Eligibility
Underwriter
Rating| Benefits | Coverage |
| Policy Maximum | Economy: $25,000 maximum per Injury/Sickness Basic: $50,000 maximum per Injury/Sickness Silver: $75,000 maximum per Injury/Sickness Gold: $100,000 maximum per Injury/Sickness Platinum: $175,000 maximum per Injury/Sickness Cardiac Conditions/Treatment $25,000 per Policy Period Limit |
| Deductible | $0 |
| Well Doctor Visit | Pays up to $75 - One Visit per person per Policy Period. The Well Doctor Visit must occur within the first 21 days from the effective date of coverage. To be eligible you must purchase at least 30 days of coverage initially |
| Hospital Room & Board including Laboratory Tests, X-Rays, Prescription Medical and other miscellaneous | Economy: Up to $1,400/day, 30 day maximum Basic: Up to $1,400/day, 30 day maximum Silver: Up to $1,750/day, 30 day maximum Gold: Up to $2,000/day, 30 day maximum Platinum: Up to $2,700/day, 30 day max |
| Hospital Intensive Care Unit | Economy: Additional $700/ day, 8 day maximum Basic: Additional $700/ day, 8 day maximum Silver: Additional $800/ day, 8 day maximum Gold: Additional $900/ day, 8 day maximum Platinum: Additional $1,150/ day, 10 day maximum |
| Surgical Treatment | Economy: Up to $3,500 Basic: Up to $3,500 Silver: Up to $4,750 Gold: Up to $6,000 Platinum: Up to $7,500 |
| Emergency Medical Evacuation | Economy: $100,000 Basic: $100,000 Silver: $100,000 Gold: Unlimited Platinum: Unlimited |
| Repatriation of Remains | Economy: $7,500 Basic: $7,500 Silver: $10,000 Gold: $20,000 Platinum: $25,000 |
| Dental Treatment for Injury to Sound, Natural Teeth | Up to $600 |
| Pre-existing conditions | Acute Onset of a Pre-existing Condition - up to policy maximum for age up to 69 years, $35,000 for age 70-79 years, $15,000 for age 80-89 per policy period subject to the sub limits as mentioned ( any coverage related to cardiac disease or conditions is limited to $25,000 for age up to 69 years, $15,000 for age 70 years and above) |
| Ambulance Services |
Economy: $500 Basic: $500 Silver: $500 Gold: $500 Platinum: $750 |
| Anesthetist | Economy: Up to $850 Basic: Up to $850 Silver: Up to $1,200 Gold: Up to $1,400 Platinum: Up to $1,800 |
| Assistant Surgeon | Economy: Up to $850 Basic: Up to $850 Silver: Up to $1,200 Gold: Up to $1,400 Platinum: Up to $1,800 |
| Physician’s Visit | Economy: Up to $55/visit, 1/day, 30 visits maximum Basic: Up to $55/visit, 1/day, 30 visits maximum Silver: Up to $70/visit, 1/day, 30 visits maximum Gold: Up to $85/visit, 1/day, 30 visits maximum Platinum: Up to $115/visit, 1/day, 30 visits maximum |
| Diagnostic X-rays & Lab Services | Economy: Up to $450 Basic: Up to $450 Silver: Up to $475 Gold: Up to $500 Platinum: Up to $675 |
| Mental & Nervous Disorder & Substance Abuse |
Economy: Up to $5,000 Basic: Up to $5,000 Silver: Up to $5,000 Gold: Up to $5,000 Platinum: Up to $20,000 30 days Max |
| Local Burial/Cremation | Up to $5,000 maximum limit |
| Initial Orthopedic Prosthesis/brace |
Economy: Up to $1,100 Basic: Up to $1,100 Silver: Up to $1,225 Gold: Up to $1,350 Platinum: Up to $1,750 |
| Chemotherapy or radiation therapy |
Economy: Up to $1,100 Basic: Up to $1,100 Silver: Up to $1,225 Gold: Up to $1,350 Platinum: Up to $1,750 |
| AD&D Principal Sum* |
Economy: Up to $25,000 common carrier Basic: Up to $25,000 common carrier Silver: Up to $35,000 common carrier Gold: Up to $35,000 common carrier Platinum: Up to $35,000 common carrier |
| Natural Disaster, Political Evacuation & Repatriation* | Economy: Up to $500 Basic: Up to $500 Silver: Up to $1,000 Gold: Up to $1,500 Platinum: Up to $2,000 |
| Return of Minor Children or Grand Children* |
Economy: Up to $5,000 Basic: Up to $5,000 Silver: Up to $7,500 Gold: Up to $7,500 Platinum: Up to $10,000 |
| Felonious Assault AD&D* |
Economy: Up to $5,000 Basic: Up to $5,000 Silver: Up to $7,500 Gold: Up to $7,500 Platinum: Up to $10,000 |
| Return to Home Coverage* | Economy: Up to 30 days per 12 months maximum $2,000 Basic: Up to 30 days per 12 months maximum $2,000 Silver: Up to 60 days per 12 months maximum $2,500 Gold: Up to 60 days per 12 months maximum $5,000 Platinum: Up to 90 days per 12 months maximum $7,500 |
| Private Duty Nurse | Economy: Up to $450 Basic: Up to $450 Silver: Up to $550 Gold: Up to $550 Platinum: Up to $700 |
| Physician’s Visits/ Urgent Care | Economy: Up to $55/visit,1/day, 30 visits Max
Basic: Up to $55/visit,1/day, 30 visits Max Silver: Up to $70/visit,1/day, 30 visits Max Gold: Up to $85/visit,1/day, 30 visitsMax Platinum: Up to $115/visit,1/day, 30 visits Max |
| Prescription Drugs(outpatient) Per Sickness/Injury | Economy: Up to $100 Basic:Up to $100 Silver: Up to $125 Gold: Up to $150 Platinum: Up to $200 |
| Outpatient Surgical Facility | Economy:Up to $1000 Basic: Up to $1000 Silver:Up to $1150 Gold: Up to $1275 Platinum: Up to $1400 |
