Liaison Travel Elite - Including USA

Plan Detail

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

Eligibility: 14 days to 80+ years old traveling to USA and other countries.
Coverage length: Minimum 5 days to maximum 12 months.
Provider Network: Direct Billing through First Health Network
Acute Pre Existing Condition: Age 0-69: $50,000,Age 70 & over: $10,000
Renew Online: Renewable up to 3 years
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Benefits Pre-existing Coverage Description Exclusions Renew Cancel Claims Provider Network

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.