ROYAL CARIBBEAN
TRAVEL PROTECTION PROGRAM
SM
Page 4 of 6
Elective Treatment and Procedures means any medical treatment
or surgical procedure that is not medically necessary including
any service, treatment, or supplies that are deemed by the federal
or a state or local government authority or by us to be research
or experimental or that is not recognized as a generally accepted
medical practice.
Home means your primary or secondary residence.
Hospital means an institution, which meets all of the following
requirements: 1) it must be operated according to law; 2) it must
give 24 hour medical care, diagnosis, and treatment to the sick
or injured on an inpatient basis; 3) it must provide diagnostic and
surgical facilities supervised by Physicians; 4) registered nurses must
be on 24 hour call or duty; and 5) the care must be given either on
the hospital’s premises or in facilities available to the hospital on a
pre-arranged basis. A Hospital is not: a rest, convalescent, extended
care, rehabilitation or other nursing facility; a facility which primarily
treats mental illness, alcoholism, or drug addiction (or any ward,
wing, or other section of the hospital used for such purposes); or a
facility which provides hospice care (or wing, ward, or other section
of a hospital used for such purposes).
Immediate Family Member includes your or the Traveling
Companion’s spouse, child, spouse’s child, son-daughter-in-law,
parent(s), sibling(s), grandparent(s), grandchild, step brother-sister,
step-parent(s), parent(s)-in-law, brother-sister-in-law, aunt, uncle,
niece, nephew, Domestic Partner, or ward.
Injury means bodily harm caused by an Accident which: 1) occurs
while your coverage is in effect under the plan; and 2) requires
examination and treatment by a Physician. The Injury must be the
direct cause of loss and must be independent of all other causes and
must not be caused by, or result from, Sickness.
Insurer means Transamerica Casualty Insurance Company.
Other Valid and Collectible Group Insurance means any group
policy or contract which provides for payment of medical expenses
incurred because of Physician, nurse, dental or Hospital care
or treatment; or the performance of surgery or administration of
anesthesia. The policy or contract providing such benets includes
group or blanket insurance policies; service plan contracts; employee
benet plans; or any plan arranged through an employer, labor union,
employee benet association or trustee; or any group plan created
or administered by the federal or a state or local government or its
agencies. In the event any other group plan provides for benets
in the form of services in lieu of monetary payment, the usual and
customary value of each service rendered will be considered a
Covered Expense.
Payments or Deposits means the cash, check, or credit card
amounts actually paid to the Policyholder for your Covered Cruise
Vacation.
Physician means a person licensed as a medical doctor by the
jurisdiction in which he/she is resident to practice the healing arts.
He/she must be practicing within the scope of his/her license for
the service or treatment given and may not be you, a Traveling
Companion, or an Immediate Family Member of yours.
Plan Participant means an eligible person who arranges a Covered
Cruise Vacation and pays any required plan payment.
Policy means the contract issued to the Policyholder providing the
benets specied herein.
Policyholder means the legal entity in whose name this Policy is
issued, as shown on the benet Schedule.
Quarantined means the isolation of a person aficted with or
exposed to a communicable disease, the purpose being to prevent
the spread of disease.
Program Medical Advisors means On Call International.
Schedule means the benet schedule shown on the Description of
Coverage for each Plan Participant.
Scheduled Departure Date means the date on which you are
originally scheduled to leave on your Covered Cruise Vacation.
Scheduled Return Date means the date on which you are originally
scheduled to return to the point where the Covered Cruise Vacation
started or to a different nal destination.
Scheduled Departure City means the city where the scheduled
Cruise Vacation on which you are to participate originates.
Sickness means an illness or disease of the body which: 1) requires
examination and treatment by a Physician; and 2) commences
while the plan is in effect. An illness or disease of the body that rst
manifests itself and then worsens or becomes acute prior to the
effective date of this plan is not a Sickness as dened herein and is
not covered by the plan.
Traveling Companion means a person whose name appears with
you on the same Cruise Vacation arrangement and who, during the
Cruise Vacation, will accompany you.
Usual and Customary Charge means those charges for necessary
treatment and services that are reasonable for the treatment of
cases of comparable severity and nature. This will be derived from
the mean charge based on the experience in a related area of the
service delivered and the MDR (Medical Data Research) schedule of
fees valued at the 90
th
percentile.
General Plan Exclusions
In Part B:
We will not pay for any loss or expense caused by or incurred
resulting from: a Pre-Existing Condition, as dened in the plan.
This Exclusion does not apply to benets under covered expenses
emergency medical evacuation or repatriation of remains of the
Medical Expense/Emergency Assistance Benets coverage.
In Parts A & B:
We will not pay for any loss under the plan caused by or
incurred resulting from: 1) mental, nervous, or psychological
disorders, except if hospitalized; 2) being under the inuence of
drugs or intoxicants, unless prescribed by a Physician; 3) normal
pregnancy, except if hospitalized; or elective abortion; 4) declared
or undeclared war, or any act of war; 5) service in the armed forces
of any country; 6) operating or learning to operate any aircraft, as
pilot or crew; 7) any unlawful acts, committed by you or a Traveling
Companion (whether Plan Participant or not); 8) any amount paid
or payable under any Worker’s Compensation, Disability Benet
or similar law; 9) Elective Treatment and Procedures; 10) medical
treatment during or arising from a Covered Cruise Vacation
undertaken for the purpose or intent of securing medical treatment;
11) business, contractual or educational obligations of you, an
Immediate Family Member, Domestic Partner, Business Partner,
or Traveling Companion; 12) failure of any tour operator, Common
Carrier, or other travel supplier, person or agency to provide the
bargained-for travel arrangements; 13) a loss that results from an
illness, disease, or other condition, event or circumstance which
occurs at a time when the plan is not in effect for you.