Liaison Travel Elite - 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 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

Elite

COVERAGE LENGTH

5 days to 1,092 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+: $20,000 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: 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 $10,0000 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

$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 Sports (Optional)

Up to Plan Maximum

Benefit Period

180 Days