Plan Administrator: Seven Corners | AM Best Rating: A "Excellent" | Underwriter: Lloyd's
All benefits listed in this Schedule of Benefits are in UNITED STATES Dollar amounts. Except as specifically indicated otherwise, all benefits are subject to Deductible and Coinsurance. Also, all benefits except Loss of Checked Baggage are per Person per Period of Coverage.
| Benefit or Service |
Choice |
|
COVERAGE LENGTH |
5 days to 364 days |
|
Coverage Area |
Worldwide "Excluding" the United States Worldwide "Including" the United States |
|
Medical Maximum Options |
$50,000; $100,000; $500,000; $1,000,000; $2,000,000; $5,000,000 Ages 80+: $15,000 Max |
|
Deductible Options (You Pay) |
$0; $100; $250; $500; $1,000; $2,500, $5,000 |
|
Coinsurance Options (The plan pays) |
Outside the United States: 100% |
|
Inside the United States In PPO Network: 90% of the first $5,000, then 100% up to the Medical Maximum Out of PPO Network: 80% of the first $5,000, then 100% to the Medical Maximum |
|
|
Hospital Room & Board |
URC Up to Plan Maximum |
|
Inpatient Hospital Services |
URC Up to Plan Maximum |
|
Outpatient Hospital / Clinical Services |
URC Up to Plan Maximum |
|
Emergency Room Services |
URC Up to Plan Maximum |
|
Doctor's Office Visits |
URC Up to Plan Maximum |
|
Prescription Drugs |
URC Up to Plan Maximum |
|
Home Healthcare |
$2,500 |
|
Local Ambulance Benefit: |
$10,000 |
|
Hospital Indemnity (Outside the United States & Canada) |
$150 per day to a maximum of 30 days |
|
Coma Benefit |
$25,000 (in addition to Medical Maximum) |
|
Precertification – 25% penalty |
Required in the United States |
|
Extension of Benefits to Home Country |
$10,000 |
|
Incidental Trips to Home Country |
$10,000 |
|
Waiver of Pre-existing Condition: United States Residents outside of the United States |
Age 0-69: $50,000 Age 70 & over: $10,000 Emergency Services & Assistance Limited to $25,000 |
|
Acute Onset of a Pre-existing Condition: Non-United States Residents traveling to the United States |
Age 0-69: $30,000 Age 70 & over: $5,000 Emergency Services & Assistance Limited to $25,000 |
|
Dental - Sudden Relief of Pain: |
$200 |
|
Dental - Accident: |
$5,000 |
|
Emergency Medical Evacuation & Repatriation: |
$500,000 (In addition to the Medical Maximum) |
|
Emergency Medical Reunion: |
Up to $200 per day / $50,000 maximum limit |
|
Return of Child(ren): |
$50,000 |
|
Return of Mortal Remains |
$50,000 |
|
Local Burial or Cremation |
$5,000 |
|
Natural Disaster Evacuation |
$50,000 |
|
Natural Disaster Daily Benefit |
$100 per day, 5-day limit |
|
Political Evacuation & Repatriation |
$50,000 |
|
Felonious Assault |
$10,000 |
|
Terrorism |
$50,000 |
|
24/7 TRAVEL ASSISTANCE SERVICES |
Included |
|
Accidental Death and Dismemberment (AD&D) |
$25,000 Primary Insured or Travel Companion $5,000 Child Aggregate limit of $250,000 for Total Number of Insureds on Plan |
|
Common Carrier Accidental Death |
$50,000 Primary Insured or Travel Companion $10,000 Child Aggregate limit of $250,000 for Total Number of Insureds on Plan |
|
Loss of Checked Luggage |
Up to $50 per article / $500 per occurrence maximum |
|
Trip Interruption |
$5,000 |
|
Personal liability |
$50,000 |
|
Hazardous Sports (Optional) |
Up to Plan Maximum |
|
Benefit Period |
180 Days |