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Inbound Immigrant Travel Insurance
Benefits
Plan Overview | Benefits
| Exclusions |
Providers
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Rates: $50,000 Max | $100,000
Max | $50,000 Max - 70+ Years
SCHEDULE OF BENEFITS
When your covered Injury or Sickness requires treatment by a physician, this
program will provide benefits for the Usual and Customary (U&C) charges
scheduled below which exceed the chosen Per Person Deductible (either $75 or
$150, or a $250 deductible for age 70 and over) for each Injury and each Sickness
and which are incurred within the 52 weeks following the Injury or Sickness
(within 32 weeks for those insureds age 70 and over). Payment for any covered
service will be no more than the Benefit Limit shown for it. The total payable
by all Benefits will be no more than $50,000 or $100,000 for each Injury and
each Sickness.
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
|
Age 14 days to Age 69 |
Age 14 days to Age 69 |
Age 70 and over |
| Maximum Limit |
$50,000 Max per Injury / Sickness |
$100,000 Max per Injury / Sickness |
$50,000 Max per Injury / Sickness |
| INPATIENT |
| Hospital Room & Board including miscellaneous |
Up to $1,650/day, 30 day max |
Up to $2,300/day, 30 day max |
Up to $1,200/day, 30 day max |
| Hospital Intensive Care Unit |
Additional $700/day, 8 day max |
Additional $975/day, 8 day max |
Additional $500/day, 8 day max |
| Surgical Treatment |
Up to $4,000 |
Up to $6,600 |
Up to $3,200 |
| Anesthetist |
Up to $1,000 |
Up to $1,650 |
Up to $800 |
| Assistant Surgeon |
Up to $1,000 |
Up to $1,650 |
Up to $800 |
| Physician's Non-Surgical Visits |
Up to $70/visit, 1/day, 30 visits |
Up to $95/day, 1/day, 30 visits |
Up to $60/visit, 1/day, 30 visits |
| Consultant Physician, when requested by
attending Physician |
Up to $500 |
Up to $575 |
Up to $450 |
| Pre-Admission Tests within 7 days before
Hospital admission |
Up to $1,300 |
Up to $1,300 |
Up to $900 |
| Private Duty Nurse |
Up to $650 |
Up to $650 |
Up to $650 |
| OUTPATIENT |
| Surgical Treatment |
Up to $4,000 |
Up to $6,600 |
Up to $3,200 |
| Anesthetist |
Up to $1,000 |
Up to $1,650 |
Up to $800 |
| Assistant Surgeon |
Up to $1,000 |
Up to $1,650 |
Up to $800 |
| Physician's Non-Surgical Visits |
Up to $70/visit, 1/day, 30 visits |
Up to $95/day, 1/day, 30 visits |
Up to $60/visit, 1/day, 30 visits |
| Diagnostic X-rays & Lab Services |
Up to $500
Additional $325 -
One Cat scan, PET scan or MRI |
Up to $575
Additional $975 -
One Cat scan, PET scan or MRI |
Up to $450
Additional $325 -
One Cat scan, PET scan or MRI |
| Hospital Emergency Room |
75% of U&C to $400 max |
75% of U&C to $650 max |
75% of U&C to $325 max |
| Prescription Drugs |
Up to $135 |
Up to $200 |
Up to $100 |
| Day surgery miscellaneous, related to outpatient
scheduled surgery performed at a Hospital or licensed outpatient surgery
center; including the cost of operating room, anesthesia, drugs and medicines
and medical supplies. |
Up to $1,150 |
Up to $1,325 |
Up to $1,000 |
| OTHERS |
| Ambulance Services |
Up to $500 |
Up to $500 |
Up to $500 |
| Initial Orthopedic Prosthesis / brace |
Up to $1,325 |
Up to $1,600 |
Up to $1,000 |
| Chemotherapy and / or radiation therapy |
Up to $1,325 |
Up to $1,600 |
Up to $1,000 |
| Dental Treatment for Injury to Sound, Natural
Teeth |
Up to $650 |
Up to $650 |
Up to $650 |
| Mental & Nervous Disorder & Substance
Abuse |
Same as any Sickness |
Same as any Sickness |
Same as any Sickness |
| Maternity (conception occurs at least 90
days after your effective date) |
Up to $2,800 |
Up to $2,800 |
N/A |
| Physiotherapy |
Up to $45/visit, 1/day, 12 visits |
Up to $45/visit, 1/day, 12 visits |
Up to $45/visit, 1/day, 12 visits |
| Emergency Evacuation |
$10,000 |
$10,000 |
$10,000 |
| Repatriation of Remains |
$7,500 |
$7,500 |
$7,500 |
| AD&D Principal Sum |
$25,000 Common Carrier |
$25,000 Common Carrier |
$25,000 Common Carrier |
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
If you or any covered dependents become sick or injured during the period of
coverage and it has been determined that an Emergency Medical Evacuation is
required to either the nearest medical facility, where appropriate medical treatment
can be obtained, or to your Country of Residence, all eligible expenses incurred
are covered up to $10,000. An Emergency Medical Evacuation must be recommended
by a legally licensed physician who certifies that the severity of the Injury
or Sickness necessitates such Emergency Medical Evacuation, and agreed to by
you or your representative. All arrangements must be coordinated by the Assistance
Provider.
Repatriation of Mortal Remains Expenses
If Injury or Sickness commencing during the Period of Coverage results in death,
all reasonable expenses incurred for preparation and return of the remains to
the Country of Residence are covered up to a maximum of $7,500 provided that
all arrangements are coordinated by the Assistance Provider.
Common Carrier Accidental Death and Dismemberment (AD&D)
Accidental Death and Dismemberment shall apply to covered accidents sustained
by an insured person while riding as a passenger in or on any land, water or
air conveyance operated under a license for the transportation of passengers
for hire. A loss must occur within 365 days after the date of accident causing
the loss:
| For Loss of: |
Indemnity |
| Life |
Principal Sum |
| Both Hands or Both Feet or Sight of Both
Eyes |
Principal Sum |
| One Hand and One Foot |
Principal Sum |
| Either Hand or Foot and Sight of One Eye |
Principal Sum |
| Either Hand or Foot |
One-Half the Principal Sum |
| Sight of One Eye |
One-Half the Principal Sum |
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