Travel Insurance

Group Insurance Premium and Coverage.  This will be a separate fee if you elect the coverage.  You are welcome to shop around or decline coverage.  The group policy will be under $100 per person. There will be a small service fee added to each person.

Group Plan - Net Program Enrollment Form

• Agency Information
Agency Name:
Agency Address:
Phone Number:
Email Address (for policy confirmation):
• Group Information
Group Name:
Destination: Final Trip Payment: Departure Date:
Return Date:
Name of Airline, Tour Operator/Cruise Line:
• Schedule of Benefits/Pricing Information
Coverage Benefit Amount TripCancellation ..........................................................................100%ofinsuredTripCost Trip Interruption ..........................................................................150% of insured Trip Cost* Trip Interruption- Return Air Only.................................................................................. $750* Trip Delay ($150 max/day) ....................................................................................................$750 Missed Connection...............................................................................................................$250 Baggage & Personal Effects Loss (Secondary) ...............................................................$1,500 Baggage Delay.......................................................................................................................$250 Medical Expense (Secondary)........................................................................................$25,000
Dental................................................................................................................................$500 Emergency Evacuation & Repatriation of Remains................................................$250,000 Accidental Death and Dismemberment .....................................................................$25,000 *Coverage forTrip Interruption andTrip Interruption-Return Air Only cannot be combined
The following non-insurance services are provided by Travel Guard.
• Travel Medical Assistance • Worldwide Travel Assistance • LiveTravel® Emergency Assistance
Optional Coverage
(The following will be included if elected and appropriate cost has been paid.)
Optional Additional Medical Coverage ..............................................Additional $25,000 Optional Additional Deluxe Medical Upgrade:
Medical Expense .......................................................................................Additional $25,000 Primary Coverage ........................................................................................................Included Emergency Evacuation
Hospital of Choice.................................................................................................Included • Plan Cost Calculation

ARC #:
Agency Contact:

• PaymentInformation

(Payment with roster is due 30 days prior to departure. If not submitted before then, a $25.00 late fee will need to be submitted with payment. If the group is formed within 30 days prior to departure, the late fee is not required.)

o CopyofGroupManifest o Enrollment Form
Name of Cardholder Signature:

o Copyofcancellationpenalties

Please include the following:

o NetPaymentviaagentcreditcardorcheckonlypayabletoTravelGuard. o American Express o MasterCard o VISA o Discover/Novus

Expiration Date

007896 EN 12/07 Page 1 of 1 12/22/11

Group Program - Overview
What is the Group Program?
A mandatory, comprehensive insurance program that allows you to book coverage as a group instead of individually. What are the stipulations?

• Coverage is MANDATORY (except in NY) for all passengers and must be collected by the time of final trip payment to qualify for this product. Coverage may not be sold separately.
  
• The agent is responsible for supplying each Group Member a Certificate upon receipt of final payment.
  
• All pre-paid, non-refundable trip costs must be covered in order to waive the Pre-existing medical condition exclusion. Maximum insurable trip cost is $25,000 per person.
  
• A Group is defined as 10 or more passengers. Student groups are allowed 1 adult for every 10 students, with the adult paying the student rate.
  
• Maximum combined tour cost of the group may not exceed $500,000.
  
• Payment to Travel Guard by net agency check or net agency credit card only. Mail payment, enrollment form, copy of cancellation penalties that apply to group and copy of
  group manifest to Travel Guard or enroll the group online via the agent toolbox. Mailing address: Travel Guard, 24851 Network Place, Chicago, IL 60673-1248. Online: Go to
  www.TravelGuard.com or fax to 1.800.955.8785 for net agency credit card payment only.
  
• Payment with roster is due 30 days prior to departure. If not submitted before then, a $25.00 late fee will need to be submitted with payment. If the group is formed within
  30 days prior to departure, the late fee is not required.
  
• The Date of Birth or age of all participants must be included on the Roster submitted to Travel Guard, or the 60+ bracket needs to be used for pricing.
  Who do I call if I have questions?
  Contact your Sales Representative for information about the program.
  Details of Coverage
  Missed Connection
  If while on a Trip the Insured misses a Trip departure resulting from cancellation or delay of 3 or more hours of all regularly scheduled airline flights due to Inclement Weather or Common Carrier caused delay, the Insurer will reimburse the Insured up to the Maximum Limit shown in the Schedule for:
  1. additional transportation expenses incurred by the Insured to join the departed Trip; 2. pre-paid, non-refundable trip payments for the unused portion of the Trip.
  The Common Carrier must certify the delay of the regularly scheduled airline flight. Coverage is secondary if reimbursable by any other source.
  Trip Delay
  The Insurer will reimburse the Insured up to the Maximum Limit(s) shown on the Schedule for Reasonable Additional Expenses until travel becomes possible if the Insured’s Trip is delayed 5 or more consecutive hours from reaching their intended Destination as a result of a cancellation or delay of a regularly scheduled airline flight for one of the Unforeseen events listed below:
  • reasons listed under Trip Cancellation and Interruption; • Common Carrier delay; • the Insured’s or Traveling Companion’s lost or stolen passports, travel documents, or money;• NaturalDisaster;or• theinsuredbeinginvolvedinordelayedduetoatraffic accident while en route to a departure as substantiated by a police report.
  Baggage & Personal Effects
  The Insurer will reimburse the Insured, up to the Maximum Limit shown in the Schedule, for loss, theft or damage to the Insured’s Baggage, personal effects, passports, travel documents and visas during the Insured’s Trip.
  Baggage Delay
  If the Insured’s Baggage is delayed or misdirected by the Common Carrier for more than 12 hours while on a Trip, the Insurer will reimburse the Insured up to the Maximum Limit shown on the Schedule for the purchase of Necessary Personal Effects.
  Medical Expense
  The Insurer will reimburse the Insured up to the Maximum Limit(s) shown on the Schedule if, while on a Trip, an Insured suffers an Injury or a Sickness that requires him or her to be treated by a Physician during the course of the Trip. The Sickness or Injury must first manifest itself during the course of the Trip. The Insurer will pay the Reasonable and Customary Charges incurred for Medically Necessary Covered Expenses received due to that Injury or Sickness only during the Insured’s Trip provided initial treatment was received during the Trip. The Injury must occur or Sickness must begin while the Insured is covered by the plan.
  Emergency Evacuation and Repatriation of Remains
  The Insurer will pay for Covered Emergency Evacuation Expenses incurred if an Insured suffers an Injury or Sickness while he or she is on a Trip that warrants his or her Emergency Evacuation.
  Accidental Death and Dismemberment
  Pays for loss of life or limb if it occurs within 365 days of an accident during the Insured’s trip.
  

Trip Cancellation & Interruption
The Insurer will pay a benefit, up to the Maximum Limit shown on the Schedule, if an Insured cancels his/her Trip or is unable to continue on his/her Trip due to the following Unforeseen events:

• Sickness, Injury or death of an Insured, Family Member, Traveling Companion, or
  Business Partner.
  
• Sickness Injury or death or hospitalization of the Insured's Host at Destination. A
  Physician must certify the Injury or Sickness.
  
• Financial Default of an airline, cruise line, or tour operator provided the Financial
  Default occurs more than 14 days following an Insured's effective date for the Trip Cancellation or Trip Interruption Benefits. There is no coverage for the Financial Default of any person, organization, agency, or firm from whom the Insured purchased travel arrangements supplied by others;
  
• Inclement Weather causing delay or cancellation of travel;
  
• Strike resulting in complete cessation of travel services at the point of departure
  or Destination;
  
• the Insured’s Primary Residence or Destination being made Uninhabitable by
  Natural Disaster, vandalism, or burglary;
  
• the Insured, or a Traveling Companion being subpoenaed, required to serve on a
  jury, hijacked, or quarantined;
  
• the Insured or Traveling Companion being called into active military service or
  having leave revoked or being reassigned;
  
• a Terrorist Incident in a City listed on the Insured’s itinerary within 30 days of the
  Insured’s scheduled arrival;
  
• Cancel for Work Reasons if the Insured or a Traveling Companion:
  1.) is required to work during his/her scheduled Trip. He/she must provide proof of requirement to work, such as a notarized statement signed by an officer of his/her employer; In the situation of self employment, proof of self- employment and a notarized statement confirming that the Insured is unable to travel due to his or her job obligations will be required;
  
  2. 2.)  is directly involved in a merger, acquisition, government required product recall, or bankruptcy proceedings and must be currently employed by the company that is involved in said event;
     
  3. 3.)  company is deemed to be unsuitable for business due to burglary, or Natural Disaster and the Insured or Traveling Companion is directly involved as a Key Employee of the disaster recovery team; (not available to residents of Washington, Pennsylvania or New York.);
     
• mechanical/equipment failure of a Common Carrier that occurs on a scheduled Trip and causes complete cessation of the Insured’s travel and results of a Loss of 50% of the Insured’s Trip length (not available to residents of Washington or Pennsylvania); or
  
• the Insured or Traveling Companion is involuntarily terminated or laid off through no fault of his or her own, provided that he or she has been an active employee for the same employer for at least one year. Termination must occur following the effective date of coverage. This provision is not applicable to temporary employment, independent contractors or self-employed persons (not available to residents of Washington or Pennsylvania).
  

Thisisonlyabriefdescriptionofthecoverage(s)available. ThePolicywillcontainreductions,limitations,exclusionsandterminationprovisions. InsuranceunderwrittenbyNationalUnionFire InsuranceCompanyofPittsburgh,Pa.,withitsprincipalplaceofbusinessinNewYork,NY. Coveragemaynotbeavailableinallstates.

12/07 007896 -SS 12/22/11