Trip Interruption
In the event You are prevented from continuing Your Trip due to: a) accidental Injury, Sickness,
or death of Yourself, an Immediate Family Member or a Traveling Companion, which results in
medically imposed restrictions as certified by a Physician at the time of loss preventing Your
continued participation in the covered Trip the Insurer will pay benefits up to the maximum
listed in the Schedule of Coverages for:
Trip Interruption: The airfare paid, to return home or rejoin the original Land/Sea
Arrangements (limited to the cost of one-way Economy Airfare by scheduled carrier, from the point
of destination to the point of origin shown on the original travel tickets) less the value of
applied credit from an unused return travel ticket.
In no event shall the amount reimbursed exceed the lesser of; the amount You pre-paid for Your
Trip, or the maximum benefit shown on the Schedule of Coverages.
Trip Delay: Travel Delay coverage will be on a one time basis for reasonable, additional
accommodations and traveling expenses incurred by You due to travel delay of 12 or more hours up to
the maximum amount listed in the Schedule of Coverages (up to a maximum amount of $125.00 per day).
Covered reasons for travel delay are: Common Carrier caused delay (including bad weather); You or
Your Traveling Companion being delayed by, but not directly involved in, a traffic accident while
en route to a departure; lost or stolen passports, money, or travel documents; quarantine;
hijacking, unannounced strike, natural disaster; and civil commotion or riot.
Baggage/Personal Effects
The Insurer will reimburse You up to the maximum shown on the Schedule of Coverages for loss,
theft, or damage to baggage and personal effects. The Insurer will pay the lesser of the
following: actual cash value at the time of the loss, less depreciation as determined by the
Insurer, or the cost of repair or replacement. Per article, there is a limit of $200. There
will also be a combined maximum limit of $400 for the following: jewelry; watches and cameras
including related equipment; articles consisting in whole or in part of silver, gold, or platinum;
furs and articles trimmed with or made mostly of fur.
Emergency Accident and Sickness Medical Expense
The Insurer will pay benefits up to the maximum shown on the Schedule of Coverages (subject to
a $100 deductible per person, per occurrence for Sickness only), if You incur Covered Medical
Expenses as a result of Emergency Treatment of a Sickness which first manifests itself during the
Covered Trip or as a result of Emergency Treatment of an Accidental Injury which first occurs
during the Covered Trip.
Emergency Treatment means necessary medical treatment, including services and supplies, which
must be performed during the Trip due to the serious and acute nature of the Sickness or
Accidental Injury.
Covered Medical Expenses are necessary services and supplies which are recommended by the
attending Physician. They include but are not limited to: the services of a Physician; charges
for Hospital confinement and use of operating rooms; charge for anesthetics (including
administration); x-ray examinations or treatments, and laboratory tests; ambulance service; and
drugs, medicines, prosthetics and therapeutic services and supplies.
The Insurer will not pay benefits in excess of the reasonable and customary charges.
Reasonable and customary charges mean charges commonly used by Physicians in the locality in
which care is furnished.
Emergency Dental Treatment: Benefits are paid for Reasonable and Customary expenses in excess of the Deductible and
Coinsurance of $250 per tooth up to a maximum of $500, for the emergency repair or replacement
to sound, natural teeth damaged as the result of a covered Accident.
Emergency Evacuation: The Insurer will pay benefits for Covered Expenses up to the
maximum shown on the Schedule of Coverages if an Injury or Sickness commencing during the course
of the covered Trip results in Your necessary Emergency Evacuation. An Emergency Evacuation must
be ordered by a legally licensed Physician who certifies that the severity of Your Injury or
Sickness warrants an Emergency Evacuation.
Evacuation means:
- Your medical condition warrants immediate transportation from the place where You are injured
or sick to the nearest hospital where appropriate medical Treatment can be obtained;
- After being treated at a local hospital, Your medical condition warrants transportation to the
United States, where You reside, to obtain further medical Treatment or to recover;
- All of the above.
Covered Expenses are reasonable and customary expenses, up to the maximum, for necessary
transportation, medical services, and medical supplies incurred in connection with Your Emergency
Evacuation. All transportation arrangements made for Your evacuation must be by the most direct
and economical route possible. Expenses for Your Emergency Evacuation must be:
- Recommended by the attending Physician;
- Required by the standard regulations of the conveyance transporting You;
- Verified and approved in advance by Universal Assist
Expenses for medical services and supplies must be recommended by the attending Physician.
Transportation means any land, water, or air conveyance required to transport You during an
Emergency Evacuation. Transportation includes, but is not limited to, air ambulances, land
ambulances, and private motor vehicles. The Insurer will not cover any expenses provided by
another party at no cost to You or already included in the cost of the scheduled Trip. All
transportation must be authorized and arranged by Universal Assist.
To access Emergency Assistance, call
Universal Assist's operation center at:
1-800-770-9111
or call collect:
1-703-370-7800
Emergency Medical Reunion: When the assistance company and Your attending Physician
determine that it is necessary and prudent for You to have an Emergency Medical Evacuation or
Repatriation, this Plan will arrange to bring an individual of Your choice, from Your current Home
Country, to be at Your side while You are hospitalized and then accompany You during Your return
to Your current Home Country. Benefits will be paid up to the maximum shown on the Schedule of
Coverages for a round-trip economy airfare ticket as well as for reasonable travel and
accommodation expenses up to a maximum of 10 days, as pre-approved and arranged by the assistance
company.
Return of Dependent Children: Should You be traveling alone and are hospitalized because
of a covered Sickness or Injury and Your Dependent Child(ren) is (are) left unattended, the
assistance company will arrange for a one-way economy fare(s) to Your current Home Country.
If an attendant/escort is necessary to ensure the safety and welfare of Your Dependent Child(ren),
the assistance company will also arrange these services. The Plan will pay for these services up
to the maximum shown on the Schedule of Coverages provided all transportation and services are
pre-approved and arranged by the assistance company. Meals and lodging are Your responsibility.
Repatriation of Remains: The Insurer will pay reasonable Covered Expenses incurred to
return Your body to the United States if You die during the covered Trip. This will not exceed
the maximum shown on the Schedule of Coverages. Covered Expenses include, but are not limited to,
expenses for embalming, cremation, minimally necessary coffins for transport, and transportation.
In Hospital Indemnity: (Available for U.S. citizens only) If You are confined to a
Hospital as a registered Inpatient as the result of a Sickness or Injury which first occurs during
Your Trip and that Sickness or Injury is not covered under this Plan, this Plan will pay benefits
up to the maximum shown on the Schedule of Coverages per day of confinement up to a maximum of 30 days.
Home Country Coverage: Incidental Trips to the Home Country - During Your Trip, You may
return to Your Home Country for incidental visits of up to 30 days per six months of coverage, or
pro rata thereof. If, during an incidental Trip home You suffer an Injury or Sickness, this Plan
shall pay up to $1,000 of Covered Expenses for that Injury or Sickness. Treatment for this Injury
or Sickness must occur within Your Home Country while on the incidental visit.
Excess Insurance Provision The coverage
provided under Parts A, B, C and E shall be in excess of all other valid and collectible insurance
or indemnity and shall apply when such other benefits are exhausted.
PRE-EXISTING CONDITIONS
Pre-Existing Conditions means the Insurer will not pay under any coverage in Parts A, C, D and E
for claims arising from an injury, sickness, or other condition (including any condition from
which death ensues) of Yourself, a Traveling Companion or an Immediate Family Member traveling
with You within the 60 day period (or 365 day period for the Travelers Primary Plus) before
the effective date Your coverage began under this protection plan which:
(a) first manifested itself 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 drugs or medicine is taken remains controlled without any
change in the required prescription;
(c) required medical Treatment or Treatment was recommended
by a Physician.
Accidental Death & Dismemberment - 24 Hour
If Injury to You results in any of the following losses within 180 days of the date of the
Accident, the Insurer will pay the largest applicable amount as follows:
- The full benefit is paid for loss of life, both hands or feet, sight of both eyes, speech and
hearing in both ears, one hand and one foot, either hand or foot and sight of one eye.
- One half the benefit amount is paid for loss of either hand or foot, sight of one eye; speech;
hearing in both ears.
- One fourth of the benefit amount is paid for thumb and index finger of the same hand.
In no event will the Insurer pay more than the maximum amount shown on the Schedule of Coverages
for all losses due to the same Accident.
Loss with regard to hand or foot, means actual complete severance through and above the wrist or
ankle joints; eye means an entire and irrecoverable loss of sight; speech or hearing means entire
and irrecoverable loss of speech or hearing of both ears; and thumb and index finger means actual
severance through or above the joint that meets the finger at the palm.
Exposure: The Insurer will pay benefits for covered losses that result from Your being
unavoidably exposed to the elements due to an Accident. The loss must occur within 365 days
after the event that caused the exposure.
Disappearance: The Insured will pay benefits for loss of life if Your body cannot be located
one (1) year after Your disappearance due to an Accident.
This Benefit is only available if You have elected the optional upgrade and have paid the
required additional protection plan fee. This optional upgrade is not available to purchase once
Your total Trip cost has been paid in full.
Trip Cancellation
In the event You are prevented from taking Your Trip due to: a) accidental Injury, Sickness, or
death of Yourself, an Immediate Family Member or a Traveling Companion, which results in medically
imposed restrictions as certified by a Physician at the time of loss preventing Your continued
participation in the covered Trip the Insurer will pay benefits up to the maximum listed in the
Schedule of Coverages for:
Trip Cancellation: non-refundable cancellation charges imposed for Your Land/Sea
Arrangements and/or airfare cancellation charges for flights joining or departing Your Land/Sea
Arrangements.
Special Conditions: In the event of a claim, You must advise OIC and the Claims
Administrator as soon as possible. The Insurer will not pay benefits for any additional charges
incurred that would not have been charged had You notified OIC and the Claims Administrator as
soon as reasonably possible.
EXCLUSIONS
The following exclusions apply to Parts A, B and C. The plan does not cover any
loss caused by or resulting from:
- Pre-Existing Conditions (Except Emergency Evacuation and Repatriation of Remains);
- Suicide or attempted suicide;
- Intentionally self-inflicted injuries;
- War, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), or civil war;
- Participation in any military maneuver or training exercise;
- Piloting or learning to pilot or acting as a member of the crew of any aircraft;
- Mental or emotional disorders, unless hospitalized;
- Participation as a professional in athletics or underwater activities;
- Being under the influence of drugs or intoxicants unless prescribed by a Physician;
- Commission or the attempt to commit a criminal act;
- Participating in bodily contact sports; skydiving; hang gliding; parachuting; mountaineering; any race; bungee cord jumping; and/or speed contest;
- Dental Treatment except as a result of accidental Injury to sound, natural teeth within twelve (12) months of the accidental Injury;
- Any non-emergency Treatment or surgery, routine physical examinations, hearing aids, eye glasses or contact lenses;
- Pregnancy and childbirth (except for complications of pregnancy); and
- Curtailment or delayed return for other than covered reasons;
- Losses sustained after the anniversary date following Your 70th birthday.
DEFINITIONS
- "Accident" means an event, independent of Sickness or self-inflicted means, which is the direct cause of bodily Injury to an Insured Person.
- "Coinsurance" means the percentage amount of Covered Expenses, after the Deductible, which is Your responsibility to pay.
- "Common Carrier" means an air conveyance operating under a license for the transportation of passengers for hire.
- "Covered Expenses" means expenses which are for Medically Necessary services, supplies, care, or Treatment due to Sickness or Injury; prescribed, performed or ordered by a Physician; Reasonable and Customary charges; incurred while insured under this Plan; and which do not exceed the maximum limits under each stated benefit.
- "Deductible" means the amount of Covered Expenses which is Your responsibility to pay before benefits under the Plan are payable.
- "Dependent Child(ren)" means the Insured's child (or children), including an unmarried child, stepchild, legally adopted child or foster child who is: (1) less than age 19 and primarily dependent on the Insured for support and maintenance; or (2) who is at least age 19 but less than age 23 and who regularly attends an accredited school or college; and who is primarily dependent on the Insured for support and maintenance.
- "Economy Airfare" means the lowest published rate for a one-way ticket.
- "Home Country" means the country where You have Your true, fixed and permanent home and principal establishment.
- "Immediate Family Member" means any children, adopted children, stepchildren, children-in-law, parents, stepparents, parents-in-law, siblings, siblings-in-law, grandparents, grandchildren, legal spouse, aunts, uncles, nieces, and nephews of You or Your Traveling Companion who reside in the United States of America.
- "Injury" means bodily injury caused by an Accident occurring while this plan is in force, and resulting directly and independently of all other causes in loss covered by the plan. The Injury must be verified by a Physician.
- "Insurer" means Virginia Surety Company, Inc.
- "Land/Sea Arrangements" means land and/or sea arrangements covered by this Protection Plan for travel outside the United States.
- "Physician" means a licensed practitioner of medical, surgical or dental services acting within the scope of his/her license. The treating Physician may not be Yourself, a Traveling Companion, or an Immediate Family Member.
- "Reasonable and Customary" means the maximum amount that the Plan determines is Reasonable and Customary for Covered Expenses You receive, up to, but not to exceed, charges actually billed. The determination considers: 1) amounts charged by other service providers for the same or similar service in the locality where received, considering the nature and severity of the bodily Injury or Sickness in connection with which such services and supplies are received; 2) any usual medical circumstances requiring additional time, skill or experience; and 3) other factors included, but not limited to, a resource based relative value scale.
- "Sickness" means illness or disease which is diagnosed and treated by a Physician on or after the effective date of the protection plan and while You are covered under this plan.
- "Traveling Companion" means a person who is sharing travel arrangements with You (to a maximum of four persons including You).
- "Treatment" means a specific in-office or Hospital physical examination of, or care rendered to You; consultation; diagnostic procedures and services; Surgery; medical services and supplies, including Medication prescribed or provided by a Service Provider.
- "Trip" means prepaid Land/Sea Arrangements and shall include flight connections to join and depart such Land/Sea Arrangements, provided such flight connections are scheduled to commence within one (1) week of the Land/Sea Arrangements.
- "You or Your" means a person who has purchased a Trip and who has paid the required plan cost for the protection plan provided herein.
Universal Assist
Worldwide Emergency Assistance
A 24-hour emergency telephone assistance service is available for Your benefit so that, in the
event of an emergency while on the Trip, English speaking help and advice may be furnished to You.
PART I - TRAVELER'S ASSISTANCE
Universal Assist's multilingual staff can assist You in solving a variety of unexpected
complications during the Trip such as lost tickets or belongings. If necessary, Universal Assist
may also help locate legal counsel. Pre-Trip information such as cultural, visa requirements and
exchange rates can also be provided.
PART II - MEDICAL ASSISTANCE
If a medical emergency arises during travel, Universal Assist may help You find local medical care.
Physicians and hospitals worldwide can contact Universal Assist to confirm coverage and, if
required, help You arrange immediate settlement of medical expenses resulting from an Injury
during the covered Trip. Universal Assist will coordinate emergency medical situations, with
Your home Physician and arrange Emergency Evacuation services.
PART III - EMERGENCY CASH TRANSFER
Universal Assist can help arrange a fund transfer through Your credit cards, family, friends,
employer or similar source if You need cash while on the Trip.
NOTE: Problems of distance, information and communication make it impossible for
Virginia Surety Company, Inc., BerkelyCare, or Universal Assist to assume any responsibility for
the availability, quality, use or result of any emergency service. In all cases, You are still
responsible for obtaining, using and paying for Your own required services of all types.
CLAIMS PROCEDURE
To facilitate prompt claims settlement:
TRIP CANCELLATION CLAIMS: IMMEDIATELY Call OIC and the Claims Administrator to report
Your cancellation and avoid non-covered expenses due to late reporting. The Claims Administrator
will then advise You on how to obtain the appropriate form to be completed by You and the
attending Physician.
TRIP INTERRUPTION: Obtain medical statements from the doctors in attendance in the
country where Sickness or Accident occurred. These statements should give complete diagnosis,
stating that the Sickness or Accident prevented traveling on dates contracted. Provide all unused
transportation tickets, official receipts, etc.
TRIP DELAY CLAIMS: Obtain receipts for any additional expenses (i.e.: meals/lodging,
etc) and submit with written documentation from the source which caused the delay for verification
(i.e.: Common Carrier, police report for traffic accident, etc.).
BAGGAGE: In case of loss, theft, or damage to personal belongings, immediately contact
the hotel manager, Tour guide or representative, transportation official, or local police; report
occurrence and obtain a written statement. Submit claim first to party responsible; i.e., airline,
hotel, etc. Provide a copy of the outcome of Your claim, along with the written loss statements,
receipts, etc.
MEDICAL EXPENSES: Obtain receipts from the providers of service, etc., stating the
amount paid and listing the diagnosis and Treatment; submit these first to other medical plans.
Provide a copy of their final disposition of Your claim.
TO OBTAIN CLAIM FORMS AND ANY ADDITIONAL INFORMATION ON HOW TO REPORT
A CLAIM, CALL OR WRITE THE PLAN ADMINISTRATOR AND REFER TO PLAN: HTP08263
ENROLLMENT PROCEDURE
- In order to quickly effect coverage, make payment for the applicable plan cost to Overseas Insurance Consultants upon booking Your Trip.
- Remit all payments for this plan to Overseas Insurance Consultants.
- Protection Plan must be purchased prior to Your departure date.
TERM OF COVERAGE
- This plan is provided to U.S. Citizens and residents in consideration of the payment in advance of the total required plan cost and fees.
- The Trip Cancellation Benefit takes effect upon receipt of the appropriate Passenger Protection Program cost by OIC.
- All other coverages take effect at 12:01 a.m. local time at Your location on the departure date of Your Trip.
- All coverages shall terminate on the earlier of the following dates: (a) Your return to the origination point as specified in the travel tickets; (b) 11:59 p.m. local time at Your location on the date Your Trip is completed, (c) The date You cancel Your Trip; or (d) The anniversary of Your Plan following age 70.
- Coverage is extended if You are involved in a natural disaster or a Common Carrier delay. All coverages will terminate at 11:59 p.m. local time at Your location on the date Your Trip is completed.
Protection Plan fees are non-refundable
FOR GENERAL QUESTIONS, SERVICE OR TO ENROLL IN THIS PROGRAM, CONTACT:
OVERSEAS INSURANCE CONSULTANTS
1-800-474-2601 or 770-663-0114
www.otpplan.com
BENEFICIARY
Your estate, unless written notice of a designated beneficiary is provided to the
Plan Administrator.
FOR PLAN INQUIRIES OR INFORMATION ON FILING
A CLAIM PLEASE CONTACT THE PLAN
ADMINISTRATOR AT:
BerkelyCare
P.O. Box 9022
Jericho, NY 11753
1-800-453-4063
or call collect:
1-516-342-2950
Mon-Fri 9:00am-5:00pm (EST)
Claims are administered by BerkelyCare, a division of Affinity Insurance Services, Inc. in all
states except: Aon Direct Insurance Administrators in CA; AIS Affinity Insurance Agency, Inc., in
OK; and AIS Affinity Insurance Agency in NH and NY. CA License # 0795465.
IN ALL OTHER STATES: BerkelyCareSM is a division of Affinity Insurance Services, Inc. in all
states other than CA, except: AIS Affinity Insurance Agency, Inc. in MN and OK and AIS Affinity
Insurance Agency in NY.
IMPORTANT NOTICE: Payments for the plan will not be accepted after the
departure date of Your Trip.
Plan is designed by Overseas Insurance Consultants
This Plan, under Plan #HTP08263 is underwritten by: Virginia Surety Company, Inc., 175 W.
Jackson Ave., 11th Fl., Chicago, IL 60604.
This Description of Coverage is a description of the group insurance policy (the Master Policy)
terms and conditions. The complete provisions regarding this insurance are contained in the Master
Policy that is on file with the trustee, Sun Trust Bank, Washington, D.C. as well as with the Plan
Administrator, BerkelyCare. In the event of any conflict between this Description of Coverage and
the Master Policy, this Description of Coverage will apply.
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