, 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 (or first
class, if your original tickets were first class) to your place of
residence in the United States of America or Canada, 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 policy;
(8) repatriation expenses for
preparation and air transportation of your remains to your place of
residence in the United States of America or Canada, or up to an
equivalent amount for a local burial in the country where death occurred,
if you die while outside the United States of America or
Canada.
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Travel Delay
If your Trip is delayed for 12 hours
or more, we will reimburse you, up to the amount shown in the Schedule for
reasonable additional expenses incurred by you for hotel accommodations,
meals, telephone calls and local transportation while you are delayed. We
will not pay benefits for expenses incurred after travel becomes
possible.
Travel Delay must be caused
by or result from: 1) Common Carrier delay; or
2) loss or theft of your passport(s), travel documents or money; or 3)
quarantine; or 4) hijacking; or 5) natural disaster or closure of public
roadways by government authorities due to adverse weather; or 6) Injury or
Sickness of you, an Immediate Family Member traveling with you, or a
Traveling Companion; or 7) death of you, an Immediate Family Member
traveling with you, or a Traveling Companion. |
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Baggage and Personal Effects
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, passports or visas during your Trip. We will also pay for
loss due to unauthorized use of your credit cards, if you have complied
with all of the credit card conditions imposed by the credit card
companies.
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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 75% 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. Items not
included above are subject to a $250 per item limit.
Items Not Covered: We will not pay for damage to or
loss of: 1) animals; 2) property used in trade, business or for the
production of income, household furniture, musical instruments, brittle or
fragile articles, or sporting equipment if the loss results from the use
thereof; 3) boats, motors, motorcycles, motor vehicles, aircraft, and
other conveyances or equipment, or parts for such conveyances; 4)
artificial limbs or other prosthetic devices, artificial teeth, dental
bridges, dentures, dental braces, retainers or other orthodontic devices,
hearing aids, any type of eyeglasses, sunglasses or contact lenses; 5)
documents or tickets, except for administrative fees required to reissue
tickets; 6) money, stamps, stocks and bonds, postal or money orders,
securities, accounts, bills, deeds, food stamps or credit cards, except as
noted above; 7) property shipped as freight or shipped prior to the
Scheduled Departure Date; 8) contraband.
Losses Not Covered: We will not pay for loss arising
from: 1) defective materials or craftsmanship; or 2) normal wear and tear,
gradual deterioration, inherent vice; or 3) rodents, animals, insects or
vermin; or 4) theft or pilferage from an unattended vehicle; or 5)
mysterious disappearance; or 6) electrical current, including electric
arcing that damages or destroys electrical devices or
appliances.
Notice to Florida
Residents: Your homeowners policy, if any, may provide coverage for
loss of personal effects. You are not required to purchase baggage
insurance in connection with purchase of tickets or with the lease or
rental of a motor vehicle.
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Baggage Delay
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 for 24 hours or more during your Trip. We
will also reimburse you up to $25 for expenses incurred during your Trip
to expedite the return of your delayed Baggage. This coverage terminates
upon your arrival at the return destination of your Trip.
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 Trip and covered under the
policy, 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.
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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. |
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In this
Policy, “you”, “your” and “yours” refer to the Insured. “We”, “us” and
“our” refer to the company providing this insurance. In addition certain
words and phrases are defined as follows:
“Actual Cash Value” means current replacement cost
for items of like kind and quality less depreciation.
“Air 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 Trip.
“Business Partner” means an individual who is
involved, as a partner, with you in a legal general partnership and shares
in the management of the business.
“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.
“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 total cessation of operations due to
insolvency, with or without the filing of a bankruptcy petition, or the
total cessation of operations following the filing of a bankruptcy
petition, by a tour operator, cruise line or airline, other than the
person, organization, agency or firm from whom you directly purchased or
paid for your Trip provided the Financial Insolvency occurs more than 15
days following your effective date for the Trip Cancellation Benefits.
“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 pre-arranged 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, spouse’s child, son-daughter-in-law, parent(s), sibling(s),
grandparent(s), grandchild, step brother-sister, step-parent(s),
parent(s)-in-law, brother-sister-in-law, aunt, uncle, niece, nephew,
guardian, Domestic Partner, foster-child, or ward.
“Injury” means bodily harm caused by an accident
which: 1) occurs while your coverage is in effect under the policy; 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
Trip and pays any required premium.
“Insurer” means Stonebridge Casualty Insurance
Company.
“Other Covered
Events” means only the following unforeseeable events or their
consequences which occur while coverage is in effect under this
Policy:
1. Air Carrier delays resulting from organized labor
strikes that affect public transportation;
2. arrangements canceled
by an airline, cruise line, or tour operator, resulting from inclement
weather or organized labor strikes that affect public
transportation;
3. arrangements canceled by an
airline, cruise line, or tour operator, resulting from Financial
Insolvency.
Item #3 above is subject to
your premium being received within 15 days of the initial deposit/payment
for your Trip.
4. 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, quarantined, 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) your Home is made uninhabitable
by fire, flood, volcano, earthquake, hurricane or other natural disaster;
d) being called into active military service to provide aid or relief in
the event of a natural disaster; e) a documented theft of passports or
visas; f) a transfer of employment of 250 miles or more;g)
a Terrorist
Act which occurs in your departure city or in a city which is a
scheduled destination for your Trip provided: 1) the Terrorist Act occurs
within 30 days of the Scheduled Departure Date for your Trip; and 2) your
premium is received within 15 days of the initial deposit/payment for your
Trip.
“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 for your Trip.
Payments made in the form of a certificate, voucher or discount are not
Payments or Deposits as defined herein.
“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 Declarations.
“Pre-Existing Condition” means an
illness, disease, or other condition during the 60 day period immediately
prior to your effective date for which you or your Traveling Companion or
Immediate Family Member 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.
“Program Medical Advisors” means ON CALL
INTERNATIONAL.
“Scheduled Departure
Date” means the date on which you are originally scheduled to leave
on your Trip.
“Scheduled Return Date”
means the date on which you are originally scheduled to return to the
point where the Trip started or to a different final
destination.
“Sickness” means an
illness or disease of the body which: 1) requires examination and
treatment by a Physician, and 2) commences while the insurance 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
insurance is not a Sickness as defined herein and is not covered by the
policy.
“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 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
appears with yours on the same Trip arrangement and who, during the Trip,
will share accommodations with you in the same room, cabin, condominium
unit, apartment unit, or other lodging.
“Trip” means a scheduled trip for which coverage has
been elected and the premium paid, and all travel arrangements are
arranged prior to the Scheduled Departure Date of the Trip.
“Usual and Customary Charge” means those charges
for necessary treatment and services that are reasonable for the treatment
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.
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The following exclusion applies to the
Accidental Death and Dismemberment coverage:
1. We will not pay for loss caused by or resulting
from Sickness of any kind.
The following
exclusion applies to the Medical Expense/Emergency Assistance,
Pre-Departure Trip Cancellation, Post-Departure Trip Interruption, and
Travel Delay coverages:
2. We
will not pay for loss or expense caused by or incurred resulting from a
Pre-Existing Condition, as defined in the policy, including death that
results therefrom. This Exclusion does not apply to benefits under covered
expenses item #3 (emergency medical evacuation) or item #8 (repatriation
of remains) of the Medical Expense/Emergency Assistance Benefits
coverage.
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The following exclusion applies to all
coverages:
3. We will not pay
for any loss under the policy, caused by, or resulting from: a) suicide, attempted suicide, or intentionally
self-inflicted injury of you, a Traveling Companion, Immediate Family
Member, or Business Partner booked to travel with you, while sane or
insane (while sane in CO & MO); b)
mental, nervous, or psychological disorders;
c) being under the influence of drugs or intoxicants, unless
prescribed by a Physician; d) normal
pregnancy or resulting childbirth or elective abortion; e) participation as a professional in athletics;
f) participation in organized amateur and
interscholastic athletic or sports competition or events; g) riding or driving in any motor competition;
h) declared or undeclared war, or any act of
war; i) civil disorder;
j) service in the armed forces of any country; k) nuclear reaction, radiation or radioactive
contamination; l) operating or learning to
operate any aircraft, as pilot or crew; m)
mountain climbing, bungee cord jumping, skydiving, parachuting, hang
gliding, parasailing or travel on any air supported device, other than on
a regularly scheduled airline or air charter company; n) any unlawful acts, committed by you or a
Traveling Companion (whether insured or not); o) any amount paid or payable under any Worker’s
Compensation, Disability Benefit or similar law; p) a loss or damage caused by detention,
confiscation or destruction by customs; q)
Elective Treatment and Procedures; r) medical
treatment during or arising from a Trip undertaken for the purpose or
intent of securing medical treatment; s)
business, contractual or educational obligations of you, an Immediate
Family Member, Business Partner, or Traveling Companion; t) Financial Insolvency of the person, organization
or firm from whom you directly purchased or paid for your Trip, Financial
Insolvency which occurred before your effective date for the Trip
Cancellation Benefits, or Financial Insolvency which occurs within 15 days
following your effective date for the Trip Cancellation Benefits; u) failure of any tour operator, Common Carrier, or
other travel supplier, person or agency to provide the bargained-for
travel arrangements other than Financial Insolvency; v) a loss that results from an illness, disease, or
other condition, event or circumstance which occurs at a time when the
policy is not in effect for you.
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| Important Note: Exclusion 3, Item v above,
applies to you, an Immediate Family Member, Traveling Companion, or
Business Partner. | |
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International Travelers Assistance |
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24-hour Telephone Service–Multi-lingual
professionals are available 24 hours a day to provide help and advice with
a medical or legal emergency.
International
Medical Assistance–If you are in need of medical attention, ON CALL
will help you locate local physicians, dentists, or medical facilities. ON
CALL will also monitor your condition and contact your personal physician
and family, if requested.
Nurse
Helpline–Registered nurses are available 24 hours a day before and
during your trip to provide general health information, clinical
assessment, and health counseling to give you assistance in making
appropriate healthcare decisions.
Medical
Evacuation–If you need to be transported to a different hospital or
treatment facility, or back home, ON CALL will arrange and pay for
transportation and a special medical escort if required. Payment is
available only for covered claims and up to the amount of coverage
provided in the policy.
Telephone
Interpretation Service–In a medical emergency, ON CALL provides
interpretation services in major languages and will transmit urgent
messages to family, friends, and business, if requested.
Failure to call ON CALL may invalidate your Medical
Expense and/or Trip Interruption or Delay
claim.
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The ON CALL Assistance Network extends
worldwide. If you are outside the United States or Canada, call the
local telephone operator for help in placing your collect
call. Within the United States and Canada, use the toll free
number. Phone answered 24 hours daily.
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Within U.S.A. &
Canada
Outside U.S.A. &
Canada
1-800-555-9095
1-603-894-4710*
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*From outside the United States & Canada, you will first
have to enter the International Access Code of the country you are
calling from.
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PLAN NUMBER :
905
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PLEASE NOTE: Neither the Insurer(s)
nor ON CALL INTERNATIONAL shall be responsible for the availability,
quality or results of any medical treatment or your failure to obtain
medical treatment.
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All claims should be presented to the Program Administrator:
Trip Mate (In CA, dba Trip Mate
Insurance Agency)
9225 Ward Parkway, Suite 200
Kansas
City, Missouri 64114
1-800-996-5378
Plan
Number: 905
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In the event of a Medical or Dental
Expense: You must provide us with all bills and reports for medical
and/or dental expenses claimed; you must provide any requested
information, including but not limited to, an explanation of benefits from
any other applicable insurance; and you must sign a patient authorization
to release any information required by us, to investigate your
claim.
In case of loss, theft or damage to
Baggage and Personal Effects you should: immediately report the
situation to the hotel manager, tour guide or representative,
transportation official, local police or other local authorities and
obtain their written report of your loss; take reasonable steps to protect
your Baggage from further damage; and make necessary, reasonable and
temporary repairs. We will reimburse you for these expenses. We will not
pay for further damage if you fail to protect your Baggage.
The Travel Insurance is Underwritten
By: Stonebridge Casualty Insurance Company, Columbus, Ohio; (all
states except as otherwise noted) under Policy/Certificate Form series
TAHC5000. In CA, CT, HI, NE, NH, PA, TN and TX Policy/Certificate Form
series TAHC5100 and TAHC5200. In IL, IN, KS, LA, OH, OR, VT, WA and WY
Policy Form #’s TAHC5100IPS and TAHC5200IPS.
Notice: If you are a resident of one of the
following states (IL, IN, KS, LA, OH, OR, VT, WA, WY) your coverage is
provided on an individual policy form. Your policy number is your complete
Name plus 905. Additional forms complete your policy and are available at
www.tripmate.com. You can also request these forms by calling Trip Mate at
1-800-996-5378.
Note: This policy
contains disability insurance benefits or health insurance benefits, or
both, that apply only during a covered Trip. You may have coverage from
other sources that already provides you with these benefits. You should
review your existing policies. If you have any questions about your
current coverage, call your insurer or health plan.
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