Travelex Protection Plan

Dream. Explore. Travel On.
TRAVEL SELECT
TRAVEL PROTECTION PLAN POLICY
TSB-1220 | 12.20
CONTACT INFORMATION AND IMPORTANT NOTES
a
QUESTIONS PRIOR TO YOUR TRIP DEPARTURE? EXPERIENCE A LOSS AND NEED TO FILE A CLAIM?
Travelex Insurance Services Berkshire Hathaway Specialty Insurance

800.819.9004 Start Here - File a Claim Online at travelexinsurance.com
8:00am – 7:00pm CST, M-F or
customersolutions@travelexinsurance.com Download ‘Travelex Insurance’ on Google Play or iTunes
855.205.6054
7:00am – 7:00pm CST, M-F
travelex.claims@bhspecialty.com
NEED ASSISTANCE WHILE TRAVELING?

IMPORTANT NOTES
World Travel Protection Who is Eligible: A person who has arranged to take a Trip,
pays the required plan cost, and has a Primary Residence in
844.215.1672 (within USA & Canada) the United States.
647.775.8042 (outside USA & Canada)
assist@wtpassist.com
24 Hours a Day, 7 Days a Week Additional Upgrades may have been purchased, please refer
to your Confirmation of Coverage for verification.
Signed for the Company at its home office:
IMPORTANT Secretary President

This coverage is valid only if the appropriate plan cost has been paid. Please
keep this document as your record of coverage under the plan.
PLEASE READ THIS DOCUMENT CAREFULLY!

Table of Contents
Section I COVERAGE DETAILS
This Policy is issued in consideration of your application and payment of the
Section II BENEFITS
premium due. This Policy describes all of the travel insurance benefits Section III DEFINITIONS
underwritten by the Company. Section IV EXCLUSIONS AND LIMITATIONS
Section V PAYMENT OF CLAIMS
This Policy is a legal contract between the Insured and the Company. It is Section VI GENERAL PROVISIONS
important that you read your Policy carefully. Please refer to the Schedule of
Benefits. It provides you with specific information about the insurance you
purchased.
PG-TA-IPL-NVIM10-NY-2/2019 Page 1 of 18
SCHEDULE OF BENEFITS Any payments under this Policy will only be made in full compliance with all United
States of America economic or trade sanction laws or regulations, including, but not
Travel Arrangement Benefits Maximum Limit Per Person limited to, sanctions, laws and regulations administered and enforced by the U.S.
Up to Trip Cost, up to a Treasury Department's Office of Foreign Assets Control ("OFAC"). Therefore, any
Trip Cancellation maximum of $50,000 expenses incurred or claims made involving travel that is in violation of such
Trip Interruption Up to 150% of Trip Cost sanctions, laws and regulations will not be covered under this Policy. For more
Up to a maximum of $75,000 information, you may consult the OFAC internet website at
http://www.treasury.gov/resource-center/sanctions/ or the Travel Insurance
Trip Interruption-Return Air Only Up to $1,000 Administrator representative.
License Fee Refund License Cost up to $200
Trip Delay (Maximum of $250 per day) To a maximum of $2,000
Minimum 5 hour delay
Missed Connection $750
Baggage & Personal Effects $1,000
$500 for first item
$250 per each additional item
$500 aggregate for items shown in the benefit
Sporting and Golf Equipment Delay $200
Emergency Evacuation* & Repatriation of Remains $500,000
Escort Maximum To a maximum of $25,000
* Trip must be overnight and Destination must be at least 100 miles from the
Insured’s Primary Residence.
Coverage for Trip Interruption and Trip Interruption-Return Air Only cannot be
combined.
For questions or information contact the Travel Insurance Administrator.
SECTION I Baggage Extension of Coverage: If an Insured’s Baggage, passports, and visas are
COVERAGE DETAILS in the charge of a Common Carrier and delivery is delayed, coverage for Baggage
and Personal Effects will be extended from the earlier/est of:
When Coverage Begins (1) the time the Common Carrier delivers the property to the Insured;
Trip Cancellation coverage will be effective at 12:01 a.m. (Standard Time) on the (2) the date the property is documented by the Common Carrier as lost,
date following payment to the Company of any required plan cost. stolen or damaged.
All other coverages will begin on the later of:

(a) 12:01 a.m. (Standard Time) on the scheduled Departure Date shown on
the travel documents; or
(b) the date and time the Insured starts his/her Trip.
When Coverage Ends

Trip Cancellation coverage end on the earlier/est of: (a) the cancellation of the
Insured’s Trip or (b) the date and time the Insured starts on his/her Trip.
All other coverages end on the earlier/est of:

(a) the date the Trip is completed;
(b) the scheduled Return Date;
(c) the Insured’s arrival at the Return Destination on a round Trip, or the
Destination on a one-way Trip;
(d) cancellation of the Trip covered by this Policy.
Extending Coverage
All coverage (except Trip Cancellation) will be extended, if:
(a) the Insured's entire Trip is covered by the plan; and
(b) the Insured's return is delayed by one of the Unforeseen events specified
under Trip Cancellation and Interruption or Trip Delay.
Request for extension of coverage will not be permitted if there is any known
claimable event on the policy and the Insured does not identify this at the time of
extension.
This extension of coverage will end on the earlier/est of:

(a) the date the Insured reaches his/her Return Destination; or
(b) 7 days after the date the Trip was scheduled to be completed.
SECTION II Transportation and Accommodation
SUMMARY OF BENEFITS (a) You or a Traveling Companion is directly involved in or delayed due to
an traffic accident, while en route to the Insured’s Destination. Traffic
TRIP CANCELLATION AND INTERRUPTION accident must be substantiated by a police report;
Benefit will be provided for loss(es) incurred by You for a covered Trip cancelled (b) mechanical/equipment failure of a Common Carrier that occurs on a
up to the date and time of departure or interrupted or delayed after the time scheduled Trip Departure Date and causes complete cessation of Your
and date of departure. A maximum benefit of up to the amount indicated in the travel and results in a Loss of 50% of Your Trip length;
Schedule of Benefits to cover certain expenses as listed below which result in the
cancellation or interruption of Your Trip due to any of the following Unforeseen (c) Strike resulting in complete interruption of travel services at the point of
events: departure or Destination;
Medical / Health Environment

(a) Any serious Injury, death, or Sickness; (a) Inclement Weather, if it causes delay or cancellation of travel;
(1) Occurring to You or a Traveling Companion, a Family Member
traveling with You, that is so disabling as to cause a reasonable (b) You or a Traveling Companion’s Primary Residence being made
person to cancel or interrupt their Trip or which results in Uninhabitable or inaccessible by Natural Disaster, vandalism, or burglary;
medically imposed restrictions as certified by a Physician at the
time of Loss preventing your continued participation in the Trip; (c) Your or a Traveling Companion’s Destination being made Uninhabitable
(2) Occurring to a Family Member not traveling with the You that is or Inaccessible by flood, tornado, earthquake, volcanic eruption, fire,
considered life-threatening, as certified by a Physician or they wildfire, or blizzard that is due to natural causes;
require Your immediate care. Such disability must be so
disabling as to reasonably cause a Trip to be canceled or (d) a named hurricane causing cancellation or interruption of travel to Your
interrupted and must be certified by a Physician; Destination that is Inaccessible or Uninhabitable. Claims are not payable if
(3) Occurring to a Business Partner that is so disabling as to cause a a hurricane is foreseeable prior to Your effective date. A hurricane is
reasonable person to cancel or interrupt their Trip to assume foreseeable on the date it becomes a named storm. The Company will only
daily management of the business. Such disability must be pay the benefits for Losses occurring within 14 days after the named
certified by a Physician; hurricane makes Your Destination Uninhabitable or Inaccessible.
(4) Sickness, Injury, death or hospitalization occurring to Your Host
at Your Destination. A Physician must certify the Sickness or Political / Violence
Injury; (a) You, or a Traveling Companion are hijacked, quarantined, subpoenaed,
or required to serve on a jury;
(b) You or a Traveling Companion is called to active military service or

military leave is revoked or reassigned;
(c) You or a Traveling Companion being the victim of a Felonious Assault (b) the Insured is unable to participate in a scheduled hunting/fishing
within 10 days prior to the Departure Date. No coverage is provided for expedition due to a delay of the necessary personal sporting equipment
Felonious Assault committed by another Insured, Family Member, by the Common Carrier;
Traveling Companion or Traveling Companion’s Family Member;
(c) the United States government or local government issues a
Work hunting/fishing activity restriction after the effective date of coverage at
(a) You or a Traveling Companion is involuntarily terminated or laid off the Destination, which prohibits the hunting/fishing activity for which
through no fault of his or her own, provided that he or she has been an the Insured has booked the Trip. Such restrictions include but are not
active employee for the same employer for at least 1 continuous year. limited to: a government closure of the reserve, a ban on
Termination must occur following the effective date of coverage. This hunting/fishing, or the hunting/fishing activity being declared illegal.
provision is not applicable to temporary employment, seasonal
employment, independent contractors or self-employed persons; SPECIAL NOTIFICATION OF CLAIM
You must notify the Travel Insurance Administrator within 72 hours or as soon
(b) the Insured or Traveling Companion is required to work during his/her as reasonably possible in the event of a Trip Cancellation or Interruption claim.
scheduled Trip. He/she must provide proof of requirement to work, such The Company will not be liable and will not pay for any additional penalty
as a notarized statement signed by an officer of his/her employer. In the charges incurred that would not have been imposed had You notified the travel
situation of self-employment, proof of self-employment and a notarized supplier within the specified period. If You are unable to provide cancellation
statement confirming that the Insured is unable to travel due to his or her notice within the required timeframe, You must provide proof of the
job obligations will be required. circumstance that prevented timely notification.
(c) the Insured or Traveling Companion is directly involved in a merger, Trip Cancellation Benefits: The Company will reimburse You for Forfeited, pre-
acquisition, government required product recall, or bankruptcy paid Trip Cost up to the Maximum Limit shown in the Schedule for Trips that are
proceedings and must be currently employed by the company that is canceled prior to the scheduled Departure due to any of the Unforeseen events
involved in said event; shown above.
(d) the Insured’s or Traveling Companion’s company is deemed to be Trip Interruption Benefits: The Company will reimburse You up to the Maximum
unsuitable for business due to burglary, or Natural Disaster and the Limit shown in the Schedule for Trips that are interrupted due to the Unforeseen
Insured or Traveling Companion is directly involved as a Key Employee events shown above for:
of the disaster recovery team. (a) Unused portion of non-refundable pre-paid insured Trip Cost; and
(b) additional transportation expenses incurred by You, either to the
Other Return Destination; or from the place that You left the Trip to the place
(a) cancellation of a scheduled event due to Inclement Weather prior to that You may rejoin the Trip; or
departing on the Trip provided attendance at the event was the sole reason (c) additional transportation expenses incurred by You to reach the original
for the Trip and the duration of the Trip does not exceed 48 hours before or Trip Destination if the Insured is delayed and leaves after the Departure
after such an event; Date.
However, the benefit payable under (b) and (c) above will not exceed the cost of TRIP DELAY
economy airfare or the same class as the Insured’s original ticket, less any
refunds paid or payable, by the most direct route. If Your Trip is delayed at least the number of consecutive hours shown in the
Schedule from the original departure time that prevents You from reaching Your
Trip Interruption – Return Air Only: The Company will reimburse You up to the intended Destination the Company will reimburse you for only one delay per
Maximum Limit shown on the Schedule for the additional transportation Insured, per Trip, up to the Maximum Limit shown in the Schedule. The Trip
expenses incurred to reach the Return Destination due to one of the Unforeseen Delay benefit will cover Reasonable Additional Expenses until travel becomes
events listed in the Trip Cancellation/Trip Interruption section. However, the possible to the originally scheduled Destination, as a result of a cancellation or
benefit payable will not exceed the cost of economy airfare (or the same class as delay Your Trip for one of the following Unforeseen events:
the Insured’s original ticket) less any refunds paid or payable and taken by the (a) Common Carrier delay;
most direct route. (b) You or a Traveling Companion have lost or had stolen, your passports,
travel documents, or money;
Benefits paid for Trip Interruption – Return Air Only cannot be combined with (c) reasons listed under Trip Cancellation and Interruption.
Trip Interruption Benefits.
Reasonable Additional Expenses incurred over $25 must be accompanied by
SINGLE OCCUPANCY BENEFIT receipts.
The Company will reimburse You, up to the Trip Cancellation and Trip If You incur more than one delay in the same Trip the Company will reimburse
Interruption Maximum Limit shown in the Schedule, for the additional cost You for the delay with the largest benefit up to the Maximum Limit shown in the
incurred during the Trip as a result of a change in the per person occupancy rate Schedule.
for prepaid, non-refundable travel arrangements if a person booked to share
accommodations with You has his/her Trip canceled or interrupted due to any MISSED CONNECTION
of the Unforeseen events shown in the Trip Cancellation and Trip Interruption
section and You do not cancel. If, while on a Trip, You miss a Trip departure resulting from cancellation or delay of
at least the number of consecutive hours shown in the Schedule of all Your regularly
LICENSE FEE REFUND BENEFIT scheduled airline flights due to Inclement Weather or Common Carrier caused delay,
the Company will reimburse You up to the Maximum Limit shown in the Schedule
The Company will reimburse You for the prepaid non-refundable cost of Your for:
hunting or fishing license or permits up to the Maximum Limit shown in the (a) additional transportation expenses incurred by the Insured to join the
Schedule if the Insured is unable to travel due to one of the Unforeseen events departed Trip; and
shown in the Trip Cancellation Interruption Benefit. (b) pre-paid, non-refundable Trip payments for the Unused portion of the Trip.
The Common Carrier must certify the delay of the regularly scheduled airline
flight. Coverage is secondary if reimbursable by any other source.
BAGGAGE PERSONAL EFFECTS, SPORTING EQUIPMENT or GOLF EQUIPMENT SPORTING EQUIPMENT AND GOLF EQUIPMENT DELAY
If Your Baggage, personal effects, passports, travel documents, sporting or golf If, while on a Trip, Your sporting or golf equipment is delayed or misdirected
equipment or visas are lost, damaged, or stolen during Your Trip, the Company by the Common Carrier for more than the number of hours shown in the
will pay the lesser of: (a) the cash value (original cash value less depreciation) as Schedule, the Company will reimburse You up to the Maximum Limit shown
determined by the Company or, (b) the cost of replacement, up to the Maximum in the Schedule for the rental or purchase of sporting golf equipment.
Limit shown in the Schedule subject to the special limitations shown below.
Incurred expenses over $25 must be accompanied by receipts.
Special Limitations:
Notwithstanding the foregoing, the Company will cover up to the maximum EMERGENCY EVACUATION and REPATRIATION OF REMAINS
amount indicated for the following:
• the amount shown in the Schedule for the first item The Company will pay for Covered Emergency Evacuation Expenses incurred due
• the amount shown in the Schedule per each additional item to an Injury or Sickness that occurs to You while You are on a Trip. Benefits
• the amount shown in the Schedule aggregate on all Losses to: payable are subject to the Maximum Limit shown in the Schedule for all
jewelry, watches, furs, cameras and camera equipment, Emergency Evacuations due to all Injuries from the same accident or all
camcorders, sporting, golf equipment, computers, electronic Sicknesses from the same or related causes during an overnight Trip with a
devices, including but not limited to: lap top computers, cell phones, Destination of at least 100 miles from Your Primary Residence.
electronic organizers and portable CD players.
Covered Emergency Evacuation Expenses are the Reasonable and Customary
Items over $150 must be accompanied by original receipts. If receipts are not Charges for necessary Transportation, related medical services and medical supplies
provided, no benefits are payable. incurred in connection with Your Emergency Evacuation. All Transportation
arrangements made for evacuating You must be by the most direct and economical
The Company may take all or part of the damaged Baggage or sporting and golf route possible and required by the standard regulations of the conveyance
equipment at the appraised or agreed value. In the event of a Loss to a pair or transporting You.
set of items, the Company may choose to:
(a) repair or replace any part to restore the pair or set to its value before the Expenses for Transportation must be:
Loss; or (a) ordered by the onsite attending Physician who must certify that the severity
(b) pay the difference between the cash value of the Baggage before and after of Your Injury or Sickness warrants Your Emergency Evacuation and adequate
the Loss. medical treatment is not locally available; and
(b) authorized in advance by the Travel Insurance Administrator. In the
event Your Injury or Sickness prevents prior authorization of the
Emergency Evacuation, the Travel Insurance Administrator must be
notified as soon as reasonably possible.
The Company will also pay a benefit for reasonable and customary expenses If You are hospitalized for more than 7 days following a covered Emergency
incurred for an escort’s transportation and accommodations subject to the Evacuation, the Company will reimburse You, subject to the limitations set out
Escort Maximum Limit shown in the Schedule if an onsite attending Physician herein, the expenses for:
recommends in writing that an escort accompany the Insured. 1. Return of Children: Return of Your Children, who were accompanying
You when the Injury or Sickness occurred, to Your residence in the
Special Limitation: In the event the Travel Insurance Administrator could not be United States, including the cost of an attendant, if necessary. Such
contacted to arrange for Emergency Evacuation, benefits are limited to the expenses shall not exceed the cost of a one-way economy airfare
amount the Company would have paid had the Company or its authorized ticket, or same class as the original ticket, less the value of any applied
representative been contacted. credit from any Unused return travel tickets for each person.
2. Bedside Traveling Companion: The Company will reimburse You for
Emergency Evacuation - means: reasonable expenses incurred for Hotel and meals shown in the
(a) Transportation from the place where You are Injured or sick to the nearest Schedule for the Traveling Companion to remain near You. For an
adequate licensed medical facility where appropriate medical treatment insured Child, a bedside companion is available immediately upon
can be obtained; or Hospital admission. Receipts must be submitted. Coverage for this
(b) Transportation from a local medical facility to the nearest adequate licensed benefit ends on the day You are discharged from the hospital. For
medical facility to obtain appropriate medical treatment if the onsite purposes of this benefit, Traveling Companion means the person is
attending Physician certifies that additional Medically Necessary treatment is Insured under this plan and accompanies the Insured on the Trip.
needed but not locally available; and You are medically able to travel; or
(c) Transportation to the adequate licensed medical facility nearest Your If you or a Traveling Companion are Hospitalized due to an Accidental Injury or
home to obtain further medical treatment or to recover, after being Sickness that first occurred during the course of Your Trip beyond the date Your
treated at a local licensed medical facility, and the onsite attending coverage ends, coverage under this benefit will be extended until You or Your
Physician determines that You are medically able to be transported; or Traveling Companion are released from the Hospital or until the Maximum
Benefit as listed in the Schedule is paid.
Advanced authorization by the Travel Insurance Administrator is needed for (a),
(b) and (c) above. REPATRIATION OF REMAINS
ADDITIONAL BENEFITS The Company will pay Repatriation Covered Expenses up to the Maximum Limit
In addition to the above covered expenses, if the Company has previously shown in the Schedule of Benefits to return Your body to the City of burial if You die
evacuated You to a medical facility, the Company will reimburse You Your airfare during the Trip.
costs, less refunds from Your Unused transportation tickets, from that facility to
Your Return Destination or home, within one year from Your original Return Repatriation Covered Expenses. include, but are not limited to, the reasonable
Date. Airfare costs will be based on medical necessity or same class as the and customary expenses for:
Insured’s original tickets. (a) embalming;
(b) cremation;
(c) the most economical coffins or receptacles adequate for transportation of “Children” or “Child” means the Insured’s Children or grandchildren, including
the remains; and an unmarried child, stepchild, legally adopted child or foster child who is:
(d) transportation of the remains, by the most direct and economical (1) under age 25 and primarily dependent on the Insured for support and
conveyance and route possible. maintenance; or
(2) who is at least nineteen (19) but less than age twenty-four (24) and who
The Travel Insurance Administrator must make all arrangements and authorize regularly attends an accredited school or college; and who is primarily
all expenses in advance. dependent on the Insured for support and maintenance.
Special Limitation: In the event the Company or the Company’s authorized “City” means an incorporated municipality having defined borders and does not
representative could not be contacted to arrange for Repatriation Covered include the high seas, uninhabited areas or airspace.
Expenses, benefits are limited to the amount the Company would have paid had
the Company or its authorized representative been contacted. “Common Carrier” means an air, land, sea conveyance operated under a license for
the transportation of passengers for hire and for which the Insured’s ticket was
SECTION III purchased through the Travel Supplier.
DEFINITIONS
(Capitalized terms within this Policy are defined herein) “Company” means Berkshire Hathaway Specialty Insurance Company.
“Actual Cash Value” means purchase price less depreciation. “Complications of Pregnancy” means conditions whose diagnoses are distinct
from pregnancy but are adversely affected by pregnancy or are caused by
“Baggage” means luggage, and personal possessions and travel documents; pregnancy. These conditions include acute nephritis, nephrosis, cardiac
whether owned, borrowed, or rented, taken by the Insured on the Trip. decompensation, missed abortion and similar medical and surgical conditions of
comparable severity. Complications of pregnancy also include nonelective
“Business Partner” means a person who: (1) is involved with the Insured or the cesarean section, ectopic pregnancy which is terminated and spontaneous
Insured’s Traveling Companion in a legal partnership; and (2) is actively involved termination of pregnancy, which occurs during a period of gestation in which a
in the daily management of the business. viable birth is not possible.
“Caregiver” means an individual employed for the purpose of providing Complications of pregnancy do not include false labor, occasional spotting,
assistance with activities of daily living to the Insured or to the Insured’s Family Physician-prescribed rest during the period of pregnancy, morning sickness,
Member who has a physical or mental impairment. The caregiver must be hyperemesis gravidarum, preeclampsia and similar conditions associated with
employed by the Insured or the Insured’s Family Member. A caregiver is not a the management of a difficult pregnancy not constituting a nosologically distinct
babysitter; childcare service, facility or provider; or persons employed by any complication of pregnancy.
service, provider or facility to supply assisted living.
“Departure Date” means the date on which the Insured is originally scheduled
to leave on his/her Trip. This date is specified in the travel documents.
“Destination” means any place where the Insured expects to travel to on his/her “Forfeited” means the Insured’s financial Loss of any whole or prorated prepaid
Trip other than Return Destination as shown on the travel documents. nonrefundable components of a Trip, including award travel costs.
“Domestic Partner” means an opposite or a same-sex partner who is at least 18 "Host At Destination" means the person with whom the Insured is sharing
years of age and has met all of the following requirements for at least 6 months: prearranged overnight accommodations in the host's home.
(a) resides with the Insured or Family Member;
(b) shares financial assets and obligations with the Insured or Family Member; “Hotel” means any establishment used for the purpose of temporary, overnight
lodging for which a fee is paid and reservations are required.
The Company may require proof of the domestic partner relationship in the form
of a signed and completed Affidavit of Domestic Partnership. “Inaccessible” means an Insured cannot reach his/her Destination by the original
mode of transportation.
“Family Member” means the Insured’s, or Traveling Companion’s
• spouse, civil union partner or Domestic Partner, “Inclement Weather” means any severe weather condition other than a hurricane
• Child, which delays the scheduled arrival or departure of a Common Carrier or prevents
• siblings, the Insured from reaching his/her Destination when traveling by a rented or owned
• parents, vehicle.
• grandparent, step-grandparent, grandchild, or step-grandchild,
• step-child, step-sibling, or step-parent, “Injury/Injured” means a bodily injury caused by an accident occurring while the
• step-aunt or step-uncle, Insured’s coverage under this Policy is in force and resulting directly and
• parent-in-law, independently of all other causes of Loss covered by this Policy. The injury must be
• daughter-in-law or son-in-law, verified by a Physician.
• brother-in-law or sister-in-law,
“Insured”, “You”, “Your” means a person:
• aunt or uncle,
(a) for whom any required application has been completed;
• niece or nephew,
(b) for whom any required plan cost has been paid;
• legal guardian,
(c) for whom a Trip is scheduled; and
• Caregiver, (d) who is covered under this Policy.
• foster Child, ward or legal ward;
• spouse, civil union partner, or Domestic Partner of any of the above. “Key Employee” means an employee of an employer who is responsible for policy
• Family Member also includes these relations to the Insured’s or Traveling and decision making.
Companion’s, spouse, civil union partner or Domestic Partner.
“Loss” means an Injury or Unforeseen event or incident (subject to the
“Financial Default” means the total cessation or partial suspension of operations exceptions contained in the following sentences) sustained by the Insured as a
due to insolvency, with or without the filing of a bankruptcy petition by a tour direct result of one or more of the events against which the Company has
operator, Cruise line, or airline. undertaken to compensate the Insured.
“Medically Necessary” means that a treatment, service, or supply is determined “Return Destination” means the place to which the Insured expects to return
by the treating Physician to be essential for diagnosis, treatment, or care of the from his/her Trip as shown in the Application.
Injury or Sickness for which it is prescribed or performed.
“Schedule” means the Schedule of Benefits which is shown at the beginning of
“Mental, Nervous or Psychological Disorder” means a mental or nervous health the Policy.
condition including, but not limited to: anxiety, depression, neurosis, phobia,
psychosis; or any related physical manifestation. “Sickness” means an illness or disease diagnosed or treated by a Physician after
the Insured’s effective date of coverage under this Policy.
“Natural Disaster” means a flood, hurricane, tornado, earthquake, volcanic
eruption, fire, wildfire or blizzard that is due to natural causes. “Strike” means a stoppage of work which:
(a) is announced, organized, and sanctioned by a labor union; and
“Necessary Personal Effects” means items such as clothing and toiletry items, (b) interferes with the normal departure and arrival of a Common Carrier.
which are included in the Insured’s Baggage and are required for the Insured’s This includes work slowdowns and sickouts. The Insured’s coverage must be
Trip. effective prior to when the strike is foreseeable. A strike is foreseeable on the
date labor union members vote to approve a strike.
“Normal Pregnancy” or “Childbirth” means a pregnancy or childbirth that is free
of complications or problems. “Terrorist Incident” means an act of violence by any person acting on behalf of
or in connection with any organization which is generally recognized as having
“Physician” means a licensed practitioner of medical, surgical, dental, services or the intent to overthrow or influence the control of any government, that is
the healing arts including accredited Christian Science Practitioner, acting within deemed terrorism by the United States Government other than civil disorder or
the scope of his/her license. The treating physician cannot be the Insured, a riot, that is not an act of war, declared or undeclared, that results in Loss of life
Traveling Companion, a Family Member, or a Business Partner. or major damage to property.
“Primary Residence” means an Insured’s fixed, permanent and main home for “Theft” means the act of stealing, the wrongful taking and carrying away of the
legal and tax purposes. personal goods or property of another, larceny.
“Reasonable Additional Expenses” means expenses for meals, taxi fares, “Transportation” means any land, sea or air conveyance required to Transport
essential telephone calls, local transportation, and lodging which are necessarily the Insured during an Emergency Evacuation. Transportation includes, but is not
incurred as the result of Trip Delay and which are not provided by the Common limited to, air ambulances, land ambulances and private motor vehicles.
Carrier or any other party free of charge.
“Travel Supplier” means the tour operator, Hotel, rental company, Cruise line,
“Return Date” means the date on which the Insured is scheduled to return to or airline that provides pre-paid travel arrangements for the Insured’s Trip.
the point where the Trip started or to a different specified Return Destination.
This date is specified in the travel documents.
“Traveling Companion” means a person or persons with whom the Insured has SECTION IV
coordinated travel arrangements and intends to travel with during the Trip. A EXCLUSIONS AND LIMITATIONS
group or tour leader is not considered a traveling companion unless the Insured
is sharing room accommodations with the group or tour leader. GENERAL EXCLUSIONS
This plan does not cover any loss caused by or resulting from:
“Trip” means a period of travel away from home to a Destination outside the (a) intentionally self-inflicted Injury, suicide, or attempted suicide of the
Insured’s City of residence; the purpose of the trip is business or pleasure and is Insured, Family Member, Traveling Companion or Business Partner while
not to obtain health care or treatment of any kind; the trip has defined Departure sane or insane;
and Return Dates specified when the Insured applies; the trip does not exceed (b) Normal Pregnancy or Childbirth, other than Unforeseen Complications
180 days; travel is primarily by Common Carrier and only incidentally by private of Pregnancy, of the Insured, a Traveling Companion or a Family
conveyance. Member;
(c) participation in professional athletic events; motor sport, or motor
“Trip Cost” means the dollar amount of Trip payments or deposits paid by the racing, including training or practice for the same;
Insured prior the Insured’s Trip Departure Date and shown on any required (d) mountain climbing that requires the use of equipment such as; pick-
application which is subject to cancellation penalties or restrictions. Trip cost will axes, anchors, bolts, crampons, carabineers, and lead or top-rope
also include the cost of any subsequent pre-paid payments or deposits paid by anchoring or other specialized equipment;
the Insured for the same Trip, after application for coverage under this plan (e) operating or learning to operate any aircraft, as student, pilot, or crew;
provided the Insured amends the Application to add such subsequent payments (f) air travel on any air-supported device, other than a regularly scheduled
or deposits and pays any required additional plan cost prior to the Insured’s airline or air charter;
Departure Date. (g) war (whether declared or not) or act of war, participation in a civil
disorder, riot, insurrection or unrest (unless specifically covered
“Unforeseen” means not anticipated or expected and occurring after the effective herein);
date of coverage. (h) any unlawful acts committed by the Insured;
(i) Mental, Nervous or Psychological Disorder;
“Uninhabitable” means (1) the building structure itself is unstable and there is a risk (j) if the Insured’s tickets do not contain specific travel dates (open tickets);
of collapse in whole or in part; (2) there is exterior or structural damage allowing (k) being under the influence of drugs or narcotics, unless administered
elemental intrusion, such as rain, wind, hail or flood; (3) immediate safety hazards upon the advice of a Physician or intoxication above the legal limit;
have yet to be cleared, such as debris or downed electrical lines; (4) the rental (l) any Loss that occurs at a time when this coverage is not in effect;
property is without electricity, gas, sewer service or water; or (5) the Destination is (m) traveling solely or substantially for the purpose of securing medical
Inaccessible. treatment;
(n) any Trip taken outside the advice of a Physician;
“Unused” means the Insured’s financial Loss of any whole, partial or prorated (o) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will
prepaid nonrefundable components of a Trip that are not depleted or exhausted, not pay for any loss or expense incurred as the result of an Injury,
including award travel expenses. Sickness or other condition (excluding any condition from which death
ensues) of an Insured, Traveling Companion, Business Partner or
Family Member which, within the 180 day period immediately (d) artificial prosthetic devices, false teeth, any type of eyeglasses,
preceding and including the Insured’s coverage effective date: (a) first sunglasses, contact lenses, or hearing aids;
manifested itself, worsened, became acute or had symptoms which (e) keys, notes, securities, accounts, currency, deeds, food stamps, bills,
would have prompted a reasonable person to seek diagnosis, care or credit cards, or other evidences of debt, or tickets;
treatment; (b) for which care or treatment was given or recommended (f) money, stamps, stocks and bonds, postal or money orders;
by a Physician; (c) required taking prescription drugs or medicines, (g) property shipped as freight, or shipped prior to the Departure Date;
unless the condition for which the drugs or medicines are taken (h) contraband, illegal transportation or trade;
remains controlled without any change in the required prescription (i) items seized by any government, government official or customs official;
drugs or medicines. (j) defective materials or craftsmanship;
(k) normal wear and tear;
The following exclusions also apply to Trip Cancellation and Trip Interruption: (l) deterioration.
Unless otherwise provided by this plan Benefits will not be provided for any loss
resulting (in whole or in part) from: The following exclusion also applies to the Emergency Evacuation Benefit;
(a) travel arrangements canceled by an airline, Cruise line, or tour operator, (a) coverage for Trips less than 100 miles from the Insured’s Primary
except as provided elsewhere in the plan; Residence;
(b) changes in plans by the Insured, a Family Member, or Traveling (b) traveling for the purpose of securing medical treatment.
Companion, for any reason;
(c) financial circumstances of the Insured, a Family Member, or a Traveling EXCESS INSURANCE LIMITATION
Companion; The insurance provided by this Policy for all coverages shall be in excess of all
(d) any government regulation or prohibition; other valid and collectible insurance or indemnity. If at the time of the
(e) an event which occurs prior to the Insured’s coverage Effective Date; occurrence of any Loss payable under this Policy there is other valid and
(f) failure of any tour operator, Common Carrier, person or agency to collectible insurance or indemnity in place, the Company shall be liable only for
provide the bargained-for travel arrangements or to refund money due the excess of the amount of Loss, over the amount of such other insurance or
the Insured; indemnity.
(g) traveling for the purpose of securing medical treatment;
The following exclusions apply to Baggage/Personal Effects and Baggage

Delay:
Benefits will not be provided for any Loss, or damage to, caused by, or resulting
in whole or in part from:
(a) animals, rodents, insects or vermin;
(b) bicycles (except when checked with a Common Carrier);
(c) motor vehicles, aircraft, boats, boat motors, ATV’s and other
conveyances;
SECTION V proof of loss within 15 days of receiving a notice of claim from You, or
CLAIMS INFORMATION someone acting on Your behalf. Claim forms can be found at the web address
shown above.
How to Make a Claim
Visit the website, mobile app, email or call the Travel Insurance Proof of Loss: You have 90 days from the date of loss to submit your claim to the
Administrator. Travel Insurance Administrator, or as soon after that as is reasonably possible.
Failure to furnish such proof within such time will not invalidate nor reduce any
Available Online: claim if it shall be shown not to have been reasonably possible to furnish such
• file first notice of loss (FNOL) and upload documents electronically proof during that time. All claims under this Policy must be submitted to the
• find out what forms and documentation you need for your claim Travel Insurance Administrator no later than one year after the date of Loss or
• download necessary claim forms insured occurrence or as soon as reasonably possible. If the Travel Insurance
Administrator has not provided claim forms within 15 days after the notice of
Mobile Application claim, other proofs of Loss should be sent to the Travel Insurance Administrator
• file first notice of loss (FNOL) and upload documents electronically by the date claim forms would be due. The Travel Insurance Administrator will
• find out what forms and documentation you need for your claim require information from You for the proof of loss. This will include, but is not
• download necessary claim forms limited to:
• written proof of the occurrence;
Email or Call: • type and amount of Loss;
• to find out what forms and documentation you need for your claim • the Insured’s name; and
• to file a claim and check its progress • the Travel Supplier Name; and
• policy number.
Claims Inquiry: • The Insured must return all unused, non-refundable tickets.
• Website: www.travelexinsurance.com
• Mobile App: Google Play or iTunes Payment of Claims:
• Email: travelex.claims@bhspecialty.com
• Telephone: 1.855.205.6054 When Paid: Claims will be paid as soon as the Travel Insurance Administrator
receives complete proof of Loss and verification of age, but no later than 60 days
Claim Procedures: after receipt of proof of loss.
Notice of Claim: You must notify the Travel Insurance Administrator as soon To Whom Paid:
as reasonably possible, and be prepared to describe the Loss, the name of the Benefits are payable to the Insured who applied for coverage and paid any
Travel Supplier (i.e., tour operator, Cruise line, or charter operator), the Trip required plan cost. Any benefits payable due to the Insured’s death will be paid
dates, purchase date and the amount that the Insured paid. The Company will to the Insured’s estate, unless written notice of a designated beneficiary is
provide You, or someone acting on Your behalf, with forms for the filing of a provided to the Company.
Emergency Evacuation benefits may be payable directly to the provider. (c) allow the Company to examine the damaged Baggage and/or the Company
However, the provider: (a) must comply with the statutory provision for direct may require the damaged item to be sent in the event of payment;
payment; and (b) must not have been paid from any other sources. (d) send sworn proof of Loss as soon as possible from date of Loss, providing
amount of Loss, date, time, and cause of Loss, and a complete list of
Trip Cancellation and Trip Interruption Proof of Loss: The Insured must provide damaged or lost items; and
the Travel Insurance Administrator documentation of the cancellation or (e) Provide original receipts for any items over $150.
interruption and proof of the expenses incurred. The Insured must provide proof
of payment for the Trip such as canceled check or credit card statements, proof Sporting and Golf Equipment Delay Proof of Loss: The Insured must provide
of refunds received, copies of applicable tour operator or Common Carrier documentation of the delay or misdirection of the Baggage by the Common
cancellation policies, and any other information reasonably required to prove Carrier and receipts for the Necessary Personal Effects purchases.
the Loss. Claims involving Loss due to Sickness, Injury, or death require signed
patient (or next of kin) authorization to release medical information and an The following provisions apply to Baggage/Personal Effects and Sportsman
attending Physician’s statement. The Insured must provide the Travel Insurance Golf Equipment Delay:
Administrator with all unused air, rail, Cruise, or other tickets if he/she is claiming
the value of those unused tickets. Notice of Loss: If the Insured's property covered under this Policy is lost or
damaged, the Insured must:
Trip Delay Proof of Loss: The Insured must provide the following to the Travel (a) notify the Travel Insurance Administrator as soon as possible;
Insurance Administrator: (b) take immediate steps to protect, save and/or recover the covered
• documentation of the delay from the Travel Supplier, as to the reason for property;
the delay; (c) give immediate notice to the carrier or bailee who is or may be liable
• A form of proof for expenses incurred. for the Loss or damage;
o copies of receipts for expenses greater than $25, or a (d) notify the police or other authority in the case of robbery or Theft
o list of the expenses incurred under $25, to include: within 24 hours.
▪ Amount paid, what the payment was for, and the date of
the payment. Claims involving Loss due to Sickness, Injury, Settlement of Loss: Claims for damage and/or destruction shall be paid
or death require signed patient (or next of kin) immediately after proof of the damage and/or destruction is presented to
authorization to release medical information and an the Travel Insurance Administrator. Claims for lost property will be paid after
attending Physician’s statement. the lapse of a reasonable time if the property has not been recovered. The
Insured must present acceptable proof of Loss and the value.
Baggage and Personal Effects Proof of Loss: The Insured Must:
(a) report Theft Losses to police or other local authorities as soon as possible; Valuation: The Company will not pay more than the Actual Cash Value of the
(b) take reasonable steps to protect his/her Baggage from further damage and property at the time of Loss. At no time will payment exceed what it would
make necessary and reasonable temporary repairs; (The Company will cost to repair or replace the property with material of like kind and quality.
reimburse the Insured for those expenses. The Company will not pay for
further damage if the Insured fails to protect his/her Baggage);
Appraisal/Disagreement Over Size of Loss: If there is a disagreement about As a condition to receiving the applicable benefits listed above, as they
the amount of the cash value or Loss either You or the Company can make a pertain to this Subrogation provision, the Insured agrees, except as may be
written demand for an appraisal. After the demand, You and the Company limited or prohibited by applicable law, to reimburse the Company for any
will each select Your own competent and disinterested appraiser and notify such benefits paid to or on behalf of the Insured, if such benefits are
the other of the appraiser selected within 20 days of such demand. The recovered, in any form, from any Third Party or Coverage.
appraisers shall first select a competent and disinterested arbitrator; and
failing for 15 days to agree on such arbitrator, then on request of the Insured The Company will not pay or be responsible, without its written consent,
or the Insurer, such arbitrator shall be selected by a judge of a court of record for any fees or costs associated with the pursuit of a claim, cause of action
in the state in which the property covered is located. The appraisers shall or right by or on behalf of an Insured or such other person against any Third
then appraise the loss, stating separately actual cash value and loss to each Party or Coverage.
item, and, failing to agree, shall submit their differences, only, to the
arbitrator. An award in writing, so itemized, of any two when filed with the Coverage - as used in this Subrogation section, means no fault motorist
Insurer shall determine the amount of actual cash value and loss. The coverage, uninsured motorist coverage, underinsured motorist coverage, or
appraiser selected by You is paid by You. The Company will pay the appraiser any other fund or insurance policy except coverage provided under this
they choose. You will share equally with the Company the cost for the Policy and any fund or insurance policy providing the Insured with coverage
arbitrator and the appraisal process. for any claims, causes of action or rights the Insured may have against the
Company.
Benefit to Bailee: This insurance will in no way inure directly or indirectly
to the benefit of any carrier or other bailee. Third Party - as used in this Subrogation section, means any person,
corporation or other entity (except the Insured and the Company).
Emergency Evacuation and Repatriation of Remains Proof of Loss: The Insured
must provide the Travel Insurance Administrator with: (a) all medical bills and
reports for medical expenses claimed; and (b) a signed patient authorization to
release medical information to the Travel Insurance Administrator.
The following provision applies to Baggage/Personal Effects:
Subrogation - To the extent the Company pays for a Loss suffered by an

Insured, the Company will take over the rights and remedies the Insured had
relating to the Loss. This is known as subrogation. The Insured must help the
Company preserve its rights against those responsible for its Loss. This may
involve signing any papers and taking any other steps the Company may
reasonably require. If the Company takes over an Insured's rights, the
Insured must sign an appropriate subrogation form supplied by the
Company.
SECTION VI Conformity with State Statutes. Any provision of this Policy which, on its
GENERAL PROVISIONS effective date, is in conflict with the statutes of the state in which this Policy is
delivered is hereby amended to conform to the minimum requirements of those
Entire Contract; Changes. This Policy, Schedule of Benefits, Application and any statutes.
attachments are the entire contract of insurance. In the absence of fraud, all
statements made by the Insured will be considered representations and not Clerical Error. Clerical error, whether by the Insured or the Company, will not
warranties. No agent may change it in any way. Only an officer of the Company void the insurance of any Insured if that insurance would otherwise have been
can approve a change. Any such change must be shown in this Policy or its in effect nor extend the insurance of any Insured if that insurance would
attachments. otherwise have ended or been reduced as provided in this Policy.
Acts of Agents. No agent or any person or entity has authority to accept service Misstatement of Age. If premiums for the Insured are based on age and the Insured
of the required proof of loss or demand arbitration on the Company’s behalf nor has misstated his or her age, there will be a fair adjustment of premiums based on
to alter, modify, or waive any of the provisions of this Policy. his or her true age. The Company may require satisfactory proof of age before
paying any claim.
Physical Examination and Autopsy. The Company at its own expense has the right
and opportunity to examine the person of any Insured whose Loss is the basis of Legal Actions. No action at law or in equity may be brought to recover on this Policy
claim under this Policy when and as often as it may reasonably require during the prior to the expiration of 60 days after written proof of Loss has been furnished in
pendency of the claim and to perform an autopsy in case of death where it is not accordance with the requirements of this Policy. No such action may be brought
forbidden by law. after the expiration of 3 years after the time written proof of loss is required to be
furnished.
Beneficiary Designation and Change. The Insured’s beneficiaries are the persons
designated by the Insured and on file with the Travel Insurance Administrator or Arbitration. If the Company and one or more Insured(s) with respect to the
the beneficiaries as shown in the Payment of Claim: To Whom Paid provision. rights of such Insured(s) under this Policy voluntarily agree to arbitration to
resolve the dispute, the Commercial Arbitration Rules of the American
An Insured over the age of majority and legally competent may change his or her Arbitration Association shall apply, except with respect to the selection of
beneficiary designation at any time, without the consent of the designated arbitrators, the payment of arbitration fees and costs, the location and the
beneficiaries, unless an irrevocable designation has been made, by providing the entry of the arbitration award. Such arbitration shall be non-binding upon all
Travel Insurance Administrator with a written request for change. When the parties.
request is received, whether the Insured is then living or not, the change of
beneficiary will relate back to and take effect as of the date of execution of the Selection of Arbitrators: One arbitrator shall be chosen by one side and
written request, but without prejudice to the Company on account of any another arbitrator by the other side. The two arbitrators will select a third
payment made by it prior to receipt of the request. arbitrator ("umpire"). If the arbitrators are unable to agree upon an umpire,
application shall be made to a justice of the Supreme Court residing in the
Assignment. An Insured may not assign any of his or her rights, privileges or county or to a county judge of the county in which the damaged property is
benefits under this Policy. or was located. Application may be made on five days' written notice to the
other party. The court, on proof by affidavit of the failure of the arbitrators Insurance With Other Insurers. If there is other valid coverage with another
to select an umpire, will appoint an umpire. All arbitrators shall be insurer that provides coverage for the same Loss, the Company will pay only the
competent and disinterested. proportion of the Loss that this Company’s Limit for that Loss bears to the total
limit of all insurance covering that Loss, plus such portion of the premium paid
Payment of Arbitration Fees and Costs: Each side shall pay the fee of its that exceeds the pro-rata portion for the benefits so determined.
chosen arbitrator and half the fee of the third arbitrator. The remaining costs
of the arbitration, including legal fees and disbursements, shall be paid as Controlling Law. Any part of this Policy that conflicts with the state law where
the written decision of the arbitrators directs, with it being expressly this Policy is issued is changed to meet the minimum requirements of that law.
understood that the intention is to favor reimbursement of such fees and
expenses to an insured that has brought a meritorious dispute. The fees to
be borne by a side consisting of more than one Party shall be divided equally
among such Parties.
Location: Any arbitration hereunder shall take place in New York, New York,
unless otherwise mutually agreed upon by the two sides.
Entry of Arbitration Award: Judgment upon an arbitration award hereunder

may be entered in, and enforced by, any court of competent jurisdiction.
Concealment or Fraud. The Company does not provide coverage if the Insured
has intentionally concealed or misrepresented any material fact or circumstance
relating to this Policy or claim.
Payment of Premium. Coverage is not effective unless all premium due has been
paid to the Travel Insurance Administrator prior to a date of Loss or insured
occurrence.
Termination of this Policy. Termination of this Policy will not affect a claim for
Loss if the Loss occurred while this Policy was in force.
Transfer of Coverage. Coverage under this Policy cannot be transferred by the

Insured to anyone else.
BAGGAGE DELAY
If, while on a Trip, Your Baggage is delayed or misdirected by the

Common Carrier for at least the number of consecutive hours shown in
the Schedule, the Company will reimburse You up to the Maximum
Limit shown in the Schedule for the purchase of Necessary Personal
Effects. Necessary Personal Effects do not include jewelry, perfume and
alcohol. Incurred expenses must be accompanied by receipts. This
benefit does not apply if Baggage is delayed after the Insured has
reached his/her Return Destination.
Incurred expenses over $25 must be accompanied by receipts.

THIS RIDER CHANGES THE POLICY. PLEASE READ IT
CAREFULLY. SECTION III DEFINITIONS
I. For the purposes of this rider, the following definitions apply:
This Rider is attached to and made part of your insurance plan. It is subject to
“Baggage” means luggage, and personal possessions and travel
all of the provisions, limitations and exclusions of the plan. documents, whether owned, borrowed, or rented, taken by the
Insured on the Trip.
This rider modifies insurance provided under the following plans:
“Common Carrier” means an air, land, sea conveyance operated under
Individual Travel Protection Insurance Policy a license for the transportation of passengers for hire and for which
the Insured’s ticket was purchased through the Travel Supplier.
I. The following is added to the SCHEDULE OF BENEFITS: “Necessary Personal Effects” means items such as clothing and
toiletry items, which are included in the Insured’s Baggage and are
Baggage Delay $200 required for the Insured’s Trip. Necessary Personal Effects does not
include jewelry, perfume or alcohol.
SECTION II SUMMARY OF BENEFITS

I. The following is added to the Summary of Benefits:
Page 1 | PG-TA-RIDE-BDR-NY-2/2016
SECTION IV EXCLUSIONS AND LIMITATIONS II. For the purposes of this endorsement, the following provisions
I. For the purposes of this rider, the following exclusions apply: apply:
The following exclusions apply to Baggage Delay: Notice of Loss: If the Insured's property covered under this Policy is
Benefits will not be provided for any Loss, or damage to, caused by, lost or damaged, the Insured must:
or resulting in whole or in part from: (a) notify the Travel Insurance Administrator as soon as
(a) animals, rodents, insects or vermin; possible;
(b) bicycles (except when checked with a Common Carrier); (b) take immediate steps to protect, save and/or recover the
(c) motor vehicles, aircraft, boats, boat motors, ATV’s and other covered property;
conveyances; (c) give immediate notice to the carrier or bailee who is or may
(d) artificial prosthetic devices, false teeth, any type of be liable for the Loss or damage;
eyeglasses, sunglasses, contact lenses, or hearing aids; (d) notify the police or other authority in the case of robbery or
(e) keys, notes, securities, accounts, currency, deeds, food Theft within 24 hours.
stamps, bills, credit cards, or other evidences of debt, or
tickets; Settlement of Loss: Claims for damage and/or destruction shall be
(f) money, stamps, stocks and bonds, postal or money orders; paid immediately after proof of the damage and/or destruction is
(g) property shipped as freight, or shipped prior to the Departure presented to the Travel Insurance Administrator. Claims for lost
Date; property will be paid after the lapse of a reasonable time if the
(h) contraband, illegal transportation or trade; property has not been recovered. The Insured must present
(i) items seized by any government, government official or acceptable proof of Loss and the value.
customs official;
(j) defective materials or craftsmanship; Valuation: The Company will not pay more than the Actual Cash
(k) normal wear and tear; Value of the property at the time of Loss. At no time will payment
(l) deterioration. exceed what it would cost to repair or replace the property with
material of like kind and quality.
SECTION V CLAIMS INFORMATION
I. For the purposes of this rider, the following has been added to the Appraisal/Disagreement Over Size of Loss: If there is a
Proof of Loss section: disagreement about the amount of the cash value or Loss either You
or the Company can make a written demand for an appraisal. After
Baggage Delay Proof of Loss: The Insured must provide the demand, You and the Company will each select Your own
documentation of the delay or misdirection of the Baggage by the competent and disinterested appraiser and notify the other of the
Common Carrier and receipts for the Necessary Personal Effects appraiser selected within 20 days of such demand. The appraisers
purchases. shall first select a competent and disinterested arbitrator; and failing
for 15 days to agree on such arbitrator, then on request of the
Insured or the Insurer, such arbitrator shall be selected by a judge of
a court of record in the state in which the property covered is
located. The appraisers shall then appraise the loss, stating
separately actual cash value and loss to each item, and, failing to
agree, shall submit their differences, only, to the arbitrator. An
award in writing, so itemized, of any two when filed with the Insurer
shall determine the amount of actual cash value and loss. The
appraiser selected by You is paid by You. The Company will pay the
appraiser they choose. You will share equally with the Company the
cost for the arbitrator and the appraisal process.
Benefit to Bailee: This insurance will in no way inure directly or

indirectly to the benefit of any carrier or other bailee.
All other terms and conditions remain unchanged.
II. The following is added to SECTION III DEFINITIONS:
“Terrorist Incident” means an act of violence by any person acting on behalf

of or in connection with any organization which is generally recognized as
having the intent to overthrow or influence the control of any government,
other than civil disorder or riot, that is not an act of war, declared or
THIS RIDER CHANGES THE POLICY. PLEASE READ IT undeclared, that results in Loss of life or major damage to property.
CAREFULLY.
all of the provisions, limitations and exclusions of the plan.
Individual Travel Protection Insurance Policy
I. The following is added to Political/Violence in TRIP CANCELLATION AND

INTERRUPTION of SECTION II SUMMARY OF BENEFITS:
a Terrorist Incident in a City listed on Your itinerary within 30 days of Your

scheduled arrival or during the Trip;
Page 1 | PG-TA-RIDE-TER2-11/2017
The following is added to SECTION II SUMMARY OF BENEFITS
TRIP CANCELLATION AND INTERRUPTION, Medical/Health:
You, your spouse, or Domestic Partner must cancel Your Trip due
to a Normal Pregnancy or Childbirth. Date of conception as
calculated by a licensed OB-GYN must occur after Your effective
date of coverage;
Item (b) of SECTION IV EXCLUSIONS AND LIMITATIONS is deleted and replaced
CAREFULLY. by the following:
This Rider is attached to and made part of your insurance plan. It is subject to (b) Normal Pregnancy or Childbirth, other than
all of the provisions, limitations and exclusions of the plan. Unforeseen Complications of Pregnancy, (unless as
specifically covered herein), of the Insured, a Traveling
This rider modifies insurance provided under the following plan: Companion or a Family Member;

Page 1 | PG-TA-RIDE-PREG-2/2019
CAREFULLY.
The EXCESS INSURANCE LIMITATION Paragraph in SECTION IV EXCLUSIONS &

LIMITATIONS is deleted.
Page 1 | PG-TA-RIDE-PRIM-11/2017
Item (o) of SECTION IV EXCLUSIONS AND LIMITATIONS is deleted and replaced by
the following:
(o) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will

THIS RIDER CHANGES THE POLICY. PLEASE READ IT not pay for any loss or expense incurred as the result of an Injury,
CAREFULLY. Sickness or other condition (excluding any condition from which death
Family Member which, within the 60 day period immediately
This Rider is attached to and made part of your insurance plan. It is subject to preceding and including the Insured’s coverage effective date: (a) first
all of the provisions, limitations and exclusions of the plan. manifested itself, worsened, became acute or had symptoms which
would have prompted a reasonable person to seek diagnosis, care or
This rider modifies insurance provided under the following plans: treatment; (b) for which care or treatment was given or
recommended by a Physician; (c) required taking prescription drugs
Individual Travel Protection Insurance Policy or medicines, unless the condition for which the drugs or medicines
are taken remains controlled without any change in the required
prescription drugs or medicines.
Page 1 | PG-TA-RIDE-PRXLB-11/2017
SECTION II SUMMARY OF BENEFITS
I. The following is added to the Emergency Evacuation Summary of

Benefits:
Hospital of Choice: Transportation from an adequate licensed

medical facility to an adequate licensed medical facility of Your
choice for further Medically Necessary treatment if the onsite
ENDORSEMENT attending Physician certifies that the Insured is medically able to
travel.
This endorsement, effective 12:01AM:
Forms a part of Policy No.: II. The following is added to the Emergency Evacuation Summary of
Issued to: Benefits:
By: Berkshire Hathaway Specialty
Insurance Company If You are hospitalized for more than 7 days following a covered
Emergency Evacuation, the Company will reimburse You, subject to the
limitations set out herein, the expenses for:
Bedside Visit: To bring one person chosen by You to and from the
EMERGENCY EVACUATION medical facility where the Insured is confined if the Insured is alone.
ENDORSEMENT The payment will not exceed the cost of one round-Trip economy
airfare ticket.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT All other terms and conditions remain unchanged.
CAREFULLY.
This endorsement modifies insurance provided under the following:
Travel Protection Insurance Policy
Page 1 | PG-TA-IPL-TVX10-NY-EEHOCBV-32018
I. The following is added to the SCHEDULE OF BENEFITS:
PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER

The Company will waive the pre-existing medical condition exclusion
up to a maximum of the amount shown in the Schedule of Trip Cost
if the following conditions are met:
(1) This plan is purchased within 15 days of Initial Trip Payment;
(2) The amount of coverage purchased equals all prepaid
nonrefundable payments or deposits applicable to the Trip at
the time of purchase and the costs of any subsequent
arrangements added to the same Trip are insured within 15
days of the date of payment or deposit for any subsequent Trip
arrangements;
(3) All Insured’s are medically able to travel when this plan cost is
THIS RIDER CHANGES THE POLICY. PLEASE READ IT paid; and
CAREFULLY. (4) The Trip Cost does not exceed the amount shown in the
Schedule per person (only applicable to Trip
Cancellation/Interruption/ Delay).
all of the provisions, limitations and exclusions of the plan. This coverage will be terminated and no benefits will be paid under
this Pre-existing Medical Condition Exclusion Waiver coverage if the
This rider modifies insurance provided under the following plans: full costs of all prepaid, non-refundable Trip arrangements are not
insured.
SECTION I COVERAGE DETAILS
I. When Coverage Ends provided under this Rider
Coverage under this Rider ends on the earliest of:
Page 1 | PG-TA-RIDE-EPPXFN1-2/2016
(c) the Insured’s arrival at the Return Destination on a round Trip, SECTION IV EXCLUSIONS AND LIMITATIONS
or the Destination on a one-way Trip; I. The following is deleted from Exclusions, Trip Cancellation and Trip
(d) cancellation of the Trip covered by this Policy. Interruption:
Financial Default
SECTION II SUMMARY OF BENEFITS The only applies if the Insurance is purchased within 15 days of Initial Trip Payment.
I. The following is added to Summary of Benefits, Trip Cancellation and
Interruption:
Trip Cancellation/Interruption due to Financial Default Coverage
Financial Default of an airline, Cruise line, Common Carrier or tour
operator provided that:
(1) The insurance was purchased within 15 days of Initial Trip
Payment; and
(2) Financial Default occurs more than 14 days following an
Insured's effective date for the Trip Cancellation or Trip
Interruption Benefits.
The Insurer will not cover Losses resulting from a Financial Default
of any person, organization, agency, or firm that solicited Your travel
arrangements to you.
SECTION III DEFINITIONS

I. For purposes of this rider, the following definitions apply:
“Financial Default” means the total cessation of operations due to

insolvency, with or without the filing of a bankruptcy petition by a tour
operator, Cruise line or airline.
“Initial Trip Payment” means the first payment made to the Insured’s
Travel Supplier toward the cost of the Insured’s Trip.
Page 2 | PG-TA-RIDE-EPPXFN1-2/2016
Signed for the Company at its home office:
Secretary President
IMPORTANT
This coverage is valid only if the appropriate plan cost has been paid. Please Limited Benefits Health Insurance: This Policy provides limited benefits health
keep this document as your record of coverage under the plan. insurance only. It does NOT provide basic hospital, basic medical, major medical,
Medicare supplement, long term care insurance, nursing home insurance only,
PLEASE READ THIS DOCUMENT CAREFULLY! home care insurance only, or nursing home and home care insurance as defined
by the New York State Department of Financial Services.
This Policy is issued in consideration of your application and payment of the
premium due. This Policy describes all of the travel insurance benefits
underwritten by the Company.
Table of Contents
This Policy is a legal contract between the Insured and the Company. It is Section I COVERAGE DETAILS
important that you read your Policy carefully. Please refer to the Schedule of Section II BENEFITS
Benefits. It provides you with specific information about the insurance you Section III DEFINITIONS
Section IV EXCLUSIONS AND LIMITATIONS
purchased. Section V PAYMENT OF CLAIMS
Section VI GENERAL PROVISIONS
PG-TA-IPL-NV15AH-NY-3/2016 Page 1 of 10
SCHEDULE OF BENEFITS SECTION I
COVERAGE DETAILS
Travel Insurance Benefits Maximum Limit Per Person When Coverage Begins
Medical Expense** $50,000 All coverages will begin on the later of:
Dental $500 (a) 12:01 a.m. (Standard Time) on the scheduled Departure Date shown on
the travel documents; or
(b) the date and time the Insured starts his/her Trip.
** Trip must be overnight and Destination must be at least 100 miles from the
Insured’s Primary Residence.
When Coverage Ends
All coverages end on the earlier/est of:
For questions or information contact the Travel Insurance Administrator. (a) the date the Trip is completed;
Any payments under this Policy will only be made in full compliance with all United
States of America economic or trade sanction laws or regulations, including, but not (c) the Insured’s arrival at the Return Destination on a round Trip, or the
limited to, sanctions, laws and regulations administered and enforced by the U.S. Destination on a one-way Trip;
Treasury Department's Office of Foreign Assets Control ("OFAC"). Therefore, any (d) cancellation of the Trip covered by this Policy.
expenses incurred or claims made involving travel that is in violation of such
sanctions, laws and regulations will not be covered under this Policy. For more A Trip shall not exceed 180 days.
information, you may consult the OFAC internet website at
http://www.treasury.gov/resource-center/sanctions/ or a Travel Insurance
Administrator representative. Extending Coverage
All coverage will be extended, if:
(a) the Insured's entire Trip is covered by the plan;
(b) the Insured requests an extension of coverage through the Travel
Insurance Administrator and pays additional fees or premiums; or
(c) the Insured's return is delayed by unavoidable circumstances beyond
his/her control.
Request for extension of coverage will not be permitted if there is any known
claimable event on the policy and the Insured does not identify this at the time
of extension.
This extension of coverage will end on:

(a) the date the Insured reaches his/her Return Destination; or
(b) 7 days after the date the Trip was scheduled to be completed.
SECTION II New York Mandated Benefits
SUMMARY OF BENEFITS
The Company will comply with New York State mandated benefits and will not
MEDICAL EXPENSE BENEFIT deny coverage if a proper claim is submitted for a covered Injury or Sickness
under this Policy.
If, while on a Trip, You suffer an Injury or Sickness that requires You to be treated
by a Physician, the Company will pay a benefit for Reasonable and Customary
Charges, up to the Maximum Limit shown in the Schedule. The Company will SECTION III
reimburse You for covered expenses determined to be necessary by the treating DEFINITIONS
Physician and which are incurred to treat such Injury or Sickness during the (Capitalized terms within this Policy are defined herein)
course of the Trip provided the initial documented treatment was received from
a Physician during the Trip. The Injury must first occur or the Sickness must first “Business Partner” means a person who: (1) is involved with the Insured or the
begin while on an overnight Trip with a Destination of at least 100 miles from Insured’s Traveling Companion in a legal partnership; and (2) is actively involved
Your Primary Residence, while covered under this Policy. Pre-existing medical in the daily management of the business.
conditions will be covered if the Pre-existing Medical Condition Waiver is in
effect. “Children” or “Child” means the Insured’s children or grandchildren, including
natural children from the moment of birth, children from a civil union and step,
Covered Expenses: foster or adopted children from the moment of placement in the Insured’s
The Company will reimburse the Insured for: home, under age 26. However, the age limit does not apply to a child who: (1)
● services of a Physician or registered nurse (R.N.); otherwise meets the definition of children; and (2) is incapable of self-
● Hospital charges; sustaining employment by reason of mental illness, developmental disability,
● X-rays; mental retardation or physical handicap. As otherwise used in this plan, it
● local ambulance services to or from a Hospital; means the Insured’s natural, step, foster, adopted children or grandchildren of
● artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices; any age.
● the cost of emergency dental treatment only during a Trip limited to the
Maximum Limit shown in the Schedule. Coverage for emergency dental “City” means an incorporated municipality having defined borders and does not
treatment does not apply if treatment or expenses are incurred after the include the high seas, uninhabited areas or airspace.
Insured has reached his/her Return Destination, regardless of the
reason. The treatment must be given by a Physician or dentist. “Common Carrier” means an air, land, sea conveyance operated under a license for
the transportation of passengers for hire and for which the Insured’s ticket was
Advance Payment: If You require admission to a Hospital, the Travel Insurance purchased through the Travel Supplier.
Administrator will arrange advance payment, if required. Hospital confinement
must be determined to be necessary by the onsite attending Physician. “Company” means Berkshire Hathaway Specialty Insurance Company.
“Complications of Pregnancy” means conditions whose diagnoses are distinct “Elective Treatment And Procedures” means any medical treatment or surgical
from pregnancy but are adversely affected by pregnancy or are caused by procedure that is not medically necessary including any service, treatment, or
pregnancy. These conditions include acute nephritis, nephrosis, cardiac supplies that are deemed by the federal, or a state or local government
decompensation, missed abortion and similar medical and surgical conditions of authority, or by us to be research or experimental or that is not recognized as a
comparable severity. Complications of pregnancy also include nonelective generally accepted medical practice.
cesarean section, ectopic pregnancy which is terminated and spontaneous
termination of pregnancy, which occurs during a period of gestation in which a “Experimental or Investigative” means treatments, devices or prescription
viable birth is not possible. medications which are recommended by a treating Physician, but are not
considered by the medical community as a whole to be safe and effective for the
Complications of pregnancy do not include false labor, occasional spotting, condition for which the treatments, devices or prescription medications are being
Physician-prescribed rest during the period of pregnancy, morning sickness, used. This includes any treatments, procedures, facilities, equipment, drugs, drug
hyperemesis gravidarum, preeclampsia and similar conditions associated with usage, devices, or supplies not recognized as accepted medical practice, and any of
the management of a difficult pregnancy not constituting a nosologically distinct those items requiring federal or other governmental agency approval not received
complication of pregnancy. at the time services are rendered. The Company will consult with the treating
Physician and licensed medical professionals as well as internal and external
“Departure Date” means the date on which the Insured is originally scheduled doctors on an as needed basis to determine if the above treatments, devices or
to leave on his/her Trip. This date is specified in the travel documents. prescriptions are Experimental or Investigative.
“Destination” means any place where the Insured expects to travel to on his/her “Family Member” means the Insured’s
Trip other than Return Destination as shown on the travel documents. • spouse, civil union partner or Domestic Partner,
• Child,
“Domestic Partner” means an opposite or a same-sex partner who is at least 18 • siblings,
years of age with: • parents,
(a) Registration as a domestic partnership or, in the case of retirees living • grandparent, step-grandparent, grandchild, or step-grandchild,
outside the City, an alternative affidavit of domestic partnership; • step-child, step-sibling, or step-parent,
(b) Proof of cohabitation (e.g., a driver’s license, tax return or other • step-aunt or step-uncle,
sufficient proof); and • parent-in-law,
(c) Evidence of two or more of the following or substantially similar items: • daughter-in-law or son-in-law,
joint bank account, joint credit card or charge card, joint obligation on a
• brother-in-law or sister-in-law,
loan, joint ownership of residence, joint ownership of real estate other
• aunt or uncle,
than residence, joint ownership of vehicle, joint ownership of major
• niece or nephew,
items of personal property (e.g., appliances, furniture), listing of both
• legal guardian,
partners as tenants on the lease of the shared residence, or other item(s)
of proof sufficient to establish economic interdependency. • foster Child, ward or legal ward;
• spouse, civil union partner, or Domestic Partner of any of the above.
“Hospital” means a short-term, acute general hospital that: “Mental, Nervous or Psychological Disorder” means a mental or nervous health
(a) is primarily engaged in providing, by or under the continuous supervision condition including, but not limited to: anxiety, depression, neurosis, phobia,
of physicians, to inpatients, diagnostic services; psychosis; or any related physical manifestation.
(b) has organized departments of medicine and major surgery;
(c) has a requirement that every patient must be under the care of a physician “Normal Pregnancy” or “Childbirth” means a pregnancy or childbirth that is free
or dentist; of Complications of Pregnancy.
(d) provides 24 hour nursing service by or under the supervision of a
registered professional nurse (R.N.); “Physician” means a licensed practitioner of medical, surgical, dental, services or
(e) if located in New York State, has in effect a hospitalization review plan the healing arts, acting within the scope of his/her license. The treating physician
applicable to all patients which meets at least the standards set forth in cannot be the Insured or an immediate family member. For the purpose of this
section 1861(k) of United States Public Law 89-97 (42 USCA 1395x(k)); definition, immediate family member means the Insured’s spouse, civil union
(f) is duly licensed by the agency responsible for licensing such hospitals; and partner or Domestic Partner; birth or adoptive parent, child, or sibling; stepparent,
(g) is not, other than incidentally, a place of rest, a place primarily for the stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law,
treatment of tuberculosis, a place for the aged, a place for drug addicts, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild; and
alcoholics, or a place for convalescent, custodial, educational or spouse of a grandparent or grandchild.
rehabilitory care.
“Primary” means the Company will pay first but reserves the right to recover
“Hotel” means any establishment used for the purpose of temporary, overnight from any other insurance carrier with which the Insured may be covered.
lodging for which a fee is paid and reservations are required.
“Primary Residence” means an Insured’s fixed, permanent and main home for
“Injury/Injured” means a bodily injury caused by an accident occurring while the legal and tax purposes.
Insured’s coverage under this Policy is in force and resulting directly and
independently of all other causes of Loss covered by this Policy. The injury must be “Return Date” means the date on which the Insured is scheduled to return to
verified by a Physician. the point where the Trip started or to a different specified Return Destination.
This date is specified in the travel documents.
“Insured”, “You”, “Your” means a person:
(a) for whom any required application has been completed; “Return Destination” means the place to which the Insured expects to return
(b) for whom any required plan cost has been paid; from his/her Trip as shown in the Application.
(c) for whom a Trip is scheduled; and
(d) who is covered under this Policy. “Schedule” means the Schedule of Benefits which is shown at the beginning of
the Policy.
“Loss” means an Injury or Unforeseen event or incident (subject to the
exceptions contained in the following sentences) sustained by the Insured as a “Sickness” means an illness or disease diagnosed or treated by a Physician,
direct result of one or more of the events against which the Company has subject to the Pre-existing Medical Condition Exclusion.
undertaken to compensate the Insured.
“Transport” means the most efficient and available method of conveyance. In all SECTION IV
cases, where practical, economy fare will be utilized. If possible, the Insured’s EXCLUSIONS AND LIMITATIONS
Common Carrier tickets will be used.
GENERAL EXCLUSIONS
“Travel Insurance Administrator” means the administrator shown in the This plan does not cover any loss caused by or resulting from:
Insured’s confirmation letter. (a) suicide, or attempted suicide or intentionally self-inflicted injury;
(b) Normal Pregnancy or Childbirth, other than Unforeseen
“Travel Supplier” means the tour operator, Hotel, rental company, Cruise line, Complications of Pregnancy, of the Insured or a Family Member;
or airline that provides pre-paid travel arrangements for the Insured’s Trip. (c) operating or learning to operate any aircraft, as student, pilot, or crew;
(d) air travel on any air-supported device, other than a regularly scheduled
“Traveling Companion” means a person or persons with whom the Insured has airline or air charter;
coordinated travel arrangements and intends to travel with during the Trip. A (e) war (whether declared or not) or act of war, participation in a felony,
group or tour leader is not considered a traveling companion unless the Insured riot, or insurrection (unless specifically covered herein);
is sharing room accommodations with the group or tour leader. (f) Mental, Nervous or Psychological Disorder. alcoholism and drug
addiction (unless hospitalized);
“Trip” means a period of travel away from home to a Destination outside the (g) being under the influence of drugs or narcotics, unless administered
Insured’s City of residence; the purpose of the trip is business or pleasure; the upon the advice of a Physician or intoxication above the legal limit;
trip has defined Departure and Return Dates specified when the Insured applies; (h) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will
the trip does not exceed 180 days; travel is primarily by Common Carrier and not pay for any loss or expense incurred as the result of an Injury,
only incidentally by private conveyance. Sickness or other condition (excluding any condition from which
death ensues) of an Insured which, within the 180 day period
“Trip Cost” means the dollar amount of Trip payments or deposits paid by the immediately preceding and including the Insured’s coverage effective
Insured prior the Insured’s Trip Departure Date and shown on any required date: (a) first manifested itself, worsened, became acute or had
application which is subject to cancellation penalties or restrictions. Trip cost will symptoms which would have prompted a reasonable person to seek
also include the cost of any subsequent pre-paid payments or deposits paid by diagnosis, care or treatment; (b) for which care or treatment was
the Insured for the same Trip, after application for coverage under this plan given or recommended by a Physician; (c) required taking
provided the Insured amends the Application to add such subsequent payments prescription drugs or medicines, unless the condition for which the
or deposits and pays any required additional plan cost prior to the Insured’s drugs or medicines are taken remains controlled without any change
Departure Date. in the required prescription drugs or medicines.
“Unforeseen” means not anticipated or expected and occurring after the effective The following exclusions also apply to the Medical Expense Benefit:
date of coverage. Unless otherwise provided by this plan Benefits will not be provided for the
following:
(a) eyeglasses, hearing aids, and examination for the prescription or fitting
thereof;
(b) dental care or treatment, except for such care or treatment due to EXCESS INSURANCE LIMITATION
accidental injury to sound natural teeth within 12 months of the accident The insurance provided by this Policy for all coverages shall be in excess of all
and except for dental care or treatment necessary due to congenital other valid and collectible insurance or indemnity. If at the time of the
disease or anomaly; occurrence of any Loss payable under this Policy there is other valid and
(c) cosmetic surgery, except that cosmetic surgery shall not include collectible insurance or indemnity in place, the Company shall be liable only for
reconstructive surgery when such service is incidental to or follows the excess of the amount of Loss, over the amount of such other insurance or
surgery resulting from trauma, infection or other diseases of the indemnity.
involved part, and reconstructive surgery because of congenital disease
or anomaly of a covered dependent child which has resulted in a SECTION V
functional defect; CLAIMS INFORMATION
(d) foot care, in connection with corns, calluses, flat feet, fallen arches, weak
feet, chronic foot strain or symptomatic complaints of the feet; How to Make a Claim
(e) care in connection with the detection and correction by manual or Visit the website, mobile app, email or call the Travel Insurance
mechanical means of structural imbalance, distortion or subluxation in Administrator.
the human body for purposes of removing nerve interference and the
effects thereof, where such interference is the result of or related to Available Online:
distortion, misalignment or subluxation of or in the vertebral column; • file first notice of loss (FNOL) and upload documents electronically
(f) treatment provided in a government hospital; benefits provided under • find out what forms and documentation you need for your claim
Medicare or other governmental program (except Medicaid), any State • download necessary claim forms
or Federal workers' compensation, employers' liability or occupational
disease law; benefits to the extent provided for any loss or portion Mobile Application
thereof for which mandatory automobile no-fault benefits are recovered • file first notice of loss (FNOL) and upload documents electronically
or recoverable; services rendered and separately billed by employees of • find out what forms and documentation you need for your claim
hospitals, laboratories or other institutions; services performed by a • download necessary claim forms
member of the covered person's immediate family; and services for
which no charge is normally made; Email or Call:
(g) rest cures, custodial care and transportation, and • to find out what forms and documentation you need for your claim
(h) the Insured’s commission of or attempt to commit a felony or to which a • to file a claim and check its progress
contributing cause was the Insured’s being engaged in an illegal
occupation. Claims Inquiry:
• Website: www.travelexinsurance.com
• Mobile App: Google Play or iTunes
• Email: travelex.claims@bhspecialty.com
• Telephone: 855.205.6054
Claim Procedures: To Whom Paid:
Benefits are payable to the Insured who applied for coverage and paid any
Notice of Claim: You must notify the Travel Insurance Administrator as soon required plan cost. Any benefits payable due to the Insured’s death will be paid
as reasonably possible, but no later than 20 days after the occurrence of the to the Insured’s estate, unless written notice of a designated beneficiary is
Loss, and be prepared to describe the Loss, the name of the Travel Supplier provided to the Company.
(i.e., tour operator, Cruise line, or charter operator), the Trip dates, purchase
date and the amount that the Insured paid. The Company will provide You, or Medical Expense Proof of Loss: The Insured must provide the Travel Insurance
someone acting on Your behalf, with forms for the filing of a proof of loss Administrator with: (a) all medical bills and reports for medical expenses
within 15 days of receiving a notice of claim from You, or someone acting on claimed; and (b) a signed patient authorization to release medical information to
Your behalf. Claim forms can be found at the web address shown above. the Travel Insurance Administrator.
Proof of Loss: You have 120 days from the date of loss to submit your claim to The following provision applies to Medical Expense:
the Travel Insurance Administrator, or as soon after that as is reasonably
possible. Failure to furnish such proof within such time will not invalidate nor Subrogation - In the event that an Insured suffers an Injury or Sickness for which
reduce any claim if it shall be shown not to have been reasonably possible to another party may be responsible, such as someone injuring the Insured in an
furnish such proof during that time. All claims under this Policy must be accident, and the Company pays benefits as a result of that Injury or Sickness, the
submitted to the Travel Insurance Administrator no later than one year after the Company will be subrogated and succeed to the right of recovery against the
date of Loss or insured occurrence or as soon as reasonably possible. If the Travel party responsible for the Insured’s Sickness or Injury to the extent of the benefits
Insurance Administrator has not provided claim forms within 15 days after the the Company has paid. This means that the Company has the right independently
notice of claim, other proofs of Loss should be sent to the Travel Insurance of the Insured to proceed against the party responsible for the Insured’s Injury or
Administrator by the date claim forms would be due. The Travel Insurance Sickness to recover the benefits the Company has paid. The Company’s right of
Administrator will require information from You for the proof of loss. This will recovery does not apply when a settlement is reached between a plaintiff and
include, but is not limited to: defendant, unless a statutory right of reimbursement exists. When entering into
• written proof of the occurrence; a settlement, it is presumed that the Insured did not take any action against the
• type and amount of Loss; Company’s rights or violate any contract between the Insured and the Company.
• the Insured’s name; and The settlement between the Insured and the responsible party does not include
• the Travel Supplier Name; and compensation for the cost of health care services for which the Company
• policy number. provided benefits.
Payment of Claims: SECTION VI

GENERAL PROVISIONS
When Paid: Claims will be paid as soon as the Travel Insurance Administrator
receives complete proof of Loss and verification of age , but no later than 60 days Entire Contract; Changes. This Policy, Schedule of Benefits, Application and any
after receipt of proof of loss. attachments are the entire contract of insurance. In the absence of fraud, all
statements made by the Insured will be considered representations and not
warranties. No agent may change it in any way. Only an executive officer of the Clerical Error. Clerical error, whether by the Insured or the Company, will not
Company can approve a change. Any such change must be shown in this Policy void the insurance of any Insured if that insurance would otherwise have been
or its attachments. in effect nor extend the insurance of any Insured if that insurance would
otherwise have ended or been reduced as provided in this Policy.
Acts of Agents. No agent or any person or entity has authority to accept service
of the required proof of loss or demand arbitration on the Company’s behalf nor Legal Actions. No action at law or in equity may be brought to recover on this Policy
to alter, modify, or waive any of the provisions of this Policy. prior to the expiration of 60 days after written proof of Loss has been furnished in
accordance with the requirements of this Policy. No such action may be brought
Physical Examination and Autopsy. The Company at its own expense has the right after the expiration of 3 years after the time written proof of loss is required to be
and opportunity to examine the person of any Insured whose Loss is the basis of furnished.
claim under this Policy when and as often as it may reasonably require during the
pendency of the claim and to perform an autopsy in case of death where it is not Arbitration. The Company and one or more Insured(s) with respect to the rights
forbidden by law. of such Insured(s) under this Policy may be submitted to voluntary arbitration if
both parties mutually agree. The Commercial Arbitration Rules of the American
Beneficiary Designation and Change. The Insured’s beneficiaries are the persons Arbitration Association shall apply, except with respect to the selection of
designated by the Insured and on file with the Travel Insurance Administrator or arbitrators, the payment of arbitration fees and costs, the location and the entry
the beneficiaries as shown in the Payment of Claim: To Whom Paid provision. of the arbitration award.
An Insured over the age of majority and legally competent may change his or her Selection of Arbitrators: One arbitrator shall be chosen by one side and
beneficiary designation at any time, without the consent of the designated another arbitrator by the other side, and a third arbitrator shall be chosen
beneficiaries, unless an irrevocable designation has been made, by providing the by the first two arbitrators before they enter into arbitration. All arbitrators
Travel Insurance Administrator with a written request for change. When the shall be disinterested.
request is received, whether the Insured is then living or not, the change of
Payment of Arbitration Fees and Costs: Each side shall pay the fee of its
beneficiary will relate back to and take effect as of the date of execution of the
chosen arbitrator and half the fee of the third arbitrator. The remaining costs
written request, but without prejudice to the Company on account of any
of the arbitration, including legal fees and disbursements, shall be paid as
payment made by it prior to receipt of the request.
the written decision of the arbitrators directs, with it being expressly
understood that the intention is to favor reimbursement of such fees and
Assignment. An Insured may not assign any of his or her rights, privileges or
expenses to an insured that has brought a meritorious dispute. The fees to
benefits under this Policy.
be borne by a side consisting of more than one Party shall be divided equally
among such Parties.
Conformity with State Statutes. Any provision of this Policy which, on its
effective date, is in conflict with the statutes of the state in which this Policy is Location: Any arbitration hereunder shall take place in New York, New York,
delivered is hereby amended to conform to the minimum requirements of those unless otherwise mutually agreed upon by the two sides.
statutes.
Entry of Arbitration Award: Judgment upon an arbitration award Conformity with State Statutes. Any provision of this Policy which, on its effective
hereunder may be entered in, and enforced by, any court of competent date, is in conflict with the statutes of the state in which the Insured resides on
jurisdiction. such date is hereby amended to conform to the minimum requirements of such
statutes.
Concealment or Fraud. The Company does not provide coverage if the Insured
has intentionally concealed or misrepresented any material fact or circumstance
relating to this Policy or claim.
Payment of Premium. Coverage is not effective unless all premium due has been
paid to the Travel Insurance Administrator prior to a date of Loss or insured
occurrence.
Termination of this Policy. Termination of this Policy will not affect a claim for
Loss if the Loss occurred while this Policy was in force.
Transfer of Coverage. Coverage under this Policy cannot be transferred by the

Insured to anyone else.
Insurance With Other Insurers. If there is other valid coverage not with the
Company, providing benefits for the same loss on a provision of service basis or on
an expense incurred basis and of which the Company has not been given written
notice prior to the occurrence or commencement of loss, the only liability under
this policy shall be for such proportion of the loss as the amount which would
otherwise have been payable hereunder plus the total of the like amounts under
all such other valid coverages for the same loss of which the Company had notice
bears to the total like amounts under all valid coverages for such loss, and for the
return of such portion of the premiums paid as shall exceed the pro-rata portion
for the amount so determined. For the purpose of applying this provision when
other coverage is on a provision of service basis, the "like amount" of such other
coverage shall be taken as the amount which the services rendered would have cost
in the absence of such coverage.
SECTION II
I. With respect to the Accidental Death and Dismemberment

coverage provided by this endorsement only, the following is
added:
ACCIDENTAL DEATH AND DISMEMBERMENT
The Company will reimburse You for this benefit for one of the
Losses shown in the Table of Losses below if You are Injured while
on a Trip other than while riding as a passenger in or boarding or
alighting from or struck or run down by a certified passenger
THIS RIDER CHANGES THE POLICY. PLEASE READ IT aircraft provided by a regularly scheduled airline or charter and
CAREFULLY. operated by a properly certified pilot. The Loss must occur within
365 days of the date of the accident which caused Injury. The
This Rider is attached to and made part of your insurance plan. It is subject to Company will pay the percentage shown below of the Maximum
all of the provisions, limitations and exclusions of the plan. Limit shown in the Schedule. The accident must occur while the
Insured is on the Trip and is covered under this Policy.
If more than one Loss is sustained by You as a result of the same
Individual Travel Protection Insurance Policy accident, only one amount, the largest applicable to the Losses
incurred, will be paid. The Company will not pay more than 100%
of the Maximum Limit for all Losses due to the same accident.
SCHEDULE OF BENEFITS
The following is added to the Schedule of Benefits:
Accidental Death & Dismemberment $25,000 per person
Page 1 | PG-TA-RIDE-ADD-NY-9/2017
Table of Losses SECTION IV
Loss of % of Maximum Limit I. With respect to the Accidental Death and Dismemberment
Life ........................................................................... 100% coverage provided by this endorsement only, the following is
Both Hands or Both Feet .......................................... 100% added:
Sight of Both Eyes..................................................... 100%
One Hand and One Foot ........................................... 100% Benefits will not be provided for the following:
Either Hand or Foot and Sight of One Eye ................. 100%
(a) loss caused by or resulting directly or indirectly from
Either Hand or Foot .................................................. 50%
Sight of One Eye ....................................................... 50% Sickness or disease of any kind.
“Loss” with regard to: SECTION V

(a) hand or foot means actual severance through or above the
wrist or ankle joints; I. With respect to the Accidental Death and Dismemberment
(b) eye means entire and irrecoverable Loss of sight in that eye. coverage provided by this endorsement only, the following is
added to Payment of Claims: To Whom Paid:
EXPOSURE
The Company will pay a benefit for covered Losses as specified Payment of Claims:
above which result from You being unavoidably exposed to the
elements due to an accidental Injury during the Trip. The Loss To Whom Paid:
must occur within 365 days after the event which caused the Benefits are payable to the Insured who applied for coverage
exposure. and paid any required plan cost. Any benefits payable due to
that Insured’s death will be paid to the Insured’s beneficiary. If
DISAPPEARANCE no beneficiary is on record with the Company, benefits will be
The Company will pay a benefit for Loss of life as specified above paid to the Insured’s estate.
if Your body cannot be located one year after a disappearance
due to an accident during the Trip. If a benefit is payable to the Insured’s estate or to a minor or
other person who is incapable of giving a valid release, the
Company may pay up to $1,000 to a relative by blood or
connection by marriage who has assumed care or custody of the
minor or responsibility for the incompetent person’s affairs. Any
payment the Company makes in good faith fully discharges the
Company to the extent of that payment.
Page 2 | PG-TA-RIDE-ADD- NY-9/2017

II. With respect to the Accidental Death and Dismemberment
coverage provided by this endorsement only, the following is
added to Payment of Claims:
Accidental Death and Dismemberment Proof of Loss: The

Insured must provide the Travel Insurance Administrator with:
(a) all medical bills and reports for medical expenses claimed;
and (b) a signed patient authorization to release medical
information to the Travel Insurance Administrator.
All other terms and conditions of the Policy remain unchanged.
Page 3 | PG-TA-RIDE-ADD- NY-9/2017

CAREFULLY.
The EXCESS INSURANCE LIMITATION Paragraph in SECTION IV EXCLUSIONS &

LIMITATIONS is deleted.
Page 1 | PG-TA-RIDE-PRIM-11/2017
Item (o) of SECTION IV EXCLUSIONS AND LIMITATIONS is deleted and replaced by
the following:
(o) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will

THIS RIDER CHANGES THE POLICY. PLEASE READ IT not pay for any loss or expense incurred as the result of an Injury,
CAREFULLY. Sickness or other condition (excluding any condition from which death
Family Member which, within the 60 day period immediately
This Rider is attached to and made part of your insurance plan. It is subject to preceding and including the Insured’s coverage effective date: (a) first
all of the provisions, limitations and exclusions of the plan. manifested itself, worsened, became acute or had symptoms which
would have prompted a reasonable person to seek diagnosis, care or
This rider modifies insurance provided under the following plans: treatment; (b) for which care or treatment was given or
recommended by a Physician; (c) required taking prescription drugs
Individual Travel Protection Insurance Policy or medicines, unless the condition for which the drugs or medicines
are taken remains controlled without any change in the required
prescription drugs or medicines.
Page 1 | PG-TA-RIDE-PRXLB-NYAH-11/2017
(2) The amount of coverage purchased equals all prepaid
nonrefundable payments or deposits applicable to the Trip at
the time of purchase and the costs of any subsequent
arrangements added to the same Trip are insured within 15
days of the date of payment or deposit for any subsequent Trip
arrangements; and
(3) The Trip Cost does not exceed the amount shown in the
Schedule per person (only applicable to Trip
Cancellation/Interruption/Delay).
This coverage will be terminated and no benefits will be paid under

this Pre-existing Medical Condition Exclusion Waiver coverage if the
full costs of all prepaid, non-refundable Trip arrangements are not
insured.
SECTION I COVERAGE DETAILS

I. When Coverage Ends provided under this Rider
CAREFULLY. Coverage under this Rider ends on the earliest of:
This Rider is attached to and made part of your insurance plan. It is subject to (b) the scheduled Return Date;
all of the provisions, limitations and exclusions of the plan. (c) the Insured’s arrival at the Return Destination on a round Trip,
or the Destination on a one-way Trip;
This rider modifies insurance provided under the following plans: (d) cancellation of the Trip covered by this Policy.
Individual Travel Protection Insurance Policy SECTION III DEFINITIONS
I. The following is added to the SCHEDULE OF BENEFITS: I. For purposes of this rider, the following definition applies:
PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER “Initial Trip Payment” means the first payment made to the Insured’s
The Company will waive the pre-existing medical condition exclusion Travel Supplier toward the cost of the Insured’s Trip.
up to a maximum of the amount shown in the Schedule of Trip Cost
if the following conditions are met: All other terms and conditions remain unchanged.
(1) This plan is purchased within 15 days of Initial Trip Payment;
Page 1 | PG-TA-RIDE-EPPX1-NY-2/2016
SECTION IV EXCLUSIONS AND LIMITATIONS
I. For the purposes of this endorsement, the following Exclusions are
deleted from General Exclusions:
(c) participation in professional athletic events, motor sport,

or motor racing, including training or practice for the
ENDORSEMENT same;
This endorsement, effective 12:01AM: (d) mountain climbing that requires the use of equipment
Forms a part of Policy No.: such as; pick-axes, anchors, bolts, crampons, carabineers,
Issued to: and lead or top-rope anchoring or other specialized
By: Berkshire Hathaway Specialty equipment;
Insurance Company
(e) operating or learning to operate any aircraft, as student,
pilot, or crew;
(f) air travel on any air-supported device, other than a

regularly scheduled airline or air charter company;
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT All other terms and conditions remain unchanged.
CAREFULLY.
This endorsement modifies insurance provided under the following:
This Coverage applies only if You have elected this coverage and consideration
of premium has been paid.
Page 1 | PG-TA-ENDE-UAS-3/2016
This Coverage applies only if You have elected this coverage and consideration
of premium has been paid.
I. The following is added to the SCHEDULE OF BENEFITS:

Accidental Death & Dismemberment
Common Carrier Air Only $200,000
* Coverage for Accidental Death & Dismemberment and Accidental

Death and Dismemberment (Common Carrier Air Only) cannot be
combined.
ENDORSEMENT
This endorsement, effective 12:01AM: SECTION II SUMMARY OF BENEFITS
Forms a part of Policy No.: I. The following benefit is added:
Issued to:
By: Berkshire Hathaway Specialty ACCIDENTAL DEATH AND DISMEMBERMENT COMMON CARRIER
Insurance Company Air Only
The Company will reimburse You for this benefit for one of the Losses
shown in the Table of Losses below if You are Injured while on a Trip
while riding as a passenger in or boarding or alighting from or struck or
run down by a certified passenger aircraft provided by a regularly
scheduled airline or charter and operated by a properly certified pilot.
The Loss must occur within 365 days of the date of the accident which
caused Injury. The Company will pay the percentage shown below of
the Maximum Limit shown in the Schedule. The accident must occur
while the Insured is on the Trip and is covered under this Policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT If more than one Loss is sustained by You as a result of the same
CAREFULLY. accident, only one amount, the largest applicable to the Losses
incurred, will be paid. The Company will not pay more than 100% of
This endorsement modifies insurance provided under the following: the Maximum Limit for all Losses due to the same accident.
Page 1 | PG-TA-ENDE-UFA1-NY-3/2016
Table of Losses SECTION IV EXCLUSIONS AND LIMITATIONS
I. For purposes of this endorsement, the following exclusion applies:
Loss of % of Maximum Limit
Life ........................................................................... 100% Benefits will not be provided for the following:
Both Hands or Both Feet .......................................... 100% (a) loss caused by or resulting directly or indirectly from Sickness
Sight of Both Eyes..................................................... 100% or disease of any kind.
One Hand and One Foot ........................................... 100%
Either Hand or Foot and Sight of One Eye ................. 100%
SECTION V CLAIMS INFORMATION
Either Hand or Foot .................................................. 50%
Sight of One Eye ....................................................... 50% I. For the purposes of this endorsement, the following provision
applies:
“Loss” with regard to:
(a) hand or foot means actual severance through or above the wrist Accidental Death & Dismemberment Proof of Loss: The Insured
or ankle joints; must provide the Travel Insurance Administrator with: (a) all medical
(b) eye means entire and irrecoverable Loss of sight in that eye. bills and reports for medical expenses claimed; and (b) a signed
patient authorization to release medical information to the Travel
EXPOSURE Insurance Administrator.
The Company will pay a benefit for covered Losses as specified
above which result from You being unavoidably exposed to the All other terms and conditions remain unchanged.
elements due to an accidental Injury during the Trip. The Loss must
occur within 365 days after the event which caused the exposure.
DISAPPEARANCE
The Company will pay a benefit for Loss of life as specified above if
Your body cannot be located one year after a disappearance due to
an accident during the Trip.
Page 2 | PG-TA-ENDE-UFA1-NY-3/2016
ASSISTANCE SERVICES*
All Assistance Services listed below are not insurance benefits and are not provided by the Insurer. World Travel Protection provides assistance through
coordination, negotiation, and consultation using an extensive network of worldwide partners. Expenses for goods and services provided by third parties are
the responsibility of the traveler.
• Arrangements for visitor to bedside of hospitalized Insured
Travel Medical Assistance • Eyeglasses and corrective lens replacement assistance
• Emergency medical transportation assistance • Medical payment arrangements
• Physician/hospital/dental/vision referrals • Medical cost containment/expense recovery and overseas investigation
• Assistance with repatriation of mortal remains • Medical bill audits
• Return travel arrangements • Coordinate shipment of medical records
• Emergency prescription replacement assistance • Assistance with medical equipment rental/replacement
• Dispatch of doctor or specialist
• Medical evacuation quote *Non-insurance services are provided by World Travel Protection.
• In-patient and out-patient medical case management
• Qualified liaison for relaying medical information to family members
PG-TA-EAS-NV1-3/2016
All Assistance Services listed below are not insurance benefits and are not provided by the Insurer. World Travel Protection provides
assistance through coordination, negotiation, and consultation using an extensive network of worldwide partners. Expenses for goods and
services provided by third parties are the responsibility of the traveler.
Worldwide Travel Assistance

• Lost baggage search; stolen luggage replacement assistance
• Lost passport/travel documents assistance
• ATM locator
• Emergency cash transfer assistance
• Travel information including visa/passport requirements
• Emergency telephone interpretation assistance
• Urgent message relay to family, friends or business associates
• Up-to-the-minute travel delay reports
• Arrangements for long-distance calling cards for worldwide
telephoning
• Inoculation information
• Embassy or consulate referral
• Currency conversion or purchase assistance
• Up-to-the-minute information on local medical advisories, epidemics,
required immunizations and available preventive measures
• Up-to-the-minute travel supplier strike information
• Legal referrals/bail bond assistance
• Worldwide public holiday information
*Non-insurance services are provided by World Travel Protection.
coordination, negotiation, and consultation using an extensive network of worldwide partners. Expenses for goods and services provided by third parties are
the responsibility of the traveler.
Emergency Assistance
• Flight rebooking
• Hotel rebooking
• Rental vehicle booking
• Emergency return travel arrangements
• Roadside assistance locator
• Rental vehicle return assistance
• Guaranteed hotel check-in
• Missed connections coordination
*Non-insurance services are provided by World Travel Protection.
coordination, negotiation, and consultation using an extensive network of worldwide partners. Expenses for goods and services provided by third parties are the
responsibility of the traveler.
Concierge Services • Tee times and course recommendations

• Restaurant referrals and reservations • Floral services
• Ground transportation arrangements
• Event ticketing arrangements *Non-insurance services are provided by World Travel Protection.

Travelex Protection Plan

Uploaded by

Document Informationclick to expand document information

Copyright:

Available Formats

Travelex Protection Plan

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Travelex Protection Plan

Uploaded by

Copyright:

Available Formats

Dream. Explore. Travel On.

Travelex Insurance Services Berkshire Hathaway Specialty Insurance

NEED ASSISTANCE WHILE TRAVELING?

IMPORTANT Secretary President

PLEASE READ THIS DOCUMENT CAREFULLY!

For questions or information contact the Travel Insurance Administrator.

All other coverages will begin on the later of:

When Coverage Ends

All other coverages end on the earlier/est of:

This extension of coverage will end on the earlier/est of:

Medical / Health Environment

(b) You or a Traveling Companion is called to active military service or

The following exclusions apply to Baggage/Personal Effects and Baggage

The following provision applies to Baggage/Personal Effects:

Subrogation - To the extent the Company pays for a Loss suffered by an

Entry of Arbitration Award: Judgment upon an arbitration award hereunder

Transfer of Coverage. Coverage under this Policy cannot be transferred by the

If, while on a Trip, Your Baggage is delayed or misdirected by the

Incurred expenses over $25 must be accompanied by receipts.

SECTION II SUMMARY OF BENEFITS

Benefit to Bailee: This insurance will in no way inure directly or

All other terms and conditions remain unchanged.

“Terrorist Incident” means an act of violence by any person acting on behalf

This rider modifies insurance provided under the following plans:

Individual Travel Protection Insurance Policy

I. The following is added to Political/Violence in TRIP CANCELLATION AND

a Terrorist Incident in a City listed on Your itinerary within 30 days of Your

Individual Travel Protection Insurance Policy

This rider modifies insurance provided under the following plans:

Individual Travel Protection Insurance Policy

The EXCESS INSURANCE LIMITATION Paragraph in SECTION IV EXCLUSIONS &

All other terms and conditions remain unchanged.

(o) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will

All other terms and conditions remain unchanged.

I. The following is added to the Emergency Evacuation Summary of

Hospital of Choice: Transportation from an adequate licensed

This endorsement modifies insurance provided under the following:

Travel Protection Insurance Policy

PRE-EXISTING MEDICAL CONDITION EXCLUSION WAIVER

SECTION III DEFINITIONS

“Financial Default” means the total cessation of operations due to

This extension of coverage will end on:

Payment of Claims: SECTION VI

Transfer of Coverage. Coverage under this Policy cannot be transferred by the

I. With respect to the Accidental Death and Dismemberment

ACCIDENTAL DEATH AND DISMEMBERMENT

The following is added to the Schedule of Benefits:

Accidental Death & Dismemberment $25,000 per person

“Loss” with regard to: SECTION V

Page 2 | PG-TA-RIDE-ADD- NY-9/2017

Accidental Death and Dismemberment Proof of Loss: The

All other terms and conditions of the Policy remain unchanged.

Page 3 | PG-TA-RIDE-ADD- NY-9/2017

This rider modifies insurance provided under the following plans:

Individual Travel Protection Insurance Policy

The EXCESS INSURANCE LIMITATION Paragraph in SECTION IV EXCLUSIONS &

All other terms and conditions remain unchanged.

(o) PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will