INDIVIDUAL TRAVEL MEDICAL EXPENSES POLICY KEY FACTS

Transcription

1 INDIVIDUAL TRAVEL MEDICAL EXPENSES POLICY

2 BATTLEFACE INSURANCE POLICY SUMMARY This summary does not contain the full terms and conditions of the insurance contract. Full details can be found in the Policy document, a copy of which is available on request. This summary does not form part of the contract of insurance. Type of Insurance And Cover This insurance is underwritten by certain underwriters at Lloyd s and provides a benefit to the Insured Person if they suffer illness or injury caused by an accident during the Period of Insurance. The Coverholder under which the Plan has been placed with Underwriters under Unique Market Reference B0621 is: Tangiers Insurance Services Limited Suite 21, 30 Churchill Square Kings Hill West Malling Kent ME19 4YU Period of Insurance This is the period between the Effective Date and the Termination Date shown on the Policy Schedule. Plan Administrator Tangiers Insurance Services Limited has been appointed by underwriters as the Plan Administrator. All communications and notices required under this Policy shall be transmitted through the Plan Administrator Tangiers Insurance Services Limited Suite 21, 30 Churchill Square Kings Hill West Malling Kent ME19 4YU The Plan Administrator acts as underwriters agent in binding risks, issuing documentation and the collection and processing of premiums and return premiums. 2

3 Cancellation For all policies that have a Period of Insurance of less than one month there is no cancellation or cooling-off period and no refund of premium will be payable at any time. For all policies that have a Period of Insurance of one month or more if the policy cover is not suitable and the Insured Person wants to cancel within fourteen (14) days of receiving the policy documentation, the Insured Person must or write to Tangiers Insurance Services Limited Suite 21, 30 Churchill Square Kings Hill West Malling Kent ME19 4YU contact@battleface.com If the Insured Person cancels after fourteen (14) days of receiving the policy documentation the premium will be refunded on a pro rata basis from the date the Insured Person s instructions are received or any later date specified by the Insured Person. Emergency Assistance Claims A twenty four (24) hour telephone Emergency Medical Assistance Service is incorporated in this Insurance. For all claims involving repatriation expenses or in-patient hospital, extended care facility or home nursing care, surgery, CAT Scan, MRI Imaging, artificial limbs clinic or hospital bed or wheelchair costs, immediate notice (and prior to any expense being incurred) must be given to: Tangiers International, Limited 54 Melita Street Valletta VLT 1122, Malta Tel.: Fax: medical@tangiersinternational.com (in the event of emergency hospital admission, notice must be given within forty eight (48) hours after the admission, or as soon as is reasonably possible but no later than one week thereafter). Other Claims Notice of claim, claimant s statement, and Proof of Claim must be mailed to the Claims Administrator: Tangiers International, Limited 54 Melita Street Valletta VLT 1122, Malta Tel.: Fax: claims@tangiersinternational.com 3

4 Complaints Any questions or concerns about this Policy or the handling of a claim should be addressed to: Tangiers Insurance Services Limited 54 Melita Street Valletta VLT 1122, Malta Tel.: Fax: medical@tangiersinternational.com A written acknowledgement of complaints will be provided within seven (7) days and a response within fourteen (14) days. If the Insured Person is not satisfied with the response, it may be possible to refer the matter to any appropriate complaints handling body in the territory in which the Insured Person resides. Details will be provided with the response. Alternatively or additionally, depending on circumstances, the Insured Person may be able to refer the matter to: Lloyd s Fidentia House, Walter Burke Way Chatham Maritime, Chatham Kent ME4 4RN Tel.: +44 (0) Fax: +44 (0) complaints@lloyds.com Details of Lloyd s complaints procedures are set out in a leaflet Your complaint How we can help available at and are also available from the above address. If the Insured Person remains dissatisfied after Lloyd s has considered their complaint, the Insured Person may have the right to refer their complaint to the United Kingdom complaints body: Financial Ombudsman Services (FOS), Exchange Tower, Harbour Exchange Square, London. E14 9SR. United Kingdom. Tel: +44 (0) complaint.info@financial-ombudsman.org.uk Web: 4

5 BATTLEFACE // INDIVIDUAL TRAVEL MEDICAL EXPENSES POLICY Compensation In the unlikely event of underwriters being unable to meet their liabilities, the Insured Person may be entitled to compensation under the Financial Services Compensation Scheme. Their contact details are: Financial Services Compensation Scheme 10th Floor, Beaufort House 15 St Botolph Street London EC3A 7QU United Kingdom Tel.: or Fax: GOING INTO HARM S WAY? YOU RE GOING TO NEED MORE THAN JUST A BAND AID. 5

6 BENEFITS & LIMITS PLAN OPTIONS Maximum for all Eligible Medical Expenses USD50, 000 or USD100,00 or USD250,000 or USD500,000* or USD1,000,000* *Not available for all destinations Deductible/Excess Options USD250 or USD500 or USD1,000 or USD2,500 or USD5,000 Per Period of Insurance. Coverage Area Cover is available worldwide. Cover will apply in respect of travel to the Destinations specified in the Application. The limits stated under Benefits B. to G inclusive, are in addition to the Maximum Benefit for A. Eligible Medical Expenses). Except in respect of Benefit G. Accidental Death and Accidental Dismemberment, all Benefits are subject to the Deductible stated in the Policy Schedule, and are per Policy Period. 6

7 BENEFITS LIMITS A. Eligible Medical Expenses Hospital Room and Board and Nursing Services For charges made by a physician for professional services, including surgery Charges for an assistant surgeon Drugs which require prescription by a physician for treatment of a covered Injury or Illness Emergency Local Ambulance Transport Physical Therapy All other Eligible Medical Expenses Maximum Benefit - As stated in the Policy Schedule, inclusive of the following: 100% Up to the average Semi-private room rate. Up to 100% Usual, Reasonable and Customary. Up to 20% of the Usual, Reasonable and Customary charge of the primary surgeon. Up to 100% Usual, Reasonable and Customary, for a maximum supply of thirty (30) days per prescription. Up to 100% Usual, Reasonable and Customary, but not exceeding USD 1,000 per policy period. Up to USD 50 per treatment, maximum 10 treatments. Up to 100% Usual, Reasonable and Customary B. Emergency Medical Evacuation Up to USD 50,000 when approved in advance and coordinated by the Claims Administrator. C. Repatriation of Remains Up to USD 15,000 when approved in advance and coordinated by the Claims Administrator. D. Local Burial or Cremation Up to USD 5,000 when approved in advance and coordinated by the Claims Administrator. E. Emergency Reunion Up to USD 5,000 when approved in advance and coordinated by the Claims Administrator. 7

8 BENEFITS LIMITS F. Return (following a covered Emergency Medical Evacuation) Up to USD 5,000 when approved in advance and coordinated by the Claims Administrator. G. Accidental Death and Accidental Dismemberment Up to 100% Usual Reasonable and Customary, for a maximum supply of thirty (30) days per prescription. 1. Accidental Death 2. Accidental Dismemberment a. Loss of two (2) or more Limbs or both eyes (or sight of both eyes) b. Loss of one (1) Limb or eye (or sight of eye) 3. Accidental Death and Accidental Dismemberment Benefits will be doubled if Accidental Death or Accidental Dismemberment results from Kidnapping, attempted Kidnapping, Hijacking or attempted Hijacking, subject to a maximum total Benefit amount in respect of all Family members covered under this Policy. USD 15,000 USD 15,000 USD 7,500 USD 250,000 Hazardous activities/sports: Amateur athletics, contact sports, intercollegiate, interscholastic, intramural, club sports or athletic activities and professional sports. Mountaineering where a reasonably prudent person would use ropes or guides at elevations of 4,500 meters or higher. hang gliding, sky diving, parachuting, bungee jumping, racing other than on foot, potholing, sub aqua pursuits and jet skiing Aviation: Air travel other than as a passenger. Suicide and criminal act: Committing or attempting to commit suicide, intentional self injury, criminal act, deliberate exposure to exceptional danger (other than in an attempt to save human life), drug and/or alcohol abuse. Alcohol and non-prescribed drugs: Injury sustained while under the influence of, or due to the effects of, alcohol or non-prescribed drugs AIDS: AIDS (Acquired Immune Deficiency Syndrome) and AIDS related conditions. Pre-existing conditions: Any pre-existing condition, physical or mental defect, infirmity or condition for which the Insured Person has received medical treatment or advice in the twelve (12) months prior to inception of this Insurance. 8

9 Benefits: Medical Benefits have specific limits and additional exclusions see Articles 2, 9 and 10. Total Sum payable: The total sum payable under this insurance in respect of one or more claims during any one Period of Insurance, shall not exceed the largest sum insured. Proof of Claim required within sixty (60) days: Proof of claim must be submitted within sixty (60) days beginning on the last day of the Period of Insurance, or Benefit Period if applicable Pre-certification: The Policy contains Pre-Certification requirements for certain medical expenses including in-patient care, surgery, surgical procedures CAT Scans and MRIs (these are detailed under Article 7 of the Policy Document). Accidental Death & Accidental Dismemberment: Underwriters will not pay more than one Benefit Amount for Accidental Death and/or Accidental Dismemberment resulting from the same Accident. 9

10 Tangiers International, Ltd 54 Melita Street Valletta VLT 1122, Malta Tel: Fax: