Policy Information

Jennifer Thomas
1318 Hogan Ln
Round Rock TX 78664
Thank you for your recent purchase of Allianz Travel Insurance. We are pleased that you have chosen to take us along on your
upcoming trip!
This packet of information will help you use your travel insurance policy and includes:
A summary of assistance services and benefits described below
Your Letter of Confirmation of insurance benefits
Your detailed Certificate of Insurance/Policy
Summary of Assistance Services and Benefits
You are entitled to important assistance services and benefits.
Service/Benefit Coverage Limits*
24-Hour Hotline Assistance
Emergency Medical Transportation $100,000.00
*USD per person unless noted otherwise
To make the most of your assistance services and benefits please:
Read the detailed Certificate of Insurance/Policy.
Download the TravelSmart app for a listing of hospitals and clinics for your destination(s) available at both the App Store and
Google Play.
If you require emergency medical care while traveling, please call our office for assistance before engaging any expense.
Save or photograph all receipts in the event you need to file a claim. Claims may be electronically filed at
http://www.etravelprotection.com/cheaptickets.
Letter of Confirmation
May 10, 2014
Jennifer Thomas
1318 Hogan Ln
Round Rock TX 78664
Dear Jennifer Thomas,
Thank you for choosing Allianz Global Assistance to protect your travel investment.
Please make sure you read this Letter of Confirmation, your enclosed Policy, and
any other attached documents, including riders or other forms carefully. Because the
Policy may describe coverage not included in your plan, be sure to look at all of the
documents to understand your specific coverage. Contact us immediately if you
think there is a mistake in your Letter of Confirmation.
We recommend that if you are traveling for your event, you take copies of these
documents with you. If you did not receive a Policy, or would like another copy,
please call 1-800-284-8300.
Information About Your Plan
Name of your plan: Trip Protector
Policy identification number: IBCTIX107837931
Number of people insured: 1
Who it insures: Jennifer Thomas
Date of purchase: May 10, 2014
Plan effective date: May 11, 2014
Travel dates: May 14, 2014 - June 11, 2014
Total cost for all travelers:
Amount paid:
$26.17
$26.17
Changes to your travel plans may require changes to your coverage. If your plans
change please contact Allianz Global Assistance.
Thanks again for purchasing a travel insurance plan from Allianz Global Assistance.
Have a safe and pleasant trip!
Please note that your policy does not cover all situations and excludes coverage for
existing medical conditions. We encourage you to carefully review your Policy to
understand your specific coverage.
Sincerely,
Mark Henson
Vice President of Travel Operations
We will refund your insurance premium if you cancel your plan within
10 days of purchase and you havent started your trip or filed a
claim.
Form No. 101-LOC-XX-02
Name: Jennifer Thomas
Policy No.: IBCTIX107837931
Emergency Assistance Card
For emergency assistance during your trip call:
1-800-654-1908 1-804-281-5700
(From U.S.) (Outside the U.S.) / (Collect)
For benefit information call:
1-800-269-9726
(From U.S.)
To modify your policy or file a claim, please visit:
http://www.etravelprotection.com/cheaptickets
9950 Mayland Drive, Richmond, VA 23233
Your plan includes the following coverage, up to the limits
shown. Please see your Policy for information about how
our insurance works.
Benefit
Coverage
Limits*
Baggage Coverage $300.00
Emergency Medical and Dental $25,000.00
Trip Cancellation Protection $430.50
Travel/Trip Delay Coverage $500.00
Trip Interruption Protection $430.50
*USD per person unless noted otherwise
Please Note
For Emergency Medical and Dental benefits, a one-time
$50.00 deductible per person applies to outpatient visits.
There is a $500 maximum for all covered dental expenses.
AGA Service Company is the licensed producer and
administrator for this plan.
Insurance coverage is provided under Form 101-P-XX-
02-201 PC and 101-P-TX-02-001 AH issued by Jefferson
Insurance Company.
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TI_LOC_P_200_013 * TI_201_03_P_TX_V2 * 101_R1_TX_02 * JIC_TXN_2013 * 101_OUT_TX_02_001_AH *
JICPRIVNOT * CSL20140106 * * * *
Dont forget to
take this document
with you!
Allianz Global Assistance and Allianz Travel Insurance branded plans are underwritten by
Jefferson Insurance Company. AGA Service Company is the licensed producer for this plan.
Form 101-P-XX-02-201 PC
Form 101-P-TX-02-001 AH TI_201_03_P_TX_V2
Allianz Travel Insurance
Individual Travel
Insurance Policy
FOR SERVICE, VISIT OR CALL:
www.etravelprotection.com
1-800-284-8300
FOR EMERGENCY ASSISTANCE
DURING YOUR TRIP CALL:
1-800-654-1908
(From U.S.)
1-804-281-5700
(Collect)
Form 101-P-XX-02-201PC 1
Your Travel Insurance Policy
Thank you for buying a travel insurance plan from us!
Your plan is described in the following documents:
This policy, which explains how our travel insurance works.
The letter of confirmation that came with your package, which tells you what coverage your
plan includes and the limits.
Any other information you receive with your package, including riders or other forms.
Please make sure you read these documents carefully. This policy may describe coverage
your plan doesnt include. Make sure you review carefully your letter of confirmation. Contact us
immediately if you dont receive your letter of confirmation or if you think there is a mistake.
All dollar amounts in these documents are in US dollars.
We can help!
Our assistance team can help you with problems 24 hours a day, almost
anywhere in the world.
In the United States, Canada, Puerto Rico
and the U.S. Virgin Islands 1-800-654-1908
All other locations, call collect 1-804-281-5700
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WHATS INSIDE
Section 1: Our agreement with you ....................................................................... 3
Section 2: What this policy includes ..................................................................... 4
Section 3: What this policy excludes .................................................................. 12
Section 4: Who is covered and when.................................................................. 14
Section 5: Claims information.............................................................................. 15
Section 6: Definitions............................................................................................. 17
Section 1: Our agreement with you 3
SECTION 1: OUR AGREEMENT WITH YOU
Your travel insurance plan (your plan) includes both insurance coverage and assistance services.
Throughout this document:
we, us and our mean Jefferson Insurance Company and its agents;
Jefferson means Jefferson Insurance Company;
you and your mean the people listed on your letter of confirmation; and
all other bolded terms are defined in Section 6, Definitions.
No one has the right to describe this travel insurance any differently than it has been described in
this document, or to change or waive any of its provisions.
About this agreement
Please read your policy carefully for full details. This is a legal contract. The entire contract
consists of the policy, any riders attached to it; and the letter of confirmation. You have a duty to
make all reasonable efforts to minimize any loss.
We have issued the policy and any attached riders based on your payment of the premium and on
the information you included in your application or other form. The statements you made in your
application or other form are representations and not warranties. We may use this information to
void insurance, reduce benefits or defend our decision about a claim.
The headings in this policy are for convenience only.
Satisfaction Guarantee
We will refund your insurance premium if you cancel your plan within 10 days of purchase
and you havent started your trip or filed a claim.
Signed for Jefferson Insurance Company, 9950 Mayland Drive, Richmond, VA 23233
Mike Nelson, President Fred Faett, Secretary
Section 2: What this policy includes 4
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SECTION 2: WHAT THIS POLICY INCLUDES
This is a named perils travel insurance policy, which means it covers only the specific situations,
events and losses included in this document, and only under the conditions we describe.
The plan you purchased may not include all the coverage described here. Make sure you check
your letter of confirmation to confirm your coverage and limits.
Your plan also includes assistance services, which are described in Help while traveling.
Coverage When it applies Page
Your trip is canceled or interrupted 5
Trip cancellation Your trip is canceled before you get started
Trip interruption Your trip is interrupted after youve left
Youre delayed 9
Travel delay Your travel is delayed six hours or more
Your baggage is lost, damaged, stolen or
delayed
10
Lost, damaged or
stolen baggage
Your baggage is lost, damaged or stolen
Delayed baggage Your baggage is delayed by a common carrier
* Underwritten by Jefferson Insurance Company
How to read Section 2
When it applies Tells you when youre eligible to make a claim. These situations and
events are called covered reasons.
What it covers Tells you the kinds of things you can be reimbursed for. Youll find out
more in Section 5, Claims information.
We can help! Tells you about related assistance services that are available to you
worldwide. Youll find a complete list in Help while traveling.
Important
Be sure to also read Section 3, What this policy excludes, as well as Section 4, Who
is covered and when, for important information on how your coverage works.
Travel insurance doesnt cover everything. Its designed to protect you when theres
a sudden, unexpected problem or event.
YOUR TRIP IS CANCELED OR INTERRUPTED
Important
You need to contact your travel suppliers within 72 hours of canceling or
interrupting your trip to qualify for the largest reimbursement possible. If you notify
your suppliers later and get a smaller refund, we will not cover the difference. If
youre seriously ill or injured, contact your travel suppliers as soon as you can.
We can help!
Need help sending an emergency message or getting flight information? See Help
while traveling, for a complete list of ways we can help.
Trip cancellation and Trip interruption coverage
When it applies
Your trip is canceled before you get started, or interrupted after youve
left, for one of the following covered reasons:
Health
Injury, illness or medical condition
You or a traveling companion is seriously ill or injured.
Specific requirements:
The injury, illness or medical condition must be disabling enough
to make a reasonable person delay, cancel or interrupt their trip.
A doctor must examine you or a traveling companion and advise
you or a traveling companion to cancel or interrupt your trip
before you cancel or interrupt it. If that isnt possible, a doctor must
examine you within 72 hours of your cancellation or interruption.
A family member who isnt traveling with you is seriously ill or injured.
Specific requirement:
The injury, illness or medical condition must be considered life
threatening, require hospitalization, or he or she must require your
care.
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Death
You, a traveling companion or family member dies.
A traveling companions or family members death must occur
before or during your trip.
Quarantine
You or a traveling companion is quarantined.
Transportation and accommodation
Financial default
Your tour operator, airline or cruise line ceases operations due to
financial default.
Specific requirements: (all must apply)
You purchased this insurance within 14 days of making your first
trip deposit or first trip payment;
The financial default happens more than seven days after your
plans effective date; and
The tour operator, airline or cruise line isnt the entity you purchased
your plan or your travel services from, or an affiliate of that entity,
and was included in our list of covered suppliers on your plans
effective date.
Please note that Jefferson can choose to give you a trip of similar value
instead of cash.
Traffic accident
You or a traveling companion is in a traffic accident on the way to your
point of departure, and:
you or the traveling companion need medical attention; or
the car needs to be repaired because its not safe to drive.
Family or friends cant accommodate you as planned
Family or friends outside the United States cant accommodate you as
planned because someone in the household has died or been diagnosed
with a serious illness or injury.
Legal
Jury duty or court-ordered appearance
Youre summoned by a court order or subpoena to serve on a jury or
appear in court.
Environment
Home uninhabitable
Your primary residence is uninhabitable because of a natural
disaster, fire, flood, burglary or vandalism.
Canceled services
Your airline, cruise line, or tour operator or travel supplier stops offering
all services for at least 24 consecutive hours where youre departing,
arriving or making a connection because of:
a natural disaster;
severe weather; or
a strike.
Your travel supplier doesnt offer you a substitute itinerary; and
The striking workers arent employed by the supplier you purchased
your plan or travel services from, or an affiliate of that supplier.
Politics and violence
Hijacking
You or a traveling companion is hijacked.
Terrorism
A terrorist event happens at your foreign destination within 30 days of
the day youre scheduled to arrive.
For locations outside the United States, youre not covered if theres
been a terrorist event at your destination in the six months before
your plans effective date.
Work
Termination or layoff
You or a traveling companion is terminated or laid off from a company
after your plans effective date.
The termination or layoff isnt your fault; and
You worked for this employer for at least three continuous years.
Military Duty in the U.S. Armed Forces
You or a traveling companion, serving in the U.S. Armed Forces, is
reassigned, or have personal leave revoked, except because of war, the
War Powers Act, base or unit mobilization, unit reassignment or
disciplinary action.
Other
Extended travel delay
You miss more than half of the total length of your trip because your
travel is delayed.
Your plan must include travel delay coverage; and
You must be delayed for a covered reason listed under travel delay
coverage.
What it covers
Please refer to your letter of confirmation to confirm your coverage and
limits in your plan.
Trip cancellation coverage
Non-refundable payments and deposits
Payments and deposits you made before your trip was canceled, less
any published refunds youre entitled to receive.
Accommodation
The extra cost of single accommodation if you prepaid for shared
accommodation and a traveling companion canceled or interrupted
their trip for a covered reason or was delayed for a covered reason.
Trip interruption coverage
Prepaid expenses
The unused part of your prepaid expenses, less any refunds you
receive.
Accommodation
The extra cost of single accommodation if you prepaid for shared
accommodation and a traveling companion canceled or interrupted
their trip for a covered reason or was delayed for a covered reason.
Transportation
Reasonable transportation expenses for getting to:
your final destination or a place where you can continue your trip;
or
your original destination another way, if your travel is delayed for
24 hours or more at the start of your trip.
Expenses for the cost of staying longer than you planned
Extra accommodation and transportation expenses because a traveling
companion is hospitalized.
Special limit:
Maximum of $100 a day for up to five days.
YOURE DELAYED
Important
You need to make reasonable efforts to continue your trip if youre delayed or you
miss your flight or cruise. The coverage described here can help. Any refunds you
receive from your travel suppliers will be deducted from your claim.
We can help!
Need help rebooking your flight or arranging for alternative transportation? See Help
while traveling, for a complete list of ways we can help.
Travel delay coverage
When it applies
Your travel is delayed for six or more consecutive hours for one of the
following covered reasons:
Strike or common carrier delay
Your departure is delayed by a common carrier.
Your departure is delayed by an unannounced strike.
Quarantine
You are quarantined.
Natural disaster
Theres a natural disaster.
Politics, violence or theft
Your passports, money or other travel documents are lost or stolen.
Your travel is delayed by a hijacking.
Your travel is delayed by civil disorder or unrest.
What it covers
Meals, accommodation and transportation
Reasonable expenses for additional meals and accommodation
while youre delayed.
Reasonable additional transportation expenses.
Special limit:
Maximum of $150 per person per day, up to the limit shown on your
letter of confirmation.
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YOUR BAGGAGE IS LOST, DAMAGED, STOLEN OR DELAYED
Important
Any refunds you receive will be deducted from your claim.
We can help!
Need help contacting local authorities or getting emergency cash from home? See
Help while traveling, for a complete list of ways we can help.
Lost, damaged or stolen baggage coverage
When it applies
Your baggage is lost, damaged or stolen while youre traveling.
You take reasonable steps to keep your baggage safe and intact,
and to recover it; and
You file a report giving a description of the property and its value
with the appropriate local authorities, common carrier, hotel or tour
operator within 24 hours of the loss.
What it covers
Actual price, actual cash value, repair or replacement (whichever is less)
actual price is the amount it would cost to buy a similar item.
actual cash value is the amount the item is worth based on its
current market value. If you dont have an original receipt, well
cover up to 75% of its current market value.
repair or replacement is the cost to repair or replace the item.
Special limit:
Maximum $500 in total for all jewelry, watches, gems, furs, cameras
and camera equipment, camcorders, sporting equipment,
computers, radios and other electronic items. You need to provide
original receipts for these items or they wont be covered.
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Delayed baggage coverage
When it applies
A common carrier, hotel or tour operator delays your baggage for 24
hours or more.
You report the loss and file a claim with the common carrier, hotel
or tour operator.
What it covers
Reasonable essential items
Reasonable essential items for you to use until your baggage arrives.
Section 3: What this policy excludes 12
SECTION 3: WHAT THIS POLICY EXCLUDES
GENERAL EXCLUSIONS
You arent covered for any loss that results directly or indirectly from any of the following general
exclusions.
The following things if they affect you, a traveling companion or a family member, whether the
family member is traveling with you or not:
existing medical conditions (unless you have existing medical condition coverage in
Section 2);
intentional self-harm or attempting or committing suicide (only applies to you);
pregnancy, (unless specifically included in Section 2), unless there are unforeseen
complications or problems with the pregnancy;
fertility treatments, childbirth or elective abortion;
a mental or nervous health disorder (like anxiety, depression, neurosis, psychosis and others),
or any related physical complications (physical complication means any physical symptom); or
the use or abuse of alcohol or drugs, or any related physical complications (physical
complication means any physical symptom).
The following activities if you, a traveling companion or a family member participates in them,
whether the family member is traveling with you or not:
flying or learning to fly an aircraft as a pilot or crew member;
participating in or training for any professional or amateur sporting competition; or
participating in extreme, high-risk sports like:
skydiving, hang gliding or parachuting;
bungee jumping;
caving;
extreme skiing, heli-skiing or skiing outside marked trails;
body contact sports (meaning any sport where the objective is to physically render an
opponent unable to continue with the competition such as boxing and full contact karate);
mountain climbing or any other high altitude activities; or
scuba diving below 120 feet (40 meters) or without a dive master.
The following events:
any problem or event that could have reasonably been foreseen or expected when you
purchased your plan;
an epidemic or pandemic;
natural disasters like hurricanes, earthquakes, fires and floods (unless specifically included
in Section 2);
air, water or other pollution, or the threat of a pollutant release;
nuclear reaction, radiation or radioactive contamination;
war (declared or undeclared), acts of war, military duty, civil disorder or unrest (unless
specifically included in Section 2);
Section 3: What this policy excludes 13
terrorist events (unless specifically included in Section 2);
financial default (unless specifically included in Section 2); or
unlawful acts.
You arent eligible for reimbursement under any coverage if:
your common carrier tickets dont show departure and return dates; or
the departure and return dates on your application or other form dont represent when you
actually intended to travel.
SPECIFIC EXCLUSIONS
You arent covered for any loss that results directly or indirectly from any of the following specific
exclusions unless theyre included in Section 2, What this policy includes.
Lost, damaged or stolen baggage coverage
intentional loss of or damage to equipment;
defective materials or workmanship; or
ordinary wear and tear.
These items arent covered:
animals;
cars and accessories, motorcycles and motors, aircraft, boats and other vehicles;
bicycles, skis and snowboards (unless theyre checked with a common carrier);
eyeglasses, sunglasses and contact lenses;
hearing aids, artificial teeth and limbs;
wheelchairs and other mobility devices;
consumables, medicines, perfumes, cosmetics and perishables;
tickets, passports, deeds and other documents;
money, credit cards, securities, bullion, stamps and keys;
rugs and carpets;
property for business or trade; and
baggage when it is:
shipped as freight;
sent before your scheduled departure date;
left in or on a car trailer; or
left in an unlocked car.
Section 4: Who is covered and when 14
SECTION 4: WHO IS COVERED AND WHEN
WHO IS COVERED BY YOUR PLAN
Your plan covers the people listed on your letter of confirmation.
WHEN YOUR COVERAGE BEGINS AND ENDS
Youre only eligible for coverage if we accept your request for insurance.
Your plans effective date depends on how you purchased it.
if you purchased its effective:
in person the day and time you purchase your plan.
by mail the day after your application or other form is postmarked.
over the phone the day after you place your telephone order.
by fax the day after we receive your fax.
online the day after we receive your online order.
Trip cancellation coverage begins on your plans effective date, as long as we receive your
premium before you cancel your trip or make a claim.
All other coverage begins on your scheduled departure date, as long as weve received your
payment. Your departure and return dates are counted as two separate days of travel when we
calculate the duration of your trip.
Your coverage ends on the earliest of:
the day youre scheduled to return;
the day you actually return, if you come back earlier;
the day and time you cancel your trip; or
the 120
th
day of the trip.
If your return travel is delayed for a covered reason, well extend your coverage until you can
get home.
Your plan cant be renewed.
Section 5: Claims information 15
SECTION 5: CLAIMS INFORMATION
HOW TO MAKE A CLAIM
Making a claim is easy just visit www.etravelprotection.com, email or call us and well be
happy to help.
Go online to:
find out what forms and documentation you need.
download a claims form and mail it in.
file a claim electronically and track its progress.
Email or call to:
file a claim and check its progress.
Claims inquiry:
Website: www.etravelprotection.com
Email: [email protected]
Telephone: 1-800-334-7525
IMPORTANT INFORMATION ABOUT CLAIMS
You have 90 days from the date of your loss to submit your claim to us, except as otherwise
provided by law.
Proof of Loss
You are responsible for providing all necessary documentation to prove your loss.
Assignment
You can assign your rights under your plan by notifying us in writing.
About beneficiaries
All benefits will be paid to your estate.
Duplicate coverage
If youre covered by another certificate or policy that weve issued with the same or similar
coverage, well use the terms and conditions of the certificate or policy that pays the most. Well
also refund any premium youve paid for duplicate coverage.
Section 5: Claims information 16
Recovery
We have the right to recover any amount you receive that exceeds the total amount of your loss.
Subrogation
When someone is responsible for your loss, we have the right to recover any payments weve
made to you or someone else in relation to your claim, as permitted by law. Everyone eligible to
receive payment for a claim submitted to us must cooperate with this process, and must refrain
from doing anything that would adversely affect our rights or the rights of Jefferson to recover
payment.
About fraud
Fraud is illegal. We will deny your claim if:
what you told us on your application or other form is deliberately misleading or inaccurate; or
you intentionally file a claim that includes false information or deliberately conceals material
facts. This may be a crime subject to criminal prosecution and civil penalties, and you may be
liable for the stated value of the claim.
Resolving disputes
If you disagree with our decision about a claim, you can request to go to arbitration through the
American Arbitration Association. If we agree, you can submit a dispute to desk arbitration, as long
as:
you submit it at least 60 days, but no more than three years, after youve filed your entire
claim with us; and
it complies with the American Arbitration Associations rules at the time you submit it.
Important
This is a named perils travel insurance policy, which means it covers only the
specific situations, events and losses included in this document, and only under the
conditions we describe.
Well only pay for reasonable, appropriate expenses that are covered by the plan
you purchased. Please check your letter of confirmation to confirm your coverage
and limits in your plan.
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Section 6: Definitions 17
SECTION 6: DEFINITIONS
Accident An unexpected and unintended event that causes injury, property
damage or both.
Accommodation A hotel or other kind of lodging where you make a reservation and pay
a fee.
Assault Physical assault that requires treatment in a hospital.
Baggage Personal property you take on your trip and the suitcases or other
kinds of containers you use to carry them.
Common carrier A company thats licensed to carry passengers on land, water or in the
air for a fee, not including car rental companies.
Covered reasons The specific situations and events that are covered by this policy.
Current market value The dollar amount an item could reasonably be sold for, based on its
original price, age and current condition.
Destination A place more than 100 miles from your primary residence where you
spend more than 24 hours of your trip.
Doctor Someone who is legally entitled to practice medicine, and is licensed if
required. This cant be you, a traveling companion, any member of
either of your immediate families, or any member of the sick or injured
persons immediate family.
Domestic partner A person youve lived with in a spousal relationship for at least 12
consecutive months who is 18 years or older. You must be able to show
evidence that youve lived together for 12 consecutive months.
Epidemic An outbreak of a contagious disease that spreads rapidly and widely
and that is identified as an epidemic by The Centers for Disease Control
and Prevention (CDC).
Existing medical
condition
An illness or injury that you, a traveling companion or family
member were seeking or receiving treatment for or had symptoms of on
the day you purchased your plan, or at any time in the 120 days before
you purchased it.
You, a traveling companion or family member are considered to have
an existing medical condition if you, a traveling companion or
family member:
saw or were advised to see a doctor;
had symptoms that would cause a prudent person to see a doctor;
or
were taking prescribed medication for the condition or the
symptoms, unless the condition or symptoms are effectively
controlled by the prescription, and the prescription hasnt changed.
Family member Any of the following people, whether or not theyre traveling with you:
spouses and common-law, civil union and domestic partners;
parents and step-parents;
children and step-children (including adopted or soon to be
adopted children);
siblings;
grandparents and grandchildren;
the following in-laws: mother, father, son, daughter, brother, sister;
aunts, uncles, nieces and nephews;
legal guardians and wards;
business partners;
paid, live-in caregivers; and
service animals (as defined by the Americans with Disabilities Act).
Immediate family members are:
adopted children);
siblings; and
grandparents and grandchildren.
Financial default A complete cessation of operations because of financial circumstances,
with or without filing for bankruptcy protection.
Hospital A facility whose primary function is to diagnose and treat sick and
injured people under the supervision of doctors. It must:
have organized departments of medicine and major surgery, on
site or off site through a pre-arranged contract provide 24 hour
nursing service supervised or provided by registered nurses;
be compensated by patients or their insurance providers for
performing these services; and
be licensed where required.
Illness Sickness, infirmity or disease. It doesnt include conditions you already
had or knew about when you purchased your plan (see existing
medical condition).
Injury Physical harm directly caused by an accident or assault, without other
contributing causes.
Medical condition A physical condition you have, or have symptoms of, that you:
have seen or been advised to see a doctor about;
have symptoms of that would cause a prudent person to see a
doctor; or
are taking prescribed medication for.
Natural disaster A large-scale extreme weather or environmental event that damages
property, disrupts transportation or endangers people. Examples
include: earthquake, fire, flood, hurricane, or volcanic eruption.
Pandemic An epidemic over a wide geographic area that affects a large portion of
the population.
Primary residence Your permanent, fixed address and primary residence for legal and tax
purposes. We call the place your primary residence is located your
place of residence.
Quarantine Mandatory isolation or restrictions on where you can go, intended to
stop a contagious disease from spreading.
Refund Cash or a credit or voucher for future travel that you get from a travel
agent, tour operator, airline, cruise line or other travel supplier, or any
credit, recovery or reimbursement you get from your employer, another
insurance company, a credit card issuer or any other entity.
Scheduled departure
date
The day and time you listed on your application or other form as the
day and time you plan to start your trip. You have paid for travel that
starts on this date.
Severe weather Hazardous weather conditions, like fog, a hailstorm or severe rainstorm,
a blizzard, or an ice storm.
Terrorist event When an organized terrorist group, as defined by the U.S. State
Department, injures or kills people or damages property to achieve a
political, ethnic or religious goal or result. Terrorist events dont include
general civil protest, unrest, rioting or acts of war.
Travel supplier A travel agent, tour operator, airline, cruise line or other travel service
provider.
Traveling companion A person traveling with you whose name appears with yours on the
same trip arrangement and who will accompany you on your trip. A
group or tour leader is not considered a traveling companion unless
you are sharing the same room with the group or tour leader.
Trip Round-trip or one-way travel to and from a place at least 100 miles from
your home. It cant include travel to receive health care or medical
treatment of any kind, or commuting to and from work.
Unlawful acts Felonies committed by you, a traveling companion or a family
member, even if the family member isnt covered by your plan.
Uninhabitable A natural disaster, fire, flood, burglary or vandalism causes enough
damage to make a reasonable person find their home or other
accommodation unfit for use.
Form 101-P-XX-02-201 PC
Form 101-P-TX-02-001 AH 20
Your Travel Insurance Policy
Thank you for buying a travel insurance plan from us!
Your plan is described in the following documents:
This policy, which explains how our travel insurance works.
The letter of confirmation that came with your package, which tells you what coverage your
plan includes and the limits.
Any other information you receive with your package, including riders or other forms.
Please make sure you read these documents carefully. This policy may describe coverage
your plan doesnt include. Make sure you review carefully your letter of confirmation. Contact us
immediately if you dont receive your letter of confirmation or if you think there is a mistake.
All dollar amounts in these documents are in US dollars.
We can help!
Our assistance team can help you with problems 24 hours a day, almost
anywhere in the world.
In the United States, Canada, Puerto Rico
and the U.S. Virgin Islands 1-800-654-1908
?
Form 101-P-TX-02-001 AH 21
WHATS INSIDE
Section 1: Our agreement with you ..................................................................... 22
Section 2: What this policy includes ................................................................... 23
Section 3: What this policy excludes .................................................................. 25
Section 4: Who is covered and when.................................................................. 27
Section 5: Claims information.............................................................................. 28
Section 6: Definitions............................................................................................. 31
Form 101-P-TX-02-001 AH 22 Section 1: Our agreement with you
SECTION 1: OUR AGREEMENT WITH YOU
Your travel insurance plan (your plan) includes both insurance coverage and assistance services.
Throughout this document:
we, us and our mean Jefferson Insurance Company and its agents;
Jefferson means Jefferson Insurance Company;
you and your mean the people listed on your letter of confirmation; and
all other bolded terms are defined in Section 6, Definitions.
No one has the right to describe this travel insurance any differently than it has been described in
this document, or to change or waive any of its provisions.
About this agreement
Please read your policy carefully for full details. This is a legal contract. The entire contract
consists of the policy, any riders attached to it; and the letter of confirmation. You have a duty to
make all reasonable efforts to minimize any loss.
We have issued the policy and any attached riders based on your payment of the premium and on
the information you included in your application or other form. The statements you made in your
application or other form are representations and not warranties. We may use this information to
void insurance, reduce benefits or defend our decision about a claim.
The headings in this policy are for convenience only.
Satisfaction Guarantee
We will refund your insurance premium if you cancel your plan within 10 days of purchase
and you havent started your trip or filed a claim.
Signed for Jefferson Insurance Company, 9950 Mayland Drive, Richmond, VA 23233
Mike Nelson, President Fred Faett, Secretary
Form 101-P-TX-02-001 AH 23 Section 2: What this policy includes
?
SECTION 2: WHAT THIS POLICY INCLUDES
This is a named perils travel insurance policy, which means it covers only the specific situations,
events and losses included in this document, and only under the conditions we describe.
The plan you purchased may not include all the coverage described here. Make sure you check
your letter of confirmation to confirm your coverage and limits.
Your plan also includes assistance services, which are described in Help while traveling.
Coverage When it applies Page
You get sick or hurt while traveling 24
Emergency
medical/dental
You have to pay for emergency medical or
dental care
* Underwritten by Jefferson Insurance Company
How to read Section 2
When it applies Tells you when youre eligible to make a claim. These situations and
events are called covered reasons.
What it covers Tells you the kinds of things you can be reimbursed for. Youll find out
more in Section 5, Claims information.
We can help! Tells you about related assistance services that are available to you
worldwide. Youll find a complete list in Help while traveling.
Important
Be sure to also read Section 3, What this policy excludes, as well as Section 4, Who
is covered and when, for important information on how your coverage works.
Travel insurance doesnt cover everything. Its designed to protect you when theres
a sudden, unexpected problem or event.
!
Form 101-P-TX-02-001 AH 24 Section 2: What this policy includes
YOU GET SICK OR HURT WHILE TRAVELING
We can help!
Need help finding a doctor or getting emergency cash from home to pay for
treatment? See Help while traveling, for a complete list of ways we can help.
Emergency medical/dental coverage
When it applies
You have to pay for emergency medical or dental care for one of the
following covered reasons:
you have a sudden, unexpected illness or injury during your trip
thats either life threatening or could cause serious and irreparable
harm if it isnt treated.
you have an injury or infection, a lost filling or a broken tooth during
your trip that requires immediate treatment by a dentist.
The treatment is medically necessary and is provided by a doctor,
dentist, hospital or other licensed provider during your trip.
What it covers
limits in your plan, including any deductible for outpatient care that may
apply to your plan.
Reasonable and customary costs
Reasonable and customary costs for supplies and services from a
doctor, dentist, hospital or other licensed provider.
Important
This is secondary coverage. If you have health insurance, you must submit your
claim to that provider first. Any benefits you receive from your primary insurance
provider or from any excess coverage will be deducted from your claim.
If youre eligible for benefits or compensation through a government-funded program
other than Medicaid, you dont qualify for this coverage.
?
!
Form 101-P-TX-02-001 AH 25 Section 3: What this policy excludes
SECTION 3: WHAT THIS POLICY EXCLUDES
GENERAL EXCLUSIONS
exclusions.
The following things if they affect you, a traveling companion or a family member, whether the
family member is traveling with you or not:
existing medical conditions (unless you have existing medical condition coverage in
Section 2);
pregnancy, (unless specifically included in Section 2), unless there are unforeseen
complications or problems with the pregnancy;
a mental or nervous health disorder (like anxiety, depression, neurosis, psychosis and others),
or any related physical complications (physical complication means any physical symptom); or
the use or abuse of alcohol or drugs, or any related physical complications (physical
complication means any physical symptom).
The following activities if you, a traveling companion or a family member participates in them,
whether the family member is traveling with you or not:
bungee jumping;
caving;
any problem or event that could have reasonably been foreseen or expected when you
purchased your plan;
natural disasters like hurricanes, earthquakes, fires and floods (unless specifically included
in Section 2);
war (declared or undeclared), acts of war, military duty, civil disorder or unrest (unless
specifically included in Section 2);
Form 101-P-TX-02-001 AH 26 Section 3: What this policy excludes
terrorist events (unless specifically included in Section 2);
financial default (unless specifically included in Section 2); or
unlawful acts.
the departure and return dates on your application or other form dont represent when you
actually intended to travel.
Form 101-P-TX-02-001 AH 27 Section 4: Who is covered and when
SECTION 4: WHO IS COVERED AND WHEN
WHO IS COVERED BY YOUR PLAN
Your plan covers the people listed on your letter of confirmation.
WHEN YOUR COVERAGE BEGINS AND ENDS
Youre only eligible for coverage if we accept your request for insurance.
Your plans effective date depends on how you purchased it.
if you purchased its effective:
in person the day and time you purchase your plan.
by mail the day after your application or other form is postmarked.
over the phone the day after you place your telephone order.
by fax the day after we receive your fax.
online the day after we receive your online order.
All coverage begins on your scheduled departure date, as long as weve received your
payment. Your departure and return dates are counted as two separate days of travel when we
calculate the duration of your trip.
Your coverage ends on the earliest of:
the day youre scheduled to return;
the day you actually return, if you come back earlier;
the day and time you cancel your trip; or
the 120
th
day of the trip.
If your return travel is delayed for a covered reason, well extend your coverage until you can
get home.
Your plan cant be renewed.
Coverage will not end solely because you become an elected official in Texas.
Form 101-P-TX-02-001 AH 28 Section 5: Claims information
SECTION 5: CLAIMS INFORMATION
HOW TO MAKE A CLAIM
Making a claim is easy just visit www.etravelprotection.com, email or call us and well be
happy to help.
Go online to:
download a claims form and mail it in.
file a claim electronically and track its progress.
Email or call to:
file a claim and check its progress.
Claims inquiry:
Website: www.etravelprotection.com
Email: [email protected]
Telephone: 1-800-334-7525
IMPORTANT INFORMATION ABOUT CLAIMS
You have 91 days from the date of your loss to submit your claim to us, except as otherwise
provided by law.
Within 15 business days after we receive notice of a claim we'll:
acknowledge receipt of the claim (If the acknowledgement is not made in writing, we'll make a
record of the date, means, and content of the acknowledgement.);
begin any investigation of the claim; and
request all items, statements, and forms ("proof of loss") we reasonably believe will be
required from you at the time. Additional requests may be made if necessary.
We'll notify you in writing if we accept or reject the claim no later than 15 business days after we
receive all proof of loss required by us. If we reject the claim, we'll tell you the reasons for the
rejection. If we're unable to accept or reject the claim within 15 business days after we receive all
proof of loss required, we'll notify you within the 15 business-day period and tell you why we
need additional time to investigate the claim. If we require additional time to investigate your claim,
we'll notify you if we accept or reject the claim no later than 45 business days after our request
for additional time to investigate the claim.
Except as otherwise provided, if we delay payment of a claim for more than 60 business days
following receipt of all required proof of loss, we'll pay the amount of the claim plus 18 percent
interest per year together with reasonable attorney fees. If a lawsuit is filed, such attorney fees
shall be taxed as part of the costs in the case.
Proof of Loss
You are responsible for providing all necessary documentation to prove your loss.
Assignment
You can assign your rights under your plan by notifying us in writing.
About beneficiaries
All benefits will be paid to your estate.
Duplicate coverage
If youre covered by another certificate or policy that weve issued with the same or similar
coverage, well use the terms and conditions of the certificate or policy that pays the most. Well
also refund any premium youve paid for duplicate coverage.
Medical examinations and autopsy
We have the right to have you medically examined as reasonably necessary to make a decision
about your medical claim. If someone covered by your plan dies, we may also require an autopsy
(except where prohibited by law). We will cover the cost of these medical examinations or
autopsies.
Recovery
We have the right to recover any amount you receive that exceeds the total amount of your loss.
Subrogation
When someone is responsible for your loss, we have the right to recover any payments weve
made to you or someone else in relation to your claim, as permitted by law. Everyone eligible to
receive payment for a claim submitted to us must cooperate with this process, and must refrain
from doing anything that would adversely affect our rights or the rights of Jefferson to recover
payment.
About fraud
Fraud is illegal. We will deny your claim if:
what you told us on your application or other form is deliberately misleading or inaccurate; or
you intentionally file a claim that includes false information or deliberately conceals material
facts. This may be a crime subject to criminal prosecution and civil penalties, and you may be
liable for the stated value of the claim.
Resolving disputes
If you disagree with our decision about a claim, you can request to go to arbitration through the
American Arbitration Association. If we agree, you can submit a dispute to desk arbitration, as long
as:
you submit it at least 60 days, but no more than three years, after youve filed your entire
claim with us; and
it complies with the American Arbitration Associations rules at the time you submit it.
Important
This is a named perils travel insurance policy, which means it covers only the
specific situations, events and losses included in this document, and only under the
conditions we describe.
Well only pay for reasonable, appropriate expenses that are covered by the plan
you purchased. Please check your letter of confirmation to confirm your coverage
and limits in your plan.
!
Form 101-P-TX-02-001 AH 31 Section 6: Definitions
SECTION 6: DEFINITIONS
Accident An unexpected and unintended event that causes injury, property
damage or both.
Assault Physical assault that requires treatment in a hospital.
Business day All days except Saturday, Sunday, or holiday recognized by the State of
Texas.
Covered reasons The specific situations and events that are covered by this policy
Deductible The dollar amount you must contribute to the loss.
Dentist Someone who is licensed and legally entitled to practice dentistry or
dental surgery. This cant be you, a traveling companion, any member
of either of your immediate families, or any member of the sick or
injured persons immediate family.
Destination A place more than 100 miles from your primary residence where you
spend more than 24 hours of your trip.
Doctor Someone who is legally entitled to practice medicine, and is licensed if
required.
Domestic partner A person youve lived with in a spousal relationship for at least 12
consecutive months who is 18 years or older. You must be able to show
evidence that youve lived together for 12 consecutive months.
Emergency medical
and/or dental care
Medical and dental services, supplies and charges that are for a health
emergency. It doesnt include things like:
elective cosmetic surgery or cosmetic foot care;
physical exams;
allergy treatments (unless life threatening);
hearing aids, eyeglasses and contact lenses;
palliative care; or
experimental treatment.
Epidemic An outbreak of a contagious disease that spreads rapidly and widely
and that is identified as an epidemic by The Centers for Disease Control
and Prevention (CDC).
Existing medical
condition
An illness or injury that you, a traveling companion or family
member were seeking or receiving treatment for or had symptoms of on
the day you purchased your plan, or at any time in the 120 days before
you purchased it.
You, a traveling companion or family member are considered to have
an existing medical condition if you, a traveling companion or
family member:
saw or were advised to see a doctor;
had symptoms that would cause a prudent person to see a doctor;
or
were taking prescribed medication for the condition or the
symptoms, unless the condition or symptoms are effectively
controlled by the prescription, and the prescription hasnt changed.
Family member Any of the following people, whether or not theyre traveling with you:
adopted children);
siblings;
grandparents and grandchildren;
the following in-laws: mother, father, son, daughter, brother, sister;
aunts, uncles, nieces and nephews;
legal guardians and wards;
business partners;
paid, live-in caregivers; and
service animals (as defined by the Americans with Disabilities Act).
Immediate family members are:
adopted children);
siblings; and
grandparents and grandchildren.
Hospital A facility whose primary function is to diagnose and treat sick and
injured people under the supervision of doctors. It must:
have organized departments of medicine and major surgery, on
site or off site through a pre-arranged contract provide 24 hour
nursing service supervised or provided by registered nurses;
be compensated by patients or their insurance providers for
performing these services; and
be licensed where required.
Illness Sickness, infirmity or disease. It doesnt include conditions you already
had or knew about when you purchased your plan (see existing
medical condition).
Injury Physical harm directly caused by an accident or assault, without other
contributing causes.
Inpatient Someone who receives medical or dental treatment while registered as
a bed patient in a hospital or other licensed provider. Room and
board is charged for the patients stay, in addition to charges for medical
treatment and care.
Medical condition A physical condition you have, or have symptoms of, that you:
have seen or been advised to see a doctor about;
have symptoms of that would cause a prudent person to see a
doctor; or
are taking prescribed medication for.
Medically necessary Treatment thats appropriate for your illness or injury, consistent with
your symptoms, and that can safely be provided to you. It meets the
standards of good medical practice and isnt for your convenience or
the providers convenience.
Other licensed
provider
A person or entity that isnt a doctor or hospital but provides medical or
dental services, and is licensed where required.
Outpatient Someone who receives medical or dental treatment but doesnt have to
stay at a hospital for overnight care.
Pandemic An epidemic over a wide geographic area that affects a large portion of
the population.
Quarantine Mandatory isolation or restrictions on where you can go, intended to
stop a contagious disease from spreading.
Reasonable and
customary costs
What customers would usually be charged for a specific service in a
particular geographic area. The charges are appropriate to the
availability of the service, and of skilled and licensed service providers.
Scheduled departure
date
The day and time you listed on your application or other form as the
day and time you plan to start your trip. You have paid for travel that
starts on this date.
Severe weather Hazardous weather conditions, like fog, a hailstorm or severe rainstorm,
a blizzard, or an ice storm.
Terrorist event When an organized terrorist group, as defined by the U.S. State
Department, injures or kills people or damages property to achieve a
political, ethnic or religious goal or result. Terrorist events dont include
general civil protest, unrest, rioting or acts of war.
Travel supplier A travel agent, tour operator, airline, cruise line or other travel service
provider.
Traveling companion A person traveling with you whose name appears with yours on the
same trip arrangement and who will accompany you on your trip. A
group or tour leader is not considered a traveling companion unless
you are sharing the same room with the group or tour leader.
Trip Round-trip or one-way travel to and from a place at least 100 miles from
your home. It cant include travel to receive health care or medical
treatment of any kind, or commuting to and from work.
Unlawful acts Felonies committed by you, a traveling companion or a family
member, even if the family member isnt covered by your plan.
34 Help while traveling
HELP WHILE TRAVELING
If you need help while traveling, our assistance team is available 24 hours a day.
Our services are here to help make challenging situations a little easier. With our global reach, we
can get you in touch with licensed medical and legal professionals and other kinds of help.
Important
Please note that the General exclusions for your plan also apply to our assistance
services. Youll find the list of these exclusions in Section 3, What this policy
excludes.
HOW TO REACH US
In the United States, Canada, Puerto Rico and U.S. Virgin Islands, call 1-800-654-1908
If you cant call collect, well call you back.
Please have this information ready when you call:
your name, location and phone number
your identification number
MEDICAL ASSISTANCE
Finding a doctor, dentist or medical facility
If you need care from a doctor, dentist or medical facility while youre traveling, we can help you
find one.
Paying or guaranteeing your hospital bill
If you need to be admitted to a hospital as an inpatient for longer than 24 hours, we can
guarantee or advance payments up to the limit of your emergency medical/dental coverage
(described in Section 2).
Monitoring your care
If youre hospitalized, our medical staff will stay in contact with you and the doctor caring for you.
We can also notify your family and your doctor back home of your illness or injury and update
them on your status.
!
LEGAL ASSISTANCE
Finding a legal advisor
We can help you find local legal advice if you need it while youre traveling.
Arranging a cash transfer
If you need to pay legal fees, we can arrange to transfer funds from your family or friends.
TRAVEL AND DOCUMENT ASSISTANCE
Replacing lost travel tickets
If your tickets are lost or stolen, we can contact the airline or other common carrier, and can help
you with your travel arrangements if your trip is interrupted.
Replacing lost passports and other travel documents
If your passport or other travel documents are lost or stolen, we can help you reach the
appropriate authorities, contact your family or friends, and assist you in getting your documents
replaced.
OTHER ASSISTANCE SERVICES
Getting flight information
If you miss your flight or its canceled, we can give you arrival and departure times for other flights
that will get you to your connecting flight or final destination.
Getting emergency cash
If your cash is lost or stolen or you need extra money to pay for unexpected expenses, we can
arrange to transfer funds from your family or friends.
Delivering emergency messages
We can help you get an urgent message to someone back home. Well try calling up to three
times within 24 hours and confirm whether we were able to reach the person you asked us to
contact.
About our assistance services
Our goal is to help you with your problem no matter where youre traveling.
Well make all reasonable efforts to help you as weve described, but there may be times when
we arent able to resolve your problem for reasons that are beyond our control.
We will always do our best to refer you to appropriate professionals, but please be aware that
they are independent providers and we cant be held responsible for the results of any services
they provide.
EMERGENCY MEDICAL TRANSPORTATION
Important
If your emergency is immediate and life threatening, seek local emergency care
at once.
Please refer to your cover letter to confirm your coverage and limits in your plan.
You or your representative must contact us and we must make all transportation
arrangements in advance. We will not pay for any of the services listed in this
section if we didn't authorize and arrange it.
Moving you to a hospital or medical clinic (emergency medical evacuation)
If you're seriously ill or injured during your trip and our medical team determines that the local
medical facilities are unable to provide appropriate medical treatment:
our medical team will consult with the local doctor;
we'll identify the closest appropriate facility, make arrangements and pay to transport you to
that facility; and
we'll arrange and pay for a medical escort if we determine one is necessary.
Getting you home after your care (medical repatriation)
If you're seriously ill or injured during your trip, under the care of a local doctor and unable to
continue your trip, medical repatriation takes place once our medical team determines that you
are medically stable to return home via commercial transportation carrier, such as a scheduled
passenger airline. We'll:
arrange and pay (less any refunds for unused tickets) for you to be transported via a
commercial transportation carrier in the same class of service that you were booked for your
trip. The transportation will be to one of the following:
your primary residence;
a location of your choice in the United States; or
a medical facility near your primary residence or city of your choice in the United
States. We'll take your request into consideration as long as the medical facility will
accept you as a patient and is approved as medically appropriate for your continued
care by our medical director.
arrange and pay for a medical escort if our medical team determines a medical escort is
necessary.
Bringing a friend or family member to you (transport to bedside)
If you're told you will be hospitalized for more than seven days during your trip, we'll transport a
friend or family member to stay with you. We'll arrange and pay for round-trip transportation in
economy class on a common carrier.
!
Getting your children home (return of dependents)
If you're told you will be hospitalized for more than seven days during your trip, well arrange for
and pay (less any refunds for unused tickets) to transport your children under the age of 23 who
are traveling with you to one of the following:
your primary residence; or
a location of your choice in the United States.
Transportation will be on a common carrier in the same class of service they were originally
booked.
Transporting your remains (repatriation of remains)
Well arrange and pay for the reasonable and necessary services to transport your remains to one
of the following:
a funeral home near your primary residence; or
a funeral home located in the United States.
We'll also assist the sending and receiving funeral homes coordinate with each other.
This benefit does not include funeral, burial or cremation expenses or related containment
expenses for items such as a coffin, urn or vault.
Your representative must contact us in advance to make these arrangements. If this is not
possible, your representative must contact us within a reasonable time, but no later than one year
after the transportation.
Medical escort A professional person contracted by our medical team to accompany a seriously
ill or injured person while they are being transported. A medical escort is trained to provide
medical care to the person being transported. A friend or family member cannot be a medical
escort.
TI_201_03_P_TX_V2
TI_201_03_P_TX_V2
2013 AGA Service Company 12/13
We're only a CLICK away!
Visit www.etravelprotection.com
to:
File a claim
Check claim status
Modify a policy
Form 101-R1-TX-02
JEFFERSON INSURANCE COMPANY
(A Stock Company)
TEXAS AMENDATORY RIDER
The policy to which this rider is attached is amended as follows:
1. SECTION 2: WHAT THIS POLICY INCLUDES, YOUR BAGGAGE IS LOST, DAMAGED, STOLEN OR DELAYED, Lost,
damaged or stolen baggage coverage, What it covers, Special limit section is amended by the deletion of the following:
Jewelry.
2. SECTION 3: WHAT THIS POLICY EXCLUDES, SPECIFIC EXCLUSIONS, These items arent covered section is amended
by adding the following:
Jewelry.
3. SECTION 4: WHO IS COVERED AND WHEN, is amended by the following:
Coverage will not end solely because you become an elected official in Texas.
4. SECTION 5: CLAIMS INFORMATION, IMPORTANT INFORMATION ABOUT CLAIMS is amended by the deletion of the
first paragraph and the addition of the following paragraphs:
You have 91 days from the date of your loss to submit your claim to us, except as otherwise provided by law.
Within 15 business days after we receive notice of a claim we'll:
acknowledge receipt of the claim (If the acknowledgement is not made in writing, we'll make a record of the date,
means, and content of the acknowledgement.);
begin any investigation of the claim; and
request all items, statements, and forms ("proof of loss") we reasonably believe will be required from you at the
time. Additional requests may be made if necessary.
We'll notify you in writing if we accept or reject the claim no later than 15 business days after we receive all proof of
loss required by us. If we reject the claim, we'll tell you the reasons for the rejection. If we're unable to accept or reject
the claim within 15 business days after we receive all proof of loss required, we'll notify you within the 15 business-
day period and tell you why we need additional time to investigate the claim. If we require additional time to investigate
your claim, we'll notify you if we accept or reject the claim no later than 45 business days after our request for
additional time to investigate the claim.
Except as otherwise provided, if we delay payment of a claim for more than 60 business days following receipt of all
required proof of loss, we'll pay the amount of the claim plus 18 percent interest per year together with reasonable
attorney fees. If a lawsuit is filed, such attorney fees shall be taxed as part of the costs in the case.
5. SECTION 6: DEFINITIONS, is amended by the addition of the following definition.
Business day
All days except Saturday, Sunday, or holiday recognized by the State of Texas.
6. Collision, loss or damage coverage is not available in Texas.
There are no other changes to the policy.
TX Important Notice JIC_TXN_2013
IMPORTANT NOTICE TO ALL TEXAS POLICYHOLDERS
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call Jefferson Insurance Companys toll-free
telephone number for information or to make a complaint
at:
1-800-497-4602
You may also write to Jefferson Insurance Company at:
Jefferson Insurance Company
9950 Mayland Drive
Richmond, VA 23233
You may contact the Texas Department of Insurance to
obtain information on companies, coverages, rights or
complaints at:
1-800-252-3439
You may write the Texas Department of Insurance:
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.texas.gov
E-mail: [email protected]
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your premium or
about a claim you should contact the Jefferson Insurance
Company first. If the dispute is not resolved, you may
contact the Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR POLICY: This notice is
for information only and does not become a part or
condition of the attached document
AVISO IMPORTANTE
Para obtener informacion o para someter una queja:
Usted puede llamar al numero de telefono gratis de
Jefferson Insurance Company para informacion o para
someter una queja al:
1-800-497-4602
Usted tambin puede escribir a Jefferson Insurance
Company:
Jefferson Insurance Company
9950 Mayland Drive
Richmond, VA 23233
Puede comunicarse con el Departamento de Seguros de
Texas para obtener informacion acerca de companias,
coberturas, derechos o quejas al:
1-800-252-3439
Puede escribir al Departamento de Seguros de Texas:
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.texas.gov
E-mail: [email protected]
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiene una disputa concerniente a su prima o a un
reclamo, debe comunicarse con el Jefferson Insurance
Company primero. Si no se resuelve la disputa, puede
entonces comunicarse con el departamento (TDI).
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de informacion y no se
convierte en parte o condicion del documento adjunto.
Form 101-OUT-TX-02-001 AH
THE POLICY DESCRIBED IN THIS OUTLINE DOES NOT MEET THE MINIMUM STANDARDS FOR
BENEFITS ESTABLISHED FOR BASIC CATEGORIES OF COVERAGE REQUIRED BY THE
INSURANCE REGULATORY AUTHORITY OF YOUR STATE.
Individual Travel Policy
REQUIRED OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. This outline of coverage provides a very brief description of some of
the important features of your policy. This is not the insurance contract and only the actual policy provisions
will control. The policy itself sets forth, in detail, the rights and obligations of both you and your insurance
company. It is, therefore, important that you READ YOUR POLICY CAREFULLY!
(2) This individual travel policy is designed to provide you with coverage for emergency medical and
dental expenses which you incur for necessary treatment and services rendered as the result of an
accidental illness or injury. Coverage is provided for the benefits outline in paragraph (3). The benefits
described in paragraph (3) may be limited by paragraph (4).
(3) Benefits
Emergency medical/dental coverage
When it applies
You have to pay for emergency medical or dental care for one of the following covered reasons:
you have a sudden, unexpected illness or injury during your trip thats either life threatening or
could cause serious and irreparable harm if it isnt treated.
you have an injury or infection, a lost filling or a broken tooth during your trip that requires
immediate treatment by a dentist.
The treatment is medically necessary and is provided by a doctor, dentist, hospital or other
licensed provider during your trip.
What it covers
Reasonable and customary costs
Reasonable and customary costs for supplies and services from a doctor, dentist, hospital or other
licensed provider.
(4) Exclusions, Limitations, and Reductions
General Exclusions
exclusions.
The following things if they affect you, a traveling companion or a family member, whether the family
member is traveling with you or not:
existing medical conditions;
pregnancy, , unless there are unforeseen complications or problems with the pregnancy;
a mental or nervous health disorder (like anxiety, depression, neurosis, psychosis and others), or
any related physical complications (physical complication means any physical symptom); or
the use or abuse of alcohol or drugs, or any related physical complications (physical complication
means any physical symptom).
The following activities if you, a traveling companion or a family member participates in them, whether
the family member is traveling with you or not:
bungee jumping;
caving;
any problem or event that could have reasonably been foreseen or expected when you purchased
your plan;
natural disasters like hurricanes, earthquakes, fires and floods;
war (declared or undeclared), acts of war, military duty, civil disorder or unrest;
terrorist events;
financial default; or
unlawful acts.
the departure and return dates on your application or other form dont represent when you actually
intended to travel.
(5) Renewability
This policy is issued for a single term and is non-renewable.
(6) Premium
Premiums are calculated based on the total of your prepaid travel expenses.
PRIVACY POLICY
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
AGA, Inc. and its subsidiaries, including Jefferson Insurance Company and AGA Service Company, d/b/a Allianz
Global Assistance (we/us/our), are committed to protecting your privacy. By using our products, services or website,
you are consenting to our collection and use of your data under this Policy.
Definitions.
1. Personal Data. Personal Data means non-public personal information that identifies an individual. It doesnt
include data that is encoded, anonymized or aggregated.
2. Sensitive Data. Sensitive Data means personal information about an individuals race or ethnicity; political,
religious, ideological or trade union memberships, opinions, views or activities; medical conditions or other
protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996;
sexuality; or administrative or criminal proceedings that are treated outside pending proceedings. In addition,
Sensitive Data includes information we receive from a third party who treats and identifies the information as
sensitive.
3. Agent. Agent means any third party that collects or uses Personal Data to perform tasks on our behalf, or our
underwriters.
Privacy Practices. We strive to comply with the laws of the countries in which we do business regarding the
protection of your Personal Data, including the EU Directive on Data Protection. In an effort to comply with such laws,
we have joined the U.S. Department of Commerce's EU Safe Harbor and Swiss Safe Harbor programs (collectively,
Safe Harbor), and we adhere to the following principles for handling your Personal Data:
1. Notice: We collect Personal Data from you including information: (i) from forms, such as application or claim
forms; or by telephone, website, email or correspondence; (ii) that is necessary to complete your transaction with
us (e.g. to underwrite coverage or process claims); (iii) regarding your transactions with us or others; (iv) we
receive from a consumer reporting agency; or (v) you provide to us or authorize us to collect from others.
We collect your Personal Data: (i) to offer or sell you our travel insurance and assistance products or provide you
with information or services for such products; (ii) to administer these products for you, including but not limited to
adjudicating claims, conducting quality/satisfaction assessments, and fraud prevention; or (iii) for purposes to
which youve otherwise consented.
When you use our website, we collect your IP address and other data about your usage. We also use Google,
Inc.s Google Analytics service, which uses cookies (text files on your computer) to transmit your IP address and
other website usage data. Google stores and aggregates to analyze such usage and create reports for us. We,
our affiliates and our Agents only use such website usage data and such Google reports for website improvement
and Payment Card Industry (PCI) compliance. You can refuse cookies by disabling them in your browser.
If we collect your Personal Data for any other reason, well notify you before using or disclosing that data, stating
our purpose for collecting and using the data, the types of non-Agent third parties to which we disclose the data,
and the means we offer you to limit the use and disclosure of the data. If we receive Personal Data from any entity
in the EU, well use that data according to the instructions such entity gives us regarding notices it provided and
the choices made by the individuals to whom such data relates.
2. Choice. Except as required by law, we do not share, sell or otherwise disclose your Personal Data to non-Agent
third parties or use it for any purpose other than for which it was originally collected or as you subsequently
authorize. However, if ever we wish to do so, we will offer you the opportunity to choose not to permit us to use
your Personal Data (opt-out) by sending an appropriately detailed request to the address provided below. In the
event that we wish to disclose your Sensitive Data to a non-Agent third party or use such data for a purpose other
than for which it was originally collected or as you subsequently authorize, we will provide you the affirmative,
explicit choice of whether you wish to permit such disclosure (opt-in).
Though we make every effort to preserve your privacy, we may need to disclose Personal Data or Sensitive Data if
we have a good-faith belief that it is necessary to (a) protect or defend our or your rights, interests or property; or
(b) comply with any applicable law, regulation, judicial rule or order, or other mandate. In any such case, we will
take reasonable care to disclose only as much Personal Data as is necessary.
3. Onward Transfer. We may disclose your Personal Data to our Agents, but only for the above-stated purposes.
We will take reasonable steps to obtain assurances from our Agents that they will safeguard your Personal Data
consistent with this Policy. Upon discovery, we will take reasonable steps to stop the Agent from using or
disclosing Personal Data that is contrary to this Policy.
4. Security. We take reasonable precautions to protect your data from loss, misuse, or unauthorized access,
disclosure, alteration and destruction. To help maintain the security of your data, we employ physical, electronic
and procedural safeguards, including utilizing policies to take reasonable precautions to (a) securely and
confidentially maintain your Personal Data; (b) assess and protect against threats/hazards to the security or
integrity of such data; and (c) prevent unauthorized access to or use of such data. To make your online
transaction with us as safe and secure as possible, we use advanced encryption technology and treat your credit
card information and other Personal Data with the highest standard of confidentiality and safety.
5. Data Integrity. To help maintain the integrity of your data, we will take reasonable steps to ensure that Personal
Data is reliable for its intended use, relevant, accurate, complete and current.
6. Access. If you discover that the data we hold about you is inaccurate or incomplete, please let us know by
contacting us as indicated below. We will grant you reasonable access to the Personal Data we hold about you
and will take reasonable steps to allow you to correct, amend or delete your Personal Data that you show to be
inaccurate or incomplete, so long as it can be done without imposing an undue burden or expense on us. You
have the right to request from your health care provider confidential communications of your PHI. Also, at your
request, you may receive an accounting of certain disclosures of PHI (e.g.: health payment records) as permitted
by law.
7. Enforcement. We verify our compliance with the Safe Harbor and the terms of this Policy by conducting a periodic
self-assessment. Any complaint or dispute about how we handle your Personal Data should be directed to the
address provided below. Additionally, complaints about how we handle your PHI may be directed to us or to the
U.S. Secretary of Health and Human Services. We will investigate and attempt to resolve any such complaints or
disputes internally; however, if we are unable to reach a mutually satisfactory resolution for such complaint or
dispute, we have agreed to participate in the dispute resolution procedures administered by the European data
protection authorities Safe Harbor dispute panel. You will not be retaliated against for filing a complaint.
Links. Our websites may provide links to non-affiliated third party websites. Be aware when visiting such websites
that we are not responsible for and make no representations regarding the content, privacy policies and practices
(security or otherwise) regarding these or any other third party websites. You should read the policies of the websites
you visit to understand their policies for the collection and treatment of data.
Changes to Policy. This Policy reflects our business practices and is not a contract. However, we will abide by the
terms of this Policy as currently in effect. We may amend this Policy at any time and will notify you of any updates by
posting a revised policy on our website. The revised policy will apply to all information collected by us, including
previously collected information, to the extent permissible under the Safe Harbor. Your continued use of our website,
products or services following any such amendment shall constitute acceptance of the revised policy. You are
responsible to regularly review this Policy.
Contact. If you have any questions or comments regarding this Policy or the way that we collect or handle your
Personal Data, or if you would like to obtain a paper copy of this Policy, please contact our Chief Privacy Officer by e-
mail at [email protected]; or by telephone at 1-800-284-8300; or by regular mail at the following address:
Allianz Global Assistance, ATTN: Chief Privacy Officer, 9950 Mayland Drive, Richmond, VA 23233.
Effective Date. This Policy was last revised on, and is effective as of, March 1, 2013.
2013 AGA Service Company. All rights reserved.
JICPRIVNOT
Insurance coverage is underwritten by BCS Insurance Company or Jefferson Insurance Company as shown on your Certificate/Policy.
2012 AGA Service Company
Covered Supplier List as of January 6, 2014
IMPORTANT NOTICE: The following list of airlines, cruise lines and tour operators are Covered Suppliers when determining eligibility for
Financial Default coverage. This is the complete list as of today and is subject to change at any time. However, such changes do not affect any
coverage already in force. This list is not intended nor should be viewed as a judgment of any travel supplier. Even if your travel supplier is not
on the list, you are still covered for everything else as mentioned in your Letter of Confirmation. All other terms and conditions apply.
Subject to your plans terms and conditions, you are covered for the specified amount of Trip Cancellation/Interruption purchased in the event a
covered supplier financially defaults as long as all these conditions are met:
1. You purchased a plan with Trip Cancellation/Interruption coverage within 14 days of paying your initial trip deposit.
2. The Financial Default occurs more than seven days after the Policy effective date.
3. The Financial Default results in a complete cessation of services of named supplier on the Covered Supplier List.
4. You did not purchase your insurance from the defaulting airline, cruise line, tour operator or their affiliates.
Airlines
Air France
Airtran Airways
Alaska Airlines
Easy Jet
Nippon Air
Qantas Airlines
Ryanair
Singapore Airlines
Southwest
Cruise Lines
Alaskan Dream Cruises
All Discovery Cruising
American Cruise Lines
Azamara Cruises
Blount Small Ship
Adventures
Carnival Cruise Lines
Celebrity Cruises
Crystal Cruises
Cunard Line
Disney Cruise Line
Holland America Lines
Hurtigruten
Imperial River Cruises
Innersea Discoveries
MSC Cruises
Norwegian Cruise Lines
Oceania Cruises
Paul Gauguin Cruises
Princess Cruises
Regent Seven Seas Cruises
Royal Caribbean
International
Seabourn Cruise Line
Star Clippers
Un-Cruise Adventures
Uniworld
Variety Cruises
Viking River Cruises
Windstar Cruises
Tour Operators
AAA Member Choice
Vacations
AAA SignaTours
AAA Sojourns
AAA South Jersey
Motorcoach Tours
AAT Kings
Abel Tasman Tours
Abercrombie & Kent
Abrams Travel, Inc.
Absolute Asia
ACFEA Tour Consultants
Adventure Dive & Travel
Adventures by Disney
Adventuresmith Explorations
AER World Tours
Aero/Mexico Vacations
Africa Safari Specialists
African Dream Travel LLC
African Portfolio, Inc.
African Travel
African Travel Seminars,
Inc.
Air & Sea Travel Center
Alaska Travel Adventures
Alaska Wildland Adventures
Alaskan Tour Guides
Alki Tours
All About Tours
All-In-One Tours & Cruises,
LLC
All Mountain Vacations
Alluring Africa
Alluring Americas
Alluring Asia
Alluring Destinations
AMA Waterways
Amber Tours
America West Vacations
American Airlines Vacations
American Music Abroad
American Tours
International (ATI)
Ampac Tours
Amtour Vacations, Inc.
Andes Adventures
Apple Vacations
Artic Kingdom Polar
Expeditions
Asia Transpacific Journeys
Atlantis Events
Australian Pacific Touring
Autoventure
Avalon Waterways
Avanti Destinations
Backroads
Beyond Band of Brothers
Big Five Tours &
Expeditions
Blue Sky Tours
Blue Odyssey Tours
Branson Country Tours
Branson Vacation Tours
Break-Away Tours
Brendan Tours
Brennan Vacations
Brian Moore International
Tours
Buenos Aires Cultural
Concierge
Butterfield & Robinson
The California Native
International Adventures
Can Am Travel
Canada al a Carte
Caravan - Serai Tours
Cartan Tours
Celebrity Coaches of
America, Inc.
Celtic International Tours
Central Holidays
Cheeseman Ecology Safari
Chima Travel Bureau
China Travel Service USA
Christian Tours/Burke
International Tours
Ciao Italy & Carrani Tours
CIE Tours International
CIG North America
City Escape Holidays
Classic Africa
Classic Custom Vacations
Clipper Vacations
Club Med
Collette Vacations
Concept Tours
Contiki Holidays
Continental Airlines
Vacations
Continental Kapers, Inc.
Coronet Travel
Corporate Travel
Cosmos
Country Walkers, Inc.
Cox & Kings Travel
Crisp Tours
Cruise & Maritime Voyages
USA, LLC
Delta Vacations
Destination World
Donna Franca Tours
Down Under Answers
Earthbound, Inc.
Eastern Travel
Easy Tours of India
EB Sports Tours
Eco Tours Expeditions, Inc.
Educational Discovery Tours
Educational Travel Services
Elite Turkey Tours
Entre Alaska
Escapade Vacations
Esprit Travel
Euro Lloyd Travel
Eurobound/Tahitibound
Euro-Connection
Europe Express
European Incoming Services
European Sojourns, LTD
European Tour Connections
Eurovacations.com
Insurance coverage is underwritten by BCS Insurance Company or Jefferson Insurance Company as shown on your Certificate/Policy.
2012 AGA Service Company
Exeter International
Experience Asia Tours
Explorer Ventures
Exxtereme Vacations
Fiesta Tours International
The Fly Shop
Food and Wine Trails
France Vacations
French Country Waterways
Functions Unlimited
Funjet Vacations
Gadabout Tours
Galapagos Travel
Gap Adventures
Gate 1 International Travel
General Tours
Georges International Tours
Geographic Expeditions
Gerber Tours
Globe Treks
Globus
Gogo Worldwide Vacations
Goway Travel
Grand American Tours &
Cruises
Grand Canyon Railway
Grand European Tours
Great American Steamboat
Company
Great Atlantic Travel &
Tours
Great Lakes Cruise
Company
Great Safaris
Great Travels
Greaves Tours LLC
Group IST
GTO Travel
GWV International
HAT Tours
Hawaii World
Hello Italy Travel
Hidden Trails
HistoryAmerica Tours
HMHF Fun Vacations
Holland America Tours
Homeric Tours
IExplore
Il Viaggio
Image Tours, Inc.
Inca Floats, Inc.
Insight Vacations, Inc.
Interlake China Tours, Inc.
International Expeditions,
Inc.
International Lifestyles, Inc.
International Travel Co.
Island Destinations
Islands in the Sun
Isle Inn Tours
Isram World of Travel
IST Cultural Tours
Italian Dream Vacation
ITS Tours
Joshua Expeditions
Journey Mexico
Journeys Unlimited
Kalos Tours
Kensington Tours
Ker & Downey
Key Tours International
Key Transportation
King Yacht Charters, Inc.
Klein Tours
Knightly Tours
Kompas USA
Kon-Tiki Tours & Travel
Kuoni Tours
Ladatco, Inc.
Latour
Laura Massoni Travel
Legacy Tours of Distinction
LimoLink International
Lindenmeyr Travel
Lost in Italy
Lotus International Tours
Luxury Trips
Magic Carpet Vacations
Maiellano Travel
Mango African Safaris
Margaret Morse Tours, Inc.
Martin & Keegan
Matterhorn Travel
Mauiva Air Tours
Mayflower Tours
Mexico Unlimited, Inc.
MexSeaSun
MGM Mirage Resort
Vacations
Micato Safaris
Millenium Tours
MLT Vacations
Moments Notice Travel
Monograms
Mountain Travel Sobek
Mountain Vacations
Nature Discoveries
Nawas International Travel
New York City Vacations
Odysseys Unlimited
Olivia Cruises and Resorts
OmniTours
Orient Flexi Pax Tours
Orion Expedition Cruises
Outer Edge Expeditions
Outlook International
Overland Adventures
Pacific Delight Tours, Inc.
Pacific Escapes
Pan Pacific Journeys, Inc.
Papas Travel Store
Peak Performance Tours
Perfect Spot Tours
Perillo Tours, Inc.
Personal Touch Tours
Petrabax West
Pleasant Holidays
Premier Gateway
Premier Vacations
PrimeSport International
Princess Tours
Proud African Safaris, LLC
Qantas Vacations
Quark Expeditions, Inc.
Rail Europe
Rail Source International Inc
Rainforest Cruises
Regina Tours
ResidenSea
Rick Steves Europe Through
the Back Door
Rockwell Tours, Inc.
Rooms Plus Inc.
Scandinavian American
World Tours
Scantours
Shore Excursions Group
ShoreTrips
Signa Tours Ltd. (Virginia)
Signature Vacations
SITA World Travel
Ski Travel/JMJ Tours
SmarTours
Sojourn Bicycling Vacations
Solar Tours
Sonesta Vacations
South Pacific Holidays
South Star Tours
Southwest Airline Vacations
Spiced Destinations Inc.
Sports Empire Inc.
Sports Travel & Tours
Spring Training Tours
Stewarts Fun Adventures
Strabo Tours
Sunward Tours Inc.
Superclubs
Sutherland Travel Services
Swain Australian Tours
T&D Tours
Tauck Tours
TBI Tours
TCS Expeditions
The Moorings
TJs Travel Club for Seniors
TNT Vacations
Tourlite International
Tourlite Zeus
Tour Resource Consultants,
LLC
Tour West
Town and Country Tours
Trading Places International,
Inc.
Trafalgar Tours
Trans Global Vacations
TRAVCOA
Travel2
Travel Beyond
Travel Bound, Inc.
Travel Dynamics
International
Travel Four Vacations
Travel Impressions, Ltd.
Travel Wise Motorcoach
Tours
Travelink Incorporated
Treasures of Travel, Inc.
TSA Tours, Inc.
Turtle Island Holidays
Tuscan Way, Inc.
Uncharted Outposts Inc.
Unique Vacations
United Vacations
Universal Studios Vacations
US Airways Vacations
USA by AAA
VExplore Tours
Vacation Express
Value World Tours
Vantage Deluxe World
Travel
Vaya Adventures
Velo Echappe
Visit Italy Tours
Voyages to Antiquity, LLC
Walt Disney Travel
Company
The Wayfarer
Western Leisure Inc
Wild African Ventures
Wildland Adventures
Wildlife Safari
Williams & Hall Wilderness
Guides and Outfitters
Windjammer Sailing
Adventures
Wine Tours of the World
World Class Vacations
World Group Travel
World on Skis
The World Outdoors
Yalla Tours USA Inc.
Yankee Holidays
Zapotec Tours
Zegrahm Expeditions

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