Atlas International

Plan Detail

Plan Administrator: Tokio Marine HCC Medical Insurance Services Group | AM Best Rating: A "Excellent" | Underwriter: Lloyd's

Benefits


BENEFIT

LIMIT

Deductibles

$0,$100,$250,$500,$1,000 or $2,500 per certiļ¬cate period.

 

Coinsurance–Claims incurred in U.S. or Canada

For the certifi cate 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 are submitted to underwriters for review and payment directly to the provider.

Coinsurance–Claims incurred out-side U.S. or Canada

For the certifi cate 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, when covered illness or injury results in hospitalization as inpatient.

Intensive Care Unit

Usual,reasonable and customary charges.

 

Emergency Room Co-payment

In addition to coinsurance, the member shall be responsible for a $200 co-payment for each use of emergency room for an Illness unless the member is admitted to the hospital. There will be no copayment for emergency room treatment of an injury

 

Urgent Care Center

For each visit, the member shall be responsible for a $15 co-payment, after which coinsurance will apply. Not subject to deductible.

Hospital Indemnity (in addition tomedical expenses)

$100 per day of inpatient hospitalization for member’s use to off set miscellaneous expenses (not subject to deductible or coinsurance).

Physical Therapy

$50 maximum per day.

All Other Eligible Medical Expenses

Usual,reasonable and customary charges.

Acute Onset of Pre-existing Condition (only available to members younger than 80)

Age 70 to 79: Up to $100,000
Under age 70: Up to the overall maximum limit
Up to $25,000 lifetime maximum for Emergency Medical Evacuation

Emergency Dental(acute onset of pain)

 

$250 limit per certifi cate period (not subject to deductible or coinsurance).

 

Emergency Medical Evacuation

$1,000,000 lifetime maximum, except as provided under acute onset of pre-existing condition (not subject to deductible or coinsurance).

Return of Minor Children

$50,000 per certifi cate period (not subject to deductible or coinsurance).

Pet Return

Up to $1,000 to return a traveling pet home if member is hospitalized.

Repatriation of Remains

Overall maximum limit (not subject to deductible or coinsurance).

 

Emergency Reunion

$50,000 limit per certifi cate period, subject to a maximum of 15 days (not subject to deductible or coinsurance).

Natural Disaster

Maximum $100 a day for 5 days (not subject to deductible or coinsurance).

Trip Interruption

$5,000 limit per certifi cate period (not subject to deductible or coinsurance).

Trip Delay

$100 for a 12-hour delay requiring an unplanned overnight stay (2 days maximum).

Lost Checked Luggage

$500 limit per certifi cate period (not subject to deductible or coinsurance).

Political Evacuation

$10,000 lifetime maximum (not subject to deductible or coinsurance).

Terrorism

$50,000 maximum lifetime limit, eligible medical expenses only.

Accidental Death and Dismemberment (excludes loss due to common carrier accident; $250,000 maximum benefi t per one family or group)

Not subject to deductible or coinsurance.

Members up to age 18

Lifetime max. - $5,000; Death - $5,000; Loss of 2 limbs - $5,000; Loss of 1 limb - $2,500.

Members age 18 through 69

Lifetime max. - $50,000; Death - $50,000; Loss of 2 limbs - $50,000; Loss of 1 limb - $25,000.

Members age 70 through 74

Lifetime max. - $12,500; Death - $12,500; Loss of 2 limbs - $12,500; Loss of 1 limb - $6,250.

Members age 75 and older

Lifetime max. - $6,250; Death - $6,250; Loss of 2 limbs - $6,250; Loss of 1 limb - $3,125.

Common Carrier Accidental Death ($250,000 maximum benefi t per any one family or group)

Not subject to deductible or coinsurance

Up to age 18 - $25,000 per member; Age 18 to 69 - $50,000 per member;

Age 70 to 74 - $12,500 per member; Age 75 and older - $6,250.

Hospital Pre-certifi cation Penalty

50% of eligible medical expenses

Overall Maximum Limit Per Certificate Period

Age 80 or older - $10,000; Age 70 to 79 - $50,000, $100,000;

All others - $50,000, $100,000, $200,000, $500,000 or $1,000,000.

 

Crisis Response

$10,000 limit per certifi cate period;

Includes access to Unity Crisis Group services.

Personal Liability

$10,000 lifetime maximum.

Bedside Visit

$1,500 (economy ticket for family member to visit if member admitted to ICU).