Diplomat America Insurance

  • Comprehensive benefits plan
  • For Non-U.S. citizens traveling to U.S.A. only
  • After deductible, Plan pays 80% of $5,000 and then 100% to policy maximum
  • Cancelable and Not Renewable
  • Deductible and Policy Maximum are per coverage period per person
  • Coverage is available from 15 days to 12 months for ages 14 days to 100 years
  • No PPO Network
  • Administrator: Global Underwriters
    Underwriter: US Fire Insurance Company
  • Other Benefits:  • Accidental Death and Dismemberment  •Coma Benefit  •Emergency Dental Treatment (Palliative)  •Emergency Medical Evacuation and Repatriation  •Emergency Medical Reunion  •Felonious Assault Benefit  •Home Alteration and Vehicle Modification  •Interruption of Trip  •Loss of Baggage  •Paralysis Benefit  •Political and Natural Disaster Evacuation  •Return of Minor Child(ren)  •Return of Mortal Remains  •Seat Belt and Airbag Benefit
  • Optional Riders:  • Athletic, Sports, and Hazardous Activity  •Enhanced AD&D  •Enhanced Political & Natural Disaster

Benefits

FeatureCoverage
Medical MaximumPlan A - $50,000, Plan B - $100,000, Plan C - $250,000, Plan D - $500, 000, Plan E - $1,000,000; Persons age 60-69 are eligible for plan A, B, and C. Persons age 70 – 79 are eligible for plans A and B; Persons age 80+ are eligible for a maximum benefit of $20,000.
Co-insurance After you pay the selected deductible, the plan pays 80% up to $5,000 of eligible costs, then 100% to the Medical Maximum. There will be an additional $250 deductible for each emergency room visit as a result of an Illness. The emergency room deductible will be waived if hospital admittance is within 12 hours of the incident.
Deductible Choices $0, $50, $100, $250, $500, $1,000, $2,500, $5,000 per person/policy period.
OUTPATIENT TREATMENT
Doctor/ urgent care visits To policy maximum
Hospital emergency room (all expenses incurred therein) To policy maximum. Extra $250 penalty/visit if ER visit for a sickness (not injury/accident) does not result in hospital admission within 12 hours of incident
Prescription drugs To policy maximum
Diagnostic x-rays lab services To policy maximum
Surgical treatment To policy maximum
Anesthetist To policy maximum
Assistant surgeon To policy maximum
Outpatient surgical facility To policy maximum
INPATIENT TREATMENT
Hospital room and board including miscellaneous To policy maximum, average semi-private room
Intensive care unit To policy maximum, 2 times average semi-private room rate
Surgical treatment To policy maximum
Anesthetist To policy maximum
Assistant surgeon To policy maximum
Physician's non-surgical visits To policy maximum
Consult physician, when requested by attending physician To policy maximum
Private duty nurse To policy maximum
Pre-admission tests within 7 days before hospital admission To policy maximum
OTHER TREATMENT AND SERVICES
Cardiovascular event Same as any other eligible medical expense
Local ambulance To policy maximum
Initial orthopedic prosthesis/brace To policy maximum
Physical therapy To policy maximum
Pre-Existing Condition Exclusion24 Months prior to the start date of coverage
PPO within USA None
PPO outside USA None
Hazardous sports Optional
Benefit period for continued treatment following termination date of policy52 weeks
DENTAL
Dental - Acute, unexpected pain 100
Dental - Accident related emergency To policy maximum
TRAVEL BENEFITS
Emergency medical evacuation/repatriation 500000
Return of mortal remains 50000
Emergency reunion 50000
Return of minor child(ren) 50000
Trip interruption 5000
Loss of checked luggage $50 per bag, $250 max
LIFE
Accidental Death & Dismemberment (AD&D) 25000
Common carrier accidental death 25000
OTHER BENEFITS
Terrorism coverage To policy maximum
Natural disaster benefit 50000
Renewable No, This policy is not renewable
Cancellation policy Before effective date, full refund minus $25 cancellation fee. After effective date, no refund.
Policy durations Min 15 days to Max 1 year (multiples of 15 days only)