|
All Coverages and Benefits are in U.S. Dollar
Amounts |
|
|
Accident and Sickness Medical Maximums Lifetime |
$200,000 Primary
Insured |
|
Deductible – Per Injury or Illness |
$0 Per Injury or Illness |
|
Coinsurance |
Company pays 100% to Plan Maximum |
|
Benefit Period |
Covered Expenses incurred during the Period of
Coverage |
|
Mental Illness |
Inpatient:
up to $10,000, to a max of 40 days Outpatient:
up to $1,000 |
|
Alcohol and Drug Abuse |
Inpatient:
$2,000 payable at 50%, up to a max of 40 days Outpatient:
$500 payable at 80% |
|
Injuries from a Motor Vehicle Accident |
Up to Plan Maximum |
|
Dental (emergency) |
$100 per tooth to a maximum of $500 |
|
Dental (Palliative) |
Up to a maximum of $500 |
|
Interscholastic Sports |
Up to $5,000 |
|
Emergency Medical Evacuation |
$200,000 |
|
Repatriation of Mortal Remains |
$25,000 |
|
Emergency |
$10,000 |
|
Visit by Family Member due to Felonious Assault* |
$2,500 |
|
Accidental Death & Dismemberment |
$10,000 per Insured |
|
Unexpected Recurrence of Pre-X |
Up to a maximum of $5,000 |
|
Personal Liability** |
Up to $100,000 Per Occurrence / $200,000 in the
aggregate |
|
Assistance |
24 hours – Worldwide |
*
Felonious Assault is not an insured benefit through Nationwide. This is a covered service provided by the
assistance company.
**
Personal Liability is provided by Virginia Surety Company, Inc.
DESCRIPTION OF BENEFITS
Medical Expenses:
This Plan shall pay Reasonable and Customary
charges for Covered Expenses, excess of the Deductible and Coinsurance up to
the Medical Maximum, incurred by you, due to an accidental Injury or Illness
which occurred during the Period of Coverage outside your Home Country (except
as provided under the Home Country Coverage).
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, the Disablement shall
be considered a continuation of the prior Disablement and not a separate
Disablement. The initial Treatment of an
Injury or Illness must occur within 30 days of the date of Injury or onset of
Illness.
Only such expenses which are specifically
enumerated in the following list of charges are incurred within the Benefit
Period, and which are not excluded, shall be considered Covered Expenses:
1)
Charges made by a Hospital for
semi-private room and board, floor nursing and other 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, iron lungs, and
medical Treatment.
8) Charges
for physiotherapy, to a maximum of $500, 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 or Surgeon.
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 to a limit of $350, within the metropolitan area in which
you are located at that time the service is used. If you are in a rural area, then licensed air
ambulance transportation to the nearest metropolitan area shall be considered a
Covered Expense.
Extension
of Benefits
Your coverage will be extended if you are Hospital
confined for a Covered Injury or Illness and under the care of a Physician on
the termination date of your Period of Coverage. Coverage will terminate on the earlier of the
following:
1)
30 days from the end of you Period of Coverage; or
2)
The maximum benefit has been paid; or
3)
Your release from the hospital or Physician care.
Pre-notification:
For each scheduled hospital admission, emergency
hospital confinement, or outpatient Treatment, you or someone on your behalf
must contact the assistance company for pre-notification as soon as possible,
but no later than 48 hours prior to the admission to the hospital, of the
hospital confinement, or Outpatient Treatment.
For Emergency Hospital Confinement, you or someone on your behalf must
notify the assistance company as soon as possible, but no later than 48 hours
after the date of admission.
Pre-notification does not guarantee or confirm benefits or the payment
of said benefits.
Mental
Illness:
Benefits are paid for Treatment or medication for
Mental Illness, which are not excluded and covered under this policy, shall be
considered a Covered Expense:
Inpatient Care – Shall be payable at 100% to
$10,000, subject to a maximum of 40 days of inpatient care.
Outpatient – Shall be payable at 100% up to a
maximum of $1,000.
Alcohol
and Drug Abuse:
Benefits are paid for Treatment or medication for
Alcohol and Drug Abuse, which are not excluded and covered under this policy
shall be considered a Covered Expense.
Inpatient Care – Shall be payable at 50% to $2,000,
subject to a maximum of 40 days of inpatient care.
Outpatient – Shall be payable at 80% up to a
maximum of $500.
Emergency
Dental Treatment:
Benefits are paid for Reasonable and Customary
expenses in excess of the Deductible and Coinsurance of $100 per tooth up to a
maximum of $500, for the emergency repair or replacement to sound, natural
teeth damaged as the result of a Covered Accident.
Dental
– Emergency Relief of Pain: This plan shall pay in
excess of the Deductible and Coinsurance up to a maximum of $500, for emergency
treatment for the relief of pain to natural teeth.
Unexpected
Recurrence of a Pre-existing Condition:
This Plan shall pay, up to $5,000 subject to the
Deductible and Coinsurance, for Covered Expenses resulting from a sudden,
unexpected recurrence of a Pre-Existing Condition while traveling outside the
Emergency
Medical Evacuation and Repatriation:
Benefits are paid for Covered Expenses incurred up
to $100,000, for any covered Injury or Illness commencing during the Period of
Coverage that result in a Medically Necessary Emergency Medical Evacuation or
Repatriation. The decision for an
Emergency Medical Evacuation or Repatriation must be pre-approved and arranged
by the assistance company in consultation with your local attending Physician.
Emergency Medical Evacuation or Repatriation means:
a) your medical condition warrants immediate transportation from the place
where you are located (due to inadequate medical facilities) to the nearest
adequate medical facility where medical Treatment can be obtained; or, b) after
being treated at a local medical facility, your medical condition warrants
transportation with a qualified medical attendant to your Home Country to
obtain further medical Treatment or to recover; or, c) both a) and b) above.
Covered Expenses are expenses for transportation,
medical services and medical supplies necessarily incurred in connection with
Emergency Medical Evacuation or Repatriation.
All transportation arrangements must be by the most direct and
economical route. Expenses for special
transportation and medical supplies and services must be: a) pre-approved and
ordered by the assistance company; and b) required by the standard regulations
of the conveyance transportation.
Transportation means any land, water or air conveyance required to
transport you. Special transportation
includes, but is not limited to, licensed ground and air ambulances, commercial
airlines, and private motor vehicles.
Return
of Mortal Remains:
Benefits will be paid for Reasonable and Customary
Covered Expenses incurred up $25,000, to return your remains to your Home
Country, if you should die. Covered
Expenses include, but are not limited to, expenses for embalming or Cremation,
a minimally necessary container appropriate for transportation, shipping costs,
and the necessary government authorizations.
All Covered Expenses in connection with a Return of Mortal Remains or
Cremation must be pre-approved and arranged by the assistance company.
Emergency
Medical
When the assistance company and your attending
Physician determine that it is necessary and prudent for you to have an
Emergency Medical Evacuation or Repatriation, this Plan will arrange to bring
an individual of your choice, from your current Home Country, to be at your
side while you are hospitalized and then accompany you during your return to
your current Home Country. Benefits will
be paid up to $10,000 for a round-trip economy airfare ticket as well as for
reasonable travel and accommodation expenses up to a maximum of 10 days, as
pre-approved and arranged by the assistance company.
Visit
by Family Member due to Felonious Assault*:
If you are the victim of a felonious assault that
has been documented by the local authorities, the assistance company will
arrange and provide transportation for a family member of your choice to come
and comfort you during your ordeal. The
plan will provide up to a maximum coverage limit of $2,500, to include coverage
for
round-trip economy transportation, meals and accommodations subject to a daily
maximum of up to $150, up
to a maximum of 5 days.
*
Felonious Assault is not an insured benefit through Nationwide. This is a covered service provided by the
assistance company.
Accidental
Death & Dismemberment:
Benefits shall be paid to you if you sustain an
accidental Injury. The Injury must occur
during the Period of Coverage and death or dismemberment as a result of that
accident must occur within 365 days from the date of Accident. Benefits payable for any such loss shall be
in accordance with the following table:
If you incur more than one Loss stated in the following Table as the
result of one Accident, only the largest amount shall be payable.
|
Description of Loss |
Percent of Principal Sum |
|
Life |
100% |
|
Both Hands or Both
Feet or Sight of Both Eyes |
100% |
|
One Hand and One Foot |
100% |
|
Either Hand or Foot
and Sight of One Eye |
100% |
|
Either Hand or Foot |
50% |
PLAN
DEFINITIONS
Benefit
Period shall mean the allowable time period you have from
the date of Injury or onset of Illness to receive Treatment for a Covered
Injury or Illness.
Coinsurance shall mean the
percentage amount of Covered Expenses, after the Deductible, which is your
responsibility to pay.
Deductible shall mean the amount
of Covered Expenses which is your responsibility to pay before benefits under
the Plan are payable.
Home Country shall mean the country
where you have your true, fixed and permanent home and principal establishment.
Illness shall mean Sickness or disease of any
kind contracted and commencing after the Effective Date of this
Plan.
Injury shall mean 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 Plan.
Inpatient
shall mean if you are confined in an institution and are charged for
room and board.
Outpatient
shall mean if you receive 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.
Pre-existing Condition shall mean
any condition for which a licensed Physician was consulted, or for which
Treatment or Medication was prescribed, or for which manifestations or symptoms
would have caused a person to seek medical advice 12 months prior to the
Effective Date of coverage under the Policy, except If the Injured Person is
covered under the Policy for 12 consecutive months, the Pre-existing Condition
exclusion will no longer apply and any eligible expenses incurred thereafter
will be considered for reimbursement.
Reasonable and Customary shall mean
the maximum amount that the Plan determines is Reasonable and Customary for
Covered Expenses you receive, up to, but not to exceed, charges actually
billed. The determination considers: 1)
amounts charged by other Service Providers for the same or similar service in
the locality where 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 included but not limited to, a resource
based relative value scale.
Treatment shall mean a specific in-office or Hospital
physical examination of, or care rendered to you; consultation; diagnostic
procedures and services; Surgery; medical services and supplies, including
Medication prescribed or provided by a Service Provider.
EXCLUSIONS
AND LIMITATIONS
No Benefit
shall be payable for Accident Medical, Sickness Medical, Dental,
Unexpected Recurrence of a Pre-existing Condition, Emergency Medical Evacuation/Repatriation,
Return of Mortal Remains, Emergency Medical Reunion, as the result of:
1. Any Pre-existing
Condition as defined hereunder. This
exclusion does not apply to Emergency Evacuation/Repatriation or Return of
Mortal Remains or the first $10,000 of an unexpected
recurrence of a pre-existing condition.
2. Injury or Illness
which is not presented to the Company for payment within 3 months of receiving
Treatment;
3. Charges
for Treatment which is not Medically Necessary;
4. Charges
provided at no cost to you;
5. Charges
for Treatment which exceeds Reasonable and Customary charges;
6. Charges incurred
for Surgery or Treatments which are Experimental/Investigational, or for
research purposes;
7. Services, supplies
or Treatment, including any period of Hospital confinement, which were not
recommended, approved and certified as Medically Necessary and reasonable by a
Physician;
8. 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
c) acting on behalf of, or in connection with, any organization with
activities directed towards the overthrow by force of the Government de jure or
de facto or to the influencing of it by terrorism or violence
d) martial law or state of siege or any events or causes which
determine the proclamation or maintenance of martial law or state of siege
(hereinafter for the purposes of this Exclusion called the “Occurrences”)
Any consequence happening or arising
during the existence of abnormal conditions (whether physical or otherwise),
whether directly or indirectly, proximately or remotely occasioned by, or
contributed to by, traceable to, arising in connection with, any of the said
Occurrences shall be deemed to be consequences for which the Plan shall not be
liable for, except to the extent that you prove that such consequence happened
independently of the existence of such abnormal conditions;
9. Injury sustained while
participating in professional athletics;
10. Injury sustained
while participating in Amateur Athletics.
This exclusion does not apply to non-competitive, recreational or
intramural activities;
11. 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;
12. Treatment
of the Temporomandibular joint;
13. Vocational,
speech, recreational or music therapy;
14. Services or supplies
performed or provided by a Relative of yours, or anyone who lives with you;
15. Cosmetic or plastic
Surgery, except as the result of a covered Accident; for the purposes of this
Plan, Treatment of a deviated nasal septum shall be considered a cosmetic condition;
16. Elective Surgery
which can be postponed until you return to your Home Country, where the
objective of the trip is to seek medical advice, Treatment or Surgery;
17. Treatment and the
provision of false teeth or dentures, normal ear tests and the provision of
hearing aids;
18. Eye refractions or
eye examinations for the purpose of prescribing corrective lenses for
eyeglasses, or for the fitting thereof, unless caused by Accidental bodily
Injury incurred while covered hereunder;
19. Treatment in connection
with alcoholism and drug addiction, or use of any drug or narcotic agent,
unless otherwise covered under this policy;
20. Any Mental and
Nervous disorders or rest cures, unless otherwise covered under this policy;
21. Congenital
abnormalities and conditions arising out of or resulting there from;
22. Expenses
which are non-medical in nature;
22. Expenses as a
result of, or in connection with, intentionally self-inflicted Injury or
Illness;
24. Expenses as a result of, or in connection
with, the commission of a felony offense;
25. 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; snowmobiling; motorcycle/motor scooter riding; scuba diving
involving underwater breathing apparatus, unless PADI or NAUI certified;
spelunking; and parasailing;
26. Treatment paid for
or furnished under any other individual or group policy 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 any cost to you;
27. Dental care, except
as the result of Injury to natural teeth caused by Accident, unless otherwise
covered under this Plan;
28. Routine
Dental Treatment;
29. For Pregnancy or
Illness resulting from Pregnancy, childbirth, or miscarriage, unless otherwise
covered under this Plan;
30. 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;
31. Treatment
for human organ tissue transplants and their related Treatment;
32. Expenses incurred
while in your Home Country, except as provided under the Home Country Coverage
and Home Country Extension of Benefits Coverage;
33. Expenses incurred
during a Hospital emergency visit which is not of an emergency nature;
34. Injury sustained as
the result of the Insured Person operating a motor vehicle while not properly
licensed to do so in the jurisdiction in which the motor vehicle accident takes
place;
35. Covered Expenses
incurred for which the Trip to the Host Country was undertaken to seek medical
Treatment for a condition;
36. Covered Expenses
incurred during a Trip after your Physician has limited or restricted travel;
37. Sex
change operations, or for Treatment of sexual dysfunction or sexual inadequacy;
38. Weight
reduction programs or the surgical Treatment of obesity.
No Benefit
shall be payable for Accidental Death and Dismemberment as the result of:
1. Suicide, or
attempt thereof, while sane, or self destruction, or any attempt thereof, while
insane;
2. Disease of any
kind; Bacterial infections, except pyogenic infection, which shall occur
through an accidental cut or wound;
3. Hernia
of any kind;
4. Injury sustained
while you are 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 you are 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:
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
c) acting on behalf of, or in connection with, any organization with
activities directed towards the overthrow by force of the Government de jure or
de facto or to the influencing of it by terrorism or violence
d) martial law or state of siege or any events or causes which
determine the proclamation or maintenance of martial law or state of siege
(hereinafter for the purposes of this Exclusion called the “Occurrences”)
Any consequence happening or arising
during the existence of abnormal conditions (whether physical or otherwise),
whether directly or indirectly, proximately or remotely occasioned by, or contributed
to by, traceable to, or arising in connection with, any of the said Occurrences
shall be deemed to be consequences for which the Plan shall not be liable,
except to the extent that you can prove that such consequence happened
independently of the existence of such abnormal conditions;
7. Service
in the military, naval or air service of any country;
8. Flying in any
aircraft being used for, or in connection with, acrobatic or stunt flying,
racing or endurance tests;
9. Flying
in any rocket-propelled aircraft;
10. Flying in any
aircraft being used for, or in connection with, crop dusting or seeding or
spraying, fire fighting, exploration, pipe or power line inspection, any form
of hunting or herding, aerial photography, banner towing or any experimental
purpose;
11. Flying in any
aircraft which is engaged in any flight which requires a special permit or
waiver from the authority having jurisdiction over civil aviation, even though
granted;
12. Sickness of any kind;
13. Being under the
influence of alcohol, or having taken drugs or narcotics unless prescribed by a
legally qualified Physician or surgeon;
14. Injury occasioned
or occurring while you are committing or attempting to commit a felony, or to
which a contributing cause was your being engaged in an illegal occupation;
15. While
riding or driving in any kind of competition;
16. This Plan does not insure against loss or
damage (including death or Injury) and any associated cost or expense resulting
directly or indirectly from the discharge, explosion or use of any device,
weapon or material employing or involving nuclear fission, nuclear fusion or
radioactive force, or chemical, biological, radiological or similar agents,
whether in time of peace or war, and regardless of who commits the act,
regardless or any other cause or event contributing concurrently or in any
other sequence thereto.
Excess Benefits: All
coverages, except Accidental Death and Dismemberment, shall be in excess of all
other valid and collectible Insurance Indemnity and shall apply only when such
benefits are exhausted.
Personal Liability:
Personal Liability is provided by Virginia Surety Company, Inc.
SCHEDULE OF BENEFITS
A. Personal Liability Insurance Coverage Limit
per CLAIM: $ 100,000
Deductible per
CLAIM $ 150
Aggregate Limit per INSURED $ 200,000
B. Medical Payments Coverage: $
25,000
C. Additional
Living Expenses Coverage:
$ 10,000
D. Payment of
Deductible Under Homeowner’s Insurance Coverage $ 1,000
E. Policy Aggregate $
200,000
DEFINITIONS
“AUTOMOBILE” means a land motor vehicle, trailer or
semi-trailer designed for travel on public roads (including any machinery or
apparatus attached thereto
“BODILY INJURY” means bodily injury, sickness or
disease sustained by any person, including death. It does not include any communicable disease.
“CLAIM(S)” means a demand for money or the service
of a suit naming an INSURED and alleging an INCIDENT. CLAIMS does not include proceedings seeking injunctive or other
non-pecuniary relief.
“CLAIMS
EXPENSES” means:
(a) Fees charged by an attorney or attorneys
designated by the Company and all other fees, costs, and expenses resulting
from the investigation, adjustment, defense settlement and appeal of a CLAIM,
suit or proceeding arising in connection therewith, if incurred by the Company,
or incurred by the INSURED with written consent of the Company, but does not
include salary charges or expenses of regular employees or officials of the
Company, or fees and expenses of independent adjusters;
(b) All costs against
the INSURED in such suits and all interest on the entire amount of any judgment
therein which accrues after entry of the judgment and before the Company has
paid or tendered or deposited, whether in court or otherwise, that part of the
judgment which does not exceed the limit of the Company’s liability thereon;
(c) Premiums on appeal
bonds and premiums on bonds to release attachments in such suits, but not for
bond amounts in excess of the applicable limit of liability of this
policy. The Company shall have no
obligation to pay for or furnish any bond;
(d) Up to $250 for loss
of earnings to each INSURED for each day or part of a day of their attendance
at the Company’s request at a trial, hearing or arbitration proceeding
involving a civil suit against such INSURED for covered DAMAGES, but the amount
so payable for any one or series of trials, hearings or arbitration proceedings
arising out of the same INCIDENTS shall in no event exceed $5,000.
“DAMAGES” means compensatory judgments, settlement
or awards, but does not include fines or penalties, the return of fees or other
consideration paid to the INSURED.
“HOST FAMILY” means the person(s) responsible for
providing the INSURED’S room, board, general welfare, and care while on a
Covered Trip/Program.
“INCIDENT” means any act or omission committed by
the INSURED during the Policy Term which unexpectedly, unintentionally, and
suddenly results in BODILY INJURY, PROPERTY DAMAGE or PERSONAL INJURY provided
the act or omission committed by the INSURED was during the POLICY TERM.
“INSURED LOCATION” means (1) the HOST FAMILY’S
residence premises and the part of any other premises, structures and grounds
used by the Insured; or (2) Any part of a premises where an Insured is temporarily
staying. An INSURED LOCATION does not
include coverage for PROPERTY DAMAGE to property rented to, occupied by, used
by, or in the care of any INSURED, to the extent that the INSURED is required
by contract to provide insurance.
“MOBILE EQUIPMENT” means a land vehicle (including
any machine or apparatus attached thereto, whether or not self-propelled), (1)
not subject to motor vehicle registration, or (2) maintained for use
exclusively on premises owned by or rented to any INSURED, including the ways
immediately adjoining, or (3) designed for use
principally off public roads, or (4) designed or maintained for the sole
purpose of affording mobility to equipment of the following types forming an
integral part of or permanently attached to such vehicle: power cranes,
shovels, loaders, diggers and drills; concrete mixers (other than the
mix-in-transit type); graders, scrappers, rollers and other construction or
repair equipment; air compressors, pumps and generators, including spraying,
wielding and building cleaning equipment; and geophysical exploration and well
servicing equipment, or (5) anything with a motor that rolls, flies or dives,
such as snowmobiles, mopeds, motorbikes, dirt bikes or (6) anything that flies
such as parasails, parachutes and hang gliders.
“PERSONAL INJURY” means:
(a) false arrest,
detention or imprisonment, wrongful entry or eviction, other invasion of
private occupancy, or malicious prosecution; or
(b) the publication or
utterance of a libel, slander or other defamatory or disparaging material; or
(c) a publication or an
utterance in violation of an individual’s right of privacy; or
(d) shock, mental
anguish, or mental injury.
PERSONAL
INJURY does not include the transmission intentionally or unintentionally of
any illness, sickness or disease by the INSURED to anyone, or any consequence
resulting from that illness, sickness or disease.
“PROPERTY
DAMAGE” means:
(a) physical injury to
or destruction of tangible property, including the loss of use thereof at any
time resulting there from; or
(b) loss of use, or loss
of the value of tangible property which has not been physically injured or
destroyed.
Personal Liability
Insurance Coverage
The Company will pay on behalf of the INSURED all
sums which the INSURED shall become legally obligated to pay as DAMAGES for
personal liability CLAIMS first made against the INSURED and reported to the
Company, during the Policy Term that his endorsement is in effect, arising out
of any INCIDENT covered under this Policy, provided always that such INCIDENT
happens:
(a) on or after the Policy Effective Date on
which this endorsement becomes effective; or
(b) on or after the effective date of the
earliest claims-made policy issued by the Company covering the INSURED to which
this is a continuous renewal.
For any claim brought in the
1) Defend
any suit; and
2) Make
such investigation, negotiation and settlement of any claim or suit as the
Company deems expedient.
Any claim or suit which
the Company elects not to investigate, settle or defend, the INSURED, under the
Company’s supervision, will make or cause to be made, such investigation and
defense as may be reasonably necessary.
Subject to prior authorization by the Company, the INSURED will effect,
to the extent possible, such settlements as the Company and the INSURED deem
prudent. The Company will reimburse the Insured for the cost of any such investigation,
settlement or defense, in the currency of the
In no event shall the Company be obligated to pay
DAMAGES or CLAIM EXPENSES or to defend, or continue to defend, any suit after
the applicable limit of the Company’s liability has been exhausted by payment
of DAMAGES and/or CLAIM EXPENSES.
OTHER
INSURANCE. If other
valid and collectible insurance is available to the Insured for a covered loss
under Coverage A, Personal Liability Insurance Coverage, the Company’s
obligations are limited as follows:
(a) Primary
Insurance:
This insurance is
primary over the PARTICIPATING ORGANIZATION’S liability insurance. If this insurance is primary, our obligations
are not affected unless any insurance other than the PARTICIPATING
ORGANIZATION’S insurance is also primary.
Then we will share with all that other insurance by the Method of
Sharing described in (b) below.
(b) Method
of Sharing:
If the other insurance permits the contribution by
equal shares, we will follow this method also.
Under this approach, each insurer contributes equal amounts until it has
paid its applicable limit of insurance or none of the loss remains, whichever
comes first.
The Policy provides excess coverage over and above
insurance which may cover the Insured, Host Family or a third party involved in
an Occurrence. The amount paid is
pursuant to the applicable coverage provision(s) of the Policy and is reduced
by the amount payable by any such Underlying Insurance.
Medical
Payments Coverage
The Company will pay up to $25,000 on behalf of the
INSURED for Medical Expenses that are incurred or medically ascertained within
52 weeks after the date of the INCIDENT and which result from an INCIDENT
causing BODILY INJURY to:
(a) A person who is on the INSURED LOCATION with
the permission of the HOST FAMILY, if the INCIDENT is caused by the activities
of the INSURED or by an animal owned by, or in the care of, an INSURED.
(b) A person not on the INSURED LOCATION, if the
INCIDENT is caused by the activities of an INSURED or by an animal owned by, or
in the care of, an INSURED.
Medical Expenses are defined
as those expenses recommended and approved by a Physician for hospital room and
board, use of an operating room, emergency room, ambulatory medical center,
fees of physicians and nurses, laboratory tests, prescription medicines or
drugs, anesthetics, transfusions, diagnostic testing, and therapeutics.
The Company will pay the benefit pursuant to this
provision only after due proof of the Medical Expenses incurred. has been
submitted to the Company,
This
coverage does not apply to the INSURED or to a dependent of an INSURED.
Additional Living
Expenses Coverage
If
an INCIDENT caused by the activities of the INSURED results in the INSURED
LOCATION becoming unfit to live in, the Company will pay for any necessary
increase in living expenses incurred by the HOST FAMILY so that the household
can maintain its normal standard of living.
Payment will be for the shortest time required to repair or replace the
damage to the INSURED LOCATION or, if the HOST FAMILY permanently relocates,
the shortest time required for the HOST FAMILY to settle elsewhere. The Company will pay the HOST FAMILY benefits
up to a maximum of $10,000 on behalf of the INSURED per POLICY TERM for
Additional Living Expenses.
Payment. The
Company will pay the benefit pursuant to this provision only after due proof of
the additional living expenses incurred has been submitted to the Company.
Payment of Deductible
Under Homeowner’s Insurance Coverage
If an INCIDENT caused by the activities of the
INSURED results in a claim being paid under a valid and collectible homeowner’s
insurance policy of the HOST FAMILY covering the INSURED LOCATION, the Company
will pay the HOST FAMILY for the loss incurred up to the amount of the
deductible under the HOST FAMILY’S homeowner’s insurance policy, not to exceed
$1,000 per INSURED per POLICY TERM.
Payment. The
Company will pay the benefit pursuant to this provision only after due proof of
the deductible amount which was incurred has been submitted to the Company
LIMIT
OF LIABILITY – CLAIMS
Regardless of the number of INSUREDS under this
Policy, the number of persons or organizations which sustain injury, or the
number of CLAIMS made or suits brought, the Company’s liability for the
Coverages provided is stated in the Schedule of Benefits.
Notwithstanding the limit of liability identified
in the Schedule of Benefits, a sub-limit of $25,000 each claim and aggregate,
as part of and not in addition to the limit of liability identified in the
Schedule for Benefits, shall constitute the only limit of liability available
for all damages and claims expenses arising out of or attributable to any suit
brought against any INSURED alleging, in whole or part sexual assault, abuse,
molestation or habitual neglect, or licentious, immoral, amoral, other behavior
that was threatened, committed or alleged to have been committed, by an INSURED
or by any person for whom the INSURED is legally responsible, This sub-limit is inclusive of all expenses derived from or based upon
the defense of any above described act. This sub-limit of liability shall
constitute the only limit of liability available for all damages and claim
expenses arising from the above described acts and no other limit of liability
shall be available for any damages or claim expenses arising from the above
described acts.
The limit of liability stated in the Schedule of
Benefits as applicable to “each claim” is the limit of the Company’s liability
for all DAMAGES because of each CLAIM covered hereby. All CLAIMS arising from the same or related INCIDENT
shall be considered a single CLAIM for the purpose of this insurance and shall
be subject to the same limit of liability.
The limit of liability stated in the Schedule of Benefits as “AGGREGATE”
is, subject to the above provision respecting “each claim”, the total limit of
the Company’s liability under this Policy for all DAMAGES as a result of all
CLAIMS made and reported to the Company during the POLICY TERM, including any
Extended Reporting Period. CLAIMS
EXPENSES are included within the applicable limit of liability stated in the
Schedule of Benefits.
WHEN
CLAIM IS TO BE CONSIDERED AS FIRST MADE
(a)
When
the Company first receives written notice from the INSURED, that a CLAIM has
been made, or
(b)
When the Company first receives written notice from the INSURED, of specific
circumstances involving a particular person or entity which may result in a
CLAIM.
All
CLAIMS arising out of the same or related INCIDENT shall be considered as
having been made at the time the first such CLAIM is made, and shall be subject
to the same limit of liability.
GENERAL
PROVISIONS
ACTION
AGAINST THE COMPANY. No
action shall lie against the Company unless, as a condition precedent thereto,
there shall have been full compliance with all of the terms of this policy, but
not until the amount of the INSURED’s obligation to pay shall have been finally
determined either by judgment against the INSURED after actual trial or by
written agreement of the INSURED, the claimant and the Company.
ASSIGNMENT. The interest of any
INSURED is not assignable. If any
INSURED shall die or be judged incompetent, this insurance shall thereupon
terminate for such person but shall cover the INSURED’s legal representative as
the INSURED with respect to liability previously incurred and covered by this
insurance.
ASSISTANCE
AND COOPERATION OF INSURED IN THE EVENT OF CLAIM OR SUIT. Upon the INSURED
becoming aware of any INCIDENT which could reasonably be expected to be the
basis of a CLAIM covered hereby, written notice shall be given by the INSURED
to the Company together with the fullest information obtainable. If CLAIM is made or suit is brought against
the INSURED, the INSURED shall immediately forward to the Company every demand,
notice, summons or other process received by the INSURED or the INSURED’s
representative. The INSURED shall
cooperate with the Company and, upon the Company’s request, assist in making
settlements in the conduct of suits and in enforcing any right of contribution
or indemnity against any person or organization who may be liable to the
INSURED because of DAMAGES with respect to which this insurance applies. The INSURED shall attend hearings and trials
and assist in securing and giving evidence and obtaining the attendance of
witnesses. The INSURED shall not, except
at the INSURED’s own cost, voluntarily make any payments, assume any obligation
or incur any expense.
CURRENCY. All premiums must be
paid to the Company, and the Company will pay all benefits, in the currency of
the United States of America at the rate of exchange prevailing on the date of
payment.
POLICY
TERM. With
respect to each INSURED, the POLICY TERM shall begin WHEN AN INSURED’S COVERAGE
BEGINS and terminate WHEN AN INSURED’S COVERAGE ENDS as stated in the General
Provisions of the Policy.
REIMBURSEMENT. While the Company has no
duty to do so, if the Company pays DAMAGES or CLAIMS EXPENSES:
(a)
within the amount of the applicable deductible; or
(b)
in excess of the applicable limit of liability,
the INSURED shall, upon written demand, repay such
amounts to the Company within thirty (30) days thereof. Failure to pay any amounts indicated above
may lead to policy cancellation and the INSURED shall not have the right to any
Extended Reporting Period option.
SUBROGATION. If the Company makes a
payment under the Policy and the person to or for whom payment was made has a
right to recover damages from another, the Company shall be subrogated to that
right. That person shall do:
1.
Whatever is necessary to enable the Company to
exercise the Company’s rights; and
2.
Nothing after the loss to prejudice those rights.
If
the Company makes a payment under the Policy and the person to or for whom
payment is made recovers damages from another, that person shall:
1.
Hold in trust for the Company the proceeds of the
recover; and
2.
Reimburse the Company to the extent of the
Company’s payment.
LIMITATIONS
AND EXCLUSIONS
This insurance does not apply to any CLAIM or suit:
1. for
BODILY INJURY or PROPERTY DAMAGE arising out of the ownership, maintenance,
operation, use, loading or unloading of any AUTOMOBILE, watercraft, MOBILE
EQUIPMENT or aircraft owned or operated by or rented or loaned to any INSURED,
other than as a passenger.
2. based on or arising out of liability
assumed by the INSURED under any contract or agreement, except liability arising
out of the performance of written duties
required by the Participating Organization as part of the Covered
Trip/Program;
3. arising out of discrimination on the
basis of age, sex, race, creed, religion, marital status, national origin or
sexual preference by any INSURED, including PERSONAL INJURY resulting there
from;
4. arising from the transmission of or
infection by, or the testing or the failure to test for the presence of
Acquired Immune Deficiency Syndrome
(AIDS), any AIDS related virus or any other disease transmitted through sexual
contact or another person’s body fluids;
5. based on or arising out of an actual or
attempted dishonest, fraudulent, criminal act, act of violence, or malicious
act or omission or deliberate misrepresentation committed by, at the direction
of, or with the knowledge of any INSURED, including intentional tortious acts;
6. arising from acts by any INSURED
expected or intended to cause BODILY INJURY or
PROPERTY DAMAGE sustained (This exclusion does not apply to BODILY
INJURY resulting from the use of
reasonable force to protect person or property.);
7. arising from any obligation for which
the INSURED or any carrier as their insurer may be held liable under any worker’s compensation, unemployment
compensation or disability benefits law, or under any similar law;
8. of
PROPERTY DAMAGE to:
a) property owned or
being transported by the INSURED, or
b) property rented to,
occupied by or in the care of the INSURED;
9. brought against any INSURED alleging, in whole or part sexual
assault, abuse, molestation, corporal punishment or physical or mental abuse,
or habitual neglect, or licentious, immoral, amoral other behavior that was threatened,
committed, or alleged to have been committed, by any INSURED or by any person
for whom the INSURED is legally responsible; however, notwithstanding the
foregoing, the INSURED shall be protected under the terms of this policy as to
any claim and/or allegation which may be covered by the policy upon which suit
may be brought against him, for any such alleged behavior by an INSURED unless
a judgment or a final adjudication adverse to the INSURED shall establish that
such behavior occurred as an essential element of the cause of action so
adjudicated;
10. for injuries caused by or contributed to
by the use, sale, manufacture, delivery, transfer or possession of controlled
substances except as administered by a physician;
11. for BODILY INJURY OR PROPERTY DAMAGE arising from the use of alcohol, intoxicants
drugs or narcotics, except as prescribed
by a licensed physician;
12. for BODILY INJURY or PROPERTY DAMAGE due
to war, whether or not declared, civil insurrection, rebellion or revolution or
to any act or condition incidental to any of the foregoing;
13. for PERSONAL INJURY or BODILY INJURY to
the INSURED or to a dependent of the Insured;
14. brought against any INSURED arising out
of the INSURED’S business pursuits, investments, or other for profit
activities;
15. for BODILY INJURY or PROPERTY DAMAGE
caused directly or indirectly by nuclear reaction, radiation, contamination
whether radioactive or not, regardless of how it was caused.
16. for BODILY INJURY or PROPERTY DAMAGE
caused directly or indirectly by pollution or asbestos, regardless of how it
was caused.
17.
The INSURED’S rendering of day care services when
such services are for persons other than the Host Family’s children.
18.
for BODILY INJURY, PERSONAL INJURY, or PROPERTY
DAMAGE arising out or participating in high-risk sports including: Hunting activities, boxing, combat sports,
mountaineering or rock climbing, potholing, aerial sports, heli-skiing,
motorized racing or speed trials, bungee jumping, scuba diving (unless the
Insured has the qualifications recognized by the competent local authority in
the contracted destination), wild water rafting, jet-skiing, professional
sports, and participation in competitive sporting events of any kind.
19. for BODILY INJURY or PROPERTY DAMAGE
among or between INSUREDs traveling together and INSUREDs and their
accompanying relatives.