Your claim is important to us, so help us help you!
By providing the information requested, you will accelerate the resolution of your claim. To assist in the claim process, the following guidelines detail the information needed to include with the claim form to process your claim. |
Required General Information
• Travel agency, agent's name and phone number (or company that booked your trip).
• Booking, reservation or invoice number.
• Travel dates.
• Protection plan purchase date and premium paid.
• Date of loss.
• Proof of Age.
Additional Required Information: |
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Pre-Departure Lodging Cancellation - Sickness or Injury |
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What you should provide:
- A signed Patient Authorization form.
 Beginning April 14, 2003, new regulations under HIPAA (Health Information Portability and Accountability Act) were enacted. A signed Patient Authorization is required nationwide by doctors' offices, hospitals and other health care providers. As a result, we must request that you sign and complete this form in its entirety. Failure to do so will result in a delay of your claim.
- A completed claim form, including the Medical section.
- Actual proof of payment for the trip, such as credit card statements or copies of front and back of cancelled checks. Invoices will not be accepted as actual proof of payment.
- Proof of refunds received, such as credit card statements or copies of front of refund checks.
What the patient's physician should provide:
- A completed Physician's Statement. (Note: Medical records pertaining to the patient's sickness or injury may be requested upon review of the physician's statement
What your travel agent should provide:
- Lodging invoice.
- All carrier and supplier cancellation policies (schedule of penalties) that applied to your trip.
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Pre-Departure Lodging Cancellation - Death |
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What you should provide:
- A signed Patient Authorization form. Beginning April 14, 2003, new regulations under HIPAA (Health Information Portability and Accountability Act) were enacted. A signed Patient Authorization is required nationwide by doctors' offices, hospitals and other health care providers. As a result, we must request that you sign and complete this form in its entirety. Failure to do so will result in a delay of your claim.
- A completed claim form, including the Medical section.
- A copy of the deceased's death certificate.
- Actual proof of payment for your trip, such as credit card statements or copies of front and back of cancelled checks. Invoices will not be accepted as actual proof of payment.
- Proof of refunds received, such as credit card statements or copies of front of checks.
What the patient's physician should provide:
- The completed Physician's Statement
What your travel agent should provide:
- Lodging invoice.
- All carrier and supplier cancellation policies (schedule of penalties) that applied to your trip.
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Emergency Assistance Benefits |
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What you should provide:
- A completed claim form, including the Medical and Other Insurance sections.
- A signed Patient Authorization form. Beginning April 14, 2003, new regulations under HIPAA (Health Information Portability and Accountability Act) were enacted. A signed Patient Authorization is required nationwide by doctors' offices, hospitals and other health care providers. As a result, we must request that you sign and complete this form in its entirety. Failure to do so will result in a delay of your claim.
- The disposition of your claim with your primary insurance and supplemental insurance carriers.
- Billing for the claim.
- Explanation of Benefits (EOB)
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Post-Departure Lodging Interruption - Sickness or Injury |
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If you are unable to continue your covered trip, after departure, due to a sickness or injury, follow these details:
What you should provide:
- A signed Patient Authorization form. Beginning April 14, 2003, new regulations under HIPAA (Health Information Portability and Accountability Act) were enacted. A signed Patient Authorization is required nationwide by doctors' offices, hospitals and other health care providers. As a result, we must request that you sign and complete this form in its entirety. Failure to do so will result in a delay of your claim.
- Proof of payment and receipts for any additional transportation incurred.
- Actual proof of payment for your trip, such as credit card statements or copies of front and back of cancelled checks. Invoices will not be accepted as actual proof of payment.
- Proof of refunds received, such as credit card statements or copies of front of refund checks.
What the patient's physician should provide:
- The completed physician's statement provided on your claim form.
- All records pertaining to the patient's illness or injury.
What your travel agent should provide:
- Lodging invoice.
- All carrier and supplier cancellation policies (schedule of penalties) that applied to your trip.
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Post-Departure Lodging Interruption - Death |
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Applies if you are unable to continue your covered trip, after departure, due to a death, follow these details:
What you should provide:
- A completed claim form (all areas).
- A signed Patient Authorization form. Beginning April 14, 2003, new regulations under HIPAA (Health Information Portability and Accountability Act) were enacted. A signed Patient Authorization is required nationwide by doctors' offices, hospitals and other health care providers. As a result, we must request that you sign and complete this form in its entirety. Failure to do so will result in a delay of your claim.
- A copy of the deceased's death certificate.
- Proof of payment and receipts for any additional transportation incurred to return home.
- Proof of payment for your trip (credit card statements or copies of front and backs of cancelled checks; this is imperative to verify the pre-existing waiver.)
- Proof of refunds (credit card statements, copies of front of refund checks).
What the patient's physician should provide:
- The completed Physician's Statement provided on your claim form.
- All records pertaining to the patient's illness or injury.
What your travel agent should provide:
- All lodging invoices.
- All cancellation policies (schedule of penalties) that applied to your trip.
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Post-Departure Lodging Interruption - Other |
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Applies if your arrival on your covered trip is delayed beyond the scheduled departure date.
What you should provide:
- Completed claim form with explanation for travel delay.
- Proof of your loss (documentation that will provide dates, circumstances and verification of your loss).
- Proof of payment and receipts for any additional transportation expenses.
- Actual proof of payment for your trip, such as credit card statements or copies of front and back of cancelled checks.
- Proof of refunds received, such as credit card statements or copies of front of refund checks.
What your travel agent should provide:
- All lodging invoices.
- All carrier and supplier cancellation policies (schedule of penalties) that applied to your trip.
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What you should provide if you are claiming additional expenses:
- Documentation from the carrier regarding the date, reason for, and length of the delay.
- Documentation regarding reason for delay, such as police report, doctor's letter, etc.
- Actual proof of payment for your trip, such as credit card statements or copies of front and back of cancelled checks.
- Proof of refunds received, such as credit card statements or copies of front of refund checks.
- Receipts for all additional expenses incurred for accommodations, meals, phone calls or transportation. (Policy maximum limits apply.)
- Proof of payment/invoices for additional transportation expenses incurred.
What your travel agent should provide if you are claiming unused expenses:
- Lodging invoice.
- All carrier and supplier cancellation policies (schedule of penalties) that applied to your trip.
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