Plan SummaryOverview Provides coverage for individuals, families, and groups who need temporary medical insurance while traveling for business or pleasure anywhere outside of your home country. | |
Maximum Limits | $50,000, $100,000, $500,000, $1,000,000 |
Individual Deductible Options | $0, $100, $250, $500, $1,000, $2,500 |
Coinsurance for treatment received in the U.S. | In the PPO network: Company pays 100% Out of the PPO network: Company pays 80% of eligible expenses up to $5,000, then 100% |
Pre-Certification | 50% reduction of eligible medical expenses if pre-certification provisions are not met |
Medical Benefits | |
Home Nursing Care | Up to the maximum limit (Upon direct transfer from an acute care facility) |
Radiology/X-ray | Up to the maximum limit |
Hospital Indemnity | Up to $100 per overnight of a required overnight stay in a hospital |
Intensive Care | Up to the maximum limit |
Assistant surgeon | 20% of primary surgeon’s charge |
Bedside Visit | $1,500 maximum limit. Must be hospitalized in an intensive care unit. Not subject to deductible. |
Outpatient Surgical / Hospital Facility | Up to the maximum limit |
Laboratory | Up to the maximum limit |
Chemotherapy / Radiation Therapy | Up to the maximum limit |
Pre-Admission Testing | Up to the maximum limit |
Reconstructive Surgery | Up to the maximum limit (surgery is incidental to and follows surgery that was covered under the plan) |
Anesthesia | Up to the maximum limit |
Chiropractic Care | Up to the maximum limit (medical order or treatment plan required) |
Extended Care Facility | Up to the maximum limit (upon direct transfer from an acute care facility) |
Interfacility Ambulance Transfer | Company pays 100% (transfer from one licensed health care facility to another licensed health care facility resulting in an inpatient hospital admission) |
Emergency Eye Examination (Loss or damage to prescription corrective lenses due to an accident) | $150 maximum limit. $50 deductible per occurrence. Subject to coinsurance. |
Hospitalization/Room & Board | Average semi-private room rate up to the maximum limit. Includes nursing service |
Emergency Local Ambulance | Up to the maximum limit. Subject to deductible and coinsurance (Injury or illness resulting in an inpatient
hospital admission) |
Prescriptions | Up to the maximum limit (Dispensing limit per prescription: 90 days) |
Physician Visits/Services | Up to the maximum limit |
Physical Therapy | Up to the maximum limit (Medical order or treatment plan required) |
Walk-In Clinic | $15 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
Urgent Care Clinic | $25 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
Hospital Emergency Room (Inside the U.S.) | Injury not subject to emergency room deductible. Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in direct inpatient hospital admission. Up to the maximum limit |
Hospital Emergency Room (Outside the U.S.) | Up to the maximum limit |
Surgery | Up to the maximum limit |
Evacuation | |
Emergency Medical Evacuation | $1,000,000 (Must be approved in advance and coordinated by the company) |
Political Evacuation & Repatriation | $100,000 maximum limit. Not subject to deductible (Must be approved in advance by the company)
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Return of Mortal Remains or Cremation/Burial | Up to the maximum limit for return of mortal remains or ashes to country of residence, or $5,000 maximum limit for cremation or local burial at the place of death. Not subject to deductible (Must be approved in advance by the company) |
Return of Minor Children | $100,000 maximum limit. Not subject to deductible (Must be approved in advance by the company)
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Emergency Reunion | $100,000 maximum limit. Not subject to deductible (Must be approved in advance by the company) |
Natural Disaster Evacuation | $25,000 maximum limit. Not subject to deductible (Must be approved in advance by the company) |
Trip Protection | |
Natural Disaster | $250 per day and maximum limit of five days for accommodations. Not subject to deductible. |
Small Pet Common Air Carrier Accidental Death | $500 maximum limit. Not subject to deductible. (For a pet cat or dog up to 30 pounds traveling with the insured person) |
Lost Luggage | $50 per item, $500 maximum limit. Not subject to deductible |
Trip Interruption | $10,000 maximum limit. Not subject to deductible |
Identity Theft | $500 maximum limit. Not subject to deductible |
Terrorism | $50,000 maximum limit. Not subject to deductible |
Dental | |
Traumatic Dental Injury (Treatment at a hospital facility due to an accident) | Up to the maximum limit. Subject to deductible and coinsurance. Additional treatment for the same injury rendered by a dental provider will be paid at 100%. |
Dental Treatment | $300 maximum limit due to dental accident or unexpected pain to sound natural teeth. Subject to deductible and coinsurance |
Additional Benefits | |
Accidental Death & Dismemberment (AD&D) | $50,000 principal sum. Death must occur within 90 days of the accident. Not subject to deductible |
Common Carrier Accidental Death | $25,000 per injured child, $100,000 per insured adult, $250,000 maximum limit per family. Not subject to deductible |
Durable Medical Equipment | Up to the maximum limit |
Incidental Trip | 14 consecutive days maximum limit (Insured person's country of residence is not the U.S.) |
Personal Liability | $25,000 combined maximum limit. Injury to a third person: $100 per injury deductible. Damage to a third person's property: $100 per damage deductible. No coverage for injury to a related third party or damage to related third person's property. (secondary to any other insurance) |
Pet Return | $1,000 maximum limit. Not subject to deductible. (For a pet cat or dog traveling with the insured person) |
Plan SummaryOverview Addresses the insurance needs of non-U.S. residents who need temporary medical insurance while traveling for business or pleasure to the United States.The plan provides a wide range of plan maximum limits and deductible options, and it is available for a minimum of five days up to a maximum of two years, in accordance with the terms of the Certificate of Insurance. | |
Maximum Limits | $50,000, $100,000, $500,000, $1,000,000 |
Individual Deductible Options | $0, $100, $250, $500, $1,000, $2,500 |
Coinsurance for treatment received in the U.S. | In the PPO network: Company pays 100% Out of the PPO network: Company pays 80% of eligible expenses up to $5,000, then 100% |
MyIMG | 24 hour secure access from anywhere in the world to manage your account at anytime |
World-Class Medical Benefits | Coverage available for inpatient and outpatient medical expenses |
Medical Benefits | |
Home Nursing Care | Up to the maximum limit (Upon direct transfer from an acute care facility) |
Hospital Indemnity | $250 per overnight inpatient confinement, maximum limit of 10 overnights. Not subject to deductible |
Intensive Care | Up to the maximum limit |
Hospital Emergency Room (Outside the U.S.) | Up to the maximum limit |
Hospital Emergency Room (Inside the U.S.) | Injury not subject to emergency room deductible. Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in direct inpatient hospital admission. Up to the maximum limit |
Assistant surgeon | 20% of primary surgeon’s charge |
Bedside Visit | $1,500 maximum limit. Must be hospitalized in an intensive care unit. Not subject to deductible. |
Outpatient Surgical / Hospital Facility | Up to the maximum limit |
Laboratory | Up to the maximum limit |
Chemotherapy / Radiation Therapy | Up to the maximum limit |
Pre-Admission Testing | Up to the maximum limit |
Reconstructive Surgery | Up to the maximum limit (surgery is incidental to and follows surgery that was covered under the plan) |
Anesthesia | Up to the maximum limit |
Chiropractic Care | Up to the maximum limit (medical order or treatment plan required) |
Extended Care Facility | Up to the maximum limit (upon direct transfer from an acute care facility) |
Interfacility Ambulance Transfer | Company pays 100% (transfer from one licensed health care facility to another licensed health care facility resulting in an inpatient hospital admission) |
Emergency Eye Examination (Loss or damage to prescription corrective lenses due to an accident) | $150 maximum limit. $50 deductible per occurrence. Subject to coinsurance. |
Prescriptions | Up to the maximum limit (Dispensing limit per prescription: 90 days) |
Hospitalization/Room & Board | Average semi-private room rate up to the maximum limit. Includes nursing service |
Walk-In Clinic | $15 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
Urgent Care Clinic | $25 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
Emergency Local Ambulance | Up to the maximum limit |
Eligible Medical Expenses | Up to the maximum limit |
Evacuation | |
Emergency Medical Evacuation | $1,000,000 maximum limit. Not subject to deductible (Must be approved in advance and coordinated by the company) |
Political Evacuation & Repatriation | $100,000 maximum limit. Not subject to deductible (Must be approved in advance by the company)
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Return of Mortal Remains or Cremation/Burial | Up to the maximum limit for return of mortal remains or ashes to country of residence, or $5,000 maximum limit for cremation or local burial at the place of death. Not subject to deductible |
Return of Minor Children | $100,000 maximum limit. Not subject to deductible (Must be approved in advance by the company)
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Emergency Reunion | $100,000 maximum limit. Not subject to deductible (Must be approved in advance by the company) |
International Emergency Care | A wide range of international emergency benefits available including emergency evacuation, emergency reunion, return of mortal remains, return of minor children, and more |
Natural Disaster Evacuation | $25,000 maximum limit. Not subject to deductible (Must be approved in advance by the company) |
Trip Protection | |
Natural Disaster | $250 per day and maximum limit of five days for accommodations. Not subject to deductible. |
Small Pet Common Air Carrier Accidental Death | $500 maximum limit. Not subject to deductible. (For a pet cat or dog up to 30 pounds traveling with the insured person) |
Identity Theft | $500 maximum limit. Not subject to deductible |
Lost Luggage | Up to $50 per item; maximum of $250. Not subject to deductible |
Trip Interruption | $5,000 maximum. Not subject to deductible |
Terrorism | $50,000 maximum limit. Not subject to deductible |
Pre-Existing Conditions | |
Acute Onset of Pre-Existing Conditions (Insured person must be under 70 years of age) | Up to the maximum limit $25,000 maximum limit for emergency medical evacuation |
Dental | |
Traumatic Dental Injury (Treatment at a hospital facility due to an accident) | Up to the maximum limit. Subject to deductible and coinsurance. Additional treatment for the same injury rendered by a dental provider will be paid at 100%. |
Dental Treatment | $300 maximum limit due to dental accident or unexpected pain to sound natural teeth. Subject to deductible and coinsurance |
Additional Benefits | |
Accidental Death & Dismemberment (AD&D) | $50,000 principal sum. Death must occur within 90 days of the accident. Not subject to deductible |
Common Carrier Accidental Death | $25,000 per injured child, $100,000 per insured adult, $250,000 maximum limit per family. Not subject to deductible |
Incidental Trip | 14 consecutive days maximum limit (Insured person's country of residence is not the U.S.) |
Personal Liability | $25,000 combined maximum limit. Injury to a third person: $100 per injury deductible. Damage to a third person's property: $100 per damage deductible. No coverage for injury to a related third party or damage to related third person's property. (secondary to any other insurance) |
Pet Return | $1,000 maximum limit. Not subject to deductible. (For a pet cat or dog traveling with the insured person) |
Plan SummaryOverview Provides first-class protection for the discerning international traveler who wants to obtain the maximum coverage available in a short-term travel medical insurance product. Additionally, the plans offer enhanced benefits and services to meet your global travel needs. You can choose from an extensive range of deductibles and maximum limits, you have exclusive access to our Global Concierge and Assistance ServicesSM, and you have access to more than 17,000 providers through our International Provider AccessSM (IPA) when seeking treatment outside the U.S. | |
Maximum Limits | $2,000,000, $5,000,000, $8,000,000 |
Individual Deductible Options | $0, $100, $250, $500, $1,000, $2,500, $5,000, $10,000, $25,000 |
Coinsurance for treatment received in the U.S. | In the PPO network: Company pays 100% Out of the PPO network: Company pays 90% of eligible medical expenses up to $5,000, then 100% |
Global Concierge & Assistance Services | Access to a dedicated service team for assistance services |
Period of Coverage | Five days up to 12 months |
World-Class Medical Benefits | Premium coverage available for inpatient and outpatient |
eDocAmerica | Access to board-certified physicians, licensed psychologists, pharmacists, dentists, dieticians, and fitness trainers to assist with any routine health-related questions |
MyIMG | 24 hour secure access from anywhere in the world to manage your account at anytime |
Medical Benefits | |
Hospital Indemnity | $250 per overnight inpatient confinement, maximum limit of 10 overnights. Not subject to deductible |
Supplemental Accident | Maximum limit per covered accident: $300 |
Intensive Care | Up to the maximum limit |
Urgent Care Clinic | $25 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
Walk-In Clinic | $15 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
Prescriptions | Up to the maximum limit (Dispensing limit per prescription: 90 days) |
Hospital Emergency Room (Inside the U.S.) | Injury not subject to emergency room deductible. Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in direct inpatient hospital admission. Up to the maximum limit |
Assistant surgeon | 20% of primary surgeon’s charge |
Bedside Visit | $1,500 maximum limit. Must be hospitalized in an intensive care unit. Not subject to deductible. |
Outpatient Surgical / Hospital Facility | Up to the maximum limit |
Laboratory | Up to the maximum limit |
Chemotherapy / Radiation Therapy | Up to the maximum limit |
Pre-Admission Testing | Up to the maximum limit |
Reconstructive Surgery | Up to the maximum limit (surgery is incidental to and follows surgery that was covered under the plan) |
Anesthesia | Up to the maximum limit |
Chiropractic Care | Up to the maximum limit (medical order or treatment plan required) |
Extended Care Facility | Up to the maximum limit (upon direct transfer from an acute care facility) |
Interfacility Ambulance Transfer | Company pays 100% (transfer from one licensed health care facility to another licensed health care facility resulting in an inpatient hospital admission) |
Emergency Eye Examination (Loss or damage to prescription corrective lenses due to an accident) | $150 maximum limit. $50 deductible per occurrence. Subject to coinsurance. |
Hospital Emergency Room (Outside the U.S.) | Up to the maximum limit |
Emergency Local Ambulance | Up to the maximum limit |
Hospitalization/Room & Board | Average semi-private room rate up to the maximum limit. Includes nursing service |
Eligible Medical Expenses | Up to the maximum limit |
Evacuation | |
Remote Transportation | $5,000 per certificate period / $20,000 maximum limit |
Emergency Medical Evacuation | Up to the maximum limit |
Return of Mortal Remains or Cremation/Burial | Up to the maximum limit for return of mortal remains or ashes to country of residence, or $5,000 maximum limit for cremation or local burial at the place of death. Not subject to deductible |
Return of Minor Children | up to $100,000 |
Political Evacuation & Repatriation | Up to $100,000 |
Emergency Reunion | Up to $100,000 |
International Emergency Care | A wide range of international emergency benefits available including emergency evacuation, emergency reunion, return of mortal remains, return of minor children, and more |
Natural Disaster Evacuation | $25,000 maximum limit. Not subject to deductible (Must be approved in advance by the company) |
Trip Protection | |
Identity Theft | Up to $500 |
Small Pet Common Air Carrier Accidental Death | $500 maximum limit. Not subject to deductible. (For a pet cat or dog up to 30 pounds traveling with the insured person) |
Lost Luggage | Up to $500; $50 per item |
Trip Interruption | up to $10,000 |
Terrorism | Up to the maximum limit |
Natural Disaster | $250 per day and maximum limit of five days for accommodations. Not subject to deductible. |
Pre-Existing Conditions | |
Acute Onset of Pre-Existing Conditions (Insured person must be under 70 years of age) | United States citizens: Age 64 and under without a primary health plan:
Age 69 and under:
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Dental | |
Traumatic Dental Injury (Treatment at a hospital facility due to an accident) | Up to the maximum limit. Subject to deductible and coinsurance. Additional treatment for the same injury rendered by a dental provider will be paid at 100%. |
Dental Treatment | $300 maximum limit due to dental accident or unexpected pain to sound natural teeth. Subject to deductible and coinsurance |
Additional Benefits | |
Accidental Death & Dismemberment (AD&D) | $50,000 principal sum. Death must occur within 90 days of the accident. Not subject to deductible |
Incidental Trip | 14 consecutive days maximum limit During the period of coverage, an insured person may return to his/her home country for incidental visits up to a cumulative two weeks total, and retain continuing coverage during such visit(s), subject to: 1) The insured person must have left their home country, 2) The total Period of Coverage must be for a minimum of 30 days, and 3) The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling. (Insured person’s country of residence is not the U.S.) |
Common Carrier Accidental Death | $100,000 per adult, $25,000 per child, maximum of $250,000 per family |
Personal Liability | $25,000 combined maximum limit. Injury to a third person: $100 per injury deductible. Damage to a third person's property: $100 per damage deductible. No coverage for injury to a related third party or damage to related third person's property. (secondary to any other insurance) |
Pet Return | $1,000 maximum limit. Not subject to deductible. (For a pet cat or dog traveling with the insured person) |
Plan SummaryOverview International travel can quickly turn into a frightening situation if you're not prepared for a medical emergency. Most travelers assume they will be covered by their standard medical plan, but that isn't always the case. While traditional plans may offer adequate domestic coverage, many are not designed for international travel. Without even realizing it, you may be putting your health at risk. Don't let your medical coverage be an uncertainty. Travel with a Visitors Care® plan so you can spend more time enjoying your international experience and less time worrying about medical coverage. Visitors Care offers a broad package of scheduled benefits for individuals traveling and/or temporarily residing outside of their home country for a minimum of five days. There are nine separate options based on deductible levels and maximum limits. Simply select the option that best fits your needs. | |
Maximum Limits | Plan A: $25,000 |
Medical Benefits | |
Extended Care Facility (Upon direct transfer from an acute care hospital) | Plan A: Covered under Hospital Room & Board |
Anesthesia | Plan A: Up to $450 max per surgical session |
Pre-Admission Testing | Plan A: Inpatient - Up to $750 max per period of coverage |
Physical Therapy (Medical order or treatment plan required) | Plan A: Up to $40 max per visit per day, 12 max visits per period of coverage |
Intensive Care | Plan A: Inpatient - Up to an additional $400 max per day, 8 day max per period of coverage |
Home Nursing Care Provided by a home healthcare agency upon direct transfer from an acute care hospital | Plan A: $550 max per period of coverage |
Durable Medical Equipment | Plan A: $550 max per period of coverage |
Chemotherapy/Radiation Therapy | Plan A: $550 max per visit |
Urgent Care Center | Plan A: $40 max per visit/10 max visits |
Physician Visits/Services | Plan A: Outpatient - $40 max per visit, 30 max visits per period of coverage Inpatient - $40 max per visit, 30 max visits per period of coverage |
Radiology/X-ray Laboratory | Plan A: Outpatient - Up to $400 max per period of coverage ($200 per procedure) |
Outpatient Surgical/Hospital Facility | Plan A: Outpatient - Up to $2,000 max per surgical session, up to $750 max per surgical session (facility) |
Surgery | Plan A: In-Patient & Outpatient - Up to $2,000 max per surgical session |
Assistant Surgeon (20% of the primary surgeon’s eligible fee) | Plan A: Up to $450 max per surgical session |
Emergency Local Ambulance | Plan A: Up to $250 max per period of coverage |
Hospital Emergency Room | Plan A: Outpatient - $200 max per visit |
Hospitalization/Room & Board (Average semi-private room rate;includes nursing, misc., and ancillary services) | Plan A: Inpatient - Up to $825 max per day 30 day max per period of coverage |
Prescriptions (Dispensing limit: 90 days) | Plan A: Outpatient - Up to $250 max per period of coverage |
Evacuation | |
Return of Mortal Remains | Plan A: $25,000 max with $5,000 max for Cremation/Burial |
Emergency Medical Evacuation | Plan A: Up to $25,000 max |
Pre-Existing Conditions | |
Acute Onset of Pre-Existing Conditions | Plan A: $25,000 max per coverage period (subject to sub-limits) |
Dental | |
Dental Injury | Plan A: Up to $550 max per period of coverage |
Additional Benefits | |
Incidental Trip Maximum days: 14 Insured person's country of residence is not the United States | 14 day maximum |
Common Carrier Accidental Death | $25,000 max per period of coverage |
Plan SummaryOverview International travel can quickly turn into a frightening situation if you're not prepared for a medical emergency. Most travelers assume they will be covered by their standard medical plan, but that isn't always the case. While traditional plans may offer adequate domestic coverage, many are not designed for international travel. Without even realizing it, you may be putting your health at risk. Don't let your medical coverage be an uncertainty. Travel with a Visitors Care® plan so you can spend more time enjoying your international experience and less time worrying about medical coverage. Visitors Care offers a broad package of scheduled benefits for individuals traveling and/or temporarily residing outside of their home country for a minimum of five days. There are nine separate options based on deductible levels and maximum limits. Simply select the option that best fits your needs. | |
Maximum Limits | Plan B: $50,000 |
Medical Benefits | |
Extended Care Facility (Upon direct transfer from an acute care hospital) | Plan B: Covered under Hospital Room & Board |
Anesthesia | Plan B: Up to $825 max per surgical session |
Pre-Admission Testing | Plan B: Inpatient - Up to $1,100 max per period of coverage |
Physical Therapy (Medical order or treatment plan required) | Plan B: Up to $40 max per visit per day, 12 max visits per period of coverage |
Intensive Care | Plan B: Inpatient - Up to an additional $660 max per day, 8 day max per period of coverage |
Home Nursing Care Provided by a home healthcare agency upon direct transfer from an acute care hospital | Plan B: $550 max per period of coverage |
Durable Medical Equipment | Plan B: $1,000 max per period of coverage |
Chemotherapy/Radiation Therapy | Plan B: $1,100 max per visit |
Urgent Care Center | Plan B: $60 max per visit/10 max visits |
Physician Visits/Services | Plan B: Outpatient - $60 max per visit, 30 max visits per period of coverage Inpatient - $60 max per visit, 30 max visits per period of coverage |
Radiology/X-ray Laboratory | Plan B: Outpatient - Up to $450 max per period of coverage ($250 per procedure) |
Outpatient Surgical/Hospital Facility | Plan B: Outpatient - Up to $3,300 max per surgical session, up to $900 max per surgical session (facility) |
Surgery | Plan B: In-Patient & Outpatient - Up to $3,300 max per surgical session |
Assistant Surgeon (20% of the primary surgeon’s eligible fee) | Plan B: Up to $825 max per surgical session |
Emergency Local Ambulance | Plan B: Up to $450 max per period of coverage |
Hospital Emergency Room | Plan B: Outpatient - $330 max per visit |
Hospitalization/Room & Board (Average semi-private room rate;includes nursing, misc., and ancillary services) | Plan B: Inpatient - Up to $1,400 max per day 30 day max per period of coverage |
Prescriptions (Dispensing limit: 90 days) | Plan B: Outpatient - Up to $250 max per period of coverage |
Evacuation | |
Return of Mortal Remains | Plan B: $25,000 max with $5,000 max for Cremation/Burial |
Emergency Medical Evacuation | Plan B: Up to $50,000 max |
Pre-Existing Conditions | |
Acute Onset of Pre-Existing Conditions | Plan B: $50,000 max per coverage period (subject to sub-limits) |
Dental | |
Dental Injury | Plan B: Up to $550 max per period of coverage |
Additional Benefits | |
Incidental Trip Maximum days: 14 Insured person's country of residence is not the United States | 14 day maximum |
Common Carrier Accidental Death | $25,000 max per period of coverage |
Plan SummaryOverview International travel can quickly turn into a frightening situation if you're not prepared for a medical emergency. Most travelers assume they will be covered by their standard medical plan, but that isn't always the case. While traditional plans may offer adequate domestic coverage, many are not designed for international travel. Without even realizing it, you may be putting your health at risk. Don't let your medical coverage be an uncertainty. Travel with a Visitors Care® plan so you can spend more time enjoying your international experience and less time worrying about medical coverage. Visitors Care offers a broad package of scheduled benefits for individuals traveling and/or temporarily residing outside of their home country for a minimum of five days. There are nine separate options based on deductible levels and maximum limits. Simply select the option that best fits your needs. | |
Maximum Limits | Plan C: $100,000 |
Medical Benefits | |
Extended Care Facility (Upon direct transfer from an acute care hospital) | Plan C: Covered under Hospital Room & Board |
Anesthesia | Plan C: Up to $1,375 max per surgical session |
Pre-Admission Testing | Plan C: Inpatient - Up to $1,100 max per period of coverage |
Physical Therapy (Medical order or treatment plan required) | Plan C: Up to $40 max per visit per day, 12 max visits per period of coverage |
Intensive Care | Plan C: Inpatient - Up to an additional $850 max per day, 8 day max per period of coverage |
Home Nursing Care Provided by a home healthcare agency upon direct transfer from an acute care hospital | Plan C: $550 max per period of coverage |
Durable Medical Equipment | Plan C: $1,300 max per period of coverage |
Chemotherapy/Radiation Therapy | Plan C: $1,350 max per visit |
Urgent Care Center | Plan C: $85 max per visit/10 max visits |
Physician Visits/Services | Plan C: Outpatient - $85 max per visit, 30 max visits per period of coverage Inpatient - Up to $85 max per visit, 30 max visits per period of coverage |
Radiology/X-ray Laboratory | Plan C: Outpatient - Up to $500 max per period of coverage ($500 per procedure) |
Outpatient Surgical/Hospital Facility | Plan C: Outpatient - Up to $5,500 max per surgical session, up to $1,000 max per surgical session (facility) |
Surgery | Plan C: In-Patient & Outpatient - Up to $5,500 max per surgical session |
Assistant Surgeon (20% of the primary surgeon’s eligible fee) | Plan C: Up to $1,375 max per surgical session |
Emergency Local Ambulance | Plan C: Up to $475 max per period of coverage |
Hospital Emergency Room | Plan C: Outpatient - $550 max per visit |
Hospitalization/Room & Board (Average semi-private room rate;includes nursing, misc., and ancillary services) | Plan C: Inpatient - Up to $2,000 max per day 30 day max per period of coverage |
Prescriptions (Dispensing limit: 90 days) | Plan C: Outpatient - Up to $250 max per period of coverage |
Evacuation | |
Return of Mortal Remains | Plan C: $25,000 max with $5,000 max for Cremation/Burial |
Emergency Medical Evacuation | Plan C: Up to $50,000 max |
Pre-Existing Conditions | |
Acute Onset of Pre-Existing Conditions | Plan C: $100,000 max per coverage period (subject to sub-limits) Emergency Medical Evacuation (arises or results directly or indirectly from ta covered acute onset of a pre-existing condition): $25,000 max per period of coverage |
Dental | |
Dental Injury | Plan C: Up to $550 max per period of coverage |
Additional Benefits | |
Incidental Trip Maximum days: 14 Insured person's country of residence is not the United States | 14 day maximum |
Common Carrier Accidental Death | $25,000 max per period of coverage |