Glossary
A
Accident
Accident means a sudden, unintentional, and unexpected occurrence caused by external, visible means and resulting in injury to you. The cause or one of the causes of such accident is external to your own body and occurs beyond your control.
Accidental Death
Accidental Death means a sudden, unintentional, and unexpected occurrence caused solely by external, visible means resulting in injury to you and your subsequent death. Death must occur within 30 days of the sudden, unintentional, and unexpected occurrence and not be contributed to by illness or disease.
Accidental Dismemberment
Accidental Dismemberment means a sudden, unintentional, and unexpected occurrence caused solely by external, visible means and resulting in complete severance from the body of one or more limbs or eyes and not contributed to by illness or disease. For purposes of the Accidental Death and Dismemberment benefit, the term “limb” shall mean: the arm when the severance is at or above (toward the elbow) the wrist, or the leg when the severance is at or above (toward the knee) the ankle. Loss of eye(s) shall mean: complete, permanent, irrevocable loss of sight.
Acute Onset of Pre-Existing Condition
Acute Onset of Pre-existing Condition means a sudden and unexpected outbreak or recurrence that is of short duration, is rapidly progressive, and requires urgent care. A pre-existing condition that is a chronic or congenital, or that gradually becomes worse over time is not acute onset of a pre-existing condition. An Acute Onset of Pre-existing Condition does not include any condition for which, as of the Effective date, the Insured Person (i) knew or reasonably foresaw he/she would receive, (ii) knew he/she should receive, (iii) had scheduled, or (iv) was told that he/she must or should receive, any medical care, drugs, or treatment.
Alcohol Abuse
Alcohol abuse means any pattern of pathological use of alcohol that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn.
Authorization Form for Use and/or Disclosure of Protected Health Information
An authorization form that gives the insurer permission to disclose and release protected health information to anyone specified on the form. WorldTrips requires that this form be signed and thoroughly completed if the member wishes for their protected health information to be disclosed and/or released to a specified person.
B
Beneficiary
Beneficiary means the individual named in your application to be the recipient of any Accidental Death or Common Carrier Accidental Death benefit. If you do not designate a beneficiary on the application, the beneficiary is automatically in the order as follows:
Members age 18 or older: 1. Spouse (if any), 2. Children (if any) equally, 3. Your estate.
Members under age 18: 1. Custodial Parent(s) (if any), 2. Siblings (if any) equally, 3. Your estate.
C
Certificate
Certificate means the document issued to you that provides evidence of benefits payable under the Master Policy and that will confirm the plan type, period of cover, home country, certificate number, special terms and/or conditions, deductible, chosen benefit list, and geographical area of cover. (Review your plan’s policy documents to confirm terminology definitions.)
Certificate Period
Certificate Period means the period of time beginning on the date and time of the certificate effective date and ending on the date and time of the certificate termination date. For Atlas Travel plans, the certificate period is a maximum of twelve (12) months. Lost checked luggage and travel delay are eligible benefits after the certificate period, if the claimed expenses or loss began during the certificate period.
Chronic
Chronic means any condition that usually persists three months or longer.
Claimant
A person or entity making a claim under a policy.
Claimant's Statement and Authorization Form
An authorization form that asks for claimant information, medical information, and authorization for the release of medical records. It is completed by the claimant and submitted to the insurer. WorldTrips requires Claimant's Statement and Authorization form for each incident.
Coinsurance
Coinsurance means your payment of eligible expenses at the percentage specified in the Schedule of Benefits and Limits.
Coinsurance
Specifies the percentage amount the insurer pays for eligible expenses and the percentage amount the insured pays for eligible expenses once the insured has met their deductible.
Common Carrier
Common Carrier means an airplane, bus, train, or watercraft operating for commercial purposes and carrying fare-paying passengers on regularly scheduled and published routes.
Complications of Pregnancy
Complications of Pregnancy means illnesses whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or caused by pregnancy and not associated with a normal pregnancy. This includes: ectopic pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed abortion, and conditions of comparable severity. Complications of Pregnancy does not include: false labor, edema, prolonged labor, prescribed rest during the period of pregnancy, morning sickness and conditions of comparable severity associated with management of a difficult pregnancy, and not constituting a medically distinct condition.
Congenital
Congenital means any medical condition, disorder, abnormality, deformity, illness, injury present at birth regardless of cause or manifestation, and whether or not previously diagnosed.
Copayments (Copays)
The fixed amount the insured person must pay out of pocket for specific medical services, such as use of an emergency room for an illness.
Covered Loss
Covered Loss means a loss for which this plan has paid a benefit under Lost Checked Luggage or for an accidental injury.
Covered Pregnancy
Covered Pregnancy means a pregnancy which began after the effective date of coverage.
Custodial Care
Custodial Care means that type of care or service, wherever furnished and by whatever name called, that is designed primarily to assist you in performing the activities of daily living. Custodial care also includes non-acute care for the comatose, semi-comatose, paralyzed, or mentally incompetent patients.
Cyber
Cyber means the use or operations, as a means for inflicting harm, of any computer, computer software program, malicious code, computer virus or process, or any other electronic system.
D
Date of Service
The date that a medical service was received. This date may differ from the date the medical claim is filed with the insurance company.
Deductible
Deductible means the dollar amount of eligible expenses, specified in the Schedule of Benefits and Limits that you must pay per certificate period before eligible expenses are paid.
Deductibles
The dollar amount of eligible expenses the insured must pay per certificate period before eligible expenses are paid.
Dental Treatment
Dental Treatment means the care of teeth, gums, or bones supporting the teeth, including dentures and preparation for dentures.
Displaced
Displaced means required to depart a destination due to an evacuation ordered by prevailing authorities.
Drug Abuse
Drug Abuse means any pattern of pathological use of a drug that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn.
Durable Medical Equipment
Durable Medical Equipment means a standard basic hospital bed and/or a standard basic wheelchair. Walking boots and crutches are not considered durable medical equipment.
E
Educational or Rehabilitative Care
Educational or Rehabilitative Care means care for restoration (by education or training) of one’s ability to function in a normal or near normal manner following an illness or injury. This type of care includes, but is not limited to, vocational or occupational therapy and speech therapy.
Emergency
Emergency means a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing your life or limb in danger if medical attention is not provided within 24 hours.
Emergency Dental
Emergency Dental means dental treatment by a Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DDM), or other licensed dental practitioner, necessary to resolve pain or to restore or replace teeth lost or damaged in an accident which was covered under this insurance.
Emergency Eye Exam
Emergency Eye Exam means an eye exam performed by a licensed optometrist to establish proper corrective lens prescription for medically necessary corrective lenses that were lost or damaged as the result of a covered loss when the prescription is unable to be determined by the existing corrective lenses due to their damage or loss.
Extended Care Facility
Extended Care Facility means an institution, or a distinct part of an institution, which is licensed as a hospital, extended care facility, or rehabilitation facility by the state in which it operates; and is regularly engaged in providing 24-hour skilled nursing care under the regular supervision of a physician and the direct supervision of a registered nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation prescribed by a physician; and provides each patient with active treatment of an illness or injury. Extended care facility does not include a facility primarily for rest, the aged, substance abuse treatment, custodial care, nursing care or for care of mental health disorders or the mentally incompetent.
F
Full-Time Scholar
Full-time Scholar means an individual who is affiliated with an educational institution and is engaging in education activities for at least 30 hours per week. These activities may include but not be limited to performing research in an area of specialty or teaching for a temporary period of time.
Full-Time Student
Full-time Student means a student at a college or university who is taking 10 credit hours (undergraduate students) or 6 credit hours (graduate students). Full-time student status for individuals enrolled at colleges or universities that do not use a credit hour system must provide documentation of full-time student status.
H
Home Country
Home Country means the country where you principally reside and receive regular mail. U.S. citizens and lawful permanent residents are not eligible for coverage within the U.S., except as provided under home country coverage, regardless of the location of your principal residence.
Home Health Care Agency
Home Health Care Agency means a public or private agency or one of its subdivisions, which operates pursuant to law and is regularly engaged in providing home nursing care under the supervision of a registered nurse, and maintains a daily record on each patient, and provides each patient with a planned program of observation and treatment by a physician.
Home Nursing Care
Home Nursing Care means services provided by a home health care agency and supervised by a registered nurse, which are directed toward the personal care of a patient, provided always that such care is provided in lieu of medically necessary inpatient care in a hospital.
Hospital
Hospital means an institution which operates as a hospital pursuant to law, and is licensed by the state or country in which it operates; and operates primarily for the reception, care and treatment of sick or injured persons as inpatients; and provides 24-hour nursing service by registered nurses on duty or call; and has a staff of one or more physicians available at all times; and provides organized facilities and equipment for diagnosis and treatment of acute medical conditions on its premises; and is not primarily a rehabilitation facility, long-term care facility, extended care facility, nursing, rest, custodial care or convalescent home, a place for the aged, drug addicts, alcoholics or runaways; or similar establishment.
Host Country
Host Country means the country, other than the home country, in which you will engage in educational pursuits. For legal residents and citizens of the U.S., the host country must be outside the U.S., including the U.S. Virgin Islands, Puerto Rico, Guam, American Samoa, and the Northern Mariana Islands.
I
Illness
Illness means a sickness, disorder, pathology, abnormality, ailment, disease, or any other medical, physical or health condition. For purposes of this insurance, illness could include. Complications of Pregnancy during the first 26 weeks of pregnancy. (Review your plan’s policy documents to confirm terminology definitions.) Illness does not include learning disabilities, attitudinal disorders, or disciplinary problems.
In Network
Refers to physicians and medical facilities who have a contract with the insurer. If you visit an in-network provider, you may receive medical services at a discounted rate.
Injury
Injury means an unexpected and unforeseen harm to the body caused by an accident that requires medical treatment.
Inpatient
Inpatient means an admitted patient who occupies a hospital bed for medical treatment and whose admission was recommended by a physician.
Intensive Care Unit
Intensive Care Unit means a cardiac care unit or other unit or area of a hospital that meets the required standards of the Joint Commission on Accreditation of Hospitals for Special Care Units.
Investigational, Experimental or for Research Purposes
Investigational, Experimental or for Research Purposes means procedures, services, or supplies that are by nature or composition, or are used or applied, in a way which deviates from generally accepted standards of current medical practice.
L
Local Ambulance
Local Ambulance means transportation from within a metro area to a hospital or other appropriate health care facility. Other than in an emergency, air ambulance may be substituted for ground ambulance if in rural area and unreachable by ground ambulance.
M
Medically Necessary
Medically Necessary means a service or supply which is necessary and appropriate for the diagnosis or treatment of an illness or injury based on generally accepted current medical practice as determined by us. A service or supply will not be considered medically necessary if is provided only as a convenience to you or the provider, and/or is not appropriate for your diagnosis or symptoms, and/or exceeds in scope, duration, or intensity that level of care which is needed to provide safe, adequate, and appropriate diagnosis or treatment of an illness or injury.
Member
Member means an individual who is covered under this insurance.
Mental Health Disorder
Mental Health Disorder means a mental or emotional disease or disorder which generally denotes a disease of the brain with predominant behavioral symptoms; or a disease of the mind or personality, evidenced by abnormal behavior; or a disorder of conduct evidenced by socially deviant behavior. Mental health disorders include: psychosis, depression, schizophrenia, bipolar affective disorder, and those psychiatric illnesses listed in the current edition of the diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association.
N
Natural Disaster
Natural Disaster means an event of natural cause, including wildfire, earthquake, windborne dust or sand, volcanic eruption, tsunami, snow, rain, or wind, that results in widespread and severe damage. Natural disaster does not include the direct or indirect effect of rain, wind or water associated with named storms meeting the definition of hurricane or typhoon, except in instances where:
1. The path of the named storm deviates by a distance of greater than 200 miles within a 72-hour period from the path forecast by a nationally recognized meteorological service
2. Or less than 72 hours advance notice of a potential landfall for a named storm exists.
O
Out of Network
Refers to physicians and medical facilities who do not have a contract with the insurer and therefore charge the full rate for their services.
Outpatient
Outpatient means a member who receives medically necessary treatment that is ordered or administrated by a physician for injury or illness that does not require overnight stay in a hospital.
P
Personal Belongings
Personal Belongings means monies and/or property of monetary value that are:
1. Being carried or transported by you when an express kidnapping or kidnapping first occurs; and
2. Are surrendered during the course of an express kidnapping or kidnapping.
Physician
Physician means a Doctor of Medicine (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DDM), Doctor of Podiatry (DPM), Doctor of Osteopathy (DO), a licensed Physical Therapist or Physiotherapist, and a Doctor of Psychology (Psy.D). Physician also includes an Advanced Practice Registered Nurse (APRN), Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Nurse Midwife or a Physician Assistant (PA) under the direction of a medical doctor. A physician must be currently licensed by the jurisdiction in which the services are provided, and the services must be within the scope of that license and covered under this Master Policy.
Pre-Existing Condition
Pre-existing Condition means any injury, illness, sickness, disease, or other physical, medical, mental, or nervous disorder, condition, or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the period prior to the effective date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, treated, or disclosed to us prior to the effective date, and including any and all subsequent, chronic, or recurring complications or consequences related thereto or resulting or arising therefrom. (Review your plan's policy documents to confirm terminology definitions.)
Q
Quarantine
Quarantine means your strict isolation imposed by a physician or government authority to prevent the spread of disease. An embargo preventing you from entering a country is not a quarantine.
R
Related Third Person
Related Third Person means your relative, your traveling companion, your traveling companion’s relative, and any other person, individual or family member with whom you are residing or being hosted.
Relative
Relative means biological or stepparent; biological or stepchild; current spouse; biological or stepsiblings; or parent-in-law, children, or sibling-in-law.
Routine Medical Examination
Routine Medical Examination means an examination of the physical body by a physician for preventative or informative purposes only, including establishing care with a physician when there is no objective impairment to normal health, and not for the diagnosis or treatment of any condition. Routine medical examination also includes diagnostic labs, x-rays, and other procedures for screening, preventative, or informative purposes.
S
Sexually Transmitted Diseases
Sexually Transmitted Diseases means diseases including but not limited to syphilis, gonorrhea, chlamydiosis, trichomoniasis, genital herpes, and Human Papillomavirus (HPV).
Spouse
Spouse means your legal spouse or domestic partner. Such relationship must have met all requirements of a valid marriage contract, domestic partnership, or civil union in the state or country where the parties’ ceremony was performed.
Student Health Center
Student Health Center means a medical facility of an educational institution that provides basic health services for students for a minimum of 10 hours per week during the school semester. Basic services must include staffing by a licensed medical provider (MD, CNP, or RN) for the purpose of assessment and treatment of minor illness and injuries and/or referral to another medical provider.
Substance Abuse
Substance Abuse means alcohol, drug, or chemical abuse, overuse, or dependency.
Sudden(ly)/Unexpected(ly)
Sudden(ly)/Unexpected(ly) means quickly with little or no warning, not expected, and unforeseen
Surgery or Surgical Procedure
Surgery or Surgical Procedure means an invasive diagnostic procedure or the treatment of illness or injury by manual or instrumental operations performed by a physician while the patient is under general or local anesthesia.
T
Terms
Terms means all terms, provisions, conditions, definitions, deductibles, coinsurance, limits, sub-limits, limitations, wordings, restrictions, requirements, qualifications, and/or exclusions that bind the Insured Person as set forth in the Master Policy, Application, and any Riders.
Therapeutic Termination of Pregnancy
Therapeutic Termination of Pregnancy means willful termination of pregnancy determined to be medically necessary for the wellbeing of the mother.
Third Person
Third Person means any individual, natural person, or other legal entity or person, other than you or a related third person.
Treated/Treating/Treatment
Treated/Treating/Treatment means any and all services and procedures rendered in the management and/or care of a patient for the purpose of identifying, diagnosing, treating, curing, preventing, controlling and/or combating any illness or injury, including without limitation: verbal or written advice, consultation, examination, discussion, diagnostic testing or evaluation of any kind, pharmacotherapy or other medication, and/or surgery.
U
Urgent Care Center
Urgent Care Center means a U.S. medical facility separate from a hospital emergency department where ambulatory patients can be treated on a walk-in basis without an appointment and receive immediate, non-routine urgent care for an injury or illness presented on an episodic basis.
Usual, Reasonable, and Customary
1. One and a half times (150%) of the charges payable under the United States Medicare program, for claims incurred outside the PPO network within the U.S., or
2. Most common charge for similar services, medicines, or supplies within the geographic area in which the charge is incurred, so long as those charges are reasonable. What is defined as usual, reasonable, and customary charges will be determined by us. In determining whether a charge is usual, reasonable, and customary, we may consider one or more of the following factors: the level of skill, extent of training, and experience required to perform the procedure or service; the length of time required to perform the procedure or services as compared to the length of time required to perform other similar services; the severity or nature of the illness or injury being treated; the amount charged for the same or comparable services, medicines or supplies in the locality; the amount charged for the same or comparable services, medicines or supplies in other parts of the country where the charges are incurred; the cost to the provider of providing the service, medicine or supply; such other factors we, in the reasonable exercise of discretion, determine are appropriate.
V
Virtual Physician Visit
Virtual Physician Visit means a live consultation conducted over the internet or phone between you and a physician.
W
We/Us/Our
We/Us/Our means WorldTrips.
Y
You/Your
You/Your means each insured person named in the certificate.
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WorldTrips is a service company and a member of the Tokio Marine HCC group of companies.
WorldTrips’ Atlas Travel Series and StudentSecure international travel medical insurance products are underwritten by Lloyd's. WorldTrips has authority to enter into contracts of insurance on behalf of the Lloyd's underwriting members of Lloyd's Syndicate 4141, which is managed by HCC Underwriting Agency, Ltd.
WorldTrips' Atlas Journey, Atlas Cruiser, and Atlas On-The-Go trip protection insurance products are underwritten by Tokio Marine HCC's U.S. Specialty Insurance Company (USSIC). USSIC is a Texas-domiciled insurance company operating on an admitted basis throughout the United States. Coverage is available to U.S. residents of the U.S. states and District of Columbia only. This plan provides insurance coverage that only applies during the covered trip. You may have coverage from other sources that provides you with similar benefits but may be subject to different restrictions depending upon your other coverages. You may wish to compare the terms of this policy with your existing life, health, home, and automobile insurance policies. Coverage may not be available in all states.
In the State of California, operating as WorldTrips Insurance Services. California Non-Resident Producer License Number: 0G39705