TripTime | Benefits

Benefits GoTime PrimeTime
Policy Maximum $50,000, $100,000, $250,000, $500,000, $1,000,000 $50,000, $100,000, $250,000, $500,000, $1,000,000, $2,000,000
Deductible $0, $100, $250, $500, $1,000, $2,500 $0, $100, $250, $500, $1,000, $2,500, $5,000
Coinsurance

In Network: 100%

Out of Network: 80% up to $10,000; 100% after up to the maximum

Outside of US: 100%
Eligible Medical Expenses subject to Deductible and Coinsurance
Physician/Urgent Care/Walk-in Clinic Up to policy maximum
Outpatient Up to policy maximum
Hospital room and board Up to policy maximum
ICU Up to policy maximum
Physical Therapy
(physician ordered)		 Max of $50 per visit, 10 visits; subject to deductible and coinsurance
Emergency Room Up to policy maximum; $350 deductible if not admitted
Acute Onset of Pre-Ex Excluding US:
  • 14 days–64 years old: Up to policy maximum with primary insurance
  • 14 days–64 years old: $20,000 without primary insurance
  • 65–69 years old: $2,500
  • 70+ years old: No Coverage
Including US:
  • No Coverage
 Excluding US:
  • 14 days–64 years old: Up to policy maximum or $1,000,000; whichever is less with primary insurance
  • 14 days–64 years old: $20,000 without primary insurance
  • 65-69 years old: $2,500
  • 70+ years old: No Coverage
Including US:
  • 14 days–69 years old: $50,000
  • 70+ years old: $10,000
Local Ambulance
(if admitted to the hospital)		 Injury: $5,000
Illness: $5,000 		Injury or Illness: Up to policy maximum
Prescriptions
(For a covered injury or illness)		 Maximum supply of 30 days
Dental Treatment Acute Onset of Dental Pain: up to $100 maximum (policy must be active for at least 30 days)
Accident: up to policy maximum 		Acute Onset of Dental Pain: up to $300 maximum (policy must be active for at least 30 days)
Accident: up to policy maximum
Emergency Eye Exam No Coverage $150 maximum
Deductible: $50
Emergency Medical Evacuation

$500,000

65–79: $50,000
80+: No Coverage

$1,000,000

65–79: $100,000
80+: No Coverage
Emergency Reunion $50,000 $100,000
Repatriation of Remains $50,000 $100,000
Local Burial/Cremation $5,000
Return of Minor Child(ren) $50,000 $100,000
Accidental Death 14 days–17: $1,250
18–69: $25,000
70–74: $12,500
75+: $5,000
Accidental Dismemberment Loss of 1 limb or eye: 50% of accidental death benefit
Loss of more than one limb or eye: 100% of accidental death benefit
Common Carrier Accidental Death 100% of accidental death benefit
Hospital Indemnity $100 per night, max of 10 nights $250 per night, max of 10 nights
Trip Interruption $5,000 $10,000
Lost Checked Luggage $50 per item, $250 max $50 per item, $500 max
Incidental Trip Home (coverage for US citizens and US Residents) Up to 15 days per 90 days of coverage; plan pays 80% to the selected Maximum Benefit
Personal Liability No Coverage $25,000
Optional Coverage
Personal Equipment Coverage Covered Sports Equipment: $1,000
Covered Photography Equipment: $1,000
Covered Electronics and Communications Equipment: $500
Emergency Pet Care Veterinary Emergency Care: $100
Emergency Kennel: $20 per day, maximum of 5 days
Emergency Pet Transportation: $500
Adventure Sports 14 days–49 years: $50,000
50–59 years: $25,000
60–64 years: $10,000
65+ years: No coverage
Marine Activities 14 days–49 years: $100,000
50-64 years: $50,000
65-69 years: $10,000
70+ years: No coverage
Please note: The benefit table listed above is a consolidated version of the full plan benefits. Please view the plan master certificate for full details of the plan.

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