INTOURIST
USA, INC. is proud to protect our clients with
Travel Insured International - the finest travel insurance
available.
Travel
Protection Plan is administered by Travel Insured International,
Inc. ® T-2013W
(6/04)
To purchase your insurance,
please complete the Enrollment Section and Application.
Evidence
of Benefits
Schedule of Benefits |
Benefits |
Limits |
Trip Cancellation |
Tour Cost* |
Trip Interruption** |
150% of Tour Cost |
Travel Delay |
$500 |
Baggage/Personal Effects |
$1,000 |
Baggage Delay |
$200 |
Sickness Medical |
$5,000 |
Accident Medical |
$5,000 |
Evacuation/Repatriation |
$50,000 |
AD&D |
$10,000 |
Assistance Services |
Included |
*Up to maximum of Tour Cost
Protected
**150% of Tour Cost paid up
to a maximum of $10,000
DESCRIPTION OF BENEFITS
TRIP CANCELLATION
You are eligible for benefits up to the amount purchased
for unused non-refundable prepaid expenses for Travel Arrangements
whenever You are prevented from taking a Trip for any of the
following reasons that occur after the Effective Date of Your
Protection Plan:
-
Sickness, Injury or death involving You or Your Traveling
Companion or a Business Partner or Family Member of either You
or Your Traveling Companion which results in medically imposed
restrictions as certified by a Legally Qualified Physician at
the time of loss preventing Your continued participation in the
Trip;
-
Strike that causes complete cessation of services of Your
Common Carrier for at least 48 consecutive hours;
-
Weather which causes complete cessation of services of Your
Common Carrier for at least 48 consecutive hours;
-
If You purchase Your Plan within ten (10) days of Your initial
Trip payment and for the full non-refundable cost of Your Trip,
You will be eligible for benefits up to a maximum limit of $10,000
or the benefit amount protected, whichever is less, due to the
Bankruptcy or Default of an airline, cruise line, or tour operator
(other than the travel agent or Travel supplier that solicited
this Protection Plan and from whom You purchased Your Travel
Arrangements) which stops service more than fourteen (14) days
following Your Protection Plan Effective Date. Your scheduled
Departure Date must be no more than fifteen (15) months beyond
the Effective Date of Your Protection Plan. Benefits will be
paid due to Bankruptcy or Default of an airline only if no alternate
transportation is available. If alternate transportation is available,
benefits will be limited to the change fee charged to allow You
to transfer to another airline in order to get to Your intended
destination. The Bankruptcy or Default benefit is excess and
secondary to all other forms of indemnity.
-
Employer termination or layoff affecting You or a person(s)
sharing the same room during Your Trip. Employment must have
been with the same employer for at least 3 continuous years;
-
If You purchase Your Plan within ten (10) days of Your initial
Trip payment and for the full non-refundable cost of Your Trip,
You will be eligible for benefits up to Your protected Trip cost
if You cancel Your Trip due to a Terrorist Incident. The Terrorist
Incident must occur in a city listed on Your itinerary within
30 days prior to Your Scheduled Departure Date. This same city
must not have experienced a Terrorist Incident within the 90
days prior to the Terrorist Incident which is causing Your cancellation.
Benefits are not provided if Your Travel Supplier offers a substitute
itinerary.
-
Hijack, quarantine, jury duty, or court ordered appearance
as a witness in a legal action in which You or Your Traveling
Companion is not a party (except law enforcement officers);
-
You or Your Traveling Companion are called to emergency military
duty for a national disaster other than war;
-
Traffic accident, substantiated by a police report, directly
involving either You or a Traveling Companion while en route
to a scheduled departure point;
-
If Your Travel Supplier cancels Your Trip, You are eligible
for benefits equal to the amount protected for Your airline tickets
or the value of the reissue fee. You must have protected the
entire cost of Your Trip including the airfare.
-
Your family or friends living abroad with whom You were planning
to stay, are unable to accommodate You due to life threatening
illness, life threatening injury or death of one of them;
All cancellations must be reported to the Travel Supplier within
72 hours of the event causing the need to cancel. If the event
delays the reporting of the cancellation beyond the 72 hours, report
the event as soon as possible. All other delays of reporting beyond
72 hours will result in reduced benefit payments.
TRIP INTERRUPTION
If
You are prevented from completing a Trip for any of the reasons
listed under the Trip Cancellation section above that occur after
Your Protection Plan Effective Date and after the departure date
of the Trip, You are eligible up to the benefit amount purchased
for:
Single supplement upgrade - You are eligible for benefits when
Your Traveling Companion cancels or interrupts a Trip for a specified
reason and You do not.
TRAVEL DELAY
You are eligible for benefits up to the benefit amount shown for:
a) Additional Transportation Cost to join the Trip or return home,
including up to $150 per day, up to the maximum limit, for reasonable
accommodations and meals, if Your delay requires an unplanned overnight
stay; or b) unused nonrefundable portion of the prepaid expenses
as long as the expenses are supported by proof of purchase and are
not reimbursable by any other source. Delay must be for 12 hours
or more and certified due to one of the following reasons: 1) Delay
of Common Carrier (which is certified by the Common Carrier); 2)
A traffic accident in which You were not directly involved (substantiated
by a police report); 3) Documented weather condition preventing You
from getting to the point of departure; 4) Quarantine, hijacking,
Strike, natural disaster, terrorism or riot; 5) Lost or stolen passports,
travel documents or money (must be substantiated by a report to the
police or the appropriate authority).
BAGGAGE & PERSONAL EFFECTS
You are
eligible for benefits up to the benefit amount shown for lost,
stolen, or damaged baggage or personal items subject to a maximum
reimbursement of up to $250 per article. A maximum of $500 applies
to the total amount payable for loss of any or all of the following:
jewelry, watches, articles trimmed with fur, cameras and their
accessories and related equipment. In addition, the following
reimbursements are included in this benefit: 1) Lost or stolen
passport or visa ($50 maximum); 2) Lost or stolen credit cards
(cost associated with the unauthorized use - $50 maximum subject
to verification that You have complied with all conditions of
the credit card company).
BAGGAGE DELAY
If Your checked baggage
is delayed or misdirected while on Your Trip for more than 24
hours from Your time of arrival at Your destination other than
Your residence by a Common Carrier, You are eligible for benefits
up to the benefit amount shown for the expense of necessary purchases
of personal items as long as the expense is substantiated by receipts
for purchases. The Common Carrier must certify the delay.
MEDICAL EXPENSE
You are eligible for
benefits up to the benefit amount shown for: Eligible Medical
Expenses incurred during Your Trip as a result of an Injury which
occurs or Sickness which first manifests itself during the Trip;
benefits will include expenses for emergency dental treatment
not to exceed $750; advance payment will be made to a Hospital,
subject to the applicable benefit amount if needed to secure Your
admission to a Hospital because of Sickness or Injury which first
occurs during the course of the Trip. The authorized Assistance
Company will coordinate advance payment to the Hospital. In all
cases, benefits will not be paid in excess of the Usual and Customary
Charges.
MEDICAL EVACUATION/REPATRIATION
You
are eligible for benefits up to the benefit amount shown for:
1) Medical Evacuation which is determined by a Legally Qualified
Physician and the authorized Assistance Company’s medical
director when Injury or Sickness is acute or life threatening
and adequate treatment is not available at a local Hospital. Transportation
will be provided to the closest Hospital or medical facility capable
of providing adequate treatment; 2) Medical Repatriation is provided
when it is deemed Medically Necessary by a Legally Qualified Physician
and the authorized Assistance Company for You to return to Your
home or a Hospital near Your home for continued treatment. Transportation
Expense incurred will be paid for You via one-way Economy transportation;
or commercial upgrade, based on Your condition as recommended
by the local attending Legally Qualified Physician and the authorized
Assistance Company: a) to return to Your permanent residence or
b) to be moved to a Hospital or medical facility closest to Your
permanent place of residence capable of providing that treatment;
3) Either: a) transportation will be provided for the return Trip
home via Economy Transportation for any dependent children under
18 who are accompanying You if You are confined to a Hospital
for more than 7 consecutive days; or b) if You are traveling alone
and are confined to a Hospital for more than 7 consecutive days,
this benefit will provide one round-trip Economy Transportation
for a person of Your choice to visit You in a Hospital. These
benefits provide the most appropriate and Economical Transportation
by the most direct and economical route. This benefit for land
or air transportation includes, but is not limited to, commercial
stretcher, medical escort, or the Usual and Customary Charges
for air ambulance, provided such transportation has been pre-approved
and arranged by the authorized Assistance Company. Benefits are
calculated less the value of an unused return travel ticket. If
benefits are payable under Your Protection Plan and You have other
insurance that may provide benefits for this same loss, we reserve
the right to recover from such other insurance. Note, Pre-existing
Condition limitation is automatically waived for Medical Evacuation/Repatriation.
WHEN YOUR BENEFITS APPLY
"Effective
Date" is the date, which begins at 12:01
a.m., on the day following Your Travel Supplier’s receipt
of full payment for Your Protection Plan.
Trip Cancellation Benefit
and Assistance Services begin on the Effective Date.
Travel Delay
Benefit is in force while You are en route to and from Your Trip.
All Other Benefits begin on 12:01 a.m. on Your Scheduled Departure
Date or Your Protection Plan Effective Date whichever is later,
and ends at the point and time of return on or before the Scheduled
Return Date.
ACCIDENTAL DEATH AND DISMEMBERMENT
You are eligible for benefits
24 hours a day, up to the benefit amount shown when You sustain
Injuries resulting in any of the following losses, within 180
days from the date of accident. Benefits will be paid for the
following types of Loss or Injury in the amounts shown:
Type of Loss |
Percentage
of Benefit Amount |
| Loss of life |
100% |
| Loss of both feet |
100% |
| Loss of both hands |
100% |
| Loss of both eyes |
100% |
| Loss of one hand and one
foot |
100% |
| Loss of one foot and one
eye |
100% |
| Loss of one hand |
50% |
| Loss of one foot |
50% |
| Loss of one eye |
50% |
Loss of hand or hands, or foot or feet,
means severance at or above the wrist joint or ankle joint, respectively.
Loss of eye or eyes means the total and irrecoverable loss of
the entire sight thereof. Only the largest applicable amount shown
above (the largest applicable) will be paid for the Injuries resulting
from one accident. The benefit for loss of: a) two limbs; b) both
eyes; or c) one limb and one eye is payable only when such loss
results from the same accident. If You are unavoidably exposed
to the elements because of an accident and suffer a loss for which
benefits are payable under this benefit, such loss will be protected.
If You are in an accident resulting in the disappearance, sinking
or damaging of an air or water conveyance and Your body has not
been found within 52 weeks from the date of the accident, it will
be presumed, unless there is evidence to the contrary that You
suffered loss of life as a result of those Injuries.
PROTECTION PLAN DEFINITIONS
"Additional Transportation Cost" means
the actual cost incurred for one-way Economy Transportation by
Common Carrier reduced by the value of an unused travel ticket.
"Bankruptcy" means
the filing of a petition for voluntary or involuntary bankruptcy
in a court of competent jurisdiction under Chapter 7 or Chapter
11 of the United States Bankruptcy Code 11 U.S.C. 101 et seq.
"Business Partner" means an individual
who: a) is involved in a legal general partnership with You; and
b) is actively involved in the day-to-day management of Your business.
"Common
Carrier" means any public land, air or water
conveyance operating under a valid license providing for the transportation
of passengers for hire.
"Default" means
the inability to provide contracted services due to a financial
failure.
"Domestic Partner" means a person
who is at least eighteen years of age and You can show: 1) evidence
of financial interdependence, such as joint bank accounts or credit
cards, jointly owned property, and mutual life insurance or pension
beneficiary designations; 2) evidence of continuous cohabitation
throughout the 180 day period prior to the Effective Date of Your
Plan; and 3) an affidavit of domestic partnership if recognized
by the jurisdiction within which they reside.
"Economy
Transportation" means the lowest published
available transportation rate for a ticket on a Common Carrier
matching the original class of transportation that You purchased
for the Trip, reduced by the value of an unused return travel ticket.
"Eligible
Medical Expense" means expense incurred
for services and supplies; a) listed below; and b) ordered or prescribed
by a Legally Qualified Physician; 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
of Injury or Sickness); transportation furnished by a professional
ambulance company to or from a Hospital; and prescribed drugs,
prosthetics and therapeutic services and supplies.
"Family
Member" means any of the following who resides
in the United States, Canada, or Mexico: You or Your Traveling
Companion’s: legal spouse (or common-law spouse where legal),
legal guardian, son or daughter (adopted, foster, step or in-law),
brother or sister (includes step or in-law), parent (includes step
or in-law), grandparent (includes in-law), grandchild, aunt, uncle,
niece or nephew, Domestic Partner, a caregiver who lives with and
is employed by You, or a person for whom You are the primary caregiver
and with whom You have lived for 12 continuous months prior to
the effective date of Your Plan, whether or not they travel with
You.
"Hospital" means: a) a place which
is licensed or recognized as a general hospital by the proper authority
of the state or country in which it is located; b) a place operated
for the care and treatment of resident inpatients with a registered
graduate nurse (RN) always on duty and with a laboratory and x-ray
facility; and c) a place recognized as a general Hospital by the
Joint Commission on the Accreditation of Hospitals. Hospital does
not include an institution licensed or used principally: 1) for
treatment or care of drug addicts or alcoholics; or 2) as a clinic,
continued or extended care facility, skilled nursing facility,
convalescent home, rest home, nursing home or home for the aged.
"Injury" or "Injuries" means
accidental bodily injury received after the Effective Date of Your
Protection Plan and prior to Your Scheduled Return Date and in
loss independently of Sickness and all other causes and certified
by a Legally Qualified Physician.
"Intoxicated" means
a blood alcohol level which equals or exceeds the legal limit for
operating a motor vehicle in the state or jurisdiction where You
are located at the time of an incident.
"Legally Qualified
Physician" means a physician or
a Christian Science Practitioner: a) other than You, a Traveling
Companion or a Family Member; b) practicing within the scope of
his or her license; and c) recognized as a physician in the place
where the services are rendered.
"Medical Treatment" means
treatment, advice or consultation by a Legally Qualified Physician.
"Medically
Necessary" means a service or supply which:
a) is recommended by the attending Legally Qualified Physician;
b) is appropriate and consistent with the diagnosis in accordance
with accepted standards of community practice; c) could not have
been omitted without adversely affecting Your condition or quality
of medical care; d) is delivered at the most appropriate level
of care and not primarily for the sake of convenience; and e) is
not considered experimental unless law requires payment of benefits
for experimental service or supplies.
"Mental or Nervous
Condition" means any condition
or disease, regardless of its cause, listed in the most recent
edition of the International Classification of Diseases as a Mental
Disorder, including but not limited to, neurosis, psychoneurosis,
psychopathy, psychosis, Bipolar Affective Disorder or Autism.
"Pre-existing
Condition" means any Injury, Sickness
or condition (including any condition from which death ensues)
of You, or Your Traveling Companion, You or Your Traveling Companion’s
Family Member or Your Business Partner which within the sixty (60)
day period prior to the Effective Date of Your Protection Plan:
a) manifested itself, became acute or exhibited symptoms which
would have caused one to seek diagnosis, care or treatment; b)
required taking prescribed drugs or medicine, unless the condition
for which the prescribed drug or medicine is taken remains controlled
without any change in the required prescription; or c) required
medical treatment or treatment was recommended by a Legally Qualified
Physician. (Note, in California, part "a" is not applicable).
"Scheduled
Departure Date" means the date on which
You are originally scheduled to leave on Your Trip.
"Scheduled
Return Date" means the date on which You
are originally scheduled to return to the point of origin or the
original final destination.
"Sickness" means
an illness or disease, which is diagnosed or treated by a Legally
Qualified Physician after the Effective Date of Your Protection
Plan and prior to Your Scheduled Return Date.
"Strike" means
any stoppage of work: a) As a result of a combined effect of workers
which was unannounced and unpublished at the time travel services
were purchased; and b) Which interferes with the normal departure
and arrival of a Common Carrier.
"Terrorist Incident" means
an incident deemed a terrorist act by the United States Government
that causes property damage and loss of life.
"Transportation
Expense" means: a) The
cost of conveyance of You and any medical personnel (if Medically
Necessary); and b) The cost of Medically Necessary services or
supplies.
"Travel Arrangements" mean: a)
transportation; b) accommodations; and c) other specified services
arranged by the Travel Supplier for the Trip.
"Traveling
Companion" means a person or persons with
whom You a) have coordinated Travel Arrangements and b) intend
to travel with during the Trip. Note: a group or tour leader is
not considered a Traveling Companion unless You are sharing room
accommodations with the group or tour leader.
"Travel
Supplier" means any entity or organization
that coordinates or supplies travel services for You.
"Trip" means
scheduled trips, tours or cruises for which: a) benefits are requested;
and b) the required plan cost is submitted prior to the Scheduled
Departure Date.
"Usual and Customary Charges" mean
those comparable charges for similar treatment, services and supplies
in the geographic area where treatment is performed, or services
or supplies are provided.
"You" or "Your" means
an individual who has purchased a Trip and who has paid the required
Plan Cost.
WHAT BENEFITS ARE NOT PAYABLE – GENERAL
EXCLUSIONS
Benefits are not payable for Sickness, Injuries
or losses of You or Your Traveling Companion: 1) Resulting from
suicide, attempted suicide, or any intentionally self-inflicted
Injury while sane or insane (in Missouri, sane only); 2) Resulting
from an act of declared or undeclared war or occurring while
participating in maneuvers or training exercises of an armed
service; 3) Occurring while or resulting from riding, driving
or participating in races, or speed or endurance contests; 4)
Occurring while or resulting from mountaineering (engaging in
the sport of scaling mountains generally requiring the use of
picks, ropes or other special equipment); 5) Occurring while
or resulting from participating as a member of a team in an organized
sporting competition; 6) Occurring while or resulting from participating
in skydiving, hang gliding, bungee cord jumping, scuba diving
or deep sea diving; 7) Occurring while or resulting from piloting
or learning to pilot or acting as a member of the crew of any
aircraft; 8) Received as a result or consequence of being Intoxicated
or under the influence of any controlled substance unless administered
on the advice of a Legally Qualified Physician; 9) To which a
contributory cause was the commission of or attempt to commit
a felony or being engaged in an illegal occupation; 10) Due to
normal childbirth, normal pregnancy (except complications of
pregnancy) or voluntarily induced abortion; 11) For dental treatment
(except as otherwise specifically provided herein); 12) Due to
a Pre-existing Condition. This exclusion is waived provided You
purchase Your Protection Plan within 10 days of Your initial
Trip payment, protect the full non-refundable cost of Your Trip,
are medically able to travel on the date You purchase Your Protection
Plan and have not filed a Trip Cancellation claim due to a Pre-Existing
Condition within 180 days prior to the Effective Date of Your
Protection Plan. Note: Pre-existing Condition limitation is automatically
waived for Emergency Medical Evacuation and Medical Repatriation
benefits. In California, benefits are not payable if, during
the 60 days prior to Your Effective Date, a Legally Qualified
Physician advises You or Your Traveling Companion not to travel
due to Sickness or Injury; or 13) Due to a Mental or Nervous
Condition unless hospitalized.
WHAT IS NOT PAYABLE UNDER BAGGAGE/PERSONAL
EFFECTS OR BAGGAGE DELAY BENEFIT
Benefits are not payable
for loss of any of the following: a) animals, b) automobile or
automobile equipment, boats or other vehicles or conveyances,
trailers, motors, aircraft, bicycles (except when checked as
baggage with a Common Carrier); c) household effects and furnishings,
antiques or collectors items; d) sunglasses (prescription or
non-prescription) or contact lenses; e) artificial teeth or dental
bridges; f) hearing aids; g) prosthetic limbs; h) prescribed
medications; i) keys; j) money, credit cards, tickets, documents
(except as otherwise specified under the benefit description) or
securities; k) stamps; l) professional or occupational equipment
or property (whether or not electronic business equipment), telephones
or computer hardware or software.
TRAVEL ASSISTANCE SERVICES
The
Travel Assistance feature provides a variety of travel related
services. Services offered include: Medical evacuation/repatriation • Repatriation
of remains • Medical or legal referral • Hospital admission
guarantee • Emergency cash advance* • Translation service • Prescription
drug replacement* • Passport/Visa information • Bail
bond* • Lost Baggage retrieval • Inoculation information
*Payment reimbursement to the Assistance Company is Your responsibility.
For Travel Assistance Services only
CALL
TOLL FREE:
1-888-268-2824
(Within the United States and Canada)
OR CALL COLLECT
1-603-898-8752
(From all other locations)
Travel assistance services are provided by an independent organization
and not by TIG Insurance Company, TIG Premier Insurance Company,
or Travel Insured International. There may be times when circumstances
beyond the Assistance Company’s control hinder their endeavors
to provide travel assistance services. They will, however, make
all reasonable efforts to provide travel assistance services and
help You resolve Your emergency situation.
FILING A CLAIM IS SIMPLE
To receive a claim form, contact Travel Insured International, or
send Your name, address, travel dates, booking number and details
of Your loss within 30 days to:
Travel Insured International
P.O. Box 280568
East Hartford , CT 06128-0568
1-800-243-2440
(Weekdays 7:45 a.m.-5:30 p.m. ET)
www.travelinsured.com
IMPORTANT: To facilitate prompt claims settlement, You will
be asked to provide proof of Your loss. Therefore, be sure to obtain
the following as applicable: 1) For medical claims – detailed
medical statements from treating physicians where and when the
accident or Sickness occurred as well as receipts for medical services
and supplies; 2) For baggage and baggage delay claims – reports
from parties responsible (i.e. airline, cruise line, etc.) for
loss, theft, damage or delay. If required, a police report will
be requested. Please obtain receipts for lost or damaged items;
3) For travel delay claims – a statement from party causing
delay and receipts for expenses; 4) For cancellation/interruption
claims – Your travel invoice, the cancellation or interruption
date, original unused tickets/vouchers, the travel organizer’s
cancellation clause with regard to nonrefundable losses. You will
also be asked to provide proof of payment.
No benefits will be paid for any expenses reimbursed to You or
services provided to You by any other source. Benefits cannot be
duplicated under Your Protection Plan.
Unless You otherwise designate a beneficiary, or in the event
the designated beneficiary predeceases You, indemnity for loss
of life will be paid to the first of the following surviving beneficiaries:
Your spouse; child or children, jointly; parents, jointly if both
are living, or the surviving parent, if only one survives; brothers
and sisters jointly; or Your estate.
If You have two Protection Plans underwritten by TIG Insurance
Company or TIG Premier Insurance Company in Florida that duplicate
benefits, You will be paid up to the highest benefit amount under
only one Protection Plan for each Trip.
FOR QUESTIONS AND GENERAL INFORMATION
Contact
Your agent or
Travel Insured International
P.O. Box 280568
East Hartford , CT 06128-0568
Customer Service
1-800-243-3174
Products underwritten by: TIG Premier Insurance Company & Ranger
Insurance Company under the management of Fairmont Specialty Group.
In addition, TIG Insurance Company, affiliated with TIG Specialty
will be used in select states.
Please note that TIG/Fairmont’s "Privacy
Policy & Practices" and "Grievance
Procedures" apply to the plan You have purchased. If You
would like to receive a copy of this information, please contact
Travel Insured International. /eyeglass
Premiums
Tour Cost
Per Person |
Premium
Per Person |
|
Tour Cost
Per Person |
Premiums Per Person |
| $ 0 - |
$600 |
$ 55 |
|
$5,001 |
$6,000 |
$ 480 |
| $601 - |
$800 |
$ 65 |
|
$6,001 |
$7,000 |
$ 560 |
| $801
- |
$1,000 |
$ 70 |
|
$7,001 |
$8,000 |
$ 650 |
| $1,001
- |
$1,500 |
$85 |
|
$8,001 |
$9,000 |
$ 790 |
| $1,501 - |
$2,000 |
$ 105 |
|
$9,001 |
$10,000 |
$ 920 |
| $2,001
- |
$2,500 |
$140 |
|
|
|
|
| $2,501 - |
$3,000 |
$170 |
|
|
|
|
| $3,001 - |
$3,500 |
$220 |
|
|
|
|
| $3,501 - |
$4,000 |
$280 |
|
|
|
|
| $4,001 - |
$4,500 |
$330 |
|
|
|
|
| $4,501 - |
$5,000 |
$400 |
|
|
|
|
Add $3.00 per day per person for each day over 30.
Enrollment Section
|