IMPORTANT
This coverage is valid only if the appropriate plan cost has been paid. Please keep this document as your record of coverage under the plan.
PLEASE READ THIS DOCUMENT CAREFULLY!
This Policy is issued in consideration of your application and payment of the premium due. This Policy describes all of the travel insurance benefits underwritten by ACE Property & Casualty Insurance Company, 436 Walnut Street, Philadelphia, PA 19106.
This Policy is a legal contract between the Insured and the Company. If the Insured is a minor under the age of 18, the legal contract is between the parent or legal guardian of the minor and the Company. It is important that you read your Policy carefully. Please refer to the Schedule of Benefits. It provides you with specific information about the insurance you purchased.
Signed for ACE Property & Casualty Insurance Company in Philadelphia, Pennsylvania.
Schedule of Benefits
Insurance must be purchased within 1 day of the Initial Payment.
| Maximum Limit Per Trip | |
|---|---|
| Accident Sickness Medical Expense Dental Maximum |
$10,000 $250 |
| Accidental Death & Dismemberment | $175,000 |
| Personal Effects Deductible |
$1,800 $250 |
For questions or information contact the Company at 1-800-352-4462 .
Any payments under this Policy will only be made in full compliance with all United States of America economic or trade sanction laws or regulations, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department's Office of Foreign Assets Control ("OFAC"). Therefore, any expenses incurred or claims made involving travel that is in violation of such sanctions, laws and regulations will not be covered under this Policy. For more information, you may consult the OFAC internet website at www.treas.gov/offices/enforcements/ofac/.
EFFECTIVE AND TERMINATION DATES
Effective Date:
All coverages will begin on the date and time the Insured starts his/her Trip.
Termination Date:
All coverages end on the earliest of:
- the date the Trip is completed; or
- the scheduled Return Date.
BENEFITS
ACCIDENT SICKNESS MEDICAL EXPENSE BENEFIT
If, while on a Trip, an Insured suffers an Injury or Sickness that requires him or her to be treated by a Physician, the Company will pay a benefit for Reasonable and Customary Charges, up to the Maximum Limit shown in the Schedule. The Company will reimburse the Insured for Medically Necessary Covered Expenses incurred to treat such Injury or Sickness within 30 days of the date of the accident that caused the Injury or the onset of the Sickness provided the initial documented treatment was received from a Physician during the Trip.
Covered Expenses:
The Company will reimburse the Insured for:
- services of a Physician or registered nurse (R.N.);
- Hospital charges;
- Hospital ancillary services (including, but not limited to, use of the operating room or emergency room);
- use of an Ambulatory Medical Center;
- X-rays;
- local ambulance services to or from a Hospital;
- artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
- rental of durable medical equipment (such as a wheelchair or a Hospital bed);
- anesthetics (including administration), treatments, transfusions and laboratory tests ordered by the attending Physician;
- medicines or drugs administered by a Physician or that can be obtained only with a Physician’s written prescription;
- physical therapy up to 10 visits within one year of the date of the Injury or Sickness up to the per visit maximum 365 days after the Insured reaches his/her Return Destination;
- the cost of emergency dental treatment only during a Trip limited to the Maximum Limit shown in the Schedule. Coverage for emergency dental treatment does not apply if treatment or expenses are incurred after the Insured has reached his/her Return Destination, regardless of the reason. The treatment must be given by a Physician or dentist.
ACCIDENTAL DEATH & DISMEMBERMENT
The Company will reimburse the Insured for this benefit for one of the Losses shown in the Table of Losses below if the Insured is Injured while on a Trip. The Loss must occur within 90 days of the date of the accident which caused Injury. The Company will pay the percentage shown below of the Maximum Limit shown in the Schedule. The accident must occur while the Insured is on the Trip and is covered under this Policy.
If more than one Loss is sustained by an Insured as a result of the same accident, only one amount, the largest applicable to the Losses incurred, will be paid. The Company will not pay more than 100% of the Maximum Limit for all Losses due to the same accident.
Table of Losses
| Loss of | % of Maximum Limit |
|---|---|
| Life | 100% |
| Both Hands or Both Feet | 100% |
| Sight of Both Eyes | 100% |
| One Hand and One Foot | 100% |
| Either Hand or Foot and Sight of One Eye | 100% |
| Either Hand or Foot | 50% |
| Sight of One Eye | 50% |
"Loss" with regard to:
- hand or foot means actual severance through or above the wrist or ankle joints; or
- eye means entire and irrecoverable Loss of sight in that eye.
PERSONAL EFFECTS
The Company will reimburse the Insured, up to the Maximum Limit shown in the Schedule subject to the special limitations shown below, for Loss, theft or damage to the Insured’s personal effects during the Insured’s Trip.
Special Limitations:
The Company will reimburse the Insured up to:
- $500 for the first item and thereafter
- $500 per each additional item
- $1,800 aggregate on all Losses to: cameras and camera equipment, camcorders, sporting sportsman golf equipment, computers, electronic devices, including but not limited to: lap top computers, electronic organizers portable CD players and wireless handheld devices.
Items over $150 must be accompanied by original receipts.
The Company will pay the lesser of:
- the cash value (original cash value less depreciation) as determined by the Company, or
- the cost of replacement.
The Company will only pay for Loss due to unauthorized use of the Insured’s credit cards if the Insured has complied with all requirements imposed by the issuing credit card companies.
DEFINITIONS
(Capitalized terms within this Policy are defined herein)
“Actual Cash Value” means purchase price less depreciation.
“Children” or “Child” means unmarried children or grandchildren of the Insured, including natural children from the moment of birth, children from a civil union and step, foster or adopted children from the moment of placement in the Insured’s home, under age 25 and primarily dependent on the Insured for support and maintenance. However, the age limit does not apply to a child who: (1) otherwise meets the definition of children; and (2) is incapable of self- sustaining employment by reason of mental or physical incapacity. As otherwise used in this plan it means the Insured’s natural, step, foster, adopted children or grandchildren of any age.
“Company” means ACE Property & Casualty Insurance Company in Philadelphia, PA.
“Complications of Pregnancy” means conditions whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy. These conditions include acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity. Complications of pregnancy also include nonelective cesarean section, ectopic pregnancy which is terminated and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.
Complications of pregnancy do not include false labor, occasional spotting, Physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, preeclampsia and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy.
“Deductible” means the amount of charges that must be incurred by an Insured before benefits become payable. The amount of the deductible is shown in the Schedule for each benefit to which a deductible applies.
“Departure Date” means the date on which the Insured is originally scheduled to leave on his/her Trip. This date is specified in the travel documents .
“Experimental or Investigative” means treatments, devices or prescription medications which are recommended by a Physician, but are not considered by the medical community as a whole to be safe and effective for the condition for which the treatments, devices or prescription medications are being used. This includes any treatments, procedures, facilities, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice, and any of those items requiring federal or other governmental agency approval not received at the time services are rendered.
“Family Member” means the Insured’s, spouse, civil union partner, domestic partner, Child, daughter-in-law, son-in- law, brother, sister, mother, father, grandparent, step-grandparent, grandchild, step-grandchild, step-child, step-brother, step-sister, step-parent, parent-in-law, brother-in-law, sister-in-law, aunt, step-aunt, uncle, step-uncle, niece, nephew, legal guardian, foster Child, ward, or legal ward; spouse, civil union partner or domestic partner of any of the above. Family Member also includes these relations to the Insured’s spouse, civil union partner or domestic partner.
“Hospital” means a facility that:
- is operated according to law for the care and treatment of sick or Injured people;
- has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis;
- has 24 hour nursing service by registered nurses (R.N.’s); and
- is supervised by one or more Physicians available at all times.
- a nursing, convalescent or geriatric unit of a hospital when a patient is confined mainly to receive nursing care;
- a facility that is, other than incidentally, a clinic, a rest home, nursing home, convalescent home, home health care, or home for the aged; nor does it include any ward, room, wing, or other section of the hospital that is used for such purposes; or
- any military or veterans hospital or soldiers home or any hospital contracted for or operated by any national government or government agency for the treatment of members or ex-members of the armed forces for which no charge is normally made.
“Insured” means a person shown on the rental agreement as well as such person’s Traveling Companion:
- for whom any required plan cost has been paid;
- for whom a Trip is scheduled; and
- who is covered under this Policy.
“Medically Necessary” means that a treatment, service, or supply:
- is essential for diagnosis, treatment, or care of the Injury for which it is prescribed or performed;
- meets generally accepted standards of medical practice;
- is ordered by a Physician and performed under his or her care, supervision, or order; and
- is not primarily for the convenience of the Insured, Physician, other providers, or any other person.
“Normal Pregnancy or Childbirth” means a pregnancy or childbirth that is free of complications or problems.
“Physician” means a licensed practitioner of medical, surgical, dental services or the healing arts including accredited Christian Science Practitioner, acting within the scope of his/her license. The treating physician cannot be the Insured or a Family Member.
“Reasonable and Customary Charges” means expenses which:
- are charged for treatment, supplies, or medical services Medically Necessary to treat the Insured’s condition;
- do not exceed the usual level of charges for similar treatment, supplies or medical services in the locality where the expenses are incurred; and
- do not include charges that would not have been made if no insurance existed. In no event will the Reasonable and Customary Charges exceed the actual amount charged.
“Schedule” means the Schedule of Benefits which is shown at the beginning of this Policy.
“Sickness” means an illness or disease diagnosed or treated by a Physician.
“Trip” means a period of travel booked through Hertz. The purpose of the Trip may be business or pleasure; the trip has defined Departure and Return Dates specified when the Insured applies; the trip does not exceed 364 days; travel is primarily by automobile or box truck in the United States.
“Traveling Companion” means up to three people with whom the eligible person shown on the rental agreement has coordinated travel arrangements and intends to travel with during the Trip.
“Unforeseen” means not anticipated or expected and occurring after the effective date of coverage.
EXCLUSIONS AND LIMITATIONS
GENERAL EXCLUSIONS
This plan does not cover any loss caused by or resulting from:
- intentionally self-inflicted Injury, suicide, or attempted suicide of the Insured while sane or insane;
- Normal Pregnancy or Childbirth, other than Unforeseen Complications of Pregnancy, or elective abortion of the Insured;
- war or act of war, whether declared or not, participation in a civil disorder, riot, or insurrection;
- commission of or attempt to commit a felony by the Insured;
- Mental, Nervous or Psychological Disorder;
- being under the influence of drugs or narcotics, unless administered upon the advice of a Physician or intoxication above the legal limit;
- any Loss that occurs at a time when this coverage is not in effect;
- participation in motor sport, or motor racing, including training or practice for the same;
- operating or learning to operate any aircraft, as student, pilot, or crew;
- PRE-EXISTING MEDICAL CONDITION EXCLUSION: The Company will not pay for any loss or expense incurred as the result of an Injury, Sickness or other condition (excluding any condition from which death ensues) of an Insured which, within the 180 day period immediately preceding and including the Insured’s coverage effective date: (a) first manifested itself, worsened, became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; (b) for which care or treatment was given or recommended by a Physician; (c) required taking prescription drugs or medicines, unless the condition for which the drugs or medicines are taken remains controlled without any change in the required prescription drugs or medicines.
Unless otherwise provided by this plan Benefits will not be provided for the following:
- routine physical examinations;
- mental health care;
- replacement of hearing aids, eye glasses, contact lenses, and sunglasses;
- routine dental care;
- any service provided by the Insured or a Family Member;
- alcohol or substance abuse or treatment for the same;
- Experimental or Investigative treatment or procedures;
- care or treatment which is not Medically Necessary, except for related reconstructive surgery resulting from trauma, infection or disease;
Benefits will not be provided for the following:
- loss caused by or resulting directly or indirectly from Sickness or disease of any kind;
- stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial infarction or heart attack; coronary thrombosis; aneurysm.
Benefits will not be provided for any Loss, or damage to, caused by, or resulting in whole or in part from:
- animals, rodents, insects or vermin;
- bicycles;
- motor vehicles, aircraft, boats, boat motors, ATV's and other conveyances;
- artificial prosthetic devices, false teeth, any type of eyeglasses, sunglasses, contact lenses, or hearing aids;
- keys, notes, securities, accounts, currency, deeds, food stamps, bills, or other evidences of debt, or tickets;
- money, stamps, stocks and bonds, postal or money orders;
- property shipped as freight, or shipped prior to the Departure Date;
- contraband, illegal transportation or trade;
- items seized by any government, government official or customs official;
- defective materials or craftsmanship;
- normal wear and tear;
- deterioration.
PAYMENT OF CLAIMS
Claim Procedures: Notice of Claim: The Insured must call the Company or its authorized representative as soon as reasonably possible, and be prepared to describe the Loss and the Trip date(s). The Company or its authorized representative will fill in the claim form and forward it to the Insured for his or her review and signature. The completed form should be returned to the Company or its authorized representative.
Claim Procedures: Proof of Loss: The claim forms must be sent back to the Company or its authorized representative no more than 90 days after a covered Loss occurs or ends, or as soon after that as is reasonably possible. All claims under this Policy must be submitted to the Company or its authorized representative no later than one year after the date of Loss or insured occurrence or as soon as reasonably possible. If the Company or its authorized representative has not provided claim forms within 15 days after the notice of claim, other proofs of Loss should be sent to the Company or its authorized representative by the date claim forms would be due. The proof of Loss should include written proof of the occurrence, type and amount of Loss, the Insured’s name, and policy number.
Payment of Claims: When Paid: Claims will be paid as soon as the Company or its authorized representative receives complete proof of Loss and verification of age.
Payment of Claims: To Whom Paid: Benefits are payable to the Insured who applied for coverage and paid any required plan cost. Any benefits payable due to that Insured’s death will be paid to the survivors of the first surviving class of those that follow:
- to his/her spouse, if living. If no living spouse, then
- in equal shares to his/her living children. If there are none, then
- in equal shares to his/her living parents. If there are none, then
- in equal shares to his/her living brothers and sisters. If there are none, then
- to the Insured’s estate.
If a benefit is payable to a minor or other person who is incapable of giving a valid release, the Company may pay up to $3,000 to a relative by blood or connection by marriage who has assumed care or custody of the minor or responsibility for the incompetent person’s affairs. Any payment the Company makes in good faith fully discharges the Company to the extent of that payment.
Accident Sickness Medical Expense benefits may be payable directly to the provider. However, the provider:
- must comply with the statutory provision for direct payment; and
- must not have been paid from any other sources.
The following provisions apply to Personal Effects:
Notice of Loss. If the Insured's property covered under this Policy is lost or damaged, the Insured must:
- notify the Company or its authorized representative as soon as possible;
- take immediate steps to protect, save and/or recover the covered property;
- give immediate notice to the carrier or bailee who is or may be liable for the Loss or damage; and
- notify the police or other authority in the case of robbery or theft within 24 hours.
Settlement of Loss. Claims for damage and/or destruction shall be paid immediately after proof of the damage and/or destruction is presented to the Company or its authorized representative. Claims for lost property will be paid after the lapse of a reasonable time if the property has not been recovered. The Insured must present acceptable proof of Loss and the value.
Valuation. The Company will not pay more than the Actual Cash Value of the property at the time of Loss. At no time will payment exceed what it would cost to repair or replace the property with material of like kind and quality.
Disagreement Over Size of Loss. If there is a disagreement about the amount of the Loss, either the Insured or the Company can make a written demand for an appraisal. After the demand, the Insured and the Company each select their own competent appraiser. After examining the facts, each of the two appraisers will give an opinion on the amount of the Loss. If they do not agree, they will select an arbitrator. Any figure agreed to by 2 of the 3 (the appraisers and the arbitrator) will be binding. The appraiser selected by the Insured is paid by the Insured. The Company will pay the appraiser it chooses. The Insured will share with the Company the cost for the arbitrator and the appraisal process.
Benefit to Bailee. This insurance will in no way inure directly or indirectly to the benefit of any carrier or other bailee.
Accident Sickness Medical Expense and Accidental Death & Dismemberment Proof of Loss: The Insured must provide the Company or its authorized representative with:
- all medical bills and reports for medical expenses claimed; and
- a signed patient authorization to release medical information to the Company or its authorized representative.
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 preserve its rights against those responsible for its 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.
As a condition to receiving the applicable benefits listed above, as they pertain to this Subrogation provision, the Insured agrees, except as may be limited or prohibited by applicable law, to reimburse the Company for any such benefits paid to or on behalf of the Insured, if such benefits are recovered, in any form, from any Third Party or Coverage.
The Company will not pay or be responsible, without its written consent, for any fees or costs associated with the pursuit of a claim, cause of action or right by or on behalf of an Insured or such other person against any Third Party or Coverage.
Coverage - as used in this Subrogation section, means no fault motorist coverage, uninsured motorist coverage, underinsured motorist coverage, or any other fund or insurance Policy and any fund or insurance Policy providing the Insured with coverage for any claims, causes of action or rights the Insured may have against the Company.
Third Party - as used in this Subrogation section, means any person, corporation or other entity (except the Insured, this Policyholder and the Company).
GENERAL PROVISIONS
Entire Contract: Changes: This Policy, Schedule of Benefits, Application Form and any attachments are the entire contract of insurance. No agent may change it in any way. Only an officer of the Company can approve a change. Any such change must be shown in this Policy or its attachments.
Acts of Agents. No agent or any person or entity has authority to accept service of the required proof of loss or demand arbitration on the Company’s behalf nor to alter, modify, or waive any of the provisions of this Policy.
Company’s Recovery Rights. In the event of a payment under this Policy, the Company is entitled to all rights of recovery that the Insured, or the person to whom payment was made, has against another. The Insured must sign and deliver to the Company any legal papers relating to that recovery, do whatever is necessary to help the Company exercise those rights, and do nothing after the loss to harm the Company’s rights. When an Insured has been paid benefits under this Policy but also recovers from another Policy, the amount recovered from the other Policy shall be held in trust for the Company by the Insured and reimbursed to the Company the extent of the Company’s payment.
Physical Examination and Autopsy. The Company at its own expense has the right and opportunity to examine the person of any Insured whose Loss is the basis of claim under this Policy when and as often as it may reasonably require during the pendency of the claim and to perform an autopsy in case of death where it is not forbidden by law.
Beneficiary Designation and Change. The Insured’s beneficiaries are the persons designated by the Insured and on file with the Company or its authorized representative or the beneficiaries as shown in the Payment of Claim: To Whom Paid provision.
An Insured over the age of majority and legally competent may change his or her beneficiary designation at any time, without the consent of the designated beneficiaries, unless an irrevocable designation has been made, by providing the Company or its authorized representative with a written request for change. When the request is received, whether the Insured is then living or not, the change of beneficiary will relate back to and take effect as of the date of execution of the written request, but without prejudice to the Company on account of any payment made by it prior to receipt of the request.
Assignment. An Insured may not assign any of his or her rights, privileges or benefits under this Policy.
Misstatement of Age. If premiums for the Insured are based on age and the Insured has misstated his or her age, there will be a fair adjustment of premiums based on his or her true age. If the benefits for which the Insured is insured are based on age and the Insured has misstated his or her age, there will be an adjustment of said benefit based on his or her true age. The Company may require satisfactory proof of age before paying any claim.
Legal Actions. No action at law or in equity may be brought to recover on this Policy prior to the expiration of 60 days after written proof of Loss has been furnished in accordance with the requirements of this Policy. No such action may be brought after the expiration of 3 years after the time written proof of loss is required to be furnished.
Arbitration. Notwithstanding anything in this coverage to the contrary, any claim arising out of or relating to this contract, or its breach, may be settled by arbitration, if mutually acceptable, administered by the American Arbitration Association in accordance with its Commercial rules except to the extent provided otherwise in this clause. Judgment upon the award rendered in such arbitration may be entered in any court having jurisdiction thereof. All fees and expenses of the arbitration shall be borne by the parties equally. However, each party will bear the expense of its own counsel, experts, witnesses, and preparation and presentation of proofs. The arbitrators are precluded from awarding punitive, treble or exemplary damages, however so denominated. If more than one Insured is involved in the same dispute arising out of the same Policy and relating to the same Loss or claim, all such Insureds will constitute and act as one party for the purposes of the arbitration. Nothing in this clause will be construed to impair the rights of the Insureds to assert several, rather than joint, claims or defenses.
Concealment or Fraud. The Company does not provide coverage if the Insured has intentionally concealed or misrepresented any material fact or circumstance relating to this Policy or claim.
Payment of Premium. Coverage is not effective unless all premium due has been paid to the Company or its authorized representative prior to a date of Loss or insured occurrence.
Termination of this Policy. Termination of this Policy will not affect a claim for Loss if coverage was purchased while this Policy was in force.
Transfer of Coverage. Coverage under this Policy cannot be transferred by the Insured to anyone else.
Insurance With Other Insurers. If there is other valid coverage with another insurer that provides coverage for the same Loss, the Company will pay only the proportion of the Loss that this Company's Limit for that Loss bears to the total limit of all insurance covering that Loss, plus such portion of the premium paid that exceeds the pro-rata portion for the benefits so determined.
Controlling Law: Any part of this Policy that conflicts with the state law where this Policy is issued is changed to meet the minimum requirements of that law.
WYOMING STATE EXCEPTION
The second sentence in the Legal Actions provision is amended as follows:
“No such action may be brought after the expiration of 3 years after the time written proof of loss is required to be furnished”.
CHUBB GROUP
U.S. PRIVACY NOTICE
FACTS
WHAT DOES THE CHUBB GROUP DO WITH YOUR PERSONAL INFORMATION?
- Why?
- What?
- How?
Insurance companies choose how they share your personal information. Federal and state law gives consumers the right to limit some but not all sharing. Federal and state law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.
The types of personal information we collect and share depend on the product or service you have with us. This information can include:
- Social Security number and payment history
- insurance claim history and medical information
- account transactions and credit scores
All insurance companies need to share customers’ personal information to run their everyday business. In the section below, we list the reasons insurance companies can share their customers’ personal information; the reasons the Chubb Group chooses to share; and whether you can limit this sharing.
| Reasons we can share your personal information | Does Chubb share? | Can you limit this sharing? |
|---|---|---|
| For our everyday business purposes – such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus | Yes | No |
| For our marketing purposes – to offer our products and services to you | Yes | No |
| For joint marketing with other financial companies | Yes | No |
| For our affiliates’ everyday business purposes – information about your transactions and experiences | Yes | No |
| For our affiliates’ everyday business purposes – information about your creditworthiness | No | We don't share |
| For our affiliates to market to you | No | We don't share |
| For nonaffiliates to market to you | No | We don't share |
Questions? Call 1-800-258-2930 or go to https://www2.chubb.com/us-en/privacy.aspx
| Who is providing this notice? | The Chubb Group. A list of these companies is located at the end of this document. |
| What we do | |
| How does Chubb Group protect my personal information? | To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. We restrict access to personal information to our employees, affiliates’ employees, or others who need to know that information to service the account or to conduct our normal business operations. |
| How does Chubb Group collect my personal information? | We collect your personal information, for example, when you
|
| Why can’t I limit all sharing? | Federal law gives you the right to limit only
|
| Definitions | |
| Affiliates | Companies related by common ownership or control. They can be financial and nonfinancial companies.
|
| Nonaffiliates | Companies not related by common ownership or control. They can be financial and nonfinancial companies.
|
| Joint Marketing | A formal agreement between nonaffiliated financial companies that together market financial products or services to you.
|
| Other important information | |
| For Insurance Customers in AZ, CA, CT, GA, IL, MA, ME, MN, MT, NV, NC, NJ, OH, OR, and VA only: Under state law, under certain circumstances, you have the right to see the personal information about you that we have on file. To see your information, write Chubb Group Attention: Privacy Inquiries, 202 Hall’s Mill Road, P.O. Box 1600, Whitehouse Station, NJ 08889-1600. Chubb may charge a reasonable fee to cover the costs of providing this information. If you think any of the information is not accurate, you may write us. We will let you know what actions we take. If you do not agree with our actions, you may send us a statement. If you want a full description of privacy rights that we will protect in accordance with the law in your home state, please contact us and we will provide it. We may disclose information to certain third parties, such as law enforcement officers, without your permission. For Nevada residents only: We may contact our existing customers by telephone to offer additional insurance products that we believe may be of interest to you. Under state law, you have the right to opt out of these calls by adding your name to our internal do-not-call list. To opt out of these calls, or for more information about your opt out rights, please contact our customer service department. You can reach us by calling 1-800-258-2930, emailing us at privacyinquiries@Chubb.com, or writing to Chubb Group, Attention: Privacy Inquiries, 202 Hall’s Mill Road, P.O. Box 1600, Whitehouse Station, NJ 08889-1600. You are being provided this notice under Nevada state law. In addition to contacting Chubb, Nevada residents can contact the Nevada Attorney General for more information about your opt out rights by calling 775-684-1100, emailing bcpinfo@ag.state.nv.us, or by writing to: Office of the Attorney General, Nevada Department of Justice, Bureau of Consumer Protection: 100 North Carson Street, Carson City, NV 89701. For Vermont residents only: Under state law, we will not share information about your creditworthiness within our corporate family except with your authorization or consent, but we may share information about our transactions or experiences with you within our corporate family without your consent. |
|
| Chubb Group Companies Providing This Notice | |
| This notice is being provided by the following Chubb Group companies to their customers located in the United States: ACE American Insurance Company, ACE Capital Title Reinsurance Company, ACE Fire Underwriters Insurance Company, ACE Insurance Company of the Midwest, ACE Life Insurance Company, ACE Property and Casualty Insurance Company, Agri General Insurance Company, Atlantic Employers Insurance Company, Bankers Standard Fire and Marine Company, Bankers Standard Insurance Company, Century Indemnity Company, Chubb Custom Insurance Company, Chubb Indemnity Insurance Company, Chubb Insurance Company of New Jersey, Chubb Lloyds Insurance Company of Texas, Chubb National Insurance Company, Executive Risk Indemnity Inc., Executive Risk Specialty Insurance Company, Federal Insurance Company, Great Northern Insurance Company, Illinois Union Insurance Company, Indemnity Insurance Company of North America, Insurance Company of North America, Pacific Employers Insurance Company, Pacific Indemnity Company, Penn Millers Insurance Company, Texas Pacific Indemnity Company, Vigilant Insurance Company, Westchester Fire Insurance Company and Westchester Surplus Lines Insurance Company. | |
Chubb Group
Notice of HIPAA Privacy Practices for Protected Health Information
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice is effective as of June 15, 2018.
The Chubb Group of Companies, as affiliated covered and hybrid entities, (the "Company") is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information, and to inform you about:
- The Company's uses and disclosures of Protected Health Information ("PHI")
- Your privacy rights with respect to your PHI;
- The Company's duties with respect to your PHI;
- Your right to file a complaint with the Company and to the Secretary of the U.S. Department of Health and Human Services ("HHS"); and
- The person or office to contact for further information regarding the Company's privacy practices.
A federal law, the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), regulates PHI use and disclosure by the Company. You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. This notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this notice and the regulations.
- Notice of PHI Uses and Disclosures
- Required Uses and Disclosures Upon your request, the Company is required to give you access to certain PHI in order to inspect and copy it.
- Uses and Disclosures to Carry Out Treatment, Payment, and Health Care Operations The Company and its business associates will use PHI without your consent, authorization or opportunity to agree or object to carry out treatment, payment and health care operations. The Company also may also disclose PHI to a plan sponsor for purposes related to treatment, payment and health care operations and as otherwise permitted under HIPAA to the extent the plan documents restrict the use and disclosure of PHI as required by HIPAA.
- Uses and Disclosures that Require Your Written Authorization The Company will not use or disclose your PHI for the following purposes without your specific, written authorization:
- Use and disclosure of psychotherapy notes, except for your treatment, Company training programs, or to defend Company against litigation filed by you.
- Use and disclosure for marketing purposes, except for face to face communications with you.
- Use and disclosure that constitute the sale of your PHI. The Company does not sell the PHI of its customers.
- Uses and Disclosures Requiring Authorizations or Opportunity to Agree or Disagree Prior to the Use or Release If you authorize in writing the Company to use or disclose your own PHI, the Company may proceed with such use or disclosure without meeting any other requirements and the use or disclosure shall be consistent with the authorization.
- The information is directly relevant to the family or friend's involvement with your care or payment for that care; and
- You have either agreed to the disclosure or have been given an opportunity to object and have not objected.
- Uses and Disclosures for which Consent, Authorization or Opportunity to Object is Not Required Use and disclosure of your PHI is allowed without your authorization or request under the following circumstances:
- Rights of Individuals
- Right to Request Restrictions on Use and Disclosure of PHI You may request the Company to restrict its use and disclosure of your PHI to carry out treatment, payment or health care operations, or to restrict its use and disclosure to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care. However, the Company may not be required to agree to your request, unless you have paid out of pocket in full for services, depending on the specific facts.
- Right to Inspect and Copy PHI You have a right to inspect and obtain a copy of your PHI contained in a "designated record set," for as long as the Company maintains the PHI.
- Right to Amend PHI You have the right to request the Company to amend your PHI or a record about you in a designated record set for as long as the PHI is maintained in the designated record set.
- Right to Receive an Accounting of PHI Uses and Disclosures Upon your request, the Company will provide you with an accounting of disclosures by the Company of your PHI during the six (6) years prior to the date of your request. However, such accounting need not include PHI disclosures made: (1) to carry out treatment, payment or health care operations; (2) to individuals about their own PHI; (3) prior to the compliance date; or (4) based upon your own written authorization.
- Right to Obtain a Paper Copy of This Notice Upon Request (Even if you have consented to receive this notice electronically) To obtain a paper copy of this notice contact: Leslie Kaltenbach, Senior Privacy Officer & Compliance Manager, Chubb Group, 202 Hall’s Mill Road, Whitehouse Station, NJ 08889, phone: 1-833-802-4822 .
- Note About Personal Representatives You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms:
- A power of attorney for health care purposes, notarized by a notary public;
- A court order of appointment of the person as the conservator or guardian of the individual; or
- An individual who is the parent of a minor child.
- The Company's Duties The Company is required by law to maintain the privacy of PHI and to provide individuals (participants and beneficiaries) with notice of its legal duties and privacy practices and to notify affected individuals of a breach of unsecured PHI. The Company is required to abide by the terms of this notice.
- "Minimum Necessary" Standard When using or disclosing PHI, or when requesting PHI from another covered entity, the Company will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations.
- Disclosures to or requests by a health care provider for treatment;
- Uses or disclosures made to the individual;
- Disclosures made to the Secretary of HHS;
- Uses or disclosures that are required by law; and
- Uses or disclosures that are required for the Company's compliance with legal regulations.
- Your Right to File a Complaint with the Company or the HHS Secretary If you believe that your privacy rights have been violated, you may complain to the Company in care of: Leslie Kaltenbach, Senior Privacy Officer & Compliance Manager, Chubb Group, 202 Hall’s Mill Road, Whitehouse Station, NJ 08889, phone: 1-833-802-4822 .
- Contact Information If you have any questions regarding this notice or the subjects addressed in it, you may contact: Leslie Kaltenbach, Senior Privacy Officer & Compliance Manager, Chubb Group, 202 Hall’s Mill Road, Whitehouse Station, NJ 08889, phone: 1-833-802-4822 .
- Chubb Group Legal Entities This following is a list of the Chubb Group companies located in the United States: ACE American Insurance Company, ACE Fire Underwriters Insurance Company, ACE Insurance Company of the Midwest, ACE Life Insurance Company, ACE Property and Casualty Insurance Company, Agri General Insurance Company, Atlantic Employers Insurance Company, Bankers Standard Insurance Company, Century Indemnity Company, Chubb Custom Insurance Company, Chubb Indemnity Insurance Company, Chubb Insurance Company of New Jersey, Chubb Lloyds Insurance Company of Texas, Chubb National Insurance Company, Executive Risk Indemnity Inc. Executive Risk Specialty Insurance Company, Federal Insurance Company, Great Northern Insurance Company, Illinois Union Insurance Company, Indemnity Insurance Company of North America, Insurance Company of North America, Pacific Employers Insurance Company, Pacific Indemnity Company, Penn Millers Insurance Company, Vigilant Insurance Company, Westchester Fire Insurance Company, Westchester Surplus Lines Insurance Company, Combined Insurance Company of America, and Combined Life Insurance Company of New York. These companies have designated themselves as hybrid entities and only those designated health care components identified by such companies are subject to HIPAA. In addition, these companies are legally separate affiliated companies under common ownership and have designated themselves as a single covered entity for purposes of HIPAA compliance.
Use and disclosure of your PHI may be required by the Secretary of Health and Human Services to investigate or determine the Company’s compliance with the privacy regulations.
Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers. For example, the Company may disclose to a treating orthodontist the name of your treating dentist so that the orthodontist may ask for your dental X-rays from the treating dentist.
Payment includes, but is not limited to, actions to make coverage determinations and payment (including establishing employee contributions, claims management, obtaining payment under a contract of reinsurance, utilization review and pre-authorizations). For example, the Company may tell a doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Company.
Health care operations include, but are not limited to, underwriting, premium rating and other insurance activities relating to creating or reviewing insurance contracts. It also includes disease management, case management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. For example, the Company may use information about your claims to refer you to a disease management program, project future benefit costs or audit the accuracy of its claims processing functions. The Company will not use or disclose PHI that is genetic information for underwriting purposes.
The Company also may contact you to provide appointment reminders or information about treatment alternatives or health- related benefits and services that may be of interest to you.
Except as otherwise indicated in this notice, uses and disclosures of PHI will be made only with your written authorization subject to your right to revoke such authorization. You may revoke an authorization by submitting a written revocation to the Company at any time. If you revoke your authorization, the Company will no longer use or disclose your PHI under the authorization. However, any use or disclosure made in reliance of your authorization before its revocation will not be affected.
Disclosure of your PHI to family members, other relatives or your close personal friends is allowed if:
(1) When required by law.
(2) When permitted for purposes of public health activities, including when necessary to report product defects and to permit product recalls and to conduct post-market surveillance. PHI may also be used or disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if authorized by law.
(3) When authorized by law to report information about abuse, neglect or domestic violence. In such case, the Company will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made. Disclosure may generally be made to the minor’s parents or other representatives although there may be circumstances under federal or state law where the parents or other representatives may not be given access to the minor’s PHI.
(4) The Company may disclose your PHI to a public health oversight agency for oversight activities authorized by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaints against providers); and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).
(5) The Company may disclose your PHI when required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request provided certain conditions are met. One of those conditions is that satisfactory assurances must be given to the Company that the requesting party has made a good faith attempt to provide written notice to you, and the notice provided sufficient information about the proceeding to permit you to raise an objection and no objections were raised or were resolved in favor of disclosure by the court or tribunal.
(6) When required for law enforcement purposes (for example, to report certain types of wounds).
(7) For law enforcement purposes, including for the purpose of identifying or locating a suspect, fugitive, material witness or missing person. Also, when disclosing information about an individual who is or is suspected to a victim of a crime but only if the individual agrees to the disclosure or the covered entity is unable to obtain the individual’s agreement because of emergency circumstances. Furthermore, the law enforcement official must represent that the information is not intended to be used against the individual, the immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and disclosure is in the best interest of the individual as determined by the exercise of the Company’s best judgment.
(8) When required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. Disclosure is permitted to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent The Company may also disclose your PHI to organ procurement organizations.
(9) The Company may use or disclose PHI for government-approved research, subject to conditions.
(10) When consistent with applicable law and standards of ethical conduct if the Company, in good faith, believes the use of disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
(11) For certain government functions such as related to military service or national security.
(12) When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.
(13) That is "incident to" an otherwise permitted use or disclosure of PHI by the Company.
The Company will accommodate reasonable requests to receive communications of PHI by alternative means or alternative locations, such as a location other than your home. The Company will accommodate this request if you state in writing that you would be in danger from receiving communications through the normal means.
You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your PHI.
Such requests should be made to: Leslie Kaltenbach, Senior Privacy Officer & Compliance Manager, Chubb Group, 202 Hall’s Mill Road, Whitehouse Station, NJ 08889, phone: 1-833-802-4822.
“Protected Health Information” (PHI) includes all individually identifiable health information transmitted or maintained by the Company, regardless of form.
"Designated Record Set" includes the medical records and billing records about individuals maintained by or for a covered health care provider; enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for a health plan; or other information used in whole or in part by or for the covered entity to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the designated record set.
The requested information will be provided within 30 days if the information is maintained on site or within 60 days if the information is maintained offsite. A single 30-day extension is allowed if the Company is unable to comply with the deadline.
You or your personal representative will be required to complete a form to request access to the PHI in your designated record set. Requests for access to PHI should be made to: Leslie Kaltenbach, Senior Privacy Officer & Compliance Manager, Chubb Group, 202 Hall’s Mill Road, Whitehouse Station, NJ 08889, phone: 1-833-802-4822.
If access is denied, you or your personal representative will be provided with a written denial setting forth the basis for the denial, a description of how you may exercise those review rights and a description of how you may complain to the Secretary of Health and Human Services.
The Company has 60 days after the request to act on the request. A single 30-day extension is allowed if the Company is unable to comply with the deadline. If the request is denied in whole or part, the Company must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI.
Requests for amendment of PHI in a designated record set should be made to: Leslie Kaltenbach, Senior Privacy Officer & Compliance Manager, Chubb Group, 202 Hall’s Mill Road, Whitehouse Station, NJ 08889, phone: 1-833-802-4822 .
You or your personal representative(s) will be required to complete a form to request amendment of the PHI in your designated record set.
If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.
If you request more than one accounting within a 12-month period, the Company will charge a reasonable, cost-based fee for each subsequent accounting.
The Company retains discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect. This also applies to personal representatives of minors.
The Company reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Company prior to that date. If a privacy practice is changed, a revised version of this notice will be provided to all past and present participants and beneficiaries for whom the Company still maintains PHI. This notice and any revised version of this notice will be posted on the Company’s internal website or mailed.
Any revised version of this notice will be distributed within 60 days of the effective date of any material change to the uses or disclosures, the individual's rights, the duties of the Company or other privacy practices stated in this notice.
However, the minimum necessary standard will not apply in the following situations:
This notice does not apply to information that has been "de-identified." De-identified information is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual is not individually identifiable health information.
In addition, the Company may use or disclose "summary health information" to a plan sponsor for obtaining premium bids or modifying, amending or terminating the Company, which summarizes the claims history, claims expenses or type of claims experienced by individuals for whom the Company Sponsor has provided health benefits under the Company; and from which identifying information has been deleted in accordance with HIPAA.
You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue S.W ., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ .
Your complaint must be submitted within 180 days of when you believe the violation occurred. The Company will not retaliate against you for filing a complaint.