Diplomat America

Plan Detail

Plan Administrator: Global Underwriters | AM Best Rating: A+ "Superior" | Underwriter: United States Fire Insurance Company

Benefits


Plan A - $50,000, Plan B - $100,000, Plan C - $250,000, Plan D - $500, 000, Plan E - $1,000,000; Persons age 60-69 are eligible for plan A, B, and C. Persons age 70 – 79 are eligible for plans A and B; Persons age 80+ are eligible for a maximum benefit of $20,000.
Deductible Choices $0, $50, $100, $250, $500, $1,000, $2,500, $5,000 per person/plan period
Co-Insurance After you pay the selected deductible, the plan pays 80% up to $5,000 of eligible costs, then 100% to the Medical Maximum. There will be an additional $250 deductible for each emergency room visit as a result of an Illness. The emergency room deductible will be waived if hospital admittance is within 12 hours of the incident.
Pre-Existing Condition Exclusion 24 Months prior to the start date of coverage
Emergency Medical Evacuation and Repatriation $500,000
Return of Mortal Remains $50,000
Emergency Medical Reunion $50,000
Return of Minor Child $50,000
Interruption of Trip $5,000
Loss of Baggage $50 per article; up to a maximum of $250
Emergency Dental Treatment Accident: Usual & Customary Expense Palliative: $100
Accidental Death and Dismemberment $25,000 (Enhanced Benefit Amounts available) with paralysis and coma, seat belt and airbag, felonious assault and home alteration and vehicle modification benefits.
Athletic & Hazardous Activity Benefit Available
Political and Natural Disaster Evacuation $50,000

The Diplomat America plan was designed mainly to provide accident & sickness and evacuation coverage for foreign nationals traveling inside the USA. It is also available to US citizens returning to the US for vacation or business trips while living abroad. A valid international address is required in order to apply.

Description of Coverage

All plan cost and benefits will be paid in U.S. dollars. We will pay Usual and Customary charges for Covered Expenses incurred during your travel. Benefits in excess of your chosen deductible and co-insurance, up to the selected Medical Maximum will be considered for payment. The initial Treatment of an Injury or Illness must occur within 30 days of the date of Injury or onset of Illness.

Covered Expenses

Only such Expenses that are specifically enumerated in the following list of charges that are incurred for medical care and supplies which are: (a) necessary and customary; (b) prescribed by a Physician for the therapeutic treatment of a disablement; (c) are not excluded under the policy; (d) are not more than the Usual and Customary charges (as determined by the Company); and (e) are incurred within 180 days from the date of the Disablement will be considered.

1) Expenses made by a Hospital for room and board, floor nursing and other services, including Expenses for professional services, except personal services of a non-medical nature, provided, however, that Expenses do not exceed the Hospital's average charge for semi-private room and board accommodation. 2) Charges made for Intensive Care or Coronary Care charges and nursing services; 3) Expenses made for diagnosis, Treatment and surgery by a Physician. 4) Charges made for an operating room. 5) Charges made for Outpatient Treatment, same as any other Treatment covered on an Inpatient basis. This includes ambulatory surgical centers, Physician's Outpatient visits/examinations, clinic care, and surgical opinion consultations. 6) Expenses made for administration of anesthetics. 7) Expenses for medication, x-ray services, laboratory tests and services, the use of radium and radio-active isotopes, oxygen, blood transfusions, iron lungs, and medical Treatment. 8) Expenses for physiotherapy, if recommended by a Physician, for the Treatment of a specific Disablement and administered by a licensed physiotherapist; With regards to chiropractic care, eligible charges up to $50.00 per visit, with a maximum of 10 visits. 9) Dressings, drugs, and medicines that can only be obtained upon written prescription of a Physician. 10) Hotel room charge, when the insured, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to the unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond the control of the insured; The charges enumerated above shall in no event include any amount in excess of the Usual and Customary charges (as determined by the Company). To determine if Expenses are Usual and Customary, the Company will consider the following: the medical care or supplies usually given and the fees usually accepted for like cases in the area. “Area” means a region large enough to get a cross section of providers or medical care or supplies. All Expenses are deemed to be incurred on the date such service is received.

Emergency Dental Treatment (Accident) – Benefits are paid for Usual and Customary Expense for emergency Dental Treatment to natural teeth.

Emergency Dental Treatment (Palliative)

Benefits are paid for Usual and Customary Expense up to $100 for the emergency Treatment for the relief of pain to natural teeth.

Emergency Medical Evacuation and Repatriation

Benefits are paid for Covered Expense incurred up to $500,000. The decision for an Emergency Medical Evacuation or Repatriation must be pre-approved and arranged by the Assistance Company in consultation with Your local attending Physician. Emergency Medical Evacuation or Repatriation means: a) Your medical condition warrants immediate transportation from the place where You are located (due to inadequate medical facilities) to the nearest adequate medical facility where medical Treatment can be obtained; b) After being treated at a local medical facility, Your medical condition warrants transportation with a qualified medical attendant to Your Home Country to obtain further medical Treatment or to recover; c) Both a. and b. above. Non-Emergency use of special transportation is excluded from this plan.

Return of Mortal Remains

If You should die, Benefits will be paid for Expenses incurred up to $50,000 to return Your remains to Your Home Country. All Covered Expense in connection with a Return of Mortal Remains or Cremation must be pre-approved and arranged by the Assistance Company.

Emergency Medical Reunion

When it is determined that it is necessary and prudent for You to have an Emergency Medical Evacuation or Repatriation, this Plan will arrange to bring an individual of Your choice, from Your current Home Country, to be at Your side while You are hospitalized and then accompany You during Your return to Your current Home Country. Benefits will be paid up to $50,000 for reasonable travel and accommodation Expense up to a maximum of 10 days, as pre-approved and arranged by the Assistance Company.

Return of Minor Child(ren)

The Plan will pay for these services up to a maximum of $50,000 provided all transportation and services are pre-approved and arranged by the Assistance Company.

Interruption of Trip

If Your trip is interrupted due to one of the following reasons: 1) Death of an Immediate Family Member; 2) Serious damage to Your principal residence from fire, flood or similar Natural Disaster (tornado, earthquake, hurricane, etc.). Benefits will be paid up to $5,000 for the expense of economy return travel ticket to return you to your area of principal residence.

Political and Natural Disaster Evacuation

Coverage is provided up to $50,000 if the Insured requires emergency evacuation, which places him/her in Imminent Bodily Harm or due to a Natural Disaster, which makes his/her location Uninhabitable. The Assistance Company shall arrange, and the plan will pay for Insured’s transportation to the nearest safe location. If evacuation becomes impractical due to hostile or dangerous conditions, the Assistance Company will maintain contact with and advise the Insured until evacuation becomes viable or the Natural Disaster situation has been resolved. Should commercial flights be available, but transportation to the airport will place the Participant in Imminent Bodily Harm, the Assistance Company shall arrange and pay for his/her secure transport to the airport. No benefit shall be payable if there is a travel warning in effect within 60 days prior to the insured person’s date of arrival in the host country. The Assistance Company must make all arrangements for the Insured. Services rendered without the Assistance Company’s coordination and approval is not covered. No claims for reimbursement will be accepted. Expenses for non-emergency transportation are the responsibility of the Participant.

Loss of Baggage

This plan will reimburse You for loss, theft, or damage to Your baggage or personal effects, checked with a Common Carrier. This plan is secondary to any coverage provided by a Common Carrier and all other valid and collective insurance. $50 per article, to a maximum of $250.

Incidental Trips

Coverage under all provisions of the plan is provided up to a maximum of 15 days for Incidental Trips to Canada, Mexico, and the Caribbean Islands only. Incidental Trip means temporary travel (not more than 15 days) outside of the United States to Canada, Mexico, and the Caribbean Islands only. NOTE: Incidental Trips does not: 1) Provide coverage in your Home Country; and 2) Extend coverage beyond the coverage dates of the plan.

Accidental Death and Dismemberment (AD&D)

If within 365 days after the date of a Covered Accident, the Insured Person’s Injury results in death or dismemberment, this Plan provides the following benefits for loss of:

Description of Loss Indemnity
Life: 100% of Principal Sum
Both Hands or Both Feet or Sight of Both Eyes or One Hand and One Foot or Either Hand or Foot and Sight of One Eye: 100% of Principal Sum
Speech and Hearing in both Ears: 100% of Principal Sum
Speech or Hearing in both Ears: 50% of Principal Sum
Either Hand or Foot or Sight of One Eye: 50% of Principal Sum
Thumb and index finger of same hand: 25% of Principal Sum

The amount of the Principal Sum is $25,000. If the Enhanced AD&D Benefit purchased, the $25,000 is included in the total benefit amount.

AD&D Disclaimer: The maximum AD&D benefit for all of our Diplomat Series of Products is $1 million of coverage, $25,000 if under 18 years of age. (Diplomat Series means: Diplomat America, International, and Long Term (LT)).

Disappearance - If the body of an Insured Person has not been found within one year of the disappearance, forced landing, stranding, sinking, or wrecking of a conveyance in which such person was an occupant, then such Person shall have suffered loss of life within the meaning of the plan.

Paralysis Benefit - If a Covered Accident renders an Insured Person Paralyzed within 365 days of the date of the Covered Accident that caused the Injury, in any one of the types of paralysis specified below:

Type of Paralysis (Loss) Indemnity

Quadriplegia........................................................$25,000

Paraplegia………………………………………………………..$18,750

Hemiplegia...........................................................$12,500

Uniplegia................................................................$6,250

Coma Benefit - If a covered Injury renders an Insured Person Comatose within 90 days of the date of the accident that caused the Injury, and if the Coma continues for a period of 30 consecutive days, The Company will pay a monthly benefit of $250. No benefit is provided for the first 30 days of the Coma. The benefit is payable monthly as long as the Insured remains Comatose due to that Injury, but ceases on the earliest of: 1) the date the insured ceases to be Comatose due to the Injury; 2) the date the Insured dies; 3) the date the total amount of monthly Coma Benefit paid for all Injuries caused by the same accident equals $25,000.

Seat Belt and Airbag Benefit - The Company will pay a $25,000 benefit when the Insured Person suffers accidental death such that an Accidental Death benefit is payable under the plan and the accident causing death occurs while the Insured Person is operating, or riding as a passenger in an Automobile if: 1) You are wearing a properly fastened seat belt, properly installed by a factory authorized dealer; and 2) You were positioned in a seat protected by a properly functioning Supplemental Restraint System, properly installed by a factory authorized dealer that inflates on impact. This benefit is in addition to any other Expenses of the program.

Felonious Assault Benefit - The Company will pay a $25,000 benefit when an Insured Person suffers one or more losses for which benefits are payable under the Accidental Death & Dismemberment Benefit or Coma Benefit provided by the plan as a result of a Felonious Assault. Only one benefit is payable for all losses as a result of the same Felonious Assault. This benefit is in addition to any other Expenses of the program.

Home Alteration and Vehicle Modification - The Company will pay Covered Home Alteration and Vehicle Modification Expenses that are incurred within one year after the date of the accident causing such loss(es), up to a maximum of $2,500 for all such losses caused by the same accident.

WORLDWIDE ASSISTANCE SERVICES

(This is an additional benefit not underwritten by Advent)

After you enroll in the Diplomat International you are eligible to use any of the assistance services provided by On Call International.

- Available 24 hours / 7 days a week

- Assistance with emergency Medical Evacuations and Repatriations

- Emergency Travel Assistance Services

- Referrals to Medical and Dental Providers Worldwide

- Multilingual personnel

- Doctors and nurses on staff