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So you’ll be prepared. Who knows what
could happen during a trip abroad – or before you even
depart. Not only does RoundTrip help ensure you’re
prepared in the event of an accident, sickness or loss
when traveling, it can even help if something causes
your trip to be cancelled.
While we’ve
optimized RoundTrip’s medical coverage for most
travelers, you may determine you need greater coverage
or specific benefits. Consider Liaison®
International or other plans from SRI for up to
$5,000,000 of international medical limits. We can
create a plan that’s right for you.
Protection Plan Outline
This
brochure describes the highlights of our protection
plan. Plan details and ID Card will be mailed to you
once you have purchased benefits or obtained immediate
information using the online system. These details
provide complete information regarding the benefits,
exclusions and limits of the protection plan. Please
read it carefully. Note: Certain terms are defined
in the Evidence of Benefits that will be mailed to you
with your confirmation.
Benefit
|
Per Person Limit
|
|
Trip Cancellation |
Tour Cost to a
maximum of: $20,000 |
|
Trip
Interruption |
Tour Cost to a
maximum of: $20,000 |
|
Trip Delay /
Missed Connection |
$500 |
|
Medical
Expense |
$10,000 |
|
Medical
Evacuation / Repatriation |
$50,000 |
|
Lost Baggage /
Personal Effects |
$1,000 |
|
Baggage Delay |
$200 |
|
24-Hour AD&D |
$10,000 |
|
Travel
Assistance Services |
Included |
|
Optional
Flight Accident per Trip |
$100,000 |
Trip Cancellation /
Interruption
Trip Cancellation:
You
have benefits in the amount purchased for unused
non-refundable prepaid expenses for travel
arrangements, whenever you are prevented from taking a
trip for any of the following reasons that occur after
the effective date* of your protection plan:
- Specified
sickness, injury or death of you, your traveling
companion, business partner or family member of
either you or your traveling companion that results
in medically imposed restrictions as certified by a
legally qualified physician at the time of loss,
preventing your continued participation in the trip.
- Strike that
causes complete cessation of services of your common
carrier for at least 48 consecutive hours.
- Weather
that causes complete cessation of services of your
common carrier for at least 48 consecutive hours.
- Employer
termination or layoff affecting you or a person
sharing the same room. Employment must have been
with the same employer for at least three continuous
years.
- Terrorism
in a country, which is part of your scheduled trip,
that causes the United States Department of State to
issue a travel warning that you should not travel
within that country for a period of time, which
covers your scheduled trip.
- Hijack,
quarantine, jury duty or court ordered appearance as
a witness in a legal action in which you or your
traveling companion are not a party (except law
enforcement officers).
- Primary
residence of you or your traveling companion is
rendered uninhabitable due to unforeseen
circumstances.
- Burglary of
you or your traveling companion's primary residence
within 10 days of departure or during your trip.
- Felonious
assault of you or your traveling companion within 10
days of departure or during your trip.
- You or your
traveling companion are called to emergency military
duty for a national disaster other than war.
- Traffic
accident directly involving either you or your
traveling companion, substantiated by a police
report, while en route to a scheduled departure
point.
- If your
travel supplier cancels your trip, you will receive
up to $75 for the reissue fee charged by the airline
for your tickets. You must cover the full cost of
the trip.
* Effective Date is the date which
begins at 12:01 a.m. following the: 1) postmark date
of your enrollment form or 2) the date you fax or
transmit your enrollment via the internet with the
proper payment.
Trip
Interruption:
If you are
prevented from completing a trip for any of the above
reasons that occur after the effective date of your
protection plan and during your trip, you will receive
up to the amount purchased for:
- Any unused
non-refundable prepaid expenses for travel
arrangements;
- One-way
economy fare to return to your original destination
or rejoin your trip less the value of the unused
travel ticket.
-
Accommodations and transportation expenses for up to
$150/day for 10 additional days when your traveling
companion must remain hospitalized or a specified
injury or sickness not requiring hospitalization
prevents you from continuing travel, causing you to
extend your trip with additional hotel nights due to
medically imposed restrictions as certified by a
legally qualified physician.
- Single
supplement upgrade - you will receive benefits when
your traveling companion cancels or interrupts a
trip for a specified reason and you do not.
Trip Delay / Missed Connection:
Benefits include additional transportation cost to
join the covered trip or return home and/or for unused
non-refundable expenses for your covered trip. Delay
must be three hours or more and certified due to one
of the following reasons:
- Delay of
common carrier
- A traffic
accident in which you were not directly involved
- Inclement
weather
- Quarantine,
hijacking or strike
- Lost or
stolen passports, travel documents or money
- Natural
disaster, terrorism or riot
Medical Expense:
Benefits include
expenses for an accidental injury or a sickness that
manifests itself during your trip, as long as you
receive initial medical treatment within 30 days after
the date of loss. Expenses will be paid for a period
of 52 weeks from the date of loss. Benefits will
include expenses for emergency dental treatments, up
to $750 ($750 sub limit does not apply in New York)
and advance payment to a hospital if needed to secure
your admission.
Medical
Evacuation / Repatriation:
You will receive
benefits if an injury or sickness first occurs during
your trip, up to the policy limit, for medical
evacuation or medically necessary repatriation to your
home or a hospital near your home for continued
treatment when your condition is acute or life
threatening and adequate treatment is not available at
a local hospital. Benefits will also be paid to
return your mortal remains to your home should you die
while on your trip (as described in the Travel
Assistance Service Section).
Benefits also
include transportation for the return trip home for
your dependent children under age 18 who are
accompanying you and are left unattended if you are
confined to a hospital for more than seven consecutive
days. Transportation will be provided for a person of
your choice to visit you if you are traveling alone
and are confined to a hospital for more than seven
consecutive days. Any use of this benefit must be
pre-approved and arranged by the authorized Assistance
Company. Note: Pre-existing condition limitations are
waived for Medical Evacuation / Repatriation.
Lost Baggage & Baggage Delay:
You will receive benefits for lost,
stolen or damaged luggage and personal items, as well
as a lost or stolen passport, visa and credit cards.
You also have benefits for checked luggage that is
delayed or misdirected by a common carrier for more
than 24 hours from your arrival time at a destination,
other than your residence, during your trip. Benefits
are payable on property not specifically scheduled
under other insurance.
Accidental
Death & Dismemberment (AD&D):
You will receive
benefits for loss of life due to an accidental injury
while on your trip.
Optional Flight
Accident Plan:
These benefits
apply to the amount purchased, for accidental death,
dismemberment or loss of sight as a result of an
accident while a passenger on a regularly scheduled
air flight, a land or water conveyance provided by the
airline as a substitute for an aircraft, a common
carrier while en route to or from the airport, or at
the airport immediately before boarding or after
disembarking from an aircraft.
Travel Assistance Service
Travel Assistance provides a variety of travel related
services. Services offered include: medical
evacuation / repatriation; repatriation of remains;
medical or legal referral; hospital admission
guarantee; emergency cash advance*; translation
service; prescription drug / eyeglass replacement*;
passport / visa information; bail bond*; lost baggage
retrieval; inoculation information. (*payment
reimbursement to the Assistance Company is your
responsibility)
"Effective Date" is 12:01a.m. following the: postmark
of your enrollment form or the date you fax or
transmit your enrollment via the Internet with the
proper payment.
- Trip
Cancellation and Assistance Services – your
eligibility begins on your effective date.
- Trip Delay
/ Missed Connection - in force while you are en
route to and from your covered trip.
- Flight
Accident Plan (if chosen) - begins on the departure
date or the date your completed enrollment form and
fees are postmarked, faxed, or transmitted via the
Internet and ends when the trip is completed or
after 30 days (unless additional days are
purchased), whichever comes first.
- All Other
Coverages (includes Trip Interruption) – you become
eligible for benefits at 12:01 a.m. on your
scheduled departure date or your effective date
whichever is later, and ends at the point and time
of return on the scheduled return date.
- Maximum
Trip Length under RoundTrip is 30 days (unless
additional days are purchased).
RoundTrip may be purchased if you are a
resident of the United States or if you purchase this
plan within the United States.
Dependent Children
are children of the Primary Applicant under 19 years
of age.
Benefits are not payable for sickness, injuries or
losses of you or your traveling companion: resulting
from suicide, attempted suicide, or intentionally
self-inflicted injury while sane or insane (in
Missouri, sane only; in New York, neither sane nor
insane apply); resulting from an act of declared or
undeclared war; while participating in maneuvers or
training exercises of an armed service; while riding,
driving or participating in races or speed or
endurance contests; while mountaineering (engaged in
the sport of scaling mountains, generally requiring
the use of picks, ropes or other special equipment; in
New York, professional mountaineering); while
participating as a member of a team in an organized
sporting competition; while participating in
skydiving, hang gliding, bungee cord jumping, scuba
diving or deep sea diving (in New York, professional
scuba – any sport that requires more than an “Open
Water 1” certification by PADI, NAUI, or other
recognized diving certification organization); any
Mental and Nervous disorders, unless hospitalized;
while piloting or learning to pilot or acting as a
member of the crew of any aircraft; received as a
result or consequence of being intoxicated or under
the influence of any controlled substance unless
administered on the advice of a legally qualified
physician; to which a contributory cause was the
commission of or attempt to commit a felony or being
engaged in an illegal occupation; due to normal
childbirth, normal pregnancy (except complications of
pregnancy) or voluntarily induced abortion (voluntary
abortion only in New York); for dental treatment
(except as coverage is otherwise specifically provided
herein); or due to a pre-existing condition - note the
pre-existing condition limitation is automatically
waived for emergency medical evacuation and medically
necessary repatriation benefits, and for benefits
purchased within 10 days from the time the initial
deposit is paid on your covered trip. In California
benefits are not payable if during the 60 days prior
to your effective date, a legally qualified physician
advised you or your traveling companion not to travel
due to a sickness or injury. No benefits will be paid
for expenses reimbursed or services provided by any
other source.
Pre-existing medical conditions, as
defined in the section below, will apply if you enroll
in the protection plan more than 10 days after making
your initial trip deposit.
"Pre-existing
Condition" means any injury, sickness or condition
(including any condition from which death ensues) of
you or your traveling companion, you and/or your
traveling companion's family member or your business
partner which within the sixty (60) day period prior
to the effective date of your trip cancellation
benefits under this protection plan: a) manifested
itself, became acute or exhibited symptoms which would
have caused one to seek diagnosis, care or treatment;
b) required taking prescribed drugs or medicine,
unless the condition for which the prescribed drug or
medicine is taken remains controlled without any
change in the required prescription; or c) required
medical treatment or treatment was recommended by a
legally qualified physician.
Note, in
California, part "(a)" of the Pre-existing Condition
is not applicable.
Once you have enrolled, you will
receive an Evidence of Benefits and ID Card, which
will describe all aspects of the program, as well as
who to contact in case of an emergency or if a claim
should occur. The Assistance Company should be
contacted if you require assistance while on your
trip. When purchasing your trip, be sure to keep all
documentation. This information will be required in
order to process any claim.
Benefits under
this plan are provided by the American Travel Services
Trust. The Trust is insured by TIG Insurance
Company. In Oregon, Kansas, New York and South
Carolina the benefits of this plan are provided by a
policy insured by TIG Insurance Company.
Notice to
residents of Florida: The benefits of this plan are
provided by the American Consumer Insurance Trust.
The Trust is insured by TIG Premier Insurance Company
and are governed by the law of a state other than
Florida. Your homeowners policy, if any, may provide
coverage for loss of personal effects provided by the
baggage and personal effects coverage. This insurance
is not required in connection with the purchase of
your travel arrangements.
Notice to
residents of California: This plan contains
disability benefits or health benefits, or both, that
only apply during the covered trip. You may have
coverage from other sources that already provides you
with these benefits. You should review your existing
policies. If you have any questions about your current
coverage, call your insurer or health plan. Note, in
California the pre-existing condition limitation is
waived for medical expenses
PROGRAM COSTS
Rates Effective
July 1, 2002
|
Trip
Cost
Per Person |
Plan Rate
Per Person based on age on date of
purchase. |
|
Coverage must be purchased for the
full cost of the trip. |
The rates below are for trips from
1 through 30 days long. |
|
|
0 to 55 |
56 to 70 |
71 to 80 |
80 and
over |
|
$0 - $500 |
$33 |
$48 |
$73 |
$122 |
|
$501 - $1,000 |
$46 |
$75 |
$102 |
$171 |
|
$1,001 - $1,500 |
$58 |
$94 |
$131 |
$219 |
|
$1,501 - $2,000 |
$74 |
$120 |
$165 |
$278 |
|
$2,001 - $2,500 |
$100 |
$150 |
$235 |
$411 |
|
$2,501 - $3,000 |
$115 |
$185 |
$284 |
$487 |
|
$3,001 - $3,500 |
$129 |
$219 |
$332 |
$564 |
|
$3,501 - $4,000 |
$144 |
$261 |
$387 |
$654 |
|
$4,001 - $4,500 |
$164 |
$302 |
$446 |
$740 |
|
$4,501 - $5,000 |
$183 |
$344 |
$501 |
$827 |
|
$5,001 - $5,500 |
$263 |
$425 |
$586 |
$983 |
|
$5,501 - $6,000 |
$288 |
$465 |
$643 |
$1,077 |
|
$6,001 - $6,500 |
$313 |
$506 |
$698 |
$1,171 |
|
$6,501 - $7,000 |
$342 |
$553 |
$765 |
$1,279 |
|
$7,001 - $8,000 |
$376 |
$607 |
$839 |
$1,404 |
|
$8,001 - $9,000 |
$424 |
$686 |
$946 |
$1,585 |
|
$9,001 - $10,000 |
$474 |
$766 |
$1,058 |
$1,772 |
For trips of
longer than 30 days, additional cost of $3 per person
per day is required.
For trip cost
between $10,001 and $20,000, contact your producer or
SRI for the rate.
You can apply online by
visiting our Online Quoting
Tool
or
1. Read
the entire brochure and complete the Roundtrip
Application in full. Plan cost for the entire package
is due at the time of application. Remember: Benefits
must be purchased for the full cost of the trip.
2. If
paying by check or money order, make payable to: “SRI”
and enclose it together with completed Application.
3.
If paying by credit card, complete the
Application and mail or fax to SRI. Be sure to sign
the Method of Payment section (for all payment
methods).
Return the Application with your
payment to:
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InternationalStudentInsurance.com
15 Cottage Avenue
Suite 201
Quincy, MA 02169
or fax to:
617-328-0615 |
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