Options Policy Conditions
1. Excess
The excess is the first amount of a claim which we will not pay for. The excess, if applicable, applies to any claim arising from a separate event in respect of Sections 1, 2, 3, 4, 5, 6, 10 and 11 of the policy only.
The excess is the amount shown on your Certificate of Insurance.
An additional excess may apply in certain circumstances, such as cover for Existing Medical Conditions where you do not meet the provisions on page 11.
If an additional excess applies we will notify you in writing.
2. Sections Of The Policy Applicable To Each Plan
If you purchase:
a) Plan I, all Sections of the policy apply;
b) Plan D, Sections 1, 3, 4, 5, 8, 9, 11, 14, 15, 16 and 17 of the policy apply;
c) Plan DA, Sections 1, 3, and 4 only of this policy apply.
3. Limits Of Liability
The limits of our liability for each Section of the policy are the amounts shown in the relevant table for the plan selected (see page 6) except:
a) Where additional luggage cover has been effected, or
b) Plan D where the maximum liability collectively shall not exceed in total the sum insured stated under the policy plan selected for Sections 3 and 4, or
c) Plan DA where the maximum liability collectively shall not exceed in total the sum insured stated under the policy plan selected for Sections 1, 3 and 4, or
d) The maximum liability collectively for Sections 14, 15 and 16, shall not exceed $25,000 on Plan I, or
e) Where you have paid an additional amount to increase the level of Rental Car Insurance excess cover, or
f) Where we have notified you in writing of different limits.
4. Cooling Off Period / Refund Of Amount Payable
You have the right to cancel the policy by notifying the Providing Entity in writing within 15 working days (i.e. Monday to Friday excluding public holidays where you are) of the date the policy was issued to you (“cooling off period”). Provided the circumstances specified in paragraphs (a) or (b) below do not apply, you are entitled, during the cooling off period, to a refund of the amount you have paid for the policy. You are not entitled to a refund if, during the cooling off period,you:
a) Make a claim under the policy; or
b) Cancel the policy after the commencement of the journey.
We will not refund any of the amount payable if notified outside the cooling off period. We may give a partial refund if you change your policy before you depart for your journey.
5. Claims
a) The loss or theft of luggage, personal effects, travel documents or money must be reported within 24 hours to the police or responsible transport provider and a written report must be obtained at that time.
b) If you are admitted to hospital, or you anticipate that your medical expenses and additional expenses are likely to exceed A$4,000, you must phone the emergency assistance number as soon as physically possible.
c) You must take all reasonable steps to prevent or minimise a claim.
d) You must not make any offer, promise of payment or admit any liability without our written consent.
e) You must advise us of any claim or occurrence, which may give rise to a claim as soon as possible and within 60 days of the return date shown on your Certificate of Insurance by sending a completed claim form.
f) You must at your own expense, supply any documents in support of your claim which we may request, such as original police reports, receipts, valuations and/or medical certificates and you must co-operate fully in the assessment or investigation of your claim.
g) Where you are a registered entity on a Plan D or Plan DA you may be entitled to an input tax credit for your amount payable and/or for things covered by this policy. You must disclose these entitlements to us if you make a claim under your policy.
h) If we agree to pay a claim under your policy we will base any claim payment on the Goods and Services Tax (GST) inclusive costs (up to the relevant policy limit). However, we will reduce any claim payment by any input tax credit you are, or would be, entitled to for the repair or replacement of insured property or for other things covered by this policy.
6. If You Are Able To Claim From A Statutory Fund, Compensation Scheme Or Transport Provider
If you are able to claim from a statutory fund, compensation scheme (for example a private health fund or workers compensation scheme) or transport provider for monies otherwise payable under this policy you must do so and the policy will only cover the remaining amount.
7. You Must Help Us To Make Any Recoveries
We have the right to sue any other party in your name to recover money payable under the policy or to choose to defend any action brought against you. You must provide reasonable assistance to us.
8. Claims Payable In Australian Dollars
All amounts payable and claims are payable in Australian dollars at the rate of exchange applicable at the time the expenses were incurred.
9. Policy Interpretation
The policy shall be interpreted in accordance with the law of the State or Territory in which it is issued.
10. Emergency Assistance
a) Where your claim is excluded or falls outside the policy coverage, the giving of emergency assistance will not in itself be an admission of liability.
b) The medical standards, sanitary conditions, reliability of telephone systems and facilities for urgent medical evacuations differ from country to country.
Responsibility for any loss, medical complication or death resulting from any factor reasonably beyond our control cannot be accepted by the emergency assistance network, Cover-More Insurance Services or us.
11. Free Extension Of Insurance
Where your journey is necessarily extended due to an unforeseen circumstance outside your control, your period of insurance will be extended until you are able to travel home by the quickest and most direct route.
The period of insurance will not be extended for any other reason.
12. Special Conditions, Limitations, Excesses And Amounts Payable
If you:
a) Want cover for an existing medical condition which does not satisfy the provisions set out on page 11-12, or
b) Answer yes to the question in the “Medical Information” section of the Enrolment Form;
cover must be separately applied for and accepted by us, and it may be subject to special conditions, limitations, excesses and amounts payable.
We will notify you in writing of these before we issue the policy.
13. Automatic Reinstatement Of Sums Insured
If you purchase the Annual Multi-Trip Policy the sums insured under each section (other than section 1) of the policy are automatically reinstated on completion of each journey and in respect of section 5, also once on each Journey.
There is no reinstatement provided in respect of section 1 on any plan.
Policy Conditions applying to Sections 2 and 3 only
- We have the option of returning you to Australia if the cost of medical and/or additional expenses overseas are likely to exceed the cost of returning you to Australia subject always to medical advice. We also have the option of evacuating you to another country.
- In all cases the cost of evacuation or to bring you back to Australia will only be met if it was arranged by and deemed necessary by the emergency assistance network.
- If you are hospitalised we will pay for a share room. If a share room is not available We will, at our discretion and that of our medical advisers, pay to upgrade you to a single room.
- If you do not hold a return airline ticket an amount equal to the cost of an economy class one way ticket will be deducted from your claim for repatriation expenses.
Policy Conditions applying to Sections 14, 15 and 16 only
- If the conveyance you are travelling in disappears, sinks or crashes and your body has not been found after 12 months you will be presumed to have died.
- You must obtain and follow advice and treatment given by a qualified doctor as soon as possible after suffering a disabling injury, during the Period Of Insurance.
