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MEDEX Plus Scholastic
AIC-TRVL-P (5/03) WA
DESCRIPTION OF COVERAGE
FOR WASHINGTON RESIDENTS
Please keep this document with you
while you travel.
A comprehensive program providing you with 24/7 emergency medical, security, and travel assistance - including emergency medical evacuation and repatriation - when you are 100 or more miles away from your permanent residence in your home country.(Expatriates are eligible regardless of distance from your expatriate home.)
This Insurance is underwritten by: Arch Insurance Company, with its principal place of business in New York, NY.
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Maximum Benefits |
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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 of Benefits 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.
Additional Benefits:
Return of Dependent Children: The Company will pay for expenses incurred to return to 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, within one year from the Insured’s original Scheduled Return Date, less refunds from the Insured’s unused transportation tickets.
Repatriation of Remains: The Company will pay the reasonable covered expenses incurred to return Your body to Your primary place of residence if You die during the Trip. This will not exceed the maximum shown on the Schedule of Benefits. Covered expenses include, but are not limited to, expenses for embalming, cremation, casket for transport, and transportation.
Medical Assistance Services
Worldwide Medical and Dental Referrals: MEDEX will provide referrals to help You locate appropriate treatment or care.
Monitoring of Treatment: MEDEX assistance coordinators will continually monitor Your case. In addition, MEDEX regional medical advisors provide consultative and advisory services, including review and analysis of the quality of medical care You are receiving.
Facilitation of Hospital Payment: Upon securing payment or a guarantee to reimburse, MEDEX will either wire funds or guarantee required emergency Hospital admittance deposits. You are ultimately responsible for the payment of the cost of medical care and treatment, including hospital expenses.
Transfer of Insurance Information to Medical Providers: MEDEX will assist You with Hospital admission, such as relaying insurance benefit information, to help prevent delays or denials of medical care. MEDEX will also assist with discharge planning.
Medication, Vaccine and Blood Transfers: In the event medication, vaccines, or blood products are not available locally, or a prescription medication is lost or stolen, MEDEX will coordinate their transfer to You upon the prescribing Physician’s authorization, if it is legally permissible.
Replacement of Corrective Lenses and Medical Devices: MEDEX will coordinate the replacement of corrective lenses or medical devices if they are lost, stolen, or broken during travel.
Dispatch of Doctors/Specialists: In an emergency where You cannot adequately be assessed by telephone for possible evacuation, or You cannot be moved and local treatment is unavailable, MEDEX will send an appropriate medical practitioner to you.
Medical Records Transfer: Upon Your consent, MEDEX will assist with the transfer of medical information and records to You or the treating physician.
Continuous Updates to Family, Employer, and Physician: WWith your approval, MEDEX will provide case updates to appropriate individuals You designate in order to keep them informed.
Hotel Arrangements for Convalescence: MEDEX will assist You with the arrangement of hotel stays and room requirements before or after hospitalization.
Emergency Travel Arrangements: MEDEX will make new reservations for airlines, hotels, and other travel services in the event of an Emergency Sickness or Injury.
Transfer of Funds: MEDEX will provide You with an emergency cash advance subject to us first securing funds from You or Your family.
Replacement of Lost or Stolen Travel Documents: MEDEX will assist You in taking the necessary steps to replace passports, tickets, and other important travel documents.
Legal Referrals: Should You require legal assistance, MEDEX will direct You to an attorney and assist You in securing a bail bond.
Translation Services: MEDEX’s multilingual assistance coordinators are available to provide immediate verbal translation assistance in a variety of languages in an emergency; otherwise MEDEX will provide You with referrals to local interpreter services.
Message Transmittals: You may send and receive emergency messages toll-free, 24-hours a day, through the MEDEX assistance center.
Emergency Pet Housing and/or Pet Return: MEDEX will coordinate arrangements for temporary boarding or the return of a pet left unattended as a result of Your Injury or Illness.
Security Evacuation Services: In the event of a threatening situation, MEDEX will assist you in making evacuation arrangements, including flight arrangements, securing visas, and logistical arrangements such as ground transportation and housing. In more complex situations, MEDEX will assist You in making arrangements with providers of specialized security services.
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. 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. All 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.
Concealment and mistrpresentation 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.
Notice of Claim Notice of claim must be reported within twenty (20) days after a loss occurs or as soon as reasonably possible. 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.
Time of Payment of Claims: Benefits for loss of life are payable to You, if living. Otherwise, benefits for loss of life are paid to the beneficiary, if named, or to Your estate. All or a portion of all other benefits provided by this policy may, at the option if the Company, be paid directly to the provider of the service(s). All benefits not paid to the provider will be paid to You. Other than for loss of life, if any benefit is payable to either another Insured or Your beneficiary who is a minor or otherwise not able to give a valid release or Your estate, the Company may pay up to $1,000 to Your beneficiary or any relative to whom the Company finds entitled to the payment. Any payment made in good faith shall fully discharge the Company from obligations under this policy to the extent of such payment.
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.


“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