| Medical Insurance |
Silver
Subject to deductible and coinsurance
|
Gold
Subject to deductible and coinsurance
|
Platinum
Subject to deductible and coinsurance
|
| Coverage Area |
Worldwide Or Worldwide Excluding US and Canada |
Worldwide Or Worldwide Excluding US and Canada |
Worldwide Or Worldwide Excluding US and Canada |
| |
| Policy Maximum Per Individual |
US$5,000,000 lifetime |
US$5,000,000 lifetime |
US$8,000,000 lifetime |
| |
| Room and Board |
$600 per day (maximum of 240 consecutive days per covered event) |
Average semi-private room rate. |
Private room rate |
| |
Hospitalization
• Semi-private room and board
• Nursing services
• Prescription medication
• Physician charges
• Diagnostic and laboratory testing
• X-rays
• Chemotherapy and radiation
• Durable medical equipment
• Treatment, services and supplies routinely provided
|
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
| |
| Intensive Care Unit |
$1,500 per day (maximum of 180 consecutive days per covered event) |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
| |
Surgery
• Surgical care
• Second surgical opinion
• Anesthetics
• Physician charges for surgery
• Treatment, services and supplies routinely provided
|
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
| |
Transplants
Limited to certain transplants and covered only within designated transplant facilities
that are members of 911Abroad's independently-contracted PPO network
|
US$250,000 per transplant |
US$1,000,000 lifetime |
US$2,000,000 lifetime |
| |
Outpatient
• Emergency treatment of illness or injury
• Surgery
• Rehabilitative treatment
• Treatment, services or supplies routinely provided
• Prescription medication
|
Visits/ Exams – 25 visits insured per period of coverage to the maximum limit as outlined: physician $70; specialist $70; psychiatrist $60; chiropractor $50; surgical intervention consultation $500; X-rays - $250 per exam maximum limit: Lab Tests - $300 per exam maximum limit. |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
| |
| Emergency Room Accident |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
| |
| Emergency Transport by Ground Ambulance |
$1,500 per covered event – not subject to deductible or coinsurance |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
| |
| Emergency Medical Evacuation |
$50,000 per period of coverage – not subject to deductible or coinsurance |
Limited to policy maximum – not subject to deductible or coinsurance |
Limited to policy maximum – not subject to deductible or coinsurance |
| |
| Return of Mortal Remains |
$25,000 lifetime maximum per insured – not subject to deductible or coinsurance |
$25,000 lifetime maximum per insured – not subject to deductible or coinsurance |
$50,000 lifetime maximum per insured – not subject to deductible or coinsurance |
| |
| Supplemental Accident |
N/A |
US$300 per occurrence - not subject to the deductible or coinsurance |
US$500 per occurrence - not subject to the deductible or coinsurance |
| |
Child Wellness
Available for eligible children under 18 years of age after 12 months of continuous coverage
|
Three visits per period of coverage – maximum $70 per visit |
US$200 per policy period (not subject to deductible or coinsurance) |
US$400 per policy period (not subject to deductible or coinsurance) |
| |
| Pre-existing Conditions |
$5,000 per period of coverage $50,000 lifetime maximum Available after 24 months of continuous coverage |
$5,000 per period of coverage $50,000 lifetime maximum Available after 24 months of continuous coverage |
SAAI – Same as any illness |
| |
| Mental/Nervous Care |
Outpatient Only – (see Outpatient page 6 of brochure) Available after 12 months of continuous coverage |
$10,000 per period of coverage up to a $50,000 lifetime maximum Available after 12 months of continuous coverage |
SAAI - $50,000 lifetime maximum Available after 12 months of continuous coverage |
| |
| Adult Wellness |
N/A |
$250 per period of coverage – not subject to deductible or coinsurance Available for those 30 years of age and over after 12 months of continuous coverage |
$500 per period of coverage – not subject to deductible or coinsurance Available for those 18 years of age and over after 12 months of continuous coverage |
| |
| Complementary Medicine |
|
Each per policy period |
Each per policy period |
| |
| Acupuncture |
N/A |
US$150 |
US$150 |
| |
| Aroma Therapy |
N/A |
US$50 |
US$50 |
| |
| Herbal Therapy |
N/A |
US$50 |
US$50 |
| |
| Magnetic Therapy |
N/A |
US$75 |
US$75 |
| |
| Massage Therapy |
N/A |
US$150 |
US$150 |
| |
| Vitamin Therapy |
N/A |
US$100 |
US$100 |
| |
Other
• Chiropractor when referred by a physician
• Radiation treatment
• Home nursing care
• Hospice care
• Physical therapy *
• Prosthetic devices
|
* (Physical therapy - maximum US$50 per visit) |
Usual, Reasonable and Customary charges |
Usual, Reasonable and Customary charges |
| |
| Maternity Rider |
Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefits for first 12 months – not subject to deductible or coinsurance. Available after 10 months of coverage- benefits reduced by 50% for births that occur in 11th or 12th month of continuous coverage |
Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefits for first 12 months – not subject to deductible or coinsurance. Available after 10 months of coverage- benefits reduced by 50% for births that occur in 11th or 12th month of continuous coverage |
SAAI – Same as any illness $1,000 additional deductible, $50,000 lifetime maximum $200 child wellness benefit for first 12 months Available after 10 months of coverage |