Insurance Information

A PLAN OF INSURANCE
A service of American Institute For Foreign Study for RESORT AMERICA

Introduction
It is our privilege to extend to all participants in our Camp America and Resort America programs one of the most comprehensive insurance plans offered to international students working in the U.S.

The medical plan applies to all participants on the program sponsored by Camp America. If you have purchased the baggage insurance, you have additional coverage.

Dates of Coverage
The insurance package will commence on your outbound flight from your home country to the United States (no earlier than May 1). Coverage ends at 153 days, October 31 or the date you cease to be a Camp America participant. Failure to show at camp will mean the insurance will be terminated.

a) Expiration of the term of coverage, which is for a maximum of 153 days or until October 31, whichever comes first. Coverage remains in effect during any independent travel.

b) Your termination as a program participant as a result of your resignation or dismissal from the program.

c) Disembarkment from your Camp America return flight home, or departure from the United States if you have provided your own transportation.

You will not be covered by your insurance during any period in which you accept employment, paid or otherwise, from any source other than the camp/resort with which you have been placed by Camp America or Resort America. The plan does not cover travel outside the U.S. and Canada. The only exception is travel to Mexico, where coverage is limited to a trip of no more than 48 hours.

Description of Benefits

Accidental Death and Dismemberment
If covered injuries result in death or dismemberment within one year after the date of accident, the plan provides the following benefits for loss of:

Only one benefit, the largest to which you are entitled, is payable for all losses resulting from the same accident. Maximum aggregate benefit per occurrence is $1,000,000.

Medical Expense Plan (Accident & Sickness)
The plan will pay usual, customary and reasonable amount of the Covered Accident and Sickness Medical Expense in excess of $50 per incident incurred within 52 weeks of date of accident or commencement of sickness— up to $500,000 for each accident or up to $500,000 for each sickness.

Emergency Dental Treatment
Shall be limited to the cost of initial emergency examination and initial treatment to alleviate pain resulting from infection of gums or sound natural teeth up to an overall maximum benefit of $500.

Participants aged 40+
Participants aged 40—60 are eligible for only $50,000 basic medical coverage and upgrades for the baggage. Participants over 60 are eligible for only a maximum $5,000 medical coverage and upgrades associated with baggage.

Return Airfare Expenses Reimbursement
Return air fare expenses incurred as a direct result of a covered accident, sickness, or emergency are covered by the plan providing the claim meet the provisions of the policy and written verification is received. Camp America must be notified first in the event a participant requires a return flight. the maximum expense payable for one or any combination of provisions is $1,000.

In the event of death of a parent, grandparent, sibling or legal guardian, the insurance company will arrange and pay for your return airfare (tourist class) from the United States to your foreign point of departure. Camp America must be advised and approve the flight. Retroactive claims will not be accepted.

Chiropractic Services
Chiropractic services and physical therapy shall be limited to a total of $50 per visit, with a maximum 10 visits per injury or illness. The overall maximum coverage per injury or illness for chiropractic care care is $500, which includes X-ray and evaluation charges.

Emergency dental
Treatment shall be limited to the cost of initial emergency examination and initial treatment to alleviate pain resulting from infection of gums or sound natural teeth up to an overall maximum benefit of $500.

Team Assist Plan (TAP), as provided by AIG Assist
The Team Assist Plan (TAP) is designed by CISI in conjunction with the Assistance Company to provide travelers with a worldwide, 24-hour emergency telephone assistance service. Multilingual help and advice may be furnished for the Insured in the event of any emergency during the term of coverage. The Team Assist Plan complements the insurance benefits provided by The Insurance Company of the State of Pennsylvania. The Assistance Company will be AIG Assist.

Emergency Medical Evacuation/Repatriation
The Company shall pay benefits for Covered Expenses incurred up to the maximum stated in the Schedule of Benefits, if any Injury or covered Illness commencing during the Period of Coverage results in the Medically Necessary Emergency Medical Evacuation or Repatriation of the Insured Person.

The decision for an Emergency Medical Evacuation or Repatriation must be ordered by the Company’s appointed Assistance Company in consultation with the Insured Person’s local attending Physician. Emergency Medical Evacuation or Repatriation means:

• a) the Insured Person’s medical condition warrants immediate transportation from the place where the Insured Person is located (due to inadequate medical facilities) to the nearest adequate medical facility where medical treatment can be obtained; or
• b) after being treated at a local medical facility, the Insured Person’s medical condition warrants transportation with a qualified medical attendant to his/her Home Country to obtain further medical treatment or to recover; or
• c) both a) and b) above.

Covered Expenses are for Emergency Medical Evacuation/Repatriation, for transportation, medical services and medical supplies necessarily incurred in connection with Emergency Medical Evacuation or Repatriation of the Insured Person.

Return of Mortal Remains or Cremation
The Company will pay the reasonable Covered Expenses incurred up to the maximum as stated in the Schedule of Benefits, Return of Mortal Remains, to return the Insured Person’s remains to his/her then current Home Country, if he or she dies. Covered Expenses include, but are not limited to, expenses for embalming, cremation, a minimally necessary container appropriate for transportation, shipping costs and the necessary government authorizations. All Covered Expenses in connection with a Return of Mortal Remains must be pre-approved and arranged by an Assistance Company representative appointed by the Company.

The Team Assist Offers These Services
Medical assistance: Medical referral, medical monitoring, prescription drug replacement/shipment, emergency message transmittal, coverage verification/ payment assistance for medical expenses

Travel assistance: Assistance in obtaining emergency cash , traveler check replacement assistance, lost/delayed luggage tracing, replacement of lost or stolen airline ticket

Technical assistance: Credit card/passport/important document replacement, locating legal services, assistance in posting bond/bail, worldwide inoculation information. Usual, Customary and Reasonable

Bases for determining payment amounts for UCR are: Usual —an amount a professional provider usually charges for a given service Customary — an amount which falls within the range of charges for a service billed by most professional providers in the same locality who have similar training and experience

Reasonable — an amount which is usual and customary or would not be considered excessive in a particular case because of unusual circumstances

• Pre-Existing Conditions, as defined, except as specified: a) If the Insured Person does not receive medical care or services, including prescription drugs or other medical supplies, and is not under the care of a Physician with respect to the Pre-Existing Condition or related condition(s), for a period of 12 consecutive months beginning on or after the first day of coverage, the preexisting condition exclusion will no longer apply and any eligible charges incurred after the treatment free period will be considered for reimbursement; b) Emergency Medical Evacuation/ Repatriation and Return of Mortal Remains
• Charges for treatment which exceed Reasonable and Customary charges
• Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes
• Services, supplies or treatment, including any period of Hospital confinement, which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician
• Suicide or any attempt thereof, while sane or self destruction or any
  attempt thereof, while sane
• Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with: a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war or b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power
• Routine physicals, immunizations, or other examinations where there are no objective indications or impairment in normal health, and laboratory diagnostic or x-ray examinations, except in the course of a Disablement established by a prior call or attendance of a Physician
• Treatment of the Temporomandibular joint
• Vocational, speech, recreational or music therapy
• Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person
• The refusal of a Physician or Hospital to make all medical reports and records available to the Company will cause an otherwise valid claim to be denied
• Cosmetic or plastic Surgery, except as the result of a covered Accident; for the purposes of this Policy, treatment of a deviated nasal septum shall be considered a cosmetic condition
• Elective Surgery/Treatment which can be postponed until the Insured Person returns to his/her Home Country, where the objective of the trip is to seek medical advice, treatment or Surgery
• Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereof, unless caused by Accidental bodily Injury incurred while insured hereunder
• Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent
• Injury sustained while under the influence of or Disablement due to wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician for a condition which is covered hereunder
• Any Mental and Nervous disorders or rest cures, except as specified
• Treatment while confined primarily to receive custodial care, educational
• or rehabilitative care, or nursing services
• Congenital abnormalities and conditions arising out of or resulting therefrom
• Expenses as a result or in connection with intentionally self-inflicted Injury or Illness
• Expenses as a result or in connection with the commission of a felony offense
• Hang gliding, parachuting, bungee jumping, racing by horse, motor vehicle or motorcycle, parasailing
• Injuries for which benefits are payable under any no-fault automobile Insurance Policy
• Dental care, except as the result of Injury to natural teeth caused by Accident, unless otherwise covered under this Polic
• Routine Dental Treatment
• For Pregnancy or Illness resulting from Pregnancy, childbirth or miscarriage
• Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion
• Treatment for human organ tissue transplants and their related treatment
• Weak, strained or flat feet, corns, calluses, or toenails
• Diagnosis and treatment of acne
• Injury sustained while the Insured Person is riding as a pilot, pilot, operator or crew member, in or on, boarding or alighting from, any type of aircraft.

In addition to the exclusions listed above, the following exclusions apply to
Accidental Death and Dismemberment Insurance only:

• Disease of any kind
• Bacterial infections except pyogenic infection which shall occur through an accidental cut or wound
• Neuroses, psychoneuroses, psychopathies, psychoses or mental or emotional diseases or disorders of any type

Right of subrogation
To the extent the Company pays for a loss suffered by an Insured, the Company will take over the rights and remedies the Insured had relating to the loss. This is known as subrogation. The Insured must help the Company to preserve its rights against those responsible for the loss. This may involve signing any papers and taking any other steps the Company may reasonably require. If the Company takes over an Insured’s rights, the Insured must sign an appropriate subrogation form supplied by the Company.

Elective surgery
Elective surgery means surgery or medical treatment not necessitated by a pathological or traumatic change in the function or structure in any part of the body first occurring after the insured’s effective date of coverage. Elective surgery includes, but is not limited to, circumcision, tubal ligation, vasectomy, breast reduction, sexual reassignment surgery and submucous resection and/or other surgical correction for deviated nasal septum, other than for necessary treatment of covered acute purulent sinusitis. Elective surgery does not apply to cosmetic surgery required to correct a covered accident.

Elective treatment
Elective treatment means surgery or medical treatment not necessitated by a pathological or traumatic change in the function or structure in any part of the body first occurring after the insured's effective date of coverage. It includes, but is not limited to, acne, nonmalignant warts and moles, weight reduction, infertility and learning disabilities.

Personal effects coverage
This coverage provides you with $2,000 in Personal Effects Coverage subject to a maximum $100 per item ($500 for electrical items/valuables) and deductible of $100 per incident for loss or theft of your personal items.

The following exclusions apply:

• loss of money, notes, securities, tickets and documents (driver’s licenses, passports, passes, etc.)
• jewelry, watches, computers, articles consisting in whole or in part of silver, gold or platinum and furs
• animals, automobiles, automobile parts and equipment, motorcycles, skis, bicycles, boats, motors or other conveyances
• any kind of glasses (including sunglasses) and contact lenses
• breakage of articles or a brittle nature unless caused by thieves
• loss or damage caused by, or resulting from, declared or undeclared war
• loss due to wear, tear, gradual deterioration or negligence on the part of the Insured

How to Make a Medical Claim

Complete the Medical Claim form fully. Attach all original bills and/or receipts for all amounts being claimed. No refunds will be made for expenses not accompanied by bills or receipts.

SUBMIT MEDICAL CLAIMS TO THE FOLLOWING ADDRESS:

Cultural Insurance Services International
9 West Broad Street,
Stamford, CT 06902 USA

You are strongly advised to copy the completed claim form and all accompanying documentation, before sending it on.

Baggage Insurance

How to Make a Baggage Claim

Report the loss/damage to the relevant authority. If your baggage has been stolen, you must:

1. Obtain a Police Report.
2. Complete the Baggage Loss/Damage Form. Submit all documentary evidence, Police Report, any bills, and/or receipts, and send to:

Cultural Insurance Services International
River Plaza
9 West Broad Street
Stamford, CT 06902, USA

You are strongly advised to keep a copy of your completed claims form and all accompanying documents before submitting your claims form (Note: you must submit originals only).

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