Diplomat Long Term incl USA Insurance

Comprehensive benefits plan
For visitors traveling outside home country (U.S.A. included)
After deductible, Plan pays 80% of $5,000 and then 100% to policy maximum
Cancelable and Not Renewable
Coverage is provided outside of home country including during travel
Deductible and Policy Maximum are per coverage period per person
Coverage is available from 3 months to 36 months for ages 14 days to 100 years
No PPO Network
Administrator: Global Underwriters
Underwriter: US Fire Insurance Company
Monthly pricing only
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 •Home Country Coverage Rider

Benefits

Feature	Benefit
Medical Maximum	Plan A: $500,000 Plan B: $1,000,000
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 ER 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
Pre-Existing Condition Exclusion	18 Months prior to the start date of coverage
Emergency Medical Evacuation and Repatriation	$500,000
Political and Natural Disaster Evacuation	$50,000; ($100,000 available with the purchase of the Enhanced Political and Natural Disaster Evacuation Rider)
Return of Mortal Remains	$50,000
Emergency Medical Reunion	$50,000
Return of Minor Child	$50,000
Interruption of Trip	$5,000
Loss of Baggage	$50 per article; up to a maximum of $250
Emergency Dental Treatment (Palliative)	$100
Accidental Death and Dismemberment (Enhanced Benefit Amounts available)	$25,000
In-Hospital Indemnity (US Citizens only)	$100 per day to a maximum of 10 days
Sudden Recurrence of a Pre-existing Condition (US Citizens only)	up to $20,000; ($2,500 for age 65 and older)

Optional Policy Enhancement Riders
Home Country Coverage Rider- provides limited coverage under Your Medical Expense Benefit while in Your Home Country. The plan pays 80% up to $5,000 of Covered Expenses, then 100% to a maximum of 1) $50,000 for Incidental Trip(s) to your Home Country or 2) $10,000 for Extension of Benefits (Follow Me Home Coverage). (Apply 1.10 factor to your total premium)
Enhanced Political and Natural Disaster Evacuation Benefit The Enhanced Political and Natural Disaster Evacuation Benefit Rider increases the maximum benefit from $50,000 to $100,000. ($30 per person per month)
Athletic Sports & Hazardous Activity Rider - provides coverage if Your Injury or Illness results from the below enumerated Athletic Sports & Hazardous activities NOTE: Any Athletic Sport & Hazardous Activity not expressly covered hereunder is excluded from this policy unless the activity is non-contact and engaged in by You solely for leisure, recreation, entertainment, or fitness purposes only.
Table 1: For the below listed activities apply the 1.25 factor to the base premium: Bobsledding; Bungee Jumping; Canopying; Hang Gliding; Heli-skiing; Horseback Riding; Jet, Snow, and Water Skiing; Kayaking; Martial Arts; Motorcycling & Motor Scooter; Mountain Biking; Mountain Climbing (under 14,000 feet); Paragliding; Parasailing; Piloting any Non-commercial Aircraft; Safari; Scuba Diving, Skydiving; Snowboarding; Snowmobiling; Spelunking; Surfing; Trekking; Whitewater Rafting (up to and including Class V Rapid only); Wind Surfing; Zip Lining.
Table 2: For the below listed activities apply the 1.25 factor to the base premium plus the monthly flat rate listed:
(1) Low Option - additional $25.00 flat monthly rate
Arial Photograph (Use of proper restraints required); BMX (Racing or Competitive); Flying in any Chartered or Leased Aircraft or Helicopter
(2)High Option - additional $50.00 flat monthly rate
Diving with Sharks; Mountain Climbing (if over 14 thousand feet, guide required); MX; Running with Bulls; Safari & Big Game Hunting (use of firearms); Security Detail (use of firearms)
Table 3: For the below listed Intercollegiate, Interscholastic Athletics, Club Sports, and Organized Amateur Sports, apply the 1.25 factor to the base premium plus the monthly flat rate listed. Under this rider, the Medical Expense Benefit is reduced to $20,000 for any Covered Injury or Illness resulting from:
(1) Low Option - additional $12.00 flat monthly rate
Baseball; Cheerleading; Cross Country; Diving; Equestrian; Fencing; Field Hockey; Golf; Polo Horse; Polo Water; Softball; Swimming; Tennis; Track and Field; Volleyball
(2)Middle Option - additional $26.00 flat monthly rate
Basketball; Competitive Cycling (Road, Track, CX); Ice Hockey; Lacrosse; Martial Arts; Skiing (Slalom, Giant Slalom, Downhill); Wrestling
(3)High Option - additional $80.00 flat monthly rate
Football (no Division One); Gymnastics; Rugby; Soccer