Liaison Travel Economy - Excluding USA

Plan Detail

Plan Administrator: Seven Corners | AM Best Rating: A "Excellent" | Underwriter: Lloyd's

Benefits


SECTION 2. SCHEDULE OF BENEFITS

All benefits listed in this Schedule of Benefits are in U.S. Dollar amounts. All Medical and Denatl benefits are subject to Deductible and Coinsurance. Also, all benefits except Loss of Checked Baggage are per Per Person per Period of Coverage.

Benefit or Service

Economy

COVERAGE LENGTH

5 days to 364 days

Coverage Area

Worldwide "Excluding" the United States Worldwide "Including" the United States

Medical Maximum Options

Worldwide “Including” the United States as indicated on the attached rate sheets:
Ages Available Benefit Maximums
14 days to 69: $50,000; $100,000; $500,000; $1,000,000; $2,000,000; $5,000,000
70-79: $50,000
Ages 80+: $15,000
Worldwide “Excluding” the United States as indicated on the attached rate sheets:
Ages Available Benefit Maximums
14 days to 69: $50,000; $100,000; $500,000; $1,000,000; $2,000,000; $5,000,000
70-79: $50,000 or $100,000
Ages 80+: $15,000

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: 80% of the first $5,000, then 100% up to the Medical Maximum Out of PPO Network: 70% 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:

$5,000

Hospital Indemnity (outside the United States & Canada)

$100 per day to a maximum of 30 days

Coma Benefit

$10,000 (In addition to Medical Maximum)

Precertification – 25% penalty

Required inside the United States penalty does not apply to emergency

Extension of Benefits to Home Country

$5,000

Incidental Trips to Home Country

$5,000

Waiver of Pre-existing Condition: U.S. Residents outside of the United States

Age 0-69: $25,000 Age 70 & over: $5,000 Emergency Services & Assistance Limited to $25,000

Acute Onset of a Pre-existing Condition: Non-U.S. Residents traveling to the United States

Age 0-69: $15,000 Age 70 & over: $2,500 Emergency Services & Assistance Limited to $25,000

Dental - Sudden Relief of Pain:

$100

Dental - Accident:

$500

Emergency Medical Evacuation & Repatriation:

$250,000 (In addition to the Medical Maximum)

Emergency Medical Reunion:

Up to $200 per day / $25,000 maximum limit

Return of Child(ren):

$25,000

Return of Mortal Remains

$25,000

Local Burial or Cremation

$5,000

Natural Disaster Evacuation

$25,000

Natural Disaster Daily Benefit

$50 per day, 5-day limit

Political Evacuation & Repatriation

$25,000

Felonious Assault

$5,000 (In addition to Medical Maximum)

Terrorism

$25,000

24/7 TRAVEL ASSISTANCE SERVICES

Included

Accidental Death and Dismemberment (AD&D)

$10,000 Primary Insured or Travel Companion $2,500 Child
Aggregate Limit of $250,000 for Total Number of Insureds on Plan

Common Carrier Accidental Death and Dismemberment

$20,000 Primary Insured or Travel Companion $5,000 Child
Aggregate Limit of $250,000 for Total Number of Insureds on Plan

Loss of Checked Luggage

Up to $50 per article $250 per occurrence maximum

Trip Interruption

$2,500

Personal liability

$25,000

Hazardous Activities (Optional)

Up to Plan Maximum

Benefit Period

180 Days