INF Choice

Plan Detail

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

Examples of Acute Onset of Pre-Existing Condition

Description


ELIGIBILITY

COVERAGE

The INF Health Care Group Policy Effective Date is June 1, 2018

Coverage for a member and any eligible dependents who enroll in this program will begin at 12:01 a.m. on the latest of the following dates, whichever is applicable:

Insured’s Effective Date: Insurance under this Policy shall become effective on the latest of the following dates:

1. The Effective Date of the Policy;

2. The date the Insured leaves their Country of Residence;

3. The date the Insured’s enrollment form is received by the INF Health Care;

4. The date the Insured’s premium is received by the INF Health Care; or

5. The date the Insured requested on the Application.

Dependent's Effective Date:

Insurance under this Policy shall become effective on the latest of the following dates:

1. The date the insured member’s coverage becomes effective;

2. The date the Dependent leaves their Home Country or Country of Residence; or

3. The date the person becomes a dependent (as defined).

Insured’s Termination Date:

The coverage provided with respect to the insured member shall terminate on the latest of the following dates:

1. The last day of the period for which the premium is paid;

2. The date the insured member returns to his or her Home Country or Country of Residence;

3. The expiration of the maximum coverage period; or

4. The date the Policy terminates.

Dependent’s Termination Date:

The coverage provided with respect to the insured member’s covered Dependents shall terminate on the latest of the following dates:

1. The date the insured member’s coverage ends;

2. The last day of the period for which the premium is paid;

3. The date an insured Dependent return to his or her Home Country or Country of Residence;

4. The expiration of the maximum coverage period; or

5. The date the Policy terminates.

Termination of Coverage will not affect a claim for a covered loss that occurred while the insured member’s coverage was in force under this policy. This coverage will not duplicate benefits available from other valid and collectible insurance. If a covered person’s Injury or Sickness is due to an act or omission of another, benefits payable by this program are subject to recovery from amounts paid to, or on behalf of, the covered person.

NOTE: If coverage is purchased after the Insured Person’s arrival in the United States, coverage under this Rider is limited to Accident only during an Insured Person’s 14 days of coverage commencing on the Insured Person’s Effective Date. Full coverage will take place after the 14th day.

DEFINITIONS

Accident or Accidental means a sudden, unexpected, specific and abrupt event that occurs by chance at an identifiable time and place while the Insured Person is covered under the Policy. Covered Accident means an Accident that results in a Covered Loss during the Policy Term.

Covered Injury means Accidental bodily injury: (1) which is sustained by an Insured Person as a direct result of an unintended, unanticipated Covered Accident that is external to the body and that occurs while the injured person's coverage under the  Policy is in force, and (2) which results directly and independently from all other causes from a Covered Accident and (3) which occurs while such person is participating in a Covered Activity. The Covered Injury must be caused through Accidental means. All injuries sustained by an Insured Person in any one Covered Accident, including related conditions and recurrent symptoms of these injuries, are considered a single injury.

Covered Loss means a loss which meets the requisites of one or more benefits and results from a Covered Accident, Covered Injury or Covered Activity.

Covered Expenses means expenses actually incurred by or on behalf of an Insured Person for treatment, services and supplies covered by this Policy. Coverage under the Policyholders. Policy must remain continually in force from the date of the Covered Accident or Sickness until the date of treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date treatment, service or supply that gave rise to the expense or the charge, was rendered or obtained.

Covered Trip means travel by air, land or sea from the Insured Person's Home Country.

Deductible means the amount that must be paid for Covered Medical Services by the Insured Person before benefits will become payable. A separate deductible shall apply to each Covered Loss.

Eligible Person means an individual as defined in the Policy Schedule of Benefits.

Emergency Sickness means an illness or disease diagnosed by a Physician which: 1. causes a severe or acute symptom that, if not provided with immediate treatment, would reasonably be expected to result in serious deterioration of the Insured Person's health or place his or her life in jeopardy; and 2. first manifests itself suddenly and unexpectedly while the Insured Person is covered under this Policy and is participating in a Covered Activity.

Home Country means a country from which the Insured Person holds a passport or where the Insured Person has primary residency. If the Insured Person holds passports from more than one Country, his or her Home Country will be the country that he or she has declared to the Company in writing as his or her Home Country.

Hospital means a facility that: 1. is operated according to law for the care and treatment of injured people; 2. has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis; 3. has 24 hour nursing service; and 4. is supervised by one or more Physicians.

A Hospital does not include: a nursing, convalescent or geriatric unit of a hospital when a patient is confined mainly to receive nursing care; a facility that is, other than incidentally, a rest home, nursing home, convalescent home or home for the aged; nor does it include any ward, room, wing, or other section of the hospital that is used for such purposes; or any military or veterans hospital or soldiers home or any hospital contracted for or operated by any national government or government agency for the treatment of members or ex-members of the armed forces.

Insured Person means an Eligible Person, as defined in the Policy Schedule of Benefits, for whom required premium has been paid when due and for whom coverage under the Policy remains in force.

Medically Necessary means medical services that: (1) are essential for diagnosis, treatment or care of the Covered Injury or Covered Accident or Emergency Sickness for which it is prescribed or performed; (2) meets generally accepted standards of medical practice; and (3) are ordered by a Physician and performed under His care, supervision or order.

Other Health Care Plan means any arrangement, whether individually purchased or incident to employment or membership in an association or other group, which provides benefits or services for health care, dental care disability benefits or repatriations of remains. An Other Health Care Plan includes group, blanket, franchise, family or individual: 1. insurance policies; 2. subscriber contracts; 3. uninsured agreements or arrangements; 4. coverage provided through Health Maintenance Organizations, Preferred Providers Organizations and other prepayment, group practices and individual practice plans; 5. medical benefits provided under automobile fault and no-fault type contracts; 6. medical benefits provided by any governmental plan or coverage or other benefit law, except: a. a state sponsored Medicaid plan; or b. a plan or law providing benefits only in excess of any private or nongovernmental plan.

Physician means a licensed health care provider practicing within the scope of his license and rendering care and treatment to the Insured Person that is appropriate for the condition and locality, and who is not: 1. the Insured Person; 2. an Immediate Family Member of either the Insured Person or the Insured Person's Spouse; 3. a person living in the Insured Person's household; or 4. a person providing homeopathic, aroma-therapeutic, or herbal therapeutic services.

Personal Deviation means 1. an activity that is not reasonably related to the Insured Persons Covered Activity; 2 such travel or activities coincide with the Insured Persons Covered Activity; and 3. Personal Deviation is limited to any consecutive 2 day period immediately prior to, during or following such Covered Activity.

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.

Sickness means disease or illness, including related conditions and recurrent symptoms, which begin after the effective date of an Insured Person's coverage and while coverage is in force.

Usual and Customary Charge (s) - means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

Payment of claims under any policy issued shall only be made in full compliance with all economic or trade and sanction laws or regulations, including but not limited to, laws and regulations administered and enforced by the US Treasury Department’s Office of Foreign Assets Control.

General questions about the Insurance Plan should be addressed to INF Health Care or your authorized insurance agent. Contact INF Health Care between 9.00 a.m. and 6.00 p.m. (EST), Monday through Friday. Please provide your Primary ID contacting the INF Health Care Office or WebTPA Claims Office.

TELADOC PROGRAM

The Teladoc program is available 24 hours a day, seven days a week and provides you with access to a physician in the United States for any medical consultation and short-term prescription refills. This program is not insurance. Find more information on how to enroll in a Teladoc account by clicking here.

Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

Services are provided by third-party agreements and are not insurance. These services include travel assistance services through Europ Assistance, USA and physician consultation services through Teladoc.

This is a brief description of the coverage provided under the policy, and is subject to the terms, conditions, limitations and exclusions of the policy. Please see the policy for details. 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

IMPORTANT NOTICE

Insurance policies providing certain health insurance coverage issued or renewed on or after September 23, 2010 are required to comply with all applicable requirements of the Patient Protection and Affordable Care Act (“PPACA”). However, there are a number of insurance coverages that are specifically exempt from the requirements of PPACA (See §2791 of the Public Health Services Act).  AXIS Insurance Company maintains this insurance is short-term, limited duration insurance and is not subject to PPACA.

AXIS Insurance Company continues to monitor federal and state laws and regulations to determine any impact on its products.  In the event these laws and regulations change, your plan and rates will be modified accordingly.

Please understand that this is not intended as legal advice. For legal advice on PPACA, please consult with your own legal counsel or tax advisor directly.