Medical Deductible

• Medical
  • Medical Deductible

  • No Medical Deductible

• What is Medical Deductible?
  The Medical Deductible is a co-pay amount that the insured is responsible for.

• What am I covered for?
  There is no Medical Deductible with this plan.

• Definitions
  “Actual Cash Value” means purchase price less depreciation.
  *This definition changes for residents of the following states: Kansas, Maine, New York. Please click here to refer to your certificate of coverage.

  “Baggage” means luggage, and personal possessions and travel documents; whether owned, borrowed, or rented, taken by the Insured on the Trip.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Business Partner” means a person who: (1) is involved with the Insured or the Insured’s Traveling Companion in a legal partnership; and (2) is actively involved in the daily management of the business.

  “Caregiver” means an individual employed for the purpose of providing assistance with activities of daily living to the Insured or to the Insured’s Family Member who has a physical or mental impairment. The caregiver must be employed by the Insured or the Insured’s Family Member. A caregiver is not a babysitter; childcare service, facility or provider; or persons employed by any service, provider or facility to supply assisted living.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Children” or “Child” means the Insured’s Children or grandchildren, including an unmarried child, stepchild, legally adopted child or foster child who is:
  1) under age 25 and primarily dependent on the Insured for support and maintenance; or
  2) who is at least nineteen (19) but less than age twenty‐four (24) and who regularly attends an accredited school or college; and who is primarily dependent on the Insured for support and maintenance.
  *This definition changes for residents of the following states: Florida, Illinois, Minnesota, New Jersey, New York, Tennessee, Utah, Virginia, Washington. Please click here to refer to your certificate of coverage.

  “City” means an incorporated municipality having defined borders and does not include the high seas, uninhabited areas or airspace.

  “Common Carrier” means an air, land, sea conveyance operated under a license for the transportation of passengers for hire and for which the Insured’s ticket was purchased through the Travel Supplier.

  “Company” means Berkshire Hathaway Specialty Insurance Company.
  *This definition changes for residents of the following states: Oklahoma, Tennessee, Wisconsin. Please click here to refer to your certificate of coverage.

  “Complications of Pregnancy” means conditions whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy. These conditions include acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity. Complications of pregnancy also include nonelective cesarean section, ectopic pregnancy which is terminated and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.

  Complications of pregnancy do not include false labor, occasional spotting, Physician‐prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, preeclampsia and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy.
  *This definition changes for residents of the following states: Idaho, Illinois, Montana, Tennessee, Utah. Please click here to refer to your certificate of coverage.

  “Deductible” means the amount of charges that must be incurred by an Insured before benefits become payable. The amount of the deductible is shown in the Schedule for each benefit to which a deductible applies.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Departure Date” means the date on which the Insured is originally scheduled to leave on his/her Trip. This date is specified in the travel documents.

  “Destination” means any place where the Insured expects to travel to on his/her Trip other than Return Destination as shown on the travel documents.

  “Domestic Partner” means an opposite or a same‐sex partner who is at least 18 years of age and has met all of the following requirements for at least 6 months:
  a) resides with the Insured or Family Member;
  b) shares financial assets and obligations with the Insured or Family Member;

  The Company may require proof of the domestic partner relationship in the form of a signed and completed Affidavit of Domestic Partnership.
  *This definition changes for residents of the following states: DC, Georgia, Kansas, Nevada, New Jersey, Oklahoma, Oregon, South Dakota, Tennessee, Washington, Wisconsin. Please click here to refer to your certificate of coverage.

  “Elective Treatment And Procedures” means any medical treatment or surgical procedure that is not medically necessary including any service, treatment, or supplies that are deemed by the federal, or a state or local government authority, or by us to be research or experimental or that is not recognized as a generally accepted medical practice.
  *This definition changes for residents of the following states: Alaska, California, Colorado, Indiana, Montana, Pennsylvania, Texas, Virginia, Washington. Please click here to refer to your certificate of coverage.

  “Exotic Vehicle” means antique cars that are over 20 years old or have not been manufactured for 10 or more years or any vehicle with an original manufacturer’s suggested retail price greater than $50,000.
  *This definition changes for residents of the following states: Florida, Kansas, New York, Texas. Please click here to refer to your certificate of coverage.

  “Experimental or Investigative” means treatments, devices or prescription medications which are recommended by a Physician, but are not considered by the medical community as a whole to be safe and effective for the condition for which the treatments, devices or prescription medications are being used. This includes any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered.
  *This definition changes for residents of the following states: Alaska, New York. Please click here to refer to your certificate of coverage.

  “Family Member” means the Insured’s, or Traveling Companion’s
  - spouse, civil union partner or Domestic Partner,
  - Child,
  - siblings,
  - parents,
  - grandparent, step‐grandparent, grandchild, or step‐grandchild,
  - step‐child, step‐sibling, or step‐parent,
  - step‐aunt or step‐uncle,
  - parent‐in‐law,
  - daughter‐in‐law or son‐in‐law,
  - brother‐in‐law or sister‐in‐law,
  - aunt or uncle,
  - niece or nephew,
  - legal guardian,
  - Caregiver,
  - foster Child, ward or legal ward;
  - spouse, civil union partner, or Domestic Partner of any of the above.
  - Family Member also includes these relations to the Insured’s or Traveling Companion’s, spouse, civil union partner or Domestic Partner.
  *This definition changes for residents of the following states: Kansas, New York, Virginia. Please click here to refer to your certificate of coverage.

  “Financial Default” means the total cessation or partial suspension of operations due to insolvency, with or without the filing of a bankruptcy petition by a tour operator, Cruise line, or airline.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Forfeited” means the Insured’s financial Loss of any whole or prorated prepaid nonrefundable components of a Trip, including award travel costs.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Hospital” means a facility that:
  a) is operated according to law for the care and treatment of sick or Injured people
  b) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis;
  c) has 24 hour nursing service by registered nurses (R.N.’s); and
  d) is supervised by one or more Physicians available at all times.

  A hospital does not include:
  a) a nursing, convalescent or geriatric unit of a hospital when a patient is confined mainly to receive nursing care;
  b) a facility that is, other than incidentally, a clinic, a rest home, nursing home, convalescent home, home health care, or home for the aged, nor does it include any ward, room, wing or other section of the hospital that is used for such purposes; or
  c) any military or veterans hospital or soldiers home or any hospital contracted for or operated by a national government or government agency for the treatment of members or ex‐members of the armed forces for which no charge is normally made.
  *This definition changes for residents of the following states: Connecticut, Florida, Indiana, Maine, Montana, North Carolina, New York, Pennsylvania, Utah, Vermont, Washington. Please click here to refer to your certificate of coverage.

  “Host At Destination” means the person with whom the Insured is sharing prearranged overnight accommodations in the host’s home.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Hotel” means any establishment used for the purpose of temporary, overnight lodging for which a fee is paid and reservations are required.

  “Inaccessible” means an Insured cannot reach his/her Destination by the original mode of transportation.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Inclement Weather” means any severe weather condition which delays the scheduled arrival or departure of a Common Carrier or prevents the Insured from reaching his/her Destination when traveling by a rented or owned vehicle.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Initial Trip Payment” means the first payment made to the Insured’s Travel Supplier toward the cost of the Insured’s Trip.

  “Injury/Injured” means a bodily injury caused by an accident occurring while the Insured’s coverage under this Policy is in force and resulting directly and independently of all other causes of Loss covered by this Policy. The injury must be verified by a Physician.
  *This definition changes for residents of the following states: Illinois, Maine, Vermont. Please click here to refer to your certificate of coverage.

  “Insured”, “You”, “Your” means a person:
  a) for whom any required application has been completed;
  b) for whom any required plan cost has been paid;
  c) for whom a Trip is scheduled; and
  d) who is covered under this Policy.

  “Key Employee” means an employee of an employer who is responsible for policy and decision making.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Loss” means an Injury or Unforeseen event or incident (subject to the exceptions contained in the following sentences) sustained by the Insured as a direct result of one or more of the events against which the Company has undertaken to compensate the Insured.

  “Medically Necessary” means that a treatment, service, or supply:
  a) is essential for diagnosis, treatment, or care of the Injury or Sickness for which it is prescribed or performed;
  b) meets generally accepted standards of medical practice;
  c) is ordered by a Physician and performed under his or her care, supervision, or order; and
  d) is not primarily for the convenience of the Insured, Physician, other providers, or any other person
  *This definition changes for residents of the following states: Alaska, California, Colorado, Connecticut, DC, Indiana, Kansas, Maine, Montana, New York, Pennsylvania, Texas, Washington. Please click here to refer to your certificate of coverage.

  “Mental, Nervous or Psychological Disorder” means a mental or nervous health condition including, but not limited to: anxiety, depression, neurosis, phobia, psychosis; or any related physical manifestation.
  *This definition changes for residents of the following states: Utah, Vermont. Please click here to refer to your certificate of coverage.

  “Natural Disaster” means a flood, hurricane, tornado, earthquake, volcanic eruption, fire, wildfire or blizzard that is due to natural causes.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Necessary Personal Effects” means items such as clothing and toiletry items, which are included in the Insured’s Baggage and are required for the Insured’s Trip.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Normal Pregnancy” or “Childbirth” means a pregnancy or childbirth that is free of complications or problems.
  *This definition changes for residents of the following states: Vermont. Please click here to refer to your certificate of coverage.

  “Physician” means a licensed practitioner of medical, surgical, dental, services or the healing arts including accredited Christian Science Practitioner, acting within the scope of his/her license. The treating physician cannot be the Insured, a Traveling Companion, a Family Member, or a Business Partner.
  *This definition changes for residents of the following states: New Mexico, New York, South Dakota. Please click here to refer to your certificate of coverage.

  “Primary” means the Company will pay first but reserves the right to recover from any other insurance carrier with which the Insured may be covered.

  “Primary Residence” means an Insured’s fixed, permanent and main home for legal and tax purposes.

  “Reasonable Additional Expenses” means expenses for meals, taxi fares, essential telephone calls, local transportation, and lodging which are necessarily incurred as the result of Trip Delay and which are not provided by the Common Carrier or any other party free of charge.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Reasonable and Customary Charges” means expenses which:
  a) are charged for treatment, supplies, or medical services Medically Necessary to treat the Insured’s condition;
  b) do not exceed the usual level of charges for similar treatment, supplies or medical services in the locality where the expenses are incurred; and
  c) do not include charges that would not have been made if no insurance existed. In no event will the Reasonable and Customary Charges exceed the actual amount charged.
  *This definition changes for residents of the following states: Alaska, California, Colorado, Indiana, Kansas, Montana, New York, Pennsylvania, Texas, Vermont, Washington. Please click here to refer to your certificate of coverage.

  “Rental Return Date” means the return date listed on the car rental agreement.
  *This definition changes for residents of the following states: Florida, Kansas, New York, Texas. Please click here to refer to your certificate of coverage.

  “Rental Car Agreement” means the entire contract into which the Insured enters when renting a vehicle from a rental car agency that describes in full all of the terms and conditions of the rental, as well as the responsibility of all parties under the Rental Car Agreement.
  *This definition changes for residents of the following states: Florida, Kansas, New York, Texas. Please click here to refer to your certificate of coverage.

  “Rented Vehicle” means a land motor vehicle which the Insured has rented for the period of time shown in the Rental Car Agreement.
  *This definition changes for residents of the following states: Florida, Kansas, New York, Texas. Please click here to refer to your certificate of coverage.

  “Return Date” means the date on which the Insured is scheduled to return to the point where the Trip started or to a different specified Return Destination. This date is specified in the travel documents.

  “Return Destination” means the place to which the Insured expects to return from his/her Trip as shown in the Application.

  “Schedule” means the Schedule of Benefits which is shown at the beginning of the Policy.

  “Sickness” means an illness or disease diagnosed or treated by a Physician after the Insured’s effective date of coverage under this Policy.
  *This definition changes for residents of the following states: Maine, Montana. Please click here to refer to your certificate of coverage.

  “Strike” means a stoppage of work which:
  a) is announced, organized, and sanctioned by a labor union; and
  b) interferes with the normal departure and arrival of a Common Carrier.
  This includes work slowdowns and sickouts. The Insured’s coverage must be effective prior to when the strike is foreseeable. A strike is foreseeable on the date labor union members vote to approve a strike.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Terrorist Incident” means an act of violence by any person acting on behalf of or in connection with any organization which is generally recognized as having the intent to overthrow or influence the control of any government, that is deemed terrorism by the United States Government other than civil disorder or riot, that is not an act of war, declared or undeclared, that results in Loss of life or major damage to property.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Theft” means the act of stealing, the wrongful taking and carrying away of the personal goods or property of another, larceny.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Transport” means the most efficient and available method of conveyance. In all cases, where practical, economy fare will be utilized. If possible, the Insured’s Common Carrier tickets will be used.
  *This definition changes for residents of the following states: Indiana, Montana, New York, Washington. Please click here to refer to your certificate of coverage.

  “Transportation” means any land, sea or air conveyance required to Transport the Insured during an Emergency Evacuation. Transportation includes, but is not limited to, air ambulances, land ambulances and private motor vehicles.
  *This definition changes for residents of the following states: California, Colorado, Indiana, Montana, New York, Pennsylvania, Texas, Washington. Please click here to refer to your certificate of coverage.

  “Travel Supplier” means the tour operator, Hotel, rental company, Cruise line, or airline that provides pre‐paid travel arrangements for the Insured’s Trip.

  “Traveling Companion” means a person or persons with whom the Insured has coordinated travel arrangements and intends to travel with during the Trip. A group or tour leader is not considered a traveling companion unless the Insured is sharing room accommodations with the group or tour leader.

  “Trip” means a period of travel away from home to a Destination outside the Insured’s City of residence; the purpose of the trip is business or pleasure and is not to obtain health care or treatment of any kind; the trip has defined Departure and Return Dates specified when the Insured applies; the trip does not exceed 364 days; travel is primarily by Common Carrier and only incidentally by private conveyance.
  *This definition changes for residents of the following states: Florida. Please click here to refer to your certificate of coverage.

  “Trip Cost” means the dollar amount of Trip payments or deposits paid by the Insured prior the Insured’s Trip Departure Date and shown on any required application which is subject to cancellation penalties or restrictions. Trip cost will also include the cost of any subsequent pre‐paid payments or deposits paid by the Insured for the same Trip, after application for coverage under this plan provided the Insured amends the Application to add such subsequent payments or deposits and pays any required additional plan cost prior to the Insured’s Departure Date.

  “Unforeseen” means not anticipated or expected and occurring after the effective date of coverage.

  “Uninhabitable” means (1) the building structure itself is unstable and there is a risk of collapse in whole or in part; (2) there is exterior or structural damage allowing elemental intrusion, such as rain, wind, hail or flood; (3) immediate safety hazards have yet to be cleared, such as debris or downed electrical lines; (4) the rental property is without electricity, gas, sewer service or water; or (5) the Destination is Inaccessible.
  *This definition changes for residents of the following states: Illinois, New York. Please click here to refer to your certificate of coverage.

  “Unused” means the Insured’s financial Loss of any whole, partial or prorated prepaid nonrefundable components of a Trip that are not depleted or exhausted, including award travel expenses.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  *Additional definitions apply to the following states: Indiana, Kansas, Minnesota, Missouri, Montana, New York, Oregon, South Dakota, Utah, Vermont, Washington. Please click here to refer to your certificate of coverage.

• Exclusions
  GENERAL EXCLUSIONS

  This plan does not cover any loss caused by or resulting from:
  a) intentionally self-inflicted Injury, suicide, or attempted suicide of the Insured, Family Member, Traveling Companion or Business Partner while sane or insane;

  b) Normal Pregnancy or Childbirth, other than Unforeseen Complications of Pregnancy, or elective abortion, of the Insured, a Traveling Companion or a Family Member;

  c) participation in professional athletic events, motor sport, or motor racing, including training or practice for the same;

  d) mountain climbing that requires the use of equipment such as; pick‐axes, anchors, bolts, crampons, carabineers, and lead or top‐rope anchoring or other specialized equipment;

  e) operating or learning to operate any aircraft, as student, pilot, or crew;

  f) air travel on any air‐supported device, other than a regularly scheduled airline or air charter;

  g) war (whether declared or not) or act of war, participation in a civil disorder, riot, insurrection or unrest (unless specifically covered herein);

  h) any unlawful acts committed by the Insured;

  i) Mental, Nervous or Psychological Disorder;

  j) if the Insured’s tickets do not contain specific travel dates (open tickets);

  k) being under the influence of drugs or narcotics, unless administered upon the advice of a Physician or intoxication above the legal limit;

  l) any Loss that occurs at a time when this coverage is not in effect;

  m) traveling solely or substantially for the purpose of securing medical

  n) any Trip taken outside the advice of a Physician;

  o) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will not pay for any loss or expense incurred as the result of an Injury, Sickness or other condition (excluding any condition from which death ensues) of an Insured, Traveling Companion, Business Partner or Family Member which, within the 180 day period immediately preceding and including the Insured’s coverage effective date: a) first manifested itself, worsened, became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; b) for which care or treatment was given or recommended by a Physician; c) required taking prescription drugs or medicines, unless the condition for which the drugs or medicines are taken remains controlled without any change in the required prescription drugs or medicines.

  PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER

  The Company will waive the pre‐existing medical condition exclusion up to a maximum of the first $30,000 of Trip Cost if the following conditions are met:

  (1) This plan is purchased within 15 days of Initial Trip Payment;

  (2) The amount of coverage purchased equals all prepaid nonrefundable payments or deposits applicable to the Trip at the time of purchase and the costs of any subsequent arrangements added to the same Trip are insured within 15 days of the date of payment or deposit for any subsequent Trip arrangements;

  (3) All Insured’s are medically able to travel when this plan cost is paid;

  (4) The Trip Cost does not exceed $100,000, per person (only applicable to Trip Cancellation/Interruption/ Delay).

  This coverage will be terminated and no benefits will be paid under this Pre‐ existing Medical Condition Exclusion Waiver coverage if the full costs of all prepaid, non‐refundable Trip arrangements are not insured.

  The following exclusions also apply to Trip Cancellation and Trip Interruption:
  Unless otherwise provided by this plan Benefits will not be provided for any loss resulting (in whole or in part) from:

  a) travel arrangements canceled by an airline, Cruise line, or tour operator, except as provided elsewhere in the plan;

  b) changes in plans by the Insured, a Family Member, or Traveling Companion, for any reason;

  c) financial circumstances of the Insured, a Family Member, or a Traveling Companion;

  d) any government regulation or prohibition;

  e) an event which occurs prior to the Insured’s coverage Effective Date;

  f) failure of any tour operator, Common Carrier, person or agency to provide the bargained-for travel arrangements or to refund money due the Insured;

  g) traveling for the purpose of securing medical treatment;

  The following exclusions apply to Baggage/Personal Effects and Baggage Delay:
  Benefits will not be provided for any Loss, or damage to, caused by, or resulting in whole or in part from:

  a) animals, rodents, insects or vermin;

  b) bicycles (except when checked with a Common Carrier);

  c) motor vehicles, aircraft, boats, boat motors, ATV’s and other conveyances;

  d) artificial prosthetic devices, false teeth, any type of eyeglasses, sunglasses, contact lenses, or hearing aids;

  e) keys, notes, securities, accounts, currency, deeds, food stamps, bills, credit cards, or other evidences of debt, or tickets;

  f) money, stamps, stocks and bonds, postal or money orders;

  g) property shipped as freight, or shipped prior to the Departure Date;

  h) contraband, illegal transportation or trade;

  i) items seized by any government, government official or customs official;

  j) defective materials or craftsmanship;

  k) normal wear and tear;

  l) deterioration.

  The following limitations and exclusions apply to Car Rental Collision Coverage:
  Coverage is not provided in whole or in part for any loss to, or due to:

  a) the Insured or his/her Traveling Companion violating the rental agreement;

  b) rentals of trucks, (not including jeeps or SUV’s) campers, trailers, off road vehicles, motor bikes, motorcycles, recreational vehicles, or Exotic Vehicles;

  c) any obligation the Insured or his or her Traveling Companion assumes under any agreement except insurance collision Deductible;

  d) failure to report the Loss to the proper local authorities (when loss exceeds $100) and the rental car company;

  e) damage to any other vehicle, structure, or person as a result of a covered Loss;

  f) participation in contests of speed, motor sport or motor racing including training or practice for the same;

  g) driving under the influence of alcohol;

  h) being under the influence of drugs or intoxicants, unless prescribed by a Physician;

  i) war or act of war, whether declared or not, the Insured’s participation in a civil disorder, riot or insurrection;

  j) Injury sustained while committing or attempting to commit a crime.

  The following exclusions also apply to the Medical Expense Benefit:
  Unless otherwise provided by this plan Benefits will not be provided for the following:

  a) routine physical examinations;

  b) mental health care;

  c) replacement of hearing aids, eye glasses, contact lenses and sunglasses;

  d) routine dental care;

  e) any service provided by the Insured, a Family Member, or Traveling Companion;

  f) alcohol or substance abuse or treatment for the same;

  g) Experimental or Investigative treatment or procedures;

  h) care or treatment which is not Medically Necessary, except for related reconstructive surgery resulting from trauma, infection or disease.

  i) coverage for Trips less than 100 miles from the Insured’s Primary Residence;

  j) traveling for the purpose of securing medical treatment.

  The following exclusion also applies to the Emergency Evacuation Benefit:

  a) coverage for Trips less than 100 miles from the Insured’s Primary Residence;

  b) traveling for the purpose of securing medical treatment.

  The following exclusions also apply to Accidental Death and Dismemberment and Accidental Death and Dismemberment (Common Carrier Air Only): Benefits will not be provided for the following:

  a) loss caused by or resulting directly or indirectly from Sickness or disease of any kind;

  b) stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial infarction or heart attack; coronary thrombosis; aneurysm;

  c) traveling for the purpose of securing medical treatment;

  *These exclusions change for the following states: Alaska, Arizona, California, Colorado, Connecticut, Florida, Idaho, Illinois, Indiana, Kansas, Michigan, Missouri, Montana, Nevada, New York, North Carolina, North Dakota, Oregon, Pennsylvania, South Dakota, Texas, Utah, Vermont, Virginia, Washington. Please click here to refer to your certificate of coverage.