Medical Maximum per Policy: | $50,000, $100,000, $250,000, $500,000, $1,000,000 |
Deductible Options per Policy: | $0, $50, $100, $250, $500, $1,000, $2,500, $5,000 |
Co-insurance per Policy: | 100% of Covered Expenses up to the policy maximum |
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 and 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 date of the Covered Accident or Sickness |
Additional Benefits (not subject to Policy Maximum, Deductible or Co-Insurance) | |
Accidental Death & Dismemberment Principal Sum: | $25,000 |
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 to $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 of Remains: | 100% up to $1,000,000 |
Emergency Reunion: | $15,000 |
Return of Minor Child(ren) or Travel Companion: | $5,000 |
Hospital Confinement: | $150 per day 15 day Maximum |
Basic Lost Baggage: | $1,000 per Policy Period |
Trip Interruption: | $7,500 per Policy Period |
Optional Benefits | |
Enhanced Baggage | Up to $3,500 |
Upgrade AD&D | Up to $1,000,000 |
Home Country Coverage/Follow Me Home Coverage | See benefit page 11 |
Athletic Sports Coverage | See benefit page 12 |
Extreme Sports/Hazardous Activities | See benefit page 12 |