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The following conditions and additional exclusions apply:
a. The care must be medically necessary to treat an emergency condition, and such care must be provided by a
doctor, dentist, hospital, or other provider authorized to practice medicine or dentistry.
b. This coverage will not pay for any care provided after your coverage ends.
c. This coverage will not pay for non-emergency care or services, such as:
1. Elective cosmetic surgery or care;
2. Annual or routine exams;
3. Long-term care;
4. Allergy treatments (unless life threatening);
5. Exams or care related to or loss of/damage to hearing aids, dentures, eyeglasses, and contact lenses;
6. Physical therapy, rehabilitation, or palliative care (except as necessary to stabilize you);
7. Experimental treatment; and
8. Any other non-emergency medical or dental care.
d. You must not have traveled against the orders or advice of any government or other public authority at any
location to, from, or through which you are traveling on your trip.
There are no other changes to your policy.
Jefferson Insurance Company
Jeff Wright, President
101-END-14-2022 E14
