|
|
|
||||
|
Medical Coverage for Individuals Traveling Outside Their Home Country
WHY YOU NEED INTERNATIONAL MEDICAL COVERAGE
International travel and relocation have become common,
if not routine for both groups and individuals from all nationalities. Unfortunately, many travelers are misinformed or unfamiliar with how their primary health insurance plan will actually pay a claim incurred outside the United States. The fact is: Most, if not all, U.S. based health plans don’t provide any of the following services in the event of an emergency abroad:
ELIGIBILITY
Diplomat International provides Accident and Sickness medical
coverage, Accidental Death and Dismemberment benefits
and Travel Assistance to individuals while traveling outside
their Home Country, but not to the United States. Coverage is available
to you, your spouse and unmarried dependent children, ages 14 days up to 18 years.
Coverage for travelers coming to the United States is available through Diplomat America. Coverage for up to 36 months is available through the Diplomat LT. Customized coverage can be obtained for groups of 5 or more.
PERIOD OF COVERAGE
The minimum period of coverage that can be purchased under this plan is 15 days and the maximum is 12 months. Coverage can be purchase in 15 day and/or monthly increments to suit your needs.
Effective Date
Coverage will begin on the latest of the following:
Expiration Date
Coverage will end on the earlier of the following:
Premium Refund
Refund of premium, less a $25 processing fee, will be considered only if written request is received by Global Underwriters prior to the effective date of coverage. After that date, the premium is considered fully earned
and non-refundable. Partial refunds are not available.
DESCRIPTION OF BENEFITS
All coverage, benefits and premiums are in U.S. Dollar amounts. If an Injury or Illness occurs outside the USA during the Period of Coverage and the Insured Person requires medical or surgical treatment; this plan will pay, subject to the selected deductible and applicable co-insurance, the following Covered Expenses, up to the selected policy maximum.
Covered Expenses
Only such expenses incurred as the result of and within 52 weeks from a Disablement, which shall mean an illness or an accidental bodily Injury necessitating medical treatment, and which are specifically enumerated in the following list of charges:
Policy Maximum Choices
Plan A - $50,000,
Plan B - $100,000, Plan C - $500,000, Plan D - $1,000,000 Persons up to age 69 are eligible for all plans; Persons age 70-79 are eligible for plans A and B; Persons age 80+ are eligible for Plan A only.
Deductible Choices
$100, $250, $500, $1,000, $2,500 per person per policy period.
Co-insurance
After you pay your selected deductible this plan will pay 100%
of Covered Expenses outside the USA and Canada up to the selected policy maximum. Any Covered Expenses incurred in the USA and Canada are paid at 80% of the first $5000 then 100% to the policy maximum. Eligible expenses are based on Regular & Customary charges.
Lost Baggage
Coverage is provided if a checked baggage is lost due to theft or misdirection if the Insured is a ticketed passenger on any land, water or air conveyance licensed for the transportation of passengers. Benefits will be paid only in excess of amounts paid or payable by the Common Carrier or any other valid and collectible insurance. $50 per Bag/$250 Maximum.
Trip Interruption
Coverage is provided if an Insured is unable to continue his/her trip due to; a) death, occurring prior to the Insured’s return to his/her Home Country, of an Insured Person’s Immediate Family Member; b) serious damage to the Insured Person’s principal residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane, etc.) $5,000 Maximum.
In Hospital Benefit
If you are in the Hospital while traveling outside of the United States or Canada, and the Hospital is considered a Covered Expense, the program will pay the covered Insured $100 for each night spent in the Hospital for a maximum of 10 consecutive days (this benefit is in addition to any other expenses of the program).
Emergency Medical Evacuation
The Company will pay benefits for Covered Expenses incurred for the necessary Emergency Medical Evacuation of an Insured Person up to a $100,000 maximum. Emergency Medical Evacuation means: a) the Insured Person’s medical condition warrants immediate transportation from the place where the Insured Person is Injured or Ill, to the nearest Hospital where appropriate medical treatment can be obtained; or b) after being treated at a local Hospital, the Insured Person’s medical condition warrants transportation to his/her Home Country to obtain further medical treatment or to recover. Covered Expenses are expenses for the transportation, medical services and supplies recommended by the attending Physician and necessarily incurred, in connection with an Insured Person’s Emergency Medical Evacuation. All transportation for an Insured Person’s Emergency Medical Evacuation must be arranged by AIG Assist utilizing the most direct and economical conveyance.
Emergency Reunion
In the event of an Emergency Medical Evacuation due to a covered Injury or Illness, where the Physician feels that it would be beneficial for the Insured to have a Family Member at their side during transport, the Company will reimburse the Insured for travel and lodging expenses, up to a maximum of $10,000.00. AIG Assist must make all arrangements and must authorize all expenses in advance. The Company reserves the right to determine the benefit payable, including reductions, if it is not reasonably possible to contact AIG Assist in advance.
Repatriation of Remains Expenses
If Injury or Illness commencing during the period of coverage results in death, all reasonable expenses incurred for preparation and return of the remains to your Home Country are covered up to a maximum of $20,000. The Repatriation must be arranged by AIG Assist utilizing the most direct and economical conveyance.
Emergency Dental Benefit
With regard to dental care up to $100 per tooth for the necessary treatment of sudden, unexpected pain to sound natural teeth is allowable.
Definitions
The term "Home Country" shall mean, the country where an eligible person(s) has his/her fixed and permanent home establishment and to which he/she has the intention of returning.
The term "Hospital" shall mean, a facility that: (1) is operated according to law for the care and treatment of Injured people; (2) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis; (3) has 24 hour nursing service by registered nurses (R.N.’s); and (4) is supervised by one or more Physicians. A Hospital does not include: (1) a nursing, convalescent or geriatric unit of a Hospital when a patient is confined mainly to receive nursing care; (2) a facility that is, other than incidentally, a rest home, nursing home, convalescent home or home for the aged; nor does it include any ward, room, wing, or other section of the Hospital that is used for such purposes; or (3) any military or veterans Hospital or soldiers home or any Hospital contracted for or operated by any national government or government agency for the treatment of members or exmembers of the armed forces. The term "Illness" shall mean, sickness or disease of any kind first manifested, treated or diagnosed after the effective date of coverage for an Insured Person; and causing loss covered by this Plan. The term "Injury" shall mean, bodily Injury caused solely and directly by violent, accidental, external, and visible means occurring while the Policy is in force; and resulting directly and independently of all other causes of loss covered by this Plan. The term "Physician" shall mean, a licensed practitioner of the healing arts acting within the scope of his or her license who is not: (1) the Insured; (2) an Immediate Family Member; or (3) retained by the Policyholder. Such definition will exclude chiropractors and physiotherapists. In the event services are provided by chiropractors or physiotherapists these healthcare professionals must be licensed and acting within the scope of their license and may not be (1) the Insured; (2) an Immediate Family Member; or (3) retained by the Policyholder. The term "Immediate Family Member" means a person who is related to the Insured in any of the following ways: spouse, brother-in-law, sister-in-law, daughter-in-law, son-in-law, mother-in-law, father-in-law, parent (includes stepparent), brother or sister (includes stepbrother or stepsister), or child (includes legally adopted or stepchild). The term "Pre Existing Condition" means any Injury or Illness which was contracted or which manifested itself, or for which treatment or medication was prescribed three (3) years prior to the effective date of this insurance.
EXCLUSIONS
Unless Home Country Coverage has been purchased, no benefit shall be payable for any expenses or losses incurred for:
ACCIDENTAL DEATH AND DISMEMBERMENT
The amount of the Principal Sum is $25,000
If Injury to the Insured results, within 365 days of the date of the accident that caused the Injury, in any one of the types of losses specified below, the Company will pay the percentage of the Principal Sum shown below for that type of loss:
The term "loss" as used herein shall mean, with regard to hands and feet, actual severance through or above wrist or ankle joint, and with regard to eyes, entire irrecoverable loss of sight.
Paralysis Benefit
If Injury to the Insured results, within 365 days of the date of the accident that caused the Injury, in any one of the types of paralysis specified below, the Company will pay the percentage of the Principal Sum shown below for that type of paralysis:
"Quadriplegia" means the complete and irreversible paralysis of both upper and both lower limbs.
"Paraplegia" means the complete and irreversible paralysis of both lower limbs. "Hemiplegia" means the complete and irreversible paralysis of the upper and lower limbs of the same side of the body. "Uniplegia" means the complete and irreversible paralysis of one limb. "Limb" means entire arm or entire leg. If the Insured suffers more than one type of paralysis as a result of the same accident, only one amount, the largest, will be paid.
Excess Benefits
All Coverage, except Accidental Death & Dismemberment, shall be in excess of all other valid and collectible insurance.
For Accidental Death and Dismemberment Indemnity this plan does not cover any loss caused by or resulting from:
OPTIONAL RIDERS
Hazardous Activity Coverage
Motorcycling, scuba diving, jet, snow, and water skiing, mountain climbing, sky diving, amateur racing, piloting any aircraft, bungee jumping, spelunking, whitewater rafting, surfing, and parasailing coverage.
Athletic Coverage
For participation in amateur, club, intramural, interscholastic or intercollegiate tennis, swimming, cross country, track, baseball, softball, volleyball and golf sports only. All other sports must be approved in advance by the Company.
Home Country Coverage
If a covered person has been enrolled on this plan for a minimum of 30 days, coverage for an incidental trip to your Home Country, as listed on your application, is available up to a maximum of two (2) months per twelve (12) months of coverage. Coverage shall be prorated five (5) days for each month purchased, in the event that an insured person’s coverage is less than twelve (12) months. Any claims paid are subject to the deductible and co-insurance and the medical benefit amount is reduced by 50% to a maximum of $ 75,000.
PREMIUMS
Rates are based on a $250 deductible. This plan is for individuals outside their home country.
For travel in excess of fifteen days, a daily rate can be calculated by dividing the fifteen day
rate by fifteen to get a per day rate.
If you are choosing a deductible other than $250, multiply the premium shown above by the following
deductible factor:
Optional Riders and Factors:
Hazardous Activity 1.25
Athletic 1.20 Home Country 1.10
Return the completed application and total premium payment to:
BuyAmericanInsurance.com 3105 Broken Bow Way, Suite 100 Plano, TX 75093, USA Make check or money order payable to Global Underwriters Agency, Inc. Credit card application can be faxed to: (972) 767- 4470
ADMINISTRATOR AND UNDERWRITER
Diplomat International is administered by
Global Underwriters (GU).
Underwritten by The Insurance Company of the State of Pennsylvania, a member company of American International Group, Inc. (AIG), rated A+ Superior by A.M. Best.
08/2004
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||