Sean Gelsey

18635 East Dorado Drive

Aurora CO 80015

Thank you for your recent purchase of Allianz Travel Insurance. We are pleased that you have chosen to take us along on your
upcoming trip!

This packet of information will help you use your travel insurance policy and includes:

 A summary of assistance services and benefits described below

 Your Letter of Confirmation of insurance benefits
 Your detailed Certificate of Insurance/Policy

Summary of Assistance Services and Benefits

You are entitled to important assistance services and benefits.

Service/Benefit
Concierge
24-Hour Hotline Assistance

To make the most of your assistance services and benefits please:

 Read the detailed Certificate of Insurance/Policy.
 Download the TravelSmart app for a listing of hospitals and clinics for your destination(s) available at both the App Store and
Google Play.
 If you require emergency medical care while traveling, please call our office for assistance before engaging any expense.
 Save or photograph all receipts in the event you need to file a claim. Claims may be electronically filed at
http://www.etravelprotection.com/deltausa.
Letter of Confirmation

right, fold, and carry with you.

Please detach the card to the
January 28, 2018 Name: Sean Gelsey
Policy No.: EUSP2101561375
Sean Gelsey
18635 East Dorado Drive Emergency Assistance Card
Aurora CO 80015

Dear Sean Gelsey,

For emergency assistance during your trip call:
Thank you for choosing Allianz Global Assistance to protect your travel investment. 1-800-419-8016 1-804-281-5700
(From U.S.) (Outside the U.S.) / (Collect)
Please make sure you read this Letter of Confirmation, your enclosed Policy, and
any other attached documents, including riders or other forms carefully. Because the For benefit information call:
Policy may describe coverage not included in your plan, be sure to look at all of the 1-800-419-8016
documents to understand your specific coverage. Contact us immediately if you (From U.S.)
think there is a mistake in your Letter of Confirmation.
To modify your policy or file a claim, please visit:
We recommend that if you are traveling for your event, you take copies of these
http://www.etravelprotection.com/deltausa
documents with you. If you did not receive a Policy, or would like another copy,
please call 1-800-284-8300.
9950 Mayland Drive, Richmond, VA 23233
Information About Your Plan Your plan includes the following coverage, up to the limits
Name of your plan: Trip Protector shown. Please see your Policy for information about how
Policy identification number: EUSP2101561375 our insurance works.

Number of people insured: 1 Coverage

Who it insures: Sean Gelsey Benefit Limits*
Baggage Coverage $300.00
Date of purchase: January 28, 2018 Baggage Delay Coverage $200.00
Plan effective date: January 29, 2018 Missed Connection Coverage $500.00
Travel dates: February 10, 2018 - February 11, 2018 Trip Cancellation Protection $350.00
Travel/Trip Delay Coverage $500.00
Total cost for all travelers: $23.63
Trip Interruption Protection $525.00
Amount paid: $23.63 *USD per person unless noted otherwise

Changes to your travel plans may require changes to your coverage. If your plans
Please Note
change please contact Allianz Global Assistance.
 Your plan includes Existing Medical Condition Coverage.
Thanks again for purchasing a travel insurance plan from Allianz Global Assistance.  AGA Service Company is the licensed producer and
Have a safe and pleasant trip! administrator for this plan.
 Insurance coverage is provided under Form 101-P-XX-
Sincerely, 02-102 PC issued by Jefferson Insurance Company.

Deloress Wellman
Vice President of Operations

AGA Service Company

We will refund your insurance premium if you cancel your plan within
10 days of purchase and you haven’t started your trip or filed a
claim.

Form No. 101-LOC-CO-02 PC 12-14

TI_LOC_P_100_004_CO * TI_102_16_P_V2PC * 101_R_CO_02 * JICPRIVNOT * * * * * * *
 Your Travel Insurance Policy
Allianz Travel Insurance
Thank you for buying a travel insurance plan from us!

Individual Travel Your plan is described in the following documents:

 This policy, which explains how our travel insurance works.
 The letter of confirmation that came with your package, which tells you what coverage your
Insurance Policy plan includes and the limits.
 Any other information you receive with your package, including riders or other forms.

Please make sure you read these documents carefully. This policy may describe coverage
FOR SERVICE, VISIT OR CALL: your plan doesn’t include. Make sure you review carefully your letter of confirmation. Contact us
www.etravelprotection.com immediately if you don’t receive your letter of confirmation or if you think there is a mistake.

1-800-284-8300 All dollar amounts in these documents are in US dollars.

FOR EMERGENCY ASSISTANCE

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We can help!
DURING YOUR TRIP CALL: Our assistance team can help you with problems 24 hours a day, almost
anywhere in the world.

1-800-654-1908 In the United States, Canada, Puerto Rico

and the U.S. Virgin Islands 1-800-654-1908
(From U.S.)
All other locations, call collect 1-804-281-5700

1-804-281-5700
(Collect)

Don’t forget to
take this document
with you!

Allianz Global Assistance and Allianz Travel Insurance branded plans are underwritten by
Jefferson Insurance Company. AGA Service Company is the licensed producer for this plan.
Form 101-P-XX-02-102 PC 0 1 Form 101-P-XX-02-102 PC
©2017 AGA Service Company TI_102_16_P_V2PC
 WHAT’S INSIDE SECTION 1: OUR AGREEMENT WITH YOU
Section 1: Our agreement with you ....................................................................... 3 Your travel insurance plan (your plan) includes both insurance coverage and assistance services.
Section 2: What this policy includes ..................................................................... 4
Throughout this document:
Section 3: What this policy excludes .................................................................. 14  we, us and our mean Jefferson Insurance Company and its agents;
 Jefferson means Jefferson Insurance Company;
Section 4: Who is covered and when .................................................................. 16  you and your mean the people listed on your letter of confirmation; and
Section 5: Claims information .............................................................................. 17  all other bolded terms are defined in Section 6, Definitions.

Section 6: Definitions............................................................................................. 19 No one has the right to describe this travel insurance any differently than it has been described in
this document, or to change or waive any of its provisions.

About this agreement

Please read your policy carefully for full details. This is a legal contract. The entire contract
consists of the policy, any riders attached to it; and the letter of confirmation. You have a duty to
make all reasonable efforts to minimize any loss.

We have issued the policy and any attached riders based on your payment of the premium and on
the information you included in your application or other form. The statements you made in your
application or other form are representations and not warranties. We may use this information to
void insurance, reduce benefits or defend our decision about a claim.

The headings in this policy are for convenience only.

Satisfaction Guarantee
We will refund your insurance premium if you cancel your plan within 10 days of purchase
and you haven’t started your trip or filed a claim.

Signed for Jefferson Insurance Company, 9950 Mayland Drive, Richmond, VA 23233

Mike Nelson, President Fred Faett, Secretary

2 3 Section 1: Our agreement with you

 SECTION 2: WHAT THIS POLICY INCLUDES
How to read Section 2
This is a named perils travel insurance policy, which means it covers only the specific situations,
events and losses included in this document, and only under the conditions we describe. When it applies Tells you when you’re eligible to make a claim. These situations and
events are called covered reasons.
The plan you purchased may not include all the coverage described here. Make sure you check
your letter of confirmation to confirm your coverage and limits. What it covers Tells you the kinds of things you can be reimbursed for. You’ll find out
more in Section 5, Claims information.
Your plan also includes assistance services, which are described in Help while traveling.
We can help! Tells you about related assistance services that are available to you

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worldwide. You’ll find a complete list in Help while traveling.
Coverage When it applies Page
Your trip is canceled or interrupted 5
Trip cancellation Your trip is canceled before you get started
Trip interruption Your trip is interrupted after you’ve left

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Important
Frequent traveler/ You have to re-deposit frequent traveler or Be sure to also read Section 3, What this policy excludes, as well as Section 4, Who
Loyalty program loyalty program awards is covered and when, for important information on how your coverage works.
You’re delayed or miss your flight or cruise 9 Travel insurance doesn’t cover everything. It’s designed to protect you when there’s
a sudden, unexpected problem or event.
Travel delay Your travel is delayed six hours or more
Missed connection You miss your connecting flight or cruise
Your baggage is lost damaged, stolen or 11 YOUR TRIP IS CANCELED OR INTERRUPTED
delayed

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Lost, damaged or Your baggage is lost, damaged or stolen Important
stolen baggage You need to contact your travel suppliers within 72 hours of canceling or
Delayed baggage Your baggage is delayed by a common carrier interrupting your trip to qualify for the largest reimbursement possible. If you notify
your suppliers later and get a smaller refund, we will not cover the difference. If
Other coverage 12 you’re seriously ill or injured, contact your travel suppliers as soon as you can.
Existing medical You have an existing medical condition
condition

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Change fee You have to change your airline ticket due to We can help!
covered reasons Need help sending an emergency message or getting flight information? See Help
while traveling, for a complete list of ways we can help.
* Underwritten by Jefferson Insurance Company

Trip cancellation and Trip interruption coverage

When it applies Your trip is canceled before you get started, or interrupted after you’ve
left, for one of the following covered reasons:

Health
Injury, illness or medical condition
You or a traveling companion is seriously ill or injured.

Section 2: What this policy includes 4 5 Section 2: What this policy includes
Specific requirements: Canceled services
 The injury, illness or medical condition must be disabling enough Your airline, cruise line, or tour operator or travel supplier stops offering
to make a reasonable person delay, cancel or interrupt their trip. all services for at least 24 consecutive hours where you’re departing,
 A doctor must examine you or a traveling companion and advise arriving or making a connection because of:
you or a traveling companion to cancel or interrupt your trip  a natural disaster; or
before you cancel or interrupt it. If that isn’t possible, a doctor must  severe weather.
examine you within 72 hours of your cancellation or interruption.
Specific requirement:
A family member who isn’t traveling with you is seriously ill or injured.  Your travel supplier doesn’t offer you a substitute itinerary.

Specific requirement: Politics and violence

 The injury, illness or medical condition must be considered life Hijacking
threatening, require hospitalization, or he or she must require your You or a traveling companion is hijacked.
care.
Terrorism
Death A terrorist event happens at your foreign destination within 30 days of
You, a traveling companion or family member dies. the day you’re scheduled to arrive.

Specific requirement: Specific requirement:

 A traveling companion’s or family member’s death must occur  For locations outside the United States, you’re not covered if there’s
before or during your trip. been a terrorist event at your destination in the 30 days before
your plan’s effective date.
Quarantine
You or a traveling companion is quarantined. Work
Termination or layoff
Transportation and accommodation You or a traveling companion is terminated or laid off from a company
Traffic accident after your plan’s effective date.
You or a traveling companion is in a traffic accident on the way to your
point of departure; and: Specific requirements: (all must apply)
 you or the traveling companion need medical attention; or  The termination or layoff isn’t your fault; and
 the car needs to be repaired because it’s not safe to drive.  You worked for this employer for at least three continuous years.

Family or friends can’t accommodate you as planned Military Duty in the U.S. Armed Forces
Family or friends outside the United States can’t accommodate you as You or a traveling companion, serving in the U.S. Armed Forces, is
planned because someone in the household has died or been diagnosed reassigned, or have personal leave revoked, except because of war, the
with a serious illness or injury. War Powers Act, base or unit mobilization, unit reassignment or
disciplinary action.
Legal
Jury duty or court-ordered appearance Other
You’re summoned by a court order or subpoena to serve on a jury or Extended travel delay
appear in court. You miss more than half of the total length of your trip because your
travel is delayed.
Environment
Home uninhabitable Specific requirements: (all must apply)
Your primary residence is uninhabitable because of a natural  Your plan must include travel delay coverage; and
disaster, fire, flood, burglary or vandalism.  You must be delayed for a covered reason listed under travel delay
coverage.
Section 2: What this policy includes 6 7 Section 2: What this policy includes
What it covers Please refer to your letter of confirmation to confirm your coverage and Redeposit fees
limits in your plan. Fees for re-depositing frequent traveler or loyalty program awards into
your account.
Trip cancellation coverage
Non-refundable payments and deposits
Payments and deposits you made before your trip was canceled, less YOU’RE DELAYED OR MISS YOUR FLIGHT OR CRUISE
any published refunds you’re entitled to receive.

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Accommodation Important
The extra cost of single accommodation if you prepaid for shared You need to make reasonable efforts to continue your trip if you’re delayed or you
accommodation and a traveling companion canceled or interrupted miss your flight or cruise. The coverage described here can help. Any refunds you
their trip for a covered reason or was delayed for a covered reason. receive from your travel suppliers will be deducted from your claim.

Trip interruption coverage

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Prepaid expenses We can help!
The unused part of your prepaid expenses, less any refunds you Need help rebooking your flight or arranging for alternative transportation? See Help
receive. while traveling, for a complete list of ways we can help.

Accommodation
The extra cost of single accommodation if you prepaid for shared
accommodation and a traveling companion canceled or interrupted Travel delay coverage
their trip for a covered reason or was delayed for a covered reason.
When it applies Your travel is delayed for six or more consecutive hours for one of the
Transportation following covered reasons:
Reasonable transportation expenses for getting to:
 your final destination or a place where you can continue your trip; Strike or common carrier delay
or  Your departure is delayed by a common carrier.
 your original destination another way, if your travel is delayed for  Your departure is delayed by an unannounced strike.
24 hours or more at the start of your trip.
Quarantine
Expenses for the cost of staying longer than you planned  You are quarantined.
Extra accommodation and transportation expenses because a traveling
companion is hospitalized. Natural disaster
 There’s a natural disaster.
Special limit:
 Maximum of $100 a day for up to five days. Politics, violence or theft
 Your passports, money or other travel documents are lost or stolen.
 Your travel is delayed by a hijacking.
Frequent traveler/Loyalty program coverage  Your travel is delayed by civil disorder or unrest.
What it covers Please refer to your letter of confirmation to confirm your coverage and
When it applies You have to re-deposit points in your frequent traveler or loyalty program
limits in your plan.
because your trip is canceled for one of the covered reasons listed
under trip cancellation coverage.
Meals, accommodation and transportation
What it covers Please refer to your letter of confirmation to confirm your coverage and  Reasonable expenses for additional meals and accommodation
limits. while you’re delayed.
 Reasonable additional transportation expenses.

Section 2: What this policy includes 8 9 Section 2: What this policy includes
 Special limit
YOUR BAGGAGE IS LOST, DAMAGED, STOLEN OR DELAYED
 Maximum of $150 per person per day, up to the limit shown on your
letter of confirmation.

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Benefits are payable under travel delay or missed connection coverage, Important
not both. Any refunds you receive will be deducted from your claim.

Missed connection coverage

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We can help!
When it applies You miss your connecting flight or cruise for one of the following Need help contacting local authorities or getting emergency cash from home? See
covered reasons: Help while traveling, for a complete list of ways we can help.
 you’re involved in or delayed by a traffic accident;
 you’re delayed by severe weather while en route to the departure;
or
 severe weather cancels one of your flights en route to the
Lost, damaged or stolen baggage coverage
connection or cruise, or delays it for at least three hours.
When it applies Your baggage is lost, damaged or stolen while you’re traveling.
Specific requirements: (all must apply)
 You allowed enough time in your itinerary to reach your flight or Specific requirements: (all must apply)
cruise on time; and  You take reasonable steps to keep your baggage safe and intact,
 You aren’t able to reach your connecting flight or cruise another and to recover it; and
way.  You file a report giving a description of the property and its value
with the appropriate local authorities, common carrier, hotel or tour
What it covers Please refer to your letter of confirmation to confirm your coverage and operator within 24 hours of the loss.
limits in your plan.
What it covers Please refer to your letter of confirmation to confirm your coverage and
Prepaid expenses limits in your plan.
The unused part of your prepaid expenses if you miss at least 24 hours
of your trip, less any refunds you receive. Actual price, actual cash value, repair or replacement (whichever is less)
 actual price is the amount it would cost to buy a similar item.
Meals, accommodation and transportation  actual cash value is the amount the item is worth based on its
 Reasonable additional expenses for meals and accommodation current market value. If you don’t have an original receipt, we’ll
related to your missed connection or cruise. cover up to 75% of its current market value.
 Reasonable additional transportation expenses to get to your  repair or replacement is the cost to repair or replace the item.
original destination or to a place where you can continue your trip.
Special limit:
Benefits are payable under only one of missed connection coverage or  Maximum $500 in total for all jewelry, watches, gems, furs, cameras
travel delay coverage. and camera equipment, camcorders, sporting equipment, computers,
radios and other electronic items. You need to provide original
receipts for these items or they won’t be covered.

Section 2: What this policy includes 10 11 Section 2: What this policy includes
Delayed baggage coverage Change fee coverage

When it applies A common carrier, hotel or tour operator delays your baggage for 24 When it applies You have to change the dates on your airline ticket for one of the
hours or more. following covered reasons:
 your trip is canceled or interrupted for a covered reason listed
Specific requirement: under trip cancellation/trip interruption coverage, except cessation of
 You report the loss and file a claim with the common carrier, hotel operations; or
or tour operator.  you or a traveling companion are delayed by severe weather on
Please refer to your letter of confirmation to confirm your coverage and the way to your flight.
What it covers
limits in your plan.
Specific requirement:
Reasonable essential items  If you were delayed by severe weather, you allowed enough time
Reasonable essential items for you to use until your baggage arrives. in your itinerary to reach your flight on time.
What it covers Please refer to your letter of confirmation to confirm your coverage and
limits.
OTHER COVERAGE
Change fees
Fees to change the dates on your airline ticket.

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Important
Please check your letter of confirmation to confirm your coverage and limits.

Existing medical condition coverage

If your plan includes this coverage, you, a traveling companion or family member can have an
existing medical condition and you will still be eligible for all coverage and assistance services,
as long as:
 you purchased your plan within 14 days of making your first trip payment or first trip deposit;
 you purchased trip cancellation coverage that covers the full cost of all your non-refundable
trip arrangements;
 you were a U.S. resident and medically able to travel on the day you purchased the plan;
 the total cost of your trip is $10,000 per person or less; and
 all other stated terms and conditions are met.

Section 2: What this policy includes 12 13 Section 2: What this policy includes
  terrorist events (unless specifically included in Section 2);
SECTION 3: WHAT THIS POLICY EXCLUDES
 financial default (unless specifically included in Section 2); or
 unlawful acts.
GENERAL EXCLUSIONS
You aren’t eligible for reimbursement under any coverage if:
 your common carrier tickets don’t show departure and return dates; or
You aren’t covered for any loss that results directly or indirectly from any of the following general  the departure and return dates on your application or other form don’t represent when you
exclusions. actually intended to travel.
The following things if they affect you, a traveling companion or a family member, whether the
family member is traveling with you or not: SPECIFIC EXCLUSIONS
 existing medical conditions (unless you have existing medical condition coverage in
Section 2); You aren’t covered for any loss that results directly or indirectly from any of the following specific
 intentional self-harm or attempting or committing suicide (only applies to you); exclusions unless they’re included in Section 2, What this policy includes.
 pregnancy, (unless specifically included in Section 2), unless there are unforeseen
complications or problems with the pregnancy; Lost, damaged or stolen baggage coverage
 fertility treatments, childbirth or elective abortion;  intentional loss of or damage to equipment;
 a mental or nervous health disorder (like anxiety, depression, neurosis, psychosis and others),  defective materials or workmanship; or
or any related physical complications (physical complication means any physical symptom); or  ordinary wear and tear.
 the use or abuse of alcohol or drugs, or any related physical complications (physical
complication means any physical symptom). These items aren’t covered:
 animals;
The following activities if you, a traveling companion or a family member participates in them,  cars and accessories, motorcycles and motors, aircraft, boats and other vehicles;
whether the family member is traveling with you or not:
 bicycles, skis and snowboards (unless they’re checked with a common carrier);
 flying or learning to fly an aircraft as a pilot or crew member;
 eyeglasses, sunglasses and contact lenses;
 participating in or training for any professional or amateur sporting competition; or
 hearing aids, artificial teeth and limbs;
 participating in extreme, high-risk sports like:
 wheelchairs and other mobility devices;
 skydiving, hang gliding or parachuting;
 consumables, medicines, perfumes, cosmetics and perishables;
 bungee jumping;
 tickets, passports, deeds and other documents;
 caving;
 money, credit cards, securities, bullion, stamps and keys;
 extreme skiing, heli-skiing or skiing outside marked trails;
 rugs and carpets;
 body contact sports (meaning any sport where the objective is to physically render an
 property for business or trade; and
opponent unable to continue with the competition such as boxing and full contact karate);
 baggage when it is:
 mountain climbing or any other high altitude activities; or
 shipped as freight;
 scuba diving below 120 feet (40 meters) or without a dive master.
 sent before your scheduled departure date;
The following events:  left in or on a car trailer; or
 any problem or event that could have reasonably been foreseen or expected when you  left in an unlocked car.
purchased your plan;
 an epidemic or pandemic;
 natural disasters like hurricanes, earthquakes, fires and floods (unless specifically included
in Section 2);
 air, water or other pollution, or the threat of a pollutant release;
 nuclear reaction, radiation or radioactive contamination;
 war (declared or undeclared), acts of war, military duty, civil disorder or unrest (unless
specifically included in Section 2);

Section 3: What this policy excludes 14 15 Section 3: What this policy excludes
 SECTION 4: WHO IS COVERED AND WHEN
SECTION 5: CLAIMS INFORMATION
WHO IS COVERED BY YOUR PLAN
HOW TO MAKE A CLAIM
Your plan covers the people listed on your letter of confirmation.
Making a claim is easy – just visit www.etravelprotection.com, email or call us and we’ll be
happy to help.
WHEN YOUR COVERAGE BEGINS AND ENDS
Go online to:
You’re only eligible for coverage if we accept your request for insurance.  find out what forms and documentation you need.
 download a claims form and mail it in.
Your plan’s effective date depends on how you purchased it.  file a claim electronically and track its progress.

Email or call to:

if you purchased it’s effective:
 find out what forms and documentation you need.
in person the day and time you purchase your plan.  file a claim and check its progress.
by mail the day after your application or other form is postmarked.
Claims inquiry:
over the phone the day after you place your telephone order.
 Website: www.etravelprotection.com
by fax the day after we receive your fax.  Email: claimsinquiry@allianzassistance.com
online the day after we receive your online order.  Telephone: 1-800-334-7525

Trip cancellation coverage begins on your plan’s effective date, as long as we receive your IMPORTANT INFORMATION ABOUT CLAIMS
premium before you cancel your trip or make a claim.
You have 90 days from the date of your loss to submit your claim to us, except as otherwise
All other coverage begins on your scheduled departure date, as long as we’ve received your
provided by law.
payment. Your departure and return dates are counted as two separate days of travel when we
calculate the duration of your trip.
Proof of Loss
You are responsible for providing all necessary documentation to prove your loss.
Your coverage ends on the earliest of:
 the day you’re scheduled to return;
Assignment
 the day you actually return, if you come back earlier;
You can assign your rights under your plan by notifying us in writing.
 the day and time you cancel your trip; or
 the 180th day of the trip. About beneficiaries
All benefits will be paid to your estate.
If your return travel is delayed for a covered reason, we’ll extend your coverage until you can
get home. Duplicate coverage
If you’re covered by another certificate or policy that we’ve issued with the same or similar
Your plan can’t be renewed. coverage, we’ll use the terms and conditions of the certificate or policy that pays the most. We’ll
also refund any premium you’ve paid for duplicate coverage.

Section 4: Who is covered and when 16 17 Section 5: Claims information

Recovery
We have the right to recover any amount you receive that exceeds the total amount of your loss.
SECTION 6: DEFINITIONS

Subrogation Accident An unexpected and unintended event that causes injury, property
When someone is responsible for your loss, we have the right to recover any payments we’ve damage or both.
made to you or someone else in relation to your claim, as permitted by law. Everyone eligible to Accommodation A hotel or other kind of lodging where you make a reservation and pay
receive payment for a claim submitted to us must cooperate with this process, and must refrain a fee.
from doing anything that would adversely affect our rights or the rights of Jefferson to recover
payment. Assault Physical assault that requires treatment in a hospital.
Baggage Personal property you take on your trip and the suitcases or other
About fraud kinds of containers you use to carry them.
Fraud is illegal. We will deny your claim if:
 what you told us on your application or other form is deliberately misleading or inaccurate; or Common carrier A company that’s licensed to carry passengers on land, water or in the
 you intentionally file a claim that includes false information or deliberately conceals material air for a fee, not including car rental companies.
facts. This may be a crime subject to criminal prosecution and civil penalties, and you may be Covered reasons The specific situations and events that are covered by this policy.
liable for the stated value of the claim.
Current market value The dollar amount an item could reasonably be sold for, based on its
Resolving disputes original price, age and current condition.
If you disagree with our decision about a claim, you can request to go to arbitration through the Destination A place more than 100 miles from your primary residence where you
American Arbitration Association. If we agree, you can submit a dispute to desk arbitration, as long spend more than 24 hours of your trip.
as:
 you submit it at least 60 days, but no more than three years, after you’ve filed your entire Doctor Someone who is legally entitled to practice medicine, and is licensed if
claim with us; and required. This can’t be you, a traveling companion, any member of
 it complies with the American Arbitration Association’s rules at the time you submit it. either of your immediate families, or any member of the sick or injured
person’s immediate family.
Domestic partner A person you’ve lived with in a spousal relationship for at least 12

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Important
consecutive months who is 18 years or older. You must be able to show
This is a named perils travel insurance policy, which means it covers only the
evidence that you’ve lived together for 12 consecutive months.
specific situations, events and losses included in this document, and only under the
conditions we describe. Epidemic An outbreak of a contagious disease that spreads rapidly and widely
and that is identified as an epidemic by The Centers for Disease Control
We’ll only pay for reasonable, appropriate expenses that are covered by the plan
and Prevention (CDC).
you purchased. Please check your letter of confirmation to confirm your coverage
and limits in your plan. Existing medical An illness or injury that you, a traveling companion or family
condition member were seeking or receiving treatment for or had symptoms of on
the day you purchased your plan, or at any time in the 120 days before
you purchased it.
You, a traveling companion or family member are considered to have
an existing medical condition if you, a traveling companion or
family member:
 saw or were advised to see a doctor;
 had symptoms that would cause a prudent person to see a doctor;
or
 were taking prescribed medication for the condition or the
symptoms, unless the condition or symptoms are effectively
controlled by the prescription, and the prescription hasn’t changed.

Section 5: Claims information 18 19 Section 6: Definitions

Family member Any of the following people, whether or not they’re traveling with you: Pandemic An epidemic over a wide geographic area that affects a large portion of
 spouses and common-law, civil union and domestic partners; the population.
 parents and step-parents; Primary residence Your permanent, fixed address and primary residence for legal and tax
 children and step-children (including adopted or soon to be purposes. We call the place your primary residence is located your
adopted children); place of residence.
 siblings;
 grandparents and grandchildren; Quarantine Mandatory isolation or restrictions on where you can go, intended to
 the following in-laws: mother, father, son, daughter, brother, sister; stop a contagious disease from spreading.
 aunts, uncles, nieces and nephews; Refund Cash or a credit or voucher for future travel that you get from a travel
 legal guardians and wards; agent, tour operator, airline, cruise line or other travel supplier, or any
 business partners; credit, recovery or reimbursement you get from your employer, another
 paid, live-in caregivers; and insurance company, a credit card issuer or any other entity.
 service animals (as defined by the Americans with Disabilities Act). Scheduled departure The day and time you listed on your application or other form as the
Immediate family members are: date day and time you plan to start your trip. You have paid for travel that
 spouses and common-law, civil union and domestic partners; starts on this date.
 parents and step-parents; Severe weather Hazardous weather conditions, like fog, a hailstorm or severe rainstorm,
 children and step-children (including adopted or soon to be a blizzard, or an ice storm.
adopted children);
 siblings; and Terrorist event When an organized terrorist group, as defined by the U.S. State
 grandparents and grandchildren. Department, injures or kills people or damages property to achieve a
political, ethnic or religious goal or result. Terrorist events don’t include
Financial default A complete cessation of operations because of financial circumstances, general civil protest, unrest, rioting or acts of war.
with or without filing for bankruptcy protection.
Travel supplier A travel agent, tour operator, airline, cruise line or other travel service
Hospital A facility whose primary function is to diagnose and treat sick and provider.
injured people under the supervision of doctors. It must:
Traveling companion A person traveling with you whose name appears with yours on the
 have organized departments of medicine and major surgery, on
same trip arrangement and who will accompany you on your trip. A
site or off site through a pre-arranged contract provide 24 hour
group or tour leader is not considered a traveling companion unless
nursing service supervised or provided by registered nurses;
you are sharing the same room with the group or tour leader.
 be compensated by patients or their insurance providers for
performing these services; and Trip Round-trip or one-way travel to and from a place at least 100 miles from
 be licensed where required. your home. It can’t include travel to receive health care or medical
treatment of any kind, or commuting to and from work.
Illness Sickness, infirmity or disease. It doesn’t include conditions you already
had or knew about when you purchased your plan (see existing Unlawful acts Felonies committed by you, a traveling companion or a family
medical condition). member, even if the family member isn’t covered by your plan.
Injury Physical harm directly caused by an accident or assault, without other Uninhabitable A natural disaster, fire, flood, burglary or vandalism causes enough
contributing causes. damage to make a reasonable person find their home or other
accommodation unfit for use.
Medical condition A physical condition you have, or have symptoms of, that you:
 have seen or been advised to see a doctor about;
 have symptoms of that would cause a prudent person to see a
doctor; or
 are taking prescribed medication for.
Natural disaster A large-scale extreme weather or environmental event that damages
property, disrupts transportation or endangers people. Examples Form 101-P-XX-02-102 PC
include: earthquake, fire, flood, hurricane, or volcanic eruption.
Section 6: Definitions 20 21 Section 6: Definitions
 HELP WHILE TRAVELING LEGAL ASSISTANCE

If you need help while traveling, our assistance team is available 24 hours a day. Finding a legal advisor
We can help you find local legal advice if you need it while you’re traveling.
Our services are here to help make challenging situations a little easier. With our global reach, we
can get you in touch with licensed medical and legal professionals and other kinds of help. Arranging a cash transfer
If you need to pay legal fees, we can arrange to transfer funds from your family or friends.

!
Important
Please note that the General exclusions for your plan also apply to our assistance TRAVEL AND DOCUMENT ASSISTANCE
services. You’ll find the list of these exclusions in Section 3, What this policy
excludes.
Replacing lost travel tickets
If your tickets are lost or stolen, we can contact the airline or other common carrier, and can help
you with your travel arrangements if your trip is interrupted.
HOW TO REACH US
Replacing lost passports and other travel documents
In the United States, Canada, Puerto Rico and U.S. Virgin Islands, call 1-800-654-1908 If your passport or other travel documents are lost or stolen, we can help you reach the
All other locations, call collect 1-804-281-5700 appropriate authorities, contact your family or friends, and assist you in getting your documents
If you can’t call collect, we’ll call you back. replaced.

Please have this information ready when you call:

OTHER ASSISTANCE SERVICES
 your name, location and phone number
 your identification number
Getting flight information
If you miss your flight or it’s canceled, we can give you arrival and departure times for other flights
MEDICAL ASSISTANCE that will get you to your connecting flight or final destination.

Finding a doctor, dentist or medical facility Getting emergency cash

If you need care from a doctor, dentist or medical facility while you’re traveling, we can help you If your cash is lost or stolen or you need extra money to pay for unexpected expenses, we can
find one. arrange to transfer funds from your family or friends.

Paying or guaranteeing your hospital bill Delivering emergency messages

If you need to be admitted to a hospital as an inpatient for longer than 24 hours, we can We can help you get an urgent message to someone back home. We’ll try calling up to three
guarantee or advance payments up to the limit of your emergency medical/dental coverage times within 24 hours and confirm whether we were able to reach the person you asked us to
(described in Section 2). contact.

Monitoring your care About our assistance services

If you’re hospitalized, our medical staff will stay in contact with you and the doctor caring for you. Our goal is to help you with your problem no matter where you’re traveling.
We can also notify your family and your doctor back home of your illness or injury and update
them on your status. We’ll make all reasonable efforts to help you as we’ve described, but there may be times when
we aren’t able to resolve your problem for reasons that are beyond our control.
We will always do our best to refer you to appropriate professionals, but please be aware that
they are independent providers and we can’t be held responsible for the results of any services
they provide.

Help while traveling 22 23 Help while traveling

 Travel Information and Reservations
CONCIERGE SERVICES When you need assistance with accommodations, flights or transportation, we stand ready to help.
 Hotel and other overnight accommodation information, referrals and reservations
If you are in need of assistance 24 hours a day, any day of the year, please call the phone number  Flight information and reservations
printed on your letter of confirmation, or the hotline at:  Train information and reservations
 Limo and car service information and reservations
1-800-654-1908 when in the U.S., Canada, Puerto Rico and U.S. Virgin Islands
1-804-281-5700 collect Business Services
When traveling on business, you will find the business services helpful should unexpected events
When you call, have the following information ready for the hotline coordinator: or important business needs occur.
 Your name and confirmation or identification number; and  Computer rental and referrals and arrangements
 Your location and local telephone number.  Audio/visual equipment referrals and arrangements
 Translation service referrals and arrangements
The hotline coordinator will confirm your enrollment and connect you with a Concierge associate.  Messenger service referrals and arrangements
 Mobile phone rental referrals and arrangements
Note: It may not be possible to call collect. If you must phone the hotline directly, give your
location and phone number to the hotline coordinator who will call you back. Specialty Services
A last minute gift need, an important thank you, or other special event while you are traveling can
Our goal is to make your travels more enjoyable and hassle free. Our Concierge associates can easily be remedied. Some common services include:
assist you with many requests from the routine to the extraordinary. The following are types of  Gift Basket purchase arrangements
services you can contact us for assistance with:
 Flower delivery purchase arrangements
Entertainment/Event Planning  Gift referral and purchase arrangements
When you are traveling, or planning your trip, the following entertainment options are at your  Gourmet food purchase arrangements
disposal:
All of our concierge benefits are service benefits, not financial benefits. Any costs associated with
 Restaurant information, referrals and reservations
the services are paid by you.
 Sports event, show and festival information, reservations and ticket purchasing
 Theater and concert event information, reservations and ticket purchasing
 Health Club information, referrals and reservations
 Golf tee times, information, referrals and reservations

Destination Assistance
Get the details on your destination from our vast experience and database of information.
 Highlights and sightseeing information
 Airport and mass transportation information
 Health and security information
 Local custom and duty information
 Exhibition, show and festival information and ticket purchase
 Museum information
 Shopping information
 Exchange rate information
 Visa and passport information
 ATM location information

TI_102_16_P_V2PC

Help while traveling 24 25 Help while traveling

We're only a CLICK away!

Visit www.etravelprotection.com
to:

• File a claim
• Check claim status
• Modify a policy

TI_102_16_P_V2PC
04/17
 JEFFERSON INSURANCE COMPANY
(A Stock Company)

COLORADO AMENDATORY RIDER

The policy to which this rider is attached is amended as follows:

1. SECTION 3: WHAT THIS CERTIFICATE EXCLUDES/GENERAL EXCLUSIONS, the exclusion regarding self-inflicted
harm or attempted suicide is deleted in its entirety and replaced with the following:
 intentionally self-inflicted harm, suicide or attempted suicide, while sane, by you, a traveling companion or a family
member;

There are no other changes to the policy.

Form 101-R-CO-02
 IMPORTANT PRIVACY CHOICES
THIS NOTICE DESCRIBES HOW PERSONAL DATA AND MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are AWP USA Inc. and its subsidiaries, including Jefferson Insurance Company and AGA Service Company d/b/a
Allianz Global Assistance. We are committed to your privacy. By using our products, services or website, you consent to
our collection and use of your Personal Data as described here.

Definitions. The below definitions apply to this Notice:

1. “Personal Data” means non-public personal information that identifies a specific person (“you”). Data identifies you if
it includes your first and last name plus any additional data specific to you. Data that does not identify you is not
Personal Data. Publicly available, encoded, anonymized, or aggregated data is not Personal Data.

2. “Sensitive Data” means Personal Data about a person’s race or ethnicity; political, religious, philosophical, ideological,
or trade union memberships, opinions, views or activities; medical or health conditions or protected health information
(“PHI”) as defined in the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”); genetic or biometric
data; financial account information (e.g. bank account number); government-issued ID numbers; sexuality; or social
security measures or administrative or criminal proceedings and sanctions that are treated outside pending
proceedings. Sensitive Data also includes information we receive from a third party who treats and notes the
information as sensitive.

3. “Agent” means a third party that collects or uses Personal Data to perform tasks on our behalf, or our underwriters.

Privacy Practices. This Notice describes how we collect, use, and maintain Personal Data. It also describes your and our
rights.

For the Personal Data of EU and Swiss residents, we (including AGA Service Company and Jefferson Insurance
Company) comply with the EU-U.S. Privacy Shield Framework and Swiss-U.S. Privacy Shield Framework as set forth by
the U.S. Department of Commerce regarding the collection, use, and retention of personal information transferred from
the European Union and Switzerland to the United States, respectively (collectively, the “Privacy Shield”). We have
certified to the Department of Commerce that we adhere to the Privacy Shield Principles regarding EU and Swiss
Personal Data received under the Privacy Shield. If there is any conflict between the terms in this Notice and the Privacy
Shield Principles, the Privacy Shield Principles shall govern in matters regarding EU and Swiss residents. To learn more
about the Privacy Shield and to view our certification, visit https://www.privacyshield.gov.

1. Notice: We collect Personal Data from you, or from your agents, representatives, suppliers and providers, or other
party from whom you have authorized us to collect it on your behalf. This may include:
(i) identifying information (e.g. name, contact information);
(ii) billing or payment information (e.g. credit card billing information);
(iii) information about your trip or event (e.g. agents, suppliers, trip plans);
(iv) information about your transactions or business with us or others (e.g. receipts, insurance EOBs);
(v) financial account information (e.g. account numbers, statements);
(vi) health information (e.g. treatment history, invoices);
(vii) information about any claim you make (e.g. details of your loss, police reports, vital records);
(viii) information about your website usage and activity (e.g. browser data, IP address);
(ix) government-issued identification numbers (e.g. social security number, driver’s license number); or
(x) any other information provided to us by you or on your behalf.

We may also collect Personal Data from consumer reporting agencies or fraud databases (e.g. fraud reports). This
data may be collected from forms, such as enrollment or claim forms; by phone, website, email, fax, or
correspondence; or via cookies.

We may use the Personal Data we collect:

(i) to offer, market, sell, underwrite, or make available to you insurance or assistance products or services;
(ii) to provide you with information or services for such products and services;
(iii) to administer your insurance and assistance products and services. This may include, for example: providing
travel-related or concierge services, serving and processing your policy or claims, conducting quality or
satisfaction assessments, and fraud prevention;
(iv) to protect our legal rights or to respond to lawful requests by public authorities, including to meet national security
or law enforcement requirements or as otherwise required by law; or
(v) for purposes to which you’ve otherwise consented.
 This may in some cases include disclosing your Personal Data to Agents. But, such disclosures are only for the
purposes described in this Notice, or for everyday business purposes or as required or allowed by law (e.g. to process
transactions, maintain accounts, respond to court orders and legal investigations, or report to credit bureaus). These
Agents may be affiliated or nonaffiliated. They may be financial services providers (e.g. underwriting insurers). They
may also be non-financial companies (e.g. health service providers, travel service providers, the agent/agency
through whom you purchased, service providers helping us with our marketing).

Where we are subject to HIPAA, we must notify you of our duties and practices with respect to PHI. Except as
described here or allowed or required by law, we will only use or disclose your PHI or health records with your prior
express consent. Under HIPAA, we may use and disclose your PHI for one or more of the following purposes:
(i) monitoring the health care treatment you receive (e.g. we may send or receive PHI to or from a doctor regarding
your condition and treatment so we can see that your treatment is appropriate);
(ii) payment for health services (e.g. we may use your PHI to make payments to a hospital that has treated you);
(iii) to help run our company (e.g. we may use your PHI to conduct quality audits of the services we provided to you.
However, we may not use or disclose genetic information about you for underwriting purposes); or
(iv) for other purposes as required to administer your insurance or assistance product (e.g. we may use PHI to
determine coverage for a claim made under an insurance policy).

We may also in some cases need to use or disclose your PHI for one or more of the following purposes:
(i) for public health and safety issues;
(ii) to comply with legal or regulatory requirements;
(iii) to address or comply with workers’ compensation, law enforcement, or other legal or government mandates or
requests; or
(iv) to respond to lawsuits or legal actions.

Cookies are text files on your computer. When you access our website, we use cookies to collect data about your
web usage. We also use Google, Inc.’s Google Analytics and AdWords services, iAdvize’s chat and monitoring
service, and other similar third party vendor services. These services use cookies to transmit your IP address and
other website navigation and usage data and device/browser-generated data. iAdvize also uses JavaScript to provide
its chat and monitoring services. These vendors may provide this data to us or store and/or aggregate this data to
analyze such usage and create reports for us. We, our affiliates and our Agents use such data and reports for our
own business purposes (e.g. to provide customer service, to optimize the content you see from us, website
improvement, other purposes stated in this notice, etc.) and Payment Card Industry Data Security Standard (“PCI”)
compliance. These vendors also display our ads on sites across the Internet, and they may use this data to later
display ads to you based on your website usage. By using our website, you consent to this use of cookies and data
for these purposes. You can refuse cookies by disabling them in your browser (this may affect the content available to
you). Our websites do not respond to “Do Not Track” requests from browsers.

Last, we may use and disclose the name, email address, or contact information of current and former customers to
Agents for marketing administration purposes. For example, we may need to disclose the email address you provided
to us to an Agent providing marketing services on our behalf to help ensure that your opt out choices are respected
and that you do not receive duplicate communications.

If we collect your Personal Data for any reason other than as stated here, we’ll notify you before using or disclosing
that data. That notice will state the purpose for collecting and using the data, the types of non-Agent third parties to
which we disclose the data, and the means we offer you to limit this. If we receive Personal Data from anyone in the
EU or Switzerland, we’ll treat that data according to the instructions such entity gives us regarding notices it provided
and the choices made by the data subject.

2. Choice. We reserve the right to disclose Personal Data to third parties as described above. The law in some
jurisdictions allows you the right to choose in some cases to opt out of us sharing your Personal Data with a third
party or using it for a purpose that is materially different from the purposes for which it was originally collected or
which you later authorize. You may exercise this right by notifying us as provided below. You may opt out of getting
non-essential marketing communications from us by giving notice as described below and disabling cookies in your
web browser. Except as required or allowed by law (e.g. for fraud prevention), we do not share, sell or otherwise
disclose your Personal Data to non-Agent third parties or use it for any purpose other than for which it was originally
collected or as you later authorize. If we ever wish to do so, we will give you the opportunity to opt out. If we wish to
disclose your Sensitive Data to a non-Agent third party or use such data for a purpose other than for which it was
originally collected or as you later authorize, we will only do so with your express consent. We will not unfairly
discriminate against you for declining to provide this consent.
 Except as allowed by law, we will not use or disclose psychotherapy notes, use or disclose your PHI for marketing
purposes, or use or disclose your PHI in a way that would constitute a sale of PHI under HIPAA unless you expressly
authorize us to do so. You may revoke this consent at any time. Such revocation will not apply to actions we have
already taken based on that consent. You may request restrictions on our use and disclosure of certain health
information for treatment, payment, or our operations. However, we are not required to agree to your request, except
as required by HIPAA.

We may need to disclose Personal or Sensitive Data if we have a good-faith belief that it is needed to protect or
defend our or your rights, interests or property or comply with any law or legal mandate, or if it is otherwise required or
allowed by law. We will take reasonable care to disclose only as much of such data as is needed.

3. Accountability for Onward Transfer. We may disclose your Personal Data to our Agents, but only for the limited and
specified purposes described here, consistent with the consent you have provided. We will take reasonable and
appropriate steps to obtain assurances from our Agents that they will effectively process and safeguard your Personal
Data consistent with our obligations under this Notice and the Privacy Shield (EU and Swiss residents only). Upon
discovery, we will take reasonable steps to stop and remediate any unauthorized processing inconsistent with this
Notice or the Privacy Shield (EU and Swiss residents only). With respect to EU or Swiss Personal Data we receive
under the Privacy Shield and later transfer to an Agent, we are responsible for the processing of such data by that
Agent. If such data is processed by that Agent in a manner inconsistent with the Privacy Shield Principles, we are
liable unless it can be proved that we are not responsible for the event giving rise to any damages.

4. Security. We take reasonable and appropriate measures to protect your data from loss, misuse, or unauthorized
access, disclosure, alteration and destruction. These measures take into account the risks involved in the processing
and the nature of the Personal Data. To help maintain the security of your data, we use administrative, physical, and
technical safeguards. These include utilizing policies to take reasonable precautions to (a) securely and confidentially
maintain your Personal Data; (b) assess and protect against threats and hazards to the security or integrity of such
data; and (c) prevent unauthorized access to or use of such data. Also, except where required or allowed by law, we
limit use of your Personal Data to the minimum necessary to accomplish the purposes for which that data was
collected and to be used as described here. We restrict access to your Personal Data to only those who need to
access it to accomplish those purposes. We use encryption to make your online transaction with us safe and secure.
We protect the privacy of your credit card information with a high degree of care and in compliance with PCI. We are
required by law to maintain the privacy and security of your PHI. If there is a breach as defined under HIPAA of your
unsecured PHI , we are required by law to notify you.

5. Data Integrity. We will only collect Personal Data to the extent it is relevant to the purposes for which it was collected.
We will not process Personal Data in a way that is incompatible with the purposes for which it has been collected or
as you later authorize. To help maintain the integrity of your data, we will take reasonable steps to ensure that
Personal Data is reliable for its intended use, relevant, accurate, complete, and current. We will adhere to these
principles for as long as we retain this data. We retain Personal Data according to our data retention policy.

6. Access. If you discover the data we hold about you is inaccurate or incomplete, please contact us. We will grant you
reasonable access to the Personal Data we hold about you. We will take reasonable steps to allow you to correct,
amend or delete your Personal Data that is inaccurate or incomplete, or has been processed in violation of this
Notice, so long as it can be done without undue burden or expense on us, without breaching any legal or professional
privilege or obligation, and without violating the rights of others. Where we are subject to HIPAA, you have the right to
request to receive confidential communications of your PHI, as applicable. In accordance with and as allowed by
HIPAA, at your request, you may inspect, amend, and copy PHI we maintain about you and receive an accounting of
certain disclosures of your PHI (e.g. health payment records).

7. Recourse, Enforcement, Liability. You can send complaints about how we handle your Personal Data to us at the
contact information below. If the data is PHI, complaints can be made to us or to the U.S. Secretary of Health and
Human Services. We will not retaliate against you for filing a complaint. For EU and Swiss Personal Data, we verify
our compliance with the Privacy Shield and the terms of this Notice by conducting a periodic self-assessment.
Complaints or disputes about how we handle EU or Swiss Personal Data should be directed to the below address.
We will promptly investigate and try to resolve any such complaints or disputes internally. But, if we can’t reach a
mutually agreeable resolution, we have agreed to cooperate with the dispute resolution procedures administered by,
as applicable, the European Data Protection Authorities or the Swiss Federal Data Protection and Information
Commissioner. Under certain conditions, by notifying us, you may invoke binding arbitration regarding certain
“residual” claims about EU or Swiss Personal Data before a Privacy Shield Panel. Such procedure is in accordance
 with the rules established under the Privacy Shield. We are subject to the investigatory and enforcement powers of
the FTC for EU and Swiss Personal Data.

Links. Our websites provide links (including social media plugins (“Plugins”)) that connect to third party websites.
Clicking such link establishes a connection and transmits data to/from the operator of such website. Clicking a Plugin
while logged in to a social media account may cause the social media website’s operator to publish activity to your
account. To avoid this, log out of your account before clicking the Plugin link. We are not responsible for and make no
representations about the content, security, or privacy practices of any other third party websites. You should read the
privacy notices of the websites you visit to understand their data privacy practices.

Changes to Notice. This Notice reflects our business practices. It is not a contract. However, we are required to and will
abide by the terms of this Notice as currently in effect. We may amend this Notice at any time. We will notify you of any
updates by posting a revised notice on our website. The revised notice will apply to all information collected by us,
including previously collected information (for EU or Swiss residents, this applies to the extent permissible under the
Privacy Shield). You accept the revised notice by your continued use of our website, products or services following any
such amendment. If we revise this Notice in a way that would allow us to disclose your Personal Data to a nonaffiliated
third party other than as already described here, we will provide you with a revised notice and give you the opportunity to
opt out of any such disclosure. You are responsible to regularly review this Notice. You have the right to a paper copy of
this Notice upon request.

Contact. If you have any questions or comments about this Notice or the way that we collect or handle your Personal
Data, or if you would like a paper copy of this Notice, please contact our Chief Privacy Officer by any of:

Email: privacy@allianzassistance.com
Phone: 1-800-284-8300
Mail: Allianz Global Assistance
ATTN: Chief Privacy Officer
9950 Mayland Drive
Richmond, VA 23233

Opt Out. To opt out of non-essential marketing communications or non-essential unaffiliated third party information
sharing, please contact our Chief Privacy Officer as noted above with your name, policy number. Please include a
statement that says “Opt out” (or something similar). Opt outs will be applied to all products and services we provide. We
will not unfairly discriminate against any person who chooses to opt out.

Electronic Notices. Unless you chose to receive them by US mail at the time of purchase, by purchasing your policy,
you consent to receive all notices and documents from us electronically. They will be sent to the email address provided
at the time of purchase. You may opt to receive notices and documents from us by mail at any time. If you wish to
change or update your notice/documents preferences, email us at customerservice@allianzassistance.com. Please
include your name, policy number, and a note that says “Only contact me by mail” (or something similar). You can also let
us know by phone at 800-284-8300 or by mail to:

Allianz Global Assistance

ATTN: Customer Service – Only contact me by mail
9950 Mayland Drive
Richmond, VA 23233

If you don’t provide an email address at purchase, you’ll receive notices and documents by mail. You may request paper
copies of any electronic information we send, or update your electronic contact information at any time by emailing or
mailing us at the above address, or by calling us. Documents sent to you from us will be in either PDF or HTML format. If
you can’t receive or read the documents we send you, please contact us so we can assist you.

Effective Date. This Notice was last revised on, and is effective as of, November 27, 2017.

© 2017 AWP USA Inc. All rights reserved. JICPRIVNOT (Ed. 11-17)