Your Guide to Benefit describes the benefit in effect as of 6/01/18.  
Benefit information in this guide replaces any prior benefit 
information you may have received. Please read and retain for your 
records. Your eligibility is determined by your financial institution.

F026R

Travel Accident Insurance 
Description of Coverage

Principal Sum: $ 1,000,000

THIS IS AN ACCIDENTAL DEATH AND DISMEMBERMENT ONLY POLICY  
AND DOES NOT PAY BENEFITS FOR LOSS FROM SICKNESS

This Description of Coverage is provided to all eligible Platinum/Platinum Plus Visa 
cardholders and replaces any and all Descriptions of Coverage previously issued to the 
insured with respect to insurance described herein.

Eligibility and Period of Coverage
As a Platinum/Platinum Plus Visa cardholder, you are covered beginning on 6/1/18 or 
the date your credit card is issued, whichever is later.

You and your dependents* become covered automatically when the entire Common 
Carrier fare is charged to your covered Platinum/Platinum Plus Visa card account 
(“Covered Person”). It is not necessary to notify the financial institution, the Insurance 
Company, or the Plan Administrator when tickets are purchased. Coverage ends when 
the policy is terminated.

*  Your spouse, unmarried dependent child(ren), under age 19 (25 if a full-time student). No age limit for 

incapacitated child. Incapacitated child means a child incapable of self-sustaining employment by reason 
of mental retardation or physical handicap, and chiefly dependent on you for support and maintenance. 
Dependent child(ren) receive fifty percent (50%) of your benefit amount.

Benefits
Subject to the terms and conditions, if a Covered Person’s accidental bodily Injury 
occurs while on a Covered Trip and results in any of the following Losses within one 
(1) year after the date of the accident, the Insurance Company will pay the following 
percentage of the Principal Sum for accidental Loss of:

Life 

Both hands or both feet 

Sight of both eyes 

One hand and one foot 

Speech and hearing 

One hand or one foot and the sight of one eye 

One hand or one foot 

Sight of one eye 

Speech or hearing 

Thumb and index finger on the same hand 

100%

100%

100%

100%

100%

100%

50%

50%

50%

25%

In no event will multiple charge cards obligate the Insurance Company in excess of 
the stated benefit for any one Loss sustained by a Covered Person as a result of any 
one accident. The maximum amount payable for all Losses due to the same accident 
is the Principal Sum.

CLAIMS SNAPSHOT

You purchase
 your entire 
Common Carrier fare 
with your covered card 

While traveling on 
your Covered Trip 
you have an accidental 
bodily injury which 
results in a loss

20 DAYS

Written notice of claim 
should be mailed to the 
Plan Administrator

Claim settled

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228    06/18

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CLAIMS SNAPSHOT

You are involved in 

a fender bender with 

your rental car

45 DAYS

Call the

Benefits Administrator; 

to report accident; 

recieve claim form

6 MONTHS

Submit Claim Form

12 MONTHS

All supporting documents

must be provided

Claim settled

change the benefits and features of all these programs.

The financial institution or the Company can cancel or choose not to renew the 
Insurance coverages for all Insureds. If this happens, the financial institution will 
notify the accountholder at least 30 days in advance of the expiration of the policy. 
Such notices need not be given if substantially similar replacement coverage takes 
effect without interruption and is provided by the same insurer. Insurance benefits 
will still apply to Covered Trips commenced prior to the date of such cancellation or 
non-renewal, provided all other terms and conditions of coverage are met. Travel 
Accident Insurance does not apply if your Platinum/Platinum Plus Visa privileges have 
been suspended or cancelled. However, insurance benefits will still apply to Covered 
Trips commenced prior to the date that your account is suspended or cancelled 
provided all other terms and conditions of coverage are met.

You are involved in 
a fender bender with 
your rental car

CLAIMS SNAPSHOT

45 DAYS

Call the
Benefits Administrator; 
to report accident; 
recieve claim form

Coverage will be void if, at any time, the accountholder has concealed or  
misrepresented any material fact or circumstance concerning this coverage or the 
subject thereof or the accountholder’s interest herein, or in the case of any fraud or 
false swearing by the Insured relating thereto. No person or entity other than the 
accountholder shall have any legal or equitable right, remedy, or claim for insurance 
proceeds and/or damages under or arising out of this coverage.  

6 MONTHS

Submit Claim Form

No action at law or in equity shall be brought to recover on this coverage prior to the 
expiration of sixty (60) days after proof of Loss has been furnished in accordance with 
the requirements of this Description of Coverage.

12 MONTHS

The Company, at its expense, has the right to have you examined as often as 
reasonably necessary while a claim is pending. The Company may also have an 
autopsy made unless prohibited by law. 

All supporting documents
must be provided

Claim settled

State Amendments
For Illinois Residents Only: The following statement is added: If a Covered Person 
recovers expenses for sickness or injury that occurred due to the negligence of a third 
party, the Company has the right to first reimbursement for all benefits the Company 
paid from any and all damages collected from the negligent third party for those 
same expenses whether by action at law, settlement, or compromise, by the Covered 
Person, the Covered Person’s parents if the Covered Person is a minor, or the Covered 
Person’s legal representative as a result of that sickness or injury. You are required 
to furnish any information or assistance, or provide any documents that we may 
reasonably require in order to exercise our rights under this provision. This provision 
applies whether or not the third party admits liability.

ADD (10/07)

Definitions
Loss means actual severance through or above the wrist or ankle joints with regard 
to hands and feet; entire and irrevocable loss of sight, speech or hearing; actual 
severance through or above the metacarpophalangeal joints with regard to thumb 
and index fingers. The life benefit provides coverage in the event of a Covered 
Person’s death. If a Covered Person’s body has not been found within one (1) year of 
disappearance, stranding, sinking, or wreckage of any Common Carrier in which the 
Covered Person was covered as a passenger, then it shall be presumed, subject to all 
other provisions and conditions of this coverage, the Covered Person suffered  
loss of life.

Injury means bodily injury or injuries, sustained by the insured person which are the 
direct cause of Loss, independent of disease cause of Loss, independent of disease or 
bodily infirmity, and occurring while the Covered Person is covered under this policy, 
while the insurance is in force.

Covered Trip means a trip (a) while the Covered Person is riding on a Common 
Carrier as a passenger and not as a pilot, operator, or crew member and (b) charged 
to your Platinum/Platinum Plus Visa card; and (c) that begins and ends at the places 
designated on the ticket purchased for the trip. Covered Trip will also include travel 
on a Common Carrier (excluding aircraft), directly to, from, or at any Common Carrier 
terminal, which travel immediately precedes departure to or follows arrival at the 
destination designated on the ticket purchased for the Covered Trip.

Common Carrier means any scheduled airline, land, or water conveyance licensed 
for transportation of passengers for hire.

Exclusions: No payment will be made for any Loss that occurs in connection with, or 
is the result of: (a) suicide, attempted suicide, or intentionally self-inflicted injury; (b) 
any sickness or disease; (c) travel or flight on any kind of aircraft or Common Carrier 
except as a fare-paying passenger in an aircraft or on a Common Carrier operated on 
a regular schedule for passenger service over an established route; or (d) war or act of 
war, whether declared or undeclared.

Beneficiary: Benefit for Loss of life is payable to your estate, or to the beneficiary 
designated in writing by you. All other benefits are payable to you.

Notice of Claim: Written notice of claim, including your name and reference to 
Platinum/Platinum Plus Visa  should be mailed to the Plan Administrator within twenty 
(20) days of a covered Loss or as soon as reasonably possible. The Plan Administrator 
will send the claimant forms for filing proof of Loss.

The Cost: This travel insurance is purchased for you by your financial institution.

Description of Coverage: This description of coverage details material facts  
about a Travel Accident Insurance Policy which has been established for you and is 
underwritten by Virginia Surety Company, Inc. Please read this description carefully. 
All provisions of the plan are in the master policy form number, VSC-VCC-01 (2/00). 
Any difference between the policy and this description will be settled according to 
the provisions of the policy.

Questions: Answers to specific questions can be obtained by writing to the  
Plan Administrator:

cbsi Card Benefit Services 
550 Mamaroneck Avenue, Suite 309 
Harrison, NY 10528

Underwritten by:   

Virginia Surety Company, Inc.  
175 West Jackson Blvd. 
Chicago, IL 60604

Additional Provisions for Travel Accident Insurance
Travel Accident Insurance is provided under a master policy of insurance issued by 
Virginia Surety Company, Inc. (herein referred to as Company). We reserve the right to 

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