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Plan Detail

Plan Administrator: Seven Corners | AM Best Rating: A "Excellent" | Underwriter: Lloyd's

Eligibility : Non-US citizens Age 0-99 traveling to USA only.
Coverage length: Minimum 5 days to maximum 6month.
PPO Network: Multi plan
Renew Online: Minimum 5 days ($5 fee each time you renew)
Acute Onset of Pre-X Coverage: Coverage up to $120,000 (varies per medical maximum) for age under 70 years.
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Benefits Pre-existing Coverage Description Exclusions Renew Cancel Claims

Benefits

Schedule of benefits

If your covered injury or sickness requires medical treatment, we will pay the coverage amounts in the schedule of benefits, minus your chosen per person deductible. Please note that treatment for your injury or sickness must be received within 26 weeks of your injury or sickness.

Covered services per injury and per sickness benefit maximums

Age 14 Days through 69	Plan A	Plan B	Plan C	Plan D	Plan E
INPATIENT	$25000 Max per Injury/Sickness	$45000 Max per Injury/Sickness	$65,000 Max per Injury/Sickness	$85,000 Max per Injury/Sickness	$120,000 Max per Injury/Sickness
Hospital Room & Board including Laboratory Tests, X-rays, Prescription Medical and other miscellaneous	Up to $910/day, 30 day max	Up to $1,260/day, 30 day max	Up to $1,565/day, 30 day max	Up to $1,725/day, 30 day max	Up to $2,340/day, 30 day max
Hospital Intensive Care Unit	Add’l $430/day, 8 day max	Add’l $595/day, 8 day max	Add’l $720/day, 8 day max	Add’l $790/day, 8 day max	Add’l $1020/day, 8 day max
Surgical Treatment	Up to $2,150	Up to $2,970	Up to $3,960	Up to $4,840	Up to $6,600
Anesthetist	Up to $500	Up to $740	Up to $990	Up to $1,210	Up to $1,650
Assistant Surgeon	Up to $500	Up to $740	Up to $990	Up to $1,210	Up to $1,650
Physician’s Non-Surgical Visits	Up to $40/visit, 1/day, 30 visits max	Up to $60/visit, 1/day, 30 visits max	Up to $65/visit,1/day, 30 visits max	Up to $75/visit, 1/day, 30 visits max	Up to $100/visit, 1/day, 30 visits max
Consultant Physician, when requested by attending Physician	Up to $350	Up to $405	Up to $465	Up to $485	Up to $600
Pre-Admission Tests w/in 7 days before Hospital admission	Up to $750	Up to $990	Up to $1,100	Up to $1,100	Up to $1,100
Private Duty Nurse	Up to $400	Up to $495	Up to $550	Up to $550	Up to $660
OUTPATIENT
Surgical Treatment	Up to $2,150	Up to $2,970	Up to $3,960	Up to $4,840	Up to $6,600
Anesthetist	Up to $500	Up to $740	Up to $990	Up to $1,210	Up to $1,650
Assistant Surgeon	Up to $500	Up to $740	Up to $990	Up to $1,210	Up to $1,650
Physician’s Non-Surgical /Urgent Care Visits	Up to $50/visit, 1/day, 10 visits max	Up to $60/visit, 1/day, 10 visits max	Up to $65/visit, 1/day, 10 visits max	Up to $75/visit, 1/day, 10 visits max	Up to $100/visit, 1/day, 10 visits max
Diagnostic X-rays & Lab Services	Up to $295 - Additional $250- One CAT scan, PET scan or MRI	Up to $405 - Additional $250 - One CAT scan, PET scan or MRI	Up to $465 – additional $375 - One CAT scan, PET scan or MRI	Up to $485 - Additional $450 - One CAT scan, PET scan or MRI	Up to $600 - Additional $500 - One CAT scan, PET scan or MRI
Hospital Emergency Room	Up to $215	Up to $295	Up to $395	Up to $465	Up to $660
Prescription Drugs	Up to $150 Per Coverage Period	Up to $250 Per Coverage Period	Up to $125 Per Coverage Period	Up to $135 Per Coverage Period	Up to $180 Per Coverage Period
Outpatient Surgical Facility	Up to $750	Up to $900	Up to $1,030	Up to $1,070	Up to $1,320
OTHER TREATMENT AND SERVICES
Ambulance Services	Up to $295	Up to $450	Up to $450	Up to $475	Up to $475
Initial Orthopedic Prosthesis/Brace	Up to $715	Up to $990	Up to $1,160	Up to $1,240	Up to $1,560
Chemotherapy and/or Radiation Therapy	Up to $715	Up to $990	Up to $1,175	Up to $1,275	Up to $1,620
Dental Treatment for Injury to Sound, Natural Teeth	Up to $360	Up to $550	Up to $550	Up to $550	Up to $550
Mental & Nervous Disorder & Substance Abuse	Same as any Sickness	Same as any Sickness	Same as any Sickness	Same as any Sickness	Same as any Sickness
Physiotherapy	Up to $30/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max
Emergency Evacuation	$50,000	$50,000	$50,000	$50,000	$50,000
Extended Care Facility	Covered under the Hospital Room & Board	Covered under the Hospital Room & Board	Covered under the Hospital Room & Board	Covered under the Hospital Room & Board	Covered under the Hospital Room & Board
Return of Remains/Local Cremation & Burial Benefit	$25,000/$5,000	$25,000/$5,000	$25,000/$5,000	$25,000/$5,000	$25,000/$5,000
Common Carrier AD&D Principal Sum	$25,000	$25,000	$25,000	$25,000	$25,000
Acute Onset of a Pre-existing Condition	$25,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation.	$45,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation.	$65,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation.	$85,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation.	$120,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation.

If you turn 70 years old during the purchased coverage period, the 70 and over benefit schedule becomes effective on the day you turn 70. If you have the $25,000 or $45,000 per injury/sickness maximum, you will receive the $40,000 maximum. If you have the $65,000 or $85,000 per injury/sickness maximum, you will receive the $60,000 maximum. If you have the $120,000 per injury/sickness policy maximum, you will receive the $100,000 per injury/sickness maximum.

Covered services injury and sickness benefit maximums (cont.)

Age 70To 99Yrs	Plan J - $40000 Policy Max	Plan K - $60,000 Policy Max	Plan L - $100,000 Policy Max
INPATIENT
Hospital Room & Board including Laboratory Tests, X-rays, Prescription Medical and other miscellaneous	Up to $870/day, 30 day max	Up to $1,260/day, 30 day max	Up to $2,050/day, 30 day max
Hospital Intensive Care Unit	Additional $380/day, 8 day max	Additional $550/day, 8 day max	Additional $900/day, 8 day max
Surgical Treatment	Up to $2,285	Up to $3,300	Up to $5,365
Anesthetist	Up to $570	Up to $825	Up to $1,340
Assistant Surgeon	Up to $570	Up to $825	Up to $1,340
Physician’s Non-Surgical Visits	Up to $45/visit, 1/day, 30 visits max	Up to $65/visit, 1/day, 30 visits max	Up to $100/visit, 1/day, 30 visits max
A Consulting Physician, when requested by attending Physician	Up to $330	Up to $480	Up to $780
Private Duty Nurse	Up to $375	Up to $450	Up to $880
Pre-Admission Tests w/in 7 days before Hospital admission	Up to $775	Up to $775	Up to $1,500
OUTPATIENT
Surgical Treatment	Up to $2,285	Up to $3,300	Up to $5,365
Anesthetist	Up to $570	Up to $825	Up to $1,340
Assistant Surgeon	Up to $570	up to $825	Up to $1,340
Physician’s Non-Surgical / Urgent Care Visits	Up to $45/visit, 1/day, 10 visits max	Up to $65/visit, 1/day, 10 visits max	Up to $100/visit, 1/day, 10 visits max
Diagnostic X-rays & Lab Services	Up to $330 - Additional $250 - One CAT scan, PET scan or MRI	Up to $480 – additional $300 - One CAT scan, PET scan or MRI	Up to $780 – additional $300 - One CAT scan, PET scan or MRI
Hospital Emergency Room (all expenses incurred therein)	Up to$208	Up to $300	Up to $480
Prescription Drugs	Up to $250	Up to $250	Up to $250
Outpatient Surgical Facility	Up to $705	Up to $1,020	Up to $1,660
OTHER TREATMENT AND SERVICES
Ambulance Services	Up to $450	Up to $450	Up to $880
Initial Orthopedic Prosthesis/brace	Up to $705	Up to $1,020	Up to $1,660
Chemotherapy and/or radiation therapy	Up to $705	Up to $1,020	Up to $1,660
Dental Treatment for Injury to Sound, Natural Teeth	$550	Up to $550	Up to $1,075
Mental & Nervous Disorder & Substance Abuse	Same as any Sickness	Same as any Sickness	Same as any Sickness
Physiotherapy	Up to $40/visit, 1/day, 12 visits max	Up to $40/visit, 1/day, 12 visits max	Up to $80/visit, 1/day, 12 visits max
Extended Care Facility	Covered under the Hospital Room & Board benefit	Covered under the Hospital Room & Board benefit	Covered under the Hospital Room & Board benefit
Emergency Evacuation	$50,000	$50,000	$50,000
Return of Remains/Local Creamation/Burial	$25,000/$5,000	$25,000/$5,000	$25,000/$5,000