INF SelectCare

Plan Detail

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

Benefits


SCHEDULE OF BENEFIT

INF SELECTCARE Inpatient Services

Covered Medical Services

$25,000 Policy Maximum Coverage Deductible $100 (0-69

$50,000 Policy Maximum Coverage Deductible $100 (0-69)

$75,000 Policy Maximum Coverage Deductible $100 (0-69

$100,000 Policy Maximum Coverage Deductible $100 (0-69)

Hospital Room and Board

Usual & Customary Charges up to $900 per day, to a maximum of 30 days

Usual & Customary Charges up to $1,300 per day, to a maximum of 30 days

Usual & Customary Charges up to $1,525 per day, to a maximum of 30 days

Usual & Customary Charges up to $1,750 per day, to a maximum of 30 day

Hospital Intensive Care Unit Room and Board

Usual & Customary Charges up to an additional $400 per day to a maximum of 8 days

Usual & Customary Charges up to an additional $525 per day to a maximum of 8 days

Usual & Customary Charges up to an additional $625 per day to a maximum of 8 days

Usual & Customary Charges up to an additional $750 per day to a maximum of 8 day

Surgeon Services

Usual & Customary Charges up to $2,000 max

Usual & Customary Charges up to $3,000 max

Usual & Customary Charges up to $4,000 max

Usual & Customary Charges up to $5,000 max

Anesthetics

Usual & Customary Charges up to $500 max

Usual & Customary Charges up to $750 max

Usual & Customary Charges up to $1,000 max

Usual & Customary Charges up to $1,250 max

Assistant Surgeon

Usual & Customary Charges up to $500 max

Usual & Customary Charges up to $750 max

Usual & Customary Charges up to $1,000 max

Usual & Customary Charges up to $1,250 max

Physician Non-Surgical Treatment/Examination Visits

Usual & Customary Charges up to $40 max per visit, 1 visit per day, 30 visits max

Usual & Customary Charges up to $60 max per visit, 1 visit per day, 30 visits ma

Usual & Customary Charges up to $80 max per visit, 1 visit per day, 30 visits max

Usual & Customary Charges up to $100 max per visit, 1 visit per day, 30 visits max

Consultant visits, when requested by a Physician

Usual & Customary Charges up to $375 max

Usual & Customary Charges up to $400 max

Usual & Customary Charges up to $425 max

Usual & Customary Charges up to $450 max

Pre-admission Tests, when requested by Physician

Usual & Customary Charges up to $950 max; test must occur within 14 days prior to Hospital admission

Usual & Customary Charges up to $1,000 max; test must occur within 14 days prior to Hospital admission

Usual & Customary Charges up to $1,050 max; test must occur within 14 days prior to Hospital admission

Usual & Customary Charges up to $1,100 max; test must occur within 14 days prior to Hospital admission

INF SELECT CARE Outpatient Services

Covered Medical Services

$25,000 Policy Maximum Coverage Deductible $100 (0-69

$50,000 Policy Maximum Coverage Deductible $100 (0-69)

$75,000 Policy Maximum Coverage Deductible $100 (0-69)

$100,000 Policy Maximum Coverage Deductible $100 (0-69)

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

Usual

Usual & Customary Charges up to $950 max

Usual & Customary Charges up to $1,000 max

Usual & Customary Charges up to $1,050 max

Usual & Customary Charges up to $1,100 max

Surgeon Services

Usual & Customary Charges up to $2,000 max

Usual & Customary Charges up to $3,000 max

Usual & Customary Charges up to $4,000 max

Usual & Customary Charges up to $5,000 max

Anesthetics

Usual & Customary Charges up to $500 max

Usual & Customary Charges up to $750 max

Usual & Customary Charges up to $1,000 max

Usual & Customary Charges up to $1,000 max

Assistant Surgeon

Usual & Customary Charges up to $500 max

Usual & Customary Charges up to $750 max

Usual & Customary Charges up to $1,000 max

Usual & Customary Charges up to $1,250 max

Physician Non-Surgical Treatment/Exam Visits

Usual & Customary Charges up to $50 max per visit, 1 visit per day, 10 visits max

Usual & Customary Charges up to $60 max per visit, 1 visit per day, 10 visits max

Usual & Customary Charges up to $80 max per visit, 1 visit per day, 10 visits max

Usual & Customary Charges up to $100 max per visit, 1 visit per day, 10 visits max

Diagnostic X-Rays and Laboratory Procedures

Usual & Customary Charges up to $275 max

Usual & Customary Charges up to $400 max

Usual & Customary Charges up to $525 max

Usual & Customary Charges up to $650 max

CAT Scan, PET Scan or MRI

Usual & Customary Charges up to an additional $275 of the Diagnostic X-Ray and Lab

Usual & Customary Charges up to an additional $400 of the Diagnostic X-Ray and Lab

Usual & Customary Charges up to an additional $525 of the Diagnostic X-Ray and Lab

Usual & Customary Charges up to an additional $650 of the Diagnostic X-Ray and Lab

Hospital Emergency Room

Usual & Customary Charges up to $275 ma

Usual & Customary Charges up to $350 max

Usual & Customary Charges up to $425 max

Usual & Customary Charges up to $500 max

Prescription Drugs

Usual & Customary Charges up to $75 max

Usual & Customary Charges up to $100 max

Usual & Customary Charges up to $125 max

Usual & Customary Charges up to $150 max

INF SELECT CARE Other Benefits

Covered Medical Services

$25,000 Policy Maximum Coverage Deductible $100 (0-69)

$50,000 Policy Maximum Coverage Deductible $100 (0-69)

$75,000 Policy Maximum Coverage Deductible $100 (0-69)

$100,000 Policy Maximum Coverage Deductible $100 (0-69)

Ambulance Services

Usual & Customary Charges up to $375 max

Usual & Customary Charges up to $400 max

Usual & Customary Charges up to $425 max

Usual & Customary Charges up to $450 max

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

Usual & Customary Charges up to $425 max

Usual & Customary Charges up to $450 max

Usual & Customary Charges up to $475 max

Usual & Customary Charges up to $500 max

Physical and Occupational Therapy

Usual & Customary Charges up to $30 per visit, 1 visit per day, 12 visits max

Usual & Customary Charges up to $35 per visit, 1 visit per day, 12 visits max

Usual & Customary Charges up to $40 per visit, 1 visit per day, 12 visits max

Usual & Customary Charges up to $45 per visit, 1 visit per day, 12 visits max

Private Duty Nursing

Usual & Customary Charges up to $350 max

Usual & Customary Charges up to $400 max

Usual & Customary Charges up to $450 ma

Usual & Customary Charges up to $500 max

Emergency Medical Evacuation

Usual & Customary Charges up to $10,000 max

Usual & Customary Charges up to $10,000 max

Usual & Customary Charges up to $10,000 max

Usual & Customary Charges up to $10,000 max

Repatriation of Remains

Usual & Customary Charges up to $10,000 max

Usual & Customary Charges up to $10,000 max

Usual & Customary Charges up to $10,000 max

Usual & Customary Charges up to $10,000 max

Accidental Death and Dismemberment

$25,000 Aggregate Sum

$25,000 Aggregate Sum

$25,000 Aggregate Sum

$25,000 Aggregate Sum

Pre-existing Conditions

No Benefits

No Benefits

No Benefits

No Benefits

Pre -Existing Condition means an illness, disease, injury or other condition of the Insured Person that in the 90 day period 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. Pre-existing Conditions are excluded from coverage under this plan.

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 $100 per person for each Covered Injury and each Sickness as shown in the table below.

Policy Maximum

New Sickness Deductible

$25,000 (Age 0-69)

$100

$50,000 (Age 0-69)

$100

$75,000 (Age 0-69)

$100

$100,000 (Age 0-69)

$100

PRE-EXISTING CONDITIONS COVERAGE

This plan does not cover pre-existing conditions.

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.

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.

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

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@europassistanceusa.com

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@europassistanceusa.com

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 Principal Sum is $25,000 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 Principal Sum

Loss of Two or More Hands or Feet

100% of the Principal Sum

Loss of Sight of Both Eyes

100% of the Principal Sum

Loss of One Hand and Foot

100% of the Principal Sum

Loss of One Hand or Foot and Sight in One Eye

100% of the Principal Sum

Loss of One Hand or Foot

50% of the Principal Sum

Loss of Sight in One Eye

50% of the Principal Sum

Exposure and Disappearance

Included