We hereby insure all persons who are accepted by the plan administrator, on behalf of Us, and whose name is identified on the program materials, invoice, itinerary, declarations page or other documentation from Costco Travel. Coverage is subject to all of the exclusions, limitations and provisions as set forth herein. Coverage is afforded only with respect to the person, coverage, amounts and limits specified herein for the Insurance and for which their specified premium has been paid to the plan administrator.

Policy Number: Your full name plus "VSCPCWA"
Policyholder: Your Name, Your Address, Your City, State, Zip
Policy Effective Date: As indicated in the Term of Coverage section of the Policy
Date Coverage Begins: As indicated in the Term of Coverage section of the Policy
Coverage Premium: As indicated on your Invoice
Date Coverage Expires: As indicated in the Term of Coverage section of the Policy

Throughout this document, You and Your refer to the named insured who purchased a Trip and who has paid the required premium for the benefits. We, Us, and Our refer to Virginia Surety Company, Inc.

Accident means a sudden, unexpected, unusual, specific event that occurs at an identifiable time and place, but shall also include exposure resulting from a mishap to a conveyance in which You are traveling.

Air Common Carrier means an air conveyance operating under a valid license for the transportation of passengers for hire.

Bankruptcy means the filing of a petition for voluntary or involuntary bankruptcy in a court of competent jurisdiction under Chapter 7 or Chapter 11 of the United States Bankruptcy Code II L.S.C. Subsection 101 et seq.

Checked Baggage means a piece of baggage for which a claim check has been issued to You by a Common Carrier.

Common Carrier means an air, land, or sea conveyance operating under a valid license for the transportation of passengers for hire.

Covered Trip means any class of scheduled trips, tours or cruises for which the You request coverage and remit the required premium.

Default means a material failure or inability to provide contracted services due to financial insolvency.

Effective Date means the date and time Your coverage begins under this Policy. (See Term of Coverage)

Hospital means a facility that:

• holds a valid license if it is required by the law,
• operates primarily for the care and treatment of sick or Injured persons as in-patients,
• has a staff of one (1) or more Physicians available at all times,
• provides twenty-four (24) hour nursing service and has at least one (1) registered professional nurse on duty or call,
• has organized diagnostic and surgical facilities, either on the premises or in facilities available to the Hospital on a pre-arranged basis, and
• is not except incidentally, a clinic, nursing home, rest home or convalescent home for the aged, or similar institution.

Immediate Family means children, step- or adopted children, children-in-law, parents, step-parents, parents-in-law, siblings, step-siblings, siblings-in-law, grandparents, grandchildren, legal or common law spouse, aunts, uncles, nieces, or nephews of You or Your Traveling Companion.

Inclement Weather means any severe weather condition that delays the scheduled arrival or departure of a Common Carrier.

Injury means bodily injury caused by an Accident occurring while this policy is in force and resulting directly and independently of all other causes in loss covered by this policy. The Injury must be verified by a Physician.

Land/Sea Arrangement means land and/or sea arrangements made by Costco Travel.

Physician means a licensed practitioner of the medical, surgical or dental services acting within the scope of his/her license. The treating Physician may not be Yourself, a Traveling Companion, or an Immediate Family member.

Policy means this document. It describes the terms, conditions, and exclusions that apply to each benefit. The Policy is the entire agreement between You and Us. Representations or promises made by anyone that are not contained in this document are not a part of Your benefits. This Policy also includes any endorsements, riders, and amendments that are subsequently issued or attached.

Scheduled Departure Date means the date on which You are originally scheduled to leave on Your Trip.

Scheduled Return Date means the date on which You are originally scheduled to return to the point of origin or to a different final destination, or the last day of any Trip taken during the Term of Coverage.

Sickness means an illness or disease which is diagnosed or treated by a Physician after the effective date of coverage and while You are covered under this policy.

Travel Supplier means the tour operator, cruise line, and/or airline providing travel arrangements for Your Trip.

Traveling Companion means one person who is booked to accompany You on Your Trip.

Trip means prepaid Land/Sea Arrangements and shall include flight connections to join and depart such Land/Sea Arrangements.

Eligibility:
This protection is valid only upon payment to the Travel Supplies of the total required premium in advance of any losses and will not cover any losses suffered prior to purchase.

Effective Date of Individual Coverage
Trip Cancellation will take effect upon receipt of the required premium and ends upon commencement of Your Land/Sea Arrangements.
The remaining benefits provided will take effect at 12:01 A.M. local time on the Scheduled Departure Date and terminate on the earliest of the following:

• Your return to Your origination point (as specified in the travel tickets); or
• 11:59 P.M. local time at Your location on the day the Land/Sea Arrangements are scheduled to be completed; or
• the date You cancel Your Trip.

Extension of Individual Coverage
Coverage will be extended under the following conditions:

• When You commence air travel from Your origination point: within two (2) days before the commencement of the Land/Sea Arrangements, coverage shall apply from the time of departure from the original point; or greater than two (2) days before the commencement of the Land/Sea Arrangements, the extension of coverage shall be provided only during Your air travel.
• If You return to Your origination point: within two (2) days after the completion of the Land/Sea Arrangements, coverage shall apply until the time of return to the origination point; or great than two (2) days after the completion of the Land/Sea Arrangements, the extension of coverage shall be provided only during Your air travel.

In no event will coverage be extended for unscheduled extensions to Your Covered Trip for which premium has not been paid in advance.

Refund of Premium
Premium for the full term of coverage will be refunded only when a written request is received by the plan administrator prior to the Effective Date of coverage. After the Effective Date of coverage, premium is considered fully earned and nonrefundable.

Trip Cancellation We will pay a benefit, up to the maximum shown on the Schedule, if You are prevented from taking the Covered Trip.

Trip Interruption
We will pay a benefit, up to the maximum shown on the Schedule, if You are unable to continue on the Covered Trip.

Trip Delay
We will reimburse You for covered expenses on a one-time basis, up to the maximum shown in the Schedule, if You are delayed en route to or from the Covered Trip for twelve (12) or more hours due to a defined Hazard.

Missed Connection
We will pay benefits, up to the amount shown on the Schedule, for missed cruise departures resulting from cancellation or delay of three (3) or more hours of regularly scheduled airline flights due to Inclement Weather.

Itinerary Change
We will pay a benefit, up to the amount shown on the Schedule, if a change in Your Trip Itinerary prevents You from participating in an event/activity which You prepaid.

Baggage/Personal Effects
We will reimburse You, up to the maximum shown on the Schedule, for loss, theft or damage to baggage and personal effects.

Baggage Delay
We will reimburse You for the expense of necessary personal effects, up to the maximum shown on the Schedule, if Your Checked Baggage is delayed or misdirected by a Common Carrier for more than twenty-four (24) hours, while on a Covered Trip, except for travel to the final destination or place of residence.

Trip Cancellation/Trip Interruption

In the event You are prevented from taking Your Trip because:

• You, Your Traveling Companion, or an Immediate Family Member suffers a death or an Injury or Sickness which results in medically imposed restrictions, as certified by a Physician, at the time of loss preventing Your continued participation in the Trip;
• You or Your Traveling Companion:
• is hijacked, quarantined, required to serve on a jury, or subpoenaed;
• has a home made uninhabitable by fire, flood, volcano, earthquake, hurricane, or other natural disaster;
• is directly involved in a documented traffic accident while en route to departure.
• Of Bankruptcy and/or Default of the Travel Supplier which occurs more than ten (10) days following Your Effective Date of Trip Cancellation coverage. Coverage is not provided for the Bankruptcy or Default of the agency from whom You purchased Your Land/Sea Arrangements. Your contracted departure date must be no more than eighteen (18) months beyond Your Effective Date of Trip Cancellation coverage;
• Terrorism occurs in a country which is part of the Trip which leads the United States government to issue a general recommendation that You should not travel within that country for a period that would
• Inclement Weather causes a complete cessation of Your Common Carrier for at least 48 consecutive hours;
• Employer termination or layoff affecting You or Your Traveling Companion or Your Family Member booked to travel with You. Employment must have been with the same employer for at least one continuous year.

We will pay benefits up to Your total Trip cost for:

• Trip Cancellation – non-refundable cancellation charges imposed by the Travel Supplier and/or airfare cancellation charges for flights joining or departing Your Land/Sea Arrangements; or the additional costs You may incur as a result of a change in the per-person occupancy rate of prepaid travel arrangements if a Traveling Companion cancels his/her Trip for a covered reason and You do not cancel. Benefits will be paid due to Bankruptcy or Default of an airline only if no alternate transportation is available. If alternate transportation is available, benefits will be limited to the change fee charged to allow You to transfer to another airline in order to get You to Your intended destination.
• Trip Interruption – unused, non-refundable land or sea expenses prepaid to Costco Travel and/or the airfare paid, less the value of applied credit from an unused return travel ticket, to return home or rejoin the original Land/Sea Arrangements (limited to the cost of one-way economy airfare by scheduled carrier, from the point of destination to the point of origin shown on the original travel tickets).

Important: The Sickness or Injury causing You to interrupt Your Trip must be verified by a Physician before You terminate the Trip.

We will also pay benefits, up to the amount shown on the schedule, for reasonable additional accommodation and transportation expenses incurred to remain near a covered traveling Immediate Family member or Traveling Companion who is Hospitalized during Your Trip.

In no event shall the amount reimbursed exceed the amount You prepaid for Your Trip.

Special Conditions: You must advise Costco Travel and the plan administrator as soon as possible in the event of a claim. We will not pay benefits for any additional charges incurred that would not have been charged had You notified these parties as soon as reasonably possible.

IMPORTANT: You, Your Traveling Companion, and Your Immediate Family member booked to travel with You must be medically capable of travel on the day You purchase this coverage. The event which necessitated the trip cancellation/interruption must occur after Your effective date of Trip Cancellation coverage. Benefits will not be paid for expenses not refunded in the event of Costco Travel’s insolvency.

Trip Delay

We will pay benefits for Covered Expenses, up to the amount shown on the Schedule, if Your flight en route to or from Your Land/Sea Arrangements is delayed for 12 hours or more due to inclement weather, strike or other job action, or equipment failure of a Common Carrier; a traffic accident en route to a departure in which You or Your Traveling Companion is not directly involved; lost or stolen passports, travel documents, or money; quarantine; hijacking; natural disaster including hurricane; civil commotion or riot.

Covered Expenses include any prepaid, unused, non-refundable Land/Sea Arrangements, any reasonable additional expenses for meals and lodging, and the cost of a one-way economy airfare ticket to catch up to the Land/Sea Arrangements or return to the place of origin shown on the travel documents.

Missed Connection

We will pay benefits, up to the amount shown on the Schedule, for missed cruise departures that result from cancellation or delay of three (3) or more hours of all regularly scheduled airline flights due to Inclement Weather or any Common Carrier caused delay.

Covered Expenses are additional transportation expenses needed to join the departed cruise, reasonable additional accommodation and meal expenses, up to the amount shown on the Schedule and non-refundable Land/Sea Arrangements for the unused portion of Your cruise. Coverage is secondary to any compensation provided by a Common Carrier. Coverage will not be provided if You are able to meet Your scheduled departure but cancel the cruise due to Inclement Weather.

Itinerary Change

We will pay benefits, up to the amount shown on the Schedule, in the event a cruise/tour supplier makes a change in Your Trip Itinerary that prevents You from participating in an event/activity which You prepaid prior to departure and is scheduled on Your Trip Itinerary.

Covered Expenses include the non-refundable prepaid event activity expense. Benefits will not be paid if the event/activity is rescheduled during the course of the Covered Trip. Verification from the cruise/tour supplier of the change in the scheduled Trip Itinerary will be necessary for claim payment.

Baggage/Personal Effects

We will reimburse You, up to the amount shown on the Schedule, for loss, theft, or damage to baggage and personal effects. We will pay the lesser of the following: original cash value of the item less depreciation as determined by Us; or cost of repair or replacement. The maximum benefit per article is as shown on the Schedule. There will be a combined maximum as shown on the Schedule for the following: jewelry; watches; articles consisting in whole or in part of silver, gold, or platinum; furs, articles trimmed with or made mostly of fur; and lost cameras and their related equipment.

Baggage Delay

You will be reimbursed for expenses of necessary personal effects, up to the amount shown on the Schedule, if Your Checked Baggage is delayed or misdirected by a Common Carrier for more than 24 hours from the time You arrived at the destination stated on Your ticket. You must be a ticketed passenger on a Common Carrier.

EXCESS COVERAGE PROVISION
THE COVERAGE PROVIDED SHALL BE IN EXCESS OF ALL OTHER VALID AND COLLECTIBLE INSURANCE OR INDEMNITY AND SHALL APPLY ONLY WHEN SUCH OTHER BENEFITS ARE EXHAUSTED.

FOR TRAVEL ARRANGEMENT PROTECTION, THIS POLICY DOES NOT COVER: ANY LOSS CAUSED BY OR RESULTING FROM: Pre-Existing Conditions, unless this exclusion has been waived in accordance with the parameters set forth following the Pre-Existing Condition exclusion. Pre-Existing Conditions is defined as: any Injury, Sickness, or other condition affecting You, a Traveling Companion, or an Immediate Family member booked to travel with You which, within the sixty (60) day period before Your benefits began under this policy: (a) First manifested itself, or had symptoms which would prompt a reasonable person to seek diagnosis, care, or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine was taken remained controlled without any change in the required prescription; or (c) required treatment or treatment was recommended by a Physician.

PLEASE NOTE: We will WAIVE this Pre-Existing Condition exclusion if Your premium is paid prior to or with Your final Trip payment, according to the final payment due date as printed on Your Costco Travel invoice.

The Insurance provided by the policy shall be in excess of all other valid and collectible Insurance or indemnity. We shall be liable only for the excess in the amount of loss, over the amount of such other insurance or indemnity and applicable deductible.

FOR TRAVEL ARRANGEMENT PROTECTION AND BAGGAGE PROTECTION THIS POLICY DOES NOT COVER ANY LOSS CAUSED BY OR RESULTING FROM: suicide or attempted suicide while sane; intentionally self-inflicted injuries; Sickness or disease except as provided for in the policy; war or any act of war whether declared or not; while serving as a member of the armed services; while or as a result of riding in any device for aerial navigation other than as provided for in the policy; participation in any professional or semi-professional team sports; being under the influence of drugs or intoxicants unless prescribed by a duly licensed Physician; participation in any felonious act or attempt thereat; scuba diving, unless it is recreational diving at less than thirty (30) feet in depth; skydiving; hang gliding; parachuting (not including parasailing); contests of speed; elective surgery; dental treatment except as a result of Injury to sound, natural teeth; elective abortion; normal pregnancy, except if Hospitalized; mental or nervous disorders, except if Hospitalized.

THE FOLLOWING EXCLUSIONS APPLY TO BAGGAGE PROTECTION FOR ANY LOSS OR DAMAGE TO: animals; automobiles and their equipment; boats; motors; motorcycles; other conveyances and their equipment (except bicycles while checked as baggage with a Common Carrier); household furniture; eyeglasses, sunglasses, and contact lenses; artificial teeth and dental bridges; hearing aids; prosthetic limbs; money and securities; tickets and documents; sporting equipment if loss or damage results from the use there of; personal computers.

ANY LOSS CAUSED BY OR RESULTING FROM: breakage of brittle or fragile articles such as cameras, musical instruments, radios, and similar property; wear and tear; gradual deterioration; insects or vermin; inherent vice or damage; confiscation or expropriation by order of any government; radioactive contamination; war or any act of war whether declared or not; theft or pilferage while left unattended in any vehicle; mysterious disappearance.

• TRIP CANCELLATIONS CLAIMS: Contact Costco Travel and the plan administrator IMMEDIATELY to notify them of Your cancellation and to avoid any non-covered expenses due to late reporting.
• EMERGENCIES ARISING DURING YOUR TRIP: For covered emergencies requiring evacuation or interruption of Your Trip, contact the designated assistance company immediately at the following numbers: Within the U.S. and Canada: 1-866-509-7717 or, outside the U.S. and Canada, call collect: 1-603-328-1730. Identify yourself by the above policy number and give the details of Your problem or medical emergency.
• BAGGAGE/PERSONAL EFFECTS CLAIMS: If your property covered under the policy is lost, stolen or damaged, You must:
• take immediate steps to protect, save and/or recover the covered property:
• give immediate notice to the carrier or bailee who is or may be liable for the loss or damage;
• notify the policy or other authority in the case of robbery or theft within twenty-four (24) hours.
• CLAIMS NOTIFICATION UPON YOUR RETURN:
  Written notice of claim must be given by the Claimant (either You or someone acting on Your behalf) to Us or Our designated representative within twenty (20) days after a covered loss first begins or as soon as reasonably possible. Notice should include Your name, Costco Travel and the Policy Number. Please include the travel dates and details describing the nature of Your loss. Notice should be sent to the plan administrator’s office, at the address shown below. IMPORTANT: In order to facilitate prompt claims settlement upon Your return, be sure to obtain as applicable: detailed medical statements from Physicians in attendance where the Accident or Sickness occurred; receipts for medical services and supplies; receipts from the Hospital; police reports or claims reports from parties responsible (i.e., airline, cruise line, hotel, etc.) for loss, theft, damage, or delay. In the event of a baggage claim, receipts for damaged items will be required. In the event of a baggage delay or trip delay claim, receipts for any additional covered expenses will be required, as well as verification of any delay.

In all cases, the plan administrator will forward a claim form to be completed.

BerkelyCare
300 Jericho Quadrangle
P.O. Box 9022
Jericho, NY 11753

1-(866) 231-1997
1-(516) 342-2720

Office Hours:
8AM - 10PM (EST), Monday - Friday
9AM - 5PM (EST), Saturday
www.travelclaim.com

Benefit to Bailee: This insurance will in no way inure directly or indirectly to the benefit of any carrier or other bailee.

Cancellation & Non-Renewal: If You are not completely satisfied with the insurance, You must notify Us or Our designated representative within fourteen (14) days of the purchase, and We will send You a full refund of Coverage Premium provided You have not already departed on a Trip or filed a claim.

This Policy is a short-term Trip Policy and is issued for the specific term shown on the attached Declaration Page. This Policy is not renewable.

Clerical Errors: We will not deny or cancel coverage because of clerical error by Us. After an error is found, We will take appropriate action. This may include adjusting, collecting or refunding premium.

Conformity of Statute: If the terms of this Policy are in conflict with the statutes of the State in which it is issued, they are automatically changed to conform to minimum requirements of such statutes.

Disagreement Over Settlement of Claim: If there is a disagreement about the amount of the loss either You or Us can make a written demand for an appraisal. After the demand, You and Us will each select his/her own competent appraiser. After examining the facts, each of the two appraisers will give an opinion on the amount of the loss. If they do not agree, they will select an arbitrator. Any figure agreed to by two (2) of the three (3) (the appraisers and the arbitrator) will be binding. The appraiser selected by You is paid by You. We will pay the appraiser they choose. You will share equally with Us the cost for the arbitrator and the appraisal process.

Dispute Resolution – Arbitration: This Policy requires binding arbitration if there is an unresolved dispute between You and Us concerning this Policy. Under this Arbitration provision, You give up your right to resolve any dispute arising from this Policy by a judge and/or a jury. You also agree not to participate as a class representative or class member in any class action litigation, any class arbitration or any consolidation of individual arbitrations. In arbitration, a group of three arbitrators (each of whom is an independent, neutral third party) will give a decision after hearing Your and Our positions. The decision of a majority of the arbitrators will determine the outcome of the arbitration and the decision of the arbitrators shall be final and binding and cannot be reviewed or changed by, or appealed to, a court of law.

To start arbitration, either You or We must make a written demand to the other party for arbitration. This demand must be made within one (1) year of the earlier of the date the loss occurred or the dispute arose. You and We will each separately select an arbitrator. The two arbitrators will select a third arbitrator called an "umpire." Each party will each pay the expense of the arbitrator selected by that party. The expense of the umpire will be shared equally by You and Us. Unless otherwise agreed to by You and Us, the arbitration will take place in the county and state in which You live. The arbitration shall be governed by the Federal Arbitration Act (9 U.S.C.A. § 1 et. seq.) and not by any state law concerning arbitration. The rules of the American Arbitration Association (www.adr.org) will apply to any arbitration under this Policy. The laws of the state of Washington (without giving effect to its conflict of law principles) govern all matters arising out of or relating to this Policy and all transactions contemplated by this Policy, including, without limitation, the validity, interpretation, construction, performance and enforcement of this Policy.

Excess Coverage: The benefits in this Policy are secondary to any coverage provided by any other party and all other valid and collectible insurance indemnity and shall apply only when such other benefits are exhausted.

Legal Actions: No legal action for a claim can be brought against Us until sixty (60) days after We receive proof of loss. No legal action for a claim can be brought against Us more than three (3) years after the time required for giving proof of loss.

No Benefit to Others: This insurance will in no way inure directly or indirectly to the benefit of any carrier or other bailee.

Payment of Claims: Benefits payable under this Policy for any loss will be paid upon receipt of due proof of loss and all required information necessary to support the claim. All benefits payable will be payable to You or, in the case of death, to Your estate or beneficiary if provided in writing by You. No person or entity other than You shall have any legal or equitable right, remedy or claim of insurance proceeds and/or damages under or arising out of this coverage.

Time Payment of Claims: Indemnities payable under this Policy for any loss will be paid immediately upon receipt of due written proof of such loss. All claims shall be paid within thirty (30) days following receipt by Us of due proof of loss. Failure to pay within such period shall entitle You to interest at the rate of [nine percent (9%)] per annum at the expiration of each four (4) weeks during the continuance of the period for which We are liable, provided that interest amounting to less than one dollar need not be paid. Any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.

Physical Examination and Autopsy: We, or Our designated representative, at their own expense, have the right to have You examined as often as reasonably necessary while a claim is pending. We, or Our designated representative, also have the right to have an autopsy performed unless prohibited by law.

Premium: The required premium must be paid to Our authorized representative prior to the Scheduled Departure Date of Your Trip. The premium is non-refundable after a [ten (10) day review.

Proof of Loss: The claimant must send Us, or Our designated representative, proof of loss within one hundred and eighty (180) days or as soon as reasonably possible days after a covered loss occurs or as soon as reasonably possible. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.

Salvage: If salvage is requested, it must be sent to the administrator at Your expense. Failure to remit requested salvage may result in denial of the claim.

Subrogation: To the extent We pay for a loss suffered by You, We will take over the rights and remedies You had relating to the loss. This is known as subrogation. You must help Us preserve Our rights against those responsible for the loss and must do everything necessary to secure these rights and must do nothing that would jeopardize them. This may involve signing any papers and taking any other steps We may reasonably require. If We take over Your rights, You may have to sign an appropriate subrogation form supplied by Us.

Valuation: We will not pay more than the actual cash value of the property at the time of loss. Damage will be estimated according to actual cash value determined by Us. At no time will payment exceed what it would cost to repair or replace the property with material of like kind and quality.

[John Smith] Secretary ______________________________

[Jane Smith] President ______________________________

TSP-A-IND-PC (7.09)

We hereby insure all persons who are accepted by the plan administrator, on behalf of Us, and whose name is identified on the program materials, invoice, itinerary, declarations page or other documentation from Costco Travel. Coverage is subject to all of the exclusions, limitations and provisions as set forth herein. Coverage is afforded only with respect to the person, coverage, amounts and limits specified herein for the insurance and for which their specified premium has been paid to the plan administrator.

Policy Number: Your full name plus "VSCAHWA"
Policyholder: Your Name, Your Address, Your City, State, Zip
Policy Effective Date: As indicated in the Term of Coverage section of the Policy
Date Coverage Begins: As indicated in the Term of Coverage section of the Policy
Coverage Premium: As indicated on your invoice
Date Coverage Expires: As indicated in the Term of Coverage section of the Policy

Throughout this document, You and Your refer to the named insured who purchased a Trip and who has paid the required premium for the benefits. We, Us, and Our refer to Virginia Surety Company, Inc.
Accident means a sudden, unexpected, unusual, specific event that occurs at an identifiable time and place, but shall also include exposure resulting from a mishap to a conveyance in which You are traveling.

Air Common Carrier means an air conveyance operating under a valid license for the transportation of passengers for hire.

Common Carrier means an air, land, or sea conveyance operating under a valid license for the transportation of passengers for hire.

Covered Trip means any class of scheduled trips, tours or cruises for which You request coverage and remit the required premium.

Effective Date means the date and time Your coverage begins under this Policy. (See Term of Coverage)

Hospital means a facility that:

• holds a valid license if it is required by the law,
• operates primarily for the care and treatment of sick or Injured persons as in-patients,
• has a staff of one (1) or more Physicians available at all times,
• provides twenty-four (24) hour nursing service and has at least one (1) registered professional nurse on duty or call,
• has organized diagnostic and surgical facilities, either on the premises or in facilities available to the Hospital on a pre-arranged basis, and
• is not except incidentally, a clinic, nursing home, rest home or convalescent home for the aged, or similar institution.

Immediate Family means children, step- or adopted children, children-in-law, parents, step-parents, parents-in-law, siblings, step-siblings, siblings-in-law, grandparents, grandchildren, legal or common law spouse, aunts, uncles, nieces, or nephews of You or Your Traveling Companion.

Injury means bodily injury caused by an Accident occurring while this policy is in force and resulting directly and independently of all other causes in loss covered by this policy. The Injury must be verified by a Physician.

Land/Sea Arrangements means land and/or sea arrangements made by Costco Travel.

Physician means a licensed practitioner of the medical, surgical or dental services acting within the scope of his/her license. The treating Physician may not be Yourself, a Traveling Companion, or an Immediate Family member.

Policy means this document. It describes the terms, conditions, and exclusions that apply to each benefit. The Policy is the entire agreement between You and Us. Representations or promises made by anyone that are not contained in this document are not a part of Your benefits. This Policy also includes any endorsements, riders, and amendments that are subsequently issued or attached.

Scheduled Departure Date means the date on which You are originally scheduled to leave on Your Trip.

Scheduled Return Date means the date on which You are originally scheduled to return to the point of origin or to a different final destination, or the last day of any Trip taken during the Term of Coverage.

Sickness means an illness or disease which is diagnosed or treated by a Physician after the Effective Date of coverage and while You are covered under this policy.

Travel Supplier means the tour operator, cruise line, and/or airline providing travel arrangements for Your Trip.

Traveling Companion means one person who is booked to accompany You on Your Trip.

Trip means prepaid Land/Sea Arrangements and shall include flight connections to join and depart such Land/Sea Arrangements.

You or Your means a person who has purchased a Trip and who has paid the required premium for the benefits provided hereunder.

Eligibility:
This protection is valid only upon payment to Costco Travel of the total required premium in advance of any losses and will not cover any losses suffered prior to purchase.

Effective Date of Individual Coverage
The benefits provided will take effect at 12:01 A.M. local time on the Scheduled Departure Date and terminate on the earliest of the following:

• Your return to Your origination point (as specified in the travel tickets); or
• 11:59 P.M. local time at Your location on the day the Land/Sea Arrangements are scheduled to be completed; or
• the date You cancel Your Trip.

Extension of Individual Coverage
Coverage will be extended under the following conditions:

• When You commence air travel from Your origination point: within two (2) days before the commencement of the Land/Sea Arrangements, coverage shall apply from the time of departure from the original point; or greater than two (2) days before the commencement of the Land/Sea Arrangements, the extension of coverage shall be provided only during Your air travel.
• If You return to Your origination point: within two (2) days after the completion of the Land/Sea Arrangements, coverage shall apply until the time of return to the origination point; or great than two (2) days after the completion of the Land/Sea Arrangements, the extension of coverage shall be provided only during Your air travel.

In no event will coverage be extended for unscheduled extensions to Your Covered Trip for which premium has not been paid in advance.

Refund of Premium
Premium for the full term of coverage will be refunded only when a written request is received by the plan administrator prior to the Effective Date of coverage. After the Effective Date of coverage, premium is considered fully earned and nonrefundable.

Accident & Sickness Medical Expense
We will pay benefits up to the maximum shown on the Schedule if You incur necessary Covered Medical Expenses as a result of an Accident that occurs during the Covered Trip or a Sickness, which first manifests itself during the Covered Trip.

Accidental Death & Dismemberment – (Air Common Carrier Only)
We will pay benefits, up to a percentage of the amount shown on the Schedule, when You, as a result of an Injury occurring while You are riding as a passenger in or on, boarding or alighting from, any air conveyance operated under a license for the transportation of passengers for hire during the Covered Trip.

Emergency Evacuation
The Insurer will pay benefits for covered expenses incurred, up to the maximum shown on the Schedule, if an Injury or Sickness commencing during the course of the Covered Trip results in the necessary Emergency Evacuation of You.

Repatriation of Remains
The Insurer will pay benefits, up to the maximum shown on the Schedule, to return Your body to the primary place of residence if You die during the Covered Trip.

Accident & Sickness Medical Expense

We will pay benefits, up to the amount shown on the Schedule, if You incur necessary Covered Medical Expenses as a result of an Injury, or up to the amount shown on the Schedule, if You incur necessary Covered Medical Expenses as a result of Sickness. The Accident causing such Injury must occur while You are covered under the Policy, and the Sickness must first manifest itself during Your Trip. You must receive initial treatment within ninety (90) days of the Accident which caused the Injury or the onset of the Sickness. All services, supplies, or treatment must be received within fifty-two (52) weeks of the date of the Accident or the onset of the Sickness.

Covered Medical Expenses are necessary services and supplies which are recommended by the attending Physician. They include the services of a legally qualified Physician, surgeon, graduate nurse, dentist, or osteopath; charges for hospital confinement and use of operating rooms; charges for anesthetics (including administration); x-ray examinations or treatments and laboratory tests; ambulance service; drugs, medicines, and therapeutic services and supplies. We will not pay benefits in excess of the reasonable and customary charges commonly used by providers of medical care in the locality in which the care is furnished.

Accidental Death & Dismemberment (Air Common Carrier Only)

If You sustain an Injury on the Trip:

• while in, on, boarding, or alighting from an air conveyance organized and licensed for the transportation of passengers for hire; or
• after being struck or run down by an aircraft which results in death or loss of limb, eyesight, speech, or hearing within 365 days of the date of the Accident; We will pay the largest applicable amount as shown on the Schedule: the benefit amount shown in the Schedule for death, loss of speech and hearing in both ears, or loss of any combination of two hands, feet, or eyes; one-half the benefit amount for loss of anyone of these; and one-quarter the benefit amount for loss of thumb and index finger of the same hand. In no event will We pay more than the maximum benefit amount shown on the Schedule for all losses due to the same Accident.

Emergency Evacuation and Repatriation of Remains

We will pay benefits for Covered Expenses, up to the amount shown on the Schedule, if an Injury or Sickness commencing during the course of the Trip results in Your necessary Emergency Evacuation. An Emergency Evacuation must be ordered by a legally licensed Physician who certifies that the severity of Your Injury or Sickness warrants an Emergency Evacuation. Emergency Evacuations must be verified, approved, and arranged in advance by the designated assistance company

We will also pay Repatriation of Remains benefits for Transportation to return Your body to Your point of origin in the event of Your death during Your Trip. We will not cover any expenses provided by another party at no cost to You or already included in the cost of the Trip.

Emergency Evacuation means:

• Your medical condition warrants immediate Transportation from the place where You are injured or sick to the nearest Hospital where appropriate medical treatment can be obtained; and/or
• after being treated at a local Hospital, Your medical condition warrants Transportation to Your origination point to obtain further medical treatment or to recover.

Covered Expenses are customary and reasonable expenses, up to the amount shown on the Schedule, for Transportation, medical services, and medical supplies necessarily incurred in connection with Your Emergency Evacuation. Expenses for medical services and supplies must be recommended by the attending Physician. All Transportation arrangements made for Your evacuation must be by the most direct and economical route possible. Expenses for Special Transportation must be:

• recommended by the attending Physician;
• required by the standard regulations of the conveyance transporting You; AND
• verified, approved, and arranged in advance by the designated assistance company.

Transportation means any land, water, or air conveyance required to transport You during an Emergency Evacuation.

Special Transportation includes, but is not limited to, air ambulances, land ambulances, and private motor vehicles.

We will not cover any expenses provided by another party at no cost to You or already included in the cost of the Trip.

Additional Covered Expenses: If You are Hospitalized for more than 7 (seven) days following a covered Emergency Evacuation, We will pay:

• to return Your accompanying dependent children under age eighteen (18) to their home, limited to the cost of one-way economy airfare, less the value of applied credit from an unused return travel ticket, with an attendant if necessary; and/or
• up to the cost of round-trip economy airfare to bring a person chosen by You to and from Your bedside if You are traveling alone. These expenses must be authorized in advance by the designated assistance company.

Repatriation of Remains means the cost, according to airline tariffs, of the shipment of Your deceased body to Your point of origin if You die during the Trip.

Covered Expenses include, but are not limited to, expenses for embalming, cremation, coffin for repatriation, and Transportation.

PLEASE NOTE: In no event will Covered Expenses for Emergency Evacuation and Repatriation of Remains exceed the amount shown on the Schedule.

FOR MEDICAL PROTECTION THIS POLICY DOES NOT COVER (except Emergency Evacuation and Repatriation of Remains) ANY LOSS CAUSED BY OR RESULTING FROM: Pre-Existing Conditions, unless this exclusion has been waived in accordance with the parameters set forth following the Pre-Existing Condition exclusion. Pre-Existing Conditions is defined as: any Injury, Sickness, or other condition affecting You, a Traveling Companion, or an Immediate Family member booked to travel with You which, within the sixty (60) day period before Your benefits began under this policy: (a) First manifested itself, or had symptoms which would prompt a reasonable person to seek diagnosis, care, or treatment; (b) required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine was taken remained controlled without any change in the required prescription; or (c) required treatment or treatment was recommended by a Physician.

PLEASE NOTE: We will WAIVE this Pre-Existing Condition exclusion if Your premium is paid prior to or with Your final Trip payment, according to the final payment due date as printed on Your Costco Travel invoice.

THIS POLICY DOES NOT COVER ANY LOSS CAUSED BY OR RESULTING FROM:

• suicide or attempted suicide while sane;
• intentionally self-inflicted injuries;
• Sickness or disease except as provided for in the policy;
• war or any act of war whether declared or not;
• while serving as a member of the armed services;
• while or as a result of riding in any device for aerial navigation other than as provided for in the policy;
• participation in any professional or semi-professional team sports;
• being under the influence of drugs or intoxicants unless prescribed by a duly licensed Physician;
• participation in any felonious act or attempt thereat;
• scuba diving, unless it is recreational diving at less than 30 feet in depth; skydiving; hang gliding; parachuting (not including parasailing);contests of speed;
• elective surgery;
• dental treatment except as a result of Injury to sound, natural teeth;
• elective abortion;
• normal pregnancy, except if hospitalized;
• mental or nervous disorders, except if hospitalized.

• EMERGENCIES ARISING DURING YOUR TRIP:
  For covered emergencies requiring evacuation, contact the designated assistance company immediately at the following numbers: Within the U.S. and Canada: 1-(866) 509-7717 or, outside the U.S. and Canada, call collect: 1-(603) 328-1730. Identify yourself by the above policy number and give the details of Your problem or medical emergency.
• CLAIMS NOTIFICATION UPON YOUR RETURN:
  Written notice of claim must be given by the Claimant (either You or someone acting on Your behalf) to Us or Our designated representative within twenty (20) days after a covered loss first begins or as soon as reasonably possible. Notice should include Your name, Costco Travel and the Policy Number. Please include the travel dates and details describing the nature of Your loss. Notice should be sent to the plan administrator’s office, at the address shown below. IMPORTANT: In order to facilitate prompt claims settlement upon Your return, be sure to obtain as applicable: detailed medical statements from Physicians in attendance where the Accident or Sickness occurred; receipts for medical services and supplies; receipts from the Hospital; police reports or claims reports from parties responsible (i.e., airline, cruise line, hotel, etc.) for loss.

In all cases, the plan administrator will forward a claim form to be completed.

BerkelyCare
300 Jericho Quadrangle
P.O. Box 9022
Jericho, NY 11753

1-(866) 231-1997
1-(516) 342-2720

Office Hours:
8AM - 10PM (EST), Monday - Friday
9AM - 5PM (EST), Saturday

www.travelclaim.com

Benefit to Bailee: This insurance will in no way inure directly or indirectly to the benefit of any carrier or other bailee.

Cancellation & Non-Renewal: If You are not completely satisfied with the insurance, You must notify Us or Our designated representative within fourteen (14) days of the purchase, and We will send You a full refund of Coverage Premium provided You have not already departed on a Trip or filed a claim.

This Policy is a short-term Trip Policy and is issued for the specific term shown on the attached Declaration Page. This Policy is not renewable.

Clerical Errors: We will not deny or cancel coverage because of clerical error by Us. After an error is found, We will take appropriate action. This may include adjusting, collecting or refunding premium.

Conformity of Statute: If the terms of this Policy are in conflict with the statutes of the State in which it is issued, they are automatically changed to conform to minimum requirements of such statutes.

Disagreement Over Settlement of Claim: If there is a disagreement about the amount of the loss either You or Us can make a written demand for an appraisal. After the demand, You and Us will each select his/her own competent appraiser. After examining the facts, each of the two appraisers will give an opinion on the amount of the loss. If they do not agree, they will select an arbitrator. Any figure agreed to by two (2) of the three (3) (the appraisers and the arbitrator) will be binding. The appraiser selected by You is paid by You. We will pay the appraiser they choose. You will share equally with Us the cost for the arbitrator and the appraisal process.

Dispute Resolution – Arbitration: This Policy requires binding arbitration if there is an unresolved dispute between You and Us concerning this Policy. Under this Arbitration provision, You give up your right to resolve any dispute arising from this Policy by a judge and/or a jury. You also agree not to participate as a class representative or class member in any class action litigation, any class arbitration or any consolidation of individual arbitrations. In arbitration, a group of three arbitrators (each of whom is an independent, neutral third party) will give a decision after hearing Your and Our positions. The decision of a majority of the arbitrators will determine the outcome of the arbitration and the decision of the arbitrators shall be final and binding and cannot be reviewed or changed by, or appealed to, a court of law.

To start arbitration, either You or We must make a written demand to the other party for arbitration. This demand must be made within one (1) year of the earlier of the date the loss occurred or the dispute arose. You and We will each separately select an arbitrator. The two arbitrators will select a third arbitrator called an "umpire." Each party will each pay the expense of the arbitrator selected by that party. The expense of the umpire will be shared equally by You and Us. Unless otherwise agreed to by You and Us, the arbitration will take place in the county and state in which You live. The arbitration shall be governed by the Federal Arbitration Act (9 U.S.C.A. § 1 et. seq.) and not by any state law concerning arbitration. The rules of the American Arbitration Association (www.adr.org) will apply to any arbitration under this Policy. The laws of the state of Illinois (without giving effect to its conflict of law principles) govern all matters arising out of or relating to this Policy and all transactions contemplated by this Policy, including, without limitation, the validity, interpretation, construction, performance and enforcement of this Policy.

Excess Coverage: The benefits in this Policy are secondary to any coverage provided by any other party and all other valid and collectible insurance indemnity and shall apply only when such other benefits are exhausted.

Legal Actions: No legal action for a claim can be brought against Us until sixty (60) days after We receive proof of loss. No legal action for a claim can be brought against Us more than three (3) years after the time required for giving proof of loss.

No Benefit to Others: This insurance will in no way inure directly or indirectly to the benefit of any carrier or other bailee.

Payment of Claims: Benefits payable under this Policy for any loss will be paid upon receipt of due proof of loss and all required information necessary to support the claim. All benefits payable will be payable to You or, in the case of death, to Your estate or beneficiary if provided in writing by You. No person or entity other than You shall have any legal or equitable right, remedy or claim of insurance proceeds and/or damages under or arising out of this coverage.

Time Payment of Claims: Indemnities payable under this Policy for any loss will be paid immediately upon receipt of due written proof of such loss. All claims shall be paid within thirty (30) days following receipt by Us of due proof of loss. Failure to pay within such period shall entitle You to interest at the rate of [nine percent (9%)] per annum at the expiration of each four (4) weeks during the continuance of the period for which We are liable, provided that interest amounting to less than one dollar need not be paid. Any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.

Physical Examination and Autopsy: We, or Our designated representative, at their own expense, have the right to have You examined as often as reasonably necessary while a claim is pending. We, or Our designated representative, also have the right to have an autopsy performed unless prohibited by law.

Premium: The required premium must be paid to Our authorized representative prior to the Scheduled Departure Date of Your Trip. The premium is non-refundable after a [ten (10) day review.

Proof of Loss: The claimant must send Us, or Our designated representative, proof of loss within one hundred and eighty (180) days or as soon as reasonably possible days after a covered loss occurs or as soon as reasonably possible. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.

Salvage: If salvage is requested, it must be sent to the administrator at Your expense. Failure to remit requested salvage may result in denial of the claim.

Subrogation: To the extent We pay for a loss suffered by You, We will take over the rights and remedies You had relating to the loss. This is known as subrogation. You must help Us preserve Our rights against those responsible for the loss and must do everything necessary to secure these rights and must do nothing that would jeopardize them. This may involve signing any papers and taking any other steps We may reasonably require. If We take over Your rights, You may have to sign an appropriate subrogation form supplied by Us.

[John Smith] Secretary ______________________________

[Jane Smith] President ______________________________

TSP-A-IND-AH (7.09)