INF Choice

Plan Detail

Plan Administrator: INF Healthcare | AM Best Rating : "A+" (Superior) | Underwriter: Axis Insurance Company.

Benefits


SCHEDULE OF BENEFIT

INF CHOICE IN-PATIENT SERVICES

Covered Medical Services

Policy Max: $25,000

Policy Max: $50,000

Max: $75,000

Hospital Room and Board

100% of Usual & Customary Charge incurred, Up to $900 a day, to a maximum of 30 days

100% of Usual & Customary Charge incurred, Up to $1,300 a day, to a maximum of 30 days

100% of Usual & Customary Charge incurred, Up to $1,525 a day, to a maximum of 30 days

Hospital Intensive Care Unit Room and Board

100% of Usual & Customary Charge incurred, Up to $400 a day, to a maximum of 8 days

100% of Usual & Customary Charge incurred, Up to $525 a day, to a maximum of 8 days

100% of Usual & Customary Charge incurred, Up to $625 a day, to a maximum of 8 days

Surgeon Services

100% of Usual & Customary Charge incurred, Up to $2,000 max

100% of Usual & Customary Charge incurred, Up to $3,000 max

100% of Usual & Customary Charge incurred, Up to $4,000 max

Anesthetics

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $750 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

Assistant Surgeon

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $750 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

Physician Non-Surgical Treatment/Examination Visits

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $60 max per visit, 1 visit per day, Up to 30 visits max

100% of Usual & Customary Charge incurred, Up to $80 max per visit, 1 visit per day, Up to 30 visits max

Consultant visits, when requested by a Physician

100% of Usual & Customary Charge incurred, Up to $375 max

100% of Usual & Customary Charge incurred, Up to $400 max

100% of Usual & Customary Charge incurred, Up to $425 max

Pre-admission Tests, when requested by Physician

100% of Usual & Customary Charge incurred, Up to $950 max, test must occur within 14 days prior to Hospital Admission

100% of Usual & Customary Charge incurred, Up to $1,000 max, test must occur within 14 days prior to Hospital Admission

100% of Usual & Customary Charge incurred, Up to $1,050 max, test must occur within 14 days prior to Hospital Admission

INF CHOICE IN-PATIENT SERVICE

Covered Medical Services

Policy Max: $100,00

Policy Max: $150,000

Policy Max: $250,000

Hospital Room and Board

100% of Usual & Customary Charges incurred, Up to $1,750 per day, to a maximum of 30 days

100% of Usual & Customary Charge incurred, Up to $1,900 per day, to a maximum of 30 days

100% of Usual & Customary Charge incurred, Up to $2,200 a day, to a maximum of 30 days

Hospital Intensive Care Unit Room and Boar

100% of Usual & Customary Charge incurred, Up to $750 a day, to a maximum of 8 days

100% of Usual & Customary Charge incurred, up to $850 per day, to a maximum of 8 days

100% of Usual & Customary Charge incurred, Up to $950 a day, to a maximum of 8 days

Surgeon Services

100% of Usual & Customary Charges incurred, Up to $5,000 max

100% of Usual & Customary Charge incurred, Up to $6,000 max

100% of Usual & Customary Charge incurred, Up to $7,000 max

Anesthetics

 100% Usual & Customary Charge incurred, Up to $1,250 max

100% of Usual & Customary Charge incurred, Up to $1,500 max

100% of Usual & Customary Charge incurred, Up to $1,750 max

Assistant Surgeon

100% of Usual & Customary Charge incurred, Up to $1,250 max

100% Usual & Customary Charge incurred, Up to $1,500 max

100% of Usual & Customary Charge incurred, Up to $1,750 max

Physician Non-Surgical Treatment/Examination Visits

100% Usual & Customary Charge incurred, Up to $100 per visit, 1 visit per day, Up to 30 visits max

100% of Usual & Customary Charge incurred, Up to $125 per visit, 1 visit per day, Up to 30 visits max

100% of Usual & Customary Charge incurred, Up to $150 max per visit, 1 visit per day, Up to 30 visits max

Consultant visits, when requested by a Physician

100% Usual & Customary Charge incurred, Up to $450 max

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $550 ma

Pre-admission Tests, when requested by Physician

100% of Usual & Customary Charge incurred, Up to $1,100 max, test must occur within 14 days prior to Hospital Admission

100% of Usual & Customary Charge incurred, Up to $1,200 max, within 14 days prior to Hospital admission

100% of Usual & Customary Charge incurred, Up to $1,350 max, test must occur within 14 days prior to Hospital Admission

 

 

 INF CHOICE OUT-PATIENT BENEFITS

Covered Medical Services

Policy Max: $25,000

Policy Max: $50,000

Policy Max: $75,000

Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)

100% of Usual & Customary Charge incurred, Up to $375 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

100% of Usual & Customary Charge incurred, Up to $1,050 ma

Surgeon Services

100% of Usual & Customary Charge incurred, Up to $2,000 max

100% of Usual & Customary Charge incurred, Up to $3,000 max

100% of Usual & Customary Charge incurred, Up to $4,000 max

Anesthetics

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $750 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

Assistant Surgeon

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $750 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

Physician Non-Surgical Treatment/Exam Visits

100% of Usual & Customary Charge incurred, Up to $40 per visit, 1 visit per day, Up to 10 visits max

100% of Usual & Customary Charge incurred, Up to $60 max per visit, 1 visit per day, Up to 10 visits max

100% of Usual & Customary Charge incurred, Up to $80 max per visit, 1 visit per day, Up to 10 visits max

Diagnostic X-Rays and Laboratory Procedures

100% of Usual & Customary Charge incurred, Up to $275 max

100% of Usual & Customary Charge incurred, Up to $400 max

100% of Usual & Customary Charge incurred, Up to $525 max

CAT Scan, PET Scan or MRI

100% of Usual & Customary incurred, Up to an additional $275 of the Diagnostic X-Ray and Lab Services Benefits

100% of Usual & Customary Charge incurred, Up to an additional $400 of the Diagnostic X-Ray and Lab Services Benefits

100% of Usual & Customary Charge incurred, Up to an additional $525 of the Diagnostic X-Ray and Lab Services Benefits

Hospital Emergency Room

100% of Usual & Customary Charge incurred, Up to $275 max

100% of Usual & Customary Charge incurred, Up to $350 max

100% of Usual & Customary Charge incurred, Up to $425 max

Prescription Drug

100% of Usual & Customary Charge incurred, Up to $75 max

100% of Usual & Customary Charge incurred, Up to $100 max

100% of Usual & Customary Charge incurred, Up to $125 max

Covered Medical
Services

Policy Max: $100,000

Policy Max: $150,000

Policy Max: $250,000

Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)

100% of Usual & Customary Charge incurred , Up to $1,100 max

100% of Usual & Customary Charge incurred, Up to $1,200 max

100% of Usual & Customary Charge incurred, Up to $1,350 max

Surgeon Services

100% of Usual & Customary Charge incurred, Up to $5,000 max

100% of Usual & Customary Charge incurred, Up to $6,000 max

100% of Usual & Customary Charge incurred, Up to $7,000 max

Anesthetics

100% of Usual & Customary Charge incurred, Up to $1,250

100% of Usual & Customary Charge incurred, Up to $1,500 max

100% of Usual & Customary Charge incurred, Up to $1,750 max

Assistant Surgeon

100% of Usual & Customary Charge incurred, Up to $1,250 max

100% of Usual & Customary Charge incurred , Up to $1,500 max

100% of Usual & Customary Charge incurred, Up to $1,750 max

Physician Non-Surgical Treatment/Exam Visits

100% of Usual & Customary Charge incurred, Up to $100 per visit, 1 visit per day, Up to 10 visits max

100% of the Usual & Customary Charge incurred, Up to $125 per visit, 1 visit per day, Up to 10 visits max

100% of Usual & Customary Charge incurred, Up to $150 max per Day, 1 visit per day, Up to 10 visits max

Diagnostic X-Rays and Laboratory Procedure

100% of Usual & Customary Charge incurred, Up to $650 max

100% of Usual & Customary Charge incurred, Up to $750 max

100% of Usual & Customary Charge incurred, Up to $900 max

CAT Scan, PET Scan or MRI

100% of Usual & Customary Charge incurred, Up to $650 of the Diagnostic X-Ray and Lab Services Benefits

100% of Usual & Customary Charge incurred, Up to an additional $1,000 of the Diagnostic X-Ray and Lab Services Benefits

100% of Usual & Customary Charge incurred, Up to an additional $1,250 of the Diagnostic X-Ray and Lab Services Benefits

Hospital Emergency Room

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $750 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

Prescription Drug

100% of Usual & Customary Charge incurred, Up to $150 max

100% of Usual & Customary Charge incurred, Up to $200 max

100% of Usual & Customary Charge incurred, Up to $250 max

INF CHOICE OTHER BENEFITS

Covered Medical Services

Policy Max: $25,000

Policy Max: $50,000

Policy Max: $75,000

Ambulance Services

100% of Usual & Customary Charge incurred, Up to $375 max

100% of Usual & Customary Charge incurred, Up to to $400 max

100% of Usual & Customary Charge incurred, Up to $425 max

Initial Orthopedic Prosthesis or Brace

100% of Usual & Customary Charge incurred , Up to $950 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

100% of Usual & Customary Charge incurred, Up to $1,050 max

Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)

100% of Usual & Customary Charge incurred, Up to $425 max

100% of Usual & Customary Charge incurred, Up to $450 max

100% of Usual & Customary Charge incurred, Up to $475 max

Chemotherapy and/or Radiation Therapy

100% of Usual & Customary Charge incurred, Up to $925 max

100% of Usual & Customary Charge incurred, Up to $1,000 max

100% of Usual & Customary Charge incurred, Up to $1,075 max

Physical and Occupational Therapy

100% of Usual & Customary Charge incurred, Up to $30 per visit, 1 visit per day, 12 visits max

100% of Usual & Customary Charge incurred, Up to $35 per visit, 1 visit per day, 12 visits max

100% of Usual & Customary Charge incurred, Up to $40 per visit, 1 visit per day, 12 visits max

Private Duty Nursing

100% of Usual & Customary Charge incurred, Up to $350 max

100% of Usual & Customary Charge incurred, Up to $400 max

100% of Usual & Customary Charge incurred, Up to $450 max

Pregnancy and Childbirth

100% of Usual & Customary Charge incurred, Up to $4,250; conception must occur after the trip begins

100% of Usual & Customary Charge incurred, Up to $4,500 max; conception must occur after the trip begins

100% of Usual & Customary Charge incurred, Up to $4,750; conception must occur after the trip begins

Emergency Medical Evacuation

100% of Usual & Customary Charges incurred, Up to a maximum of $10,000 max

100% of Usual & Customary Charge incurred, Up to $10,000 max

100% of Usual & Customary Charge incurred, Up to $10,000 max

Repatriation of Remains

100% of Usual & Customary Charges incurred, Up to a maximum of $10,000

100% of Usual & Customary Charge incurred, Up to $10,000 max

100% of Usual & Customary Charge incurred, Up to $10,000 max

Accidental Death and Dismemberment

$500,000 Aggregate Sum

$500,000 Aggregate Sum

$500,000 Aggregate Sum

Covered Medical Services

Policy Max: $100,00

Policy Max: $150,000

Policy Max: $250,000

Ambulance Services

100% of Usual & Customary Charge incurred, Up to $450 max

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $600 max

Initial Orthopedic Prosthesis or Brace

100% of Usual & Customary Charge incurred, Up to $1,100 max

100% of Usual & Customary Charge incurred, Up to $1,200 max

100% of Usual & Customary Charge incurred, Up to $1,350 max

Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred, Up to $550 max

100% of Usual & Customary Charge incurred, Up to $650 max

Chemotherapy and/or Radiation Therapy

100% of Usual & Customary Charge incurred, Up to $1,150 max

100% of Usual & Customary Charge incurred , Up to $1,250 max

100% of Usual & Customary Charge incurred , Up to $1,400 max

Physical and Occupational Therapy

100% of Usual & Customary Charge incurred, Up to $45 per visit, 1 visit per day, 12 visits max

100% of Usual & Customary Charge incurred, Up to $50 per visit, 1 visit per day, 12 visits max

100% of Usual & Customary Charge incurred, Up to $55 per visit, 1 visit per day, 12 visits max

Private Duty Nursing

100% of Usual & Customary Charge incurred, Up to $500 max

100% of Usual & Customary Charge incurred , Up to $550 max

100% of Usual & Customary Charge incurred, Up to $600 max

Pregnancy and Childbirth

100% of Usual & Customary Charge incurred, Up to $5,000; conception must occur after the trip begins

100% of Usual & Customary Charge incurred, Up to $5,500; conception must occur after the trip begins

100% of Usual & Customary Charge incurred, Up to $6,000; conception must occur after the trip begins

Emergency Medical Evacuation

100% of Usual & Customary Charge incurred, Up to $10,000 max

100% of Usual & Customary Charge incurred, Up to $10,000 max

100% of Usual & Customary Charge incurred, Up to $10,000 max

Repatriation of Remains

100% of Usual & Customary Charges incurred, Up to $10,000 max

100% of Usual & Customary Charge incurred, Up to $10,000 max

100% of Usual & Customary Charge incurred, Up to $10,000 max

Accidental Death and Dismemberment

$500,000 Aggregate Sum

$500,000 Aggregate Sum

$500,000 Aggregate Sum

Pre-Existing Condition means an illness, disease, injury or other condition of the Insured Person that before the Insured Person's coverage became effective under the Policy: 1. was treated by a Physician or treatment had been recommended by a Physician; 2. required taking prescribed drugs or medicines, or 3. first manifested itself, worsened, became acute or exhibited symptoms that would have caused an ordinarily prudent person to seek diagnosis.

SCHEDULE OF BENEFITS – SUMMARY

We will pay Medical Benefits for Covered Medical Services that result directly, and from no other cause, from a Covered Accident or Sickness. These benefits are subject to a Deductible of $75, $250, $500, $1,000, $5,000 or $10,000 per person for each Covered Injury and each Sickness as seen in the table below. Medical Benefits are only payable: (1) for Usual and Customary Charges incurred after the Deductible, has been met; (2) for those Medically Necessary Covered Medical Services that the Insured Person incurs; (3) for charges incurred for services rendered to the Insured Person while on a Covered Trip; and (4) provided the first charge is incurred within 90 days of the Covered Accident or Sickness. Payment for Covered Medical Services will not exceed the benefit limits shown below. The total amount payable under the policy will not exceed the Policy Maximums shown on the next page.

Policy Maximum Coverage

Pre-Existing Maximum Coverage for each deductible

$75

$250

$500

$1,000

$5,000

$10,000

$25, 000 (Age 0-89)

$1, 000

$1,500

$1,750

 

 

 

$50, 000 (Age 0-89)

$1, 500

$2,000

$2,500

 

 

 

$75, 000 (Age 0-89)

$2, 500

$3,500

$4,500

 

 

 

$100, 000 (Age 0-89)

$3, 500

$4,500

$5,500

$6,500

 

 

$150, 000 (Age 0-69)

$4, 500

$5,500

$6,500

$7,500

 

 

$150, 000 (Age 0-69)

 

 

$7,000

$9,000

$13, 000

$15, 000

PRE-EXISTING CONDITIONS COVERAGE

Pre-existing Coverage is limited to Acute Onset coverage. If you experience an acute onset of a pre-existing condition, benefits are payable according to your policy benefits. Treatment for said condition must be obtained within 12 hours of the sudden and unexpected outbreak or reoccurrence. Please view the premiums & coverage tables for full list of preexisting maximums: www.infplans.com/inf-easy-select-premiums.php

LIMITED BENEFITS

This insurance includes limited benefits. Limited benefits plans are insurance products with reduced benefits and are not intended to be an alternative to or integrated with comprehensive coverage. Further, this insurance does not coordinate with any other insurance plan. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, this insurance is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.

Network Provider: FirstHealth Network

Network means the FirstHealth Network. When a covered Injury or Sickness requires treatment by a Doctor, this Policy will provide benefits while coverage is in force for the Usual and Customary charges incurred which exceed the deductible per person for each Injury or Sickness. Payment for any covered service will be no more than the Benefit Limit shown for it. In no event will the total combined benefits for a single Injury or Sickness (either in a single Policy year or through continuing year's coverage) exceed the Policy Maximum Benefit. Medical Expense Benefits are only payable: (1) for Usual and Customary Charges incurred after the Deductible, if any, has been met; (2) for those Medically Necessary Covered 

When a covered Injury or Sickness requires treatment by a Doctor, this Policy will provide benefits while coverage is in force for the Usual and Customary charges incurred which exceed the deductible per person for each Injury or Sickness. Payment for any covered service will be no more than the Benefit Limit shown for it.

PERIODS OF COVERAGE & PREMIUM RATES

Premium Rates in all tables (www.infplans.com/inf-easy-select-premiums.php) are per month (30 days coverage) and any single days premium is prorated based on 30 day monthly premium.

Enrollment is subject to the following rules:

- You must enroll and pay premium for at least 30 days of coverage

- You may enroll for up to 300 consecutive days and pay the required premium at the time of enrollment 

- You must pay the full premium for the requested months at the time of enrollment

- A $15 application fee will be charged for each enrollment and is non-refundable even if insurance is canceled. 

- If you are on a Trip and wish to extend your coverage you may enroll for an additional period subject to a minimum period of one day and an overall maximum period of 12 months

PROGRAM ELIGIBILITY

You are eligible to elect this insurance is you are an active member of the INF and are visiting the USA or Canada. Members are auto-enrolled in membership by paying $15 application fee. Membership expires at the termination date of each policy. Membership fees are required for new applications & renewals.

All Visitors & Travelers to the United States (included Non-US Citizens & US Citizen Expatriates visiting the United States) are eligible to enroll in this policy. You may elect coverage for your Eligible Dependents traveling with you.

Eligible Dependents are any of the following persons: the insured member's legal spouse, and their unmarried dependent children under 19 years of age (19 years and older if a child is incapable of self-sustaining employment due to physical or mental handicap).

If adoption, birth or marriage occurs while the insured member is covered under this insurance, the insured member will have 31 days within which to enroll a newly eligible dependent and pay the required premium for coverage to continue for the remainder of the period of coverage.

INSURANCE ENROLLMENT

To enroll in the INF HEALTH CARE Accident & Sickness Insurance Program, you may enroll online or submit paper application from your agent. Click here to complete application online. To enroll in the health plans offered, follow the steps listed below:

1. Complete the Insurance Enrollment Form

2. Submit the forms either electronically or as shown below.

VIA FAX: 

Fax the membership and enrollment forms (fax versions of the forms are available under download link) with charge authorization to 408-520-4967

VIA MAIL:

Mail a check for the exact amount with completed enrollment forms: the membership form & insurance form. Prepare two checks

1. Application fee of $15 made payable to INF Health Care, LLC and

2. Premium amount made payable to ‘INF Health Care, LLC’and mail the package to:

INF Health Care
7065 Westpointe Blvd, Suite 209 
Orlando, FL 32835-8758

Processing of an insurance enrollment may take up to 2 working days; when processing is complete, if you enroll for a coverage term of 1 month or more. Fulfillment is completed electronically. Physical delivery of an ID card is subject to an additional $5 processing fee. Requests may be submitted to operations@infplans.com

Benefits will not be paid for services or treatment rendered by any person who is: Employed or retained by the policyholder; Living in the Insured Persons household; An Immediate Family Member of either the Insured Person or the Insured Persons Spouse; or The Insured Person.

If We determine the benefits paid under this Policy are eligible benefits under any other benefit plan, We may seek to recover any expenses covered by another plan to the extent that the Insured Person is eligible for reimbursement.

Europ TRAVEL ASSISTANCE SERVICES

Europ Assistance can help travelers with medical emergencies by:

The Europ Assistance communications network is available 24 hours a day, seven days a week to provide assistance to the Insured Person.

Inside the United States/Canada call (877) 243-4134

Outside United States/Canada call collect 240-330-1528

or email OPS@europassistance-usa.com

OTHER BENEFITS - MEDICAL EVACUATION AND REPATRIATION BENEFITS

EMERGENCY MEDICAL EVACUATION AND REPATRIATION: These Benefits will not be payable unless We (or Our authorized travel assistance provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our a travel assistance provider. Contact Europ Assistance for these services at (877) 243-4134 or call collect from outside the United States at (240) 330-1528 (24 hours a day, 7 days a week). Email: OPS@europassistance-usa.com.

EMERGENCY MEDICAL EVACUATION BENEFIT:

We will pay Emergency Medical Evacuation Benefits as shown for Covered Expenses incurred for the Emergency Evacuation of a Insured Person. Benefits are payable up to the Benefit Maximum shown, if the Insured Person suffers a Covered Injury or Emergency Sickness during the course of the Covered Trip that requires Emergency Evacuation.

REPATRIATION OF REMAINS BENEFIT:

We will pay Repatriation Benefits up to the Benefit Maximum shown for preparation and return of a Insured Persons body to his or her place of primary residence if he or she dies as a result of a Covered Injury or Emergency Sickness while traveling on a Covered Trip.

ACCIDENTAL DEATH AND DISMEMBERMENT:

If Injury to the Insured Person results, within 365 days of the date of a Covered Accident, in any one of the losses shown below, We will pay the Benefit Amount shown below for that loss. The Aggregate Sum is $500,000 as shown. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.

Covered Loss

Benefit Amount

Loss of Life

100% of the Aggregate Sum

Loss of Two or More Hands or Feet

100% of the Aggregate Sum

Loss of Sight of Both Eyes

100% of the Aggregate Sum

Loss of One Hand and Foot

100% of the Aggregate Sum

Loss of One Hand or Foot and Sight in One Eye

100% of the Aggregate Sum

Loss of One Hand or Foot

50% of the Aggregate Sum

Loss of Sight in One Eye

50% of the Aggregate Sum

Exposure and Disappearance

Included