EFTA00317266

Letter Of Confirmation August 28. 2014 Global Assistance Name: Ka na Shuliak Policy No.: Karyna Shuliak Emergency Assistance Card For emergency assistance during your trip call: 1.800.949.6201 1.804281.5700 Dear Karyna Shuliak, (From U.S.) (Outside U.S. /Collect) Thank you for choosing us to protect your travel investment. For benefit information call: 1.800.949.6201 Please make sure you read this Letter of Confirmation, your enclosed Certificate of (From U.S.) Insurance/Policy. and any other attached documents, including riders or other forms carefully. Because the Certificate of Insurance/Policy may describe coverage To modify your policy or file a claim, please visit: not included in your plan, be sure to look at all of the documents to understand your www.allianztravelinsurance.com specific coverage. Contact us immediately if you think there is a mistake in your Letter of Confirmation. P. O. Box 72031. Richmond. VA 23255-2031 What Your Plan Includes Information about your plan Your plan includes the following coverage, up to the limits Name of your plan: Annual Executive Plan shown. Please see your Certificate/Policy for information about Policy identification number. how our insurance works. Type of order: Phone Benefit Coverage Limits* Baggage Coverage $1,000.00" Number of people insured: 1 Baggage Delay Coverage $1,000.00" Who it insures: Karyna Shuliak Business Equipment Coverage $1,000.00" Date of purchase: August 28, 2014 Business Equipment Rental Coverage $1,000.00" Plan effective date: September 5. 2014 - September 5. 2015 Collisionloss Damage Insurance S45,000.00' Change Fee Coverage S250.00' Total cost: $459.00 Concierge 24-Hour Hotline Assistance Emergency Medical Transportation $250,000.00" Thanks again for purchasing a travel insurance plan from us. Have a safe and Emergency Medical and Dental S50,000.00' pleasant trip! $5,000.00" Trip Cancellation Protection Travel/Trip Delay Coverage $1,500.00" Sincerely, Dairy emit $150.00. Trip Interruption Protection $5,000.00" Travel Accident Coverage $100,000.00' 'USD per person unless noted °therms° Mark Henson Please Note Vice President of Travel Operations • Emergency Medical and Dental Benefits are secondary and there is no deductible. • Collision, loss or damage benefits and coverage limits We will refund your insurance premium if you cancel your insurance are per policy. within 10 days of purchase and have not filed a claim or departed on • There is a $500 maximum for all covered dental your trip. expenses. • AGA Service Company is the licensed producer and To modify your policy or file a claim, please visit administrator of this plan. www.allianztravelinsurance.com. ht. Insurance coverage is provided under Form No. 52.201 series or 52.401 series issued by BCS Insurance Company. How can we help? EFTA00317266 A53V2_B ' ANNL2_NY_D ' BCSPRIVNOT " EFTA00317267 INSURING CLAUSE Part I. EFFECTIVE DATE BCS Insurance Company. herein referred to as the Company, Coverage Term: The Coverage Term shall start at 12:01 A.M. will pay You the insurance benefits described in this Policy. on the date shown in Your Letter of Confirmation, subject to Allianz Travel Insurance This Policy and attached Riders, if any, are issued in payment of the premium due. The Coverage Term ends at consideration of the statements in the enrollment form and the 12:01 A.M. on the 366th day after the date the Coverage Term payment of the initial premium. Please refer to the starts, except as stated in the Extension of Coverage Provision accompanying Letter of Confirmation. It provides You with or if renewed for another annual term. Individual Travel specific information about the plan You purchased. Please Effective Date: The Trip Cancellation coverage is in effect for contact Us immediately if You believe that the Letter of each Trip made during the Coverage Term. The other Insurance Policy Confirmation is incorrect. *Indicates insurance coverage provided under this Policy and coverages are in effect during each Trip made during the Coverage Term, effective on or after each Trip's Scheduled underwritten by BCS Insurance Company. Departure Date and upon You leaving Your residence, place of employment, lodging or other location from which You RENEWAL CONDITIONS directly start Your Trip. FOR SERVICE, VISIT OR CALL: This Policy is issued for a single term as stated in the Letter of Notwithstanding, no coverage is in effect for any Trip that is www.allianztravelinsurance.com Confirmation and may be renewed for subsequent Coverage made by mass transit, taxi, limousine service, personal Terms. automobile, bus, commuter rail or airline service, including 1-800-284-8300 inter-urban rail service by Amtrak unless the Trip is scheduled: SATISFACTION GUARANTEE 1. To take You at least 100 miles from Your residence, Within 10 days of purchasing the plan, We will process a full place of employment, lodging or other location from which FOR EMERGENCY ASSISTANCE refund of premium to You, as long as You have not already You directly start Your Trip: and DURING YOUR TRIP CALL: departed on Your Trip or filed a claim. No refunds shall be paid 2. The scheduled Trip must not exceed 45 days length at to You after 10 days of purchasing the plan. the time of booking. 1.800.654-1908 PLEASE READ THIS POLICY CAREFULLY FOR FULL Part II. TERMINATION DATE (From U.S.) DETAILS. This Policy is a legal contract. The entire contract is Termination of Coverage for a Trip: Subject to the Extension made up of the Policy and any Riders attached to it. of Coverage provision, all coverages with respect to a given 1.804-281-5700 Trip end subject to the Extension of Coverage provision below, (Collect) PLAN FEATURES on the earliest of: TABLE OF CONTENTS 1. Your arrival at Your residence, place of employment, Part I. Effective Date lodging or other location at Your return destination to Part II. Termination Date which You go directly following Your Trip; Part III. General Exclusions 2. Your return date; Part IV. Description of Travel Insurance Benefits 3. Cancellation of the Trip for reasons other than those Part V. General Provisions Related to Insurance Benefits covered under the Policy: Part VI. Claim Filing Procedures 4. 12:01 A.M. on the 121st day after the date You started Part VII Definitions Your Trip; or 5. At 12:01 A.M. on the 366th day after the Coverage Term starts. 4,• Signed for BCS Insurance Company, 2 MidAmerica Plaza, Extension of Coverage for a Trip: All coverages will be Suite 200. Oakbrook Terrace. IL 60181. extended with respect to a given Trip provided: .••••• • BCS .4s BCS Insurance CornarY / 1FLIAIL ANI II PRESIDENT SECRETARY 1. Your entire Trip falls within a Coverage Term: and 2. Your retum is delayed by unforeseeable circumstances beyond Your control. Allianz Global Assistance and Allianz Travel Insurance branded plans are underwritten by BCS Insurance Company. AGA Service Company is the licensed producer for this plan. Form 52.201NY 02014 AGA Service Company ANNL2 NY D Page 1 EFTA00317268 If coverage is extended for the above reason, coverage will high altitude activities, caving, heli-skiing, extreme skiing, These plans do not cover You: end on the ea dier of: or any skiing outside marked trails; 1. If the purpose of the travel is to receive medical care, 1. Your arrival at Your residence, place of employment, 8. Scuba diving (unless accompanied by a dive master and medication or treatment; lodging or other location at the return destination to which not deeper than 130 feet); 2. If the stated Trip departure and return dates do not reflect the insured directly goes following the Trip: or 9. Operating or learning to operate any aircraft as pilot or Your intended departure and return dates; 2. Seven days after the return date. crew; 3. If the tickets do not indicate the travel dates: Termination of Annual Coverage: Premium is paid on an 10. Nuclear reaction, radiation or radioactive contamination; 4. If You give incorrect data or facts; or annual basis. Your insurance will continue in effect until 12:01 11. Natural disasters (unless as specifically covered); 5. If the loss is not submitted to Us within 90 days from the A.M. on the 366th day after the date of the Coverage Term 12. Epidemic; date of loss, except as otherwise prohibited by law. starts as shown in Your Letter of Confirmation. The insurance 13. Pollution or threat of pollutant release; will continue for subsequent annual terms, subject to timely 14. Any unlawful acts committed by You, Family Members, or PRE-EXISTING CONDITIONS EXCLUSION payment of premium. You may terminate this plan by giving Us Traveling Companions, whether they are insured or not; This exclusion applies to Trip Cancellation and Interruption 31 days advanced written notice. We will refund any unearned or Protection. Emergency Medical and Dental Benefits, and to premium. 15. Any expected or reasonably foreseeable events. those Travel Assistance Services related to medical problems. The plan does not cover losses or expenses if they result Part III. GENERAL EXCLUSIONS For all Accident and Health benefits: from a Pre-existing Condition. Inland Marine benefits are considered to be Baggage 1. Intentionally self-inflicted harm, suicide or attempted For the purposes of determining any Pre-existing Conditions, Coverage. Baggage Delay Coverage, Travel Delay Coverage, suicide, by You, a Traveling Companion or a Family the effective date of Your insurance will be Your Trip and Collision/Loss Damage Insurance. Member Cancellation Insurance effective date, if Trip Cancellation Accident and Health benefits are considered to be Trip 2. Pregnancy. other than unforeseen complications of Insurance is purchased. If no Trip Cancellation Insurance is Cancellation and Interruption Benefits. Emergency Medical pregnancy, of You, a Traveling Companion or a Family purchased. it will be Your Trip departure date. and Dental Benefits, and Travel Accident Coverage. member You have purchased a plan where Pre-existing Conditions These exclusions apply to the plan benefits and services 3. Mental or emotional disorders, or physical complications are waived. The Company and We cover these Pre• indicated. In addition to any exclusions that apply to a related thereto. of Your, a traveling Companion or a existing Conditions provided: particular benefit, no coverage is provided for any loss arising Family Member; 1. On the date of purchase of insurance, You were directly or indirectly out of or as a result of the following: 4. Alcoholism or drug addition, intoxication or under the medically able to travel and You had not filed a claim for For all Inland Marine benefits: influence of any narcotic unless administered on the Trip Cancellation due to a pre-existing Illness within 120 1. Intentionally self-inflicted harm, suicide or attempted advice of a Physician or physical complications related days prior to the purchase of insurance; suicide, by You, a Traveling Companion or a Family thereto. of You, a Traveling Companion or a Family 2. The total Trip cost is $10,000 per person or less; and Member Member 3. On the date of purchase of insurance, You are a resident 2. Normal Pregnancy, fertility treatments. Childbirth or 5. War (whether declared or undeclared), acts of war, of the United States. elective abortion, other than unforeseen complications of participation in a riot or insurrection (except as provided If You do not meet the above criteria, You may still be covered pregnancy, of You, a Traveling Companion or a Family for in the Travel Delay benefit); or service in the Armed for Trip Cancellation or Trip Interruption caused by reasons Member Forces or units auxiliary thereto (except as specifically other than those related to the Pre-existing Condition. 3. Mental or nervous health disorders, including but not covered); limited to: anxiety. depression, neurosis or psychosis; or 6. Aviation, other than as a fare-paying passenger on a Part IV. DESCRIPTION OF TRAVEL INSURANCE physical complications related thereto, of You, a scheduled or charter flight, operated by a scheduled BENEFITS (what is covered) Traveling Companion or a Family Member: airline; The following insurance benefits are designed to protect You 4. Alcohol or substance abuse; or conditions or physical 7. Participation in a felony or to which a contributing cause against situations or losses that result from sudden and complications related thereto, of You, a Traveling of the loss was a person being engaged in an illegal unexpected conditions or events. The benefits do not cover Companion or a Family Member; occupation. This includes You, Family Member, or conditions or events that, on the date of purchase, are 5. War (whether declared or undeclared), acts of war, Traveling Companions. whether they are insured or not; either known to You or likely to occur. Please be aware military duty (unless as specifically covered), civil disorder or that this stipulation may be applied to policies purchased or unrest (except as provided for in Travel Delay); 8. Financial Default of a travel supplier. with the Pre-existing Conditions Exclusion Waiver. The 6. Participation in professional or amateur sport events Company and We reserve the right to reject applications. (including training); 7. All extreme, high risk sports including but not limited to: bodily contact sports; skydiving; hang gliding, bungee jumping, parachuting; mountain climbing or any other Page 2 EFTA00317269 TRIP CANCELLATION AND INTERRUPTION 6. Your Primary Residence being made uninhabitable or 13. Theft of Your automobile that results in Your inability to PROTECTION' Your company being made unsuitable for business by take or continue Your Trip. Trip Cancellation coverage provides benefits for loss(es) You fire, flood, burglary. vandalism, or natural disasters. 14. For Trip Cancellation benefits only, Your Normal incur for Trips cancelled up to the time and date of departure. 7. You or a Traveling Companion being directly involved in a Pregnancy as long as the pregnancy occurs after Your Trip Interruption coverage provides benefits for loss(es) You traffic Accident while directly en route to a departure or effective date of coverage that can be verified by medical incur for Trips that are interrupted or delayed after the time that causes either: 1) a medical emergency for You or a records. and date of departure. Traveling Companion; or 2) damage to the automobile 15. For Trip Cancellation benefits only, You will be attending For all of the covered reasons outlined below, You must that creates an immediate need for repair to ensure the an Immediate Family Members Childbirth at the time the notify the appropriate travel supplier(s) of Your safety of the passengers. covered Trip is supposed to take place as long as the cancellation or interruption within 72 hours of the 8. A terrorist act committed by an organized terrorist group pregnancy occurs after the effective date of coverage that occurrence, unless the condition prevents it, then as soon (recognized as such by the U.S. State Department) that can be verified by medical records. as reasonably possible. Otherwise the right to results in property damage, Injury or loss of life. The 16. You or a Traveling Companion are required to work compensation will lapse. incident must take place in a domestic or foreign city in during Your scheduled Trip. You must demonstrate proof A maximum benefit of up to the amount indicated in Your which You are scheduled to arrive within 30 days of requirement to work, such as a notarized statement Letter of Confirmation is provided to cover certain expenses as following the incident and Your tour operator (if signed by an officer of Your employer. listed below which result from the cancellation or interruption applicable) must not have offered a substitute itinerary. 17. You or a Traveling Companion become legally separated of Your Trip due to: For foreign terrorism coverage only, coverage for or divorced after the purchase of insurance and prior to 1. Any serious Injury or any unforeseen serious medical travel to or through countries in which such a the departure date, provided that the Insurance was condition: documented or reported incident has occurred in the purchased within 14 calendar days of the initial Trip a. Occurring to You or Your Traveling Companion, which 30 days prior to the purchase of travel is excluded. deposit or payment. is so disabling as to cause a reasonable person to Losses resulting due to the issuance of travel 18. Your company being directly involved in a merger or delay. cancel, or interrupt their Trip: advisories, bulletin or alerts; war or acts thereof; civil acquisition. You must be an active employee of the b. Occurring to a Family Member that is considered life disorder, riot or unrest; bomb scares or threats of company that is merging and You must be involved in threatening or requiring hospitalization; or terrorist activity; or terrorist acts against any such an event. c. Occurring to a Family Member requiring Your care. Common Carrier (e.g., airline or cruise line) are not In all cases You must notify the appropriate travel For Trip Cancellation benefits, an actual examination by a covered. supplier(s) of Your cancellation or interruption within 72 Physician must take place within 72 hours of the cancellation. 9. You, who are on Active Military Duty in the United States hours, unless the condition prevents it, then as soon as For Trip Interruption benefits, this examination must take place Armed Forces: reasonably possible. Otherwise the right to compensation during Your Trip. This Physician may not be a member of Your a. having Your personal leave revoked within 10 days will lapse. or Your Traveling Companion's immediate family or yourself, prior to Your departure date (as long as such or an Immediate Family Member of the person whose revocation is in writing by a superior officer and is Coverage is for: condition caused the cancellation or interruption. not due to war-related situations, invocation of the 1. Forfeited, published. Trip payments or deposits incurred as 2. Your death, the death of a Family Member or a Traveling War Powers Act, base or unit mobilization, unit a result of cancellation penalties for which You are not Companion if the death occurs prior to Your Scheduled reassignment for any reason, or disciplinary action); eligible to receive a Refund; Departure Date or during Your Trip. or 2. For Trip Interruption, the pro-rated portion of the pre-paid 3. Strikes, natural disasters, bad weather or FM mandated b. are personally reassigned within 10 days prior to Trip missed; shutdown resulting in the complete cessation of services Your departure date, whether temporary or 3. The additional cost resulting from a change in the per- by the airline, the tour operator or the cruise line for at permanent. person occupancy rate for prepaid travel arrangements if a least 24 consecutive hours OR a road closure causing a 10. You being the victim of a Felonious Assault within 10 Traveling Companion's Trip is canceled or interrupted for delay in reaching Your destination for at least 12 days prior to Your departure date or during Your Trip. A one of the above covered reasons and Yours is not; consecutive hours. The Company will not cover losses Felonious Assault may not be inflicted by You, a Family 4. Reasonable, additional accommodation and transportation resulting from strikes of the person. organization. agency, Member. Traveling Companion or Traveling Companion's expenses up to $100 per day up to a maximum of five or tour operator, or their affiliate companies, that solicited Family Member. days if a Traveling Companion must re-main hospitalized; this coverage and/or Your insured travel arrangements to 11. You, after having been with the same employer for at 5. Reasonable. additional travel costs for You to reach Your You. least three continuous years, are terminated or laid off, original destination if You must depart after Your planned 4. You or a Traveling Companion being hijacked, carjacked through no fault of Your own, after Your effective date of departure date due to one of the above reasons: or or quarantined. coverage. 6. Reasonable, additional transportation expenses needed to 5. You being required to serve on a jury, served with a court 12. A covered Travel Delay that results in the loss of more reach the scheduled termination point of Your Trip or to order or subpoena. than 50% of Your scheduled Trip length. travel from the place Your Trip was interrupted to the place Page 3 EFTA00317270 where You can rejoin Your Trip and the unused portion of part, and reconstructive surgery because of congenital Property or losses not covered: any non-refundable land, sea and air arrangements that disease or anomaly of a covered dependent child that 1. Losses incurred as a result of any General Exclusion; were paid as part of Your Trip. has resulted in a functional defect; physical exams, 2. Animals; The benefits paid under 5 and 6 above will not exceed the cost allergies, hearing aids, eyeglasses, contact lenses, 3. Automobiles and equipment, motorcycles and motors; of an economy airfare by the most direct route on the next palliative care or cosmetic foot care, experimental 4. Bicycles, skis. snowboards (except when checked with a available carrier. less any Refunds paid to You. treatment, or other services which are not Medically Common Carrier); Trip Cancellation(Interruption benefits do not cover Necessary to provide Emergency Medical or Dental 5. Aircraft, boats or any other vehicles or conveyances; loss(es) due to: Care); 6. Eyeglasses. sunglasses, contact lenses, hearing aids, 1. Any General Exclusion or Pre-existing Condition"; 3. Treatment received in unlicensed facilities or given by artificial teeth and limbs; 2. You or a Traveling Companion: a) making changes to unlicensed health care providers; 7. Tickets, keys, money, securities, bullion, stamps, credit personal plans; b) having a business or contractual 4. Treatment given by a Family Member or a Traveling cards, documents (travel or otherwise) and deeds; obligation; c) being unable to obtain necessary travel Companion, whether or not a licensed provider; 8. Property shipped as freight or shipped prior to Your Trip documents: or d) being detained or having property 5. Any Illness or bodily Injury which occurs in the course of departure date: confiscated by any Customs authority; employment if benefits or compensation is provided, in 9. Rugs or carpets of any type; 3. Carrier caused delays (including bad weather) unless as whole or in part, under the provisions of any legislation of 10. Perishables, medicines, perfumes, cosmetics and covered above; any governmental unit; or consumables; 4. Prohibition or regulation by any govemment; or 6. Benefits provided by any governmental agency or unit. 11. Property used in trade, business or for the production of 5. Travel arrangements cancelled by the airline, cruise line Benefits may be coordinated with any other excess coverage income or offered for sale or trade or components of or tour operator. You may have and any benefits paid in excess of Your actual goods offered for sale or trade; " The Pre-existing Condition provision limitation applies only loss may be recovered. 12. Damage to the property resulting from defective materials during the first Policy year and not consecutive and Please refer to Your Letter of Confirmation to determine which or workmanship, ordinary wear and tear, and normal subsequent Policy years. benefits are specifically included within the plan You deterioration; or Please refer to Your Letter of Confirmation to determine which purchased and their corresponding maximum amount of 13. Property that is left in a vehicle if the vehicle is not benefits are specifically included within the plan You coverage. properly secured. purchased and their corresponding maximum amount of coverage. BAGGAGE COVERAGE " The plan will pay the lesser of: Coverage is secondary to any coverage provided by a 1. The actual purchase price of a similar item; or EMERGENCY MEDICAL AND DENTAL BENEFITS' Common Carrier or hotel, if any. 2. The Actual Cash Value of the item at the time of loss, This coverage is primary. If Baggage is lost, damaged or stolen, the Company will pay which includes deduction for depreciation (for items A maximum benefit of up to the amount listed in Your Letter of the loss, up to the maximum amount indicated in Your Letter of without receipts, the plan will pay up to 75% of the Confirmation is provided for covered Emergency Medical or Confirmation, provided You have taken all reasonable determined depreciated value); or Dental Care expenses incurred as a result of accidental Injury measures to protect, save andlor recover Your property at all 3. The cost to repair or replace the item. or Illness occurring during a Trip within the Coverage Period. times. Notwithstanding the foregoing, We will continue to Please refer to Your Letter of Confirmation to determine which We will only pay Reasonable and Customary Charges for cover up to a maximum amount of $500 for any and all benefits are specifically included within the plan You health care services or supplies provided by Physicians, jewelry, watches, gems, furs, cameras and camera purchased and their corresponding maximum amount of licensed dentists, Hospitals, and Other Licensed Providers that equipment, camcorders, sporting equipment, computers, coverage. are received during Your Trip and that are received greater radios and other electronic items and only when original than 100 miles from home and which are Medically receipts are provided. BAGGAGE DELAY COVERAGE " Necessary for. You must notify the appropriate local authorities at the place If Your personal Baggage is delayed or misdirected for at least 1. Emergency Medical Care: and the loss occurred and inform them of the value and description 24 hours by a Common Carrier, the plan will reimburse You on 2. Emergency Dental Care. There is a $500 maximum for of Your property within 24 hours after the loss. Finally, You a one-time basis for the reasonable, additional purchase of all covered dental expenses. must file written proof of loss with the Company within 90 days essential items. Verification of the delay by the Common Coverage is not provided for: from the date of loss, except as otherwise prohibited by law, Carrier and receipts for the emergency purchases must 1. Expenses incurred as a result of any General Exclusion attaching copies of airline, cruise line or Common Carrier accompany any claim. or Pre-existing Condition; claims forms, original police reports, an itemization and No coverage will be provided for loss(es) due to any 2. Non-emergency services, supplies, or charges (examples description of lost items and their estimated value, and all General Exclusion. are those for cosmetic surgery, except reconstructive receipts, credit card statements, canceled checks, photos, or surgery that is incidental to or follows surgery resulting other appropriate documentation as may be required. from trauma. infection or other disease of the involved Page 4 EFTA00317271 Please refer to Your Letter of Confirmation to determine which No coverage will be provided for loss due to any General 6. Vehicles used for commercial or livery use whether or not benefits are specifically included within the plan You Exclusion nor any loss due to air travel except while You are licensed for such use (commercial use includes hauling purchased and their corresponding maximum amount of riding, boarding or alighting as a ticketed passenger on a or transporting materials or goods necessary to or coverage. certified aircraft provided by a regularly scheduled airline on a reasonably considered to be engaged in a commercial or regularly scheduled Trip or charter. livery use); TRAVEL DELAY COVERAGE • Please refer to Your Letter of Confirmation to determine which 7. Any vehicle with an original manufacturer's suggested Coverage under the plan will pay on a one-time basis up to the benefits are specifically included within the plan You retail price greater than $75,000; maximum amount listed in Your Letter of Confirmation for purchased and their corresponding maximum amount of 8. Any vehicle used off maintained roadways; reasonable, additional accommodation and traveling expenses coverage. 9. Any loss not reported to the renting agency; due to a departure delay of 6 or more hours. Prepaid 10. Any obligation You assume under any agreement (other expenses are not covered. Expenses must be incurred by COLUSIONILOSS DAMAGE INSURANCE than Your insurance collision or comprehensive You. Payments for additional expenses will not exceed $150 The plan will pay up to the amount indicated in Your Letter of Deductible); per day per person. Confirmation for: 11. Any damage which occurs while You are in violation of Covered reasons for Travel Delay are: 1. Physical damage to a Rental Car that occurs while You the Rental Car Agreement; or 1. Carrier caused delay (including bad weather); are driving or while the Rental Car is left unattended 12. Any rental or leases exceeding 45 consecutive days. 2. Lost or stolen passports, money, or travel documents; during the rental period (under this benefit, You refers to If You incur a loss, You must contact the hotline center 3. Quarantine; the insured and licensed drivers who are designated as immediately so that the Company or We can arrange for an 4. Hijacking; drivers on the Rental Car Agreement); insurance adjuster to assess the damage. 5. Unannounced strikes; 2. Reasonable and customary rental charges which may be Please refer to Your Letter of Confirmation to determine which 6. Natural disaster; or imposed by the car rental company while the car is being benefits are specifically included within the plan You 7. Civil disorder or unrest. repaired; and purchased and their corresponding maximum amount of 8. Severe storms that cause a route closing validated by the 3. Any loss of, or damage to. the Rental Car resulting from coverage. National Weather Service records and local Department causes other than collision (for example: fire, storm, of Transportation Records. vandalism, theft). BUSINESS EQUIPMENT COVERAGE' No coverage will be provided for loss(es) due to any The plan will cover the lesser of: Coverage is secondary to any coverage provided by the General Exclusion. 1. The reasonable and customary cost of repairs and rental Common Carrier. Please refer to Your Letter of Confirmation to determine which charges while the car is being repaired, or If Your business equipment is lost by the Common Carrier, or benefits are specifically included within the plan You 2. The Actual Cash Value of the Rental Car. damaged, or stolen, We will pay up to the amount in Your purchased and their corresponding maximum amount of This coverage is primary to any other coverage You may have. Letter of Confirmation provided You have taken all reasonable coverage. Collisionloss Damage Insurance is available for travel in measures to protect, save and recover Your property at all the United States and most foreign countries. No times. TRAVEL ACCIDENT COVERAGE* coverage is provided for motor vehicles rented in Israel, Property or losses not covered: This benefit provides coverage for a loss due to a covered Jamaica, Republic of Ireland or Northern Ireland. 1. Losses incurred as a result of any General Exclusion; Accident. The loss must occur within 365 days of the covered Additionally, coverage is not applicable where precluded 2. Items other than business equipment; Accident. The plan will pay the full amount (as listed on Your by law or in violation of the territorial terms of the rental 3. Intentional Acts; Letter of Confirmation), in a lump sum, for loss of life or any agreement or prohibited by individual merchants. 4. Gross negligence or willful and wanton conduct; combination of two eyes, hands or feet; and one half of the As a condition of payment. You must provide the Company 5. Business equipment shipped as freight or shipped prior to amount for loss of one eye. hand or foot. Loss of eye means and Us with all proper documentation and information required Your Scheduled Departure Date; total and irrecoverable loss of entire sight; and loss of hand or to assess and process the claim. 6. Business equipment that is left in or on a vehicle or a car foot means the actual complete and permanent severance at The plan will not cover: trailer; or above the wrist or ankle joint. Death or loss must be a direct 1. Any loss(es) due to General Exclusions; 7. Business equipment that is lost by a Common Carrier and result of the Accident sustained during the Coverage Period. 2. Vehicles not required to be licensed; the loss is not reported to the Common Carrier within 24 Benefits will be payable for only one loss, that being the 3. Trucks, campers, jeep-type vehicles, trailers, all terrain hours after the loss and a claim is not filed with the greatest amount. Benefits are payable to You or, if applicable, vehicles, motorbikes, recreational vehicles, vans or Common Carrier; to Your estate unless a beneficiary is named on Your minivans mounted on a truck chassis; 8. Business equipment that is stolen and the theft is not application. 4. Antique cars (meaning cars that are over 20 years old or reported to the appropriate authorities; or have not been manufactured for 10 or more years); 9. Damage to the business equipment resulting from 5. Limousines; defective materials or workmanship, ordinary wear and tear and normal deterioration. Page 5 EFTA00317272 If Your business equipment is lost or stolen or damaged, 4. Benefits are payable to You or, if applicable, to Your Assignment: You may assign Your interest under the Policy the plan will pay the lesser of: estate unless a beneficiary is named on Your application. by giving Us written notice of such assignment. The 1. The cost to repair the item if damaged: or 5. For Inland Marine Benefits Only: All suits. actions or assignment will not be effective until We receive the written 2. An amount based on the age of the item as follows: legal proceedings arising from the plans. benefits, or notice. Neither the Company nor We assume any If up to 12 months old 90% of the purchase price services provided through the plans (collectively responsibility for the validity of any assignment. If up to 24 months old 50% of the purchase price "Controversies") may be submitted to binding desk Physical Examinations and Autopsy: The Company has the If up to 48 months old 25% of the purchase price arbitration in accordance with the rules then applying to right to physically examine You as often as reasonably needed Over 48 months old 0% the American Arbitration Association. No demand for while a claim is pending. The Company may also require an A police report is required for any stolen business equipment arbitration can be brought to recover benefits until 60 autopsy in the case of death, where it is not forbidden by law. claim. A Common Carrier report is required for any business days have elapsed following submission of Your entire The Company will bear all costs for these. equipment claim due to the equipment being lost or damaged claim to Us. No action in any form can be brought after Conformity with State Statutes: On the Policy effective date by a Common Carrier. In addition, damaged business three years from the date Your claim was submitted to shown on the Letter of Confirmation, if any provision conflicts equipment may require inspection by Us prior to claims World Access Service Corp. with the laws of the state in which You reside, it shall be payment and should be kept as proof of loss. 6. MISREPRESENTATIONS AND FRAUD: Coverage shall deemed amended to conform to law. Please refer to Your Letter of Confirmation to determine which be void if, whether before or after a loss, the insured has Misstatement of Age: If Your age is misstated, the Company benefits are specifically included within the plan You concealed or misrepresented any material fact or will adjust the premium, benefits, or both based on the true purchased and their corresponding maximum amount of circumstance concerning this Policy or the subject age. No misstatements will continue insurance otherwise coverage. thereof, or the interest of the insured therein, or if the validly terminated or terminate insurance otherwise validly in insured commits fraud or false swearing in connection force. BUSINESS EQUIPMENT RENTAL COVERAGE• with any of the foregoing. For Inland Marine Benefits Only: If Your business equipment is damaged. lost or delayed by the 7. You have a duty to make all reasonable efforts to Subrogation: The Company or We have the right to recover Common Carrier for 12 hours or more, or stolen, the plan will minimize losses from any insured benefit or Covered any payments We have made from anyone who may be reimburse You on one-time basis for the reasonable costs of Service. responsible for the loss. You and/or any person to whom We renting business equipment during Your Trip up the amount The following apply to the Accident and Health Benefits: make a payment must sign any papers and do whatever is indicated in Your Letter of Confirmation Notice of Claim: Written notice of claim must be given within necessary to transfer this right to Us. You and/or any person to A police report is required if Your business equipment is 20 days after a covered loss starts or as soon as reasonably whom We make a payment agree(s) to cooperate with Us and stolen. A Common Carrier report is required for proof of possible. The notice can be given to Us. Notice must include to do nothing after the loss that will adversely affect Our rights damage by. delay by or being lost by the Common Carrier. Your name and the Policy number. or those of the Company. No coverage will be provided for loss(es) due to any Claim Forms: When notice of claim is received, You will be General Exclusion. sent forms for filing proof of loss. If these forms are not sent Part VI. CLAIM FILING PROCEDURES Please refer to Your Letter of Confirmation to determine which within 15 days. You may meet the proof of loss requirement by To obtain a claim form, call Us at 1.800.949.6201 or visit benefits are specifically included within the plan You sending Us a written statement of the nature and extent of the www.allianztravelinsurance.com 24 hours a day seven days purchased and their corresponding maximum amount of loss within the time limit stated in the Proof of Loss provision. a week. All benefits will be paid in United States dollars. coverage. Proof of Loss: Written proof of loss must be given within 90 We will need certain information from You in the event You days after the date of loss. If it is not reasonably possible to need to file a claim. This documentation will include, but is not Part V. GENERAL PROVISIONS RELATED TO INSURANCE give written proof in the time required, the Company will not limited to, the following: BENEFITS reduce or deny the claim for this reason if the proof is filed as 1. No agent or other person has authority to accept or make soon as reasonably possible. In any event, the proof required General Documentation representations or information or alter, modify or waive must be given no later than 1 year from the time specified a. Receipts and itemized bills for all expenses. any of the provisions of this Policy. unless You lacked legal capacity. b. Original of any Refunds or expense allowances received 2. Claims must be submitted to Us within 90 days from date Time of Payment of Claim: Payment will be made from Your tour operator, travel agency, Common Carrier or of loss. except as otherwise prohibited by law. immediately upon receipt of due written proof of loss. other entity. 3. In the event that You are covered under another policy Legal Action: No action at law or in equity shall be brought to Trip Cancellation and Interruption Claims issued by the Company that provides the same or similar recover on this Policy prior to the expiration of 60 days after a. Any appropriate documentation that officially explains the coverage, the Company will adjust Your claim by applying written proof of loss has been furnished in accordance with the cause of Your trip cancellation or interruption. Any terms and conditions from the coverage that pays the requirements of this Policy. No action may be brought after explanation of diagnosis along with Your original itemized most. Any premium paid for duplicate coverage will be three years from the date written proof of loss is due unless bills, receipts, and proof of other insurance payments. refunded. otherwise provided by law. Page 6 EFTA00317273 b. Original unused tickets, copies of invoices, proof of b. Original police report or other report from local authorities Family Member means Your spouse: parent; child(ren), payments, and other documents that substantiate the cost verifying the theft of Your business equipment, if applicable. including children who are, or are in the process of becoming, or occurrence of the trip cancellation or interruption. c. Original receipt for the business equipment and rental costs. adopted; sibling: grandparent or grandchild(ren); step-parent; c. Documentation of Refunds received from the travel step-child; or step-sibling; in-laws (parent, son, daughter, supplier(s) and/or Common Carrier(s). Part VII. DEFINITIONS brother or sister); aunt: uncle; niece: nephew: legal guardian; d. Copy of the suppliers literature that describes penalties. Accident means an unexpected, unintended, unforeseeable ward; business partner; an employed caregiver who lives with e. A letter from the tour operator or an itemized bill from the event causing Injury. You; or a person with whom You have lived for 12 continuous travel agent stating the non-refundable amounts of the Trip Active Military Duty means serving in the United States months prior to the coverage effective date: whether or not costs. Armed Forces on a full-time basis, not including the United they travel with You. Emergency Medical or Dental Claim States Armed Forces Reserves. Felonious Assault is an act of violence against You requiring Any explanation of diagnosis(es) along with Your original Actual Cash Value means the amount an item is determined medical treatment in a Hospital. itemized bills, receipts, and proof of other insurance to be worth based on its market value, age and condition at Financial Default is a complete suspension of operations due payment(s). the time of loss. to financial circumstances whether or not a bankruptcy petition Baggage Insurance Claims Baggage means luggage and personal possessions, whether is filed. a. Original claim determination from the Common Carrier, if owned. borrowed or rented, taken by You on the Trip. Hospital means a provider that is a short-term, acute. general applicable. Common Carrier means an entity licensed to carry Hospital that: b. Original police report or other report from local authorities. passengers for hire on land. water or air, excluding vehicle 1. is a duly licensed institution; c. Original receipts and list of stolen, lost or damaged items. rental companies. 2. in retum for compensation from its patients. is primarily d. Proof of loss providing amount of loss, date, time and cause Coverage Period means the time during which benefits are engaged in providing Inpatient diagnostic and therapeutic of loss. payable hereunder, beginning on the effective date and ending services for the diagnosis. treatment, and care of injured Baggage Delay Claims on the termination date. and sick persons by or under supervision of Physicians: Proof from the Common Carrier that personal Baggage was Covered Service means a service or supply specified herein 3. has organized departments of medicine and major delayed or misdirected for at least 24 hours. for which benefits will be provided. surgery: Travel Delay Claims Deductible means a specified dollar amount shown on the 4. provides 24-hour nursing service by or under the Original police. Common Carrier or other report that verifies Letter of Confirmation that You must incur before the supervision of registered graduate nurses; and the cause and duration of the delay. Company or We will assume any liability for all or part of the 5. is not other than incidentally a) a skilled nursing facility, Travel Accident Claims remaining Covered Services. nursing home. custodial care home. health resort, spa or Copy of death certificate Emergency Dental Care means the services or supplies sanatorium. place for rest, place for the aged, place for CollisionlLoss Damage Insurance Claims provided by a licensed dentist, Hospital or Other Licensed the provision of rehabilitation care: b) a place for the a. Original police report. Provider that are medically and immediately necessary to treat treatment of mental illness: c) a place for the treatment of b. Original Rental Car Agreement. dental problems resulting from Injury, infection, breakage to alcoholism or drug abuse: d) a place for the provision of c. An itemized statement of repairs for the rental vehide tooth surface or loss of filling. hospice care; ore) a place for the treatment of pulmonary (unless the Company's adjuster has seen the car). Emergency Medical Care means the services or supplies tuberculosis. Business Equipment Coverage Claims provided by a Physician. Hospital or Other Licensed Provider Illness means a sickness, infirmity or disease that causes a a. Original loss report and claim determination from the that are Medically Necessary to treat any covered medical loss that begins during a Coverage Period and is not a Pre- Common Carrier verifying that the business equipment was Illness or Injury. the onset of which is sudden, that manifests existing Condition. lost or damaged by the Common Carrier, if applicable. itself by symptoms of sufficient severity, including sever pain, Immediate Family Member means Your spouse: parent; b. Original police report or other report from local authorities that a prudent layperson, possessing an average knowledge of child(ren). including children who are. or are in the process of verifying that the business equipment was stolen, if medicine and health, could reasonably expect the absence of becoming, adopted; Your siblings: Your grandparent or applicable. immediate medical attention to result in: grandchild(ren); step-parent; step-child; or step-sibling. c. Original receipts and list of stolen, damaged or lost business 1. placing the health of the person afflicted with such Individual Coverage is the insurance plan under which only equipment. condition in serious jeopardy; You are covered if You have selected this on Your application. d. Repair estimate, if the business equipment is damaged. 2. serious impairment to such person's bodily functions: Injury means bodily Injury caused by an Accident, directly and e. Proof of loss providing amount of loss, date. time and cause 3. serious dysfunction of any bodily organ or part of such independently of all other causes and sustained on or after the of loss. person: or effective date of this coverage and before the termination date. Business Equipment Rental Coverage Claims 4. serious disfigurement of such person. Benefits for Injury will not be paid for any loss caused by a. Proof from the Common Carrier that Your business sickness or other bodily diseases or infirmity. equipment was damaged, lost or delayed for at least 12 hours, if applicable. Page 7 EFTA00317274 Inpatient means a person who is treated as a registered bed Reasonable and Customary Charge means a charge in an Trip means: patient in a Hospital or Other Licensed Provider and for whom amount consistently made by other vendors/providers for a 1. a period of round-trip travel to and from a destination that a room and board charge is made. given service in the same geographic area and which reflects is at least 100 miles from Your main place of residence; Medically Necessary or Medical Necessity means the the complooty of the service taking into account availability of and services or supplies provided by a Hospital, Physician or Other experienced personnel, availability of services or parts, and 2. such travel is not to obtain health care or treatment of any Licensed Provider that are required to identify or treat Your with respect to Collision Damage Insurance, reflects the effort kind. Illness or Injury and which, as determined by Us. are: of the vendor/provider to repair the damaged vehicle (as We, Us or Our refers to BCS Insurance Company and its 1. consistent with the symptom or diagnosis and treatment measured by the ratio of total repair time to total time the agents. of Your condition, disease, Illness ailment or Injury; vehicle is in the vendor/provider's possession). You or Your refers to all persons listed on the Letter of 2. appropriate with regard to standards of good medical Refund means: Confirmation under the plan purchased. practice; 1. Money returned to You by the travel agent, tour operator, 3. not solely for the convenience of You, a Physician or airline, cruise line or other travel supplier; other provider; and 2. Any credit or voucher for future travel provided to You by 4. the most appropriate supply or level of service that can the travel agent, tour operator, airline. cruise line or other be safety provided to You. travel supplier; or When applied to the care of an Inpatient, it further means that 3. Any credits, recoveries or reimbursements from Your Your medical symptoms or condition requires that the services employer, another insurance company. a credit card cannot be safely provided to You as an Outpatient. issuer or any other institution. Normal Pregnancy or Childbirth means a pregnancy or Rental Car means a land motor vehicle with four or more Childbirth that is free of complications or problems. wheels, that is designed for use mainly on public roads and Other Licensed Providers means any person or entity other which You have rented for the period of time shown on the than a Hospital or Physician which is licensed, where required, Rental Car Agreement. to render medical or dental services. Rental Car Agreement means the entire contract that You Outpatient means a person who receives medical or dental receive when renting a car from a rental car agency that services or supplies while not an Inpatient. describes in full all of the terms and conditions of the rental, as The rest of this page intentionally left blank Physician means a person who is licensed and legally entitled well as the responsibilities of all parties under the Rental Car to practice medicine in the applicable field for which services Agreement. are delivered. Scheduled Departure Date means the date You have Preexisting Conditions means: selected to begin travel as shown on Your application and for 1. Any Injury occurring to You, a Traveling Companion, or a which paid travel arrangement have been made. Family Member prior to and including the effective date of Terrorism means the unsanctioned and illegal use of force Your insurance; and that caused destruction of property, Injury, or death by an 2. Any Illness occurring to You, a Traveling Companion, or a individual or group for the express or implied purpose of Family Member during the 120 days prior to and including achieving a political, ethnic, or religious goal or result. the effective date of Your insurance for which: a) medical Terrorism does not include general civil protest. unrest, rioting, diagnosis and treatment by a Physician has been sought or an act of war. or advised or for which symptoms exist which would Traveling Companion is a person traveling with You who cause a prudent person to seek diagnosis, care or must be listed on Your application and who shares the same treatment; or b) require taking prescribed drugs or accommodations as You. medicine unless the Illness remains controlled without Traveling Family Member is Your spouse. and any of Your any change in the required prescription. unmarried children under age of 23. including step-children or For the purposes of determining any Preexisting Conditions, legally adopted children, or grandparents and grandchildren the effective date of Your insurance will be Your Trip when traveling together without a parent. Any unmarried child, Cancellation Insurance effective date, if Trip Cancellation regardless of age. who is incapable of self-sustaining Insurance is purchased. If no Trip Cancellation Insurance employment by reason of mental Illness. developmental coverage is purchased, it will be Your Trip departure date. disability, mental retardation or physical handicap and became Form 52.201NY Primary Residence means a person's fixed, permanent and so incapable prior to age 23, shall be eligible for coverage. principal home for legal and tax purposes. Page 8 EFTA00317275 TRAVEL POLICY • OUTLINE OF COVERAGE LIMITED 6. Aviation, other than as a fare-paying passenger on a TRAVEL ASSISTANCE SERVICES PROVIDED BY AGA BENEFIT HEALTH COVERAGE scheduled or charter flight, operated by a scheduled SERVICE COMPANY 1. Read Your Policy Carefully — This outline of coverage airline; Our goal is to provide immediate help for common travel provides a very brief description of the important features of 7. Participating in a felony or to which a contributing cause problems almost everywhere in the world. However, despite the accident and health benefits ONLY of Your Policy. This is of the loss was a person being engaged in an illegal our best efforts, situations arise which are beyond our control not the insurance contract and only the actual Policy occupation. This includes You, Family Members, or and under these circumstances, we can only promise to make provisions will control. The Policy itself sets forth, in detail, the Traveling Companions, whether they are insured or not; every reasonable effort to help you resolve your problems. The rights and obligations of both You and Your insurance 8. Pre-existing conditions unless otherwise covered. hotline center staff will do its best to refer you to appropriate Company. It is, therefore, important that you READ YOUR None of these plans cover You: medical and legal providers. However, we cannot be held POLICY CAREFULLY! 1. If the purpose of the travel is to receive medical care, responsible for the quality of results of any medical or legal 2. Limited Benefit Health Coverage — Policies of this medication or treatment; services provided by these independent practitioners. category are designed to provide, to persons insured, limited 2. If the stated Trip departure and return dates do not reflect If you are in trouble and need help: or supplemental coverage. Your intended departure and return dates; 1. Call the hotline. From the U.S. call 1.800.6541908. From 3. Benefits - In addition to other benefits provided by this 3. If the tickets do not indicate the travel dates: all other locations call collect to 1.804281.5700. Policy, this Policy pays a maximum benefit of up to the amount 4. If You give incorrect data or facts; or If your emergency is immediate and life threatening, seek local listed in Your Letter of Confirmation is provided for covered 5. If the loss is not submitted to Us within 90 days from the emergency assistance at once and contact the hotline as soon Emergency Medical or Dental Care expenses incurred as a date of loss, except as otherwise prohibited by law, as possible. result of accidental Injury or Illness occurring during a Trip subject to the provision entitled Proof of Loss in this 2. Have the following information ready for the hotline within the Coverage Period. We will only pay for health care Policy. coordinator: services or supplies provided by Physicians, licensed dentists, Renewability — This Policy is issued for a stated term as a. Your name and ID number; and Hospitals, and Other Licensed Providers that are received shown in the Letter of Confirmation. b. Your location and local telephone number. during Your Trip and that are received greater than 100 miles The hotline coordinator will confirm your enrollment and from home and which are Medically Necessary for Emergency provide you with assistance. Medical and Dental treatment. Note: In some countries it may not be possible to call collect. If 4. Exclusions — In addition to any other general limitations you must phone the hotline directly, give your location and described in the Policy, coverage is not provided under the phone number to the hotline coordinator who will call you accident and health benefits for: back. 1. Intentionally self-inflicted harm, suicide or attempted suicide, of You, Your Traveling Companion, or Your Medical Assistance Family Member; If you have medical problems and are unable to find local care, 2. Pregnancy. other than unforeseen complications of we will refer you to a local physician. dentist, Hospital, medical pregnancy, of You, Your Traveling Companion, or Your facility or other appropriate resource, when available. Family Member; Medical Consultation and Monitoring 3. Mental or emotional disorders, or physical complications If you are hospitalized, the hotline center medical staff will related thereto, of You, Your Traveling Companion or keep in frequent contact with you and your local physician to Your Family Member; get information on the care you are receiving and to determine 4 Alcoholism or drug addiction, intoxication or under the the need for further assistance. We will also contact your influence of any narcotic unless administered on the personal physician and family at home, if necessary. advice of a Physician or physical complications related On•Site Hospital Payments thereto. of You. Your Traveling Companion or Your We will advance payments to Hospitals or guarantee Family Member; payments to secure your Medically Necessary admission to a 5. War (whether declared or undeclared), acts of war, Hospital. You must have the Emergency Medical & Dental participation in a riot or insurrection (except as provided Benefits and the maximum guarantee will be up to the limits for in the Travel Delay benefit); or service in the Armed specific in the Letter of Confirmation. Forces or units auxiliary thereto (except as specifically covered); Form 52.811 Page 9 EFTA00317276 Definitions Emergency Cash Transfer Getting you home after your care (medical repatriation) Hospital means a provider that is a short-term, acute. general If your cash or traveler's checks are lost or stolen, or if you If you're seriously ill or injured during your trip, under the care Hospital that: need funds for the immediate payment of unanticipated of a local doctor and unable to continue your trip, medical 1. is a duly licensed institution; expenses, we will help arrange to have emergency cash (in repatriation takes place once our medical team determines 2. in return for compensation from its patients, is primarily currency. traveler's checks or any other form acceptable to us) that you are medically stable to retum home via commercial engaged in providing inpatient diagnostic and therapeutic transmitted to you from your family or friends. Our hotline transportation carrier, such as a scheduled passenger airline. services for the diagnosis. treatment, and care of injured center staff will make all the necessary arrangements for you. and sick persons by or under supervision of physicians; Emergency Message Center • arrange and pay (less any refunds for unused tickets) for 3. has organized departments of medicine and major In the event of an emergency, call the hotline center, identify you to be transported via a commercial transportation surgery: yourself by your ID number, and give the hotline coordinator carrier in the same class of service that you were booked 4. provides 24-hour nursing service by or under the your message. We will make at least 3 attempts in 24 hours to for your trip. The transportation will be to one of the supervision of registered graduate nurses; and reach your requested party, and we will provide you with an following: 5. is not other than incidentally: a) a skilled nursing facility, update on the disposition of our attempts to deliver the • your primary residence; nursing home, custodial care home, health resort, spa or message. (We are not responsible for delivery of a message if • a location of your choice in the United States; or sanatorium, place for rest, place for the aged. place for the the recipient cannot be reached). This service can be used for • a medical facility near your primary residence or city of provision of rehabilitation care; b) a place for the treatment trips anywhere in the world. your choice in the United States. We'll take your of mental illness; c) a place for the treatment of alcoholism Flight Information request into consideration as long as the medical or drug abuse; d) a place for the provision of hospice care; If you are faced with a canceled or missed flight, just call the facility will accept you as a patient and is approved as ore) a place for the treatment of pulmonary tuberculosis. hotline center for 24-hour information on alternate flights. We medically appropriate for your continued care by our Medically Necessary means the services or supplies can provide you with scheduled departure and arrival times of medical director. provided by a Hospital, physician or other licensed provider alternate, direct flights only. We do not book reservations or • arrange and pay for a Medical Escort if our medical team that are required to identify or treat your illness or injury and pay for tickets. This service can be used on trips within the determines a Medical Escort is necessary. which, as determined by us, are: U.S.. Canada, the Caribbean and Mexico only. 1. consistent with the symptom or diagnosis and treatment of Bringing a friend or family member to you (transport to your condition, disease, illness. ailment or injury; Emergency Medical Transportation bedside) 2. appropriate with regard to standards of good medical Important If you're told you will be hospitalized for more than seven days practice; If your emergency is immediate and life threatening, seek during your trip, we'll transport a friend or family member to 3. not solely for the convenience of you, a physician or other local emergency care at once. stay with you. We'll arrange and pay for round-trip provider, and transportation in economy class on a common carrier. 4. the most appropriate supply or level of service that can be Your emergency medical transportation limit is the total Getting your children home (return of dependents) safely provided to you. amount available for all covered services described If you're told you will be hospitalized for more than seven days When applied to the care of an inpatient, it further means that below. Please refer to your Letter of Confirmation to during your trip, well arrange for and pay (less any refunds for your medical symptoms or condition requires that the services confirm that you have this benefit in your plan and your unused tickets) to transport your children under the age of 23 cannot be safely provided to you as an outpatient. total dollar limit who are traveling with you to one of the following: You or your representative must contact us and we must • your primary residence: or Travel Document and Ticket Replacement Assistance • a location of your choice in the United States. make all transportation arrangements in advance. We will not The plan provides you with information to assist in obtaining Transportation will be on a common carrier in the same class pay for any of the services listed in this section if we didn't replacements of lost passports or other important travel authorize and arrange it. of service they were originally booked. documents. We also help you to replace lost airline and other Transporting your remains (repatriation of remains) travel tickets and will assist you in obtaining money for this Moving you to a Hospital or medical clinic (emergency medical evacuation) We'll arrange and pay for the reasonable and necessary purpose. These funds will come from your family or friends. services to transport your remains to one of the following: We will make all the necessary arrangements for you, If you're seriously ill or injured during your trip and our medical team determines that the local medical facilities are unable to • a funeral home near your primary residence: or including assisting you to return home if your trip is interrupted. provide appropriate medical treatment: • a funeral home located in the United States. Legal Assistance • our medical team will consult with the local doctor, We'll also assist the sending and receiving funeral homes If you have legal problems, our hotline center staff will help • well identify the closest appropriate facility, make coordinate with each other. you find a local legal advisor. If you require the posting of bail arrangements and pay to transport you to that facility; and This benefit does not include funeral, burial or cremation or immediate payment of legal fees, we will help arrange a • well arrange and pay for a Medical Escort if we determine expenses or related containment expenses for items such as a cash transfer from your family or friends. one is necessary. coffin, urn or vault. Page 10 EFTA00317277 Your representative must contact us in advance to make these This page intentionally left blank arrangements. If this is not possible, your representative must contact us within a reasonable time, but no later than one year after the transportation. Definitions Hospital means a provider that is a short-term, acute, general Hospital that: 1. is a duly licensed institution; 2. in return for compensation from its patients, is primarily engaged in providing inpatient diagnostic and therapeutic services for the diagnosis, treatment, and care of injured and sick persons by or under supervision of physicians: 3. has organized departments of medicine and major surgery; 4. provides 24-hour nursing service by or under the We're only a CLICK away! supervision of registered graduate nurses; and 5. is not other than incidentally: a) a skilled nursing facility, nursing home, custodial care home, health resort, spa or Visit sanatorium, place for rest, place for the aged, place for the provision of rehabilitation care; b) a place for the treatment www.allianztravelinsurance.com of mental illness; c) a place for the treatment of alcoholism to: or drug abuse: d) a place for the provision of hospice care; ore) a place for the treatment of pulmonary tuberculosis. • File a claim Medical Escort means a professional person contracted by our medical team to accompany a seriously ill or injured • Check claim status person while they are being transported. A Medical Escort is • Modify a policy trained to provide medical care to the person being • Quote a new policy transported. A friend or family member cannot be a Medical Escort. • Save a quote CONCIERGE SERVICES While on your covered trip, we can help make your vacation more memorable. Please contact us for: • Restaurant and local event information • Emergency and after hours hotel information and reservations • Golf tee times, information, referrals and reservations All of our concierge benefits are service benefits, not financial benefits. Any costs associated with the services Global Assistance are paid by you. Please refer to your Letter of Confirmation to determine if this benefit is specifically included within the plan you purchased. ANNL2_NY_D ANNL2_NY_D Page 11 02/14 EFTA00317278 BCS Insurance Company Privacy Notice BCS respects the privacy of its customers and farmer customers and protects the security and confidentiality of their nonpublic personal information. To safeguard our customers' confidential information, we comply with all applicable laws and regulations and have instituted our own policies to: (1) insure the security and confidentiality of customer records and information; (2) protect against any anticipated threats or hazards to the security or integrity of such records: and (3) protect against unauthorized access to or use of such records or information which could result in substantial harm or inconvenience to any customer. BCS PRIVACY POLICY: Policies and practices with respect to disclosing your nonpublic personal information: We do not disclose any nonpublic personal financial information about our customers or former customers to anyone, except as permitted by law. Categories of nonpublic personal information that we collect: We collect nonpublic personal financial information about you from the following sources: (1) information we receive from you on applications or other forms; (2) information about your transactions with us, our affiliates, or others, and; (3) information we receive from a consumer reporting agency. Policies we maintain to protect the confidentiality and security of nonpublic personal information: We maintain physical, electronic, and procedural safeguards that comply with federal and state regulations to guard your nonpublic personal financial information. We restrict access to your nonpublic personal information to employees who need it to provide information or services to you. AGA Service Company d/bla Allianz Global Assistance is the administrator of this insurance policy on behalf of BCS Insurance Company. We will adhere to at least the same standards for handling and protecting your data as described above. For more information about how we handle and protect your data, please see our privacy policy, located at http://mws.alfianzassistance.com/privacy or contact us at: Allianz Global Assistance, ATTN: Chief Privacy Officer. P. O. Box 72031. Richmond, VA 23255-2031. BCSPRIVNOT EFTA00317279