Eligibility
Underwriter
Optional Riders
Coinsurance? Acute Onset of a Pre-existing Condition| Benefits | Coverage |
| Hospital room and board | Average semi-private room rate up to the maximum limit. Includes nursing service |
| Intensive care | Up to the maximum limit |
| Surgery | Up to the maximum limit |
| Physician visits | Up to $15 copay for walk-in clinic. Up to $25 copay for urgent care center. (Copay not applicable when $0 deductible is selected) |
| Emergency local ambulance | Up to the maximum limit |
| Emergency room accident | Up to the maximum limit |
| Emergency dental treatment | $300 maximum limit due to accident or unexpected pain to sound natural teeth. |
| Traumatic Dental Injury | Up to the period of coverage maximum limit. Subject to deductible and coinsurance. (Treatment at a hospital due to an accident) |
| Emergency medical evacuation | $1,000,000 maximum limit. (independent of the maximum limit) |
| Emergency reunion | $50,000 maximum limit. |
| Return of mortal remains or cremation/burial | $50,000 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. |
| Return of minor children | $50,000 maximum limit. |
| Political evacuation | $10,000 maximum limit. |
| Natural disaster | Up to $250 per day and maximum limit of five days for accommodations. Not subject to deductible. |
| Terrorism | Up to $50,000 maximum limit. |
| Hospital indemnity | Up to $100 per overnight up to a maximum of 10 overnights. |
| Common carrier accidental death | $50,000 per insured person and $250,000 maximum limit per lifetime and per family. |
| Accidental death & dismemberment | $25,000 principal sum. |
| Hospital Emergency Room:International | Up to the maximum limit |
| Hospital Emergency Room:United States | Injury not subjected to emergerncy room deductible. Illness:Subject to a $250 deductible to each emergency room visit for treatment that does not result in direct inpatient. |
| Trip interruption | $10,000 maximum limit. Not subject to deductible |
| Intensive Care | Up to the maximum limit |
| Terrorism | $50,000 maximum limit. Not subject to deductible |
| 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 |
| Laboratory | Up to the maximum limit |
| Physical Therapy | Up to the maximum limit |
| Assistant Surgeon | 20% of the primary surgeon’s eligible fee |
| Pet Return | $1,000 maximum limit. Not subject to deductible |
| Small Pet Common Air Carrier Accidental Death Benefit | $500 maximum limit. Not subject to deductible. |
| Interfacility Ambulance Transfer | Company pays 100% |
| Lost luggage | $50 per item, $500 maximum limit. Not subject to deductible |
| Identity Theft | $500 maximum limit. Not subject to deductible |
| Pre-Certification | 50% reduction of eligible medical expenses if pre-certification provisions are not met |
| 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. |
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