Travel Assistance - Services

Subject to the definitions, general provisions, exclusions and limitations stated herein Lifeguard Emergency Travel, Inc. will provide services to each participant while traveling more than one hundred miles (100) from his or her permanent residence. All services in connection with this agreement must be pre-approved and arranged by Lifeguard's Assistance Provider.

SECTION I. SERVICES
1a.	Emergency Medical Evacuation. In the event a Participant suffers from a Certified Illness or Injury that requires medical transportation of that sick or injured Participant, Lifeguard's Assistance Provider will provide medical transportation from the attending Hospital to the nearest appropriate Hospital capable of providing such treatment. Such transportation will be provided upon certification by Lifeguard's Assistance Provider's Program Medical Director, liaising with the attending Physician, that the Participant's severity of Illness or Injury Necessitates medical transportation to the nearest appropriate Hospital.
1b.	Medically Necessary Repatriation. In the event Lifeguard's Assistance Provider's Program Medical Director, liaising with the attending Physician, determine it is Medically Necessary to bring the Participant from the attending Hospital to a Hospital or nursing home nearer his/her Permanent Residence, subsequent to receiving Emergency Medical Evacuation Services provided under this Agreement, Lifeguard's Assistance Provider will provide flight by common carrier or air ambulance, and ground ambulance, if necessary, by the most direct and economical route. All Services in connection with an Emergency Medical Evacuation or Medically Necessary Repatriation must be pre-approved and arranged by Lifeguard's Assistance Provider. [Eligible Emergency Medical Evacuation/Medically Necessary Repatriation - Limit of US$100,000 per Participant per Agreement Period.]
2.	Transportation of Mortal Remains. In the event of death of a Participant, caused by a Certified Illness or Injury, Lifeguard's Assistance Provider will arrange to have the Participant's remains returned to a location nearest the Participant's Permanent Residence, including but not limited to, preparation, transportation and container for transportation. All Services in connection with a Return of Mortal Remains must be pre-approved and arranged by Lifeguard's Assistance Provider. [Eligible Return of Mortal Remains - Limit of US$20,000 per Participant per Agreement Period.]
3.	Transportation of Escort . In the event a Participant requires Emergency Medical Evacuation by air ambulance or Repatriation by commercial airline provided in this Agreement, air transport of the Participant's Spouse or other Family Member or traveling companion will be provided so that person may accompany the Participant in flight, subject to space availability, giving priority to medical equipment and medical personnel aboard and for the welfare and safety of the Participant receiving Services in this Agreement. All Services in connection with Transportation of Escort must be pre-approved and arranged by Lifeguard's Assistance Provider.
4.	Family Visitation. In the event a Participant, who is traveling alone, is expected to be Hospitalized for more than seven (7) days, round trip economy transportation on a regularly scheduled airline or equivalent will be provided for one Family Member or relative from the commercial airport nearest the Family Member's Permanent Residence to the Hospital where the Participant is confined so that Family Member may attend the Participant during the Hospitalization. All Services in connection with Family Visitation must be pre-approved and arranged by Lifeguard's Assistance Provider. [Eligible Family Visitation - Limit of $ 5,000 to include Round Trip Economy Airfare and Food and Lodging $100 per Day/10 day maximum per Participant per Agreement Period.]
5.	Minor Child(ren) Return/ Escort. In the event a Participant's Minor Child(ren) are left unattended as a result of a Participant's Emergency Medical Evacuation, being Hospitalized for more than 24 hours due to Illness or Injury, or in the event of death, one way economy transportation on a regularly scheduled airline, or the equivalent, will be provided to return the Minor Child(ren) to the Participant's Permanent Residence. A qualified attendant will also be provided by Lifeguard's Assistance Provider to accompany the Minor Child(ren) under the age of 16 when necessary. All Services in connection with Minor Child(ren) Return/Escort must be pre-approved and arranged by Lifeguard's Assistance Provider. [Eligible Return of Minor Child(ren) - Limit of one, One Way Economy Airfare to a Maximum Limit of $5,000 per Participant per Agreement Period.]
6.	Vehicle Return. In the event a Participant should suffer from a Certified Illness, Injury or death which requires Emergency Medical Evacuation/ Medically Necessary Repatriation or Transportation of Mortal Remains and the Participant is thereby unable to drive his/her vehicle, Lifeguard's Assistance Provider will provide vehicle return service for ground vehicles such as cars, trucks, vans, travel trailers or motor homes, operated by the Participant, to the Participant's Permanent Residence. This benefit will pay the cost, up to $1,000 for fuel, oil, driver and tolls to affect such vehicle return. The Participant will bear the cost of any repair due to mechanical breakdown en route, as well as, costs for food and accommodations during the trip. The vehicle must be in a condition capable of being safely operated on the highway. All Services in connection with Vehicle Return must be pre-approved and arranged by Lifeguard's Assistance Provider. [Eligible Return of Vehicle - Limit of $1,000 per Participant per Agreement Period]
7.	24-Hour Information Service. Should the Participant need information before and/or during travel he/she may call Lifeguard's Assistance Provider 24 hours a day to obtain help. The multilingual staff is prepared to assist and coordinate the management of a wide variety of travel related situations. Services include but are not limited to information on required documents, immunization requirements; State Department Travel Advisory warnings on travel to certain locations; weather and hazard information about foreign locations; suggested medical exams or treatment before departure and medical care en route.
8.	Medical Monitoring. Should the Participant need to be medically monitored, Lifeguard's Assistance Provider's duty Physician will monitor the case while liaising with the Participant, the local attending Physician, the family Physician and the medical director of Lifeguard's Assistance Provider.
9.	Medical Referral. Should the Participant need help locating a Physician or Hospital, Lifeguard's Assistance Provider will provide referrals to a local pre-qualified Physician and/or Hospital.
10.	Guarantee of Medical Expenses. Should the Participant need help for overseas medical payments, Lifeguard's Assistance Provider will arrange for payment or guarantee of payment to medical providers.
11.	Insurance Coordination. Should the Participant need help for overseas medical claims, Lifeguard's Assistance Provider will assist him/her in coordinating the claims procedure with the Participant's insurance program.
12.	Lost Document Service. Should the Participant need help to replace lost or stolen travel documents (i.e. passport, baggage, tickets, credit cards, etc...), Lifeguard's Assistance Provider will advise and assist where possible regarding their replacement.
13.	Legal Assistance. Should the Participant need help arranging local attorneys, embassies and consulates, arranging bail, or coordination of payment for legal Services, Lifeguard's Assistance Provider will provide referrals and payments, from available resources of the Participant.
14.	Emergency Delivery of Prescription Items. Should the Participant need prescription medication or lenses not available locally, Lifeguard's Assistance Provider will organize the delivery of the prescribed item to the Participant upon written authorization from the prescribing Physician when possible and legally permissible.
15.	Emergency Cash Transfers and Advances. Should the Participant need cash as a result of loss or theft, Lifeguard's Assistance Provider will arrange for emergency cash transfers and advances through additional sources, including hotels, banks, Consulates and Western Union, up to a limit of $500 per transaction. All transactions are subject to any government regulation and to the availability of the Participant's confirmed personal credit.
16.	Language Assistance. Should the Participant need help communicating in a foreign country, Lifeguard's Assistance Provider will provide telephone interpretation.

SECTION II. DEFINITIONS

Accident or Accidental shall mean an event, independent of Illness or self-inflicted means, which is the direct cause of bodily Injury to the Participant.

Administrator shall mean Lifeguard Emergency Travel, Inc.

AIDS shall mean Acquired Immune Deficiency Syndrome, as that term is defined by the United States Centers for Disease Control.

Lifeguard's Assistance Provider shall mean the contracted service organization that provides 24-hour availability to Services in this Agreement for Lifeguard Emergency Travel, Inc.

Services shall mean Services and expenses provided on behalf of the Participant which are for Medically Necessary Services, supplies, care or treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician; incurred while provided under this Agreement; and which do not exceed the maximum limits shown.

Agreement shall mean the description of Services provided herein.

Complications of Pregnancy shall mean any or all of the following conditions which are made worse by, occur during, or are caused by pregnancy; acute nephritis, nephritis, cardiac decompensation, missed abortion, hyperemensis gravidarum, ectopic pregnancy that is ended, non-elective cesarean section, pre eclampsia, gestational diabetes, spontaneous end of pregnancy which occurs when a viable birth is not possible, and other medical problems of similar severity.

Certified Illness shall mean sickness or disease of any kind contracted and commencing after the Effective Date of this Agreement and causing loss provided by this Agreement.

Dependent shall mean the spouse who is legally married to the Primary Participant; the Primary Participant's unmarried Child(ren) from birth until his/her 18th birthday; or the Primary Participant's unmarried Child(ren) who is over 18 years old but not older than 25 years old and is enrolled as a full-time student at an accredited school or college and/or is not employed on a full-time basis.

10.

Effective Date shall mean the date the Primary Participant became the recipient of Services, which made him/her eligible for the Services provided in this Agreement.

11.

Emergency shall mean a medical condition manifesting itself by acute signs or symptoms, which could reasonably result in placing the Participant's life or limb in danger if medical attention is not provided within 24 hours.

12.

Family Member shall mean a spouse, parent, sibling or Child(ren) of the Participant.

13.

HIV Positive shall mean laboratory evidence defined by the United States Center for Disease Control as being positive for human immunodeficiency virus infection.

14.

Home Country shall mean the country where the Participant has his or her true, fixed and Permanent Residence and principal establishment.

15.

Hospital shall mean except as may otherwise be provided, a Hospital (other than an institution for the aged, chronically ill or convalescent, resting or nursing homes) operated pursuant to law for the care and treatment of sick or Injured persons with organized facilities for diagnosis and surgery and having 24-hour nursing service and medical supervision.

16.

Host Country shall mean any country other than the country where a Participant has his or her true, fixed and Permanent Residence and principal establishment.

17.

Injury shall mean bodily Injury caused solely and directly by violent, Accidental, external and visible means occurring while this Agreement is in force and resulting directly and independently of all other causes in Loss provided by this Agreement.

18.

Lifeguard shall mean Lifeguard Emergency Travel, Inc.

19.

Medically Necessary or Medical Necessity shall mean Services or supplies received while the Participant is eligible that are determined by Lifeguard's Assistance Provider and Lifeguard's Assistance Provider's program medical director to be 1.) appropriate and necessary for the symptoms, diagnosis, or direct care and treatment of the Participant's medical conditions, 2.) within the standards the organized medical community deems good medical practice for the Participant's condition; 3.) not primarily for the convenience of the Participant, the Participant's Physician or another Service Provider or person; 4.) not Experimental/Investigational or unproven, as recognized by the organized medical community, or which are used for any type of research program or protocol; and 5.) not excessive in scope, duration, or intensity to provide safe and adequate, and appropriate treatment. For Hospital stays, this means that acute care as an Inpatient is necessary due to the kinds of Services the Participant is receiving or the severity of the Participant's condition, in that safe and adequate care cannot be received as an Outpatient or in a less intensified medical setting. The fact that any particular Physician may prescribe, order, recommend, or approve a service, supply, or level of care does not, of itself, make such treatment Medically Necessary or make the charge of a Benefit or Service provided under this Agreement.

20.

Medicine or Medication shall mean the drugs prescribed or dispensed to the Participant, by a licensed Physician, as a result of a Benefits and Services provided under this Agreement. Medicine or Medication shall mean the generic equivalent of a drug, or if the generic equivalent is not available, the brand name drug.

21.

Mental Illness shall mean any condition or disease listed in the most recent edition of the International Classification of Diseases as a mental disorder, which clinically significant behavioral or psychological disorder marked by a pronounced deviation from a normal healthy state and associated with a present painful symptom or impairment in one or more important areas of functioning. This disease must not be merely an expectable response to a particular stimulus. Mental Illness does not mean learning disabilities, attitudinal disorders or disciplinary problems.

22.

Minor Child(ren) shall mean the Primary Participant's step-Child(ren) or Child(ren) under the Primary Participant's legal guardianship, but only if such Child(ren) depends on the Primary Participant's support and maintenance and lives with the Primary Participant in a parent-Child(ren) relationship. The term Minor Child(ren) does not include a foster Child(ren) who is eligible for benefits provided by a governmental program or law, unless required by the law of the State. The age limits that apply to Dependent Child(ren) will not apply to any Participating Child(ren) of the Primary Participant who remains dependent on the Primary Participant for support and maintenance because he or she becomes incapable of working due to a physical handicap or retardation which occurs: before reaching the age limit and while being a Participant under this Agreement or any prior plan, provided such Child(ren) was Participating on the date of termination of the prior plan.

23.

Participant shall mean a person who is eligible for Services provided in this Agreement.

24.

Permanent Residence shall mean the country where a Participant has his or her true, fixed and permanent home and principal establishment, and to which he or she has the intention of returning.

25.

Physician shall mean a licensed practitioner of the healing arts acting within the scope of his or her license. The attending Physician may not be (a) the Participant; (b) the Participant's Spouse; (c) a person booked to accompany the Participant on the trip; or (d) a person who is related to the Participant, or a person booked to accompany the Participant on the trip in any of the following ways: child, parent, or sibling. Such definition will exclude chiropractors and physiotherapists.

26.

Preexisting Condition shall mean:

a)	a condition that would have caused an ordinarily prudent person to seek medical advise, diagnosis, care or treatment during the 90 days prior to the Effective Date of this Agreement,
b)	a condition for which medical advise, diagnosis, care or treatment was recommended or received during the 90 days prior to the Effective Date of this Agreement;
c)	Conditions or complications of pregnancy in the third trimester.

27.

Pregnancy shall mean the physical condition of being pregnant, including Complications of Pregnancy.

28.

Primary Participant shall mean the person who is the recipient of benefits which made him/her eligible for the Services provided in this Agreement, and whom may have Dependents who are Participants.

29.

Registered Nurse shall mean a graduate nurse who has been registered or licensed to practice by a State Board of Nurse Examiners or other jurisdictional authority, and who is legally entitled to place the letters "R.N." after his or her name.

30.

Relative shall mean spouse, parent, sibling, Child(ren), grandparent, grandchild, step-parent, step-child, step-sibling, in-laws (parent, son, daughter, brother, or sister), aunt, uncle, niece, nephew, legal guardian, ward, or cousin of the Participant.

31.

Repatriation shall mean the transportation of the Participant to his/her Home Country

32.

Service Provider shall mean a Hospital, convalescent/skilled nursing facility, ambulatory surgical center, psychiatric Hospital, community mental health center, residential treatment facility, psychiatric treatment facility, alcohol or drug dependency treatment center, birthing center, Physician, dentist, chiropractor, licensed medical practitioner, nurse, medical laboratory, assistance service company, air/ground ambulance firm, or any other such facility that Lifeguard's Assistance Provider approves.

33.

Substance Abuse shall mean alcohol, drug, or chemical abuse, overuse or dependency.

SECTION III. GENERAL PROVISIONS

Access of Services. All arrangements for transportation or Services under this Agreement must be made by Lifeguard's Assistance Provider. The Participant agrees to notify Lifeguard's Assistance Provider promptly of the need for Emergency Medical Evacuation specifying the nature of the Injury or Illness requiring air transportation. Lifeguard's Assistance Provider will require a reasonable period of time to confirm Participant's benefits and to initiate the Participant's Medically Necessary transportation. The Participant must recognize that diligence is necessary to properly accommodate a medical emergency; therefore, Lifeguard's Assistance Provider requires notice at the earliest possible moment to secure Lifeguard's Assistance Provider's Program Medical Director's consent and to allow proper time to prepare the Participant's transportation.

Authorization. The Participant does hereby authorize any Physician, Hospital, medical attendant or others to furnish to Lifeguard's Assistance Provider any and all information regarding the Participant's physical condition including x-rays acquired in the course of examinations and treatment. The Participant hereby further agrees to authorize Lifeguard's Assistance Provider's medical team or Lifeguard's Assistance Provider's Agreementor's medical team authority to perform those procedures deemed necessary.

Assignment. The Services provided in this Agreement cannot be assigned by the Participant

Death, Disability and Injury. Lifeguard's Assistance Provider and/or Administrator shall not be liable to any person for the death, disability or Injury of the Participant, the Patient, or any other person accompanying the patient unless such Injury is caused by the sole negligence of Lifeguard's Assistance Provider and/or the Administrator, its agents, servants and employees. It is understood and agreed that Lifeguard's Assistance Provider and/or the Administrator may enter into Agreements with regional air ambulance carriers and that Lifeguard's Assistance Provider and/or the Administrator shall not be liable under any circumstances in the event of any Injury or death to the Participant which might occur during the course of transport by such Agreement carrier.

Eligibility. Guarantee issue to all eligible Primary Participants and dependents over the age of 14 days and under the age of 80 years old and as described in the Participant's membership plan.

Entire Agreement. All provisions of this Agreement, Participant's identification card, or other Agreements to provide Services, constitute the entire Agreement between the Administrator and the Participant. If any provision is declared void under the law, that provisions severable and the remainder of this Agreement shall remain in full force and effect.

Excess Benefits All Services shall be in excess of all other valid and collectible Insurance Indemnity and shall apply only when such benefits are exhausted. Other valid and collectible Insurance Indemnity for which benefits may be payable are Insurance programs provided by:

a.	Individual, group or blanket Insurance or coverage;
b.	Other prepayment coverage provided on a group or individual basis;
c.	any coverage under labor management trusteed plans, union welfare plans, employer organizational plans, employee benefit organization plans, or other arrangement of benefits for individuals of a group;
d.	Any coverage required or provided by any statute, socialized Insurance program;
e.	Any no-fault automobile Insurance; or
f.	Any third party liability Insurance.

Impossibility of Performance. Lifeguard's Assistance Provider and/or the Administrator shall not be liable for failure to perform under this Agreement if such failure is caused by rebellion riot, military uprising, war, terrorism, labor disturbance, strikes, nuclear accidents, acts of God, fire, flood, war or any other cause beyond the control of Lifeguard's Assistance Provider and/or the Administrator. Nothing herein contained shall require Lifeguard's Assistance Provider and/or the Administrator to take any action contrary to law or to any order or regulation of any governmental agency or officer or contrary to any authorization granted to Lifeguard's Assistance Provider and/or the Administrator by any governmental agency.

Liability. Lifeguard's Assistance Provider and/or the Administrator shall use all reasonable diligence in selecting persons, companies and equipment to provide the described Services. If companies outside of those contracted through Lifeguard are used to provide any Services, Lifeguard and Lifeguard's Assistance Provider and/or the Administrator shall not be liable for any negligence or tortuous acts resulting from such Services. Lifeguard's Assistance Provider and/or the Administrator are not liable for departures or arrivals delayed in transport when deemed unsafe by airport authorities or by pilot due to operational conditions, Acts of God, or mechanical failure.

10.

Monetary Limits The monetary limits stated in this Agreement shall be in US dollars. For Services outside of the territorial limits of the United States, the exchange rate date used to determine the amount of US dollars to be paid is the date the Services in this Agreement were provided to the eligible Participant.

11.

Not in Lieu of Worker's Compensation This Agreement is not in lieu of and does not affect any requirements for coverage by Worker's Compensation Insurance.

12.

Service Agreement. The Participant shall not make Agreement, authorize or engage any service or expense in the name of or on behalf of Lifeguard's Assistance Provider and/or the Administrator. The obligations of Lifeguard's Assistance Provider and/or the Administrator in this Agreement are limited to providing the various Services described herein. Lifeguard's Assistance Provider and/or Administrator are under no obligation to reimburse the Participant should the Participant independently authorize, Agreement, or make payment for any service.

13.

Trip Duration. The benefits provided by this Agreement cover trips up to ninety (90) consecutive days or less.

SECTION IV. EXCLUSIONS
Benefits will not be provided for any loss, cost or expense resulting, in whole or in part from:

1. Any Injury or Illness, which meets the following criteria:

a) a condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care or treatment during the 90 days prior to the Effective Date this Agreement;

b) a condition for which medical advice, diagnosis, care or treatment as recommended or received during the 90 days prior to the Effective Date this Agreement;

c) conditions or complications of pregnancy in the third trimester;

2. Charges for treatment, which is not Medically Necessary or exceeds Reasonable and Customary charges.

3. Charges provided at no cost to the Participant;

4. Charges incurred during any period of Hospital confinement;

5. Services, supplies or treatment, which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician;

6. Suicide or any attempt there at, while sane or self destruction or any attempt there at, while insane;

7. War, declared or undeclared, or any act thereof;

8. Injury Sustained while participating in professional, amateur or interscholastic athletics;

9. Services or supplies performed or provided by a Relative of the Participant;

10. Elective Surgery which can be postponed until the Participant returns to his/her Home Country;

11. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent, or Injury sustained while under the influence of or disablement due to alcohol or drugs;

12. Congenital anomalies and conditions arising out of or resulting there from;

13. Expenses which are non-medical in nature;

14. Expenses as a result or in connection with intentionally self-inflicted Injury or Illness;

15. Expenses as a result or in connection with the commission of a felony offense;

16. Injury sustained while taking part in mountaineering where ropes or guides are normally used, hang gliding and parachuting, racing by horse, motor or motorcycle, and scuba diving involving underwater breathing apparatus (unless PADI certified);

17.
Treatment paid for or furnished under any other individual or group policy or other service or medical pre-payment plan arranged through the Participant's employer to the extent so furnished or paid, or under any mandatory government program or facility set up for treatment without cost to any individual;

18. Injuries for which benefits are payable under any no-fault automobile Insurance Agreement;

19. Charges for treatment which is incurred by Participants who were HIV Positive or afflicted with Venereal disease at the time of application for this Agreement and Testing for the following: HIV, seropositivity to the AIDS virus, AIDS related Illnesses, ARC Syndrome, AIDS. AIDS virus, AIDS related Illness, ARC Syndrome, AIDS, and/or any Illness arising as complications from these conditions;

20. Any Mental or nervous disorders or rest cures.

Travel Assistance - Services

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