Visitors Care

Plan Detail

Plan Administrator:  International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International

Benefits Acute Pre-Ex Coverage Description Exclusions Renew Cancel Claims Provider Network

Benefits

  PLAN A PLAN B PLAN C
Maximum Coverage Limit Age 15 days to 79 years: US$25,000 per Period of Coverage, and for the life of the plan
Age 80+ years: US$10,000 per Period of Coverage, and for the life of the plan		 Age 15 days to 79 years: US$50,000 per Period of Coverage, and for the life of the plan Age 15 days to 79 years: US$100,000 per Period of Insurance, and for the life of the plan
Deductible All Deductibles are per Period of Coverage and are shown on the Declaration All Deductibles are per Period of Coverage and are shown on the Declaration All Deductibles are per Period of Coverage and are shown on the Declaration
Inpatient Treatment:
Hospital Room & Board including miscellaneous Up to $825 per day, limited to 30 days per Period of Coverage Up to $1400 per day, limited to 30 days per Period of Coverage Up to $1,950 per day, limited to 30 days per Period of Coverage
Intensive Care Up to an additional $400 per day, limited to 8 days per Period of Coverage Up to an additional $660 per day, limited to 8 days per Period of Coverage Up to an additional $850 per day, limited to 8 days per Period of Coverage
Pre-admission Testing Up to $750 per Period of Coverage Up to $1100 per Period of Coverage Up to $1100 per Period of Coverage
Surgery
Surgeon Up to $2,000 per Surgical session
Assistant Surgeon Up to $450 per Surgical session
Anesthetist Up to $450 per Surgical session
Surgeon Up to $3,300 per Surgical session
Assistant Surgeon Up to $825 per Surgical session
Anesthetist Up to $825 per Surgical session
Surgeon Up to $5,500 per Surgical session
Assistant Surgeon Up to $1,375 per Surgical session
Anesthetist Up to $1,375 per Surgical session
Inpatient Physician Visits Up to $40 allowable charge per visit and 1 visit per day, limited to 30 visits per Period of Coverage Up to $55 allowable charge per visit and 1 visit per day, limited to 30 visits per Period of Coverage Up to $85 allowable charge per visit and 1 visit per day, limited to 30 visits per Period of Coverage
Physician Consult Up to $350 per Period of Coverage, when requested by attending Physician Up to $450 per Period of Coverage, when requested by attending Physician Up to $500 per Period of Coverage, when requested by attending Physician
Private Duty Nurse Up to $400 per Period of Coverage Up to $550 per Period of Coverage Up to $550 per Period of Coverage
Outpatient Treatment:
Surgery
session Surgical Facility Fee Up to $750 per Surgical
session Surgeon Up to $2,000 per Surgical
session Assistant Surgeon Up to $450 per Surgical
session Anesthetist Up to $450 per Surgical
session Surgical Facility Fee Up to $900 per Surgical
session Surgeon Up to $3,300 per Surgical
session Assistant Surgeon Up to $825 per Surgical
session Anesthetist Up to $825 per Surgical
session Surgical Facility Fee Up to $1,000 per Surgical
session Surgeon Up to $5,500 per Surgical
session Assistant Surgeon Up to $1,375 per Surgical
session Anesthetist Up to $1,375 per Surgical
Outpatient Physician Visits Up to $50 allowable charge per day and 1 visit per day, limited to 10 visits per Period of Coverage Up to $55 allowable charge per day and 1 visit per day, limited to 10 visits per Period of Coverage Up to $85 allowable charge per day and 1 visit per day, limited to 10 visits per Period of Coverage
Diagnostic Lab & Xray Up to $650 per Period of Coverage, limited to $325 allowable charge per procedure Up to $800 per Period of Coverage, limited to $400 allowable charge per procedure Up to $950 per Period of Coverage, limited to $475 allowable charge per procedure
Hospital Emergency Room Up to $200 allowable charge per v 75% of URC to a maximum of $330 allowable charge per visit 75% of URC to a maximum of $550 allowable charge per visit
Prescription Drugs Up to $150 per Period of Coverage Up to $250 per Period of Coverage Up to $250 per Period of Coverage
Emergency Local Ambulance Up to $250 per Period of Coverage Up to $450 per Period of Coverage Up to $450 per Period of Coverage
Physical Therapy Up to $25 allowable charge per visit and 1 visit per day, limited to 12 visits per Period of Coverage Up to $40 allowable charge per visit and 1 visit per day, limited to 12 visits per Period of Coverage Up to $40 allowable charge per visit and 1 visit per day, limited to 12 visits per Period of Coverage
Dental Accident Up to $350 per Period of Coverage Up to $550 per Period of Coverage Up to $550 per Period of Coverage
Extended Care Facility Up to $150 per day, limited to 15 days per Period of Coverage Up to $200 per day, limited to 15 days per Period of Coverage Up to $250 per day, limited to 15 days per Period of Coverage
Common Carrier Accidental Death Benefit $25,000 $25,000 $25,000
Emergency Medical Evacuation Expenses Up to $25,000 per evacuation, must be approved in advance and coordinated by the Company Up to $50,000 per evacuation, must be approved in advance and coordinated by the Company Up to $50,000 per evacuation, must be approved in advance and coordinated by the Company
Return of Mortal Remains Up to $7,500, or up to US$5,000 for local burial or cremation, must be approved in advance and coordinated by the Company Up to $7,500, or up to US$5,000 for local burial or cremation, must be approved in advance and coordinated by the Company Up to $7,500, or up to US$5,000 for local burial or cremation. Must be approved in advance and coordinated by the Company
Incidental Trip Coverage Up to 14 days per Period of Coverage Up to 14 days per Period of Coverage Up to 14 days per Period of Coverage