Miles Care Terms and Conditions
MILES CARE PROTECTION
Miles Care enables the coverage benefits described in the following section.
Benefits are subject to all the following:
- All terms, conditions, provisions and exclusions of this document, including the applicable Appendices, Annexes or Endorsements
- Current subscription to the Miles Care App and program
- Any associated registration fee, if applicable
- Coverage and provisions apply only to covered persons in attendance to acquired subscriptions, benefits and limits (Miles Care Basic, Miles Care Single Trip Domestic, Miles Care single Trip Regional, Miles Care Single Trip International, Miles Care Membership Low, Miles Care Membership Medium, Miles Care Membership High)
- Only new trips that begins after the date the Member was informed about the coverage are covered.
- The words and terms in bold in the case of the title (other than those of the titles and headings) will have the meanings indicated in Part VII - Definitions.
ClickHelpNet, LLC has been designated as the Claims Administrator (TPA). All communications, notices and claims payments required under this coverage will be transmitted to the Covered Person through the Claims Administrator.
Miles Care COMMUNICATIONS
Miles Care can contact Members for any matter related to the program by chat, voice or video call including automatic notifications (Push). To update, change, modify or delete your Miles Care information. To modify the consent to receive these promotions, the Member must contact the Miles Care Administrator using the information provided in the mobile application. In addition, Miles Care reserves the right to record and / or monitor all interactions in order to ensure the proper service development; Such recordings could be used in the event of discrepancies related to the care provided.
By becoming a member of Miles Care, Members authorize the administrator, to use information related to the participation and the account of Miles Care (and the information provided by you to participate in the Miles Care program) to customize the Miles Care experience. This may include the communication of special offers, outstanding rewards opportunities and the personalization of promotional information (if chosen to receive such promotions).
If the Member wishes to request a paper copy of these terms and conditions, or withdraw consent to receive electronic communications, they must contact the Miles Care Customer Service using the information provided in the mobile application.
With the acquisition of Miles Care in any of its categories, you agree that at the end of its term and using the same payment method used for its initial purchase, the Administrator performs the renewal (acquisition) for a period equal to the initial service plan; however, prior to the expiration of the initial one, you may express your willingness not to renew it and you may also indicate your desire to modify the service initially acquired in order to obtain coverage and benefits according to the different categories. The services and benefits of each of the coverages can be consulted through the Miles Care app.
CLARIFICATIONS AND LIMITATIONS RELATED TO THE MILES CARE TERMS AND CONDITIONS
The Miles Care Administrator will notify members of any significant change in the program Terms and Conditions, unless the member decides to terminate, it will be subject to the revised Terms and Conditions.
The Miles Care member may take use of the right of withdrawal from the moment of purchase and that does not exceed 5 business days established by law from the acquisition of the service. Additionally, Miles Care will not make partial or total returns once the trip has started.
TERMS AND CONDITIONS
Miles Care will provide the Benefits described in this condition as a result of the acquisition of Miles Care. The subscriber's agreement is subject to all the terms, conditions, provisions and exclusions of this document (Terms & Conditions), including the declaration, and all documentary evidence, benefits chart and / or endorsements attached hereto.
Miles Care In compliance with the legal provisions regarding the matter, it has acquired insurance policies where it acts as an insured and beneficiary, with the power to transfer the coverage and benefits to the members of its membership, as well as to all those persons linked to its service plans.
Therefore, all communications, notifications, payment requirements and services included in this document, will be directly transmitted and attended through Miles Care.
Considering all the above and for the purposes of this document it will be understood that Miles Care will act as policyholder / insured and to that extent transfer all protections and benefits to the people linked to their service plans.
Miles Care, provided by novae care & connect., which operates under the name of Miles Care. as Policy Holder with address at 55 NE 5th Ave, Suite 501, Boca Raton, FL 33432, USA, provides the coverage benefits described in the next section. Miles Care is fully subscribed by Canopius, 4444 Syndicate in Lloyds, whose only market reference is B0524CSP18XXX6195.
The Surplus Lines Agent in Florida is Betsy L. Brougher with license number P037090 and address at 212 W 10th St. # C400, Indianapolis, Indiana 46220.
APPLICABLE LAW AND JURISDICTION: This Insurance contract shall be governed by the laws of the United States of America, and shall be construed in accordance with those laws, and the parties agree to submit to the exclusive jurisdiction of the US courts under the election clause of court LMA 5020 and the Applicable Law LMA5021 (USA).
Benefits are subject to the following:
- All terms, conditions, provisions and exclusions of this document, including all applicable Appendices, Annexes or Endorsements.
- The current subscription to the Miles Care application.
- All associated subscription charges, if any.
- Only new trips that are made as of the effective date of the coverage that has been informed to the covered Member.
- Usual, Reasonable and Regular Charges: The most common charge for services, medications, or similar supplies within the area in which the expense is incurred. What is defined as Usual, Reasonable and Regular charges will be determined by the Claims Administrator. In determining whether a position is Usual, Reasonable and Regular, the Claims Administrator may consider one or more of the following factors: the level of ability, the degree of training and the experience required to perform the procedure or service; the time required to perform the procedure or services compared to the time required to perform other similar services; the severity or nature of the disease or injury being treated; the amount charged for services, medicines or supplies equal or comparable in the locality; the amount charged for the same or similar services, medications or supplies in other parts of the country; the cost to the medical provider of the service, the medication or the input; and other factors such as the reasonable discretion of the Claims Administrator.
The words and terms in bold and uppercase (other than titles and headings) will have the meaning assigned to them in Part VII: Definitions.
ClickHelpNet, LLC has been designated as Claims Administrator (TPA). All communications, notifications and payment of claims that must be made under this coverage will be transmitted to the Covered Person and managed through the Claims Administrator.
EFFECTIVE DATE OF COVERAGE FOR A COVERED PERSON
Coverage is effective at the time the Covered Person leaves his place of residence more than 100 kilometers away or leaves his Country of Origin.
The protections and benefits provided by Miles Care. They will be valid domestic, regional and / or outside the country of residence of the Holder, subject to the conditions of the product and always more than 100 kilometers from their usual residence traveled by air.
End Date of Coverage of a Covered Person: Coverage ends on the first of the following dates:
- the day the Covered Person returns to his Country of Origin; or
- at 11:59 PM on the 120th day after the date on which the Covered Person leaves his Country of Origin; or
- at 11:59 PM of the last day of the Affiliation Period; or
- the day on which the Covered Person no longer meets the eligibility requirements stipulated herein or does not meet the minimum required distance of loss (100 kilometers).
FALSITY AND FRAUD
Any false statement, reluctance, hidden from the truth or fraud in relation to any claim, or if any method or ploy is used by the owner or by any person acting on his behalf, this service program will be null and void and all Claims submitted under it will be rejected.
PROOF OF CLAIM
- The Miles Care partner should contact alle, our interactive contact tool, to present the required documentation / voucher.
- Payment of Claims: All Benefits payable will be delivered to the Covered Person or, in case of death, to their respective assets.
- False Statement and Fraud: The coverage of a Covered Person will be void if, before or after a loss, you have hidden or misrepresented any significant fact or circumstance concerning the coverage or its object, or the interest that the Covered Person has in it , or if the Covered Person commits fraud or gives false testimony in relation to the foregoing.
If any difference arises over the amount payable under this coverage (if liability is otherwise admitted), this difference must be referred to arbitration, according to the procedures of the London Court of International Arbitration. When any difference is referred to arbitration under this provision, any adjudication will be considered a condition precedent to any right of action against the Claims Administrator.
The obligations arising from the contract expire 60 days after a report was filed through the Miles Care App and / or its temporary validity has ended in the event of coverage in domestic and / or international travel. For those cases in which the care service is the direct result of a self-management action, the obligations arising from the contract will expire 30 days after the date of the incident and will be evaluated at 50% of the total expenses incurred.
The Covered Person agrees to cooperate with the Claims Administrator in the prosecution of each and every valid claim that may be against third parties and that arise from any incident that results in a compensation (or that may give rise to it) by the Claims Administrator, as well as to account for any amount recovered, on the basis that the Claims Administrator shall be entitled to recover the sums paid by them, in full, before the Covered Person benefits from amount recovered. If the Covered Person fails to demand valid claims from third parties and then the Claims Administrator must make a payment under this coverage, the Claims Administrator will be subrogated to all rights of the Covered Person. Any amount recovered by the Claims Administrator will be used to pay the Miles Care collection and reimbursement expenses for any time you have paid or that you must pay under this coverage. All remaining amount must be paid to the Covered Person.
RIGHT OF RECOVERY
In cases of overpayment of any claim, for the following reasons:
- All or part of the expenses were not paid by the Covered Person or in his name or were later recovered by the Covered Person or in his name.
- Any family member of the Covered Person, not a Covered Person, receives a refund of all or part of the expenses from a source outside Miles Care.
- All or part of the expenses were not Eligible Expenses.
- All or part of the expenses were paid or reimbursed based on the incorrect application of Benefits.
In these cases, the Claims Administrator has the right to recover the overpayment amount of the Covered Person or the Hospital, the Physician or other Medical Provider of services or supplies. The amount of recovery is the difference between
- the amount of expenses paid by the Claims Administrator, and
- the amount of Benefits that the Claims Administrator should have paid.
If the Covered Person or the Hospital, the Physician or other Medical Provider of services or supplies does not immediately make any reimbursement to the Claims Administrator, the Claims Administrator may do the following, in addition to using any other available resources: (I) reduce the amount of any future claims that are otherwise eligible for payment, to the extent of reimbursement due to the Claims Administrator; or (II) cancel the coverage provided to the Covered Person contained in this document by written notice thirty (30) days in advance, in accordance with the provisions of the notice contained in this document.
Among the services provided by Miles Care in its developments, is the assistance service provided by the Doctor Help system, which is why we present the operating Terms and Conditions for this particular service.
DOCTOR HELP SERVICES
All treating providers that provide services through Doctor Help are independent professionals exclusively responsible for the services each provides. Doctor Help does not practice medicine or any other licensed profession and does not interfere with the practice of medicine or any other profession with a provider treatment licensed, each of which is responsible for its services and compliance with the requirements applicable to their profession and according to their license. Neither Doctor Help nor any third party that promotes the services or provides this service will be responsible for any professional advice obtained from a treatment provider through the Services.
None of the contents of the site (apart from the information received from the Suppliers) or the first contact with the services included in the sites, should be considered as Medical advice or an endorsement, representation or guarantee that any particular medication or treatment is safe, appropriate or effective for you.
- The services included in Doctor Help correspond to the provision of health care services using chat, interactive audio and video technology, in which the patient and the health professional are not in the same physical location of the applicant. During the service consultation with a treatment provider, the details of your health history and personal medical information can be discussed with you through the use of interactive video, audio or other telecommunications technology and your treatment provider who can practice a medical exam through these technologies.
- The services you receive from providers are not intended to replace a primary or permanent medical care relationships. It is possible to form an ongoing treatment relationship with some treating providers. However, your initial visit with a treatment provider will begin as a consultation (for example, to determine the most appropriate treatment setting for you to receive care) and does not necessarily result in a continuous treatment relationship. You should seek emergency help, or when recommended by a treatment provider, or when necessary otherwise follow-up care, and consult with your Primary Care Physician and other health professionals as recommended.
We can arrange for follow-up care, either through Doctor Help or other means. You will have direct access to customer service for monitoring reactions to medications, side effects or other adverse events. Among the Benefits of our services is the best access to health and comfort professionals using the technological means available for this purpose. However, as with any health service, there are potential risks associated with the use of the services. These risks include, but are not limited to:
- In rare cases, the information transmitted may not be sufficient (for example, due to poor image resolution) to allow an appropriate health care decision by the treatment provider.
- Delays in evaluation or treatment may occur due to failures of electronic equipment. If this happens, you can be contacted by phone or other means of communication.
- In rare cases, lack of access to all of your health records may result in adverse drug effects or allergic reactions or other errors of judgment.
- Although the electronic systems we use will incorporate network protocols and software security to protect the privacy and security of health information, Rarely, security protocols may fail, causing a violation of the privacy of personal medical information.
- You understand that it is possible to expect the Advance Benefits of using the services in your care, but that the results cannot be guaranteed or assured.
- You understand that the laws that protect the privacy and security of health information apply to services, and you have received notification from Doctor Help about privacy practices. Electronic communications are directed to your provider (s) in the treatment and their supervision through a secure encrypted video interface and electronic medical record.
- If your membership coverage does not include or is not sufficient to meet the cost of services in full, you may be fully or partially responsible for payment.
- Your treatment provider may determine that the services are not appropriate for all or some of your treatment needs, and therefore may deny the provision of services to those through the Sites.
- You also have the ability to send written notes to therapists or other treatment or customer support providers using a secure messaging portal on the sites.
The messages you send through the sites can be viewed by more than one agent or customer service and treatment provider and will usually be answered within 48 hours.
You should not rely on messaging sites if you need immediate attention from a treatment provider or other health professional. If you are experiencing a medical emergency, you should call the regular local Emergency line or go to the nearest emergency room.
You understand and accept that the messaging treatment with the providers through the messaging portal does not result in a doctor-patient relationship and does not do so on its own to treatment, diagnosis, therapy or medical advice.
Miles Care, through Doctor Help, is obliged to comply with privacy and health security laws and keep the information protected to assure your medical information. In addition, the information you provide to your treatment provider in the medical consultation or therapy session is legally confidential, with certain legal exceptions.
As part of providing the services, we may have to offer you certain communications such as appointment reminders, service announcements and administrative messages. These communications are considered part of the services and your account. While secure electronic messaging is always preferred to insecure email, under certain circumstances, email communication with personal information can take place between you and Doctor Help. Miles Care cannot guarantee the security or confidentiality of messages sent by email. Information regarding your care, including clinical notes and medical records, is stored on secure servers, encrypted and maintained by Miles Care.
USE OF SERVICES BY MINORS
The services provided by Miles Care are available for use by minors, however, the Partner, for all users under 18 must be a parent or legal guardian. If you register as the parent or legal guardian on behalf of a minor, you will be fully responsible for compliance with these terms and conditions.
RIGHTS OF ACCESS
We hereby grant you a non-exclusive, limited, non-transferable license to access the applications and use the Services solely for your personal non-commercial use and only as provided in these Terms and Conditions and any separate agreements you may have entered with us ("Access rights").
We reserve the right, in our sole discretion, to deny or suspend the use of the Sites or Services for any person for any reason. You agree that you will not, and will not try to:
(A) impersonate another person or entity, or in any other way falsify your association to any person or entity.
(B) use the Site or the Services to violate any local state, national or international law.
(C) reverse engineer, disassemble, decompile or translate any software or other components of the Site or the Services.
(D) distribute viruses or any other harmful computer code through the Site or
(E) otherwise use the services or the Sites in no way exceed the scope of use previously granted.
In addition, you agree to abstain from abusive language when communicating with providers through the modules and refrain from contacting service providers outside the application modules. Miles Care is not responsible for any interaction with suppliers that are not carried out through the means established in this document.
We reserve the right to change, add or remove parts of these terms and conditions at any time. The continued use of the sites and / or the Services following notification of such changes will indicate that you acknowledge such changes and agree to be bound by the revised terms and conditions, including such changes.
You expressly agree that: THE USE OR SERVICES IS AT YOUR OWN RISK. BOTH, the sites and services are provided "AS IS" AND "AS AVAILABLE". Miles Care EXPRESS ALL WARRANTIES OF ANY KIND, either express or implied, INCLUDING, BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, SUITABILITY FOR USE OR PURPOSE, NON-INFRINGEMENT, TITLE, OPERATION, CONDITION, ENJOYMENT AND VALUE, ACCURACY OF DATA AND INTEGRATION SYSTEM.
You acknowledge and agree that Miles Care does not provide medical advice, diagnosis or treatment, and is strictly a technology and infrastructure platform for connecting users with providers of assets, services or treatment, including doctors and other providers in the Miles Care.
You acknowledge and agree that the treating providers using the sites are solely responsible and will have complete authority, responsibility, supervision and control over the provision of all medical services, advice, instructions, treatment decisions, and other professional care services of the health carried out, and that all diagnoses, treatments, procedures and other professional health care services that will be identified and will be carried out only by or under the supervision of the treating providers, in their sole discretion, that they deem appropriate.
LIMITATION OF LIABILITY
You understand that the extension permitted by applicable law, in no event will be Miles Care or its officers, employees, directors, parents, subsidiaries, affiliates, agents or licensees RESPONSIBLE FOR INCIDENTAL, INDIRECT, SPECIAL, consequential or exemplary damages, including but not limited to, loss of income damages, benefits, clientele, use, data or other intangible losses arising from or RELATED TO THE USE OF THE SITE OR THE SERVICES, regardless of whether such damages are based on contract, tort (including negligence and strict liability), warranty, LAW OR OTHER. To the extent that perhaps, as a matter of applicable law, we deny any implied warranties or limit your liabilities, the scope and duration of such warranty and the scope of our liability will be the minimum allowed under such applicable law.
You agree to indemnify, defend and maintain novae care & connect. Miles Care. and Doctor Help understood this as a product of novae care & connect. t / a Miles Care. free from liability and also to its executives, directors, employees, agents, subsidiaries, licensees and suppliers, of and against any claims, actions, demands, responsibilities and settlements, including, without limitation, legal costs and accounting expenses ( "Claims"), as a result of, or allegedly the result of, your violation of these terms and conditions. In addition, you agree to indemnify, defend and keep your provider (s) harmless against any third-party claim that results from the lack of adherence with the advice or recommendation (s) of said treatment provider.
novae care & connect. t / a Miles Care. does not guarantee that all products, services and / or material described, or the services available through the Miles Care application are appropriate or available for use in some locations.
DOCTOR HELP DISCLOSURES
All medical personnel involved in Miles Care have professional licenses issued by the professional licensing boards in the places where they practice, with the title of Doctor of Medicine and have received post-doctoral training. You can report a complaint regarding the services provided by a treatment provider by contacting the professional licensing board at the place where the services were received. In a professional relationship, sexual intimacy is never appropriate, and the board that issue licenses, registrations, or certification of the licensee must be informed.
It is your understanding that by accepting these Terms and Conditions and / or any other form that is presented to you, you accept these terms and that such action constitutes a legal signature.
You agree that we may send notices, accesses, or communications related to the services (collectively, "Communications") through electronic means, including, but not limited to: (1) by email, using the address you provide to us, provided during registration, or (2) by posting communications on the Sites and direct notifications through the application.
The delivery of any of our Communications is effective when it is sent by us, regardless of whether it is read and accepted once received. You may withdraw your consent to receive communications by canceling or suspending the use of the Services.
No waiver of any term or condition set forth in these terms and conditions shall be deemed a subsequent or continued waiver of such terms or conditions or a waiver of any other term or condition, and the fact that the Company may protect a right or provision in under these Terms and Conditions.
If any provision of these Terms and Conditions are considered by a competent court as invalid, illegal or unenforceable for any reason, such provision will be eliminated or limited to the minimum extent such that the remaining provisions of the conditions of use will continue in full effect. novae care & connect Inc. t / and Miles Care devotes considerable effort to the optimization of signal strength and diagnostic deficiencies but is not responsible for the Internet or bandwidth and signal data of your device. Report any violation of these Terms and Conditions through the established contact means. If you believe in good faith that the materials that appear on these sites infringe your copyright, you (or your agent) may send us a notice requesting that the material be removed, or access to it. In addition, if you believe in good faith that a notice of copyright violation has been improperly filed against you, you may send a response notice. Notices and counter-notices must comply with the mandatory requirements established by law.
Eligibility - The following individuals are eligible for Benefits under this cover for up to 120 days maximum per Trip:
- Individuals who hold valid extensions of Corporate or Business cards issued by Miles Care and have joined the Miles Care program when a loss occurs
- Individual cardholders who have active memberships and have joined the Miles Care program when a loss occurs, and the following:
- Their Eligible Spouse; and
- Their Dependent Child(ren) who are at least 14 days old; and
- Their Dependent Parents each of which is a Covered Person.
Membership Period - This cover becomes effective and terminates on the dates and at the times advised to the Member. This cover can be renewed for subsequent periods subject to agreement of Miles Care. This cover can be cancelled by the Member by giving not less than 60 days advance notice to Miles Care at the start of this Evidence of Cover. This cover can be cancelled by Miles Care by giving not less than 60 days advance notice to the Member. In the event this cover is cancelled by either party, or is not renewed at any anniversary, coverage in regards to Miles Care Covered Persons shall terminate as of the date of cancellation or non-renewal. Notwithstanding the forgoing, Miles Care may cancel this cover at any time in accordance with Part VI, General Conditions and Conditions Precedent, of this cover.
Termination Date of Coverage for a Covered Person - Coverage ends on the earliest of the following:
1) The moment the Covered Person returns to their Home Country or residence, or
2) 11:59 pm on the 120th day following the date the Covered Person departs his or her Home Country if annual applicable, or
3) 11:59 pm on the last day of the Membership Period, or
4) the date the Covered Person no longer meets the Eligibility requirements stated herein.
When requiring any type of protection, the Miles Care partner should communicate through alle, our interactive contact tool, using his preferred channel such as chat with voice or video scaling option. Through these channels you can also present the documentation and / or proof of the case, if necessary.
If Miles Care 's member coverage includes some type of compensation, it will be reflected in the member's digital or registered card account.
Once the compensation has been processed, the Miles Care partner will receive a confirmation/notification after the transaction, as well as a detailed description of that compensation.
Miles Care VISA DIGITAL CARD
Miles Care VISA DIGITAL CARD is not a credit card, a debit or a prepaid card. Miles is a hybrid card that offers the freedom to combine multiple global currencies, rewards, and all your credit, debit and Usership cards in one.
The Miles Care VISA DIGITAL CARD is issued by Stripe pursuant to a license from Visa Inc and may be used everywhere Visa is accepted. Stripe is the Card Network principal issuing member(s) that participates in the Program, currently Regions Bank, an Alabama FDIC-insured state bank.
Banking services are provided by Metropolitan Commercial Bank, Member FDIC, and are subject to the terms of a Cardholder Agreement. “Metropolitan Commercial Bank” and “Metropolitan” are registered trademarks of Metropolitan Commercial Bank© 2014.
UpperClub Inc. is a technology services providers and administrators of the card program under the agreement with stripe and issuer.
GLOSSARY OF TERMS
Accident: A sudden, unintentional and unexpected occurrence caused by external, visible means and resulting in physical Injury to the Covered Person. The cause or one of the causes of such accident is external to the Covered Person's own body and occurs beyond the Covered Person's control.
Accidental Death: Death of the Covered Person resulting from an Accident.
Act of Terrorism: For Section I and Section III: An act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
For Section II: An unlawful act, including the use of force or violence, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s), committed for political, religious or ideological purposes including the intention to influence any government and/or to put the public in fear for such purposes.
AIDS: Acquired Immune Deficiency Syndrome as that term is defined by the United States Centers for Disease Control.
ARC: AIDS Related Complex as that term is defined by the United States Centers for Disease Control.
Amateur Athletics: A sport or other athletic activity that is organized and/or sanctioned, involving regular or scheduled practices and/or regular or scheduled games. This definition does not include athletic activities that are non-contact and engaged in by a Covered Person solely for recreational, entertainment or fitness purposes and not for wage, reward or profit.
Benefits: The Eligible Expenses which may be paid under this cover.
Claims Administrator: the entity stated as such at the start of this Evidence of Cover.
Claims Excess: The Dollar amount of Eligible Expenses specified in the cover that the Covered Person must pay before Benefits are paid hereunder.
Common Carrier: A licensed mode of public transportation.
Consultant(s): The consultant appointed by the Claims Administrator.
Contact Sports: A sport or other athletic activity that necessarily involves physical contact with opposing players as part of normal play. Contact Sports include, but are not limited to, American football, boxing, ice hockey, rugby, soccer, and wrestling.
Covered Person: A person who meets the eligibility requirements stated in Part 1 – Coverage Provisions.
Custodial Care: That type of care or service, wherever furnished and by whatever name called, that is designed primarily to assist a Covered Person in performing the activities of daily living. Custodial Care also includes non-acute care for the comatose, semi-comatose, paralyzed or mentally incompetent patients until they are fit to return home.
Daily Living: A twenty-four (24) hour period during which a Covered Person engages in normal daily activities including but not limited to eating, drinking and washing.
Delivery: Procedures concerning childbirth.
Dental Treatment: Treatment of the teeth and gums.
Dependent Child(ren): The individual Member’s child who meets all the following conditions:
- is unmarried.
- is a natural child, legally adopted child, or a child who has been placed under the legal guardianship of the Member.
- The age requirement does not apply if the child is less than 14 days old and over 25 years old, depends on the individual Member for support, is a Full-time Student and resides with the individual Partner. The age requirement does not apply to children with mental retardation or physical disabilities who cannot support themselves, provided they have begun to suffer the disability before they turn 19. Proof of disability must be submitted to the Claims Administrator, and additional evidence may be requested from time to time.
The term Dependent Child(ren) does not include the following: a person who is emancipated from the Member; any person who is on active duty with any military, and/or any person who is covered hereunder as an individual Member.
Dependent Parent(s}: The natural or adopted mother and/or father of the Member who is wholly dependent on the Member for support.
Durable Medical Equipment: A standard basic hospital bed and/or a standard basic wheelchair.
Educational or Rehabilitative Care: 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.
Eligible Expenses: Expenses for services and supplies which are covered under this cover.
Eligible Spouse: An individual who is married to the Member. The marriage must have met all the requirements of a valid marriage contract in the jurisdiction of the marriage of the individuals. The term Eligible Spouse does not include the following:
a person who is legally separated or divorced from the Member, any person who is on active duty with any military, and/or any person who is covered hereunder as an individual Member.
Emergency: A medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Covered Person's life in danger if medical attention is not provided within twenty-four (24) hours.
Emergency Room: That part of a Hospital designated for the immediate care of Emergency medical conditions.
Enforced Political Evacuation: The evacuation of Covered Person(s) from the Country in which they are visiting/staying as a result of an Evacuation Advisory triggered by a Political Event for travel being any journey outside of the Covered Persons Home Country.
Evacuation Advisory: An instruction issued to the Covered Person by a civil or military authority of the Covered Person’s Home Country to the effect that the Covered Person should evacuate from the country in which the Covered Person is situated.
Extended Care Facility: An institution, or a distinct part of an institution, which is licensed as a Hospital, Extended Care Facility or rehabilitation facility by the jurisdiction in which it operates; and is regularly engaged in providing twenty four (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.
Family: All Relatives of a Member.
Full-time Student: A person who is enrolled in and regularly attends an accredited college or university or other educational institution, but not including colleges, universities or other educational institutions operated primarily via the internet, for the minimum number of credit hours required by the accredited college or university or other educational institution in order to maintain Full-time Student status.
Gadgets: Mobile/smart phones, tablet computers, laptops, computers, smart watches, satellite navigation systems (GPS), Personal Digital Assistants (PDAs), games consoles (including handheld consoles) and all accessories for these items.
HIV+: Laboratory evidence defined by the United States Centers for Disease Control as being positive.
Home Country: The country where the Covered Person resides permanently.
Hospital: A place that is legally licensed for the purpose of providing medical or surgical care and treatment to sick or injured people in the country in which it is located. Hospital does not mean a long-term care facility, spa, hydroclinic, sanatorium, nursing home for the aged or any other facility which is not a Hospital.
Host Country: The country being visited by the Covered Person, or where the Covered Person resides temporarily. Host Country does not include the Covered Person’s Home Country.
Illness: A sickness, disorder, pathology, abnormality, ailment, disease or any other medical, physical or health condition. Illness does not include learning disabilities, attitudinal disorders or disciplinary problems.
Injury: Identifiable physical harm to the body caused by an Accident that requires medical treatment.
Inpatient: A patient who occupies a Hospital bed for more than twenty-four (24) hours for medical treatment and whose admission was recommended by a Physician.
Intensive Care Unit: 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: Terms used to describe 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.
Kidnap and Ransom: Unlawful detention of a Covered Person against their will, whether hijacked, kidnapped or detained, by any person or persons not known to him/her.
Medical Provider: A Hospital, Physician or other person or organization which provides medical services and/or supplies.
Medically Necessary: 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 the Claims Administrator. A service or supply will not be considered Medically Necessary if it is provided only as a convenience to the Covered Person or Medical Provider, and/or is not appropriate for the Covered Person's 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: An individual who meets the Eligibility requirements stated under Part I but who is not an Eligible Spouse, Dependent Child or Dependent Parent.
Mental Health Disorder: 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 but are not limited to: psychosis, those psychiatric Illnesses listed in the current edition of the diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association.
Newborns: Babies under the age of one month.
Outpatient: A Covered Person who receives Medically Necessary treatment by a Physician for Injury or Illness that does not require overnight stay in a Hospital.
Physician: A Doctor of Medicine (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DDM) or a licensed Physical Therapist or Physiotherapist. Physician does not include a Doctor of Chiropractic (DC), a doctor of Osteopathy (DO), a Doctor of Psychology (Ph.D.), a doctor of Psychiatry (Psy.D.) or any other degree or designation. A Physician must be currently licensed by the jurisdiction in which the services are provided, and the services provided must be within the scope of that license. A Physician must be a person other than the Covered Person, the Covered Person's Relative, or one who ordinarily resides with the Covered Person.
Political Event: means an incident that may lead to a loss arising out of an:
Act of Terrorism
Sabotage. Sabotage shall mean willful physical damage or destruction perpetrated for political reasons by known or unknown person(s).
Riots. Riots shall mean any act committed in the course of a disturbance of the public peace (where such disturbance is motivated by political reasons) by any person taking part together with others in such disturbance or any act of any lawfully constituted authority for the purpose of suppressing or minimizing the consequence of such act.
Strikes. Strikes shall mean any willful act of any striker or locked-out worker in the furtherance of a strike or in resistance to a lock-out or any act of any lawfully constituted authority for the purpose of suppressing or minimizing the consequence of such act.
Civil Commotion. Civil Commotion shall mean the same as Riots as defined in this Cover.
Malicious Damage. Malicious Damage shall mean all physical loss or physical damage resulting directly from an act(s) by anyone during a disturbance of the public peace where such malicious act is perpetrated for political reasons by known or unknown person(s).
Insurrection, Revolution and Rebellion. Insurrection, Revolution and Rebellion shall mean a deliberate, organized and open resistance, by force and arms, to the laws or operations of a sovereign government, committed by its citizens or subjects and/or a rising against a sovereign government or other authority.
Mutiny. Mutiny shall mean a wilful resistance by members of legally armed or peace-keeping forces to a superior officer.
Coup d’état. Coup d’état shall mean the sudden, violent and illegal overthrow of a sovereign government or any attempt at such overthrow.
Civil War. Civil War shall mean an internecine war, or a war carried on between or among opposing citizens of the same country or nation.
Pre-existing Condition: (1) Any condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the two (2) years immediately preceding the Effective Date of Coverage for any covered Trip;
(2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the two (2) years immediately preceding the Effective Date of Coverage for any covered Trip;
(3) Injury, Illness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed within the two (2) years immediately preceding the Effective Date of Coverage for any covered Trip.
Pregnancy: The physical condition of being pregnant.
Principal Residence: The location where the Covered Person ordinarily resides, not including locations in the Host Country.
Professional Sports: A sporting activity undertaken for wage, reward or profit.
Proof of Claim: A completed and signed Claimant's Statement and Authorization form, together with any/all required attachments, original receipts for any expenses which have already been paid by or on behalf of the Covered Person, and any other documentation that is deemed necessary by the Claims Administrator. For claims under Section I the original itemized bills must be from Physicians, Hospitals and other Medical Providers.
Public Transport: any type of transport which conveys members of the public including, but not limited to, coach, bus, train and aircraft.
Registered Nurse: A graduate nurse who has been registered or licensed to practice by the local authority Board of Nurse Examiners or any other authority, and who is legally entitled to place the letters "RN" after his or her name.
Relative: Biological or stepparent or grandparent; biological or stepchild or grandchild; Eligible Spouse; biological or stepsibling; parent, children, or sibling in law; aunt, uncle or cousin; fiancé or betrothed individual.
Routine Physical Exam: Examination of the physical body by a Physician for preventative or informative purposes only, and not for the diagnosis or treatment of any condition.
Scheduled Trip: A Trip which has been booked in advance.
Sexually Transmitted Diseases: Syphilis, gonorrhea, lymphogranuloma venereum, chancroid, granuloma inguinale, chlamydiosis, pelvic inflammatory disease, trichomoniasis, genital candidiasis, genital herpes, genital warts, amebiasis, viral hepatitis, scabies, crab lice, cervical dysplasia, and bacterial vaginitis.
Substance Abuse: Alcohol, drug or chemical abuse, overuse or dependency.
Surgery: 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.
Trip: The period within the Membership Period beginning on the Effective Date of Coverage for a Covered Person and ending on the Termination Date of Coverage for a Covered Person as Part 1 – Coverage Provisions.
Unattended: Not in the Member’s direct sight and control.
Usual, Reasonable and Customary: The most common charge for similar services, medicines or supplies within the 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 the Claims Administrator. In determining whether a charge is Usual, Reasonable and Customary, the Claims Administrator 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; the cost to the Medical Provider of providing the service, medicine or supply; such other factors as the Claims Administrator in the reasonable exercise of discretion, determine are appropriate.
ELEGIBLE EXPENSES & LOSSES – STAY CARE
Subject to the Deductible and Limits stated in the Schedule of Benefits and Limits, Miles Care will pay the following expenses incurred by a Covered Person during a covered Trip:
- Charges made by a Hospital for:
- daily room and board and nursing services not to exceed the Hospital's average semi-private room rate; and
- daily room and board and nursing services in Intensive Care Unit; and
- use of operating, treatment or recovery room; and services and supplies which are routinely provided by the Hospital to persons for use while Inpatients, except for personal services and supplies of a non-medical nature; and
- Emergency Room treatment of an Injury due to an Accident; and
- Emergency Room treatment of an Illness resulting in admission to the Hospital as an Inpatient for further treatment of that Illness; and
- Emergency Room treatment of an Illness which does not result in admission to the Hospital as an Inpatient, if non-Emergency Room care was not available due to the time or location of the Covered Person at the onset of symptoms.
- For Surgery at an Outpatient Surgical facility, including services and supplies.
- For charges made by a Physician for professional services, including Surgery. Charges for an assistant surgeon are covered up to 20% of the Usual, Reasonable and Customary charge of the primary surgeon, but standby availability will not be deemed a professional service and therefore is not covered hereunder. Professional charges for providing a Second Medical Opinion are covered, including reasonable expenses for compilation of documentation, official translations, shipment of documents and verification of clinical history.
- For dressings, sutures, casts or other supplies which are Medically Necessary and administered by or under the supervision of a Physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except Durable Medical Equipment as herein defined.
- For diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included).
- For reconstructive Surgery that takes place while this coverage is in effect when the reconstructive Surgery is directly related to an Accident which also takes place while this coverage is in effect.
- For hemodialysis and the charges by the Hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components.
- For oxygen and other gasses and their administration by or under the supervision of a Physician.
- For anesthetics and their administration by a Physician or anesthetist.
- For drugs which require prescription by a Physician for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, subject to a maximum supply of thirty (30) days per prescription and the Limit stated in the Schedule of Benefits and Limits.
- For care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital.
- Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital and only in lieu of Medically Necessary Inpatient hospitalization.
- Emergency Local Ambulance transport necessarily incurred in connection with Injury or Illness resulting in Inpatient hospitalization.
- Dental Treatment necessary to restore or replace sound natural teeth lost or damaged in an Accident which was covered under this cover, up to the Limit stated in the Schedule of Benefits and Limits.
- Dental Treatment necessary to resolve sudden onset of acute pain, up to the Limit stated in the Schedule of Benefits and Limits.
- Medically Necessary rental of Durable Medical Equipment (consisting of a standard basic Hospital bed and or a standard basic wheelchair) up to the purchase prices.
- Physical therapy by a licensed physiotherapist necessarily incurred to continue recovery from a covered Injury or Illness. Such physical therapy must be prescribed by a Physician who is not affiliated with the physiotherapy practice performing the physical therapy.
- Emergency Medical Evacuation: Subject to the CONDITIONS AND RESTRICTIONS contained in this provision, Miles Care will pay the following expenses arising out of Emergency Medical Evacuation, provided such expenses are approved in advance and arranged by Miles Care:
- Emergency air transportation to a suitable airport nearest to the Hospital where the Covered Person will receive treatment; and
- Emergency ground transportation necessarily preceding Emergency air transportation; and from the destination airport to the Hospital where the Covered Person will receive treatment.
- The cost of an economy one-way air and/or ground transportation ticket for the Covered Person from the area where the Covered Person was hospitalized following an Emergency Medical Evacuation to the area where the Covered Person was initially evacuated from, or to the terminal serving the area of the Covered Person's main Residence. CONDITIONS AND RESTRICTIONS:
- Miles Care will provide Emergency Medical Evacuation Benefits only when the Illness or Injury giving rise to the Emergency Medical Evacuation is covered under this cover; and
- Miles Care will provide Emergency Medical Evacuation Benefits only when all of the following conditions are met:
Medically Necessary treatment, services and supplies cannot be provided locally; and
- Transportation by any other method would result in loss of the Covered Person 's life or
- loss of limb that could give rise to the loss of the Covered Person's life; and
III. recommended by the attending Physician who certifies to the above; and
- agreed upon by the Covered Person or a Relative of the Covered Person;
- the condition giving rise to the Emergency Medical Evacuation occurred spontaneously and without advance warning, either in the form of Physician recommendation or symptoms which would have caused a prudent person to seek medical attention prior to the onset of the Emergency.
- Miles Care will provide Emergency Medical Evacuation only to the nearest Hospital that is qualified to provide the Medically Necessary treatment, services and supplies to prevent the Covered Person's loss of life or loss of limb that could give rise to the loss of the Covered Person's life.
- Miles Care will use their best efforts to arrange any Emergency Medical Evacuation within the least amount of time possible. The Covered Person understands that the timeliness of Emergency Medical Evacuation can be affected by circumstances which are not within the control of Miles Care including but not limited to availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems and weather. The Covered Person agrees to hold Miles Care harmless and Miles Care shall not be held liable for any delays that are not within their direct and immediate control. Notwithstanding the foregoing items B. i.-v. and C., Miles Care will pay for expenses to return the Covered Person to their Home Country if the attending Physician, the Covered Person and Miles Care (or their duly appointed medical consultant) agree that transfer to the Home Country is more appropriate than transfer to the nearest qualified Hospital.
- Reunion – Miles Care will pay the following Reunion expenses in the event the Covered Person is hospitalized or is expected to be hospitalized as an Inpatient for more than 10 days, provided such expenses are approved in advance and arranged by upperClub:
- The cost of an economy round-trip air or ground transportation ticket for one Relative of the Covered Person for transportation to the terminal serving the area where the Covered Person is hospitalized or is expected to be hospitalized; and
- Reasonable expenses for lodging and meals for the Relative, which are incurred in the area where the Covered Person is hospitalized for a period not to exceed fifteen (15) days.
- Repatriation of Mortal Remains - Subject to the CONDITIONS AND RESTRICTIONS contained in this provision, Miles Care will pay the following Repatriation of Remains expenses arising from the death of a Covered Person, provided such expenses are approved in advance and arranged by Miles Care
- Air or ground transportation of bodily remains or ashes to the airport or ground transportation terminal nearest to the main Residence of the deceased Covered Person; and
- Reasonable costs of preparation of the remains necessary for transportation.
CONDITIONS AND RESTRICTIONS:
- Miles Care will provide Repatriation of Mortal Remains Benefits only when the death of the Covered Person occurs as a result of an Injury or Illness that is covered under this cover; and
- Miles Care will provide Repatriation of Mortal Remains Benefits only when the death of the Covered Person occurs outside the Covered Person's Home Country or 100 kilometers away from main residence, and while this coverage is in effect; and
- Miles Care will use their best efforts to arrange any Repatriation of Mortal Remains Benefits within the least amount of time possible.
The Covered Person understands that the timeliness of Repatriation of Mortal Remains can be affected by circumstances which are not within the control of Miles Care including but not limited to local customs, availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems and weather. The Covered Person , and their heirs, agree to hold Miles Care harmless and Miles Care shall not be held liable for any delays which are not within their direct and immediate control. Further, Miles Care are held harmless and shall not be held liable for loss of or any damage or other impairment to bodily remains incurred during the Repatriation or Mortal Remains process or otherwise.
- Return of Minor Child(ren) - Subject to the CONDITIONS AND RESTRICTIONS contained in this provision, Miles Care will pay the following Return of Minor Child(ren) expenses following a covered Inpatient hospitalization of a Covered Person which results in the minor child(ren) being left unattended, provided such expenses are approved in advance and arranged by Miles Care:
- The cost of an economy one-way air or ground transportation ticket for each minor child under age 15 who is traveling with the Covered Person, for transportation to the terminal serving the area where the minor child(ren) permanently reside(s), less credit for the unused portion of the original ticket purchased for the minor child(ren); and
- A chaperone, if necessary, for the safety of the minor child(ren).
CONDITIONS AND RESTRICTIONS:
- The Covered Person must be traveling alone with the minor child(ren) who would otherwise be left unattended upon the hospitalization of the Covered Person; and
B. Miles Care will use their best efforts to arrange any Return of Minor Child(ren) Benefit within the least amount of time possible. The Covered Person understands that the timeliness of the Return of Minor Child(ren) can be affected by circumstances which are not within the control of Miles Care including but not limited to availability of transportation equipment and staff, delays or restrictions on flights caused by mechanical problems, government officials, telecommunications problems and weather. The Covered Person agrees to hold Miles Care harmless and Miles Care shall not be held liable for any delays that are not within their direct and immediate control. The Covered Person understands that the safety of minor child(ren) before, during and after transportation is Miles Care highest priority; however, the Covered Person agrees to hold Miles Care harmless and Miles Care shall not be held liable for Injury or Illness of the minor child(ren) which occurs during or results from the Return of Minor Child(ren) Benefit.
ELEGIBLE EXPENSES & LOSSES – FLY CARE
Subject to the Deductible and Limits stated in the Schedule of Benefits and Limits, Miles Care will pay the following expenses incurred by a Covered Person during a covered Trip.
Trip Interruption – Miles Care will pay the following Trip Interruption expenses if, during a covered Trip there is an unexpected death of the Covered Person 's travel companion or immediate family member (Eligible Spouse, child, parent or sibling), provided such expenses are approved in advance and arranged by Miles Care:
- The cost of a one-way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket, for the Covered Person
TRIP INTERRUPTION OTHER REASONS
If the Covered Person cannot complete a Scheduled Trip for any of the reasons listed in the previous Trip Cancellation section that occurs after the start of the Membership Period and after the scheduled Trip departure date, the Person Covered may access up to the limit indicated for the following purposes: (Interruption other reasons)
- Any unused and non-refundable expenses paid in advance for Travel Arrangements.
- Air transportation: One-way transportation to return to the original destination or return to your trip less the value of the original unused return ticket.
- Accommodation and transportation costs for up to USD 150 per day for an additional 10 days when a Travel Partner must remain Hospitalized or when an Injury or Illness that does not require Hospitalization prevents him from continuing the Trip and must extend it with additional nights of stay due to medical restrictions imposed on a Travel Partner as certified by a Legally Qualified Physician.
- Single Room Supplement: The Covered Person is eligible for Benefits when their Travel companion cancels or interrupts a Trip for a specific reason and the Covered Person does not.
Trip Cancellation: Miles Care will pay prepaid, non-refundable and unused transportation and accommodation expenses up to the indicated limit or the cost of the paid airfare of the Covered Person, whichever is less, if the Covered Person cannot make a Scheduled Trip for any of the following reasons that occur after the start of the period:
- Illness, specified Injury or death of the Covered Person, Travel companion, business or Family partner of the Covered Person caused by restrictions imposed medically and certified by a legally qualified Physician at the time of the incident, which prevent the continued participation of the Covered Person in the Scheduled Trip.
- Climatic conditions that cause the complete cessation of the services of the common carrier of the Covered Person for at least 48 consecutive hours.
- Employer termination or layoff affecting the Covered Person or a person sharing the same room. Employment must have been with the same employer for at least three continuous years.
- Terrorism. The Act of Terrorism must occur in a city listed on the Covered Person’s itinerary within 30 days prior to the scheduled departure date. This same city must not have experienced an Act of Terrorism within the 90 days prior to the Act of Terrorism, which is causing the Covered Person’s cancellation. Benefits are not provided if the Covered Person’s travel supplier offers a substitute itinerary
- Hijack, quarantine, jury duty or court ordered appearance as a witness in a legal action in which the Covered Person or their traveling companion are not a party (except law enforcement officers).
- Primary residence of the Covered Person or their traveling companion is rendered uninhabitable due to unforeseen circumstances.
- Traffic accident directly involving either the Covered Person or their traveling companion, substantiated by a police report, while in route to a scheduled departure point.
Miles Care will also pay up to USD 2,000 or 75%, whichever is less, for prepaid non-refundable and unused transportation and lodging expenses or the cost of the paid Airfare of the Covered Person if he chooses not to make a Scheduled Trip for some other reason that occurs during the Affiliation Period.
CONDITIONS AND RESTRICTIONS:
- All cancellations must be reported to the travel supplier and to the Claims Administrator within 72 hours of the event causing the need to cancel or the day of departure. If the event delays the reporting of the cancellation beyond the 72 hours, report the event as soon as possible.
Trip Cancellation by the Airline: In the event that the contracted airline cancels the flight of the Covered Person, a new reservation will be made or a credit will be given for the amount of compensation up to 100% of the penalty or the difference in fare or a new ticket up to the indicated limit.
International Connection loss: If the Covered Person loses his international connection flight, another flight will be assigned with the same conditions as the initial flight.
Delayed flight: If during the trip the covered person suffers a flight delay greater than 6 hours, a credit will be issued with the value of the compensation up to the value indicated on their product.
If the international connection flight of the Covered Person is delayed for more than 6 hours, the reservation will be changed, or a credit will be issued with the value of the compensation up to the limit included in the benefit.
Lost and / or delayed baggage: If the luggage of the Covered Person is confirmed to have been lost, the compensation value will be granted up to the value indicated upon receipt of the certification provided by the airline. In case of Delay, a compensation will be granted up to the limit indicated in the benefit.
Accidental Death in Air Transportation: Miles Care will pay the amount set out in the Benefits and Limits only when all of the following apply:
- The death of the Covered Person occurs as a result of an Air Transport Accident.
- Death occurs during the validity of the covered trip.
- The Accident takes place while the Covered Person is traveling.
Emergency Political Evacuation: In accordance with the Deductibles and Limits stipulated in the Benefits and Limits Annex, Miles care will pay the following expenses incurred by a Covered Person during a Covered Trip:
Any evacuation costs as a result of an Emergency Political Evacuation, including:
- All transportation costs by air.
- Consultant's fees and expenses.
- All reasonable and necessary Additional Expenses incurred during and after a Forced Political Evacuation by a Covered Person.
- Emergency Housing / living expenses.
- The cost of the safety equipment that the Consultant (s) deems necessary and that is used only and directly as a result of a Forced Political Evacuation.
- The cost of a qualified interpreter to assist the Covered Person in relation to Forced Political Evacuation.
CONDITIONS AND RESTRICTIONS:
Authorization Requirements: To meet the Authorization Requirements, the Covered Person must:
- Contact the Claims Administrator through the Miles Care communication routes as soon as possible before the expense is incurred; and
- Comply with the Claims Administrator 's instructions and submit any requested information or document.
If the Covered Person meets the Authorization Requirements and the expenses are authorized, Miles Care will pay the Benefits, subject to all the terms, conditions, provisions and exclusions contained herein. If the Covered Person does not meet the Authorization Requirements or if the expenses are not authorized, all the Benefits indicated in this document will be lost.
In the event of a forced political evacuation , authorization must be granted within 48 hours or as soon as reasonably possible, but not after one week.
The authorization of the expenses does not guarantee the payment of the Benefits or their amount. Eligibility for Benefits and payment are subject to all terms, conditions, provisions and exclusions contained herein.
Subject to the Deductible and Limits stated in the Schedule of Benefits and Limits, Miles Care will pay the following losses incurred by a Covered Person during a covered Trip:
Personal Property / Gadget Coverage: Up to the amount stated for the value of, or repair to, any of the Covered Person ’s Gadgets (not hired, loaned or entrusted to the Covered Person ) purchased with the card associated with the Miles Care platform, which are lost stolen, damaged or destroyed. Cover is provided based on the amount the Covered Person paid for the Gadget(s) or the current recommended retail price whichever is the lower, excluding any credit charges, interest charges or coverage costs and allowing for wear, tear and depreciation.
At Miles Care discretion, Miles Care may replace the Gadget with a refurbished item from one of Miles Care dedicated suppliers.
CONDITIONS AND RESTRICTIONS:
Miles Care will not cover gadgets which are:
- left in an Unattended vehicle (other than a trailer, as long as gadgets are out of sight), or
- within checked-in luggage or in luggage compartments/racks not immediately adjacent to the Covered Person on any form of Public Transport (other than hand luggage that always stays with the Covered Person.
Mobile Banking App coverage (Fraud in application)
Miles Care will indemnify the Member for financial loss arising out of the unauthorized use of the Member’s Mobile Banking App associated with the Miles Care platform, following loss or theft of the Mobile Device, providing that the loss occurs within the 24 hours prior to and the 168 hours after the Member notifies the Bank of the loss or theft of the Mobile Device. Any loss must occur during a covered Trip.
CONDITIONS AND RESTRICTIONS:
This Indemnity is limited to two claims per Member per annum.
Coverage is excess of any other applicable coverage or indemnity the Member may have.
- Notification of Claims: claims must be notified to the appointed Third-Party Administrator within 45 days.
- Claims Forms: The Claims Administrator, upon receipt of a notice of claim, will furnish to the Accountholder the necessary forms for filing proof of loss.
- Proof of Loss: Written proof of loss including any required information necessary to support a claim must be furnished to the Claims Administrator at its said location within ninety (90) days after the date of the incident. For “Covered transaction” claims, the Accountholder must complete the claim form and attach all requested documentation, including a legible copy of the bank account statement.
- App Download: The Mobile Banking App must be the main mobile application that the Bank or Financial Institution provides for account management and payments and must be downloaded from a digital distribution platform or App Store that the Bank or Financial Institution has approved for the distribution of said Mobile Banking App.
- Claims payment times: Benefits payable under this cover for any loss will be paid immediately upon receipt of the written proof of such loss and all required information necessary to support the claim. Miles Care may in any claim exercise their rights of subrogation should the perpetrator of the fraud be caught.
- Payment of Claims: All Benefits payable will be paid to the Covered Person’s or, in the case of death, to the Covered Person’s estate.
- Misrepresentation and Fraud: Coverage for a Covered Person shall be void if, whether before or after a loss, the Covered Person has concealed or misrepresented any material fact or circumstances concerning this cover or the subject thereof, or the interest of the Covered Person therein, or if the Covered Person commits fraud or false swearing in connection with any of the foregoing.
- Miles Care Right to Recover from Others; If Miles Care make a payment, it is entitled to recover such amounts from other parties or persons. Any party or person to or from whom Miles Care make a payment must transfer to Miles Care his or her rights of recovery against any other party or person. The party or person transferring such must do everything necessary to secure these rights and must do nothing that would jeopardies them.
Purchase Protection: Miles Care will indemnify the Covered Person against theft or accidental loss or damage to goods acquired abroad with the Miles Care card on file registered, while on the Trip. Cover includes goods given as a gift when stolen or damaged.
Losses must occur within the first 30 days after purchase. No registration of the purchase is necessary.
Coverage is excess of any other applicable coverage or indemnity the Cardholder may have. Coverage is limited only to those amounts not covered by any other coverage or indemnity, up to the original purchase amount. In no event will this coverage apply as contributing amount. This cover is excess of all other valid and collectable cover including any coverage irrespective of the clauses found in such coverage or indemnity language.
CONDITIONS AND RESTRICTIONS:
- Notification of Claims: claims need to be notified to the Claims Administrator within 45 days.
- Claims Forms: The Claims Administrator, upon receipt of a notice of claim, will furnish to the Covered Person the necessary forms for filing proof of loss.
- Proof of Loss: Written proof of loss including any required information necessary to support a claim must be furnished to the Claims Administrator at its said location within ninety (90) days after the date of the incident. The Covered Person must complete the claim form and attach all requested documentation, including a legible copy of the credit card charge slip and/or store receipt and police report or other proof of loss.
- Payment of Claims times: Benefits payable under this program for any loss will be paid immediately upon receipt of the written proof of such loss and all required information necessary to support the claim. Miles Care may in any claim for damage recoverable hereunder, require the Covered Person to send the damaged item to the Claim Administrator’s address at the Covered Person ’s expense.
- Payment of Claims: All Benefits payable will be paid to the Covered Person or, in the case of death, to the Covered Person ’s estate.
- Misrepresentation and Fraud: Coverage to a Covered Person shall be void if, whether before or after a loss, the Covered Person has concealed or misrepresented any material fact or circumstances concerning this cover or the subject thereof, or the interest of the Covered Person therein, or if the Covered Person commits fraud or false swearing in connection with any of the foregoing.
- Miles Care Right to Recover from Others: If Miles Care make a payment, they are entitled to recover such amounts from other parties or persons. Any party or person to or from whom Miles Care make a payment must transfer to Miles Care his or her rights of recovery against any other party or person. The party or person transferring such must do everything necessary to secure these rights and must do nothing that would jeopardize them.
Automated Teller Machine (ATM) Robbery: Miles Care will indemnify the Covered Person for loss of cash sustained as a direct result of robbery occurring at or within a set distance of the ATM and within a set time period when such cash has been dispensed using a card issued by a Bank associated with the Miles Care platform.
CONDITIONS AND RESTRICTIONS:
- The assault on the Covered Person must occur at or within 50 meters of the ATM.
- The assault on the Covered Person must be within 30 minutes of when such cash has been dispensed.
- The assault must occur during a covered Trip.
- If the Robbery is effected against a Covered Person by means of threats to the life of, or of bodily injury to any person other than the Cardholder while such person is held against their will at a distance of more than 50 meters from the ATM from which the Cardholder had thereby been forced to make a cash withdrawal, such Robbery shall be deemed to have occurred within 50 meters of such machine.
- Coverage and reimbursement will be denied if a Loss is caused by or results from any of the following:
- The Covered Person willingly divulges his or her Personal Identification Number (PIN)
- The Covered Person does not report the loss to the police within 30 minutes of the occurrence and a written report obtained from them
- The Covered Person does not report the loss to the Claims Administrator within 24 hours of the occurrence.
- Charges of any nature resulting from or occurring during the commission of a violation of law by the Covered Person, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
- Charges of any nature incurred in the Covered Person's Home Country.
- Charges of any nature resulting directly or indirectly from the use of any biological, chemical, non-medical radioactive or non-medical nuclear agent, material, device or weapon.
- Charges of any nature resulting from or occurring during the Covered Person's direct or indirect involvement in any war, Act of Terrorism, strike, riot or civil commotion, Kidnap and Ransom or while the Covered Person is a member of any military or para-military.
- Charges of any nature sustained when the Covered Person has entered and/or unreasonably failed or refused to depart a country within forty-eight (48) hours of the time an Evacuation Advisory has been issued by the Covered Person 's Home Country.
- Charges of any nature which are not presented to the Claims Administrator for payment within 60 days of the date the charge is incurred.
- Charges of any nature and any claim (including Common Carrier Accidental Death) resulting from self -inflicted Injury or Illness and/or suicide or attempted suicide whether sane or insane.
- Pre-existing Conditions, except Emergency treatment of a Pre-existing Condition subject to the maximum limit stated in the Schedule of Benefits and Limits.
- Diagnosis or treatment of all forms of cancer/ neoplasm.
- All charges related to Pregnancy, including but not limited to pre-natal care, Delivery, and post-natal care, and care of Newborns, except Emergency medical treatment subject to the maximum limit stated in the Schedule of Benefits and Limits.
- Treatment related to birth defects and congenital Illnesses. Birth defects are deemed to include hereditary conditions.
- Any drug, treatment or procedure that either promotes or prevents conception including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal of sterilization.
- Any drug, treatment or procedure that either promotes, enhances or corrects impotency or sexual dysfunction.
- Abortions, except to save the life of the mother.
- All expenses of any cryogenic preservation and implantation or re-implantation of living cells.
- Treatment related to hypertension, hypotension, syncope or sequels.
- Organ or tissue transplants or related services.
- Treatment for acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus.
- The following care, treatment or supplies for the feet: orthopaedic shoes, orthopaedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails.
- Charges for treatment of Mental Health Disorders.
- Dental Treatment, except for Dental Treatment necessary to restore sound natural teeth lost or damaged in a covered Accident or to resolve sudden onset of acute pain.
- Charges resulting from Accidents occurring while the Covered Person is participating in any of the following:
- Contact Sports, intercollegiate, interscholastic, intramural, and club Amateur Athletics sports or athletic activities and Professional Sports. Non-contact and non-organized/non-sanctioned amateur athletics or athletic activities engaged in solely for leisure, recreational, entertainment or fitness purposes are not excluded unless they are excluded by (b) through (c) of this provision; and
- Any one or combination of the following: abseiling, BMX, bobsledding, bungee jumping, caving, hang gliding, heli-skiing, high diving, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering normally involving ropes or guides or in excess of 4,500 meters, scuba diving in excess of 50 meters depth, skydiving, spelunking, whitewater rafting in excess of Class V; and
- Any other sport or activity which is undertaken for thrill seeking and exposes the individual to abnormal risk of Injury.
- Weight modification or Surgical treatment of obesity, including but not limited to wiring of the teeth and all forms of intestinal bypass Surgery.
- Modifications of the physical body intended to improve psychological, mental or emotional well-being, including but not limited to sex-change Surgery.
- Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, dentures or dental appliances and any examination or fitting related to these devices.
- Orthoptic, visual eye training and eye Surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
- Treatment of the temporomandibular joint.
- Diagnosis or treatment of venereal disease, including all Sexually Transmitted Diseases and conditions.
- Routine Physical Exams and treatment, including but not limited to vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to the suitability of employment or travel.
- Treatment by a chiropractor.
- Medical treatment for Substance Abuse or addiction or conditions that may be attributed to Substance Abuse or addictions and direct consequences thereof.
- Treatment of Covered Persons who are HIV+, have AIDS or ARC, and all diseases caused by and/or related to HIV.
- Charges for treatment of any condition(s) when the purpose of departing the Home Country was to obtain treatment in the Host Country(ies).
- Treatment, services or supplies that are not Medically Necessary and administered by or under the supervision of a Physician, and products that can be purchased without a Physician's prescription.
- Treatment, services or supplies provided at no cost to the Covered Person and any treatment, services or supplies performed or provided by a Relative of the Covered Person or any person who ordinarily resides with the Covered Person.
- Telephone consultations or failure to keep a scheduled appointment.
- Surgeries, treatments, services or supplies that are investigational, Experimental or for Research Purposes.
- Charges incurred while confined primarily to receive Custodial Care, Educational or Rehabilitative Care, or any medical treatment in any establishment for the care of the aged.
- Surgeries, treatments, services or supplies for cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is directly related to an Accident which is covered under this cover.
- Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinestherapy.
- Services, supplies, or treatment for hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed by a Physician.
- Exercise programs, whether or not prescribed or recommended by a Physician.
- Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder.
- Charges for travel or accommodation not specifically included as an Eligible Expense under this cover.
- Charges which exceed the Usual, Reasonable and Customary charge for the service or supply provided.
- Charges for any supply or service that is not Medically Necessary.
- Injury and/or Common Carrier Accidental Death sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician but not for the treatment of Substance Abuse.
- All Benefits in the event the Trip is undertaken with a visa other than a tourist visa, and/or with the intention of establishing temporary or permanent residence in the Host Country.
- All Benefits in respect to professional activities undertaken for compensation, reward or profit.
- All Benefits for Injury, Illness and/or Common Carrier Accidental Death relating to or resulting from hurricanes, earthquakes and other unexpected climate or natural phenomena.
- Charges for religious or funerary services or special coffins.
- Charges for treatment of Injury or Illness after the Covered Person abandons the medical facility or discontinues the course of treatment recommended by the attending Physician.
- Charges incurred before the Effective Date of Coverage or after the Termination Date of Coverage of the Covered Person, subject always to a maximum period of coverage of 120 days per Trip.
- Any claim or benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose the Claims Administrator to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.
- Any actual or alleged failure of the Covered Person to procure or maintain authorized/official immigrant status and, work, residence or similar visa, permits or other documentation unless the Covered Person can show that such allegations were intentionally false, malicious and made solely and directly to achieve a political, propaganda or coercive effect upon or at the expense of the Covered Person;
- Non-political evacuation from a country within 14 days after issuance of an Evacuation Advisory;
- Covered Persons having travelled to a region at a time when an Evacuation Advisory has been issued in respect of that region;
- Any Covered Person who is a member of any military or paramilitary organization;
- Any act or alleged act which would be a criminal offence if committed by the same party in their country of residence, but excluding minor traffic violations.
- Directly or indirectly arising out of or in any way involving any nuclear radiation or radioactive contamination except for those approved processes or techniques that are approved by appropriate governmental or other applicable regulatory authority
- Loss or damage by electronic means including but not limited to computer hacking or the introduction of any form of computer virus or corrupting or unauthorized instructions or code or the use of any electromagnetic weapon. However, this shall not apply to losses arising from the use of any computer, computer system or computer software programmer or any other electronic system in the launch and/or guidance system and/or firing mechanism of any weapon or missile.
- Excluded Territories: Afghanistan, Chechnya, Iraq, Israel (West Bank, Gaza and the occupied territories). Venezuela, Myanmar, Haiti, Syria, Yemen, Libya, Pakistan, Lebanon, North and South Sudan and then Sub-Saharan Africa (as defined by United Nations but not including Botswana, Namibia, South Africa, Cape Verde, Mauritius, Seychelles and Malawi) and any US/UK/European Sanctioned Countries.
CYBER RISK PROTECTION
The insurer will pay on behalf of the insured all loss in excess of the retention that the insured becomes legally obligated to pay as a result of a claim, first made against the insured during the policy period, arising out of:
- technology products; or
- the performance of technology services by the insured or its sub-contractors;
where the claim is for:
- civil liability arising from a breach of a written contract; or
- negligence or breach of a duty to use reasonable skill and care; or
- negligent misrepresentation or negligent misstatement; or
- breach of confidence, misuse of information or breach of privacy; or
- libel, slander, defamation, product disparagement, or malicious falsehood; or
- passing-off or infringement of copyright, moral right, trademark or design right, plagiarism, piracy, misappropriation of formats, characters, trade names, character names, titles, plots, musical compositions, voices, slogans, graphic materials or artwork; or
- negligent transmission of a virus or Trojan horse; or
- denial of service attack
A2 MULTIMEDIA LIABILITY
The insurer will pay on behalf of the insured all loss in excess of the retention that the insured becomes legally obligated to pay as a result of a claim, first made in writing against the insured during the policy period, arising out of the performance of media activities by the insured or its sub-contractors where the claim is for:
- negligence or breach of duty to use reasonable skill and care; or
- negligent misrepresentation or negligent misstatement; or
- libel, slander, defamation, product disparagement or trade libel (malicious falsehood); or
- infringement of copyright, or domain name, or the dilution or infringement of any trademark, service mark, service name or trade name; or
- plagiarism or piracy; or
- breach of confidence or misuse of information.
A2 SECURITY AND PRIVACY LIABILITY
The insurer will pay on behalf of the insured all loss in excess of the retention that the insured becomes legally obligated to pay as a result of a claim, first made in writing against the insured during the policy period, arising out of a privacy and security wrongful act by an insured or its sub-contractors.
B FIRST PARTY INSURING CLAUSES
The insurer will provide coverage under these insuring clauses B1 to B10 in excess of the retention and up to the limit of liability provided that the relevant insuring clause has been agreed in the Schedule. Nothing in the following insuring clauses shall increase the aggregate limit of liability.
B1 PRIVACY NOTIFICATION AND CRISIS MANAGEMENT COSTS
The insurer will reimburse the following costs, reasonably incurred by the insured with the insurer’s Cyber Service Provider referred to at item 5 of the Schedule, with the prior written consent of the insurer, as a result of a data breach, network compromise or extortion demand which is first discovered or made against the insured during the policy period:
- the costs of performing computer forensics to determine the existence, cause, and scope of a network compromise or data breach;
- legal fees in order to determine the actions necessary to comply with legislation related to the data breach or network compromise;
- the cost of notifying individuals of the data breach whether or not they are required to be notified pursuant to legislation;
- the costs of operating a call center to manage inquiries from individuals potentially affected by the data breach or network compromise;
- the costs of providing credit or identity monitoring and identity protection for those individuals whose personal data was or may have been affected by the data breach or network compromise;
- the fees of a public relations or crisis communication firm solely in order to minimize harm to the insured’s reputation.
B2 EMERGENCY RESPONSE COSTS
Where it has not been practicable to seek the insurer’s prior written consent to incur expenses referred to at insuring clause B1 above, the insurer will reimburse the insured for such expenses in respect of reasonable and necessary emergency payments.
B3 EXTORTION DEMANDS
The insurer will reimburse to the insured any sums paid (if legally permissible) in response to an extortion demand and first made against the insured during the policy period, by a third party or employee which has committed or credibly threatens to commit a network compromise or a data breach provided that prior to the delivery or transfer of funds, the insured receiving such threat:
- has reported the extortionist’s demand to the police or local law enforcement authorities; and
- had a reasonable belief that such threat was credible, could cause loss to the insured, and was technologically feasible at the time made.
B4 REGULATORY INVESTIGATIONS
The insurer will pay defense costs and regulatory fines (where insurable by law) arising from a regulatory investigation, but only where the insured is first made aware during the policy period of the intention to hold such investigation.
B5 BUSINESS INTERRUPTION
The insurer will reimburse the insured for loss of profit and operational expenses during the period of restoration directly caused by a network compromise first discovered during the policy period which has:
- caused a partial or total network interruption; or
- necessitates a partial or total shutdown in order to prevent further loss.
B6 LOSS OF ELECTRONIC DATA
The insurer will reimburse the reasonable costs, incurred with the prior written consent of the insurer, of updating or restoring the insured’s electronic data from backups which have been destroyed, lost, damaged, or altered as a result of a network compromise which first occurs during the policy period, but only up to the level which existed prior to the network compromise;
B7 LOSS OF PHYSICAL DOCUMENTS
The insurer will reimburse the reasonable cost of replacing or repairing tangible documents negligently destroyed or mislaid or damaged by the insured during the policy period and which belong to clients of the insured and were in the insured’s care, custody or control at the time of the destruction, mislaying or damage.
B8 LOSS MITIGATION
The insurer agrees to pay any reasonable costs necessarily incurred by the insured with the insurer’s prior written consent in respect of measures taken by the insured for the sole purpose of avoiding or mitigating a claim or potential claim which the insured establishes to the insurer’s satisfaction, might otherwise reasonably have been expected to give rise to a loss covered under insuring clauses A1 and A2 if such measures were not taken.
B9 PAYMENT OF OUTSTANDING FEES
If the insured’s client has reasonable grounds for being dissatisfied with the work the insured or its sub-contractors have done during the policy period and refuses to pay for some or all of the work and threatens to bring a claim against the insured, the insurer may, in its sole discretion, pay any amount in whole or in part owed to the insured excluding any VAT or other taxes, or profit costs, if, in the insurer’s opinion, this will prevent a claim being made against the insured for a greater amount, which the insurer considers might reasonably be expected to give rise to a loss covered under insuring clause A1. Upon payment to the insured, the insured will assign all rights against its client to the insurer in respect of such debt. In the event that a claim is subsequently made against the insured, any such sums paid under this insuring clause B9 will be set off against any indemnity payable to the insured.
B10 TRIAL ATTENDANCE COSTS
The insurer will pay as payments for trial attendance up to USD 250 for loss of earnings to the insured for each day or part of a day an employee is in attendance, at the insurer’s request, at a trial, hearing or arbitration involving a claim which is the subject of indemnity under this policy by or against the insured. Payments for trial attendance are not subject to the retention and are part of the aggregate limit of liability. In no event will the total amount of payments for trial attendance exceed USD 250 per day or USD 5,000 per policy period for all insureds.
The insurer will not be liable to make any payment for any loss, loss of profit, extortion demands, regulatory fines, operational expenses, defense costs, or other costs, fees or expenses:
C1 Acquisitions and Sales
arising out of any act, error, omission, personal injury, network compromise or data breach committed:
- by any entity newly formed or acquired by any insured unless it becomes a newly acquired subsidiary in accordance with clause G1; or
- by any entity before it became a newly acquired subsidiary, unless the insurer agrees by endorsement to the policy to provide such coverage (except as provided by clause G2); or
- by any entity that was a subsidiary or newly acquired subsidiary after it ceases to be a subsidiary or newly acquired subsidiary.
arising out of any actual or alleged asbestos or any materials containing asbestos.
incurred to enhance or improve the computer system or data contained therein to a level beyond the state existing prior to any network compromise or data breach the subject of any claim or loss covered under this policy.
C4 Bodily injury
arising out of actual or alleged bodily injury, except that this exclusion will not apply to any mental anguish or emotional distress.
C5 Business Practice
arising out of any actual or alleged anti-trust violation, price fixing, restraint of trade, unfair competition, violation of consumer protection laws, or false, deceptive or unfair trade practices. This exclusion, however, does not apply to claims based on data breach under consumer privacy protection laws.
C6 Contractual Liability
arising out of liability assumed or accepted by an insured under any contract or agreement, including any guarantee or warranties, except to the extent the insured would have been liable in the absence of such contract or agreement. However, in relation to ensuring clause A1 of this policy, this exclusion will not apply to a claim brought by a client of the insured for:
- breach of an express or implied contractual warranty that technology products or technology services will conform to a previously agreed written specification; or
- breach of an express or implied duty relating to quality, fitness for purpose or safety of the technology products or technology services; or breach of a warranty or guarantee that the technology products or technology services will not infringe another’s intellectual property rights (but not patent infringement or trade secret misappropriation), privacy rights or breach of any duty of confidentiality.
C7 Director, Officer and Employee Claims
arising out of a claim made by or on behalf of or instigated by any director, officer, or employee of an insured except in respect of a data breach.
C8 Dishonest, Intentional, Illegal or Reckless Acts
arising out of any dishonest, intentional, fraudulent, malicious, reckless, or criminal act or omission by any party with the consent or prior knowledge of any officer, director or partner, or spouse of any officer, director or partner of the insured.
C9 Electrical Failure
arising out of, or in any way involving any electrical failure including electrical power interruption, surge, brownout or blackout, except this exclusion does not apply when the electrical failure is solely caused by an insured’s negligence in performing technology services.
C10 Electromagnetic Discharge
arising out of, or in any way involving the existence, emission or discharge of any electromagnetic field, radiation or magnetism that allegedly or actually affects the health, safety or condition of any person or environment, or that affects the value, marketability, condition or use of any property.
C11 Employment Practices, Directors and Officers
arising out of employer-employee relations, policies, practices, acts, or omissions, any actual or alleged refusal to employ any person, or misconduct with respect to employees, discrimination, humiliation, harassment, or misconduct based on an individual’s race, creed, color, age, gender, national origin, religion, disability, marital status or sexual preference or other classification.
arising out of actual or alleged violation of:
- the Employee Retirement Income Security Act of 1974 (USA);
- the Securities Act of 1933 (USA);
- the Securities Exchange Act of 1934 (USA);
- the Racketeer Influenced and Corrupt Organization Act 1961 (USA);
- the Securities Fraud Enforcement Act 1988 (USA);
- the Money Laundering Control Act 1981 (USA);
- the Bank Security Act 1970 (USA);
- the Right of Financial Privacy Act 1978 (USA); or
- any rules, regulations or amendments issued in relation to the above acts, or any similar legislation in any other jurisdiction.
C13 Financial Guarantees
arising out of any promise, representation, or guarantee for or relating to return on investment, cost savings, or profits.
C14 Force Majeure
arising out of or caused by force majeure, including power outage and any failure due to any cause whatsoever of any system, infrastructure, or network over which the insured has no direct control.
C15 Gaming and lotteries
arising out of any actual or alleged gambling, contest, lottery, promotional game or other game of chance;
C5 Insufficient Resources
where, at the time the contract was entered into, the insured was aware or ought reasonably to have been aware that there were not sufficient technical, creative, logistical, or financial resources to perform the contract as promised, including any under budgeting of a project.
C16 Insured’s claim jurisdiction and territorial limits
arising out of any:
- legal proceedings brought in a court of law outside the jurisdiction stated at item 9 of the schedule or brought in a court of law within the jurisdiction stated at item 9 of the schedule to enforce a judgment or order made in any court of law outside the jurisdiction stated at item 9 of the schedule; or
- technology products distributed, licensed, leased or sold, services provided, or media activities undertaken, or technology services provided outside the territorial limits stated at item 8 of the schedule.
C17 Insured v Insured
arising out of a claim made by or on behalf of an insured against any other insured.
C18 Licensing fees and Royalties
arising out of licensing fees or royalties ordered, directed or agreed to be paid by an insured pursuant to a judgment, arbitration award, settlement agreement or similar order for the use of a person or entity’s copyright, design rights, performing rights, title, slogan, trademark, trade name, trade dress, service mark, or service name.
arising out of any act, error, omission, personal injury, or data breach committed or any extortion demand, or network compromise that occurs:
- after the insured, or all or substantially all of its assets, are acquired by another entity,
- after the insured is merged or consolidated with or into another entity if the insured is not the surviving entity, or
- after any person or entity or group of persons and entities obtains the right to vote, select or appoint more than fifty percent (50%) of the directors of the insured.
arising out of a claim by any person or entity if on or after the date or time of the act, error or omission giving rise to such claim:
- any insured controlled, owned, operated or managed such entity; or
- any insured was an owner, partner, member, director, officer or employee of such person or entity.
Control of or ownership in a business enterprise is presumed if any insured owned or held ten percent (10%) or more of the equity and/or debt instruments of such enterprise.
C21 Other Professional Advice
arising out of any professional advice (unless given in relation to technology services).
C22 Patents and Trade Secrets
arising out of any patent rights, misuse of patents or trade secrets.
arising out of, whether suddenly or over a period of time, any:
- actual, alleged or threatened emission, discharge, dispersal, seepage, release or escape of pollutants; or
- injury, damage, payments, costs or expense incurred as a result of any testing for, monitoring, removal, containment, treatment, detoxification, neutralization or cleanup of any pollutants.
C24 Prior Acts
arising out of any fact or circumstance known to the insured or ought reasonably to have been known by the insured whether or not such fact or circumstance was notified under another insurance policy, or which arises from or is related to the same originating cause as any notified fact or circumstance;
C25 Product Recall
arising out of the costs of:
- tracing, recall, replacement and/or disposal of any technology products sold, distributed, licensed or leased; or
- reprinting, recall, withdrawal, removal or disposal of any media communication.
C26 Property Damage
arising out of actual or alleged physical damage or destruction of any tangible property, including resulting loss of use.
C27 Regulatory Action
arising out of any governmental, quasi-governmental or regulatory action or investigation, except with respect to a regulatory investigation.
C28 Retroactive date
arising out of any act, error, omission, personal injury or first party event that occurs before the retroactive date specified in the Schedule.
C29 Shareholder Action
arising out of a claim made by or on behalf of or instigated by any shareholder of an insured, acting in their capacity as such, except when made as a customer or client of that insured.
C30 Strike, War, Insurrection
arising out of strikes or similar labor action, war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition or destruction of or damage to property by or under the order of any government or public or local authority or any action taken to hinder or defend against these actions.
C31 Supplier disputes
arising out of any accounting or recovery of profits, royalties, fees, contractual penalties, or other monies claimed to be due from any insured or for alleged excessive or unwarranted fees, compensation or charges of any kind made by the insured.
arising out of an act, including the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, or other ideological reasons or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear. Provided that this exclusion shall not apply to any network compromise or data breach unless such is part of or in support of any military action or war.
C33 Unlawful activity
arising out of any act or omission of an insured intended to secure a profit or advantage to which that insured is not legally entitled.
C34 Unsolicited Communications and Data Collection
arising out of:
- unsolicited faxes, emails or other communications sent by or on behalf of an insured to any third party;
- actions brought under the Telephone Consumer Protection Act, the CAN- SPAM Act of 2003 or similar legislation in any other jurisdiction.
exclusion shall not apply to loss arising from claims under insuring clause A3 directly resulting from a network compromise which is covered.
C35 Wear and Tear
arising out of wear and tear or gradual deterioration or failure of any electronic equipment in normal use.
D1 aggregate limit of liability means the maximum amount that the insurer will pay uner this policy as specified in item 3 of the Schedule.
D2 bodily injury means physical injury or illness of any person (including death sustained as a result of such) mental anguish or emotional distress.
D3 business trend means the trend, variations and circumstances of the insured either before or after the network compromise which would have affected the insured had the network compromise not occurred, so that the adjusted loss of profit will represent as closely as reasonably practicable the results which except for the network compromise, would have been obtained during the period of restoration;
D4 change in control will include any one or more of the following events:
- the sale, merger or change in control of the parent company;
- material change in the business of the parent company or, with respect to a particular insured only, of that insured;
- with respect to a particular insured only, the appointment of a receiver, liquidator, administrator or trustee in bankruptcy for that insured; or
- with respect to a particular insured only, any process whereby that insured becomes a subsidiary of another previously unaffiliated entity, or becomes controlled by another previously unaffiliated entity by virtue of any law.
D5 claim means:
- a written demand for monetary or non-monetary relief arising from a wrongful act; or
- a written communication alleging a wrongful act; or
- an action alleging a wrongful act in a court of law or in arbitration; or
- with respect to insuring clause B4 only, a regulatory investigation.
D6 computer system means a system of computer hardware, software, and associated electronic devices that is controlled, operated or owned by the insured.
D7 confidential business information means any non-public third party business information, whether encrypted or unencrypted, that cannot be lawfully obtained or known by the general public, including trade secrets, customer lists, drawings, financial information and marketing plans that are provided to the insured by a third party.
D8 data breach means the unauthorised acquisition by an unauthorised third party,disclosure or loss of data, which an executive officer first becomes aware of during the policy period, that compromises the security, confidentiality and/or integrity of personal data or confidential business information held by the insured.
D9 defence costs means reasonable legal fees and expenses incurred with the prior written consent of the insurer in the defence of any claim or regulatory investigation which is covered under this policy.
D10 denial of service attack means an attack implemented over a network or the internet intended to disrupt the normal operations of a computer system, and to render that system inaccessible to authorised users.
D11 discovered or discovery means when a responsible person first has knowledge of any act, omission or event which could reasonably be foreseen to give rise to a loss covered by this policy, even though the exact amount or details of that loss, act, omission or event are not known at the time of discovery. Discovery shall constitute discovery by every company.
D12 discovery period means a period immediately following expiry of the policy period during which written notice may be given to the insurer of a claim first made during such period or the policy period, for an act, error or omission committed before expiry of the policy period.
D13 electronic data means information in electronic form, including but not limited to computer programs.
D14 employee means a natural person who was, is, or during the policy period becomes employed by an insured,;
D15 extortion demand means any sums unlawfully demanded from an insured by a third party or an employee.
D16 first party event means network compromise, data breach, extortion demand or other event that triggers coverage under any of insuring clauses B1 to B6.
D17 gross profit is income less expenditure of the insured company or companies.
D18 insured means any one or more of the following:
- (a) the parent company;
- (b) a subsidiary.
D19 insurer means XL Insurance Company SE and any other participating insurers.
D20 limit of liability means the relevant amount specified for a given insuring clause in item 3 of the Schedule, but shall not include the aggregate limit of liability.
D21 loss means:
- (a) damages, judgments, settlements or other amounts that the insured is legally obliged to pay to a third party as a result of a claim which is covered under this policy;
- (b) defence costs.
Loss does not include:
- punitive, aggravated, or exemplary damages or the multiplied portion of any damages award; or
- salaries, benefits fees commission, bonuses, overheads, charges or expenses of any insured; or
- contractual penalties, service credits, liquidated damages (but only to the extent that such liquidated damages exceed the amount for which the insured would have been liable in the absence of such liquidated damages clause);
- civil or criminal fines or penalties which are uninsurable under the law governing this policy, the insurer or insured;
- PCI Fines
- taxes incurred by any person or entity
- the insured’s costs or expenses of complying with any injunctive relief or any form of equitable relief;
- the monetary value of any electronic fund transfer or transactions which is lost of diminished during transfer.
D22 loss of profit means the amount by which A exceeds B. For the purpose of this calculation:
A = gross profit net of taxes that would have been earned during the period of restoration adjusted for business trend based upon the gross profit earned during the 2 years prior to the network compromise;
B = actual gross profit net of taxes earned during the period of restoration.
D23 malware means any unauthorised, malicious, corrupting or harmful code which has inserted itself or been inserted into a computer system.
D24 media activities means the publishing, transmission, display, broadcast, web cast, dissemination, distribution or release of information on the internet by or on behalf of the insured.
D25 network compromise means any unauthorised access to, use or misuse of, modification to the computer system, or denial of computer system resources by attacks “by a third party or rogue employee through any electronic means, including” malware, viruses, worms, and trojan horses, spyware and adware, zero-day attacks, hacker attacks and denial of service attacks.
D26 operational expenses means reasonable costs of renting additional IT equipment and other additional services, incurred in order to minimise the loss of profit caused by a network compromise.
D27 parent company means the entity named at item 1 of the Schedule.
D28 period of restoration means the period that begins once there has been an interruption or suspension (whether partial or full) of the computer system that has lasted longer than the retention and was caused by a network compromise, and ends on the date that such interruption or suspension ends. The period of restoration will not in any event exceed 180 days.
D29 personal data means data which relates to a living individual who can be identified from such data.
D30 personal injury means injury, other than bodily injury, to a third party arising out of one or more of the following offenses by an insured arising out of media activities:
- libel, slander, or other defamatory or disparaging statements or materials;
- oral or written publication of material that breaches an individual’s right of privacy;
- plagiarism, piracy or misappropriation of ideas or style of doing business; and
- infringement or misappropriation of copyright, title, slogan, trademark, trade name, trade dress, logo, service mark or service name.
D31 policy period means the period from the inception date until the expiration date as set out in the Schedule.
D32 privacy and security wrongful act means:
- failure to reasonably protect personal data or confidential business information;
- violation of any law, statue, regulation governing the authenticity, availability, confidentiality, storage, control, disclosure, or use of personal data;
- violation of a law, statute or regulation that requires the insured to provide notification to affected persons of a data breach.;
- negligence resulting in a failure to prevent a network compromise that results in:
- the inability of an authorised third party user to gain access to the insured’s computer system;
- the malicious addition, alteration, copy, destruction, deletion, disclosure, damage, removal or theft of data residing on the insured’s computer system;
- a denial of service attack emanating from the insured’s computer system which damages, destroys third party hardware, computer programs or electronic data residing on a third party’s network; or
- the transmission of malware from the insured’s computer system to third parties.
D33 regulatory fine means an insurable civil fine or civil monetary penalty imposed by a governmental or regulatory authority for a data breach.
D34 regulatory investigation means an actual or threatened investigation in writing by a regulator or governmental authority into an actual or alleged privacy and security wrongful act caused by the insured or its sub-contractors, that may result in the imposition of a regulatory fine on the insured.
D35 responsible person means any Executive Director, Chief Information Officer, Chief Security Officer, Chief Technology Officer, Head of Legal, Compliance Officer, Head of Audit, Risk Manager or Insurance Manager (or equivalent position of any of the foregoing) of the parent company.
D36 retention means the first part of loss sustained by the insured in respect of a claim and/or request for coverage under insuring clauses B1 to B10 for which the insured is self-insured and which it will retain for its own account, and which is set out in item 4 of the Schedule. In respect of insuring clause B5, retention shall be the period of time referred to in item 4 of the Schedule that must pass after the start of the partial or total network interruption before the period of restoration begins.,
D37 retroactive date means the date shown in Item 10 in the Declarations.
D38 sub-contractors means independent consultants or sub-contractors who provide technology services on behalf of the insured under a written contract.
D39 subsidiary means any entity, other than an investment vehicle, in which the parent company either directly or indirectly through one or more entities:
- controls the composition of the board of directors;
- controls more than half of the shareholder voting power; or
- holds more than half of the issued share capital;
on or before the inception date of this policy. Subsidiary will include all those entities referred to in clause G1(a).
D40 technology products means a computer or telecommunications hardware or software product, or related electronic product that are created, manufactured or developed by the insured for others, or distributed, licensed, leased or sold by or on behalf of the insured to others for a fee, including software updates, service packs and other maintenance releases provided for such products, but will not include technology services.
D41 technology services means computer and electronic technology services, including but not limited to data processing, internet services, data and application hosting, computer systems analysis, technology consulting and training, custom software programming, computer and software systems installation, management, repair, maintenance and integration, computer and software support, and network management services, provided by or on behalf of an insured to others for a fee, but does not include technology products.
D42 wrongful act means:
- in relation to insuring clause A1, any of the acts, errors or omissions referred to in clauses A1(a) to (g);
- in relation to insuring clause A2, any of the acts, errors or omissions referred to in clauses A2(a) to (f);
- a privacy and security wrongful act.
MISCELLANEOUS COVERAGE PROVISIONS
Additional Coverage or Assistance Program – Miles Care shall not pay any expense if there is additional coverage or another assistance program that would, or would but for the existence of this cover, pay such expense. Except, where benefit amounts insured elsewhere are less than the applicable benefit amount covered hereunder, Miles Care will pay the difference between the benefit amounts insured elsewhere and the applicable benefit amount of this coverage, subject always to the applicable Claims Excess. Miles Care shall not pay any claim in respect to care, treatment, services or supplies furnished by any program or agency funded by any government.
For Section I and Section II
To comply with the Authorization Requirements, the Covered Person must:
- Contact the Claims Administrator via Miles Care app as soon as possible before the expense is to be incurred; and
- comply with the instructions of the Claims Administrator and submit any information or documents they require; and
- notify all Physicians, Hospitals and other Medical Providers that this cover contains Authorization requirements and ask them to fully cooperate with the Claims Administrator.
If the Covered Person meets the Authorization Requirements, and the expenses are authorized, Miles Care will pay Benefits, subject to all terms, conditions, provisions and exclusions herein. If the Covered Person does not comply with the Authorization Requirements or if the expenses are not authorized, all Benefits hereunder are forfeited.
Additionally, for Section I:
- In the event of an Emergency, authorization must be made within 48 hours, or as soon as is reasonably possible but no later than one week thereafter.
- The fact that expenses are authorized does not guarantee either the payment of Benefits or the amount of Benefits. Eligibility for and payment of Benefits are subject to all the terms, conditions, provisions and exclusions herein.
- For Inpatient stays of any kind, the Claims Administrator will authorize a limited number of days of confinement. Additional days of Inpatient confinement may later be authorized if the Covered Person receives prior approval.
Currency - The monetary limits and Premiums stated in this cover are in US dollars. Benefits may be paid in local currency equivalents.
Notice - Any notice to the Member shall be sent by registered mail and addressed to the Miles Care app on the date the notice is due. Notwithstanding the foregoing, Miles Care and the Member may agree to electronic means of notice in which case any notice to the Member shall be transmitted to the electronic address on file with Miles Care on the date the notice is sent. It is the responsibility of the Member to advise Miles Care of any change in personal reported information.
Complaints Procedure –
Complaints relating to claims should be notified to the Claims Administrator in the first instance.
55 NE 5th Avenue, Suite 501
Any complaints which do not relate to claims should be notified to:
CLICK HELP NETWORK.
55 NE 5th Ave, Suite 501
A written response will be provided to the Covered Person within fourteen (14) days.
Misrepresentation and Fraud
Miles Care rely on the statements made by the Covered Person on the Claimant's Statement and in connection with the submission of any claim hereunder in determining whether or not and to what extent Benefits under this may be payable.
Any misstatement, concealment or fraud in the making of any claim hereunder shall render this cover null and void and all claims hereunder shall be forfeited, in addition to any and all other remedies available to the Claims Administrator.
Proof of Claim - When the Claims Administrator receives notice of a claim, they will provide the Covered Person with forms for filing Proof of Claim. The following is considered to be Proof of Claim:
- A completed and signed Claimant's Statement and Authorization form, together with any/all required attachments; and
- original itemized bills; and
- original receipts for any expenses that have already been paid by or on behalf of the Covered Person.
Subsequent to receipt of Proof of Claim, the Claims Administrator may, at their sole discretion, request and require additional information, including but not limited to medical records, necessary to confirm the validity of any claim under Section I prior to payment thereof.
Appealing a Claim
- Time Limit:
In the event the Claims Administrator denies all or part of a claim under this cover, the Covered Person shall have sixty (60) days from the date the notice of denial was mailed to the Covered Person's last known address, to file a written appeal with the Claims Administrator . The written appeal must include sufficient information to identify the claim under appeal and must specify the reason(s) for the appeal with supporting documentation, if applicable.
- Appeal Procedure:
Within thirty (30) days of the Claims Administrator's receipt of the appeal, the Claims Administrator will review the claim. A written response will be forwarded to the Covered Person.
Legal Actions - No action of law or equity may be brought to recover Benefits under this cover until sixty (60) days after written Proof of Claim, as herein defined, has been provided to the Claims Administrator. No such action may be brought after the end of two (2) years after the time that written Proof of Claim, as herein defined, is required to be furnished.
Waiver of Rights - In the event that Miles Care do not enforce or require compliance with any provision herein, this will not invalidate, modify or render such provision unenforceable at any other time, whether or not the circumstances are the same.
Claims Cooperation - The Covered Person and their Physician (s), Hospital (s) and other Medical Providers shall cooperate fully with the Claims Administrator including granting full right of access to all related medical documentation, reports and evidence. The Claims Administrator may deny coverage for any claim where there has been a refusal or material failure to so cooperate.
Assignment - The Covered Person may assign Benefits under this cover to a Hospital, Physician or other Medical Provider. Any assignment shall not confer upon such Hospital, Physician or other Medical Provider, any right or privilege granted to the Covered Person under this cover except for the right to receive Benefits, if any, which are determined to be due and payable hereunder. No Hospital, Physician or other Medical Provider shall have any direct or indirect claim or right of action against the Claims Administrator or Miles Care.
Claims Assistance - Every attempt will be made to help Covered Persons understand the Benefits provided by this cover, however, any statement made by an employee of the Claims Administrator will be deemed a representation and not a warranty. Actual Benefit payment can only be determined at the time a claim is submitted and all facts are presented in writing. If a definite answer to a specific question is required, the Covered Person can submit a written request, including all pertinent information and a statement from the attending Physician (if applicable), and a written reply will be sent to the Covered Person and kept on file.
Affordable Care Act -_Important Notice to US Citizens/Residents regarding the Patient Protection and Affordable Care Act: This cover is not subject to, and does not provide certain of the cover benefits required by the United States' Patient Protection and Affordable Care Act ("ACA"). This cover does not provide, and Miles Care does not intend to provide, minimum essential coverage under ACA. In no event will benefits be provided in excess of those specified in this cover. This is short-term limited duration travel benefit that only provides coverage for Trips of up to 120 days. The Covered Person should consult their attorney or tax professional to determine if ACA's requirements are applicable to them.
Miles Care is a registered trademark of a & a Co, marketed as novae care & connect.