Pre-Existing Condition

• Medical
  • Pre-Existing Condition

  • Covered if purchased within 21 days of trip deposit

• 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:

  1. due to a Pre-Existing Condition, as defined in the policy. This Pre-Existing Condition exclusion does not apply to the Emergency Medical Evacuation or Repatriation of Remains coverage;

  Waiver of the Pre-Existing Condition Exclusion

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

  a) Your premium for this policy is received within the Time Sensitive Period; and

  b) You insure 100% of the cost of all Travel Arrangements that are subject to cancellation penalties or restrictions by the Travel Supplier; and

  c) You or the individual with the Pre-Existing Condition, are not disabled from travel at the time Your premium is paid; and

  d) The booking for the Trip is the Insured’s first and only booking for this travel period and destination.

  “Pre-Existing Condition” means an illness, disease, or other condition during the 180 day period immediately prior to the Effective Date of Your coverage for which You or Your Traveling Companion, Business Partner or Family Member: 1) received or received a recommendation for a test, examination, or medical 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 180 day period before Your 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 less depreciation.

  “Additional Transportation Cost” means the actual cost incurred for one-way Economy Transportation (or for the original class of fare, if the original tickets were for a higher class of fare) by Common Carrier by the most direct route, less any refunds paid or payable, for unused original tickets.

  “Baggage” means luggage and personal effects (whether owned, borrowed or rented) taken by You on Your Trip. “Business Equipment” means property used in trade, business, or for the production of income; or offered for sale or trade or components of goods offered for sale or trade.

  “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 a person 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 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 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, not including taxicabs or rented, leased or privately owned motor vehicles.

  “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.
  *This definition changes for residents of the following states: New York, Utah. Please click here to refer to your certificate of coverage.

  “Dependent” means lawful spouse, Your children including an unmarried child, stepchild, legally adopted child or foster child who is: (1) less than age 19 and primarily dependent on You for support and maintenance; or (2) who is at least age 19 but less than age 26 and who regularly attends an accredited school or college; and who is primarily dependent on You for support and maintenance.
  *This definition changes for residents of the following states: Illinois, Indiana, Massachusetts, Minnesota, New York, Tennessee, Utah. Please click here to refer to your certificate of coverage.

  “Domestic Partner” means an opposite or same-sex partner who is at least eighteen (18) years of age and has met all the following requirements for at least 10 months:

  1) Resides with You;

  2) Shares financial assets and obligations with You.

  3) Is not related by blood to You to a degree of closeness that would prohibit a legal marriage;

  4) Neither You nor Your Domestic Partner is married to anyone else, or has any other Domestic Partner.
  *This definition changes for residents of the following states: California, DC, New York, Oregon, Washington. Please click here to refer to your certificate of coverage.

  “Economy Transportation” means the lowest published available transportation rate for a ticket on a Common Carrier. “Effective Date” means the date and time Your coverage begins, as indicated in Section IV-Coverage Provisions, When Coverage Begins and Ends.

  “Elective Treatment and Procedures” means any medical treatment or surgical procedure that is not medically required, including any service, treatment, or supplies that are deemed by the federal, or a state or local government authority to be research or experimental or that is not recognized as a generally accepted medical practice.

  “Eligible Person” means a citizen or resident of the United States of America .

  “Exotic Vehicles” means any antique, limited production, or collectible car or any other private passenger vehicle with a Manufacturer’s Suggested Retail Price (MSRP) over $50,000.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Family Member” means any of the following: 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.
  *This definition changes for residents of the following states: Louisiana, New York. Please click here to refer to your certificate of coverage.

  “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 in-patients with a registered graduate nurse (RN) always on duty and with a laboratory and X-ray facility; c) 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.
  *This definition changes for residents of the following states: Missouri, New York. Please click here to refer to your certificate of coverage.

  “Hospitalized” means admitted to a Hospital for a period of at least 24 hours or where the patient is charged by the Hospital for a minimum of one day of inpatient charges.

  “Host at Destination” means a person with whom You are sharing pre-arranged overnight accommodations at the host’s usual principal place of residence.

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

  “Injury” means bodily harm caused by an Accident that: 1) occurs while Your coverage is in effect under the policy; and 2) requires examination and treatment by a 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 the person named on the Confirmation of Benefits that is scheduled to participate on a Trip, provided the required premium has been paid. Insured also means “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.

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

  “Medical Evacuation” means Physician-ordered Transportation Expense which is arranged and approved by Our Program Assistance Provider. An unscheduled return by the same or like mode of transportation as originally scheduled without additional transportation requirements is not a Medical Evacuation.

  “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 Physician.

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

  “Payments or Deposits” means the cash, check, or credit card amounts, rewards, miles or points; actually paid or used for Your Trip. Certificates, vouchers, discounts and/or credits applied (in part or in full) towards the cost of Your Travel Arrangements are not Payments or Deposits as defined herein.

  “Physician” means a person licensed as a medical doctor in the jurisdiction where the services are rendered or a Christian Science Practitioner who is: (a) other than You, a Traveling Companion or a Family Member; and (b) practicing within the scope of his or her license.

  “Pre-Existing Condition” means an illness, disease, or other condition during the 180 day period immediately prior to the Effective Date of Your coverage for which You or Your Traveling Companion, Business Partner or Family Member: 1) received or received a recommendation for a test, examination, or medical 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 180 day period before Your coverage is effective under this policy.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Program Assistance Provider” means OnCall International.

  “Rental Car” means a private passenger vehicle (including mini-vans and sport utility vehicles) rented from a rental car agency and being used solely for transportation on public roads.

  “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 that: 1) requires examination and treatment by a Physician, and 2) commences while Your coverage is in effect. An illness or disease of the body that first manifests itself and then worsens or becomes acute prior to the Effective Date of Your coverage is not a Sickness as defined herein and is not covered by the policy.

  “Strike” means any labor disagreement resulting in a stoppage of work: (a) as a result of a combined effort of workers which is unannounced and unpublished at the time Travel Arrangements are purchased and (b) which interferes with the normal departure and arrival of a Common Carrier.

  “Terrorist Incident” means an incident deemed a terrorist attack by the United States government.
  *This definition changes for residents of the following states: Oregon. Please click here to refer to your certificate of coverage.

  “Third Party(ies)” means any person, corporation or other entity except You and Us.

  “Time Sensitive Period” means within 21 days of the date Your initial deposit/payment for Your Trip is received.

  “Transportation Expense” means the cost of Medically Necessary conveyance and personnel, including Usual and Customary charges for required medical services and supplies.

  “Travel Arrangement(s)” means: (a) transportation; (b) accommodations; and © other specified services arranged by Your Travel Supplier for Your Trip.

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

  “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.

  “Trip” means a scheduled trip of 180 days or less in length; 1) for which coverage is elected, the premium paid and all Travel Arrangements are arranged prior to the Scheduled Departure Date; 2) with a per person cost of $50,000 or less; and 3) and is 50 miles or more from Your primary residence.
  *This definition changes for residents of the following states: New York. Please click here to refer to your certificate of coverage.

  “Unforeseen” means not anticipated or expected and occurring after the Effective Date for Trip Cancellation of the policy.

  “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; or (4) the property is without electricity, gas, sewer service or water or under an order of mandatory evacuation by local government authorities.

  “Usual and Customary” means the comparable level of charges for similar treatment, services and supplies in the geographic area where treatment, services or supplies are provided or performed.

  *Additional definitions apply to the following states: Florida, Massachusetts, New York, Oregon. Please click here to refer to your certificate of coverage.

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

  1. due to a Pre-Existing Condition, as defined in the policy. This Pre-Existing Condition exclusion does not apply to the Emergency Medical Evacuation or Repatriation of Remains coverage;

  Waiver of the Pre-Existing Condition Exclusion

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

  a) Your premium for this policy is received within the Time Sensitive Period; and

  b) You insure 100% of the cost of all Travel Arrangements that are subject to cancellation penalties or restrictions by the Travel Supplier; and

  c) You or the individual with the Pre-Existing Condition, are not disabled from travel at the time Your premium is paid; and

  d) The booking for the Trip is the Insured’s first and only booking for this travel period and destination.

  2. 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;

  3. war, invasion, acts of foreign enemies, hostilities between nations (whether declared or undeclared), or civil war;

  4. participating in maneuvers or training exercises of an armed service or police force of any country;

  5. mountaineering (engaging in the sport of scaling mountains generally requiring the use of picks, ropes, or other special equipment);

  6. participating as a professional in a stunt, athletic or sporting event or competition;

  7. participating in skydiving or parachuting, hang gliding, bungee cord jumping, extreme skiing, skiing outside marked trails or heli-skiing, any race or speed contests, scuba diving if the depth exceeds 130 feet or if You are not PADI or NAUI certified to dive and a dive master is not present during the dive; spelunking or bodily contact sports;

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

  9. being Intoxicated or under the influence of any controlled substance unless taken as administered or prescribed by a Physician;

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

  11. normal pregnancy (except Complications of Pregnancy) and/or resulting childbirth, except as otherwise covered under Trip Cancellation or Trip Interruption, or voluntarily induced abortion;

  12. any non-emergency treatment or surgery, routine physical examinations, hearing aids, eye glasses, contacts or any Elective Treatment and Procedures;

  13. any loss occurring during a Trip booked or taken for the purpose or intent of securing medical treatment;

  14. a mental, or nervous or psychological disorder, unless Hospitalized for that condition while the policy is in effect for You.

  *These exclusions change for the following states: Illinois, Indiana, New York, Oregon. Please click here to refer to your certificate of coverage.