Master Policy #PCU Effective: September 1, 2017 Issued to: The Triptime Insurance Trust

Transcription

1 Master Policy #PCU Effective: September 1, 2017 Issued to: The Triptime Insurance Trust Plan Administrator: Point Comfort Underwriters, Inc. 212 W. 10 th St. #C400 Indianapolis, IN USA SPECIMEN

2 This Declaration is a part of the Master Policy Master Policy Number: PCU Assured: The Triptime Insurance Trust c/o Solomon Harris First Caribbean House, 3 rd Floor Grand Cayman KY Cayman Islands Master Policy Period: Effective Date: 1 st July, 2017 Termination Date: 30 th June 2018 Rates: As indicated on Exhibit A attached hereto. Plan Administrator: Point Comfort Underwriters, Inc. 1

3 Table of Contents Part Pages PERIOD, RENEWAL AND CANCELLATION 4 Part I Coverage Provisions 4-5 Part II MedPack 5-9 Part III EvacPack 9-13 Part IV AdventurePack 13 Part V LifePack 14 Part VI TroublePack Part VII Exclusions Part VIII General Provisions and Conditions Precedent Part VIX Definitions

4 Triptime Master Policy Plan Administrator: Point Comfort Underwriters, Inc. 212 W. 10 th St. #C400 Indianapolis, IN USA IMPORTANT NOTICE AND DISCLAIMER CONCERNING THE UNITED STATES PATIENT PROTECTION AND AFFORDABLE CARE ACT: This insurance is not subject to, and does not provide certain insurance benefits required by the United States Patient Protection and Affordable Care Act ( PPACA ). PPACA requires certain US citizens or US residents to obtain PPACA compliant health insurance or minimum essential coverage. PPACA also requires certain employers to offer PPACA compliant insurance coverage to their employees. Tax penalties may be imposed on US residents or citizens who do not maintain minimum essential coverage, and on certain employers who do not offer PPACA compliant insurance coverage to their employees. In some cases, certain individuals may be deemed to have minimum essential coverage under PPACEA even if their insurance coverage does not provide all of the benefits required by PPACA. You should consult your attorney or tax professional to determine whether this policy meets any obligations you may have under PPACA. Certain Underwriters at Lloyd s, London ( Underwriters ) will provide the Triptime Benefits described in this Master Policy in consideration of the Assured s Application, each Insured Person's Application and payment of premium. Only the Benefits for which eligible members of the Assured have applied for and for which premium has been paid will be provided for Insured Persons. Point comfort Underwriters, Inc. act as agent for the Underwriters pursuant to an authority granted under Binding Authority Agreement UMR: B1921YA000310R and have been appointed by Underwriters as the Plan Administrator. All Communications, payments and notices required under this Master Policy shall be transmitted through the Plan Administrator. It is a condition of this Master Policy that the Assured cooperates fully with the Plan Administrator in the performance of its duties hereunder. Underwriter s agreement is subject to all terms, conditions, provisions and exclusions of this Master Policy, including the Declaration, and any Exhibits, Schedules, and/or Endorsements attached hereto. The Certificate provided to Insured Persons is a summary of this Master Policy. In the event of any conflict between this Master Policy and the Certificate, the Master Policy shall prevail. 3

5 PERIOD, RENEWAL AND CANCELLATION A. Master Policy Period: The Master Policy Period is the period of time beginning on the Effective Date and ending on the Termination Date indicated on the Declaration attached hereto. B. Renewal: This Master Policy may be renewed for subsequent periods, subject to agreement of Underwriters and the Assured. C. Cancellation: This Master Policy may be cancelled by either the Assured or the Underwriters giving not less than ninety (90) days advance written notice to the other party. In the event this Master Policy is cancelled at any time, or is not renewed at any anniversary, coverage with respect to Certificates issued prior to cancellation shall remain in full force and effect until their natural expirations, which shall not be longer than eighteen (18) months following the date cancellation or non-renewal of this Master Policy takes effect. Part I COVERAGE PROVISIONS Eligibility Triptime Certificates are available to members of the Assured who are at least 14 days old while traveling outside their Home Country. TripTime Cetificates are not available to US citizens. Certificate Period - The Certificate Period is the period of time beginning on the Effective Date and ending on the Termination Date indicated on the Certificate Declaration issued to Insured Persons. Only Registered Trips which begin during the Certificate Period are covered hereunder. Effective Date of Coverage for a Registered Trip Triptime coverage becomes effective on the latest of the following: 1) The date and time indicated on the Registered Trip Confirmation issued to the Insured Person; or 2) The moment the Insured Person departs from his/her Home Country, provided always that Triptime Days are fully paid and available. Termination Date of Coverage for a Registered Trip Triptime coverage ends on the earlier of the following: 1) The date and time indicated on the Registered Trip Confirmation issued to the Insured Person; or 2) The moment the Insured Person returns to his/her Home Country; or 3) 11:59 pm on the last day of fully paid Triptime Days; or 4) The date the Insured Person no longer meets the Eligibility requirements set forth herein. Triptime Top-Up Days Additional Triptime Days may be added to Certificates issued to Insured Persons, subject to a maximum of 365 total Triptime Days per Insured Person per Certificate Period. Triptime Top-Up Days are subject to payment of premium at the rates in effect on the date the Triptime Top-Up Days are purchased. Triptime Top-Up Days can be purchased at A non-refundable administrative fee may be charged for each Triptime Top-Up purchase. 4

6 Premium Refund Premiums paid for Triptime Days, including Triptime Top-Up Days, are refundable to Insured Persons if not used during their Certificate Periods, provided total unused Triptime Days and Triptime Top-U Days exceed 5 days. Premium refunds will be made within 30 days of the last day of the Certificate Period. Part II MedPack MedPack Schedule of Benefits and Limits Maximum Limits Options: $50,000, $100,000, $250,000, $500,000 or $1,000,000 per Insured Person per Certificate Period, subject to the following: 1. The Maximum Limit for Individuals age 70 to 79 is $50,000; and 2. The Maximum Limit for individuals age 80 or older is $10,000. Individual Deductible Options: $0, $100, $250, $500, $1,000 or $2,500 per Insured Person per Registered Trip Coinsurance for treatment received outside the US & Canada No Coinsurance Coinsurance for treatment received within the US & Canada In PMP Network the plan pays 90% of Eligible MedPack Expenses up to $5,000; then 100% up to the Maximum Limit Out of PMP Network the plan pays 80% of Eligible MedPack Expenses up to $5,000; then 100% up to the Maximum Inpatient and Outpatient care (includes Hospital charges, outpatient facility charges, diagnostic x-ray and laboratory charges and charges for professional services and supplies Prescription Drugs Limit. (PMP means Preferred Medical Provider) 100% of Usual, Reasonable and Customary charges, up to the Maximum Limit (Hospital room and board limited to average semiprivate or ward rate) Usual, Reasonable and Customary charges, up to the Maximum Limit (30 day supply limit) 5

7 Physical Therapy Local Ambulance Emergency Room Dental Dental Sudden Onset of Acute Pain Up to $50 per visit, maximum 10 visits per Certificate Period Up to $5,000 per Certificate Period Injury due to Accident Up to the Maximum Limit Illness with Inpatient admission Up to the Maximum Limit Illness without Inpatient admission Up to the Maximum Limit with additional Deductible of $250 Injury due to Accident Up to the Maximum Limit Up to $100 for Registered Trips of 30 days or more. MedPack Eligible Expenses Subject to the Deductible and Limits set forth on the MedPack Schedule of Benefits and Limits, Underwriters will pay the following expenses incurred by an Insured Person while on a Registered Trip: 1. Charges made by a Hospital for: a. daily room and board and nursing services not to exceed the Hospital s average semi-private room rate; and b. daily room and board and nursing services in Intensive Care Unit; and c. use of operating, treatment or recovery room; and d. services and supplies which are routinely provided by the Hospital to persons for use while Inpatients, with the exception of personal services and supplies of a non-medical nature; and e. Emergency Room treatment of an Injury due to an Accident; and f. Emergency Room treatment of an Illness resulting in admission to the Hospital as Inpatient for further treatment of that Illness; and g. Emergency Room treatment of an Illness which does not result in admission to the Hospital as Inpatient, if non Emergency Room care was not available due to the time or location of the Insured Person at the onset of symptoms. h. Emergency Room treatment of an Illness which does not result in admission to the Hospital as Inpatient, subject to an additional Deductible as stated in the MedPack Schedule of Benefits and Limits. 2. For Surgery at an outpatient Surgical facility, including services and supplies. 6

8 3. For charges made by a Physician for professional services, including Surgery. Charges for an assistant surgeon are covered up to 20% of the Usual, Reasonable and Customary charge of the primary surgeon, but standby availability will not be deemed to be a professional service and therefore is not covered hereunder. 4. For dressings, sutures, casts or other supplies which are Medically Necessary and administered by or under the supervision of a Physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except Durable Medical Equipment as herein defined. 5. For diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included). 6. For artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the replacement or repair thereof. 7. For reconstructive Surgery when the reconstructive Surgery is directly related to Surgery which is covered hereunder. 8. For hemodialysis and the charges by the Hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components. 9. For oxygen and other gasses and their administration by or under the supervision of a Physician. 10. For anesthetics and their administration by a Physician or anesthetist. 11. For drugs which require prescription by a Physician for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of thirty (30) days per prescription. 12. For care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital. 13. Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital and only in lieu of Medically Necessary Inpatient hospitalization. 14. Emergency Local Ambulance transport necessarily incurred in connection with Injury or Illness resulting in Inpatient hospitalization. 15. Dental Treatment necessary to restore or replace sound natural teeth lost or damaged in an Accident which was covered under this insurance. 16. Dental Treatment necessary to resolve sudden onset of acute pain, subject to a maximum of $100 per Insured Person per Certificate Period. 7

9 17. Medically Necessary rental of Durable Medical Equipment (consisting of a standard basic hospital bed and or a standard basic wheelchair) up to the purchase prices. 18. Physical therapy by a licensed physiotherapist necessarily incurred to continue recovery from a covered Injury or Illness, and subject to the maximum amounts specified in the Schedule of MedPack Benefits. Such physical therapy must be prescribed by a Physician who is not affiliated with the physiotherapy practice performing the physical therapy. Other Insurance Underwriters shall not pay any MedPack expense if there is other insurance that would, or would but for the existence of this insurance, pay such expense. Except, where benefit amounts insured elsewhere are less than the applicable benefit amount insured hereunder, Underwriters will pay the difference between the benefit amounts insured elsewhere and the applicable benefit amount of this insurance, subject always to the applicable Deductible and Coinsurance. Underwriters shall not pay any claim in respect to care, treatment, services or supplies furnished by any program or agency funded by any government. Pre-certification Requirements The following MedPack expenses must always be Pre-certified: 1. Inpatient care; and 2. Any Surgery or Surgical Procedure; and 3. Care in an Extended Care Facility; and 4. Home Nursing Care; and 5. Durable Medical Equipment; and 6. Artificial limbs; and 7. Computerized Tomography (CAT Scan); and 8. Magnetic Resonance Imaging (MRI). To comply with the Pre-certification requirements, the Insured Person must: 1. Contact the Plan Administrator at the telephone number contained in the Insured Person's Identification Card as soon as possible before the expense is to be incurred; and 2. Comply with the instructions of the Plan Administrator and submit any information or documents they require; and 3. Notify all Physicians, Hospitals and other Medical Providers that this insurance contains Pre-certification requirements and ask them to fully cooperate with the Plan Administrator. If the Insured Person complies with the Pre-certification requirements, and the expenses are Precertified, Underwriters will pay MedPack Benefits, subject to all terms, conditions, provisions and exclusions herein. If the Insured Person does not comply with the Pre-certification requirements or if the expenses are not Pre-certified: 1. Eligible MedPack Expenses will be reduced by 50%; and 2. The Deductible will be subtracted from the remaining amount. 8

10 In the event of an Emergency Hospital admission, Pre-certification must be made within 48 hours after the admission, or as soon as is reasonably possible but no later than one week thereafter. The fact that expenses are Pre-certified does not guarantee either payment of Benefits or the amount of Benefits. Eligibility for and payment of Benefits are subject to all the terms, conditions, provisions and exclusions herein. For Inpatient stays of any kind, the Plan Administrator will Pre-certify a limited number of days of confinement. Additional days of Inpatient confinement may later be Pre-certified if the Insured Person receives prior approval. Preferred Medical Provider Requirements - Nothing contained in this insurance restricts or interferes with the Insured Person's right to select the Hospital, Physician or other Medical Provider of his/her choice. Nothing contained in this insurance restricts or interferes with the relationship between the Insured Person and the Hospital, Physician or other Medical Providers with respect to treatment or care of any condition, or the right of any Insured Person to receive, at his or her own expense, services and/or supplies that are not covered under this insurance. To comply with the Preferred Medical Provider requirements, the Insured Person must receive medical treatment from Preferred Medical Providers as directed by the Plan Administrator. If the Insured Person chooses to seek treatment from a Preferred Medical Provider, Underwriters will remit payment for Eligible Expenses directly to the Preferred Medical Provider. The Insured Person may review a listing of Preferred Medical Providers for the area where he or she will be receiving treatment by contacting the Plan Administrator. PART III EvacPack EvacPack Schedule of Benefits and Limits All EvacPack Benefits must be approved in advance and arranged by the Plan Administrator. Failure to obtain advance approval will result in forfeiture of Benefits. Emergency Medical Evacuation Maximum Limit Emergency Reunion Maximum Limit Up to $500,000 per Insured Person per Certificate Period, subject to the following: 1. The Maximum Limit for individuals age 65 to 79 is $50, No coverage is provided for individuals age 80 or older. 3. The Maximum Limit in respect to an Acute Onset of a Pre-existing Condition is $10,000. Up to $50,000 per Insured Person per 9

11 Repatriation of Mortal Remains or Cremation/Burial Maximum Limit Return of Minor Child(ren) Trip Interruption Certificate Period Up to $50,000 per Insured Person per Certificate Period for Repatriation of Mortal Remains, or $5,000 for Local Cremation/Burial Up to $5,000 per Insured Person per Certificate Period. Period Up to $5,000 per Insured Person per Certificate Period. Emergency Medical Evacuation Expenses Subject to the Limits set forth in the EvacPack Schedule of Benefits and Limits, and subject to the Conditions and Restrictions contained in this provision, Underwriters will pay the following expenses arising out of Emergency Medical Evacuation: 1. Emergency air transportation to a suitable airport nearest to the Hospital where the Insured Person will receive treatment; and 2. Emergency ground transportation necessarily preceding Emergency air transportation; and from the destination airport to the Hospital where the Insured Person will receive treatment. 3. The cost of an economy one-way air and/or ground transportation ticket for the Insured Person from the area where the Insured Person was hospitalized following an Emergency Medical Evacuation to the area where the Insured Person was initially evacuated from, or to the terminal serving the area of the Insured Person's Principal Residence. Conditions and Restrictions: a. Underwriters will provide Emergency Medical Evacuation Benefits only when the Illness or Injury giving rise to the Emergency Medical Evacuation is covered under this Insurance; and b. Underwriters will provide Emergency Medical Evacuation Benefits only when all of the following conditions are met: i. Medically Necessary treatment, services and supplies cannot be provided locally; and ii. transportation by any other method would result in loss of Insured Person's life or limb; and iii. recommended by the attending Physician who certifies to the above; and iv. agreed upon by the Insured Person or a Relative of the Insured Person; and v. the condition giving rise to the Emergency Medical Evacuation occurred spontaneously and without advance warning, either in the form of Physician recommendation or symptoms which would have caused a prudent person to seek medical attention prior to the onset of the Emergency. 10

12 c. Underwriters will provide Emergency Medical Evacuation only to the nearest Hospital that is qualified to provide the Medically Necessary treatment, services and supplies to prevent the Insured Person's loss of life or limb. d. Underwriters will use their best efforts to arrange any Emergency Medical Evacuation within the least amount of time possible. The Insured Person understands that the timeliness of Emergency Medical Evacuation can be affected by circumstances which are not within the control of Underwriters including but not limited to availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems and weather. The Insured Person agrees to hold Underwriters harmless and Underwriters shall not be held liable for any delays that are not within their direct and immediate control. Notwithstanding the foregoing items b. i.-v and c., Underwriters will pay for expenses to return the Insured Person to his/her Home Country if the attending Physician, the Insured Person and Underwriters (or their duly appointed medical consultant) agree that transfer to the Home Country is more appropriate than transfer to the nearest qualified Hospital. Emergency Reunion Expenses Subject to the Limits set forth in the EvacPack Schedule of Benefits and Limits, Underwriters will pay the following Emergency Reunion Expenses following a covered Emergency Medical Evacuation: 1. The cost of an economy round-trip air or ground transportation ticket for one Relative of the Insured Person for transportation to the terminal serving the area where the Insured Person is hospitalized or is to be hospitalized following a covered Emergency Medical Evacuation; and 2. Reasonable expenses for lodging and meals for the Relative, which are incurred in the area where the Insured Person is hospitalized for a period not to exceed fifteen (15) days. Repatriation of Mortal Remains Expenses - Subject to the Limits set forth in EvacPack Schedule of Benefits and Limits, and subject to the Conditions and Restrictions contained in this provision, Underwriters will pay the following Repatriation of Remains or Local Burial or Cremation expenses arising from the death of an Insured Person: 1. Air or ground transportation of bodily remains or ashes to the airport or ground transportation terminal nearest to the Principal Residence of the deceased Insured Person; and 2. Reasonable costs of preparation of the remains necessary for transportation; or 3. In lieu of 1. and 2. above, Underwriters will pay the reasonable expenses of Local Burial or Cremation. Conditions and Restrictions: a. Underwriters will provide Repatriation of Mortal Remains or Local Burial or Cremation Benefits only when the death of the Insured Person occurs as a result of an Injury or Illness that is covered under this insurance; and b. Underwriters will provide Repatriation of Mortal Remains or Local Burial or Cremation Benefits only when the death of the Insured Person occurs outside the Insured Person s Home Country, and while this coverage is in effect; and c. Underwriters will use their best efforts to arrange any Repatriation of Mortal Remains or Local Burial or Cremation Benefits within the least amount of time possible. The 11

13 Insured Person understands that the timeliness of Repatriation of Mortal Remains or Local Burial or Cremation can be affected by circumstances which are not within the control of Underwriters including but not limited to local customs, availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems and weather. The Insured Person, and his/her heirs, agree to hold Underwriters harmless and Underwriters shall not be held liable for any delays which are not within their direct and immediate control. Further, Underwriters are held harmless and shall not be held liable for loss of or any damage or other impairment to bodily remains incurred during the Repatriation or Mortal Remains process or otherwise. Return of Minor Child(ren) Expenses - Subject to the Limit set forth in the EvacPack Schedule of Benefits and Limits, and subject to the Conditions and Restrictions contained in this provision, Underwriters will pay the following Return of Minor Child(ren) Benefits following a covered Inpatient hospitalization of an Insured Person or following the death of an Insured Person resulting in the minor child(ren) being left unattended: 1. The cost of an economy one way air or ground transportation ticket for each minor child (under age 17) traveling with the Insured Person for transportation to the terminal serving the area where the minor child(ren) permanently reside(s); and 2. A chaperone, if necessary for the safety of the minor child(ren). Conditions and Restrictions: a. The Insured Person must be traveling alone with the minor child(ren) who would otherwise be left unattended upon the hospitalization or death of the Insured Person; and b. Underwriters will use their best efforts to arrange any Return of Minor Child(ren) Benefit within the least amount of time possible. The Insured Person understands that the timeliness of the Return of Minor Child(ren) can be affected by circumstances which are not within the control of Underwriters including but not limited to availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems and weather. The Insured Person agrees to hold Underwriters harmless and Underwriters shall not be held liable for any delays that are not within their direct and immediate control. The Insured Person understands that the safety of minor child(ren) before, during and after transportation is Underwriter s highest priority; however, the Insured Person agrees to hold Underwriters harmless and Underwriters shall not be held liable for Injury or Illness of the minor child(ren) which occurs during or results from the Return of Minor Child(ren) Benefit. Trip Interruption - Subject to the Limit set forth in the EvacPack Schedule of Benefits and Limits, Underwriters will pay the following Trip Interruption Benefits if, during a Registered Trip there is an unexpected death of the Insured Person s immediate Family member (spouse, child, parent or sibling), or in the event of substantial destruction of the Insured Person s Principal Residence due to fire or natural disaster: 12

14 1. The cost of a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket, for the Insured Person. Other Insurance Underwriters shall not pay any EvacPack expense if there is other insurance that would, or would but for the existence of this insurance, pay such expense. Except, where benefit amounts insured elsewhere are less than the applicable benefit amount insured hereunder, Underwriters will pay the difference between the benefit amounts insured elsewhere and the applicable benefit amount of this insurance. Underwriters shall not pay any claim in respect to care, treatment, services or supplies furnished by any program or agency funded by any government. Part IV - AdventurePack AdventurePack Schedule of Benefits and Limits Maximum Limit for MedPack and Age Lifetime Maximum EvacPack Benefits for claims due to 0-49 $50,000 Adventure Sports $25, $10, Not Available Adventure Sports Included Abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating (with helmets and pads), jet skiing, zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4,500 meters), scuba diving (to 50 meters), skydiving, snowboarding, snow mobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), wildlife safaris, windsurfing. Subject to the Maximum Limits set forth in the AdventurePack Schedule of Benefits and Limits, Underwriters will pay MedPack and EvacPack Benefits in respect of Injuries sustained by Insured Persons while participating in the Adventure Sports listed in the AdventurePack Schedule of Benefits and Limits, provided always that the Adventure Sports listed are not undertaken for wage, reward or profit. 13

15 Part V LifePack LifePack Schedule of Benefits and Limits Accidental Death Accidental Dismemberment Two or more Limbs/Eyes Accidental Dismemberment One Limb or Eye Family Maximum Age 18 to 69 - $25,000, $50,000 or $100,000 Lump Sum Benefit. Age 14 days to 17 - $5,000 Age 70 to 74 Benefits reduce 50% Age 75 and older - $5, % of the Accidental Death Lump Sum Benefit 50% of the Accidental Death Lump Sum Benefit $250,000 per Certificate Period Accidental Death - Subject to the Limits set forth in LifePack Schedule of Benefits and Limits, and subject to the Conditions and Restrictions contained in this provision, Underwriters will pay the Lump Sum Benefit to the Insured Person s Beneficiary. Accidental Dismemberment - Subject to the Limits set forth in LifePack Schedule of Benefits and Limits, and subject to the Conditions and Restrictions contained in this provision, Underwriters will pay the Lump Sum Benefit to the Insured Person. Family Maximum In no event will Underwriters pay more than $250,000 in respect of any one Family. Conditions and Restrictions: a. Underwriters will provide Accidental Death or Accidental Dismemberment Benefits only when the death or dismemberment of the Insured Person occurs as a result of an Accident that is covered under this insurance; and b. Underwriters will provide Accidental Death or Accidental Dismemberment Benefits only when the death or dismemberment of the Insured Person occurs outside the Insured Person s Home Country, and while this coverage is in effect. Part VI - TroublePack TroublePack Schedule of Benefits and Limits Crisis Management $150,000 or $250,000 Extra Expenses including Legal, Political Evacuation, 14

16 Security, Translation, Re-location Insured Event 10% of the Crisis Management Limit Wrongful Detention, Kidnapping, Blackmail and Extortion, Political Threat, Disappearance, Hijack, Act of Terrorism, Violent Crime Subject to the Limits set forth in the TroublePack Schedule of Benefits and Limits, and subject to the Conditions and Restrictions contained in this provision, Underwriters will pay the following expenses resulting from an Insured Event: 1. The fees and costs of the Crisis Management Consultant appointed by Underwriters that are incurred during the Crisis Coverage Period; and 2. Extra Expenses incurred by the Insured Person during the Crisis Coverage Period. Extra Expense includes the following expenses incurred as a result of an Insured Event: a) Emergency Political Evacuation Costs, b) Legal expenses, c) fees and expenses of an independent interpreter, d) costs of relocation travel and accommodation; e) fees and expenses of security guards temporarily retained for the purpose of protecting the Insured Person located in the country where an Insured Event has occurred. Conditions and Restrictions 1. The Insured Event must occur while the Insured Person is covered under this insurance. 2. The Insured Event must occur while the Insured Person is outside his/her Home Country PART VII EXCLUSIONS Exclusions Applicable to All Parts 1. Charges of any nature resulting from or occurring during the commission of a violation of law by the Insured Person, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations. 2. Charges of any nature incurred in the Insured Person s Home Country. 3. Charges of any nature resulting directly or indirectly from the use of any biological, chemical, nonmedical radioactive or non-medical nuclear agent, material, device or weapon. 4. Charges of any nature resulting from or occurring during the Insured Person s direct or indirect involvement in any war, Act of Terrorism, strike, riot or civil commotion or while the Insured Person is a member of any military or para-military. 5. Notwithstanding number 4. of this provision, charges of any nature resulting from the following are excluded: 15

17 a. war, whether declared or not, between any of the following countries: China, France, the United Kingdom, the Russian Federation and the United States of America; or b. war in Europe, whether declared or not, other than: civil war or any enforcement action by or on behalf of the United Nations, in which any of the countries stated in (a) above or any armed forces thereof are engaged. 6. Charges of any nature sustained when the Insured Person has entered and/or unreasonably failed or refused to depart a country within forty-eight (48) hours of the time an evacuation order has been issued by the Insured Person s Home Country. 7. Charges of any nature which are not presented to Underwriters for payment within 60 days of the date the charge is incurred. 8. Charges of any nature and any claim (including Accidental Death and/or Accidental Dismemberment claims) resulting from self-inflicted Injury or Illness and/or suicide or attempted suicide whether sane or insane. 9. No Underwriter shall be deemed to provide cover and no Underwriter shall be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose that Underwriter to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America. 10. Charges of any nature that are presented to Underwriters for payment more than ninety (90) days following the date the charge is incurred. Exclusions Applicable to Parts II (MedPack), III (EvacPack) and IV (AdventurePack) 1. Pre-existing Conditions. 2. Diagnosis or treatment of all forms of cancer / neoplasm. 3. All charges related to Pregnancy, including but not limited to pre-natal care, Delivery, and post natal care, and care of Newborns. 4. Treatment related to birth defects and congenital Illnesses. Birth defects are deemed to include hereditary conditions. 5. Any drug, treatment or procedure that either promotes or prevents conception including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal of sterilization. 16

18 6. Any drug, treatment or procedure that either promotes, enhances or corrects impotency or sexual dysfunction. 7. Abortions, except to save the life of the mother. 8. All expenses of any cryogenic preservation and implantation or re-implantation of living cells. 9. Organ or tissue transplants or related services. 10. Treatment for acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus. 11. The following care, treatment or supplies for the feet: orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails. 12. Charges for treatment of Mental Health Disorders. 13. Dental Treatment, except for Dental Treatment necessary to restore sound natural teeth lost or damaged in a covered Accident or Dental Treatment necessary to resolve sudden onset of acute pain, subject to a maximum of $100 per Insured Person per Certificate Period. 14. All MedPack and EvacPack Benefits are excluded, unless the Insured Person has purchased and is covered under AdventurePack, with respect to Accidents occurring while the Insured Person is participating in any of the following: a. Contact Sports, intercollegiate, interscholastic, intramural, and club Amateur Athletics sports or athletic activities and Professional Sports. Non-contact and non-organized/non-sanctioned Amateur Athletics or athletic activities engaged in solely for leisure, recreational, entertainment or fitness purposes are not excluded unless they are excluded by (b) through (c) of this provision; and b. Any one or combination of the following: Abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating (with helmets and pads), jet skiing, zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4,500 meters), scuba diving (to 50 meters), skydiving, snowboarding, snow mobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), wildlife safaris, windsurfing; and c. Any other sport or activity which is undertaken for thrill seeking and exposes the individual to abnormal risk of Injury. 15. Weight modification or Surgical treatment of obesity, including but not limited to wiring of the teeth and all forms of intestinal bypass Surgery. 17

19 16. Modifications of the physical body intended to improve psychological, mental or emotional wellbeing, including but not limited to sex-change Surgery. 17. Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, dentures or dental appliances and any examination or fitting related to these devices. 18. Orthoptics, visual eye training and eye Surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism. 19. Treatment of the temporomandibular joint. 20. Diagnosis or treatment of venereal disease, including all Sexually Transmitted Diseases and conditions. 21. Routine Physical Exams and treatment, including but not limited to vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to the suitability of employment or travel. 22. Treatment by a chiropractor. 23. Medical treatment for Substance Abuse or addiction or conditions that may be attributed to Substance Abuse or addictions and direct consequences thereof. 24. Treatment of Insured Persons who are HIV+, have AIDS or ARC, and all diseases caused by and/or related to HIV. 25. Charges for treatment of any condition(s) when the purpose of departing the Home Country was to obtain treatment in the Host Country(ies). 26. Treatment, services or supplies that are not Medically Necessary and administered by or under the supervision of a Physician, and products that can be purchased without a Physician s prescription. 27. Treatment, services or supplies provided at no cost to the Insured Person and any treatment, services or supplies performed or provided by a Relative of the Insured Person or any person who ordinarily resides with the Insured Person. 28. Telephone consultations or failure to keep a scheduled appointment. 29. Surgeries, treatments, services or supplies that are Investigational, Experimental or for Research Purposes. 18

20 30. Charges incurred while confined primarily to receive Custodial Care, Educational or Rehabilitative care, or any medical treatment in any establishment for the care of the aged. 31. Surgeries, treatments, services or supplies for cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is directly related to and follows Surgery which was covered hereunder. 32. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinestherapy. 33. Services, supplies, or treatment for hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed by a Physician. 34. Exercise programs, whether or not prescribed or recommended by a Physician. 35. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder. 36. Charges for travel or accommodation, except for Local Ambulance as provided for in MedPack, the EvacPack Benefits and as specified in TroublePack Extra Expenses. 37. Charges which exceed the Usual, Reasonable and Customary charge for the service or supply provided. 38. Charges for any supply or service that is not Medically Necessary. Exclusions Applicable to Parts II (MedPack), III (EvacPack), IV (AdventurePack) and V (LifePack) 1. Injury and/or Accidental Death and/or Accidental Dismemberment sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician but not for the treatment of Substance Abuse. Exclusion Applicable to Parts III(EvacPack) and VI (TroublePack) 1. All expenses not approved or arranged in advance by Underwriters. Exclusions Applicable to Part VI (TroublePack) 1. In respect of Wrongful Detention, any actual or alleged violation of the laws of the Host Country or a failure to maintain and possess duly authorised and issued required documents and visas, unless Underwriters determine that such allegations were intentionally false, fraudulent, and malicious and made solely to achieve a political propaganda or coercive effect upon or at the expense of the Insured Person. 19

21 2. Any Kidnapping of an Insured Person by a Relative or as a result of a domestic dispute. 3. An Insured Person who has had Kidnap insurance cancelled or declined in the past. 4. Any Kidnapping of an Insured Person who has been Kidnapped in the past. 5. Any Kidnapping, Blackmail or Extortion of an Insured Person within their Home Country. 6. The payment of any Ransom. 7. Loss or destruction of or damage to any property whatsoever or any loss or expense whatsoever resulting or arising therefrom or any consequential loss. 8. Any legal liability of whatsoever nature directly or indirectly caused by or contributed to, by or arising from: a) ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel; or b) the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof. PART VIII GENERAL PROVISIONS AND CONDITIONS PRECEDENT General Provisions Currency - The monetary limits and Premiums stated in this Master Policy are in U.S dollars. Benefits may be paid in local currency equivalents. Notice - Any notice to the Assured shall be sent by registered mail and addressed to the mailing address on file with Underwriters on the date the notice is mailed. Any notice to the Insured Person shall be sent by registered mail and addressed to the mailing address on file with Underwriters on the date the notice is mailed. Notwithstanding the foregoing, Underwriters, the Assured and/or the Insured Person may agree to electronic means of notice in which case any notice to the Assured or Insured Person shall be transmitted to the electronic address on file with Underwriters on the date the notice is sent. It is the responsibility of the Assured and each Insured Person to advise Underwriters of any change in mailing address or electronic address. Complaints Procedure Complaints, if any, should be addressed in the first instance in writing to the Plan Administrator. A written response will be provided to the Assured or any Insured Person within fourteen (14) days. If the Assured or any Insured Person is not satisfied with the response or the way a complaint has been dealt with the Assured or any Insured Person may ask the Complaints Department at Brit Syndicates Limited to review the case without prejudice to their rights in law. The address is: Brit Global Specialty Complaints Department The Leadenhall Building 122 Leadenhall Street 20

22 London EC3V 4AB Should the foregoing prove unsatisfactory, the Assured and any Insured Persons are entitled to contact the Financial Ombudsman Services (FOS), South Quay Plaza, 183 Marsh Wall, London E149SR.. Claims Complaints and Proceedings - If the Assured is made aware by a member of a claim or complaint that the member wishes to make under the Master Policy, the Assured shall promptly inform the member of the arrangements established by the Underwriters for the making of claims or complaints (as applicable) and shall promptly notify to the Plan Administrator full details of the claim or complaint (as applicable). Where the Assured is aware of any legal or regulatory proceedings or actions commenced against Lloyd s, the Underwriters, the Assured, or the Plan Administrator arising out of the operation of or in connection with the Master Policy, the Assured shall promptly provide the Underwriters with full details of the same. Promotional and Marketing Material Any specific marketing or promotional material to be used in relation to the Master Policy, including on any internet website, portal or similar online system, must first be approved by Underwriters. Conditions Precedent The following are conditions precedent to Underwriters liability under this insurance: Premium 1. Rate: The initial rates for this insurance shall be as set forth in the Declaration. The rate for Top-Up Days, if any, shall be the rate for Top-Up Days in effect on the date the Top-UP Days are added to any Certificate. 2. Payment: Payment of the required initial premium shall be remitted to Underwriters on or before the first day of any Certificate Period. Payment of required premium for Top-Up Days shall be remitted to Underwriters at the time the Top-Up days are added to any Certificate. 3. Premiums for this insurance may be refunded in full upon written request from the Insured Person prior to the first day of any Certificate Period. 4. Premiums for the number of unused and paid Triptime Days or Triptime Top-Up Days that exceed 5 days as of the last day of any Certificate Period will be refunded to the Insured Person within 30 days beginning on the last day of the Certificate Period. Duty of Fair Presentation 1) If, prior to entering into this Master Policy, the Assured shall breach the duty of fair presentation, the remedies available to the Insurer are set out below. 21

23 a) If the Assured s breach of the duty of fair presentation is deliberate or reckless: i) Underwriters may avoid the contract, and refuse to pay all claims; and, ii) Underwriters need not return any of the premiums painid. b) If the Assured s breach of the duty of fair presentation is not deliberate or reckless, Underwriter s remedy shall depend upon what Underwriters would have done if the Assured had complied with the duty of fair presentation: i) If Underwriters would not have entered into the contract at all, Underwriters may avoid the contract and refuse all claims, but must return the premiums paid. ii) If Underwriters would have entered into the contract, but on different terms (other than terms relating to the premium), the contract is to be treated as if it had been entered into on those different terms from the outset, if Underwriters so require. iii) In addition, if Underwriters would have entered into the contract, but would have charged a higher premium, Underwriters may reduce proportionately the amount to be paid on a claim (and, if applicable, the amount already paid on prior claims). In those circumstances, Underwriters shall pay only X% of what it would otherwise have been required to pay, where X = (premium actually charged/higher premium) x ) If, prior to entering into a variation to this Master Policy, the Assured shall breach the duty of fair presentation, the remedies available Underwriters are set out below. a) If the Assured s breach of the duty of fair presentation is deliberate or reckless: i) Underwriters may by notice to the Assured treat the contract as having been terminated from the time when the variation was concluded; and, ii) Underwriters need not return any of the premiums paid. b) If the Assured s breach of the duty of fair presentation is not deliberate or reckless, Underwriters remedy shall depend upon what Underwriters would have done if the Assured had complied with the duty of fair presentation: i) If Underwriters would not have agreed to the variation at all, Underwriters may treat the contract as if the variation was never made, but must in that event return any extra premium paid. ii) If Underwriters would have agreed to the variation to the contract, but on different terms (other than terms relating to the premium), the variation is to be treated as if it had been entered into on those different terms, if Underwriters so require. iii) If Underwriters would have increased the premium by more than it did or at all, then Underwriters may reduce proportionately the amount to be paid on a claim arising out of events after the variation. In those circumstances, the Insurer shall pay only X% of what it would otherwise have been required to pay, where X = (premium actually charged/higher premium) x 100. iv) If Underwriters would not have reduced the premium as much as it did or at all, then Underwriters may reduce proportionately the amount to be paid on a claim arising out of events after the variation. In those circumstances, the Insurer shall pay only X% of what it would otherwise have been required to pay, where X = (premium actually charged/reduced total premium) x

24 3) If this Master Policy provides cover for any person who is not a party to the contract (an Insured Person) and a fraudulent claim is made under the contract by or on behalf of an Insured Person, Underwriters may exercise the rights set out in clause (1) and (2) above as if there were an individual insurance contract between Underwriters and the Insured Person. However, the exercise of any of those rights shall not affect the cover provided under the contract for any other person. Fraudulent Claims 1) If the Assured makes a fraudulent claim under this Master Policy, Underwriters: a) Are not liable to pay the claim; and b) May recover from the Assured any sums paid by Underwriters to the Assured in respect of the claim; and c) May by notice to the Assured treat the contract as having been terminated with effect from the time of the fraudulent act. 2) If Underwriters exercise their right under clause (1)(c) above: a) Underwriters shall not be liable to the Assured in respect of a relevant event occurring after the time of the fraudulent act. A relevant event is whatever gives rise to Underwriters liability under this Master Policy (such as the occurrence of a loss, the making of a claim, or the notification of a potential claim); and, b) Underwriters need not return any of the premiums paid. 3) If this Master Policy provides cover for any person who is not a party to the contract (an Insured Person), and a fraudulent claim is made under the contract by or on behalf of an Insured Person, Underwriters may exercise the rights set out in clause (1) above as if there were an individual insurance contract between Underwriters and the Insured Person. However, the exercise of any of those rights shall not affect the cover provided under the contract for any other person. Nothing in these clauses is intended to vary the position under the Insurance Act Law and Jurisdiction This Master Policy and any dispute or claim arising out of or in connection with it or its subject matter or formation (including non-contractual disputes or claims) shall be governed by, and construed in accordance with, the law of England and Wales. The courts of England and Wales shall have exclusive jurisdiction over any dispute or claim arising out of or in connection with this Master Policy or its subject matter or formation (including noncontractual disputes or claims). Proof of Claim - When Underwriters receive notice of claim, they will provide the Insured Person with forms for filing Proof of Claim. The following is considered to be Proof of Claim: 1. A completed and signed Claimant's Statement and Authorization form, together with any/all required attachments; and 23