Reside Blue Worldwide Insurance

Plan Summary

Reside Blue Worldwide Insurance provides a medical program for professional mariners throughout the world. Regardless of the type of vessel, Mariners require coverage that provides security, flexibility and benefits unique to the demands of today's Marine Industry.

Policy Maximum	Maximum medical coverage is $50,000 or $100,000 per each injury or sickness. For 70+ age group coverage is limited to $50,000.
Deductible	resideblueworldwide-marineinsurance.asp
Co-insurance	Plan will pay 100% of the covered amount.
Eligibility	- For non-United States citizens immigrating to the US or visiting for business, pleasure or to study	- Age: 14 days to 99 years - Policy must become effective within 24 months of arrival in US.
Pre-Existing Condition Definition	- Pre-existing conditions are any Injury or Illness that meets the following criteria: 1) A condition that would have caused a person to seek medical advice, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2) A condition for which manifestation, medical advice, diagnosis, care or treatment (including medication) was recommended or received prior to the Effective Date of coverage under this Certificate; 3) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate.
Pre-Existing Condition Coverage	- If an existing condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by a rider, your pre-existing condition will be covered up to a lifetime maximum of $50,000 ($5,000 limit per year) after you have been continuously insured for 24 months.
Coverage	- Hospital room & board charges - Hospital intensive care unit charges - Physician (hospital & doctor office visits), surgeon, nursing services fee	- Diagnostics: X-Rays, MRI, CAT scan, urinanalysis etc - Prescription Drugs - Dental: Only injury to sound natural teeth covered
Plan Life	1 month to 5 years
Underwriter	Reside blue is underwritten by Certain Underwriters at Lloyd's of London
Buy - Online	Apply & purchase online Reside Blue Worldwide Insurance
Brochure	Complete, mail/fax the Reside Blue Worldwide Insurance Brochure along with payment

Reside Blue Worldwide Insurance benefits

The Reside Prime program is available to persons of any country who are at least 15 days of age and who have not yet reached age 75. For US Citizens: Applicants / Insured Persons must either be outside the United States at the time. For Non-US Citizens: Applicants / Insured Persons must be outside the United States at the time of application.

Schedule of Benefits

Lifetime Maximum Benefit	$5,000,000 per Insured Person.
Policy Period Deductible Options	$250; $500; $1,000; $2,500; $5,000 Maximum of 3 Deductible payments for families enrolling on one Application. Any Eligible Expenses incurred and applied to your Policy Period Deductible in the last 30 days prior to your renewal date will carry over and be applied to the next Policy Period Deductible.
Outside of the United States	After the Deductible, the Policy pays 100% of Eligible Expenses to the Policy Maximum. Hospital Admissions must be Pre-Notified using Seven Corners’ Pre-Notification Program.
Inside of the United States	After the Deductible, the Policy pays 80% of the next $5,000 of Eligible Expenses, then 100% up to the Policy Maximum. Expenses incurred inside the United States and Canada must be Pre-Notified using Seven Corners’ Pre-Notification Program. If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.
Inpatient Hospital Expenses	Average Semi-Private room and board; Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-Rays up to the Policy Maximum.
Intensive Care	Intensive Care room and board; Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-rays up to the Policy Maximum.
Surgery	URC Charges for Surgery, Physician and Anesthetics up to the Policy Maximum.
Outpatient Treatment	Usual, Reasonable, and Customary (URC) Charges for Emergency Treatment, Surgery, Prescription Medication up to the Policy Maximum.
Physiotherapy, Chiropractic	Up to $75 per visit ($10,000 Lifetime Maximum), when referred in advance by a Physician.
Medical Supplies	URC Charges up to Policy Maximum.
Ambulance	URC Charges up to Policy Maximum.
Well Child Care	Up to $200 Policy Period Maximum for checkups and routine visits after 12 month waiting period. Up to age 18.
Maternity	Usual, Reasonable, and Customary (URC) Charges up to $7,500 per pregnancy, must be pre-notified within the first 90 days of pregnancy. Waiting period of 12 months before maternity benefit begins.
Mental & Nervous	Usual, Reasonable, and Customary (URC) Charges up to a Maximum of $10,000 per Policy Period after 12-month waiting period. Inpatient limited to a maximum of 45 days per Policy Period. Outpatient limited to a maximum of 40 visits per Policy Period at 70% of Eligible Expenses. Lifetime Maximum of $30,000.
Dental	Usual, Reasonable, and Customary (URC) Charges for repair and replacement of sound, natural teeth damaged as a result of an accident, limited to $500 per Policy Period. A Dental Benefit Rider may be purchased to expand Dental Coverage.
Emergency Medical Evacuation	$250,000 Limit per person per Policy Period – when adequate medical facilities and/or treatment is not available when traveling outside your current Country of Residence. (Preapproval required.) (pre-approval required).
Repatriation of Remains	$25,000 Limit per person – when traveling outside your current Country of Residence. (Preapproval required.)
Emergency Medical Reunion	$10,000 Limit per person per Policy Period – when traveling outside your current Country of Residence. (Pre-approval required).
Preventive Benefits	Females and Males up to $250 policy period maximum for checkups, routine physical exams, inoculations and vaccinations, female preventative exams and mammograms after 12- month waiting period. Not subject to deductible or coinsurance.
AccidentalDeath & Dismemberment (AD&D)	Principal Sum: $10,000 for Insured and Spouse, $2,000 for Dependent Children. For Common Carrier, Principal Sum: $40,000 for Insured and Spouse, $8,000 for Dependent Children.
Lifetime Transplant Benefit	Up to $1,000,000 per Insured Person.
Newborn Benefit	$25,000 lifetime maximum for the first 31 days after birth.
well child care	Up to $200 policy period maximum for checkups and routine visits after 12-month waiting period. Up to age 18.

Who Needs Reside Blue Worldwide Insurance?

Professional Mariners require a medical program that they can depend on to protect them throughout the world. Regardless of the type of vessel, Mariners require coverage that provides security, flexibility and benefits unique to the demands of today’s Marine Industry. With coverage onboard the vessel and when signed off, you have a true universal policy, created for the Mariner Lifestyle. Sail and travel anywhere with the confidence that you are protected with comprehensive, marine-specific coverage providing the safety that you deserve.

Eligilibity

The Reside Prime program is available to persons of any country who are at least 15 days of age and who have not yet reached age 75.

The Reside Blue program is available to persons of any country who are at least 15 days of age and who have not yet reached age 75. All applicants / insured persons must be currently or usually an Employee aboard a sea going vessel and expect to be outside the United States at least 6 months per year. All members must also not be eligible and/or able to secure adequate US domestic health insurance, which provides continuous coverage worldwide. All applicants / insured persons must complete the Declaration of Residence for or provide a non-U.S. resident address.

For U.S. Citizens: All applicants / insured persons must either be outside the United States at the time of application, or must depart the United States within 30 days of the certificate’s effective Date. In addition, the applicant / insured person must not reside inside the United States greater than 9 months during any given 12-month period to meet the eligibility requirements of an applicant / insured person. Should any applicant / insured person reside in the United States longer than 9 months during any given 12-month period, their coverage shall immediately terminate.

*It is the insured person’s responsibility to maintain all records regarding travel history, age and student status and provide any documents to the administrator, which would verify the Eligibility Requirements.

Rewnewability

The initial Period of Coverage cannot exceed twelve (12) months. The Insured Person, however, may apply for renewal of coverage at the Renewal Rates in force at the time of renewal. The renewal Period of Coverage may not total more than twelve (12) months. Renewal(s) will be contingent upon the Insured Person submitting the applicable renewal premiums for their class, as determined by the Company. Renewal(s) will also be contingent upon the Insured Person declaring that they continue to meet the Eligibility Requirements.

Maternity

Reside blue provides maternity and newborn child benefits to eligible Insured Persons. See Schedule of Benefits for limits and conditions. A pregnancy must be Pre-Notified during the first 90 days of the pregnancy. Failure to Pre-Notify a pregnancy will result in a 25% reduction in eligible benefits. The plan does not pay expenses related to a pregnancy within the first 12 months of coverage.

Newborn Child Coverage

When a parent remains eligible for coverage and the pregnancy is considered an eligible pregnancy, newborn children are automatically covered for the first thirty-one (31) days after birth. In no event shall the Company’s maximum liability exceed the maximum stated in the Schedule of Benefits.

In order to continue coverage beyond the first thirty-one (31) days and be accepted as any other new Insured Person subject to the Insurance Provisions, Scope of Coverage and Exclusions sections of this Certificate or other sections relating to a Newborn Child(ren) up to the maximum amount of this Certificate the following conditions must be met: (1) An Application and any applicable premium is submitted and Approved by the Company within thirty-one (31)m days of the birth of a Newborn Child(ren); (2) The Pregnancy that led to the birth of a Newborn Child(ren) was an eligible pregnancy covered under this Certificate; (3) The mother of the Newborn Child(ren) remain covered under this Certificate; (4) The mother and Newborn Child(ren) meets and will continue to meet the Eligibility Requirements of this Certificate.
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Limitations

Pre-existing Conditions:

If an existing condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by a rider, your pre-existing condition will be covered up to a lifetime maximum of $50,000 ($5,000 limit per year) after you have been continuously insured for 24 months.

Pre-existing conditions are any Injury or Illness which meets the following criteria: 1) A condition that would have caused a person to seek medical advice, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2) A condition for which manifestation, medical advice, diagnosis, care or treatment (including medication) was recommended or received prior to the Effective Date of coverage under this Certificate; 3) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate.

Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or symptoms occur during the first 180 days of coverage hereunder beginning on the initial effective date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder. Note: coverage for such illnesses or surgeries may be further limited under the pre-existing condition exclusion and definition contained herein, or other exclusions contained herein; and

The following conditions, treatments, supplies, services, and/or expenses are not covered:

(This is a Summary of the Exclusions contained in the Certificate of Coverage.)

Pre-existing conditions as defined above.
Claims not presented to Company within ninety (90) days following incident.
Treatment not medically necessary, treatment which exceeds reasonable and customary charges, treatment provided at no cost to the Insured Person, or treatment performed by a relative or anyone who lives with the Insured Person.
Experimental treatment.
Suicide or any attempted suicide.
War or warlike operations.
Injury in organized, professional, amateur, or interscholastic athletics.
Routine physicals or procedures.
Treatment of Temporomandibular joint.
Vocational, Speech, Recreational or Music Therapy.
Cosmetic surgery except as a result of a covered accident.
Dental or eye treatment unless otherwise covered.
Injuries as a result of disablement due to liquor or drugs.
Telephone consultations.
Treatment or services relating to custodial, rehabilitative, or nursing home care.
Congenital conditions.
Non-medical expenses.
Self-inflicted injury or illness.
Expenses in connection with the commission or attempt of a criminal offense.
Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing, scuba diving (unless PADI, NAUI, YMCA, SSI or PDIC certified).
Treatment of venereal or sexually transmitted disease.
Treatment due to HIV or AIDS.
Drug treatment relating to infertility.

This brochure is only a brief description of RESIDE Prime. A complete description of the Master Policy Provisions and Benefits is contained in the Certificate of Insurance, which will be mailed to you once your application and premium have been received and approved by Seven Corners.