TRAVEL INSURANCE TERMS & CONDITIONS

Whereas the Policyholder has made to Allianz Insurance Lanka Ltd (hereinafter called the Company), a proposal which is hereby agreed to be the basis of this Policy and has paid the premium specified in the Schedule, now the Company agrees, subject always to the following terms, conditions, exclusions, and limitations, to indemnify the Insured in excess of the amount of the Deductible and subject always to the Sum Assured against such loss as is herein provided.

A       OPERATIVE PARTS

Section A: Overseas emergency accident and sickness medical expenses, Evacuation and Repatriation  

1.1        The Company will indemnify the Insured up to the Section A Sum Assured (in excess of USD 50) specified in the Schedule of Benefits in respect of:

1.1.1     The medical and related expenses incurred by the Insured for medical Treatment outside Sri Lanka. The expenses covered would include Physician services, hospital and medical services and local emergency medical transportation. Dental services for immediate relief of dental pain are covered up to USD. 500. However dental care rendered necessarily as a result of a covered accident shall be subject to the limit of cover as stated in the policy.

1.1.2     Medical evacuation to a hospital in Sri Lanka required as a result of accidental bodily injury and/or sickness and/or disease occurring or having first manifested itself during an Insured journey. The medical evacuation will have to be pre approved by the Claims Administrator of the Company.

1.1.3     In case of medical evacuation to a hospital in Sri Lanka as per 1.1.2 above and if approved by the Claims Administrator, and subject to the section A sum Insured remaining (if any), the Company will also indemnify the Insured in respect of the medical expenses incurred by him within Sri Lanka to continue medical treatment commenced by the Insured outside of Sri Lanka, as a result of the Insured first having sustained accidental bodily injury and/or sickness and/or disease during the course of the Insured Journey. The Company’s liability to make payment hereunder shall be limited to a period of 60 days from and including the date upon which the aforesaid accidental bodily injury and/or sickness and/or disease occurred or first manifested itself, and to medical expenses at the Usual and Customary level.

1.1.4     The Company shall be under no liability to make payment of any medical expenses incurred beyond the expiry of the policy period, same as provided for under section 1.1.5

1.1.5     The cost of repatriating the Insured’s mortal remains to Sri Lanka, or up to an equivalent amount for the burial or cremation of the Insured in the country where the death occurred in the event of the Insured’s death outside of Sri Lanka as a result of accidental bodily injury and/or sickness and/or disease occurring or having first manifested itself during an Insured journey. These expenses should have to be pre approved by the claim administrator prior to the remains being prepared for transportation to Sri Lanka or for local burial or cremation.

The deductible applicable as per the schedule of benefits would be applicable in respect of each and every claim made under the policy and the Company’s liability would be restricted to the section A sum assured as per the schedule of benefits during the policy period.

Exclusions Applicable for section A 
        
1.2        The Company shall be under no liability to make payment in respect of any routine physical or other examination where there is no objective indication of impairment or normal health, and for medical treatment obtained within Sri Lanka save as provided for under section 1.1.3
        
1.3        The Company shall be under no to make payment of any medical expenses incurred beyond the expiry of the policy period.

1.4         the Company shall be under no liability to make payment hereunder in respect of any claim directly indirectly caused by, based on, arising out of or how so ever attributable to any of the following
                             
                        1.4.1     Where the Insured is

1.4.1.1. Travelling against the advice of the physician; or

1.4.1.2. Receiving or on a waiting list for specified medical treatment or

1.4.1.3. Travelling for the purpose of obtaining treatment; or

1.4.1.4. In respect of a terminal prognosis for a medical condition

1.4.2.     Suicide, attempted suicides or wilful or self inflected injury or
Illness, mental disorder, anxiety, stress or depression, venereal disease, alcoholism, drunkenness or the abuse of the drugs.
                       
1.4.3     Any injury, illness, death, loss expense or other liability attributable to HIV (Human immune deficiency virus) and/or any HIV related illness including AIDS (Acquired immune deficiency syndrome) and/or any mutant derivative or variation thereof how ever caused

1.4.4.     Pregnancy, childbirth, miscarriage, abortion or complication arising out of any of the foregoing.

1.4.5.    The cost of dentures, dental appliances, false limbs, hearing aids, contact or cornel lenses or spectacles (prescribed or otherwise)

1.4.6.    Treatment for any illness/sickness which was pre existing prior to purchase of the return air ticket using the Card members American Express Green or Gold credit card.

1.4.7.    Treatment of any congenital anomalies/defects.  

1.4.8.    The additional cost of a single or private room at a hospital, clinic or nursing home except when the medical practitioner considers it necessary.

1.4.9.    Services, supplies or treatment, including any period of hospital confinement, which were not recommended, approved and certified as Medically Necessary by a Physician;

1.4.10   elective, cosmetic, or plastic surgery, except as a result of  an accident;

1.4.11   the diagnosis and treatment of acne

1.4.12   organ transplants that competent medical professionals consider experimental:

1.4.13   child care such as medical examinations, vaccinations and immunizations;

1.4.14   expenses which are not exclusively medical in nature

1.4.15   any expenses incurred in Sri Lanka

1.4.16   eyeglasses, contact lenses, hearing aids, and examination for the prescription of fitting thereof, unless injury or Sickness has caused impairment of vision or hearing; or
                          
1.4.17    treatment provided in a government hospital or services for which no charge is normally made;

1.4.18   medical expenses covered under any workers compensation only

2. Section B : Personal Accident

2.1        The Company will pay the percentage up to section B sum assured specified in the schedule of benefits if the Insured sustain accidental bodily injury during the course of the Insured journey and such bodily injury is within 12 months of the date of such bodily injury the sole and direct cause of the:

2.1.1. Insured’s death, as per the Table of Losses below

2.1.2. Permanent Total Disablement as per Table of Losses below ,

2.2        Provided always that the policy will not pay under more than one of the Foregoing sub clauses in respect of the same accident and in excess of the amount stated in the Scheduled of Benefits.

2.3       The Company' will be liable to pay 50% of the Sum assured stated in the Schedule of Benefits in respect of the death of the Insured person if the Insured Person’s age is under 16 years at the time of death;

Table of Losses

Exclusions Applicable for section B 
        
2.4         the Company shall be under no liability to make payment hereunder in respect of any claim directly indirectly caused by, based on, arising out of or how so ever attributable to any of the following

2.4.1.    Amateur sports involving physical contact and other sports activities as defined in sports and leisure activities. In any event there shall be no over under this insurance for sky jumping, flying, acrobatics, stunting, mountaineering, randonee, bungee jumping, rock climbing or mountaineering, normally requiring the use of ropes and guides, caving or potholing, rafting or canoeing involving white water rapids in excess of grade 6, parachuting, paragliding, paragliding, hangliding, motor sports or competitions, hunting or equestrian competitions, yachting or boating outside costal water (12 miles), scuba diving at a depth of more than 30 meters, professional sports, riding or driving in races or allies.

2.4.2     Loss arising from accidents as a driver on motorised vehicle unless at the time of the accident the Insured is in possession of a current full international driving license and while riding a two wheeler is wearing a safety crash helmet.

2.4.3.     Aviation other than solely as a paying passenger in a duly certified multi engined passenger carrying aircraft flown in the course of licensed operations for the transportation of passengers by properly licensed crew.

2.4.4.     Losses arising directly or indirectly from manual work (not including bar work, waitressing, fruit picking and other similar light casual work not requiring the use of machinery or power tools) or hazard occupation, self exposure to needless perils (except an attempt to save a human life), or if engaging in any criminal or illegal act.

2.4.5.     Winter Sports

2.4.6.     Loss caused directly or indirectly, wholly or partly by bacterial infections (except pyogenic infections which shall occur through an accidental cut or wound) or any other kind of disease;

3       Section C: Loss of Common Carrier Checked in Baggage

3.1           The Company will pay the Insured up to the section C sum assured specified in the schedule of benefits in respect of the complete and permanent loss of the Insured’s checked in baggage. 

Special conditions applicable for section C

3.1         In the event of any loss to your property whilst in the custody of an air line or other carrier the Insured has to notify the air line or the carrier upon discovery of the loss and obtain a property irregularity report/official letter from the airline stating the loss of baggage which the Insured has to submit to the Claims Administrator.

3.4        The Company’s liability to make payment shall not arise until liability is admitted by the airline. If any compensation is paid or payable by the air line, Company’s liability is only to indemnify the excess amount if any.

3.5         In case of the same baggage being covered under any other insurance, the policy will contribute its rateable proportion.

3.6        Loss of Checked in baggage during the trip will be covered only subject to proof of ownership of the baggage and valuables.

3.4        The Company’s liability to make payment shall not arise until liability is admitted by the airline. If any compensation is paid or payable by the air line, Company’s liability is only to indemnify the excess amount if any.

3.5        In case of the same baggage being covered under any other insurance, the policy will contribute its rateable proportion.

3.6        Loss of Checked in baggage during the trip will be covered only subject to proof of ownership of the baggage and valuables.

3.7        The Company reserve the right to replace or pay the intrinsic value of any lost article maximum up to the amount stated in the Schedule of Benefits.

3.8        Depreciation will be applicable for Articles more than 5 years in age. 

Exclusions applicable for Section C

3.9        The Company shall not be liable to make payments for:

3.9.1.    Loss to the Insured’s personal baggage as a result of the confiscation or detention by customs, police or any other authority.

3.9.2.    Loss caused by the Insured’s failure to take reasonable steps to guard against the loss of the personal baggage.

3.9.3.    Any loss to stamps, money or securities, tickets, documents, contact, corneal lenses, spectacles dentures, hearing aids, fragile articles or business goods and samples.

3.9.4.    animals, birds or fish

3.9.5.   perishables and consumables

4.      Section D: Delay of checked in Baggage

4.1     the Company will reimburse the Insured up to the section D sum assured specified in the schedule of benefits in respect of the Insured’s emergency purchases of toiletries, medication and clothing to replace those contained in Checked in baggage, the arrival of which is delayed by more than 4 hours beyond the time of the Insured’s arrival at the intended destination outside of Sri Lanka. 

Special Conditions applicable for section D

4.2         It is a condition precedent to the Company’s liability hereunder that upon discovering the delay in arrival of the checked baggage the Insured shall obtain written non delivery confirmation from the air line along with period of delay, which must be submitted to the Claims Administrator in the event of a claim

4.3        The Company’s liability to make payment shall not arise until liability is admitted by the airline. If any compensation is paid or payable by the airline, Company’s liability is only to indemnify the excess amount if any.

4.4        The claim payment is subject to the submission of the original purchase receipts and evidence to prove the period of delay. 

5.      Section E: Loss of passport

5.1        In the event of the Insured’s loss of his passport, the Company will pay the Insured up to the section E sum assured specified in the schedule of benefits towards expenses necessarily incurred by the Insured in obtaining a duplicate or fresh passport.

Exclusions applicable for section E

5.2       The Company shall be under no liability to make payment for loss of Insured’s passport as a result of the confiscation or detention by customs, police or any other authority.

5.3       Loss which is not reported to the appropriate police authority within 24 hours of the discovery of the loss, in respect of which an official report has not been obtained

5.4       Loss caused by the Insured’s failure to take reasonable steps to guard against the loss of passport.

5.5        Any loss of passport whilst left unattended at any time.

6.      Section F: Personal Liability

6.1.       The Company will indemnify the Insured up to the section F sum insured (less the deductible) specified in the schedule of benefits against any legal liability incurred by the Insured in his private capacity to pay damages for third party civil claims arising out of accidental bodily injury or accidental property damage occurring during insured journey.

Special conditions applicable for section F

6.2.       No deductible shall be applicable in respect of the legal liability incurred by the Insured in his private capacity to pay damages for third party accidental bodily injury.

6.3.       The Company liability to indemnify the Insured under this section shall be to the expenses finally determined by a foreign court of law or otherwise as consented to in advance by the Company. In the event that legal action is taken against the Insured within Sri Lanka, it is a condition precedent to the Company liability hereunder that the Insured shall:

6.3.1.    Give immediate written notice to the Company to the address specified in the schedule, and

6.3.2.    Not incur any defence costs or expenses, admit liability for or settle or attempt to settle, make any admission or offer any payment or otherwise assume any contractual obligation with respect to any claim or claimant without the prior written consent of the Company, which shall be entitled (but in no case obligated) at any time to take over and conduct in the name of the Insured the defence and/or settlement of any action or claim and shall be entitled at all times receive the Insured’s corporation and assistance and to appoint lawyers on the Insured’s behalf. Any and all costs and expenses incurred by the Company or the lawyer appointed by the Company shall be a first charge on the sum assured hereunder.

6.4.       The Company shall not settle any claims without the express consent of the Insured, but if the Insured refuses an available settlement recommended by the Company then the Company’s liability shall thereafter be restricted to the amount by which the claim could have been settled.

Exclusions applicable for section F

6.5.1. The Insured’s liability to any employee (whether under a contract of or for service)

6.5..2. Bodily injury to and/or property damage to property belonging to the Insured’s family, any co worker of the Insured, and any travelling companion of the Insured;

6.5..3. Any liability for bodily injury and/or property damage arising directly or indirectly from or due to:                                                 

6.5..3.1.     Livestock belonging to the Insured or in the Insured’s care, custody or occupation

6.5..3.2.     Any wilful, malicious, criminal or unlawful act, error, or omission;

6.5..3.3.     The pursuit of any trade, business or profession, employment or occupation; 

6.5..3.4.     The parachuting, hand gliding, hot air ballooning or the use of firearms or any other dangerous or hazardous activity;

6.5..3.5.     The ownership, possession or use of vehicle, aircraft, or watercraft;

6.5..3.6.     The use or misuse of any alcohol, hallucinogenic substance, drugs (expect those used medically prescribed), or drug addiction;

6.5..3.7.     The supply of goods or service

6.5..3.8.     Any form of ownership or occupation of land or building (other than occupation only of any temporary residence)

7.      Section G: Legal Fees
        
7.1         The Company will pay legal fees an Insured Person incurs during the course of an Insured Journey, as a result of false arrest or wrongful detention by any Government or Foreign Power up to the amount stated in the Schedule of Benefits.

8.      Section H: Hijack cover

8.1.        For each 24 hour period the Insured is detained by hijackers following hijacking of any air craft in which the Insured is travelling, the Company will pay the sum specified in the schedule of benefits.

9.      Section I: Trip Delay

9.1.        If the air craft on which the Insured is booked to travel for his/her Insured Journey is delayed due to aircraft technical defects/malfunction, adverse weather conditions and Industrial strikes or other job action by employees of a Common Carrier scheduled to be used by an Insured during an Insured Journey, beyond 4 hours than the original scheduled departure time, the Company will reimburse Reasonable Additional Expenses incurred up to the sum mentioned in the schedule of benefits in excess of 4 hours, subject to the maximum amount mentioned in the schedule of benefits.

Exclusions applicable for section I
           
However, the Company will not pay,

9.1.1     for any departure which is delayed as a result of failing to check-in correctly as required by the airlines by  the Insured .

9.1.2     If the air craft is taken out of service on the instructions of the civil aviation authority or similar authority

9.1.3      Any delay due to aircraft technical defects/malfunction, adverse weather conditions and Industrial strike which was made public or known to an Insured prior to the departure of the Insured Journey                                   

Special conditions applicable for section I
              
The Company’s liability to make payment shall not arise until liability is admitted by the airline. If any compensation is paid or payable by the air line, Company’s liability is only to indemnify the excess amount if any.

9.      Section J: Trip Cancellation

9.1        Company will reimburse expenses incurred for travel and/or accommodation up to the amount stated in the Schedule of Benefits for such expenses paid in advance by the Insured and for which the Insured is legally liable and which are not recoverable from any other source, consequent upon the cancellation of travel occurring between the date of payment of Travel and/or accommodation expenses and the date of commencement of the Insured Journey caused by:

                  (i). Unexpected Death, Serious Injury or Sickness of the Insured Person, Insured Person's Travelling Companion and Insured Person's Immediate Family Member.
           
                  (ii). an Insured Person's place of residence or business being rendered uninhabitable 10 days or less prior to the commencement of an Insured Journey as a result of accidental damage or an Insured Person's presence being required by the Police following burglary or attempt thereat at an Insured Person's place of residence or business.                   

10.     Section K: Golfer’s Hole In One
        
10.1     Company shall reimburse expenses incurred in celebration of achieving a hole-in-one by the Insured during the trip, any where in the world excluding Sri Lanka. In a United Stated Golfer’s Association (USGA) recognised golf course subject to maximum limit in the schedule of benefits. Provided that all expenses be spent using the Insured's Nations Trust Bank American Express Credit Card.          

11.     Section L: Tennis Winning Sets            

11.1      If an Insured  purchased a entry Ticket using the said credit card to Wimbledon/US Open/Australian Open/French Open Semi-Final or Final Tennis Championship match specifically and due to adverse weather the event is cancelled.The Company will reimburse the Insured upto USD 750/- of the Ticket costs. Provided only that the entry Ticket be bought using the said credit card and in  excess of what was reimbursed to them by the respective Tennis officials only.s      

12.     Section M: Grand Prix Chequered Flag

12.1      If an Insured has purchased a entry Ticket using the said credit card to the Grand Prix races specifically anywhere in the world excluding Sri Lanka and due to adverse weather the event is  cancelled. The Company will reimburse the Insured upto USD 1,000/- of the Ticket costs. Provided only that the entry Ticket be bought using the said card and in excess of what was reimbursed to them by the respective Grand Prix officials only.

13.      Section N: World Cup Specials

13.1     If an Insured has purchased a entry Ticket using the said credit card to any World Cup Semi Finals/Finals match anywhere in the World excluding Sri Lanka for the following sports only:
                       
                        - Rugby
                        - Soccer
                        - Cricket 
                       
                        and due to adverse weather the event is cancelled. The Company will reimburse the Insured upto USD 500/- of the Ticket costs. Provided only that the entry Ticket be bought using said card and in excess of what was reimbursed to them by the respective World Cup Sporting officials only.

DEFINITIONS

The following words or terms shall have the meaning described below  wherever they appear in this Policy, and reference to the singular shall include the plural wherever the context so permits:

“ Insured ” means holder of an American Express Green or Gold Credit Card issued by Nations Trust Bank PLC,  who is no more than 70 years of age and/or members of his/herImmediate Family and who purchase their return trip air ticket using the said cards only

Immediate Family" means an Insured Person's legal spouse; unmarried children up to age of 18 (or dependant unmarried children up to the age of 23 if in full time education and dependant upon their parents for support) who permanently reside with the Insured Person, and receive the majority of maintenance and support from the Insured Person.

"Immediate Family Member" in respect of Section J-Trip Cancellation means an Insured Person's legal spouse; children; children-in-law, siblings, siblings in law; parents; parents in law; grand parents; grandchildren; step or adopted children; step parents; aunts; uncles; nieces; and nephews who reside in Sri Lanka

"Maximum Duration" means 90 days limited for each and every trip

“Claims Administrator” means the Company or any person appointed by the Company to administer claims.

 "Medical Advisors” means the medical practitioner appointed by the Claims Administrator.

“Physician” means a qualified medical practitioner holding a valid license (issued by the appropriate authority in the jurisdiction within which he operates) and acting within the scope of such license.  “Physician” shall not include any member of the Insured’s family.

“Medical Expenses” means medical expenses (including those for medicines, Physicians, hospitals, ambulances, medical procedures and services) that in the written opinion of the the treating Physician, expressed at the time of examination or treatment of the Insured, are medically necessary in order to maintain life and/or relieve immediate pain or distress caused by Sickness and/or Disease and/or Accidental Bodily Injury first manifested and/or sustained during the Policy Period and approved by the Claims Adminstrator.

“Checked in Baggage” means the baggage offered by the Insured and accepted by an Airline for international transportation in the same aircraft as the Insured and for which the airline has provided a baggage receipt, and the contents of the baggage checked in by the Insured so long as such contents do not violate any Airline policy or rule restricting the nature of items that may be carried on board its aircraft.

“Policy Period”  means the period of one year from the first date that this services will be made available to the Cardmember/s and for any subsequent period as may from time to time be agreed between Allianz Insurance Lanka Ltd and Nations Trust Bank Plc American Express and upon payment of the agreed premium.

“Accident” and “Accidental” means a fortuitous event or circumstance that is sudden, unexpected and unintentional.

“Cardmember” means a holder of an American Express Green and or Gold Credit Card issued by Nations Trust Bank PLC who purchases his return trip air ticket using the said cards only

“Bodily Injury” means any Accidental physical bodily harm but does not
include any Sickness or Disease.

“ Usual and Customary Level ” means medical charges that:

a. do not exceed the usual levy of charges for similar treatment or allied services, in the locality where such treatment or allied services have been obtained; and

b. do not include charges that would not have been made if no insurance  existed.

" Policy ” means the proposal, the Schedule, the Policy documents and any endorsements attaching to or forming part hereof either on the commencement date or during the Policy Period.

" Sickness ” means a condition or an ailment affecting the general soundness and health of the Insured’s body that first manifests itself during the Policy Period and for which immediate treatment by a Physician is necessary.

“ Disease” means an affliction of the bodily organs having a defined and recognised pattern of symptoms that first manifests itself during the Policy Period and for which immediate treatment by a Physician is necessary.

“ Deductible” means the amount stated in the Schedule, which shall be borne by the Insured in respect of each and every Claim made under this Policy.  The Company’s liability to make any payment under the Policy is in excess of the Deductible.

“ Theft” means the dishonest misappropriation by any person of the Insured’s property with the intention to permanently deprive the Insured of that property.

“ Sum Assured” means the amount stated in the Schedule against each relevant Section, which shall be the Company’s maximum liability under this Policy (regardless of the number of the amount of Claims made) for any one Claim and in the aggregate for all Claims under such Section  made per Insured person.

“ Claim” means a Claim under an operative part of this Policy in respect of an insured event that has taken place or is likely to take place.  All Claims resulting from one and the same event or circumstance shall jointly constitute one Claim under this Policy and as having been made at the time when the first Claim was made in writing and the Deductible shall be applicable to each section independently.

“ Airline” means a public airline that holds a proper license for the jurisdictions in which it operates and that operates scheduled flights for passengers and cargo.

“ Schedule” means the schedule, and any annexure to it, attached to and forming part of this Policy.

" Insured Journey”  means the first 90 days of any trip outside Sri Lanka falling within the Policy Period, where 100% of the tickets for travel have been paid for using the Cardmember's American Express Credit Card. The journey shall be deemed to have begun with the Cardmember's departure from home in Sri Lanka and shall have ended upon return to home in Sri Lanka.

 “ Property Damage” means actual physical damage to tangible material property belonging to a third party.

“Damages” means monetary sums payable pursuant to judgements or awards but shall not include fines, penalties, punitive damages, exemplary damages, any non-pecuniary relief, or any other amount for which an Insured is not financially liable, or which is without legal recourse to the Insured, or any matter that may be deemed to be uninsurable under Sri Lankan Law.

“ Pollution ” means and includes pollution or contamination by solids, liquids, gaseous or thermal irritants, contaminants, smoke, vapour, soot, fumes, acids, alkalis, radioactive and/or nuclear material, chemical or waste materials (including but not limited to any materials to be recycled, reconditioned or reclaimed) or otherwise of atmosphere, water, soil or other tangible material property.

" Reasonable Additional Expenses " any expenses for meals and lodging which were necessarily incurred as the result of covered hazard and which were not provided by the Common Carrier or any other party free of charge.

" Hole in One " means when a golf player hits the golf ball directly from the tee (the area at the beginning of a hole from which the golf player's first stroke is taken) into the cup with one shot during a golf tournament.

GENERAL CONDITIONS APPLICABLE TO ALL SECTIONS

Notification of Claims

It is a condition precedent to the Company’s liability under this Policy that, upon the happening of any event giving rise to or likely to give rise to a Claim under any Section of this Policy, the Insured complies with the provisions set out below:

a. In respect of any Claim under Sections A and/or B, the Insured or, if deceased, his legal or other representative, shall immediately notify the Claims Administrator and provide him with the name of the Physician, the name and telephone number of the hospital at which treatment is being obtained, and the fact or matter giving rise to the need for medical treatment, and any other documentation or information that might be required or requested by the Claims Administrator.

b. For all other Claims, the Insured shall immediately, and in any event not later than

c. 14 days after his return to Sri Lanka, notify the Claims Administrator and obtain a Claim Form for completion and return to the Claims Administrator along with supporting invoices and any other documentation or information that might be required or  requested by the Claims Administrator.The Insured shall not admit any liability or make any offer or promise of payment without the prior written consent of the Company.

Reasonable Care

The Insured shall take all reasonable and proper steps to safeguard and protect himself and his possessions against any fact, matter, circumstance or cause that might result in a Claim under this Policy, and shall not do or cause to be done anything that might enhance the likelihood of a Claim under this Policy (except in an attempt to save human life).

Transfer of Interest

The Insured may not transfer his interest in this insurance, but his legal representatives may represent him in respect of a Claim under this Policy if the Insured is incapacitated or deceased. This Policy of Insurance is a Contract between the Company and the Insured Person. The Insured Person) shall not transfer, assign, alienate or in any way pass the benefits and/or liabilities to any other person, Institution, Hospital, Company or Body Corporate without specific prior approval in writing by a duly authorised officer of the Company. However, if the Insured Person(s) is permanently incapacitated or deceased, the legal heirs of the Insured may represent him in respect of a Claim under the Policy.

Assessment of Claim & Payment

d. No sum payable under this policy shall carry interest.

e. The Company shall be under no liability to make payment in respect of any Claim until such time as the Insured has provided it and/or provided the Claims Administrator with whatever documentation and/or information as may be requested and established the quantum of any amount claimed to the Company’s satisfaction.

f. The obligation of the Company to make payments to the Insured in respect of Claims made after the Insured’s return to Sri Lanka shall be to make payment in Sri Lankan Rupees only.

g. Specifically in respect of a Claim under Sections A and/or B:

i. The Company’s liability to make payment is in respect of those charges approved by the Claims Administrator

ii. If requested by the Claims Administrator and/or the Company, the Insured shall (at his own expense) furnish all certificates, information, proofs or other evidence in support of the Claim, present himself for medical examination by a Medical Advisor as considered necessary by the Claims Administrator and/or the Company, and the Insured agrees that the Claims Administrator and/or the Company may approach anyone who may have treated the Insured for information and/or documentation in respect of the Claim.

iii. In the event of the Insured’s death, the Company shall have the right to carry out a post mortem at its own expense.

iv. Where the Insured is incapacitated or otherwise unable to give a valid release for the Claim, the Company may make arrangements to pay the Claim to the Insured’s legal guardian or legal representative.  Any payment made by the Company thereby in good faith shall operate as a complete and effective discharge of the Company’s liability in respect of the Claim.

v. The Company shall not pay Medical Expenses except at the Usual and Customary Level.

Arbitration

If any dispute or difference shall arise as to the quantum to be paid under the Policy (liability being otherwise admitted) such dispute or difference shall independently of all other questions be referred to arbitration under and in terms of the Arbitration Act No.11 of 1996 for resolution by a sole arbitrator or if the parties cannot agree on a sole arbitrator within 30 days of any party invoking arbitration, such dispute or difference shall be referred for resolution by a panel of three (3 arbitrators, one arbitrator to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by the said two arbitrators. The place of arbitration shall be Colombo and the language of the arbitral proceedings shall be English.

It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of this Policy.

Fraud

If the Insured shall make or advance any Claim knowing the same to be false or fraudulent as regards to amount or otherwise, this Policy shall be void in respect of such Insured and all Claims or payments hereunder shall be forfeited

Cancellation

This insurance may be terminated by either party (Allianz Insurance Lanka Ltd or Nations Trust Bank PLC) at the expiry of this Policy or at any other time by giving not less than 30 days prior written notice.

Notifications & Declarations

Any and all notices and declarations for the attention of the Company shall be submitted in writing and shall be sent to the address specified in the Schedule.

Subrogation

The Insured and any claimant under this Policy, shall at the expense of the Company do or concur in doing or permit to be done all such acts and things that may be necessary or reasonably required by the Company for the purpose of enforcing any rights and remedies or obtaining relief or indemnity from other parties to which the Company shall be or would become entitled or subrogated upon the Company paying for or making good any loss or damage under this Policy whether such acts and things shall be or become necessary or required before or after the Insured's indemnification by the Company.

Governing Law

The construction, interpretation and meaning of the provisions of this policy shall be determined in accordance with the laws of Sri Lanka. The section headings of this Policy are included for descriptive purposes only and do not form part of this Policy for the purpose of its construction or interpretation. The terms of this policy shall not be waived or changed except by endorsement issued by the Company.

Entire Contract

The Policy constitutes the complete contract of insurance.  No change or alteration in this Policy shall be valid or effective unless approved in writing by the Company, which approval shall be evidenced by an endorsement on the Policy. No agent shall or has the authority to change in any respect whatsoever any term of this Policy or waive any of its provisions.

Due Observance

The due observance of and compliance with the terms, provisions, warranties and conditions of this Policy in so far as they relate to anything to be done or complied with by the Insured shall be a condition precedent to the Company’s liability under this Policy.

Contribution

If, at the time of the happening of any loss or damage covered by this Policy there shall be existing any other insurance of any nature whatsoever covering the same, whether effected by the Insured or not, then the Company shall not be liable to pay or contribute more than its rateable proportion of any loss or damage.

WARRANTIES

This Policy is subject to the warranty that the Cardmember(s) will not book or commence any journey contrary to medical advice, or with intention to obtain medical treatment or after a terminal prognosis has been made

This Policy is subject to the warranty that the Cardmember (s) are no more that 70 years of age at the Commencement date of the Policy or at the start of any subsequent journey.

If any conflict should arise between the content of this document and the master policy, the terms and conditions of the master policy shall govern in all cases.

The Company shall be under no liability to make payment hereunder in respect of any Claim directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following:

• The Insured’s participation in any naval, military or air force operations whether in the form of military exercises or war games or actual engagement with the enemy, whether foreign or domestic.

• War, invasion, acts of foreign enemy, hostilities (whether war be declared or not), civil war, civil unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition of or destruction of or damage to property by or under the order of any government or local authority.

• The loss or destruction or damage to any property whatsoever or any loss or expenses whatsoever resulting or arising therefrom or any consequential loss directly or indirectly caused by or contributed to by or arising from:

• Ionising radiation or contamination by radioactivity form any nuclear waste from combustion of nuclear fuel; or

• the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof, or

• asbestosis or any related Sickness or Disease resulting from the existence, production, handling, processing, manufacture, sale, distribution, deposit or use of asbestos, or products thereof.

• The Insured’s actual or attempted engagement in any criminal or other unlawful act.

• Any consequential losses.

• In respect of travel by the Insured to any country against whom the Republic of Sri Lanka has imposed general or special travel restrictions, or any country which has imposed such restrictions against travel by a citizen of the Republic of Sri Lanka to such country prior to departure of Insured from Sri Lanka.

• The Insured engaging in air travel unless he flies as a passenger on an Airline. For the purpose of this exclusion, air travel means being in or on, or boarding an aircraft for the purpose of flying therein or alighting therefrom following a flight.

Following is not an insurance benefit but an assistance provided by the Service Provider International SOS. The terms and conditions are as below:

Emergency Cash advance

This is an assistance Service when the Insured person requires emergency cash following incidents like theft/burglary of luggage /money or hold up. The assistance Company shall co-ordinate with the Insured person’s relatives to provide emergency cash assistance to the person as per his requirement, up to the limit specified in the policy schedule.

As soon as the need arises, Insured person calls up SOS International on the telephone number
0091 11 418 98852

SOS shall verify the details of the Insured and ascertain the amount of cash required, local contact in Sri Lanka who can provide payment security including delivery charge through credit card or close relative.

SOS organizes cash delivery after obtaining payment security from Insured or his relative.

ANNEXURE

ENTITLEMENT FOR BENEFITS

A claim form must be completed by the Insured and submitted within 90 days of expenditure being incurred. This time limit may be extended subject to prior approval of the Claims department where supporting accounts are not available in time. All accounts submitted in respect of expenditure incurred must be original and not photocopies. All claims requested relating to the travel benefits should be made to ALLIANZ INSURANCE LANKA LTD, No 92, Glennie Street, Colombo 02, Sri Lanka by complying with the requisite claim formalities. Te policy reference number for American Express Primary/Supplementary Cardmember is ATO/HO/08/0008

DOCUMENTS REQUIRED FOR CLAIMS PROCESSING

Claim forms for all claims can be obtained from Allianz Insurance Lanka Ltd., American Express Card Centre, of by sending an email to travel@allianz.lk or from the website www.americanexpress.lk.

1. All claims should be submitted within 30 days of arrival in Sri Lanka

2. Documents required and the procedure in respect of each type of claim (for all types of claims, proof of travel tickets purchased through the use of the American Express credit card should be submitted);

TYPE OF CLAIMS

Accidental Death

Documents required
The beneficiary of the Insured should submit the following:

• The Claim form
• Birth Certificate
• Death Certificate
• Post Mortem Report
• Allianz Claims Dept will advice upon receipt of claim notification for any additional documentation/information.
• Copy of Return Air Ticket

Procedure
In case of a death or dismemberment whilst on a common carrier, all documents pertaining to the loss including correspondence with carrier should be submitted.

Accidental Dismemberment

Documents required
Same as Emergency Accident claims.

Procedure
Same as Emergency Accident claims

Overseas Emergency Accident & Sickness Medical Expenses (Excess USD 50)

Documents required

• The claim form
• Doctor's reports
• Original administration/ discharge card
• Original bills/receipts/prescriptions
• Original X-Ray reports/pathological/investigative reports
• Copy of passport/visa with entry and exit stamp
• Copy of Return Air Ticket

Procedure
In case of hospitalisation please keep all Insured's medical reports/bills/invoices/receipts safely.

Common Carrier Baggage Loss (excess 4 Hrs)

Documents required

• The claim form
• Copy of the passport/visa with entry and exit stamp
• Copies of baggage tags
• Copies of correspondence with the airline authorities/common carrier/others about loss of checked in baggage
• Property Irregularity Report (obtained from airline/common carrier)
• Details of compensation received from airlines/ common carrier/other authorities, if any
• Original receipts of all additional expenses incurred due to the delay
• Copy of Return Air Ticket

Procedure
Intimate the airline/common carrier about Insured's loss and lodge complaints. All records pertaining to Insured's compliant and their response should be submitted.

Common Carrier Baggage Delay and/or Flight/Trip Delay (excess 4 Hrs)

Documents required

• The claim form
• Original bill of purchases made/expenses incurred due to the delay
• Copy of travel ticket and boarding pass
• Copies of correspondence with the airline authorities certifying the Delay.
• Copy of Return Air Ticket
• Copy of the passport/visa with entry and exit stamp
• Property Irregularity Report (obtained from airline/common carrier)
• Details of compensation received from airlines/ common carrier/other authorities, if any

Procedure
Please obtain a written clarification from the airline regarding the delay and the cause of delay. Keep a record of hours of delay from the scheduled time. Keep receipts of all additional expenses (meal, and lodging in particular) incurred due to the delay.

Trip Cancellation

Documents required

• The claim form
• Original travel tickets/bills of prepaid non-refundable expenses (travel and accommodation only)
• Death Certificate of Immediate Family member in case of Death of Family member
• Police report in case of Burglary or attempt thereat at an Insured's place of residence or business.
• Allianz Claims Dept will advice upon receipt of claim notification for any additional documentation/information.
• Copy of Return Air Ticket

Personal Liability

Documents required

• Full statement of the facts in writing
• Witness statements
• Any other documents relevant to the incident, including summons, legal notices etc.
• Any other information relevant to the incident.
• Allianz Claims Dept will advice upon receipt of claim notification for any additional documentation/information.
• Copy of Return Air Ticket
• Copy of the passport/visa with entry and exit stamp

Procedure
Do not commit any benefit/compensation or enter into any agreements. Submit all documents along with a detailed statement to Allianz

Loss of Passport

Documents required

• Copy of the new passport with exit stamp
• Original bills/invoices of expenses incurred for obtaining a new passport
• Copy of the Police Report
• Copy of Return Air Ticket

Legal Fees

Documents required

• All information relating to the subject legal expenses to be give in writing along with the invoice.
• Allianz Claim Dept will advice upon receipt of claim notification and will contact the Insured for any additional information.
• Copy of Return Air Ticket
• Copy of the passport/visa with entry and exit stamp

Procedure
Submit the duly signed claim form and all the documents to Allianz address given below:

Allianz Insurance Lanka Ltd.
No. 92, Glennie Street,
Colombo 02, Sri Lanka
Tel: +94 11 2300400  Fax: +94 11 2304404

Golfer's Hole in one

Documents required

• Duly signed Claim form
• A letter from the USGA/ Golfing official certifying that the Insured has hit a hole in one.
• All the Original receipts for the expenses incurred with regard to celebration of the hole in one.
• Copy of Return Air Ticket

Procedure
Submit all documents to the Company

Tennis Winning Sets/Grand Prix Checkered Flag/ World Cup Specials

Documents required

• Duly signed Claim form
• A letter from the respective sporting officials certifying/confirming the cancellation of the event.
• Original receipts of the expenses incurred to purchase the Entry Ticket -Mandatory
• Copy of Return Air Ticket

Procedure
Submit all documents to the Company

Notes:

• Above listed documents and procedures are guidelines only. Allianz may call for additional documents/information as relevant and it is your duty as the Insured to take all reasonable actions/precautions to prevent/minimize any accident/loss/damage.
• If any hospital does not submit a bill to you for the treatment/service rendered please intimate SOS International before you leave the hospital.