| Medical Maximum per Policy: |
$50,000, $100,000, $250,000, $500,000, $1,000,000
*Persons aged 70-79 are eligible for the $50,000 or $100,000 plans only |
| Medical Deductible |
$0 |
| Co-insurance per Policy: |
100% of Covered Expenses up to the policy maximum |
| Primary / Secondary |
Primary |
| Medical Expense Benefits |
(subject to Policy Maximum, Deductible and Co-Insurance) |
| Hospital Room and Board Charges: |
The average semi-private room rate |
| ICU Room and Board Charges: |
three times the average semi-private room rate |
| Outpatient Medical: |
Usual customary charge to the selected Medical Maximum |
| Emergency Medical Treatment of Pregnancy: |
$2,500 per Policy Period |
| Mental or Nervous Disorders: |
$2,500 per Policy Period |
| Physiotherapy/Physical Medicine/Chiropractic: |
$50 per visit per day; up to 10 visits per Policy Period |
| Dental Treatment (injury or emergency alleviation of pain): |
$500 per Policy Period |
| Doctor Visits, X-rays and Prescriptions, Ambulance: |
Usual customary charge to the selected Medical maximum |
| Unexpected Recurrence of a Pre-existing Condition: |
the first $20,000 of Covered Expenses up to age 65 or the first $10,000 for over age 65 |
| Benefit Period |
1 year from the dates of the Covered Accident or Sickness |
| Additional Benefits |
(not subject to Policy Maximum, Deductible or Co-Insurance) |
| Accidental Death and Dismemberment Principle Sum: |
$25,000 per adult - $10,000 per child
|
| Coma Benefit: |
$10,000 |
| Felonious Assault and Violent Crime: |
100% up to $50,000 |
| Adaptive Home and Vehicle: |
$5,000 |
| Seatbelt Benefit: |
10% up to $50,000 |
| Airbag Benefit: |
10% up t0 $50,000 |
| Hijacking and Air or Water Piracy: |
Covered |
| Emergency Medical Evacuation: |
100% up to $2,000,000 |
| Political/Natural Disaster Evacuation: |
$25,000 |
| Repatriation or Remains: |
100% up to $1,000,000 |
| Emergency Reunion: |
$15,000 |
| Return of Minor Child(ren) or Travel Companion: |
$5,000 |
| Hospital Confinement: |
pays you $150 in addition to paying the hospital |
| Basic Lost Baggage: |
$1,000 per Policy Period |
| Trip Cancellation: |
100% of the insured Trip Cost |
| Trip Interruption: |
150% of the insured Trip Cost |
| Trip Delay: |
$1,000 per person - $100 daily limit - Covered after 12 hour delay |
| Missed Departure: |
100% of the actual cost up to $1,000 -
Covered after a 12 hour delay |
| Loss of Passport: |
Up to $250 |
| Optional Benefits |
|
| Upgrade AD&D |
up to $500,000 |
| Home Country Coverage/Follow Me Home Coverage |
See benefit page 6 |
| Athletic Sports Coverage |
See benefit page 6 |
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