ARCH INSURANCE COMPANY
(A Missouri Corporation)
Home Office Address:
3100 Broadway, Suite 511
Kansas City, MO 64111
Administrative Address:
One Liberty Plaza, 53rd Floor
New York, NY 10006
Tel: (800) 817-3252
817
SHORT TERM TRAVEL POLICY INCLUDING BAGGAGE, ACCIDENTAL DEATH AND
DISMEMBERMENT, ACCIDENT AND SICKNESS MEDICAL BENEFITS
BENEFITS,, DENTAL BENEFITS,
EMERGENCY MEDICAL REUNION BENEFITS, and
TRIP INTERRUPTION BENEFITS
In consideration of the payment of premium in the manner and at the time stated in Section VII, Policy
Provisions, #11 Premium the Company agrees with the Policyholder named in the Declarations (herein
called Policyholder) to insure Eligible Persons of the Policyholder (herei
(herein
n individually called Insured
Persons), to the extent herein provided and subject to all of the exceptions, limitations, exclusions and
provisions of the Policy.
SECTION I – DECLARATIONS
1. Producer Name and Address: RCM&D, 555 Fairmount Avenue, Baltimore, MD 21286
2. Policy Number:
STA010026400
00
3. Name of Policyholder: American Group Travel Trust, Bank of Newport, Trustee
Address: Bank of Newport, Rhode Island
4. Period of Coverage:
Policy Effective Date:
Policy Expiration Date:
March 1, 2014
February 28, 2015
5. Notices to Insurer:
Notice of Loss, Damage, Claim(s) or Potential Claim(s) to be sent to: Administrative Concepts, Inc.
6. Eligible Persons:
The following persons shall be eligible for Insurance hereunder:
Liberty University, 1971 University Blvd, Lynchburg, VA 24502
Class 1: Students or faculty/staff of Liberty University who are temporarily engaged in educational
activities,, including Immersion Activities, sponsored by the University outside of the United States
and Home Country in school sponsored education abroad programs.
Class 2: Chaperones and Spouses of Students or faculty/staff of Liberty University who are
temporarily engaged in educational activities
activities, including Immersion Activities, sponsored by the
University outside of the United States and Home Country in school sponsored education abroad
programs.
IN WITNESS WHEREOF, Arch Insurance Company has caused this policy to be executed and attested.
Patrick K. Nails
Secretary
Michael R. Murphy
President
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SECTION II – SCHEDULE OF BENEFITS
Accidental Death and Dismemberment
Principal Sum
$10,000
For Loss of
Percentage of Principal Sum
Life
100%
Both Hands or Both Feet .............................................................................. 100%
Sight of Both Eyes ........................................................................................ 100%
One Hand and One Foot .............................................................................. 100%
One Hand and the Sight of One Eye ............................................................ 100%
One Foot and the Sight of One Eye .............................................................. 100%
Speech and Hearing in Both Ears ................................................................ 100%
One Hand or One Foot ................................................................................... 50%
The Sight of One Eye ..................................................................................... 50%
Speech or Hearing in Both Ears .................................................................... 50%
Hearing in One Ear ......................................................................................... 25%
Thumb and Index Finger of Same Hand ......................................................... 25%
$1,000,000
Aggregate Limit of Indemnity Per Accident
Accident Medical*
Sickness Medical*
Per Insured Person
Up to $250,000 Maximum
Deductible
$0
*Combined Accident & Sickness Medical Benefit per occurrence
Coinsurance: per Occurrence Per Each Insured Person:
Company pays up to 100% of Accident & Sickness Medical Limit
Home Country Benefit
30 days; $100 deductible with a $10,000 limit
Host Country is the country where the Insured Person is traveling to, outside of his or her Home
Country.
Pre-Existing Condition
Up to $5,000
Coverage for maternity is only provided up to the stated benefit amounts if conception was
during the time this Policy was in force and coverage was provided for the Insured Person.
Benefits are not provided after the Policy Expiration Date.
Extension of Benefits
Up to 10 Days
Benefit Period
Accident & Sickness
52 Weeks
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Dental
Accidental Dental Limit per Person
Up to $1,000 ($250 maximum per
tooth)
Palliative Dental - Dental emergency pain relief treatment to natural teeth up to $500
The following benefits are added to the Accident & Sickness Medical Benefits
Nervous or Mental Disorders are payable a) up to $2,500 for outpatient treatment; or b) up to
$10,000 on an inpatient basis. The Company shall not be liable for more than one such
inpatient or outpatient occurrence per lifetime under this Policy with respect to any one
Insured.
Chiropractic Care: Services shall be limited to a total of $50.00 per visit with a maximum of 10
visits per injury or illness.
Emergency Medical Reunion
Per Insured Person
Up to $12,500
Round Trip Economy Airfare;
Food and Lodging (Maximum, $350 per day up to 10 Days)
The attending Physician believes it would be beneficial for the Insured Person to have one
individual (selected by the Insured Person) at his or her side.
Coverage is also provided immediately (to up to 15 days) following a felonious assault (ie. theft
or rape) for victims needing the support of a family member or friend.
If Insured Person dies, up to $2,500 for a family member to accompany mortal remains.
Trip Cancellation (Class 1 only)
Up to $5,000
Trip Interruption
Up to $5,000
Coverage is also provided for a life-threatening accident or
sickness.
Trip Interruption (Chaperone
or Faculty Leader only)
Up to $5,000
Coverage includes reimbursement for: 1) the replacement chaperone or faculty leader, up to the
published rate of a round trip economy class ticket from his or her place of permanent residence
to the next scheduled destination where the replacement can join the Trip; and 2) returning
chaperone or faculty leader, up to the published rate of a round trip economy class ticket from
his or her assigned location back home.
Baggage and Personal Effects
$50 deductible, Up to $100 per article, maximum benefit is
$200.
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TABLE OF CONTENTS
SECTION III – DEFINITIONS
5
SECTION IV – BENEFIT PROVISIONS
9
Scope of Coverage
Accidental Death and Dismemberment
Accident Medical Expenses
Sickness Medical Expenses
Accidental Dental
Emergency Medical Reunion
Trip Cancellation
Trip Interruption
Baggage and Personal Effects
SECTION V – EXCLUSIONS
15
SECTION VI – PREMIUMS
17
SECTION VII – POLICY PROVISIONS
17
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SECTION III - DEFINITIONS
“Accident” or “Accidental” shall mean an event, independent of Illness or self inflicted means,
which is the direct cause of bodily Injury to an Insured Person.
“Assistance Company” means the service provider with which the Company has
contracted to coordinate and deliver Emergency travel assistance, medical evacuation,
and repatriation.
“Benefit Period” means the allowable time period the Insured Person has from the date of
Injury or onset of Illness to receive Treatment for a covered Injury or Illness. If the Insured
Person’s plan terminates during the Benefit Period, the Insured Person will still be eligible to
receive Treatment so long as the Treatment is within the Benefit Period and outside the Insured
Person’s Home Country.
“Common Carrier” shall mean any land, sea, and/or air conveyance operating under a valid
license for the transportation of passenger for hire.
“Company” shall be Arch Insurance Company.
“Covered Expenses” shall mean expenses which are for Medically Necessary services,
supplies, care, or Treatment; due to Illness or Injury; prescribed, performed or ordered by a
Physician; Reasonable and Customary charges; incurred while insured under this Policy; and
which do not exceed the maximum limits shown in Section II, Schedule of Benefits, under each
stated benefit.
“Deductible” shall mean the amount of eligible Covered Expenses which are the responsibility
of each Insured Person and must be paid by each Insured Person before benefits under the
Policy are payable by the Company. The Deductible amount is stated in Section II, Schedule of
Benefits, under each stated benefit.
“Dentist” shall mean a legally licensed doctor of dental Surgery; dental medicine or dental
science. A dental hygienist who works within the scope of his/her license, under the supervision
of a Dentist, is a covered practitioner.
“Disablement” as used with respect to medical expenses shall mean an Illness or an
Accidental bodily Injury necessitating medical treatment by a Physician as defined in this Policy.
“Effective Date” shall mean the date the Insured Person’s coverage under this Policy begins.
The Effective Date of this Policy is the later of the following:
1. The Date the Company receives a completed application and premium for the Policy
Period or
2. The Effective Date requested on the application or
3. The Date the Company approves the application.
“Elective Surgery or Elective Treatment” shall mean surgery or medical treatment which is
not necessitated by a pathological or traumatic change in the function or structure in any part of
the body first occurring after the Insured’s effective date of coverage. Elective Surgery includes,
but is not limited to, circumcision, tubal ligation, vasectomy, breast reduction, sexual
reassignment surgery, and submucous resection and/or other surgical correction for deviated
nasal septum, other than for necessary treatment of covered purulent sinusitis. Elective
Surgery does not apply to cosmetic surgery required to correct a covered Accident.
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“Emergency” shall mean a medical condition manifesting itself by acute signs or symptoms
which could reasonably result in placing the Insured Person’s life or limb in danger if medical
attention is not provided within 24 hours.
“Experimental/Investigational” means all services or supplies associated with: 1) Treatment
or diagnostic evaluation which is not generally and widely accepted in the practice of medicine
in the United States of America or which does not have evidence of effectiveness documented
in peer reviewed articles in medical journals published in the United States. For the Treatment
or diagnostic evaluation to be considered effective such articles should indicate that it is more
effective than others available: or if less effective than other available Treatments or diagnostic
evaluations, is safer or less costly; 2) A drug which does not have FDA marketing approval; 3) A
medical device which does not have FDA marketing approval; or has FDA approval under 21
CFR 807.81, but does not have evidence of effectiveness for the proposed use documented in
peer reviewed articles in medical journals published in the United States. For the devise to be
considered effective, such articles should indicate that it is more effective than other available
devices for the proposed use; or if less effective than other available devices, or is safer or less
costly. The company will make the final determination as to whether a service or supply is
Experimental/Investigational.
“Family Member” shall mean a spouse, parent, sibling, Child, or grandparent of the Insured
Person.
“Home Country” shall mean the country where an Insured Person has his or her true, fixed
and permanent home and principal establishment.
“Hospital” as used in this Policy means a place that 1.) is legally operated for the purpose of
providing medical care and Treatment to sick or injured persons for which a charge is made that
the Insured is legally obligated to pay in the absence of insurance 2.) provides such care and
Treatment in medical, diagnostic, or surgical facilities on its premises, or those prearranged for
its use; 3.) provides 24-hour nursing service under the supervision of a Registered Nurse at all
times; and 4.) operates under the supervision of a staff of one or more Doctors. Hospital also
means a place that is accredited as a hospital by the Joint Commission on Accreditation of
Hospitals, American Osteopathic Association, or the Joint Commission on Accreditation of
Health Care Organizations (JCAHO).
Hospital does not mean:
-a convalescent, nursing, or rest home or facility, or a home for the aged;
-a place mainly providing custodial, educational, or rehabilitative care; or
-a facility mainly used for the Treatment of drug addicts or alcoholics.
“Illness” wherever used in this Policy shall mean Sickness or disease of any kind contracted
and commencing after the Effective Date of this Policy.
“Injury” wherever used in this Policy means accidental bodily injury or injuries caused by an
accident. The Injury must be the direct cause of the loss, independent of disease, bodily
infirmity or other causes. Any loss due to Injury must begin after the Effective Date of this policy.
“Insurance” shall mean the coverage that is provided under this Policy.
“Insured Person(s)” shall mean a person eligible for coverage under the Policy as defined in
Section I, Declarations #3 “Eligible Persons” who has applied for coverage and is named on the
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application and for whom the company has accepted premium. This may be the Insured Person
or Dependent(s).
“Loss” in reference to quadriplegia, paraplegia, hemiplegia, and uniplegia, shall mean the
complete and irreversible paralysis of such limbs and with regard to hands and feet, actual
severance through and above the wrist or ankle joints, and with regard to eyes, entire
irrecoverable Loss of sight and with regard to thumb and index finger, actual severance through
or above the joint that meets the finger at the palm. Loss in reference to other coverages shall
mean injury or damage sustained by the Insured in consequence of happening of one or more
of the accidents against which the Company has undertaken to indemnify the Insured.
“Maximum Benefit” means the largest total amount of Covered Expenses that the Company
will pay for the Insured.
“Medically Necessary” or “Medical Necessity” shall mean services and supplies received by
the Insured Person while insured that are determined by the Company to be: 1) appropriate and
necessary for the symptoms, diagnosis, or direct care and Treatment of the Insured Person’s
medical conditions; 2) within the standards the organized medical community deems good
medical practice for the Insured Person’s condition; 3) not provided solely for educational
purposes or primarily for the convenience of the Insured Person, the Insured Person’s Physician
or another Service Provider or person; 4) not Experimental/Investigational or unproven, as
recognized by the organized medical community, or which are used for any type of research
program or protocol; and 5) not excessive in scope, duration, or intensity to provide safe and
adequate, and appropriate Treatment. For Hospital stays, this means that acute care as an
Inpatient is necessary due to the kinds of services the Insured Person is receiving or the
severity of the Insured Person’s condition, in that safe and adequate care cannot be received as
an Outpatient or in a less intensified medical setting. The fact that any particular Physician may
prescribe, order, recommend, or approve a service, supply, or level of care does not, of itself,
make such Treatment Medically Necessary or make the charge of a Covered Expense under
this Policy.
“Medicine” or “Medications” shall mean the drugs prescribed or dispensed to the Insured
Person, by a licensed Physician, as a result of a Covered Expense. Medicine or Medication
shall mean the generic equivalent of a drug, or if the generic equivalent is not available, the
brand name drug.
“Mental and Nervous Disorder” shall mean any condition or disease listed in the most recent
edition of the International Classification of Diseases as a mental disorder, which exhibits
clinically significant behavioral or psychological disorder marked by a pronounced deviation
from a normal healthy state and associated with a present painful symptom or impairment in
one or more important areas of functioning.
“Outpatient” shall mean an Insured Person who receives care in a Hospital or another
institution, including; ambulatory surgical center; convalescent/skilled nursing facility; or
Physician’s office, for an Illness or Injury, but who is confined and is not charged for room and
board.
“Policy Period” or “Period of Coverage” shall mean the period of coverage issued by the
Company to the Insured Person, typically beginning with the Effective Date and ending with the
termination date or the date coverage is renewed by the Company.
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“Physician” as used in this Policy shall mean a doctor of medicine or a doctor of osteopathy
licensed to render medical services or perform Surgery in accordance with the laws of the
jurisdiction where such professional services are performed, however, such definition will
exclude chiropractors and physiotherapists.
“Policy” shall mean this document, the application and any endorsements, riders or
amendments that will attach during the Period of Coverage.
"Policyholder" means the Policyholder shown on the face page of this Policy.
“Pre-existing Condition” for the purposes of the policy shall mean 1) a condition that would
have caused a person to seek medical advice, diagnosis, care or Treatment during the 12
months prior to the Effective Date of coverage under the policy.
“Reasonable and Customary” shall mean the maximum amount that the Company
determines is Reasonable and Customary for Covered Expenses the Insured Person receives,
up to but not to exceed charges actually billed. The Company’s determination considers: 1)
amounts charged by other Service Providers for the same or similar service in the locality were
received, considering the nature and severity of the bodily Injury or Illness in connection with
which such services and supplies are received; 2) any usual medical circumstances requiring
additional time, skill or experience; and 3) other factors the Company determines are relevant,
including but not limited to, a resource based relative value scale.
For a Service Provider who has a reimbursement agreement, the Reasonable and Customary
charge is equal to the amount that constitutes payment in full under any reimbursement
agreement with the Company.
If a Service Provider accepts as full payment an amount less than the negotiated rate under a
reimbursement agreement, the lesser amount will be the maximum Reasonable and Customary
charge.
The Reasonable and Customary charge is reduced by any penalties for which a Service
Provider is responsible as a result of its agreement with the Company.
“Registered Nurse” shall mean a graduate nurse who has been registered or licensed to
practice by a State Board of Nurse Examiners or other jurisdictional authority, and who is legally
entitled to place the letters “R.N.” after his or her name.
“Relative” shall mean spouse, parent, sibling, Child, grandparent, grandchild, step-parent,
step-child, step-sibling, in-laws (parent, son, daughter, brother and sister), aunt, uncle, niece,
nephew, legal guardian, ward, or cousin of the Insured Person.
"Scheduled Departure Date" means the date on which the Insured Person is originally
scheduled to leave on the Trip.
"Scheduled Return Date" means the date on which the Insured Person is originally scheduled
to return to the point of origin or to a different final destination.
“Service provider” shall mean a Hospital, convalescent/skilled nursing facility, ambulatory
surgical center, psychiatric Hospital, community mental health center, residential Treatment
facility, psychiatric Treatment facility, alcohol or drug dependency Treatment center, birthing
center, Physician, Dentist, chiropractor, optometrist, optician, professional counselor,
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psychologist, clinical social worker, podiatrist, physical therapist, chiropodist, clinical nurse
specialist who renders mental health services, audiologist, speech pathologist, certified nurse
midwife, marriage and family therapist or licensed acupuncturist, Registered Nurse, medical
laboratory, assistance service company, air/ground ambulance firm, or any other such facility
that the Company approves.
“Sickness” means illness or disease contracted and causing loss commencing while the Policy
is in force as to the Insured Person whose Sickness is the basis of claim. Any complication or
any condition arising out of a Sickness for which the Covered Person is being treated or has
received Treatment will be considered as part of the original Sickness.
“Surgery” shall mean an invasive diagnostic procedure; or the Treatment of Illness or Injury by
manual or instrumental operations performed by a Physician while the patient is under general
or local anesthesia.
“Unexpected” means not anticipated or expected and occurring after the effective date of the
Policy.
SECTION IV – BENEFIT PROVISIONS
SCOPE OF COVERAGE
Benefits are payable under this Policy for Covered Expenses incurred by an Insured Person for
the items stated in Section II, Schedule of Benefits. Benefits shall be payable to either the
Insured Person or the Service Provider for Covered Expenses incurred outside the Insured
Person’s Home Country. The duration of the Insured Person’s trip cannot exceed 364 days.
The Insured Person must remain continuously insured under the Policy for the duration of the Treatment.
The charges enumerated herein shall in no event include any amount of such charges which are
in excess of Reasonable and Customary charges. If the charge incurred is in excess of such
average charge such excess amount shall not be recognized as a Covered Expense. All charges
shall be deemed to be incurred on the date such services or supplies, which give rise to the
expense or charge, are rendered or obtained.
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ACCIDENTAL DEATH AND DISMEMBERMENT
Accidental Death and Dismemberment Insurance is afforded to an Insured Person which shall
apply only to Injury, as defined in Section III, Definitions, sustained by such Insured Person
during the course of coverage. Such Insurance includes such Injury which occurs during the
course of time the Insured Person is covered under the Policy;
The Company shall pay an indemnity determined from Section II Schedule of Benefits,
Accidental Death and Dismemberment, Table of Losses, if an Insured Person sustains a Loss
stated therein resulting from Injury, provided that:
1) such Loss occurs within 365 days after the date of Accident causing such Loss; and
2) the indemnity payable for any such Loss shall be the Principal Sum stated in Section II,
Schedule of Benefits, Accidental Death and Dismemberment, Principal Sum, as applicable
to such Insured Person and this Insurance; and
3) if more than one Loss stated in said Table is sustained as the result of one Accident, only
one of the amounts so stated in said Table, the largest, shall be payable.
Exposure
If by reason of an Accident covered by the Policy an Insured Person is unavoidably exposed to
the elements and as a result of such exposure suffers a Loss for which the Principal Sum is
otherwise payable hereunder such Loss will be covered under the terms of this Policy.
Disappearance
If the body of an Insured Person has not been found within one year of the disappearance,
forced landing, stranding, sinking, or wrecking of a conveyance in which such Insured Person
was an occupant, then it shall be deemed, subject to all other terms and provisions of the
Policy, that such Insured Person shall have suffered Loss of life within the meaning of the
Policy.
ACCIDENT MEDICAL EXPENSES
The Company will pay Covered Expenses due to Accident only, as per the limits stated in
Section II, Schedule of Benefits, Accident Medical. Coverage is limited to Covered Expenses
incurred subject to Section V, Exclusions. All bodily Injuries sustained in any one Accident shall
be considered one Disablement; all bodily disorders existing simultaneously which are due to
the same or related causes shall be considered one Disablement. If a Disablement is due to
causes which are the same or related to the cause of a prior Disablement (including
complications arising there from), the Disablement shall be considered a continuation of the
prior Disablement and not a separate Disablement.
Treatment of an Injury must occur within 30 days of the Accident.
When a covered Injury is incurred by the Insured Person the Company will pay Reasonable and
Customary medical expenses of the Deductible and Coinsurance as stated in section II,
Schedule of Benefits, Accident Medical. In no event shall the Company’s maximum liability
exceed the maximum stated in Section II, Schedule of Benefits, Accident Medical, as to
Covered Expenses during any one period of individual coverage.
The Deductible and Coinsurance amount consists of Covered Expenses which would otherwise
be payable under this Policy. These expenses must be borne by the Insured Person.
Covered Accident Medical Expenses
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For the purpose of this section, only such expenses, incurred as the result of a Disablement,
which are specifically enumerated in the following list of charges, and which are not excluded in
Section V, Exclusions, shall be considered as Covered Expenses:
1. Charges made by a Hospital for semi-private room and board, floor nursing while
confined in a ward or semi-private room of a Hospital and other Hospital services
inclusive of charges for professional service and with the exception of personal services
of a non-medical nature; provided, however, that expenses do not exceed the Hospital’s
average charge for semiprivate room and board accommodation.
2. Charges made for Intensive Care or Coronary Care charges and nursing services.
3. Charges made for diagnosis, Treatment and Surgery by a Physician.
4. Charges made for an operating room.
5. Charges made for Outpatient Treatment, same as any other Treatment covered on an
Inpatient basis. This includes ambulatory Surgical centers, Physicians’ Outpatient
visits/examinations, clinic care, and Surgical opinion consultations.
6. Charges made for the cost and administration of anesthetics.
7. Charges for medication, x-ray services, laboratory tests and services, the use of radium
and radioactive isotopes, oxygen, blood, transfusions, and medical Treatment.
8. Charges for physiotherapy, if recommended by a Physician for the Treatment of a
specific Disablement and administered by a licensed physiotherapist.
9. Dressings, drugs, and medicines that can only be obtained upon a written prescription of
a Physician.
10. Local transportation to or from the nearest Hospital or to and from the nearest Hospital
with facilities for required Treatment. Such transportation shall be by licensed ground
ambulance only, within the metropolitan area in which the Insured Person is located at
that time the service is used. If the Insured Person is in a rural area, then qualified
licensed ground ambulance transportation to the nearest metropolitan area shall be
considered a Covered Expense.
Accident Medical Benefit Period
Only those expenses specifically described above which are incurred within the Benefit Period
stated in Section II, Schedule of Benefits, Accident Medical, from the onset of an Injury and
which are not excluded in Section V, Exclusions, are considered Covered Expenses.
Accident Medical Incidental Home Country Benefit Period
As an accommodation and supplemental benefit, the Insured Person will be covered under this
insurance during incidental return trips to his/her Home Country during the Period of Coverage
provided that:
1. The Insured Person has departed his/her Home Country prior to any Incidental Trip;
and
2. The Insured Person has timely paid applicable Premium for at least thirty (30) days
of continuous coverage; and
3. The intention or purpose of the Insured Person's return trip to the Home Country is
not to receive Treatment for an Illness or Injury incurred or sustained while traveling
outside of his/her Home Country; and
4. The Insured Person's return trip to the Home Country does not result in receiving
Treatment for an Illness or Injury incurred or sustained while traveling outside of
his/her Home Country.
Only those expenses specifically described above which are incurred within the Insured
Person’s Home Country for an Illness which occurred inside the Insured Person’s Home
Country as stated in section II, Schedule of Benefits, Sickness Medical, Home Country Benefit,
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per 12 months of coverage, or pro rata thereof. Covered Expenses described (in 1 through 10)
above which are incurred in the Insured Person’s Home Country are limited to the maximum
stated in Section II, Schedule of Benefits, Accident Medical, Home Country Benefit.
Extension of Benefits
Those Covered Expenses that are incurred inside the Insured Person’s Home Country related
to an Illness or Injury which occurred outside the Insured Person’s Home Country and during
the period of coverage shall be paid. Covered Expenses described in (1 through 10) above
which are incurred in the Insured Person’s Home Country are limited to the maximum stated in
Section II, Schedule of Benefits, Accident Medical, Extension of Benefits.
SICKNESS MEDICAL EXPENSES
The Company will pay Covered Expenses, as per the limits stated in Section II, Schedule of
Benefits, Sickness Medical. Coverage is limited to Covered Expenses incurred subject to
Section V, Exclusions. All bodily disorders existing simultaneously which are due to the same of
related causes shall be considered one Disablement. If a Disablement is due to causes which
are the same or related to the cause of a prior Disablement (including complications arising
there from), the Disablement shall be considered a continuation of the prior Disablement and
not a separate Disablement.
Treatment of an Illness must occur within 30 days of the onset of the Illness. Illness must
manifest itself during the Period of Coverage.
When a covered Illness is incurred by the Insured Person the Company will pay Reasonable
and Customary medical expenses excess of the Deductible and Coinsurance as stated in
Section II, Schedule of Benefits, Sickness Medical. In no event shall the Company’s maximum
liability exceed the maximum stated in Section II, Schedule of Benefits, Sickness Medical, as to
Covered Expenses during any one period of individual coverage.
The Deductible and Coinsurance amount consists of Covered Expenses which would otherwise
be payable under this Policy. These expenses must be borne by the Insured Person.
Covered Sickness Medical Expenses
For the purpose of this section, only such expenses, incurred as the result of a Disablement,
which are specifically enumerated in the following list of charges, and which are not excluded in
Section V, Exclusions, shall be considered as Covered Expenses:
1. Charges made by a Hospital for semi-private room and board, floor nursing while
confined in a ward or semi-private room of a Hospital and other Hospital services
inclusive of charges for professional service and with the exception of personal services
of a non-medical nature; provided, however, that expenses do not exceed the Hospital’s
average charge for semiprivate room and board accommodation.
2. Charges made for Intensive Care or Coronary Care charges and nursing services.
3. Charges made for diagnosis, Treatment and Surgery by a Physician.
4. Charges made for an operating room.
5. Charges made for Outpatient Treatment, same as any other Treatment covered on an
Inpatient basis. This includes ambulatory Surgical centers, Physicians’ Outpatient
visits/examinations, clinic care, and Surgical opinion consultations.
6. Charges made for the cost and administration of anesthetics.
7. Charges for medication, x-ray services, laboratory tests and services, the use of radium
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and radioactive isotopes, oxygen, blood, transfusions, and medical Treatment.
8. Charges for physiotherapy, if recommended by a Physician for the Treatment of a
specific Disablement and administered by a licensed physiotherapist.
9. Dressings, drugs, and medicines that can only be obtained upon a written prescription of
a Physician.
10. Local transportation to or from the nearest Hospital or to and from the nearest Hospital
with facilities for required Treatment. Such transportation shall be by licensed ground
ambulance only, within the metropolitan area in which the Insured Person is located at
that time the service is used. If the Insured Person is in a rural area, then qualified
licensed ground ambulance transportation to the nearest metropolitan area shall be
considered a Covered Expense.
Coverage is not included for diagnosis and treatment of acne, weak, strained or flat feet,
corns, calluses or toenails.
Sickness Medical Benefit Period
Only those expenses specifically described above which are incurred within the Benefit Period
stated in Section II, Schedule of Benefits, Sickness Medical, from the onset of the Illness and
which are not excluded in Section V, Exclusions, are considered Covered Expenses. Initial
Treatment of an Illness must occur within 30 days of the onset of the Illness.
Sickness Medical Incidental Home Country Benefit Period
As an accommodation and supplemental benefit, the Insured Person will be covered under
this insurance during incidental return trips to his/her Home Country during the Period of
Coverage, provided that:
1. The Insured Person has departed his/her Home Country prior to any
Incidental Trip; and
2. The Insured Person has timely paid applicable Premium for at least thirty (30)
days of continuous coverage; and
3. The intention or purpose of the Insured Person's return trip to the Home
Country is not to receive Treatment for an Illness or Injury incurred or
sustained while traveling outside of his/her Home Country; and
4. The Insured Person's return trip to the Home Country does not result in
receiving Treatment for an Illness or Injury incurred or sustained while
traveling outside of his/her Home Country.
Only those expenses specifically described above which are incurred within the Insured
Person’s Home Country for an Illness which occurred inside the Insured Person’s Home
Country as stated in section II, Schedule of Benefits, Sickness Medical, Home Country Benefit,
per 12 months of coverage, or pro rata thereof. Covered Expenses described in (1 through 10
above which are incurred in the Insured Person’s Home Country are limited to the maximum
stated in Section II, Schedule of Benefits, Sickness Medical, Home Country Benefit.
Extension of Benefits
Those Covered Expenses that are incurred inside the Insured Person’s Home Country related
to an Illness or Injury which occurred outside the Insured Person’s Home Country and during
the period of coverage shall be paid. Covered Expenses described in (1 through 10) above
which are incurred in the Insured Person’s Home Country are limited to the maximum stated in
Section II, Schedule of Benefits, Accident Medical, Extension of Benefits.
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DENTAL
When covered Dental expenses are incurred by the Insured Person the Company will pay
Reasonable and Customary expenses in excess of the Deductible and Coinsurance as stated in
Section II, Schedule of Benefits, Dental. In no event shall the Company’s maximum liability
exceed the maximum stated in Section II, Schedule of Benefits, Dental, as to Covered Expenses
during any one period of individual coverage.
For the purpose of this section, only such expenses, incurred as the result of an eligible Dental
condition, in which services or Medications are prescribed, performed, or ordered by a Dentist
and enumerated below, and which are not excluded in Section V, Exclusions, shall be
considered as Covered Expenses. With respect to Accidental Dental, an eligible Dental
condition shall mean emergency dental repair or replacement to sound, natural teeth damaged
as a result of a covered Accident.
EMERGENCY MEDICAL REUNION
When an Insured Person is hospitalized for more than 24 consecutive hours, the Company will
arrange and pay for round-trip economy-class transportation for one individual selected by the
Insured Person, from the Insured Person’s Home Country to the location where the Insured
Person is hospitalized and return to the current Home Country. The benefits payable will include:
•
The cost of a round trip economy air fare and their hotel and meals up to the maximum
stated in Section II Schedule of Benefits, Emergency Medical Reunion
The period of Emergency Medical Reunion is not to exceed 15 days, including travel.
All transportation in connection with an Emergency Medical Reunion must be pre-approved and
arranged by an Assistance Company representative appointed by the Company.
TRIP CANCELLATION – Class I only
Trip Cancellation coverage provides benefits up to the maximum stated in Section II, Schedule
of Benefits, Trip Cancellation, Trip Cancellation Limit, for Loss(es) the Insured Person incurs for
trips if cancelled prior to departure. Coverage is provided for losses (after the Effective Date)
the Insured Person incurs due to the cancellation of the Insured Person’s trip if caused by:
(A) Sickness, Accidental Injury or death of the Insured Person (or Family Member),
which results in medically imposed restrictions as certified by a Physician at the time of
loss preventing your continued participation in the Trip. A Physician must advise
cancellation of the Trip on or before the Scheduled Departure Date:
(1) The Insured Person’s (or Family Member) Sickness or Injury. The severity or
acuteness of the condition must be so disabling as to reasonably cause the Trip
to be cancelled and a Physician has recommended that due to the severity of the
condition it is Medically Necessary that the Insured Person (or Family Member)
cancels the trip. The Insured Person must be under the direct care and
attendance of a Physician.
(2) Death of the Insured Person, legal spouse; child; son-in-law; daughter-in-law;
sibling; parent; parent-in-law; or grandparents. For all of the above situations, the
incident that causes cancellation must occur within 30 days of the scheduled
travel dates.
(B)The Insured Person being hijacked, quarantined at the Insured Person’s home,
(C)The Inured Person who is on active military duty in the United States Armed Forces:
has their personal leave revoked within 10 days prior to the departure date (as long as
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such revocation is in writing by a superior officer and is not due to war-related situations,
invocation of the War Powers Act, base or unit mobilization, unit reassignment for any
reason, or disciplinary action); or are personally reassigned within 10 days prior to the
departure date, whether temporary or permanent.
The Company will reimburse for the following:
The amount of forfeited, and prepaid, and non-refundable unused payments or deposits that
you paid for the Covered Trip.
In no event shall the amount reimbursed exceed the lesser of the amount the Insured Person
prepaid for the Covered Trip or the maximum benefit shown on the Schedule of Coverages.
TRIP INTERRUPTION
Trip Interruption coverage provides benefits up to the maximum stated in Section II, Schedule of
Benefits, Trip Interruption, Trip Interruption Limit, for Loss(es) the Insured Person incurs for trips
if interrupted after departure. Coverage is provided for losses (after the Effective Date) the
Insured Person incurs due to the interruption of the Insured Person’s trip if caused by 1) Death
of a Family Member, parent, spouse, sibling, child, grandparent; 2) Serious damage to the
Insured Person’s principal residence from fire, flood or similar natural disaster (tornado,
earthquake, hurricane, etc.)
Coverage is provided for the cost of a round trip air or ground transportation ticket of the same
class as the unused travel ticket to return an Insured Person from the International airport
nearest to where the Insured Person was located at the time of learning of such death or
destruction to the International airport nearest to: (i) the location of the funeral or place of burial
in the case of the Unexpected death of a Relative, or (ii) the Insured Person's principal
residence in the case of substantial destruction thereof; subject to the following conditions and
limitations:
1.
The Insured Person must be outside of his/her Home Country at the time of the death of
the Relative or the substantial destruction of the principal residence; and
2.
The death of the Relative or the substantial destruction of the residence must have
occurred during the Period of Coverage.
BAGGAGE AND PERSONAL EFFECTS
The Company will reimburse the Insured Person, up to the amount stated in Section II, Schedule
of Benefits, Baggage and Personal Effects, for theft or damage to baggage and personal effects,
checked with a Common Carrier provided the Insured Person has taken all reasonable measures
to protect, save and/or recover his/her property at all times. The baggage and personal effects
must be owned by and accompany the Insured Person at all times.
There will be a per article limit of $100.
The Company will pay the lesser of the following:
1. The actual cash value (cost less proper deduction for depreciation at the time of loss,
theft or damage);
2. The cost to repair or replace the article with material of a like kind and quality; or
3. $100 per article.
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SECTION V - EXCLUSIONS
For benefits listed in Section II, Schedule of Benefits, Accidental Death and Dismemberment,
this Insurance does not cover:
1. Suicide or attempt thereof by the Insured Person while sane or self destruction or any
attempt thereof by the Insured Person while insane;
2. Disease of any kind; Sickness of any kind;
3. Bacterial infections except pyogenic infection which shall occur through an accidental cut
or wound;
4. Injury sustained while the Insured Person is riding as a pilot, student pilot, operator or
crew member, in or on, boarding or alighting from, any type of aircraft;
5. Injury sustained while the Insured Person is riding as a passenger in any aircraft (a) not
having a current and valid Airworthy Certificate and (b) not piloted by a person who
holds a valid and current certificate of competency for piloting such aircraft;
6. Any consequence, whether directly or indirectly, proximately or remotely occasioned by,
contributed to by, or traceable to, or arising in connection with war, invasion, act of
foreign enemy hostilities, warlike operations (whether war be declared or not), or civil
war; mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution,
military or usurped power;
7. Injury occasioned or occurring while the Insured Person is committing or attempting to
commit a felony or to which a contributing cause was the Insured Person being engaged
in an illegal occupation;
8. Service in the military, naval or air service of any country;
9. While riding or driving in any kind of competition.
For all other benefits listed in Section II, Schedule of Benefits, this Insurance does not cover:
1. Pre-existing conditions for the continuous 12 month period after the policy effective date
during which the insured receives no medical advice or treatment in connection with the
Pre-existing condition, or the earlier of the policy expiration date or the end of the two
year period commencing on the effective date of the persons coverage. This exclusion
does not apply to Emergency Evacuation/Repatriation;
2. Injury or Illness claim which is not presented to the Company for payment within 12
months of receiving treatment;
3. Charges for treatment which is not Medically Necessary;
4. Charges for treatment which exceed Reasonable and Customary charges;
5. Charges incurred for Surgery or treatments which are, Experimental/Investigational, or
for research purposes;
6. Any consequence, whether directly or indirectly, proximately or remotely occasioned by,
contributed to by, or traceable to, or arising in connection with:
a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be
declared or not), or civil war.
b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution,
military or usurped power.
7. Injury sustained while participating in intercollegiate, club, interscholastic (unless
coverage is included on the Schedule of Benefits) and professional athletics;
8. Routine physicals, immunizations or other examinations where there are no objective
indications or impairment in normal health, and laboratory diagnostic or x-ray
examinations, except in the course of a Disablement established by a prior call or
attendance of a Physician unless otherwise covered under this Policy;
9. Treatment of the Temporomandibular joint;
10. Vocational, speech, recreational or music therapy;
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11. Services or supplies performed or provided by a Relative of the Insured Person, or
anyone who lives with the Insured Person;
12. Travel arrangements that were neither coordinated by nor approved by the Assistance
Company in advance, unless otherwise specified;
13. Cosmetic or plastic Surgery, except as the result of a covered Accident; for the purposes
of this Policy, treatment of a deviated nasal septum shall be considered a cosmetic
condition;
14. Elective Surgery which can be postponed until the Insured Person returns to his/her
Home County, where the objective of the trip is to seek medical advice, treatment or
Surgery;
15. Treatment and the provision of false teeth or dentures, normal ear tests and the
provision of hearing aids;
16. Eye refractions or eye examinations for the purpose of prescribing corrective lenses for
eye glasses or for the fitting thereof, unless caused by Accidental bodily Injury incurred
while insured hereunder;
17. Treatment for any Mental and Nervous Disorders except as provided in this policy;
18. Congenital abnormalities and conditions arising out of or resulting there from;
19. Expenses as a result or in connection with the commission of a felony offense, unless
otherwise specified;
20. Injury sustained while taking part in mountaineering where ropes or guides are normally
used; hang gliding, parachuting, bungee jumping, racing by horse, motor vehicle or
motorcycle and parasailing
21. Treatment paid for or furnished under any other individual or group policy (including nofault automobile)or other service or medical pre-payment plan arranged through the
employer to the extent so furnished or paid, or under any mandatory government
program or facility set up for treatment without cost to any individual;
22. Expenses incurred while the Insured Person is in their Home Country, unless otherwise
covered under this Policy;
23. Treatment for human organ tissue transplants or bone marrow transplants and their
related Treatment;
24. Dental care, except as the result of Injury to natural teeth caused by Accident and
palliative dental treatment unless coverage is provided on the Schedule of Benefits;
25. Routine Dental Treatment;
26. Drug, Treatment or procedure that either promotes or prevents conception, or prevents
childbirth, including but not limited to: artificial insemination, Treatment for infertility or
impotency, sterilization or reversal thereof, or abortion;
27. Covered Expenses incurred for which the Trip to the Host Country was undertaken to
seek medical Treatment for a condition;
28. Sex change operations, or for Treatment of sexual dysfunction or sexual inadequacy;
29. Weight reduction programs or the surgical Treatment of obesity.
For benefits listed in section II, Schedule of Benefits, Baggage Loss, this Insurance does not
cover:
1.
Animals;
2.
Artificial teeth or limbs, hearing aids;
3.
Sunglasses, contact lenses or eyeglasses;
4.
Documents of any kind, including but not limited to documents, bills, currency, deeds,
evidences of debt, letters of credit, stamps, credit cards, money, notes, securities,
transportation or other tickets;
5.
household furnishings.
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SECTION VI - PREMIUMS
Premiums to be paid to the Company as outlined in Section VII Policy Provisions, #11 Premium
on a monthly basis. Premiums charged per Insured Person.
Composite Rate:
Class 1: $40.50 per student or faculty/staff per month which equals
$1.33 per day. Group will be charged $1.33 per day based on number
of days traveled
Class 2: $129.00 per chaperone or spouse of student or faculty/staff
per month which equals $4.24 per day. Group will be charged $4.24
per day based on number of days traveled
Premium afforded herein shall be complete and total payment for the Insured Benefits stated
Section II Schedule of Benefits.
SECTION VII - POLICY PROVISIONS
1.
Entire Contract; Changes: The Policy, including the endorsements and attachments, if
any, constitutes the entire contract of Insurance. No change in the Policy shall be valid
until approved by an executive officer of the Company and unless such approval is
endorsed hereon. No agent has authority to change this Policy or to waive any of its
provisions;
2.
Notice of Claim: Written notice of claim must be given to the Company within 30 days
after the occurrence or commencement of any Disablement covered by the Policy, or as
soon thereafter as is reasonably possible. Notice given by or on behalf of the claimant to
the Administrative Offices of the Company, or to any authorized agent of the Company,
with information sufficient to the identify the Insured Person shall be deemed notice to
the Company.
3.
Claim Forms: The Company, upon receipt of a notice of claim, will furnish to the
claimant such forms as are usually furnished by it for filing Proofs of Loss. If such forms
are not furnished within fifteen days after the giving of such notice the claimant shall be
deemed to have complied with the requirements of the Policy as to proof of loss upon
submitting, within the time fixed in the Policy for filing Proofs of Loss written proof
covering the occurrence, the character and the extent of the Disablement for which claim
is made.
4.
Proof of Loss: Written Proof of Loss must be furnished to the Company at its said
office in case of claim for loss for which this Policy provides any periodic payment
contingent upon continuing loss within 90 days after the termination of the period for
which the Company is liable and in case of claim for any other loss within ninety days
after the date of such loss. Failure to furnish such proof within the time required shall not
invalidate nor reduce any claim if it was not reasonably possible to give proof within such
time, provided such proof is furnished as soon as reasonably possible. In any case, the
proof required must be given no later than one year from the time specified except in the
absence of legal capacity.
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5.
Time of Payment of Claims: Indemnities payable under the Policy for any loss other
than loss for which the Policy provides any periodic payment will be paid immediately
upon receipt of due written proof of such loss. Subject to due written Proof of Loss, all
accrued indemnities for loss for which the Policy provides periodic payment will be paid
at the expiration or each four weeks during the continuance of the period for which the
Company is liable, and any balance remaining unpaid upon the termination of liability will
be paid immediately upon receipt of due written proof.
6.
Payment of Claims: Indemnity for loss of life will be payable in accordance with the
beneficiary designation and the provisions respecting such payment which may be
prescribed herein and effective at the time of payment. If no such designation or
provision is then effective, such indemnity shall be payable to the estate of the Insured
Person. Any other accrued indemnities unpaid at the Insured Person’s death may, at the
option of the Company, be paid either to such beneficiary or to such estate. All other
indemnities will be payable to the Insured Person.
If any indemnity of the Policy shall be payable to the Insured Person or to an Insured
Person who is a minor or otherwise not competent to give a valid release, the Company
may pay such indemnity, up to an amount not exceeding $1000, to any Relative by
blood or connection by marriage of the Insured Person who is deemed by the Company
to be equitably entitled thereto. Any payment made by the Company in good faith
pursuant to this provision shall fully discharge the Company to the extent of such
payment.
Subject to any written direction of the Insured Person all or a portion of any indemnities
provided by this Policy on account of Hospital, nursing, medical or Surgical service may,
at the Company’s option and unless the Insured Person requests otherwise in writing not
later than the time for filing proof of such loss, be paid directly to the Hospital or person
rendering such services, but is not required the service be rendered by a particular
Hospital or person.
Virginia:
a) Written notice of claim is to be provided to the Company within 20 days of the loss or
medical expense incurred. Failure to give notice within 20 days shall not invalidate or
reduce any claim if it can be shown that notice was given as soon as reasonably
possible.
b) The Company will furnish forms for filing a proof of loss. These forms will be provided
to the insured within 15 days of notice of loss. If such forms are not furnished by the
Company to the Insured within such 15 days, the person making the claim shall be
deemed to have complied with the requirements of the policy as to proof of loss upon
submitting within the time fixed in the policy the filing of proof of loss covering the
occurrence.
c) Proof of loss shall be provided to the Company within 90 days after the date of loss
or incurred medical expense. Failure to furnish such proof of loss within 90 days shall
not invalidate or reduce any claim if it was not reasonably possible to furnish the
proof of loss within that time frame and proof of loss is furnished as soon as
reasonably possible. In no event, except in the absence of the legal capacity of the
claimant, shall proof of loss be furnished later than 1 year from the time proof is
otherwise required.
d) Benefits payable under the policy shall be paid within 60 days after receipt of proof of
loss.
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e) Benefits for the loss of life of the insured person shall be payable to the beneficiary
designated by the person insured.
7.
Physical Examination and Autopsy: The Company at its own expenses shall have
the right to examine the person of any individual whose Injury or Illness is the basis of
claim when and as often as it may reasonably require during the pendency of a claim
hereunder and to make an autopsy in case of death, where it is not forbidden by law
during the period of contestability and the autopsy must be performed in South Carolina.
8.
Legal Actions: No actions at law or in equity shall be brought to recover on the Policy
prior to the expiration of sixty days after written proof of loss has been furnished in
accordance with requirements of this Policy. No such action shall be brought after
expiration of two years after that time written Proof of Loss is required to be furnished.
9.
Conformity With State Statues: Any provision of the Policy which, on its effective
date, is in conflict with the statues of the state in which the Policy was delivered or
issued for delivery is hereby amended to conform to the minimum requirements of such
statues.
10.
Policy Period: The Policy shall become effective upon the Policy Effective Date shown
in Section I, Declarations, #2 at 12:01 A.M. standard time at the address of the
Policyholder stated in Section I, Declarations, #1 thereof and shall continue in force until
either a) the Policy Expiration Date stated in Section I, Declarations, #2; or b) the Policy
Period is renewed continuously for successive one year period ( Policy anniversary date)
thereafter until cancelled or non-renewed pursuant to the terms of the Policy.
11.
Premium: Premiums due for the Policy shall be remitted to the Company by an officer
of the Policyholder or by any other person designated by the Policyholder to remit such
premiums. The premium bases and rates as stated in Section VI Premiums.
(a)
Estimated Annual Premium Subject to Audit: If a premium is set opposite
Estimated Annual Premium, Subject to Audit, in Section VI Premiums, such
premium is to be an estimated premium only. Upon conclusion of the first and
each renewal Policy year, or upon termination of the Policy, the Company
shall audit such of the Policyholder’s records as have a bearing on this
Insurance to determine the earned premium for the Insurance afforded.
(b)
Annual Premium Not Subject to Audit: If a Premium is set opposite Annual
Premium, Not Subject to Audit in Section VI Premiums, such premium shall
be the total earned premium for all such insurance as is afforded by the
Policy for the first Policy year and shall not be subject to any adjustment.
(c)
Change of Premium Rates: Subject to the provisions of this section on the
first renewal of the Policy and on each renewal thereafter, the Company may
by notifying the Policyholder, change the rate at which further premiums,
including the one then due, shall be computed.
(d)
Payment of Premiums: Estimated Annual Premiums- Subject to Audit, of
Annual Premiums- Not Subject to Audit, for the Policy shall become due and
payable on the Effective Date of the Policy and on any renewal date thereof,
provided that such premiums may be paid in installments in accordance with
and if so designated in Section VI Premiums.
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(e)
Grace Period: A grace period of thirty-one days will be granted for the
payment of each premium falling due after the first premium, during which
grace period the Policy will continue in force, but the Policyholder shall be
liable to the Company for the payment of the premium accruing for the period
the Policy continues in force.
12.
Effective Date of Individual Insurance: The persons eligible for inclusion as Insured
Persons hereunder shall be all persons denoted in Section I, Declarations, #3 Eligible
Persons. Individual coverage will become effective upon the latest of the following: The
Effective Date of the Policy.
13.
Termination Date of Individual Insurance: Individual coverage will terminate upon the
earlier of the following: The moment the Insured Person returns to their Home Country,
unless otherwise covered under the Insured Person’s Policy; or the end of the period for
which premium has been paid; the Date the Insured Person fails to be considered an
Eligible Person; or the Maximum Benefit amount has been paid.
14.
Certificate of Insurance: The Company shall issue to the Policyholder for delivery to
each Insured Person an individual Certificate which shall state the essential features of
Insurance to which such person is entitled and to whom benefits are payable if required to
do so by the laws of the state in which the Insured Person resides when his Insurance
becomes effective.
15. Data Furnished by Policyholder: If requested to do so by the Company the Policyholder
shall furnish the Company with the names of all persons initially insured, of all new persons
who become insured, and of all Insured Persons whose Insurance is canceled, together
with data necessary for the calculation of premium. Failure on the part of the Policyholder
to furnish the name of an Insured Person to the Company shall not invalidate his Insurance;
nor shall failure on the part of the Policyholder to report Termination of Insurance of a
person continue such Insurance in force beyond the Date of Termination in accordance
with this Section.
Insured Persons shall furnish all information requested on the application and any
additional information requested by the Company. All newborn Children of the Insured
Person, who are not initially covered under this Insurance, shall be underwritten, no earlier
than the age of fourteen (14) days old.
Failure on the part of the Insured Person to furnish an application for a newborn Child to
the Company for underwriting, shall not constitute valid Insurance under this contract for
the newborn Child. A dependent Child cannot be added to this Insurance without a
completed application and approval of the Company.
16. Assignment: The Insurance provided hereunder is not assignable, but benefits may be
assigned in accordance with Section VII, Policy Provision #6, Payment of Claims.
17. Not in Lieu of Worker’s Compensation: The Policy is not in lieu of and does not affect
any requirements for coverage by Worker’s Compensation Insurance.
18. Aggregate Limit of Indemnity: The Aggregate Limit of Indemnity stated in Section II
Schedule of Benefits, #1 Accidental Death and Dismemberment, shall be the total limit of
the Company’s liability for all independents payable under Accidental Death and
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Dismemberment Indemnity with respect to all classes of Insured Persons arising out of
Injury sustained by two or more Insured Persons as the result of any one Accident.
19. Primary Benefits: All coverages shall be payable as primary.
20.
Monetary Limits: The monetary limits stated in this Policy and the premium shall be in
U.S. dollars. For service outside of the territorial limits of the United States, the exchange
rate date used to determine the amount of U.S. dollars to be paid is the exchange rate
effective for the date the claims expense was incurred.
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COMPREHENSIVE MEDICAL EVACUATION
Emergency Medical Evacuation
The Company will pay, subject to the limitations set out herein, for Covered Emergency
Evacuation Expenses reasonably incurred, a) if the Covered Person suffers an Injury or
Emergency Sickness that warrants his or her Emergency Evacuation while traveling during the
educational institution’s sponsored trip or b) after being treated at a local medical facility, once
stabilized, if the Covered Person’s medical condition warrants transportation with a qualified
medical attendant to his/her Home Country. Emergency Evacuation eligible expenses are
payable subject to the Maximum Amount per Covered Person listed on the Table for all
Emergency Evacuations due to all Injuries from the same Accident or all Emergency Sicknesses
from the same or related causes.
A legally licensed Physician, in coordination with the Assistance Service Provider, must order
the Emergency Evacuation and must certify that the severity of the Covered Person's Injury or
Emergency Sickness warrants his or her Emergency Evacuation to the closest adequate
medical facility. It must be determined that such Emergency Evacuation is required due to the
inadequacy of local facilities.
The certification and approval for Emergency Evacuation must be coordinated through the most
direct and economical conveyance and route possible, such as air or land ambulance, or
commercial airline carrier.
Covered Emergency Evacuation Expenses are those for Medically Necessary Transportation,
including reasonable and customary medical services and supplies incurred in connection with
the Emergency Evacuation of the Covered Person. Expenses for Transportation must be: (a)
recommended by the attending Physician; and (b) required by the standard regulations of the
conveyance transporting the Covered Person; and (c) reviewed and pre-approved by the
Assistance Service Provider.
Return of Mortal Remains
The Company will pay the reasonable Covered Expenses incurred to return the Covered
Person's body to their primary residence if he/she dies while traveling during the educational
institution’s sponsored trip. This will not exceed the Return of Mortal Remains maximum listed
in the Table.
Covered Expenses include, but are not limited to, expenses for embalming, cremation, casket
for transport and transportation.
All Covered Expenses in connection with a return of mortal remains must be pre-approved and
arranged by our Assistance Service Provider.
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COMPREHENSIVE SECURITY EVACUATION
Political Evacuation:
If the Covered Person requires a Security Evacuation due to a covered Occurrence that takes
place while traveling during the educational institution’s sponsored trip which places the
Covered Person in Imminent Physical Danger as determined by Our Assistance Service
Provider in accordance with local and U.S. authorities, Our Assistance Service Provider shall
arrange and pay for Transportation and Related Costs to the Nearest Safe Location if
applicable, and then to a) the Covered Person’s Home Country or country of Residence; or b)
where the educational institution that sponsored the Covered Person’s trip is located; or c) back to
the country in which the Covered Person is traveling while traveling during the educational
institution’s sponsored trip, if the Company deems appropriate; or d) to another program
location of the educational institution.
The method of Transportation will be as deemed most appropriate to ensure the Covered
Person’s safety. If evacuation becomes impractical due to hostile or dangerous conditions, Our
Assistance Service Provider will maintain contact with and advise the Covered Person until
evacuation becomes viable or the political or social upheaval has resolved.
Natural Disaster Evacuation:
If the Covered Person requires emergency evacuate Security Evacuation due to a Natural
Disaster, which makes the Covered Person’s location uninhabitable, Our Assistance Service
Provider will arrange and pay for Transportation and Related Costs from a safe departure point
to the Nearest Safe Location if applicable, and then to a) the Covered Person’s Home Country or
country of Residence; or b) where the educational institution that sponsored the Covered Person’s
trip is located; or c) back to the country in which the Covered Person is traveling while traveling
during the educational institution’s sponsored trip, if the Company deems appropriate; or d) to
another program location of the educational institution.
The Covered Person must contact Our Assistance Service Provider within seven (7) days from
the date the Host Country issues the official disaster declaration. The method of Transportation
will be as deemed most appropriate to ensure the Covered Person’s safety. If evacuation
becomes impractical due to hostile or dangerous conditions, we will maintain contact with and
advise the Covered Person until evacuation becomes viable or the Natural Disaster situation
has passed.
Expenses will not be payable unless Our Assistance Service Provider authorize in writing, or by
an authorized electronic or telephonic means, all expenses in advance, and services are
rendered by Our Assistance Service Provider. Our Assistance Service Provider is not
responsible for the availability of Transport services.
Security Evacuation eligible expenses are payable only once per Occurrence and are subject to
the maximum listed in the Table. Security Evacuation expenses include consulting services for
the Designated Security Consultant for seeking information on Missing person or kidnapping
cases if the Covered person is deemed as a Missing Person or kidnapped by local or
international authorities.
24
DEFINITIONS:
Advisory means a formal recommendation by the Appropriate Authorities that the Covered
Person or citizens of his or her Home Country or citizens of the Host Country leave the Host
Country.
Appropriate Authority(ies) means the government authority(ies) in the Covered Person’s
Home Country or the government authority(ies) of the Host Country.
Assistance Service Provider means Assist America, Inc. (AAI)
Covered Expenses mean expenses which are for Medically Necessary services, supplies,
care, or Treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician;
reasonable and customary charges; incurred while covered; and which do not exceed the
maximum amounts listed in the Table.
Covered Person means Students or faculty/staff of Liberty University who are temporarily
engaged in educational activities, including Immersion Activities, sponsored by the University
outside of the United States and Home Country in school sponsored education abroad
programs.
Designated Security Consultant means an employee of a security firm under contract to AAI
or an AAI designated service provider who is experienced in security and measures necessary
to ensure the safety of the Covered Person(s) in his or her care.
Emergency Evacuation means the Covered Person’s medical condition warrants immediate
transportation from the place where the Covered Person is injured or sick to the nearest hospital
where appropriate medical treatment can be obtained.
Emergency Sickness means an illness or disease, diagnosed by a legally licensed Physician,
which meets all of the following criteria: (1) there is a present severe or acute symptom
requiring immediate care and the failure to obtain such care could reasonably result in serious
deterioration of the Covered Person’s condition or place his or her life in jeopardy; (2) the
severe or acute symptom occurs suddenly and unexpectedly; and (3) the severe or acute
symptom occurs while coverage is in force while the Covered Person suffers the symptom.
Excluded Countries means the following countries from which Security Evacuations are not
available including any country subject to the administration and enforcement of U. S. economic
embargoes and trade sanctions by the Office of Foreign Assets Control (OFAC).
Home Country means the country of citizenship of the Covered Person. If the Covered Person
has dual citizenship, for the purposes of this benefit, his or her Home Country is the country of the
passport he or she used to enter the Host Country.
Host Country means any country, other than an Excluded Country, in which a Covered Person is
traveling during the educational institution’s sponsored trip.
Imminent Physical Danger means the Covered Person is subject to possible physical injury or
sickness that could result in grave physical harm or death.
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Injury means accidental bodily injury or injuries caused by an accident. The Injury must be the
direct cause of the loss, independent of disease, bodily infirmity or other causes.
Missing Person means a Covered Person who disappeared for an unknown reason and whose
disappearance was reported to the Appropriate Authority(ies).
Natural Disaster means a storm (wind, rain, snow, sleet, hail, lighting, dust or sand), earthquake,
flood, volcanic eruption, wildfire or other similar event that:
1. is due to natural causes; and
2. results in such severe and widespread damage that the area of damage is officially declared a
disaster area by the government of the Host Country and the area is deemed to be
uninhabitable or dangerous.
Nearest Safe Location means a location, as determined by the Our Assistance Service Provider,
if applicable, where:
1. the Covered Person can be presumed safe from the Occurrence that precipitated the Covered
Person’s Security Evacuation; and
2. the Covered Person has access to transportation; and
3. the Covered Person has the availability of temporary lodging, if needed.
Occurrence means any of the following situations in which a Covered Person finds him or herself
while traveling during the educational institution’s sponsored trip:
1. expulsion from a Host Country or being declared persona non-grata on the written authority of the
recognized government of a Host Country;
2. political or military events involving a Host Country, if the Appropriate Authorities issue an Advisory
stating that citizens of the Covered Person’s Home Country or citizens of the Host Country should
leave the Host Country;
3.Verified Physical Attack or a Verified Threat of Physical Attack from a third party, which places
the Covered Person in Imminent Physical Danger;
4.deemed kidnapped or a Missing Person by local or international authorities and, when found,
his or her safety and/or well-being are in question within 7 days of his or her being found.
5. Natural Disaster within 7 days of an event.
Physician means a doctor of medicine or a doctor of osteopathy licensed to render medical
services or perform Surgery in accordance with the laws of the jurisdiction where such
professional services are performed, however, such definition will exclude chiropractors and
physiotherapists.
Related Costs means food, lodging and if necessary physical protections for the Covered Person
during Transportation to the Nearest Safe Location, for up to 5 days.
Security Evacuation means the extrication of a Covered Person from the Host Country due to an
Occurrence which results in the Covered Person being placed in Imminent Physical Danger.
Transport/Transportation means the most efficient and available method of conveyance. In all
cases, where practical, economy fare will be utilized. If possible, the Covered Person’s common
carrier tickets will be used.
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Verified Physical Attack means deliberate physical harm of the Covered Person confirmed by
documentation or physical evidence.
Verified Threat of Physical Attack means a threat against the Covered Person’s health and
safety as confirmed by documentation and/or physical evidence.
EXCLUSIONS:
No benefits are payable for charges, fees or expenses:
1. That are recoverable through the Covered Person’s employer;
2. Arising from or attributable to an actual fraudulent, dishonest or criminal act committed
or attempted by a Covered Person, acting alone or in collusion with others;
3. Arising from or attributable to an alleged:
• Violation of the laws of the Host country by a Covered Person;
• Violation of the laws of the Covered Person’s Home Country unless the Designated
Security Consultant determines that such allegations were intentionally false,
fraudulent and malicious and made solely to achieve a political, propaganda and/or
coercive effect upon or at the expense of the Covered Person;
4. Due to the Covered Person’s failure to maintain and possess duly authorized and issued
required travel documents and visas;
5. Arising from an Occurrence which took place in an Excluded Country;
6. For medical services;
7. Arising from or attributable, in whole or part, to a debt, insolvency, commercial failure,
the repossession of any property by any title holder or lien holder or any other financial
cause;
8. For monies payable in the form of a ransom if a Missing Person case evolves into a
kidnapping;
9. Arising from or attributable, in whole or in part to non-compliance by the Covered Person
with regard to any obligation specified in a contract or license;
10. Due to military or political issues if the Covered Person’s Security Evacuation request is
made more than 10 days after the Appropriate Authority(ies) Advisory was issued.
Table: Maximum Amount per Covered Person
Emergency Medical
Evacuation/Repatriation
100% of Covered Expenses
Return of Mortal Remains
100% of Covered Expenses
Comprehensive Security
Evacuation
100% of Covered Expenses
with a $50,000 limit
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PRIVACY POLICY AND PRACTICES OF
ARCH INSURANCE COMPANY (ARCH)
Insurance companies must collect a certain amount of nonpublic personal information to serve customers and
administer business. ARCH values your trust and is committed to the responsible management, use and protection
of your nonpublic personal information. This notice describes our policy regarding the collection and disclosure of
nonpublic personal information.
What is nonpublic personal information?
Nonpublic personal information, as used in this notice, means information that identifies an individual personally
and is not otherwise available to the public. It includes information such as credit history, income, financial
benefits, policy or claim information. It also includes personal health information such as individual medical
records or information about an illness, disability, or injury.
Why does ARCH collect nonpublic personal information?
ARCH collects nonpublic personal information to support our normal business operations. We may obtain
nonpublic personal information directly from you or from other parties, such as a consumer reporting agency.
Personal information such as a name, address, income, payment history or credit history is gathered from sources
such as applications, transactions and consumer reports.
With whom might ARCH share your nonpublic personal information?
We only disclose nonpublic personal information about you as permitted or as required by law. ARCH’s employees
have access to nonpublic personal information in the course of doing their jobs which includes underwriting
policies, paying claims, developing new products or advising customers of our products and services. ARCH may
share nonpublic personal financial information with our affiliates, such as insurance companies, agents, brokerage
firms and administrators.
ARCH may also share information with unaffiliated third parties, including agents, brokerage firms, insurance
companies, administrators and other service providers. We may also disclose nonpublic personal information as
required by law. We may disclose personal health information with proper written authorization or as otherwise
permitted or required by law.
What does ARCH do to make sure that nonpublic personal information is secure and confidential?
ARCH uses manual and electronic security procedures to maintain the confidentiality of personal information in our
possession and guard against unauthorized access. Some techniques we employ to protect information include
locked files, user authentication, firewall technology, and the use of detection software.
ARCH is responsible for identifying information that must be protected, providing an adequate level of protection
for that data and granting access to protected data only to individuals who must use it in the performance of their
job-related duties.
Does ARCH maintain confidentiality of nonpublic personal information after a policy expires?
ARCH will continue to follow this policy regarding nonpublic personal information even when you are no longer
our customer.
We reserve the right to change our privacy policy. You will receive a notice of any such change.
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