Back to Home

LOST WORLD ADVENTURES INC
Group Description of Coverage

ID #: 10-084
Plan #: V2B
Group #: V2 2011
Date: 6/00

SCHEDULE OF BENEFITS
(Maximum Benefit Amount)
Trip Delay/Missed Connection
$500
Sickness Medical Expense
$5,000
Accident Medical Expense
$5,000
Common Carrier Accidental Death & Dismemberment
$25,000
24-Hour Accidental
Death & Dismemberment
$10,000
Medical Evacuation / Reparation
$25,000
Baggage/Personal Effects
$1,000
Baggage Delay
$200
Assistance Services
Included
You may purchase this coverage up to 15 days prior to the date of departure, however, the Preexisting Condition limitation will apply to purchases made more than 14 days after your initial deposit.

TRIP DELAY/MISSED CONNECTION
You are covered up to the Maximum Benefit Amount purchased for: a) Additional Transportation Cost to join the Covered Trip or return home, including up to $150 per day for reasonable accommodations and meals, if Your delay requires an unplanned overnight stay; and/or b) unused non-refundable 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 3 hours or more and certified due to 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 Inclement 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 (substantiated by a police report).

MEDICAL EXPENSE
You are covered up to the Maximum Benefit Amount purchased for 1) Covered Expenses incurred as a result of an accidental Injury which occurs or a Sickness which first manifests itself during the Covered Trip. You must receive initial Medical Treatment for the Injury or Sickness within 30 days after the date of the accident that caused the Injury or the onset of Sickness. All treatment and Covered Expenses must be received within 52 weeks following the date of the accident or onset of the Sickness. 2) Benefits will include expenses for emergency dental treatment, for injury to sound natural teeth, not to exceed $750. 3) Advance payment will be made to a Hospital, up to the Maximum Benefit Amount if needed to secure Your admission to a Hospital because of a covered Sickness or Injury which first occurs during the course of the Covered Trip. The authorized travel 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.

ACCIDENTAL DEATH & DISMEMBERMENT
You are covered 24 hours a day, up to the Maximum Benefit Amount purchased, when You sustain covered Injures during Your Covered Trip results in any of the following losses within 180 days from the date of the accident Where applicable You are also covered for the amount purchased when You sustain covered Injuries on a Common Carrier: 1) reserved while a passenger (not as a pilot operator or member of the crew) riding in, boarding or alighting from a public conveyance provided by a Common Carrier, and 2) resulting in any of the following losses within 180 days from the date of the accident Benefits will be paid as follows: loss of life, both feet both hands, both eyes, one hand and one foot one hand and one eye or one foot and one eye - Maximum Benefit Amount loss of one hand, one foot or one eye - one half the Maximum Benefit Amount 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 one of the amounts 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, while covered by this benefit You are unavoidably exposed to the elements because of a covered accident and suffer a loss for which benefits are payable under this benefit such loss will be covered. If, while covered by this benefit, You are in an accident resulting in the disappearance, sinking or damaging of an air or water conveyance on which You are covered by this benefit, 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.

BAGGAGE & PERSONAL EFFECTS
You are covered up to the Maximum Benefit Amount purchased for lost stolen, or damaged baggage or personal items with a maximum reimbursement of up to $300 per article. A combined maximum of $600 will be paid for jewelry, watches, articles consisting in whole or in part of silver, gold or platinum, articles trimmed with fur, cameras and their accessories and related equipment In addition, the following reimbursements are included: 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 compiled with all contributions of the credit card company). The lesser of the following amounts will be paid: a) the actual cash value (cost loss proper deduction for depredation) at the time of loss, theft or damage; b) the cost to repair or replace the article with material of a like kind and quality; or c) $300 per article. Loss of or damage to property specifically scheduled under other insurance is not covered.

BAGGAGE DELAY
If Your checked baggage is delayed or misdirected by a Common Carrier while on Your Covered Trip for more than 24 hours from Your time of arrival at Your destination other than Your residence, You are covered for the expense of necessary purchases of personal items up to the Maximum Benefit Amount as long as the expense is substantiated by receipts for purchases. Common Carrier must certify the delay.

MEDICAL EVACUATION / REPATRIATION
You are covered up to the Maximum Benefit Amount purchased for: 1) Medical Evacuation which is determined by a Legally Qualified Physician and the authorized Assistance Company medical director that an Injury or Sickness is acute or life threatening and adequate treatment is not available at a local Hospital. Transportation will go 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; a) to return to Your permanent residence orb) to be moved to a Hospital or medical facility closest to Your permanent place of residence capable of providing that treatment 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; 3) 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 if You are traveling alone and are confined to a Hospital for more than? 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, which must be by the most direct and economical route. Covered 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 paid less the value of an unused return travel ticket If benefits are payable under this coverage and You have other insurance that may provide benefits for this same loss, Old Republic Insurance Company and American National Insurance Company reserve the right to recover from such other insurance.

Note, Preexisting Condition limitation is automatically waived for Medical Evacuation/Repatriation.

TRAVEL ASSISTANCE SERVICES
Services offered include:

  • Medical evacuation/repatriation
  • Repatriation of remains
  • Medical or legal referral
  • Hospital admission guarantee
  • Emergency cash transfer
  • Translation service
  • Prescription drug/eyeglass replacement*
  • Passport/Visa information
  • Bail bond*
  • Lost baggage retrieval
  • Inoculation information.

* Payment reimbursement to the Assistance Company is Your responsibility.

For 24 HOUR Emergency Assistance While On Your Trip: CALL TOLL FREE....(800) 231-5857 (within the U.S. and Canada) OR COLLECT (905) 523-7066 (from all other locations) For Questions Regarding Claims Only, Call (888) 322-67?6


Travel Assistance Services are provided by an independent organization and not by Old Republic Insurance Company, American National Insurance Company, or Travelex Insurance Services. There may be times when circumstances beyond the assistance provider'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. Travel Assistance provides a variety of travel related services.

PROTECTION PLAN DEFINITIONS
"Additional Transportation Cost" means the actual cost incurred for one-way Economy Transportation reduced by the value of an unused travel ticket
"Baggage and Personal Effects" means goods being used by You during a covered trip.
"Business Partner" means an individual who: a) is involved in a legal general partnership with You; and b) is actively involved in the day-today 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.
"Covered Expense" means expense incurred for services and supplies: a) listed below; and b) ordered or prescribed by a Legally Qualified Physician as Medically Necessary for diagnosis or treatment; which are limited to: the services of 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 Covered Trip, if recommended as a substitute for a hospital room for recovery of an Injury or Sickness); transportation furnished by a professional ambulance company to and/or from a Hospital; and prescribed drugs, prosthetics and therapeutic services and supplies.
"Covered Trip" means scheduled trips, tours or cruises for which: a) coverage is requested; and b) the required plan cost is submitted prior to the Scheduled Departure Date.
"Economy Transportation" means the lowest published available transportation rate for a ticket on a Common Carrier matching the original class of transportation that the Insured purchased for the Covered Trip, reduced by the value of an unused return travel ticket
"Eligible Person" means a resident of the United States or a person who purchases this coverage within the United States.
"Family Member" means 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, provided the Family Member resides in the United States, Canada or Mexico.
"Hospital" means: a) a place which is licensed or recognized as a general Hospital by the proper authority of the state 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; c) a place recognized as a general Hospital by the Joint Commission on the Accreditation of Hospitals. Not included is a hospital or 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, nest home, nursing home or home for the aged.

"Inclement Weather" means any weather condition, which delays the scheduled arrival or departure of a common carrier.
"Injury" or "Injuries" means accidental bodily Injuries received while protected under this coverage and resulting In ices independent 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 an Insured is 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. "Maximum Benefit Amount" means the maximum amount payable for each coverage as shown on the Schedule of Benefits on page 1. "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 roost appropriate level of care and not primarily for the sake of convenience; and e) is not considered experimental unless coverage for experimental service or supplies is required by law.
"Inclement Weather" means any weather condition, which delays the scheduled arrival or departure of a common carrier.
"Injury" or "Injuries" means accidental bodily Injuries received while protected under this coverage and resulting In ices independent 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 an Insured is 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.
"Maximum Benefit Amount" means the maximum amount payable for each coverage as shown on the Schedule of Benefits on page 1.
"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 roost appropriate level of care and not primarily for the sake of convenience; and e) is not considered experimental unless coverage for experimental service or supplies is required by law.
"Scheduled Departure Date" means the date on which You are originally scheduled to leave on Your Covered 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 plan and while You are covered under this plan.
"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.
"
Transportation Expense" means a) the cost of conveyance of You and any medical personnel (if Medically Necessary); and b) Medically Necessary services or supplies.
"Traveling Companion" means a person or persons, up to a maximum of 4 people, with whom a covered person is sharing the same room accommodations.
"Usual and Customary Charges" mean those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.
"YOU" or "Your" means the Eligible Person named on the enrollment form who has purchased a Covered Trip and who has paid the required cost for this Protection Plan.

WHEN YOU ARE COVERED
"Effective Date" is 12:01 a.m. following the date You pay the Travel Suppler Your protection plan cost

Trip Delay/Missed Connection - In force while You are en route to and from Your Covered Trip.

All Other Coverages (Including Trip Interruption) begin at 12:01 a.m. on Your Scheduled Departure Date or Your Effective Date whichever is later, and end at the point and time of return on or before the scheduled Return Date.

WHAT IS NOT COVERED
Benefits are not payable for Sickness, Injuries, or losses of You or Your Traveling Companion: resulting from suicide, attempted suicide, or any intentionally self-inflicted Injury while sane or insane (in Missouri, sane only); resulting from an act of declared or undeclared war, while participating in maneuvers or training exercises of an armed service; while riding, driving or participating in races, or speed or endurance contests; while mountaineering (engaging in the sport of scaling mountains generality requiring the use of picks, ropes or other special equipment); while participating as a member of a team in an organized sporting competition; while participating in skydiving, hang-gliding, bungee cord jumping, scuba diving or deep sea diving; while piloting or teaming to pilot or acting as a member of the crew of any aircraft 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; to which a contributory cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation; due to normal childbirth, normal pregnancy (except complications of pregnancy) or voluntarily induced abortion; for dental treatment (except as coverage is otherwise specifically provided herein) or due to a Preexisting Condition -note, the Preexisting Condition limitation is automatically waived for medical evacuation repatriation coverage, and coverage purchased within 14 days from the time the initial deposit is paid on the Covered Trip. In California, benefits are not payable if during the 60 days prior to the Effective Date, a Legally Qualified Physician advised the Insured or his/her Traveling Companion not to travel due to Sickness or Injury.


FOR BAGGAGE & BAGGAGE DELAY: Benefits are not payable for animals, automobile and automobile equipment beats or other vehicles or conveyances, trailers, motors, aircraft, bicycles (except when checked as baggage with a Common Carrier), household effects and furnishings, antiques and collectors items, sunglasses (prescription or nonprescription), contact lenses, artificial teeth, dental bridges, hearing aids, prosthetic limbs, prescribed medications, keys, money, credit cards, tickets, and documents (except as coverage is otherwise specifically provided herein), securities, stamps, professional or occupational equipment or property whether or not electronic business equipment telephones, computer hardware or software.

FILING A CLAIM IS SIMPLE
To receive a claim form: Call 1-888-322-6776, or send Your name, address, travel dates, details of Your loss along with the lD#, Group # and Plan # (listed at the top of page 1)within 30 days to:
Old Republic Insurance Company
Travelex Claims Department
4600 Witmer Industrial Estates, Suite 6
Niagara Falls, NY 14305

 

IMPORTANT: To facilitate prompt claims settlement You will be asked to provide proof of Your loss within 90 days after the date of loss or as soon as is reasonably possible. Proof must however be furnished no later that 12 months from the time it is otherwise required, except in the absence of legal capacity. Therefore, be sure to obtain as applicable:

for trio delay claims: statement from party causing delay and receipts for covered expenses; for medical claims: detailed medical statements from treating physicians where and when the accident or Sickness occurred; receipts for medical services and supplies; for baggage and baggage delay claims: reports from parties responsible (i.e. airline, cruiseline, etc.) for loss, theft, damage or delay. If applicable, a police report will be required. Please obtain receipts for lost or damaged items.

Benefits under any coverage will not be paid for expenses reimbursed or services provided by any other source. Benefits cannot be duplicated under this 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.

 

This product is underwritten by Old Republic Insurance Company -Greensburg, PA. In Florida, Maryland and Texas this product is underwritten by American National Insurance Company (a member of National Accident Insurance Group).For additional inquiries, please call 1-488-322-4716 and provide ID #, Group # and Plan # (listed at the top of page 1).

If You have two Protection Plans underwritten by Old Republic Insurance Company or American National Insurance Company, You will be paid up to the highest benefit amount under only one plan for each Covered Trip.

Note: This plan contains disability insurance benefits or health insurance benefits, or both, that only apply during the Covered Trip. You may have coverage from other sources that already provide You with these benefits. You should review Your existing policies. If You have any questions about Your current coverage, call Your insurer or heath plan.