| Policy Maximum |
| Per plan period
Plan (A-E)
|
$50,000; $100,000; $250,000; $500,000; $1,000,000
Persons age 60-69 are eligible for plans of $50,000, $100,000, and $250,000 (A-C). Persons age 70 – 79 are
eligible for plans $50,000 and $100,000 (A&B); Persons age 80+ are eligible for a maximum benefit of $20,000
|
|
Deductible
|
|
Per plan period
|
$0, $50, $100, $250, $500, $1,000, $2,500, $5,000
|
|
ER Deductible
|
$250; waived if admitted within 12 hours
|
|
Coinsurance
|
After you pay the selected deductible, the plan pays 80% up to $5,000 of eligible costs, then 100% to the
Medical Maximum.
|
|
Pre-Existing Conditions
|
|
Acute Onset
(under the age of 70)
|
Up to Policy Maximum
|
|
Hospital services
|
|
Hospital Room and Board
|
URC
|
|
Hospital Miscellaneous Expense
|
URC
|
|
ICU
|
URC
|
|
Local Ambulance
|
URC
|
|
Miscellaneous Surgery and Surgeon (In or Outpatient) Benefits
|
URC
|
|
Diagnostic X-Ray and Laboratory Testing
|
URC
|
|
Physiotherapy
|
Inpatient: URC
Outpatient: $50 a day/10 day maximum
|
|
Physician Benefit
|
URC
|
|
Prescription Medication
|
30 day supply
|
|
International Emergency Care
|
|
Emergency Medical Evacuation and Repatriation
|
$500,000
|
|
Return of Mortal Remains
|
$50,000
|
|
Emergency Medical Reunion
|
$50,000
|
|
Return of Minor Child
|
$50,000
|
|
Political and Natural Disaster
|
$50,000
|
|
Additional Benefits
|
|
Trip Interruption
|
$5,000
|
|
Loss of Baggage
|
$50 per article; up to a maximum of $250
|
|
Incidental Trip
|
maximum of 15 days for Incidental Trips outside of the US to Canada, Mexico, and the Caribbean Islands only
|
|
Felonious Assault
|
$25,000
|
|
Dental Care
|
|
Accident
|
URC
|
|
Alleviate the Onset of Pain
|
Up to $100
|
|
Accidental Death and Dismemberment
|
$25,000; optional add on for 18+ up to $1 Mil
|
|
Common Carrier AD&D
|
$25,000
|
