|
|
Day Tripper INTERNATIONAL
SHORT TERM MISSIONARY TRAVEL HEALTH INSURANCE
Underwritten by Lloyd's London
Administered by MultiNational
Underwriters, Inc.
Distributed by Good Neighbor Insurance, Inc.
Schedule of Benefits and Limits
|
Deductibles:
|
$100
or $250 per Certificate Period.
|
|
Coinsurance
– Claims incurred outside US or Canada
|
For
the Certificate Period, Underwriters will pay 100% of Eligible Expenses after
the Deductible up to the Overall Maximum Limit.
|
|
Hospital
Room and Board
|
Average
Semi-Private room rate, including nursing services.
|
|
Intensive
Care Unit
|
Usual,
Reasonable and Customary charges.
|
|
All
Other Eligible Expenses
|
Usual,
Reasonable and Customary charges.
|
|
Emergency
Dental (Acute Onset of Pain)
|
$100
limit per Certificate Period
|
|
Local
Ambulance
|
Usual,
Reasonable and Customary charges, when covered Illness or Injury results in
hospitalization.
|
|
Emergency
Evacuation
|
Overall Maximum Limit
|
|
Repatriation
of Remains
|
Overall
Maximum Limit
|
|
Emergency
Reunion
|
$10,000
limit per Certificate Period
|
Trip Interruption
|
$5,000
limit per Certificate Period
|
|
Lost
Checked Luggage
|
$250
limit per Certificate Period (not subject to Deductible or Coinsurance)
|
|
Accidental
Death and Dismemberment
|
Death
- $25,000
Loss
of 2 Limbs - $25,000
Loss
of 1 Limb - $12,500
Benefits
reduce 50% at age 70 and an additional 50% at age 75.
|
|
Common
Carrier Accidental Death
|
$50,000
|
|
Hospital
Pre-Notification Penalty
|
50%
of Eligible Medical Expenses.
|
|
Optional
Hazardous Sports Rider
|
$25,000 limit per Certificate Period
|
|
Overall
Maximum Limit per Certificate Period
(includes all benefits except Accidental Death and Dismemberment and
Common Carrier Accidental Death)
|
Age
80 or older: $10,000.
Age
70 to 79: $50,000.
All
others: $50,000 or $100,000.
|
This is a summary of Benefits.
For more details, or for a complete copy of the Master Policy, contact
Good Neighbor Insurance, Inc.
WHY BUY TRAVEL INSURANCE?
The answer is easy. Whether you
travel for business or pleasure, international travel involves risk. You may
arrive at your destination to find that your luggage with personal items has
disappeared, or a personal emergency may necessitate your early return back
home, or a medical emergency may require hospitalization or even air
evacuation. In most cases, your existing insurance will not provide adequate
protection for these and other risks. Without appropriate travel insurance, you
may be exposed to significant financial liability. MultiNational Underwriters,
Inc. has designed The “Day Tripper” to take the risks out of
international travel, so you can have an enjoyable and productive trip.
WHEN DOES COVERAGE BECOME EFFECTIVE AND WHEN DOES IT END?
Your coverage becomes
effective on the later of: the date we receive your completed application and
correct premium, the date of departure from your Home Country, or the date you
request on your application. Your coverage will end on the earliest of: the end
of the period for which you have paid a premium, the date requested on your
application, or the date you return to your Home Country (unless you have
started a Benefit Period, in which case you will be covered for eligible
medical expenses for 180 days from the on-set of the condition).
WHAT IS COVERED?
All benefits, except Lost
Checked Luggage, Accidental Death & Dismemberment and Common Carrier
Accidental Death, are subject to the Deductible and Coinsurance. Policy Limits
apply to all benefits:
Medical:
1. Inpatient and
Outpatient charges made by a Hospital.
2. Charges made
by a Physician, Surgeon, radiologist, anesthesiologist, and any other medical
specialist to whom the Physician has referred the case.
3. Charges made
for dressings, sutures, casts or other supplies prescribed by the attending
Physician or specialist.
4. Charges for
diagnostic testing using radiology, ultrasonographic or laboratory services.
5. Charges for
oxygen and other gases and anesthetics and their administration.
6. Charges for
Prescription drugs, for treatment of a covered Injury or Illness, but not for
the replacement of lost, stolen, damaged, expired or otherwise compromised
drugs.
7. Charges made
by a licensed Extended Care Facility upon direct transfer from an acute care
Hospital.
8. Emergency
Local Ambulance transport incurred in connection with Injury or Illness
resulting in Hospitalization.
Emergency Dental:
1. Emergency
Dental Treatment and Dental Surgery necessary to restore or replace sound
natural teeth lost or damaged in an Accident, which is covered under this
insurance.
2. Emergency
Dental Treatment necessary to resolve acute, spontaneous and unexpected onset
of pain.
Emergency Evacuation:
If recommended by your
attending Physician, who certifies that evacuation is necessary to safeguard your
life or limb and that Medically Necessary treatment is not available locally,
and if approved in advance and coordinated by MultiNational Underwriters, Inc.,
this plan will provide the following benefits:
Emergency air and/or ground transportation to the nearest Hospital that
is qualified to provide the
Medically Necessary treatment.
Emergency Reunion
In the event of a covered
Emergency Evacuation, this plan will provide the following benefits: The cost
of an economy round trip air and/or ground transportation ticket for one of
your relatives (parent, spouse, sibling or child age 18 or older) for
transportation to the area where you are hospitalized following Emergency
Evacuation and reasonable expenses for lodging and meals for your relative, for
a period not to exceed 10 days.
Trip Interruption:
If, after you have departed,
you learn of the death of a parent, spouse, sibling or child, or you learn of
the substantial destruction of your principal residence by fire or weather,
this plan will provide the following benefit: The cost of an economy one way
air and/or ground transportation ticket for you to the area of your principal
residence or following a covered Emergency Evacuation, the attending Physician
states that it is Medically Necessary for your return to your Home Country or
to the area from which you were initially evacuated for continued treatment,
recuperation and recovery, the “Day Tripper” will provide the following
benefit: The cost of a one way economy air and/or ground transportation ticket
for your transportation from the area where you were hospitalized following the
Emergency Evacuation, to the area where you were initially evacuated from, to
the terminal serving the area of your principal residence..
Repatriation of Remains:
In event of a covered Injury
or Illness resulting in your death, this plan will provide the following
benefit: Air or ground transportation of bodily remains or ashes to the area of
your Principal Residence, and reasonable costs of preparation of your remains
necessary for transportation.
Lost Checked Luggage:
In the event your checked
luggage is permanently lost by the transportation provider, this plan will
provide the following benefit: Up to
$250 for replacement of clothes and personal hygiene items, not to exceed $50
for any one item. You must file a formal claim with the transportation
provider, and provide the Plan Administrator with copies of all claim forms,
and proof that the transportation provider has paid you its normal
reimbursement for the lost checked luggage.
Accidental Death and
Dismemberment:
In the event of your
Accidental Death (except while traveling in a common carrier) or Dismemberment
resulting from a covered Injury, this plan will provide the following benefit:
1. Accidental Death
‑ Principal Sum of $25,000 to the Beneficiary designated on your
Application. The Principal Sum shall reduce by 50% (to
$12,500) if you are age 70 to 74 at time of death, and an additional 50% (to $6,250) if you are age 75 or older
at time of death.
2. Accidental
Dismemberment ‑
a. Loss of
2 or more eyes or limbs - Principal
Sum of $25,000 to you.
b. Loss of
1 eye or limb ‑ One-half of the Principal Sum ($12,500) to you.
c. The Principal
Sum(s) shall reduce by 50% if you are age 70 to 74 at time of death or
dismemberment, and an additional 50% if you are age 75 or older at time of
death or dismemberment.
Common Carrier Accidental
Death:
In the event of your
Accidental Death while traveling on board a commercial common carrier,
this plan will provide the
following benefit: Principal Sum of $50,000 to the Beneficiary designated on
your Application.
“Day Tripper” Travel Assistance Services:
The following Travel Assistance Services are available to you 24 hours a
day – 7 days a week while your coverage is inn effect.
Pre-trip Health and Safety
Advisories (available after your
purchase of the “Day Tripper” and before your departure) –
call us for current passport, visa, inoculation and vaccine requirements, well
as up-to-date travel safety advisories.
Livetravel Services –
we will make emergency travel and itinerary
changes for you including rebooking flights, hotel reservations and ground
transportation arrangements.
BagTrak – We are the industry leaders in tracking lost
baggage. We will help you locate your lost baggage and deliver it to you
anywhere in the world.
Emergency Message Relay – we will relay messages to your family, friends
and co-workers helping you to maintain contact during an emergency.
Emergency Cash Transfers – we will assist you in arranging and obtaining
cash transfers anywhere in the world.
Other important Assistance Services
include:
Medical referrals
Up-to-the-minute
travel medical advisories
Assistance with prescription
drug replacement
Dispatch of a
doctor or specialist
Emergency travel
arrangements for family members
Lost passport or
travel documents assistance
Embassy and
consulate referrals
Legal and
accounting referrals
Bail bond
assistance
Translation and
interpretation assistance
These Travel Assistance Services are not insurance benefits and provision
of any Travel Assistance Services is not a guarantee of any other benefit under
the “ Day Tripper”
plan.
WHAT IS EXCLUDED?
The following charges,
treatments, surgeries, medications, conditions and circumstances:
1.
Pre-existing Conditions ‑ Charges resulting
directly or indirectly from any Pre-existing Condition, as herein defined, are
excluded from this insurance. A
Pre-existing Condition is any Illness, Injury, or medical condition or chronic
or recurring Illness or Injury or medical condition, including any associated
complications or consequences, which exist at or during the 5 years immediately
preceding your effective date.
2.
Treatment for or related to any congenital condition.
3. Pregnancy,
childbirth, birth control, artificial insemination, infertility, impotency or
sexual dysfunction, sterilization or reversal thereof.
4. Mental
Health Disorders or Substance Abuse.
5.
Not incurred during the Certificate Period or the applicable Benefit Period
and charges which are not presented to Underwriters for payment within 60 days
from the end of the Certificate Period or the applicable Benefit Period.
6. Charges of use of Emergency
Room for treatment of Illness unless the patient is directly admitted to the
hospital as Inpatient for further treatment of that Illness.
7. Not
Medically Necessary and administered or ordered by a Physician.
8. Provided
at no cost, or by a family member or by a person who ordinarily resides with
you, or which are attributable to or recoverable from any other party including
government sponsored plans.
9.
Charges which exceed Usual, Reasonable and Customary.
10. Investigational,
Experimental or for Research purposes.
11. While
confined primarily to receive Custodial Care, Educational or Rehabilitative
Care.
12. Venereal
Disease, AIDS or ARC.
13. Dental
Treatment, including treatment of the temporomandibular joint, except for
Emergency Dental Treatment necessary to replace sound natural teeth lost or
damaged in an Accident covered hereunder or for the relief of acute,
spontaneous and unexpected onset of pain.
14. Eyeglasses,
contact lenses, hearing aids, hearing implants, eye refraction, visual
therapy, or visual eye training or eye
surgery (including cataract surgery and radial keratotomy) or for any
examination or fitting related to these devices or procedures.
15. Injury
sustained while taking part in the following activities: Amateur or professional sports or athletics,
except this does not include Amateur sports or athletics which are non-contact
and undertaken solely for leisure,
recreational, entertainment or fitness purposes unless such sports or athletics
are otherwise excluded by this provision.
The following are excluded: mountaineering where ropes or guides are
normally used or at elevations of 4,500 meters or higher; and aviation (except
when traveling solely as a passenger in a commercial aircraft); and hang
gliding, sky diving, parachuting or bungee jumping; and snow skiing or
snowboarding, except for recreational downhill and/or cross country snow skiing
or snowboarding (no cover provided whilst skiing away from prepared and marked
in-bound territories and/or against the advice of the local ski school or local
authoritative body); and racing by any animal or motorized vehicle; and
spelunking; and subaqua pursuits involving underwater breathing apparatus
unless NAUL/PADI certified, accompanied by a certified instructor and at depth
of less than 10 meters; jet skiing; and any other sport or athletic activity
which is undertaken for thrill seeking and exposes you to abnormal or extreme
risk of injury.
16. Injury
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.
17. Willfully
self-inflicted Injury or Illness and Immunizations and Routine Physical Exams.
18. The Deductible,
Coinsurance and charges, which are not included as Eligible Expenses as
described in the Master Policy, and charges which exceed the policy limits.
19. Treatment
required as a result of complications or consequences of a treatment or condition
not covered hereunder.
20. Charges
for travel or accommodations, except as provided for in the Local Ambulance,
Emergency Medical Evacuation, Repatriation of Remains, Emergency Reunion and
Trip Interruption sections of this insurance.
21. Treatment
incurred as a result of exposure to non-medical nuclear radiation and/or
radioactive material(s).
22.
Organ or Tissue Transplants or related services.
23.
Acts of terrorism, war, insurrection, riot or any
variation thereof.
24. Treatment by a Chiropractor.
25. Disease of the skin.
This a summary of Exclusions. For more details, or for a complete copy of
the Master Policy, contact Good Neighbor Insurance, Inc.
WHAT ARE THE PRE-NOTIFICATION REQUIREMENTS?
All Hospitalizations,
Surgeries, Emergency Evacuations, Emergency Reunions, Trip Interruptions,
Repatriation of Remains, Computerized Tomography (CAT Scan) and Magnetic
Resonance Imaging (MRI) must be Pre-notified.
Simply call, or have your Physician call, Multi-National Underwriters,
Inc. with all information relative to your claim. Be sure to have your ID number available. If you do not Pre-notify, medical expenses
will be reduced by 50%, and all other expenses will be forfeited.
WHO IS THE PLAN ADMINISTRATOR?
MultiNational Underwriters,
Inc., headquartered in Indianapolis, Indiana, is a full service organization,
offering a comprehensive portfolio of insurance products designed specifically
to address the insurance needs of international travelers. As a TRAVEL GUARD® International company, we
benefit from the experience of a corporate group that protected over 6 million
travelers last year. Our international
claims specialists, medical professionals and customer service representatives
are available 24 hours a day, 7 days a week to answer your questions and respond
to your needs. Whether you have lost
your luggage or are in need of Emergency Evacuation, you will find our service
team to be prompt, compassionate, and of the highest professional quality.
WHO IS THE INSURER?
Lloyd’s, the largest and
oldest insurance market in the world is the insurer of this plan - Rated A- by AM Best Company, and A by
Standard and Poors, Lloyd’s provides financial strength and security that is
unparalleled in the worldwide insurance market. Lloyd’s is recognized as a market leader in the accident and
health insurance arena, and is well known for its innovative products and
services. Presently, Lloyd’s provides
accident and health insurance to millions of individuals in almost every country
of the world
CONTACT
INFORMATION
| Producer Number: 9870SS |
Producer Name: Jeff Gulleson |
| Company Name: Good Neighbor Insurance, Inc. |
Street Address: 620 S Winthrop |
| City: Gilbert |
State: AZ |
Postal Code: 85296 |
| Country: USA |
Telephone: (480) 813-9100 |
Fax: (480) 813-9930 |
| E-mail Address: jeff@gninsurance.com
|
Signature:
[SIGNED] Jeff Gulleson | |
|
|
|
