HDI Global Specialty SE Disclaimer

Notice

This web page is a brief description of the important features of the plan. It is not a contract of insurance. This plan includes both insurance and non-insurance benefits. The terms and conditions of coverage are set forth in the Plan issued to the policyholder. For a detailed plan description, exclusions, and limitations please view the plan on file with Seven Corners, Inc. The Policy contains a complete description of all of the terms, conditions, and exclusions of the insurance plan as underwritten by HDI Global Specialty SE. The Policy will prevail in the event of any discrepancy between this web page and the Policy.

Disclaimer

I declare that I have read and understood and agree to the following statements:

ITA Global Trust, Ltd.

This Insurance is available to members of the ITA Global Trust. By continuing with your purchase of this insurance provided by HDI Global Specialty SE you will, at no additional cost, become a member of the ITA Global Trust, Ltd for the period of the Insurance.

Master Policy

I understand that the information provided by my certificate is a summary of the benefits to which I may be entitled under the Master Policy and, if there is any difference, the provisions of the Master Policy shall prevail. I understand that I may obtain a copy of the Master Policy upon request to Seven Corners.

Payment

Total payment for the full term of coverage requested must be paid in U.S. dollars at the time of application for coverage to be issued. Coverage purchased by credit card is subject to validation and acceptance by the credit card company.

Consumer Acceptance

I understand that this coverage is not a general health insurance policy but a limited benefit period, travel medical program intended for use while away from my Home Country.

I declare that I have read and understand the terms and conditions of this product. I understand that preexisting conditions, as defined, are excluded, unless otherwise specifically noted as covered in the Certificate. I agree that I have not been restricted from travel and that I am not traveling for the purpose of obtaining medical treatment.

I agree that, if I am purchasing this policy for a third party, then I have forwarded a copy of the policy to the third party. Policy documents will be sent via email to the email address provided on this application.

Patient Protection and Affordable Care Act (PPACA)

THIS IS NOT QUALIFYING HEALTH COVERAGE ("MINIMUM ESSENTIAL COVERAGE") THAT SATISFIES THE HEALTH CARE COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.

Laws and Sanctions

I understand that, wherever coverage provided would be in violation of any law, such coverage will be null and void. If my Home Country is subject to sanctions, prohibitions, and restrictions set out in United Nation Security Council Resolutions or the trade or economic sanctions laws or regulations of the European Union, the United Kingdom, or the United States or if I am personally the subject of any sanctions or am a “Designated Person” for such purposes, coverage cannot be provided, and any Certificate sent to me will be null and void from its issuance.

For the purposes of this plan, “Home Country” is the country where you have your true, fixed, and permanent residence.

Geographic Restrictions

I certify and agree (i) that I understand that Antarctica is an excluded destination under this Policy and (ii) that I will not travel to Antarctica on the trip(s) covered by this Policy.

Fraud

Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an Insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.