(Weekdays, 8:00am - 5:00pm EST)
Mail: Seven Corners, Inc 303 Congressional Boulevard Carmel, Indiana 46032
FILING A CLAIM
You can download the appropriate claim form under Your travel protection plan from www.usa-assist.com (Customer Service / Claims section). To report a claim You should complete the form and send it to the Claim Administrator with all required information and documents as soon as possible but no later than 30 days from the date of your occurrence.
To facilitate prompt claims settlement, You will be asked to provide proof of Your loss and proof of residency. Therefore, be sure to obtain the following as applicable:
∼ For medical claims: detailed medical statements from treating physicians where and when the Accident or Sickness occurred as well as receipts for medical services and supplies; also your personal doctor medical history;
∼ For baggage delay claims: reports from parties responsible (i.e. airline, cruiseline, etc.) for delay;
∼ For trip delay claims: a statement from party causing delay and receipts for expenses;
∼ For cancellation / interruption claims: Your travel invoice, the cancellation or interruption date, original unused tickets/vouchers, the travel organizer's cancellation clause with regard to nonrefundable losses. You will also be asked to provide proof of payment.
∼ For all claims: copy of your passport and paper air ticket or boarding pass.
Note: Your may lose your rights to eligible benefits and claim case will be closed after 90 day period of no response from You with the requested necessary documentation.
∼ During an emergency (whether prior to admission, during a hospitalization or after Your release from the hospital), the Insurer reserves the right to: a) transfer You to one of its preferred health care providers; and/or b) return You to Your country of residence, for the medical treatment of Your sickness or injury, provided that this will not represent danger to Your life or health. The Insurer will make every provision for Your medical condition when choosing and arranging the mode of your transfer or return and, in the case of a transfer, when choosing the hospital. If you choose to decline the transfer or return when declared medically stable by the Insurer, the Insurer will be released from any liability for expenses incurred for such sickness or injury after the proposed date of transfer or return.
∼ No benefits will be paid for any expenses reimbursed to You or services provided to You by any other source. Benefits cannot be duplicated under Your Protection Plan.
∼ Unless You otherwise designate a beneficiary, or in the event the designated beneficiary predeceases You, indemnity for loss of life will be paid to the first of the following surviving beneficiaries: Your spouse; child or children, jointly; parents, jointly if both are living, or the surviving parent, if only one survives; brothers and sisters jointly; or Your estate.
∼ If You have two USA-ASSIST Plans that duplicate benefits, You will be paid up to the highest benefit amount under only one Protection Plan for each trip.
∼ Protection Plan cost is non-refundable.
Benefits under Your Protection Plan are supported by Guardian Life of the Caribbean Ltd. rated A- (Excellent) by AM Best.
QUESTIONS AND INFORMATION Contact your agent, broker or USA-ASSIST
USA-ASSIST® Group Affinity Coverage
marketed by International Travel Assist, LLC
+1 310 694-8453
+1 877 539-8619 (Toll Free)
(Weekdays, 8:00am - 5:00pm EST)
Mail: Seven Corners, Inc 303 Congressional Boulevard Carmel, Indiana 46032
Claims Services Important Note:
Claim forms and receipts for medical expenses must be sent to Seven Corners quickly. Claim submissions must be made within ninety (90) after the Date of Service. Should they be received after ninety (90) days, they may be considered ineligible. To report claims or verify eligibility, send the original bills and claim forms to Seven Corners, Inc., or call or fax to the numbers below.
Be certain to include Your ID# shown on the ID Card with all correspondences:
Seven Corners, Inc.
303 Congressional Blvd;
Carmel, IN 46032
800-335-0477 or 317-575-2256; Fax: 317-575-2659
Email: [email protected]
It is important to submit Your claims to Seven Corners quickly. To be considered, all claims must be submitted to the Seven Corners Claim Department within 90 days after the date of service.
PART V - POLICY PROVISIONS
1. Notice of Claim: Written notice of claim must be given to the Underwriter within ninety (90) days after the occurrence or commencement of any Disablement covered by the Policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the claimant to the Administrative Offices of the Underwriter, or to any authorized agent of the Underwriter, with information sufficient to identify the Insured Person shall be deemed notice to the Underwriter.
2. Claim Forms: The Underwriter, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing Proofs of Loss. If such forms are not furnished within fifteen (15) days after the giving of such notice the claimant shall be deemed to have complied with the requirements of the Policy as to Proof of Loss upon submitting, within the time fixed in the Policy for filing Proofs of Loss, written proof covering the occurrence, the character and the extent of the Disablement for which claim is made.
3. Proof of Loss: Written Proof of Loss must be furnished to the Underwriter at its said office in case of claim for loss for which this Policy provides any periodic payment contingent upon continuing loss within 90 (ninety) days after the termination of the period for which the Underwriter is liable and in case of claim for any other loss within ninety (90) days after the date of such loss. 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. The Underwriter at its option may pend resolution and adjudication of submitted claims and/or deny coverage for Proof of Loss submitted thereafter, or for incomplete Proof of Loss and/or failure to submit Proof of Loss.
4. Time of Payment of Claims: Indemnities payable under the Policy for any loss other than loss for which the Policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written Proof of Loss, all accrued indemnities for loss for which the Policy provides periodic payment will be paid at the expiration of each four (4) weeks during the continuance of the period for which the Underwriter is liable, and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.
5. Payment of Claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the Insured Person. Any other accrued indemnities unpaid at the Insured Person's death may, at the option of the Underwriter, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the Insured Person. If any indemnity of the Policy shall be payable to the estate of an Insured Person, or to an Insured Person who is a minor or otherwise not competent to give a valid release, the Underwriter may pay such indemnity, up to an amount not exceeding $1,000, to any Relative by blood or connection by marriage of the Insured Person who is deemed by the Underwriter to be equitably entitled thereto. Any payment made by the Underwriter in good faith pursuant to this provision shall fully discharge the Underwriter to the extent of such payment. Subject to any written direction of the Insured Person all or a portion of any indemnities provided by this Policy on account of Hospital, nursing, medical or Surgical service may, at the Underwriter's option and unless the Insured Person requests otherwise in writing not later than the time for filing proof of such loss, be paid directly to the Hospital or person rendering such services, but it is not required that the service be rendered by a particular Hospital or person.
6. Physical Examination and Autopsy: The Underwriter at its own expenses shall have the right and opportunity to examine the person of any individual whose Injury or Illness is the basis of claim when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death, where it is not forbidden by law.
7. Legal Actions: No actions at law or in equity shall be brought to recover on the Policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with requirements of this Policy. No such action shall be brought after expiration of three (3) years after that time written Proof of Loss is required to be furnished.
8. Patient Protection and Affordable Care Act: This insurance is not subject to, and does not provide certain insurance benefits required by the United States Patient Protection and Affordable Care Act ("PPACA"). The insurance benefits provided by this policy are stated in Your policy documents and do not include any additional benefits required by the PPACA. The PPACA requires certain U.S. residents and citizens to obtain PPACA compliant insurance coverage. In certain circumstances penalties may be imposed on U.S. residents and citizens who do not maintain PPACA compliant insurance coverage. You should consult Your attorney, insurance agent, or tax professional to determine if the PPACA's requirements are applicable to You.
9. Coordination of Benefits: The Underwriter coordinates benefits with other payers when an Insured Person(s) is covered by two (2) or more health plans. Coordination of Benefits is the industry standard practice used to share the cost of care between two (2) or more carriers when an Insured Person(s) is covered by more than one (1) health benefit plan. Our Coordination of Benefits and Services provision is attached hereto as APPENDIX A.
10. Any initial inquiry or compliant should be addressed to the Administrator, as defined herein. If the Insured Person is not satisfied with the manner in which an inquiry or complaint has been managed by the Administrator, the Insured Person may request in writing to the Complaints & Advisory Department at Lloyd's to review the case without prejudice to Your rights in law.
Complaints and Advisory Department of Lloyd's 1 Lime Street London EC3M 7HA United Kingdom
All coverages, except Accidental Death and Dismemberment, shall be in excess of all other valid and collectible Insurance Indemnity and shall apply only when such benefits are exhausted. Other valid and collectable Insurance Indemnity for which benefits may be payable are Insurance programs provided by: a. Individual, group or blanket Insurance or coverage; b. Other prepayment coverage provided on a group or individual basis; c. Any coverage under labor management trusted plans, union welfare plans, employer organizational plans, employee benefit organization plans, or other arrangement of benefits for individuals of a group; d. Any coverage required or provided by any statute, socialized Insurance program; e. Any no-fault automobile Insurance; f. Any third party liability Insurance.
Refund of Premium
Certain Underwriters at Lloyds, London realizes that there is uncertainty in international travel. Refund of total plan cost will only be considered if written request is received by the Administrator prior to the Effective Date of Coverage. If written request is received after the Effective Date of Coverage, the unused portion of the Plan cost may be refunded minus a cancellation fee, provided no claim has been submitted to the Administrator for reimbursement.
To the extent the Underwriter pays for a loss suffered by an Insured, the Underwriter will take over the rights and remedies the Insured had relating to the loss. This is known as subrogation. The Insured must help the Underwriter to preserve its rights against those responsible for the loss. This may involve signing any papers and taking any other steps the Underwriter may require. If the Underwriter takes over an Insured’s rights, the Insured must sign an appropriate subrogation form supplied by the Underwriter.
Please be aware that this is not a general health insurance policy but an interim travel medical program intended for use while away from
Your Home Country or Country of Residence.