| Emergency Medical Evacuation | Up to the maximum limit. Not subject to deductible |
| Emergency reunion | $100,000 maximum limit. Not subject to deductible |
| Return of mortal remains or Cremation / Burial | $50,000 maximum limit for return of mortal remains or $5,000 maximum limit for cremation or local burial at the place of death. |
| Emergency room | Up to the maximum limit. Additional $250 deductible if not admitted as an inpatient. |
| Hospital Emergency Room:International | Up to the maximum limit |
| Hospital Emergency Room:Up to the maximum limit | Injury not subjected to emergerncy room deductible. Illness:Subject to a $250 deductible to each emergency room visit for treatment that does not result in direct inpatient. |
| Urgent Care Clinic | 25 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible. |
| Walk-In Clinic | $15 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
| Accidental Death and Dismemberment | $50,000 principal sum. Not subject to deductible |
| Common carrier accidental death | $25,000 per insured child, $100,000 per insured adult, $250,000 maximum limit per family. Not subject to deductible |
| Incidental Home Country Coverage | Up to 14 consecutive days |
| Anesthesia | Up to the maximum limit |
| Chiropractic Care | Up to the maximum limit |
| Extended Care Facility | Up to the maximum limit |
| Interfacility Ambulance Transfer | Company pays 100% |
| Pet Return | $1,000 maximum limit. Not subject to deductible |
| Small Pet Common Air Carrier Accidental Death Benefit | $500 maximum limit. Not subject to deductible. |
| Bedside Visit | $1,500 maximum limit. Not subject to deductible. |
| Trip interruption | $10,000 maximum limit. Not subject to deductible |
| Lost luggage | $50 per item, $500 maximum limit. Not subject to deductible |
| Identity Theft | $500 maximum limit. Not subject to deductible. |
| Personal Liability | $25,000 combined maximum limit. Injury to a third person: $100 per injury deductible. Damage to a third person’s property: $100 per damage deductible. No coverage for injury to a related third party or damage to related third person’s property. |
| Natural disaster | $25,000 maximum limit. Not subject to deductible. |
| Terrorism | Up to $50,000 maximum limit. Not subject to deductible. |
| Return of minor children | $100,000 maximum limit. Not subject to deductible |
| Political evacuation | $100,000 maximum limit. Not subject to deductible |
| Local Ambulance | Up to the Maximum Limit |
| Hospital Intensive Care | Up to the Maximum Limit |
| Prescription Drugs | Up to the Maximum Limit |
| Hospital room and board | Outside the U.S: Up to the maximum limit Inside the U.S: Subject to a $250 deductible for each emergency room visit for treatment that does not result in direct inpatient hospital admission. Up to the maximum limit |
| Pre-Certification | 50% reduction of eligible medical expenses if pre-certification provisions are not met |
| Intensive care | Up to the maximum limit |
| Surgery | Up to the maximum limit |
| Physician visits | Up to $15 copay for walk-in clinic. Up to $25 copay for urgent care center. (Copay not applicable when $0 deductible is selected) |
| Pre-Admission Testing | Up to the maximum limit |
| Reconstructive Surgery | Up to the maximum limit |
| Assistant Surgeon | 20% of the primary surgeon’s eligible fee |
| Hospital indemnity | $250 per overnight inpatient confinement, maximum limit of 10 overnights. Not subject to deductible |
| Emergency dental treatment | $300 maximum limit due to accident or unexpected pain to sound natural teeth. |
| Traumatic Dental Injury | Up to the maximum limit. Additional treatment for the same injury rendered by a dental provider will be paid at 100%. |
| Adventure Sports Rider | covers insureds up to age 65 |
| 0-49 years - $50,000 | |
| 50-59 years - $30,000 | |
| 60-64 years - $15,000 | |
| Enhanced AD&D Rider(available to the primary Insured on individual plans only | Up to an additional $400,000 |
| Evacuation Plus Rider(available to Insureds up to age 65 on individual plans only) | Non-life-threatening medical evacuation: Up to a maximum of $25,000. |
| Natural disaster evacuation: Up to a maximum of $5,000 | |
| Chaperone/Faculty Leader Replacement Rider (available on group plans only) | Up to $3,000 for round-trip economy airline ticket |
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