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BASIC TRAVEL INSURANCE PLAN U.S.A
Trip Cancellation and Trip Interruption
Lost, Damaged or Delayed Baggage
Medical Expense Benefits
Accidental Death & Dismemberment
Travel Emergency Assistance
Limited
Coverage:
Please Read Carefully – Exclusions Apply to Certain Medical Conditions
Applicable
only to G.M.’s booking in the United States.
This coverage supercedes any previously existing coverage and is
subject to change without notice.
PLEASE
READ THIS DOCUMENT CAREFULLY AND CARRY IT WITH YOU ON YOUR TRIP.
Effective
May 1, 2008
Plan Code: 10CM
DESCRIPTION OF COVERAGES
SCHEDULE OF COVERAGES
Maximum
Benefit Amount
Trip
Cancellation :
$ 1,000
Trip Interruption: $
1,000
Baggage and Personal Effects: $
1,500
Baggage Delay (in village credit): $100
Village Boutique Voucher
Medical or Dental Expenses: $ 5,000
Accidental Death & Dismemberment:
$15,000
Notice:
If you are a resident of one of the following states (IN, KS, LA, OH,
OR, VT, WA, WY) your coverage is provided and governed by an individual
policy form. Additional information about your individual policy is
available by calling CSA at 1-877-519-3007.
For
coverage questions or to request a claim form, call toll-free in the
U.S. 1.877.519.3007.
Collect
worldwide 1.858.810.2012.
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Blanket
Travel Accident Insurance
PLEASE
READ CAREFULLY. Applicable
only to current members who have booked and paid for the Covered Trip
and membership fees in the U.S. This
coverage supercedes any previously issued coverage and is subject to
change without notice. Keep this document and carry a copy with you when
you travel.
Insurance
Coverage
Travel
Insurance is underwritten by: Stonebridge Casualty Insurance Company,
Columbus, Ohio; NAIC # 10952 under Policy/Certificate Form series
TAHC5000GCS and TAHC5000GPS. This plan is administered by CSA Travel
Protection and Insurance Services.
Travel
Insurance Plan
PLEASE
READ CAREFULLY. Applicable
only to current members who have booked and paid for the Trip and
membership fees in the U.S. This
coverage supercedes and previously issued coverage and is subject to
change without notice.
DEFINITIONS
In the Certificate, “you”, “your” and “yours” refer to the
Insured. “We”, “us” and “our” refer to the company providing
this coverage. In addition, certain words and phrases are defined as
follows:
Accident means a sudden, unexpected, unintended and external event,
which causes Injury.
Actual
Cash Value Accidental death and dismemberment.
Baggage means luggage, personal possessions and travel documents taken
by you on the Covered Trip.
Common Carrier means any conveyance operated under a license for the
transportation of passengers for hire.
Covered Trip means a scheduled Covered Trip to a Club Med
Village
including travel arrangements provided by Club Med prior to the
Scheduled Departure Date of the Trip. Travel arrangements not provided
by Club Med are not considered a part of a Covered Trip, as defined, and
are NOT covered by the Policy.
Elective Treatment and Procedures means any medical treatment
or surgical procedure that is not medically necessary including
any service, treatment, or supplies that are deemed by the federal, ora
state or local government authority, or by us to be research or
experimental or that is not recognized as a generally accepted medical
practice.
FINANCIAL INSOLVENCY means the total cessation or complete suspension of
operations due to insolvency, with or without the filing of a bankruptcy
petition, whether voluntary or involuntary, by a tour operator, cruise
line, airline, rental car company, hotel, condominium, railroad, motor
coach company, or other supplier of travel services which is duly
licensed in the state(s) of operation other than the entity or the
person, organization, agency or firm from whom you directly purchased or
paid for your Covered Trip. There is no coverage for the total cessation
or complete suspension of operations for losses caused by fraud or
negligent misrepresentation by the supplier of travel services.
Home
means your primary or secondary residence.
Hospital means an institution which meets all of the following
requirements:
1.
it must be operated according to law;
2. it must give 24-hour medical care, diagnosis and treatment to the
sick or injured on an inpatient basis;
3. it must provide diagnostic and surgical facilities supervised by
Physicians;
4. registered nurses must be on 24-hour call or duty; and
5. the care must be given either on the hospital’s premises or in
facilities available to the hospital on a prearranged basis.
A
Hospital is not: a rest, convalescent, extended care, rehabilitation or
other nursing facility; a facility which primarily treats mental
illness, alcoholism, or drug addiction (or any ward, wing or other
section of the hospital used for such purposes); or a facility which
provides hospice care (or wing, ward or other section of a hospital used
for such purposes).
Immediate
Family Member includes your or your Traveling Companion’s dependent,
spouse, child, spouse’s child, son/daughter-in-law, parent(s),
sibling(s), brother/sister, grandparent(s), grandchild, stepbrother/
sister, step-parent(s), parent(s)-in-law, brother/sister-in-law, aunt,
uncle, niece, nephew, guardian, ward or business partner.
Injury means bodily harm caused by an Accident which: 1) occurs while
your coverage is in effect under the plan; and 2) requires direct cause
of loss and must be independent of all other causes and must not be
caused by, or result from, Sickness.
Insured means an eligible person who arranges a Covered Trip, and pays
any required plan payment.
Insurer
means Stonebridge Casualty Insurance Company. Other Valid and
Collectible Group Insurance means any group policy or contract which
provides for payment of medical expenses incurred because of Physician,
nurse, dental or Hospital care or treatment; or the performance of
surgery or administration of anesthesia. The policy or contract
providing such benefits includes group or blanket insurance policies;
service plan contracts; employee benefit plans; or any plan arranged
through an employer, labor union, employee benefit association or
trustee; or any group plan created or administered by the federal or a
state or local government or its agencies. In the event any other group
plan provides for benefits in the form of services in lieu of monetary
payment, the usual and customary value of each service rendered will be
considered a Covered Expense.
Physician
means a person licensed as a medical doctor by the jurisdiction in which
he/she is resident to practice the healing arts. He/she must be
practicing within the scope of his/her license for the service or
treatment given and may not be you, a Traveling Companion, or a
Immediate Family Member of yours.
Schedule Departure Date means the date on which you are originally
scheduled to leave on your Covered Trip.
Scheduled Return Date means the date on which you are originally
scheduled to return to the point where the Covered Trip started or to a
different final destination.
Scheduled Trip Departure City means the city where the scheduled trip on
which you are to participate originates.
Sickness means an illness or disease of the body which: 1) requires
examination and treatment by a Physician, and 2) commences while the
plan is in effect.
Traveling Companion means a person whose name(s) appear(s) with you on
the same Covered Trip arrangement and who, during the Covered Trip, will
accompany you.
Uninhabitable means the dwelling is not suitable for human occupancy in
accordance with local public safety guidelines.
Usual and Customary Charge means those charges for necessary treatment
and services that are reasonable for the treatment of cases of
comparable severity and nature. This will be derived from the mean
charge based on the experience in a related area of the service
delivered and the MDR (Medical Data Research) schedule of fees valued at
the 100th percentile and the Anesthesia Relative Value Guide.
INDIVIDUAL ELIGIBILITY, EFFECTIVE &
TERMINATION DATES
Persons
eligible for insurance under the policy are current Club Med members who
have booked and paid for the Covered Trip and membership fees in the
United States of America.
Effective Date:
All coverages (except Pre-Departure Trip Cancellation and
Post-Departure Trip Interruption) will take effect on the later of: 1)
the date the plan payment has been received by Club Med; 2) the date and
time you start your Covered Trip; or 3) 12:01 A.M. Standard Time on the
Scheduled Departure Date of your Covered Trip. Pre-Departure Trip
Cancellation coverage will take effect on the day your plan payment is
received by Club Med. Post-Departure Trip Interruption coverage will
take effect on the Scheduled Departure Date of your Covered Trip if the
required plan payment is received.
Termination
Date:
Your
coverage automatically ends on the earlier of:
1. the date the Covered Trip is completed; or
2. the Scheduled Return Date; or
3. your arrival at the return destination on a round trip, or the
destination on a one-way trip; or
4. cancellation of the Covered Trip covered by the plan.
Extension
of Coverage
All coverages under the plan will be
extended if your entire Covered Trip is covered by the plan and your
return is delayed by unavoidable circumstances beyond your control. If
coverage is extended for the above reasons, coverage will end on the
earlier of the date you reach your originally scheduled return
destination or seven (7) days after the Scheduled Return Date.
GENERAL PLAN EXCLUSIONS
The
following exclusion applies to all coverages. We will not pay for any
loss under the plan, caused by, or resulting from:
a.
your, your Traveling Companion’s, or Immediate Family
Member’s suicide, attempted suicide, or intentionally self-inflicted
injury, booked to travel with you, while sane or insane (while sane in
CO & MO);
b.
mental, nervous, or psychological disorders;
c.
being under the influence of drugs or intoxicants, unless
prescribed by a Physician;
d.
normal pregnancy or resulting childbirth or elective abortion;
e.
participation as a professional in athletics;
f.
participation in organized athletic events (other than those
sponsored and supervised by Club Med);
g.
riding or driving in any motor competition;
h.
declared or undeclared war, or any act of war;
i.
civil disorder;
j.
service in the armed forces of any country;
k.
nuclear reaction, radiation or radioactive contamination;
l.
operating or learning to operate any aircraft, as pilot or crew;
m.
mountain climbing or travel on any air-supported device, other
than on a regularly scheduled airline or air charter company;
n.
any unlawful acts, committed by you or a Traveling Companion
(whether insured or not);
p.
a loss or damage caused by detention, confiscation or destruction
by customs;
q.
elective Treatment and Procedures;
r.
pandemic and/or epidemic;
s.
medical treatment during or arising from a Covered Trip
undertaken for the purpose orintent of securing medical treatment;
t.
Financial Insolvency of the person, organization or firm from
whom you directly purchased or paid for your Covered Trip, Financial
Insolvency which occurred, or for which a petition for bankruptcy was
filed by a travel supplier;
u.
a loss that results from an illness, disease, or other condition,
event or circumstance which occurs at a time when the plan is not in
effect for you.
PRE-EXISTING CONDITION
The
following exclusion applies to the Medical or Dental Expense, Trip
Cancellation and Trip Interruption coverages: We will not pay for loss
or expense caused by or incurred resulting from a Pre- Existing
Condition, as defined in the plan, including death that results
therefrom.
Pre-existing Condition means an illness, disease, or other condition
during the 90-day period immediately prior to your effective date for
which you or your Traveling Companion or Immediate Family Member is
scheduled or booked to travel with you: 1) received, or received a
recommendation for, a diagnostic test, examination, or medical
treatment; or 2) took or received a prescription for drugs or medicine.
Item 2 of this definition does not apply to a condition which is treated
or controlled solely through the taking of prescription drugs or
medicine and remains treated or controlled without any adjustment or
change in the required prescription throughout the 90-day period before
coverage is effective under this Policy.
Maximum Limit of Liability. All
limits are applied per Covered Trip. We will pay no more than $1,000,000
per occurrence to or on account of any person insured under the policy.
Our Maximum Limit of Liability for all claims resulting from the same
occurrence will be $10,000,000 collectively under the TAHC series of
policies.
TRIP
CANCELLATION AND TRIP INTERRUPTION BENEFITS
Pre-Departure Trip Cancellation
We will pay a Pre-Departure Trip Cancellation Benefit, up to the amount
in the Schedule, if you are prevented from taking your Covered Trip due
to your, your Immediate Family Member’s, or Traveling Companion’s
Sickness, Injury, or death that occurs before departure on your Covered
Trip. The Sickness or Injury must: a) commence while your coverage is in
effect under the plan; b) require the examination and treatment by a
Physician, in person, at the time the Covered Trip is canceled; and c)
in the written opinion of the treating Physician, be so disabling as to
prevent you from taking your Covered Trip.
We will pay a benefit if you are prevented from taking your Covered Trip
due to Other Covered Events, as defined, that occur before departure on
your Covered Trip.
Pre-Departure
Trip Cancellation Benefits
We
will reimburse you, up to the amount in the Schedule, for the amount of
forfeited, prepaid, nonrefundable, non-refunded, and unused published
payments or deposits that you paid for your
Covered
Trip. We will pay your additional cost as a result of a change in the
per-person occupancy rate for prepaid travel arrangements if a Traveling
Companion’s Covered Trip is canceled and your Covered Trip is not
canceled.
Post-Departure
Trip Interruption
We will pay a Post-Departure Trip Interruption Benefit, up to the amount
in the Schedule, if: 1) your arrival on your Covered Trip is delayed
beyond the Scheduled Departure Date; or 2) you are unable to continue on
your Covered Trip after you have departed on your Covered Trip due to
your, a Immediate Family Member’s, or Traveling Companion’s
Sickness, Injury, or death.
For
item 1 above, the Sickness or Injury must: a) commence while your
coverage is in effect under the plan; b) for item 2 above, commence
while you are on your Covered Trip and your coverage is in effect under
the plan; and c) for both items 1 and 2 above, require the examination
and treatment by a Physician, in person, at the time the Covered Trip is
interrupted or delayed; and d) in the written opinion of the treating
Physician, be so disabling as to delay your arrival on your Covered Trip
or to prevent you from continuing your Covered Trip. The Sickness or
Injury must: a) commence while your coverage is in effect under the
plan; b) require the examination and treatment by a Physician, in
person, at the time the Covered Trip is canceled; and c) in the written
opinion of the treating Physician, be so disabling as to prevent you
from taking your Covered Trip.
We
will pay a benefit if: 1) your arrival on your Covered Trip is delayed
beyond the Scheduled Departure Date; or 2) you are unable to continue on
your Covered Trip after you have departed on your Covered Trip due to
Other Covered Events, as defined.
Post-Departure
Trip Interruption Benefits
We
will reimburse you, less any refund paid or payable, for unused land or
water travel arrangements, plus one of the following:
1.
the additional transportation expenses by the most direct route from the
point you interrupted your Covered Trip:
a. to the next scheduled destination where you can catch up
to your Covered Trip; or
b. to the final
destination of your Covered Trip; or
2.
the additional transportation expenses incurred by you by the most
direct route to reach your original Covered Trip destination if you are
delayed and leave after the Scheduled Departure Date. However, the
benefit payable under 1 and 2 above will not exceed the cost of a
one-way economy air fare (or first class, if the original tickets were
first class) by the most direct route less any refunds paid or payable
for your unused original tickets.
3.
your additional cost as a result of a change in the per-person occupancy
rate for prepaid travel arrangements if a Traveling Companion’s
Covered Trip is interrupted and your Covered Trip is continued.
Other
Covered Events means only the following unforeseeable events or their
consequences which occur while coverage is in effect under this Policy:
1.
Common Carrier delays resulting from inclement weather, or mechanical
breakdown of the aircraft, ship or boat or motor coach on which you are
scheduled to travel, or organized labor strikes that affect public
transportation;
2.
arrangements canceled by an airline, cruise line, motor coach company,
or tour operator, resulting from inclement weather, mechanical breakdown
of the aircraft, ship or boat or motor coach on which the Insured is
scheduled to travel, or organized labor strikes that affect public
transportation.
Items
1 and 2 above are subject to the following conditions:
a.
the scheduled carrier connecting times must meet airline required
legal minimum connect times; and
b.
the scheduled time between arrival at the Scheduled Trip
Departure City and the scheduled trip departure must be 2 hours or
longer.
3.
a change in plans by you, a Immediate Family Member traveling with you,
or Traveling Companion resulting from one of the following events which
occurs while coverage is in effect under this Policy:
a.
being directly involved in a documented traffic accident while en
route to departure;
b.
being hijacked, quarantined (except as a result of a pandemic or
epidemic), required to serve on a jury, or required by a court order to
appear as a witness in a legal action, provided you, a Immediate Family
Member traveling with you or a Traveling Companion is not 1) A party to
the legal action, or 2) Appearing as a law enforcement officer;
c.
your Home made Uninhabitable by fire, flood, volcano, earthquake,
hurricane or other natural disaster;
d.
being called into active military service to provide aid or
relief in the event of a natural disaster;
e.
a documented theft of passports or visas;
f.
a permanent transfer of employment of 250 miles or more;
BAGGAGE AND PERSONAL EFFECTS BENEFIT
We
will reimburse you, less any amount paid or payable from any other valid
and collectible insurance or indemnity, up to the amount shown in the
Schedule, for direct loss, theft, damage or destruction of your Baggage,
passports or visas during your Covered Trip. We will also pay for loss
due to unauthorized use of your credit cards, if you have complied with
all of the credit card conditions imposed by the credit card companies.
Items Not Covered
We
will not pay for damage to or loss of:
1.
animals; or
2.
property used in trade, business or for the production of income;
or
3.
boats, motors, motorcycles, motor vehicles, aircraft, and other
conveyances or equipment, or parts for such conveyances; or
4.
artificial limbs or other prosthetic devices, artificial teeth,
dental bridges, dentures, dental braces, retainers or other orthodontic
devices, hearing aids, any type of eyeglasses, sunglasses or contact
lenses; or
5.
documents or tickets, except for administrative fees required to
reissue tickets; or
6.
money, stamps, stocks and bonds, postal or money orders,
securities, accounts, bills, deeds, food stamps or credit cards, except
as noted above; or
7.
property shipped as freight or shipped prior to the Scheduled
Departure Date; or
8.
contraband.
Special Limitation: We will not pay more than $250 (or the Baggage
and Personal Effects limit, if less) on all losses to jewelry; watches;
precious gems; articles consisting in whole or in part of silver, gold
or platinum; cameras, camera equipment; digital or electronic equipment
and media; and articles consisting in whole or in part of fur. Items not
included above are subject to a $300 per item limit.
Losses Not Covered
We will not pay for loss
arising from:
1.
defective materials or craftsmanship; or
2.
normal wear and tear, gradual deterioration, inherent vice; or
3.
rodents, animals, insects or vermin; or
4.
mysterious disappearance; or
5.
electrical current, including electric arcing that damages or
destroys electrical devices or appliances.
Valuation and Payment of Loss
Payment
of loss under the Baggage and Personal Effects Benefit will be
calculated based upon an Actual Cash Value basis. For items without
receipts, payment of loss will be calculated based upon 75% of the
Actual Cash Value at the time of loss. At our option, we may elect to
repair or replace your Baggage. We will notify you within 30 days after
we receive your Proof of Loss.
We
may take all or part of damaged Baggage as a condition for payment of
loss. In the event of a loss to a pair or set of items, we will: 1)
repair or replace any part to restore the pair or set to its value
before the loss; or 2) pay the difference between the value of the
property before and after the loss.
Continuation of Coverage
If
the covered Baggage, passports or visas are in the custody of a Common
Carrier, and delivery is delayed, this coverage will continue until the
property is delivered to you. This continuation of coverage does not
include loss caused by or resulting from the delay.
Notice of Claim
We
must be given written notice of claim within 30 days after a covered
loss occurs. If notice cannot be given within that time, it must be
given as soon as reasonably possible. Notice may be given to us or to
our authorized agent. Notice should include the claimant’s name and
enough information to identify him or her.
Important: The Insured must report all theft losses occurring at
the Village to the Village Gestionnaire (Assistant Village Manager) and
obtain a written report of his/her loss. All other losses must be
reported to the local police or other authorities, and a written report
of the Insured’s loss must be obtained from them. The Insured must
observe ordinary and proper care in the supervision of the property
covered hereby, and in case of loss, theft or damage to Baggage and
Personal Effects, you should:
1.
take reasonable steps to protect your Baggage from further damage, and
make necessary, reasonable
and temporary repairs. We will reimburse
you for these expenses. We will not pay for further damage if
you fail to protect your Baggage.
2.
immediately report the incident to the Club Med Village
Gestionnaire, transportation official, local police or other local
authorities and obtain their written report of your loss; and
3.
give notice of the claim as soon as possible to CSA Travel
Protection; and
4.
furnish such information and evidence, documentary or otherwise,
in substantiation of any claim, as the Company may reasonably require;
and
BAGGAGE DELAY BENEFIT
We
will reimburse you, up to the amount shown in the Schedule for the cost
of reasonable additional clothing and personal articles purchased by
you, if your Baggage is delayed for 12 hours or more during your Covered
Trip. This coverage terminates upon your arrival at the return
destination of your Covered Trip.
MEDICAL OR DENTAL EXPENSE BENEFITS
We
will pay this benefit, up to the amount on the Schedule, for the
following Covered Expenses incurred by you, subject to the following: 1)
Covered Expenses will only be payable at the Usual and Customary level
of payment; 2) benefits will be payable only for Covered Expenses
resulting from a Sickness that first manifests itself or an Injury that
occurs while on a Covered Trip; 3) benefits payable as a result of
incurred Covered Expenses will only be paid after benefits have been
paid under any Other Valid and Collectible Group Insurance in effect for
you. We will pay that portion of Covered Expenses, which exceeds the
amount of benefits payable for such expenses under your Other Valid and
Collectible Group Insurance.
Covered
Expenses:
1.
expenses for the following Physician-ordered medical services: services
of legally qualified Physicians and graduate nurses, charges for
Hospital confinement and services, local ambulance services,
prescription drugs and medicines, and therapeutic services, incurred by
you within one year from the date of your Sickness or Injury during a
Covered Trip;
2.
expenses for emergency dental treatment incurred by you during a Covered
Trip.
ACCIDENTAL DEATH AND DISMEMBERMENT
We
will pay this benefit, up to the amount on the Schedule, if you are
injured in an Accident, which occurs while you are on a Covered Trip,
and covered under the plan, and you suffer one of the losses listed
below within 180 days of the Accident. The principal sum is the benefit
amount shown on the Schedule.
Percentage of Principal
Loss:
Sum Payable
Life
100%
Both
Hands; Both
Feet
100%
Sight
of Both Eyes; One Hand and One Foot
100%
One
Hand and Sight of One Eye
100%
One
Foot and Sight of One Eye
100%
One
Hand; One Foot or Sight of One Eye
50%
If you suffer more than one loss from one Accident, we will pay only for
the loss with the larger benefit. Loss of a hand or foot means complete
severance at or above the wrist or ankle joint. Loss of sight of an eye
means complete and irrecoverable loss of sight.
Exposure
and Disappearance:
If
by reason of an Accident covered by the plan, you are unavoidably
exposed to the elements and as a result of such exposure suffer a loss
for which benefits are otherwise payable; such loss shall be covered
hereunder.
If
you are involved in an Accident which results in the sinking or wrecking
of a conveyance in which you were riding and your body is not located
within one year of such Accident, it will be presumed that you suffered
loss of life resulting from Injury caused by the Accident.
The
following exclusion applies to the Accidental Death and Dismemberment
coverage: We will not pay for loss caused by or resulting from Sickness
of any kind.
CLAIMS PROCEDURES
Trip
Cancellation/Interruption Claims: If you need to cancel your trip,
contact your Travel Agent or Club Med immediately at 1.800.258.2633 to
cancel your reservation. You must also notify CSA Travel Protection in
writing within 30 days, or as soon after that as is reasonable possible.
A Claim Form will be sent to you, which you must be complete (and the
attending Physician in the case of a Medical or Dental Expense). If you
must interrupt your Covered Trip, you must contact the Village Traffic
Office who will arrange reservations for your flight back. You must also
notify CSA Travel Protection in writing within 30 days, or as soon after
that as is reasonable possible. A Claim Form will be sent to you, which
you must be complete (and the attending Physician in the case of a
Medical or Dental Expense)
Baggage
and Personal Effects:
Your
Duties in the Event of a Loss. In
case of loss, theft or damage to Baggage and Personal Effects, you
should:
1.
take reasonable steps to protect your Baggage from further damage, and
make necessary, reasonable
and temporary repairs. We will reimburse
you for these expenses. We will not pay for further damage if
you fail to protect your Baggage.
2.
immediately report the incident to the Club Med Village
Gestionnaire, transportation official, local police or other local
authorities and obtain their written report of your loss; and
3.
give notice of the claim as soon as possible to CSA Travel
Protection; and
4.
furnish such information and evidence, documentary or otherwise,
in substantiation of any claim, as the Company may reasonably require;
and
Your
duties in the event of a Medical or Dental Expense:
1) You must provide us with all bills and reports for medical and/or
dental expenses claimed. 2) You must provide any requested information,
including but not limited to, an explanation of benefits from any other
applicable insurance. 3) You must sign a patient authorization to
release any information required by us, to investigate your claim.
Notice
of Claim:
We must be given written notice of claim within 30 days after a covered
loss occurs. If notice cannot be given within that time, it must be
given as soon as reasonably possible.
Notice
may be given to us or to our authorized agent. Notice should include the
claimant’s name and enough information to identify him or her.
To
Obtain a Claim Form, Call or Write:
CSA
Travel Protection
P. O. Box 939057
San Diego, CA 92193-9057
Phone: 1.800.541.3522
CLAIMS PROVISIONS
Proof
of Loss Written Proof of Loss must be sent to us within 90 days after
the date the loss occurs. We will not reduce or deny a claim if it was
not reasonably possible to give us written Proof of Loss within the time
allowed. In any event, you must give us written Proof of Loss within
twelve (12) months after the date the loss occurs unless you are legally
incapacitated.
Legal
Actions.
No legal action may be brought to recover on the plan within 60 days
after written Proof of Loss has been given. No such action will be
brought after three years from the time written Proof of Loss is
required to be given. If a time limit of the plan is less than allowed
by the laws of the state where you live, the limit is extended to meet
the minimum time allowed by such law.
Payment
of Claims.
Benefits for loss of life will be paid to your estate, or if no
estate, to your beneficiary. All other benefits are paid directly to
you, unless otherwise directed. Any accrued benefits unpaid at your
death will be paid to your estate, or if no estate, to your beneficiary.
If you have assigned your benefits, we will honor the assignment if a
signed copy has been filed with us. We are not responsible for the
validity of any assignment.
Physical Examination and Autopsy.
At our expense, we have the right to have you examined as often
as necessary while a claim is pending. At our expense, we may require an
autopsy unless the law or your religion forbids it.
GENERAL PROVISIONS
Arbitration
If we and you disagree on the amount of loss, either may make written
demand for arbitration. In this event, each party will select a
competent and impartial arbitrator. The two arbitrators will select a
third. If they cannot agree within 30 days, either may request that
selection be made by a judge of a court having jurisdiction. Each party
will 1) pay the expense if incurred and 2) bear the expenses of the
third arbitrator equally. A decision agreed to by two arbitrators will
be binding.
Concealment
or Fraud.
We do not provide coverage if you have intentionally concealed or
misrepresented any material fact or circumstance relating to the
coverage plan.
Conformity
to Law.
Any provision of the plan that is in conflict with the laws of
the state in which it is issued is amended to conform with the laws of
that state.
Duplication
of Coverage.
You may only purchase one certificate from us for each Covered
Trip. If you do purchase more than one certificate for a specific
Covered Trip, the Maximum Limit of Coverage payable will be as specified
in the certificate with the highest level of benefits. We will refund
plan payments received from you under any other certificate.
Entire
Contract; Changes.
The plan may be changed at any time by written agreement between
us. Only our President, Vice President or Secretary may change or waive
the provisions of the plan. No agent or other person may change the plan
or waive any of its terms. The change will be endorsed on the plan.
Examination
Under Oath.
As often as we may reasonably require, you or any person making a
claim under the plan must submit to examination under oath.
Maximum
Limit of Coverage.
The maximum benefit amount for each claim is listed in the Schedule,
subject to the individual benefit amount and the company’s Maximum
Limit of Liability. The total limit of our liability for any one covered
event, in which two or more persons submit a claim, is subject to the
individual benefit amount and the company’s Maximum Limit of
Liability. In the event of multiple claims by you for one event, the
available funds will be distributed in order of notice of claim by each
Insured subject to the above limitations.
Our
Right to Recover From Others.
We have the right to recover any payments we have made from
anyone who may be responsible for the loss. You and anyone else we
insure must sign any papers and do whatever is necessary to transfer
this right to us. You and anyone else we insure will do nothing after
the loss to affect our rights.
NOTICE
TO ALASKA RESIDENTS
(TAHC5000AS.AK).
The GENERAL PROVISIONS, CONCEALMENT OR FRAUD section is deleted in its
entirety and replaced with the following:
CONCEALMENT
OR FRAUD. We do not provide
coverage when the Insured has intentionally concealed or misrepresented
any material fact or circumstance relating to this Policy if: 1)
fraudulent; 2) material or hazardous in our acceptance; or 3) in good
faith we would not have issued the Policy or not issued a policy in as
large an amount, or at the same premium rate, or provided coverage with
respect to the hazard resulting in the loss if the true facts had been
known.
NOTICE
TO COLORADO RESIDENTS.
We do not provide coverage when the Insured has intentionally
concealed or misrepresented any material fact or circumstance relating
to this Policy if: 1) fraudulent; 2) material or hazardous in our
acceptance; or 3) in good faith we would not have issued the Policy or
not issued a policy in as large an amount, or at the same premium rate,
or provided coverage with respect to the hazard resulting in the loss if
the true facts had been known.
NOTICE
TO FLORIDA RESIDENTS
(TAHC5000AC.FL)
The
second sentence in the LEGAL ACTIONS provision under CLAIMS PROVISIONS
is deleted and replaced by the following sentence: No such action will
be brought after five years from the time written Proof of Loss is
required to be given.
Please
direct all inquiries or to obtain information about this coverage and to
provide assistance in resolving complaints to CSA Travel Protection at
1.877.519.3007
The
definition of FINANCIAL INSOLVENCY under the DEFINITIONS section is
amended to remove the last sentence; “There is no coverage for the
total cessation or complete suspension of operations for losses caused
by fraud or negligent misrepresentation by the supplier of travel
services.”
NOTICE
TO MARYLAND RESIDENTS
(TAHC5000AS.MD)
The
CLAIMS PROVISION, LEGAL ACTIONS section, is deleted in its entirety and
replaced with the following: LEGAL ACTIONS No action at law or in equity
shall be brought to recover on this Policy prior to the expiration of
sixty days after written Proof of Loss has been furnished in accordance
with the requirements of this Policy. No such action shall be brought
after the expiration of three (3) years after the written Proof of Loss
is required to be furnished.
NOTICE
TO MISSISSIPPI RESIDENTS
(TAHC5000AS.MS
The GENERAL PROVISIONS is amended as follows:
OUR
RIGHT TO RECOVER FROM OTHERS.
Payments of any benefits will allow us to be subrogated to and
succeed to the rights of the Insured for recovery against any person,
organization or carrier in accordance with applicable laws if you have
been fully compensated. The Insured and anyone else we insure must sign
any papers and do whatever is necessary to transfer this right to us.
The Insured and anyone else we insure will do nothing after the loss to
affect our right.
The
CLAIMS PROVISIONS is amended as follows:
The
autopsy provision of the PHYSICAL EXAMINATION AND AUTOPSY section is
deleted.
The
following is added to the PAYMENT OF CLAIMS section:
Medical expense benefits for Covered Expenses will be paid within
twenty-five (25) days after receipt of due written proof of such loss in
the form of a clean claim where claims are submitted electronically, and
will be paid within thirty-five (35) days after receipt of due written
proof of such loss in the form of a clean claim where claims are
submitted in paper format. A "clean claim" means a claim
received by us for adjudication and which requires no further
information, adjustment or alteration by the provider of services or the
Insured in order to be processed and paid by us. In the event medical
expense benefits due are not paid within the applicable time period
prescribed, we will pay interest on accrued medical expense benefits at
the rate of one and one-half percent (1.5%) per month until the claim is
finally settled or adjudicated. In the event we fail to pay benefits
when due, the person entitled to such benefits may bring action to
recover such benefits, and any interest, which may accrue, and any other
damages.
ARBITRATION
AGREEMENT
(TAHC5001AS.MS)
This
Arbitration Agreement requires both You and Us (the "Parties"
to this Policy) to resolve by arbitration, and not in a court of law,
any and all disputes, benefit claims, or disagreements that remain
unresolved following negotiation. The Parties shall negotiate in good
faith to resolve disputes of any kind concerning or relating to this
Policy. Dispute subject to this Arbitration Agreement include, but are
not limited to, the following areas:
·
Interpretation
of this Policy;
·
Benefit
payments;
·
Ownership;
·
Beneficiary
Designation;
·
Assignment;
·
Replacement;
·
Conversion;
·
Reinstatement;
·
Premium
payments;
·
Sales
representations or sales presentations;
·
The
taking of the application;
·
Information
contained in the application;
·
Agent
conduct;
·
Any
claim alleging fraud, misrepresentation, deceit, suppression of any
material fact or how the Policy was sold; or
·
Any
other matter arising out of or relating in any way to this Policy or
your relationship with the company, its agents, servants, employees,
officers, directors or affiliate companies.
The
parties shall have sixty (60) days from the first day the dispute is
communicated by one party to the other to resolve the dispute. If the
dispute concerns a benefit claim, the sixty (60) day time period begins
on the date we receive due Proof of Loss and sufficient information to
make a claim decision. If the parties do not resolve the dispute within
sixty (60) days, the unresolved dispute shall be submitted to binding
arbitration upon written notice by either party to the other.
Arbitration
shall commence within sixty (60) days after giving written notice of
election to arbitrate a dispute. Arbitration proceedings shall be
conducted in your county of residence, unless another location is
mutually agreed upon by both parties. The Arbitration proceeding shall
be governed by the Federal Arbitration Act and The Arbitration Rules of
the American Arbitration Association. Upon your request, we will provide
to you, at no charge, a copy of the rules of The American Arbitration
Association that will govern any Arbitration proceeding hereunder. We
shall pay the cost of all Arbitration proceedings, except for the cost
of your representation, experts, witness fees, and expenses. However,
the arbitrator shall have the authority to order a party to pay the cost
of all Arbitration proceedings, including the other party's cost of
representation, experts, witness fees, and expenses, based upon
applicable law. If a party is entitled to and makes a request for a
panel of three (3) arbitrators, that party shall by all fees for the two
(2)
additional arbitrators.
The
award entered by the arbitrator shall be binding against the parties and
enforceable in any court having jurisdiction, but shall not otherwise be
subject to judicial review, except in those circumstances set forth in
the Federal Arbitration Act. The parties shall have sixty (60) days from
the first day the dispute is communicated by one party to the
STONEBRIDGE
CASUALTY INSURANCE COMPANY
ARBITRATION NOTICE
ADMINISTRATIVE OFFICE
520 PARK AVENUE
BALTIMORE, MD 21201
Should
you need additional information regarding this Arbitration Agreement,
you may contact us: Toll free at: 1.877.519.3007
All
other Policy Provisions remain unchanged.
ARBITRATION
NOTICE
(TAHC5002.AS.MS)
Important notice about your insurance coverage.
This document affects your legal rights.
READ
THE FOLLOWING INFORMATION CAREFULLY.
1.
The group or blanket policy under which you are covered includes
a binding Arbitration Agreement.
2.
The Arbitration Agreement requires that any dispute related to your
insurance coverage must be resolved
by arbitration and not in a court of law.
3.
The results of the arbitration are final and binding on you and
the insurance company.
4.
In an arbitration, one or arbitrators, who are independent,
neutral decision maker, render a decision after hearing the positions of
the parties.
5.
When you become a certificate holder under this insurance Policy,
you must resolve any dispute related to the Policy by binding
arbitration instead of a trial in court, including a trial by jury.
6.
Binding arbitration generally takes the place of resolving
disputes by a judge and jury.
7.
Should you need additional information regarding the binding
Arbitration Provision in the Policy, you may contact our toll free
assistance line at 1.877.519.3007.
NOTICE
TO MONTANA RESIDENTS
(TAHC5000AS.MT)
The
following provision is added to the GENERAL PROVISIONS section of the
Policy:
CONFORMITY
WITH MONTANA STATUTES The provisions of this Policy conform to the
minimum requirements of Montana law and control over any conflicting
statutes of any state in which the Insured resides on or after the
effective date of this Policy.
The
PHYSICAL EXAMINATION AND AUTOPSY provision under the CLAIM PROVISIONS
section of the Policy is deleted in its entirety and replaced with the
following:
PHYSICAL
EXAMINATION AND AUTOPSY At our expense, we have the right to have the
Insured examined as often as necessary while a claim is pending. At our
expense, we may require an autopsy in case of death unless the law or
religion of the Insured forbids it.
NOTICE
TO NORTH CAROLINA RESIDENTS
(TAHC5000AS.NC)
The
following CAUTIONARY NOTICE is added to the Policy: This Policy contains a Pre-Existing Condition Exclusion.
The
definition of OTHER VALID AND COLLECTIBLE GROUP INSURANCE is deleted in
its entirety and replaced by the following:
OTHER
VALID AND COLLECTIBLE GROUP INSURANCE means any group policy or contract
which provides for payment of medical expenses incurred because of
Physician, nurse, dental or Hospital care or treatment; or the
performance of surgery or administration of anesthesia. The policy or
contract providing such benefits includes group insurance policies;
service plan contracts; employee benefit plans; or any plan arranged
through an employer, labor union, employee benefit association or
trustee; or any group plan created or administered by the federal or a
state or local government or its agencies. In the event any other group
plan provides for benefits in the form of services in lieu of monetary
payment, the usual and customary value of each service rendered will be
considered a Covered Expense.
EXCESS
INSURANCE
This
Policy is not intended to be issued where other medical insurance
exists. If other medical insurance does exist at the time of the claim
then the amounts of benefit payable by such other medical insurance will
become the deductible amount of this Policy if such benefits exceed the
deductible amount shown in the Benefit Schedule.
The
following exclusion in the EXCLUSIONS section is deleted in its
entirety: “nuclear reaction, radiation or radioactive contamination”
and replaced with the following: “nuclear reaction, radiation or
radioactive contamination, except for involuntary exposure”.
The
PROOF OF LOSS provision in the Claims Provisions section of the Policy
is deleted in its entirety and replaced by the following:
PROOF
OF LOSS Written Proof Of Loss must be sent to us within 180 days after
the date the loss occurs. We will not reduce or deny a claim if it was
not reasonably possible to give us written Proof of Loss within the time
allowed. In any event, you must give us written Proof of Loss within
twelve (12) months after the date the loss occurs unless the Insured is
legally incapacitated.
NOTICE
TO OKLAHOMA RESIDENTS
(TAHC5000AM.OK)
Under
GENERAL PROVISIONS, the Arbitration provision is deleted entirely.
Under
GENERAL PROVISIONS, the first sentence in OUR RIGHT TO RECOVER FROM
OTHERS is amended to read: We have a right to recover, within 24 months
of the payment date in the absence of fraud, to recover any payments we
have made from anyone who will be responsible for the loss.
NOTICE
TO RHODE ISLAND RESIDENTS
(TAHC5000AS.RI)
The
CLAIMS PROVISIONS, PAYMENT OF CLAIMS section is amended as follows: The
1st paragraph is deleted in its entirety and replaced with the
following: Claims for benefits provided by this Policy will be paid not
more than 60 days after written proof is received. Benefits are paid to
the Insured, unless directed otherwise by the Insured.
The
following language is added as paragraph 3: Any payment that we make in
good faith will fully discharge us to the extent of that payment.
The
CLAIMS PROVISIONS, PROOF OF LOSS section, last sentence of the Policy,
is deleted in its entirety and replaced with the following: In any
event, the Insured must give us written Proof of Loss within twelve (12)
months from the time proof is otherwise required, unless you are legally
incapacitated.
NOTICE
TO SOUTH DAKOTA RESIDENTS
(TAHC5000AS.SD)
Under
the EXCLUSIONS provision, the following item is deleted: “being under
influence of drugs or intoxicants, unless prescribed by a Physician”
The
GENERAL PROVISIONS is amended as follows:
ARBITRATION
section is deleted in its entirety and replaced with the following:
ARBITRATION If we and the Insured disagree on the amount of loss, both
parties must mutually agree to the Arbitration, and each party will
select a competent and impartial arbitrator. The two arbitrators will
select a third. If they cannot agree within 30 days, either may request
that selection be made by a judge of a court having jurisdiction. Each
party will 1) pay the expense if incurred; and 2) bear the expenses of
the third arbitrator equally. A decision agreed to by two arbitrators
cannot be binding on either party.
ENTIRE
CONTRACT; CHANGES section, 2nd, paragraph, 3rd paragraph, and
4th sentence are deleted in its entirety and replaced with the
following: No agent or other person may change this Policy or waive any
of its terms, however, if you make a change through the agent and the
agent fails to make the change with the Company, the change will be
handled as if the agent had made the change. No change will be made
except by endorsement.
The
CLAIMS PROVISIONS is amended as follows:
LEGAL
ACTIONS section, 2nd sentence is deleted in its entirety and replaced
with the following: No such action will be brought after six years from
the time written Proof of Loss is required to be given.
NOTICE
TO WISCONSIN RESIDENTS
(TAHC5000AS.WI)
The
GENERAL PROVISIONS, OUR RIGHT TO RECOVER FROM OTHERS section, is deleted
in its entirety and replaced with the following:
OUR
RIGHT TO RECOVER FROM OTHERS. We have the right to recover
any payments we have made from anyone who may be responsible for the
loss. The Insured and any other person to whom we make payment must sign
any papers and do whatever is necessary to transfer this right to us.
The Insured and any person to whom we make payment agree(s) to cooperate
with us and to do nothing after the loss that will adversely affect our
rights. We will not retain any payments until you have been made whole
with regard to any claim payable under this Policy.
PART
2: 24-HOUR TRAVEL
EMERGENCY
EVACUATION ASSISTANCE
“Europe Assistance”
Assistance
is assumed by EUROP ASSISTANCE and not by Club Med®.
Any enrolment in Club Med®,
directly or through a travel agent makes the G.M®
eligible
for EUROP ASSISTANCE services that cover personal medical assistance
during his stay or his trip. The rights and obligations stipulated in
the policy are explained in the following pages.
1.
Definitions
1.1.
Beneficiary
Any
person travelling within a trip or stay with CLUB MEDITERRANEE is
considered as Beneficiary.
1.2.
Country of origin
The country where you reside shall be deemed your country of origin.
2.
Rules to be followed in case of Assistance
To
enable EUROP ASSISTANCE to act, it is necessary:
·
To
contact EUROP ASSISTANCE immediately
- Telephone: +33 1 41 85 84
86
- Fax: +33 1 41 85 85 71
·
To
obtain EUROP ASSISTANCE prior consent before taking any initiative or
incurring any expenses.
·
To
comply with the solutions recommended by EUROP ASSISTANCE.
3.
Geographic Coverage
This
assistance agreement ("Agreement") covers G.Ms®,
hereinafter called "Beneficiaries," worldwide.
4.
Term of Coverag
Personal
assistance services take effect on the starting date of the stay or the
trip and expire on the planned return date, with a maximum term of three
months. Travel advice
services take effect on the day the Contract is purchased so that
Beneficiaries can use them before the start date of their stay or trip.
The
validity of this Agreement is subject to the validity of the memorandum
of agreement signed by EUROP ASSISTANCE and Club Mediterranée.
If this memorandum of agreement is terminated, this Agreement
will be cancelled automatically.
5.
Tickets
When
transportation is organized and paid for pursuant to the provisions of
this Agreement, the Beneficiary agrees to reserve the right for EUROP
ASSISTANCE to use tickets it holds. Likewise, the Beneficiary agrees to
reimburse EUROP ASSISTANCE any amounts he may receive as reimbursement
from the organization issuing this ticket.
6.
Assistance Services
6.1.
Personal Assistance
6.1.1.
Transportation
If a Beneficiary is sick or injured while traveling in one of the
countries covered by this Assistance Agreement: the EUROP ASSISTANCE
doctors contact the local doctor who treated the Beneficiary as a
result
of the illness or the accident.
The
EUROP ASSISTANCE doctors collect all the information necessary for the
decision that must be made in the Beneficiary’s medical interest from
the local doctor and potentially from the Beneficiary’s regular
doctor.
The
information collected allows EUROP ASSISTANCE, following the decision
made by its EUROP ASSISTANCE doctors, to initiate and organize, based
solely on medical requirements, either the Beneficiary’s return to his
home or his transportation, if necessary, under medical supervision, to
an appropriate hospital service close to his home by light medical
vehicle, ambulance, sleeper car, first class train (couchette or seat),
commercial airline or medical plane.
In
certain cases, the Beneficiary’s safety may require initial transport
to a local clinic before considering a return to a facility close to his
home.
Our
Medical Service can reserve a place in the department where
hospitalization has been planned. Only the Beneficiary’s medical
interest and compliance with the health rules in force are taken into
consideration in making the transportation decision, the choice of the
means used for this transportation and the choice of a potential
hospitalization site.
The
information from the local doctors or from the Beneficiary’s regular
doctor, which may be essential, helps EUROP ASSISTANCE make the most
advisable decision. In this regard, it is expressly agreed that the
final decision implemented in the medical interest of the Beneficiary
is, as a last resort, up to the EUROP ASSISTANCE doctors, in order to
avoid any medical authority conflicts. Furthermore, if the Beneficiary
refuses to follow the decision considered to be the most advisable by
the EUROP ASSISTANCE doctors, he expressly releases EUROP ASSISTANCE
from all liability, particularly in case of return by his own means or
in case of any aggravation of his condition.
6.1.2.
Return of the Family
If a Beneficiary is repatriated, EUROP ASSISTANCE organizes and pays for
the return of the members of his immediate family (spouse, partner,
child, father, mother, brother or sister) and/or a maximum of two minor
children traveling with him by train (first class) or commercial airline
(economy class) if no one remaining behind can take care of them.
6.1.3.
Hospitalization
If a Beneficiary is hospitalized and his condition makes it impossible
to consider transporting him for 7 days, EUROP ASSISTANCE organizes and
pays the round-trip fare for one of his immediate family members from
the Beneficiary’s country of origin to the Beneficiary’s bedside by
train (first class) or by commercial airline (economy class). EUROP
ASSISTANCE also assumes the hotel costs (room and breakfast) up to 80
euros, all taxes included, per day for a maximum of 10 nights. Meal
expenses will not be paid.
6.1.4.
Expenses Related to an Extended Hotel Stay
If a Beneficiary’s condition does not justify his transport as defined
in article 5.1.1 “Transport,” and does not allow him to make the
return trip home on the date initially planned, EUROP ASSISTANCE
participates in the expenses resulting from the extended hotel stay for
the Beneficiary and the members of his immediate family (spouse,
partner, children, father, mother, brother or sister) or a maximum of
two companions who are also beneficiaries, up to 80 euros per person and
per day, all taxes included, capped at 150 euros, all taxes included,
per day and per event for a maximum of 10 days. This service cannot be
cumulated with the “Hospitalization” service.
6.1.5.
Accompaniment of Children
A Beneficiary is ill or injured during travel in one of the countries
covered by this Agreement, and his condition does not allow him to take
care of children under the age of 15 traveling with him: EUROP
ASSISTANCE organizes and pays for the round-trip fare, from his country
of origin, by train (first class) or plane (economy class) for a person
of his choice or one of its attendants to accompany the children to
their home by train (first class) or plane (economy class). The
children’s tickets will be paid for by their family.
6.1.6.
Medical Expenses
A Beneficiary is ill or injured during travel outside his country of
origin, in one of the countries covered by this Agreement: EUROP
ASSISTANCE will reimburse him, up to a maximum of 75,000 euros, all
taxes included, for the medical expenses incurred abroad and for which
he remains responsible following reimbursement by Social Security,
insurance and/or any other coverage agency. A 50-euro inclusive
deductible per Beneficiary and per event is applied in all cases. Dental
care is reimbursed under the same conditions with a cap of 100 euros,
all taxes included. The Beneficiary or his legal successors agree, for
this purpose, to take all steps necessary to recover these costs from
the agencies concerned as soon as they return to their country of
origin.
EUROP
ASSISTANCE will proceed with the reimbursement as defined above,
provided that the Beneficiary or his legal successor provide it with the
following documents:
•
the
original statements from the social agencies and/or coverage agencies
providing proof of the reimbursements obtained;
•
photocopies
of medical bills providing proof of the expenses incurred.
Nature
of the Medical Expenses Giving Entitlement to Supplemental
Reimbursement:
•
medical
fees;
•
costs
of drugs prescribed by a doctor;
•
costs
of an ambulance ordered by a doctor for a local trip;
•
costs
of hospitalization as long as the Beneficiary is deemed unfit for
transport by decision of the EUROP ASSISTANCE doctors made after
collecting information from the local doctor. The additional
reimbursement of these hospitalization expenses ceases as of the date
EUROP ASSISTANCE is capable of carrying out the transport;
•
dental
emergency.
6.1.7.
Advance on Hospitalization Expenses
A Beneficiary is ill or injured while traveling outside his country of
origin, in one of the countries covered by this Agreement: as long as he
is hospitalized, EUROP ASSISTANCE may advance hospitalization expenses
up to a maximum amount of 75,000 euros, all taxes included, subject to
the following cumulative conditions:
•
for
care prescribed in agreement with the EUROP ASSISTANCE doctors;
•
as
long as the Beneficiary is deemed unfit for transport by decision of the
EUROP ASSISTANCE doctors made after collecting information from the
local doctor.
•
no
advance is granted as of the date on which EUROPASSISTANCE is capable of
carrying out the transport.
The
Beneficiary agrees, in all cases, to repay this advance to EUROP
ASSISTANCE within 30 days following receipt of our bill. This obligation
applies even if the Beneficiary has begun the reimbursement procedures
cited in 6.1.6. Of course, as soon as these procedures have been
completed, EUROP ASSISTANCE assumes the difference between the amount of
the advance that the Beneficiary repaid to EUROP ASSISTANCE and the
amounts collected from social agencies and/or coverage agencies, in
accordance with the conditions and in the amounts set forth in 6.1.6.
and provided that the Beneficiary or his legal successors provide EUROP
ASSISTANCE with the documents set forth in 6.1.6.
6.1.8.
Transport in the Event of Death
A Beneficiary dies while traveling in one of the countries covered by
this Agreement: EUROP ASSISTANCE organizes and assumes the cost of
transporting the deceased to the funeral site in his
country
of origin. EUROP ASSISTANCE also assumes all the expenses necessitated
by preparation and arrangements specific to the transport.
Furthermore, EUROP ASSISTANCE participates in the cost of the
coffin in the maximum inclusive amount of 450 euros.
The other expenses (particularly for the ceremony, local funeral
procession, burial) are the financial responsibility of the family.
6.1.9.
Taxi Expenses
EUROP ASSISTANCE will participate up to a maximum inclusive amount of 45
euros, in the taxi expenses incurred for transporting the Beneficiaries
to the train station, the airport or to the site where they must go to
have access to the assistance services described above. EUROP ASSISTANCE
assumes this share of the expense on the sole condition that the service
is organized by it.
6.1.10.
Dispatch of Medicines
A Beneficiary cannot procure the drugs essential for continuing a
treatment in progress on site. EUROP ASSISTANCE finds and sends these
drugs to his vacation location, subject to the local and French legal
constraints. EUROP ASSISTANCE pays the shipping costs. The other costs
(purchase cost of the drugs, customs charges, etc.) are payable by the
Beneficiary.
6.1.11.
Bail and Attorneys Fees
While traveling outside his/her country of origin in one of the
countries covered by this Agreement, a Beneficiary is subject to legal
prosecution following a traffic accident, excluding all other causes:
EUROP ASSISTANCE may advance bail money in the maximum inclusive amount
of 15,000 euros, as well as attorney’s fees in the maximum inclusive
amount of 3,000 euros. The Beneficiary agrees to repay these advances to EUROP
ASSISTANCE within 3 months of the date of the advance, or, for the bail
bond, as soon as this bond has been returned to beneficiary by the
authorities, if this occurs before the end of this period. The right to
bill the Beneficiary for the entire cost of the services is reserved.
6.2.
Travel Advice/Message Service
6.2.1.
Travel Information
With a simple phone call to the following number: 01 41 85 84 86, EUROP
ASSISTANCE puts the Beneficiary in contact with a person qualified to
answer all his questions concerning the regulatory and practical aspects
of his trip:
•
Medical
precautions to take before beginning the journey (vaccines, medicines,
etc.);
•
Travel
conditions (possibility of transport, etc.)
•
Local
living conditions (temperature, climate, food, etc.).
The
Travel Advice Team can be reached from 9 a.m. to 6 p.m. every day except
Sundays and holidays.
6.2.2.
Transmission of Urgent Messages
If, while traveling, a Beneficiary finds it impossible to contract
acperson, EUROP ASSISTANCE transmits, at the time and on the date chosen
by the Beneficiary, the message previously left by telephone at the
following number: 01 41 85 81 13 (or +33 1 41 85 81 13 from abroad). The
Beneficiary may also use this number to leave a message for a person of
his choice who can get this message with a simple call.
7.
Exclusions
EUROP
ASSISTANCE CANNOT IN ANY CASE SUBSTITUTE FOR THE LOCAL EMERGENCY
ASSISTANCE AGENCIES.
The
following are excluded:
•
Costs
incurred without the agreement of EUROP ASSISTANCE or not expressly set
forth in this Agreement;
•
Costs
not justified by original documents;
•
Claims
occurring in countries excluded from the coverage or outside the
contract validity dates;
•
pre-existing
diagnosed and/or treated illnesses or injuries that required
hospitalization during the six months preceding the request for
assistance;
•
The
organization and management cited in 6.1.1. for minor ailments that can
be treated on site and that do not prevent the Beneficiary from
continuing his trip or his stay;
•
The
consequences of using medications, drugs, narcotics and like products
not medically prescribed, the excessive consumption of alcohol and
attempted suicide;
•
The
effects of intentional acts on the part of the beneficiary and the
effects of fraudulent acts;
•
Incidents
tied to pregnancy whose risk was known before departure and in all
cases, incidents due to pregnancy as of the 8th month;
•
Medical
expenses incurred in the Beneficiary’s country of origin;
•
Optical
expenses (glasses or contact lenses, for example);
•
Vaccines
and vaccination costs;
•
Expenses
for searches for persons in the mountains, at sea or in the desert;
•
The
costs of fuel and tolls;
•
Customs
duties.
•
NBC
(nuclear, biological and chemical) risks;
The following
may not result in intervention:
•
Situations
involving infectious risks in an epidemic requiring quarantine or
preventive measures or specific surveillance by the local or national
health authorities in the country of origin;
•
Pathological
conditions arising from an infection and contagious illness or from
exposure to biological infecting agents, an explosion of chemical
substances such as combat gas, incapacitators, neurotoxins, or
persistent toxic effects or from contamination by radio-nucleids
following an accident or deliberate (terrorism) act.
8.
Case of Exemption of Liability due to Force Majeure
EUROP
ASSISTANCE cannot be held liable for failure to perform services
resulting from cases of force majeure or events such as civil or foreign
wars, well known political instability, popular uprisings, riots,
terrorist acts, reprisals, restriction to the free movement of people
and goods, strikes, explosions, natural disasters, nuclear explosion, or
delays in performing the services as a result of the same causes.
9.
Subrogation
After
incurring expenses within the framework of our assistance guarantees, we
have full rights of subrogation. Our subrogation is limited to the
amount of payments under the policy.
10.
Limitation
Any
action regarding this policy has a term of limitation of two years
effective from the insured occurrence.
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