Emergency Medical

C. EMERGENCY MEDICAL EXPENSE PLAN

1. EMERGENCY MEDICAL EXPENSE BENEFIT

Subject to SECTION II – EFFECTIVE AND TERMINATION DATES OF INSURANCE, A. EFFECTIVE DATE, the Insured’s coverage under the Emergency Medical Expense Benefit will take effect on the Scheduled Date of Departure.

We will pay the Insured an Emergency Medical Expense Benefit, for the Covered Expenses described below in this Emergency Medical Expense Benefit section, up to the corresponding Maximum Covered Amount per Insured shown in the Schedule for the following Covered Expenses incurred by the Insured, subject to the following: (i) Covered Expenses will only be payable at the Usual and Customary level of payment; (ii) benefits will be payable only for Covered Expenses resulting from a Sickness that first manifests itself or a Covered Injury that occurs while on a Covered Trip; (iii) the Insured must first receive treatment by a Physician, in person during his/her Covered Trip; and (iv) benefits payable as a result of incurred Covered Expenses will only be paid after benefits have been paid under any In Force Policy in effect for the Insured or in accordance with a Coordination of Benefits provision in jurisdictions where excess coverage provisions are not permitted.

The following are Covered Expenses under this Emergency Medical Expense Benefit:

(1) expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services incurred by the Insured that occurred during a Covered Trip; and

(2) expenses for a Hospital Admission Guarantee Charge or a Medical Expense Guarantee Charge if while traveling outside of the Insured’s country of Primary Residence on a Covered Trip, the Insured suffers a medical emergency. We or Our Assistance Provider will pay on the Insured’s behalf or reimburse up to the Hospital Admission Guarantee Charge or Medical Expense Guarantee Charge Benefit, up to the corresponding Maximum Covered Amount per Insured shown in the Schedule, for actual expenses incurred for guarantee of payment to the Hospital or the medical provider.

The Insured’s duties in the event of a Medical Expense:

(i) The Insured must provide Us with all bills and reports for medical expenses claimed.

(ii) The Insured must provide any requested information, including but not limited to, an explanation of benefits from any other applicable insurance.

(iii) The Insured must sign a patient authorization to release any information required by Us to investigate his/her claim.

2. EMERGENCY DENTAL EXPENSE BENEFIT – Maximum Covered Amount per Insured $1,000

Subject to SECTION II – EFFECTIVE AND TERMINATION DATES OF INSURANCE, A. EFFECTIVE DATE, the Insured’s coverage under the Emergency Dental Expense Benefit will take effect on the Scheduled Date of Departure.

We will pay the Insured an Emergency Dental Expense Benefit, up to the corresponding Maximum Covered Amount per Insured shown in the Schedule, for the following Covered Expenses incurred by the Insured, subject to the following: (i) Covered Expenses will only be payable at the Usual and Customary level of payment; (ii) benefits will be payable only for Covered Expenses resulting from a Covered Injury that occurs while on a Covered Trip; (iii) the Insured must first receive treatment during his her Covered Trip by a Dentist; and (iv) benefits payable as a result of incurred Covered Expenses will only be paid after benefits have been paid under any Other Valid and Collectible Insurance in effect for the Insured or in accordance
with a Coordination of Benefits provision in jurisdictions where excess coverage provisions are not permitted.

The following are Covered Expenses under this Emergency Dental Expense Benefit:

a. expenses for emergency dental treatment incurred by the Insured during his/her Covered Trip.

The Insured’s duties in the event of a Dental Expense:

(1) The Insured must provide Us with all bills and reports for dental expenses claimed.

(2) The Insured must provide any requested information, including but not limited to, an explanation of benefits from any other applicable insurance.

(3) The Insured must sign a patient authorization to release any information required by Us to investigate his/her claim.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

EMERGENCY ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for covered Medical Expenses incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following: 1) covered Medical Expenses will only be payable at the Usual and Customary level of charges; 2) benefits will be payable only for covered Medical Expenses resulting from an Emergency Condition that first manifests itself or occurs while on Your Trip; and 3) only Medical Expenses incurred during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

Benefits will include up to $750 for expenses incurred during Your Trip for emergency dental treatment. Dental expenses incurred after Your Trip is completed are not covered.

“Emergency Condition” means an Injury or Sickness diagnosed by a Physician for which You have sudden and unexpected severe or acute symptoms requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of Your condition or place Your life in jeopardy. The severe or acute symptoms must occur while on Your Trip.

“Medical Expenses” means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip), if recommended by Your attending Physician and approved by Us or Our Program Assistance Provider as a substitute for a hospital room for recovery from Your Emergency Condition;

3. local Transportation Expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

We will advance payment to a Hospital, up to the Maximum Benefit Amount shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital because of a covered Emergency Condition.

EMERGENCY ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for covered Medical Expenses incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following: 1) covered Medical Expenses will only be payable at the Usual and Customary level of charges; 2) benefits will be payable only for covered Medical Expenses resulting from an Emergency Condition that first manifests itself or occurs while on Your Trip; and 3) only Medical Expenses incurred during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

Benefits will include up to $750 for expenses incurred during Your Trip for emergency dental treatment. Dental expenses incurred after Your Trip is completed are not covered.

“Emergency Condition” means an Injury or Sickness diagnosed by a Physician for which You have sudden and unexpected severe or acute symptoms requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of Your condition or place Your life in jeopardy. The severe or acute symptoms must occur while on Your Trip.

“Medical Expenses” means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip), if recommended by Your attending Physician and approved by Us or Our Program Assistance Provider as a substitute for a hospital room for recovery from Your Emergency Condition;

3. local Transportation Expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

We will advance payment to a Hospital, up to the Maximum Benefit Amount shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital because of a covered Emergency Condition.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits , subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits , subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits , subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

TRAVEL MEDICAL EXPENSE

We will pay a benefit to reimburse you for the reasonable and customary charges, up to the maximum limit shown in the schedule of benefits (and after satisfaction of the deductible) if you suffer an injury or sickness during the covered trip that requirestreatment by a physician. The injury must occur or the sickness must first begin while on a covered trip. The initial documented treatment must be given by a physician during the covered trip.

Travel Medical Covered Expenses:

We will pay a benefit to reimburse you the medically necessary expenses incurred for:

a. Services of a physician or nurse, and related tests or treatment;

b. Hospital charges or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or hotel room, not already included in the cost of your covered trip, if recommended as a substitute for a hospital room for recovery from an injury or sickness;

c. Prescription medication to treat the injury or sickness;

d. Charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;

e. Local ambulance services to and from a hospital;

f. Hospital room and board

g. Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices; and

h. The cost of emergency dental treatment for accidental injury to sound natural teeth that occurs during a covered trip limited to the Maximum Limit shown in the schedule of benefits.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after you have reached your return destination, regardless of the reason. The treatment must be given by a physician or dentist.

We will pay a benefit to reimburse you for these expenses for all treatment related to the initial injury or sickness for thirty (30) days from the date of the first treatment during the covered trip, or until the return date, whichever is later. Otherwise, we will not pay for any expenses incurred after the Coverage Termination Date as shown in the Effective and Termination Dates section of this policy, regardless of the reason.

We will not pay benefits in excess of the reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or already included within the cost of the covered trip.

Adventure Sports Coverage: Benefits will be paid up to the limit shown in the schedule of benefits, if you suffer an injury while participating adventure activities.

Extreme Sports Coverage: Benefits will be paid up to the limit shown in the schedule of benefits, if you suffer an injury while participating in extreme activities

Winter Sports Coverage: Benefits will be paid up to the limit shown in the schedule of benefits, if you suffer an injury while participating in winter activities.

Advance Payment: If you require admission to a hospital during a covered trip for an injury or sickness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. Hospital confinement must be certified as medically necessary by the onsite attending physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the schedule of benefits. You agree to reimburse this payment to us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or

b. It is determined that your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by you. However:

a. We reserve the right to deny a request for advance payment if we confirm that your claim is not covered under the Policy; and

b. An advance payment made by us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the policy.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre‐existing medical conditions will be covered if the Pre‐ existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:
● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X‐rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Berkshire Hathaway Specialty Concierge will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician.

The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip.

Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:

The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● Local ambulance services to and/or from a Hospital; and
● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Berkshire Hathaway Specialty Concierge will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip. Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:
The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● Local ambulance services to and/or from a Hospital; and
● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Preexisting Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip.

Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.Covered Expenses:

The Company will reimburse the Insured for:
● Services of a Physician, Dentist, or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● Local ambulance services to and/or from a Hospital; and
● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason.

The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Berkshire Hathaway Specialty Insurance will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip. Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:
The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● Local ambulance services to and/or from a Hospital; and

● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or

Hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center
services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

NOTICE OF SPORTS COVERAGE – EXTREME SPORTS BENEFITS

If You suffer a Loss due to an Accidental Injury while participating in Extreme Sports as defined, such activities will not be excluded under LIMITATIONS AND EXCLUSIONS, and You have access to benefits outlined in this Policy up to the Maximum Benefit subject to any applicable sub-limit shown on the Schedule of Benefits for Extreme Sports.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center
services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

NOTICE OF SPORTS COVERAGE – EXTREME SPORTS BENEFITS

If You suffer a Loss due to an Accidental Injury while participating in Extreme Sports as defined, such activities will not be excluded under LIMITATIONS AND EXCLUSIONS, and You have access to benefits outlined in this Policy up to the Maximum Benefit subject to any applicable sub-limit shown on the Schedule of Benefits for Extreme Sports.

MEDICAL AND DENTAL COVERAGE

We will pay this benefit, up to the amount on the Schedule, for the following covered expenses incurred by you, subject to the following:

1. Covered expenses will only be payable at the Usual and Customary level of payment; and

2. Benefits will be payable only for covered expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on a Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you within one year from the date of your Sickness or Injury during a Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental Expense:

1. You must provide us with all bills and reports for medical and/or dental expenses claimed.

2. You must provide any requested information related to the claimed expense(s), including but not limited to, an explanation of benefits from any other applicable insurance.

3. You must sign a patient authorization to release any information required by us, to investigate your claim.

Please refer to the Definitions, for an explanation of Pre- Existing Conditions, which are excluded under the Medical or Dental Expense Benefits.

Coordination of Benefits

If you reside in CT, ID, IL, and excess coverage for Medical and Dental Expense Benefits is not permitted, then coordination of benefit provisions in accordance with the laws and regulations in your state will apply in lieu of the excess coverage provisions.

MEDICAL AND DENTAL COVERAGE

We will pay this benefit, up to the amount on the Schedule, for the following covered expenses incurred by you, subject to the following:

1. Covered expenses will only be payable at the Usual and Customary level of payment; and

2. Benefits will be payable only for covered expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on a Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you within one year from the date of your Sickness or Injury during a Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental Expense:

1. You must provide us with all bills and reports for medical and/or dental expenses claimed.

2. You must provide any requested information related to the claimed expense(s), including but not limited to, an explanation of benefits from any other applicable insurance.

3. You must sign a patient authorization to release any information required by us, to investigate your claim.

Please refer to the Definitions, for an explanation of Pre- Existing Conditions, which are excluded under the Medical or Dental Expense Benefits.

Coordination of Benefits

If you reside in CT, ID, IL, and excess coverage for Medical and Dental Expense Benefits is not permitted, then coordination of benefit provisions in accordance with the laws and regulations in your state will apply in lieu of the excess coverage provisions.

MEDICAL AND DENTAL COVERAGE

We will pay this benefit, up to the amount on the Schedule, for the following covered expenses incurred by you, subject to the following:

1. Covered expenses will only be payable at the Usual and Customary level of payment; and

2. Benefits will be payable only for covered expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on a Trip; and

3. Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for you. This coverage is in excess to any other health insurance you have available to you at the time of the loss. You must submit your claim to that provider first. Any benefits you receive from your primary or supplementary insurance providers will be deducted from your claim with us.

Covered Expenses:

1. Expenses for the following Physician-ordered medical services: services of legally qualified Physicians and graduate nurses, charges for Hospital confinement and services, local ambulance services, prescription drugs and medicines, and therapeutic services, incurred by you within one year from the date of your Sickness or Injury during a Trip; and

2. Expenses for emergency dental treatment incurred by you during a Trip up to the amount in the Schedule.

Your duties in the event of a Medical or Dental Expense:

1. You must provide us with all bills and reports for medical and/or dental expenses claimed.

2. You must provide any requested information related to the claimed expense(s), including but not limited to, an explanation of benefits from any other applicable insurance.

3. You must sign a patient authorization to release any information required by us, to investigate your claim.

Please refer to the Definitions, for an explanation of Pre- Existing Conditions, which are excluded under the Medical or Dental Expense Benefits.

Coordination of Benefits

If you reside in CT, ID, IL, and excess coverage for Medical and Dental Expense Benefits is not permitted, then coordination of benefit provisions in accordance with the laws and regulations in your state will apply in lieu of the excess coverage provisions.

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing are not covered under this Plan.

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate including for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Note: Injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United State government.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture

Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Choice of Hospital and Physician: Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan.

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving at a depth of 20 meters or less, provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing are not covered under this Plan.

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate including for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Note: Injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United State government.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture

Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Choice of Hospital and Physician: Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving at a depth of 20 meters or less, provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

*Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing or expenses for quarantining(confinement outside of a hospital setting) are not covered under this Plan

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate other than for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture
Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Note: For existing and/or perspective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or travel to that country or location is issued by the United State government.

Choice of Hospital and Physician:

Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan.

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving at a depth of 20 meters or less, provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Note: For existing and/or prospective members, injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location or is traveling to a country or location following the date a warning to leave or avoid travel to that country or location is issued by the United States government.

*Coronavirus disease (COVID-19) and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are not subject to the above exception and are covered as any other Injury or Illness. Medical Expenses associated with asymptomatic testing or expenses for quarantining (confinement outside of a hospital setting) are not covered under this Plan.

Services and Supplies Provided by a Hospital

For any eligible condition not excluded under this Certificate other than for Mental, Emotional or Functional Nervous Conditions or Disorders, and Substance Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.

Note: When outside the United States, this benefit will provide coverage for private rooms if that is all that is available or if the choice is between a ward or a more than two person room and a private room.

2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

3. Emergency Hospitalization and Emergency Medical Care provided in a Hospital emergency room, including professional air and ground ambulance services for transport to and from the Hospital for such Emergency Hospitalization and Emergency Medical Care.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.

2. Services are provided only for the number of days required to treat the Covered Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Note: Injuries and Illnesses resulting from Terrorism and pandemics are covered as any other Injury or Illness provided all of the following conditions are met:

1. The Covered Person had no direct or indirect involvement in the Terrorist Activity;

2. The Covered Person has not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United State government.

Professional and Other Services

The Insurer will pay Covered Expenses not excluded under this Certificate for:

1. Services of a Physician.

2. Services of an anesthesiologist or an anesthetist.

3. Outpatient diagnostic radiology and laboratory services.

4. Surgical implants.

5. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.

6. Self-Administered injectable drugs.

7. Syringes when dispensed with self-administered injectable drugs (except insulin).

8. Blood transfusions, including blood processing and the cost of un-replaced blood and blood products.

9. Rental or purchase of Durable Medical Equipment and/or supplies that are all of the following:

a) ordered by a Physician;

b) of no further use when medical need ends;

c) usable only by the patient;

d) not primarily for the Covered Person’s comfort or hygiene;

e) not for environmental control;

f) not for exercise; and

g) manufactured specifically for medical use.

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Certificate of Coverage. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services

The following ambulance services are covered under this Certificate of Coverage:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.

2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

The Insurer pays as stated in the Benefit Overview Matrix.

Complications of Pregnancy

Complications of Pregnancy are covered under this Certificate of Coverage as any other medical condition. Benefits for complications of pregnancy shall be provided for all Covered Persons.

Dental Care for an Accidental Injury

Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Covered Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;

2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and

3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Certificate of Coverage.

In addition, the Certificate of Coverage provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering general anesthesia are not considered Medically Necessary. The Insurer pays as stated in the Benefit Overview Matrix.

Dental Care for Relief of Pain

Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Covered Person is covered under this Certificate of Coverage. Services must be received while covered during the Trip Coverage Period. The Insurer pays as stated in the Benefit Overview Matrix.

Physical and/or Occupational Therapy/Medicine, Including spinal manipulations and other specified therapies including acupuncture
Charges incurred for the following rehabilitative therapies, if prescribed by a Physician to restore function loss due to an illness or injury covered under this Certificate of Coverage: physical, occupational, chelation, massage, hearing and cardiac/pulmonary therapy. Additionally, coverage shall also be provided for chiropractic care delivered by a currently licensed chiropractor acting within the scope of his or her practice. The coverage shall include initial diagnosis and clinically appropriate and Medically Necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the Certificate of Coverage; Acupuncture that treats a covered illness or injury provided by Doctor of Acupuncture.

Therapies excluded under this coverage include, but are not limited to: speech therapy, vocational rehabilitation, behavioral training, gym or swim therapy, dance therapy, marital counseling, legal or financial counseling, biofeedback, neuro-feedback, hypnosis, sleep therapy, employment counseling, back to school, return to work services, work hardening programs, driving safety, and services, training, educational therapy or other non-medical ancillary services for learning disabilities, developmental delays or intellectual disabilities.

These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

Choice of Hospital and Physician: Nothing contained in this Plan restricts or interferes with the Eligible Participant’s right to select the Hospital or Physician of the Eligible Participant’s choice. Also, nothing in this Plan restricts the Eligible Participant’s right to receive, at his/her expense, any treatment not covered in this Plan.

Benefits for Claims resulting from downhill skiing and scuba diving

The Insurer will pay Covered Expenses for claims resulting from downhill (alpine) skiing. It will also pay Covered Expenses resulting from scuba diving at a depth of 20 meters or less, provided that the diver is certified by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI), or equivalent governing body, or provided that he/she is diving under the supervision of a certified instructor. These Covered Expenses are Limited as stated in the Benefit Overview Matrix.

ACCIDENT and SICKNESS MEDICAL EXPENSE BENEFIT

We will pay Usual Reasonable and Customary charges for Eligible Expenses, excess of the chosen Deductible and Coinsurance up to the selected Medical Maximum (age 70-79, medical maximum limited to$100,000 unless reduced maximum amount selected; age 80+ medical maximum limited to $20,000), incurred by You due to an accidental Injury or Sickness which occurred during the period of coverage outside your Home Country(except as provided under the Home Country Coverage). All bodily disorders existing simultaneously which are due to the same or related causes will be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement, the Disablement will be considered a continuation of the prior Disablement and not a separate Disablement. The initial treatment of an Injury or Sickness must occur within 30 days of the date of Injury or onset of Sickness.

We will pay Accident and Sickness Medical Expense Benefits for Eligible Expenses. These benefits are subject to the Deductibles, Coinsurance Factors, Benefit Maximums and other terms or limits shown below and in the Schedule of Benefits. Only such Expenses that are specifically enumerated in the following list of charges that are incurred for the medical care and supplies which are incurred within: i) 52 weeks for US Citizens; or ii) 26 weeks for Non US Citizens from the date of the disablement will be considered.

Accident and Sickness Medical Expense Benefits are only payable:

1) for Usual, Reasonable and Customary Charges incurred after the Deductible has been met;

2) for those Medically Necessary Eligible Expenses incurred by or on behalf of the Plan Participant;

No benefits will be paid for any expenses incurred that are in excess of Usual, Reasonable and Customary Charges. Eligible Expenses include:

1) Hospital Admission Expenses: Charges for each hospital admission.

2) Outpatient Pre-Surgical Testing benefit – charges for Pre-surgical testing. A scheduled surgical procedure must occur within 7days of the testing.

3) Nursing Services – Outpatient Charges for nursing services by a Registered Nurse or Licensed Professional.

4) Dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon.

5) Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.

6) In-Patient Hospital Room & Board Benefit, Intensive Care Unit Benefit, Hospital Miscellaneous Expense Benefit, Day Surgery Miscellaneous, Surgeon (In or Outpatient) Benefits, Assistant Surgeon Benefit (In or Outpatient).

7) Pre-Admission Testing Benefit, Anesthesia Benefit, Diagnostic X-Ray and Laboratory Benefit

8) Ambulance Benefit

9) Physician Visit Benefit (Inpatient or Outpatient), Consultant Physician Benefit.

10) Emergency Room Benefit, Physiotherapy Expense Benefit (In / URC) or (Outpatient / Physiotherapy Care subject to $50 per visit 10 visits maximum), Durable Medical Equipment Expense Benefit

11) Out-Patient Prescription Drug Benefit

Emergency Dental Treatment (Accident) -We will pay benefits as described in the Schedule of Benefits for expenses incurred during the Plan Participant’s Trip for emergency dental treatment. Only expenses for emergency dental treatment to natural teeth incurred during the Trip will be reimbursed. Expenses incurred after the Trip are not cover.

Emergency Dental Treatment (Palliative) – We will pay benefits as described in the Schedule of Benefits for eligible expenses for Palliative Dental; an eligible Dental condition will mean emergency pain relief treatment to natural teeth.

ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, subject to any Deductible shown on the Schedule of Benefits if You incur Covered Medical Expenses for Necessary Treatment as a result of an Accidental Injury or Sickness that occurs during the Trip. You must receive initial treatment for Accidental Injuries within thirty (30) days of the Accident that caused them or the onset of the Sickness and while on the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services; and
f) emergency and palliative dental treatment (limited to expenses incurred while on Your Trip).

The Company will not reimburse benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or Sickness which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, subject to any Deductible shown on the Schedule of Benefits if You incur Covered Medical Expenses for Necessary Treatment as a result of an Accidental Injury or Sickness that occurs during the Trip. You must receive initial treatment for Accidental Injuries within thirty (30) days of the Accident that caused them or the onset of the Sickness and while on the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms;
c) charge for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services; and
f) emergency and palliative dental treatment (limited to expenses incurred while on Your Trip).

The Company will not reimburse benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or Sickness which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

ACCIDENT & SICKNESS MEDICAL AND DENTAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a) benefits will be payable only for Medical Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on Your Trip (of a duration of one hundred eighty (180) days or less for Sickness) and requires treatment in person by a Physician;

b) only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy. An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

ACCIDENT & SICKNESS MEDICAL AND DENTAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a) benefits will be payable only for Medical Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on Your Trip (of a duration of one hundred eighty (180) days or less for Sickness) and requires treatment in person by a Physician;

b) only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits. Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered. We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy. An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

G. ELIGIBLE MEDICAL EXPENSES:

Subject to the Terms of this insurance, and the insurance plan shown in the Declaration, the Company will reimburse the Insured Person up to the amount shown in the BENEFIT SUMMARY for the following costs, Charges and expenses incurred by the Insured Person during the Period of Coverage with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Illness or Injury is covered under this Certificate, Charges are Usual, Reasonable and Customary, and Charges are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”):

(1) Charges incurred at a Hospital for:

a) daily room and board, nursing services, and Ancillary Services not to exceed the average semi-private room rate. A private room will be considered when no semi-private room is available or if medical necessity warrants this type of room. The private room rate is not to exceed the average private room rate.

b) daily room and board, nursing services and Ancillary Services in an Intensive Care Unit

c) use of operating, Treatment or recovery room

d) services and supplies that are routinely provided by the Hospital to persons for use while an Inpatient

e) Emergency Treatment of an Injury, even if Hospital confinement is not required

f) Emergency Treatment of an Illness; however, an additional Deductible (as shown in the BENEFIT SUMMARY) will be required unless the Insured Person is directly admitted to the Hospital as Inpatient for further Treatment of that Illness

(2) Charges incurred for Surgery at an Outpatient Surgical Facility, including services and supplies

(3) Charges by a Physician for professional services rendered, including Surgery; provided, however, that Charges by or for an assistant surgeon will be limited and covered at the rate of up to twenty percent (20%) of the Usual, Reasonable and Customary charge of the primary surgeon; and provided, further, that the standby availability of a Physician or surgeon will not be deemed to be a professional service and is not eligible for coverage

(4) Charges incurred for:

a) dressings, sutures, casts or other supplies that are Medically Necessary

b) diagnostic testing using Radiology, ultrasonography or laboratory services. Laboratory services billed for professional component fees are covered if the pathologist has direct involvement in providing a written report or verbal consultation for specimen-specific pathology services

c) Implant devices that are Medically Necessary; however, any Implants provided outside the PPO network are limited to a payment of no more than one hundred fifty percent (150%) of the established invoice price and/or list price for that item

d) basic functional artificial limbs, eye or larynx or breast prostheses, but not the replacement or repair thereof

e) reconstructive Surgery when the Surgery is incidental to and follows Surgery that was covered hereunder

f) radiation therapy or Treatment, and chemotherapy

g) hemodialysis for the Treatment of acute renal failure only and the Charges by a Hospital for processing and administration of blood or blood components

h) oxygen and other gases and their administration

i) anesthetics and their administration by a Physician

j) drugs that require a prescription by a Physician for Treatment of Illness or Injury, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of ninety (90) days of any one (1) prescription

k) care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital

l) Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital

m) Emergency Local Ambulance Transport necessarily incurred in connection with:

i) an Injury

ii) an Illness resulting in Hospital confinement as an Inpatient

n) Interfacility Ambulance Transfer must be a result of an Inpatient Hospital Admission, Medically Necessary and from one licensed health care Facility to another licensed health care Facility via air or land ambulance

o) chiropractic services prescribed by a Physician and performed by a professional chiropractor and necessarily incurred to continue recovery from a covered Injury or covered Illness; services include manipulations, x-rays and laboratory tests ordered by the chiropractor

p) physical therapy prescribed by a Physician and performed by a professional physical therapist and necessarily incurred to continue recovery from a covered Injury or covered Illness

q) Durable Medical Equipment, as defined herein, deemed to be Medically Necessary

r) a Telehealth, Teleconsultation or Virtual Physician Visit

(5) Charges incurred for Treatment at an Urgent Care Clinic

(6) Charges incurred for Treatment at a Walk-in Clinic

(7) Charges for Treatment of an Injury to the foot due to an Accident covered hereunder

(8) Charges for Treatment of an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment

(9) Charges for Dental Treatment as follows up to the amount shown in the BENEFIT SUMMARY:

a) Charges for Treatment following Traumatic Dental Injury from a covered Accident that resulted in physical Injury to the Insured Person

b) Charges for necessary Dental Treatment of Unexpected pain to sound natural teeth

c) Charges incurred for non-emergency Dental Treatment necessary due to an Accident covered hereunder (10) Charges for an Emergency eye examination performed by a licensed optometrist or ophthalmologist to obtain a Medically Necessary prescription for corrective lenses that were lost or damaged due to an Accident covered hereunder, but not for the replacement of prescription corrective lenses or contact lenses

(11) Charges for Treatment resulting from COVID-19/SARS-CoV-2

(12) Charges for value-added tax (VAT) or like tax incurred on Eligible Medical Expenses..

N. HOSPITAL INDEMNITY:

• Overnight limit: $250
• Maximum nights: 10
• Outside Insured Person’s Country of Residence and the United States
• Inpatient Hospitalization only

Subject to the Terms of this insurance and in the event the Insured Person has been Hospitalized in a Facility outside the Country of Residence and the United States, during the Period of Coverage, the Company will pay the Insured Person the amount shown in the BENEFIT SUMMARY for each overnight Hospitalization as an Inpatient, so long as the Treatment received during the overnight Hospitalization is considered to be an Eligible Medical Expense.

ACCIDENT & SICKNESS MEDICAL AND DENTAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a) benefits will be payable only for Medical Expenses resulting from a Sickness that first manifests itself or an Injury that occurs while on Your Trip (of a duration of one hundred eighty (180) days or less for Sickness) and requires treatment in person by a Physician;
b) only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits. Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;
2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;
3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental expenses incurred after Your Trip is completed are not covered;
4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the policy.

An advance payment made by Us is not a guarantee that Your Medical Expense claims are covered.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

G. ELIGIBLE MEDICAL EXPENSES:

Subject to the Terms of this insurance, and the insurance plan shown in the Declaration, the Company will reimburse the Insured Person up to the amount shown in the BENEFIT SUMMARY for the following costs, Charges and expenses incurred by the Insured Person during the Period of Coverage with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Illness or Injury is covered under this Certificate, Charges are Usual, Reasonable and Customary, and Charges are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”):

(1) Charges incurred at a Hospital for:

a) daily room and board, nursing services, and Ancillary Services not to exceed the average semi-private room rate. A private room will be considered when no semi-private room is available or if medical necessity warrants this type of room. The private room rate is not to exceed the average private room rate.

b) daily room and board, nursing services and Ancillary Services in an Intensive Care Unit

c) use of operating, Treatment or recovery room

d) services and supplies that are routinely provided by the Hospital to persons for use while an Inpatient

e) Emergency Treatment of an Injury, even if Hospital confinement is not required

f) Emergency Treatment of an Illness; however, an additional Deductible (as shown in the BENEFIT SUMMARY) will be required unless the Insured Person is directly admitted to the Hospital as Inpatient for further Treatment of that Illness (2) Charges incurred for Surgery at an Outpatient Surgical Facility, including services and supplies (3) Charges by a Physician for professional services rendered, including Surgery; provided, however, that Charges by or for an assistant surgeon will be limited and covered at the rate of up to twenty percent (20%) of the Usual, Reasonable and Customary charge of the primary surgeon; and provided, further, that the standby availability of a Physician or surgeon will not be deemed to be a professional service and is not eligible for coverage

(4) Charges incurred for:

a) dressings, sutures, casts or other supplies that are Medically Necessary

b) diagnostic testing using Radiology, ultrasonography or laboratory services. Laboratory services billed for professional component fees are covered if the pathologist has direct involvement in providing a written report or verbal consultation for specimen-specific pathology services

c) Implant devices that are Medically Necessary; however, any Implants provided outside the PPO network are limited to a payment of no more than one hundred fifty percent (150%) of the established invoice price and/or list price for that item

d) basic functional artificial limbs, eye or larynx or breast prostheses, but not the replacement or repair thereof

e) reconstructive Surgery when the Surgery is incidental to and follows Surgery that was covered hereunder

f) radiation therapy or Treatment, and chemotherapy

g) hemodialysis for the Treatment of acute renal failure only and the Charges by a Hospital for processing and administration of blood or blood components

h) oxygen and other gases and their administration

i) anesthetics and their administration by a Physician

j) drugs that require a prescription by a Physician for Treatment of Illness or Injury, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of ninety (90) days of any one

(1) prescription

k) care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital

l) Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital

m) Emergency Local Ambulance Transport necessarily incurred in connection with:

i) an Injury

ii) an Illness resulting in Hospital confinement as an Inpatient

n) Interfacility Ambulance Transfer must be a result of an Inpatient Hospital Admission, Medically Necessary and from one licensed health care Facility to another licensed health care Facility via air or land ambulance

o) chiropractic services prescribed by a Physician and performed by a professional chiropractor and necessarily incurred to continue recovery from a covered Injury or covered Illness; services include manipulations, x-rays and laboratory tests ordered by the chiropractor

p) physical therapy prescribed by a Physician and performed by a professional physical therapist and necessarily incurred to continue recovery from a covered Injury or covered Illness

q) Durable Medical Equipment, as defined herein, deemed to be Medically Necessary

r) a Telehealth, Teleconsultation or Virtual Physician Visit

5) Charges incurred for a Teladoc Consultation subject to the limitations set forth in the BENEFIT SUMMARY

6) Charges incurred for Treatment at an Urgent Care Clinic

7) Charges incurred for Treatment at a Walk-in Clinic

8) Charges for Treatment of an Injury to the foot due to an Accident covered hereunder

9) Charges for Treatment of an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment

(10) Charges for Dental Treatment as follows up to the amount shown in the BENEFIT SUMMARY:

a) Charges for Treatment following Traumatic Dental Injury from a covered Accident that resulted in physical Injury to the Insured Person

b) Charges for necessary Dental Treatment of Unexpected pain to sound natural teeth

c) Charges incurred for non-emergency Dental Treatment necessary due to an Accident covered hereunder

(11) Charges for an Emergency eye examination performed by a licensed optometrist or ophthalmologist to obtain a Medically Necessary prescription for corrective lenses that were lost or damaged due to an Accident covered hereunder, but not for the replacement of prescription corrective lenses or contact lenses

(12) Charges for Treatment resulting from COVID-19/SARS-CoV-2

(13) Charges for value-added tax (VAT) or like tax incurred on Eligible Medical Expenses.

N. HOSPITAL INDEMNITY:

• Overnight limit: $250
• Maximum nights: 10
• Outside Insured Person’s Country of Residence and the United States
• Inpatient Hospitalization only

Subject to the Terms of this insurance and in the event the Insured Person has been Hospitalized in a Facility outside the Country of Residence and the United States, during the Period of Coverage, the Company will pay the Insured Person the amount shown in the BENEFIT SUMMARY for each overnight Hospitalization as an Inpatient, so long as the Treatment received during the overnight Hospitalization is considered to be an Eligible Medical Expense.

G. ELIGIBLE MEDICAL EXPENSES:

Subject to the Terms of this insurance, and the insurance plan shown in the Declaration, the Company will reimburse the Insured Person up to the amount shown in the BENEFIT SUMMARY for the following costs, Charges and expenses incurred by the Insured Person during the Period of Coverage with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Illness or Injury is covered under this Certificate, Charges are Usual, Reasonable and Customary, and Charges are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”):

(1) Charges incurred at a Hospital for:

a) daily room and board, nursing services, and Ancillary Services not to exceed the average semi-private room rate. A private room will be considered when no semi-private room is available or if medical necessity warrants this type of room. The private room rate is not to exceed the average private room rate.

b) daily room and board, nursing services and Ancillary Services in an Intensive Care Unit

c) use of operating, Treatment or recovery room

d) services and supplies that are routinely provided by the Hospital to persons for use while an Inpatient

e) Emergency Treatment of an Injury, even if Hospital confinement is not required

f) Emergency Treatment of an Illness; however, an additional Deductible (as shown in the BENEFIT SUMMARY) will be required unless the Insured Person is directly admitted to the Hospital as Inpatient for further Treatment of that Illness

(2) Charges incurred for Surgery at an Outpatient Surgical Facility, including services and supplies

(3) Charges by a Physician for professional services rendered, including Surgery; provided, however, that Charges by or for an assistant surgeon will be limited and covered at the rate of up to twenty percent (20%) of the Usual, Reasonable and Customary charge of the primary surgeon; and provided, further, that the standby availability of a Physician or surgeon will not be deemed to be a professional service and is not eligible for coverage

(4) Charges incurred for:

a) dressings, sutures, casts or other supplies that are Medically Necessary

b) diagnostic testing using Radiology, ultrasonography or laboratory services. Laboratory services billed for professional component fees are covered if the pathologist has direct involvement in providing a written report or verbal consultation for specimen-specific pathology services

c) Implant devices that are Medically Necessary; however, any Implants provided outside the PPO network are limited to a payment of no more than one hundred fifty percent (150%) of the established invoice price and/or list price for that item

d) basic functional artificial limbs, eye or larynx or breast prostheses, but not the replacement or repair thereof

e) reconstructive Surgery when the Surgery is incidental to and follows Surgery that was covered hereunder

f) radiation therapy or Treatment, and chemotherapy

g) hemodialysis for the Treatment of acute renal failure only and the Charges by a Hospital for processing and administration of blood or blood components

h) oxygen and other gases and their administration

i) anesthetics and their administration by a Physician

j) drugs that require a prescription by a Physician for Treatment of Illness or Injury, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of ninety (90) days of any one (1) prescription

k) care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital

l) Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital

m) Emergency Local Ambulance Transport necessarily incurred in connection with:

i) an Injury
ii) an Illness resulting in Hospital confinement as an Inpatient

n) Interfacility Ambulance Transfer must be a result of an Inpatient Hospital Admission, Medically Necessary and from one licensed health care Facility to another licensed health care Facility via air or land ambulance

o) chiropractic services prescribed by a Physician and performed by a professional chiropractor and necessarily incurred to continue recovery from a covered Injury or covered Illness; services include manipulations, x-rays and laboratory tests ordered by the chiropractor

p) physical therapy prescribed by a Physician and performed by a professional physical therapist and necessarily incurred to continue recovery from a covered Injury or covered Illness

q) Durable Medical Equipment, as defined herein, deemed to be Medically Necessary

r) a Telehealth, Teleconsultation or Virtual Physician Visit

(5) Charges incurred for Treatment at an Urgent Care Clinic

(6) Charges incurred for Treatment at a Walk-in Clinic

(7) Charges for Treatment of an Injury to the foot due to an Accident covered hereunder

(8) Charges for Treatment of an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment

(9) Charges for Dental Treatment as follows up to the amount shown in the BENEFIT SUMMARY:

a) Charges for Treatment following Traumatic Dental Injury from a covered Accident that resulted in physical Injury to the Insured Person

b) Charges for necessary Dental Treatment of Unexpected pain to sound natural teeth

c) Charges incurred for non-emergency Dental Treatment necessary due to an Accident covered hereunder

(10) Charges for an Emergency eye examination performed by a licensed optometrist or ophthalmologist to obtain a Medically Necessary prescription for corrective lenses that were lost or damaged due to an Accident covered hereunder, but not for the replacement of prescription corrective lenses or contact lenses

(11) Charges for value-added tax (VAT) or like tax incurred on Eligible Medical Expenses.

M. HOSPITAL INDEMNITY:

-Overnight limit: $250
-Maximum nights: 10
-Outside Insured Person’s Country of Residence and the United States
-Inpatient Hospitalization only

Subject to the Terms of this insurance and in the event the Insured Person has been Hospitalized in a Facility outside the Country of Residence and the United States, during the Period of Coverage, the Company will pay the Insured Person the amount shown in the BENEFIT SUMMARY for each overnight Hospitalization as an Inpatient, so long as the Treatment received during the overnight Hospitalization is considered to be an Eligible Medical Expense.

F. ELIGIBLE MEDICAL EXPENSES:

Subject to the Terms of this insurance, and the insurance plan shown in the Declaration, the Company will reimburse the Insured Person up to the amount shown in the BENEFIT SUMMARY for the following costs, Charges and expenses incurred by the Insured Person during the Period of Coverage or any applicable Benefit Period, with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Illness or Injury is covered under this Certificate, Charges are Usual, Reasonable and Customary, and Charges are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”):

(1) Charges incurred at a Hospital for:

a) daily room and board, nursing services, and Ancillary Services not to exceed the average semi-private room rate. A private room will be considered when no semi-private room is available or if medical necessity warrants this type of room. The private room rate is not to exceed the average private room rate.

b) daily room and board, nursing services and Ancillary Services in an Intensive Care Unit

c) use of operating, Treatment or recovery room

d) services and supplies that are routinely provided by the Hospital to persons for use while an Inpatient

e) Emergency Treatment of an Injury or Illness, even if Hospital confinement is not required (2) Charges incurred for Surgery at an Outpatient Surgical Facility, including services and supplies (3) Charges by a Physician for professional services rendered, including Surgery; provided, however, that Charges by or for an assistant surgeon will be limited and covered at the rate of up to twenty percent (20%) of the Usual, Reasonable and Customary charge of the primary surgeon; and provided, further, that the standby availability of a Physician or surgeon will not be deemed to be a professional service and is not eligible for coverage

(4) Charges incurred for:

a) dressings, sutures, casts or other supplies that are Medically Necessary

b) diagnostic testing using Radiology, ultrasonography or laboratory services. Laboratory services billed for professional component fees are covered if the pathologist has direct involvement in providing a written report or verbal consultation for specimen-specific pathology services

c) Implant devices that are Medically Necessary; however, any Implants provided outside the PPO network are limited to a payment of no more than one hundred fifty percent (150%) of the established invoice price and/or list price for that item

d) basic functional artificial limbs, eye or larynx or breast prostheses, but not the replacement or repair thereof

e) reconstructive Surgery when the Surgery is incidental to and follows Surgery that was covered hereunder

f) radiation therapy or Treatment, and chemotherapy

g) hemodialysis for the Treatment of acute renal failure only and the Charges by a Hospital for processing and administration of blood or blood components

h) oxygen and other gases and their administration

i) anesthetics and their administration by a Physician

j) drugs that require a prescription by a Physician for Treatment of Illness or Injury, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of ninety (90) days of any one (1) prescription

k) care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital

l) Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital

m) Emergency Local Ambulance Transport necessarily incurred in connection with:

(i) an Injury

(ii) an Illness resulting in Hospital confinement as an Inpatient

n) Interfacility Ambulance Transfer must be a result of an Inpatient Hospital Admission, Medically Necessary and from one licensed health care Facility to another licensed health care Facility via air or land ambulance

o) chiropractic services prescribed by a Physician and performed by a professional chiropractor and necessarily incurred to continue recovery from a covered Injury or covered Illness; services include manipulations, x-rays and laboratory tests ordered by the chiropractor

p) physical therapy prescribed by a Physician and performed by a professional physical therapist and necessarily incurred to continue recovery from a covered Injury or covered Illness

q) Durable Medical Equipment, as defined herein, deemed to be Medically Necessary

r) a Telehealth, Teleconsultation or Virtual Physician Visit

(5) Charges incurred for Treatment at an Urgent Care Clinic

(6) Charges incurred for Treatment at a Walk-in Clinic

(7) Charges for Treatment of an Injury to the foot due to an Accident covered hereunder

(8) Charges for Treatment of an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment

(9) Charges for Dental Treatment as follows up to the amount shown in the BENEFIT SUMMARY:

a) Charges for Treatment following Traumatic Dental Injury from a covered Accident that resulted in physical Injury to the Insured Person

b) Charges for necessary Dental Treatment of Unexpected pain to sound natural teeth

c) Charges incurred for non-emergency Dental Treatment necessary due to an Accident covered hereunder

(10) Charges for an Emergency eye examination performed by a licensed optometrist or ophthalmologist to obtain a Medically Necessary prescription for corrective lenses that were lost or damaged due to an Accident covered hereunder, but not for the replacement of prescription corrective lenses or contact lenses

(11) Charges for Treatment resulting from COVID-19/SARS-CoV-2

(12) Charges for value-added tax (VAT) or like tax incurred on Eligible Medical Expenses.

Q. HOSPITAL INDEMNITY: Overnight limit: $250, Maximum nights: 10

Subject to the Terms of this insurance and in the event the Insured Person has been Hospitalized in a Facility outside the Country of Residence and the United States, during the Period of Coverage, the Company will pay the Insured Person the amount shown in the BENEFIT SUMMARY for each overnight Hospitalization as an Inpatient, so long as the Treatment received during the overnight Hospitalization is considered to be an Eligible Medical Expense.

F. ELIGIBLE MEDICAL EXPENSES:

Subject to the Terms of this insurance, and the insurance plan shown in the Declaration, the Company will reimburse the Insured Person up to the amount shown in the BENEFIT SUMMARY for the following costs, Charges and expenses incurred by the Insured Person during the Period of Coverage or any applicable Benefit Period with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Illness or Injury is covered under this Certificate, Charges are Usual, Reasonable and Customary, and Charges are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”):

(1) Charges incurred at a Hospital for:

a) daily room and board, nursing services, and Ancillary Services not to exceed the average semi-private room rate. A private room will be considered when no semi-private room is available or if medical necessity warrants this type of room. The private room rate is not to exceed the average private room rate.

b) daily room and board, nursing services and Ancillary Services in an Intensive Care Unit

c) use of operating, Treatment or recovery room

d) services and supplies that are routinely provided by the Hospital to persons for use while an Inpatient

e) Emergency Treatment of an Injury or Illness, even if Hospital confinement is not required

(2) Charges incurred for Surgery at an Outpatient Surgical Facility, including services and supplies

(3) Charges by a Physician for professional services rendered, including Surgery; provided, however, that Charges by or for an assistant surgeon will be limited and covered at the rate of up to twenty percent (20%) of the Usual, Reasonable and Customary charge of the primary surgeon; and provided, further, that the standby availability of a Physician or surgeon will not be deemed to be a professional service and is not eligible for coverage

(4) Charges incurred for:

a) dressings, sutures, casts or other supplies that are Medically Necessary

b) diagnostic testing using Radiology, ultrasonography or laboratory services. Laboratory services billed for professional component fees are covered if the pathologist has direct involvement in providing a written report or verbal consultation for specimen-specific pathology services

c) Implant devices that are Medically Necessary; however, any Implants provided outside the PPO network are limited to a payment of no more than one hundred fifty percent (150%) of the established invoice price and/or list price for that item

d) basic functional artificial limbs, eye or larynx or breast prostheses, but not the replacement or repair thereof

e) reconstructive Surgery when the Surgery is incidental to and follows Surgery that was covered hereunder

f) radiation therapy or Treatment, and chemotherapy

g) hemodialysis for the Treatment of acute renal failure only and the Charges by a Hospital for processing and administration of blood or blood components

h) oxygen and other gases and their administration

i) anesthetics and their administration by a Physician

j) drugs that require a prescription by a Physician for Treatment of Illness or Injury, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of ninety (90) days of any one (1) prescription

k) care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital

l) Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital

m) Emergency Local Ambulance Transport necessarily incurred in connection with:

i) an Injury

ii) an Illness resulting in Hospital confinement as an Inpatient

n) Interfacility Ambulance Transfer must be a result of an Inpatient Hospital Admission, Medically Necessary and from one licensed health care Facility to another licensed health care Facility via air or land ambulance

o) chiropractic services prescribed by a Physician and performed by a professional chiropractor and necessarily incurred to continue recovery from a covered Injury or covered Illness; services include manipulations, x-rays and laboratory tests ordered by the chiropractor

p) physical therapy prescribed by a Physician and performed by a professional physical therapist and necessarily incurred to continue recovery from a covered Injury or covered Illness

q) Durable Medical Equipment, as defined herein, deemed to be Medically Necessary

r) a Telehealth, Teleconsultation or Virtual Physician Visit

(5) Charges incurred for a CareClix Consultation subject to the limitations set forth in the BENEFIT SUMMARY

(6) Charges incurred for Treatment at an Urgent Care Clinic

(7) Charges incurred for Treatment at a Walk-in Clinic

(8) Charges for Treatment of an Injury to the foot due to an Accident covered hereunder

(9) Charges for Treatment of an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment

(10) Charges for Dental Treatment as follows up to the amount shown in the BENEFIT SUMMARY:

a) Charges for Treatment following Traumatic Dental Injury from a covered Accident that resulted in physical Injury to the Insured Person

b) Charges for necessary Dental Treatment of Unexpected pain to sound natural teeth

c) Charges incurred for non-emergency Dental Treatment necessary due to an Accident covered hereunder

(11) Charges for an Emergency eye examination performed by a licensed optometrist or ophthalmologist to obtain a Medically Necessary prescription for corrective lenses that were lost or damaged due to an Accident covered hereunder, but not for the replacement of prescription corrective lenses or contact lenses

(12) Charges for Treatment resulting from COVID-19/SARS-CoV-2

(13) Charges for value-added tax (VAT) or like tax incurred on Eligible Medical Expenses.

Q. HOSPITAL INDEMNITY: Overnight limit: $250, Maximum nights: 10

Subject to the Terms of this insurance and in the event the Insured Person has been Hospitalized in a Facility outside the Country of Residence and the United States, during the Period of Coverage, the Company will pay the Insured Person the amount shown in the BENEFIT SUMMARY for each overnight Hospitalization as an Inpatient, so long as the Treatment received during the overnight Hospitalization is considered to be an Eligible Medical Expense.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip

Covered Expenses for this benefit include but are not limited to:
a) The services of a Physician

b) Charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel/Motel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) Charges for anesthetics (including administration);

e) X-ray examinations or treatments, and laboratory tests;

f) Ambulance service;

g) Drugs; medicines; prosthetics; and therapeutic services and supplies; and

h) Emergency dental treatment for the relief of pain

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth while on your trip

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth while on Your Trip.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

Advance Payment: If You require admission to a Hospital during a Covered Trip for an Injury or Sickness, We or Our designated representative will arrange advance payment, if required by the Hospital, directly to the Hospital. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the Schedule of Benefits. You agree to reimburse this payment to Us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or

b. It is determined that Your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by You. However:

a. We reserve the right to deny a request for advance payment if We confirm that Your claim is not covered under the Policy; and

b. An advance payment made by Us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the Policy.

Dental Covered Expenses

If You suffer an Injury or a Sickness that requires emergency dental treatment by a Dentist, We will reimburse You, up to the amount shown in the Schedule of Benefits, for the following emergency dental expenses:

a. Services and supplies for the relief of dental pain; and

b. The repair or replacement of teeth or dental implants.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after You have reached Your Return Destination, regardless of the reason.

Your duties in the event of a Loss:

1. You must provide Us with all bills and reports for medical and/or dental expenses claimed;

2. You must provide any requested information related to the claimed expense(s), including but not limited to, an explanation of benefits from any other applicable insurance;

3. You must sign a patient authorization to release any information required by Us, to investigate Your claim.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services; This will also include expenses for a Cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended as a substitute for a Hospital room for recovery from an Accidental Injury or a Sickness.

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services; This will also include expenses for a Cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended as a substitute for a Hospital room for recovery from an Accidental Injury or a Sickness.

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services; This will also include expenses for a Cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended as a substitute for a Hospital room for recovery from an Accidental Injury or a Sickness.

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services; This will also include expenses for a Cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended as a substitute for a Hospital room for recovery from an Accidental Injury or a Sickness.

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services; This will also include expenses for a Cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended as a substitute for a Hospital room for recovery from an Accidental Injury or a Sickness.
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT & SICKNESS MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip;
b. only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered;

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury, Sickness or Emergency Condition;

3. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Emergency Condition means an Injury or Sickness diagnosed by a Physician for which You have sudden and unexpected severe or acute symptoms requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of Your condition or place Your life in jeopardy. The severe or acute symptoms must occur while on Your Trip.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

Emergency Dental Expense Benefit

Benefits will be paid for Emergency Dental Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

1. benefits will be payable only for Emergency Dental Expenses resulting from an Injury to sound natural teeth that occurs while on Your Trip and requires treatment in person by a Physician;

2. only Emergency Dental Expenses incurred by You during Your Trip will be reimbursed. Dental Expenses incurred after You return from Your Trip are not covered;

3. benefits payable as a result of incurred Emergency Dental Expenses will only be paid after benefits have been paid under any other valid and collectible insurance in effect for You or in accordance with a provision in jurisdictions where excess coverage provisions are not permitted.

Emergency Dental Expenses means expenses incurred only for the following:

a. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

b. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury;

c. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental Expenses incurred after Your Trip are not covered.

We will not pay benefits in excess of the Usual and Customary level of charges.

We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 for expenses for emergency dental treatment due to Injury to natural teeth.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, prosthetics, and therapeutic services and supplies ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 expenses for emergency dental treatment due to Injury to natural teeth.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, prosthetics, and therapeutic services and supplies ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

EMERGENCY ACCIDENT & SICKNESS
MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip;
b. only Medical Expenses incurred by You during Your Trip will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered;
c. benefits payable as a result of incurred Medical Expenses will only be paid after benefits have been paid under any other valid and collectible insurance in effect for You or in accordance with a provision in jurisdictions where excess coverage provisions are not permitted.

If You suffer one or more Injury or Sickness while on the same Trip, the maximum amount payable for all Injuries or Sicknesses will not exceed the Maximum Benefit Amount shown in the Schedule of Benefits.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us
or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury, Sickness or Emergency Condition;

3. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Emergency Condition means an Injury or Sickness diagnosed by a Physician for which You have sudden and unexpected severe or acute symptoms requiring immediate care and the failure to obtain such care could reasonably result in serious deterioration of Your condition or place Your life in jeopardy. The severe or acute symptoms must occur while on Your Trip.

Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

Emergency Dental Expense Benefit – up to $750

Benefits will be paid for Emergency Dental Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

1. benefits will be payable only for Emergency Dental Expenses resulting from an Injury to sound natural teeth that occurs while on Your Trip and requires treatment in person by a Physician;

2. only Emergency Dental Expenses incurred by You during Your Trip will be reimbursed. Dental Expenses incurred after You return from Your Trip are not covered;

3. benefits payable as a result of incurred Emergency Dental Expenses will only be paid after benefits have been paid under any other valid and collectible insurance in effect for You or in accordance with a provision in jurisdictions where excess coverage provisions are not permitted.

Emergency Dental Expenses means expenses incurred only for the following:

1. dental services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to sound natural teeth. Dental Expenses incurred after Your Trip are not covered.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

3.2 Medical Covered Expenses.

Subject to the terms of the Certificate, the Company will reimburse You for Covered Expenses up to the Medical Maximum in the Schedule of Benefits for the following medical Expenses that are incurred as the result of and within the Benefit Period:

a. Hospital Expenses for room and board that do not exceed the Hospital’s average charge for semiprivate accommodations, Inpatient Treatment, Surgery, operating room, Intensive Care, nursing services, and services and supplies routinely provided by the Hospital to Inpatients;

b. Outpatient Treatment or Surgery;

c. Administration of anesthetics;

d. Medication, x-ray services, laboratory tests and services, use of radium and radioactive isotopes, oxygen, and blood transfusions;

e. Dressings, sutures, casts, splints, drugs, and medicines that can only be administered by a Physician or Surgeon or obtained through a written prescription;

f. Medically Necessary rental of a non-motorized wheelchair, crutches, or a basic hospital bed up to the purchase price;

g. Hotel room when the Insured Person, otherwise necessarily confined in a Hospital, is under the care of a duly qualified Physician in a hotel room due to unavailability of a Hospital room due to capacity or distance;

h. Artificial limbs, eyes, larynx, and orthotic appliances other than for replacement of such items;

i. Home Health Care in bed if recommended by the attending Physician, provided by a Home Health Care agency upon direct transfer from an acute care Hospital and only in lieu of Medically Necessary Inpatient hospitalization; and

j. Telehealth Consultation or Care.

The initial Treatment of an Injury or Illness must occur within thirty (30) days of the date of Injury or onset of Illness. If initial Treatment does not occur within thirty (30) days, and the delay in Treatment increases the severity of the Injury or Illness, the Company will only be responsible for Expenses it would have incurred had You sought Treatment immediately.

The Deductible, Copay and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility.

The exclusions in Section 8 apply to the coverage provided under this section.

4.1 Dental Emergency — Sudden Relief of Pain – $100

If the Period of Coverage is greater than thirty (30) days, the Company will reimburse You up to the amount in the Schedule of Benefits for Covered Expenses for emergency Treatment for the relief of pain to teeth.

The Deductible and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility. Dental, Vision, and Hearing Exclusion 8 (j) is waived for this benefit. All other exclusions in Section 8 apply to the coverage provided under this section.

4.2 Dental Emergency — Accident – $250

The Company will reimburse You up to the amount in the Schedule of Benefits for Covered Expenses for emergency Treatment to repair or replace teeth damaged as the result of an Accidental Injury caused by external contact with a foreign object. Coverage does not apply if You break a tooth while eating or biting into a foreign object.

The Deductible and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility. Dental, Vision, and Hearing Exclusion 8 (j) is waived for this benefit. All other exclusions in Section 8 apply to the coverage provided under this section.

3.7 Terrorist Activity – $10,000

The Company will reimburse You up to the amount in the Schedule of Benefits for Covered Expenses incurred resulting from Terrorist Activity provided that:

a. You have no direct or indirect involvement in the Terrorist Activity;
b. the Terrorist Activity is not in a country or location where the United States government has issued a Level 3 Terrorism, Level 3 Civil Unrest, or any Level 4 Travel Advisory or the appropriate authorities of either Your Host Country or Your Home Country have issued similar warnings, any of which have been in effect within the six (6) months prior to Your date of arrival; and
c. You departed the country or location following the date a warning to leave that country or location is issued by the United States government or the appropriate authorities of either Your Host Country or Your Home Country.

The Deductible, Copay and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility.

Terrorist Activity and War Exclusion 8(ss) is waived for this benefit. All other exclusions in Section 8 apply to the coverage provided under this section.

Terrorist Activity: Act or acts including, but not limited to, the use of force or violence or the threat thereof of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological, or ethnic purposes or reasons, including the intention to influence any government or to put the public or any section of the public in fear.

3.1 Medical Covered Expenses.

Subject to the terms of the Certificate, the Company will reimburse You for Covered Expenses up to the Medical Maximum in the Schedule of Benefits for the following medical Expenses that are incurred as the result of and within the Benefit Period:

a. Hospital Expenses for room and board that do not exceed the Hospital’s average charge for semi-private accommodations, Inpatient Treatment, Surgery, operating room, Intensive Care, nursing services, and services and supplies routinely provided by the Hospital to Inpatients;

b. Outpatient Treatment or Surgery;

c. Administration of anesthetics;

d. Medication, x-ray services, laboratory tests and services, use of radium and radioactive isotopes,oxygen, and blood transfusions;

e. Dressings, sutures, casts, splints, drugs, and medicines that can only be administered by a Physician or Surgeon or obtained through a written prescription;

f. Medically Necessary rental of a non-motorized wheelchair, crutches, or a basic hospital bed up to the purchase price;

g. Physiotherapy and Chiropractic Care if recommended by a Physician for the Treatment of a specific Occurrence and administered by a physical therapist;

h. Hotel room when the Insured Person, otherwise necessarily confined in a Hospital, is under the care of a duly qualified Physician in a hotel room due to unavailability of a Hospital room due to capacity or distance;

i. Artificial limbs, eyes, larynx, and orthotic appliances other than for replacement of such items;

j. Home Health Care in bed if recommended by the attending Physician, provided by a Home HealthCare agency upon direct transfer from an acute care Hospital and only in lieu of Medically Necessary Inpatient hospitalization; and

k. Telehealth Consultation or Care

The initial Treatment of an Injury or Illness must occur within thirty (30) days of the date of Injury or onset of Illness. If initial Treatment does not occur within thirty (30) days, and the delay in Treatment increases the severity of the Injury or Illness, the Company will only be responsible for Expenses it would have incurred had You sought Treatment immediately.

The Deductible, Copay and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility.

The exclusions in Section 8 apply to the coverage provided under this section.

4.1 Dental Emergency — Sudden Relief of Pain.

If the Period of Coverage is greater than thirty (30) days, theCompany will reimburse You up to the amount in the Schedule of Benefits for Covered Expenses for emergency Treatment for the relief of pain to teeth.

The Deductible and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility. Dental, Vision, and Hearing Exclusion 8 (j) is waived for this benefit. All other exclusions in Section 8 apply to the coverage provided under this section.

4.2 Dental Emergency — Accident.

The Company will reimburse You up to the amount in the Schedule of Benefits for Covered Expenses for emergency Treatment to repair or replace teeth damaged as the result of an Accidental Injury caused by external contact with a foreign object. Coverage does not apply if You break a tooth while eating or biting into a foreign object.

The Deductible and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility. Dental, Vision, and Hearing Exclusion 8 (j) is waived for this benefit. All other exclusions in Section 8 apply to the coverage provided under this section.

3.6 Terrorist Activity.

The Company will reimburse You up to the amount in the Schedule of Benefits for Covered Expenses incurred resulting from Terrorist Activity provided that:

a. You have no direct or indirect involvement in the Terrorist Activity;

b. the Terrorist Activity is not in a country or location where the United States government has issued a Level 3 Terrorism, Level 3 Civil Unrest, or any Level 4 Travel Advisory or the appropriate authorities of either Your Host Country or Your Home Country have issued similar warnings, any of which have been in effect within the six (6) months prior to Your date of arrival; and

c. You departed the country or location following the date a warning to leave that country or location is issued by the United States government or the appropriate authorities of either Your Host Country or Your Home Country.

The Deductible, Copay and Coinsurance in Section 3.1 apply to this coverage and will be Your responsibility. Terrorist Activity and War Exclusion 8 (rr) is waived for this benefit. All other exclusions in Section 8 apply to the coverage provided under this section.

ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Covered Expenses:

The Company will reimburse the Insured for:

- services of a Physician or registered nurse (R.N.);
- Hospital charges;
- X-rays;
- local ambulance services to or from a Hospital;
- artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
- the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Tin Leg will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip.

Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:

The Company will reimburse the Insured for:
● Services of a Physician, Dentist, or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● Local ambulance services to and/or from a Hospital; and
● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for reasonable and customary charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Preexisting Medical Condition Waiver is in effect.

Covered Expenses: The Company will reimburse the Insured for:

- services of a Physician or registered nurse (R.N.);
- Hospital charges;
- X-rays;
- local ambulance services to or from a Hospital;
- artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
- the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Tin Leg will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip. Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:

The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● Local ambulance services to and/or from a Hospital; and
● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, Tin Leg will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip. Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:
The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● Local ambulance services to and/or from a Hospital; and

● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Preexisting Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● local ambulance services to or from a Hospital;
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EXCESS INSURANCE LIMITATION

The insurance provided by this Policy for all coverages except Baggage Delay, shall be in excess of all other valid and collectible insurance or indemnity. If at the time of the occurrence of any Loss payable under this Policy there is other valid and collectible insurance or indemnity in place, the Company shall be liable only for the excess of the amount of Loss, over the amount of such other insurance or indemnity, and applicable deductible. Medical Expense will become Primary if this plan is purchased within 15 days of Initial Trip Payment.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip.

Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:

The Company will reimburse the Insured for:
● Services of a Physician, Dentist, or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● Local ambulance services to and/or from a Hospital; and
● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or

Hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges.

We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

TRAVEL MEDICAL EXPENSE

We will pay a benefit to reimburse you for the reasonable and customary charges, up to the maximum limit shown in the schedule of benefits if you suffer an injury or sickness during the covered trip that requires treatment by a physician. The injury must occur or the sickness must first begin while on a covered trip. The initial documented treatment must be given by a physician during the covered trip.

Travel Medical Covered Expenses:

We will pay a benefit to reimburse you the medically necessary expenses incurred for:

a. Services of a physician or registered nurse (R.N.), and related tests or treatment;

b. Hospital charges or ambulatory medical-surgical centerservices (this may also include expenses for a cruise ship cabin or hotel room, not already included in the cost of your covered trip, if recommended as a substitute for a hospital room for recovery from an injury or sickness;

c. Prescription medication to treat the injury or sickness;

d. Charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;

e. Local ambulance services to and from a hospital;

f. Hospital room and board;

g. Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices; and

h. The cost of emergency dental treatment for accidental injury to sound natural teeth that occurs during a covered trip limited to the Maximum Limit shown in the schedule of benefits. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after you have reached your return destination, regardless of the reason. The treatment must be given by a physician or dentist.

We will not pay for any expenses incurred after the Coverage Termination Date as shown in the Effective and Termination Dates section of this policy, regardless of the reason.

We will not pay benefits in excess of the reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or already included within the cost of the covered trip.

Advance Payment: If you require admission to a hospital during a covered trip for an injury or sickness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. Hospital confinement must be certified as medically necessary by the onsite attending physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the schedule of benefits. You agree to reimburse this payment to us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or

b. It is determined that your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by you. However:

a. We reserve the right to deny a request for advance payment if we confirm that your claim is not covered under the policy; and

b. An advance payment made by us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the policy.

Travel Medical Expense Exclusions:

In addition to the General Limitations and Exclusions, the following exclusions apply to the Travel Medical Expense Benefit. No benefits will be paid for any loss for, caused by, or resulting from:

a. Any service provided by you, a family member, or your traveling companion;

b. Alcohol orsubstance abuse or treatment for the same;

c. Experimental or investigative treatment or procedures;

d. Expenses incurred by any child born during the covered trip;

e. Care or treatment which is not medically necessary, except for related reconstructive surgery resulting from trauma,infection or disease;

f. Mental health care; or

g. Physical therapy or occupational therapy.

TRAVEL MEDICAL EXPENSE

We will pay a benefit to reimburse you for the reasonable and customary charges, up to the maximum limit shown in the schedule of benefits if you suffer an injury or sickness during the covered trip that requires treatment by a physician. The injury must occur or the sickness must first begin while on a covered trip. The initial documented treatment must be given by a physician during the covered trip.

Travel Medical Covered Expenses:

We will pay a benefit to reimburse you the medically necessary expenses incurred for:

a. Services of a physician or registered nurse (R.N.), and related tests or treatment;

b. Hospital charges or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or hotel room, not already included in the cost of your covered trip, if recommended as a substitute for a hospital room for recovery from an injury or sickness;

c. Prescription medication to treat the injury or sickness;

d. Charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;

e. Local ambulance services to and from a hospital;

f. Hospital room and board;

g. Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices; and

h. The cost of emergency dental treatmentfor accidental injury to sound natural teeth that occurs during a covered trip limited to the Maximum Limit shown in the schedule of benefits.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after you have reached your return destination, regardless of the reason. The treatment must be given by a physician or dentist.

We will not pay for any expenses incurred after the Coverage Termination Date as shown in the Effective and Termination Dates section of this policy, regardless of the reason.

We will not pay benefits in excess of the reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or already included within the cost of the covered trip.

Advance Payment: If you require admission to a hospital during a covered trip for an injury or sickness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. Hospital confinement must be certified as medically necessary by the onsite attending physician.

This amount will be deducted from the Travel Medical Expense benefit limit shown in the schedule of benefits. You agree to reimburse this payment to us if:

a. You do not complete the claims process as outlined in the Payment of Claims section; or

b. It is determined that your Travel Medical Expense claim is not covered.

We will provide advance payment when required and requested by you. However:

a. We reserve the right to deny a request for advance payment if we confirm that your claim is not covered under the policy; and

b. An advance payment made by us is not a guarantee of claim approval.

Benefits for Advance Payment will not duplicate any other benefits payable under the policy.

Travel Medical Expense Exclusions:

In addition to the General Limitations and Exclusions, the following exclusions apply to the Travel Medical Expense Benefit. No benefits will be paid for any loss for, caused by, or resulting from:

a. Any service provided by you, a family member, or your traveling companion;

b. Alcohol or substance abuse or treatment for the same;

c. Experimental or investigative treatment or procedures;

d. Expenses incurred by any child born during the covered trip;

e. Care or treatment which is not medically necessary, except for related reconstructive surgery resulting from trauma, infection or disease;

f. Mental health care; or

g. Physical therapy or occupational therapy.

TRAVEL MEDICAL AND DENTAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits if You incur necessary Covered Expenses while on Your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip and the initial documented treatment is given by a Physician during this Trip.

Benefits payable as a result of incurred covered expenses will only be paid after benefits have been paid under any Other Valid and Collectible Health Insurance in effect for You. This coverage is in excess of any other health insurance You have available to You at the time of the loss. You must submit Your claim to that provider first. Any benefits You receive from Your primary or supplementary insurance providers will be deducted from Your claim with Us.

Covered Expenses for this benefit include but are not limited to:
a. The services of a Physician or registered nurse (R.N), and related test or treatment;
b. Charges for Hospital confinement and use of operating rooms;
c. Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel/Motel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);
d. Charges for anesthetics (including administration);
e. X-ray examinations or treatments, and laboratory tests;
f. Ambulance service;
g. Drugs, medicines, prosthetics and therapeutic services and supplies; and
h. Emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth while on Your Trip.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

Dental Covered Expenses

If You suffer an Injury or a Sickness that requires emergency dental treatment by a Dentist, We will reimburse You, up to the amount shown in the Schedule of Benefits, for the following emergency dental expenses:

a. Services and supplies for the relief of dental pain; and
b. The repair or replacement of teeth or dental implants.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after You have reached Your Return Destination, regardless of the reason.

Your duties in the event of a Loss:

a. You must provide Us with all bills and reports for medical and/or dental expenses claimed;
b. You must provide any requested information related to the claimed expense(s), including but not limited to, an explanation of benefits from any other applicable insurance;
c. You must sign a patient authorization to release any information required by Us, to investigate Your claim.

ACCIDENT & SICKNESS MEDICAL EXPENSE

Benefits will be paid for the Covered Expense incurred, up to the Maximum Benefit Amount shown in the Confirmation of Benefits as a result of a Covered Accidental Injury or covered Sickness, which first occurs during Your Trip (of a duration of 90 days or less for Sickness). Only Covered Expenses incurred during Your Trip (of duration of 90 days or less for Sickness) will be reimbursed. Expenses incurred after Your Trip are not covered.

Benefits will include up to $750 expenses for emergency dental treatment due to Injury to natural teeth.

Benefits will not be paid in excess of the Usual and Customary Charges.

Advance payment will be made to a Hospital, up to the Maximum Benefit Amount, if needed to secure Your admission to a Hospital, because of a Covered Accidental Injury or covered Sickness. The authorized travel assistance company will coordinate advance payment to the Hospital.

For the purpose of this benefit:

“Covered Expense” means expense incurred only for the following:

1. The medical services, prescription drugs, prosthetics, and therapeutic services and supplies ordered or prescribed by a Legally Qualified Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services (including expenses for a cruise ship cabin or hotel room, not already included in the cost of the Your Trip, if recommended as a substitute for a hospital room for recovery from a Covered Accidental Injury or covered Sickness);

3. Transportation furnished by a professional ambulance company to and/or from a Hospital.

These benefits will not duplicate any benefits payable under the Policy or any coverage(s) attached to the Policy.

ACCIDENT & SICKNESS
MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip (of a duration of 180 days or less for Sickness);

b. only Medical Expenses incurred by You during Your Trip (of a duration of 180 days or less for Sickness) will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital. We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

ACCIDENT & SICKNESS MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip (of a duration of 180 days or less for Sickness);
b. only Medical Expenses incurred by You during Your Trip (of a duration of 180 days or less for Sickness) will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered;

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

ACCIDENT & SICKNESS MEDICAL EXPENSE BENEFIT

Benefits will be paid for Medical Expenses incurred by You, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

a. Sickness must first commence or manifest itself and Injury must first occur while on Your Trip (of a duration of 180 days or less for Sickness);

b. only Medical Expenses incurred by You during Your Trip (of a duration of 180 days or less for Sickness) will be reimbursed. Medical Expenses incurred after You return from Your Trip are not covered.

Medical Expenses means expenses incurred only for the following:

1. medical services (including charges for anesthetics, x-ray examinations or treatments, and laboratory tests) and supplies, prescription drugs, and therapeutic services ordered or prescribed by a Physician as Medically Necessary for treatment;

2. Hospital or ambulatory medical-surgical center services, including expenses for a cruise ship cabin or hotel room, not already included in the cost of Your Trip, if recommended by Your attending Physician and approved by Us or Our designated Travel Assistance Services Provider as a substitute for a hospital room for recovery from Your Injury or Sickness;

3. emergency dental treatment incurred during Your Trip due to an Accidental Injury to natural teeth. Dental expenses incurred after Your Trip is completed are not covered;

4. local transportation expense to and/or from a Hospital.

We will not pay benefits in excess of the Usual and Customary level of charges. We will not cover any expenses provided by another party at no cost to You or already included within the cost of Your Trip.

Advance Payment: If You require admission to a Hospital or treatment at a clinic, Our designated Travel Assistance Services Provider will arrange advance payment (directly to the provider) necessary for Your admission to a Hospital because of a covered Injury or Sickness, up to the Maximum Benefit Amount shown in the Schedule of Benefits, provided You agree to reimburse Us if it is determined that Your Medical Expense claim is not covered.

These benefit(s) will not duplicate any other benefits payable under the policy or any coverage(s) attached to the policy.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● local ambulance services to or from a Hospital;

● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;

● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip. Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:

The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● Local ambulance services to and/or from a Hospital; and

● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Preexisting Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:
- services of a Physician or registered nurse (R.N.);
- Hospital charges;
- X-rays;
- local ambulance services to or from a Hospital;
- artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
- the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule ,if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip. Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:

The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);
● Hospital charges;
● X-rays;
● Local ambulance services to and/or from a Hospital; and
● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

MEDICAL EXPENSE BENEFIT

If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse You for Medically Necessary covered expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial documented treatment was received from a Physician during the Trip. The Injury must first occur or the Sickness must first begin while on an overnight Trip with a Destination of at least 100 miles from Your Primary Residence, while covered under this Policy. Pre-existing medical conditions will be covered if the Pre-existing Medical Condition Waiver is in effect.

Covered Expenses:

The Company will reimburse the Insured for:

● services of a Physician or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● local ambulance services to or from a Hospital;

● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;

● the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.

Advance Payment: If You require admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY MEDICAL EXPENSE

The Company will reimburse for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule, if the Insured suffers an Injury or Sickness that requires them to be treated by a Physician. The Injury must first occur or the Sickness must first begin while on the Trip. The Company will reimburse Medically Necessary covered expenses determined by the treating Physician which are incurred to treat such Injury or Sickness during the course of the Trip. Coverage for Emergency Medical Expenses does not apply if treatment or expenses are incurred after the Insured has reached their Return Destination, regardless of the reason.

Covered Expenses:
The Company will reimburse the Insured for:

● Services of a Physician, Dentist, or registered nurse (R.N.);

● Hospital charges;

● X-rays;

● Local ambulance services to and/or from a Hospital; and

● Artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices.T

The Company will also reimburse the Insured for the cost of emergency dental treatment during a Trip, up to the Dental coverage Limit shown in the Schedule.

Advance Payment: If the Insured requires admission to a Hospital, the Travel Insurance Administrator will arrange advance payment, if required. Hospital confinement must be certified as Medically Necessary by the onsite attending Physician.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;
b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;
c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;
d) ambulance service;
e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

EMERGENCY ACCIDENT AND SICKNESS MEDICAL EXPENSE

The Company will reimburse benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, if You incur Covered Medical Expenses for Necessary Treatment of an Accidental Injury or a Sickness that occurs during the Trip.

Covered Medical Expenses are limited to the list below:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms; Hospital or ambulatory medical-surgical center services;

c) charges for anesthetics (including administration); x-ray examinations or treatments, and laboratory tests;

d) ambulance service;

e) drugs, medicines and therapeutic services.

The Company will pay benefits up to the Maximum Benefit shown on the Schedule of Benefits, subject to any applicable sub-limits, for dental Necessary Treatment for Accidental Injury to Sound Natural Teeth. Both the Accidental Injury and the dental Necessary Treatment must occur during the Trip.

The Company will not pay benefits in excess of reasonable and customary charges. The Company will not cover any expenses provided by another party at no cost to You, or already included within the cost of the Trip.

If You are hospitalized due to an Accidental Injury or a Sickness, which first occurs during the Trip, beyond the Scheduled Return Date, coverage will be extended for up to ninety (90) days, or until You are released from the Hospital or until You have exhausted the Maximum Benefits payable under this coverage, whichever occurs first.

TRAVEL MEDICAL AND DENTAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on Your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip and the initial documented treatment is given by a Physician during this Trip.

This coverage can be considered Primary up to the amount listed in the Schedule of Benefits.

Covered Expenses for this benefit include but are not limited to:

a) The services of a Physician or registered nurse (R.N), and related test or treatment;
b) Charges for Hospital confinement and use of operating rooms;
c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel/Motel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);
d) Charges for anesthetics (including administration);
e) X-ray examinations or treatments, and laboratory tests;
f) Ambulance service;
g) Drugs, medicines, prosthetics and therapeutic services and supplies; and
h) Emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth while on Your Trip.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

Dental Covered Expenses

If You suffer an Injury or a Sickness that requires emergency dental treatment by a Dentist, We will reimburse You, up to the amount shown in the Schedule of Benefits, for the following emergency dental expenses:

a) Services and supplies for the relief of dental pain; and
b) The repair or replacement of teeth or dental implants.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after You have reached Your Return Destination, regardless of the reason.

TRAVEL MEDICAL AND DENTAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on Your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip and the initial documented treatment is given by a Physician during this Trip.

This coverage can be considered Primary up to the amount listed in the Schedule of Benefits.

Covered Expenses for this benefit include but are not limited to:

a. The services of a Physician or registered nurse (R.N), and related test or treatment;
b. Charges for Hospital confinement and use of operating rooms;
c. Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel/Motel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);
d. Charges for anesthetics (including administration);
e. X-ray examinations or treatments, and laboratory tests;
f. Ambulance service;
g. Drugs, medicines, prosthetics and therapeutic services and supplies; and
h. Emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth while on Your Trip.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

Dental Covered Expenses

If You suffer an Injury or a Sickness that requires emergency dental treatment by a Dentist, We will reimburse You, up to the amount shown in the Schedule of Benefits, for the following emergency dental expenses:

a. Services and supplies for the relief of dental pain; and
b. The repair or replacement of teeth or dental implants.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after You have reached Your Return Destination, regardless of the reason.

Your duties in the event of a Loss:

a. You must provide Us with all bills and reports for medical and/or dental expenses claimed;
b. You must provide any requested information related to the claimed expense(s), including but not limited to, an explanation of benefits from any other applicable insurance;
c. You must sign a patient authorization to release any information required by Us, to investigate Your claim.

TRAVEL MEDICAL AND DENTAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on Your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip and the initial documented treatment is given by a Physician during this Trip.

This coverage can be considered Primary up to the amount listed in the Schedule of Benefits.

Covered Expenses for this benefit include but are not limited to:

a) The services of a Physician or registered nurse (R.N), and related test or treatment;

b) Charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel/Motel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) Charges for anesthetics (including administration);

e) X-ray examinations or treatments, and laboratory tests;

f) Ambulance service;

g) Drugs, medicines, prosthetics and therapeutic services and supplies; and

h) Emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth while on Your Trip.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

Dental Covered Expenses

If You suffer an Injury or a Sickness that requires emergency dental treatment by a Dentist, We will reimburse You, up to the amount shown in the Schedule of Benefits, for the following emergency dental expenses:

a) Services and supplies for the relief of dental pain; and

b) The repair or replacement of teeth or dental implants.

Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after You have reached Your Return Destination, regardless of the reason.

Your duties in the event of a Loss:

a) You must provide Us with all bills and reports for medical and/or dental expenses claimed;

b) You must provide any requested information related to the claimed expense(s), including but not limited to, an
explanation of benefits from any other applicable insurance;

c) You must sign a patient authorization to release any information required by Us, to investigate Your claim.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;

g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

EMERGENCY ACCIDENT AND EMERGENCY SICKNESS MEDICAL EXPENSE

We will pay Reasonable and Customary Charges up to the maximum limit shown on the Schedule of Benefits, subject to the Deductible, if You incur necessary Covered Expenses while on your Covered Trip and as a result of an Accidental Injury or Emergency Sickness that first manifests itself during the Covered Trip.

Covered Expenses for this benefit include but are not limited to:

a) the services of a Physician;

b) charges for Hospital confinement and use of operating rooms;

c) Hospital or ambulatory medical-surgical center services (this may also include expenses for a cruise ship cabin or Hotel room, not already included in the cost of Your Covered Trip, if recommended as a substitute for a Hospital room for recovery from an Emergency Sickness);

d) charges for anesthetics (including administration);

e) x-ray examinations or treatments, and laboratory tests;

f) ambulance service;(g) drugs, medicines, prosthetics and therapeutic services and supplies; and

h) emergency dental treatment for the relief of pain.

We will pay benefits, up to the amount shown on the Schedule of Benefits, for emergency dental treatment for Accidental Injury to natural teeth.

We will not pay benefits in excess of the Reasonable and Customary Charges. We will not cover any expenses incurred by another party at no cost to You or already included within the cost of the Covered Trip.

We will advance payment to a Hospital, up to the maximum shown on the Schedule of Benefits, if needed to secure Your admission to a Hospital during the Covered Trip because of Accidental Injury or Emergency Sickness.

Emergency Accident and Sickness Medical Expense

Please note: this coverage is in excess of any other coverage available to You. Please see Excess Insurance under the GENERAL PROVISIONS section for details.

Benefits will be paid for Your covered reasonable and necessary Medical Expenses incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

1. covered Medical Expenses will only be payable at the Usual and Customary level of charges;

2. benefits will be payable only for covered Medical Expenses resulting from a Sickness or an Injury that occurs while on Your Trip; and

3. Medical Expenses to be considered are only those incurred by You during Your Trip. Medical Expenses incurred after You return from Your Trip are not covered.

We will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

Emergency Accident and Sickness Medical Expense

Please note: this coverage is in excess of any other coverage available to You. Please see Excess Insurance under the GENERAL PROVISIONS section for details.

Benefits will be paid for Your covered reasonable and necessary Medical Expenses incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

1. covered Medical Expenses will only be payable at the Usual and Customary level of charges;

2. benefits will be payable only for covered Medical Expenses resulting from a Sickness or an Injury that occurs while on Your Trip; and

3. Medical Expenses to be considered are only those incurred by You during Your Trip. Medical Expenses incurred after You return from Your Trip are not covered.

We will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

Excess Insurance: Insurance provided by this Policy shall be in excess of all Other Insurance. If, at the time of the occurrence of any other loss, there is Other Insurance in place, We shall be liable only for the excess of any amount paid or payable under Other Insurance. Recover of losses from other parties does not result in a refund of premium paid.

Upgrade – Primary Coverage: Emergency Accident and Sickness Medical Expense

If you purchase this optional upgrade, the following changes apply:

Under the heading “GENERAL PROVISIONS”, “Emergency Accident and Sickness Medical Expense” is removed from the “Excess Insurance” provision, and added to the “Primary Insurance” provision:

Primary Insurance: Benefits provided under Emergency Accident and Sickness Medical Expense coverage shall be considered primary. This is subject to recovery, as We may pay a claim first and then seek recovery from any responsible third party.

Excess Insurance: Insurance provided by this Policy shall be in excess of all Other Insurance (except for Emergency Accident and Sickness Medical Expense). If, at the time of the occurrence of any other loss, there is Other Insurance in place, We shall be liable only for the excess of any amount paid or payable under Other Insurance. Recover of losses from other parties does not result in a refund of premium paid.

Emergency Accident and Sickness Medical Expense

Please note: this coverage is primary. Please see Primary Insurance under the GENERAL PROVISIONS section for details.

Benefits will be paid for Your covered reasonable and necessary Medical Expenses incurred, up to the Maximum Benefit Amount shown in the Schedule of Benefits, subject to the following:

1. covered Medical Expenses will only be payable at the Usual and Customary level of charges;

2. benefits will be payable only for covered Medical Expenses resulting from a Sickness or an Injury that occurs while on Your Trip; and

3. Medical Expenses to be considered are only those incurred by You during Your Trip. Medical Expenses incurred after You return from Your Trip are not covered.

We will not cover any expenses provided by another party at no cost to You or already included within the cost of the Trip.

Primary Insurance: Benefits provided under Emergency Accident and Sickness Medical Expense coverage shall be considered primary. This is subject to recovery, as We may pay a claim first and then seek recovery from any responsible third party.