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TOTAL
PEACE OF MIND™ OPTIONAL UPGRADE PLAN – U.S.A
Trip
Cancellation and Trip Interruption
Lost, Damaged or Delayed Baggage
Medical Expense Benefits
Accidental Death & Dismemberment
Travel Emergency Assistance
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: 20CM
DESCRIPTION
OF COVERAGE
SCHEDULE OF COVERAGES
Optional
Upgraded Plan
If
you elect to purchase the Optional Upgraded Plan at the time of initial
deposit, you are entitled to the following coverage per person.
Maximum
Benefit Amount
Trip
Cancellation
Trip Cost
Trip Interruption
Trip Cost
Baggage and Personal Effects
$3,000
Baggage Delay (in village credit)
$100 Village Boutique Voucher
Medical or Dental Expenses
$30,000
Accidental Death & Dismemberment
$25,000
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WAIVER OF PRE-EXISTING CONDITION
The
Pre-Existing Condition Exclusion is waived provided you meet all
of the following requirements:
1. the payment
for this plan is received with your initial payment for your
Covered
Trip; and
2. you are not disabled from travel at the time you make
your plan payment.
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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.
EUROP
ASSISTANCE
24
Hour Travel Emergency Assistance
For
complete details regarding coverage’s for personal assistance and
medical assistance provided by EUROP ASSISTANCE, please refer to the Basic
Travel Insurance Plan description of coverage.
To
contact EUROP ASSISTANCE:
Telephone:
+33 1 41 85 84 86
Fax:
+33 1 41 85 85 71
CANCEL FOR ANY
REASON WAIVER
The
Optional Upgraded Plan includes Club Med’s Cancel for Any Reason waiver
benefit which allows you to cancel your Club Med travel arrangements for
any reason not covered by insurance up to 48-hours prior to departure. You
will be issued a future travel credit equivalent to 90% of the
cancellation charges for the land portion of your vacation package. Air
transportation penalties, change fees, or other portions not booked
through Club Med are not covered. The future travel credits can be used
for a Club Med vacation, at any Club Med Resort worldwide, and are valid
for ONE year from the date of cancellation.
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