Worldwide Group Protector

Brief Outline of Coverages

Accident / Sickness Medical Expense

If an insured person should become injured or sick and require medical attention while participating in the travel program, the insurance company will pay 100% of covered expenses up to the limit chosen. A $50 deductible per incident applies to medical expenses and consists of covered expenses which would otherwise be payable under the policy. The deductible must be paid by the insured.

Covered expenses include:

Hospital room and board (not to exceed the hospital's average charge for semi-private room and board accommodation or two (2) times the average semi-private room charge made by the servicing hospital if confinement to an intensive care unit is required, or the actual charge for intensive care unit made by the servicing hospital, whichever is less), floor nursing and other professional services (except personal services of a non-medical nature); diagnosis, treatment and surgery by a physician; anesthetics; medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, iron lungs, and medical treatment; physiotherapy, if recommended by a physician for the treatment of a specific disablement and administered by a licensed physiotherapist; hotel room charge, when the insured, otherwise necessarily confined in a hospital, shall be under the care of a duly qualified physician in a hotel room owing to unavailability of a hospital room by reason of capacity or distance or to any circumstances beyond control of the insured; dressings, drugs, and medicines that can only be obtained upon a written prescription of a physician or surgeon.

The charges enumerated above shall in no event include any amount of such charges which are in excess of regular and customary charges.

Emergency Medical Evacuation

If a covered injury or sickness commencing during the course of a trip results in the necessary emergency evacuation of the insured person, the policy will pay benefits for covered expenses incurred up to a maximum of $30,000. An emergency evacuation must be ordered by a legally licensed physician who certifies that the severity of the insured person's injury warrants the emergency evacuation of the insured person.

This coverage is very important, as the cost of medically transporting an ill or injured person is extremely expensive. This type of transportation is usually arranged on a scheduled carrier, and when a stretcher is required the patient must purchase the equivalent of nine economy class seats or four first class seats.

Emergency Medical Evacuation insurance is not included in most U.S. group medical insurance policies. However, it is an essential benefit for international travelers.

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Bedside Visitation

The Company will pay the cost of a round trip economy airline ticket to bring one person chosen by the Insured to and from the hospital or other medical facility where the insured is confined when, in the opinion of a medical practitioner acceptable to the Company, such a visit is necessary due to a bodily injury or illness which constitutes an immediate danger to life. AIGAssist must make all arrangements for any benefit to be payable.

Accidental Death & Dismemberment (AD&D)

When injury results in any of the following losses within three hundred sixty-five (365) days after the occurrence of the covered accident, the company will pay for:

The aggregate limit of liability is $100,000 per accident for Options A and B; $250,000 for Option C.

Loss Means - With regard to hand or foot, actual severance through or above the wrist or ankle joints; with regard to eye, speech or hearing, entire and irrecoverable loss; with regard to thumb and index finger, complete severance through or above the metacarpophalangeal joints. Only one benefit, the largest to which the Insured Person is entitled, is payable for all losses resulting from one accident.

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.

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Repatriation of Remains

The insurance company will pay the reasonable covered expenses incurred to prepare and return the insured person's body to his/her place of permanent residence in the event of death, not to exceed the maximum of $7,500.

This benefit is not generally included in many U.S. group medical insurance policies and is therefore recommended for travelers.

Emergency Medical Assistance Service

24-Hour Multilingual Emergency Assistance - Insured Persons will be provided with an emergency telephone number they can call toll free in the U.S. or collect from outside the U.S. to reach the 24-hour multilingual assistance staff at AIGAssist. 

Medical Referrals/Medical Consultation and Monitoring - As soon as AIGAssist is notified of a medical emergency resulting from an accident or sickness of an Insured, AIGAssist will work in conjunction with its medical panel and the attending physician to determine the best course of action to be taken. AIGAssist will verify coverage, and if possible and if appropriate, the eligible person's family physician will be contacted. AIGAssist will then organize a response to the medical emergency, doing whatever appropriate, including but not limited to recommending or securing the availability of services of a local physician, and arranging hospital confinement of the insured person, where at its discretion, AIGAssist deems such confinement appropriate. 

Medical Evacuation/Repatriation of Remains - AIGAssist will also arrange any medical transportation if deemed necessary, and in the event of death, arrange repatriation of remains. 

Miscellaneous Services - AIGAssist can also arrange legal assistance, and assistance with lost luggage and passports.

All emergency evacuations, bedside visitations and repatriations are to be arranged through AIGAssist.

Exclusions

1. For Accident & Sickness Medical Expense, this insurance does not cover:
2. Pre-existing conditions, defined as any injury or illness which was contracted or which manifested itself, or for which treatment or medication was prescribed within three (3) years prior to the effective date of this insurance;
3. Services, supplies or treatment, including any period of hospital confinement, which were not recommended, approved and certified as necessary and reasonable by a physician;
4. Expenses incurred as a result of or in connection with: declared or undeclared war or any act thereof; intentionally self-inflicted injury; suicide or any attempt thereat while sane or insane; commission of a felony offense;
5. Specific named hazards: motorcycle driving, scuba diving, mountain climbing, skiing, sky diving, professional or amateur racing, piloting an aircraft, professional athletics;
6. Expenses for routine physicals 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 disability established by the prior call or attendance of a physician;
7. Expenses which are non-medical in nature; cosmetic or plastic surgery, except as the result of an accident; elective surgery which can be postponed until the insured returns to his/her country of residence; congenital anomalies; mental and nervous disorders or rest cures; dental care, except as the result of injury to natural teeth caused by accident; eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or contact lenses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured; expenses incurred in connection with alcoholism or drug addiction, or use of any drug or narcotic agent; the ordinary cost of a one-way airplane ticket used in the transportation back to the insured's country where an air ambulance benefit is provided;
8. Treatment paid for or furnished under any other individual or group policy, or other service or medical prepayment 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 cost to any individual;
9. Sickness resulting from pregnancy, childbirth or miscarriage, including miscarriage resulting from an accident;
10. Medical expenses incurred in the insured's country of residence.

With respect to Accidental Death & Dismemberment, Emergency Medical Evacuation, and Repatriation of Remains, this policy does not cover any loss, fatal or non-fatal, caused by or resulting from: 1) suicide or self destruction of any attempt thereat while sane or insane; 2) disease of any kind; 3) bacterial infections except pyogenic infection which shall occur through an accidental cut or wound; 4) hernia of any kind; 5) injury sustained in consequence of riding as a pilot, operator, or member of crew of any aircraft, except as a passenger; 6) declared or undeclared war or any act thereof; 7) service in the military, naval or air service of any country.

With regard to Emergency Medical Evacuation, and Repatriation of Remains, exclusions 2, 3, and 4 above shall be deleted.

This description is presented as a matter of general information only. The contents are not to be accepted or construed as a substitute for the provisions of the master policy.

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