|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||Up to the maximum limit. Additional $250 deductible if not admitted as an inpatient.|
|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. Not subject to deductible. Must be approved in advance and coordinated by the company.|
|Emergency reunion||$50,000 maximum limit. Not subject to deductible. Must be approved in advance and coordinated by the company.|
|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.
Not subject to deductible.
|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.|
|Physical Therapy||Up to the maximum limit.|
|Trip interruption||Up to $5,000|
|Lost luggage||Up to $50 per item; maximum of $250.|
|Identity Theft||$500 maximum limit. Not subject to deductible.|
|Hospital Emergency Room:International||Deductible waived|
|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.
|Incidental Trips to Home Country||14 consecutive days maximum limit|
|Personal Liability||Injury to third person: $100 per injury deductible Damage to third person's property: $100 per injury deductible|