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This Certificate of Insurance describes all of the travel insurance benefits, underwritten by Nationwide Mutual Insurance Company and herein referred to as the Company. The insurance benefits vary from program to program. Please refer to the accompanying Confirmation of Coverage. It provides You with specific information about the program You purchased. Please contact the Plan Administrator immediately if You believe that the accompanying Confirmation of Coverage is incorrect.
This Certificate of Insurance is issued in consideration of the enrollment form and payment of any premium due. All statements in the enrollment forms are representations and not warranties. Only statements contained in a written enrollment form will be used to void insurance, reduce benefits or defend a claim.
All premium is non-refundable after a ten (10) day review period from the date of purchase in the event You have not incurred any claims during that time. In the event the premium paid for coverage is less than the required premium for coverage, benefits will be paid in direct proportion of the actual amount paid to the required premium due.
NO DIVIDENDS WILL BE PAYABLE UNDER THIS CERTIFICATE.
The President and Secretary of Nationwide Mutual Insurance Company witness this Certificate.
Licensed Resident Agent
(where required by law)
TRAVEL PROTECTION CERTIFICATE
TABLE OF CONTENTS
Accidental Death & Dismemberment
Accidental Death & Dismemberment – Common Carrier (Air Only)
Accident and Sickness Medical Expense
Repatriation of Remains
LIMITATIONS AND EXCLUSIONS
NATIONWIDE MUTUAL INSURANCE COMPANY
TRAVEL PROTECTION INSURANCE CERTIFICATE
Throughout this document, when capitalized, certain words and phrases are defined as follows:
Accident means a sudden, unexpected, unintended, specific event that occurs at an identifiable time and place, but shall also include exposure resulting from a mishap to a conveyance in which You are traveling.
Accidental Injury means a Bodily Injury caused by an Accident (of external origin) being the direct and independent cause in the Loss.
Actual Cash Value means the lesser of the replacement cost and the purchase price less depreciation.
Additional Expenses means any reasonable expenses for meals and lodging that were necessarily incurred as the result of a Hazard and that were not provided by the Common Carrier or other party free of charge.
Bodily Injury means identifiable physical injury that is caused by an Accident and is solely and independently of another other cause, except illness resulting from, or medical or surgical treatment rendered necessary by, such injury.
Certificate of Insurance means this document, and any endorsements, riders or amendments that will attach during the period of coverage.
Checked Baggage means a piece of baggage that accompanies You for which a claim check has been issued to You by a Common Carrier.
Common Carrier means any land, sea, and/or air conveyance operating under a valid license for the transportation of passengers for hire. Taxis and limousines are not Common Carriers as defined herein.
Company means Nationwide Mutual Insurance Company.
Confirmation of Coverage means the accompanying document that outlines Your benefits and Maximum Benefit amounts.
Covered Expenses means expenses incurred by You that are for Medically Necessary care or treatment; due to Sickness or Bodily Injury; prescribed, performed or ordered by a Physician; Reasonable and Customary Charges incurred while insured under this Certificate; and that do not exceed the Maximum Benefit limits shown in the accompanying Confirmation of Coverage, under each stated benefit.
Dependent Child(ren) means Your natural or adopted child (or children), less than age twenty-six (26). Dependent Child(ren) also includes Your step child, child subject to legal guardianship, foster child, grandchild, or other blood relative less than age 26.
Domestic Partner means a person with whom You reside and can show evidence of cohabitation (including the shared responsibility for basic living expenses) for at least the previous six (6) months and has an affidavit of domestic partnership, if recognized by the jurisdiction within which You reside.
Economy Fare means the lowest published rate for a round trip economy ticket.
Effective Date means 12:01 A.M. local time, at Your location, on the day after the required premium for such coverage is received by the Company or its authorized representative.
Extreme Sports means an athletic pursuit that involves a high degree of danger or risk.
Family Member means Your legal or common law spouse, parent, legal guardian, step-parent, grandparent, parents-in-law, grandchild, natural or adopted child, step-child, children-in-law, brother, sister, step-brother, step-sister, brother-in-law, sister-in-law, aunt, uncle, niece, nephew, or Domestic Partner.
a) Any delay of a Common Carrier (including Inclement Weather).
b) Any delay by a traffic accident en route to a departure, in which You or a Traveling Companion is not directly involved.
c) Any delay due to lost or stolen passports, travel documents or money, Quarantine, hijacking, unannounced Strike, natural disaster, civil commotion or riot.
d) A closed roadway causing cessation of travel to the destination of the Trip (substantiated by the department of transportation, state police, etc.)
Home Country means the country where You have Your true, fixed and permanent home and principal establishment.
Hospital means a facility that:
(a) holds a valid license if it is required by the law;
(b) operates primarily for the care and treatment of sick or injured persons as in-patients;
(c) has a staff of one or more Physicians available at all times;
(d) provides twenty-four (24) hour nursing service and has at least one registered professional nurse on duty or call;
(e) has organized diagnostic and surgical facilities, either on the premises or in facilities available to the hospital on a pre-arranged basis; and
(f) is not, except incidentally, a clinic, nursing home, rest home, drug or physical rehabilitation facility or convalescent home for the aged, or similar institution.
Inclement Weather means any severe weather condition that delays the scheduled arrival or departure of a Common Carrier.
Insured means the person who enrolled for coverage and whose premium was paid under the Policy.
Loss means Bodily Injury, Sickness or damage sustained by You, while coverage is in effect, in consequence of happening of one or more of the occurrences against which the Company has undertaken to indemnify You.
Maximum Benefit means the largest total amount that the Company will pay under any one benefit for You, as shown on the accompanying Confirmation of Coverage.
Medically Necessary means a service or supply that: (a) is recommended by the attending Physician; (b) is appropriate and consistent with the diagnosis in accord with accepted standards of community practice; (c) could not have been omitted without adversely affecting Your condition or quality of medical care; (d) is delivered at the most appropriate level of care and not primarily for the sake of convenience; and (e) is not considered experimental unless coverage for experimental services or supplies is required by law.
Mountaineering means 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.
Parachuting means an activity involving the breaking of a free fall from an airplane using a parachute.
Participating Organization means a travel agency, tour operator, cruise line, airline or other organization that applies for coverage under the Policy and remits the required premium to the Company.
Physician means a licensed practitioner of medical, surgical or dental services acting within the scope of his/her license. The treating Physician may not be You, a Traveling Companion or a Family Member.
Policy means the Group Master Policy including the application and any endorsements, riders or amendments that will attach during the period of coverage.
Quarantine means Your strict isolation imposed by a Government authority or Physician to prevent the spread of disease. An embargo preventing You from entering a country is not a Quarantine.
Reasonable and Customary Charges mean charges commonly used by Physicians in the locality in which care is furnished.
Scheduled Departure Date means the date on which You are originally scheduled to leave on the Trip.
Scheduled Return Date means the date on which You are originally scheduled to return to the point of origin or to a different final destination.
Sickness means an illness or disease of the body that requires a physical examination and medical treatment by a Physician after the Effective Date of coverage while Your are covered by this Certificate, unless it suddenly worsens or becomes acute after the Effective Date.
Sound Natural Teeth means teeth that are whole or properly restored and are without impairment, periodontal or other conditions and are not in need of the treatment provided for any reason other than an Accidental Injury. For purposes of this Certificate, teeth previously restored with a crown, inlay, onlay, or porcelain restoration or treated by endodontics, except amalgam or composite resin fillings, are not considered Sound Natural Teeth.
Strike means any unannounced labor disagreement that interferes with the normal departure and arrival of a Common Carrier.
Traveling Companion means a person who has coordinated travel arrangements or vacation plans with You, intends to travel with You during the Trip and is further described on the accompanying Confirmation of Coverage. Note, a group or tour leader is not considered a Traveling Companion unless You are sharing room accommodations with the group or tour leader.
Trip means a trip or class of trips outside Your Home Country as described on the accompanying Confirmation of Coverage.
You or Your refers to the Insured.
The following provisions apply to all coverages:
LEGAL ACTIONS - No legal action for a claim can be brought against the Company until sixty (60) days after the Company receives Proof of Loss. No legal action for a claim can be brought against the Company more than three (3) years after the time required for giving Proof of Loss.
CONTROLLING LAW - Any part of this Certificate that conflicts with the state law where the Certificate is issued is changed to meet the minimum requirements of that law.
GOVERNING JURISDICTION – The insurance regulatory agency and courts of the jurisdiction in which You reside shall have jurisdiction over the individual or group insurance coverage as if such coverage or plan were issued directly to You.
MISREPRESENTATION AND FRAUD – Your coverage shall be void if, whether before or after a Loss, You concealed or misrepresented any material fact or circumstance concerning this Certificate or the subject thereof, or Your interest therein, or if You commit fraud or false swearing in connection with any of the foregoing.
You must fully cooperate in the event the Company determines that an investigation of any claim is warranted.
After two years from the date of issue of this Certificate, no misstatements, except fraudulent misstatements, made by the applicant on the application for such Certificate shall be used to void the Certificate or to deny a claim for Loss incurred or disability (as defined in the Certificate) commencing after the expiration of such two year period.
SUBROGATION - To the extent the Company pays for a Loss suffered by You, the Company will take over the rights and remedies You had relating to the Loss. This is known as subrogation. You must help the Company to preserve its rights against those responsible for the Loss. This may involve signing any papers and taking any other steps the Company may reasonably require. If the Company takes over Your rights, You must sign an appropriate subrogation form supplied by the Company.
ASSIGNMENT - This Certificate is not assignable, whether by operation of law or otherwise, but benefits may be assigned.
WHEN YOUR COVERAGE BEGINS - Provided:
(a) coverage has been elected; and
(b) the required premium has been paid.
All coverage will begin on the later of the Effective Date or upon Your departure from Your Home Country.
WHEN YOUR COVERAGE ENDS - Your coverage will end at 11:59 P.M. local time on the date that is the earliest of the following:
(a) the Scheduled Return Date as stated on the travel tickets;
(b) upon Your return to Your Home Country;
(c) three hundred sixty-five (365) days after the Effective Date.
EXTENDED COVERAGE - Coverage will be extended under the following conditions, should they occur during the journey to the return destination or to a different destination:
(a) If You are a passenger on a scheduled Common Carrier that is unavoidably delayed up to five (5) days in reaching the final destination, coverage will be extended for the period of time needed to arrive at the final destination.
ENTIRE CONTRACT; CHANGES: This Certificate, including the endorsement and attached papers, if any, constitutes the entire contract of insurance. No change in this Certificate shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this Certificate or to waive any of its provisions.
NOTICE TO POLICYHOLDERS
If You have a complaint or claims settlement issue that You do not feel We are properly handling or not handling in a timely manner, You may contact the Indiana Department of Insurance with Your complaint and seek assistance from the governmental agency that regulates insurance.
To contact the Department, write or call:
Public Information/Market Conduct
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, IN 46204-2787
Consumer Hotline: 1-800-622-4461
In the Indianapolis Area: 1-317-232-2395