COB-CW
Purchase Details
Your Travel Supplier Name:
Fareportal, Inc. and its affiliates
Plan Number:
F200B
Effective Date For Trip Cancellation:
Date Premium Received by Your Travel Supplier
Effective Date For Other Benefits:
Scheduled Departure Date for Your Covered Trip
Please Note:
This plan is only effective for You if the required premium for the Covered Trip has been paid to Your Travel Supplier. Your premium must be received by
Your Travel Supplier with or before your final payment for Your Trip.
| Schedule of Benefits |
| Benefit |
Maximum Benefit Amount |
| Accidental Death and Dismemberment |
$100,000 |
| Trip Cancellation |
Air Ticket Cost* |
| Trip Interruption |
Return Flight Cost* |
| Travel Delay |
$200 |
| Baggage Delay |
$200 |
| *Up To $100,000 |
|
| Schedule of Services |
| Benefit |
Maximum Service Amount |
| One Call 24-Hour Assistance Services |
Included |
| Global Xpi Medical Records Services |
Included |
The Insurance Plan is underwritten by: United States Fire Insurance Company under form TP-401-CW.
To Report A Claim
Thank you for purchasing a Trip Mate plan. Have questions, want to report a claim? You can call us toll-free at the number listed below.
You can also report and complete your claim(s) online at www.tripmate.com.
Customer Service or to Report A Claim
1-844-777-6859
One Call 24-Hour Assistance Services
One Call Worldwide Travel Services Network, Inc. provides: medical, legal and travel assistance services available 24 hours a day/365 days a year. A
complete list of these services is included in your certificate/policy. To contact One Call:
Within U.S.A. & Canada Outside U.S.A. & Canada
1-855-226-1722 1-603-952-2043
United States Fire Insurance Company
Administrative Office: 5 Christopher Way
Eatontown, NJ 07724
(Hereinafter referred to as "the Company")
Plan # F200B
TRAVEL PROTECTION INSURANCE POLICY
Limited Benefit Short-Term Single Premium Policy
United States Fire Insurance Company, herein referred to as the Company, will pay You (the Insured) the insurance benefits described in this Policy. This
Policy and attached Riders, if any, are issued in consideration of the statements in the enrollment form and the payment of the initial premium. This
Policy is a legal contract between You and the Company.
This Policy describes all of the travel insurance benefits underwritten by the Company. Please refer to the accompanying Confirmation of Benefits for
specific information about the program You purchased. You should contact the Company immediately if You believe that the Confirmation of Benefits is
incorrect.
Signed for the Company,
President
If You are not completely satisfied with the insurance, You must notify Your Travel Supplier within 10 days of purchase and return the Policy. The Company
will give You a full refund of premium provided You have not already departed on the Covered Trip or filed a claim.
TP-401-CW
TABLE OF CONTENTS
I. COVERAGES
II. DEFINITIONS
III. INSURING PROVISIONS
IV. GENERAL LIMITATIONS AND EXCLUSIONS
V. GENERAL PROVISIONS
SECTION I. Coverages
ACCIDENTAL DEATH AND DISMEMBERMENT
You are eligible for benefits 24 hours a day, up to the Maximum Benefit Amount, when You sustain an Injury during the Trip which results in any of the
following losses within 180 days of the date of the Injury causing the Loss.
Benefits will be paid as follows:
| Loss |
Percentage of Principal Sum Payable |
| Life |
100% |
| Both Hands; Both Feet or Sight of Both Eyes |
100% |
| 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% |
Loss of hand or hands, or foot or feet
, means severance at or above the wrist joint or ankle joint, respectively. Loss of eye or eyes means the total and irrecoverable loss of
the entire sight thereof. Only one of the amounts shown above (the largest applicable) will be paid for Injuries resulting from one accident.
The benefit for loss of: (a) two limbs; (b) both eyes; or (c) one limb and one eye is payable only when such loss results from the same accident.
The Principal Sum is the Maximum Benefit Amount shown in the Confirmation of Benefits.
TRIP CANCELLATION AND TRIP INTERRUPTION
Benefits will be paid up to the Maximum Benefit Amount purchased to cover You:
For Trip Cancellation -
for the Published Penalties and unused non-refundable prepaid expenses for Travel Arrangements;
For Trip Interruption -
for the non-refundable, unused portion of the prepaid expenses for Travel Arrangements and/or the Additional Transportation Cost paid to return home or
rejoin the Covered Trip;
when You are prevented from taking or completing Your Covered Trip due to:
1. Death involving You or Your Traveling Companion or Your or Your Traveling Companion’s Business Partner or Your Family Member;
2. A covered Sickness or Injury involving You, Your Traveling Companion or Business Partner, or Your Family Member which necessitates Medical Treatment at
the time of cancellation and results in medically imposed restrictions, as certified by a Legally Qualified Physician, which prevents Your participation in
the Covered Trip;
3. You or Your Traveling Companion being hijacked, quarantined, required to serve on a jury (notice of jury duty must be received after Your Effective
Date) served with a court order to appear as a witness in a legal action in which You or Your Traveling Companion is not a party (except law enforcement
officers);
4. You or Your Traveling Companion’s principal place of residence being rendered uninhabitable by fire, flood, or burglary within 10 days of departure;
5. Natural disaster at the site of Your destination, which renders Your destination accommodations uninhabitable;
6. You or Your Traveling Companion being directly involved in a traffic accident, which must be substantiated by a police report, while en route to Your
scheduled point of departure;
7. Unannounced Strike that causes complete cessation of services of Your Common Carrier for at least 12 consecutive hours;
8. You or Your Traveling Companion is in the Military and called to emergency duty for a national disaster other than war;
9. A Terrorist Incident that occurs in a city listed on the itinerary of Your Covered Trip and within 30 days prior to Your Scheduled Departure Date. This
same city must not have experienced a Terrorist Incident within the 90 days prior to the Terrorist Incident that is causing Your cancellation of the
Covered Trip. Benefits are not provided if the Travel Supplier offers a substitute itinerary;
10. Revocation of Your previously granted leave or re-assignment due to war. Official written revocation/re-assignment by a supervisor or commanding
officer of the appropriate branch of service will be required;
provided such circumstances occurred after Your Effective Date.
TRIP DELAY
If You are delayed for 12 hours or more while in route to or from a Covered Trip, due to:
1. any delay of a Common Carrier. The delay must be certified by the Common Carrier;
2. a traffic accident in which You or Your Traveling Companion are not directly involved (must be substantiated by a police report);
3. lost or stolen passports, travel documents or money (must be substantiated by a police report); or
4. quarantine, hijacking, strike, natural disaster, terrorism or riot;
5. documented weather condition preventing You from getting to the point of departure;
benefits will be paid, on a one-time basis, up to the Maximum Benefit Amount, for:
1. the Additional Transportation Cost from the point where You were delayed to a destination where he or she can join the Covered Trip;
2. the Additional Transportation Cost to return You to Your originally scheduled return destination;
3. reasonable accommodation and meal expenses, up to $100 per day, necessarily incurred by You for which You have proof of purchase and which were not paid
for or provided by any other source; and
4. the non-refundable, unused portion of the prepaid expenses for the Covered Trip.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
The Maximum Benefit Amount is shown in the Confirmation of Benefits.
BAGGAGE DELAY
For Baggage Delay:
If, while on a Covered Trip, Your checked baggage is delayed or misdirected by a Common Carrier for more than 12 hours from Your time of arrival at a
destination other than at Your place of permanent residence, benefits will be paid, up to the Maximum Benefit Amount for the actual expenditure for
necessary personal effects. You must be a ticketed passenger on a Common Carrier. The Common Carrier must certify the delay or misdirection. Receipts for
the purchases must accompany any claim.
Benefits will not be paid for any expenses which have been reimbursed or for any services which have been provided by the Common Carrier, hotel or Travel
Supplier; nor will benefits be paid for loss or damage to property specifically scheduled under any other insurance.
These benefits will not duplicate any benefits payable under the policy or any coverage(s) attached to the policy.
The Maximum Benefit Amount is shown in the Confirmation of Benefits.
SECTION II. Definitions
"Additional Transportation Cost" means the actual cost incurred for one-way Economy Transportation by a Common Carrier reduced by the
value of an unused travel ticket.
"Business Partner" means an individual who (a) is involved in a legal general partnership with You and/or (b) is actively involved in the
day to day management of Your business.
"Common Carrier" means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
"Confirmation of Benefits" means the coverage confirmation provided to You following enrollment and payment of the applicable premium.
"Covered Trip" means scheduled trips, tours or cruises for which (a) coverage is requested: and (b) the required premium is submitted
prior to the Scheduled Departure Date.
"Economy Transportation" means the lowest published available transportation rate for a ticket on a Common Carrier matching the original
class of transportation that You purchased for the Covered Trip.
"Family Member" means Your or a Traveling Companion’s: legal spouse or common-law spouse where legal; legal guardian; son or daughter
(adopted, foster or step); son-in-law; daughter-in-law; grandmother; grandmother-in-law; grandfather; grandfather-in-law; grandchild; aunt; uncle; niece;
or nephew; brother, step-brother; sister; step-sister; brother-in-law; sister-in-law; mother; father; step-parent.
"Injury" or "Injuries" means accidental bodily injuries: (a) received while insured under the Policy and any attached
coverages: (b) resulting in loss independently of sickness and all other causes: and (c) not excluded from coverage.
"Insured" means the person(s) named on the enrollment form or Roster as the Principal Participant, participant’s spouse or participant’s
child.
"Intoxicated" means a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or
jurisdiction where You are located at the time of an incident.
"Legally Qualified Physician" means a physician or a Christian Science Practitioner: (a) other than You, a Traveling Companion or a Family
Member: (b) practicing within the scope of his/her license: and (c) recognized as a physician in the place where the services are rendered.
"Maximum Benefit Amount"
means the maximum amount payable for coverage provided to You as shown in the Confirmation of Benefits.
"Medical Treatment"
means treatment, advice or consultation by a Legally Qualified Physician.
"Pre-Existing Condition"
means any injury, sickness or condition (including any condition from which death ensues) of You, Your Traveling Companion, or Your or Your Traveling
Companion’s Family Member or Your Business Partner for which within the 60 day period prior to the effective date of Your Trip Cancellation coverage under
the Policy which (a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required
taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the
required prescription; or (c) required medical treatment or treatment was recommended by a Legally Qualified Physician.
"Published Penalties"
means any published cancellation penalties issued by Your travel agency or travel supplier that apply to all clients of the travel agency or travel
supplier and can be documented at time of trip sale. The maximum amount reimbursable under the travel agencies published penalties is 10% of the total trip
cost excluding taxes and other non-commissionable items.
"Scheduled Departure Date"
means the date on which You are originally scheduled to leave on the Covered Trip.
"Scheduled Return Date"
means the date on which You are originally scheduled to return to the point of origin or the original final destination.
"Sickness"
means an illness or disease that is diagnosed or treated by a Legally Qualified Physician after the effective date of insurance and while You are covered
under the Policy.
"Strike"
means any stoppage of work: (a) as a result of a combined effort of workers which was unannounced and unpublished at the time travel services were
purchased: and (b) which interferes with the normal departure and arrival of a Common Carrier.
"Third Party"
means a person or entity other than You or the Company.
"Travel Arrangements"
means: (a) transportation; (b) accommodations; and (c) other specified services arranged by the Travel Supplier for the Trip.
"Travel Supplier"
means any entity or organization that coordinates or supplies travel services for You.
"Traveling Companion"
means a person or persons with whom You have coordinated Travel Arrangements and intend to travel with during the Covered Trip.
SECTION III. Insuring Provisions
Policy Term:
This Policy is a short-term trip Policy and is issued for the specific term shown on the attached Confirmation of Benefits. This Policy is not renewable.
For Trip Cancellation:
Coverage begins on the Effective Date and time specified in the Confirmation of Benefits. Coverage ends at the point and time of departure on Your
Scheduled Departure Date.
For Trip Delay:
Coverage is in force while en route to and from the Covered Trip.
For all other coverages:
Coverage begins at the point and time of departure on the Scheduled Departure Date. Coverage ends at the point and time of return on Your Scheduled Return
Date.
In the event the Scheduled Departure Date and/or the Schedule Return Date are delayed, or the point and time of departure and/or point and time of return
are changed because of circumstances over which neither the Travel Supplier nor You have control Your term of coverage shall be automatically adjusted
accordance with the Travel Supplier’s notice to the Company of the delay or change.
SECTION IV. General Limitations and Exclusions
Benefits are not payable for Sickness, Injuries or losses of You, Your Traveling Companion or Your Traveling Companion’s Family Member, or Your Business
Partner:
1. resulting from suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane (in Missouri, sane only);
2. resulting from an act of declared or undeclared war;
3. while participating in maneuvers or training exercises of an armed service;
4. while riding, driving or participating in races, or speed or endurance contests;
5. while mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes, or other special equipment);
6. while participating as a member of a team in an organized sporting competition;
7. while participating in skydiving, hang gliding, bungee cord jumping, scuba diving or deep sea diving;
8. while piloting or learning to pilot or acting as a member of the crew of any aircraft;
9. received as a result or consequence of being Intoxicated, as specifically defined in the policy, or under the influence of any controlled substance
unless administered on the advise of a Legally Qualified Physician to which a contributory cause was the commission of or attempt to commit a felony or
being engaged in an illegal occupation;
11. due to normal childbirth, normal pregnancy through the first 6 months of pregnancy or voluntarily induced abortion;
12. for dental treatment (except as coverage is otherwise specifically provided herein);
13. which exceed the Maximum Benefit Amount for each attached coverage as shown in the Confirmation of Benefits: or;
14. due to a Pre-existing Condition, as defined in the Policy. The Pre-existing Condition Limitation does not apply to: (a) Emergency Medical Evacuation,
Medical Repatriation and Return of Remains coverage; or (b) to coverage purchased within 24 hours from the time the initial Covered Trip deposit is paid.
The following limitation applies to Trip Cancellation: All cancellations must be reported directly to the Travel Supplier within 72 hours of the event
causing the need to cancel, unless the event prevents it, and then as soon as is reasonably possible. If the cancellation is not reported within the
specified 72 hour period, the Company will not pay for additional charges which would not have been incurred had You notified the Travel Supplier in the
specified period. If the event prevents You from reporting the cancellation, the 72-hour notice requirement does not apply; however, You must, if
requested, provide proof that said event prevented You from reporting the cancellation within the specified period.
Additional Limitations and Exclusions Specific to Baggage and Personal Effects
Benefits are not payable for any loss caused by or resulting from:
a) breakage of brittle or fragile articles;
b) wear and tear or gradual deterioration;
c) confiscation or appropriation by order of any government or custom’s rule;
d) theft or pilferage while left in any unlocked vehicle;
e) property illegally acquired, kept, stored or transported;
f) Your negligent acts or omissions; of
g) property shipped as freight or shipped prior to the Scheduled Departure Date.
WHERE TO PRESENT A CLAIM
Present all claims to the Program Administrator:
Trip Mate, Inc.*
9225 Ward Parkway, Suite 200
Kansas City, Missouri 64114 Tel: 1-844-777-6859
Plan Number: F200B
Claims may also be reported/completed online at:
www.tripmate.com
*In CA & UT, dba Trip Mate Insurance Agency
SECTION V. General Provisions
Entire Contract:
Changes: This Policy and any attachments are the entire contract of Insurance. No agent may change it in any way. Only an officer of the Company can
approve a change. Any such change must be shown in the Policy or its attachments.
Clerical Error:
Clerical Error on the Company’s part or that of a Travel Supplier in keeping records or furnishing information will not void coverage if it is otherwise
validly in force; nor will it continue coverage if it is otherwise validly terminated under the terms of this Policy.
Conformity with State Statutes:
The provisions of this Policy must conform to the laws of the state in which it was issued. If they do not, they are hereby amended to conform.
Notice of Claim:
Notice of claim must be reported within 20 days after a loss occurs or as soon as is reasonably possible. You or someone on Your behalf may give the
notice. The notice should be given to the Company or designated representative and should include sufficient information to identify You.
Claim Forms:
When notice of claim is received by the Company or designated representative, forms for filing proof of loss will be furnished. If these forms are not sent
within 15 days, the proof of loss requirements can be met by sending a written statement of what happened. This statement must be received within the time
given for filing proof of loss.
Proof of Loss:
Proof of loss must be provided within 90 days after the date of the loss or as soon as is reasonably possible. Proof must, however, be furnished no later
than 12 months from the time it is otherwise required, except in the absence of legal capacity.
Time of Payment of Claims:
The Company or its designated representative, will pay the claim after receipt of acceptable proof of loss.
Payment of Claims:
Benefits for loss of life are payable to the Principal Insured, who is the beneficiary for all other Insureds. If: (a) the Principal Insured predeceases
You: and (b) a beneficiary is not otherwise designated by the Principal Insured benefits for loss of life will be paid to the first of the following
surviving preference beneficiaries:
a) Your spouse;
b) Your child or children jointly;
c) Your parents jointly if both are living or the surviving parent if only one survives;
d) Your brothers and sisters jointly; or
e) Your estate.
All or a portion of all other benefits provided by the Policy may, at the option of the Company, be paid directly to the provider of the service(s). All
benefits not paid to the provider will be paid to the Principal Insured.
Other than for loss of life, if any benefit is payable to: (a) You or the Principal Insured’s beneficiary who is minor or otherwise not able to give a
valid release: or (b) the Principal Insured’s estate: the Company may pay up to $1,000 to the Principal Insured’s beneficiary or any relative to whom the
Company finds entitled to the payment. Any payment made in good faith shall fully discharge the Company to the extent of such payment.
Physician Examination and Autopsy:
The Company, at the expense of the Company, may have You examined when and as often as is reasonable while the claim is pending. The Company may have an
autopsy done (at the expense of the Company) where it is not forbidden by law.
Legal Actions:
No legal action for a claim can be brought against us until 60 days after we receive proof of loss. No legal action for a claim can be brought against us
more than 3 years after the time required for giving proof of loss. This 3-year time period is extended from the date proof of loss is filed and the date
the claim is denied in whole or in part.
Concealment and Misrepresentation:
The entire coverage will be void, if before, during or after a loss, any material fact or circumstance relating to this insurance has been concealed or
misrepresented.
Other Insurance with the Company:
You may be covered under only one travel policy with the Company for each Covered Trip. If You are covered under more than one such policy, You may select
the coverage that is to remain in effect. In the event of death, the selection will be made by the beneficiary or estate. Premiums paid (less claims paid)
will be refunded for the duplicate coverage that does not remain in effect.
Subrogation:
If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the
Third Party responsible for the loss, the Company will be subrogated to that right. You shall help the Company exercise the Company’s rights in any
reasonable way that the Company may request: nor do anything after the loss to prejudice the Company’s rights: and in the event You recover damages from
the Third Party responsible for the loss, You will hold the proceeds of the recover for the Company in trust and reimburse the Company to the extent of the
Company’s previous payment for the loss.
Additional Claims Provisions Specific to Baggage
Your Duties After Loss of or Damage to Property or Delay of Baggage: In case of loss, theft, damage or delay of baggage or personal effects, and You must:
a) take all reasonable steps to protect, save or recover the property:
b) promptly notify, in writing, either the police, hotel proprietors, ship lines, airlines, railroad, bus, airport or other station authorities, tour
operators or group leaders, or any Common Carrier or bailee who has custody of Your property at the time of loss:
c) produce records needed to verify the claim and its amount ,and permit copies to be made:
d) provide to the Company, within 90 days from the date of loss, a detailed proof of loss signed and sworn to: and
e) be examined, if requested.
Reductions in the Amount of Insurance:
The applicable benefit amount will be reduced by the amount of benefits, if any, previously paid for any loss or damage under this coverage for this
Covered Trip.
TRAVEL PROTECTION INSURANCE
State Exceptions to the Certificate of Insurance or Policy
KANSAS:
Under the General Provisions, "Subrogation" does not apply to reimbursement of medical, surgical, hospital or funeral expenses. "Legal Actions" is amended
to read "5-years". The following exclusion is added to read as follows: 15. due to Mental or Nervous Conditions, unless hospitalized.
"Mental or Nervous Conditions" means disorders specified in the diagnostic and statistical manual of mental disorders, fourth edition, (DSM-IV, 1994) of
the American Psychiatric Association but shall not include conditions not attributable to mental disorders that are a focus of attention or treatment
(DSM-IV, 1994).
The definition of Usual and Customary means, for charges incurred in the United States:
a) charges and fees for medical services or supplies that are the lesser of:
the usual charge by the provider for the service or supply given; or
the average charges for the service or supply in the area where the service or supply is received; and
b) Treatment and medical service that is reasonable in relationship to the service or supply given and the severity of the condition.
Usual and Customary charges are calculated using the national database in Ingenix, Inc. or similar provider. Ingenix and similar providers update the data
every 6 months.
For Charges incurred outside the United States, payment is based on billed charges that the Company receives proof of the service or supply being given.
The definition of Family Member is amended to delete the reference to Traveling Companion, as the Traveling Companion is not eligible as a Family Member.
The General Limitation and Exclusions section is amended to delete the reference to Traveling Companion as such person is not eligible as a Family Member.
The definition of Physician is amended to read:
Legally Qualified Physician" means a physician: (a) other than You or a Family Member; (b) practicing within the scope of his or her license; and (c)
recognized as a physician in the place where the services are rendered.
Mental and Nervous Disorders
Subject to the terms, limitations, and conditions of the Policy, the Company will cover the following services. The Company will provide coverage for
services for treatment of Mental and Nervous Disorders for inpatient confinement for up to 45 days of such Inpatient Confinement per Calendar Year as long
as the insurance is in effect on a day of confinement.
Inpatient Confinement per Calendar Year as long as the insurance is in effect on a day of confinement. Inpatient benefits are limited to the Allowable
Expense and subject to any deductibles, co-payments and maximum benefit limitations. In addition, the Company will provide coverage for outpatient services
for Mental and Nervous Disorders. Outpatient mental health expenses will be covered at 100% of the first $100 incurred, 80% of the next $100 incurred and
50% for the next $1,640 incurred in a calendar year up to a lifetime maximum of $7,500. Outpatient benefits are limited to the Allowable Expense and
subject to any deductibles, co-payments and maximum benefit limitations.
The expense must be incurred while the policy is in force with respect to the covered person or it is not considered an Allowable Expense. The Mental and
Nervous Disorder must first be diagnosed while the policy is in force with respect to the covered person and the purpose of the travel may not be for
medical treatment of such Mental and
Nervous Disorder. Coverage ends on the date the policy terminates.
Mental and Nervous Disorders
means the following: Schizophrenia, schizoaffective disorder, schizophreniform disorder, brief reactive psychosis, paranoid or delusional disorder,
atypical psychosis, major affective disorders (bipolar and major depression), cyclothymic and dysthymic disorders, obsessive compulsive disorder, panic
disorder,
pervasive developmental disorder, including autism, attention deficit disorder and attention deficit hyperactive disorder as such terms are defined in the
diagnostic and statistical manual of mental disorders, fourth edition, (DSM-IV, 1994) of the American psychiatric association but shall not include
conditions not attributable to a mental disorder that are a focus of attention or treatment.
Diabetes Coverage
Subject to the terms, limitations, and conditions of the Policy, the Company will cover the following services. The Company shall provide coverage for
medically necessary equipment and supplies, limited to hypodermic needles and supplies used exclusively with diabetes management and outpatient
self-management training and education,
including medical nutrition therapy, for the treatment of insulin dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin using
diabetes if prescribed by Physician. The Company shall also provide coverage for diabetes outpatient self-management training and education when provided
by a certified, registered or licensed health care professional with expertise in diabetes. The coverage for outpatient self-management training and
education shall be required only if ordered by a Physician legally authorized to prescribe such services and the diabetic: (1) is treated at a program
approved by the American diabetes association; (2) is treated by a person certified by the National Certification Board for Diabetes Educators; or (3) is,
as to nutritional education, treated by a licensed dietitian pursuant to a treatment plan authorized a Physician legally authorized to prescribe such
services and the diabetic: (1) is treated at a program approved by the American diabetes association; (2) is treated by a person certified by the National
Certification Board for Diabetes Educators; or (3) is, as to nutritional education, treated by a licensed dietitian pursuant to a treatment plan authorized
a Physician.
The service must be rendered while the covered person is covered under the Policy or it is not considered an Allowable Expense. The benefit is subject to
any deductible and maximum benefit limitations required by the Policy. Diabetes must first be diagnosed while the Policy is in force with respect to the
covered person and the purpose of the travel may not be for medical treatment of diabetes. Coverage ends on the date the Policy terminates.
General Anesthesia for Dental Surgery
Subject to the terms and conditions of the Policy, the Company will cover the following services. The Company shall provide coverage for the medically
necessary administration of general anesthesia and Hospital charges for dental care provided to the following Covered Persons:
a) a child five years of age and under; or
b) a person who is severely disabled; or
c) a person has a medical or behavioral condition that requires hospitalization or general anesthesia when dental care is provided.
The service must be rendered while the covered person is covered under this Policy or it is not considered an Allowable Expense. The benefit is subject to
any deductible and maximum benefit limitations required by the Policy. The dental work must first be diagnosed while the Policy is in force with respect to
the covered person and the purpose of the travel must not be for dental treatment. Coverage ends on the date the Policy terminates.
Off Label Prescription Drugs for Cancer Treatment
Subject to the terms, limitations, and conditions of the Policy, the Company will cover off label prescription drugs as follows. The Company will not
exclude coverage of a prescription drug for cancer treatment on the grounds the prescription drug has not been approved by the federal food and drug
administration for that covered indication if the prescription drug is recognized for treatment of the indication in one of the standard reference
compendia or in substantially accepted peer-reviewed medical literature. The prescribing physician shall submit to the Company documentation supporting the
proposed off-label use or uses prior to it being covered.
The service must be rendered while the covered person is covered under this Policy or it is not considered an Allowable Expense. The benefit is subject to
any deductible and maximum benefit limitations required by the Policy. The cancer must first be diagnosed while the Policy is in force with respect to the
covered person and the purpose of the travel must not be to obtain treatment for such cancer or to obtain off label prescription drugs for such cancer
treatment. Coverage ends on the date the Policy terminates.
COB-TX
Purchase Details
Your Travel Supplier Name:
Fareportal, Inc. and its Affiliates
Plan Number:
F200B
Effective Date For Trip Cancellation:
Date Premium Received by Your Travel Supplier
Effective Date For Other Benefits:
Scheduled Departure Date for Your Covered Trip
Please Note:
This plan is only effective for You if the required premium for the Covered Trip has been paid to Your Travel Supplier. Your premium must be received by
Your Travel Supplier with or before your final payment for Your Trip.
| Schedule of Benefits TP-401-TX-AH |
| Plan Benefits |
Maximum Benefit Amount |
| Accidental Death & Dismemberment |
| 24-Hour Coverage |
$100,000 |
| Schedule of Benefits TP-401-TX-PC
|
| Plan Benefits |
Maximum Benefit Amount |
| Trip Cancellation |
Air Ticket Cost* |
| Trip Interruption |
Return Flight Cost* |
| Baggage and Personal Effects |
Not Included |
| Baggage Delay |
$200 |
| Trip Delay |
$200 |
|
*Up To $100,000 |
| Schedule of Services |
| Plan Services |
Maximum Service Amount |
| One Call 24-Hour Assistance Services |
No Dollar Limit |
| Global Xpi Medical Records Service |
No Dollar Limit |
The Insurance Plan is underwritten by: United States Fire Insurance Company under forms TP-401-TX-AH and TP-401-TX-PC
To Report A Claim
Thank you for purchasing a Trip Mate plan. Have questions, want to report a claim? You can call us toll-free at the number listed below.
You can also report and complete your claim(s) online at www.tripmate.com.
Customer Service or to Report A Claim
1-844-777-6859
One Call 24-Hour Assistance Services
One Call Worldwide Travel Services Network, Inc. provides: medical, legal and travel assistance services available 24 hours a day/365 days a year. A
complete list of these services is included in your certificate/policy. To contact One Call:
Within U.S.A. & Canada Outside U.S.A. & Canada
1-855-226-1722 1-603-952-2043
United States Fire Insurance Company
Administrative Office: 5 Christopher Way
Eatontown, NJ 07724
(Hereinafter referred to as "the Company")
Plan # F200B
TRAVEL PROTECTION INSURANCE POLICY
United States Fire Insurance Company, herein referred to as the Company, will pay You the insurance benefits described in this Policy. This Policy and
attached Riders, if any, are issued in consideration of the statements in the enrollment form and the payment of the initial premium. This Policy is a
legal contract between You and the Company.
RENEWAL CONDITION
Policy Term: This Policy is a short-term trip Policy and is issued for the specific term shown on the attached Confirmation of Benefits. This Policy is not
renewable.
This Policy describes all of the travel insurance benefits underwritten by the Company. Please refer to the accompanying Confirmation of Benefits for
specific information about the program You purchased. You should contact the Company immediately if You believe that the Confirmation of Benefits is
incorrect.
Signed for the Company
Douglas M. Libby
Chairman and CEO |
If You are not completely satisfied with the insurance, You must notify Your Travel Supplier within 10 days of purchase and return the Policy. The Company
will give You a full refund of premium provided You have not already departed on the Covered Trip or filed a claim.
TP-401-TX-AH
TABLE OF CONTENTS
I. DEFINITIONS
II. COVERAGES
III. INSURING PROVISIONS
IV. GENERAL LIMITATIONS AND EXCLUSIONS
V. GENERAL PROVISIONS
SECTION I. DEFINITIONS
"Business Partner"
means an individual who (a) is involved in a legal general partnership with You and or (b) is actively involved in the day to day management of Your
business.
"Confirmation of Benefits"
means the coverage confirmation provided to You following enrollment and payment of the applicable premium.
"Covered Trip"
means scheduled trips, tours or cruises for which (a) coverage is requested: and (b) the required premium is submitted prior to the Scheduled Departure
Date.
"Domestic Partner"
means a person who is responsible with the Named Insured for each other’s welfare. A domestic partnership relationship may be demonstrated by any three of
the following types of documentation 1) a joint mortgage or lease; 2) designation of the domestic partner as beneficiary for life insurance; 3) designation
of the domestic partner as primary beneficiary in the Named Insured’s will; 4) powers of attorney for property and/or health care; and 5) joint ownership
of either a motor vehicle checking account or credit account.
"Family Member"
means any of the following who resides in the United States, Canada, or Mexico: Your or Your Traveling Companion’s: legal spouse (or common-law spouse
where legal), legal guardian, son or daughter (adopted, foster, step or in-law), brother or sister (includes step or in-law), parent (includes step or
in-law), grandparent (includes in-law), grandchild, aunt, uncle, niece or nephew, Domestic Partner, an employed caregiver who lives with You, or a person
for whom You is the primary caregiver with whom You have lived for 12 continuous months prior to the effective date of Your Plan, whether or not they
travel with You.
"Hospital"
means (a) a place which is licensed or recognized as a general hospital by the proper authority of the state in which it is located: (b) a place operated
for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility: (c) a
place recognized as a general hospital by the Joint Commission on the Accreditation of Hospitals. Not included is a hospital or institution licensed or
used principally: (1) for the treatment or care of drug addicts or alcoholics: or (2) as a clinic continued or extended care facility, skilled nursing
facility, convalescent home, rest home, nursing home or home for the aged.
"Injury" or "Injuries"
means accidental bodily injuries: (a) received while insured under the Policy and any attached coverages: (b) resulting in loss independently of sickness
and all other causes: and (c) not excluded from coverage.
"Insured’
means the individual named on the enrollment form who has purchased a Covered Trip and who has paid the required premium. Insured mean You and Yours.
"Intoxicated"
mean a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where You are located at the
time of an incident.
"Legally Qualified Physician"
means a healthcare practitioner practicing within the scope of his or her license.
"Medical Treatment"
means treatment advice or consultation by a Legally Qualified Physician.
"Medically Necessary
" means a service or supply which: (a) is recommended by the attending Legally Qualified Physician: (b) is appropriate and consistent with the diagnosis in
accordance with accepted standards of community practice: (c) could not have been omitted without adversely affecting Your condition or quality of medical
care: (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience: and (e) is not considered experimental unless
coverage for experimental services or supplies is required by law.
"Mental or Nervous Conditions"
means any condition or disease, regardless of its cause, listed in the most recent edition of the International Classification of Diseases as a Mental
Disorder, including but not limited to, neurosis, psychoneurosis, psychopathy, psychosis, bipolar Affective Disorder or Autism.
"Pre-existing Condition"
means any injury, sickness or condition (including any condition from which death ensues) of You or Traveling Companion, or Your and/or Traveling
Companion’s Family Member or Your Business Partner for which within the sixty (60) day period prior to the effective date of Your Effective Date under this
Policy which (a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required
taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the
required prescription; or (c) required medical treatment or treatment was recommended by a Legally Qualified Physician.
"Scheduled Return Date"
means the date on which You are originally scheduled to return to the point of origin or the original final destination.
"Sickness"
means an illness or disease that first manifests itself after the effective date of insurance and while you are covered on a trip.
"Third Party"
means a person or entity other than You or the Company.
"Travel Arrangements"
means: (a) transportation: (b) accommodations: and (c) other specified services arranged by the Travel Supplier for the covered trip.
"Traveling Companion"
means a person or persons with whom You have coordinated Travel Arrangements and intends to travel with during the Covered Trip. Note, a group or tour
leader is not considered a Traveling Companion unless You are sharing room accommodations with the group or tour leader.
"Travel Supplier"
means any entity or organization that coordinates or supplies travel services for You.
SECTION II. COVERAGES
ACCIDENTAL DEATH AND DISMEMBERMENT
You are eligible for benefits 24 hours a day, up to the Maximum Benefit Amount, when You sustain an Injury during the Trip which results in any of the
following losses within 180 days of the date of the Injury causing the Loss.
Benefits will be paid as follows:
| Loss |
Percentage of Principal Sum Payable: |
| Life |
100% |
| Both Hands; Both Feet or Sight of Both Eyes |
100% |
| 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% |
Loss of hand or hands, or foot or feet
, means severance at or above the wrist joint or ankle joint, respectively. Loss of eye or eyes means the total and irrecoverable loss of
the entire sight thereof. Only one of the amounts shown above (the largest applicable) will be paid for Injuries resulting from one accident.
The benefit for loss of: (a) two limbs; (b) both eyes; or (c) one limb and one eye is payable only when such loss results from the same accident.
The Principal Sum is shown in the Confirmation of Benefits.
SECTION III. INSURING PROVISIONS
Coverage begins at the point and time of departure on the Scheduled Departure Date. Coverage ends at the point and time of return on Your Scheduled Return
Date.
In the event the Scheduled Departure Date and/or the Schedule Return Date are delayed, or the point and time of departure and/or point and time of return
are changed because of circumstances over which neither the Travel Supplier nor You have control Your term of coverage shall be automatically adjusted
accordance with the Travel Supplier’s notice to the Company of the delay or change.
SECTION IV.
GENERAL LIMITATIONS AND EXCLUSIONS
Benefits are not payable for Sickness, Injuries or losses of You or Your Traveling Companion:
1. resulting from suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane;
2. resulting from an act of declared or undeclared war;
3. while participating in maneuvers or training exercises of an armed service;
4. while riding, driving or participating in races, or speed or endurance contests;
5. while mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes, or other special equipment);
6. while participating as a member of a team in an organized sporting competition;
7. while participating in skydiving, hang gliding, bungee cord jumping, scuba diving if the depth exceeds 130 feet or if You are not certified to dive and
a dive master is not present during the dive;
8. while piloting or learning to pilot or acting as a member of the crew of any aircraft;
9. received as a result or consequence of being Intoxicated, as specifically defined in the policy, or under the influence of any controlled substance
unless administered on the advise of a Legally Qualified Physician;
10. to which a contributory cause was Your commission of or attempt to commit a felony or being engaged in an illegal occupation;
11. due to normal childbirth, normal pregnancy (except complications of pregnancy) or voluntarily induced abortion;
12. for dental treatment (except as coverage is otherwise specifically provided herein);
13. which exceed the Maximum Benefit Amount for each attached coverage as shown in the Confirmation of Benefits: or;
14. due to a Pre-existing Condition, as defined in this policy;
15. due to a mental or nervous condition, unless hospitalized.
SECTION V. GENERAL PROVISIONS
Entire Contract: Changes:
This Policy and any attachments are the entire contract of Insurance. No agent may change it in any way. Only an officer of the Company can approve a
change. Any such change must be shown in the Policy or its attachments.
Clerical Error:
Clerical Error on the Company’s part or that of a Travel Supplier in keeping records or furnishing information will not void coverage if it is otherwise
validly in force; nor will it continue coverage if it is otherwise validly terminated under the terms of this Policy.
Conformity with State Statutes:
The provisions of this Policy must conform to the laws of the state in which it was issued. If they do not, they are hereby amended to conform.
Notice of Claim:
Notice of claim must be reported within 20 days after a loss occurs or as soon as is reasonably possible. You or someone on Your behalf may give the
notice. The notice should be given to the Company or designated representative and should include sufficient information to identify the Insured.
The Company shall, not later than the 15th day after receipt of such notice of a claim:
a) acknowledge receipt of the claim;
b) commence any investigation of the claim; and
c) request from the Claimant all items, statements, and forms that the Company reasonably believes, at that time, will be required from the claimant.
Additional requests may be made if during the investigation of the claim such additional requests are necessary.
If the acknowledgement of the claim is not made in writing, the Company shall make a record of the date, means, and content of the acknowledgement.
The Company shall notify a claimant in writing of the acceptance or rejection of the claim not later than the 15th business day after the date the Company
receives all items, statements, and forms required by the Company, in order to secure final proof of loss. If the company rejects the claim, the Company
will inform the Claimant of the reasons for the rejection. If the Company is unable to accept or reject the claim within 15 business days after the date
the Company receives all items, statements, and forms required by the Company, the Company shall notify the claimant within such 15 business day period.
The notice provided must give the reasons that the Company needs additional time. Not later than the 45th day after the date the Company notifies a
Claimant of the need for additional time to investigate a claim, the Company shall accept or reject the claim.
Except as otherwise provided, if the Company delays payment of a claim following its receipt of all items, statements, and forms reasonably requested and
required for more than 60 days, the Company shall pay, in addition to the amount of the claim, 18 percent per annum of the amount of such claim as damages,
together with reasonable attorney fees. If suit is filed, such attorney fees shall be taxed as part of the costs in the case.
"Business Day"
means a day other than a Saturday, Sunday, or holiday recognized by Texas.
Claim Forms:
When notice of claim is received by the Company or designated representative, forms for filing proof of loss will be furnished. If these forms are not sent
within 15 days, the proof of loss requirements can be met by sending a written statement of what happened. This statement must be received within the time
given for filing proof of loss.
Proof of Loss:
The Claimant must send the Company, or its designated representative, proof of loss within ninety-one (91) days after a covered loss occurs or as soon as
reasonably possible.
Time of Payment of Claims:
The Company or its designated representative will pay the claim immediately after receipt of due proof of loss.
Payment of Claims:
Benefits for loss of life are payable to the Principal Insured, who is the beneficiary for all other Insureds. If: (a) the Principal Insured predeceases
You: and (b) a beneficiary is not otherwise designated by the Principal Insured benefits for loss of life will be paid to the first of the following
surviving preference beneficiaries:
a) the Principal Insured’s spouse;
b) the Principal Insured’s child or children jointly;
c) Your parents jointly if both are living or the surviving parent if only one survives;
d) Your brothers and sisters jointly; or
e) the Principal Insured’s estate.
All or a portion of all other benefits provided by the Policy may, at the option of the Company, be paid directly to the provider of the service(s). All
benefits not paid to the provider will be paid to the Principal Insured.
Other than for loss of life, if any benefit is payable to: (a) You or the Principal Insured’s beneficiary who is minor or otherwise not able to give a
valid release: or (b) the Principal Insured’s estate: the Company may pay up to $1,000 to the Principal Insured’s beneficiary or any relative to whom the
Company finds entitled to the payment. Any payment made in good faith shall fully discharge the Company to the extent of such payment.
If the Company notifies a claimant that the Company will pay a claim or part of a claim, the Company shall pay the claim not later than the fifth business
day after the notice has been made. If the claimant conditions payment of the claim or part of the claim on the performance of an act, the Company shall
pay the claim not later than the fifth business day after the date the act is performed.
Physician Examination and Autopsy:
The Company, at the expense of the Company, may have You examined when and as often as is reasonable while the claim is pending. The Company may have an
autopsy done (at the expense of the Company) where it is not forbidden by law.
Legal Actions:
No legal action for a claim can be brought against us until 60 days after we receive proof of loss. No legal action for a claim can be brought against us
more than 3 years after the time required for giving proof of loss.
Concealment and Misrepresentation:
The entire coverage will be void, if before, during or after a loss, any material fact or circumstance relating to this insurance has been concealed or
misrepresented.
Other Insurance with the Company:
You may be covered under only one travel policy with the Company for each Covered Trip. If You are covered under more than one such policy, You may select
the coverage that is to remain in effect. In the event of death, the selection will be made by the beneficiary or estate. Premiums paid (less claims paid)
will be refunded for the duplicate coverage that does not remain in effect.
Subrogation:
If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the
Third Party responsible for the loss, the Company will be subrogated to that right. You shall help the Company exercise the Company’s rights in any
reasonable way that the Company may request: nor do anything after the loss to prejudice the Company’s rights: and in the event You recover damages from
the Third Party responsible for the loss, the Insured will hold the proceeds of the recover for the Company in trust and reimburse the Company to the
extent of the Company’s previous payment for the loss.
Reductions in the Amount of Insurance:
The applicable benefit amount will be reduced by the amount of benefits, if any, previously paid for any loss or damage under this coverage for this
Covered Trip.
United States Fire Insurance Company
Administrative Office: 5 Christopher Way
Eatontown, NJ 07724
(Hereinafter referred to as "the Company")
Plan # F200B
TRAVEL PROTECTION INSURANCE POLICY
Limited Benefit Short-Term Single Premium Policy
United States Fire Insurance Company, herein referred to as the Company, will pay You the insurance benefits described in this Policy. This Policy and
attached Riders, if any, are issued in consideration of the statements in the enrollment form and the payment of the initial premium. This Policy is a
legal contract between You and the Company.
Coverage will not end solely because a person becomes an elected official in Texas.
This Policy describes all of the travel insurance benefits underwritten by the Company. Please refer to the accompanying Confirmation of Benefits for
specific information about the program You purchased. You should contact the Company immediately if You believe that the Confirmation of Benefits is
incorrect.
Signed for the Company
Douglas M. Libby
Chairman and CEO |
If You are not completely satisfied with the insurance, You must notify Your Travel Supplier within 10 days of purchase and return the Policy. The Company
will give You a full refund of premium provided You have not already departed on the Covered Trip or filed a claim.
TP-401-TX-PC
TABLE OF CONTENTS
I. COVERAGES
II. DEFINITIONS
III. INSURING PROVISIONS
IV. GENERAL LIMITATIONS AND EXCLUSIONS
V. GENERAL PROVISIONS
SECTION I. COVERAGES
TRIP CANCELLATION
Benefits will be paid up to the Maximum Benefit Amount purchased to cover You for the Published Penalties and unused non-refundable prepaid expenses for
Travel Arrangements when You are prevented from taking his or her Covered Trip due to:
a) death of You, Traveling Companion or Business Partner, or Family Member of Yours or Your Traveling Companion;
b) a covered Sickness or Injury involving You , Traveling Companion or Business Partner, or Family Member of You or Traveling Companion which necessitates
Medical Treatment at the time of cancellation and results in medically imposed restrictions, as certified by a Legally Qualified Physician, which prevents
Your participation in the Covered Trip;
c) You or Traveling Companion being hijacked, quarantined, required to serve on a jury (notice of jury duty must be received after the Effective Date)
served with a court order to appear as a witness in a legal action in which You or Traveling Companion is not a party (except law enforcement officers);
d) You or Your Traveling Companion’s principal place of residence being rendered uninhabitable by fire, flood, or burglary within 10 days of departure;
e) You or Traveling Companion being directly involved in a traffic accident, which must be substantiated by a police report, while en route to Your
scheduled point of departure;
f) Bankruptcy or Default of an airline, cruise line, tour operator or travel supplier (other than the tour operator or travel agency from whom You
purchased Your travel arrangements) which stops service more than 14 days following Your Effective Date. Benefits will be paid due to Bankruptcy or Default
of an airline only if no alternate transportation is available. If alternate transportation is available, benefits will be limited to the change fee
charged to allow You to transfer to another airline in order to get to Your intended destination. This benefit only applies if the policy has been
purchased within 1 day of Your initial payment for the Covered Trip and for the full cost of the Covered Trip;
g) You or a Traveling Companion is in the Military and called to emergency duty for a national disaster other than war;
h) Employer termination or layoff affecting You or a person(s) sharing the same room with You during Your Covered Trip. Employment must have been with the
same employer for at least 3 continuous years;
i) Unannounced Strike that causes complete cessation of services of Your Common Carrier for at least 48 consecutive hours;
j) Strike that causes complete cessation of Your Covered Trip services for at least 48 consecutive hours;
k) Weather that causes complete cessation of services of Your Common Carrier for at least 48 consecutive hours;
l) Natural disaster at the site of Your destination, which renders their destination accommodations uninhabitable;
m) Felonious Assault of You or Traveling Companion within 10 days of the Scheduled departure Date;
n) A Terrorist Incident that occurs in a city listed on the itinerary of Your Covered Trip and within 30 days prior to Your Scheduled Departure Date. This
same city must not have experienced a Terrorist Incident within the 90 days prior to the Terrorist Incident which is causing Your cancellation of the
Covered Trip. Benefits are not provided if the Travel Supplier offers a substitute itinerary;
o) Revocation of Your previously granted leave or re-assignment due to war. Official written revocation/re-assignment by a supervisor or commanding officer
of the appropriate branch of service will be required;
p) Your family or friends living abroad with whom You were planning to stay, are unable to provide accommodations due to life threatening illness, life
threatening injury or death of one of them;
provided such circumstances occurred after Your Effective Date
If You must reschedule the Covered Trip due to a covered reason You will be eligible for benefits up to a maximum of $50 for the reissue fee charged by the
airline for Your tickets;
All cancellations must be reported to the Travel Supplier within 72 hours of the event causing the need to cancel. If the event delays the reporting of the
cancellation beyond the 72 hours, the event should be reported as soon as possible. All other delays of reporting beyond 72 hours will result in reduced
benefit payments;
If Your Travel Supplier cancels Your Covered Trip, You are covered up to $50 for the reissue fee charged by the airline for the tickets. You must have
covered the entire cost of the Covered Trip including the air;
The maximum payable under this benefit is the lesser of: a) total cost of Your Covered Trip; or b) the total amount of coverage You purchased.
TRIP INTERRUPTION - RETURN AIR ONLY
Benefits will be paid, up to the Maximum Benefit Amount, for one way Economy Transportation for the Insured to return to their original destination or
rejoin their Trip less the value of the original unused return travel ticket when You are prevented from completing Your Trip due to:
a) Sickness, Injury or death involving You or Your Traveling Companion or You or Your Traveling Companion’s Business Partner or Your Family Member which
results in medically imposed restrictions as certified by a Legally Qualified Physician at the time of loss preventing Your continued participation in the
Trip;
b) Unannounced Strike that causes complete cessation of services of Your Common Carrier for at least 48 consecutive hours;
c) Weather that causes complete cessation of services of Your Common Carrier for at least 48 consecutive hours;
d) Employer termination or layoff affecting You or a person(s) sharing the same room during Your Trip. Employment must have been with the same employer for
at least three (3) consecutive years;
e) Your Primary Residence or that of Your Traveling Companion is rendered uninhabitable by unforeseen circumstances;
f) Burglary of You or Your Traveling Companion’s primary residence within 10 days of departure of the Trip;
g) Felonious Assault of the Insured or Traveling Companion within 10 days of departure or during the Trip;
h) Bankruptcy or Default of an airline, cruise line, or tour operator (other than the travel agency from whom the Insured purchased their travel
arrangements) which stops service more than fourteen (14) days following the Effective Date.
i) Terrorism in a country which is part of the Trip, which causes the United States Department of State to issue a travel warning that You should not
travel within that country for a period of time that would include the Trip. Such travel warning must be made after the Effective Date;
j) Hijack, quarantine, jury duty, or court ordered appearance as a witness in a legal action in which You or Your Traveling Companion is not a party
(except law enforcement officers);
k) The Insured or Traveling Companion is called to emergency military duty for a national disaster other than war;
l) Traffic accident, substantiated by a police report, directly involving either the Insured or Traveling Companion while en route to a scheduled point of
departure;
m) If the Travel Supplier cancels the Your Trip, You are eligible for the benefit amount shown in the Confirmation of Benefits for the reissue fee charged
by the airline for each of the Insureds’ tickets. You must have protected the entire cost of the Trip, including the airfare.
The Maximum Benefit Amount is shown in the Confirmation of Benefits.
BAGGAGE AND PERSONAL EFFECTSAND BAGGAGE DELAY
For the purposes of this Benefit:
"Baggage and Personal Effects"
means goods being used by You during a Covered Trip. The term Baggage and Personal Effects does not include:
a) animals;
b) automobiles and automobile equipment;
c) boats or other vehicles or conveyances;
d) trailers;
e) motors;
f) aircraft;
g) bicycles, except when checked as baggage with a Common Carrier;
h) household effects and furnishings;
i) antiques and collectors items;
j) sunglasses, contact lenses, artificial teeth, dental bridges or hearing aids;
k) prosthetic limbs;
l) prescribed medications;
m) keys, money, credit cards (except as coverage is otherwise specifically provided herein);
n) securities, stamps, tickets and documents (except as coverage is otherwise specifically provided herein);
o) professional or occupational equipment or property, whether or not electronic business equipment; or
p) telephones, computer hardware or software.
For Baggage and Personal Effects:
Coverage will be provided to You: (a) against all risks of permanent loss, theft or damage to Your Baggage and Personal Effects; (b) subject to all
Exclusions and Limitations in the policy; (c) up to the Maximum Benefit Amount; and (d) occurring while this coverage is in force.
The lesser of the following amounts will be paid: a) the actual cash value (cost less proper deduction for depreciation) at the time of loss, theft or
damage; b) the cost to repair or replace the article with material of a like kind and quality; or c) $300 per article.
A combined maximum of $600 will be paid for jewelry, watches, articles consisting in whole or in part of silver, gold or platinum, articles trimmed with
fur, cameras and their accessories and related equipment.
A maximum of $50 will be paid for the cost of replacing a passport or visa.
A maximum of $50 will be paid for the cost associated with the unauthorized use of lost or stolen credit cards, subject to verification that You have
complied with all conditions of the credit card company.
For Baggage Delay:
If, while on a Covered Trip, Your checked baggage is delayed or misdirected by a Common Carrier for more than 12 hours from Your time of arrival at a
destination other than at Your place of permanent residence, benefits will be paid, up to the Maximum Benefit Amount, for the actual expenditure for
necessary personal effects. You must be a ticketed passenger on a Common Carrier. The Common Carrier must certify the delay or misdirection. Receipts for
the purchases must accompany any claim.
Benefits will not be paid for any expenses which have been reimbursed or for any services which have been provided by the Common Carrier, hotel or Travel
Supplier; nor will benefits be paid for loss or damage to property specifically schedule under any other insurance.
The Maximum Benefit Amount is shown in the Confirmation of Benefits.
TRIP DELAY
If You are delayed for 12 hours or more while in route to or from a Covered Trip, due to:
a. any delay of a Common Carrier. The delay must be certified by the Common Carrier;
b. a traffic accident in which You or Your Traveling Companion are not directly involved (must be substantiated by a police report);
c. lost or stolen passports, travel documents or money (must be substantiated by a police report); or
d. quarantine, hijacking, strike, natural disaster, terrorism or riot;
e. documented weather condition preventing You from getting to the point of departure;
benefits will be paid, on a one-time basis, up to the Maximum Benefit Amount, for:
a. the Additional Transportation Cost from the point where You were delayed to a destination where You can join the Covered Trip;
b. the Additional Transportation Cost to return You to Your originally scheduled return destination;
c. reasonable accommodation and meal expenses, up to $100 per day, necessarily incurred by You for which You have proof of purchase and which were not paid
for or provided by any other source; and
d. the non-refundable, unused portion of the prepaid expenses for the Covered Trip.
Benefits will not be paid for any expenses that have been reimbursed or for any services that have been provided by the Common Carrier.
The Maximum Benefit Amount is shown in the Confirmation of Benefits.
SECTION II. DEFINITIONS
"Additional Transportation Cost"
means the actual cost incurred for one-way Economy Transportation by Common Carrier reduced by the value of an unused travel ticket.
"Bankruptcy"
means the filing of a petition for voluntary or involuntary bankruptcy in a court of competent jurisdiction under Chapter 7 or Chapter 11 of the United
States Bankruptcy Code 11 L.S.C. Subsection 101 et seq.
"Business Partner"
means an individual who (a) is involved in a legal general partnership with You and or (b) is actively involved in the day to day management of Your
business.
"Common Carrier"
means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
"Confirmation of Benefits"
means the coverage confirmation provided to You following enrollment and payment of the applicable premium.
"Covered Trip"
means scheduled trips, tours or cruises for which (a) coverage is requested: and (b) the required premium is submitted prior to the Scheduled Departure
Date.
"Default"
means the inability to provide contracted services due to a material financial failure.
"Domestic Partner"
means a person who is at least eighteen years of age and can show: 1) evidence of financial interdependence, such as joint bank accounts or credit cards,
jointly owned property, and mutual life insurance or pension beneficiary designations; 2) evidence of continuous cohabitation throughout the 180 day period
prior to Your Effective Date of the Plan; and 3) an affidavit of domestic partnership if recognized by the jurisdiction within which they reside.
"Economy Transportation"
means the lowest published available transportation rate for a ticket on a Common Carrier matching the original class of transportation that You purchased
for the Covered Trip, reduced by the value of an unused return travel ticket.
"Family Member"
means any of the following who resides in the United States, Canada, or Mexico: Your or Your Traveling Companion’s: legal spouse (or common-law spouse
where legal), legal guardian, son or daughter (adopted, foster, step or in-law), brother or sister (includes step or in-law), parent (includes step or
in-law), grandparent (includes in-law), grandchild, aunt, uncle, niece or nephew, Domestic Partner, an employed caregiver who lives with You, or a person
for whom You are the primary caregiver with whom You have lived for 12 continuous months prior to the effective date of Your Plan, whether or not they
travel with You.
"Hospital"
means (a) a place which is licensed or recognized as a general hospital by the proper authority of the state in which it is located: (b) a place operated
for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility: (c) a
place recognized as a general hospital by the Joint Commission on the Accreditation of Hospitals. Not included is a hospital or institution licensed or
used principally: (1) for the treatment or care of drug addicts or alcoholics: or (2) as a clinic continued or extended care facility, skilled nursing
facility, convalescent home, rest home, nursing home or home for the aged.
"Injury" or "Injuries"
means accidental bodily injuries: (a) received while insured under the Policy and any attached coverages: (b) resulting in loss independently of sickness
and all other causes: and (c) not excluded from coverage.
"Insured’
means the individual named on the enrollment form who has purchased a Covered Trip and who has paid the required premium. Insured means You and Yours.
"Intoxicated"
mean a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where You are located at the
time of an incident.
"Legally Qualified Physician"
means a physician or a Christian Science Practitioner (a) other than You , a Traveling Companion or a Family Member: (b) practicing within the scope of
Your license: and (c) recognized as a physician in the place where the services are rendered.
"Maximum Benefit Amount"
means the maximum amount payable for coverage provided to an Insured as shown in the Confirmation of Benefits.
"Medical Treatment"
means treatment advice or consultation by a Legally Qualified Physician.
"Medically Necessary"
means a service or supply which: (a) is recommended by the attending Legally Qualified Physician: (b) is appropriate and consistent with the diagnosis in
accordance with accepted standards of community practice: (c) could not have been omitted without adversely affecting Your condition or quality of medical
care: (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience: and (e) is not considered experimental unless
coverage for experimental services or supplies is required by law.
"Mental or Nervous Conditions"
means any condition or disease, regardless of its cause, listed in the most recent edition of the International Classification of Diseases as a Mental
Disorder, including but not limited to, neurosis, psychoneurosis, psychopathy, psychosis, bipolar Affective Disorder or Autism.
"Pre-existing Condition"
means any injury, sickness or condition (including any condition from which death ensues) of You, Your Traveling Companion, or Your or Your Traveling
Companion’s Family Member or Your Business Partner for which within the 60 day period prior to the effective date of Your Trip Cancellation coverage under
the Policy which (a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; (b) required
taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the
required prescription; or (c) required medical treatment or treatment was recommended by a Legally Qualified Physician.
"Published Penalties"
means any published cancellation penalties issued by Your travel agency or Travel Supplier that apply to all clients of the travel agency or Travel
Supplier and can be documented at time of the Covered Trip sale. You must be in the Travel Supplier’s penalty period. The maximum amount reimbursable under
the travel agency’s Published Penalties is 10% of the Covered Trip cost (excluding taxes and other non-commissionable items) or 10% of the amount You have
paid, whichever is less. Maximum payable under any one claim is the Covered Trip cost, excluding taxes and other non-commissionable items.
"Scheduled Departure Date"
means the date on which You are originally scheduled to leave on the Covered Trip.
"Scheduled Return Date"
means the date on which You are originally scheduled to return to the point of origin or the original final destination.
"Sickness"
means an illness or disease that is diagnosed or treated by a Legally Qualified Physician after the effective date of insurance and while You are covered
under the Policy.
"Strike"
means any stoppage of work: (a) as a result of a combined effort of workers which was unannounced and unpublished at the time travel services were
purchased: and (b) which interferes with the normal departure and arrival of a Common Carrier.
"Terrorist Incident"
means an incident deemed a terrorist act by the United States Government that causes property damage and loss of life.
"Third Party"
means a person or entity other than You or the Company.
"Travel Arrangements"
means: (a) transportation: (b) accommodations: and (c) other specified services arranged by the Travel Supplier for the covered trip.
"Traveling Companion"
means a person or persons with whom You have coordinated Travel Arrangements and intends to travel with during the Covered Trip. Note, a group or tour
leader is not considered a Traveling Companion unless You are sharing room accommodations with the group or tour leader.
"Travel Supplier"
means any entity or organization that coordinates or supplies travel services for You.
SECTION III. INSURING PROVISIONS
Policy Term:
This Policy is a short-term trip Policy and is issued for the specific term shown on the attached Confirmation of Benefits. This Policy is not renewable.
For Trip Cancellation:
Coverage begins on the Effective Date and time specified in the Confirmation of Benefits. Coverage ends at the point and time of departure on Your
Scheduled Departure Date.
For Trip Delay:
Coverage is in force while en route to and from the Covered Trip.
For all other coverages:
Coverage begins at the point and time of departure on the Scheduled Departure Date. Coverage ends at the point and time of return on Your Scheduled Return
Date.
EXCESS INSURANCE LIMITATION:
The insurance provided by this Policy shall be in excess of all other valid and collectible insurance or indemnity. If at the time of the occurrence of any
loss there is other valid and collectible insurance or indemnity in place, the Company shall be liable only for the excess of the amount of loss, over the
amount of such other insurance or indemnity, and applicable deductible. Recovery of losses from other parties does not result in a refund of premium paid.
In the event the Scheduled Departure Date and/or the Schedule Return Date are delayed, or the point and time of departure and/or point and time of return
are changed because of circumstances over which neither the Travel Supplier nor You have control Your term of coverage shall be automatically adjusted
accordance with the Travel Supplier’s notice to the Company of the delay or change.
SECTION IV. GENERAL LIMITATIONS AND EXCLUSIONS
Benefits are not payable for Sickness, Injuries or losses of You or Your Traveling Companion:
1. resulting from suicide, attempted suicide or any intentionally self-inflicted injury while sane or insane (in Missouri, sane only);
2. resulting from an act of declared or undeclared war;
3. while participating in maneuvers or training exercises of an armed service;
4. while riding, driving or participating in races, or speed or endurance contests;
5. while mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes, or other special equipment);
6. while participating as a member of a team in an organized sporting competition;
7. while participating in skydiving, hang gliding, bungee cord jumping, scuba diving if the depth exceeds 130 feet or if You are not certified to dive and
a dive master is not present during the dive; or deep sea diving;
8. while piloting or learning to pilot or acting as a member of the crew of any aircraft;
9. received as a result or consequence of being Intoxicated, as specifically defined in the policy, or under the influence of any controlled substance
unless administered on the advise of a Legally Qualified Physician;
10. to which a contributory cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation;
11. due to normal childbirth, normal pregnancy (except complications of pregnancy) or voluntarily induced abortion;
12. for dental treatment (except as coverage is otherwise specifically provided herein);
13. which exceed the Maximum Benefit Amount for each attached coverage as shown in the Confirmation of Benefits: or;
14. due to a Pre-existing Condition, as defined in the policy. The Pre-existing Condition Limitation does not apply to: (a) Emergency Medical Evacuation,
Medical Repatriation and Return of Remains coverage; or (b) to coverage purchased within 24 hours from the time the initial Covered Trip deposit is paid;
15. due to a mental or nervous condition, unless hospitalized;
16. This policy does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly or indirectly from
the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical,
biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless of any other cause or event
contributing concurrently or in any other sequence thereto.
The following limitation applies to Trip Cancellation: All cancellations must be reported directly to the Travel Supplier within 72 hours of the event
causing the need to cancel, unless the event prevents it, and then as soon as is reasonably possible. If the cancellation is not reported within the
specified 72-hour period, the Company will not pay for additional charges which would not have been incurred had You notified the Travel Supplier in the
specified period. If the event prevents You from reporting the cancellation, the 72-hour notice requirement does not apply; however, You must, if
requested, provide proof that said event prevented him or her from reporting the cancellation within the specified period.
Additional Limitations and Exclusions Specific to Baggage and Personal Effects
Benefits are not payable for any loss caused by or resulting from:
a) breakage of brittle or fragile articles;
b) wear and tear or gradual deterioration;
c) confiscation or appropriation by order of any government or custom’s rule;
d) theft or pilferage while left in any unlocked vehicle;
e) property illegally acquired, kept, stored or transported;
f) Your negligent acts or omissions; or
g) property shipped as freight or shipped prior to the Scheduled Departure Date.
SECTION V. GENERAL PROVISIONS
Entire Contract:
Changes: This Policy and any attachments are the entire contract of Insurance. No agent may change it in any way. Only an officer of the Company can
approve a change. Any such change must be shown in the Policy or its attachments.
Clerical Error:
Clerical Error on the Company’s part or that of a Travel Supplier in keeping records or furnishing information will not void coverage if it is otherwise
validly in force; nor will it continue coverage if it is otherwise validly terminated under the terms of this Policy.
Conformity with State Statutes:
The provisions of this Policy must conform to the laws of the state in which it was issued. If they do not, they are hereby amended to conform.
Notice of Claim:
Notice of claim must be reported within 20 days after a loss occurs or as soon as is reasonably possible. You or someone on Your behalf may give the
notice. The notice should be given to the Company or designated representative and should include sufficient information to identify the Insured.
The Company shall, not later than the 15th day after receipt of such notice of a claim:
a) acknowledge receipt of the claim;
b) commence any investigation of the claim; and
c) request from the Claimant all items, statements, and forms that the Company reasonably believes, at that time, will be required from the claimant.
Additional requests may be made if during the investigation of the claim such additional requests are necessary.
If the acknowledgement of the claim is not made in writing, the Company shall make a record of the date, means, and content of the acknowledgement.
The Company shall notify a claimant in writing of the acceptance or rejection of the claim not later than the 15th business day after the date the Company
receives all items, statements, and forms required by the Company, in order to secure final proof of loss. If the company rejects the claim, the Company
will inform the Claimant of the reasons for the rejection. If the Company is unable to accept or reject the claim within 15 business days after the date
the Company receives all items, statements, and forms required by the Company, the Company shall notify the claimant within such 15 business day period.
The notice provided must give the reasons that the Company needs additional time. Not later than the 45th day after the date the Company notifies a
Claimant of the need for additional time to investigate a claim, the Company shall accept or reject the claim.
Except as otherwise provided, if the Company delays payment of a claim following its receipt of all items, statements, and forms reasonably requested and
required for more than 60 days, the Company shall pay, in addition to the amount of the claim, 18 percent per annum of the amount of such claim as damages,
together with reasonable attorney fees. If suit is filed, such attorney fees shall be taxed as part of the costs in the case.
"Business Day"
means a day other than a Saturday, Sunday, or holiday recognized by Texas.
The provision entitled "Payment of Claim" is amended by the addition of the following paragraph:
If the Company notifies a claimant that the Company will pay a claim or part of a claim, the Company shall pay the claim not later than the fifth business
day after the notice has been made. If the claimant conditions payment of the claim or part of the claim on the performance of an act, the Company shall
pay the claim not later than the fifth business day after the date the act is performed.
Claim Forms:
When notice of claim is received by the Company or designated representative, forms for filing proof of loss will be furnished. If these forms are not sent
within 15 days, the proof of loss requirements can be met by sending a written statement of what happened. This statement must be received within the time
given for filing proof of loss.
Proof of Loss:
The Claimant must send the Company, or its designated representative, proof of loss within ninety-one (91) days after a covered loss occurs or as soon as
reasonably possible.
Time of Payment of Claims:
The Company or its designated representative, will pay the claim after receipt of acceptable proof of loss.
Payment of Claims:
Benefits for loss of life are payable to the Principal Insured, who is the beneficiary for all other Insureds. If: (a) the Principal Insured predeceases
You: and (b) a beneficiary is not otherwise designated by the Principal Insured benefits for loss of life will be paid to the first of the following
surviving preference beneficiaries:
a) the Principal Insured’s spouse;
b) the Principal Insured’s child or children jointly;
c) Your parents jointly if both are living or the surviving parent if only one survives;
d) Your brothers and sisters jointly; or
e) the Principal Insured’s estate.
All or a portion of all other benefits provided by the Policy may, at the option of the Company, be paid directly to the provider of the service(s). All
benefits not paid to the provider will be paid to the Principal Insured.
Other than for loss of life, if any benefit is payable to: (a) You or the Principal Insured’s beneficiary who is minor or otherwise not able to give a
valid release: or (b) the Principal Insured’s estate: the Company may pay up to $1,000 to the Principal Insured’s beneficiary or any relative to whom the
Company finds entitled to the payment. Any payment made in good faith shall fully discharge the Company to the extent of such payment.
Physician Examination and Autopsy:
The Company, at the expense of the Company, may have You examined when and as often as is reasonable while the claim is pending. The Company may have an
autopsy done (at the expense of the Company) where it is not forbidden by law.
Legal Actions:
No legal action for a claim can be brought against us until 60 days after the Company receives proof of loss. No legal action for a claim can be brought
against us more than 3 years after the time required for giving proof of loss. This 3-year time period is extended from the date proof of loss is filed and
the date the claim is denied in whole or in part.
Concealment and Misrepresentation:
The entire coverage will be void, if before, during or after a loss, any material fact or circumstance relating to this insurance has been concealed or
misrepresented.
Other Insurance with the Company:
You may be covered under only one travel policy with the Company for each Covered Trip. If You are covered under more than one such policy, You may select
the coverage that is to remain in effect. In the event of death, the selection will be made by the beneficiary or estate. Premiums paid (less claims paid)
will be refunded for the duplicate coverage that does not remain in effect.
Subrogation:
If the Company has made a payment for a loss under this coverage, and the person to or for whom payment was made has a right to recover damages from the
Third Party responsible for the loss, the Company will be subrogated to that right. You shall help the Company exercise the Company’s rights in any
reasonable way that the Company may request: nor do anything after the loss to prejudice the Company’s rights: and in the event You recover damages from
the Third Party responsible for the loss, the Insured will hold the proceeds of the recover for the Company in trust and reimburse the Company to the
extent of the Company’s previous payment for the loss.
Additional Claims Provisions Specific to Baggage
Insured’s Duties After Loss of or Damage to Property or Delay of Baggage: In case of loss, theft, damage or delay of baggage or personal effects, and
Insured must:
a) take all reasonable steps to protect, save or recover the property:
b) promptly notify, in writing, either the police, hotel proprietors, ship lines, airlines, railroad, bus, airport or other station authorities, tour
operators or group leaders, or any Common Carrier or bailee who has custody of Your property at the time of loss:
c) produce records needed to verify the claim and its amount, and permit copies to be made:
d) provide to the Company, within 90 days from the date of loss, a detailed proof of loss signed and sworn to: and
e) be examined, if requested.
Reductions in the Amount of Insurance:
The applicable benefit amount will be reduced by the amount of benefits, if any, previously paid for any loss or damage under this coverage for this
Covered Trip.
TEXAS
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call the United States Fire Insurance Company’s toll-free telephone number for information or to make a complaint at:
1-800-232-7380
You may also write to the United States Fire Insurance Company at:
The United States Fire Insurance Company
Complaint Department
c/o Fairmont Specialty
5 Christopher Way
Eatontown, NJ 07724
Web:
http://www.tdi.state.tx.us
Email:
ConsumerProtection@tdi.state.tx.us
You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at:
1-800-252-3439
You may write the Texas Department of Insurance:
P. O. Box 149104
Austin, Texas 78714-9104
FAX No. 512-475-1771
PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent first. If the dispute is not
resolved, you may contact the Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR POLICY.
This Notice is for information only and does not become part of condition of the attached document.
TEXAS
AVISO IMPORTANTE
Para obtener informacion o para someter una queja:
Usted puede llamar al numero de telefono gratis de the United States Fire Insurance Company para informacion o para someter una queja al:
1-800-232-7380
Usted tambien puede escribir a United States Fire Insurance Company:
The United States Fire Insurance Company
Complaint Department
c/o Fairmont Specialty
5 Christopher Way
Eatontown, NJ 07724
Web:
http://www.tdi.state.tx.us
Email:
ConsumerProtection@tdi.state.tx.us
Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al:
1-800-252-3439
Puede escribir al Departamento de Seguros de Texas:
P. O. Box 149104
Austin, Texas 78714-9104
FAX No. 512-475-1771
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiene una disputa concerniete a su prima o a un reclamo, primero debe comunicarse con el agente. Si no se resuelve la disputa, puede entonces
comunicarse con el Departamento (TDI).
ANADA / ADJUNTE UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto.
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
This insurance provides limited benefits, if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is
not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it pays:
• The benefits stated in the policy and coverage for the same event is provided by Medicare
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
• Hospitalization
• Physician services
• Hospice
• Other approved items and services
BEFORE YOU BUY THIS INSURANCE
• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the
insurance company.
• For help in understanding your health insurance, contact your state insurance department or state senior insurance counseling program.
WHERE TO PRESENT A CLAIM
Present all claims to the Program Administrator:
Trip Mate, Inc.*
9225 Ward Parkway, Suite 200
Kansas City, Missouri 64114
Tel: 1-844-777-6859
Plan Number: F200B
Claims may also be reported/completed online at:
www.tripmate.com
*In CA & UT, dba Trip Mate Insurance Agency