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Call 1-800-732-5309 to learn more |
DESCRIPTION OF COVERAGE FOR WASHINGTON RESIDENTS
This Insurance is underwritten by: Arch Insurance Company,
with its principal place of business in
New York, NY.
Schedule of Basic Coverages & Services Maximum Benefit for all Coverages.................$100,000 |
Schedule of Optional Coverages and Services Optional Lost Baggage.............................................. $1000 Optional Trip Cancellation/Trip Interruption.............. $5000 |
If You need medical attention:
Call the 24-hour MEDEX Emergency Response Center. Telephone numbers are listed on Your I.D. card. The multilingual coordinators will provide direct access to MEDEX Physician Advisors, approved hospitals, and other service providers around the world. Be prepared to give Your name, I.D. number, and a brief description of Your problem. MEDEX Assistance will immediately take appropriate action to assist You and monitor Your care until the situation is resolved. Trained multilingual assistance coordinators are available 24 hours a day, to make the necessary arrangements on Your behalf.
In the case of an emergency go IMMEDIATELY to the nearest Physician or hospital without delay, then notify MEDEX Assistance of Your situation.
REMEMBER to call MEDEX Assistance. The traveler’s assistance services are provided to help You and provide the skilled professional assistance necessary. Please do not attempt to provide Your own solutions to Your problems and subsequently ask us to pay for all of the expenses incurred. MEDEX Assistance is there to provide You with the skilled professional assistance necessary.
Payments arranged by MEDEX Assistance:
Most Physicians and hospitals will provide you with the necessary Medical Treatment and will either send their bill directly to MEDEX Insurance Services, or in the case of small dollar amounts, may ask You to pay at time services are rendered. Ask the hospital or Physician to contact MEDEX Assistance. MEDEX Assistance will confirm Your protection plan coverage and arrange for prompt payments. You will be asked to pay for any deductible amount or items not covered by Your plan.
Payments made by You:
If You are required to pay for Medical Treatment, obtain a signed receipt and a signed statement by a Physician describing the problem and the treatment. Once Your other insurance has processed Your claim, submit a copy of their final disposition along with a MEDEX Insurance Services claim form and a copy of Your receipts to:
MEDEX Insurance Services
8501 LaSalle Road, Suite 200
Baltimore , MD 21286
1-800-732-5309 or 1-410-453-6380
For claim forms or questions, call between 8:00 A.M. and 5:00 P.M. Monday through Friday Eastern Time.
EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE
Emergency Accident and Sickness Medical Expense:
The Insurer will pay benefits up to the maximum shown on the Schedule, subject to any deductible, if an Insured incurs necessary Covered Medical Expenses as a result of an Accidental Injury or Sickness which occurs during the Covered Trip outside the United States. The Insured must receive initial treatment for Accidental Injuries or Sickness while on the Covered Trip outside the United States.
Covered Medical Expenses are necessary services and supplies which are recommended by the attending Physician. They include but are not limited to: the services of a Physician; charges for Hospital confinement and use of operating rooms; charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests; ambulance service; drugs, medicines, prosthetics and therapeutic services and supplies; emergency dental treatment for the relief of pain.
The Company will not pay benefits in excess of the reasonable and customary charges. Reasonable andcustomary charges means charges commonly used by Physicians in the locality in which care is furnished. The Company will not cover any expenses provided by another party at no cost to the Insured or already included within the cost of the Trip.
Benefits will include expenses for emergency dental treatment not to exceed the amount shown in the Schedule of Benefits. These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
EMERGENCY EVACUATION AND REPATRIATION OF REMAINS
Emergency Evacuation: The Company will pay, subject to the limitations set out herein, for Covered Emergency Evacuation Expenses reasonably incurred if the Insured suffers an Injury or Emergency Sickness that warrants his or her Emergency Evacuation while he or she is on a Trip. Benefits payable are subject to the Maximum Amount per Insured shown on the Schedule for all Emergency Evacuations due to all Injuries from the same Accident or all Emergency Sicknesses from the same or related causes.
A legally licensed Physician, in coordination with the Assistance Company, must order the Emergency Evacuation and must certify that the severity of the Insured's Injury or Emergency Sickness warrants his or her Emergency Evacuation to the closest adequate medical facility. It must be determined that such Emergency Evacuation is required due to the inadequacy of local facilities. The certification and approval for Emergency Evacuation must be coordinated through the most direct and economical conveyance and route possible, such as air or land ambulance, or commercial airline carrier. Covered Emergency Evacuation Expenses are those for Medically Necessary Transportation, including Reasonable and Customary medical services and supplies incurred in connection with the Emergency Evacuation of the Insured.
Expenses for Transportation must be: (a) recommended by the attending Physician; and (b) required by the standard regulations of the conveyance transporting the Insured; and (c) reviewed and pre-approved by the Assistance Company. The Company will also pay reasonable and customary charges, up to the maximum escort limit shown on the policy, for escort expenses required by the Insured, if the Insured is disabled during a Trip and an escort is recommended in writing by the Company's attending Physician and must be pre-approved by the Assistance Company.
Return of Dependent Children: The Company will pay for expenses to return where they reside, with an attendant if necessary, any of the Insured’s Dependent Children who were accompanying the Insured when the Injury or Emergency Sickness occurred, but not to exceed the cost of a single one-way economy airfare ticket less the value of applied credit from any unused return travel tickets per person.
Transportation to Join a Hospitalized Member: If the Insured is going to be hospitalized for more than up to 7 days following a covered Emergency Evacuation expense, the Company will pay subject to the limitations set out herein, for expenses to bring one person chosen by the Insured to and from the Hospital or other medical facility where the Insured is confined if the Insured is alone; but not to exceed the cost of one round-trip economy airfare ticket.
Transportation after Stabilization: In addition to the above covered expenses, if the Company has previously evacuated an Insured to a medical facility, the Company will pay his/her airfare costs from that facility to the Insured’s primary residence. Commercial airfare costs will be in the same class of service, as Your original airline tickets, or in business or first class as in compliance with Your medical necessities and requirements upon Your discharge, less refunds from Your unused transportation tickets.
Repatriation of Remains: The Insurer will pay reasonable Covered Expenses incurred to return Your body to Your primary residence if You die during the covered Trip. This will not exceed the maximum shown on the Schedule of Coverage and Services.
Covered Expenses include, but are not limited to, expenses for embalming, cremation, minimally necessary caskets for transport, and transportation.
OPTIONAL COVERAGES
Trip Cancellation: The Insurer will pay a benefit, up to the maximum shown on Your Confirmation Letter, if You are prevented from taking Your covered Trip or continuing on Your Trip due to the following Unforeseen events:
a) Sickness, Injury or death involving You or Your Traveling Companion, or You or Your Traveling Companion’s Business Partner or Your Family Member, which results in medically imposed restrictions as certified by a Legally Qualified Physician at the time of loss preventing the Insured’s continued participation in the Trip;
b) Hijack, quarantine, jury duty, or court ordered appearance as a witness in a legal action in which an Insured or Traveling Companion is not a party (except law enforcement officers);
c) Your primary residence or that of Your Traveling Companion is rendered uninhabitable by Unforeseen circumstances;
d) If within 30 days of the departure of an Insured, a politically motivated Terrorist Attack occurs within the territorial limits of the city listed on the Insured's itinerary;
e) The Insured or Traveling Companion is called to emergency military duty for a disaster other than war;
f) Traffic accident, substantiated by a police report, directly involving either the Insured or Traveling Companion while en route to a scheduled point of departure;
g) The Insured's Traveling Companion or Family Member, who are military personnel, and are called to emergency duty for a natural disaster other than war.
Trip Cancellation: Benefits will be paid, up to the Maximum Benefit Amount for the non-refundable cancellation charges imposed by Your Travel Supplier.
Trip Interruption: Benefits will be paid, up to the Maximum Benefit Amount for the additional cost for one-way Economy Transportation for the Insured to return to their original destination or rejoin their Trip less the value of the original unused return travel ticket.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
Lost Baggage:
The Insurer will pay benefits if Your Checked Baggage is lost due to theft or misdirection or damage by a Common Carrier while You are on a Covered Trip and are a ticketed passenger on the Common Carrier.
Benefits will also be paid for Carry On Baggage that is lost or stolen while You are on a Covered Trip and are a ticketed passenger on a Common Carrier.
The Insurer will reimburse the Insured for the cost of replacement of the baggage and its contents up to the maximum shown on the Schedule.
There is a deductible per occurrence as shown on the Schedule. There will be a per article limit shown on the Schedule. There will be a combined maximum limit shown on the Schedule for the following: jewelry; watches; articles consisting in whole or in part of silver, gold or platinum; furs; articles trimmed with or made mostly of fur; personal computers, cameras and their accessories and related equipment.
All claims must be verified by the Common Carrier who must certify the loss or theft occurred while in possession of the Common Carrier or while You were riding in the Common Carrier for Carry On Baggage.
This coverage is secondary to any coverage provided by a Common Carrier and all other valid and collectible insurance indemnity and shall apply only when such other benefits are exhausted.
The Insurer will pay the lesser of the following: actual cash value at time of loss, theft or damage to baggage and personal effects, or the cost of repair or replacement.
EXCLUSIONS
The following exclusions apply:
1) suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane;
2) resulting from an act of declared or undeclared war;
3) while participating in maneuvers or training exercises of an armed service;
4) while riding, driving or participating in races, or speed or endurance contests;
5) while mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes, or other special equipment);
6) while participating as a member of a professional sports team in an organized sporting competition;
7) while participating in skydiving, hang gliding, bungee cord jumping, scuba diving or deep sea diving;
8) while piloting or learning to pilot or acting as a member of the crew of any aircraft;
9) commission or the attempt to commit a criminal act by the Insured or Traveling Companion.
10) due to normal childbirth, normal pregnancy (except complications of pregnancy) or voluntarily induced abortion;
11) for dental treatment (except as coverage is otherwise specifically provided herein);
12) Pre-Existing Conditions. The Pre-Existing Condition Limitation does not apply to: Emergency Evacuation or Medical Repatriation
13) for mental or nervous disorders
The following exclusion applies to Emergency Accident and Sickness Medical Expense only:
14) due to alcoholism and drug addiction
The following exclusion applies to Trip Cancellation, Trip Interruption and Emergency Evacuation/Repatriation of Remains only:
15) expenses incurred as a result or consequence of being Intoxicated, as specifically defined in the policy, or under the influence of any controlled substance unless administered on the advise of a Legally Qualified Physician.
The following limitation applies to Trip Cancellation only:
All cancellations must be reported directly to the Travel Supplier within 72 hours of the event causing the need to cancel, unless the event prevents it, and then as soon as is reasonably possible. If the cancellation is not reported within the specified 72-hour period, the Company will not pay for additional charges which would not have been incurred had an Insured notified the Travel Supplier in the specified period.
If the event prevents You from reporting the cancellation, the 72-hour notice requirement does not apply; however, You must, if requested, provide proof that said event prevented You from reporting the cancellation within the specified period.
The following exclusions apply to Lost Baggage only:
Benefits will not be paid for any expenses which have been reimbursed or for any services which have been provided by the Common Carrier, hotel or Travel Supplier; nor will benefits be paid for loss or damage to property specifically covered under any other insurance.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
Your Duties After Loss of or Damage to Property: In case of loss, theft, damage or delay of Baggage or Personal Effects, You must:
a) take all reasonable steps to protect, save or recover the property;
b) promptly notify, in writing, either the police, hotel proprietors, ship lines, airlines, railroad, bus, airport or other station authorities, tour operators or group leaders, or any Common Carrier or bailee who has custody of an Insured’s property at the time of loss;
c) produce records needed to verify the claim and its amount ,and permit copies to be made;
d) provide to the Company, within 90 days from the date of loss, a detailed proof of loss signed and sworn to; and
e) be examined, if requested.
Reductions in the Amount of Insurance : The applicable benefit amount will be reduced by the amount of benefits, if any, previously paid for any loss or damage under this coverage for this Trip.
No Benefit to Bailee : This insurance shall not benefit any Common Carrier or bailee.
Benefits are not payable for any loss caused by or resulting from:
a) breakage of brittle or fragile articles;
b) wear and tear or gradual deterioration;
c) confiscation or appropriation by order of any government or custom’s rule;
d) theft or pilferage while left in any unlocked vehicle;
e) property illegally acquired, kept, stored or transported;
f) an Insured’s negligent acts or omissions; or
g) property shipped as freight or shipped prior to the Scheduled Departure Date.
DEFINITIONS
"Accident" - means a sudden, unexpected, or unintended event that occurs while this Policy is in force and causes Injury.
“Assistance Company” means MEDEX.
“Carry On Baggage” means a piece of baggage that has not been checked and is owned by and accompanies the Insured while traveling on a Common Carrier.
“Checked Baggage” means a piece of baggage for which a claim check has been issued to the Insured by a Common Carrier.
“Common Carrier” - means any public land, air, or water conveyance operating under a valid license providing for the transportation of passengers for hire.
“Complication of Pregnancy” means a condition whose diagnosis is distinct from pregnancy but is adversely affected or caused by pregnancy.
“Dependent Child(ren)” means the Insured’s child (or children), including an unmarried child, stepchild, legally adopted child or foster child who is: (1) less than age 19 and primarily dependent on the Insured for support and maintenance; or (2) who is at least age 19 but less than age 23 and who regularly attends an institution of learning (or) an accredited school or college and who is primarily dependent on the Insured for support and maintenance.
“Economy Transportation” means the lowest published available transportation rate for a ticket on a Common Carrier matching the original class of transportation that the Insured purchased for the Trip, reduced by the value of an unused return travel ticket.
“Eligible Expense” means expense incurred for services and supplies: (a) listed below; and (b) ordered or prescribed by a Legally Qualified Physician as Medically Necessary for diagnosis or treatment, which are limited to:
i ) the services of a Legally Qualified Physician;
ii ) Hospital or ambulatory medical-surgical center services (this will also include expenses for a cruise ship cabin or hotel room, not already included in the cost of the Insured’s Trip, if recommended as a substitute for a hospital room for recovery of an Injury);
iii ) transportation furnished by a professional ambulance company to and/or from a Hospital; and
iv ) prescribed drugs, prosthetics and therapeutic services and supplies.
“Emergency Evacuation” means the Insured's medical condition warrants immediate transportation from the place where the Insured is injured or sick to the nearest Hospital where appropriate Medical Treatment can be obtained;
“Emergency Sickness” means an illness or disease, diagnosed by a legally licensed Physician, which meets all of the following criteria: (1) there is a present severe or acute symptom requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of the Insured’s condition or place his or her life in jeopardy; (2) the severe or acute symptom occurs suddenly and unexpectedly; and (3) the severe or acute symptom occurs while coverage is in force as to the Insured suffering the symptom and during the Insured’s Trip.
"Family Member" - means the Insured's or Traveling Companion's legal or common law spouse, Domestic Partner, parent, legal guardian, step-parent, grandparent, parents-in-law, grandchild, natural or adopted child, foster child, step-child, children-in-law, brother, sister, step-brother, step-sister, brother-in-law, sister-in-law, aunt, uncle, niece or nephew.
“Hospital” - means (a) a place which is licensed or recognized as a general Hospital by the proper authority of the state in which it is located: (b) a place operated for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility: (c) a place recognized as a general Hospital by the Joint Commission on the Accreditation of Hospitals. Not included is a Hospital or institution licensed or used principally: (1) for the treatment or care of drug addicts or alcoholics: or (2) as a clinic, continued or extended care facility, skilled nursing facility, convalescent home, rest home, nursing home or home for the aged.
“Injury” or “Injuries”- means accidental bodily Injuries (a) received after the Effective Date and prior to the Insured’s Scheduled Return Date; and (b) resulting in loss independently of sickness and all other causes and certified by a Legally Qualified Physician.
“Insured,” “You” or “Your” - means the Principal Insured and his or her Family Members, Business Partner, or Traveling Companion who are covered under the Principal Insured’s policy.
“The Insurer” or “The Company” - means Arch Insurance Company.
“Intoxicated” - means a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where an Insured is located at the time of an incident.
“Legally Qualified Physician” means a licensed practitioner of medical, surgical or dental services acting within the scope of his/her license. The treating Physician may not be the Insured, a Traveling Companion or a Family Member. (NOTE: WA has a split definition depending on if it’s A&H or P&C – I think we can make a good argument that the majority of the benefits here are A&H, and therefore, can use the less confusing definition).
“Scheduled Departure Date” means the date on which You are originally scheduled to leave on the Trip.
“Scheduled Return Date” means the date on which You are originally scheduled to return to the point of origin or the original final destination.
“Schedule of Benefits” means the coverage confirmation provided to You following Your enrollment and payment of the applicable premium.
“Sickness” means an illness or disease that is first manifested, diagnosed, or treated by a Legally Qualified Physician after the effective date of insurance and while the Insured is covered under this Policy.
“Terrorist Attack” means an incident deemed an act of terrorism by the U.S. Department of State or the U.S. Government.
“Transportation” means any land, sea or air conveyance required to transport the Insured during an Emergency Evacuation. Transportation includes, but is not limited to, Common Carrier, air ambulances, land ambulances, and private motor vehicles.
“Travel Arrangements” means: (a) transportation, (b) accommodations, and (c) other specified services arranged by the Travel Supplier for the Trip.
“Traveling Companion” means a person or persons with whom a covered person has coordinated travel arrangements and intends to travel with during the Trip.
“Travel Supplier” means any entity or organization that coordinates or supplies Your travel services for You.
“Trip” means scheduled trips, tours or cruises for which (a) coverage is requested, and (b) the required premium is submitted prior to the Scheduled Departure Date. Maximum Trip duration is 6 (six) months.
" Unforeseen"means not anticipated or expected and occurring after the effective date of the policy.
To facilitate prompt claims settlement:
TRIP CANCELLATION CLAIMS: IMMEDIATELY Call Travel Supplier and the Claims Administrator to report Your cancellation and avoid non-covered expenses due to late reporting. The Claims Administrator will then advise You on how to obtain the appropriate form to be completed by You and the attending Legally Qualified Physician.
INTERRUPTION : Obtain medical statements from the doctors in attendance in the country where Sickness or Accident occurred. These statements should give complete diagnosis, stating that the Sickness or Accident prevented traveling on dates contracted. Provide all unused transportation tickets, official receipts, etc.
MEDICAL EXPENSES : Obtain receipts from the providers of service, etc., stating the amount paid and listing the diagnosis and treatment; submit these first to other medical plans. Provide a copy of their final disposition of Your claim.
BAGGAGE : Obtain a statement from the Common Carrier that Your Baggage was delayed or a police report showing Your Baggage was stolen along with copies of receipts for Your purchases.
INSURING PROVISIONS
This is a legal contract between Arch Insurance Company and You. This policy is issued in consideration of payment of the appropriate plan cost. Arch Insurance Company, herein called the Company, will pay Youbenefits described in this policy, subject to all policy limitations, and exclusions, when You sustain a loss specified under a provision of the policy under which You are covered, as shown in this Description of Coverage.
The entire contract is made up of the policy and any attachments. No agent may change it in any way. Only an officer of the Company can approve a change. Any such change must be shown in the policy or its attachments.
FOURTEEN-DAY LOOK. You may cancel this policy by giving the Company or the agent written notice within the first to occur of the following: (a) 14 days after the Effective Date of Your policy; or (b) Your Scheduled Departure Date. If You do this, the Company will refund Your premium paid provided no Insured has filed a claim under this policy.
PERIOD OF COVERAGE: The “Effective Date” of Your Travel Protection policy begins at 12:01 a.m. following the date You enroll and pay the required plan cost. The Trip Cancellation Benefit begins on the Effective Date. All other Benefits begin on 12:01 a.m. on the later of Your Scheduled Departure Date or the Effective Date of Your Travel Protection policy, as described above. Benefits end for all Insureds when You cancel Your Trip, when You return home, or when You complete the term of Your Trip.
CLERICAL ERROR. Clerical error on the Company’s part or that of a Travel Supplier in keeping records or furnishing information will not void an Insured’s coverage if it is otherwise validly in force; nor will it continue an Insured’s coverage if it is otherwise validly terminated under the terms of this policy.
LEGAL ACTIONS. No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives proof of loss. No legal action for a claim can be brought against us more than three (3) years after the time required for giving proof of loss. This three (3) year time period is extended from the date proof of loss is filed and the date the claim is denied in whole or in part.
CONCEALMENT AND MISREPRESENTATION. The entire coverage will be void, if before, during or after a loss, any material fact or circumstance relating to this insurance has been intentionally concealed or misrepresented.
SUBROGATION. If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the Third Party responsible for the loss, the Company will be subrogated to that right. An Insured shall help the Company exercise the Company’s rights in any reasonable way that the Company may request, nor do anything after the loss to prejudice the Company’s rights, and in the event an Insured recovers damages from the Third Party responsible for the loss, the Insured will hold the proceeds of the recover for the Company in trust and reimburse the Company to the extent of the Company’s previous payment for the loss. You are entitled to complete reimbursement for loss covered under this policy before the Company is entitled to subrogation proceeds.
WHEN AN INSURED'S COVERAGE BEGINS. All coverage (except Trip Cancellation) will take effect at 12:01 A.M. local time, at the location of the Insured, on the Scheduled Departure Date provided:
(a) coverage has been elected; and
(b) the required premium has been paid.
Trip Cancellation coverage will take effect at 12:01 A.M. local time at the location of the Insured, on the day after the required premium for such coverage is received by the Company or its authorized representative.
EXTENDED COVERAGE. All coverage under the policy will be extended, if: (a) the Insured's entire Trip is covered by the policy; and (b) the Insured's return is delayed by inclement weather. If coverage is extended for the above reasons, coverage will end on the earlier of: (a) the date the Insured reaches his/her Return Destination; or (b) seven (7) days after the date the Trip was scheduled to be completed.
NOTICE OF CLAIM. Notice of claim must be reported within twenty (20) days after a loss occurs or as soon as reasonably possible. You or someone on Your behalf may give the notice. The notice should be given to the Company or designated representative and should include sufficient information to identify the Insured.
CLAIM FORMS : When notice of claim is received by the Company or designated representative, forms for filing proof of loss will be furnished. If these forms are not sent within 15 days, the proof of loss requirements can be met by sending a written statement of what happened. This statement must be received within the time given for filing proof of loss.
PROOF OF LOSS. Proof of loss must be provided within 90 days after the date of the loss or as soon as is reasonably possible. Proof must, however, be furnished no later than 12 months from the time it is otherwise required, except in the absence of legal capacity.
PAYMENT OF CLAIMS. All benefits are payable to You, if alive. Otherwise benefits are payable to Your estate.
PHYSICAL EXAMINATION AND AUTOPSY. The Company, at the expense of the Company, may have an Insured examined when and as often as is reasonable while the claim is pending. The Company may have an autopsy done, at the expense of the Company, where it is not forbidden by law.
OTHER INSURANCE WITH THE COMPANY: An Insured may be covered under only one travel policy with the Company for each Trip. If an Insured is covered under more than one such policy, he or she may select the coverage that is to remain in effect. In the event of death, the selection will be made by the beneficiary or estate. Premiums paid (less claims paid) will be refunded for the duplicate coverage that does not remain in effect.
CONFORMITY WITH STATE STATUTES: The provisions of this policy must conform with the laws of the state in which the policy is issued. If any do not, they are hereby amended to conform.
Protection plan fees are non-refundable.
Plan is designed by MEDEX
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“Not only did the insurance pay for everything, including upgrading our flight home, but it paid for the medical coverage in Prague. Having that kind of support system back home is terrific. ”
Gert Brieger
