Coverage |
Details |
Overall Maximum Limit per Certificate Period (includes
all benefits except Accidental Death and Dismemberment,
Emergency Medical Evacuation and Common Carrier
Accidental Death): |
Age 14 days to 69 -
$50,000, $100,000, $250,000, $500,000 or $1,000,000; Age
70 to 79 - $50,000; Age 80 or older - $10,000 |
Deductibles: |
$0, $100, $250, $500,
$1,000 or $2,500 per Certificate Period |
Coinsurance – Claims incurred in US or Canada: |
For the Certificate
Period, Underwriters will pay 80% of the next $5,000 of
Eligible Expenses after the Deductible, then 100% to the
Overall Maximum Limit. Coinsurance will be waived if
expenses are incurred within the PPO and expenses are
submitted to Underwriters for review and payment
directly to the provider |
Coinsurance – Claims incurred outside US or Canada: |
For the Certificate
Period, Underwriters will pay 100% of Eligible Expenses
after the Deductible up to the Overall Maximum Limit |
Hospital Room and Board: |
Average Semi-private
room rate, including nursing services |
Local Ambulance: |
Usual, Reasonable and
Customary charges |
Hospital Indemnity: |
$100 per day (not
subject to Deductible or Coinsurance) |
Intensive Care Unit: |
Usual, Reasonable and
Customary charges |
Outpatient Treatment: |
Usual, Reasonable and
Customary charges |
Acute Onset of Pre-existing Condition: |
$15,000 limit per
Certificate Period for Eligible Medical Expenses
$25,000 limit per Certificate Period for Emergency
Medical Evacuation
(Only available to Members under age 70) |
Physical Therapy: |
$50 Maximum per visit |
All Other Eligible Medical Expenses: |
Usual, Reasonable and
Customary charges |
Emergency Dental: |
Accident – Overall
Maximum Limit
Acute Onset of Pain – $100 limit per Certificate Period |
Emergency Medical Evacuation: |
$500,000 Maximum
Lifetime Limit |
Emergency Reunion: |
$15,000 limit per Certificate Period |
Return of Minor Children: |
$5,000 limit per
Certificate Period |
Political Evacuation: |
$10,000 Maximum
Lifetime Limit |
Terrorism: |
$50,000 Maximum
Lifetime Limit, Eligible Medical Expenses only |
Accidental Death and Dismemberment: |
Principal Sum
$25,000 Adults age 18-69
$12,500 Adults age 70-74
$ 6,250 Adults age 75 and above
$ 5,000 Children age 17 and below |
Common Carrier Accidental Death: |
$50,000 per adult,
$25,000 children under age 18; $250,000 Maximum per
family |
Repatriation of Remains: |
Overall Maximum Limit |
Natural Disaster Benefit: |
Maximum $100 a day for
5 days |
Trip Interruption: |
$5,000 limit per
Certificate Period |
Lost Checked Luggage: |
$250 limit per
Certificate Period (not subject to Deductible or
Coinsurance) |
Hospital Pre-certification Penalty: |
50% of Eligible
Medical Expenses |
Optional Hazardous Sports Rider: |
Overall Maximum Limit |
View
Policy Details |

|
Online Fulfillment
Available |
|
By selecting online
fulfillment, your policy information will be
available to print once your application has
been processed and credit card approved. A
duplicate copy of this information is also
delivered to the email address you indicate on
the insurance application. By selecting "Yes",
you acknowledge that you have accepted
online-fulfillment of your insurance documents.
If you prefer your insurance documents mailed to
you, please select "No" for the Online
Fulfillment option. |
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