Eligibility
Underwriter
Rating
Optional Riders| Benefits | Coverage |
| Medical expense benefits (subject to policy maximum, deductible and co-insurance) | |
| Hospital Room and Board Charges | The average semi private room rate |
| ICU Room and Board Charges | Three times the average semi private room rate |
| Outpatient Medical | Usual customary charge up to the selected medical maximum |
| Medical Emergency Care Expenses | Maximum; Within a) 24 hours acute onset of pre-existing condition or b) 72 hours of newly diagnosed sickness or injury). These expenses include the attending doctor's charges, X-rays, laboratory procedures, use of the emergency room and supplies |
| Emergency Medical Treatment of Pregnancy | $1,000 |
| Mental or Nervous Disorders | $2,500 |
| Coinsurance? | IN NETWORK: Plan pays 100% OUT OF NETWORK: Plan pays 80% of eligible expenses up to $5,000, then 100% |
| Cardiac Conditions or Treatment | $25,000 per policy period up to age 69 at age 70 the maximum is $15,000 per policy period |
| Physiotherapy or Physical Medicine or Chiropractic | $50 per visit per day; up to 10 visits per policy period |
| Dental Treatment (Injury and emergency alleviation of pain) | $250 |
| Doctor Visits, X-rays and Prescriptions, Ambulance | Usual customary charge to the selected medical maximum |
| Acute onset of pre-existing condition(s) per policy period Subject to the sub limits for each benefit listed |
For people age 69 and below up to Policy Maximum for Acute Onset of Pre-Existing and up to $25,000 for coverage related to cardiac disease or conditions. For people age 70 and above up to $35,000 for Acute Onset of Pre-Existing and up to $15,000 for coverage related to cardiac disease or conditions. |
| Benefit Period | 1 year from the date of the covered accident or sickness |
| Additional Benefits (not subject to Policy Maximum, Deductible or Co-Insurance) | |
| Emergency Medical Evacuation | 100% up to $2,000,000 |
| Political/Natural Disaster Evacuation | $25,000 |
| Repatriation of Remains | 100% up to $1,000,000 |
| Emergency Reunion | $15,000 |
| Return of Minor Child(ren) or Travel Companion | $5,000 |
| Trip Interruption | $5,000 per Policy Period (does not cover lost trip cost) |
| Basic Lost Baggage | $1,000 per Policy Period |
| Accidental Death & Dismemberment Principal Sum | $25,000 |
| Coma Benefit | $10,000 |
| Felonious Assault and Violent Crime | 100% up to $50,000 |
| Adaptive Home and Vehicle | $5,000 |
| Seatbelt Benefit | 10% up to $50,000 |
| Airbag Benefit | 10% up to $50,000 |
| Hijacking and Air or Water Piracy | Covered |
| Optional Benefits | |
| Upgrade AD&D | $50,000, $100,000, $250,00 or $500,000 |
| Home Country Coverage/Follow Me Home Coverage | Up to 60 days - prorated |
| Athletic Sports Coverage | Some Sports are covered |
The Primary insurance plan is the one that starts to pay as soon as there is an unexpected injury/illness or when there is a medical expense without assuming that there is a secondary plan. In other words, the primary plan should pay regardless of the existence of the secondary plan just as if the patient had only the primary plan to cover him/her. The Secondary health insurance plan unlike the Primary under the coordination of benefits provision will then take into consideration the expenses that were not covered by the primary plan and will be considered for payment under the Secondary plan. Therefore, the Secondary plan will fill any gaps found in coverage from the Primary plan.
