Pre-Existing Condition

• Medical
  • Pre-Existing Condition

  • Covered if policy purchased before the final trip payment

• What is Pre-Existing Condition?
  A Pre-Existing Condition is an illness or other medical condition that was treated, diagnosed, or changed during a policy’s lookback period.

• What am I covered for?
  Benefits are not payable for any loss due to, arising or resulting from:

  12. due to a Pre-Existing Condition, as defined in the Policy. The Pre-Existing Condition Limitation does not apply to the Emergency Medical Evacuation or return of remains coverage;

  Pre-Existing Condition Exclusion:

  The Company will not pay for any expense as a result of any illness, disease, or other condition during the sixty (60) day period immediately prior to the date Your coverage is effective for which You or Your Traveling Companion, Business Partner or Family Member scheduled or booked to travel with You: 1) received or received a recommendation for a test, examination, or Medical Treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or 2) took or received a prescription for drugs or medicine. Item (2) of this Exclusion does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the sixty (60) day period before coverage is effective under this Policy.

  Waiver of the Pre-Existing Condition Exclusion

  The exclusion for Pre-Existing Condition will be waived provided:

  a) Your Payment or Deposit for this Policy and enrollment form are received within 24 hours of the final Payment for Your Trip or before the final Payment for Your Trip; and

  b) You are not disabled from travel at the time Your premium is paid.

  “Pre-Existing Condition” means an illness, disease, or other condition during the sixty (60) day period immediately prior to the date Your coverage is effective for which You or Your Traveling Companion, Business Partner or Family Member scheduled or booked to travel with You: 1) received or received a recommendation for a test, examination, or Medical Treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or 2) took or received a prescription for drugs or medicine. Item (2) of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the sixty (60) day period before coverage is effective under this Policy.

• Definitions
  “Accident” means a sudden, unexpected unusual specific event that occurs at an identifiable time and place, and shall also include exposure resulting from a mishap to a conveyance in which You are traveling.

  “Actual Cash Value” means current replacement cost for items of like kind and quality.

  “Additional Transportation Cost” means the actual cost incurred for one (1) way Economy Transportation by Common Carrier reduced by the value of an unused travel ticket.

  “Air Carrier” means any air conveyance operating under a valid license for the transportation of passengers for hire.

  “Baggage and Personal Effects” means luggage, personal possessions and travel documents taken by You on Your Trip.

  “Bankruptcy or Default” means the total cessation of operations due to insolvency, with or without the filing of a bankruptcy petition by an airline, cruise line, tour operator, or other travel provider provided the Bankruptcy or Default occurs more than fourteen (14) days following Your Effective Date for the Trip Cancellation Benefits. There is no coverage for the Bankruptcy or Default of any person, organization, agency or firm from whom You purchased Travel Arrangements supplied by others.

  “Business Partner” means an individual who (a) is involved in a legal general partnership with You and (b) is actively involved in the day to day management of Your business.

  “Caregiver” means an individual employed for the purpose of providing assistance with activities of daily living to You or to Your Family Member who has a physical or mental impairment. The Caregiver must be employed by You or Your 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 or skilled nursing personnel.

  “Child Caregiver” means an individual providing basic childcare service needs for Your minor children under the age of eighteen (18) while You are on the Trip without the minor children. The arrangement of being the Child Caregiver while You are on the Trip must be made thirty (30 or more days prior to the Scheduled Departure Date.

  “Common Carrier” means any land, sea, or air conveyance operating under a valid license for the transportation of passengers for hire.

  “Complications of Pregnancy” means conditions (when the pregnancy is not terminated) 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 non-elective 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 does 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.

  “Covered Accident” means an Accident that occurs while coverage is in force and results in a loss for which benefits are payable.

  “Covered Vehicle” means a private passenger vehicle (including mini-vans, pickup trucks and sport utility vehicles) which is registered or rented to You during Your Trip, which is rated 3⁄4 ton in weight or less, not used for racing, dealer services, dealer loaners, taxi, limousine, shuttle, delivery, hauling, towing, road repair service, construction service, snow removal, or as a public livery vehicle, or any other commercial use.

  “Dive/Diving” means recreational snorkeling or scuba diving, dive training or diving as a scuba instructor, dive master, underwater photographer or while performing research under the auspices and following the Diving safety guidelines of the American Academy of Underwater Scientists. A Dive begins upon entry into the water and ends upon exit from the water. A Dive must occur in an area in which snorkeling and/or scuba Diving is not prohibited. In the case of scuba Diving, You must be equipped with Personal Diving Equipment. Diving must be done by a person (a) At least 10 years of age and qualified as a diver; the holder of a valid diver’s certificate (recognized by international Diving organizations); and according to the generally accepted standards of the Diving community or (b) who is in the process of obtaining his/her qualification as a diver and is under the supervision of and Diving with a qualified Diving instructor affiliated with a certifying organization or agency.

  “Domestic Partner means an opposite or same sex partner who, for at least twelve (12) consecutive months, has resided with You and shared financial assets/obligations with You. Both You and the Domestic Partner must:

  1. intend to be life partners;

  2. be at least the age of consent in the state in which You both reside; and

  3. be mentally competent to contract.

  Neither You nor the Domestic Partner can be related by blood to a degree of closeness that would prohibit a legal marriage, be married to anyone else, or have any other Domestic Partner. The Company may require proof of the Domestic Partner relationship in the form of a signed and completed affidavit of domestic partnership.

  “Economy Transportation” means the lowest published available transportation rate for a ticket on a Common Carrier matching the original class of transportation that You purchased for Your Trip.

  “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.

  “Excluded Country” means one of the following countries from which Non-Medical Emergency Evacuations are not available such as any country subject to the administration and enforcement of U.S. economic embargoes and trade sanctions by the OFFICE OF FOREIGN ASSET CONTROLS (OFAC);

  “Family Member” means any of the following who resides in the United States, Canada, or Mexico: Your or Your Traveling Companion’s legal spouse (or common-law spouse where legal), legal guardian or ward, son or daughter (adopted, foster, step or in-law), brother or sister (includes step or in-law), parent (includes step or in-law), grandparent (includes in-law), grandchild, aunt, uncle, niece or nephew, Domestic Partner, Caregiver, or Child Caregiver.

  “Home” means Your primary place of residence.

  “Hospital” means (a) a place which is licensed or recognized as a general Hospital by the proper authority of the state in which it is located: (b) a place operated for the care and treatment of resident inpatients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility: © a place recognized as a general Hospital by the Joint Commission on the Accreditation of Hospitals; (d) other than a residence, a place where treatment in a Hyperbaric chamber can be received. Not included is a Hospital or institution licensed or used principally: (1) for the treatment or care of drug addicts or alcoholics: or (2) as a clinic continued or extended care facility, skilled nursing facility, convalescent home, rest home, nursing home or home for the aged.

  “Inclement Weather” means any weather condition that delays the scheduled arrival or departure of a Common Carrier.

  “Injury” or “Injuries” means bodily harm and/or decompression illness caused by an Accident which: 1) occurs while Your coverage is in effect under the Policy; and 2) requires examination and treatment by a Legally Qualified Physician. The Injury must be the direct cause of loss and must be independent of all other causes and must not be caused by, or result from, Sickness.

  “Insured” means a person(s) who is booked to travel on a Trip, completes the enrollment form and for whom the required premium is paid, also referred to as You and Your.

  “Intoxicated” mean a blood alcohol level that equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where You are located at the time of an incident.

  “Legally Qualified Physician” means a physician: (a) other than You, a Traveling Companion or a Family Member; (b) practicing within the scope of his or her license; and ©recognized as a physician in the place where the services are rendered.

  “Maximum Benefit Amount” means the maximum amount payable for coverage provided to You as shown in the Schedule of Benefits.

  “Medically Fit to Travel” means based on assessment a Legally Qualified Physician has advised You, a Traveling Companion, Family Member or Business Partner booked to travel with You in writing that there is no medical condition, illness, Injury or Sickness that would likely interfere with a Trip at the time of purchase of Coverage for a Trip.

  “Medically Necessary” means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.

  “Medical Treatment” means examination and treatment by a Legally Qualified Physician for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted reasonable person to seek diagnosis, care or treatment.

  “Natural Disaster” means a flood, hurricane, tornado, earthquake, mudslide, tsunami, avalanche, landslide, volcanic eruption, fire, wildfire or blizzard that is due to natural causes.

  “Partial Hospitalization” means an outpatient program specifically designed for the diagnosis or active treatment of a serious mental disorder when there is a reasonable expectation for improvement or when it is necessary to maintain a patient’s functional level and prevent relapse or full hospitalization. Partial Hospital programs are usually furnished by a Hospital as distinct and organized intensive ambulatory treatment service of less than 24-hour daily care.

  “Payments or Deposits” means the cash, check, or credit card amounts actually paid for Your Trip.

  “Penalty” means a fee assessed for canceling a reservation. For airline tickets, the cancellation Penalty is usually collected by refunding only a portion of the ticket price. For hotel reservations, the cancellation Penalty is charged to the credit card or deposit used to secure the reservation.

  “Pre-Existing Condition” means an illness, disease, or other condition during the sixty (60) day period immediately prior to the date Your coverage is effective for which You or Your Traveling Companion, Business Partner or Family Member scheduled or booked to travel with You: 1) received or received a recommendation for a test, examination, or Medical Treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or 2) took or received a prescription for drugs or medicine. Item (2) of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the sixty (60) day period before coverage is effective under this Policy.

  “Prepaid” means Payments or Deposits paid to a Travel Supplier for Travel Arrangements for Your Trip prior to Your actual or Scheduled Departure Date. Payments or Deposits for shore excursions, theater, concert or event tickets or fees, or sightseeing, if such arrangements are made during Your Trip and are to be used prior to the Scheduled Return Date of Your Trip, are not considered Prepaid as defined herein.

  “Program Medical Advisor” means iTravelInsured®, Inc.

  “Published Penalties” means any published cancellation penalties levied by Your travel agency or Travel Supplier that apply to all clients of the travel agency or Travel Supplier and can be documented at time of Your purchase of Travel Arrangements from Your travel agency. The maximum amount reimbursable for travel agency Published Penalties is twenty-five percent (25%) of the total trip cost excluding taxes and other non-commissionable items.

  “Scheduled Departure Date” means the date on which You are originally scheduled to leave on Your Trip.

  “Scheduled Return Date” means the date on which You are originally scheduled to return to the point of origin or the original final destination of Your Trip.

  “Sickness” means an illness or disease of the body which: 1) requires examination and treatment by a Legally Qualified Physician, and 2) commences while Your coverage is in effect. An illness or disease of the body which first manifests itself and then worsens or becomes acute prior to the Effective Date of Your coverage is not a Sickness and is considered a Pre-Existing Condition as defined herein and is not covered by the Policy.

  “Strike” means any organized and legally sanctioned labor disagreement resulting in a stoppage of work: 1) as a result of a combined effort of workers which was unannounced and unpublished at the time travel services were purchased; and 2) which interferes with the normal departure and arrival of a Common Carrier.

  “Terrorist Incident” means an act of violence, 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, by any person acting alone or in association with other persons on behalf of or in connection with any organization of foreign government which is generally recognized as having the intent to overthrow or influence the control of any other foreign government.

  “Third Party” means a person or entity other than You or the Company.

  “Transportation Expense” means the cost of Medically Necessary conveyance, personnel, and services.

  “Travel Advisory or Travel Warning” means U.S. State Department communication advising caution in traveling to specified destinations due to reasons such as armed violence, civil or political unrest, high incidence of crime (specially kidnapping and/or murder), Natural Disaster or outbreak of one or more contagious diseases.

  “Traveling Companion” means a person or persons whose names appear with Yours on the same Travel Arrangements and who, during Your Trip, will accompany You. A group or tour organizer, sponsor or leader is not a Traveling Companion as defined, unless sharing accommodations in the same room, cabin, condominium unit, apartment unit or other lodging with You.

  “Travel Supplier” means any entity or organization that coordinates or supplies travel services for You.

  “Trip” means a scheduled trip for which coverage for Travel Arrangements is requested and the premium is paid prior to Your actual or Scheduled Departure Date of Your Trip.

  “Us”, “We”, “Our” means United States Fire Insurance Company.

  “Usual and Customary Charges” means those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.

• Exclusions
  Benefits are not payable for any loss due to, arising or resulting from:

  1. suicide, attempted suicide or any intentionally self-inflicted Injury of You, a Traveling Companion, Family Member or Business Partner booked to travel with You, while sane or insane;

  2. an act of declared or undeclared war;

  3. participating in maneuvers or training exercises of an armed service, except while participating in weekend or summer training for the reserve forces of the United States, including the National Guard;

  4. riding or driving in races, or speed or endurance competitions or events;

  5. participating as a member of a team in an organized sporting competition or participating as a professional in a stunt, athletic or sporting event or competition;

  6. piloting or learning to pilot or acting as a member of the crew of any aircraft;

  7. being Intoxicated as defined herein, or under the influence of any controlled substance unless as administered or prescribed by a Legally Qualified Physician;

  8. the commission of or attempt to commit a felony or being engaged in an illegal occupation;

  9. normal childbirth or pregnancy (except Complications of Pregnancy) or voluntarily induced abortion;

  10. dental treatment (except as coverage is otherwise specifically provided herein);

  11. amounts which exceed the Maximum Benefit Amount for each coverage as shown in the Schedule of Benefits;

  12. due to a Pre-Existing Condition, as defined in the Policy. The Pre-Existing Condition Limitation does not apply to the Emergency Medical Evacuation or return of remains coverage;

  13. any amount paid or payable under any Worker’s Compensation, Disability Benefit or similar law;

  14. a loss or damage caused by detention, confiscation or destruction by customs;

  15. Elective Treatment and Procedures;

  16. Complications from Elective Treatment and Procedures otherwise not payable under this Policy;

  17. Medical Treatment during or arising from a Trip undertaken for the purpose or intent of securing Medical Treatment;

  18. failure of any tour operator, Common Carrier, or other Travel Supplier, person or agency to provide the bargained- for travel arrangements for reasons other than Bankruptcy or Default;

  19. a mental or nervous condition, unless hospitalized or Partially Hospitalized for that condition while the Policy is in effect for You;

  20. a loss that results from a Sickness, Injury, disease or other condition, event or circumstance which occurs at a time when the Policy is not in effect for You;

  21. due to loss or damage (including death or Injury) and any associated cost or expense resulting directly from the discharge, explosion or use of any device, weapon or material employing or involving chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act and regardless of any other sequence thereto.

  22. Diving while in an abnormal state of which You were aware and/or due to which You were disqualified or not entitled to engage in Diving;

  23. Diving as a professional diver other than as a Diving instructor, Dive master, underwater photographer, or while performing research under the auspices and following the guidelines of the American Academy of Underwater Sciences (AAUS);

  24. Diving in an area where Diving is forbidden.

  25. an assessment from a Legally Qualified Physician advising You in writing that You, a Traveling Companion, Family Member or Business Partner booked to travel with You are not Medically Fit to Travel, as defined in the Policy, at the time of purchase of Coverage for a Trip.

  Pre-Existing Condition Exclusion:

  The Company will not pay for any expense as a result of any illness, disease, or other condition during the sixty (60) day period immediately prior to the date Your coverage is effective for which You or Your Traveling Companion, Business Partner or Family Member scheduled or booked to travel with You: 1) received or received a recommendation for a test, examination, or Medical Treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or 2) took or received a prescription for drugs or medicine. Item (2) of this Exclusion does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the sixty (60) day period before coverage is effective under this Policy.

  Waiver of the Pre-Existing Condition Exclusion

  The exclusion for Pre-Existing Condition will be waived provided:

  a) Your Payment or Deposit for this Policy and enrollment form are received within 24 hours of the final Payment for Your Trip or before the final Payment for Your Trip; and

  b) You are not disabled from travel at the time Your premium is paid.

  Medically Fit to Travel Exclusion

  The Company will not pay any expense as a result of You having been advised in writing that You, a Traveling Companion, Family Member or Business Partner booked to travel with You are not Medically Fit to Travel, as defined in the Policy, at the time of purchase of Coverage for a Trip. If Coverage for a Trip is purchased and it is later determined that You, a Traveling Companion, Family Member or Business Partner booked to travel with You were not Medically Fit to Travel, as defined in the Policy, at the time of purchase of Coverage for a Trip, the Coverage is void and premium paid will be returned.