Brochure and Details link | |
Medical Maximum Options (per person per disablement) | |
Ages 14 days to 64 $50,000; $100,000; $250,000; $500,000; $1,000,000 |
Ages 14 days to 64 $50,000; $100,000; $250,000; $500,000; $1,000,000 |
Hospital room and board | |
Usual, Reasonable and Customary to the medical maximum. | Usual, Reasonable and Customary to the medical maximum. |
Prescription Drugs | |
Inside the U.S - $0 copay (not subject to the deductible) Outside the U.S - $0 copay (deductible applies) |
Inside the U.S - $10 copay for generic/$20 copay for brand name (not subject to the deductible) Outside the U.S - $0 copay (deductible applies) |
Vaccinations (in the U.S. only as required by school, university or visa program) | |
$200 per 364 days of continuous coverage | $100 per 364 days of continuous coverage |
Physical Therapy | |
$75 per day to a max of 60 days | $25 per day to a max of 60 days |
Spinal Manipulation | |
$75 per day to a max of 60 days (if prescribed by a physician for pain relief) | $25 per day to a max of 60 days (if prescribed by a physician for pain relief) |
Local Ambulance Benefit | |
Inside the U.S - $750 per disablement (injury/illness) Outside the U.S - Up to medical maximum |
Inside the U.S - $350 per disablement (injury/illness) Outside the U.S - Up to medical maximum |
Coma Benefit | |
$50,000 (separate from the medical maximum) | $10,000 (separate from the medical maximum) |
Extension of Benefits to Home Country | |
$10,000 | $1,000 |
Incidental Trips to Home Country (for minimum purchases of 30 days) |
|
$10,000 | $1,000 |
Waiver of Pre-existing Conditions | |
After a waiting period of 364 days of continuous coverage, pre-existing conditions are covered as any other disablement. | After a waiting period of 364 days of continuous coverage, pre-existing conditions are covered as any other disablement. |
Acute Onset of a Pre-existing Condition (during the initial 364 days of coverage) |
|
Medical covered expenses up to $25,000 | Medical covered expenses up to $5,000 |
Mental Illness including Alcohol & Substance Abuse | |
Inpatient: $20,000 (45 days max), Outpatient: $2,000 | Inpatient: $5,000 (45 days max), Outpatient: 80% of URC to $500 |
Motor Vehicle Accident | |
Inside the U.S - 100% up to $100,000 Outside the U.S - Up to medical maximum |
Inside the U.S - 50% up to $100,000 Outside the U.S - Up to medical maximum |
Non-contact Amateur Sports | |
$10,000 | $2,500 |
Maternity Care For a pregnancy to be covered, conception must occur 180 days after coverage begins. |
|
|
$500 Benefits reduced 25% for failure to notify us within the first 90 days of pregnancy |
Routine Newborn Care | |
$750 per newborn child | $250 per newborn child |
Dental - Sudden Relief of Pain (for minimum purchases of 30 days) |
|
$350 | $150 |
Dental - Accident | |
$2,500 | $500 |
Emergency Medical Evacuation & Repatriation | |
$750,000 (separate from the medical maximum) | $100,000 (separate from the medical maximum) |
Emergency Medical Reunion | |
Up to $200 per day/$50,000 maximum | Up to $200 per day/$15,000 maximum |
Return of Child(ren) | |
$50,000 | $25,000 |
Return of Mortal Remains | |
$50,000 | $50,000 |
Local Burial or Cremation | |
$5,000 | $5,000 |
Natural Disaster Evacuation | |
$10,000 | $5,000 |
Natural Disaster Daily Benefit | |
$75 per day, 5-day limit | $25 per day, 5-day limit |
Political Evacuation & Repatriation | |
$10,000 | $10,000 |
Felonious Assault | |
$20,000 (separate from the medical maximum) | $10,000 (separate from the medical maximum) |
Terrorism | |
$100,000 | $25,000 |
Accidental Death and Dismemberment (AD&D) | |
|
|
Personal liability | |
$100,000 | $25,000 |
Hazardous Activities | |
Up to medical maximum | Up to medical maximum |