Grand Tourism

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Introduction
Your policy has been conceived by AVI International, an insurance broker/administrator specializing in travel insurance.

This webpage is divided into sections which describe the many types of insurance coverage included in your policy. Each section will be a summary of the limits of coverage provided in your policy, along with major exclusions.

Important Information
Insurance holder
The insurance holder is your travel agent. You are the beneficiary of the policy Since the insurance holder is your travel agent, it cannot be considered a third party under the terms of this contract. Should a dispute/lawsuit occur between you and your travel agent, both in your home and/or your host country, no coverage would be provided under the third party liability or legal assistance benefits.

I.D. card - In addition to the orange booklet, you have received your AVI International insurance I.D. card. This card identifies you as an insured person.
Keep this card with you at all times. You may need it for doctors, hospitals and others who require proof of insurance before providing services.

Subrogation right of insurance companies
The insurance companies underwriting this contract, in accordance with the terms of article L 121.12 of the insurance code, are subrogated to the amount of the costs or services which they provided to the insured if those costs or services are the result of another person's negligence.

This means that the insurance companies retain the right to take legal action against the party causing you the damage or injury, be it a friend or your host family. If you deny this right to the insurance carriers underwriting this contract, you deny yourself the right to compensation for the particular claim leading to the subrogation right. If the insurance companies have already paid providers fees on your behalf, these will have to be reimbursed by you to the insurance companies or their legal representative / counsel. This will have no effect on other coverages of the contract which will still be considered valid.
In case of false or fraudulent statement, the policy shall be void.

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DEFINITION OF TERMS

Person insured : Any person who has paid the insurance premium and has been reported to AVI International.
Family member : Refers to the insured's de jure or de facto spouse, sisters or brothers, mother or father.
Country of usual residence : The country where you are used to living and where the insurance documents should be sent.
Home country : The country where your family lives.
Period of insurance coverage : The insurance coverage is valid only while you are traveling abroad.
Therefore, domestic travel and damage in the country of residence and/or home country are excluded from your policy.

The period of insurance coverage begins upon your going through customs or boarding an aircraft, train, boat or coach bound for your international destination.
The period of insurance coverage ends once you are back in your home country, upon your going through customs or landing from a plane, train, boat or coach arriving from your international destination

Territory : Worldwide, except in the insured's home country, unless specified otherwise in a specific coverage.

Accident/Injury: The terms "injury/accident" wherever used in this policy mean bodily injury caused solely and directly by accidental, external, and visible means occurring while this policy is in force and resulting directly and independently of all other causes in a loss covered by this policy.

Illness: The term "illness" wherever used in this policy shall mean unexpected sickness or disease of any kind contracted and commencing after the effective date of this policy which causes a "loss" covered by this policy.

Pre-existing condition : Pre-existing conditions are not covered under the policy. A pre-existing condition means a medical condition for which treatment has been received or taken, or which exhibited symptoms which would lead a reasonable insured to believe that or inquire into whether treatment was required prior to any effective date, purchase date or departure date for any insured trip. This includes a medically recognized complication or recurrence of a medical condition.
Are considered «treatment» : follow-up exams, investigation, prescription of medication, change of type or change of dosage of medication and in general all medical and laboratory exams, x-rays, etc, related to that condition.

Emergency dental treatment : Shall mean to alleviate pain related to an infection of the gum or tooth, and contracted and commencing after the effective date of the insured's arrival in the host country and necessitating an emergency treatment to alleviate the pain.

Hospitalization : Any hospitalization, surgery, in-patient investigation MUST be reported within 24 hours to the Emergency center for approval and payment procedures. Failure to call the Emergency Center may lead to coverage denial or to partial coverage only.

Disability : For the purpose of this agreement, the term "disability" shall mean that following an accident, you do not recover permanent and total use of bodily functions.

Deductible : This coverage has been developed by AVI International with no deductible on any type of coverage.

Medical providers network/guarantee of payment
This service is available only in the USA.
To find a medical provider nearest to you, you can access our website http://www.avi-international.info.

We strongly recommend that you contact the Alarm Center so it can guarantee payment to your medical provider (provided care is covered under our policy) and to check our coverage limit.

Remember you should always have your insurance card with you when seeking medical care.

A. Medical/Accident Coverage
Car accident
Note that AVI International provides coverage only in excess of any other auto insurance coverage available to pay medical care for the insured.
This means that the claim will have to be submitted first to the auto insurance company(ies) of all drivers involved in the accident.
To submit the claim for payment of the excess, the insured must provide a police report and written proof from the concerned auto insurance company that all benefits have been paid, no matter what coverage is used : medical care, uninsured motorist, etc, or that no coverage is available.
Also, in filing a claim you agree to release all information which the insurance company requires.
Only original invoices will be considered proof of rendered services.
Work accident
In case of accident at work, this coverage is secondary to the employer's work compensation. Sport accident
In case of accident while practising a sport in a club, this coverage is secondary to your club insurance policy. In the case your club cannot provide accident insurance, coverage can be purchased from AVI International through your travel agent at extra charge.

Note : Claims and subrogation
As stated previously, it is an obligation of the insured to let the Insurance Company, the Claims Office or the Emergency Center know of a loss as soon as the insured himself is made aware of that damage.
The subrogation right of insurance companies may apply (see definition).

1. Cost of care due to illness or accident
For the cost of care, the insurance company will reimburse the following expenses up to the limit of the policy coverages. However, the guarantee of payment can be denied or limited for costs that are manifestly unreasonable or unusual.

• Cost of medical care and treatment and hospitalization as required. There is no daily maximum for in-patient medical care or hospitalization.
• Prescriptions and medical supplies as prescribed by a physician.
• Local emergency transportation to a hospital via ambulance.
• Services of a private nurse.

2.  Non emergency surgery/elective surgery
Due to differences in medical cultures/procedures among the medical profession worldwide and to make this travel insurance plan easy to understand by the insured and easy to implement worldwide, the following has been decided:
Knee surgery is not covered. Only the cost of travel to your home country will be paid for.
Surgery that is not PRESCRIBED by the attending physician AND which is not PERFORMED by the attending surgeon within 10 days of the accident or the diagnosis of the sickness or the diagnosis revision of the accident, is NOT considered an emergency and is NOT covered.
A second opinion will be sought if either party (insured or insurance company) is not in agreement with the initial diagnosis.
If the surgery is necessary for the insured to carry out his/her normal activities but not a medical emergency, the insurance company retains the right to return the insured to the home country for surgical procedures and for all necessary rehabilitation procedures.
In such a case, the insurance company will be responsible for all related transportation costs, including the return flight to the host country upon the insured's recovery.
If the insured elects not to return to his/her home country and wants the non emergency surgery performed in his/her host country, THE INSURANCE COMPANY WILL BE LIABLE TO PAY MEDICAL EXPENSES RELATED TO THE NON EMERGENCY SURGERY ONLY UP TO THE COST OF A ROUND TRIP TICKET FROM THE HOST COUNTRY TO THE HOME COUNTRY OF THE INSURED.

B. Emergency Dental Coverage

1. Emergency dental treatment (see definition)
Coverage for the alleviation of pain related to an infection of the gum or tooth, and contracted and commencing after the effective date of the insured's arrival in the host country and necessitating an emergency treatment.
Note : all dental claims MUST include an x-ray of the concerned tooth/gum. X-rays will be reimbursed at the customary cost charged in the area the dentist provided the dental care.
Please call the Emergency Center for details.

Exclusions : No coverage is provided for claims submitted without the mandatory x-ray film. No coverage is provided for routine dental examination, pre-existing conditions including caries/cavities, restorative work, orthodontics, dental equipment, crown build-up, crowns, reconstructive work or all other treatments unrelated to pain alleviation.

2. Dental care necessitated by an accident (see definition)

Special orthodontics coverage has been provided for dental treatment resulting from an accident. Such treatment may be performed following your return home if a medical expert determines that treatment could not be performed immediately due to your condition or age. In such a case, AVI will be secondary to any Health Plan you may benefit from.

Exclusions : Broken or chipped teeth, loosened or lost fillings/amalgams while eating, chewing and biting, are not at any time considered an accident or a result of an accident under the terms of this policy. They are considered the result of a pre-existing condition therefore, no coverage is provided.

Exclusions and Limitations of the Medical Coverage

The medical exclusions of this travel insurance policy include but are not limited to the following :

• Any hospitalization, surgery and subsequent treatment, in-patient investigation NOT approved by the emergency center.
• Preventive or routine medical, dental and eye examinations.
• Physical examination for sports.
• Vaccinations and immunizations (eg. school required TB shots, x-rays) as well as their consequences.
• Dental crowns and orthodontics (non-accident related), eye glasses, contact lenses and artificial limbs/prothesis.
• Acne (unless treated with antibiotics).
• Medical treatment for primarily cosmetic reasons (e.g. removal of warts, scars, moles, etc).
• Cost of treatment related to birth control, pregnancy, abortion, childbirth or illness related to pregnancy.
• Treatments related to epilepsy, malaria, hepatitis C, HIV, AIDS or sexually transmitted disease.
• Treatments related to eating disorders such as but not limited to anorexia, bulimia, etc.
• Use of sedatives.
• Use of illegal substances such as narcotics or assimilated drugs not prescribed by a physician.
• Alcohol intoxication and/or abuse.
• Medical care and/or evacuations for pre-existing conditions/illness defined as:
  1) treatment prescribed by a physician in the insured's home country as well as treatment stemming from a prior illness or accident (see definition).
  2) treatment due to a chronic medical or mental illness previously known or unknown to the insured as well as their consequences.
• Congenital illness such as but not limited to pilonidal cysts.
• Ingrown toenails, corns, warts...
• Chiropractic treatment, physical therapy, psychological or psychiatric counseling/evaluation.
• Cost of travel related to illness resulting from the above listed exclusions.

Exclusions and Limitations of the Accident Coverage

The accident exclusions of this travel insurance policy include but are not limited to the following:

• Consequences of the above excluded illnesses which could lead to an accident.
• Any hospitalization, surgery and subsequent treatment, in-patient investigation NOT approved by the emergency center.
• Dental crowns and orthodontics (non-accident related), eye glasses, contact lenses and artificial limbs.
• Injuries incurred as a driver of any motorized vehicle.
• lnjuries incurred as a driver of a recreational vehicle.
• Competitions or trials in motor vehicles even with recreational vehicles.
• Injuries incurred as a driver or passenger of a motorcycle.
• Plane accidents while a crew member (Passengers on the flight who are not part of the flight crew are covered for accidental injury).
• Accidents or injuries resulting from participation in high-risk or violent sports such as but not limited to: scuba diving, horse jumping, hang gliding, skiing or snow boarding outside maintained trails or slopes of ski resorts, mountaineering, hunting, use of firearms or air/spring powered guns, parachuting, ice hockey, boxing and martial arts, wave running, bungie-cord jumping, etc.
• Injuries resulting from initiation by the insured of a criminal/illegal act or act of violence.
• Self-inflicted injuries.
• Suicide or attempted suicide.
• Cost of travel related to accidents resulting from the above listed exclusions.
• Consequences of acts of war or terrorism.

C. Transportation Expenses

Note : Claims and subrogation
As stated previously, it is an obligation of the insured to let the Insurance Company, the Claims Office or the Emergency Center know of a loss as soon as the insured himself is made aware of that damage.
The subrogation right of the insurance companies may apply (see definition).
The insurance company will reimburse or pay directly the costs of:

• Medical evacuation to home country due to acute illness or accidental injury when the insured is deemed fit to fly. The means of transportation, necessity and schedule of evacuation will be decided exclusively on medical and technical grounds by the Emergency Center physician in order to avoid any dispute between medical authorities.
  AVI International reserves the right to determine if a medical evacuation is appropriate for those illnesses or injuries which can be treated in the host country.
• Transportation due to an early or delayed return to your home country due to a treatment in the host country whenever your original return ticket cannot be used.
• Repatriation of remains to the home country.
• Transportation of one (1) family member from the home country, if the insured's hospitalization is planned to last more than five (5) days. Maximum US$ 1,500.00 including cost of lodging.
• Cost of lodging for those visiting the insured while hospitalized.
  

  Maximum

  - One person - US$50.00 per day up to 7 days.

IMPORTANT: You MUST secure prior agreement from the Emergency Center for such travel in order to receive compensation.
The Emergency Center is used to working with airlines and may be able to find a seat for a family member even when planes are fully booked. Any refund directly from the airline due to the emergency nature of the trip will be deducted from the claim payment or if no refund is granted by the transportation company, the original transportation ticket will have to be remitted to the insurance company or to the Emergency Center.

Exclusions and Limitations of the Transportation Benefit

The transportation exclusions of this travel insurance policy include but are not limited to the following:

Insured :