Inbound Immigrant Insurance

Plan Summary

Inbound Immigrant Insurance Details

Why You Need this Program

As a solution, Inbound Immigrant was developed to provide a simple program to visitors and immigrants that will provide up to 5 years of protection.

Eligibility

Period of Coverage

Effective Date - Your coverage will begin on the latest of the following:

1. Your departure from your Home Country; or
2. The date your Application and premium are received by SRI; or
3. The date your Application and premium are accepted by SRI; or
4. The date you request on the Application.
   

Expiration Date - Your coverage will end on the earlier of the following:

1. The date shown on the Insurance Confirmation Card, for which premium has been paid; or
2. The date you return to your Home Country; or
3. 60 months after your original Effective Date; or
4. The day an insured becomes a U.S. citizen; or
5. The date of entry into active military service.
   

Upon each renewal, rates, benefits, and program in general are subject to change.

Renewal

Schedule of Benefits

For persons age 70 and over, the maximum benefit limit is $50,000, the period in which covered expenses must be incurred is 32 weeks following the Injury or Sickness, and a separate schedule applies.

Covered Services Injury and Sickness Benefit Limits

Inpatient

Outpatient

Others

Should an insured person turn 70 during the purchased coverage period, the 70 and over benefit schedule becomes effective upon the day the insured turns 70.

Emergency Medical Evacuation Expenses

Repatriation of Mortal Remains Expenses

Common Carrier Accidental Death and Dismemberment (AD&D)

Additional Benefits

• Ambulance service
• Initial orthopedic prosthesis
• Chemotherapy/radiation therapy
• Mental & nervous disorder & substance abuse
• Maternity
• Physiotherapy
• Emergency medical evacuation
• Repatriation of mortal remains
• Common carrier AD&D



Definitions


"Injury" means: bodily injury: (1) directly and independently caused by specific accident which is unrelated to any pathological, functional, or structural disorder of injury, (2) treated by a Physician within 30 days after the date of accident; and (3) which causes loss during the term of the policy.

"Sickness" means: sickness or disease of the insured Person which causes loss and originates while the Insured Person is covered under the policy. All related conditions and recurrent symptoms of the same or a similar condition will be considered one sickness.

"Pre-Existing Condition" means: (1) the existence of symptoms within the 6 months (or 12 months for persons 70 and older) immediately prior to the Insured's Effective Date under the policy, or, (2) any condition which originates, is diagnosed, treated or recommended for treatment within the 6 months (or 12 months for persons 70 and older) immediately prior to the Insured's Effective Date under the policy; or (3) congenital conditions.

"Usual and Customary Charges" means: a reasonable charge which is: (1) usual and customary when compared with the charges made for similar services and supplies; and (2) made to persons having similar medical conditions in the locality of the Policyholder. No payment will be made under the policy for any expenses incurred which in the judgment of the Company are in excess of Usual and Customary Charges.



Exclusions


No benefits will be paid for loss or expense caused by, contributed to, or resulting from:
1. Pre-existing Conditions;
2. Any loss that occurs while traveling solely for the purpose of obtaining medical treatment while on a waiting list for a specific treatment, or while traveling against the advice of a physician;
3. Expense incurred within the Insured Person's Home Country or country of regular domicile;
4. Routine physical or other examinations where there are no objective indications of impairment of normal health, or well baby care;
5. Eye examinations; prescriptions or fitting of eyeglasses and contact lenses; or other treatment for visual defects and problems. "Visual defects: means any physical defect of the eye which does or can impair normal vision;
6. Hearing examinations or hearing aids; or other treatment for hearing defects and problems. "Hearing defects: means any physical defect of the ear which does or can impair normal hearing:
7. Dental treatment, except as the result of injury to sound, natural teeth as stated in the Schedule of Benefits:
8. Professional services rendered by a Member of the Insured Person's immediate family, or anyone who lives with the Insured Person;
9. Services or supplies not necessary for the medical care of the patient's injury or sickness;
10. Weak, strained or flat feet, corns, calluses, or toenails;
11. Cosmetic surgery, or treatment for congenital anomalies (except as specifically provided), except reconstructive surgery as the result of a covered Injury or Sickness. Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or covered Sickness;
12. Elective Surgery and Elective Treatment;
13. Diagnostic or surgical procedures in connection with infertility unless infertility is a result of a covered Injury or covered Sickness;
14. Birth control, including surgical procedures and devices;
15. Routine new-born baby care, well-baby nursery and related Physician charges;
16. Participation in professional or intercollegiate athletics;
17. Injury or Sickness for which benefits are paid or payable under any Worker's Compensation or Occupational Disease Law or Act, or similar legislation;
18. Organ transplants;
19. War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period not covered);
20. Participation in a riot or civil disorder, commission of or attempt to commit a felony in the country in which it was attempted or committed;
21. Suicide or attempted suicide (including drug overdose), while sane or insane (while sane in Missouri), or intentionally self-inflected Injury;
22. Charges of an institution, health service, or infirmary for whose service payment is not required in the absence of insurance;
23. Treatment of nervous or mental disorders, except as stated in the Schedule of Benefits, or treatment of alcoholism or drug abuse, except as provided for treatment of mental or nervous disorders, according to the Schedule of Benefits;
24. Loss incurred from riding in any aircraft, other than as a passenger in an aircraft licensed for the transportation of passengers;
25. Treatment services, supplies or facilities in a hospital owned or operated by: a) The Veteran's Administration; or b) A national government or any of its agencies. (This exclusion does not apply to treatment when a charge is made which the Insured is required by law to pay);
26. Duplicate services actually provided by both a certified nurse-midwife and Physician;
27. Expenses payable under any prior policy which was in force for the person making the claim;
28. Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
29. Expenses incurred for outpatient treatment in connection with the detection or correction by manual or mechanical means of structural imbalance, distortion or sublimation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column;
30. Injury sustained as the result of the Insured operating a motor vehicle while not properly licensed to do so in the jurisdiction the motor vehicle accident occurs;
31. Voluntary or elective abortion;
32. Expense covered by any other valid and collectible medical, health or accident insurance;
33. Expense incurred after the date insurance terminates for an Insured Person except as may be specifically provided;
34. Expenses incurred for injuries resulting from the use of alcohol or intoxicants, or any drugs unless prescribed by a Physician;
35. Sexually transmitted diseases, including AIDS.
    

Enrolling in Inbound Immigrant Insurance

1. Complete entire application.
2. Select method of payment.
3. If paying by check or money order, make payable to: "SRI" and enclose it together with completed Application.
4. If paying by credit card, complete Application and mail or fax to SRI. Be sure to sign Method of Payment section.
   



Inbound Immigrant Monthly Rates

$75 Per Injury / Sickness Deductible Per Person



Age	$50,000 Maximum	$100,000 Maximum
Age 2 weeks - 49	$65	$95
Age 50 - 69	$103	$145
Dependent Child (Age 2 weeks through age 18)	$54	$81




$150 Per Injury / Sickness Deductible Per Person



Age	$50,000 Maximum	$100,000 Maximum
Age 2 weeks - 49	$62	$91
Age 50 - 69	$100	$142
Dependent Child (Age 2 weeks through age 18)	$51	$76




$250 Per Injury / Sickness Deductible Per Person



Age	$50,000 Maximum	$100,000 Maximum
Age 70 - 79	$111	N/A
Age 80 +	$144	N/A




Dependent Child rate is applicable when at least one parent will also be covered under Inbound Immigrant.


Please be aware that this is not a general health insurance policy, but an interim program intended for temporary use. Inbound Immigrant does not guarantee payment to a facility or individual for medical expenses until the Company determines that it is an eligible expense.



Refund of Premium


Refund of premium shall be considered only if written request is received by SRI prior to the Effective Date of Coverage. After the Effective Date of Coverage, the premium is considered fully earned and non-refundable.


What You Will Receive


Upon successful enrollment in Inbound Immigrant, you will receive an information packet from SRI. This packet will include your ID Card and Program Summary. The Program Summary describes all the benefits of Inbound Immigrant in complete detail. In addition, the Program Summary tells you the procedure for submitting claims.



The Insurance Company


Inbound Immigrant is underwritten by The Insurance Company of the State of Pennsylvania, a member company of the American International Group of Companies (AIG) and is rated A++ "Superior" by the A.M. Best Company.


Inbound Immigrant, Copyright 2002, Specialty Risk International, Inc.(SRI)
"Inbound" is a service mark of SRI