Liaison Travel Elite - Including 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 UNITED STATES Dollar amounts. All Medical and Dental 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

Elite

COVERAGE LENGTH

5 days to 1,092 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+: $20,000
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+: $20,000

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: 100% Coinsurance Out of PPO Network: 90% 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:

Medical Maximum

Hospital Indemnity (outside the United State & Canada)

$250 per day to a maximum of 30 days

Coma Benefit

$50,000 (In addition to Medical Maximum)

Precertification – 25% penalty

Required inside the United States
Penalty does not apply to an emergency

Extension of Benefits to Home Country

$20,000

Incidental Trips to Home Country

$50,000

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

With a Primary Health Plan: Age 0-64 Up to the Medical Maximum Without a Primary Health Plan: Age 0-64 Up to $50,000 Ages 65+ $2,500
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: $50,000 Age 70 & over: $10,000 Emergency Services & Assistance Limited to $25,000

Dental - Sudden Relief of Pain:

$250

Dental - Accident:

Medical Maximum

Emergency Medical Evacuation & Repatriation:

$1,000,000 (In addition to the Medical Maximum)

Emergency Medical Reunion:

Up to $200 per day $100,000 maximum limit

Return of Child(ren):

$100,000

Return of Mortal Remains

$100,000

Local Burial or Cremation

$5,000

Natural Disaster Evacuation

$100,000

Natural Disaster Daily Benefit

$250 per day, 10-day limit

Political Evacuation & Repatriation

$100,000

Felonious Assault

$20,000

Terrorism

Up to Med Max

24/7 TRAVEL ASSISTANCE SERVICES

Included

Accidental Death and Dismemberment (AD&D)

$50,000 Primary Insured or Travel Companion $10,000 Child Aggregate Limit of $250,000 for Total Number of Insureds on Plan

Common Carrier Accidental Death and Dismemberment

$100,000 Primary Insured or Travel Companion $20,000 Child Aggregate Limit of $250,000 for Total Number of Insureds on Plan

Loss of Checked Luggage

Up to $50 per article $1,000 per occurrence maximum

Trip Interruption

$10,000

Personal liability

$100,000

Hazardous Activities (Optional)

Up to Plan Maximum

Benefit Period

180 Days

 

 

Patient Protection and Affordable Care Act (“PPACA”). THE INSURANCE PROVIDED HEREUNDER IS NOT SUBJECT TO, IS NOT INTENDED TO COMPLY WITH, AND DOES NOT PROVIDE ALL BENEFITS REQUIRED BY PPACA. THIS INSURANCE IS NOT QUALIFYING HEALTH COVERAGE (“MINIMUM ESSENTIAL COVERAGE”) THAT SATISFIES THE HEALTH CARE COVERAGE REQUIREMENT OF PPACA. IF AN INSURED PERSON DOE NOT HAVE MINIMUM ESSENTIAL COVERAGE, HE OR SHE MAY OWE AN ADDITIONAL PAYMENT WITH HIS OR HER TAXES. INSURED PERSONS ARE RESPONSIBLE FOR DETERMINING IF AND HOW PPACA IS APPLICABLE TO HIM OR HER AND SHOULD CONSULT HIS OR HER OWN TAX ADVISORS. NEITHER THE COMPANY NOR THE ADMINISTRATOR SHALL HAVE LIABILITY WHATSOVER FOR AN INSURED PERSON’S FAILURE TO OBTAIN PPACA-COMPLIANCE COVERAGE.

THIS INSURANCE IS ISSUED PURSUANT TO APPLICABLE SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF STATE INSURANCE GUARANTY LAWS TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER.