AVI international assistance assurance voyage insurance


SECURITY PASS'PORT
Introduction Important Information Definition of Terms Person Insured Period of Insurance Coverage Territory Accident Illness Pre-existing condition Emergency Dental Care Medical providers network/ Doctor visits/ Guarantee of Payment Medical/Accident Coverage Emergency Dental Coverage Medical Exclusions Accident Exclusions	Transportation Expenses Transportation Exclusions Accidental Death Abroad Accidental Disability/ Paralysis Baggage and Personal Effects Benefit Third Party Liability Coverage Third Party Liability Exclusions Force Majeure Your Insurance Professionals
Introduction
Your policy has been conceived by AVI International, an insurance broker/administrator specializing in travel insurance. As a participant, you are covered by one of the most comprehensive youth travel insurance programs available today. The purpose of this booklet is to familiarize you with your insurance coverage in order to make your participation in the program an educational, enjoyable and worry-free experience. This booklet is divided into sections which describe the many types of insurance coverage included in your policy. Each section will be a summary of the limits of coverage provided in your policy, along with major exclusions. Top of the page
Important Information
GENERAL EXCLUSIONS CANNOT BE COVERED consequences of catastrophic events: civil or foreign war, damage of a nuclear origin, earthquakes, volcanic eruptions or other cataclysms (except for medical evacuation). Insurance holder The insurance holder is your sponsoring organization. You are the beneficiary of the policy Since the insurance holder is your sponsoring organization, it cannot be considered a third party under the terms of this contract. Should a dispute/lawsuit occur between you and your sponsoring organization, both in your home and/or your host country, no coverage would be provided under the third party liability or legal assistance benefits. I.D. card - In addition to this booklet, you have received your AVI International insurance I.D. card. This card identifies you as an insured participant. Keep this card with you at all times. You may need it for doctors, hospitals and others who require proof of insurance before providing services. Subrogation right of insurance companies The insurance companies underwriting this contract, in accordance with the terms of article L 121.12 of the insurance code, are subrogated to the amount of the costs or services which they provided to the insured if those costs or services are the result of another person's negligence. This means that the insurance companies retain the right to take legal actions against the party causing you the damage or injury, be it a friend or your host family. If you deny this right to the insurance carriers underwriting this contract, you deny yourself the right to compensation for the particular claim leading to the subrogation right. If the insurance companies have already paid providers fees on your behalf, these will have to be reimbursed by you to the insurance companies or their legal representative / counsel. This will have no effect on other coverages of the contract which will still be considered valid. In case of false or fraudulent statement, the policy shall be void. Top of the page
DEFINITION OF TERMS
Person insured : Any participant in the program who has paid the insurance premium and has been reported to AVI International. Family member: Refers to the insured's de jure or de facto spouse, sisters or brothers, mother or father. Period of insurance coverage : The insurance coverage is valid only while the insured is participating in the program and within the dates of coverage reported to AVI International. The insurance coverage period begins upon the participant's departure from the home country, and ends upon the arrival in the home country at the end of the program. Stop-overs between the participant's home country and host country, unless arranged or approved by your sponsoring organization, are not covered by this insurance. Territory : Worldwide, except in the participant's home country, unless specified otherwise in a specific coverage. Accident/Injury: The terms "injury/accident" wherever used in this policy mean bodily injury caused solely and directly by accidental, external, and visible means occurring while this policy is in force and resulting directly and independently of all other causes in a loss covered by this policy. Illness: The term "illness" wherever used in this policy shall mean unexpected sickness or disease of any kind contracted and commencing after the effective date of this policy which causes a "loss" covered by this policy. Pre-existing condition : Pre-existing conditions are not covered under the policy. A pre-existing condition means a medical condition for which treatment has been received or taken, or which exhibited symptoms which would lead a reasonable participant to believe that or inquire into whether treatment was required in the 6 months prior to any effective date, purchase date or departure date for any insured trip. This includes a medically recognized complication or recurrence of a medical condition. Are considered «treatment» : follow-up exams, investigation, prescription of medication, change of type or change of dosage of medication and in general all medical and laboratory exams, x-rays, etc. related to that condition. Emergency dental treatment : Shall mean to alleviate pain related to an infection of the gum or tooth, and contracted and commencing after the effective date of the participant's arrival in the host country and necessitating an emergency treatment to alleviate the pain. Hospitalization : Any hospitalization, surgery, in-patient investigation MUST be reported within 24 hours to the Emergency center for approval and payment procedures. Failure to call the Emergency Center may lead to coverage denial or to partial coverage only. Disability : For the purpose of this agreement, the term "disability" shall mean that following an accident, you do not recover permanent and total use of bodily functions. Emergency Room Deductible : A US$ 250 deductible will be applied for emergency room visits unless: 1. You are admitted to the hospital OR 2. Treatment was necessary for acute illness or accident. Claims processing: A separate claim form must be submitted for each illness or injury. Every time you file a claim, there is no limit to the number of invoices with can be included in that claim, as long as they are all sent in together and pertain to one illness or injury. This means that you should consolidate your bills, invoices and prescriptions for each illness or injury. Medical providers network/ Doctor visits/ Guarantee of payment This service is available only in the USA. Please visit our website www.avi-international.info to find our nearest participating medical provider. We strongly recommend you call the Emergency Center so it can guarantee payment to your medical provider (provided care is covered under our policy) and to check our coverage limit. Remember you should always have your insurance card with you when seeking for medical care. Top of the page
Medical/Accident Coverage
Car accident Note that AVI International provides coverage only in excess of any other auto insurance coverage available to pay medical care for the insured. This means that the claim will have to be submitted first to the auto insurance company(ies) of all drivers involved in the accident. To submit the claim for payment of the excess, the insured must provide a police report and written proof from the concerned auto insurance company that all benefits have been paid, no matter what coverage is used: medical care, uninsured motorist, etc. or that no coverage is available. Also, in filing a claim you agree to release all information which the insurance company requires. Only original invoices will be considered proof of rendered services. Work accident In case of accident at work, this coverage is secondary to the employer's work compensation. Sport accident In case of accident while practising a sport in a club, this coverage is secondary to your club insurance policy. In the case your club cannot provide accident insurance, coverage can be purchased from AVI International through your sponsoring organization at an extra charge. Note : Claims and subrogation As stated previously, it is an obligation of the insured to let the Insurance Company, the Claims Office or the Emergency Center know of a loss as soon as the insured himself is made aware of that damage. The subrogation right of insurance companies may apply (see definition). 1. Cost of care due to illness or accident For the cost of care, the insurance company will reimburse the following expenses up to the limit of the policy coverages. However, the guarantee of payment can be denied or limited for costs that are manifestly unreasonable or unusual. Cost of medical care and treatment and hospitalization as required. There is no daily maximum for in-patient medical care or hospitalization. Prescriptions and medical supplies as prescribed by a physician. Cost of treatment for psychological/psychiatric illness is reimbursed according to the length of your stay, up to the limit of coverage when prescribed by a physician. Chiropractic/physiotherapy treatments are covered only subsequent to the date the participant has been referred to treatment by a physician who is not himself a chiropractor/physiotherapist. Local emergency transportation to a hospital via ambulance. Services of a private nurse. 2. Non emergency surgery/elective surgery Due to differences in medical cultures/procedures among the medical profession worldwide and to make this travel insurance plan easy to understand by the insured and easy to implement worldwide, the following has been decided: Knee surgery is not covered. Only the cost of a round trip ticket will be paid for. Surgery that is not PRESCRIBED by the attending physician AND which is not PERFORMED by the attending surgeon within 10 days of the accident or the diagnosis of the sickness or the diagnosis revision of the accident, is NOT considered an emergency and is NOT covered. A second opinion will be sought if either party (insured or insurance company) is not in agreement with the initial diagnosis. If the surgery is necessary for the insured to carry out his/her normal activities but not a medical emergency, the insurance company retains the right to return the participant to the home country for surgical procedures and for all necessary rehabilitation procedures. In such a case, the insurance company will be responsible for all related transportation costs, including the return flight to the host country upon the participant's recovery. If the insured elects not to return to his/her home country and wants the non emergency surgery performed in his/her host country, THE INSURANCE COMPANY WILL BE LIABLE TO PAY MEDICAL EXPENSES RELATED TO THE NON EMERGENCY SURGERY ONLY UP TO THE COST OF A ROUND TRIP TICKET FROM THE HOST COUNTRY TO THE HOME COUNTRY OF THE INSURED. Top of the page
Emergency Dental Coverage
1. Emergency dental treatment (see definition) Coverage provided for the alleviation of pain related to an infection of the gum or tooth, and contracted and commencing after the effective date of the participant's arrival in the host country and necessitating an emergency treatment, depends on the length of your stay abroad. Note : all dental claims MUST include an x-ray of the concerned tooth/gum. X-rays will be reimbursed at the customary cost charged in the area the dentist provided the dental care. The cost of initial emergency examination relating to the above to alleviate pain is covered. However, subsequent treatments exceeding US$ 100.00 must be justified by a dental treatment plan/ estimate for review and pre-approval by the Emergency Center. Please call the Emergency Center for details. Exclusions: No coverage is provided for claims submitted without the mandatory x-ray film, for routine dental examination, pre-existing conditions including caries/cavities, restorative work, orthodontics, dental equipment, crown build-up, crowns, reconstructive work or all other treatments unrelated to pain alleviation. 2. Dental care necessitated by an accident (see definition) Coverage is provided according to the lengh of your stay for services of a dentist or oral surgeon provided for the treatment of your sound natural teeth as the result of a direct accidental blow to the mouth. In addition, special orthodontics coverage has been provided for dental treatment resulting from an accident. The benefit amount is US$ 250.00 per tooth for dental orthodontics whatever the stay duration. Such treatment may be performed following your return home if a medical expert determines that treatment could not beb performed immediately due to your condition or age. In such a case, AVI will be secondary to any Health Plan you may benefit from. Exclusions: Broken or chipped teeth, loosened or lost fillings/amalgams while eating, chewing and biting, are not at any time considered an accident or a result of an accident under the terms of this policy. Top of the page
Exclusions and limitations of the medical coverage
Exclusions and Limitations of the Medical Coverage of this travel insurance policy include but arenot limited to the following : Any hospitalization, surgery and subsequent treatment, in-patient investigation NOT approved by the emergency center. Preventive or routine medical, dental and eye examinations. Physical examination for sports. Vaccinations and immunizations (eg. school required TB shots, x-rays) as well as their consequences. Medications not prescribed by a physician. Dental crowns and orthodontics (non-accident related), eye glasses, contact lenses and artificial limbs/prothesis. Acne (unless treated with antibiotics). Medical treatment for primarily cosmetic reasons (e.g. removal of warts, scars, moles, etc...). Cost of treatment related to birth control, pregnancy, abortion, childbirth or illness related to pregnancy. Treatments related to epilepsy, malaria, hepatitis C, HIV, AIDS or sexually transmitted disease. Treatments related to eating disorders such as but not limited to anorexia, bulimia, etc... Use of sedatives. Use of illegal substances such as narcotics or assimilated drugs not prescribed by a physician. Alcohol intoxication and/or abuse. Medical care and/or evacuations for pre-existing conditions/illness defined as: 1) treatment prescribed by a physician in the insured's home country as well as treatment stemming from a prior illness or accident (see definition). 2) treatment due to a chronic medical or mental illness previously known or unknown to the insured as well as their consequences. Congenital illness such as but not limited to pilonidal cysts. Ingrown toenails, corns, warts... Chiropractic treatment, physical therapy, psychological or psychiatric counseling/evaluation if not previously referred by M.D. Cost of travel related to illness resulting from the above listed exclusions or dismissal from the program. Top of the page
Exclusions and Limitations of the Accident Coverage
The accident exclusions of this travel insurance policy include but are not limited to the following: Consequences of the above excluded illnesses which could lead to an accident. Any hospitalization, surgery and subsequent treatment, in-patient investigation NOT approved by the emergency center. Dental crowns and orthodontics (non-accident related), eye glasses, contact lenses and artificial limbs. Injuries resulting from participation in team sports not supervised by high school, college or university coaches or community group coaches or authorities. Activities that are engaged in for recreational, entertainment, or fitness purposes are covered. Sports competitions not organized, supervised or officially scheduled by your high school, college or university. Injuries incurred as a driver of any motorized vehicle ). Competitions or trials in motor vehicles even with recreational vehicles. Injuries incurred as a driver or passenger of a motorcycle or a recreational vehicle. Plane accidents while a crew member (Passengers on the flight who are not part of the flight crew are covered for accidental injury). Accidents or injuries resulting from participation in highrisk or violent sports such as but not limited to: scuba diving, horse jumping, hang gliding, skiing or snow boarding outside maintained trails or slopes of ski resorts, mountaineering, hunting, use of firearms or air/spring powered guns, parachuting, ice hockey, boxing and martial arts, wave running, bungie-cord jumping, etc... Injuries resulting from initiation by the insured of a criminal/illegal act or act of violence. Self-inflicted injuries. Suicide or attempted suicide. Cost of travel related to accidents resulting from the above listed exclusions. Consequences of acts of war or terrorism Top of the page
Transportation Expenses
IMPORTANT: You MUST secure prior agreement from the Emergency Center for such travel in order to receive compensation. The Emergency Center is used to working with airlines and may be able to find a seat for a family member even when planes are fully booked. Any refund directly from the airline due to the emergency nature of the trip will be deducted from the claim payment or if no refund is granted by the transportation company, the original transportation ticket will have to be remitted to the insurance company or to the Emergency Center. The insurance company will reimburse or pay directly the costs of: Medical evacuation to home country due to acute illness or accidental injury when the insured is deemed fit to fly. The means of transportation, necessity and schedule of evacuation will be decided exclusively on medical and technical grounds by the Emergency Center physician in order to avoid any dispute between medical authorities. AVI International reserves the right to determine if a medical evacuation is appropriate for those illnesses or injuries which can be treated in the host country. Repatriation of remains to the home country. Transportation of one (1) family member from the home country, if the insured's hospitalization is planned to last more than three (5) days. Maximum $2,500.00 including cost of lodging . Transportation of a 2nd family member from the home country, if insured's hospitalization is planned to last more than seven (7) days. Maximum $2,500.00 including cost of lodging. Note : Claims and subrogation As stated previously, it is an obligation of the insured to let the Insurance Company, the Claims Office or the Emergency Center know of a loss as soon as the insured himself is made aware of that damage. The subrogation right of the insurance companies may apply (see definition). Top of the page
Exclusions and Limitations of the Transportation Benefit
The transportation exclusions of this travel insurance policy include but are not limited to the following: Participant: - Cost of travel related to all of the above exclusions and conditions listed in Medical and Accident Exclusions. - Illnesses or injuries which can be treated in the host country. - Dismissal from the program. Participant's parents: Cost of travel and lodging related to all of the above exclusions and conditions. Top of the page
Accidental Death Abroad
Compensation for the accidental death of a participant and the repatriation of remains to the place of burial in the home country will be paid to the participant's natural parents or to the parent who registered the participant to the stay or to the legal heirs. Exclusions: Compensation as well as repatriation of remains will not be paid in case of the insured's death, if the cause of death was an excluded illness, an excluded accident or an act of war or terrorism. In case of death related to a covered illness, only repatriation of remains will be granted. Note: Claims and subrogation As stated previously, the right of subrogation of the insurance companies may apply (see definition). Top of the page
Disability / Paralysis Resulting from an Accident
In case of a disability/ paralysis resulting from an accident, a medical expert will be appointed to determine the percentage of disability. The disability will be rated as partial or total disability. Partial Disability: 1% to 99% Total Disability: 100% Disability will be evaluated at the time of consolidation via a medical survey. Only the physiological consequences of the accident are examined in the survey. When a third party is responsible for the accident which led to your disability, the insurance company will advance disability payments to you. If there is no party involved in the accident leading to your disability, compensation will be paid directly to you by the insurance company. Exclusions: - Disability resulting from an illness. - Disability resulting from an excluded accident. - Disability resulting from an act of war or terrorism Top of the page
Baggage & Personal Effects Benefit
Your personal belongings are insured up to US $ 2,500.00 during your homestay when they are damaged or lost solely due to theft, robbery or assault. Always take special care to protect your valuable property by locking it in a safe place when not in use. If a loss occurs during your homestay, you will be reimbursed if your host family's homeowners insurance carries a deductible or if your belongings are not covered under that policy. If you are en route or are staying at a campus dormitory or hotel, only fire or water damage is reimbursed, since the primary theft insurance is provided by the hotel or dormitory facility. In case of a robbery, you must report IMMEDIATELY the loss to the police, transportation company, hotel, etc, and provide a copy of this report to the AVI Claims Departement along with your request for reimbursement. Only an official theft/loss or police report will be accepted by the insurance companies. It is the participant's responsibility to submit a comprehensive police report. This is mandatory in order to process your claim. In filing a claim for property, you must also provide a detailed description of the property along with its date of purchase and value. Bills, invoices or other proof of value are required. Stolen or damaged property will be valued allowing for wear and tear at the time of the loss. Maximum compensation per item is US$500.00 The insurance covers property which belongs to you, or has been borrowed by you for your personal use. This coverage also includes "theft prone" property such as jewelry, watches, cameras, MP3, borrowed bicycles, etc. They are covered up to a maximum of US$ 500.00 per item and US$ 500.00 in total. IMPORTANT: Original proof of value is requested to process your claim. Property will be valued according to wear and tear. Only in case of an assault or theft will I.D. cards, drivers license, passport be reimbursed. Property not covered: Musical instruments, bicycles, weapons and hunting gear (even when borrowed), lost or abandoned property, glasses, contact lenses, artificial limbs/prothesis, all means of payment (check, credit card, coins, currencies), stamps, manuscripts, concert tickets, legal/professional documents, all transportation tickets, keys, cellular phones, etc. Also excluded are animals, motor-driven vehicles, boats, etc. EXCLUSIONS: No coverage is provided... if jewels are lost in the course of sports or if they are not worn. if the theft occurs from unlocked premises. if property is left anytime in a convertible, a tent or in a trailer. if property is visible in the interior of any car. if property is left from 10 p.m. to 7 a.m. in any car. if the car was not broken into. for normal wear and tear or due to atmospherical influences. for damage caused to moths and rodents. for damage due to unsuitable packing. for property confiscated by any authority. for loss of I.D. cards, drivers license, passport or local transportation tickets. for damage caused by carried liquids. for damage caused by accidental fall. due to negligence of the insured such as but not limited to bags left unattended in public areas (e.g. premises to which more than you have access). Top of the page
Third Party Liability Coverage
IMPORTANT: This contract does not cover the third party liability of your sponsoring organization in your host or home country. In no way can the insurers of this contract be considered co-insurers of your sponsoring organization or of your sponsoring organization's professional liability insurance underwriters. The insurance holder is your sponsoring organization; you are the beneficiary of the policy. Since the insurance holder is your sponsoring organization, it cannot be considered a third party under the terms of this contract. Should a dispute/lawsuit occur between you and your sponsoring organization, both in your home and/or your host country, no coverage would be provided under the third party liability or legal assistance benefits. You may be held responsible for unintentional damage you cause to others. In case of an accidental injury to another person, you could be liable for the following types of expenses: medical costs, lost earnings, pain & suffering, etc... You are covered for these types of expenses if you are found to be liable for the injury. Top of the page
Exclusions of the Third Party Liability Coverage
Hunting or use of firearms or air / spring powered guns. Liability in connection with the use of illegal substances such as narcotics or assimilated drugs not prescribed by a physician. Alcohol intoxication and/or abuse. Liability in connection with the initiation, by the insured of a criminal/illegal act or act of violence. Liability in connection with the transmission of a contagious disease. Liability in connection with HIV, AIDS or sexually transmitted disease. Intentional acts. Liability in connection with the use, ownership or operation of horses and animals in general, motor driven vehicles, boats, planes, farm vehicles or recreational vehicles and gardening equipment. Liability during the course of full-time or part-time paid employment or in any child care capacity such as but not limited to baby-sitting, etc... Liability in connection with activities such as but not limited to: scuba diving, horse jumping, hang gliding, skiing or snow boarding outside maintained trails or slopes of ski resorts, mountaineering, hunting, use of firearms or air/spring powered guns, parachuting, ice hockey, boxing and martial arts, sailing, wave running, surfing, bungie-cord jumping, archery, etc... Punitive damages granted to the victim by a local jurisdiction. Top of the page
Force Majeure
The insurance company is not responsible for nonperformance or delays in the settlement of a claim which may be delayed due to war, riots, acts of terrorism, strikes or intervention by government authorities. Disputes This contract is regulated by the French Insurance Commission. All disputes between the policy holder or the insured and the insurance companies must be brought to court in France. Top of the page
Your Insurance Professional
Your policy, and the unique coverage it offers has been conceived specifically by AVI International, an insurance broker specializing in insurance programs for youth and student travel for over 30 years. Insurance Carrier - ACE European Group Limited - France General Management for France : Le Colis�e - 8, avenue de l�Arche - 92419 Courbevoie Cedex Identification number: 450 327 374 00028 - R.C.S Nanterre - APE 65.12Z. Head Office: 100 Leadenhall street - London, EC3A 3BP - United Kingdom. S.A. with a capital of 544.741.144 � Control authority: Financial Services Authority 25 The North Colonnade, Canary Wharf, London, E14 5HS United Kingdom. Some cases could be controled under conditions different from those applicable in the United Kingdom. This is are the carrier underwriting the contract at the time of printing. If need be, it can be changed by AVI International, provided coverages remain unchanged. If such an event were to occur, insureds of the policy would be notified. AVI International 106-108 rue La Boétie 75008 PARIS FRANCE Top of the page