Premiums

Tour cost per person:      Premium per person:
Up to $250..................................$21.50
$251- 500.................................... $38.40
$501- 750.................................... $57.60
$751- 1000.................................. $76.80
$901- 1100.................................. $96.00
$1000- 1500................................ $120.00
$1501-2000................................. $168.00
$2001-2500................................. $216.00
$2501 and up is $8.40 per $100 of coverage up to $12,00

Domestic Plan Description of Coverage

Schedule of                                                                              Maximum Benefits
Coverage’s & Services                                                         Per Person

Part A – Travel Protection
Trip Cancellation.................................................................... Total Trip Cost*
Trip Interruption..................................................................... Total Trip Cost*
Travel Delay............................................................................ $500 ($100 max per day)
*Coverage only included if the required premium has been paid.

Part B – Medical Protection
Accident and Sickness Medical Expense........................... $25,000
Emergency Evacuation & Repatriation................................Covered

Part C – Baggage Protection
Baggage and Personal Effects............................................. $1,500
Baggage Delay........................................................................ $200

Part D – One Call 24-Hour Travel Assistance
World Wide Travel Assistance.......................................... included
Prescription assistance.........................................................included
Family visit if hospitalized....................................................included
24 Hour legal assistance in a legal emergency.................. included
Global XPI internet based health information service.......included

This plan is underwritten by: United States Fire Insurance Company, Eatontown, NJ. under Form Series TP 401. In KS, LA, SD, TX, and UT Form #’s TP-401 CW. In WA under Form #TP-401-WA. In OR under Form #TP-401 OR.

To Purchase Insurance, complete the Enrollment Form below. Your plan cost is based on the per person cost of your trip. Payments of insurance premiums are accepted in the form of checks and money orders only. Make the check payable and send to:

Advance Tour & Travel

6858 Selmore Rd

Ozark, MO 65721

(A certificate of insurance will be mailed back to you)
Or click here this certificate:
www.tripmate.com/wpTPG27