(Form Date: 04/01/2015; updated 03/28/2021)
INTERNATIONAL PATHFINDER
APPLICATION
FRM_IntlPathnderApplication_INTEN | Page 3 of 5
Accidental Death and Dismemberment Benets:
If your injury results within 180 days from the date of a Covered Accident in any on the losses shown below, we will pay the Benet Amount shown on the next page for that loss. Your Principal Sum of
$5,000 or $10,000 or $20,000 depends on the Option you have selected. If multiple losses occur, only one Benet Amount, the largest will be paid for all losses due to the same Covered Accident.
Life 100% of the Principal Sum
Two or more Members 100% of the Principal Sum
One Member 100% of the Principal Sum
Quadriplegia 100% of the Principal Sum
Paraplegia 100% of the Principal Sum
Hemiplegia 100% of the Principal Sum
Thumb and Index Finger of the Same Hand 25% of the Principal Sum
Uniplegia 25% of the Principal Sum
“Quadriplegia” means total Paralysis of both upper and lower limbs. “Hemiplegia” means total Paralysis of the upper and lower limbs on one side of the body. “Uniplegia” means total
Paralysis of one lower limb or one upper limb. “Paraplegia” means total Paralysis of both, lower limbs or both upper limbs. “Paralysis” means total loss of use. A Doctor must determine the
loss of use to be complete and not reversible at the time the claim is submitted.
“Member” means Loss of Hand or Foot, Loss of Sight, Loss of Speech and Loss of Hearing. “Loss of Hand or Foot” means complete Severance through or above the wrist or ankle joint. “Loss of
Sight” means the total, permanent Loss of Sight of one eye. “Loss of Speech” means total and permanent loss of audible communication that is irrecoverable by natural, surgical or articial
means. “Loss of Hearing” means total and permanent Loss of Hearing in both ears that is irrecoverable and cannot be corrected by any means. “Loss of a Thumb and Index Finger of the
Same Hand” means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the ngers and the hand). “Severance” means the complete
separation and dismemberment of the part from the body.
Accident Medical Expense Benets:
We will pay for Covered Expenses that result directly, and from no other cause, from a Covered Accident. These benets must be incurred within 180 days from the date of the Covered Accident
and are subject to a $0 Deductible. The Maximum Benet for all Accident Medical Expense Benets is dependent on the Option you have chosen. The Maximum for Dental Expenses is $1,500.
These benets are only payable: 1) for Usual and Customary Charges incurred after the Deductible has been met; 2) for those Medically Necessary Covered Expenses that you receive; and 3)
if the rst incurred expenses are within 90 days from the date of the Covered Accident. No benets will be paid for any expenses incurred that, in Our judgment, are in excess of Usual and
Customary Charges. In addition to the General Exclusions, W e will not pay Accident Medical Expense Benets for any loss, treatment or services resulting from or contributed to by:
• Treatment by persons employed or retained by the Policyholder, or by any Immediate Family or member of your household
• Treatment of sickness, disease or infections except pyogenic infections or bacterial infections that result from the accidental ingestion of contaminated substances.
• Treatment of hernia, Osgood-Schlatter’s Disease, osteochondritis, appendicitis, osteomyelitis, cardiac disease or conditions, pathological fractures, congenital weakness, detached retina unless
caused by an Injury, or mental disorder or psychological or psychiatric care or treatment (except as provided in the Policy), whether or not caused by a Covered Accident.
• Pregnancy, childbirth, abortion or any complications of any of these conditions.
• Mental and nervous disorders (except as provided in the Policy).
• Damage to or loss of dentures or bridges, or damage to existing orthodontic equipment (except as specically covered by the Policy)
• Expenses incurred for treatment of temporomandibular or craniomandibular joint dysfunction and associated myofascial pain (except as provided by the Policy).
• Injury covered by Workers’ Compensation, Employer’s Liability Laws or similar occupational benets or while engaging in activity for monetary gain from sources other than the Policyholder.
• Injury or loss contributed to by the use of drugs unless administered by a Doctor.
• Cosmetic surgery, except for reconstructive surgery needed as the result of an Injury.
• Any elective treatment, surgery, health treatment, or examination, including any service, treatment or supplies that: (a) are deemed by us to be experimental; and (b) are not recognized and
generally accepted medical practices in the United States.
• Eyeglasses, contact lenses, hearing aids, wheelchairs, braces, appliances, examinations or prescriptions for them, or repair or replacement of existing articial limbs, orthopedic braces, or
orthotic devices.
• Expenses payable by any automobile insurance Policy without regard to fault. (This exclusion does not apply in any state where prohibited).
• Conditions that are not caused by a Covered Accident.
• Participation in any activity or hazard not specically covered by the Policy.
• Any treatment, service or supply not specically covered by the Policy.
Emergency Medical Benets:
We will pay up to $10,000 for Covered Expenses incurred for emergency medical services to treat you if you: 1) suer a Medical Emergency during the course of a Trip; and 2) are traveling 100
miles or more away from your place of permanent residence. Covered Expenses include expenses for guarantee of payment to a medical provider, Hospital or treatment facility. Benets for
these Covered Expenses will not be payable unless the charges incurred: 1) are Medically Necessary and do not exceed the charges for similar treatment, services or supplies in the locality
where the expense is incurred; and 2) do not include charges that would not have been made if there were no insurance. Benets will not be payable unless We authorise in writing, or by an
authorised electronic or telephonic means, all expenses in advance, and services are rendered by Our assistance provider.
Emergency Medical Evacuation Benet:
We will pay 100% of Covered Expenses incurred for your medical evacuation if you: 1) suer a Medical Emergency during the course of the Trip; 2) require Emergency Medical Evacuation; and
3) are traveling 100 miles or more away from your place of permanent residence. Covered Expenses; 1) Medical Transport: expenses for transportation under medical supervision to a dierent