| Brochure |
| Worldmed Inbound Brochure |
Worldmed Outbound Brochure |
| Period of Coverage |
| 5 days to 364 days |
5 days to 364 days |
| Medical Expense Options |
| $500,000, $1,000,000, or $2,000,000 |
$500,000, $1,000,000, or $2,000,000 |
| Deductible Options |
| $0, $250, $500, $1,000, or $2,500 per certificate period |
$0, $250, $500, $1,000, or $2,500 per certificate period |
| Coinsurance – Claims Incurred in the U.S. |
- In-Network Payment - 100% after deductible, up to the overall the overall maximum
- Out of network payment - Usual, reasonable and customary. You may be responsible for charges exceeding payable amount
|
- In-Network Payment - 100% after deductible, up to the overall the overall maximum
- Out of network payment - Usual, reasonable and customary. You may be responsible for charges exceeding payable amount
|
| Coinsurance – Claims Incurred outside the U.S. |
| Plan pays 100% after deductible, up to the overall maximum limit |
Plan pays 100% after deductible, up to the overall maximum limit |
| Hospital Room and Board |
| Average semi-private room rate, including nursing services |
Average semi-private room rate, including nursing services |
| Intensive Care Unit |
| Up to the overall maximum limit |
Up to the overall maximum limit |
| Local Ambulance |
| Usual, reasonable and customary charges |
Usual, reasonable and customary charges |
| Emergency Room Co-payment |
Claims incurred in U.S.: $250 co-pay for emergency room for an illness unless you are admitted to the hospital. No co-pay for emergency room treatment of an injury.
Claims incurred outside the U.S.: No co-payment.
|
Claims incurred in U.S.: $250 co-pay for emergency room for an illness unless you are admitted to the hospital. No co-pay for emergency room treatment of an injury.
Claims incurred outside the U.S.: No co-payment.
|
| Acute Onset of Pre-existing Condition(excludes chronic and congenital conditions) |
Under age 60 up to $200,000
For age 60 to 69 years up to $20,000 |
Under age 60 up to $200,000
For age 60 to 69 years up to $20,000 |
| Outpatient Physical Therapy and Chiropractic Care |
| Usual, reasonable and customary charges. Must be ordered in advance by a physician |
Usual, reasonable and customary charges. Must be ordered in advance by a physician |
| Emergency Dental Treatment |
| Up to $1,000 due to accident and up to $100 for acute onset of pain |
Up to $2,000 due to accident and up to $200 for acute onset of pain |
| Urgent Care Facility Co-payment |
Claims incurred in the U.S.: Up to $25 co-pay for urgent care center. (Copay not applicable when $0 deductible is selected)
Claims incurred in the U.S.: No co-payment.
|
Claims incurred in the U.S.: Up to $50 co-pay for urgent care center. (Copay not applicable when $0 deductible is selected)
Claims incurred in the U.S.: No co-payment.
|
| Accidental Death & Dismemberment |
| Under age 18 up to $5,000 lifetime maximum and age 18 to 69 up to $50,000 lifetime maximum. $250,000 maximum benefit any one family or group |
Under age 18 up to $5,000 lifetime maximum and age 18 to 69 up to $50,000 lifetime maximum. $250,000 maximum benefit any one family or group |
| Emergency Medical Evacuation |
| Up to $1,000,000 lifetime maximum |
Up to $1,000,000 lifetime maximum |
| Return of Minor Children |
| Up to $50,000 |
Up to $50,000 |
| Repatriation of Remains |
| Up to $50,000 |
Up to $50,000 |
| Emergency Reunion |
| Up to $100,000, subject to a maximum of 15 days |
Up to $100,000, subject to a maximum of 15 days |
| Terrorism |
| Up to $50,000 lifetime maximum |
Up to $50,000 lifetime maximum |
| Political Evacuation |
| Up to $100,000 lifetime maximum |
Up to $50,000 lifetime maximum |
| Trip Interruption |
| Up to $10,000 |
Up to $10,000 |
| Hospital Indemnity |
| Up to $100 per day for 5 days for inpatient hospitalization |
Up to $100 per day for 5 days for inpatient hospitalization |
| Lost Baggage |
| Up to $500 |
Up to $1,000 |
| Stolen Passport or Visas |
| Up to $100 |
Up to $100 |
| Personal Liability |
Up to $10,000 lifetime maximum
$10,000 third person injury
$10,000 third person property
$2,500 related third person property |
Up to $10,000 lifetime maximum
$10,000 third person injury
$10,000 third person property
$2,500 related third person property |
| Natural Disaster |
| Up to $250 a day for 5 days |
Up to $100 a day for 5 days |
| Emergency Eye Exam |
| Up to $150 ($50 deductible per occurrence) |
Up to $150 ($50 deductible per occurrence) |
| Crisis Response Rider |
| Up to $100,000 per certificate period, $10,000 for Natural Disaster Evacuation |
Up to $100,000 per certificate period, $10,000 for Natural Disaster Evacuation |
| Border Entry Protection |
| Up to $500 |
Not Covered |
| Optional Add-On Benefits |
- Intercollegiate or Interscholastic Sports Rider up to $20,000.
- Hazardous Activities Rider up to the overall maximum limit.
- Accidental death & dismemberment buy ups up to $100,000.
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- Intercollegiate or Interscholastic Sports Rider up to $20,000.
- Hazardous Activities Rider up to the overall maximum limit.
- Accidental death & dismemberment buy ups up to $100,000.
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Worldmed insurance Underwriter
