Safe Travels USA

Plan Detail

Plan Administrator: Trawick International | AM Best Rating: B++ | Underwriter: GBG Insurance Limited

Benefits


Benefits of Coverage

 Medical Maximum Choices per Policy Period:

$50,000, $100,000, $250,000, $500,000, $1,000,000

Deductible Choices per Policy Period:

In Network $0
Out of Network $0, $50, $100, $250, $500, $1,000, $2,500, $5,000

Urgent Care Co-Pay

$30
(If the $0 is chosen, there is no co-pay)

Co-insurance per Policy Period:

100% in Network, 80/20 - $5,000 out of Network

Well Doctor Visit:

Pays up to $75 - One Visit per person per policy period. The Well Doctor Visit must occur within the first 21 days from the effective date of coverage. To be eligible you must purchase at least 30 days of coverage initially.

Medical Expense Benefits (subject to Policy Maximum, Deductible and Co-Insurance)

Unexpected Recurrence of a Pre-Existing Condition:

This plan shall pay, up to $1,000 subject to the chosen Deductible and Coinsurance for Covered Expenses resulting from a sudden, unexpected recurrence of a Pre-Existing Condition while traveling outside the Covered Person’s Home Country. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage.

Hospital Room and Board

The average semi private room rate

ICU Room and Board Charges:

Three times the average semi private room rate

Outpatient Medical:

Usual customary charge to the selected Medical Maximum

Doctor Visits, X-rays, Prescriptions, Ambulance:

Usual customary charge to the selected Medical Maximum

Emergency Room Illness with no direct Hospital Admission

$200 additional deductible per visit - Only applies when receiving care in an emergency room for an Illness that does not result in a hospital admittance.

Emergency Room Injury/Accident or Illness with direct Hospital Admission

Usual customary charge to the selected Medical Maximum

Emergency Medical Treatment of Pregnancy:

$1,000 per Policy Period

Mental or Nervous Disorders:

$2,500 per Policy Period

Physiotherapy/Physical Medicine/Chiropractic:

$50 per visit per day; up to 10 visits per Policy Period

Dental Treatment:

$250 per Policy Period (Injury and emergency alleviation of pain)

Additional Benefits

Emergency Medical Evacuation:

100% up to $2,000,000*

Political/Natural Disaster Evacuation:

$25,000*

Repatriation of Remains:

100% up to $50,000*

Local Burial/Cremation

$5,000 Maximum Limit per person for preparation, local burial or cremation of the Insured Person’s mortal remains at the time of death. Must be approved in advance and coordinated by GBG Assist.

Emergency Reunion:

$15,000 *

Return of Minor Child(ren) or Travel Companion:

$5,000*

Trip Interruption:

$5,000 per Policy Period (does not cover lost trip cost)*

Basic Lost Baggage:

$1,000 per Policy Period*

Accidental Death & Dismemberment Principal Sum:

$ 25,000*

Coma Benefit:

$10,000*

Felonious Assault and Violent Crime:

100% up to $50,000*

Adaptive Home and Vehicle:

$5,000*

Seatbelt Benefit:

10% up to $50,000*

Airbag Benefit:

10% up to $50,000*

Hijacking and Air or Water Piracy:

Covered*

Benefit Period:

90 days from the date of the Covered Accident or Sickness

PRIMARY INSURANCE

We will pay Covered Accident and Sickness Medical Expenses up to the Maximum Benefit as outlined in the Schedule of Benefits and after each Insured satisfies any Deductible, without regard to any other Health Care Plan benefits payable for the Insured. We will pay these benefits without regard to any Coordination of Benefits provision in any other Health Care Plan.

PRE-EXISTING CONDITION DEFINITION

"Pre-Existing Condition" means any injury, illness, sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the 36 months prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom. This specifically includes but is not limited to any medical condition, Sickness, Injury , Illness, disease, Mental Illness or Mental Nervous Disorder, for which medical advice, diagnosis, care or Treatment was recommended or received or for which a reasonably prudent person would have sought Treatment during the 36 month period immediately preceding the Effective Date of Coverage under this Certificate. A Pre-Existing Condition which is a chronic or congenital condition or that gradually becomes worse over time and/or known, scheduled, required, or expected medical care, drugs or Treatments existing or necessary prior to the Effective Date are not considered to be an Acute Onset.

DESCRIPTION OF BENEFITS

Covered Medical Expenses Benefit - If a covered Injury or Illness occurs during the Policy Period and you require medical or surgical treatment; this plan will pay, subject to the selected deductible, applicable co-insurance and benefit maximums, the following Covered Expenses, up to the selected policy maximum. The first charges must be incurred within 90 days after the date of the Covered Accident or Sickness. No benefits will be paid for any expenses incurred which are in excess of Usual and Customary Charges.

1. Hospital Room and Board Expenses: the average daily rate for a semi private room when a Covered Person is Hospital Confined and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge.

2. Ancillary Hospital Expenses: services and supplies including operating room, laboratory tests, anesthesia and medicines when Hospital Confined. This does not include personal services of a non-medical nature.

3. Daily Intensive Care Unit Expenses: three times the average semi private room rate when a Covered Person is Hospital Confined in a bed in the Intensive Care Unit and nursing services other than private duty nursing services.

4. Medical Emergency Care (room and supplies) Expenses: incurred within 72 hours of an Accident or Sickness and including the attending Doctor’s charges, X-rays, laboratory procedures, use of the emergency room and supplies.

5. Doctor Non-Surgical Treatment and Examination Expenses including the Doctor’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Doctor.

6. Doctor’s Surgical Expenses.

7. Assistant Surgeon Expenses when Medically Necessary.

8. Anesthesiologist Expenses for pre-operative screening and administration of anesthesia during a surgical procedure whether on an inpatient or outpatient basis.

9. Physiotherapy Physical Medicine/Chiropractic Expenses on an inpatient or outpatient basis including treatment and office visits connected with such treatment when prescribed by a Doctor, including diathermy, ultrasonic, whirlpool, heat treatments, adjustments, manipulation, or any form of physical therapy and limited to $50 per visit, one visit per day and 10 visits per Policy Period.

10. X-ray Expenses (including reading charges).

11. Dental Expenses up to $250 due to Accidents or emergency alleviation of pain including dental x-rays for the repair or treatment of each tooth that is whole, sound and a natural tooth at the time of the Accident or emergency alleviation of dental pain.

12. Ambulance Expenses for transportation from the emergency site to the Hospital.

13. Prescription Drug Expenses including dressings, drugs and medicines prescribed by a Doctor.

14. Medical Services and Supplies: expenses for blood and blood transfusions; oxygen and its administration.

15. Emergency medical treatment of pregnancy up to $1,000 per Policy Period.

16. Mental or nervous disorders or rest cures up to $2,500 per Policy Period.

17. Emergency Room Illness with no direct Hospital Admission - $200 additional deductible per visit. Only applies when receiving care in an emergency room for an Illness that does not result in a hospital admittance.

18. Emergency Room Injury/Accident or Illness with direct Hospital Admission - Usual customary charge to the selected Medical Maximum

Unexpected Recurrence of a Pre-Existing Condition Benefit

This plan shall pay, up to $1,000 subject to the chosen Deductible and Coinsurance for Covered Expenses resulting from a sudden, unexpected recurrence of a Pre-Existing Condition while traveling outside the Covered Person’s Home Country. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage.

Emergency Medical Evacuation Benefit

We will pay 100% up to $2,000,000 if you are traveling outside of your Home Country and suffer an Injury or Sickness during the course of the Trip which requires Emergency Medical Evacuation from the place where you suffer an Injury or Sickness to the nearest Hospital or other medical facility where appropriate medical treatment can be obtained; or transportation to your Home Country to obtain further medical treatment in a Hospital or other medical facility or to recover after suffering an Injury or Sickness. An Emergency Medical Evacuation includes Medically Necessary medical treatment, medical services and medical supplies necessarily received in connection with such transportation. If after hospitalization or treatment for a covered Injury or Sickness, you are unable to continue your journey, Our designated assistance provider, in conjunction with the local attending Doctor and/or your habitual Doctor, will organize your return to your Home Country. If the gravity of the situation so dictates, Our designated assistance provider will ensure that appropriate medical care is provided to you during the return journey. If Our designated assistance provider and the local attending medical practitioner consider you stable enough to be medically repatriated, without endangering your health, and you refuse repatriation, We will continue to pay medical expense benefits incurred after the date repatriation was recommended only up to the amount that would have been payable for the medical repatriation, subject to policy maximums and limitations. Benefits will not be payable unless We authorize in writing or by an authorized electronic or telephonic means all expenses in advance. Benefits will not be payable unless: 1. the Doctor ordering the Emergency Medical Evacuation certifies the severity of your Injury or Sickness requires an Emergency Medical Evacuation; 2. all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible; 3. the charges incurred are Medically Necessary and do not exceed the usual level of charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and4. do not include charges that would not have been made if there were no insurance.

Political/Natural Disaster Evacuation Benefit

Up to $25,000 maximum for extrication from the Host Country due to an Occurrence which could result in grave physical harm or death. You are covered if an Occurrence takes place while coverage is in effect; and while you are traveling outside of your Home Country or country of residence. Benefits will be paid for: 1. your Transportation and Related Costs to the Nearest Place of Safety, necessary to ensure your safety and well-being as determined by the Designated Security Consultant. 2. your Transportation and Related Costs within 14 days of the Political Evacuation to either to the country in which you are traveling while covered by the Policy; or your Home Country; or 3. consulting services by a Designated Security Consultant for seeking information on a Missing Person or kidnapping cases, if you are kidnapped or are reported as a Missing Person to local or international authorities. Benefits will not be payable unless We (or Our authorized assistance provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our assistance provider. Our assistance provider is not responsible for the availability of Transport services. Where a Political Evacuation becomes impractical due to hostile or dangerous conditions, a Designated Security Consultant will endeavor to maintain contact with you until a Political Evacuation occurs. Political Evacuation Benefits are payable only once for any one Occurrence. If, after a Political Evacuation is completed, it becomes evident that you were an active participant in the events that led to the Occurrence, We have the right to recover all Transportation and Related costs from you.

Repatriation of Remains Benefit

We will pay 100% up to $50,000 for preparation and return of your body to your Home Country if you die due to an Injury or Sickness. Benefits will not be payable unless We authorize in writing or by an authorized electronic or telephonic means all expenses in advance. Covered expenses include: 1. expenses for embalming or cremation; 2. the least costly coffin or receptacle adequate for transporting the remains; 3. transporting the remains by the most direct and least costly conveyance and route possible.

Local Burial Benefit

We will pay up to $5,000 Maximum Limit per person for preparation, local burial or cremation of the Insured Person’s mortal remains at the time of death. Must be approved in advance and coordinated by GBG Assist. Includes death due to a Pre-existing Condition. The Company will pay the reasonable Covered Expenses incurred up to the maximum states in the Schedule of Benefits for preparation, local burial or cremation of your mortal remains at the country of death in accordance with the commonly accepted cultural and religious belief’s practiced by You. Coverage is not provided for burial and cremation costs incurred for religious practitioner, flowers, music, food or beverages. If the Local Cremation or Burial is chosen, the Return of Mortal Remains benefit will not apply. Failure to utilize GBG Assist to arrange for these services will result in the denial of benefits. Restrictions: Must use Assistance Provider to arrange for the services. Cannot use with the Repatriation of Remains Benefit. Exclusions: Coverage is not provided for burial and cremation costs incurred for religious practitioner, flowers, music, food or beverages.

Emergency Reunion Benefit

Up to $15,000 maximum. Covers the cost of a one economy airfare ticket and other local travel related expenses; or the reasonable expenses incurred for lodging and meals of your Immediate Family Member for a period of up to 10 days to accompany you to your Home Country or Hospital where you are confined if: 1. the Emergency Medical Evacuation Benefit is payable under the Policy; and 2. you are alone outside of your Home Country; and 3. the place of confinement is more than 100 miles from your Home Country; and 4. expenses were authorized in advance by the Company.

Basic Lost Baggage Benefit

Up to $1,000 maximum for the replacement costs of Necessities, up to $75 per article, if your luggage is checked onto a Common Carrier, and is then lost, stolen or damaged beyond use. Replacement costs are calculated on the basis of the depreciated standard and its average usable period. You must file a formal claim with the transportation provider and provide Us with copies of all claim forms and proof that the transportation provider has paid you its normal reimbursement for the lost, stolen or damaged luggage.

Trip Interruption Benefit

Up to $5,000 maximum for reimbursement of the cost of one-way economy air and/or ground transportation ticket if your Trip is interrupted as the result of: 1. the death of an Immediate Family Member; or 2. your unforeseen Injury or Sickness or, the Injury or Sickness of a Traveling Companion or Immediate Family Member. The Injury or Sickness must be so disabling as to reasonably cause a Trip to be interrupted; or 3. substantial destruction of your principal residence by fire or weather related activity; or 4. a Medically Necessary, covered Emergency Medical Evacuation to return you to your Home Country or to the area from which you were initially evacuated for continued treatment, recuperation and recovery.

Hospital Confinement Benefit

$50 per day per Policy Period, payable to you, when you are Hospital Confined, and all of the following conditions are met: 1. The Hospital stay is the direct result, from no other causes, of Injuries sustained in a Covered Accident, or Sickness that occurs while the Policy is in effect. 2. The Hospital stay begins within 3 days of a Covered Accident or Sickness and lasts for at least 3 days. We will pay this benefit retroactive to the first day of the Hospital stay. Benefit payments will end on the first of the following: 1. the date the Hospital stay ends; 2. the date you die; 3. 10th day of hospitalization; or 4. the date the coverage terminates.

Return of Minor Child(ren) or Travel Companion Benefit

If you are the only person traveling with minor Dependent children who are under the age of 21 or a Travel Companion, and you suffer an Injury or Sickness and must be confined in a Hospital for at least 48 consecutive hours or are medically evacuated to another location, We will reimburse the cost of the Dependent or Travel Companion’s one way economy airfare ticket and/ or ground transportation ticket to their Home Country, not to exceed $5,000. All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the usual level of charges for similar transportation in the locality where the expense is incurred. Benefits will not be paid unless all expenses are approved in advance by Us, and services are rendered by the Company’s assistance provider.

Accidental Death & Dismemberment Benefit

Insured Principal Sum $25,000 Spouse/Domestic Partner/Traveling Companion Principal Sum $25,000 Dependent Child Principal Sum $10,000

If Injury to the Covered Person results in any one of the losses shown below within 365 days from date of Accident, We will pay the Benefit Amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Accident.

Covered Loss Benefit Amount

Life, Quadriplegia or Two or more Members 100% of the Principal Sum
Hemiplegia or Paraplegia 75% of the Principal Sum
One Member 50% of the Principal Sum
Uniplegia or Thumb and Index Finger of the Same Hand 25% of the Principal Sum

Exposure and Disappearance Benefit - 100% of the Principal Sum if you are exposed to the elements after the forced landing, stranding, sinking, or wrecking of a vehicle in which you were traveling. You are presumed dead if you are in a vehicle that disappears, sinks or is stranded or wrecked and your body is not found within six months of the Covered Accident.

Hijacking and Air or Water Piracy Benefit - Covers Injury during the: 1. hijacking of an Aircraft; 2. air or water piracy; or 3. unlawful seizure or attempted seizure of an aircraft or watercraft.

Coma Benefit - We will pay this benefit in a lump sum of $10,000 if you become Comatose within 31 days of a Covered Accident or Sickness and remain in a Coma for at least 31 days.

Seatbelt and Airbag Benefit - 10% of the Principal Sum up to a maximum benefit of $50,000 if you die or are dismembered directly and independently from Injuries sustained while wearing a seatbelt and operating or riding as a passenger in an Automobile.

Felonious Assault and Violent Crime Benefit - 100% of the Principal Sum applicable to the Covered Loss to a maximum of $50,000 and subject to the following conditions, when you suffer a Covered Loss resulting directly and independently of all other causes from a Covered Accident that occurs during a violent crime or felonious assault.

Adaptive Home and Vehicle Benefit - Up to a $5,000 maximum If you have an Injury which results in a Loss payable under the Accidental Death and Dismemberment Benefit, We will pay an additional benefit equal to the least of the actual cost of the alterations or $5,000 for the one-time cost of alterations to your principal residence; and/or private Automobile to make the residence accessible and/or the private Automobile drivable or rideable.

Benefit Period

While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate, in accordance with this provision, we will pay eligible medical expenses for up to 90 days beginning on the first day of diagnosis or treatment of a covered injury or illness while you are outside your home country. The benefit period applies only to eligible medical expenses related to the eligible injury or illness that began while the certificate was in effect. In the event you begin a benefit period while the certificate is in effect, and the certificate terminates because you return to your home country, we will continue to pay eligible medical expenses which are incurred in your home country during the benefit period until the exhaustion of the Benefit period or the Policy Medical Maximum, whichever comes first.