SUMMARY OF BENEFITS
Coverage Maximum Amount in U.S. Dollars
Medical, Hospital And Pharmaceutical Expenses
Emergency Dental Expenses
Repatriation To Domicile After Treatment
Hotel Convalescence Expenses
$100 per day Maximum of 10 days
Transfer of Accompanying Minors
Round-Trip Ticket For A Family Member
Hotel Expenses For A Family Member
$50 per day Maximum of 10 days
Search And Transportation Of Luggage and Personal Belongings
Supplemental Indemnity For Loss Of Luggage
• For all travel outside the country of residence up to 30 days in length.
• Rider applies to all insured persons under WEA Signature Plan
To be attached and be made an integral part of WEA Policy.
This Annex is issued to the health insurance policy, provided by WEA Policy. Coverage of travel assistance covered by this Annex shall apply only to persons insured under this Policy, and amended only in regards to the assistance services provided to the Persons Insured, in the manner and up to the limits indicated below:
2 WEA_101116 © Copyright 2016 WEA. All rights reserved.
General Conditions Coverage of International Travel Assistance
Assistance Services Territorial Scope
The Insured shall be entitled to travel assistance services, as long as such have taken place outside their country of residence.
Effectiveness Period of the Assistance Services
International travel assistance services shall be in force for 30 calendar days starting from the Insured’s date of departure from the country of residence.
The coverage ceilings indicated in § 2. International Travel Assistance Service are understood to be applicable to each trip.
1. PREVIOUS PROVISIONS
A) Covered Accident: Any event that causes bodily harm to an Insured caused solely and directly by an external violent, sudden and evident cause (excluding illness), that originally occurs after the date of departure from the country of residence.
B) Covered Illness: Any disease contracted by an Insured and arising after the date of departure from the country of residence.
C) INSURER’s medical team: It is the proper medical team for each intervention determined by the medical adviser of the INSURER and the local physician.
D) Assistance services: Benefits provided by THE INSURER to the INSURED under the terms and conditions, which are set forth in this Annex, for cases of assistance situations of the Insured.
E) Assistance situation: Any event, situation or fact from those described in this Annex – § 2. International Travel Assistance Service – which grants the right to an Insured to receive assistance services, outside the borders of their country of residence.
2. INTERNATIONAL TRAVEL ASSISTANCE SERVICE
It is made expressly clear that all coverage foreseen in this section is exclusively applied worldwide, outside the Insured’s country of residence.
2.1. Covered Medical, Hospital and Pharmaceutical Expenses
In the event that an INSURED PERSON suffers an accident or an illness, the INSURER will pay the medical and hospital expenses that may be necessary up to a maximum of $10,000 USD – this figure amount includes the cost of medications that may have been prescribed during the care. Such medical expenses include: emergency medical attention, in-office consultation, in- office pharmaceutical expenses, doctor’s fees, lodging and room in the hospital, tests, surgery, intensive therapy services and supplies, several physicians and nurses. The costs of prosthesis or orthotics of any nature as well as surgical interventions for the placement of (contact lenses, glasses, hearing aids, dentures, crutches, etc.) and plastic surgery are excluded. Also excluded are the medical expenses incurred abroad but prescribed in the country of residence before the commencement of the trip, and the medical expenses incurred in the country of residence after the return of the INSURED, even if they are a result of an accident or disease sustained during the trip abroad. Also excluded is the cost of psychiatric or psychological assistance.
2.2. Emergency Dental Expenses
Dental emergencies are covered up to a maximum of $250.00 USD.
Emergency Dental treatment and Dental surgery necessary to restore or replace sound natural teeth lost or damaged in an Accident which is covered under this insurance subject to a maximum of $250 or Emergency Dental treatment necessary to resolve acute, spontaneous and unexpected onset of dental disorder subject to a maximum benefit.
3 WEA_101116 © Copyright 2016 WEA. All rights reserved.
expenses: $50.00 USD for hotel per day, with a maximum of 10 days.
2.9. Legal Assistance
When the Insured hires a lawyer to defend him/her of criminal liability as a result of a traffic accident, the Company will pay the same fees up to a maximum of $1,500.00.
2.10. Supplementary Compensation for Loss
When the INSURED with existing coverage suffers the total loss of his/her luggage during international transport checked in airplane cargo in a regular airline and such is not located, the INSURER will pay him/ her a supplementary economic compensation. The supplement payable by the INSURER will be that which is necessary to complete $50 per kg with a maximum of 20 kg. Until reaching a maximum of $1,000.00 USD on regular international flights.
The ceiling of $1,000.00 USD is the aggregate total for the baggage checked-in by the INSURED for air transport (not per each suitcase). In order to be entitled to this benefit, the following requirements must be accredited before the INSURER:
A) That the luggage has been lost during its transportation on an international flight (between two countries) of a regular airline plane.
B) That the luggage in question has been duly dispatched in the cargo areas of the indicated transportation carrier.
C) That the INSURED has had the right to be
compensated by the transporting airline.
D) That the loss of the luggage occurs between the times in which such is turned into the authorized personnel of the airline company to be boarded and the time in which it must be delivered to the passenger upon completing the trip.
E) That the luggage was misplaced outside the country of residence, except for losses caused on international flights that arrive at the country of residence of the INSURED.
F) That the regular airline has assumed responsibility for the loss of the above-mentioned luggage and has paid the corresponding compensation to the INSURED.
2.3. In-Office Medications
Are covered when related to a covered illness or injury up to a maximum of $300.00 USD.
2.4. Hotel Expenses for Convalescence
After being discharged from the hospital after an accident or illness, and whenever it is necessary upon the recommendation of the medical team of the INSURER and the attending physician, the INSURER shall pay the INSURED under the concept of INSURED’s stay expenses at a hotel of his/her choice, up to a maximum of $100.00 USD per day and with a maximum ceiling of 10 days.
2.5. Home Repatriation after Treatment
If the INSURED, after a covered Assistance Situation, and according to the discretion of the attending physician and the INSURER’S medical team, cannot return to his/ her country of residence as a regular passenger, the INSURER will organize and will pay for his/her repatriation by air ambulance.
2.6. Transfer of Minor Companions
When the INSURED is being repatriated or transferred due to an accident or illness in application of the previous guarantees 2.5. and if there were a child under 15 years of age that does not have a relative or trusted person to accompany him/her on the trip, the INSURER will make available a person to travel with him/her to his/her place of domicile or to wherever the INSURED is hospitalized at.
2.7. Round-Trip Ticket for a Family Member
In the event of hospitalization of the INSURED PERSON overseas due to an accident or disease and that their hospital admission is foreseen to be longer than 10 days in length, and such is found to be alone and at the discretion of the medical team of the INSURER, this will make available for a person designated by the INSURED a round-trip ticket (Economy class) originating at the country of residence of the INSURED in order to come to be beside him. The ceiling is $1,000.00 USD.
2.8. Hotel Expenses for a Family Member
In the event that the hospitalization of the INSURED is longer than 10 days, the INSURER will pay the family member mentioned in the preceding clause, the following
4 WEA_101116 © Copyright 2016 WEA. All rights reserved.
the event, will contact the INSURER to notify the situation.
B) Hospitalization without prior notification to THE INSURER: in case of accident or illness requiring the INSURED’s hospitalization without prior notice to the INSURER, he/she or his/her representative, as soon as possible, must contact the INSURER within 24 hours following the accident or illness. In the event that the communication is not made within said period of time, the INSURER will be relieved of its obligation to cover the costs of said event.
3.3. Standards for Medical Transport
In the case of medical transport and repatriation, and in order to facilitate a better intervention by THE INSURER, the INSURED or his/her representative must provide:
A) The name, address and telephone of the attending physician and if necessary, the physician’s information that habitually attends the INSURED in his/her country of residence.
B) The name, address and telephone of the hospital or medical center where the INSURED is admitted.
The medical team of THE INSURER or its representatives must have free access to the INSURED to assess the conditions he/she is in. If such access is unjustifiably denied, the INSURED will lose the right to the assistance services.
In every case, the medical team of the INSURER will decide when is the most appropriate time for the transfer and/ or repatriation and will set the dates and the most suitable means for transfer or repatriation. In the event that the repatriation of the INSURED is to be carried out by the INSURER, the same must submit to the INSURER the portion of the original ticket not used as compensation for the cost of such repatriation.
G) That the loss of the checked-in luggage is complete, as there is no supplementary compensation in the event of partial loss; i.e. it works on the full lot. There is no supplementary compensation for breakage of luggage or its contents. In these latter cases, responsibility can only be assumed by airline transportation company, but there is no compensation from the INSURER. It is an essential condition to be eligible for this warranty, that the INSURED has given notice to THE INSURER of the loss within 24 hours since the loss occurred.
LENGTH OF COVERAGE: Thirty (30) straight days at a maximum worldwide.
3. OBLIGATIONS OF THE INSURED
3.1. Request for Assistance
In any case of an assistance situation and before initiating any action, the INSURED will call the INSURER, providing the following data:
A) Name, credentialing number and date of
commencement of the journey.
B) It shall indicate his/her location and phone number where THE INSURER may keep contacting the INSURED or his/her representative.
C) Description of the problem or ailment that afflicts him/her and the type of assistance requested. THE INSURER reserves the right to verify the accuracy of the above-mentioned data and to that effect the INSURANCE COMPANY accepts the obligation to check and confirm to the INSURER, upon the latter’s request, the character of the INSURED of the applicant and the validity of his/her coverage.
3.2. Impossibility to Notify The Insurer
A) In a life-threatening event: In a danger of death situation, the INSURED or his/her representative must always act with the utmost speed to organize the transfer of the wounded or sick to the hospital to the place closest to where the accident or illness took place by the most appropriate and immediate means and will take the most opportune measures, and as soon as possible, within 24 hours of the taking place of
5 WEA_101116 © Copyright 2016 WEA. All rights reserved.
The INSURED is obligated to try to mitigate and limit the effects of situations of assistance.
4.2. Cooperation with THE INSURER
The INSURED must cooperate with THE INSURER to facilitate the recovery of payments made in different interventions, providing the INSURER with the necessary documents, helping the INSURER to comply with required formalities.
4.3. Limitation of Claims
Any claim relating to a situation of assistance, must be submitted within 60 days from the date it occurred, limiting any legal action after such period of time has elapsed.
THE INSURER will be subrogated to the extent of costs incurred and the amount paid in the rights and actions corresponding to the INSURED against anyone responsible for an accident or disease that may have resulted from the provision of assistance services. When the services provided by the INSURER are covered in whole or in part, by an insurance policy, the INSURER is subrogated in the rights and actions corresponding to the INSURED on the basis of said policy. To that effect, the INSURED will provide his/her absolute cooperation, without it bearing any responsibility for the company.
The INSURED declares himself/herself to be in medical condition to travel, not being the purpose of his/her trips within his/her country of residence or abroad the seeking of medical treatment, accepting the terms, conditions and exclusions of the INSURER.
The INSURED takes as direct agents the persons or professionals appointed by the INSURER for his/her assistance, without any recourse against THE INSURER and/or the company based on such designation. Likewise, it is also expressly established that the INSURED will
directly carry out and process with THE INSURER all notices, claims and requests for refunds, etc., derived from travel assistance, not being responsible THE INSURANCE COMPANY for these concepts, given that the emerging obligations of Travel Assistance are the INSURER’s towards the INSURED.
THE INSURER expressly accepts that all currently INSURED are covered by these general conditions and, consequently, the INSURER will fulfill its obligations upon a request for assistance by the INSURED that provides consistent information relating to their INSURED status, whose existence and validity will be subsequently verified by the INSURANCE COMPANY, who must confirm to THE INSURER that at the time of the fact that originated the assistance, the INSURED was covered by the INSURANCE COMPANY, and the coverage being in effect.
The assistance situations, which occurred during the INSURED’s travel or vacation taken against the advice of their physician or during travel exceeding a period of thirty (30) days, are not entitled to assistance services.
INSURED individuals will be entitled to be reimbursed by the INSURER only if they had given notice to the INSURER within 24 hours of the event and after having received the latter’s authorization.
The following assistance situations are also excluded, whether a direct or indirect result of:
A) Wars, invasions, acts of foreign enemies, hostilities (whether war was or was not declared), civil war, rebellion insurrection, terrorism or pronouncement, demonstrations and/or population manifestations.
B) Self-injury or participation by the INSURED in
C) Participation of the INSURED in combat, except
in self-defense cases.
6 WEA_101116 © Copyright 2016 WEA. All rights reserved.
D) Practicing sports whether the participation is professional or non-professional, in scheduled official competitions or exhibitions.
E) Participation by the INSURED in horse, bicycle, car and motorcycle racing, or any race, exhibitions.
F) Radiation emanating from the transmutation or nuclear disintegration, radioactivity or any type of accident caused by nuclear fuels.
G) Any pre-existing condition
H) Pregnancies in the last three months before the scheduled delivery date, as well as the latter and prenatal examinations. During the first 6 months of pregnancy only acute and emergency episodes related to pregnancy will be covered.
I) Mental illnesses or psychological disorders.
J) Illnesses or injuries resulting from direct or
indirect criminal action by the INSURED.
K) Illnesses or pathological conditions caused by the intentional ingestion or use of toxic (drugs), narcotics and alcohol, or by the use of non- prescribed medications.
L) Physicals and regular medical check-up visits.
M) Suicide or illnesses and injuries resulting from
a suicide attempt.
N) Convalescence or relapses of disease under a course of treatment before the start of the trip.
O) The injuries sustained during the practice of a manual labor profession (work-related illnesses and their consequences).
P) Extra expenses: hotel, restaurants, etc.
Q) Payment of fines or administrative sanctions.
R) Volcanic eruptions, earthquakes, floods, tsunamis, landslides, hurricanes, cyclonic tornadoes.
S) Prosthesis and orthesis of any kind that are auto-assistive not expressly and previously authorized.
T) Repatriation of Mortal Remains
U) Routine dental treatment will not cover damage to or the loss of dental bridges, dentures, mouth guards, braces, or other orthodontic devices — even if stolen from your luggage.
7 WEA_101116 © Copyright 2016 WEA. All rights reserved.