Visit USA Healthcare Insurance

  • Comprehensive benefits plan
  • For Non-U.S. citizens traveling to U.S.A. only
  • In USA & Canada:
    a) In Network & Directly Billed: After deductible, Plan pays 100% to policy maximum
    b) Otherwise: After deductible, Plan pays 90% of $10,000 and then 100% to policy maximum
    Outside USA & Canada: After deductible, Plan pays 100% to policy maximum
  • Cancelable and Not Renewable
  • $10,000 for sudden onset of pre-existing conditions if age under 65 and $2500 if 65 & above
  • Coverage is provided outside of home country including during travel
  • Deductible and Policy Maximum are per policy period per person
  • Coverage is available from 5 days to 364 days for ages 14 days to 100+ years
  • Coventry Health Care PPO Network
  • Not available if mailing address and insured is physically located at the time of quote in Maryland(MD), New York(NY) & Washington(WA)
  • Administrator: USI Travel Insurance Services
    Claims Administrator: HCC Medical Insurance Services
    Underwriter: Lloyd’s of London
  • Application Fee: $5
  • Other Benefits:  • Accidental Death and Dismemberment  •Complications of Pregnancy (until 26 weeks pregnancy)  •Emergency Dental  •Emergency Medical Evacuation  •Emergency Reunion  •Loss of Baggage  •Recreational Sports  •Return of Minor Children  •Return of Mortal Remains  •Stolen Passports/Visas  •Terrorism  •Trip Interruption  •World Wide Assistance Services
  • Optional Riders:  • Additional Accidental Death & Dismemberment  •Hazardous Activities  •Intercollegiate/Interscholastic & Amateur Sports

Benefits

Except as specifically indicated otherwise, all benefits are subject to Deductible, Coinsurance, and are per Certificate Period.
BenefitLimit
Deductibles$0, $250, $500, $1000, per Certificate Period
Coinsurance – Claims incurred in US or CanadaFor the Certificate Period, Underwriters will pay 90% of the next $10,000 of Eligible Expenses after the Deductible, then 100% to the Overall Maximum Limit. Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider.
Coinsurance – Claims incurred outssiidde US orr CanadaFor the Certificate Period, Underwriters will pay 100% of Eligible Expenses after the Deductible up to the Overall Maximum Limit
Hospital Room and BoardAfrer Deductible and Coinsurance, Usual, Reasonable and Customary charges up to Overall Maximum Limit.
Local AmbulanceAfter Deductible and Coinsurance, Usual, Reasonable and Customary charges up to Overall Maximum Limit.
Intensive Care UnnitAfter Deductible and Coinsurance, Usual, Reasonable and Customary charges up to Overall Maximum Limit.
Emergency Room Co-paymentIn addition to Coinsurance, the Member shall be responsible for a $250 co-payment for each use of Emergency room for an Illness unless the Member is admitted to the Hospital. There will be no copayment for Emergency room treatment of an Injury.
Urgent Care CenterFor each visit, the Member shall be responsible for a $50 co- payment, after which Coinsurance will apply. Not subject to Deductible.
Outpatient TreatmentAfter Deductible and Coinsurance, Usual, Reasonable, and Customary charges up to the Overall Maximum Limit.
Physical Therapy and Chiropractic CareAfter Deductible and Coinsurance, Usual, Reasonable and Customary charges up to Overall Maximum Limit.
Intercollegiate or Interscholastic Sports (Available only under the optional Intercollegiate Sports Riider)After Deductible and Coinsurance, Usual, Reasonable and Customary charges up to $20,000 per Certificate Period.
Mental Health DisordersAfter Deductible and Coinsurance, Usual, Reasonable and Customary charges up to $5,000 per Certificate Period.
All Other Eligible Medical ExpensesAfter Deductible and Coinsurance, Usual, Reasonable, and Customary charges up to the Overall Maximum Limit.
Acute Onset of Pre-existing ConditionAfter Deductible and Coinsurance, for members age 14 days through age 64 inclusive, $10,000 per Certificate Period; for members Age 65 and over, $2500 per Certificate period
Emergency Dental Treatment due to Accident$1000 Maximum per Certificate Period (not subject to Deductible or Coinsurance)
Emergency Dental (Acute Onset of Pain)$100 limit per Certificate Period not subject to Deductible or Coinsurance)
Emergency Medical Evacuation$250,000 Maximum Lifetime Limit (not subject to Deductible or Coinsurance)
Return of Minor Children$50,000 per Certificate Period (not subject to Deductible or Coinsurance)
Repatriation of Remains$50,000 (not subject to Deductible or Coinsurance)
Emergency Reunion$15,000 limit per Certificate Period, subbbjjjeecctt to a maximum of 15 days (not subject to Deductible orrr Coiinsurraanccee))
Natural DisasterMaximum $100 a day for 5 days (not subject to Deductible or Coinsurance)
Lost or Stolen Passport/Travel Visa$100 per Certificate Period
Trip Interruption$5,000 limit per Certificate Period (not subject to Deductible or Coinsurance)
Lost Checked Luggage$250 limit per bag; $500 per Certificate Period (not subject to Deductible or Coinsurance). $500 maximum per item.
Political Evacuation$50,000 Maximum Lifetime Limit (not subject to Deductible or Coinsurance)
Terrorism$50,000 Maximum Lifetime Limit, Eligible Medical Expenses only Expenses only
Overall Maximum Limit per Certificate Period (includes all benefits except Accidental Death and Dismemberment, Emergency Medical Evacuation and Commoon Carrier Accidental Death)Age 80 or older $10,000; Age 70 to 79: $50,000; All others: $50,000, $100,000
Accidental Death and Dismemberment Members
under age 18.Lifetime Maximum - $5,000
Death – Principal Sum
Loss of 2 Limbs – Principal Sum
Loss of 1 Limb - 50% of Principal Sum
Members age 18 to age 70.Lifetime Maximum - $50,000 (or $100,000 when optional coverage is selected)
Death – Principal Sum
Loss of 2 Limbs – Principal Sum
Loss of 1 Limb - 50% of Principal Sum
Members age 70 to age 74 inclusive.Lifetime Maximum - $20,000.
Death – Principal Sum
Loss of 2 Limbs – Principal Sum
Loss of 1 Limb - 50% of Principal Sum
Members Age 75 and over:Lifetime Maximum - $10,000
Death – Principal Sum
Loss of 2 Limbs – Principal Sum
Loss of 1 Limb - 50% of Principal Sum
*$250,000 Maximum Benefit any one family or Group

The term Usual, Reasonable and Customary charges (URC) refers to the prevailing charges for services delivered within a geographic area.