NOTICE: Not available to residents of Washington State.

Residents leaving the USA, please view the description of coverage for you. Outbound Description


TravMed Choice - Inbound

Description of Coverage

For Visitors to the United States

All Coverage and Benefits are in U.S. Dollar Amounts:

Benefit Limit
Accidental Death & Dismemberment $25,000
Accident and Sickness Medical policy maximum Amount chosen – maximum $250,000
Deductible Amount chosen - $100 or $250
Coinsurance 20% to $5,000, then 0% to policy maximum
Incidental trips to your Home Country $25,000
Emergency Dental $200 per tooth, maximum $1,000
Emergency Evacuation $100,000
Return of Minor Children $5,000
Repatriation of Mortal Remains $25,000
Emergency Reunion $10,000
Baggage and Personal Effects $250
Trip Interruption $5,000
Optional Sports Rider Available up to Plan Maximum

HOW TO USE TRAVMED CHOICE SERVICES

24 hours a day, 7 days a week, 365 days a year

MEDEX is Your key to travel safety. If You have a medical or travel problem, simply call Us for assistance. Our toll-free and collect-call telephone numbers are printed on Your ID card. Either dial the toll-free number of the country you are in, or call the Emergency Response Center COLLECT at:

Baltimore, Maryland, USA +1-410-453-6330

An assistance coordinator will ask for Your name, Your company or group name, the MEDEX ID number shown on Your card, and a description of Your situation.

If the condition is an emergency, You should go immediately to the nearest physician or hospital without delay and then contact the 24-hour Emergency Response Center. We will then take the appropriate action to assist You and monitor Your care until the situation is resolved.

DEFINITIONS

Please note, certain words used in this document have specific meanings. These terms will be capitalized throughout the document. The definition of any word, if not defined in the text where it is used, may be found either in this Definitions section or in the Schedule of Benefits.

“Common Carrier” means a vehicle or service licensed to carry passengers for hire on a regularly scheduled basis.

“Complication of Pregnancy” means a condition requiring Hospital confinement, whose diagnosis is distinct from pregnancy but adversely affected or caused by pregnancy, such as: a) acute nephritis or nephrosis; b) cardiac decompensation; c) missed abortion; and d) similar medical and surgical conditions of comparable severity.

Complications of Pregnancy will also include: a) non-elective cesarean section; b) termination of ectopic pregnancy; and c) spontaneous termination of pregnancy, occurring during a period of gestation in which a viable birth is not possible. However, the term Complication of Pregnancy will not include: a) false labor, occasional spotting, or morning sickness; b) Doctor prescribed rest; c) hyperemesis gravidarum; d) pre-eclampsia; or any similar condition associated with the management of a difficult pregnancy not consisting of a nosologically distinct Complication of Pregnancy.

“Covered Accident” means an Accident that occurs while coverage is in force for a Covered Person and results in a loss or Injury covered by the Policy for which benefits are payable.

“Covered Expenses” With regard to Trip Interruption means:

  1. before the Scheduled Departure Date, the lesser of:
    1. the cancellation charges imposed by a Travel Supplier for the Covered Trip;
    2. the cost of substituting a travel arrangement not provided due to the Financial Insolvency of a Travel Supplier to enable the Covered Person to take the Covered Trip; and
    3. all sums prepaid to Travel Suppliers for the Covered Trip that become non-recoverable due to the Financial Insolvency of a Travel Supplier; or
  2. after the Scheduled Departure Date, the greater of either:
    1. the amount of the unused, non-refundable prepaid air arrangements which formed a part of the Covered Person’s Covered Trip; or
    2. the fare paid, less the value of applied credit from the unused travel tickets, to return to the Covered Person’s place of permanent residence or to continue a Covered Trip limited to the cost of one-way Economy Airfare, or first class if the Covered Person’s original tickets were first-class by a scheduled carrier from the Destination point to the point of origin shown on the original travel tickets; and
    3. the cost of any unused, non-refundable Land and Sea Arrangements prepaid to the Travel Supplier for the Covered Person’s Covered Trip.

“Covered Person” means any eligible person, including Dependents if eligible for coverage under the Policy, who applies for coverage and for whom the required Premium is paid. If the cost for this insurance is paid for by the Policyholder, individual applications are not required for an eligible person to be a Covered Person.

“Covered Trip” means a) A period of round-trip travel away from Home to a Destination outside of the Covered Person’s Home Country; the purpose of the trip is business or pleasure and is not to obtain health care or treatment of any kind; the trip has defined departure and return dates specified when the Covered Person applies; the trip does not exceed 365 days; or the purpose of the trip is business or pleasure and is not to obtain health care or treatment of any kind; the trip has defined departure and arrival dates and defined departure and arrival places specified when the Covered Person applies; and the trip does not exceed 365 days in length.

In this policy, Covered Trip is also referred to as “Trip”.

“Destination” means the place where the Covered Person expects to travel on his or her Trip.

“Dependent” means an Insured’s lawful Spouse; Domestic Partner; or an Insured’s unmarried child, from the moment of birth to age 19, 25 if a full-time student, who is chiefly dependent on the Insured for support. A child, for eligibility purposes, includes an Insured’s natural child; adopted child, beginning with any waiting period pending finalization of the child’s adoption; or a stepchild who resides with the Insured or depends on the Insured for financial support. A Dependent may also include any person related to the Insured by blood or marriage and for whom the Insured is allowed a deduction under the Internal Revenue Code.

Insurance will continue for any Dependent child who reaches the age limit and continues to meet the following conditions: 1) the child is handicapped, 2) is not capable of self-support and 3) depends mainly on the Insured for support and maintenance. The Insured must send Us satisfactory proof that the child meets these conditions, when requested. We will not ask for proof more than once a year.

If the Insured has elected coverage for a Dependent child, any newly born child of the Insured will be covered from the moment of birth for 31 days. Coverage may be continued beyond this time period if the Insured notifies Us within 31 days of the child’s birth and pays any required Premium.

“Doctor” means a licensed health care provider acting within the scope of his or her license and rendering care or treatment to a Covered Person that is appropriate for the conditions and locality. It will not include a Covered Person or a member of the Covered Person’s Immediate Family or household.

“Domestic Partner” means a person of the same or opposite sex of the Covered Person who:

  1. shares the Covered Person’s primary residence;
  2. has resided with the Covered Person for at least 6 months prior to the date of enrollment and is expected to reside with the Covered Person indefinitely;
  3. is financially interdependent with the Covered Person in each of the following ways;
    1. by holding one or more credit or bank accounts, including a checking account, as joint owners;
    2. by owning or leasing their permanent residence as joint tenants;
    3. by naming, or being named by the other as a beneficiary of life insurance or under a will;
    4. by each agreeing in writing to assume financial responsibility for the welfare of the other.
  4. has signed a Domestic Partner declaration with the Covered Person, if recognized by the laws of the state in which they reside;
  5. has not signed a Domestic Partner declaration with any other person within the last 12 months.
  6. Is older than 18 years old;
  7. Is not currently married to another person;
  8. Is not in a position as a blood relative that would prohibit marriage.

“Family Member” means a) the Covered Person’s Traveling Companion(s); and b) the Covered Person’s or Traveling Companion’s: 1) Spouse; 2) child; 3) parent; 4) sibling; 5) grandparent or child; 6) step-parent, child or sibling; 7) son- or daughter-in-law; 8) parents-in-law; 9) brother- or sister-in-law; 10) aunt; 11) uncle; 12) niece or nephew; 13) legal guardian; 14) legal ward.; 15.) Domestic Partner

“Home Country” means a country from which the Covered Person holds a passport or greencard. If the Covered Person holds passports or greencards from more than one country, his or her Home Country will be that country which the Covered Person has declared to Us in writing as his or her Home Country.

“Immediate Family” means a Covered Person’s parent, grandparent, Spouse, child, brother, sister or in-laws.

“Hospital” means an institution that: 1) operates as a Hospital pursuant to law for the care, treatment, and providing of in-patient services for sick or injured persons; 2) provides 24-hour nursing service by Registered Nurses on duty or call; 3) has a staff of one or more licensed Doctors available at all times; 4) provide organized facilities for diagnosis, treatment and surgery, either: (i) on its premises; or (ii) in facilities available to it, on a pre-arranged basis; 5) is not primarily a nursing care facility, rest home, convalescent home, or similar establishment, or any separate ward, wing or section of a Hospital used as such; and 6) is not a place for drug addicts, alcoholics, or the aged.

“Injury” means accidental bodily harm sustained by a Covered Person that results directly and independently from all other causes from a Covered Accident. The Injury must be caused solely through external, violent and accidental means. All Injuries sustained by one person in any one Covered Accident, including all related conditions and recurrent symptoms of these injuries, are considered a single Injury.

“Insured” means the person for whom the required Premium is paid making insurance in effect for that person.

“Insurer” means ACE American Insurance Company.

“Medical Emergency” means a condition caused by an Injury or Sickness that manifests itself during the Covered Trip which requires immediate and emergent medical treatment not available in the Covered Person’s location and without which there would be a significant risk of death or serious impairment.

“Medically Necessary” means a treatment, service or supply that is: 1) required to treat an Injury; prescribed or ordered by a Doctor or furnished by a Hospital; 2) performed in the least costly setting required by the Covered Person’s condition; and 3) consistent with the medical and surgical practices prevailing in the area for treatment of the condition at the time rendered. Purchasing or renting 1) air conditioners; 2) air purifiers; 3) motorized transportation equipment; 4) escalators or elevators in private homes; 5) eye glass frames or lenses; 6) hearing aids; 7) swimming pools or supplies for them; and 8) general exercise equipment are not Medically Necessary. A service or supply may not be Medically Necessary if a less intensive or more appropriate diagnostic or treatment alternative could have been used. We may consider the cost of the alternative to be the Covered Expense.

“Primary” means We will pay first, but reserve the right to recover from any other insurance carrier with which the Covered Person may be enrolled.

“Pre Existing Condition” means an illness, disease or other condition of the Insured, that in the 12-month period before the Insured’s coverage became effective under this Policy: 1. first manifested itself, worsened, became acute or exhibited symptoms that would have caused an ordinarily prudent person to seek diagnosis, care or treatment; or 2. required taking prescribed drugs or medicines, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or 3. was treated by a Doctor or treatment had been recommended by a Doctor.

“Return Destination” means the place to which the Covered Person expects to return from his or her Trip.

“Scheduled Departure Date” means the date on which the Covered Person is scheduled to leave on his or her Covered Trip. This date is shown on the Covered Person's Schedule of Benefits.

“Scheduled Return Date” means the date on which the Covered Person is scheduled to return from his or her Covered Trip.

“Sickness” means an illness, disease or condition of the Covered Person that occurs during the Trip, and that requires treatment by a Doctor. Sickness includes Complications of Pregnancy.

“Unforeseen” means not anticipated or expected and occurring after the effective date of the certificate.

“Usual and Customary Charge” means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

“We”, “Our”, “Us” means MEDEX.

DESCRIPTION OF COVERAGES

MEDICAL EXPENSE BENEFIT

The Insurer will pay Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident or Sickness. These benefits are subject to the Deductibles, Benefit Periods, Benefit Maximums and other terms and/or limits shown in the Schedule of Benefits.

Medical Expense Benefits are only payable: 1. for Usual and Customary Charges incurred after the Deductible has been met; 2. for those Medically Necessary Covered Expenses that the Covered Person incurs; and 3. for charges incurred for services rendered to the Covered Person while traveling on a scheduled Trip; and 4. provided the first charge is incurred within the Incurral Period shown in the Schedule of Benefits.

No benefits will be paid for any expenses incurred that are in excess of Usual and Customary Charges.

Covered Expenses include Confinement in a Hospital; Treatment by a Doctor; Services and supplies ordered by a Doctor; Care given by a graduate nurse; Ambulance service to and from the Hospital; Prescription drugs prescribed by a Doctor and administered on an outpatient basis; Dental care due to Injury to sound, natural teeth.

Payment of Loss: The Covered Person must provide Us with: (a) all medical bills and reports for Medical Expenses claimed; and (b) a signed patient authorization to release medical information to Us.

The Insurer will not pay benefits in excess of the Usual and Customary Charges commonly used by providers of medical care in the locality in which the care is furnished. The Insurer will not pay for hotel accommodations and extra living expenses for the Covered Person or Traveling Companion incurred while being hospitalized or treated on an outpatient basis.

In the event that the Covered Person is hospitalized beyond the date the insurance coverage terminates, the Insurer will continue to pay Medical Expense Benefits for Covered Medical Expenses until: a) the Covered Person is released from the hospital, or b) the maximum benefit is paid.

EMERGENCY MEDICAL EVACUATION BENEFIT

The Insurer will pay Emergency Medical Evacuation Benefits as shown in the Schedule of Benefits for Covered Expenses incurred for the medical evacuation of a Covered Person. Benefits are payable up to the Maximum Limit shown in the Schedule of Benefits if the Covered Person:

  1. suffers a Medical Emergency during the course of the Trip;
  2. requires Emergency Medical Evacuation;
  3. is travelling outside of their Home Country

Covered Expenses:

Medical Transport: expenses for transportation under medical supervision to a different hospital, or treatment facility for Medically Necessary treatment in the event of the Covered Person's Medical Emergency and upon the request of the Doctor designated by Us in consultation with the local attending Doctor.

Dispatch of a Doctor or Specialist: the Doctor’s or specialist’s travel expenses and the medical services provided on location, if, based on the information available, a Covered Person’s condition cannot be adequately assessed to evaluate the need for transport or evacuation and a Doctor or specialist is dispatched by Us to the Covered Person’s location to make the assessment.

Return of Dependent Child(ren): expenses to return each Dependent child who is under age 18 to his or her principal residence, not to exceed the Benefit Maximum shown in the Schedule of Benefits, if a) the Covered Person is age 18 or older; and b) the Covered Person is the only person traveling with the minor Dependent child(ren); and c) the Covered Person suffers a Medical Emergency and must be confined in a Hospital.

Benefits for these Covered Expenses will not be payable unless a) the Doctor ordering the Emergency Medical Evacuation certifies the severity of the Covered Person’s Medical Emergency requires an Emergency Medical Evacuation; b) all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible; and c) the charges incurred are Medically Necessary and do not exceed the Usual and Customary Charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and benefits will not be payable unless We authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance.

MEDICAL REPATRIATION BENEFIT

The Insurer will pay expenses incurred for medical repatriation after a hospitalization or medical treatment for a Covered Accident or Sickness, if the Covered Person is (a) unable to continue his or her Trip as recommended by the treating doctor in consultation with Us or (b) if it is Medically Necessary for the Covered Person to return home for continued medical treatment.

We will coordinate with the local attending Doctor to arrange the Covered Person’s return to his or her Home Country. We will provide the appropriate medical personnel to accompany the Covered Person during the return Trip if it is Medically Necessary.

Covered Expenses include transportation incurred in connection with a Covered Person’s repatriation. All transportation arrangements made for repatriating the Covered Person must be by the most direct and economical route possible. Expenses for transportation must be: (a) recommended by the local attending Doctor; (b) required by the standard regulations of the conveyance transporting the Covered Person; and (c) arranged and authorized in advance by Us. The expenses paid will be less the value of any unused ticket.

EMERGENCY REUNION BENEFIT

In the event the Covered Person is or will be confined in a Hospital for at least 7 consecutive days due to a covered Injury or Sickness and is traveling alone, the Insurer will pay the expenses incurred for travel of a person chosen by him or her, up to the Benefit Limit shown in the Schedule of Benefits. Covered expenses are limited to a round-trip economy airline ticket. All travel arrangements must be made by Us and approved in advance.

HOME COUNTRY BENEFIT

The Insurer will pay the benefit shown in the Schedule of Benefits when the Covered Person returns to his or her Home Country or country of principal residence for incidental visits, and suffers an injury or sickness during the incidental trip, provided a) the period of coverage is for a period of at least 30 days; and b) the primary reason for the Covered Person’s return to the Home Country or country of principal residence is not to obtain medical treatment for an Injury or Sickness that occurred while traveling.

REPATRIATION OF REMAINS BENEFIT

The Insurer will pay Repatriation Benefits as shown in the Schedule of Benefits for preparation and return of a Covered Person’s body to his or her home if he or she dies as a result of a Medical Emergency while traveling outside his or her Home Country. Covered Expenses include a) expenses for embalming or cremation; b) the minimally necessary coffin or receptacle adequate for transporting the remains; c) transporting the remains; and d) documentation fees.

All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the Usual and Customary Charges for similar transportation in the locality where the expense is incurred.

Benefits will not be payable unless We authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance.

BAGGAGE AND TRAVEL DOCUMENTS BENEFIT

Lost/Damaged Baggage

The Insurer will reimburse the Covered Person up to the maximum shown in the Schedule of Benefits for loss of or damage to Baggage on a Common Carrier during the Trip. The Insurer will pay the lesser of the following: the original cash value of the item less depreciation as determined by the Insurer; or the cost of repair or replacement limit per article - $50. If receipts are not provided, benefits may be reduced.

Payment of Loss: The Insurer will pay the lesser of the cost to repair an item, or to replace it with an item of like kind and quality. The Insurer will pay, in cash, the cost of repair or replacement of the Covered Person’s damaged Baggage, less depreciation; or repair or replace the Covered Person’s Baggage.

TRAVEL PROTECTION

TRIP INTERRUPTION BENEFIT

The Insurer will pay this Primary benefit, up to the Maximum Limit shown in the Schedule of Benefits if a Trip is interrupted for the Covered Person, due to any of the following Unforeseen reasons:

  1. Death of a Family Member.
  2. the Covered Person’s Home being made uninhabitable by fire, flood, or natural disaster.

However, the benefit will not exceed the cost of Economy Airfare or first class if the Covered Person’s original tickets were first class by the most direct route, less any refunds paid or payable.

TRAVEL ACCIDENT PROTECTION

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

If Injury to Covered Person results, within the Time Period for Loss shown in the Schedule of Benefits, in any one of the losses shown below, We will pay the Benefit Amount shown below for that loss. The Principal Sum is shown in the Schedule of Benefits. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.

Schedule of Covered Losses

Covered Loss Benefit Amount
Life 100% of the Principal Sum
Two or more Members 100% of the Principal Sum
One Member 50% of the Principal Sum

“Member” means Loss of Hand or Foot, Loss of Sight, Loss of Speech, and Loss of Hearing. “Loss of Hand or Foot” means complete Severance through or above the wrist or ankle joint. “Loss of Sight” means the total, permanent Loss of Sight of one eye. “Loss of Speech” means total and permanent loss of audible communication that is irrecoverable by natural, surgical or artificial means. “Loss of Hearing” means total and permanent Loss of Hearing in both ears that is irrecoverable and cannot be corrected by any means. “Severance” means the complete separation and dismemberment of the part from the body.

Exposure and Disappearance

Coverage under this hazard includes exposure to the elements after the forced landing, stranding, sinking, or wrecking of a vehicle in which the Covered Person was traveling.

A Covered Person is presumed dead if: 1) he or she is in a vehicle that disappears, sinks, or is stranded or wrecked on a Trip covered by this Policy; and 2) the body is not found within one year of the Covered Accident.

OPTIONAL SPORTS COVERAGE

If the optional Hazardous Sport Coverage is purchased: benefits will be paid if the Insured Person is injured while participating in any of the following sports: mountaineering where ropes or guides are normally used (4500 meter limit), parachuting, bungee jumping, snowmobiling, scuba diving involving underwater breathing apparatus, snorkeling, water skiing, snow skiing, spelunking, and snow boarding

SCOPE OF COVERAGE

Excess Coverage The benefits payable under the Policy, except for Accidental Death and Dismemberment Benefit, will only be paid on an excess basis over and above any benefits or services provided for by: a) any other valid or collectible insurance; or b) any other form of indemnity payable by those responsible for the loss, such as an airline.

GENERAL EXCLUSIONS

These exclusions apply to the Accidental Death and Dismemberment.

The Policy does not cover loss due to:

  1. intentionally self-inflicted Injury, suicide, or attempted suicide, while sane or insane (in Missouri, while sane).
  2. Sickness or disease.
  3. Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food.
  4. hernia, unless resulting from a Covered Accident.
  5. Injury sustained while riding as a pilot, crew member or student pilot on any Aircraft or device for aerial navigation.
  6. war or any act of war, whether declared or not, civil disturbance or insurrection.
  7. civil disorder or riot.
  8. military duty or service; while serving as a member of the naval, air or Armed Services of any country;
  9. flight in, boarding or alighting from an Aircraft or any craft designed to fly above the Earth’s surface being used for crop dusting, spraying or seeding, giving and receiving flying instruction, fire fighting, sky writing, sky diving or hang-gliding, pipeline or power line inspection, aerial photography or exploration, racing, endurance tests, stunt or acrobatic flying, or any operation that requires a special permit from the FAA, even if it is granted.
  10. Injury or loss or Sickness that occurs while the Covered Person is legally intoxicated (as determined by that state’s law) or while under the influence of any drug unless administered under the advice and consent of a Doctor.
  11. commission of, or attempt to commit, a felony, an assault or other criminal activity.
  12. participation in motor racing including training or practice for the same.
  13. pregnancy or childbirth, or elective abortion, or Complications of Pregnancy.
  14. hazardous sports activities for mountaineering where ropes or guides are normally used (4500 meter Limit); parachuting; bungee cord jumping; racing by horse, motor vehicle or motorcycle; snowmobiling; scuba diving involving underwater breathing apparatus; snorkeling; water skiing; spelunking; and snow boarding (This exclusion does not apply, if the additional premium is paid for these sports activities).
  15. Injury sustained while the Covered Person is riding as a passenger in any aircraft (a) not having a current and valid Airworthy Certificate and (b) not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft
  16. air travel on any air-supported device, other than a regularly scheduled airline or air charter company.

These exclusions apply to all other benefits.

The Policy does not cover loss due to:

Pre-existing Medical Condition Exclusion Applicable To All Coverages (except Emergency Medical Evacuation and Repatriation of Remains): The Policy will not pay for loss or expense incurred as the result of Injury [or Sickness] of the Covered Person or Family Member which manifests itself during the 12 months immediately preceding and including the Effective Date, unless the condition is controlled through the taking of prescription drugs or medication and remains controlled throughout the 12 month period. A Sickness has manifested itself when: (a) medical care or treatment has been given; or (b) there exist symptoms which would cause a reasonably prudent person to seek diagnosis, care, or treatment.

  1. any non-emergency treatment or surgery;
  2. Covered Medical Expenses for which the Covered Person would not be responsible for in the absence of this Policy;
  3. any expenses which exceed the Maximum Benefit Amount shown in the Schedule of Benefits;
  4. any Elective Treatment, surgery, health treatment, or examination, including any service, treatment or supplies that: (a) are deemed by Us to be experimental; and (b) are not recognized and generally accepted medical practices in the United States;
  5. intentionally self-inflicted Injury, suicide, or attempted suicide, while sane or insane (in Missouri, while sane);
  6. war or any act of war, whether declared or not, civil disturbance or insurrection.
  7. civil disorder or riot.
  8. participation in professional athletic events, organized or interscholastic team sports, motor sport or motor racing including training or practice for the same;
  9. expense incurred for treatment of temporomandibular or craniomandibular joint dysfunction and associated myofacial pain (except as provided by the Policy);
  10. treatment by persons employed or retained by a Covered Person, or by any Immediate Family or member of the Covered Person’s household;
  11. elective or cosmetic surgery except for necessary treatment due to covered Injury;
  12. traveling expressly for the purpose of obtaining medical treatment;
  13. dentures, false teeth or dental treatment, except as a result of a covered Injury to sound, natural teeth or non-elective emergency dental surgery;
  14. replacement of hearing aids unless a covered Injury has caused impairment of hearing;
  15. replacement of eyeglasses or contact lenses, or eye examinations for the correction of vision or fitting of glasses unless a covered Injury has caused impairment of sight;
  16. alcohol or substance abuse;
  17. Injury or loss or Sickness that occurs while the Covered Person is legally intoxicated (as determined by that state’s law) or while under the influence of any drug unless administered under the advice and consent of a Doctor;
  18. mental, psychological or nervous disorders including anxiety, depression, neurosis or psychosis;
  19. any treatment, service or supply not specifically covered by the Policy;
  20. intentionally self-inflicted Injury, suicide, or attempted suicide, while sane or insane (in Missouri, while sane);
  21. Injury sustained while committing or attempting to commit a felony or misdemeanor;
  22. hazardous sports activities for mountaineering where ropes or guides are normally used (4500 meter Limit); parachuting; bungee cord jumping; racing by horse, motor vehicle or motorcycle; snowmobiling; scuba diving involving underwater breathing apparatus; snorkeling; water skiing; spelunking; and snow boarding;
  23. venereal disease or syphilis; (This exclusion does not apply if the Sports coverage premium is paid)
  24. routine dental care; dental treatment except as a result of Injury to sound natural teeth;
  25. pregnancy, childbirth, miscarriage, abortion or any complications of any of these conditions;
  26. travel or activity outside the United States;
  27. traveling expressly for the purpose of obtaining medical treatment;
  28. birth defects and congenital anomalies; or complications which arise from such conditions;
  29. any expenses covered by any other employer or government sponsored plan for which, and to the extent that the Covered Person is eligible for reimbursement;
  30. expenses incurred for birth control including surgical procedures and devices;
  31. Expenses incurred for services related to the diagnostic treatment of infertility or other problems related to the inability to conceive a child, including but not limited to, fertility testing and in-vitro fertilization.
  32. Organ or tissue transplants and related services
  33. Services, supplies, or treatment including any period of Hospital confinement which were not recommended, approved and certified as necessary and reasonable by a Doctor; or expenses which are non-medical in nature.
  34. Injury or sickness where the Covered Person is traveling against the advice of a medical professional.
  35. Sexual transgendering surgery; sexual transformation surgery; sexual reassignment surgery.
  36. Weight management services and supplies

If We determine the benefits paid under this Policy are eligible benefits under any other benefit plan, We may seek to recover any expenses covered by another plan to the extent that the Covered Person is eligible for reimbursement.

This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims.

The following Exclusions apply to Baggage Protection only:

Property Not Covered: We will not pay for damage or loss of: animals; bicycles except when checked with a Common Carrier; motor vehicles and equipment, Aircraft, and other conveyances and their equipment; boats, motorcycles, motors or any other vehicles; artificial limbs, artificial teeth, dental bridges/appliances, any type of eyeglasses, sunglasses or contact lenses; hearing aids; tickets, money, notes, securities, accounts, bills, currency, deeds, food stamps or other evidence of debt, credit cards and other travel documents except passports and visas; household furniture or furnishings;

Additional Exclusions: We will not pay this benefit for loss due to: normal wear and tear; gradual deterioration; rodents, animals or insects; damage while being worked on; natural defect or damage sustained due to any process or repair; civil war, insurrection, rebellion, revolution or warlike act by a military force, whether war is declared or not declared; confiscation or expropriation by order of any government; nuclear reaction, nuclear radiation, or radioactive contamination; sporting equipment damaged while being used; theft or pilferage while left unattended in any vehicle; mysterious disappearance.

Payment of Loss: The Insurer will pay the lesser of the cost to repair an item, or to replace it with an item of like kind and quality. The Insurer will pay, in cash, the cost of repair or replacement of the Covered Person’s damaged Baggage, less depreciation; or repair or replace the Covered Person’s Baggage.

Effective Date Of Insurance

After Premium is paid by the Covered Person and the Application is completed and signed, TRIP INTERRUPTION BENEFIT will be effective:

  1. at 12:00 a.m. on the day after the Application is postmarked to Us if coverage is purchased by mail; or
  2. at 12:00 a.m. on the day after the Application is phoned in to Us if coverage is purchased by phone; or
  3. at 12:00 a.m. on the day after the Application is faxed to Us if coverage is purchased by facsimile;
  4. at 12:00 a.m. on the day after the online purchase confirmation date;
  5. on the day after the Application is completed online.

All other coverages will begin on the later of:

  1. the date and time the Covered Person starts his or her Trip, or
  2. the scheduled Trip Departure Date shown on the Application;
  3. the date after the Premium is paid.

Termination Date Of Insurance

All coverage ends on earliest of:

  1. the date the Trip is completed; or
  2. the scheduled Trip Completion Date; or
  3. the Covered Person’s arrival at the Return Destination on a round Trip or the Destination on a one-way Trip; or
  4. cancellation of the Trip covered by the Policy.

CLAIM PROVISIONS

Notice Of Claim: A claimant must give Us or Our authorized representative written (or authorized electronic or telephonic) notice of claim within 90 days after any loss covered by the Policy occurs. If notice cannot be given within that time, it must be given as soon as reasonably possible. This notice should identify the Covered Person and the Policy Number.

Proof Of Loss: Written (or authorized electronic or telephonic) proof of loss must be sent to the agent authorized to receive it. Written (or authorized electronic or telephonic) proof must be given within 90 days after the date of loss. If it cannot be provided within that time, it should be sent as soon as reasonably possible. In no event, except in the absence of legal capacity, should proof of loss be sent later than one year from the time proof is otherwise required.

Payment Of Claims: If the Insured dies, any death benefits or other benefits unpaid at the time of the Insured’s death will be paid to the beneficiary Our records indicate the Insured designated for these plan benefits.

If there is no named beneficiary or surviving beneficiary on record with Us or Our authorized agent, We pay benefits in equal shares to the first surviving class of the following:

  1. Spouse;
  2. Children;
  3. Parents;
  4. Brothers and sisters.

If there are no survivors in any of these classes, We will pay the Insured’s estate.

All other benefits will be paid to the Insured. If the Insured is: (1) a minor; or (2) in Our opinion unable to give a valid release because of incompetence, We may pay any amount due to a parent, guardian, or other person actually supporting him or her. Any payment made in good faith will end Our liability to the extent of the payment.

Assignment: At the request of the Insured or his or her parent or guardian, if the Insured is a minor, medical benefits may be paid to the provider of service. Any payment made in good faith will end Our liability to the extent of the payment.

Physical Examinations And Autopsy: We have the right to have a Doctor of Our choice examine the Covered Person as often as is reasonably necessary. This section applies when a claim is pending or while benefits are being paid. We also have the right to request an autopsy in the case of death, unless the law forbids it. We will pay the cost of the examination or autopsy.

Legal Actions: No lawsuit or action in equity can be brought to recover on the Policy before 60 days following the date proof of loss was given to Us. No such action can be brought after expiration of the applicable statute of limitations from the time written proof of loss is required to be furnished.

FOR PLAN INQUIRIES OR INFORMATION ON FILING A CLAIM PLEASE CONTACT:

MEDEX Insurance Services at 1-800-739-5309 or 1-410-453-6380.

GENERAL PROVISIONS

Entire Contract; Changes: The Policy (including any endorsements or amendments), the signed application of the Policyholder, and any individual applications of Covered Persons, are the entire contract. Any statements made by the Policyholder or Covered Persons will be treated as representations and not warranties. No such statement shall void the insurance, reduce the benefits, or be used in defense of a claim for loss incurred unless it is contained in a written application.

To be valid, any change or waiver must be in writing. It must be signed by Our President or Secretary and be attached to the Policy. No agent has authority to change or waive any part of the Policy.

Policy Effective Date And Termination Date: The Policy begins on the Policy Effective Date at 12:00 a.m. (midnight) at the address of the Policyholder where this Policy is delivered. We may terminate this Policy by giving 31 days advance notice in writing (or authorized electronic or telephonic means) to the Policyholder. Either We or the Policyholder may terminate this Policy on any Premium Due Date by giving 31 days advance written (or authorized electronic or telephonic) notice to the other party. This Policy may be terminated at any time by mutual written consent of the Policyholder and Us. This Policy terminates automatically on the earlier of: 1) the last day of the Policy term; or 2) the Premium due date if Premiums are not paid when due. Termination takes effect at 12:00 a.m. (midnight) at the Policyholder's address on the date of termination.

Clerical Error: If a clerical error is made, it will not affect the insurance of any Covered Person. No error will continue the insurance of a Covered Person beyond the date it should end under the Policy terms.

Examination Of Records And Audit: We shall be permitted to examine and audit the Policyholder’s books and records at any time during the term of the Policy and within 2 years after the final termination of the Policy as they relate to the premiums or subject matter of this insurance.

Conformity With State Laws: On the effective date of this Policy, any provision that is in conflict with the laws in the state where it is issued is amended to conform to the minimum requirements of such laws.

Subrogation: We may recover any benefits paid under the Policy to the extent a Covered Person is paid for the same Injury or Sickness by a third party, another insurer, or the Covered Person’s uninsured motorist insurance. We may only be reimbursed to the amount of the Covered Person’s recovery. Further, We have the right to offset future benefits payable to the Covered Person under the Policy against such recovery.

We may file a lien in a Covered Person’s action against the third party and have a lien on any recovery that the Covered Person receives whether by settlement, judgment, or otherwise, and regardless of how such funds are designated. We shall have a right to recovery of the full amount of benefits paid under the Policy for the Injury or Sickness, and that amount shall be deducted first from any recovery made by the Covered Person. We will not be responsible for the Covered Person’s attorney’s fees or other costs.

Upon request the Covered Person must complete the required forms and return them to Us or Our authorized agent. The Covered Person must cooperate fully with Us or Our representative in asserting its right to recover. The Covered Person will be personally liable for reimbursement to Us to the extent of any recovery obtained by the Covered Person from any third party. If it is necessary for Us to institute legal action against the Covered Person for failure to repay Us, the Covered Person will be personally liable for all costs of collection, including reasonable attorneys’ fees.

REFUND POLICY

If for any reason you wish to cancel your policy, you must submit your cancellation request in writing to MEDEX Insurance Services in order to receive a refund of premium. To be eligible for a full refund, the request for cancellation must be received prior to your effective date. Cancellation requests received after the effective date will be subject to the following conditions: 1) only the unused portion of the plan cost will be refunded; and 2) only members who have no claims are eligible for premium refund.

Plan is designed by MEDEX.

This Insurance, under policy #AH-18103 is underwritten by: ACE American Insurance Company at Philadelphia, Pennsylvania.

Policy terms and conditions are briefly outlined in this Description of Coverage. Complete provisions pertaining to this insurance are contained in the Master Policy . In the event of any conflict between this Description of Coverage and the Master Policy, the Master Policy will govern.

MIS-CHOICE-INBOUND-01-11

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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