Travel Insurance Classic Plan Online Services

General Exclusions

In addition to any other exclusions that may apply to a particular

benefit, no coverage is provided for any loss that results directly

or indirectly from any of the following unless as specifically

included: existing medical conditions (unless as specifically

covered); intentionally self-inflicted harm, suicide or attempted

suicide by you, your traveling companion or your family member;

normal pregnancy (unless as specifically covered), fertility

treatments, childbirth or elective abortion, other than unforeseen

complications of pregnancy, of you, a traveling companion, or a

family member; mental or nervous health disorders, including

but not limited to: anxiety, depression, neurosis, psychosis and

others; or physical complications related thereto of you, a traveling

companion or a family member; alcohol or substance abuse or

use; or conditions or physical complications related thereto of you,

a traveling companion or a family member; war (whether declared

or undeclared), acts of war, military duty (unless as specifically

covered), civil disorder or unrest (except as provided for in travel

delay); participation in professional or amateur sporting events

(including training); all extreme, high risk sports including but not

limited to: bodily contact sports; skydiving; hang gliding, bungee

jumping, parachuting; mountain climbing or any other high

altitude activities, caving, heli-skiing, extreme skiing, or any skiing

outside marked trails; scuba diving (unless accompanied by a dive

master and not deeper than 120 feet); operating or learning to

operate any aircraft as pilot or crew; nuclear reaction, radiation or

radioactive contamination; natural disasters (unless as specifically

covered); terrorist events (unless as specifically covered); epidemic

or pandemic; pollution or threat of pollutant release; any unlawful

acts committed by you, family members, or traveling companions,

whether they are insured or not; any expected or reasonably

foreseeable events; or financial default of a travel supplier (unless

as specifically covered).

Existing Medical Conditions Coverage & Exclusion

Your plan may provide existing medical conditions coverage if

you, a traveling companion or family member has an existing

medical condition. An existing medical condition is an illness

or injury that exhibited symptoms or was treated for any time

120 days prior to purchasing your plan. Coverage for an existing

medical condition is excluded unless: 1) You purchased your

plan within 14 days of making your first trip payment or first trip

deposit; 2) You purchased trip cancellation coverage that covers

the full cost of all your non-refundable trip arrangements; 3) You

were a U.S. resident and medically able to travel on the day you

purchased the plan; and 4) The total cost of your trip is $50,000

per person or less.

All other contract terms and conditions apply.

Supplier Financial Default Protection

Supplier financial default protection is provided when:

1) You purchase your insurance within 14 days of initial trip

payment or deposit; 2) Financial default occurs more than

seven days after the policy’s effective date; and 3) You use a

travel supplier (other than the organization from which you

purchased this insurance or their affiliate companies) listed as

a covered supplier at the time of insurance purchase. A list of

these covered suppliers can be found on our website at

PLEASE BE ADVISED: This optional coverage may duplicate

coverage already provided by your personal auto insurance

policy, homeowner’s insurance policy, personal liability

insurance policy or other source of coverage. This insurance is

not required to purchase any other products/services. Unless

separately licensed, travel retailer employees are not qualified/

authorized to answer technical questions about coverage

details or evaluate your existing coverage. Plan is intended for

U.S. residents only and may not be available in all jurisdictions.

Additionally:

California Residents: This plan contains disability insurance

benefits or health insurance benefits, or both, that only apply

during the covered trip. You may have coverage from other

sources that already provides you with these benefits. You

should review your existing policies. If you have any questions

about your current coverage, call your insurer or health

plan. We are doing business in California as Allianz Global

Assistance Insurance Agency, License # 0B01400.

Florida Residents: The benefits of the Policy providing your

coverage are governed primarily by the law of a state other

than Florida.

New York Residents: The licensed producer represents the

insurer for purposes of the sale. Compensation paid to the

producer may depend on the policy selected, or the producer’s

expenses, volume of business, or profitability. The purchaser

may request and obtain information about the producer’s

compensation, except as otherwise provided by law.

Utah Residents: We are doing business in Utah as Allianz

Global Assistance Insurance Agency.

Footnotes from opposite side.

Benefits are per person. All insureds must purchase the same plan in order to

be on the same policy.

NY Residents: this coverage is covered under the trip cancellation/interruption

protection benefit.

Due to fire, flood, vandalism, burglary, natural disaster.

Children 17 years of age or under on the date the insurance is purchased are

also covered in full when traveling with their parents or grandparents –at no

extra cost. The maximum benefit payable to a child (under 18 years of age) is

equal to the maximum benefit payable to a covered parent or grandparent.

Travelers under the age of 18 who are not traveling with their parent(s) or

grandparent(s) will be subject to the rates for travelers 18–30.

Jefferson Insurance Company

BCS Insurance Company

Allianz Global Assistance

Travel Insurance

Classic Plan

Online Services

With Allianz Travel Insurance, you can

purchase your plan, modify your plan,

even file and track claims, through

2 Insurance coverage is underwritten by BCS

Insurance Company (OH, Administrative Office:

Oakbrook Terrace, IL), rated “A-” (Excellent) by

A.M. Best Co., under BCS Form No. 52.201 series or

52.401 series, or Jefferson Insurance Company

(NY, Administrative Office: Richmond, VA), rated

“A” (Excellent) by A.M. Best Co., under Jefferson

Form No. 101-C series or 101-P series, depending

on the insured’s state. Allianz Global Assistance and

Allianz Travel Insurance are brands of AGA Service

Company. AGA Service Company is the licensed

producer and administrator of this plan and an

affiliate of Jefferson Insurance Company. The insured

shall not receive any special benefit or advantage

because of the affiliation between AGA Service

Company and Jefferson Insurance Company.

PID 3432, 3433, 3436

Purchasing your travel insurance

is fast and easy.

Contact PrintName at:

Phone

Altphone

PrintWebAddress

Effective Oct., 2013

AGA Service Company is the licensed producer and administrator for this plan.

12092 040814

ACCAM NUMBER

ACCAM

www.allianztravelinsurance.com.

Covered Reasons for Trip Cancellation

and Trip Interruption

Allianz Travel Insurance can pay trip cancellation and

interruption claims when you cancel or interrupt your trip

due to certain situations*. These situations are called “covered

reasons”. For this plan, these covered reasons include:

Kids Coverage for Free

There is no charge for covering kids 17 and under when they

are traveling with their parents or grandparents.

Maximize Your Coverage

To make sure you’re eligible for the available Required to Work

enhancement, existing medical conditions coverage and

supplier financial default protection, buy the Classic Plan

within 14 days of your initial trip deposit.

Classic Plan Rates

Trip Cost Per

Person ($)

up to

age 17

age

18-30

age

31-59

age

60-70

age

71-75

age

76-79

age

80+



$0 $26 $30 $41 $53 $62 $80

1-500 $0 $29 $38 $51 $90 $111 $160

501-1,000 $0 $41 $58 $78 $110 $135 $191

1,001-1,500 $0 $54 $79 $107 $146 $179 $250

1,501-2,000 $0 $68 $103 $145 $187 $228 $315

2,001-2,500 $0 $92 $130 $174 $235 $287 $392

2,501-3,000 $0 $109 $151 $200 $265 $323 $439

3,001-3,500 $0 $126 $149 $232 $302 $368 $500

3,501-4,000 $0 $137 $169 $259 $336 $410 $554

4,001-4,500 $0 $169 $175 $267 $346 $422 $569

4,501-5,000 $0 $171 $242 $359 $463 $569 $760

5,001-5,500 $0 $193 $277 $406 $522 $643 $856

5,501-6,000 $0 $215 $312 $454 $583 $718 $954

6,001-6,500 $0 $258 $381 $547 $701 $866

$1,145

6,501-7,000 $0 $289 $426 $606 $770 $947

$1,251

7,001-8,000 $0 $306 $452 $642 $815

$1,001 $1,322

8,001-9,000 $0 $335 $498 $704 $893

$1,098

$1,448

9,001-10,000 $0 $356 $532 $750 $950

$1,168

$1,539

For additional pricing, visit

for pricing on trips from $10,001–$100,000. Prices subject to change.



Zero trip cost means there is no coverage for trip cancellation

or trip interruption.

This is a brief description of the insurance and assistance benefits provided by this plan. Terms, conditions and

exclusions apply. A complete description of coverage, found in the Certificate of Insurance/Policy, will be provided

to you upon purchase. If you do not receive this document please call 800-284-8300.

Classic Plan

Assistance Services

Emergency Medical Transportation $500,000

Provides medically necessary transportation to the nearest

appropriate facility following a covered illness or injury. Also

covers the cost of your transportation back home following

a covered illness or injury. (FL, NY, OR, & WA residents see 2)

24-Hour Hotline Help Included

Help is just a phone call away with Allianz Global

Assistance. Our staff of multilingual problem solvers

is available to help you with any medical, legal or

travel-related emergency.

Benefit Enhancements

Trip +

Enjoy the protection of Classic with double the limits

for the following benefits:

Missed Connection

Travel Delay

Emergency Medical and Dental

Emergency Medical Transportation

Baggage Loss/Damage

Baggage Delay

Required to Work

2 Provides trip cancellation and interruption coverage

when the following reasons stand between you and your

travel plans: you are required to work due to business/

company merger, because your workplace becomes

unsuitable for business,

or simply because your boss

tells you so.

Trip Cost Protection

Trip Cancellation Up to 100% of Trip Cost

2 Reimburses your prepaid, non-refundable expenses

if you must cancel your trip due to a covered reason.

Maximum coverage: $100,000.

• Special coverage: Airline change fees

and Frequent

Flyer mile redeposit fees are covered up to $250 each

Trip Interruption Up to 150% of Trip Cost

2 Reimburses for the unused, non-refundable portion

of your trip and for the increased transportation costs it

takes for you to return home or to continue your trip due

to a covered reason. Maximum coverage: $150,000.

Missed Connection $800

2 Reimburses for covered expenses resulting from a

covered delay that causes you to miss your scheduled

flight or cruise.

Travel Delay $800

2 Receive up to $200 per day per person to cover

additional accommodation/travel expenses and lost

prepaid expenses due to a departure delay of six or

more hours.

Medical Protection

Emergency Medical and Dental $25,000

2 This primary coverage provides benefits for losses

due to covered medical and dental emergencies that

occur during your trip. No deductible. $750 maximum

for emergency dental care.

Baggage Protection

Baggage Loss/Damage $1,000

2 Covers loss, damage or theft of baggage and

personal effects.

Baggage Delay $300

2 Covers the reasonable additional purchase of

essential items during your trip if your baggage is

delayed or misdirected by a common carrier for

24 hours or more. Receipts for emergency purchases

are required.

Want peace of mind knowing that you can

cancel your trip for almost any reason?*

Ask your travel professional about

Classic with Cancel Anytime.

* Terms, conditions and exclusions apply. Consult Allianz Global

Assistance for the terms and conditions or download them at

** Trip cancellation only. Pregnancy must occur after effective date.

*** Due to fire, flood, vandalism, burglary, natural disaster.

†

Must be employed with your current employer for

12 continuous months.

‡

At least 24 hours due to FAA shutdown, severe weather, strike,

natural disaster.

◊

Coverage not available in all countries or for all cars.

Required to Work Rates

Additional $34 per person.

Trip + Rates

Additional 35% of Classic Plan rate per person.

Save Time and Money at the

Rental Counter

Rental Car Protector

◊

provides primary

coverage with no deductible, for only $9 a day.

Talk to your agent today!

See reverse for footnotes.

Insurance benefit. See reverse for more information.

When you purchase an Allianz Global

Assistance travel insurance plan, you have

10 days to review the coverage details. In

that timeframe, you can cancel your plan

for any reason and receive a full refund, as

long as you haven’t already traveled or filed

a claim. The review period differs by state, so

refer to your insuring agreement for details.

Covered Illness, injury, death

Supplier financial default

Victim of felonious assault

Subpoena/court order

Normal pregnancy**

Employer termination†

Loss of accommodation

Travel delay resulting in

loss of 50% of trip length

Destination

uninhabitable***

Legal separation/divorce

Home uninhabitable**

Traffic accident en route

Terrorism

Military duty

Witness birth**

Hijacking

Quarantine

Jury duty

Complete shutdown of

service by travel supplier

‡