Liaison Travel Economy - Including USA

Plan Detail

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

Eligibility: Non US citizen age 0-99 traveling to USA and traveling outside their home country.
Coverage Length: Min 5 days up to max 365 days.
Renew Online: Policy can be renewed up to maximum of 365 days, also Renewal fees of $5 applies.
Acute Onset of Pre-existing Condition: Under age 70: Up to Maximum $15,000; Age 70-99:Up to Maximum $2,500.
Co-Insurance:
- In Network: Plan pays 80% of first $5,000 and then 100% up to policy max.
- Out-of-Network: Outside of PPO network, plan pays 70% of first $5,000 and then 100% up to policy max.
PPO Network :Provides United Health Care PPO Network.
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Benefits Acute Pre-Ex Coverage Description Exclusions Renew Cancel Claims Provider Network

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