WHY ROUNDTRIP?

So you'll be prepared. Who knows what could happen during a trip abroad - or before you even depart. Not only does RoundTrip help ensure you're prepared in the event of an accident, sickness or loss when traveling, it can even help if something causes your trip to be cancelled.

While we've optimized RoundTrip's medical coverage for most travelers, you may determine you need greater coverage or specific benefits. Consider Liaison® International or other plans from SRI for up to $5,000,000 of international medical limits. We can create a plan that's right for you.

Protection Plan Outline

This brochure describes the highlights of our protection plan. Plan details and ID Card will be mailed to you once you have purchased benefits or obtained immediate information using the online system. These details provide complete information regarding the benefits, exclusions and limits of the protection plan. Please read it carefully. Note: Certain terms are defined in the Evidence of Benefits that will be mailed to you with your confirmation.

SCHEDULE OF BENEFITS

DESCRIPTION OF BENEFITS

Trip Cancellation / Interruption

Trip Cancellation:

You are benefits in the amount purchased for published penalties and unused non-refundable prepaid expenses for travel arrangements, whenever you are prevented from taking a trip for any of the following reasons that occur after the effective date of your protection plan:

Trip Interruption:

If you are prevented from completing a trip for any of the above reasons that occur after the effective date of your protection plan and during your trip, you will receive up to the amount purchased for:

Trip Delay:

Benefits include additional transportation cost to join the covered trip or return home and/or for unused non-refundable expenses for your covered trip. Delay must be three hours or more and certified due to one of the following reasons:

Medical Expense:

Benefits include expenses for an accidental injury or a sickness that manifests itself during your trip, as long as you receive initial medical treatment within 30 days after the date of loss. Expenses will be paid for a period of 52 weeks from the date of loss. Benefits will include expenses for emergency dental treatments, up to $750 ($750 sub limit does not apply in New York) and advance payment to a hospital if needed to secure your admission.

Medical Evacuation / Repatriation:

You will receive benefits if an injury or sickness first occurs during your trip, up to the policy limit, for medical evacuation or medically necessary repatriation to your home or a hospital near your home for continued treatment when your condition is acute or life threatening and adequate treatment is not available at a local hospital.

Benefits also include transportation for the return trip home for your dependent children under age 18 who are accompanying you and are left unattended if you are confined to a hospital for more than seven consecutive days. Transportation will be provided for a person of your choice to visit you if you are traveling alone and are confined to a hospital for more than seven consecutive days. Any use of this benefit must be pre-approved and arranged by the authorized Assistance Company. Note: Pre-existing condition limitations are waived for Medical Evacuation / Repatriation.

Lost Baggage & Baggage Delay:

You will receive benefits for lost, stolen or damaged luggage and personal items, as well as a lost or stolen passport, visa and credit cards. You also have benefits for checked luggage that is delayed or misdirected by a common carrier for more than 24 hours from your arrival time at a destination, other than your residence, during your trip. Benefits are payable on property not specifically scheduled under other insurance.

Accidental Death & Dismemberment (AD&D):

You will receive benefits for loss of life due to an accidental injury while on your trip.

Optional Flight Accident Plan:

These benefits apply to the amount purchased, for accidental death, dismemberment or loss of sight as a result of an accident while a passenger on a regularly scheduled air flight, a land or water conveyance provided by the airline as a substitute for an aircraft, a common carrier while en route to or from the airport, or at the airport immediately before boarding or after disembarking from an aircraft.

Travel Assistance Service

Travel Assistance provides a variety of travel related services. Services offered include: medical evacuation / repatriation; repatriation of remains; medical or legal referral; hospital admission guarantee; emergency cash advance*; translation service; prescription drug / eyeglass replacement*; passport / visa information; bail bond*; lost baggage retrieval; inoculation information. (*payment reimbursement to the Assistance Company is your responsibility)

WHEN YOU ARE ELIGIBLE FOR BENEFITS

"Effective Date" is 12:01a.m. following the: postmark of your enrollment form or the date you fax or transmit your enrollment via the Internet with the proper payment.

WHEN BENEFITS DO NOT APPLY

Benefits are not payable for sickness, injuries or losses of you or your traveling companion: resulting from suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane (in Missouri, sane only; in New York, neither sane nor insane apply); resulting from an act of declared or undeclared war; while participating in maneuvers or training exercises of an armed service; while riding, driving or participating in races or speed or endurance contests; while mountaineering (engaged in the sport of scaling mountains, generally requiring the use of picks, ropes or other special equipment; in New York, professional mountaineering); while participating as a member of a team in an organized sporting competition; while participating in skydiving, hang gliding, bungee cord jumping, scuba diving or deep sea diving (in New York, professional scuba - any sport that requires more than an "Open Water 1" certification by PADI, NAUI, or other recognized diving certification organization); while piloting or learning to pilot or acting as a member of the crew of any aircraft; received as a result or consequence of being intoxicated or under the influence of any controlled substance unless administered on the advice of a legally qualified physician; to which a contributory cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation; due to normal childbirth, normal pregnancy (except complications of pregnancy) or voluntarily induced abortion (voluntary abortion only in New York); for dental treatment (except as coverage is otherwise specifically provided herein); or due to a pre-existing condition - note the pre-existing condition limitation is automatically waived for emergency medical evacuation and medically necessary repatriation benefits, and for benefits purchased within 10 days from the time the initial deposit is paid on your covered trip. In California benefits are not payable if during the 60 days prior to your effective date, a legally qualified physician advised you or your traveling companion not to travel due to a sickness or injury. No benefits will be paid for expenses reimbursed or services provided by any other source.

WHEN "PRE-EXISTING" APPLIES

Pre-existing medical conditions will apply if you enroll in the protection plan more than 10 days after making your initial trip deposit.

"Pre-existing Condition" means any injury, sickness or condition (including any condition from which death ensues) of you or your traveling companion, you and/or your traveling companion's family member or your business partner which within the sixty (60) day period prior to the effective date of your trip cancellation benefits under this protection plan: a) manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or c) required medical treatment or treatment was recommended by a legally qualified physician. Note, in California, part "(a)" of the Pre-existing Condition is not applicable.

CLAIM QUESTIONS & SITUATIONS

Once you have enrolled, you will receive an Evidence of Benefits and ID Card, which will describe all aspects of the program, as well as who to contact in case of an emergency or if a claim should occur. The Assistance Company should be contacted if you require assistance while on your trip. When purchasing your trip, be sure to keep all documentation. This information will be required in order to process any claim.

Benefits under this plan are provided by the American Insurance Consumers Trust. The Trust is insured by TIG Insurance Company. In Oregon, Kansas, New York and South Carolina the benefits of this plan are provided by a policy insured by TIG Insurance Company.

Notice to residents of Florida: The benefits of this plan are provided by the American Insurance Consumers Trust. The Trust is insured by TIG Premier Insurance Company and are governed by the law of a state other than Florida. Your homeowners policy, if any, may provide coverage for loss of personal effects provided by the baggage and personal effects coverage. This insurance is not required in connection with the purchase of your travel arrangements.

Notice to residents of California: This plan contains disability benefits or health benefits, or both, that only apply during the covered trip. You may have coverage from other sources that already provides you with these benefits. You should review your existing policies. If you have any questions about your current coverage, call your insurer or health plan. Note, in California the pre-existing condition limitation is waived for medical expenses.

PROGRAM COSTS
Rates Effective January 1, 2001

For trips of longer than 30 days, additional cost of $3 per person per day is required.
For trip cost between $10,001 and $20,000, contact your producer of SRI for the rate.

ENROLLMENT IS EASY

Return the Application with your payment to:

SRI
9200 Keystone Crossing, Ste 300
Indianapolis, IN 46240 USA
Fax: 317-575-2659 (credit card orders)
Phone: 800-335-0611 or 317-575-2652
Online: www.traveler-ins.com 

(You may fax if paying by credit card only. Originals are not required if application is faxed to SRI with credit card payment.)

January 1, 2001
Producer # 5536
Protection Plan may be purchased if you are a resident of the United States or if you purchase this plan within the United States.

Application Information
(First Name - Middle Name - Last Name)

Trip Information

Personal Information

Rate Calculation
Plan must be purchased for the FULL cost of the trip. See rates.

For Trips of 31 - 90 Days. Include departure & return dates in calculation:

Optional Flight Coverage (Maximum $500,000 / person):

Method of Payment

Plan costs are non-refundable after 10-day review period.
In Florida, Florida Resident - Agent No. A107028