1. The death, Accidental Bodily Injury, disease or physical illness of You or an Immediate Family Member of the Insured person; or
2. Default of the Common Carrier resulting from financial insolvency.

The death, Accidental injury, disease or physical illness must be verified by a Physician and must prevent You from traveling on the trip.

Note: Common Carriers may issue a credit voucher for the value of the unused ticket. A fee may be associated with changing or cancelling the ticket. Reimbursement of fee may be eligible at time of Loss. Most Common Carrier credit vouchers expire in one year. Proof of unused credit voucher can be submitted for reimbursement after expiration. Payment will not exceed either the actual Non-Refundable amount paid by the Insured Person for a Common Carrier passenger(s) fare(s), or up to $2,000.

No Trip Cancellation or Interruption benefits will be paid for Loss caused by or resulting from:

• A Pre-existing Condition
• Accidental Bodily Injuries arising from participation in interscholastic or professional sports events, racing or speed contests, or uncertified scuba diving
• Cosmetic surgery, unless such cosmetic surgery is rendered necessary as a result of a Loss covered under this policy
• The Insured Person or an Immediate Family Member being under the influence of drugs (except those prescribed and used as directed by a Physician) or alcohol
• The Insured Person or an Immediate Family Member: a) traveling against the advice of a Physician; or b) traveling while on a waiting list for specified medical treatment; or c) traveling for the purpose of obtaining medical treatment; or d) traveling in the third trimester (seventh month or after) of pregnancy
• Suicide, attempted suicide, or intentionally self-inflicted injuries
• Declared or undeclared war, but war does not include acts of terrorism
• An Insured Person’semotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection or bodily malfunctions, exceptphysical illness ordisease which prevent the insured person from traveling on a covered trip. This Exclusion does not apply to loss resulting from an insured person’s bacterial infection caused by an accident or from accidental consumption of a substance contaminated by bacteria.

The Plan Administrator will ask you for some preliminary information and send You the appropriate claim forms. Failure to give notice within twenty (20) days will not invalidate or reduce any otherwise valid claim, if notice is given as soon as reasonably possible.

When the Plan Administrator receives notice of a claim, the Plan Administrator will send You forms for giving proof of Loss within fifteen (15) days. If You do not receive the forms, You should send the Plan Administrator a written description of the Loss.

Answers to specific questions can be obtained by writing to the Plan Administrator. To make a claim, please contact the Plan Administrator.

Please return Your completed and signed claim form and the documents listed below as soon as possible to the Plan Administrator:

• A copy of Your monthly billing statement or the travel itinerary (showing the last four [4] digits of the Account number) confirming the Common Carrier ticket was purchased using the covered Account and/or rewards programs associated with Your covered Account.
• If more than one method of payment was used, please provide documentation as to additional currency, voucher, points or any other payment method utilized.
• Confirmation of the non-refundable amounts for the unused Common Carrier tickets and/or travel vouchers
• Confirmation that the tickets were cancelled with the Common Carrier
• A copy of the travel itinerary showing the passenger names and ticket cost
• Confirmation of the reason for the Trip Cancellation; (completed attached physician statement, confirmation of death of Immediate Family Member or documentation confirming any other cause of Loss)
• A copy of the cancellation or refund policies of the Common Carrier, Tour Operator or Travel Supplier

Once you've met the conditions of this benefit, you may receive payment to replace your item, an amount not more than the original purchase price, less shipping and handling charges, up to one thousand dollars ($1,000.00) per claim and ten thousand dollars ($10,000.00) per cardholder. You will only be reimbursed up to the dollar amount to replace the item or the program limit, whichever is less. Under normal circumstances, reimbursement will take place within five (5) business days.

As a cardholder, You, Your spouse (or Domestic Partner), and unmarried Dependent Children will be automatically insured up to one thousand dollars ($1,000) for Accidental Loss of life, limb, sight, speech, or hearing. This benefit applies while:

1. Riding as a passenger in or entering or exiting any Common Carrier; or
2. Riding as a passenger in, entering, or exiting any conveyance licensed to carry the public for a fee and while traveling to or from the airport:
   1. Immediately preceding the departure of a Common Carrier on which the Insured Person has purchased passage; and
   2. Immediately following the arrival of a Common Carrier on which the Insured Person was a passenger; or
3. At the airport, terminal or station, at the beginning or end of the Common Carrier Covered Trip.

• Accidental Loss of Life, two or more Members, sight of both eyes, speech and hearing or any combination thereof (Benefit Maximum:$1,000.00)
• Accidental Loss of one Member, sight of one eye, speech or hearing (Benefit Maximum: $500.00)
• Accidental Loss of the thumb and index finger of the same hand (Benefit Maximum: $250.00)
• Loss means, with respect to a hand, complete severance through or above the knuckle joints of at least four (4) fingers on the same hand or at least three (3) fingers and the thumb on the same hand; with respect to a foot, complete severance through or above the ankle joint. The Company will consider it a Loss of hand or foot even if the fingers, thumb, or foot is later reattached.
• In order to be eligible for this additional coverage, the entire cost of the Common Carrier passenger fare(s), less redeemable certificates, vouchers, or coupons, must be charged to Your covered Account and/or rewards programs associated with Your covered Account during the policy period. If the purchase is not made prior to the Insured Person’s arrival at the airport, coverage begins at the time the entire cost of the Common Carrier passenger fare is purchased.
• This travel accident benefit is provided to eligible cardholders. Your financial institution pays the cardholder’s premium as a benefit of the card membership.
• The Loss must occur within one year of the Accident. The Company will pay the single largest applicable Benefit Amount. In the event of multiple Accidental deaths per Account arising from any one Accident, the Company’s liability for all such Losses will be subject to a maximum limit of insurance equal to two times the Benefit Amount for Loss of life. Benefits will be proportionately divided among the Insured Persons up to the maximum limit of insurance.
• The Loss of Life benefit will be paid to the Beneficiary designated by you. If no such designation has been made, that benefit will be paid to the first surviving Beneficiary in the following order: a)Your spouse, b) Your Children, c) Your parents, d) Your brothers and sisters, e) Your estate. All other indemnities will be paid to you.

Loss caused by or resulting from:

• An Insured Person’s emotional trauma, mental or physical illness, disease, normal pregnancy, normal childbirth or elective abortion, bacterial or viral infection, or bodily malfunctions. This exclusion does not apply to loss resulting from an insured person’s bacterial infection caused by an accident or from accidental consumption of a substance contaminated by bacteria
• Suicide, attempted suicide, or intentionally self-inflicted injuries
• Declared or undeclared war, but war does not include acts of terrorism
• An Accident occurring while you are in, entering, or exiting any aircraft while acting or training as a pilot or crew member (does not apply if you temporarily perform pilot or crew functions in a lifethreatening emergency)

Within twenty (20) days of the accident or as soon as reasonably possible, You must provide (written) claim notice to the Plan Administrator. The Plan Administrator will ask You for some preliminary information and send You the appropriate claim forms. Failure to give notice within twenty (20) days will not invalidate or reduce any otherwise valid claim, if notice is given as soon as reasonably possible.

When the Plan Administrator receives notice of a claim, the Plan Administrator will send you forms for giving proof of Loss within fifteen (15) days. If you do not receive the forms, you should send the Plan Administrator a written description of the Loss.

Answers to specific questions can be obtained by writing to the Plan Administrator. To make a claim, please contact the Plan Administrator.

• A copy of the police report
• A completed medical authorization form for each treating medical facility
• Copy of the certificate of death, if applicable
• A copy of the travel itinerary
• A copy of the credit card statement reflecting the purchase, verification of the cardholder’s name and the first six digits of the credit card number

If you choose to mail your documents, please send a copy of your documents and retain the originals for your records. Claim Benefit Services is unable to return any submitted documents. You will be contacted by a claim adjuster if additional information or documentation is required.

• As a handy reference guide, please read this and keep it in a safe place with Your other insurance documents.
• This description of coverage is not a contract of insurance but is simply an informative statement of the principal provisions of the insurance while in effect. Complete provisions pertaining to this plan of insurance are contained in the master policy, on file with the Policyholder: BNY Midwest Trust Company as trustee of the Chubb Financial Institution Group Insurance Trust for the Account of participating financial institutions. Policy #: 6478-07-74
• Signed or pinned transactions are covered as long as You use Your eligible card to secure the transaction.
• You shall do all things reasonable to avoid or diminish any Loss covered by this benefit. This provision will not be unreasonably applied to avoid claims.
• If you make any claim knowing it to be false or fraudulent in any respect, no coverage shall exist for such claim, and Your benefit may be cancelled. Each cardholder agrees that representations regarding claims will be accurate and complete. Any and all relevant provisions shall be void in any case of fraud, intentional concealment, or misrepresentation of material fact.
• No legal action for a claim may be brought against the Provider until sixty (60) days after the Provider receives Proof of Loss. No legal action against the Provider may be brought more than two (2) years after the time for giving Proof of Loss. Further, no legal action may be brought against the Provider unless all the terms of the Guide to Benefits have been complied with fully.
• This benefit is provided to eligible cardholders at no additional cost. The terms and conditions contained in this Guide to Benefits may be modified by subsequent endorsements. Modifications to the terms and conditions may be provided via additional Guide to Benefits mailings, statement inserts, statement messages or electronic notification. The benefits described in this Guide will not apply to cardholders whose Accounts have been suspended or cancelled.
• Termination dates may vary by financial institutions. Your financial institution can cancel or non-renew the benefits for cardholders, and if they do, they will notify You at least thirty (30) days in advance. Federal Insurance Company (“Provider”) is the underwriter of these benefits and is solely responsible for its administration and claims. The Plan Administrator provides services on behalf of the Provider.
• After the Plan Administrator has paid Your claim, all Your rights and remedies against any party in respect of this claim will be transferred to the Plan Administrator to the extent of the payment made to You. You must give the Plan Administrator all assistance as may reasonably be required to secure all rights and remedies.
• This benefit does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit the provision of insurance, including, but not limited to, the payment of claims.

For more information about the benefit described in this guide, contact the Plan Administrator:
cbsi Card Benefit Services
550 Mamaroneck Avenue, Suite 309
Harrison, NY 10528