Travelex: FlightPlus Single Trip Protection
DESCRIPTION OF COVERAGE
(Questions? Call 1-800-694-4311)
Does your medical insurance plan cover you while traveling abroad?
What if you require medical care while overseas?
What if you have a medical emergency and require medical evacuation?
What if your baggage or travel documents are lost or stolen while traveling?
It's important to consider these questions before you depart on your
trip to ensure you are covered in the event of the unexpected.
The Travelex Flight Plus Protection plan offers peace of mind
protection for you and your family at an affordable cost. Available
benefits include:
• Accidental Death & Dismemberment coverage
• Coverage for emergency medical and medical evacuation expenses
• Coverage for lost or stolen baggage and baggage delay
• Worldwide coverage
• Travel assistance services available 24/7
In addition, travelers may choose to enhance their plan with additional
flight accident coverage. Plans offering only flight accident coverage
are also available.
IMPORTANT
Certain capitalized words are defined terms within this document.
INDIVIDUAL COVERAGE PERIOD
"Effective Date" is the later of the date and time of departure of the
Covered Trip or: i) the date the enrollment is deposited in an airport kiosk;
ii) the Postmark of Your enrollment form; iii) the date You phone in the enrollment;
iv) the date Your enrollment form is received by facsimile or v) the date You
submit the enrollment via the internet, provided that in all cases the proper
plan cost has been paid.
Flight Accident Plan begins on the departure date of the Covered Trip or
the Effective Date whichever is later. The Flight Accident Plan ends when the
trip is completed or after 180 days, whichever comes first.
All Other Coverages begin at 12:01 a.m. on Your Scheduled Departure Date
of the Covered Trip or Your Effective Date, whichever is later, and end at the
point and time of return, on or before Your Scheduled Return Date of the Covered
Trip.
EXTENSION OF COVERAGE
If the duration of Your Covered Trip is prolonged and not completed during the
policy period because of the delay (beyond the control of any person insured hereunder)
of the means of transport by which You are traveling or are due to travel provided
that such transportation was due to arrive at Your destination within the policy
period and provided that the Covered Trip is completed with reasonable dispatch,
the insurance is extended automatically beyond the expiration date without additional
premium for a period of 72 hours. Should You be Hospitalized, coverage will be
automatically extended for the period of the Hospital confinement and, in addition,
5 days after release for both You and one insured Traveling Companion.
FLIGHT ACCIDENT
You are covered for the amount purchased for accidental death, dismemberment or
loss of sight as the result of an accident while a passenger on:
a) a regularly scheduled airline flight or regularly scheduled charter
operated: (i) in scheduled air transportation pursuant to economic
authority issued by the Civil Aeronautics Board; (ii) by an intrastate
scheduled airline of United States registry maintaining regularly
published schedules and licensed for the transportation of passengers
by a duly constituted authority having jurisdiction over civil aviation in
the state in which said airline operates; or (iii) by a scheduled airline
of foreign registry maintaining regularly published schedules and
licensed for transportation of passengers by the duly constituted
governmental authority having jurisdiction over civil aviation in the
country of registry of such airline;
b) any aircraft, other than a single-engine jet, which at the time is
making a flight for the principal purpose of transporting passengers
and not for any other operational, tactical or test purposes, and which
is operated by: (i) the Military Airlift Command of the United States;
(ii) the Royal Canadian Air Force Air Transport Command; or
(iii) the Royal Air Force Air Transport Command of Great Britain;
c) any land or water conveyance provided at the expense of the air
carrier as a substitute for an aircraft covered by this plan;
d) a vehicle licensed to carry passengers for hire, but only:
(i) when going to an airport to board an aircraft on which You are
covered by this plan; or (ii) when leaving an airport after alighting
from such an aircraft;
e) received while upon airport premises designated for passenger use
immediately before boarding or immediately after alighting from an
aircraft on which You are covered by this plan.
When You sustain covered Injuries resulting on any of the following
losses within 180 days from the date of the accident, benefits will be
paid as follows:
• Loss of life, both feet, both hands, both eyes, one hand and one
foot, one hand and one eye or one foot and one eye — Maximum
Benefit Amount;
• Loss of one hand, one foot or one eye — one half the Maximum
Benefit Amount.
Loss of hand or hands, or foot or feet, means complete and permanent
severance at or above the wrist joint or ankle joint, respectively. Loss
of eye or eyes means the total and irrecoverable loss of the entire sight
thereof. Only one of the amounts shown above (the largest applicable)
will be paid for the Injuries resulting from one accident.
The benefit for loss of: a) two limbs; b) both eyes; or c) one limb and
one eye is payable only when such loss results from the same accident.
If, while covered by this benefit, You are unavoidably exposed to the
elements because of a covered accident and suffer a loss for which
benefits are payable under this benefit, such loss will be covered. If,
while covered by this benefit, You are in an accident resulting in the
disappearance, sinking or damaging of an air or water conveyance on
which You are covered by this benefit, and Your body has not been
found within 52 weeks from the date of the accident, it will be
presumed, unless there is evidence to the contrary, that You suffered
loss of life as a result of those Injuries.
The Flight Accident Plan also includes a medical expense feature that
pays You up to $50 for each $1,000 of Your chosen benefit amount. If
medical expense occurs within 52 weeks of a covered accident, You
will be paid for: treatment by a Legally Qualified Physician or surgeon;
care or service from a Hospital; services and supplies provided by an
ambulatory medical-surgical facility; home health care from a
licensed home health agency, but only if continued Hospital care
would otherwise have been required; attendance of a registered
graduate nurse; x-ray examination; or, use of an ambulance. Loss
must occur within 100 days of the accident. To receive benefits, the
loss must be independent of Sickness and all other causes.
MEDICAL EXPENSE BENEFITS
You are covered up to the Maximum Benefit Amount for:
1) Covered Expenses incurred as a result of an Injury which occurs or
a Sickness which first manifests itself during the Covered Trip. You
must receive initial Medical Treatment for the Injury or Sickness within
30 days after the date of the accident that caused the Injury or the
onset of the Sickness. All treatment and Covered Expenses must be
received within 52 weeks following the date of the accident or onset
of the Sickness.
2) Benefits will include expenses for emergency dental
treatment for injury to sound natural teeth not to exceed $750.
3) Advance payment will be made to a Hospital, up to the Maximum
Benefit Amount, if needed to secure Your admission to a Hospital
because of a covered Sickness or Injury which first occurs during the
course of the Covered Trip.
The authorized travel Assistance Company will coordinate advance
payment to the Hospital. In all cases, benefits will not be paid in
excess of the Usual and Customary Charges.
Benefits will not duplicate any benefits payable under the policy or
any coverage(s) attached to the policy.
MEDICAL EVACUATION/REPATRIATION BENEFITS
You are covered up to the Maximum Benefit Amount purchased for:
1) Medical Evacuation which is determined by a Legally Qualified
Physician and the authorized Assistance Company’s medical director
that an Injury or Sickness is acute or life threatening and adequate
treatment is not available at a local Hospital. Transportation will be
to the closest Hospital or medical facility capable of providing
adequate treatment.
2) Medical Repatriation when it is deemed Medically Necessary by a
Legally Qualified Physician and the authorized Assistance Company
for You to return home or to a Hospital near Your home for continued
treatment. Transportation Expense incurred will be paid for You; a) to
return to Your permanent residence or b) to be moved to a Hospital or
medical facility closest to Your permanent place of residence capable
of providing that treatment; via one-way, Economy Transportation; or
commercial upgrade, based on Your condition as recommended by the
local attending Legally Qualified Physician and the authorized
Assistance Company;
3) Repatriation of Remains: In the event of Your covered death,
occurring during the Covered Trip, the Company will pay either the
cost of the actual expense incurred for preparation, standard
container and transportation of Your body or ashes to the outbound
point of departure or for the reasonable cost for burial or cremation
abroad, in either case not to exceed $5,000.
4) Transportation for the return trip home via Economy Transportation
for any dependent children under age 18 who are accompanying You
if You are confined to a Hospital for more than seven (7) consecutive
days. If You are traveling alone and are confined to a Hospital for more
than seven (7) consecutive days, this benefit will provide, upon
request by You or next of kin, one round-trip Economy Transportation
for a person of Your choice to visit You in the Hospital.
These benefits provide Economy Transportation which must be by
the most direct route. Covered land or air transportation includes,
but is not limited to, commercial stretcher, medical escort, or the
Usual and Customary Charges for air ambulance, provided such
transportation has been pre approved and arranged by the
authorized Assistance Company.
Benefits are paid less the value of an unused return travel ticket.
If benefits are payable under this coverage and You have other
insurance that may provide benefits for this same loss, the Company
reserves the right to recover from such other insurance.
Note: The Pre-existing Condition limitation is automatically waived for
Medical Evacuation / Repatriation.
CONDITIONS
If benefits are payable under Medical Evacuation/Repatriation and You
have other insurance that may provide benefits for this same loss, the
Company reserves the right to recover benefits from such other insurance.
You shall:
a) notify the Company of any other insurance;
b) cooperate with the Company to exercise the Company’s rights in
any reasonable way that the Company may request, including the
filing and assignment of other insurance benefits;
c) not do anything after the loss to prejudice the Company’s rights;
and
d) reimburse to the Company, to the extent of any payment the
Company has made, for benefits received from such other insurance.
BAGGAGE & BAGGAGE DELAY
BAGGAGE AND PERSONAL EFFECTS
You are covered up to the Maximum Benefit Amount for lost, stolen, or
damaged baggage or personal items with a maximum reimbursement
of up to $300 per article. A combined maximum of $600 will be paid
for jewelry, watches, articles consisting in whole or in part of silver,
gold or platinum, articles trimmed with fur, cameras and their
accessories and related equipment.
In addition, the following reimbursements will apply:
1) lost or stolen passport or visa ($50 maximum);
2) lost or stolen credit cards ($50 maximum for the cost associated
with unauthorized use subject to verification that You have complied
with all conditions of the credit card company).
The lesser of the following amounts will be paid:
a) the actual cash value (cost less proper deduction for depreciation)
at the time of loss, theft or damage;
b) the cost to repair or replace the article with material of a like kind
and quality; or
c) $300 per article.
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 scheduled under any other
insurance.
BAGGAGE DELAY
If Your checked baggage is delayed or misdirected by a Common
Carrier while on Your Covered Trip for more than 24 hours from Your
time of arrival at the destination other than Your residence, You are
covered for the expense of necessary purchases of personal items up
to the Maximum Benefit Amount as long as the expense is
substantiated by receipts for purchases. The Common Carrier must
certify the delay.
ACCIDENTAL DEATH & DISMEMBERMENT
24 HOUR
You are covered 24 hours a day, up to the Maximum Benefit Limit,
when You sustain covered Injuries resulting in any of the following
losses within 180 days from the date of the accident.
Benefits will be paid as follows:
• loss of life, both feet, both hands, both eyes, one hand and one
foot, one hand and one eye or one foot and one eye — Maximum
Benefit Amount;
• loss of one hand, one foot or one eye — one half of the Maximum
Benefit Amount.
Loss of hand or hands, or foot or feet, means complete and permanent
severance at or above the wrist joint or ankle joint, respectively. Loss of
eye or eyes means the total and irrecoverable loss of the entire sight
thereof. Only one of the amounts shown above (the largest applicable)
will be paid for the Injuries resulting from one accident. The benefit for
loss of: a) two limbs; b) both eyes; or c) one limb and one eye is
payable only when such loss results from the same accident.
If, while covered by this benefit, You are unavoidably exposed to the
elements because of a covered accident and suffer a loss for which
benefits are payable under this benefit, such loss will be covered.
If, while covered by this benefit, You are in an accident resulting in the
disappearance, sinking or damaging of an air or water conveyance on
which You are covered by this benefit, and Your body has not been
found within 52 weeks from the date of the accident, it will be
presumed, unless there is evidence to the contrary, that You suffered
loss of life as a result of those Injuries.
TRAVEL ASSISTANCE
You can access a wide-range of valuable services, through a toll-free telephone
call, 24-hours a day, 7 days a week. Travel Assistance provides a variety of travel
related services, including:
Medical evacuation/repatriation* • Repatriation of remains* •
Medical or legal referral • Hospital admission guarantee* •
Emergency cash transfer** • Translation service •
Prescription drug-eyeglass replacement** • Passport/visa information •
Bail bond** • Lost baggage retrieval • Inoculation information
* Only available with the Flight Plus Package Plan
** Benefit reimbursement to the Assistance Company is your responsibility.
TRAVEL ASSISTANCE CARD
For 24 hour emergency assistance
while on Your trip, please use the following numbers:
Within the U.S. & Canada — 1-(800) 231-5857
Elsewhere — call collect — 1-(905) 523-7066
To initiate or inquire about a claim, please call 1-888-322-6776
DEFINITIONS
“Baggage and Personal Effects” means goods being used by an Insured during
a Covered Trip. (See Exclusions on p.5)
“Common Carrier” means any public land, air or water conveyance operating
under a valid license providing for the transportation of passengers for hire.
“Confirmation of Coverage” means the coverage confirmation provided to
You following enrollment and the payment of the applicable plan cost.
“Covered 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: the services
of a Legally Qualified Physician; 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 Your Covered Trip, if recommended as a substitute
for a hospital room for recovery of an Injury or Sickness); transportation furnished
by a professional ambulance company to and/or from a Hospital; and prescribed
drugs, prosthetics and therapeutic services and supplies.
“Covered Trip” means scheduled trips, tours or cruises for which: a) coverage
is requested and b) the required plan cost is paid prior to the Scheduled Departure
Date.
“Economy Transportation” means the lowest published available transportation
rate for a ticket on a Common Carrier matching the original class of transportation
that You purchased for the Covered Trip, reduced by the value of an unused return
travel ticket.
“Eligible Person” means a resident of the United States.
“Family Member” means You or Your Traveling Companion’s: legal spouse or
common-law spouse (where legal), legal guardian, legal ward, son or daughter (adopted,
foster, step or in-law), brother or sister (includes step or in-law), parent (includes
step or in-law), grandparent (includes in-law), grandchild, aunt, uncle, niece,
nephew or Key Person, provided the Family Member resides in the United States,
Canada or Mexico.
“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 an 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 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” mean accidental bodily Injuries received
while protected under this coverage and resulting in loss independently of Sickness
and all other causes and certified by a Legally Qualified Physician.
“Intoxicated” means a blood alcohol level which equals or exceeds the legal
limit for operating a motor vehicle in the state or jurisdiction where You are
located at the time of an incident.
“Key Person” means a) an employed caregiver of a dependant of the Insured
or the Insured's traveling companion or b) a person to whom the Insured or the
Insured's traveling companion is not married and with whom the Insured or the
Insured's traveling companion has cohabited for 12 continuous months.
“Legally Qualified Physician” means a physician or a Christian Science
Practitioner: a) other than You, a Traveling Companion or a Family Member; b)
practicing within the scope of his or her license; and c) recognized as a physician
in the place where the services are rendered.
“Maximum Benefit Amount” means the maximum amount payable for each coverage
as shown on the Confirmation of Coverage.
“Medical Treatment” means treatment, advice or consultation by a Legally
Qualified Physician.
“Medically Necessary” means a service or supply which: a) is recommended
by the attending Legally Qualified Physician; b) is appropriate and consistent
with the diagnosis in accordance with accepted standards of community practice;
c) could not have been omitted without adversely affecting Your condition or quality
of medical care; d) is delivered at the most appropriate level of care and not
primarily for the sake of convenience; and e) is not considered experimental unless
coverage for experimental service or supplies is required by law.
“Postmark” means the U.S. Postal Service mark that records the date and
place of mailing to the addressee on the Protection Plan enrollment form.
“Scheduled Departure Date” means the date on which You are originally scheduled
to leave on Your Covered Trip.
“Scheduled Return Date” means the date You are originally scheduled to
return to the point of origin or the original final destination.
“Sickness” means an illness or disease which is diagnosed or treated by
a Legally Qualified Physician after the Effective Date of Your plan and while
You are covered under this plan.
“Terrorist Incident” means the unsanctioned and illegal use of violence
which caused destruction of property, Injury, or death by an individual or group
for the express or implied purpose of achieving a political, ethnic, or religious
goal or result. A Terrorist Incident does not include general civil disturbance,
rioting, an act of war (declared or undeclared) or the intentional release of
a biological material. The Terrorist Incident must be documented in a travel warning
issued by the United States Department of State advising that one should not travel
to the Insured's country of destination or, for U.S. cities, reported by the major
news media.
“Transportation Expense” means: a) the cost of the conveyance of You and
any medical personnel (if Medically Necessary); and b) Medically, Necessary services
and supplies.
“Traveling Companion” means a person or persons with whom You have coordinated
Travel Arrangements and intend to travel with during the Covered Trip (to a maximum
of four persons including You). Note: a group or tour leader is not considered
a Traveling Companion, unless You are sharing room accommodation with the group
or tour leader.
“Usual and Customary Charges” means those comparable charges for similar
treatment, services and supplies in the geographic area where treatment is performed.
“You or Your” means the individual(s) named on the enrollment form.
FILING A CLAIM IS SIMPLE
To receive a claim form: Contact us within 30 days of Your loss at 1-888-322-6776,
or send Your name, address, travel dates, confirmation number (provided on Your
confirmation of coverage), and details of Your loss to:
Old Republic Insurance Company
Travelex Claims Department
4600 Witmer Industrial Estates, Suite 6
Niagara Falls, NY 14305
IMPORTANT: To facilitate prompt claims settlement, You will be asked to
provide proof of Your loss within 90 days after the date of 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.
Therefore, be sure to obtain as applicable: for medical claims: detailed
medical statements from treating physicians where and when the accident or Sickness
occurred; receipts for medical services and supplies; for baggage and baggage
delay claims: reports from parties responsible (i.e. airline, cruiseline,
etc.) for loss, theft, damage or delay. If applicable, a police report will be
required. Please obtain receipts for lost or damaged items. The company will investigate
and negotiate any claim on your behalf.
Benefits under any coverage will not be paid for expenses reimbursed
or services provided by any other source.
Benefits cannot be duplicated under this Protection Plan.
Unless You otherwise designate a beneficiary, or in the event the
designated beneficiary predeceases You, indemnity for loss of life will
be paid to the first of the following surviving beneficiaries: Your
spouse; child or children, jointly; parents, jointly if both are living, or
the surviving parent, if only one survives; brothers and sisters jointly;
or Your estate.
GENERAL EXCLUSIONS & LIMITATIONS
Benefits are not payable for Sickness, Injuries or losses of You and Your Traveling
Companion:
a) resulting from suicide, attempted suicide, or any intentionally selfinflicted
Injury while sane or insane (in Missouri, sane only);
b) resulting from a Terrorist Incident, hostilities or an act of declared
or undeclared war;
c) while participating in maneuvers or training exercises of an
armed service;
d) while riding, driving or participating in races, or speed or
endurance contests;
e) while mountaineering (engaging in the sport of scaling mountains
generally requiring the use of picks, ropes or other special equipment);
f) while participating as a member of a team in an organized sporting competition;
g) while participating in skydiving, hang gliding, bungee cord jumping, scuba diving or deep sea diving;
h) while piloting or learning to pilot or acting as a member of the crew of any aircraft;
i) received as a result or consequence of being Intoxicated or under
the influence of any controlled substance unless administered on the
advice of a Legally Qualified Physician;
j) to which a contributory cause was the commission of or attempt to
commit a felony or being engaged in an illegal occupation;
k) resulting from a governmental regulation or prohibition;
l) unless medically fit to travel at the time of purchase of coverage;
m) relating to a diagnosed Sickness from which no recovery is
expected and for which only palliative treatment is provided and
which carries a prognosis of death within 12 months of the policy
Effective Date;
n) resulting from non-physical Sickness such as mental, nervous,
emotional or personality disorders in any form whatsoever unless the
affected person is hospitalized for 3 consecutive days or more after
the policy Effective Date;
o) due to normal childbirth, normal pregnancy (except complications
of pregnancy) or voluntarily induced abortion;
p) for dental treatment (except as coverage is otherwise specifically
provided herein);
q) where coverage has been purchased for travel to or through
countries for which travel warnings have been issued by the United
States Department of State at the time this insurance is purchased; or
r) resulting from the intentional release of a biological material.
For Residents of California, benefits are not payable if during the 60 days
prior to Your Effective Date, a Legally Qualified Physician advised You or
Your Traveling Companion not to travel due to a Sickness or Injury.
EXCLUSIONS FOR BAGGAGE & BAGGAGE DELAY ONLY
Benefits are not payable for:
a. animals;
b. automobile and automobile equipment, boats or other vehicles or
conveyances, trailers, motors,
c. aircraft, bicycles (except when checked as baggage with a
Common Carrier);
d. household effects and furnishings, antiques and collector’s items;
e. sunglasses (prescription or non-prescription), contact lenses;
f. artificial teeth, dental bridges;
g. hearing aids;
h. prosthetic limbs;
i. prescribed medications;
j. keys;
k. money, credit cards, tickets and documents (except as coverage is
otherwise specifically provided herein), securities;
l. stamps;
m. professional or occupational equipment or property whether or not
electronic business equipment, telephones, computer hardware or
software.
Maximum Limit of Liability: All limits are applied per trip. The Company’s
maximum limit of liability resulting from the same occurrence will be $10,000,000.
If the loss for all Insureds from such an occurrence exceeds $10,000,000 the Company
will pay each Insured that proportion of the benefits stated which $10,000,000
bears to the total loss of all persons insured under all travel and flight insurance
in force under this policy. The Company will pay no more than $500,000 per occurrence
to or on account of any person insured.
GENERAL POLICY PROVISIONS
Plan costs and fees: All protection plan costs and fees are nonrefundable.
In the event the plan cost paid for coverage is less than the required plan cost
for coverage, benefits will be paid in direct proportion of the actual amount
paid to the required plan cost due.
Medical Records: In the event of a claim, the Company reserves the right
to review any and all of Your medical records, whether or not the contents of
such records were made known to You.
Duplicate Coverage: If You have two or more Protection Plans underwritten
by the Company that duplicate benefits, You will be paid up to the highest benefit
amount under only one plan for each Covered Trip. Maximum Flight Accident is $500,000
for any one person at any one time under this coverage.
Subrogation: The Company, upon making any payment or assuming liability
thereon under this policy, shall be subrogated to all rights of Your recovery
against any person or corporation and may bring action in the name of the covered
person to enforce such rights.
Coordination of Benefits: If an Insured is entitled to similar benefits
through any other insurer the benefits payable under this insurance shall be coordinated
so that total benefits from all insurers shall not exceed the actual loss insured.
Errors or Mis-payments: If any benefit is paid in error or payment is made
in excess of the amount allowed under the provisions of this policy, the Company
reserves the right to recover the excess or ineligible payment from You, Your
estate, any institution, insurer or person to whom the payment was made.
Currency: All monies described in this policy are expressed in United States
of America currency.
Limitations of Time for Bringing Suit: No action at law or in equity shall
be brought to recover on this policy prior to the expiration of sixty days after
proof of loss has been filed in accordance with the requirements of this policy,
nor shall such action be brought at all unless brought within two years from the
expiration of the time within which proof of loss is required by the policy.
Limitations Controlled by Statute: If any time limitation of this policy
with respect to giving notice of claim or furnishing proof of loss is less than
permitted by the laws of the jurisdiction of the United States in which the Insured
resides at the time this policy is issued, such limitation is extended to agree
with the minimum period permitted by such law.
Notice to Residents of Florida: The Benefits of the Plan providing Your
coverage are governed primarily by the law of a state other than Florida. Your
homeowners policy, if any, may provide coverage for loss of personal effects provided
by the Baggage and Personal Effects coverage. This insurance is not required in
connection with the purchase of Your travel arrangements.
Note: This plan contains disability insurance benefits or health insurance
benefits, or both, that only apply during the 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 provider.
Individual Travel Policy
Underwritten by:
Old Republic Insurance Company • 414 West Pittsburgh Street •
Greensburg, PA 15601 (called “the Company”)
Administered by:
Old Republic Insurance Company • 4600 Witmer Industrial Estates -
Suite 6 • Niagara Falls, NY 14305
Limited Benefit Short Term Travel Policy
This is a legal contract between Old Republic Insurance Company and
You. This Policy is issued in consideration of the Application,
Confirmation of Coverage, this evidence of coverage and the payment
of the appropriate premium.
POLICY NUMBER
Your Policy number for this individual Policy is the number found on Your Confirmation
of Coverage. Use this number to identify Yourself and coverage in all correspondence
with the Company.
State Exceptions:
Oregon -
Clerical Error: Clerical Error on the Company’s part or that of a Travel
Supplier in keeping records or furnishing information will not void
coverage if it is otherwise validly in force; nor will it continue coverage
if it is otherwise validly terminated under the terms of this Policy.
Conformity with State Statutes: The provisions of this Policy must
conform to the laws of the state in which it was issued. If they do not,
they are hereby amended to conform.
Kansas -
Under the General Policy Provisions, “Subrogation” does not
apply to reimbursement of medical, surgical, hospital or funeral expenses.
New York -
Under General Exclusions and Limitations the following
apply: 1) “while sane or insane” is deleted; 2) add “professional”
in front of “mountaineering”; 3) replace “scuba diving and deep sea
diving” with “professional scuba diving (any diving that requires more
than an “Open Water 1” certification from PADI, NAUI, or other
recognized diving certification organization.”; 4) delete “due to normal
childbirth, normal pregnancy (except complications of pregnancy).
PLEASE REVIEW THE PDF VERSION
OF THIS DOCUMENT TO READ OFFICER SIGNATURES