SafetyWing
Insurance™

Description of Coverage
Administered by: WorldTrips

1101150223

Contents
Important Notice and Disclaimer Concerning the UnitedStates Patient Protection and Affordable Care Act .........3
Description of Coverage Summary ..................................3

Arbitration and Class Action Waiver ............................. 12
Pre-Existing Medical Conditions ................................... 13
Acute Onset of Pre-Existing Condition...................... 14

Important Features of Your Travel Insurance .................3

Medical & Repatriation Expenses ................................. 14

Cancellation .................................................................3

Medical Expenses ..................................................... 14

U.S. Preferred Provider Organization (PPO) ................4
Claims ..........................................................................4
Appeals and Complaints ..............................................4
Definitions ...................................................................4
Pre-Existing Conditions………………………………..…………..4
Data Protection ...........................................................4
Rights of Third Parties .................................................4
Law and Jurisdiction ....................................................5
Arbitration ...................................................................5WorldTrips ...................................................................5
Member Eligibility ...........................................................5
Certificate Effective & Termination Dates .......................5
Certificate Effective Date ............................................5
Certificate Termination Date .......................................6
Benefit Period & Home Country Coverage ......................6
Benefit Period ..............................................................6
Incidental Home Country Coverage ............................6

Emergency Medical Evacuation ................................ 16
Trip Interruption ....................................................... 16
Return of Minor Children.......................................... 17
Political Evacuation................................................... 17
Repatriation of Remains ........................................... 18
Local Burial or Cremation ......................................... 18
Indemnity Benefit & Visitation Expenses ..................... 19
Hospital Indemnity ................................................... 19
Emergency Reunion .................................................. 19
Bedside Visit ............................................................. 19
Travel Assistance .......................................................... 20
Travel Delay .............................................................. 20
Lost Checked Luggage............................................... 20
Natural Disaster - Replacement Accommodations ... 21
Emergency Quarantine Indemnity – Covid-19.......... 21
Border Entry Protection............................................ 22
Pet Return ................................................................. 22

Schedule of Benefits and Limits ......................................7

Personal Accident ......................................................... 23

Claim Procedures...........................................................10

Accidental Death and Dismemberment ................... 23

Claims Notification………………………………..…………….…10
Proof of Claim ............................................................10

Common Carrier Accidental Death Benefit .............. 24

Claims Cooperation ...................................................11
Access to Additional Materials ..................................11

Crisis Response ............................................................. 26
Personal Liability ........................................................... 27

Other Insurance.........................................................11

Terrorism ...................................................................... 29

Appeal and Complaints Procedure ................................11

General Exclusions ........................................................ 30

Appealing a Claim ......................................................11

Definitions .................................................................... 33

Complaints Procedure ...............................................122

Description of Coverage | WorldTrips

Important Notice and Disclaimer
Concerning the United States Patient
Protection and Affordable Care Act
This insurance is not subject to, and does not provide certain insurance benefits required by the UnitedStates’ Patient Protection and Affordable Care Act (“PPACA”). PPACA requires certain US citizens or US
residents to obtain PPACA compliant health insurance, or “minimum essential coverage.” PPACA also
requires certain employers to offer PPACA compliant insurance coverage to their employees. Tax penalties
may be imposed on U.S. residents or citizens who do not maintain minimum essential coverage, and on
certain employers who do not offer PPACA compliant insurance coverage to their employees. In somecases, certain individuals may be deemed to have minimum essential coverage under PPACA even if theirinsurance coverage does not provide all of the benefits required by PPACA. You should consult yourattorney or tax professional to determine whether this policy meets any obligations you may have under
PPACA.

Description of Coverage Summary
This Description of Coverage is a summary of the provisions contained in Master Policy No.231920-SW.
For a complete copy of the Master Policy, please contact WorldTrips.
This Description is to help you understand the insurance that your certificate provides. It details the key
features, benefits, limitations, exclusions, definitions, Schedule of Benefits and Limits, and any
endorsements, applying to your certificate.
The levels of coverage which apply to your coverage are detailed in the Schedule of Benefits and Limits.

Important Features of Your Travel
Insurance
Cancellation
We hope you are happy with the cover this policy provides. However, if after reading it, this insurance
does not meet with your requirements, please notify us of your wish to cancel and we will refund yourpremium.
Premiums will be refunded in full if a cancellation request is received prior to the certificate effective
date.
Premiums may be refunded after the certificate effective date subject to the following provisions:a. A $25 cancellation fee will apply for administrative costs incurred by us; andb. Only the prorated portion of the premium will be refunded; and3

Description of Coverage | WorldTrips

c. You cannot have filed any claims to be eligible for a premium refund.

U.S. Preferred Provider Organization (PPO)This insurance policy offers the option of a PPO network for medical treatment received in the UnitedStates. If you choose to seek treatment from a PPO provider, billed charges for eligible expenses may be
reduced and we will remit payment directly to the provider. Additionally, we will apply the in-network
coinsurance applicable to the expenses.
You may review a listing of hospitals, physicians and other medical service providers included in the PPO
Network for the area where you will be receiving treatment by accessing the Internet website forWorldTrips: www.worldtrips.com. For assistance locating a provider, contact us at 1-800-605-2282.

ClaimsThis insurance policy has in it a Claims Procedure which tells you what steps you must take to file a claim,and explains our obligations to you. Beginning on the last day of your certificate period, you shall have 60
days to provide us proof of claim.

Appeals and Complaints
This insurance policy has in it an Appeals and Complaints Procedure which tells you what steps you cantake if you wish to make an appeal or complaint.

Definitions
This insurance policy has defined terms, indicated by bolded words (excluding headers). The definedterms may be found in the relevant benefit section or in the general definitions.

Pre-Existing Conditions
This insurance policy excludes coverage for pre-existing conditions, except as provided for under the
Acute Onset of Pre-existing Conditions benefit. This policy defines a pre-existing condition and provides
the description of the Acute Onset of Pre-Existing Conditions benefit.

Data Protection
We respect individual privacy and value your confidence. We restrict access to personal information toemployees/partners who need to know that information to perform their jobs. Any employee that wedetermine is in violation of this policy will be subject to disciplinary action, up to and including
termination and criminal prosecution.
We will not disclose your personal information to third parties outside WorldTrips and our partners
unless ordered to do so to comply with the law of the countries in which we do business or whencomplying with the legal process. You may review the WorldTrips privacy policy here:
https://www.worldtrips.com/about-worldtrips/privacy-policy.

Rights of Third Parties
You may assign benefits under this insurance to a hospital, physician or other provider. Any assignment
shall not confer upon such hospital, physician or other provider, any right or privilege granted to you
under this insurance except for the right to receive benefits, if any, which are determined to be due and4

Description of Coverage | WorldTrips

payable hereunder. No hospital, physician or other provider shall have any direct or indirect claim or rightof action against us.

Law and Jurisdiction
No action of law or equity may be brought to recover benefits under this insurance until 60 days after thedate of the last claim was incurred during the certificate period or an applicable benefit period. No suchaction may be brought more than three (3) years after the date the last claim was incurred during thecertificate period or an applicable benefit period. The validity, interpretation, and performance of thisagreement shall be governed by and construed in accordance with the laws of Bermuda.

Arbitration
EXCEPT FOR CERTAIN TYPES OF DISPUTES DESCRIBED IN THE “ARBITRATION AND CLASS ACTION
WAIVER”, AND IF YOU DO NOT OPT-OUT AS SET FORTH IN THAT SAME SECTION, YOU AGREE THATDISPUTES BETWEEN YOU AND WORLDTRIPS AND/OR THE UNDERWRITERS WILL BE RESOLVED BY
BINDING, INDIVIDUAL ARBITRATION, AND YOU WAIVE YOUR RIGHT TO BRING OR RESOLVE ANYDISPUTE AS, OR PARTICIPATE IN, A CLASS, CONSOLIDATED, REPRESENTATIVE, COLLECTIVE, OR PRIVATEATTORNEY GENERAL ACTION OR ARBITRATION.

WorldTrips
WorldTrips is a subsidiary of HCC Insurance Holdings, Inc., d/b/a Tokio Marine HCC. HCC Lloyd’s Syndicate
4141 is managed by HCC Underwriting Agency Ltd which is authorized by the Prudential Regulation
Authority (PRA) and regulated by the Financial Conduct Authority (FCA) and the PRA. Registered inEngland and Wales No. 04632146. Registered office: 1 Aldgate, London EC3N 1RE, United Kingdom.
These details can be checked on the Financial Services Register by visiting: www.fca.org.uk or contacting
the Financial Conduct Authority on 0800 111 6768.

Member Eligibility
U.S. Citizens and non-U.S. Citizens who are at least fourteen (14) days of age through age 69 are eligible
for coverage outside of their home countries, except as provided under home country coverage. U.S.
Citizens and residents are not eligible for coverage within the U.S, except as provided under incidental
home country coverage or an eligible benefit period.
Individuals age 65 to 69 as of the certificate effective date are subject to a $100,000 overall maximum
limit or less.

Certificate Effective & Termination Dates
Certificate Effective Date
Insurance hereunder is effective on the later of:5

Description of Coverage | WorldTrips

a. The moment we receive an application and correct premium if the application and payment ismade online or by fax;
b. 12:01am U.S. Eastern Time on the date we receive an application and correct premium if theapplication and payment is made by mail;c. The moment you depart from your home country; ord. 12:01am U.S. Eastern Time on the date requested on the application if correct premium isreceived.

Certificate Termination Date
Insurance hereunder terminates on the earlier of:a. 11:59pm U.S. Eastern Time on the last day of the period for which premium has been paid;b. 11:59pm U.S. Eastern Time on the date requested on the application; orc. The moment of arrival upon your return to your home country (unless you have started a benefit
period or are eligible for home country coverage).

Benefit Period & Home Country Coverage
Benefit Period
While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate,including when you return to your home country, the benefit period applies for up to 90 days only toeligible medical expenses directly related to an injury or illness that was diagnosed or treated while thecertificate was in effect. The benefit period begins on the first day of diagnosis or treatment of acovered injury or illness made while you are outside your home country. The benefit period applies
whether or not you return to your home country.

Incidental Home Country Coverage
You must have purchased three months of coverage for the Incidental Home Country Coverage to be ineffect.
U.S. home country: For every three-month period during which you are covered, eligible medical
expenses incurred in the U.S. are covered up to a maximum of 15 days.
Non-U.S. home country: For every three-month period during which you are covered, eligible medical
expenses incurred in your home country are covered up to a maximum of 30 days.
Any benefit accrued under a single three-month period does not accumulate to another period. Failure tocontinue your international trip or your return to your home country for the sole purpose of obtaining
treatment for an illness or injury that began while traveling shall void any incidental home country
coverage.
Except for a benefit period, coverage provided under this Master Policy is for a maximum duration of 364
days. Any extension of coverage is based upon the eligibility rules in force and is solely at our discretion.

6

Description of Coverage | WorldTrips

Notwithstanding the foregoing, coverage under all plans shall terminate on the date we, at our sole
option, elect to cancel all members of the same sex, age, class or geographic location, provided we give noless than 30 days advance written notice by mail to your last known address.

Schedule of Benefits and Limits
Plan Details
Overall Maximum Limit

Age 65 to 69: $100,000
All others: $250,000

Maximum per Injury / Illness

Age 65 to 69: $100,000
All others: $250,000

Deductibles$250 per certificate period

Coinsurance

We will pay 100% of eligible expenses after the deductible
up to the overall maximum limit.

Eligible expenses are subject to deductible, overall maximum limit,
and are per certificate period unless specifically indicated otherwise.
BenefitLimit

Hospital Room and Board

Average semi-private room rate, including nursing services

Intensive Care Unit

Up to the overall maximum limit

Local Ambulance

Usual, reasonable and customary charges, only when
covered illness or injury results in hospitalization as
inpatient.

Emergency Room Co-payment – Claims
incurred in U.S.

Claims incurred in the U.S.
You shall be responsible for a $100 co-payment for eachuse of emergency room for an illness unless you areadmitted to the hospital. There will be no co-payment for
emergency room treatment of an injury.
Claims incurred outside the U.S.
No co-payment

Urgent Care Center – Claims incurred in
U.S.

Claims incurred in the U.S.
For each visit, you shall be responsible for a $50 copayment– not subject to deductible
Claims incurred outside the U.S.
No co-payment

Outpatient Physical Therapy and
Chiropractic Care7

Up to $50 maximum per day. Must be ordered in advanceby a physician.

Description of Coverage | WorldTrips

Emergency Dental (Acute Onset ofPain)

Up to $1,000 - not subject to deductible

Emergency Eye Exam for a Covered
Loss

Up to $150. $50 deductible per occurrence (plan deductible
is waived).

Acute Onset of Pre-existing Condition(See benefit description)

Up to the overall maximum limit
Up to $25,000 lifetime maximum for Emergency Medical
Evacuation

Terrorism

Up to $50,000 lifetime maximum, eligible medical expenses
only

All Other Eligible Medical Expenses

Up to the overall maximum limit

Emergency Travel Benefits

Limit

Emergency Medical Evacuation

Up to $100,000 lifetime maximum, except as provided
under Acute Onset of Pre-existing Condition- not subject to deductible or overall maximum limit

Repatriation of Remains

Up to $20,000 lifetime maximum - not subject to deductible
or overall maximum limit

Local Burial or Cremation

Up to $10,000 lifetime maximum - not subject to deductible

Crisis Response - Ransom, Personal
Belongings, and Crisis Response Fees
and Expenses

Up to $10,000 - not subject to deductible or overallmaximum limit

Emergency Reunion

Up to $50,000, subject to a maximum of 15 days - notsubject to deductible

Bedside Visit

Up to $1,500 - not subject to deductible

Return of Minor Children

Up to $5,000 - not subject to deductible

Pet Return

Up to $1,000 - not subject to deductible

Political Evacuation

Up to $10,000 lifetime maximum- not subject to deductible

Trip Interruption

Up to $5,000 - not subject to deductible

Accidental Death & Dismemberment(excludes loss due to Common Carrier
Accident)
Ages 18 through 69

Lifetime Maximum - $25,000
Death - $25,000
Loss of 2 Limbs - $25,000
Loss of 1 Limb - $12,500

Under age 18

Lifetime Maximum - $5,000
Death - $5,000
Loss of 2 Limbs - $5,000
Loss of 1 Limb - $2,500

8

Description of Coverage | WorldTrips

$250,000 maximum benefit any one family or group.
- not subject to deductible or overall maximum limit
Common Carrier Accidental Death
Ages 18 through 69
Under age 18$50,000$10,000
Subject to a maximum of $250,000 any one family or group.
- not subject to deductible or overall maximum limit

Lost Checked Luggage

Up to $3,000 per certificate period; $500 per item.
Up to $6,000 lifetime limit.
- not subject to deductible

Travel Delay

Up to $100 a day after a 12-hour delay period requiring an
unplanned overnight stay. Subject to a maximum of 2 days.
- not subject to deductible

Lost or Stolen Passport/Travel Visa

Up to $100 - not subject to deductible

Border Entry Protection

Up to $500 if traveling on a valid B-2 visa and denied
entrance at the U.S. border. - not subject to deductible

Natural Disaster - Replacement
Accommodations

Up to $100 a day for 5 days - not subject to deductible

Emergency Quarantine Indemnity –COVID-19$50 a day for up to 10 days. Must have a minimum of 28days of coverage. Proof of quarantine mandated by aphysician or governmental authority required. Quarantine
must be due to you testing positive for COVID-19/SARSCoV2, or you are symptomatic and waiting on diagnostic
test results. Benefit may be used only once per 364-day
period. Not available while in your home country.
-not subject to deductible

Hospital Indemnity$100 per day of inpatient hospitalization - not subject todeductible

Personal Liability

Up to:$25,000 lifetime maximum$25,000 third person injury$25,000 third person property$2,500 related third person property- not subject to deductible or overall maximum limit

U.S. Preferred Provider Organization (PPO)
Requirements
9

Description of Coverage | WorldTrips

Nothing contained in this insurance restricts or interferes with your right to select the hospital, physician
or other medical service provider of your choice. Nothing contained in this insurance restricts orinterferes with the relationship between you and the hospital, physician or other providers with respect
to treatment or care of any condition, nor your right to receive, at your own expense, services and/or
supplies that are not covered under this insurance.
To comply with the United States Preferred Provider Organization (PPO) requirements, you must receive
medical treatment from PPO providers while in the United States. If you receive treatment from a PPO
provider, we will remit payment for eligible expenses directly to the provider.
You may review a listing of hospitals, physicians and other medical service providers included in the PPO
Network for the area where you will be receiving treatment by visiting WorldTrips website located at:www.worldtrips.com. For assistance locating a provider, contact us at 1-800-605-2282.

Claim Procedures
Claims Notification
All claims and related claim information, including a proof of claim, should be submitted to the Company
at the contact information below, or online at http://service.worldtrips.com/ as soon as possible.
Online:http://service.worldtrips.com/

Postal Mail:

WorldTrips
P.O. Box 2005
Farmington Hills, MI 48333
USA

Proof of Claim
You must send proof of claim for any expenses that you are requesting to be paid by us. This includes
treatment or services for which the medical provider bills us directly. No payments will be made by us
without you first submitting a proof of claim.
We must receive proof of claim within 60 days of the last day of your certificate period (or for claims
incurred during a benefit period, 60 days from the date the claim is incurred).
A proof of claim must include all of the following:
1. A completed and signed Claimant’s Statement and Authorization form, together with any/all
required attachments;
2. Itemized bills from physicians, hospitals and other medical providers; and3. Receipts for any expenses which have already been paid by you or on your behalf.
Subsequent to receipt of proof of claim, we may, at our sole discretion, request and require additional
information, including but not limited to medical records, necessary to confirm whether coverage exists
for the validity of any claim prior to payment thereof.

10

Description of Coverage | WorldTrips

Claims Cooperation
You shall provide assistance and cooperate with us or our representatives in obtaining any other records
we or they feel necessary to evaluate your claim or any incident giving rise to your claim. You shallprovide, when asked, all authorizations necessary to obtain your medical records. If you do not fully
cooperate with us and/or our investigation of the claim, we shall not be liable to pay any claim.

Access to Additional Materials
You shall provide us, or our designated representatives, all information, documentation and medical
information that we or they may reasonably require during the term of this policy, or until all claims
have been resolved, whichever is later.

Other Insurance
We shall not pay any claim if there is other insurance which would, or would but for the existence of thisinsurance, pay such claim. This insurance will apply with respect to expenses in excess of the amount
paid or payable under such other insurance. We shall not pay any claim in respect to care, treatment,
services or supplies furnished by any insurance, program or agency funded by any government.

Appeal and Complaints Procedure
Appealing a ClaimIn the event we deny all or part of a claim under this insurance, you may file a written appeal with us.
The written appeal must include sufficient information to identify the claim under appeal and mustspecify the reason(s) for the appeal with supporting documentation, if applicable.
Please submit your written appeal online, by email. or by postal mail at the following:
Online:Email:
Postal Mail:

http://service.worldtrips.com/
appeals@worldtrips.com
WorldTrips Appeals
P.O. Box 2058
Farmington Hills, MI 48333
USA

When we receive the appeal, we will review the claim and a written response will be sent to you. Afteryou receive our response to the appeal, you may initiate a second appeal. With our receipt of the second
appeal, medical and/or claims personnel who were not involved in the original claim determination or the
initial appeal will review the claim. A final determination will be made and a letter will be sent to you.
Please note that appealing a claim is not a requirement to following the complaints procedure detailed
below.

11

Description of Coverage | WorldTrips

Complaints Procedure
We are dedicated to providing a high-quality service and want to ensure that it is maintained at all times.
If you feel that we or another party connected with this policy have not offered a first-class service
please contact us and we will do our best to resolve the problem.
Please send your written complaint online, by email, or by postal mail at the following:
Online:Email:
Postal Mail:

http://service.worldtrips.com/
appeals@worldtrips.com
WorldTrips Appeals
P.O. Box 2058
Farmington Hills, MI 48333
USA

We will acknowledge receipt of your complaint promptly after receiving it.
If you are a UK citizen and you have not been given an answer within 8 (eight) weeks or should you
remain dissatisfied, you may, refer your complaint to Lloyd’s, who will investigate and assess yourcomplaint. Lloyd’s contact details are as follows:
Complaints
Lloyd’s
One Lime Street
London EC3M 7HA
Email:
Telephone:
Fax:
Web:

complaints@lloyds.com+44 (0)20 7327 5693
+44 (0)20 7327 5225
www.lloyds.com/complaints

This complaints procedure does not affect any legal right you have to take action. Once you have received
your final response from Lloyd’s, and if you are still not satisfied you can contact the Financial
Ombudsman Service:
Financial Ombudsman Service
Exchange Tower, Harbour Exchange Square, London, E14 9SR
Phone: +44 (0) 20 7964 0500
Email: complaint.info@financial-ombudsman.org.uk
If you have purchased your policy online or by other electronic means within the European Union (EU) you
may also make your complaint via the EU’s online dispute resolution (ODR) platform. The website for the
ODR platform is: http://ec.europa.eu/odr

Arbitration and Class Action Waiver
Excluding claims for injunctive or other equitable relief, any dispute or controversy between a Member
and any of the WorldTrips, Underwriters or their affiliates arising out of or relating to this Master Policy,
including without limitation, any and all disputes, claims (whether in tort, contract, statutory orotherwise) or disagreements concerning the existence, breach, interpretation, application or terminationof this Master Policy, shall be resolved by final and binding arbitration pursuant to the Federal

12

Description of Coverage | WorldTrips

Arbitration Act and in accordance with the JAMS Inc. Comprehensive Arbitration Rules & Procedures
then in effect. Such claims shall be arbitrated on an individual basis only and the parties waive any rightor authority for any claims to be resolved in a class, consolidated, representative, collective or private
attorney general action or arbitration. Instructions regarding how to commence an arbitration areavailable on the JAMS website, located at https://www.jamsadr.com. The arbitration shall take place in
Houston, Texas or at the option of the party seeking relief, by telephone, online, or via written
submissions alone, and be administered by JAMS. The arbitral tribunal (“Tribunal”) shall be composed of
one arbitrator, who shall be independent and impartial. If the parties fail to agree on the arbitrator
within twenty (20) calendar days after the initiation of an arbitration hereunder, JAMS shall appoint thearbitrator. The arbitration shall be conducted in the English language. The decision of the arbitrator will
be final and binding on the parties. Judgment on any award(s) rendered by the arbitrator may beentered in any court having jurisdiction thereof. The arbitrator shall have the authority to determine
arbitrability of any disputes arising out of or relating to this Master Policy. Nothing in this Section shallprevent either party from seeking immediate injunctive relief from any court of competent jurisdiction,
and any such request shall not be deemed incompatible with the agreement to arbitrate or a waiver ofthe right to arbitrate. The parties undertake to keep confidential all awards in their arbitration, together
with all confidential information, all materials in the proceedings created for the purpose of thearbitration and all other documents produced by the other party in the proceedings and not otherwise in
the public domain, save and to the extent that disclosure may be required of a party by legal duty, toprotect or pursue a legal right or to enforce or challenge an award in legal proceedings before a court orother judicial authority. The arbitrator shall award all fees and expenses, including reasonable attorney’s
fees, to the prevailing party. This agreement to arbitrate does not apply to claims Members may have for
medical malpractice against their medical providers.
Members may choose to opt out of the agreement to arbitrate by mailing a written opt-out notice(“Notice”) to WorldTrips. The Notice must be postmarked no later than sixty (60) days after the last day of
your certificate period. The Notice must be mailed to: HCC Insurance Holdings, 13403 Northwest
Freeway, Houston, Texas 77040, to the attention of General Counsel. This procedure is the only
mechanism by which you can opt out of the agreement to arbitrate. Opting out of the agreement toarbitrate has no effect on any other parts of this Master Policy, or any previous or future arbitrationagreements that you have entered into with WorldTrips.

Pre-Existing Medical Conditions
This policy does not cover charges, in whole or in part, resulting from, related to, arising from, ornecessitated by a pre-existing conditions, except and unless charges resulted directly from an acuteonset of pre-existing condition in which case the charges will be covered only according to the Terms of
the Acute Onset of Pre-existing Conditions provision.
Pre-existing Condition means any injury, illness, sickness, disease, or other physical, medical, mental,
or nervous disorder, conditions, disorder or ailment that, with reasonable medical certainty, existed at
the time of application or at any time during the 2 years prior to the effective date of this insurance,
whether or not previously manifested, symptomatic or known, diagnosed, treated, or disclosed to us
prior to the effective date, and including any and all subsequent, chronic or recurring complications orconsequences related thereto or resulting or arising therefrom.

13

Description of Coverage | WorldTrips

For the purposes of the Complications of Pregnancy coverage offered hereunder, pregnancy will not
be included within the definition of a pre-existing condition.

Acute Onset of Pre-Existing Condition
Subject to all other terms, conditions and limitations of this Master Policy, in the event you experiencean acute onset of a pre-existing condition during the certificate period for which immediate treatment
is essential and necessary to stabilize the pre-existing condition, this Master Policy will cover eligible
medical expenses incurred during the certificate period with respect to an acute onset of the preexisting condition provided that at the time of the acute onset of a pre-existing condition. The benefit
will apply only if all of the following conditions are met:a. The Acute onset of a Pre-Existing Condition does not directly or indirectly relate toa chronic condition or congenital condition;b. Treatment must be obtained within twenty-four (24) hours of the sudden andunexpected outbreak or reoccurrence;c. You must be under eighty (80) years of age;d. You must not be traveling against or in disregard of the recommendations,established treatment programs, or medical advice of a physician or other
healthcare provider;e. You must not be traveling with the intent or purpose to seek or obtain treatment
for the pre-existing condition;
f. You must be traveling outside your Home Country.
Such coverage shall be subject to all other policy terms, conditions and exclusions, including the General
Exclusions and the limits set forth in Schedule of Benefits and Limits

Medical & Repatriation Expenses

Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions andrestrictions contained in this provision, we will pay the following expenses incurred while this insurance
is in effect.

Medical Expenses
YOU ARE COVERED FOR:
1. Charges made by a hospital for:a. Daily room and board and nursing services not to exceed the average semi-private room rate;andb. Daily room and board and nursing services in Intensive Care Unit; andc. Use of operating, treatment or recovery room; andd. Services and supplies which are routinely provided by the hospital to persons for use while
inpatients; ande. Emergency treatment of an injury, even if hospital confinement is not required; and14

Description of Coverage | WorldTrips

f. Emergency treatment of an illness; subject to emergency room co-pay as outlined in the
Schedule of Benefits and Limits. ER co-payment is waived when you are directly admitted tothe hospital as inpatient for further treatment of that illness.
2. Surgery at an outpatient surgical facility, including services and supplies.
3. Charges made by a physician for professional services, including virtual physician visits andsurgery. Charges for an assistant surgeon are covered up to 20% of the usual, reasonable andcustomary charge of the primary surgeon, but standby availability will not be deemed to be aprofessional service and therefore is not covered hereunder.
4. Dressings, sutures, casts or other supplies which are medically necessary and administered by orunder the supervision of a physician, but excluding nebulizers, oxygen tanks, diabetic supplies,
other supplies for use or application at home, and all devices or supplies for repeat use at home,
except durable medical equipment.
5. Diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric,
intelligence, behavioral and educational testing are not included).
6. Artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the
replacement or repair thereof.
7. Reconstructive surgery when the reconstructive surgery is directly related to a surgery which iscovered hereunder.
8. Hemodialysis and the charges by the hospital for processing and administration of blood or blood
components but not the cost of the actual blood or blood components.
9. Oxygen and other gasses and their administration by or under the supervision of a physician.
10. Anesthetics and their administration by a physician.
11. Drugs which require prescription by a physician for treatment of a covered injury or illness, but
not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, andfor a maximum supply of 60 days per prescription.
12. Care in a licensed extended care facility upon direct transfer from an acute care hospital.
13. Home nursing care in bed by a qualified licensed professional, provided by a home health careagency upon direct transfer from an acute care hospital and only in lieu of medically necessary
inpatient hospitalization.
14. Emergency local ambulance transport necessarily incurred in connection with injury or illness
resulting in inpatient hospitalization.
15. Emergency dental treatment and dental surgery necessary to restore or replace natural teeth lostor damaged in an accident which was covered under this insurance.
16. Emergency dental treatment necessary to resolve acute onset of pain, provided that initial
treatment is obtained within seventy-two (72) hours of the acute onset of pain.
17. Emergency Eye Exam if your prescription corrective lenses are lost or damaged due to a covered
loss and an exam is required to obtain a lens prescription for medically necessary correctionlenses, but not for the replacement cost of prescription corrective lenses or contact lenses.
18. Medically necessary rental of durable medical equipment (consisting of a standard basic hospital
bed and or a standard basic wheelchair) up to the purchase prices.
19. Outpatient physical therapy or chiropractic care if prescribed by a physician who is not affiliatedwith the physical therapy or chiropractic practice, necessarily incurred to continue recovery from acovered injury or illness.
20. Injury or illness resulting from participation in sports or athletic activities not otherwise excluded
under this insurance.

15

Description of Coverage | WorldTrips

YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Emergency Medical Evacuation
YOU ARE COVERED FOR:
1. Emergency air transportation to a suitable airport nearest to the hospital where you will receive
treatment; and2. Emergency ground transportation necessarily preceding emergency air transportation; and fromthe destination airport to the hospital where you will receive treatment.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The evacuation is recommended by the attending physician who certifies that it is medicallynecessary and that transportation by any other method would result in the loss of your life or limb;
and2. The evacuation is agreed upon by you or your relative; and3. Travel arrangements, excluding Emergency Local Ambulance, are approved in advance andcoordinated by us.
YOU ARE NOT COVERED IF:
The illness or injury giving rise to the expense is not covered under this insurance; orMedically necessary treatment, services and supplies can be provided locally; orIf transportation by any other method would not result in the loss of your life or limb; or
The condition giving rise to the Emergency Medical Evacuation did not occur suddenly andunexpectedly and without advance warning, either in the form of physician recommendation or
symptoms which would have caused a prudent person to seek medical attention prior to the onsetof the emergency; or
5. Expenses arise directly or indirectly from anything in the General Exclusions.

1.
2.
3.
4.

We will provide Emergency Medical Evacuation only to the nearest hospital that is qualified to provide
the medically necessary treatment, services and supplies to prevent your loss of life or limb.
The timeliness of arrangements can be affected by circumstances which are not within our control suchas: availability of transportation equipment and staff, delays or restrictions on flights caused bymechanical problems, government officials, telecommunications problems, weather and other acts ofGod. We shall not be held liable for any delays that are not within our direct and immediate control.
Notwithstanding the foregoing, and if you are visiting the U.S., we will pay for expenses to return you toyour home country if the attending physician and our medical consultant agree that transfer to yourhome country is more appropriate than transfer to the nearest qualified hospital.

Trip Interruption
YOU ARE COVERED FOR:
1. The cost of an economy one-way air or ground transportation ticket for you to the terminal
serving the area of your principal residence; and/or

16

Description of Coverage | WorldTrips

2. The cost of an economy one-way air and/or ground transportation ticket for you from the area
where you were hospitalized following an Emergency Medical Evacuation to the area where youwere initially evacuated from or to the terminal serving the area of your principal residence.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You provide written proof of one or more of the following events: destruction, after departurefrom home country, resulting from fire or weather of more than 40% of your principal residence,or death of a biological or stepparent, biological or stepchild/grandchild, current spouse, biologicalor stepsibling, or parent, children or sibling in law; or
2. Following a covered Emergency Medical Evacuation, the attending physician states that it is
medically necessary for you to return to your home country or to the area from which you were
initially evacuated for continued treatment, recuperation and recovery.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Return of Minor Children
YOU ARE COVERED FOR:
1. The cost of a one-way economy air and/or ground transportation ticket for each covered minor
child to the terminal serving the area of the principle residence of each minor child.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You are the only person age 18 or older, traveling with one or more minor children under the ageof 18 who are also covered hereunder; and2. You are hospitalized for treatment of a covered illness or injury, resulting in the children being left
unattended for a period of time expected to exceed 36 hours; and3. The Return of Minor Children benefit must be agreed upon by you and/or by an authorized adultrelative of the affected, covered minor children.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.
The timeliness of arrangements can be affected by circumstances which are not within our control suchas: availability of transportation equipment and staff, delays or restrictions on flights caused bymechanical problems, government officials, telecommunications problems, weather and other acts ofGod. We shall not be held liable for any delays that are not within our direct and immediate control.

Political Evacuation
YOU ARE COVERED FOR:
1. The cost of transportation by the most economical means possible for you to the nearest countryof safety or to your home country. We will determine to which country you will be evacuated.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The U.S. Department of State has issued a level 3 or higher travel advisory after your arrival in
the destination country; and17

Description of Coverage | WorldTrips

2. Your coverage was effective prior to the advisory being issued; and3.

You contact us within 10 days of the date the warning is issued.

YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Repatriation of Remains
YOU ARE COVERED FOR:
1. Air or ground transportation of bodily remains or ashes to the airport or ground transportation
terminal nearest your principal residence; and2. Reasonable costs of preparation of the remains necessary for transportation.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The illness or injury giving rise to the expense are covered under this insurance; and2. Travel arrangements are approved in advance and coordinated by us.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.
We are held harmless and shall not be held liable for loss of or any damage or other impairment tobodily remains incurred during the repatriation process or otherwise.
The timeliness of arrangements can be affected by circumstances which are not within our control suchas: availability of transportation equipment and staff, delays or restrictions on flights caused bymechanical problems, government officials, telecommunications problems, weather and other acts ofGod. We shall not be held liable for any delays that are not within our direct and immediate control.

Local Burial or Cremation
YOU ARE COVERED FOR:
1. For you to be buried or cremated in the country of death in lieu of Repatriation of Remains up to
the specified benefit maximum.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The illness or injury giving rise to the expense is covered under this insurance; and2. Travel arrangements are approved in advance and coordinated by us.
YOU ARE NOT COVERED IF:
1. The death occurs in your home country; or
2. The Emergency Medical Evacuation or Repatriation of Remains benefit is used; or
3. Expenses arise directly or indirectly from anything in the General Exclusions.
The timeliness of arrangements can be affected by circumstances which are not within our control suchas: availability of transportation equipment and staff, delays or restrictions on flights caused bymechanical problems, government officials, telecommunications problems, weather and other acts ofGod. We shall not be held liable for any delays that are not within our direct and immediate control.

18

Description of Coverage | WorldTrips

Indemnity Benefit & Visitation Expenses
Hospital Indemnity
YOU ARE COVERED FOR:
1. The Hospital Indemnity benefit for each night you spend in the hospital.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You must provide verification of an eligible inpatient hospitalization.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Emergency Reunion
YOU ARE COVERED FOR:
1. The cost of an economy round-trip air or ground transportation ticket for one relative fortransportation to the terminal serving the area where you are hospitalized or are to behospitalized following Emergency Medical Evacuation; and2. Reasonable expenses for lodging and meals for the relative, which are incurred in the area where
you are hospitalized for a period not to exceed 15 days.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You have a covered Emergency Medical Evacuation.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Bedside Visit
YOU ARE COVERED FOR:
1. The cost of an economy round-trip air or ground transportation ticket for one relative fortransportation to the terminal serving the area where you are hospitalized or are to be hospitalized.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You are confined to a hospital intensive care unit following a covered life-threatening bodily injury
or life-threatening illness.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

19

Description of Coverage | WorldTrips

Travel Assistance
Travel Delay
YOU ARE COVERED FOR:
1. Reimbursement for reasonable accommodations and meals when your delay requires anunplanned overnight stay.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The delay must be twelve (12) hours or more and certified due to the following reasons:a. Delay of common carrier (which is certified by the common carrier); or
b. A traffic accident while enroute to the point of departure from an airport outside of yourhome country (substantiated by a police report); or
c. Organized labor strike; ord. You being hijacked or quarantined; ore. Your passports or travel documents are stolen (substantiated by a police report).
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.
Common Carrier means an airplane, bus, train or watercraft operating for commercial purposes andcarrying fare-paying passengers on regularly scheduled and published routes.

Lost Checked Luggage
YOU ARE COVERED FOR:
1. Reimbursement for the cost of lost checked luggage, not to exceed $500 any one item. Coverage
will be reduced by any recovery you receive from the transportation provider.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The lost checked luggage must have been checked, in accordance with routine luggage checking
procedures, for transportation with you, on board a regularly scheduled commercial airline or
cruise line, upon which you were a fare-paying passenger; and2. You must file a formal claim for lost luggage with the transportation provider, and follow all
instructions and take all measures as directed by the transportation provider to locate andretrieve the lost checked luggage; and3. You must provide us with copies of all documentation of the claim filed with the transportation
provider, and a written statement from the transportation provider confirming that the luggage
was checked and after careful search, the luggage remains missing; and The lost checked luggage
must be lost as of the date of our payment and as of that date, must have been lost for at least 10
days.
YOU ARE NOT COVERED:
1. Expenses arising directly or indirectly from anything in the General Exclusions.

20

Description of Coverage | WorldTrips

LOST OR STOLEN PASSPORT/TRAVEL VISA
YOU ARE COVERED FOR:
1. Reimbursement for reasonable cost in replacing your passport or travel visa.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You exercise reasonable care for the safety and supervision of the passport or travel visa; and2. Loss or theft is reported to the police within 24 hours and a written police report is obtained; and3. You provide receipts for the costs associated with the passport or travel visa replacement.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Natural Disaster - Replacement Accommodations
YOU ARE COVERED FOR:
1. Replacement accommodations in the event you are displaced from planned paid accommodations
due to evacuation from forecasted natural disaster or following a natural disaster strike.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You provide a receipt of proof of payment for the accommodations from which you weredisplaced.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.
The following definitions apply to Natural Disaster – Replacement Accommodations coverage:
Displaced means required to depart a destination due to an evacuation ordered by prevailing
authorities.
Natural Disaster means an event of natural cause, including wildfire, earthquake, windborne dust or
sand, volcanic eruption, tsunami, snow, rain or wind, that results in widespread and severe damage.
Natural disaster does not include the direct or indirect effect of rain, wind or water associated withnamed storms meeting the definition of hurricane or typhoon, except in instances where:
1. The path of the named storm deviates by a distance of greater than 200 miles within a 72-hour
period from the path forecast by a nationally recognized meteorological service; or
2. Less than 72 hours advance notice of a potential landfall for a named storm exists.

Emergency Quarantine Indemnity – COVID-19
YOU ARE COVERED FOR:
1. The Emergency Quarantine Indemnity – COVID-19 benefit for each day you are quarantined.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The quarantine is mandated by a physician or governmental authority due to 1) you having tested
positive for COVID-19/SARS-CoV2, or 2) you are symptomatic and waiting on diagnostic test results;
and21

Description of Coverage | WorldTrips

2. You have not previously claimed under this benefit within a 364-day period; and3. You are outside your home country while in quarantine.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Border Entry Protection
YOU ARE COVERED FOR:If you are traveling on a Visitor Visa B-2 for tourism, for visiting family or friends, or on holiday, and you
are denied entry to the United States at the border by customs officials:
1. Reimbursement for the cost of an economy one-way air or ground transportation ticket to theoriginal country of origin; or
2. Common carrier change fee for transportation to the original country of origin less the amountcredited for any unused portion of the return travel arrangements.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You must return to the country of origin; and2. You must not be a citizen or of the United States, have home country of the United States, and/or
have permanent residency in the United States.
YOU ARE NOT COVERED IF:
1.
2.
3.
4.
5.
6.
7.
8.
9.

You are traveling to the United States without a Visitor Visa B-2, or you are travelling illegally; or
You are from a country named on any active executive order at the time of purchase; or
You are on the United States terror watch list; or
You were denied entry to the United States upon arrival or while en route to the United States
because you have violated any rule, law, condition of or guideline regarding the visa upon which
you are traveling; orYou are visiting the United States for medical treatment, participation by amateurs in musical,
sports, or similar events or contests, if compensation is received; or
You are visiting the United States for studies that receive credits towards a degree; or
You committed a crime en route or upon entry to the United States which caused or would havecaused you to be returned to your country of origin; or
The United States government or the common carrier has paid, offered to pay, or will pay for yourrepatriation to your country of origin; or
You have an unused return ticket or credit issued by the common carrier. If credit is not used, theamount reimbursed will be reduced by the amount of the credit.

The following definitions apply to Border Entry coverage:
Country of Origin means the country you were in when you first departed for the United States.
Executive Order means a rule or order issued by the United States President on how federal agencies
are to use their resources and having the force of law.

Pet Return
YOU ARE COVERED FOR:

22

Description of Coverage | WorldTrips

1. The cost of a one-way economy air and/or ground transportation ticket for a pet to be returned tothe terminal serving the area of your principle residence.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You are the only person aged 18 or older traveling with the pet; and2. You are hospitalized for treatment of a covered illness or injury, resulting in the pet being left
unattended for a period of time expected to exceed 36 hours.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.

Personal Accident
Accidental Death and Dismemberment
YOU ARE COVERED FOR:
1. Death – we will pay the amount indicated in the Schedule of Benefits to the beneficiary; or
2. Loss of 2 or more limbs or eyes – we will pay you the amount indicated in the Schedule ofBenefits; or
3. Loss of 1 limb or eye – we will pay you the amount indicated in the Schedule of Benefits.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The accident giving rise to the Accidental Death or Dismemberment must be covered under thisinsurance; and2. The accident giving rise to the accidental death must not be a common carrier accident; and3. Death must occur within 30 days of the sudden, unintentional and unexpected occurrence and not
be contributed to by illness or disease.
YOU ARE NOT COVERED IF:
1. Accidents or loss is caused by or contributed to by any of the following:a. Terrorism, war or act of war, whether declared or undeclared;b. Your participation in a riot, insurrection or violent disorder;c. Your service in the armed forces of any country;
d. Suicide or attempted suicide or intentional self-inflicted injury, while sane or insane;e. The voluntary use of any chemical compound, poison or drug, unless used according to thedirections of a physician;f. Committing or attempting to commit a felony;g. Illness, mental health disorder, or pregnancy;h. As the result, directly or indirectly, of: i) intoxication as defined by the laws of the jurisdiction inwhich the accident or injury occurred, or ii) intoxication consistent with a .08 BAC (Blood
Alcohol Content); whichever is lower;i. Myocardial infarction or cerebrovascular accident (CVA / Stroke);j. Infection, except infection through a wound that was caused solely by an accident;

23

Description of Coverage | WorldTrips

k. Injury while riding, boarding, or alighting from an aircraft if you were operating the aircraft,learning to operate the aircraft, serving as a member of the aircraft crew, or if the aircraft was
being used for any purpose other than passenger transportation;l. Medical or surgical treatment for any of the above; orm.Any non-covered sports activities.
2. Expenses arise directly or indirectly from anything in the General Exclusions.
In no event will our payment under this benefit total more than the principal sum. The maximum liability
under Accidental Death and Dismemberment for any group or family is limited to $250,000.

Common Carrier Accidental Death Benefit
YOU ARE COVERED FOR:
1. The amount indicated in the Schedule of Benefits to the beneficiary.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The accident giving rise to the accidental death must occur while you are a fare paying passenger
on a regularly scheduled trip on board a commercial airline or cruise line;
2. Death must occur within 30 days of the sudden, unintentional and unexpected occurrence and not
be contributed to by illness or disease; and3. The maximum liability under this Common Carrier Accidental Death Benefit for a group or family islimited to $250,000.
YOU ARE NOT COVERED IF:
1. Expenses arise directly or indirectly from anything in the General Exclusions.
The following definitions apply to Personal Accident coverage:
Accidental Death means a sudden, unintentional and unexpected occurrence caused solely by external,
visible means resulting in injury to you and your subsequent death. Death must occur within 30 days ofthe sudden, unintentional and unexpected occurrence and not be contributed to by illness or disease.
Accidental Dismemberment means a sudden, unintentional and unexpected occurrence caused solely
by external, visible means and resulting in complete severance from the body of one or more limbs oreyes and not contributed to by illness or disease. For purposes of the Accidental Death andDismemberment benefit, the term “limb” shall mean: the arm when the severance is at or above(toward the elbow) the wrist, or the leg when the severance is at or above (toward the knee) the ankle.
Loss of eye(s) shall mean: complete, permanent, irrevocable loss of sight.
Beneficiary means the individual named in your application to be the recipient of any Accidental Deathor Common Carrier Accidental Death benefit. If you do not designate a beneficiary on the application,
the beneficiary is automatically in the order as follows:
Members age 18 or older: 1. Spouse (if any), 2. Children (if any) equally, 3. Your estate.
Members under age 18: 1. Custodial Parent(s) (if any), 2. Siblings (if any) equally, 3. Your estate.

24

Description of Coverage | WorldTrips

Sports and Activities
YOU ARE COVERED FOR:
1. You are covered for taking part in amateur/non-professional sports and activities, unless it is
excluded below. Coverage is for recreational purposes incidental to a trip.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. You must ensure that appropriate safety equipment (such as protective headwear, life jacketsetc.) are worn at all times.
YOU ARE NOT COVERED IF:
1.
2.
3.
4.

The activity is organized athletics involving regular or scheduled practice and/or games; orThe activity is performed in a professional capacity or for any wage, reward, or profit; orExpenses arise directly or indirectly from anything in the General Exclusions; or
Any of the excluded items listed below:• All-Terrain Vehicles• American Football• Aussie Rules Football• Aviation (except when traveling solely as apassenger in a commercial aircraft)• Base Jumping• Big Game Hunting• Bobsleigh• Boxing• Cave Diving• Cliff Jumping• Hang-Gliding• Heli-Skiing• Hot Air Ballooning as a Pilot• Ice Hockey• Jousting• Kite-Surfing• Luge• Martial Arts
• Modern Pentathlon• Motorized Dirt Bikes• Mountaineering at elevations of 4,500
meters or higher• Outdoor Endurance Events• Parachuting• Paragliding

25

Description of Coverage | WorldTrips• Parasailing• Powerlifting• Quad Biking• Racing by any Animal, Motorized Vehicle,
or BMX, and Speed Trials and Speedway• Rugby• Running with the Bulls• Skeleton• Sky Surfing• Snow Skiing and Snowboarding, except
recreational
downhillskiing,snowboarding and/or cross-country snow
skiing (no cover provided for recreational
downhill skiing or snowboarding whileskiing away from prepared and marked
in-bound territories and/or for any skiing
or snowboarding against the advice of thelocal ski school or local authoritativebody)• Snow Mobiles• Spelunking• Sub Aqua Pursuits involving underwater
breathing apparatus unless accompanied
by a certified instructor at depths lessthan 10 meters, or PADI/NAUI/SSI
certified• Tractors• Whitewater Rafting• Wrestling

Crisis Response
YOU ARE COVERED FOR:
1. Ransom; and/or
2. Crisis Response Fees and Expenses; and/or
3. Personal Belongings

KIDNAPPING AND EXPRESS KIDNAPPINGYOU ARE NOT COVERED unless you fulfill the following conditions:
1. Notification: Before surrendering a ransom, the person authorizing the surrender shall have notified
or made every reasonable attempt to notify:
a. The Federal Bureau of Investigation or local law enforcement agencies as soon as practicablebearing in mind the safety of the person(s) held or threatened; andb. Unity Advisory Group / On Call International via us.
2. The surrender of a ransom must not be:a. Carried by, transported by or otherwise in your possession at the time that an express kidnappingor kidnapping first occurs; orb. At the location where an express kidnapping or kidnapping first occurs.
3. Confidentiality: You must at all times use best efforts to ensure that knowledge of the existence of thisinsurance is restricted as far as possible.
YOU ARE NOT COVERED IF:
1. Any kidnapping or express kidnapping first occurs in Afghanistan, Central African Republic,

Democratic Republic of the Congo, Iraq, Libya, Mali, Niger, Nigeria, North Korea, Pakistan,
Somalia, Sudan, South Sudan, Syria, Venezuela, Yemen, or any country for which we areprohibited from transaction due to sanctions by the United States Department of the Treasury’s Officeof Foreign Assets Control (OFAC).
2. Any express kidnapping or kidnapping is a result of fraudulent, dishonest or criminal act(s) by you or
your authorized representative (whether acting alone or in collusion with others) unless the person
authorizing the ransom payment had, prior to payment, made every reasonable attempt to determinethat the ransom demand or threat was genuine.
3. Expenses arising directly or indirectly from anything in the General Exclusions.
Limits of Liability:
1. Certificate Period Aggregate: Our total liability for all insured losses shall not exceed the certificate
period aggregate limit set forth herein.
2. In the event that you are covered by two or more policies issued by us covering insured losses arisingfrom a kidnapping or express kidnapping, it is agreed that our aggregate liability for insured losses
sustained by you shall not be cumulative and shall in no event exceed the largest amount available
under any one of the policies.
The following definitions apply to Crisis Response coverage:
26

Description of Coverage | WorldTrips

The following definitions apply to Crisis Response coverage:
Valuation: We shall not be liable for more than the actual cash value of any consideration at the time of its
surrender. If insured losses involve currency other than that of the United States of America, we shall not beliable for more than the United States Dollar equivalent of foreign currency based on the rate of exchange in
the Wall Street Journal in effect on the day the monies are surrendered and/or expense incurred.
Crisis Response Fees and Expenses means all fees and expenses of Unity Advisory Group / On Call
International related to your kidnapping or express kidnapping.
Express Kidnapping means the actual abduction, transportation, and holding of you against your will for aminimum of one (1) hour where your personal belongings and/or readily available assets are surrenderedby you in exchange for your release.
Kidnapping means the actual, alleged, or attempted abduction and holding of you against your will by aperson or persons who demand a ransom specifically from your assets in exchange for your release.
Insured Losses means the following covered losses and expenses: ransom, personal belongings, and/or
crisis response fees and expenses.
Personal Belongings means monies and/or property of monetary value that are:1. Being carried or transported by you when an express kidnapping or kidnapping first occurs; and2. Are surrendered during the course of an express kidnapping or kidnapping.
Ransom means monies and/or other consideration of monetary value that are surrendered or to be
surrendered by you or on your behalf to meet an express kidnapping or kidnapping demand.
Transportation means you being taken from one location to another by means of vehicle, rail, aircraft, or
ship.

Personal Liability
YOU ARE COVERED FOR:
Up to the sum insured shown in the Schedule of Benefits and Limits (inclusive of legal costs andexpenses) if you become legally liable to pay damages in respect of:
1. Accidental bodily injury, including death, illness and disease of a third person; and/or
2. Accidental loss of or damage to a third person’s material property (property that is both material
and tangible); and/or
3. Accidental loss of or damage to a related third person’s material property (property that is bothmaterial and tangible).
YOU ARE NOT COVERED unless you fulfill the following conditions:27

Description of Coverage | WorldTrips

1. You or your legal representatives gives us written notice immediately if you have received notice ofany prosecution or inquest in connection with any circumstances which may give rise to liability
under this section.

2. No admission, offer, promise, payment or indemnity shall be made by or on behalf of you without

our prior written consent.

3. Every claim notice, letter, writ or process or other document served on you shall be forwarded to us

and immediately upon receipt.

4. We shall be entitled to take over and conduct in your name the defence or settlement of any claim or

to prosecute in your name for our own benefit any claim for indemnity or damages against all otherparties or persons.

5. We may at any time pay you in connection with any claim or series of claims the sum insured (after

deduction of any sums already paid as compensation) or any lesser amount for which such claim(s)can be settled. Once this payment is made we shall relinquish the conduct and control and be underno further liability in connection with such claim(s) except for the payment of costs and expenses
recoverable or incurred prior to the date of such payment.

6. We will consider paying or advancing, but without any obligation or contractual duty to do so, up to$2,500 to you or for your benefit to settle and compromise an asserted claim against you so long as:a. The asserted claim is one that may be eligible for coverage under this insurance;b. A lawsuit has not yet been filed, or, if already filed, no response has been filed;c. You obtain a written release and/or covenant-not-to-sue satisfactory to us; andd. A full proof of claim and other necessary documentation is satisfactorily provided to us.

YOU ARE NOT COVERED FOR:
1. Intentionally committed acts, or arising from the influence of alcohol or drugs not medicallyprescribed by a licensed physician;
2. Bodily injury, illness or disease of any person under a contract of employment, service orapprenticeship with you when the bodily injury, illness or disease arises out of and in the course of
their employment to you, or in connection with any trade, business or profession;
3. Loss or damage to property belonging to or held in trust by or in the custody or control of you otherthan temporary accommodation occupied by you in the course of the trip;
4. Bodily injury or damage caused directly or indirectly in connection with the ownership, possession or
use by you or on behalf of you of: aircraft, hovercraft, watercraft, motorized vehicles, parachute,parasail, glider, firearms, fireworks, explosives, deadly weapons, or any racing activity;
5. Any damages, losses or claims caused in whole or in part by you during any hunt or as a result of
hunting;
6. Bodily injury caused directly or indirectly in connection with the ownership, possession or occupationof land or buildings, immobile property or caravans or trailers;
7. Damages resulting from any fire, flood, wind, hail, waterleak, gas leak, explosion or other natural or
man-made catastrophe;
8. Fraudulent, dishonest or criminal acts of you or any person authorised by you to commit such acts;
9. The consequences of any breach, violation or failure to perform any contractual undertakings or
obligations, whether verbal or in writing;28

Description of Coverage | WorldTrips

10. Punitive or exemplary damages, or fines, penalties, assessments or claims by any governmental
authorities or regulatory bodies;
11. Gambling, gaming, or betting of any kind;
12. Animals or pets belonging to you, or in your care, custody or control;
13. Expenses arising directly or indirectly from anything in the General Exclusions.
The following definitions apply to Personal Liability coverage:
Third Person means any individual, natural person, or other legal entity or person, other than you or a
related third person.
Related Third Person means your relative, your traveling companion, your traveling companion’s relative,
and any other person, individual or family member with whom you are residing or being hosted.

Terrorism
YOU ARE COVERED FOR:
1. Eligible Medical Expenses for treatment of injuries and illnesses resulting from an Act of Terrorism, up
to the limit set forth in the Schedule of Benefits and Limits, provided all of the following conditions aremet.
YOU ARE NOT COVERED unless you fulfill the following conditions:
1. The injury or illness does not result from the use of any biological, chemical, cyber, radioactive or
nuclear agent, material, device or weapon;
2. You have no direct or indirect involvement in the Act of Terrorism;
3. The Act of Terrorism is not in a country or location where the United States government has issued alevel 3 or higher travel advisory that has been in effect within the 60 days immediately prior to yourdate of arrival; and4. You have not failed to depart a country or location within 10 days following the date a level 3 orhigher travel advisory for that country or location is issued by the United States government.
YOU ARE NOT COVERED IF:
1. Loss, damage, cost or expense directly or indirectly caused by, resulting from or in connection with anyof the following regardless of any other cause or event contributing concurrently or in any othersequence to the loss, damage, cost or expense:
a. War, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared
or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions ofor amounting to an uprising, military or usurped power;b. The use of any biological, chemical, cyber, radioactive or nuclear agent, material, device or
weapon; however, this exclusion shall not apply where you are exposed to nuclear radioactive
and/or radioactive material for the purpose of medical treatment;
29

Description of Coverage | WorldTrips

c. Any Act of Terrorism, not specifically covered above;d. Coverage for loss, damage, cost or expense of whatsoever nature directly or indirectly caused by,resulting from or in connection with any action taken in controlling, preventing, suppressing or inany way relating to (a), (b) or (c) above; or
e. Expenses arise directly or indirectly from anything in the General Exclusions.
For the purpose of this insurance, an “Act of Terrorism” means an act, including but not limited to, the useof force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone oron behalf of or in connection with any organization(s) or government(s) committed for political, religious,
ideological or similar purposes including the intention to influence any government and/or to put the public,or any section of the public, in fear.
If we allege that by reason of this exclusion, any loss, damage, cost or expense is not covered by thisinsurance, the burden of proving the contrary shall be upon you.
In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shallremain in full force and effect.
The following definitions apply to Terrorism:
Cyber means the use or operations, as a means for inflicting harm, of any computer, computer software
program, malicious code, computer virus or process or any other electronic system.

General Exclusions
Excluded Conditions, Treatments (includes Diagnoses, Tests, and Examinations), Services, Supplies, Acts,
Omissions, and/or Events:
1. Pre-existing Conditions, except charges resulting directly from an acute onset of pre-existing
condition, as herein defined, subject to the limits set forth in the Schedule of Benefits and Limits.
2. Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
3. Mental health disorders.
4. Pregnancy except as covered under Complications of Pregnancy, as herein defined, termination ofpregnancy except in connection with covered Complications of Pregnancy, all charges related topregnancy after the 26th week of pregnancy, routine prenatal care, childbirth, postnatal care, andcharges incurred by a child under the age of 14 days.
5. Impotency or sexual dysfunction.
6. All sexually transmitted diseases and conditions.
7. HIV, AIDS, or ARC, and all diseases caused by and/or related to HIV.
8. All forms of cancer / neoplasm.

30

Description of Coverage | WorldTrips

9. Substance abuse or addiction or conditions that may be attributed to substance abuse or addictions
and direct consequences thereof.
10. Acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, hypertrophic andatrophic conditions of skin, nevus.
11. Sleep apnea or other sleep disorders.
12. Obesity or weight modification, including but not limited to wiring of the teeth and all forms ofintestinal bypass surgery.
13. Intentional self-inflicted injury or illness and/or suicide or attempted suicide whether sane or insane.
14. Injury sustained that is due wholly or partially to the effects of intoxication or drugs other than drugs
taken in accordance with treatment prescribed by a physician and except drugs prescribed for thetreatment of substance abuse.
15. Injury sustained while operating any motorized vehicle, aircraft or watercraft whether registered or
not while under the influence of alcohol as defined under the law of the jurisdiction where the injury
occurs or with a .08 Blood Alcohol Content (BAC), whichever is lower.
16. Routine medical examinations, including but not limited to vaccinations, immunizations, annual checkups, the issue of medical certificates and attestations, and examinations as to the suitability of
employment or travel.
17. Dental treatment and treatment of the temporomandibular joint, except for emergency dental
treatment necessary to replace natural teeth lost or damaged in an accident covered hereunder or forthe emergency relief of acute onset of pain.
18. Promotion or prevention of conception including but not limited to: artificial insemination, treatment
for infertility, sterilization or reversal of sterilization.
19. Organ or tissue transplants or related services.
20. Eye surgery, such as corrective refractory surgery, when the primary purpose is to correctnearsightedness, farsightedness or astigmatism.
21. Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing
implants, eye refraction, visual therapy, and any examination or fitting related to these devices,
dentures or dental appliances, and all vision and hearing tests and examinations, except as provided
for under Emergency Eye Exam.
22. Orthoptics and visual eye training.
23. Orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of
weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns,
calluses or toenails.
24. Hair loss including wigs, hair transplants or any drug that promises hair growth, whether or notprescribed.
25. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy,
holistic care of any nature, massage and kinesiotherapy.
26. Psychometric, intelligence, competency, behavioral and educational testing.
27. Cosmetic or aesthetic reasons, except for reconstructive surgery when such surgery is directly related
to and follows a surgery which was covered hereunder.

31

Description of Coverage | WorldTrips

28. Modifications of the physical body intended to improve the psychological, mental or emotional wellbeing, including but not limited to sex-change surgery.
29. Exercise programs, whether or not prescribed or recommended by a physician.
30. Incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
31. Cryo preservation and implantation or re-implantation of living cells.
32. Genetic or predictive testing.
33. Investigational, experimental or for research purposes.
34. While confined primarily to receive custodial care, educational or rehabilitative care, or any medical
treatment in any establishment for the care of the aged, except rehabilitative care received upon
direct transfer from an acute care hospital.
35. Not medically necessary.
36. Not administered by or under the supervision of a physician, and products that can be purchased
without a doctor's prescription.
37. Provided by a relative, family member or any person who ordinarily resides with you.
38. Provided at no cost to you.
39. Failure to keep a scheduled appointment.
40. Payable under any government system, including the Australian Medicare system.
41. Payable under Worker’s Compensation or Employer’s Liability Laws, or by any coverage provided or
required by law.
42. Charges exceeding usual, reasonable and customary.
43. Charges resulting from or occurring during the commission of a violation of law, including without
limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
44. Any illness or injury incurred as a result of epidemics, pandemics, public health emergencies, natural
disasters, or other disease outbreak conditions that may affect a person’s health when, prior to youreffective date, any of the following were issued:a. The United States Centers for Disease Control & Prevention had issued a Warning/Alert Level 3 orhigher for a location or destination, including common carriers; orb. The United States Centers for Disease Control & Prevention had issued a Global or Worldwide
Warning/Alert Level 3 or higher.
This exclusion is applicable when 1) any of the above were in effect within 60 days immediately prior
to your effective date or 2) within 10 days following the date the alert/warning is issued you havefailed to depart the country or location. This exclusion does not apply to charges resulting fromCOVID-19/SARS-CoV-2.
45. War, military action or while on duty as a member of a police or military force unit.
46. Travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical
Evacuation, Repatriation of Remains, Emergency Reunion, Natural Disaster, Return of Minor Children,
Political Evacuation, Trip Interruption, Travel Delay, Emergency Quarantine Indemnity, and Border
Entry Protection sections of this insurance.
47. Incurred outside your certificate period.
48. Submitted to us for payment more than 60 days after the last day of the certificate period.
32

Description of Coverage | WorldTrips

49. When departure from the home country is to obtain treatment in the destination country/countries.
50. Complications or consequences of a treatment or condition not covered hereunder.
51. Not included as Eligible Expenses as described herein.

Definitions
Accident means a sudden, unintentional and unexpected occurrence caused by external, visible means andresulting in injury to you. The cause or one of the causes of such accident is external to your own body andoccurs beyond your control.
Accidental Death means a sudden, unintentional and unexpected occurrence caused solely by external,
visible means resulting in injury to you and your subsequent death. Death must occur within 30 days of thesudden, unintentional and unexpected occurrence and not be contributed to by illness or disease.
Accidental Dismemberment means a sudden, unintentional and unexpected occurrence caused solely byexternal, visible means and resulting in complete severance from the body of one or more limbs or eyes andnot contributed to by illness or disease. For purposes of the Accidental Death and Dismemberment benefit,
the term “limb” shall mean: the arm when the severance is at or above (toward the elbow) the wrist, or theleg when the severance is at or above (toward the knee) the ankle. Loss of eye(s) shall mean: complete,permanent, irrevocable loss of sight.
Acute Onset of Pain (Emergency Dental) means a sudden and unexpected occurrence of pain which occurs
and without advance warning, either in the form of physician or dentist recommendation or symptoms,
including pain, which would have caused a prudent person to seek medical or dental attention prior to theonset of pain. Initial treatment must be obtained within seventy-two (72) hours of the sudden andunexpected occurrence of pain.
Acute Onset of Pre-existing Condition means a sudden and unexpected outbreak or recurrence that is ofshort duration, is rapidly progressive, and requires urgent care. A pre-existing condition that is a chronic
or congenital, or that gradually becomes worse over time is not acute onset of a pre-existing condition.
An Acute Onset of Pre-existing Condition does not include any condition for which, as of the Effective
date, the Insured Person (i) knew or reasonably foresaw he/she would receive, (ii) knew he/she should
receive, (iii) had scheduled, or (iv) was told that he/she must or should receive, any medical care, drugs ortreatment.
Beneficiary means the individual named in your application to be the recipient of any Accidental Death or
Common Carrier Accidental Death benefit. If you do not designate a beneficiary on the application, thebeneficiary is automatically in the order as follows:
Members age 18 or older: 1. Spouse (if any), 2. Children (if any) equally, 3. Your estate.
Members under age 18: 1. Custodial Parent(s) (if any), 2. Siblings (if any) equally, 3. Your estate.

33

Description of Coverage | WorldTrips

Certificate means the document issued to you that provides evidence of benefits payable under the Master
Policy and that will confirm the plan type, period of cover, home country, certificate number, special terms
and/or conditions, deductible, chosen benefit list, and geographical area of cover.
Certificate Period means the period of time beginning on the date and time of the certificate effective dateand ending on the date and time of the certificate termination date.
Chronic means any condition that usually persists three months or longer.
Congenital means any medical condition, disorder, abnormality, deformity, illness, or injury present atbirth regardless of manifestation, and whether or not previously diagnosed.
Coinsurance means your payment of eligible expenses at the percentage specified in the Schedule ofBenefits and Limits.
Common Carrier means an airplane, bus, train or watercraft operating for commercial purposes and carrying
fare-paying passengers on regularly scheduled and published routes.
Complications of Pregnancy means illnesses whose diagnoses are distinct from pregnancy, but are adversely
affected by pregnancy or caused by pregnancy and not associated with a normal pregnancy. This includes:
ectopic pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed
abortion and conditions of comparable severity. Complications of Pregnancy does not include: false labor,edema, prolonged labor, prescribed rest during the period of pregnancy, morning sickness and conditions ofcomparable severity associated with management of a difficult pregnancy, and not constituting a medicallydistinct condition.
Covered Loss means a loss for which this plan has paid a benefit under Lost Checked Luggage or for an
accidental injury.
Custodial Care means that type of care or service, wherever furnished and by whatever name called, that isdesigned primarily to assist you in performing the activities of daily living. Custodial care also includes nonacute care for the comatose, semi-comatose, paralyzed or mentally incompetent patients.
Cyber means the use or operations, as a means for inflicting harm, of any computer, computer software
program, malicious code, computer virus or process or any other electronic system.
Deductible means the dollar amount of eligible expenses, specified in the Schedule of Benefits and Limits
that you must pay per certificate period before eligible expenses are paid.
Displaced means required to depart a destination due to an evacuation ordered by prevailing authorities.
Durable Medical Equipment means a standard basic hospital bed and/or a standard basic wheelchair.
Educational or Rehabilitative Care means care for restoration (by education or training) of one’s ability tofunction in a normal or near normal manner following an illness or injury. This type of care includes, but is
not limited to, vocational or occupational therapy and speech therapy.
Emergency means a medical condition manifesting itself by acute signs or symptoms which could reasonably
result in placing your life or limb in danger if medical attention is not provided within 24 hours.
Emergency Eye Exam means an eye exam performed by a licensed optometrist to establish propercorrective lens prescription for medically necessary corrective lenses that were lost or damaged as the34

Description of Coverage | WorldTripsresult of a covered loss when the prescription is unable to be determined by the existing corrective lenses
due to their damage or loss.
Extended Care Facility means an institution, or a distinct part of an institution, which is licensed as a
hospital, extended care facility or rehabilitation facility by the state in which it operates; and is regularly
engaged in providing 24-hour skilled nursing care under the regular supervision of a physician and the directsupervision of a registered nurse; and maintains a daily record on each patient; and provides each patientwith a planned program of observation prescribed by a physician; and provides each patient with active
treatment of an illness or injury. Extended care facility does not include a facility primarily for rest, theaged, substance abuse treatment, custodial care, nursing care or for care of mental health disorders or thementally incompetent.
Home Country means the country where you principally reside and receive regular mail. U.S. Citizens are noteligible for coverage within the U.S., except as provided under home country coverage, regardless of thelocation of your principal residence.
Home Health Care Agency means a public or private agency or one of its subdivisions, which operates
pursuant to law and is regularly engaged in providing home nursing care under the supervision of aregistered nurse, and maintains a daily record on each patient, and provides each patient with a planned
program of observation and treatment by a physician.
Home Nursing Care means services provided by a home health care agency and supervised by a registerednurse, which are directed toward the personal care of a patient, provided always that such care is provided
in lieu of medically necessary inpatient care in a hospital.
Hospital means an institution which operates as a hospital pursuant to law, and is licensed by the state or
country in which it operates; and operates primarily for the reception, care and treatment of sick or injured
persons as inpatients; and provides 24-hour nursing service by registered nurses on duty or call; and has astaff of one or more physicians available at all times; and provides organized facilities and equipment for
diagnosis and treatment of acute medical conditions on its premises; and is not primarily a rehabilitation
facility, long-term care facility, extended care facility, nursing, rest, custodial care or convalescent home, aplace for the aged, drug addicts, alcoholics or runaways; or similar establishment.
Illness means a sickness, disorder, pathology, abnormality, ailment, disease or any other medical, physical or
health condition. For purposes of this insurance, illness includes Complications of Pregnancy during the first
26 weeks of pregnancy. Illness does not include learning disabilities, attitudinal disorders or disciplinary
problems.
Injury means an unexpected and unforeseen harm to the body caused by an accident that requires medical
treatment.
Inpatient means a patient who occupies a hospital bed for more than 24 hours for medical treatment andwhose admission was recommended by a physician, or a patient held for observation in a hospital for atleast 12 hours.
Intensive Care Unit means a cardiac care unit or other unit or area of a hospital that meets the required
standards of the Joint Commission on Accreditation of Hospitals for Special Care Units.
Investigational, Experimental or for Research Purposes means procedures, services or supplies that are by
nature or composition, or are used or applied, in a way which deviates from generally accepted standards ofcurrent medical practice.
35

Description of Coverage | WorldTrips

Medically Necessary means a service or supply which is necessary and appropriate for the diagnosis ortreatment of an illness or injury based on generally accepted current medical practice as determined by us.
A service or supply will not be considered medically necessary if is provided only as a convenience to you or
the provider, and/or is not appropriate for your diagnosis or symptoms, and/or exceeds in scope, duration
or intensity that level of care which is needed to provide safe, adequate and appropriate diagnosis ortreatment of an illness or injury.
Member means an individual who is covered under this insurance.
Mental Health Disorder means a mental or emotional disease or disorder which generally denotes a diseaseof the brain with predominant behavioral symptoms; or a disease of the mind or personality, evidenced byabnormal behavior; or a disorder of conduct evidenced by socially deviant behavior. Mental healthdisorders include: psychosis, depression, schizophrenia, bipolar affective disorder, and those psychiatricillnesses listed in the current edition of the diagnostic and Statistical Manual for Mental Disorders of theAmerican Psychiatric Association.
Natural Disaster means an event of natural cause, including wildfire, earthquake, windborne dust or sand,volcanic eruption, tsunami, snow, rain or wind, that results in widespread and severe damage. Natural
disaster does not include the direct or indirect effect of rain, wind or water associated with named storms
meeting the definition of hurricane or typhoon, except in instances where:
1. The path of the named storm deviates by a distance of greater than 200 miles within a 72-hour period
from the path forecast by a nationally recognized meteorological service
2. Or less than 72 hours advance notice of a potential landfall for a named storm exists.
Outpatient means a member who receives medically necessary treatment by a physician for injury orillness that does not require overnight stay in a hospital.
Physician means a Doctor of Medicine (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine(DDM), Doctor of Podiatry (DPM), Doctor of Osteopathy (DO), a licensed Physical Therapist or
Physiotherapist, and a Doctor of Psychiatry (Psy.D) and a Doctor of Psychology (Pys.D). Physician also
includes an Advanced Practice Registered Nurse (APRN), Certified Nurse Practitioner (CNP), Certified
Registered Nurse Anesthetist (CRNA), Nurse Midwife or a Physician Assistant (PA) under the direction of a
medical doctor. A physician must be currently licensed by the jurisdiction in which the services are provided,
and the services must be within the scope of that license and covered under this Master Policy.
Quarantine means your strict isolation imposed by a physician or government authority to prevent the
spread of disease. An embargo preventing you from entering a country is not a quarantine.
Related Third Person means your relative, your traveling companion, your traveling companion’s relative,
and any other person, individual or family member with whom you are residing or being hosted.
Relative means biological or stepparent; biological or stepchild; current spouse; biological or stepsiblings; orparent, children, or sibling in law.
Routine Medical Examination means and examination of the physical body by a physician for preventative
or informative purposes only, and not for the diagnosis or treatment of any condition.
Sexually Transmitted Diseases means diseases including but not limited to syphilis, gonorrhea, chlamydiosis,
trichomoniasis, genital herpes, and Human Papillomavirus (HPV).

36

Description of Coverage | WorldTrips

Spouse means your legal spouse or domestic partner. Such relationship must have met all requirements of avalid marriage contract, domestic partnership, or civil union in the state or country where the parties’
ceremony was performed.
Substance Abuse means alcohol, drug or chemical abuse, overuse or dependency.
Sudden(ly)/Unexpected(ly) means quickly with little to no warning, not expected and unforeseen.
Surgery or Surgical Procedure means an invasive diagnostic procedure or the treatment of illness or injury
by manual or instrumental operations performed by a Physician while the patient is under general or local
anesthesia.
Terms means all terms, provisions, conditions, definitions, deductibles, coinsurance, limits, sub-limits,
limitations, wordings, restrictions, requirements, qualifications and/or exclusions that bind the Insured
Person as set forth in the Master Policy, Application and any Riders.
Third Person means any individual, natural person, or other legal entity or person, other than you or a
related third person.
Treated/Treating/Treatment means any and all services and procedures rendered in the management
and/or care of a patient for the purpose of identifying, diagnosing, treating, curing, preventing, controlling
and/or combating any Illness or Injury, including without limitation: verbal or written advice, consultation,
examination, discussion, diagnostic testing or evaluation of any kind, pharmacotherapy or othermedication, and/or surgery.
Urgent Care Center means a U.S. medical facility separate from a hospital emergency department where
ambulatory patients can be treated on a walk-in basis without an appointment and receive immediate, nonroutine urgent care for an injury or illness presented on an episodic basis.
Usual, Reasonable and Customary means the lesser of the following:
1. One and a half times (150%) of the charges payable under the United States Medicare program, forclaims incurred outside the PPO network within the U.S., or
2. Most common charge for similar services, medicines or supplies within the geographic area in which
the charge is incurred, so long as those charges are reasonable. What is defined as usual, reasonable
and customary charges will be determined by us. In determining whether a charge is usual,reasonable and customary, we may consider one or more of the following factors: the level of skill,extent of training, and experience required to perform the procedure or service; the length of timerequired to perform the procedure or services as compared to the length of time required to perform
other similar services; the severity or nature of the illness or injury being treated; the amount charged
for the same or comparable services, medicines or supplies in the locality; the amount charged for thesame or comparable services, medicines or supplies in other parts of the country where the charges
are incurred; the cost to the provider of providing the service, medicine or supply; such other factors
we, in the reasonable exercise of discretion, determine are appropriate.
Virtual Physician Visit means a live consultation conducted over the internet or phone between you and aphysician.
You/Your means each insured person named in the certificate.
We/Us/Our means WorldTrips.

37

Description of Coverage | WorldTrips