Plan Administrator: USI Affinity Travel Insurance Services | AM Best Rating: A+ "Superior" | Underwriter: Lloyd's of London
All benefits, except Emergency Medical Evacuation, Repatriation of Remains, Local Burial or Cremation, and Emergency Reunion, are subject to deductible and are per injury or illness, up to the overall policy maximum, unless stated otherwise.
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Plan A | Plan B | |
Ages 14 days - 69 years | $0, $50, $100, or $250 | |
Age 70 and above | $100 or $250 | |
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Plan A | Plan B | |
Ages 14 days - 64 years | $50,000 | $150,000 |
Ages 65 - 69 years | $50,000 | $100,000 |
Ages 70-79 | $50,000 | |
Ages 80 and above | $20,000 | |
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Plan A | Plan B | |
Hospital Room &Board, including miscellaneous unless specified | $1,500 per day, 30 days max | $2,750 per day, 30 days max |
Intensive Care Unit, including miscellaneous unless specified | $2,500 per day, 8 days max | $4,000 per day, 8 days max |
Surgery | $4,000 per session | $8,000 per session |
Consultant physician | $450 | $650 |
Private duty nurse | $550 | $700 |
Physician visits | $75 per visit, 30 visits max | $125 per visit, 30 visits max |
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Plan A | Plan B | |
Surgery | $3,300 per session | $7,150 per session |
Outpatient Surgical Facility | $1,100 | $1,500 |
Pre-admission Testing | $1,100 | $1,450 |
Diagnostic X-ray and Labs | $500, plus $400 for one CAT Scan, MRI or PET | $750, plus $650 for one CAT Scan, MRI or PET |
Emergency Room (all expenses incurred therein) | $375 | $785 |
Observation Room Services (all expenses incurred therein) | $355 | $750 |
Outpatient Prescription Drugs | $150 | $300 |
Office Visits, including Urgent Care | $75 per visit, 10 visits max | $150 per visit, 10 visits max |
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Plan A | Plan B | |
Anesthesiologist | $825 | $1,775 |
Assistant Surgeon | $825 | $1,775 |
Local Ambulance | $500 | $500 |
Physical Therapy | $50 per visit, 1 visit per day, maximum 12 visits | |
Durable Medical Equipment | $1,100 | $1,700 |
Acute Onset of Pre-existing Conditions |
Ages 65 and above: $2,500 All others: $20,000 |
Ages 65 and above: $2,500 All others: $20,000 |
$25,000 Lifetime Maximum for Emergency Medical Evacuation | ||
Terrorism | Up to $25,000, eligible medical expenses only | |
Not subject to deductible or overall policy maximum |
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Plan A | Plan B | |
Emergency Medical Evacuation | $100,000 Lifetime Maximum, except as provided under Acute Onset of Pre-existing Condition. | |
Repatriation of Remains | $25,000 | |
Local Burial & Cremation | $5,000 | |
Emergency Reunion | $15,000, subject to a maximum of 15 days - not subject to deductible or coinsurance | |