INF Premier 2

Plan Detail

Plan Administrator: INF Healthcare I AM Best Rating : "A++" I Underwriter: CHUBB American Insurance Company.

Examples of Covered Pre-Existing Condition

Benefits


SCHEDULE OF BENEFIT

INF PREMIER INPATIENT BENEFITS

COVERED SERVICES

$100,000 Policy Coverage

$150,000 Policy Coverage

Hospital Room (average semi-private) and Board and Miscellaneous

Up to $1,750 a day maximum, to 30 days

Up to $1,900 a day maximum, to 30 days

Hospital Intensive Care Unit

Up to $750 maximum additional a day, to 8 days

Up to $850 maximum additional a day, to 8 days

Surgeon

Up to $5,000 maximum

Up to $6,000 maximum

Anesthetist

Up to $1,250 maximum

Up to $1,500 maximum

Assistant Surgeon

Up to $1,250 maximum

Up to $1,500 maximum

Doctor’s Non-Surgical Visits

Up to $100 maximum a visit, 1 visit a day, to 30 visits

Up to $125 maximum a visit, 1 visit a day, to 30 visits

Consultant Doctor, when requested by attending Doctor

Up to $450 maximum

Up to $500 maximum

Pre-Admission Tests within 14 days before hospital admission

Up to $1100 maximum

Up to $1200 maximum

INF PREMIER OUTPATIENT BENEFITS:

COVERED SERVICES

$100,000 Policy Coverage

$150,000 Policy Coverage

Surgical Room and Supply Expenses

Up to $1,100 maximum

Up to $1,200 maximum

Surgeon

Up to $5,000 maximum

Up to $6,000 maximum

Anesthetist

Up to $1,250 maximum

Up to $1,500 maximum

Assistant Surgeon

Up to $1,250 maximum

Up to $1,500 maximum

Doctor’s Non-Surgical Visits

Up to $100 a visit maximum, 1 visit a day, to 10 visits

Up to $125 a visit maximum, 1 visit a day, to 10 visits

Diagnostic X-rays and Lab Services

Up to $650 maximum

Up to $750 maximum

CAT Scan, PET Scan or MRI

Up to $650 additional

Up to $1,000 additional

Hospital Emergency Room

Up to $500

Up to $750

Prescription Drugs

Up to $150 maximum

Up to $200 maximum

INF PREMIER OTHER BENEFITS

COVERED SERVICES

$100,000 Policy Coverage

$150,000 Policy Coverage

Ambulance Services

Up to $450 maximum

Up to $500 maximum

Rehabilitative Braces or Appliances

Up to $1,100 maximum

Up to $1,200 maximum

Dental Treatment injury to sound, natural teeth- due to accident

Up to $500 maximum. There are no benefits for dental services for immediate relief of pain

Up to $550 maximum. There are no benefits for dental services for immediate relief of pain

Chemotherapy and/or Radiation Therapy

Up to $1,150 maximum

Up to $1,250 maximum

Physical and Occupational Therapy

Up to $45 a visit max, 1 visit a day to 12 visits

Up to $50 a visit max, 1 Visit a day to 12 visits

Private Duty Nurse

Up to $500 maximum

Up to $550 maximum

Pregnancy and Childbirth (conception must occur after the Trip begins

Up to $5000 maximum

Up to $5500 maximum

Medical Evacuation

$20,000 maximum

$25,000 maximum

Repatriation of Remain

$15,000 maximum

$20,000 maximum

Intercollegiate Sports

No Benefits

No Benefits

Pre-existing Conditions Coverage

Options for Members Age 69 & Under: $20,000 Benefit with $1,000 Deductible  $40,000 Benefit with $5,000 Deductible

Options for Members Age 70-99: $15,000 Max Benefit with $1,000 Deductible

$25,000 Maximum Benefit with $5,000 Deductible

Options for Members Age 69 & Under
$30,000 Maximum Benefit/$1,000 Deductible

$60,000 Maximum Benefit/$5,000 Deductible

This coverage is not available for Members Age 70-99.

“Preexisting Condition” means an illness, disease, or other condition of the Covered Person that before the Covered Person’s coverage became effective under the Policy.

1. first manifested itself, worsened, became acute, or exhibited symptoms that would have caused a person to seek diagnosis, care, or treatment; or
2. required taking prescribed drugs or medicines, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or
3. was treated by a Doctor or treatment had been recommended by a Doctor.

SCHEDULE OF BENEFITS IN-PATIENT, OUT-PATIENT, AND OTHER

PRE-EXISTING CONDITIONS COVERAGE

This feature of INF Health Care’s Accident and Sickness Insurance Program provides coverage for Pre-Existing Conditions, defined as an illness, disease, or other condition of the Covered Person that before the Covered Person’s coverage became effective under the Policy: (1) first manifested itself, worsened, became acute, or exhibited symptoms that would have caused a person to seek diagnosis, care, or treatment; or (2) required taking prescribed drugs or medicines, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or (3) was treated by a Doctor or treatment had been recommended by a Doctor.

Pre-Existing Conditions coverage is subject to a Maximum Benefit as given by the following table:

Policy Maximum

New Sickness Deductible

Pre-Existing Maximum

Pre-Existing Deductible

$100,000 (Age 0-99

$75 (Age 0-69) | $250 (Age 70-99)

$20,000 (Age 0-69) | $15,000 (Age 70-99)

$1,000 (Age 0-99)

$100,000 (Age 0-99

$75 (Age 0-69) | $250 (Age 70-99)

$40,000 (Age 0-69) | $25,000 (Age 70-99)

$5,000 (Age 0-99)

$100,000 (Age 0-99

$250 (Age 0-69) | $500 (Age 70-99)

$20,000 (Age 0-69) | $15,000 (Age 70-99)

$1,000 (Age 0-99)

$100,000 (Age 0-99

$250 (Age 0-69) | $500 (Age 70-99)

$40,000 (Age 0-69) | $25,000 (Age 70-99)

$5,000 (Age 0-99)

$150,000 (Age 0-69)

$75 (Age 0-69)

$30,000 (Age 0-69)

$1,000 (Age 0-69)

$150,000 (Age 0-69)

$75 (Age 0-69)

$60,000 (Age 0-69)

$5,000 (Age 0-69)

$150,000 (Age 0-69)

$250 (Age 0-69)

$30,000 (Age 0-69)

$1,000 (Age 0-69)

$150,000 (Age 0-69)

$250 (Age 0-69)

$60,000 (Age 0-69)

$5,000 (Age 0-69)

MEDICAL EXPENSE BENEFITS

The Plan will pay Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident or Sickness. These benefits are subject to a Deductible of $75/$250 (Age 0-69) & $250/$500 (Age 7099) per person for each Injury and each Sickness. 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 Expenses that the Covered Person incurs; (3). for charges incurred for services rendered to the Covered 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 Expenses will not exceed the benefit limits shown below. The total amount payable under the policy for you and your Dependents (if you have elected Dependent coverage and paid the required premium) will not exceed the Policy Maximums shown below.

This is a Fixed benefit plan and it is up to the providers to bill insurance directly. However, Insured can file a claim for reimbursement after they settle the bill with providers. We require a claim be filed by the insured any time the insurance is used.

This Plan carries no network requirement.

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 90 days of coverage
- You may enroll for up to 12 consecutive months 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:

INSURANCE ENROLLMENT (Continued)

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

Processing of an insurance enrollment may take up to 2 working days. 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

AXA Travel ASSISTANCE SERVICES (AVAILABLE FOR INSURED MEMBERS ONLY)

AXA Travel Assistance Services at 1-855-327-1414 will provide 24-hour access to the following services

Medical Assistance including referral to a doctor or medical specialist, medical monitoring when you are hospitalized, emergency medical evacuation to an adequate facility, medically necessary repatriation, and return of mortal remains.

You will receive information Travel Assistance on your Certificate of Insurance that will provide you with emergency call numbers. Information on how to access CHUBB’s Travel Assistance Web Portal can be found in the brochure for this plan.

This information provides you with a brief outline of the services available to you. These services are subject to the terms and conditions of the Policy under which you are insured. Travel assistance services are not available if your coverage under the Policy providing insurance benefits is not in effect.

Other Policies Features

Accidental Death and Dismemberment

$25,000 Maximum

Pre-certification

Not Required

Pre-certification

Excess

Benefit Period

36 Months

MeMD PROGRAM

The MeMD 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.

MeMD does not replace the primary care physician. MeMD does not guarantee that a prescription will be written. MeMD operates subject to state regulation and may not be available in certain states. MeMD 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.

EMERGENCY MEDICAL EVACUATION AND REPATRIATION OF REMAINS BENEFITS

Emergency Medical Evacuation Benefit- We will pay up to the maximum indicated above in the Schedule of Benefits for your medical evacuation if you: 1) suffer a Medical Emergency during the course of the Trip; 2) require Emergency Medical Evacuation; and 3) are traveling on a covered Trip.

Covered Expenses include;

1) Medical Transport: expenses for transportation under medical supervision to a different hospital, treatment facility or to your place of residence for Medically Necessary treatment in the event of your Medical Emergency and upon the request of the Doctor designated by Our assistance provider in consultation with the local attending Doctor.
2) Dispatch of a Doctor or Specialist: the Doctor’s or specialist’s travel expenses and the medical services provided on location, if, based on the information available, your condition cannot be adequately assessed to evaluate the need for transport or evacuation and a doctor or specialist is dispatched by Our service provider to your location to make the assessment.
3) Return of Dependent Child (ren):expenses to return each Dependent child who is under age 18 to his or her principal residence if a) you are age 18 or older; and b) you are the only person traveling with the minor Dependent child(ren); and c) you suffer a Medical Emergency and must be confined in a Hospital.
4) Escort Services: expenses for an Immediate Family Member or companion who is traveling with you to join you during your emergency medical evacuation to a different hospital, treatment facility or your place of residence.

Benefits for these Covered Expenses will not be payable unless: 1) the Doctor ordering the Emergency Medical Evacuation certifies the severity of your Medical Emergency requires an Emergency Medical Evacuation;

2) all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible; 3) the charges incurred are Medically Necessary and do not exceed the Usual and Customary Charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and 4) do not include charges that would not have been made if there were no insurance.

Benefits will not be payable unless We authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our assistance provider. In the event you refuse to be medically evacuated, we will not be liable for any medical expenses incurred after the date medical evacuation is recommended

Repatriation of Remains Benefit

We will pay up to the maximum indicated above in the Schedule of Benefits for the preparation and return of your body to your home if you die as a result of a Medical Emergency while traveling on a covered Trip.
Covered expenses include: 1) expenses for embalming or cremation;2) the least costly coffin or receptacle adequate for transporting the remains; 3) transporting the remains; and 4) Escort Services which include expenses for an Immediate Family Member or companion who is traveling with you to join your body during the repatriation to your place of residence.

All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the Usual and Customary Charges for similar transportation in the locality where the expense is incurred. Benefits will not be payable unless We authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our assistance provider.

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS of $25,000

Definition of Injury and Scope of Coverage – 24 Hour Coverage

Principal Sum for Covered Injury: $25,000

Accidental Death and Dismemberment Benefits - If your Injury results, within 365 days from 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. Principal Sum for you and your Dependents (if you have elected Dependent coverage and the required premium has been paid) is $25,000. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.

Schedule of Covered Losses

Covered Loss Benefit Amount

Life......................... 100% of the Principal Sum
Two or more Members....................... 100% of the Principal Sum
One Member...................... 50% of the Principal Sum

Member means Loss of Hand or Foot, and Loss of Sight. “Loss of Hand or Foot" means complete Severance through or above the wrist or ankle joint. “Loss of Sight” means the total, permanent Loss of Sight of one eye. “Severance” means the complete separation and dismemberment of the part from the body.

Aggregate Limit - We will not pay more than $125,000 for all losses. If, in the absence of this provision, We would pay more than this amount for all losses under the policy, then the benefits payable to each person with a valid claim will be reduced proportionately.