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Hi FERNANDO,
Thank you for protecting your travel plans with us. We’re here to give you peace of mind before, during, and
after your trip.
To get the most out of your travel protection plan, we recommend downloading our free, award-winning
TravelSmart™ app. It allows you to view your policy on your smartphone, file a claim on the go, and get 24-hour
emergency assistance with the touch of a button. It’s one of the many ways we make it easier for you to get the
help you need, when you need it.
This packet contains your Declaration of Coverage, your Policy/Certificate of Insurance, and a description of the
Travel Assistance Services available to you. The total amount paid was $98.30, which includes $91.95 for
insurance and $6.35 for assistance—giving you access to our worldwide team of problem-solving experts that
can help with medical and travel-related emergencies.
Please read the attached documents for a complete description of your benefits, and save all your receipts in
case you need to file a claim. We want you to have the best travel experience possible.
Have a safe trip,
Allianz Global Assistance
OUR PROMISE TO YOU

Since your satisfaction is our priority, we are pleased to give you 10 days to review your plan. If, during this 10-
day period, you are not completely satisfied for any reason, you may cancel your plan and receive a full refund.
Please note that this refund is only available if the trip has not started and if a claim has not been initiated. After
this 10-day period, your plan is nonrefundable. Some states provide for longer periods or different terms for
refunds. For more information, please refer to the plan documents that begin on the next page.
DECLARATION OF COVERAGE
Product Name: Global Travel Protector II
Policy Number: AMR12535002393
Number of People Insured: 1
Insured(s): FERNANDO ROLDAN
Date of Purchase: October 4, 2021
Coverage Effective Date: October 5, 2021
Coverage End Date: December 3, 2021
Departure Date: November 21, 2021
Return Date: December 3, 2021
Total Insurance Cost for All Insureds: $91.95
MAXIMUM
COVERAGE WHEN IT APPLIES
BENEFIT
Trip Cancellation Coverage You have to cancel your trip before you depart. $1,268.34
Pre-existing Medical Condition Limit: Claims for trip cancellation
due to a pre-existing medical condition can be covered up to the
maximum trip cancellation benefit limit, not to exceed
$1,268.34. Conditions apply.
Trip Interruption Coverage Your travel plans are interrupted while you are on your trip. $1,902.51
Pre-existing Medical Condition Limit: Claims for trip interruption
due to a pre-existing medical condition can be covered up to the
maximum trip interruption benefit limit, not to exceed
$1,902.51. Conditions apply.
Baggage Loss Coverage Your baggage is lost, damaged, or stolen while on your trip. $300.00
Maximum benefit for all high value items, per policy - $300.00
Emergency Transportation Transportation is needed following a medical emergency $50,000.00

Coverage while on your trip.
Emergency Medical/Dental You have to pay for emergency medical or dental while on $50,000.00
Coverage your trip.
Dental Care maximum sublimit - $500.00
One-Time Deductible - $50.00
MAXIMUM
ENDORSEMENTS: WHEN IT APPLIES
BENEFIT
Epidemic Coverage Adds coverage for certain losses resulting from an epidemic Included
or pandemic disease.
The above is only a brief description of the coverage available under your policy. Terms, conditions, and exclusions apply to
all coverages. Please carefully review your policy for complete details. Any term used in this Declaration of Coverage is as
defined in your policy’s Definitions section.
101-PDEC-802-2020 1
Important Notices:
 Emergency Medical/Dental Coverage is primary.
 If not otherwise specified, the benefit limits shown above are per insured.
 If your policy was purchased with a one-way booking, your Departure Date will be the departure date for your trip
as shown on your travel documents, and your Coverage End Date and Return Date will be the return date for your
trip as shown on your travel documents (not exceeding 180 days from the Departure Date). Please contact us if
you need to make any changes to your dates.
 AGA Service Company is the licensed producer and administrator for this policy.
 Insurance coverage is provided under Form 101-P-MD-800-2018 issued by Jefferson Insurance Company, 9950
Mayland Drive, Richmond, VA 23233.
OUR PROMISE TO YOU

Since your satisfaction is our priority, we are pleased to provide For customer service, please call:
you 15 days to review your plan following the date of delivery. If, 1-800-628-5404 1-804-281-5700
during this 15-day period, you are not completely satisfied for any (From U.S.) (Outside U.S./Collect)
reason, you may cancel your plan and receive a full refund of the
plan price. Please note that this refund is not available if either the To file a claim, please visit:
trip has started or a claim has been filed. After this 15-day period, http://www.etravelprotection.com/aa
the plan price is nonrefundable.
101-PDEC-802-2020 2
WELCOME_LTR * TRDEC_BP1_2017 * TI_800_S13_P_MD_V4 * 101_POE_03_800_2020_04 * JICPRIVNOT * * * * * *
©2021 AGA Service Company 400004178
TI_800_S13_P_MD_V4
JEFFERSON INSURANCE COMPANY
(A STOCK COMPANY)
ABOUT THIS POLICY

This policy is our contract with you. Please read it carefully. We have tried to make it simple and easy to
understand while also clearly describing the terms and conditions of your coverage. We also recognize that
insurance can be confusing, so if you have any questions, we are available 24 hours a day, 365 days a year. Just
visit us online or give us a call. And if your travel arrangements change, please be sure to let us know so we can
make any necessary updates to your policy.
This policy has been issued based on the information you provided at the time of purchase. We will provide the
insurance described in this policy in return for payment of the premium and your compliance with all provisions
of this policy. You will also notice that some words are italicized. These words are defined in the “Definitions”
section. Headings are provided for convenience only and do not affect your coverage in any way.
WHAT THIS POLICY INCLUDES AND WHOM IT COVERS

This travel insurance policy covers only the specific situations, events, and losses included in this policy, and only
under the conditions described. For this reason, it is known as a “named perils” policy. Please review this policy
carefully.
Your policy consists of two parts:

1. This policy document (including any amendments and endorsements), which describes the coverages and
conditions; and
2. The Declaration of Coverage (“Declarations”), which provides the particular list of coverages, benefits, and
individuals covered under your policy.
NOTE:
 Not every loss is covered, even if it is due to something sudden, unexpected, or out of your control. Only
those losses meeting the conditions described in this policy may be covered.
OUR PROMISE TO YOU

Since your satisfaction is our priority, we are pleased to provide you 15 days to review your plan following the date
of delivery. If, during this 15-day period, you are not completely satisfied for any reason, you may cancel your plan
and receive a full refund of the plan price. Please note that this refund is not available if either the trip has started
or a claim has been filed. After this 15-day period, the plan price is nonrefundable.
SIGNED FOR JEFFERSON INSURANCE COMPANY

9950 MAYLAND DRIVE, RICHMOND, VIRGINIA 23233
Elena Edwards, President Jack Zemp, Secretary
INDIVIDUAL TRAVEL INSURANCE POLICY
101-P-MD-800-2018 1
WHAT’S INSIDE
TRAVEL SERVICES DURING YOUR TRIP 3

DEFINITIONS 4
DESCRIPTION OF COVERAGES 7
A. TRIP CANCELLATION COVERAGE 7
B. TRIP INTERRUPTION COVERAGE 8
C. BAGGAGE LOSS COVERAGE 10
D. EMERGENCY TRANSPORTATION COVERAGE 11
E. EMERGENCY MEDICAL/DENTAL COVERAGE 13
GENERAL EXCLUSIONS 14
PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER 15
WHEN YOUR COVERAGE BEGINS AND ENDS 16
CLAIMS INFORMATION 17
GENERAL PROVISIONS AND CONDITIONS 18
101-P-MD-800-2018 2
TRAVEL SERVICES DURING YOUR TRIP
If you need travel or medical assistance during your trip, we are available 24 hours a day. With our global reach
and multi-lingual staff, we are here to help you anytime, anywhere.
To Reach Us:
In the United States, Canada, Puerto Rico and U.S. Virgin Islands:
800.654.1908
All other locations, call:

804.281.5700
We will accept collect calls, or call you back.
Flight Assistance
If you miss your flight or it's canceled, we can give you arrival and departure times for other flights that will get
you to your connecting flight or final destination.
Accommodation Assistance
If your trip has been interrupted or delayed, we can assist you in changing your reservation or finding alternate
accommodation.
Destination Information
We can provide you with important information about your destination, such as travel documentation
requirements, travel advisories, and vaccine requirements.
Lost Travel Documents Assistance

If your passport or other travel documents are lost or stolen, we can assist you in getting your documents replaced
and can help you change your travel arrangements as required.
Emergency Language Translation

We can assist you with translation services in the event you need help in a foreign country.
Emergency Cash Assistance

If your travel is delayed or interrupted and you need extra money to pay for unexpected expenses, we can assist
in arranging the transfer of funds from your family or friends.
Legal Referrals
We can help you find local legal advice if you need it while you are traveling.
Emergency Message Delivery

We can assist you in getting an urgent message to someone back home.
Finding a Doctor or Medical Facility

If you need care from a doctor or medical facility while you are traveling, we can assist you in finding one.
Monitoring Your Care

If you are 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.
101-P-MD-800-2018 3
DEFINITIONS
Throughout this policy, words and any form of the word appearing in italics are defined in this section.
Accident An unexpected and unintended event that causes injury, property damage, or both.
Accommodation A hotel or any other kind of lodging for which you make a reservation or where you
stay and incur an expense.
Actual cash value The amount an item is reasonably worth based on its fair market value, age, usage,
and condition immediately prior to the loss.
Baggage Personal property you take with you or acquire on your trip.
Climbing sports An activity utilizing harnesses, ropes, belays, crampons, or ice axes. It does not
include supervised climbing on artificial surfaces intended for recreational climbing.
Cohabitant A person you currently live with and have lived with for at least 12 consecutive
months and who is at least 18 years old. You must be able to show evidence that
you have lived together for 12 consecutive months.
Coverage period The period of time between and including the Coverage Effective Date and the
Coverage End Date.
Covered reasons The specifically named situations or events for which you are covered under this
policy.
Criminal act An act that is criminally unlawful.
Date of delivery The date plan materials are sent to you.
Departure date The originally scheduled date that you have selected to begin travel as shown on
your trip itinerary and in your Declarations.
Doctor Someone who is legally authorized to practice medicine or dentistry and is licensed
if required. This cannot be you, a traveling companion, your family member, a
traveling companion’s family member, or the sick or injured person’s family
member.
Epidemic A contagious disease that spreads rapidly and widely among the population in an
area and which is recognized as an epidemic by the World Health Organization
(WHO) or Centers for Disease Control and Prevention (CDC).
Family member Your:
1. Spouse (by marriage, common law, domestic partnership, or civil union);
2. Cohabitants (defined above);
3. Parents and stepparents;
4. Children, stepchildren, foster children, adopted children, or children currently in
the adoption process;
5. Siblings;
6. Grandparents and grandchildren;
7. The following in-laws: mother, father, son, daughter, brother, sister, and
grandparent;
8. Aunts, uncles, nieces, and nephews;
9. Legal guardians and wards;
10. Paid, live-in caregivers; and
11. Service animals (as defined by the Americans with Disabilities Act).
High-altitude activity An activity that includes, or is intended to include, going above 15,000 feet in
elevation, other than as a passenger in a commercial aircraft.
High value items Collectibles, jewelry, watches, gems, furs, cameras (including video cameras) and
related equipment, musical instruments, professional audio equipment, sporting
equipment, electronic mobile devices, smartphones, computers, radios, drones,
robots, and other electronic items.
101-P-MD-800-2018 4
Hospital A short-term, acute care facility that has a primary function of diagnosing and
treating sick and injured people under the supervision of doctors. It must:
1. Be primarily engaged in providing inpatient diagnostic and therapeutic services;
2. Have organized departments of medicine and major surgery; and
3. Be licensed where required.
Injury Physical bodily harm.
Mechanical breakdown A mechanical issue which prevents the vehicle from being driven normally, including
flat tires or running out of fuel, fluids, or power.
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. This cannot be a friend,
traveling companion, or family member.
Medically necessary Treatment that is required for your illness, injury, or medical condition, consistent
with your symptoms, and can safely be provided to you. Such treatment must meet
the standards of good medical practice and is not for your or the provider’s
convenience.
Natural disaster A large-scale extreme weather or environmental event that damages property,
disrupts transportation or utilities, or endangers people, including without
limitation: earthquake, fire, flood, hurricane, or volcanic eruption.
Plan The travel protection plan you purchased, which may include travel insurance, travel
assistance services, and cancellation fee waivers.
Policy The travel insurance coverage purchased. The policy includes this policy document,
any amendments and endorsements attached to it, and the Declarations.
Primary residence Your permanent, fixed home address for legal and tax purposes.
Pre-existing medical An injury, illness, or medical condition that, within the 120 days prior to and
condition including the purchase date of this policy:
1. Caused a person to seek medical examination, diagnosis, care, or treatment by
a doctor;
2. Presented symptoms; or
3. Required a person to take medication prescribed by a doctor (unless the
condition or symptoms are controlled by that prescription, and the prescription
has not changed).
The illness, injury, or medical condition does not need to be formally diagnosed in
order to be considered a pre-existing medical condition.
For example, a sprained knee you have had treated in the 120 days prior to and
including the purchase date of your policy will be considered a pre-existing medical
condition. If you later have to cancel your trip because, for instance, the sprained
knee now requires surgery, or because your recovery is taking longer than expected,
or for any other reason arising out of the knee sprain, this would be considered a
pre-existing medical condition.
Quarantine Mandatory confinement, intended to stop the spread of a contagious disease to
which you or a traveling companion may have been exposed.
Reasonable and The amount usually charged for a specific service in a particular geographic area.
customary costs The charges must be appropriate to the availability and complexity of the service,
the availability of needed parts/materials/supplies/equipment, and the availability
of appropriately-skilled and licensed service providers.
Refund Cash, credit, or a voucher for future travel that you are eligible to receive from a
travel supplier, or any credit, recovery, or reimbursement you are eligible to receive
101-P-MD-800-2018 5
from your employer, another insurance company, a credit card issuer, or any other
entity.
Severe weather Hazardous weather conditions including but not limited to windstorms, hurricanes,
tornados, fog, hailstorms, rainstorms, snow storms, or ice storms.
Sporting equipment Equipment or goods used to participate in a sport.
Terrorist event An act carried out by an organized terrorist group recognized by the U.S. State
Department that injures people or damages property to achieve a political, ethnic,
or religious result. It does not include general civil protest, unrest, rioting, or acts of
war.
Travel carrier A company licensed to commercially transport passengers between cities for a fee
by land, air, or water. It does not include:
1. Rental vehicle companies;
2. Private, chartered, or non-commercial transportation carriers; or
3. Local, commuter, or other urban transit system carriers (such as commuter rail,
city bus, subway, ferry, taxi, for-hire driver, or other such carriers) that transport
you or a traveling companion less than 100 miles.
Travel supplier A travel agent, tour operator, airline, cruise line, hotel, or other travel service
provider.
Traveling companion A person or service animal (as defined by the Americans with Disabilities Act)
traveling with you or traveling to 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 Your travel to, within, and/or from a location at least 100 miles from your primary
residence. It cannot include travel with the intent to receive health care or medical
treatment of any kind, moving, or commuting to and from work, and it cannot last
longer than 180 days.
Uninhabitable A natural disaster, fire, flood, burglary, or vandalism has caused enough damage
(including extended loss of power, gas, or water) to make a reasonable person find
their home or destination inaccessible or unfit for use.
We, Us, or Our Jefferson Insurance Company and its agents, including AGA Service Company.
You or Your All persons listed as insureds on the Declarations.
101-P-MD-800-2018 6
DESCRIPTION OF COVERAGES
In this section, we will describe the many different types of insurance coverages which are included in your policy.
We explain each type of coverage and the specific conditions that must be met for the coverage to apply.
A. TRIP CANCELLATION COVERAGE
If your trip is canceled or rescheduled for a covered reason listed below, we will reimburse you for your non-
refundable trip payments, deposits, cancellation fees, and costs to rebook your transportation (less available
refunds), up to the maximum benefit for Trip Cancellation Coverage. Please note that this coverage only applies
before you have left for your trip.
Also, if you prepaid for shared accommodations and your traveling companion cancels their trip due to one or
more of the covered reasons listed below, we will reimburse any additional accommodation fees you are required
to pay, such as a single supplement fee from a cruise line.
IMPORTANT: You must notify all of your travel suppliers within 72 hours of discovering that you will need to
cancel your trip (this includes being advised to cancel your trip by a doctor). If you notify any travel suppliers later
than that and get a smaller refund as a result, we will not cover the difference. If a serious illness, injury, or medical
condition prevents you from being able to notify your travel suppliers within that 72 hour period, you must notify
them as soon as you are able.
Covered reasons:
1. You or a traveling companion becomes ill or injured, or develops a medical condition.
The following conditions apply:

a. The illness, injury, or medical condition must be disabling enough to make a reasonable person cancel
their trip; and
b. A doctor advises you or a traveling companion to cancel your trip before you cancel it. If that isn’t possible,
a doctor must either examine or consult with you or the traveling companion within 72 hours after the
cancellation to confirm the decision to cancel.
2. A family member who is not traveling with you becomes ill or injured, or develops a medical condition.
The following condition applies:

a. The illness, injury, or medical condition must be considered life threatening by a doctor or require
hospitalization.
3. You, a traveling companion, or family member dies on or after your policy’s Coverage Effective Date and before
your trip.
4. You or a traveling companion is quarantined.
5. You or a traveling companion is in a traffic accident (not including a mechanical breakdown) on the departure
date.
One of the following conditions must apply:

a. You or a traveling companion need medical attention; or
b. The vehicle needs to be repaired because it is not safe to operate.
101-P-MD-800-2018 7
6. Family or friends outside the U.S. cannot accommodate you as planned because someone in their household
has died, become seriously ill or injured, or developed a serious medical condition.
7. You are legally required to attend a legal proceeding during your trip.

a. The attendance is not in the course of your occupation (for example, if you are attending in your capacity
as an attorney, court clerk, expert witness, law enforcement officer, or other such occupation, this would
not be covered).
8. Your primary residence is uninhabitable.
9. Your travel carrier cannot get you to your original itinerary’s destination for at least 24 consecutive hours from
the originally scheduled arrival time due to one of the following reasons:
A. A natural disaster; or
B. Severe weather.
However, if you can get to your original destination another way, we will reimburse you for the following, up
to your policy’s Trip Cancellation Coverage maximum benefit:
i. The reasonable cost of the alternate transportation, less available refunds; and
ii. The cost of any lost prepaid accommodations caused by your delayed arrival, less available refunds.

a. Alternate transportation arrangements must be in a similar or lower class of service as you were originally
booked with your travel carrier.
10. A terrorist event happens within 100 miles of any U.S. or foreign city you are traveling to during your trip, as
indicated on your original itinerary.

a. A terrorist event must not have occurred within 25 miles of that city any time in the 30 days prior to your
policy’s Coverage Effective Date.
11. You or a traveling companion is terminated or laid off by a current employer after your policy’s purchase date.

a. The termination or layoff is not your or your traveling companion’s fault;
b. The employment must have been permanent (not temporary or contract); and
c. The employment must have been for at least three continuous years.
12. You, a traveling companion, or a family member serving in the U.S. Armed Forces is reassigned or has personal
leave status changed, except because of war, the War Powers Act, or disciplinary action.
IMPORTANT: Please refer to your Declarations to confirm your applicable limit.
B. TRIP INTERRUPTION COVERAGE
If you have to interrupt your trip or end it early due to one or more of the covered reasons listed below, we will
reimburse you, less available refunds, up to the maximum benefit for Trip Interruption Coverage listed in your
Declarations, for:
101-P-MD-800-2018 8
i. The prorated portion of your unused non-refundable trip payments and deposits.
ii. Additional accommodation fees you are required to pay, such as a single supplement fee from a cruise line, if
you prepaid for shared accommodations and your traveling companion has to interrupt their trip.
iii. Reasonable transportation expenses you incur to continue your trip or return to your primary residence.
iv. Additional accommodation and transportation expenses if the interruption causes you to stay at your
destination (or the location of the interruption) longer than originally planned. There is a per policy maximum
of $250 per day for 5 days.
IMPORTANT: You must notify all of your travel suppliers within 72 hours of discovering that you will need to
interrupt your trip (this includes being advised to interrupt your trip by a doctor). If you notify any travel suppliers
later than that and get a smaller refund as a result, we will not cover the difference. If a serious illness, injury, or
medical condition prevents you from being able to notify your travel suppliers within that 72 hour period, you
must notify them as soon as you are able.
Covered reasons:
1. You or a traveling companion becomes ill or injured, or develops a medical condition.

a. The illness, injury, or medical condition must be disabling enough to make a reasonable person interrupt
their trip; and
b. A doctor must either examine or consult with you or the traveling companion within 72 hours of the trip
interruption to confirm the decision to interrupt the trip.
2. A family member who is not traveling with you becomes ill or injured, or develops a medical condition.

hospitalization.
3. You, a traveling companion, or family member dies during your trip.
4. You or a traveling companion is quarantined during your trip.
5. You miss at least 50% of the length of your trip due to one of the following:
A. A travel carrier delay (except for the financial condition of the travel carrier, with or without filing for
bankruptcy);
B. A natural disaster;
C. Roads being closed or impassable due to severe weather;
D. Lost or stolen travel documents;
E. Civil disorder; or
F. Being involved in or delayed by a traffic accident.
6. You or a traveling companion is in a traffic accident (not including a mechanical breakdown).
One of the following conditions must apply:

a. You or a traveling companion needs medical attention; or
b. The vehicle needs to be repaired because it is not safe to operate.
7. Family or friends outside the U.S. cannot accommodate you as planned because someone in their household
has died, become seriously ill or injured, or developed a serious medical condition.
101-P-MD-800-2018 9
8. You are legally required to attend a legal proceeding during your trip.

a. The attendance is not in the course of your occupation (for example, if you are attending in your capacity
as an attorney, court clerk, expert witness, law enforcement officer or other such occupation, this would
not be covered).
9. Your primary residence is uninhabitable.
10. Your travel carrier cannot get you to your original itinerary’s destination for at least 24 consecutive hours from
the originally scheduled arrival time due to one of the following reasons:
A. A natural disaster; or
B. Severe weather.
However, if you can get to your original destination another way, we will reimburse you for the following, up
to your policy’s maximum Trip Interruption Coverage maximum benefit:
i. The reasonable cost of alternate transportation, less available refunds; and
ii. The cost of any lost prepaid accommodations caused by your delayed arrival, less available refunds.

a. Alternate transportation arrangements must be in a similar or lower class of service as you were originally
booked with your travel carrier.
11. You or a traveling companion is a traveler on a hijacked aircraft, train, vehicle, or vessel.
12. A terrorist event happens within 100 miles of any U.S. or foreign city you are traveling to during your trip, as
indicated on your original itinerary.

a. A terrorist event must not have occurred within 25 miles of that city any time in the 30 days prior to your
policy’s Coverage Effective Date.
13. You, a traveling companion, or a family member serving in the U.S. Armed Forces is reassigned or has personal
leave status changed, except because of war, the War Powers Act, or disciplinary action.
C. BAGGAGE LOSS COVERAGE
If your baggage is lost, damaged, or stolen while you are on your trip, we will pay you, less available refunds, the
lowest of the following, up to the maximum benefit listed for Baggage Loss in your Declarations:
i. Actual cash value of the baggage;
ii. Cost to repair the damaged baggage; or
iii. Cost to replace the lost, damaged, or stolen baggage.

a. You have taken reasonable steps to keep your baggage safe and intact and to recover it;
b. You have filed a report giving a description of the property and its value with the appropriate local authorities,
travel carrier, hotel, or tour operator within 24 hours of discovery of the loss;
101-P-MD-800-2018 10
c. You must provide original receipts for the lost items. For items without an original receipt, we will cover up
to 75% of the actual cash value; and
d. High value items are covered up to the maximum benefit for high value items shown in your Declarations.
The following items are not covered:

1. Animals, including remains of animals;
2. Cars, motorcycles, motors, aircraft, watercraft, and other vehicles and related accessories and equipment;
3. Bicycles, skis, and snowboards (except while they are checked with a travel carrier);
4. Hearing aids, eyeglasses, sunglasses, and contact lenses;
5. Artificial teeth and prosthetics;
6. Wheelchairs and other mobility devices;
7. Consumables, medicines, medical equipment/supplies, perfumes, cosmetics, and perishables;
8. Tickets, passports, deeds, blueprints, stamps, and other documents;
9. Money, currency, credit cards, notes or evidences of debt, negotiable instruments, securities, bullion, and
keys;
10. Rugs and carpets;
11. Firearms and other weapons, including ammunition;
12. Intangible property, including software and electronic data;
13. Property for business or trade;
14. Property you do not own; and
15. Baggage while it is:
a. Shipped, unless with your travel carrier;
b. In or on a car trailer; or
c. Unattended and in an unlocked car.
D. EMERGENCY TRANSPORTATION COVERAGE
IMPORTANT: If your emergency is immediate and life threatening, seek local emergency care at once.
Emergency Evacuation (Transporting you to the nearest appropriate hospital)

If you become seriously ill or injured or develop a medical condition while on your trip and we determine that the
local medical facilities are unable to provide appropriate medical treatment:
1. Our medical team will consult with the local doctor;
2. We will identify the closest appropriate hospital or other appropriate facility, make arrangements to transport
you there, and pay for that transport; and
3. We will arrange and pay for a medical escort if we determine one is necessary.

a. You or someone on your behalf must contact us, and we must make all transportation arrangements in
advance. If we did not authorize and arrange the transportation, we will only pay up to what we would have
paid if we had made the arrangements.
Medical Repatriation (Getting you home after you receive care)

If you become seriously ill or injured or develop a medical condition while on your trip and our medical team
confirms with the treating doctor that you are medically stable to travel, we will:
1. Arrange and pay for you to be transported via a commercial transportation carrier in the same class of service
that you originally booked (unless otherwise medically necessary) for the return leg of your trip, less available
refunds for unused tickets. The transportation will be to one of the following:
101-P-MD-800-2018 11
a. Your primary residence;
b. A location of your choice in the U.S.; or
c. A medical facility near your primary residence or in a location of your choice in the U.S. In either case, the
medical facility must be willing and able to accept you as a patient and must be approved by our medical
director as medically appropriate for your continued care.
2. Arrange and pay for a medical escort if our medical team determines that one is necessary.

a. Special accommodations must be medically necessary for your transportation (for example, if more than one
seat is medically necessary for you to travel).
b. You or someone on your behalf must contact us, and we must make all transportation arrangements in
Transport to Bedside (Bringing a friend or family member to you)

If you are told by the treating doctor that you will be hospitalized for more than 48 hours during your trip, we will
arrange and pay for round-trip transportation in economy class on a travel carrier for one friend or family member
to stay with you.

Return of Dependents (Getting minors and dependents home)

If you are told by the treating doctor you will be hospitalized for more than 24 hours during your trip, we will
arrange and pay to transport your traveling companions who are under the age of 18 or dependents requiring
your full-time supervision and care to one of the following:
1. Your primary residence; or
2. A location of your choice in the U.S.
Transportation will be on a travel carrier in the same class of service they were originally booked. Available refunds
for unused tickets will be deducted from the total amount payable.

a. This benefit is only available while you are hospitalized and if you do not have an adult family member traveling
with you that is capable of caring for the minors/dependents.
b. You or someone on your behalf must contact us, and we must make all transportation arrangements in
Repatriation of Remains (Getting your remains home)

We will arrange and pay for the reasonable and necessary services and supplies to transport your remains to one
of the following:
1. A funeral home near your primary residence; or
2. A funeral home located in the U.S.
This benefit does not include funeral, burial, or cremation expenses, or related containment expenses for items
such as a casket, urn, or vault.
101-P-MD-800-2018 12
a. Someone on your behalf must contact us, and we must make all transportation arrangements in advance. If
we did not authorize and arrange the transportation, we will only pay up to what we would have paid if we had
made the arrangements; and
b. The death must occur while on your trip.
IMPORTANT: The most we will pay for benefits under your Emergency Transportation Coverage is the maximum
benefit listed for Emergency Transportation Coverage in your Declarations. Please refer to your Declarations to
confirm your applicable limit.
E. EMERGENCY MEDICAL/DENTAL COVERAGE
If you receive emergency medical or dental care while you are on your trip for one of the following covered
reasons, we will reimburse the reasonable and customary costs of that care for which you are responsible, up to
the maximum benefit listed for Emergency Medical/Dental Coverage in your Declarations (dental care is subject
to the maximum sublimit listed for Dental Care):
1. While on your trip, you have a sudden, unexpected illness, injury, or medical condition that could cause serious
harm if it is not treated.
2. While on your trip, you have a dental injury or infection, a lost filling, or a broken tooth that requires treatment.
The following conditions and exclusions apply:

a. The care must be medically necessary to treat an emergency condition, and such care must be provided by a
doctor, dentist, hospital, or other provider authorized to practice medicine or dentistry.
b. This coverage will not pay for any care provided after your coverage ends.
c. This coverage will not pay for non-emergency care or services, such as:
1. Elective cosmetic surgery or care;
2. Annual or routine exams;
3. Long-term care;
4. Allergy treatments (unless life threatening);
5. Exams or care related to or loss of/damage to hearing aids, dentures, eyeglasses, and contact lenses;
6. Physical therapy, rehabilitation, or palliative care (except as necessary to stabilize you to transport);
7. Experimental treatment; and
8. Any other non-emergency medical or dental care.
IMPORTANT: Please refer to your Declarations to confirm your applicable limit and any deductible that may apply.
If you need to be admitted to a hospital as an inpatient for longer than 24 hours, we can guarantee or advance
payments, where accepted, up to the limit of your emergency medical/dental coverage.
101-P-MD-800-2018 13
GENERAL EXCLUSIONS
This section describes the general exclusions applicable to all coverages under your policy. An “exclusion” is
something that is not covered by this insurance policy, and therefore no reimbursement would be available.
This policy does not provide coverage for any loss that results directly or indirectly from any of the following
general exclusions if they affect you, a traveling companion, or a family member:
1. Any loss, condition, or event that was known, foreseeable, intended, or expected when your policy was
purchased;
2. Pre-Existing medical conditions, except as waived under the Pre-Existing Medical Condition Exclusion Waiver;
3. Your intentional self-harm or if you attempt or commit suicide;
4. Normal pregnancy or childbirth;
5. Fertility treatments or elective abortion;
6. A mental or nervous health disorder, as recognized by the American Psychiatric Association, including but not
limited to Alzheimer’s disease, anxiety, dementia, depression, neurosis, psychosis, or any related physical
symptoms. This exclusion applies only to Trip Cancellation Coverage and Trip Interruption Coverage;
7. The use or abuse of alcohol or drugs, or any related physical symptoms. This does not apply to drugs
prescribed by a doctor and used as prescribed;
8. Acts committed with the intent to cause loss;
9. Operating or working as a crew member (including as a trainee or learner/student) aboard any aircraft or
commercial vehicle or commercial watercraft;
10. Participating in or training for any professional sporting competition;
11. Participating in or training for any amateur sporting competition while on your trip;
12. Participating in extreme, high-risk sports and activities, including but not limited to:
a. Skydiving, BASE jumping, hang gliding, or parachuting;
b. Bungee jumping;
c. Caving, rappelling, or spelunking;
d. Skiing or snowboarding outside marked trails or in an area accessed by helicopter;
e. Climbing sports or free climbing;
f. Any high-altitude activity;
g. Personal combat or fighting sports;
h. Racing or practicing to race any motorized vehicle or watercraft;
i. Free diving; or
j. Scuba diving at a depth greater than 60 feet or without a dive master.
13. A criminal act resulting in a conviction, except when you, a traveling companion, or a family member is the
victim of such act;
14. An epidemic;
15. Natural disaster, except as expressly covered under Trip Cancellation Coverage or Trip Interruption Coverage;
16. Air, water, or other pollution, or the threat of a pollutant release, including thermal, biological, and chemical
pollution or contamination;
17. Nuclear reaction, radiation, or radioactive contamination;
18. War (declared or undeclared) or acts of war;
19. Military duty, except as expressly covered under Trip Cancellation Coverage or Trip Interruption Coverage;
20. Civil disorder or unrest, except as expressly covered under Trip Cancellation Coverage or Trip Interruption
Coverage;
21. Terrorist events, except as expressly covered under Trip Cancellation Coverage or Trip Interruption Coverage;
22. Acts, travel alerts/bulletins, or prohibitions by any government or public authority, except as expressly
covered under Trip Cancellation Coverage or Trip Interruption Coverage;
101-P-MD-800-2018 14
23. Any travel supplier’s complete cessation of operations due to financial condition, with or without filing for
bankruptcy, except as expressly covered under Trip Cancellation Coverage or Trip Interruption Coverage;
24. Travel supplier restrictions on any baggage, including medical supplies and equipment; or
25. Ordinary wear and tear or defective materials or workmanship.
This policy does not provide any coverage, benefit, or services for any activity that would violate any applicable
law or regulation, including without limitation any economic/trade sanction or embargo.
IMPORTANT: You are not eligible for reimbursement under any coverage if:
1. Your travel carrier tickets do not show travel date(s);
2. The travel dates in your Declarations do not represent when you actually intended to travel (does not apply
to insurance purchased with a one-way booking); or
3. You intend to receive health care or medical treatment of any kind while on your trip.
PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER
This Pre-Existing Medical Condition Exclusion Waiver describes the circumstances in which a pre-existing medical
condition MAY be covered under this policy and NOT excluded from coverage.
Because your policy includes this waiver, you can still be covered for losses due to a pre-existing medical condition
if you meet all of the following requirements:
a. Your policy was purchased within 14 days of the date of the first trip payment or deposit;
b. You were a U.S. resident when the policy was purchased; and
c. You were medically able to travel when the policy was purchased.
If you incur additional non-refundable trip expenses after you purchase this policy, you must insure them with us
within 14 days of their purchase. If you do not, those expenses will still be subject to the pre-existing medical
condition exclusion.
IMPORTANT: The amount payable for claims for Trip Cancellation Coverage or Trip Interruption Coverage due to
a pre-existing medical condition cannot exceed the Pre-Existing Medical Condition Limit listed in your Declarations.
Amounts payable for claims under other coverages are subject to limits listed in your Declarations.
101-P-MD-800-2018 15
WHEN YOUR COVERAGE BEGINS AND ENDS
You are only eligible for coverage if we accept your request for insurance. Your policy’s Coverage Effective Date
and Coverage End Date are indicated in your Declarations. The policy is effective on the day after we receive both
the order and the full premium. The order and full premium must be received on or before the departure date.
In order to be eligible for coverage, losses must occur while your policy is in effect. The maximum policy length is
770 days.
Except for one-way and same-day return trips, the departure date and return date that you provided at time of
purchase are counted as two separate days of travel when we calculate the duration of your trip.
Your policy ends on the Coverage End Date listed in your Declarations. However, there are situations where your
policy may end on a different date. If your policy was purchased with a one-way booking, your Coverage End Date
will be the scheduled return date for your trip as shown on your travel documents (not exceeding 180 days from
the departure date shown on your travel documents). Additionally, your policy will end on the earliest of:
1. The day you cancel your policy;
2. The day you cancel your trip;
3. The day you end your trip, if you end your trip early;
4. The day you arrive at a medical facility for further care if you end your trip due to a medical reason; or
5. The 180th day of the trip.
However, if your return travel is delayed due to a covered reason, we will extend your coverage period until the
earlier of when you are able to return to your point of origin or primary residence, or until you arrive at a medical
facility for further care following a medical repatriation or trip interruption.
Please note that this policy applies for a specific trip and cannot be renewed.
101-P-MD-800-2018 16
CLAIMS INFORMATION
We believe that filing an insurance claim should not be difficult, that is why we simplified our process and
requirements. We hope you like the results!
Before you file a claim, please review your policy details and the Declarations to ensure that your situation meets
the criteria for a covered claim. Please note that not every loss is covered, even if it is due to something sudden,
unexpected, or out of your control.
To File Your Claim Online:

 Go to www.etravelprotection.com and click on File a Claim.
 Provide policy details.
 Determine which forms and documentation are required.
 File your claim and track your claim status.
Or, To File Your Claim by Contacting Us by Phone or Email

 Email: [email protected]
 Toll-Free: 800.334.7525
101-P-MD-800-2018 17
GENERAL PROVISIONS AND CONDITIONS
In addition to the conditions, limitations, and exclusions specified above, the below general provisions and
conditions apply to all coverages under your policy.
Proof of Loss
As with any insurance, you are responsible for proving your loss. We require that you:
1. Notify us of your claim within 90 days of the date of loss or as soon as reasonably possible (except as otherwise
allowed by law). If you do not report your claim within this time, we will not invalidate or reduce it unless the
delay impairs our rights;
2. Make all reasonable efforts to minimize your loss (including without limitation making reasonable efforts to
start, catch up to, or continue your trip; and promptly notifying your travel supplier upon discovering that you
need to cancel or interrupt your trip, including being advised to cancel or interrupt your trip by a doctor);
3. Provide to us a signed, sworn proof of loss upon our request;
4. Provide all requested documentation (including without limitation proof of payment for claimed losses,
statements and records from treating doctors, police reports, and information from travel suppliers);
5. Cooperate with us in the investigation of your claim; and
6. At our request, submit to examination under oath and/or provide a sworn affidavit.
Assignment
You can assign your rights under your policy by notifying us in writing. The assignment will not be effective until
we receive the written notice. However, we will not recognize the assignment of any right or benefit under this
policy to any person or organization engaged in the business of medical transportation unless we approve this
assignment in writing and in advance. Any attempt to make such an assignment will not be effective. We do not
assume any responsibility for the validity of any assignment.
Benefits Payable
All benefits are payable to the first named insured in your Declarations or a party you designate in writing. If you
are under 18 years old, benefits are payable to your parent or legal guardian or a party they designate. Benefits
are limited to the amount of your loss and are subject to the applicable limit of liability and any deductible stated
in the Declarations. If you die, benefits will be paid to your estate unless you have designated one or more
beneficiaries. If you have named one or more beneficiaries, benefits will be paid to each named beneficiary in
equal shares (unless you have designated otherwise). Except as described here, there are no other beneficiaries
of any of the benefits under this policy. All dollar amounts described in this policy are expressed in U.S. dollars. If
you have a loss, you will not be reimbursed twice for the same expense. For example, you cannot be reimbursed
for the same expense under both Travel Delay and Trip Interruption coverages.
Changes and Cancellation

You or the policy purchaser may request changes to the policy by notifying us. You may request to change the
return date at any time prior to your Coverage End Date. All other changes to your policy must be requested prior
to your original departure date. If the change results in an increase in premium, you must pay the increase in
premium. Any decrease in premium as a result of the change will be refunded to the policy purchaser. Any change
will be effective immediately, so long as we have received any additional premium due. If the plan is canceled
within 15 days following the date of delivery, we will provide a full refund of the plan price. Please note that this
refund is not available if either the trip has started or a claim has been filed. After this 15-day period, the plan
price is nonrefundable.
101-P-MD-800-2018 18
Duplicate Coverage
If you are covered by another insurance policy that we have issued with the same or similar coverage, we will pay
no more than the highest amount of coverage payable under any one insurance policy. We will also refund any
premium you have paid for duplicate coverage.
Fraud and Misrepresentation

You are responsible for all statements or other representations you make. Any materially misleading or inaccurate
information in any statements or representations you make may result in us cancelling your policy or reducing
benefits, or we may use them to defend our decision about a claim. Any person who knowingly or willfully
presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false
information in an application for insurance is guilty of a crime and may be subject to fines and confinement in
prison.
Fraud is illegal and may subject you to criminal prosecution and civil penalties. We will deny your claim if you or
someone acting on your behalf:
1. Makes any false statements or statements that are deliberately misleading or deceptive;
2. Conceals or misrepresents any material fact; or
3. Otherwise attempts or commits fraud.
Legal Actions
No action at law or in equity shall be brought to recover on this policy prior to the expiration of 60 days after
written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall
be brought after the expiration of three years from the date of loss.
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 policy 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 from us that exceeds the total amount of your loss unless
prohibited by law.
Subrogation
When someone is responsible for your loss, we have the right to recover any payments we have made to you or
someone else in relation to your claim, as permitted by law. In such case, we may require any person receiving
payment from us to assign their rights to recover such payment, including signing and providing any documents
reasonably required allowing us to do so. 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 to recover
payment.
Travel Requirements
You are responsible for meeting all requirements to travel, including obtaining required travel
authorizations/documentation (for example, passports or visas), obtaining required immunizations (unless you
are medically unable) and medical supplies/equipment (including verifying that your supplies/equipment meet
your travel supplier’s requirements), and anything else required for you to travel.
Waiver or Amendment
No one has the right to describe our policy any differently than is described here or to change or waive any of its
provisions.
101-P-MD-800-2018 19
TRAVEL SERVICES DURING YOUR TRIP
If you need travel or medical assistance related to your trip, we are available 24 hours a day. With our global reach
and multi-lingual staff, we are here to help you anytime, anywhere.
To Reach Us:
800.654.1908

804.281.5700
Prescription Replacement
If you need to refill your prescription, we can refer you to a physician and a pharmacy to assist you.
Medical Equipment Arrangements

If you need medical equipment while traveling, we can refer you to a medical supply vendor or assist you in getting
the supplies you need.
Personal Effects Collection and Return

If you cannot take your personal belongings home with you or leave them behind while on your trip, we can assist
in locating them and arranging their collection and return.
Child Care Equipment Assistance

If you need child care equipment (such as cribs, highchairs, or car seats) to use during your trip, we can assist in
the location and delivery of the equipment.
Care of Your Pet While on Your Trip

If you need assistance in the lodging of your pet, return of your pet, or locating a veterinarian, we can provide you
with referral options and assist you in making reservations.
20
CONCIERGE SERVICES
Our Concierge associates are here to assist you with requests from the routine to the extraordinary, 24 hours a
day, any day of the year.
To Reach Us:
800.654.1908

804.281.5700
All of our concierge benefits are service benefits, not financial benefits. Payment of any costs associated with
these services is your responsibility. The following are types of services you can contact us for assistance with:
Activity/Entertainment Planning
When you are traveling or planning your trip, we can assist you with referrals, reservations, or ticketing for:
 Restaurants
 Sports events, shows, and festivals
 Theater and concert events
 Health Clubs
 Golf courses and tee times
 Tours
 Museums
 Shopping
 Hobby or special interest classes
 Other such activities/entertainment
Destination Information
Get information on your destination, such as:
 Highlights and sightseeing
 Airport and mass transportation
 Health and security
 Local customs and duty
 Exchange rates
 Visa and passport requirements
 ATM locations
Business Services
When traveling on business, we can assist with:
 Computer and mobile device rental
 Audio/visual equipment rental
 Translation service
 Messenger service
 Location of banquet or private meeting venues
 Arranging catering, banquet, and event services
21
Specialty Services
When you are traveling, we can arrange specialty services, such as:
 Gift basket delivery
 Flower delivery
 Gift idea referrals
 Gourmet food delivery
 Personal care referrals (such as hair, makeup, and massages)
All of our concierge benefits are service benefits, not financial benefits. Payment of any costs associated with
these services is your responsibility.
22
TI_800_S13_P_MD_V4
06/21
JEFFERSON INSURANCE COMPANY
(A Stock Company)
ENDORSEMENT
EPIDEMIC COVERAGE ENDORSEMENT
I. DEFINITIONS
The following definitions are removed in their entirety and replaced with the following:
Epidemic A contagious disease recognized or referred to as an epidemic by a representative of

the World Health Organization (WHO) or an official government authority.
Quarantine Mandatory involuntary confinement by order or other official directive of a
government, public or regulatory authority, or the captain of a commercial vessel on
which you are booked to travel during your trip, which is intended to stop the spread
of a contagious disease to which you or a traveling companion has been exposed.
II. DEFINITIONS
The following definition is added:
Pandemic An epidemic that is recognized or referred to as a pandemic by a representative of

the World Health Organization (WHO) or an official government authority.
III. DESCRIPTION OF COVERAGES
Trip Cancellation Coverage

Covered reasons 1 and 2 under Trip Cancellation Coverage are removed in their entirety and replaced with the
following:
1. You or a traveling companion becomes ill or injured, or develops a medical condition (including being
diagnosed with an epidemic or pandemic disease such as COVID-19).

a. The illness, injury, or medical condition must be disabling enough to make a reasonable person
cancel their trip; and
b. A doctor advises you or a traveling companion to cancel your trip before you cancel it. If that isn’t
possible, a doctor must either examine or consult with you or the traveling companion within 72
hours after the cancellation to confirm the decision to cancel.
2. A family member who is not traveling with you becomes ill or injured, or develops a medical condition
(including being diagnosed with an epidemic or pandemic disease such as COVID-19).

hospitalization.
101-POE-03-800-2020
Trip Cancellation Coverage
The “You or a traveling companion is quarantined” covered reason under Trip Cancellation Coverage is removed
in its entirety and replaced with the following:
1. You or a traveling companion is quarantined before your trip due to having been exposed to:
a. A contagious disease other than an epidemic or pandemic; or
b. An epidemic or pandemic (such as COVID-19), but only when the following conditions are met:
i. The quarantine is specific to you or a traveling companion, meaning that you or a traveling
companion must be specifically and individually designated by name in an order or directive to
be placed in quarantine due to an epidemic or pandemic; and
ii. The quarantine does not apply generally or broadly (a) to some segment or all of a population,
geographical area, building, or vessel (including without limitation shelter-in-place, stay-at-
home, safer-at-home, or other similar restriction), or (b) based on to, from, or through where
the person is traveling. This condition (ii) applies even if the quarantine order or directive
specifically designates you or a traveling companion by name to be quarantined.
IV. DESCRIPTION OF COVERAGES
Trip Interruption Coverage

Covered reasons 1 and 2 under Trip Interruption Coverage are removed in their entirety and replaced with the
following:
1. You or a traveling companion becomes ill or injured, or develops a medical condition (including being
diagnosed with an epidemic or pandemic disease such as COVID-19).

a. The illness, injury, or medical condition must be disabling enough to make a reasonable person
interrupt their trip;
b. A doctor must either examine or consult with you or the traveling companion within 72 hours of the
trip interruption to confirm the decision to interrupt the trip; and
c. You or a traveling companion must not have traveled against the orders or advice of any
government or other public authority at any location to, from, or through which you are traveling on
your trip.
2. A family member who is not traveling with you becomes ill or injured, or develops a medical condition
(including being diagnosed with an epidemic or pandemic disease such as COVID-19).

hospitalization.
Trip Interruption Coverage

The “You or a traveling companion is quarantined” covered reason under Trip Interruption Coverage is removed
in its entirety and replaced with the following:
1. You or a traveling companion is quarantined during your trip due to having been exposed to:
a. A contagious disease other than an epidemic or pandemic; or
101-POE-03-800-2020
b. An epidemic or pandemic (such as COVID-19), but only when the following conditions are met:
i. The quarantine is specific to you or a traveling companion, meaning that you or a traveling
companion must be specifically and individually designated by name in an order or directive to
be placed in quarantine due to an epidemic or pandemic; and
ii. The quarantine does not apply generally or broadly (a) to some segment or all of a population,
geographical area, building, or vessel (including without limitation shelter-in-place, stay-at-
home, safer-at-home, or other similar restriction), or (b) based on to, from, or through where
the person is traveling. This condition (ii) applies even if the quarantine order or directive
specifically designates you or a traveling companion by name to be quarantined.
V. DESCRIPTION OF COVERAGES
Emergency Transportation Coverage
The “Emergency Evacuation” and “Medical Repatriation” sections of Emergency Transportation Coverage are
removed in their entirety and replaced with the following:
Emergency Evacuation (Transporting you to the nearest appropriate hospital)

If you become seriously ill or injured or develop a medical condition while on your trip (including being
diagnosed with an epidemic or pandemic disease such as COVID-19) and we determine that the local medical
facilities are unable to provide appropriate medical treatment:
1. Our medical team will consult with the local doctor;
2. We will identify the closest appropriate hospital or other appropriate facility, make arrangements to
transport you there, and pay for that transport; and
3. We will arrange and pay for a medical escort if we determine one is necessary.

b. One or more emergency transportation providers must be willing and able to transport you from your
current location to the identified hospital or facility.
c. You must not have traveled against the orders or advice of any government or other public authority at any
location to, from, or through which you are traveling on your trip.
Medical Repatriation (Getting you home after you receive care)

If you become seriously ill or injured or develop a medical condition while on your trip (including being
diagnosed with an epidemic or pandemic disease such as COVID-19) and our medical team confirms with the
treating doctor that you are medically stable to travel, we will:
1. Arrange and pay for you to be transported via regularly scheduled service on a common carrier in the same
class of service that you originally booked (unless a different class of service is otherwise medically
necessary) for the return leg of your trip, less available refunds for unused tickets. The transportation will be
to one of the following:
a. Your primary residence;
b. A location of your choice in the U.S.; or
c. A medical facility near your primary residence or in a location of your choice in the U.S. In either case,
the medical facility must be willing and able to accept you as a patient and must be approved by our
medical director as medically appropriate for your continued care.
101-POE-03-800-2020
2. Arrange and pay for a medical escort if our medical team determines that one is necessary.

a. One or more common carriers must be willing and able to transport you on regularly scheduled service from
your current location to your chosen destination.
b. Special accommodations must be medically necessary for your transportation (for example, if more than one
seat is medically necessary for you to travel).
c. You or someone on your behalf must contact us, and we must make all transportation arrangements in
d. You must not have traveled against the orders or advice of any government or other public authority at any
VI. DESCRIPTION OF COVERAGES
Emergency Medical/Dental Coverage

The Emergency Medical/Dental Coverage section is removed in its entirety and replaced with the following:
If you receive emergency medical or dental care while you are on your trip for one of the following covered
reasons, we will reimburse the reasonable and customary costs of that care for which you are responsible, up to
the maximum benefit listed for Emergency Medical/Dental Coverage on your Declarations (dental care is subject
to the maximum sublimit listed for Dental Care):
1. While on your trip, you have a sudden, unexpected illness, injury, or medical condition that could cause
serious harm if it is not treated (including being diagnosed with an epidemic or pandemic disease such as
COVID-19).
2. While on your trip, you have a dental injury or infection, a lost filling, or a broken tooth that requires
treatment.
The following conditions and exclusions apply:

a. The care must be medically necessary to treat an emergency condition, and such care must be provided by a
doctor, dentist, hospital, or other provider authorized to practice medicine or dentistry.
b. This coverage will not pay for any care provided after your coverage ends.
c. This coverage will not pay for non-emergency care or services, such as:
1. Elective cosmetic surgery or care;
2. Annual or routine exams;
3. Long-term care;
4. Allergy treatments (unless life threatening);
5. Exams or care related to or loss of/damage to hearing aids, dentures, eyeglasses, and contact lenses;
6. Physical therapy, rehabilitation, or palliative care (except as necessary to stabilize you to transport);
7. Experimental treatment; and
8. Any other non-emergency medical or dental care.
d. You must not have traveled against the orders or advice of any government or other public authority at any
IMPORTANT: Please refer to your Declarations to confirm your applicable limit and any deductible that may
apply.
If you need to be admitted to a hospital as an inpatient for longer than 24 hours, we can guarantee or advance
payments, where accepted, up to the limit of your emergency medical/dental coverage.
101-POE-03-800-2020
VII. GENERAL EXCLUSIONS
The general exclusion for “an epidemic” is removed in its entirety and replaced with the following:
1. An epidemic or pandemic.
VIII. OTHER AMENDMENTS
1. The general exclusion for “an epidemic or pandemic” does not apply to the covered reasons added or
revised by this endorsement under: Trip Cancellation Coverage, Trip Interruption Coverage, Emergency
Transportation Coverage, or Emergency Medical/Dental Coverage.
2. Other than as expressly stated in this endorsement, coverage is excluded for all losses directly or
indirectly resulting from “an epidemic or pandemic.”
There are no other changes to your policy.
Jefferson Insurance Company
Elena Edwards, President
101-POE-03-800-2020
IMPORTANT PRIVACY NOTICE
THIS NOTICE DESCRIBES HOW PERSONAL DATA AND MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
AWP USA Inc. and its subsidiaries, including Jefferson Insurance Company and AGA Service Company d/b/a Allianz
Global Assistance are committed to protecting your privacy. By using our products, services or website, you consent to
our collection and use of your Personal Data as described in this notice (“Notice”).
Definitions. The below definitions apply to this Notice:
1. “Personal Data” means non-public personal information that identifies a specific identified or identifiable person
(“you”). An identifiable person is one who can be identified by reference to an identifier (such as name) or other
factors specific to that person. Personal Data does not include publicly available, de-identified, or aggregated data.
2. “Sensitive Data” means Personal Data about a person’s race or ethnicity; political, religious, philosophical, ideological,
or trade union memberships, opinions, views or activities; medical or health conditions or protected health information
(“PHI”) as defined in the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”); genetic or biometric
data; financial account information (e.g. bank account number); government-issued ID numbers; sexuality; or social
security measures or administrative or criminal proceedings and sanctions that are treated outside pending
proceedings. Sensitive Data also includes information we receive from a third party who treats and notes the
information as sensitive.
3. “Agent” means a third party that collects or uses Personal Data to perform tasks on our behalf, or our underwriters.
4. “We/Us/Our” means one or more of AWP USA Inc., Jefferson Insurance Company and AGA Service Company.
Privacy Practices. This Notice describes how we collect, use, and maintain Personal Data. It also describes your and our
rights.
1. Notice: We collect Personal Data from you, or from your agents, representatives, suppliers and providers, or other
party from whom you have authorized us to collect it on your behalf. This may include:
(i)Identifiers and other identifying personal information (e.g. name, contact information like address, email address, or
other unique personal identifiers, signature, date of birth, insurance policy numbers, education, employment
information and history);
(ii) billing or payment information (e.g. bank account or payment card number and billing information);
(iii) information about your trip, event, or enrollment (e.g. agents, suppliers, trip itinerary and plans; tuition and
enrollment information);
(iv) information about your transactions or business with us or others (e.g. personal information you provide us for us
to generate quotes or to purchase products, quote/purchase history, receipts, insurance EOBs);
(v) financial account information (e.g. account numbers, statements);
(vi) health information (e.g. health insurance information, disability information, medical treatment history, invoices);
(vii) information about or related to any claim you make or other use of our products (e.g. details of your loss, police
reports, health/vital records, professional or employment-related information) records of interactions,
communications and correspondence between you and us, including audio and electronic information);
(viii) information about your websites and/or mobile application (e.g. browser data, IP address, information about your
interaction with a website, application, or advertisement);
(ix) geolocation data (e.g. for use of location-based website or mobile application customization or services);
(x) biometric information (e.g. fingerprinting required for insurance licenses);
(xi) protected class information (e.g. age, which may be used for purposes of quoting, or disability which may be used
in administration of your claim)
(xii) government-issued identification numbers (e.g. social security number, driver’s license number, passport
number); or
(xiii) any other information provided to us by you or on your behalf.
We may also collect Personal Data from consumer reporting agencies or fraud databases (e.g. fraud reports). This
data may be collected from forms, such as enrollment or claim forms; by phone, website, email, fax, or
correspondence; or via cookies.
We may use the Personal Data we collect from any of the above categories to:
(i) to offer, market, sell, underwrite, or make available to you insurance or assistance products or services;
(ii) to provide you with information or services for such products and services;
(iii) to service and administer your insurance, assistance, or other products and services. This may include, for
example: providing travel assistance or concierge services, servicing and processing your policy or claims,
conducting quality or satisfaction surveys and assessments, keeping electronic or audio records of our
interactions and correspondence with you and documents sent and received; and fraud prevention;
(iv) to arrange for the provision of services you request;
(v) to protect our legal rights or to respond to lawful requests by public authorities, including to meet national security
or law enforcement requirements or as otherwise required by law; or
(vi) for purposes to which you’ve otherwise consented.
This may in some cases include disclosing your Personal Data to Agents. But, such disclosures are only for the
purposes described in this Notice, or for everyday business purposes or as required or allowed by law (e.g. to process
transactions, maintain accounts, respond to court orders and legal investigations, or report to credit bureaus). These
Agents may be affiliated or nonaffiliated, and may be located both inside and outside of the US. They may be
financial services providers (e.g. underwriting insurers). They may also be non-financial companies (e.g. health
service providers, travel service providers, the agent/agency through whom you purchased, service providers helping
us with marketing or technology).
Should you be purchasing insurance on another’s behalf, we and the insurer may require the personal information of
the insured to provide and administer the benefits of their plan. By providing the insured's personal information at the
time of purchase, you are confirming that you have obtained the insured's consent to provide this personal information
for this use.
Where we are subject to HIPAA, we must notify you of our duties and practices with respect to PHI. Except as
described here or allowed or required by law, we will only use or disclose your PHI or health records with your prior
express consent. Under HIPAA, we may use and disclose your PHI for one or more of the following purposes:
(1) monitoring the health care treatment you receive (e.g. we may send or receive PHI to or from a doctor regarding
your condition and treatment so we can see that your treatment is appropriate);
(2) payment for health services (e.g. we may use your PHI to make payments to a hospital that has treated you);
(3) to help run our company (e.g. we may use your PHI to conduct quality audits of the services we provided to you.
However, we may not use or disclose genetic information about you for underwriting purposes); or
(4) for other purposes as required to administer your insurance or assistance product (e.g. we may use PHI to
determine coverage for a claim made under an insurance policy).
We may also in some cases need to use or disclose information about you which may include your PHI for one or
more of the following purposes:
(1) for public health and safety issues;
(2) to comply with legal or regulatory requirements;
(3) to address or comply with workers’ compensation, law enforcement, or other legal or government mandates or
requests; or
(4) to respond to lawsuits or legal actions.
Cookies are text files on your computer. When you access our website or use our mobile application, we use cookies,
among other things, to collect data about your web usage. We also use Google, Inc.’s Google Analytics and
AdWords services, iAdvize and Jacada’s chat and monitoring service, and other similar third-party vendor services.
These services use cookies to transmit your IP address and other website navigation and Internet usage/network
activity data and device/browser-generated data, including regarding your browsing history and your interaction with
our and other websites, applications, and advertisements. iAdvize also uses JavaScript to provide its chat and
monitoring services. These vendors may provide this data to us or store and/or aggregate this data to analyze such
usage and create reports for us. We, our affiliates and our Agents use such data and reports for our own business
purposes (e.g. to provide customer service, to optimize the content you see from us, website improvement, other
purposes stated in this Notice, etc.) and Payment Card Industry Data Security Standard (“PCI”) compliance. These
vendors may also display our ads on sites across the Internet, and they may use this data to later display ads or other
information to you based on your website usage or other information collected as described above. By using our
website, you consent to this use of cookies and data for these purposes. You can refuse cookies by disabling them in
your browser (this may affect the content available to you). Our websites do not respond to “Do Not Track” requests
from browsers.
We may use your geolocation information for generating location-specific product advertisements and offers or to
provide and administer the insurance and assistance services as described above. This information may also be used
for location-based website or mobile website application services, such as access to local alerts and emergency
services numbers and providers, maps, and translation services, and other similar services, or for purposes to which
you otherwise consent or as described here.
Last, we may use and disclose the name, email address, or contact information of current and former customers to
Agents for marketing administration purposes. For example, we may need to disclose the email address you provided
to us to an Agent providing marketing services on our behalf to help ensure that your opt out choices are respected
and that you do not receive duplicate communications.
Upon notification and consent your personal data may be used for other reasons. That notice will state the 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 this.
2. Choice. We reserve the right to disclose Personal Data to third parties as described above. The law in some
jurisdictions allows you the right to choose in some cases to opt out of us sharing your Personal Data with a third
party or using it for purposes described or that is materially different from the purposes for which it was originally
collected or which you later authorize. You may exercise this right by notifying the Privacy Officer at the information
provided below. You may opt out of getting non-essential marketing communications from us by giving notice as
described below and disabling cookies in your web browser. Except as required or allowed by law (e.g. for fraud
prevention), 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 later authorize. If we ever wish to do so, we will give
you the opportunity to opt out. If 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 later authorize, we will only do so with your
express consent. We will not unfairly discriminate against you for declining to provide this consent.
Except as allowed by law, we will not use or disclose psychotherapy notes, use or disclose your PHI for marketing
purposes, or use or disclose your PHI in a way that would constitute a sale of PHI under HIPAA unless you expressly
authorize us to do so. You may revoke this consent at any time. Such revocation will not apply to actions we have
already taken based on that consent. You may request restrictions on our use and disclosure of certain health
information for treatment, payment, or our operations. However, we are not required to agree to your request, except
as required by HIPAA.
We may need to disclose Personal or Sensitive Data if we have a good-faith belief that it is needed to protect or
defend our or your rights, interests or property or comply with any law or legal mandate, or if it is otherwise required or
allowed by law. We will take reasonable care to disclose only as much of such data as is needed.
3. Accountability for Onward Transfer. We may disclose your Personal Data to our Agents, but only for the limited and
specified purposes described here, consistent with the consent you have provided. We will take reasonable and
appropriate steps to obtain assurances from our Agents that they will effectively process and safeguard your Personal
Data consistent with our obligations under this Notice. Upon discovery, we will take reasonable steps to stop and
remediate any unauthorized processing inconsistent with this Notice.
Our Binding Corporate Rules related to data transfers may be viewed here: https://www.allianz-
partners.com/en_US/allianz-partners---binding-corporate-rules-.html
4. Security. We take reasonable and appropriate measures to protect your data from loss, misuse, or unauthorized
access, disclosure, alteration and destruction. These measures take into account the risks involved in the processing
and the nature of the Personal Data. To help maintain the security of your data, we use administrative, physical, and
technical safeguards. These include utilizing policies to take reasonable precautions to (a) securely and confidentially
maintain your Personal Data; (b) assess and protect against threats and hazards to the security or integrity of such
data; and (c) prevent unauthorized access to or use of such data. Also, except where required or allowed by law, we
limit use of your Personal Data to the minimum necessary to accomplish the purposes for which that data was
collected and to be used as described here. We restrict access to your Personal Data to only those who need to
access it to accomplish those purposes. We use encryption to make your online transaction with us safe and secure.
We protect the privacy of your credit card information with a high degree of care and in compliance with PCI. We are
required by law to maintain the privacy and security of your PHI. If there is a breach as defined under HIPAA of your
unsecured PHI, we are required by law to notify you.
5. Data Integrity. We will only collect Personal Data to the extent it is relevant to the purposes for which it was collected.
We will not process Personal Data in a way that is incompatible with the purposes for which it has been collected or
as you later authorize. 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. We will adhere to these
principles for as long as we retain this data. We retain Personal Data according to our data retention policy.
6. Access. If you discover the data we hold about you is inaccurate or incomplete, please contact us. We will grant you
reasonable access to the Personal Data we hold about you. We will take reasonable steps to allow you to correct,
amend or delete your Personal Data that is inaccurate or incomplete, or has been processed in violation of this
Notice, so long as it can be done without undue burden or expense on us, without breaching any legal or professional
privilege or obligation, and without violating the rights of others. Where we are subject to HIPAA, you have the right to
request to receive confidential communications of your PHI, as applicable. In accordance with and as allowed by
HIPAA, at your request, you may inspect, amend, and copy PHI we maintain about you and receive an accounting of
certain disclosures of your PHI (e.g. health payment records).
7. Recourse, Enforcement, Liability. You can send complaints about how we handle your Personal Data to us at the
contact information below. If the data is PHI, complaints can be made to us or to the U.S. Secretary of Health and
Human Services. We will not retaliate against you for filing a complaint.
Links. Our websites provide links (including social media plugins (“Plugins”) that connect to third party websites. Clicking
such link establishes a connection and transmits data to/from the operator of such website. Clicking a Plugin while logged
in to a social media account may cause the social media website’s operator to publish activity to your account. To avoid
this, log out of your account before clicking the Plugin link. We are not responsible for and make no representations about
the content, security, or privacy practices of any other third party websites. You should read the privacy notices of the
websites you visit to understand their data privacy practices.
Changes to Notice. This Notice reflects our business practices. It is not a contract. However, we are required to and will
abide by the terms of this Notice as currently in effect. We may amend this Notice at any time. We will notify you of any
updates by posting a revised notice on our website. The revised notice will apply to all information collected by us,
including previously collected information. You accept the revised notice by your continued use of our website, products
or services following any such amendment. If we revise this Notice in a way that would allow us to disclose your Personal
Data to a nonaffiliated third party other than as already described here, we will provide you with a revised notice and give
you the opportunity to opt out of any such disclosure. You are responsible to regularly review this Notice. You have the
right to a paper copy of this Notice upon request.
Contact. If you have any questions or comments about this Notice or the way that we collect or handle your Personal
Data, or if you would like a paper copy of this Notice, please contact our Chief Privacy Officer by any of:
Email: [email protected]
Phone: 1-800-284-8300
Mail: Allianz Global Assistance
ATTN: Chief Privacy Officer
9950 Mayland Drive
Richmond, VA 23233
Opt Out/Exercise of Rights. To opt out of non-essential marketing communications or non-essential unaffiliated third
party information sharing, please contact our Chief Privacy Officer as noted above with your name, policy number. Please
include a statement that says “Opt out” (or something similar). Opt outs will be applied to all products and services we
provide. We will not unfairly discriminate against any person who chooses to opt out, or exercise any of their rights as
described in this Notice.
Electronic Notices. Unless you chose to receive them by US mail at the time of purchase, by purchasing your policy,
you consent to receive all notices and documents from us electronically. They will be sent to the email address provided
at the time of purchase. You may opt to receive notices and documents from us by mail at any time. If you wish to
change or update your notice/documents preferences, email us at [email protected]. Please
include your name, policy number, and a note that says “Only contact me by mail” (or something similar). You can also let
us know by phone at 800-284-8300 or by mail to:
Allianz Global Assistance

ATTN: Customer Service – Only contact me by mail
9950 Mayland Drive
Richmond, VA 23233
If you don’t provide an email address at purchase, you’ll receive notices and documents by mail. You may request paper
copies of any electronic information we send, or update your electronic contact information at any time by emailing or
mailing us at the above address, or by calling us. Documents sent to you from us will be in either PDF or HTML format. If
you can’t receive or read the documents we send you, please contact us so we can assist you.
California Residents. In addition to as defined above, Personal Data may also include information (other than
information that is publicly available, de-identified or aggregated), that identifies, relates to, describes, is reasonably
capable of being associated with, or could be reasonably linked to a particular California resident or household.
We have collected the following categories of Personal Data from consumers from the sources and for the purposes as
described in this Notice in the past 12 months: identifiers, personal information, characteristics of protected classifications,
commercial information, biometric information, internet or other electronic network activity information, geolocation data,
audio/electronic/visual information, and professional or employment-related information. We use these categories data for
purposes as described in Section 1 of this Notice. We do not sell Personal Data. We have disclosed the following
categories of Personal Data for business purposes as described in this Notice to the categories of third parties identified in
this Notice in the past 12 months: identifiers, personal information, characteristics of protected classifications, commercial
information, biometric information, internet or other electronic network activity information, geolocation data,
audio/electronic/visual information, and professional or employment-related information.
You may in some cases have certain rights under California law. However, these rights are not available in all cases, and
they are subject to applicable exceptions, exemptions, and limitations as provided by law (including without limitation with
respect to Personal Data collected pursuant to the Gramm-Leach-Bliley Act). Please contact the Chief Privacy Officer for
more information. These rights may include the following: (1) the right to request that we disclose to you the categories
and specific pieces of your Personal Data we have collected over the past 12 months; the categories of sources from
which that data is collected; the business or commercial purpose for collecting or selling that data; the categories of third
parties with whom we share that data; and the specific pieces of that data we have collected about you in that period; the
categories of Personal Data sold about you during that period and the categories of third parties to whom that information
was sold, by category of Personal Data for each category of third parties to whom the Personal Data was sold; and the
categories of Personal Data we disclosed about you for a business purpose during that period; (2) the right to request that
we delete Personal Data we have collected about you; (3) the right that we will not discriminate against you for exercising
any of these rights, including without limitation by denying goods or services to you; charging a different price or rates for
goods or services, including through the use of discounts or other benefits or imposing penalties; providing a different
level or quality of goods or services to you; or suggesting that you will receive a different price or rate for, or a different
level of quality of, goods or services. You can submit a request to exercise these rights by contacting the Chief Privacy
Officer as described above. Upon verification of your request, we will respond to you with the information requested or
confirmation of deletion, or with an explanation for why the information will not be provided or why the data will not be
deleted, as applicable.
Effective Date. This Notice was last revised on, and is effective as of, December 1, 2020.
© 2020 AWP USA Inc. All rights reserved.

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Hi FERNANDO,

Have a safe trip,

Allianz Global Assistance

OUR PROMISE TO YOU

Emergency Transportation Transportation is needed following a medical emergency $50,000.00

OUR PROMISE TO YOU

ABOUT THIS POLICY

WHAT THIS POLICY INCLUDES AND WHOM IT COVERS

Your policy consists of two parts:

OUR PROMISE TO YOU

SIGNED FOR JEFFERSON INSURANCE COMPANY

Elena Edwards, President Jack Zemp, Secretary

INDIVIDUAL TRAVEL INSURANCE POLICY

TRAVEL SERVICES DURING YOUR TRIP 3

All other locations, call:

Lost Travel Documents Assistance

Emergency Language Translation

Emergency Cash Assistance

Emergency Message Delivery

Finding a Doctor or Medical Facility

Monitoring Your Care

A. TRIP CANCELLATION COVERAGE

The following conditions apply:

The following condition applies:

4. You or a traveling companion is quarantined.

One of the following conditions must apply:

The following condition applies:

8. Your primary residence is uninhabitable.

The following condition applies:

The following condition applies:

The following conditions apply:

IMPORTANT: Please refer to your Declarations to confirm your applicable limit.

B. TRIP INTERRUPTION COVERAGE

The following conditions apply:

The following condition applies:

3. You, a traveling companion, or family member dies during your trip.

4. You or a traveling companion is quarantined during your trip.

6. You or a traveling companion is in a traffic accident (not including a mechanical breakdown).

One of the following conditions must apply:

The following condition applies:

9. Your primary residence is uninhabitable.

The following condition applies:

The following condition applies:

IMPORTANT: Please refer to your Declarations to confirm your applicable limit.

C. BAGGAGE LOSS COVERAGE

The following conditions apply:

The following items are not covered:

IMPORTANT: Please refer to your Declarations to confirm your applicable limit.

D. EMERGENCY TRANSPORTATION COVERAGE

Emergency Evacuation (Transporting you to the nearest appropriate hospital)

The following condition applies:

Medical Repatriation (Getting you home after you receive care)

The following conditions apply:

Transport to Bedside (Bringing a friend or family member to you)

The following condition applies:

Return of Dependents (Getting minors and dependents home)

The following conditions apply:

Repatriation of Remains (Getting your remains home)

E. EMERGENCY MEDICAL/DENTAL COVERAGE