Liaison Worldwide Insurance
Liaison Worldwide Insurance or Liaison Worldwide Travel Medical Insurance offers medical insurance for U.S. citizens traveling outside of the United States and Foreign Nationals traveling to the United States. Plan is ideal for trips between 5 days to 3 years, with continuous renewal available as little as 5 days at a time. Immediate coverage available and ability to print ID card immediately after online quote, application and purchase. Underwritten by Nationwide Insurance USA, Liaison Worldwide Insurance plan is administered by Seven Corners Insurance worldwide.
Liaison Worldwide Insurance Plan
Liaison Worldwide Insurance Plan benefits the global traveler and offers non-U.S. citizens visiting USA and American citizens traveling abroad, review plan benefit information, policy options, coverage details and purchase policy online.
| |
 |
| |
Liaison Worldwide |
| Quote / Buy Liaison Travel Medical Insurance Online |
Liaison Worldwide Insurance Quote |
| Plan Brochure |
Liaison Worldwide Insurance Brochure |
| Coverage Period or Duration |
Up to 12 months; Renewable: Up tp 3 years (Age 65+ - up to 1 year) |
| Maximum Medical Benefit |
$50,000, $150,000, $300,000, or $500,000 |
| Emergency medical evacuation/ repatriation |
Up to $300,000 (in addition to the Medical Maximum) |
| Accidental death & dismemberment (AD & D) |
Up to $25,000 |
| Waiver of Pre-Existing conditions |
Up to $20,000 (see plan exclusion in the Brochure) |
| Travel Assistance Services |
Included and Available 24/7/365 |
| Terrorism Coverage |
Coverage Available |
| Available for purchase in all states |
See 1 below |
| Terrorism covered as any other accident or sickness |
Yes |
| Coverage for Political Evacuation |
- |
| 24 Hour Worldwide Assistance service included |
Yes |
| Medical benefit maximum options |
$50,000
$150,000
$300,000
$500,000
See 3 below
|
| Separate benefit for Emergency Evacuation |
Yes |
| Inpatient and Outpatient services covered |
Yes |
| Insurance Underwriter |
Nationwide |
| Rating of Insurance Company at least A- or better |
Yes |
| Quote / Buy Liaison Travel Medical Insurance Online |
Buy Liaison Worldwide Insurance |
- Any Country Except: Albania, Bulgaria, Belarus, Bosnia-Herzegovina,
Burma, Ivory Coast (Cote d'Ivoire), Congo, (Democratic) Republic of
Croatia, Cuba, Greece, Iran, Iraq, Liberia, Macedonia, North Korea,
Palestinian Authority, Sudan, Serbia-Montenegro, Syrian Arab Republic
Turkey, Zimbabwe
All States Except: Connecticut, Washington DC, Kansas, Louisiana,
Maryland, Maine, North Carolina, New Hampshire, New York Oregon,
Vermont, Washington
- Points from above table
- For insured persons age 80 years or older, Medical Maximum is limited to $15,000
Disclaimer: The information provided on this page is only a summary, be sure to read full brochure for complete details. Also this might change and always refer the plan brochure for the latest information on the plans.
Liaison Worldwide Travel Insurance
EVIDENCE OF BENEFITS
Eligibility:
Liaison Worldwide Plan provides coverage for individuals and families provided You are either: a) a U.S. citizen traveling outside the United States; or b) a
Non-U.S. citizen traveling outside Your Home Country; or c) an Eligible Spouse or Eligible Dependent Child as defined hereunder.
Coverage is not available in all Countries. Please refer to the Information section of this document for a listing of these Countries.
Home Country is defined as: The country where You have Your true, fixed and permanent home and principal establishment.
Eligible individuals may also purchase coverage for their eligible dependents. An eligible spouse shall be defined as the Primary Insureds legal spouse. An
Eligible Dependent Child shall mean the Primary Insured Persons unmarried children over 30 days and under 19 years of age or under 25 years of age if
they are attending an accredited institution of higher learning on a regular full-time basis and/or wholly dependent upon the Insured Person for maintenance
and support.
Period of Coverage:
The minimum period of coverage under the Liaison Worldwide Plan is 5 days, maximum is 12 months. Coverage can be purchased in a combination of
monthly and/or daily periods by paying the appropriate Plan Cost.
Effective Date of Coverage begins on the latest of the following:
1. The date and time the Company receives a completed application and Plan Cost for the Period of Coverage; or
2. The Effective Date requested on the application; or
3. The moment You depart Your Home Country; or
4. The date the Company approves the application.
Expiration Date of Coverage terminates on the earlier of the following:
1. Your return to Your Home Country (except as provided under the Home Country Coverage); or
2. The expiration of 12 months from the Effective Date of Coverage; or
3. The date shown on the ID Card; or
4. The end of the period for which Plan Cost has been paid; or
5. The date You fail to be considered an Eligible Person; or
6. The maximum benefit amount has been paid.
SCHEDULE OF BENEFITS:
All coverages and plan costs listed in this Evidence of Benefits are in U.S. Dollar amounts.
Medical Maximum $50,000; $150,000; $300,000, $500,000 (age 80+, maximum limited to $15,000)
Deductible $0; $100; $250; $500; $1,000; $2,500: Deductible is per person per policy period Deductible.
The selected Deductible and Coinsurance amount must be met for each 12-month period.
Coinsurance Foreign Nationals Traveling to the United States: After You pay the Deductible, the plan pays
80% of the next $5,000 of eligible expenses, then 100% to the selected Maximum.
United States Citizens Traveling Outside the United States: After You pay the Deductible,
the plan pays 100% to the selected Maximum.
Hospital Indemnity* $150 per night, up to a maximum of 30 days
Dental (Accident Coverage) To a maximum of $500
Dental (Sudden Relief of Pain) To a maximum of $100
Emergency Medical Evacuation/ Repatriation $300,000 (in addition to the Medical Maximum)
Return of Mortal Remains $50,000
Return of Minor Child(ren) $50,000
Emergency Reunion $50,000
Accidental Death & Dismemberment (AD&D) $25,000 Principal Sum for Insured or Insured Spouse / $5,000 for Dependent Child
Baggage Loss and/or Delay $250
Interruption of Trip $5,000
Home Country Coverage Incidental Trips to The Home Country: Up to $50,000
Extension of Benefits: Up to 30 days or $5,000 of coverage
Hospital Room & Board Usual, reasonable and customary to the selected Policy Maximum
Intensive Care Usual, reasonable and customary to the selected Policy Maximum
Outpatient Medical Expenses Usual, reasonable and customary to the selected Policy Maximum
Unexpected Recurrence of a Pre-existing
Condition*
Up to $20,000
Benefit Period 180 days
*These benefits are only available for U.S. citizens traveling outside the U.S.
DESCRIPTION OF BENEFITS
Medical Expenses:
Liaison Worldwide Plan shall pay Reasonable and Customary charges for Covered Expenses, excess of the chosen Deductible and Coinsurance up to the
selected Medical Maximum, incurred by You due to an Accidental Injury or Illness which occurred during the Period of Coverage outside Your Home Country
(except as provided under the Home Country Coverage). All bodily disorders existing simultaneously which are due to the same or related causes shall be
considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement, the Disablement shall be
considered a continuation of the prior Disablement and not a separate Disablement. The initial treatment of an Injury or Illness must occur within 30 days of
the date of Injury or onset of Illness.
Only such expenses which are specifically enumerated in the following list of charges are incurred within 180 days from the date of accident or onset of
Illness, and which are not excluded shall be considered Covered Expenses:
1) Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service and with the
exception of personal services of a non-medical nature; provided, however, that expenses do not exceed the Hospitals average charge for
semiprivate room and board accommodations.
2) Charges made for Intensive Care or Coronary Care charges and nursing services.
3) Charges made for diagnosis, Treatment and Surgery by a Physician.
4) Charges made for an operating room.
5) Charges made for Outpatient Treatment, same as any other Treatment covered on an Inpatient basis.
This includes ambulatory Surgical centers, Physicians Outpatient visits/examinations, clinic care, and Surgical opinion consultations.
6) Charges made for the cost and administration of anesthetics.
7) Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood, transfusions,
iron lungs, and medical Treatment.
8) Charges for physiotherapy, if recommended by a Physician for the Treatment of a specific Disablement
and administered by a licensed physiotherapist.
9) Dressings, drugs, and Medicines that can only be obtained upon a written prescription of a Physician or Surgeon.
10) Local transportation to or from the nearest Hospital or to and from the nearest Hospital with facilities for required Treatment. Such transportation
shall be by licensed ground ambulance only to a limit of $5,000, within the metropolitan area in which You are located at that time the service is
used. If You are in a rural area, then licensed
air ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense.
Pre-Notification / Referral:
In order to ensure Your claims are addressed as efficiently as possible, You or the provider of service must contact the Assistance Company for
prenotification prior to: any medical Treatment in the U.S. as well as hospital admissions and inpatient / outpatient surgeries incurred worldwide. The
Assistance Company has trained personnel available 24 hours a day,
7 days a week throughout the year to answer Your questions, provide assistance, and guide You to an appropriate facility if necessary. In the case of an
Emergency Admission, the Assistance Company must be contacted within 48 hours, or as soon as reasonably possible. Pre-notification does not guarantee
that benefits will be paid.
Please be aware that this is not a general health insurance policy, but an interim, limited benefit period, travel medical plan intended for use while
away from Your Home Country. The Liaison Worldwide Plan does not guarantee payment to a facility or individual for medical expenses until it
has been determined that it is an eligible expense.
Unexpected Recurrence of a Pre-Existing Condition: (This benefit is only available to U.S. citizens traveling outside the United States) This Plan shall
pay, up to $20,000 subject to the chosen Deductible and Coinsurance, for Covered Expenses resulting from a sudden, unexpected recurrence of a Pre-
Existing Condition while traveling outside the United States. This benefit does not include coverage for known, scheduled, required, or expected medical
care, drugs or treatments existent or necessary prior to the Effective Date of coverage.
Hospital Indemnity: (This benefit is only available to U.S. citizens traveling outside the United States) If You are confined to a Hospital as a registered
Inpatient as the result of an Illness or Injury which occurs during Your Period of Coverage, this plan will pay Benefits up to $150 per day of confinement, in
addition to any other covered expense, up to a maximum of thirty (30) days.
Dental: Accident Coverage: This Plan shall pay in excess of the chosen Deductible and Coinsurance of up to a maximum of $500, for emergency
treatment to repair or replace sound natural teeth damaged as the result of a covered accident.
Dental: Emergency Relief of Pain: This plan shall pay in excess of the chosen Deductible and Coinsurance up to a maximum of $100, for emergency
treatment for the relief of pain to natural teeth.
Emergency Medical Evacuation/Repatriation: The Plan will pay Covered Expenses incurred if any covered Injury or Illness commences during the
Period of Coverage that results in the Medically Necessary Emergency Medical Evacuation or Repatriation (Your medical condition warrants immediate
transportation from the medical facility where You are located to the nearest adequate medical facility where medical Treatment can be obtained). This
benefit must be approved and arranged by the Assistance Company in consultation with the local attending Physician.
Return of Mortal Remains: The Plan will pay the reasonable Covered Expenses incurred up to a maximum of $50,000 to return Your remains to Your
Home Country, if You should die. This benefit must be approved and arranged by the Assistance Company.
Return of Minor Child(ren): Should You be traveling alone with a Minor Child(ren) and are hospitalized because of a covered Illness or Injury and the
Minor Child(ren), under age 19, is left unattended, the Plan will arrange and pay up to $50,000 for a one way economy fare to their Home Country (including
the cost of an attendant/escort, if necessary to insure the safety and welfare of a Minor Child(ren)). This benefit must be approved and arranged by the
Assistance Company.
Emergency Medical Reunion: When Emergency Medical Evacuation or Repatriation is ordered and the attending Physician recommends that a family
member travel with You, the plan will arrange and pay, up to $50,000, for a round trip economy-class transportation for one individual of Your choice, from
Your Home Country, to be at Your side while You are hospitalized and then accompany You during Your return to Your Home Country. This benefit must
be approved and arranged by the Assistance Company.
Accidental Death & Dismemberment: Benefits shall be paid to You if You sustain an Accidental Injury. The Injury must occur during the Period of
Coverage and death or dismemberment as a result of that Accident must occur within 365 days from the date of Accident. Benefits payable for any such
loss shall be in accordance with the following table: If You incur more than one Loss stated in the following Table as the result of one Accident, only the
largest amount, shall be payable.
Description of Loss Percent of Principal Sum
Life 100%
Both Hands or Both Feet or Sight of Both Eyes 100%
One Hand and One Foot 100%
Either Hand or Foot and Sight of One Eye 100%
Either Hand or Foot 50%
Life as the result of a Common Carrier Accident 200%
Baggage Loss and/or Delay: This Plan will reimburse You for lost baggage and personal effects checked with a Common Carrier provided the Insured
Person has taken all reasonable measures to protect, save and/or recover his/her property at all times. The baggage and personal effects must be owned
by and accompany the Insured Person at all times. There will be a per article limit of $50 to a maximum benefit limit of $250 as per the Schedule of
Benefits. The Plan will pay the lesser of the following:
1. The actual cash value (cost less proper deduction for depreciation at the time of loss);
2. The cost to repair or replace the article with material of a like kind and quality; or
3. $50 per article.
For Baggage Delay: If Your checked baggage is delayed or misdirected by a Common Carrier for more than 24 hours from Your time of arrival at a
destination other than Your Home Country, benefits will be paid, up to the amount stated in the Schedule of Benefits, Baggage Loss and/or Delay, for the
actual expenditure for necessary personal effects. An Insured Person must be a ticketed passenger on a Common Carrier. The Common Carrier must
certify the delay or misdirection. Receipts for the purchases must accompany any claim.
This coverage is secondary to any coverage provided by a Common Carrier. You must furnish proof to the Company that full reimbursement has been
obtained from the airline.
Interruption of Trip: If You are unable to continue the trip due to the death of an Immediate Family member (parent, spouse, sibling or child) or due to
serious damage to Your principal residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane, etc.), the Plan will reimburse (up to
$5,000) for the cost of economy travel, less the value of applied credit from an unused return travel ticket, to return You home to Your area of principal
residence. This benefit must be approved and arranged by the Assistance Company.
Home Country Coverage:
Incidental Trips to Your Home Country: This benefit covers You for incidental trips to Your Home Country (60 days per 12 months of purchased coverage
or pro rata thereof - example: approximately 5 days per month of purchased coverage). Maximum benefit is reduced to $50,000 for any illness or injury
occurring while on an incidental trip to Your Home Country.
Home Country Extension of Benefits: The Plan shall pay up to a maximum of $5,000 for Covered Expenses incurred in Your Home Country related to an
Injury or Illness which occurred, was diagnosed and treated outside Your Home Country during Your period of coverage (does not apply for Emergency
Evacuation or Repatriation).
Assistance Services: Upon enrollment into Liaison Worldwide Plan, You are eligible to use any of the assistance services provided by the Assistance
Services Provider. Additional information is contained in the Plan Summary. Open 24 hours / day, 365 days a year - Multilingual personnel - Physicians /
Nurses on staff - Locate local facilities - Help with emergency situations.
PLAN DEFINITIONS
Benefit Period shall mean the allowable time period You have from the date of Injury or onset of Illness to receive Treatment for a Covered Injury or Illness.
If Your Plan terminates during Your Benefit Period, You will still be eligible to receive Treatment so long as the treatment is within Your Benefit Period and
outside Your Home Country (except as provided under the Home Country Coverage).
Coinsurance shall mean the percentage amount of Covered Expenses, after the Deductible, which is Your responsibility to pay.
Common Carrier shall mean any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire.
Company shall mean Nationwide Life Insurance Company. Florida residents Company shall mean Nationwide Mutual Insurance Company.
Deductible shall mean the amount of Covered Expenses which is Your responsibility to pay before benefits under the Plan are payable.
Eligible Dependent Child shall mean Your unmarried children over 30 days and under 19 years of age or under 25 years of age if they are attending an
accredited institution of higher learning on a regular full-time basis and/or wholly dependent upon the Insured Person for maintenance and support.
Eligible Spouse shall mean Your legal spouse.
Home Country shall mean the country where You have Your true, fixed and permanent home and principal establishment.
Illness shall mean sickness or disease of any kind contracted and commencing while this Policy is in force as to the Insured Person whose Illness is the
basis of claim. Any complication or any condition arising out of an Illness for which the Insured Person is being treated or has received Treatment will be
considered as part of the original Illness.
Injury shall mean accidental bodily injury or injuries caused by an accident which occurs after the Effective Date of this Policy. The Injury must be the direct
cause of the loss, independent of disease or bodily infirmity.
Inpatient shall mean if You are confined in an institution and are charged for room and board.
Mountaineering shall mean the sport, hobby or profession of walking, hiking, and climbing up mountains either: 1) utilizing harnesses, ropes, crampons or
ice axes; or 2) ascending 4,500 meters or above.
Outpatient shall mean if You receive care in a Hospital or another institution, including; ambulatory surgical center; convalescent/skilled nursing facility; or
Physicians office, for an Illness or Injury, but who is confined and is not charged for room and board.
Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute.
Pre-existing Condition shall mean any condition that would have caused a person to seek medical advice, diagnosis, care or treatment during the 36
months prior to the Effective Date of coverage under this Plan; 2) a condition for which medical advice, diagnosis, care or Treatment was recommended or
received during the 36 months prior to the Effective Date of coverage under this Plan;
If You are a U.S. citizen and traveling outside the United States the period is lowered from 36 months to 12 months prior to the Effective Date of Coverage.
Reasonable and Customary shall mean the maximum amount that the Plan determines is Reasonable and Customary for Covered Expenses You receive,
up to but not to exceed charges actually billed. The determination considers:
1) amounts charged by other Service Providers for the same or similar service in the locality where received, considering the nature and severity of the
bodily Injury or Illness in connection with which such services and supplies are received;
2) any usual medical circumstances requiring additional time, skill or experience; and
3) other factors included but not limited to, a resource based relative value scale.
Treatment means a specific in-office or Hospital physical examination of or care rendered to You, consultation, diagnostic procedures and services,
Surgery, medical services and supplies including medication prescribed or provided by a Service Provider.
You or Your shall mean the Primary Insured Person.
EXCLUSIONS AND LIMITATIONS
No Benefit shall be payable for Accident Medical, Sickness Medical, In-Hospital Indemnity, Unexpected Recurrence, Dental, Emergency Medical
Evacuation/Repatriation, Return of Mortal Remains, Return of Minor Child, Emergency Medical Reunion, as the result of:
1. Any Pre-Existing Condition as defined hereunder. This exclusion does not apply to Emergency Evacuation/Repatriation.
2. Injury or Illness which is not presented to the Company for payment within 3 months of receiving Treatment;
3. Charges for Treatment which is not Medically Necessary;
4. Charges provided at no cost to You;
5. Charges for Treatment which exceeds Reasonable and Customary charges;
6. Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes;
7. Services, supplies or treatment, including any period of Hospital confinement, which were not recommended, approved and certified as Medically
Necessary and reasonable by a Physician;
8. Suicide, or any attempt thereof, while sane or self destruction or any attempt thereof, while sane;
9. Any consequence, whether proximately or remotely occasioned by, or traceable to, or arising in connection with the following, which shall hereinafter
for the purposes of this Exclusion be called the Incidents:
a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power.
c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the
Government du jure or de facto.
d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of marital law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether proximately or remotely
occasioned by, traceable to, arising in connection with, any of the said Incidents shall be deemed to be consequences for which the Company shall
not be liable under this Policy except to the extent that the Insured Person shall prove that such consequence happened independently of the
existence of such abnormal conditions.
10. Injury sustained while participating in professional athletics;
11. Injury sustained while participating in amateur or interscholastic athletics;
12. Routine physicals, immunizations or other examinations where there are no objective indications or impairment in normal health, and laboratory
diagnostic or x-ray examinations, except in the course of a disablement established by a prior call or attendance of a Physician;
13. Treatment of the temporomandibular joint;
14. Vocational, speech, recreational or music therapy;
15. Services or supplies performed or provided by a relative of Yours, or anyone who lives with You;
16. Cosmetic or plastic Surgery, except as the result of a covered Accident; for the purposes of this Plan, treatment of a deviated nasal septum shall be
considered a cosmetic condition;
17. Elective Surgery which can be postponed until You return to Your Home Country, where the objective of the trip is to seek medical advice, treatment
or Surgery;
18. Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids;
19. Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or for the fitting thereof, unless caused by
Accidental bodily Injury incurred while covered hereunder;
20. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent;
21. Injury sustained or Disablement due wholly or partly to the Insured being intoxicated as defined and determined by the laws of the state where the
Injury occurred; or to the Insured being under the influence of any narcotic, unless administered on the advice of a Physician;
22. Any Mental and Nervous disorders or rest cures;
23. Congenital abnormalities and conditions arising out of or resulting there from;
24. Expenses which are non-medical in nature;
25. Expenses as a result of or in connection with intentionally self-inflicted Injury or Illness;
26. Expenses as a result of or in connection with the commission of a felony offense;
27. Injury sustained while taking part in mountaineering; hang gliding; parachuting; bungee jumping; racing by horse, motor vehicle or motorcycle;
snowmobiling; motorcycle/motor scooter riding; scuba diving, involving underwater breathing apparatus (unless PADI or NAUI certified); snorkeling;
water skiing; snow skiing; spelunking; parasailing and snow boarding;
Hazardous Sport Coverage: the following are covered if the required premium has been paid: motorcycle/motor scooter riding, hang gliding,
parachuting, bungee jumping, water skiing, snow skiing, snowmobiling, snow boarding and spelunking.
28. Treatment paid for or furnished under any other individual or group policy or other service or medical pre-payment plan arranged through the employer
to the extent so furnished or paid, or under any mandatory government plan or facility set up for treatment without any cost to You;
29. Treatment of venereal disease;
30. Dental care, except as the result of Injury to natural teeth caused by Accident, unless otherwise covered under this Plan;
31. Routine Dental Treatment;
32. For Pregnancy or Illness resulting from Pregnancy, childbirth, or miscarriage;
33. For miscarriage resulting from Accident;
34. Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination,
treatment for infertility or impotency, sterilization or reversal thereof;
35. Treatment for human organ tissue transplants and their related treatment;
36. Expenses incurred while in Your Home Country, except as provided under the Home Country Coverage;
37. Expenses incurred during a Hospital emergency visit which is not of an emergency nature;
38. Covered Expenses incurred for which the Trip to the Host Country was undertaken to seek medical treatment for a condition;
39. Covered Expenses incurred during a Trip after Your Physician has limited or restricted travel;
40. This Policy does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly from the
discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical,
biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act.
41. Sex change operations, or for treatment of sexual dysfunction or sexual inadequacy;
42. Weight reduction programs or the surgical treatment of obesity;
43. Expenses resulting from Acquired Immune Deficiency Syndrome (AIDS), Aids-Related Complex (ARC) or the Human Immunodeficiency Virus (HIV).
No Benefit shall be payable for Accidental Death and Dismemberment as the result of:
1. Suicide or attempt thereof while sane or self destruction or any attempt thereof while insane;
2. Disease of any kind; Bacterial infections except pyogenic infection which shall occur through an accidental cut or wound;
3. Hernia of any kind;
4. Injury sustained while You are riding as a pilot, student pilot, operator or crew member, in or on, boarding or alighting from, any type of aircraft;
5. Injury sustained while You are riding as a passenger in any aircraft (a) not having a current and valid Airworthy Certificate and (b) not piloted by a
person who holds a valid and current certificate of competency for piloting such aircraft;
6. Any consequence, whether proximately or remotely occasioned by, or traceable to, or arising in connection with the following, which shall hereinafter
for the purposes of this Exclusion be called the Incidents:
a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power.
c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the
Government du jure or de facto.
d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of marital law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether proximately or remotely
occasioned by, traceable to, or arising in connection with, any of the said Incidents shall be deemed to be consequences for which the Company shall
not be liable under this Policy except to the extent that the Insured Person shall prove that such consequence happened independently of the
existence of such abnormal conditions.
7. Service in the military, naval or air service of any country;
8. Flying in any aircraft being used for or in connection with acrobatic or stunt flying, racing or endurance tests;
9. Flying in any rocket-propelled aircraft;
10. Flying in any aircraft being used for or in connection with crop dusting or seeding or spraying, fire fighting, exploration, pipe or power line inspection,
any form of hunting or herding, aerial photography, banner towing or any experimental purpose;
11. Flying in any aircraft which is engaged in any flight which requires a special permit or waiver from the authority having jurisdiction over civil aviation,
even though granted;
12. Sickness of any kind;
13. Being under the influence of alcohol or having taken drugs or narcotics unless prescribed by a legally qualified Physician or surgeon;
14. Injury occasioned or occurring while You are committing or attempting to commit a felony or to which a contributing cause was You being engaged in
an illegal occupation;
15. While riding or driving in any kind of competition;
16. Pregnancy, childbirth, miscarriage or abortion;
17. This Policy does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly from the
discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical,
biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act.
No Benefit shall be payable for the following items under the Loss of Checked Baggage Benefit:
1. Aircraft, automobiles, automobile equipment, motors, motorcycles, bicycles (except bicycles when checked as baggage with a common carrier), boats
or other conveyances or their accessories;
2. Animals;
3. Artificial teeth or limbs, hearing aids;
4. Sunglasses, contact lenses or eyeglasses;
5. Documents of any kind, including but not limited to documents, bills, currency, deeds, evidences of debt, letters of credit, stamps, credit cards, money,
notes, securities, transportation or other tickets;
6. Household furniture or furnishings.
PLAN PROVISIONS
Refund of Premium:
Nationwide realizes that there is uncertainty in international travel. Refund of total plan cost will only be considered if written request is received by the
Administrator prior to the Effective Date of Coverage. If written request is received after the Effective Date of Coverage, the unused portion of the Plan cost
may be refunded minus a cancellation fee, provided no claim has been submitted to the Administrator for reimbursement.
Claim Submission:
Filing a claim is easy. You will receive a Liaison Worldwide Plan, Identification card and claim form once You are approved for insurance. When You
receive Treatment, send the original, itemized bills to the Administrator within 90 days. Eligible bills are automatically converted from local currencies to U.S.
dollars. For payments of eligible medical expenses, notify the Administrator of pending treatments and we can refer You to approved health care providers
worldwide. You are only responsible for Your Deductible, Coinsurance amounts and non-eligible expenses. For more details, consult the Plan Summary
that is provided with Your insurance kit, or contact the Administrator.
Time of Payment of Claims: Indemnities payable under the Policy for any loss other than loss for which the Policy provides any periodic payment will be
paid within 30 days upon receipt of due written proof of such loss. Benefits paid more than 30 days following the Companys receipt of due written proof of
loss will include interest that will accrue at the rate of 9% per annum from the 30th day after receipt of such proof to the date the benefit is paid. Subject to
due written Proof of Loss, all accrued indemnities for loss for which the Policy provides periodic payment will be paid at the expiration of each four weeks
during the continuance of the period for which the Company is liable, and any balance remaining unpaid upon the termination of liability will be paid
immediately upon receipt of due written proof.
Excess Benefits: All coverages, except Accidental Death and Dismemberment, shall be in excess of all other valid and collectible Insurance Indemnity and
shall apply only when such benefits are exhausted. Other valid and collectable Insurance Indemnity for which benefits may be payable are Insurance
programs provided by:
(a) Individual, group or blanket Insurance or coverage;
(b) Other prepayment coverage provided on a group or individual basis;
(c) Any coverage under labor management trusted plans, union welfare plans, employer organizational plans, employee benefit organization
plans, or other arrangement of benefits for individuals of a group;
(d) Any coverage required or provided by any statute, socialized Insurance program;
(e) Any no-fault automobile Insurance;
(f) Any third party liability Insurance.
Monetary Limits:
The monetary limits stated in this Plan and the plan cost shall be in U.S. dollars. For service outside of the territorial limits of the United States, the
exchange rate date used to determine the amount of U.S. dollars to be paid is the exchange rate effective for the date the claims expense was incurred.
About the Administrator:
Nationwide has selected Seven Corners, Inc. as the Administrator of the Liaison Worldwide Plan. Since 1993, Seven Corners has provided medical
insurance to corporations, international travelers, expatriates, students, overseas visitors, immigrants and global citizens. With expertise and efficiency they
have served clients in more than a hundred countries.
Information:
This Insurance, under Policy NWD07-070515-01TM is underwritten by: Nationwide Mutual Insurance Company, Nationwide Life Insurance Company and
Nationwide Mutual Fire Company. (Florida residents Policy is underwritten by: Nationwide Mutual Insurance Company.)
Complete provisions pertaining to this insurance are contained in the Master Policy on file with the trustee, the American Travel Services Trust, and Liaison
Worldwide Plan. In the event of any conflict between this Evidence of Benefits and the Master Policy, the Policy will govern.
For U.S. citizens, this product may vary by state and/or may not be available in Your state at this time, please visit our website or contact Your local agent
for product availability, terms and conditions by state.
Excluded Country List: Coverage is not available for travel to or from the following Countries*: Balkans, Belarus, Burma, Cote dIvoire (Ivory Coast), Cuba,
Democratic Republic of the Congo, Iran, Iraq, Liberia, North Korea, Palestinian Authority, Sudan, Syria or Zimbabwe.
* The above list is subject to change, please visit www.sevencorners.com for an up-to-date list.
FOR RESIDENTS IN THE STATES OF COLORADO, KANSAS, NEW HAMPSHIRE, NORTH DAKOTA, SOUTH DAKOTA, TEXAS AND WEST
VIRGINIA:
Please note that for these States, a separate Policy will be provided.
FOR RESIDENTS IN THE STATE OF DELAWARE:
- Exclusions & Limitations section, Exclusion 6 under the Accidental Death and Dismemberment section is deleted in its entirety and replaced as
follows:
6. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in
connection with the following, which shall hereinafter for the purposes of this Exclusion be called the Incidents:
a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power.
c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of
the Government du jure or de facto.
d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of marital law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or
indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Incidents shall
be deemed to be consequences for which the Company shall not be liable under this Policy except to the extent that the Insured Person shall
prove that such consequence happened independently of the existence of such abnormal conditions.
- Exclusions & Limitations section, Exclusion 9 under the Accident Medical, Illness Medical section is deleted in its entirety and replaced as follows:
9. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in
connection with the following, which shall hereinafter for the purposes of this Exclusion be called the Incidents:
a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power.
c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of
the Government du jure or de facto.
d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of marital law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether proximately or
remotely occasioned by, traceable to, arising in connection with, any of the said Incidents shall be deemed to be consequences for which the
Company shall not be liable under this Policy except to the extent that the Insured Person shall prove that such consequence happened
independently of the existence of such abnormal conditions.
FOR RESIDENTS IN THE STATE OF KENTUCKY:
- Definitions, the definition of Physician is deleted in its entirety and replaced as follows:
Physician shall mean a doctor of medicine or a doctor of osteopathy licensed to render medical services or perform Surgery in accordance with the
laws of the jurisdiction where such professional services are performed. Physician such also mean a duly licensed optometrist, chiropractor,
podiatrist, psychologist or clinical social worker.
- Exclusions & Limitations section, Exclusion 6 under the Accidental Death and Dismemberment section is deleted in its entirety and replaced as
follows:
6. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to, or arising in connection with the
following, which shall hereinafter for the purposes of this Exclusion be called the Incidents:
a) war, invasion, act or foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
b) Mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power.
c) Any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of
the Government du jure or de facto or to the influencing of it by violence.
d) Martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or
indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Incidents shall
be deemed to be consequences for which the Company shall not be liable under this Policy except to the extent that the Insured Person shall
prove that such consequence happened independently of the existence of such abnormal conditions.
- Exclusions & Limitations section, Exclusion 9 under the Accident Medical, Illness Medical section is deleted in its entirety and replaced as follows:
9. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in
connection with the following, which shall hereinafter for the purposes of this Exclusion be called the Incidents;
a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not); or civil war.
b) mutiny, riot, strike, military of popular uprising insurrection, rebellion, revolution, military or usurped power.
c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of
the Government du jure or de facto or to the influencing of it by violence.
d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or
indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, arising in connection with, any of the said incidents shall
be deemed to be consequences for which the Company shall not be liable under this Policy except to the extent that the Insured Person shall
prove that such consequence happened independently of the existence of such abnormal conditions.
- Exclusions & Limitations section, Exclusion 13 under the Accident Medical, Illness Medical section, regarding the temporomandibular joint, is
deleted in its entirety.
- Exclusions & Limitations section, Exclusion 34 under the Accident Medical, Illness Medical section, is deleted in its entirety and replaced as
follows:
34. Drug, Treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial
insemination, Treatment for infertility or impotency, sterilization or reversal thereof, or abortion;
- Exclusions & Limitations section, Exclusion 43 under the Accident Medical, Illness Medical section, regarding Expenses resulting from Acquired
Immune Deficiency Syndrome (AIDS), AIDS-Related Complex (ARC) or the Human Immunodeficiency Virus (HIV) is deleted in its entirety.
- POLICY PROVISIONS, Excess Benefits is deleted in its entirety and replaced as follows:
Benefits: All coverages except Accidental Death and Dismemberment shall be paid according to the Coordination of Benefits provision of this Plan.
FOR RESIDENTS IN THE STATE OF MISSOURI:
- Definitions, the definition of Eligible Dependent Child is deleted in its entirety and replaced as follows:
Eligible Dependent Child shall mean the Primary Insured Persons unmarried children over 30 days and under 19 years of age or under 25 years of
age if they are attending an accredited institution of higher learning on a regular full-time basis and/or wholly dependent upon the Insured Person for
maintenance and support. An Eligible Dependent Child includes a natural child, a legally adopted child, a step-child or a child under the Insured
Persons legal guardianship.
The age limits that apply to Eligible Dependent Child(ren) will not apply to any Insured Dependent Child of the Primary Insured Person who remains
dependent on the Primary Insured Person for support and maintenance because he or she becomes incapable of working due to a mental or physical
handicap which occurs: before reaching the age limit[; and while insured under this Policy or any Prior Plan, provided such Insured Dependent Child
was insured on the date of termination of the prior plan.
- Exclusions & Limitations section, Exclusion 25 under the Accident Medical, Illness Medical section, is deleted in its entirety and replaced as
follows:
33. Expenses as a result or in connection with intentionally self-inflicted Injury or Illness while insane;
FOR RESIDENTS IN THE STATE OF MISSISSIPPI:
- Definitions, the definition of Pre-existing Condition is deleted in its entirety and replaced as follows:
Pre-existing Condition shall mean 1) a condition that would have caused a person to seek medical advice, diagnosis, care or treatment during the
180 days prior to the Effective Date of coverage under this Policy; 2) a condition for which medical advice, diagnosis, care or treatment was
recommended or received during the 180 days prior to the Effective Date of coverage under this Policy.
- Description of Benefits, Medical Expenses section, the following benefits are added:
11) Charges made for Spinal Manipulation which is prescribed, performed, or ordered by a licensed chiropractor for the relief of pain.
12). Charges made for diagnosis and Surgery of temporomandibular joint disorder and craniomandibular disorder by either a Physician or a Dentist.
The lifetime maximum for the treatment of temporomandibular joint disorder and craniomandibular disorder is $5,000.
- Exclusions & Limitations section, Exclusion 6 under the Accidental Death and Dismemberment section is deleted in its entirety and replaced as
follows:
6. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to, or arising in connection with the
following, which shall hereinafter for the purposes of this Exclusion be called the Incidents:
a) War, invasion, act or foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
b) Mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power.
c) Any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of
the Government du jure or de facto or to the influencing of it by violence.
d) Martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or
indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Incidents shall
be deemed to be consequences for which the Company shall not be liable under this Policy except to the extent that the Insured Person shall
prove that such consequence happened independently of the existence of such abnormal conditions.
- Exclusions & Limitations section, Exclusion 9 under the Accident Medical, Illness Medical section is deleted in its entirety and replaced as follows:
9. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in
connection with the following, which shall hereinafter for the purposes of this Exclusion be called the Incidents;
a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not); or civil war.
b) mutiny, riot, strike, military of popular uprising insurrection, rebellion, revolution, military or usurped power.
c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of
the Government du jure or de facto or to the influencing of it by violence.
d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege.
Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or
indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, arising in connection with, any of the said incidents shall
be deemed to be consequences for which the Company shall not be liable under this Policy except to the extent that the Insured Person shall
prove that such consequence happened independently of the existence of such abnormal conditions.
- Exclusions & Limitations section, Exclusion 13 under the Accident Medical, Illness Medical section, regarding the temporomandibular joint, is
deleted in its entirety.
- Policy Provisions, the Time of Payment of Claims provision is deleted in its entirety and replaced with:
Time of Payment of Claims: Indemnities payable under the Policy for any loss other than loss for which the Policy provides any periodic payment
will be paid immediately upon receipt of due written proof of such loss.
Subject to due written Proof of Loss, all accrued indemnities for loss for which the Policy provides periodic payment will be paid monthly during the
continuance of the period for which the Company is liable, and any balance remaining unpaid upon the termination of liability will be paid
immediately upon receipt of due written proof of loss.
If a claim is not paid within 35 days of receipt of written proof of loss in the form of a clean claim (25 days if proof of loss is submitted to the
Company electronically in the form of a clean claim), interest will be paid on the over due amount at a monthly rate of 1½ % per month or as
required by law until the claim is finally settled or adjudicated. If the Company fails to pay benefits when due, the person entitled to such benefits
may bring action to recover such benefits, any interest which may accrue, and any other damages permissible by law. A "clean claim" means a
claim which requires no further information, adjustment or alteration by the provider of the services or the Insured Person in order to be processed
and paid by the Insurance Company. A claim is clean if it has no defect or impropriety, including any lack of substantiating documentation, or
particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this provision. A clean claim
includes resubmitted claims with previously identified deficiencies corrected.
|
