Seven Corners Inbound USA Choice Insurance

Plan details of Inbound USA Choice Insurance

• Plan Options

  Medical Maximum Options Age 14 days to 69 years: $50,000; $100,000; $150,000
  Age 70 to 99 years: $50,000; $100,000

  Deductible Options Age 14 days to 69 years: $0; $50; $100
  Age 70 to 99 years: $100; $200

  Medical Benefits

  Hospital Room & Board, including Laboratory Tests, X-Rays, Prescription Medication, Extended Care Facility and other Up to $2,000/day, 30 day maximum

  Hospital Intensive Care Unit Additional $750/day, 8 day maximum

  Surgery(Inpatient & Outpatient) Up to $5,000

  Anesthetist(Inpatient & Outpatient) Up to $1,000

  Assistant Surgeon(Inpatient & Outpatient) Up to $1,000

  Physician Non-Surgical Visits, including Urgent Care(Inpatient & Outpatient) Up to $75/visit, 1/day, 30 visits maximum

  Consulting Physician when requested by attending Physician Up to $500

  Private Duty Nursing Up to $650

  Pre-Admission Tests within 7 days of Hospital admission Up to $1,000

  Diagnostic Basic(X-ray & Laboratory Tests) Up to $750

  Diagnostic Comprehensive(PET, CAT, MRI) Up to $1250

  Hospital emergency room Up to $500

  Prescription Drugs and Medications Up to $200 Per Period of Coverage

  Outpatient Surgical Facility Up to $1,000

  Initial Orthopedic Prosthesis or Brace Up to $1,250

  Mental Illness including Substance Abuse Same as any Illness

  Local Ambulance Up to $500

  Pre-certification 25% penalty

  Incidental trips to Home Country $25,000

  Acute Onset of Pre-Existing Conditions

  Acute Onset of Pre-Existing Conditions Age 14 days to 69 years: Up to $75,000
  Age 70 to 79 years: Up to $25,000
  Age 80 and older: Not Available

  Dental

  Dental Emergency — Accident Coverage Up to $750

  Dental Emergency - Sudden Relief of Pain Up to $750

  Emergency Services and Assistance

  Benefit period 180 days

  Emergency medical evacuation $100,000

  <Return of mortal remains $25,000

  Local Cremation or Burial $5,000

  Terrorist Activity $50,000

  Common Carrier Accidental Death and Dismemberment $25,000 per Insured Person (aggregate limit of $125,000 per any one Accident)

  International Travel Coverage Up to medical maximum

  24/7 Travel Assistance Services Included
• Inbound USA Choice Insurance Claims
  

  Please visit: Seven Corners Claims Forms
  Toll Free Number: 1-800-335-0611 (Seven Corners claims phone number)
  Claims Department:
  Email: claims@sevencorners.com
  Fax: (+1) 317-575-2256
  Seven Corners, Inc
  Attn: Claims
  PO Box 211760
  Eagan, MN 5512
  
  

• Inbound USA Choice Insurance Exclusions
  
  1. Pre-Existing Condition(s) except as waived under Acute Onset of Pre-Existing Condition(s); Return of Mortal Remains and Local Burial or Cremation in the plan document.
  2. Claims not received by the Company or Administrator within ninety (90) days of the date of service;
  3. Treatment that is Investigational, Experimental, or for research purposes;
  4. Treatment, services, or supplies that are not administered by or under the supervision of a Physician or Surgeon and products that can be purchased without a Physician’s or Surgeon’s prescription;
  5. Routine physicals, inoculations, or other examinations or tests conducted when there is no objective indications or impairments in normal health;
  6. Chiropractic care or acupuncture;
  7. Services, supplies, medications, testing, or Treatment prescribed, performed, or provided by a Relative or Immediate Family Member;
  8. False teeth, dentures, dental appliances, dental expenses, normal ear or hearing tests, hearing aids, hearing implants, eye refractions, eye examinations for prescribing corrective lenses or eye-glasses unless caused by Accidental Injury, eyeglasses, contact lenses, or eye surgery when the primary purpose is to correct nearsightedness, farsightedness, or astigmatism;
  9. Replacement of artificial limbs, eyes, larynx, and orthotic appliances;
  10. Custodial Care, Educational or Rehabilitative Care, or any Treatment in any establishment for the care of the aged;
  11. Vocational, occupational, sleep, speech, recreational, art, or music therapy;
  12. Pregnancy, Illness or complications from Pregnancy, childbirth, abortion, miscarriage including that resulting from an Accident, postnatal care, preventing conception or childbirth, artificial insemination, infertility, impotency, sexual dysfunction, or sterilization or reversal thereof;
  13. Sleep apnea or other sleep disorders;
  14. Mental and Nervous Disorders unless specifically covered herein, Rest Cures, learning disabilities, attitudinal disorders, or disciplinary problems;
  15. Congenital abnormalities and conditions arising out of or resulting therefrom.
  16. Temporomandibular joint;
  17. Occupational Diseases;
  18. Exposure to non-medical nuclear radiation or radioactive materials;
  19. Sexually transmitted diseases, venereal diseases, and conditions and any consequences thereof;
  20. Acquired Immune Deficiency Syndrome (AIDS), AIDS-Related Complex (ARC), or the Human Immunodeficiency Virus (HIV);
  21. Human organ or tissue transplants
  22. Exercise programs whether prescribed or recommended by a Physician or therapist;
  23. Weight reduction programs or the surgical Treatment of obesity including, but not limited to, wiring of the teeth and all forms of intestinal bypass Surgery;
  24. Cosmetic or plastic Surgery including deviated nasal septum; modifications of Your physical body intended to improve Your psychological, mental, or emotional well-being including, but not limited to, sex-change Surgery;
  25. Acne, moles, skin tags, disease of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of the sebaceous glands, hypertrophic and atrophic conditions of skin, nevus;
  26. Hazardous Activities;
  27. Injuries sustained while participating in professional Athletics, amateur Athletics, or interscholastic Athletics including, but not limited to, events, games, matches, practice, training camps, sport camps, conditioning, and any other activity related thereto and excluding non-competitive, recreational, or intramural activities;
  28. Abuse, misuse, illegal use, overuse, or being under the influence of alcohol, drugs, chemicals, or narcotic agents unless administered under the advice of a Physician and taken in accordance with the proper dosing as directed by the Physician;
  29. Terrorist Activity except as provided in the plan document; War, Hostilities, or War-Like Operations;
  30. Commission of a criminal offense or any other criminal or illegal activity as defined by the local governing body;
  31. You unreasonably fail or refuse to depart a country or location following the date a warning to leave that country or location is issued by the United States government or similar warnings issued by other appropriate authorities of either Your Host Country or Your Home Country;
  32. Service in the military, naval, coast guard, or air service of any country or while on duty as a member of a police force or unit;
  33. Treatment paid for or furnished under any other individual, government, or group policy or Expenses incurred at no cost to You;
  34. You while in Your Home Country unless covered under Incidental Trips to Home Country in the plan document;
  35. Conditions for which travel was undertaken to seek Treatment after Your Physician has limited or restricted travel;
  36. Travel accommodations;
  37. Injury sustained while You are riding as a pilot, student pilot, operator, or crew member, in or on, boarding or alighting, from any type of aircraft;
  38. Injury sustained while You are riding as a passenger in any aircraft (i) not having a current and valid Airworthy Certificate and (ii) not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft;
  39. Flying in any aircraft being used for acrobatic or stunt flying, racing, endurance tests, rocket-propelled aircraft, crop dusting or seeding or spraying, firefighting, exploration, pipe or power line inspection, any form of hunting or herding, aerial photography, banner towing, or any experimental purpose;
  40. Participating in contests of speed or riding or driving in any type of competition; and
  41. Charges incurred for treatment or surgeries which are Experimental/Investigational, or for research purposes; expenses which are non-medical in nature, expenses for Custodial Care, vocational, speech, recreational or music therapy.
• Inbound USA Choice Insurance Restrictions
  
  • State Restrictions: The plan will not accept a mailing address in Maryland, Washington, New York, South Dakota, and Colorado.
  • Country Restrictions: The plan will not accept an address in Cuba, Islamic Republic of Iran, Syrian Arab Republic, United States Virgin Islands, Gambia, Ghana, Nigeria, and Sierra Leone.
  • Destination Restrictions: The plan will not cover trips to to Antarctica, Islamic Republic of Iran, Syrian Arab Republic, and Cuba.
• What is pre-certification requirements for Inbound USA Choice insurance
  Inbound USA Choice Insurance Pre-Certification
  The following expenses must always be pre-certified in the U.S. only:
  
  1. Outpatient surgeries or procedures;
  2. Inpatient surgeries, procedures, or stays including those for rehabilitation;
  3. Diagnostic procedures including MRI, MRA, CT, and PET Scans;
  4. Chemotherapy;
  5. Radiation therapy;
  6. Physiotherapy (must include physician’s recommendation and treatment plan); and
  7. Extended Care Facility.
  To comply with the pre-certification requirements, you must:
  
  1. Contact Seven Corners Assist before the expense is incurred;
  2. Comply with Seven Corners Assist’s instructions;
  3. Notify all medical providers of the pre-certification requirements and ask them to cooperate with Seven Corners Assist.
  Once we pre-certify your expenses, we will review them to determine if they are covered by the plan. If you do not comply with the pre-certification requirements:
  
  1. Covered expenses will be reduced by $500; and
  2. The deductible will be subtracted from the remaining benefit amount.
  Pre-certification does not guarantee coverage, payment, or reimbursement. Eligibility, coverage, and payment or reimbursement is subject to the terms, conditions, provisions, and exclusions in the plan document.