Visitor Secure Insurance | Be Safe Insurance

Low cost, Limited (Fixed) benefits plan
For visitors traveling outside home country (U.S.A. included)
Fixed benefit limits increase with Policy Maximum
Cancelable and Renewable
$100,000 if Policy Maximum is $100,000 or more, otherwise it is same as policy maximum for acute onset of pre-existing conditions for age under 70 years
Coverage is provided outside of home country including during travel
Deductible is per injury/sickness per person and Policy Maximum is per policy period
Must be purchased and effective with in 30 days of arrival to USA if age above 65
Coverage is available from 5 days to 364 days for ages 14 days to 99 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: HCC Medical Insurance Services
Underwriter: Lloyd’s of London
Other Benefits: • Common Carrier Accidental Death & Dismemberment •Dental Accident •Emergency medical evacuation (< 70) •Local Ambulance •Repatriation of Remains

Benefits

	PLAN A	PLAN B	PLAN C	PLAN D
Deductible
Ages 14 days - 69 years	$0, $50, or $100	$0, $50, or $100	$0, $50, or $100	$0, $50, or $100
Ages 70 - 79	$100 or $200	$100 or $200	N/A	N/A
Ages 80 and above	$100 or $200	N/A	N/A	N/A
Overall Policy Maximum
Ages 14 days - 69 years	50000	75000	100000	130000
Ages 70 - 79	50000	75000	N/A	N/A
Ages 80 and above	10000	N/A	N/A	N/A
Inpatient Treatment
Hospital room and board, including miscellaneous	$1,450 per day, maximum 30 days	$1,725 per day, maximum 30 days	$2,000 per day, maximum 30 days	$2,585 per day, maximum 30 days
Intensive care unit, including miscellaneous	$2,110 per day, maximum 8 days	$2,480 per day, maximum 8 days	$2,850 per day, maximum 8 days	$3,690 per day, maximum 8 days
Surgery	$3,300 per session	$4,400 per session	$5,500 per session	$7,150 per session
Consultant physician	$450 maximum	$475 maximum	$500 maximum	$650 maximum
Private duty nurse	$550 maximum	$550 maximum	$550 maximum	$700 maximum
Physician visits	$60 maximum per visit, 30 visits maximum	$75 maximum per visit, 30 visits maximum	$90 maximum per visit, 30 visits maximum	$115 maximum per visit, 30 visits maximum
Outpatient Treatment
Surgery	$3,300 per session	$4,400 per session	$5,500 per session	$7,150 per session
Outpatient surgical facility	$1,000 maximum	$1,050 maximum	$1,100 maximum	$1,400 maximum
Pre-admission testing	$1,100 maximum	$1,100 maximum	$1,100 maximum	$1,450 maximum
Diagnostic x-ray and labs	$450 maximum, plus $250 for one CAT Scan, MRI or PET	$475 maximum, plus$375 for one CAT Scan, MRI or PET	$500 maximum, plus$500 for one CAT Scan, MRI or PET	$650 maximum, plus$600 for one CAT Scan, MRI or PET
Emergency room (all expenses incurred therein)	$355 maximum	$465 maximum	$575 maximum	$750 maximum
Outpatient prescription drugs	$100 maximum	$125 maximum	$150 maximum	$200 maximum
Office visits, including urgent care	$60 allowable per visit, 10 visitsmaximum	$75 allowable per visit, 10 visitsmaximum	$90 allowable per visit, 10 visitsmaximum	$115 allowable per visit, 10 visitsmaximum
Miscellaneous Inpatient & Outpatient Treatment
Anesthesiologist	825	1110	1375	1775
Assistant surgeon	825	1110	1375	1775
Local ambulance	$475 maximum	$475 maximum	$475 maximum	$475 maximum
Dental accident	$550 maximum	$550 maximum	$550 maximum	$550 maximum
Physical therapy	$40 maximum per visit, 1 visit per day, maximum 12 visits	$40 maximum per visit, 1 visit per day, maximum 12 visits	$40 maximum per visit, 1 visit per day, maximum 12 visits	$40 maximum per visit, 1 visit per day, maximum 12 visits
Durable medical equipment	$1,100 maximum	$1,200 maximum	$1,300 maximum	$1,700 maximum
Other Benefits (not subject to deductible or overall policy maximum)
Emergency medical evacuation	$50,000 lifetime maximum, except as provided under acute onset of pre-existing condition. Available only to members under age 70.	$50,000 lifetime maximum, except as provided under acute onset of pre-existing condition. Available only to members under age 70.	$50,000 lifetime maximum, except as provided under acute onset of pre-existing condition. Available only to members under age 70.	$50,000 lifetime maximum, except as provided under acute onset of pre-existing condition. Available only to members under age 70.
Repatriation of remains	$7,500 per member	$7,500 per member	$7,500 per member	$7,500 per member
Common carrier accidental death & dismemberment	$25,000 lifetime maximum principal sum per member Not subject to deductibleDeath or loss of two limbs - principal sum Loss of one limb - one-half the principal sum	$25,000 lifetime maximum principal sum per member Not subject to deductibleDeath or loss of two limbs - principal sum Loss of one limb - one-half the principal sum	$25,000 lifetime maximum principal sum per member Not subject to deductibleDeath or loss of two limbs - principal sum Loss of one limb - one-half the principal sum	$25,000 lifetime maximum principal sum per member Not subject to deductibleDeath or loss of two limbs - principal sum Loss of one limb - one-half the principal sum
Acute onset of pre-exiting condition (only available to mem- bers under age 70)	$50,000 lifetime maximum for eligible expenses. $25,000 lifetime maximum for emergency medical evacuation.	$75,000 lifetime maximum for eligible expenses. $25,000 lifetime maximum for emergency medical evacuation.	$100,000 lifetime maximum for eligible expenses. $25,000 lifetime maximum for emergency medical evacuation.	$100,000 lifetime maximum for eligible expenses. $25,000 lifetime maximum for emergency medical evacuation.