All amounts shown are in U.S. dollars.
Deductible – Your choice of US$100, $250, $500, $1,000 or $2,500 deductible per insured person, per coverage period
$50 Doctor Office Visit Copay
Medical Maximum Benefits: $25,000, $50,000, $100,000 & $250,000 ( Age 80+ $15,000 policy Maximum)
Coinsurance
– (After deductible paid by insured) -
(See locating PPO Provider on the web sites)
Plan - A In PPO Network: The plan Pays 90% of eligible expenses
up to the Policy Maximum limits.
Plan - A
Out of PPO Network: Pays 70% of eligible expenses up to the Policy Maximum limits.
Outside the U.S. & Canada: No Coinsurance (100%).
New Improved 100% PPO Benefits!
Plan - B In PPO Network: The plan Pays 100% of eligible expenses
up to the Policy Maximum limits.
Plan - B
Out of PPO Network: The plan Pays 70% of the next US$5,000 then 100% of eligible expenses up to the Policy Maximum limits.
Outside the U.S. & Canada: No Coinsurance (100%).
Benefit Period – If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-month Benefit Period may provide continued coverage. When the certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than six months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Policy Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.
Period of Coverage – Minimum 5 days and maximum 12 consecutive months for any one policy period
Emergency Evacuation – Up to US$100,000 when coordinated through the Plan Administrator. This Plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the country of residence or the country where the evacuation occurred.
Repatriation – Up to US$20,000 per adult, US$5,000 per child when coordinated through the Plan Administrator. If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the country of residence will be covered up to a maximum of US$20,000 per adult and US$5,000 per child.
Emergency Reunion – Up to US$15,000 when coordinated through the Plan Administrator. This Plan provides emergency reunion coverage, up to US$15,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the country of residence to be reunited with the insured.
Local Ambulance – To Policy Maximum
Accidental Death and Dismemberment – US$25,000 principal sum. The Plan includes US$25,000 principal sum benefit for Accidental Death and Dismemberment occurring during the Period of Coverage: Accidental Loss of life – principal sum; Accidental Loss of two Members – principal sum; Accidental Loss of one Member – 50% of principal sum. "Member" means hand, foot or eye. For additional information please see the Conditions of Coverage section.
Hospital Room and Board – Average semi-private room rate up to the Policy Maximum.
Intensive Care - Two times the average semi-private room rate up to the Policy Maximum.
Medical Expenses – Usual, reasonable and customary up to the Policy Maximum.
Outpatient Medical – Usual, reasonable and customary up to the Policy Maximum.
Emergency Room – Charges incurred for the use of the Emergency Room due to an accident are covered up to the Policy Maximum. Charges incurred for the use of the Emergency Room for the treatment of an illness are subject to an additional (extra) US$250 deductible if treatment does not require admittance to the hospital.
Prescription Drugs – 80% after the deductible.
Dental – Injury due to an accident: The Plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Policy Maximum. Sudden dental pain: The Plan will pay up to US$100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Returning Minor Children – To US$5,000 when coordinated through the Plan Administrator. If an insured person is hospitalized due to a covered illness/ injury and is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Plan will pay up to US$5,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren).
Special Coverages & Rider – Incidental Home Country Coverage, End of Trip Home Country Coverage, Trip Interruption, Lost Luggage, Common Carrier Accidental Death, and Sports & Activities Coverage
End of Trip Home Country Coverage - For every five months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s).
Trip Interruption - To US$5,000. If, during a covered trip, there is a death of an immediate family member (spouse, child, parent or sibling) or the substantial destruction of the insured's principal residence, the Plan will pay to return the insured to the area of principal residence. The Plan will pay for a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.
Lost Luggage - To US$50 per item of personal property; maximum of US$250 per Period of Coverage. This benefit will be paid in the event that the Common Carrier permanently loses an insured person's checked luggage. This coverage is secondary to any other available coverage, including the Carrier's.
Common Carrier Accidental Death - US$50,000 to Beneficiary; maximum of US$250,000 per family. If accidental death should occur while traveling on a commercial Common Carrier, US$50,000 will be paid to the designated beneficiary, to a maximum of US$250,000 per family.
Sports & Activities Coverage - VMP TM covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. Some of these sports and activities include, but are not limited to, motor cycle/motorscooter riding, scuba diving (to 10m), snorkeling, wakeboarding, and water skiing. However, activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition.
The following hazardous activities are excluded unless the Adventure Sports Rider is purchased: abseiling, BMX, bobsleigh, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, horseback riding, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris. To be covered under the Adventure Sports Rider, these adventure activities must be engaged in solely for leisure, recreation, or entertainment purposes.
Injury sustained while participating in contact sports of any kind, racing of any kind, BASE jumping, kiteboarding, mountaineering or climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty, scuba below 50 meters; and/or adventure sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.