Your Home Country is where you reside at the time you apply for the insurance. There can be only one Home Country declared on each Application.
For the purposes of determining the proper premium and insurance benefits, Africa will include (but not necessarily be limited to) every country located on the continent of Africa and the islands of Madagascar and the Seychelles.
For the purposes of determining the proper premium and insurance benefits, the Middle East will include (but not necessarily be limited to) the following countries: Turkey, Cyprus, Syria, Iraq, Iran, Jordan, Lebanon, Israel, Saudi Arabia, Kuwait, Qatar, United Arab Emirates, Bahrain, Oman and Yemen.
For the purposes of determining the proper premium and insurance benefits, Asia will include (but not necessarily be limited to) the following countries: Afghanistan, Pakistan, India, Maldives, Sri Lanka, Nepal, Tibet, Bangladesh, Bhutan, Myanmar, Thailand, Laos, Kampuchea, Vietnam, Malaysia, Singapore, Indonesia, Brunei, Papua New Guinea, Philippines, China, Taiwan, North and South Korea, Mongolia, Hong Kong and Japan.
For the purposes of determining the proper premium and insurance benefits, the Caribbean Islands will include (but not necessarily be limited to) the following: The Bahamas, Greater Antilles (Cuba, Jamaica, Puerto Rico, Hispaniola), Lesser Antilles (Virgin Islands, Leeward Islands, Windward Islands, Barbados, Tobago, Trinidad), and the Netherlands Antilles (Aruba, Bonaire, Curacao).
An eligible person over the age of 15 days and under the age of 71 years who is living or traveling outside their home country for whom the applicable premium has been received and accepted by the Company. Eligible children are those children over the age of 15 days and under the age of 20 years living with their parent(s) outside their Home Country.
A bodily injury which results directly and independently of all other causes, from an accident occurring while you are covered under the Policy.
A sickness, illness or disease which first manifests itself while you are covered under the Policy.
The Usual and Customary expenses incurred during the Period of Insurance for medical care, treatment, services or supplies, recommended and approved by the attending Physician which are the direct result of a Covered Injury or Sickness.
Any injury or sickness, or complications arising therefrom, for which you had manifested symptoms, or for which a Physician was consulted, treatment or medication was prescribed or taken, within one year (365 days) immediately prior to the Period of Insurance.
A person properly licensed to practice medicine in the jurisdiction and/or country where the treatment is provided and includes doctors of medicine, general practitioners, specialists and medical consultants other than you or your immediate family.
Pan-American Life Insurance Company
601 Poydras Street
New Orleans, Louisiana 70130 USA
Wallach & Company, Inc.
107 West Federal Street, Post Office Box 480
Middleburg, Virginia 20118-0480 USA
Law and Conformity to Statutes
Any provision of the Policy which, on its effective date, is in conflict with the statutes of your legal jurisdiction, is hereby amended to conform to the minimum requirements of such statutes.
Entire Contract: Changes
The Policy and your Application constitute the entire contract between the parties. No change in the Policy shall be valid unless approved by an executive officer of the Company and unless such approval be endorsed hereon or attached hereto.
Notice of Claim
Written notice of claim must be given to the Administrator within 45 days after the occurrence or commencement of any loss covered by the Policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the claimant to the Administrator at its offices or to any authorized agent of the Company, with information sufficient to identify you, shall be deemed notice of claim.
Upon receipt of a written notice of claim, the Administrator will furnish to the claimant such forms as are usually furnished for filing Proof of Loss. If such forms are not furnished within 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.
Proof of Loss
Written Proof of Loss must be furnished to the Company within 45 days after the date of such loss, or as soon thereafter as reasonably possible. The completed claim form must be accompanied by the original Proofs of Loss such as bills, receipts, etc. for all expenses. Photocopies are not acceptable.
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 therein and effective at the time of payment.
Medical Expense Benefits payable under this policy will be coordinated with those of other insurance policies you may have so that the total benefits from all policies do not exceed the actual medical expenses incurred. The Company retains full rights of subrogation.
Right of Subrogation
Subrogation means the Company has the right to request a refund of payments made under the following conditions:
The Company will be subrogated to any claim you have against a third party provided:
- You were injured or became ill due to the act or omission of the third party; and
- The Company paid benefits to you under this insurance for such Covered Injury or Sickness.
The Company can only seek repayment of the amount of benefits paid.
If you collect any sums for damages from the third party, he/she will be liable to the Company for the benefits already paid by the Company. If you sue to recover expenses, the Company can join in the suit. If you do not sue, the Company can do so in your name.
You are obligated to:
- Avoid doing anything that would prejudice the Company’s Right of Subrogation; and
- Execute any documents required to enforce the Company’s right. (Failure to execute the required documents does not waive the Company’s right to collect any sums for damages from the third party.)
Once settlement has been made and the Company has been reimbursed the amount of benefits paid, no other benefits are payable for the condition or related condition which gave rise to the claim.
The beneficiary designation for Insured Persons shall be “ESTATE”. You may name a beneficiary or change a named beneficiary by written request to the Company. The request takes effect on the date it is executed regardless of whether or not you are living when the Company receives it. The Company will be relieved of further responsibility to the extent of any payment made in good faith before receiving said request.
Not in Lieu of Workers’ Compensation
The Policy is not in lieu of and does not affect any requirement for coverage by Workers’ Compensation Insurance, or any other occupational benefit plan or public assistance program.
Change of Premiums
The Company has the right to change the rate at which premiums will be calculated for any time period or Period of Insurance under the Policy. Additional premium may be required to cover certain war risks otherwise excluded. Persons traveling to an area where a state of war exists, that is faced with the threat of war, or is in a state of civil unrest must include that information on the Application.
Exposure and Disappearance
If by reason of an accident covered by the Policy you are unavoidably exposed to the elements and as a result suffers (within six months after the accident), a loss attributable to such exposure, the loss will be covered. If your body has not been found within six months of an accident or disappearance of the aircraft or vessel on which you were known to be a passenger, then it shall be deemed (subject to all other provisions of this insurance), that you shall have suffered loss of life at the time of the incident.
Extension of Benefits
If on the last day of the Period of Insurance, you are hospitalized (as an inpatient) outside your Home Country for a Covered Injury or Sickness, the Period of Insurance will be extended until it is medically confirmed that further inpatient hospitalization is no longer necessary, subject to an overall maximum of 13 weeks beyond the last day of the Period of Insurance.
Physical Examinations and Autopsy
While a claim is pending, the Company has the right at their expense: (a) to have you examined by a physician, when and as often as is reasonably necessary; and (b) in case of death to perform an autopsy, unless forbidden by law or local custom.
No legal action may be taken against the Company: (a) before 90 days following the date the fully completed proof of loss is sent to the Company; or (b) after three years following the date Proof of Loss is due.
The coverages under the Policy are not generally assignable. However, benefits payable for services received under the Medical Expense Benefits provision may be assigned to the provider of those services in accordance with the Payment of Claims provision of the Policy.
Certificate of Insurance
The Company will issue for delivery to you an individual Certificate of Insurance describing the benefits to which you are entitled under the Policy, the limitations and exclusions of the Policy, and the Period of Insurance as it pertains to you.
Payment of Premium and Renewal of Policy
If payment of a premium is not honored by the bank or credit card drawn upon, the insurance is deemed to have not been purchased. No less than 30 days prior to the expiration of the policy, a renewal Application will be mailed to you at the most recent address on file. The completed renewal Application and correct premium must be received by the Administrator prior to the expiration of the previous policy in order for coverage to remain in effect. All renewals are subject to approval by the Company.
The insurance policy is in force only while you are living (or traveling) outside your Home Country; however, limited coverage remains in force if; (a) you return to your Home Country for a temporary visit. (See Home Country Coverage.); or (b) if you return to your Home Country permanently prior to the expiration of the insurance. (See Period of Insurance.)