Introduction

The policy consists of three sections. Section 1 is mandatory, while sections 2 and 3 are optional. The schedule will indicate which options have been selected by the insured. Coverage is provided as long as premium is paid before the start of travel to the destination country.

Definitions

As is typical for most policies, We, Us, or Our refers to the insuring company, QBE Insurance, and Insured Person or You/Your refers to the person traveling for medical and or wellness reasons and is named in the schedule. Additional terms are defined as follows:

 

Additional Expenses – Provides coverage for longer than anticipated stay in the hospital or hotel, medical and travel expenses that are reasonable and necessary due to medical complications from the treatment provided. Loss of earnings is not covered.

 

Complications –Any adverse or unexpected results of the medical treatment that requires immediate medical attention, delayed recovery, or death during the medical treatment.

 

Delayed Recovery – An increase in the anticipated recovery time that results in either a delay in discharge from the hospital or a delay in departure from the destination country.

 

Medical Treatment – The treatment that is declared in the schedule.

 

Medical Malpractice - Professional negligence by act, error, or omission of a health care provider that causes injury to the insured person.

 

Medical Malpractice Claim - Any action, procedure or demand by the insured or the carrier for compensation of losses arising as a result of Medical Malpractice during the course of the insured's medical treatment.

 

Period of Insurance - Coverage is provided based on the selected sections. Section 1 provides coverage for the arrival date to departure date. Section 2 provides coverage for 60 days immediately following departure, and Section 3 provides coverage for 12 months immediately following departure.

 

Legal Expenses - With the company's prior consent, all reasonable legal costs and expenses incurred in pursuit of a medical malpractice claim covered by the terms of this policy.

 

Policy Limits – Shown in the schedule.

 

Reasonable Prospects of Success – If a suit is filed, the likelihood that the amounts the insured receives and reasonably expects to obtain will exceed the cost of obtaining them, together with any amounts awarded against the insured.

 

Originating Country - The country where the insured normally resides.

 

Destination Country - The country the insured travels to in order to receive medical treatment.

Section 1 – Medical Complications in the Destination Country

Additional expenses incurred by the insured due to complications from treatment in the destination country are covered. In the event of the death of the named insured during medical treatment, all reasonable expenses for repatriation of the named insured and expenses for any relative required to attend to the affairs of the named insured in the destination country are covered.

Excluded under section I are complications that were not unexpected in the view of medical treatment and the named insured's pre-existing conditions. For example, if an insured has a pre-existing immune condition and it is known that such condition increases the possibility of infection during the medical procedure and a severe infection occurs, costs for treating that resultant infection are not covered. Expenses that are not incurred directly by the named insured are not covered, nor are the loss of prepaid hotel costs as a result of a prolonged hospital stay due to delayed recovery. Also, additional expenses that occur outside the destination country are not covered.

Conditions under section I require the insured to provide written documentation from the practitioner in charge of the named insured's care that the insured was unable to travel on the original departure date or that additional time in the hospital was required. Original receipts of additional expenses are required.

Section 2 – Medical Complications in the Origination Country

This is optional coverage that provides coverage for complications that occur once the named insured has returned to the country of origin. Additional expenses incurred in order to return to the destination country for treatment are covered.

The first two exclusions in section 2 are identical to the first two exclusions in section 1. A third exclusion is for expense or loss that is covered by state healthcare coverage or private medical insurance from which the named insured benefits. For example, if the insured has private insurance, complications from the surgery that occur in the insured's home country are not covered under this policy.

Conditions are that complications must have occurred before the expiration date of this policy. In order for coverage for complications to apply, documentation from the registered medical practitioner is required that shows:

1. The named insured was fit to travel when leaving the destination country

2. At the date of departure from the destination country no complications from treatment had arisen

3. The insured's return to the destination country for remedial treatment is medically necessary

Section 3 – Legal Expenses

The third section is another optional coverage. Coverage is available for legal expenses related to a medical malpractice claim up to the policy limit. Excluded from this coverage are claims for less than $5000 or where the insurer considers that the named insured does not have reasonable prospects of success. In event the carrier does not foresee a reasonable prospect of success the insured has the right to challenge this assumption. At the insured's expense the carrier will request the opinion of an independent attorney. If the attorney agrees that there is limited prospect of success, the insured will pay all fees. If the independent attorney disagrees and believes that there is potential for success, the carrier will bear the cost and will continue to pursue the case. The policy excess as shown on the schedule is excluded as well.

There are a number of conditions in this section. Any claim must be initiated in the destination country, and the insurer has the option to take control over the legal proceedings. If the insured wishes to change attorneys, the attorney is required to meet the carrier's requirements for necessary competencies. The insured must agree to pay any additional legal expenses that result from changing attorneys. The insured must give proper instructions to the carrier, provide the carrier with information as requested, make every effort to attend appointments, medical examinations, and court hearings, instruct the attorney to disclose to the carrier relevant case papers and documents, provide the carrier with updates on the case, give the carrier priority over any sums recovered in repayment for expenses the carrier has paid under the terms of the policy, help to minimize the cost of any suit under the policy and not do anything to prejudice the case.

The carrier also reserves the right to decline or cease to provide coverage in the event that, in the carrier's opinion, the legal process in the destination country would either lead to undue delay in obtaining a judgment or expenses would outweigh any award the insured could possibly obtain.

General Conditions

Like all policies, this policy contains general conditions that apply to the policy as follows:

Observance - The insured is required to observe all policy conditions in order for the carrier to make payment on any claims.

Subrogation - The carrier, at its own expense, may take steps in the insured's name to recover from a third party any amounts paid under this policy by the carrier and such recoveries shall belong to the carrier.

Assignment - The insured may not assign rights under this policy without the permission of the carrier.

Misrepresentation - If any misrepresentation or concealment is involved in the obtaining of the policy by the named insured the policy shall be void, the premium shall be forfeited, and the carrier may recover any amounts they have paid or incurred under the policy.

Notice - Every notice under this policy must be given in writing.

Claims Notification – The carrier must be notified of any claims or potential claims as soon as possible, or at a minimum under Section 1 within thirty days of returning to the originating country; under section 2 within ninety days of returning to the originating country; and under section 3 within thirty days of any loss within the twelve month period for claims under this section.

Assistance – If the insured wishes to make a claim under the policy, the insured agrees to assist the carrier in the investigation of the claim including signing consent for access to medical records, attending medical examinations required by the carrier and providing full cooperation in any claim.

Approved Hospitals - Treatment must be at approved hospitals by a registered medical practitioner.

Age Limit - The named insured must be over 21 years of age and less than 70 years of age at the time of travel and medical treatment.

Transfer/Assignment – Unless specifically agreed to by the carrier, this policy is not transferable.

General Exclusions

Exclusions that apply to all three policy sections are as follows:

·Amounts in excess of the policy limits or regarding sections 2 and 3, incurred without the carrier's prior written permission

·Any claim not made to the carrier within the required time frame

·Any amounts that would have been covered under another policy had it not been for the existence of this policy

·Claims for any medical treatment received by the named insured before the effective date of this policy

·Any medical treatment or loss not directly associated with complications arising from the medical treatment covered under this policy

·Consequential loss, including any kind of loss of enjoyment

·Loss, expense, or liability directly or indirectly caused by or arising from:

oPressure waves caused by aircraft or other aerial devices

oRadiation or contamination from any nuclear fuel or from nuclear waste from the combustion of nuclear fuel

oRadioactive, toxic, explosive, or other hazardous properties of any explosive nuclear assembly or component

oWar, invasion, act of foreign enemy, terrorism, riot, rebellion, insurrection, usurped power