| |
|
Overseas Travel Medical Plan
* Travel
with Peace of Mind Short-term medical protection for individuals traveling
internationally
* Flexible
Coverage Options Choice of deductibles and Maximum Benefit Amounts
Who should apply for
Overseas Travel Medical?
Anyone traveling outside of their home country needs the type of
comprehensive protection the Overseas Travel Medical Plan provides.
United States citizens You can purchase the Overseas Travel Medical
Plan to travel anywhere outside of the U.S.* If You are a U.S.
citizen residing outside of the U.S., You can purchase this protection as
long as You hold a current and valid U.S. passport.
* (At this
time, this product is not available in all states)
Foreign visitors traveling to the United States You can purchase the
Overseas Travel Medical Plan as long as You provide us with your current and
valid passport I.D. number.
What is 24-Hour
Medical Emergency Protection?
The Overseas Travel Medical Plan includes a unique added benefit for You and
Your family, 24-Hour Medical Emergency Protection.
Our emergency assistance services are superior and include:
Medical
referrals and medical care location
Communication arrangements between family and doctors
International hospital bill translation/interpretation services
Medical
case management and catastrophic case notification
Coordinating emergency medical evacuation or repatriations
Assisting
in the replacement of lost passports
Locating
legal assistance and local interpreters
Arrangements for medical transportation
What are the Schedule of
Benefits?
Accident
& Sickness Medical Benefits Maximum Choices:* $50,000, $100,000, $250,000,
$1,000,000
Deductible Choices:$0, $125, $250, $500, $1,000, $2,500
The
Coinsurance (after satisfaction of the Deductible) for U.S. citizens or
residents outside of the U.S. is 100% of Covered Expenses; and for non U.S.
citizens inside of the U.S. it is 80% of the first $5,000 of Covered
Expenses, and then 100% of the remaining Covered Expenses.
* The
Maximum for Accident & Sickness Medical Benefits is limited to $10,000 for
Eligible Persons ages 80 and above.
* The
Maximum for Accident & Sickness Medical Benefits is limited to $10,000 for
the Hazardous Sports Rider.
Why do you need Overseas
Travel Medical?
Today, more and more people are traveling outside of their home country,
either for business, recreation or personal reasons. Frequently, domestic
health insurance does not provide coverage for overseas medical emergencies,
and international travelers are unable to obtain this type of protection
after they are outside of their home country.
Furthermore, most traditional health insurance does not provide coverage for
expenses for an emergency medical evacuation, medical reunion, return of
mortal remains, trip interruption or loss of checked luggage.
Who is Eligible for Coverage?
Eligible Persons: A person who has applied for benefits, is named on the
application and for whom HPA has received the appropriate plan cost, is
considered eligible for benefits under this Plan.
Eligible Dependents: Are considered a spouse who is legally married to you;
or your unmarried Child from 30 days old until his/her 19th birthday.
When does the coverage start?
Effective Date of the Term of Protection begins on the latest of the
following:
1. The Date
HPA receives a completed Application and the appropriate Plan Cost for the
Period of Protection; or
2. The
Effective Date requested on the Application; or
3. The
moment You arrive in the country noted on the Application; or
4. The Date
HPA approves the Application.
What are the Benefits of this
plan?
Medical Benefits: Benefits will be paid for Reasonable and Customary Covered
Expenses incurred by You due to an accidental Injury or Illness up to the
earlier of the maximum amount You chose after the Deductible and Coinsurance
is satisfied, or the Expiration Date of Your Term of Protection. All bodily
disorders, or bodily injuries sustained in any one Accident, existing
simultaneously which are due to the same or related causes shall be
considered one Disablement.
If a Disablement is due to causes which are the same or related to the cause
of a prior Disablement (including complications arising there from), the
Disablement shall be considered a continuation of the prior Disablement and
not a separate Disablement.
The initial treatment of the Illness or Injury must occur within 30 days of
the Accident or onset of the Illness.
Why buy from us?
HPA has provided innovative health care solutions for over 60 years, meeting
the needs of our customers with integrity, creativity and value. We strive
to provide the best possible insurance coverage in a cost effective manner.
HPA is a customer-driven company differentiating itself through knowledge
and experience. We, in conjunction with our trusted insurance carriers and
licensed agents, share a mutual desire to provide important benefits to our
customers and to meet their needs in an innovative, hassle-free manner.
HPA has a professional team of customer support, marketing, underwriting,
claims and compliance specialists. State-of-the-art computer systems and
reporting capabilities allow HPA to provide superior service and flexibility
to agent distributors and clients. Licensed and approved nationally, HPA has
always met or exceeded all state-mandated requirements including financial
security, surety bonds, insurance coverage, and licensing.
What are some Features of the
Plan?
Emergency
Medical Evacuation: $100,000
Return of
Mortal Remains: $20,000
Emergency
Medical Reunion: $10,000
Return of
Minor Children: $5,000
Interruption of Trip: $5,000
Unexpected recurrence of a pre-existing condition: $5,000
(for US Citizens only)
Loss of
Checked Luggage: $250
Emergency
Dental for accidents: $500
Accidental Death and Dismemberment: $25,000 for Eligible Person; and $5,000
for each Eligible Dependent(s)
Home
country coverage:
- Incidental visits to $50,000
- 30-day extension of benefits to $5,000
TERM OF PROTECTION
The minimum Term of Protection is 15 days; the maximum is 12 months.
Benefits can be purchased in a combination of monthly and 15-day periods by
paying the appropriate Plan Cost.
What are the payment options?
Convenient Plan Cost payment options include:
(1)
Payment in Full by check, money order or Visa, MasterCard or Discover credit
cards.
(2) Monthly
Pay as you go, allows you to pay monthly by automatic bank drafts, Visa,
MasterCard or Discover credit cards.
Your subsequent monthly credit card/ach premium deductions will occur based
upon the effective date of coverage. If your coverage effective date is the
1st-14th, your premium will be deducted on the 1st of the month. If your
coverage effective date is the 15th-31st, your premium will be deducted on
the 15th of the month.
When does the coverage terminate?
Expiration Date of the Term of Protection terminates on the earlier of the
following:
1. The
moment You return to Your Home Country; or
2. The
expiration of twelve months from the Effective Date; or
3. The date
shown on the Schedule provided by HPA; or
4. The end
of the period for which the Plan Cost has been paid; or
5. The date
You are no longer considered an Eligible Person; or
6. For
foreign visitors, the Date You become a permanent resident of the United
States.
What are the Benefits,
Terms and Conditions?
Only the following, which are specifically enumerated in the following list
of charges and which are not excluded, shall be considered as Covered
Expenses:
1. Charges
made by a Hospital for room and board, floor nursing and other services
inclusive of charges for professional service and with the exception of
personal services of a non-medical nature; provided, however, that expenses
do not exceed the Hospitals average charge for semiprivate room and board
accommodation.
2. Charges
made for intensive care, coronary care charges and nursing services.
3. Charges
made for diagnosis, treatment and surgery by a Physician.
4. Charges
made for an operating room.
5. Charges
made for outpatient treatment, same as any other treatment covered on an
inpatient basis. This includes ambulatory Surgical centers, Physicians
outpatient visits and examinations, clinic care, and surgical opinion
consultations.
6. Charges
made for the cost and administration of anesthetics.
7. Charges
for medication, X-ray services, laboratory tests and services, the use of
radium and radioactive isotopes, oxygen, blood, transfusions, iron lungs,
and medical treatment.
8. Charges
for physiotherapy, if recommended by a Physician for the treatment of a
specific Disablement and administered by a licensed physiotherapist.
9.
Dressings, drugs, and medicines that can only be obtained upon a written
prescription of a Physician or surgeon.
10. Local
transportation to or from the nearest Hospital or to and from the nearest
Hospital with facilities for required treatment. Such transportation shall
be by licensed ground ambulance only, within the metropolitan area in which
You are located at that time the service is used. If You are in a rural
area, then licensed air ambulance transportation to the nearest metropolitan
area shall be considered a Covered Expense.
Optional Hazardous Sports Rider:
If You purchase the Optional Hazardous Activity Coverage, benefits will be
paid up to the chosen plan maximum, if You become injured while
participating in any of the following Sports: Hang gliding, parachuting,
bungee jumping, snowmobiling, snorkeling, jet skiing, water skiing, snow
skiing, spelunking, parasailing, and snow boarding.
Emergency Dental Treatment:
Benefits are paid for Reasonable and Customary expenses up to the maximum
shown on the Schedule of Benefits for repair or replacement to sound,
natural teeth damaged as a result of an Accident.
Emergency Medical Evacuation and Medically Necessary Repatriation:
Benefits are paid for Eligible Expenses incurred up to the maximum shown in
the Schedule of Benefits, if Injury or Illness commences during the Term of
Protection results in Your Medically Necessary Emergency Medical Evacuation
or Repatriation. The decision for an Emergency Medical Evacuation or
Repatriation must be pre-approved and arranged by the Assistance Company in
consultation with Your local attending Physician.
Return of Mortal Remains:
Benefits will be paid for the reasonable Covered Expenses incurred up to the
maximum as stated in the Schedule of Benefits, to return Your remains to
Your current Home Country, if You die. Covered Expenses include, but are not
limited to, expenses for embalming, or cremation, a minimally necessary
container appropriate for transportation, shipping costs, and the necessary
government authorizations. All Covered Expenses in connection with a Return
of Mortal Remains or cremation must be pre-approved and arranged by the
Assistance Company.
Emergency Medical Reunion:
When the
Assistance Company and Your attending Physician determine that it is
necessary and prudent for You to have an Emergency Medical Evacuation or
Repatriation, this Plan will arrange to bring an individual of Your choice,
from Your current Home Country, to be at Your side while You are
hospitalized and then accompany You during Your return to Your current Home
Country. Benefits will be paid up to $10,000 for a round trip economy air
fare ticket as well as for reasonable travel and accommodation expenses up
to a maximum of 10 days, as pre-approved and arranged by the Assistance
Company.
Return of Minor Child(ren):
Should You be
traveling alone and are hospitalized because of a covered Illness or Injury
and Your Minor Child(ren) is left unattended, the Assistance Company will
arrange for a one way economy fare(s) to Your current Home Country. If an
attendant/escort is necessary to ensure the safety and welfare of Your Minor
Child(ren), the Assistance Company will also arrange these services. The
Plan will pay for these services up to a maximum of $5,000 provided all
transportation and services are pre-approved and arranged by the Assistance
Company. Meals and lodging are Your responsibility.
Interruption of Trip: If your trip is interrupted due to one of the
following reasons:
1. Death of
a Family Member.
2. Serious
damage to your principal residence from fire, flood or similar natural
disaster (tornado, earthquake, hurricane, etc.). Benefits will be paid up to
$5,000 for the cost of economy travel less the value of applied credit from
an unused return travel ticket to return you home to your area of principal
residence.
Loss of
Checked Luggage:
Benefits will be paid up to the maximum shown in the Schedule of Benefits,
for loss, theft or damage to baggage and personal effects, checked with a
Common Carrier provided You have taken all reasonable measures to protect,
save and/or recover Your property at all times. This plan is secondary to
any coverage provided by a Common Carrier and all other valid and collective
insurance. There will be a per article limit of $50 to a maximum of $250.
Accidental
Death and Dismemberment:
Benefits shall be paid up to the maximum noted on the Schedule of Benefits
if You sustain an Accidental Injury. The Injury must:
a) Occur
during Your Term of Protection; and
b) Occur
within 365 days after the date of Accident causing such Loss.
Is pre-notification required?
Pre-notification (notification to HPA) is required prior to all hospital
admissions and inpatient/outpatient surgeries. In case of an Emergency
Admission notification to HPA must be within 24 hours, or as soon as
reasonably possible. This does not guarantee that benefits will be paid. HPA
does not guarantee payment to a facility or individual for medical expenses
until HPA determines that it is a Covered Expense.
What are the Plan Provisions?
Notice of Claim:
Written notice of claim must be given to HPA within 30 days after the
occurrence or commencement of any Disablement provided by the Plan, or as
soon thereafter as is reasonably possible. Notice given by or on behalf of
the claimant to HPA, or to any authorized agent of HPA, with information
sufficient to Your identity shall be deemed notice to HPA.
Claim Forms:Upon receipt of a notice of claim, claim forms shall be
furnished to You as are usually furnished for filing Proofs of Loss.
Who is the Trust?
Benefits under this Plan are provided by the American Consumer Insurance
Trust. The Trust is insured by U.S. Fire Insurance Company.
Notice to residents of Florida: The benefits of this Plan are provided by
the American Consumer Insurance Trust. The Trust is insured by U.S. Fire
Insurance Company and is governed by the law of a state other than Florida.
Your homeowners policy, if any, may provide coverage for loss of personal
effects provided by the baggage and personal effects benefits. For U.S.
Residents: This insurance is not required in connection with the purchase of
Your travel arrangements.
Notice to residents of California: This plan contains disability benefits or
health benefits, or both, that only apply during Your trip. You may have
coverage from other sources that already provide You with these benefits.
You should review Your existing policies. If You have any questions about
Your current coverage, call Your insurer or health plan administrator. Note,
in California, the pre-existing condition limitation is waived for medical
expenses.
Can I get a refund?
Refund of Plan Cost will be considered only if You send a written request to
HPA and it is received by HPA prior to Your Effective Date of Protection.
After Your Effective Date of Protection the Plan Cost is considered fully
earned and nonrefundable.
What are the Exclusions of
this plan?
No Benefit shall
be payable for Accident Medical, Sickness Medical, Unexpected Recurrence,
Dental, Emergency Medical Evacuation/Repatriation, Return of Mortal Remains
and Emergency Medical Reunion, as the result of:
Any
Pre-existing Condition as defined hereunder:
1) A
condition that would have caused a person to seek medical advice, diagnosis,
care or treatment during the 36 months prior to the Effective Date of
coverage under this Policy;
2) a
condition for which manifestation, medical advice, diagnosis, care or
treatment was recommended, received or noticed during the 36 months prior to
the Effective Date of coverage under this Policy.
Note: For U.S. citizens, this policy does pay benefits to a maximum of
$5,000 for loss due to a pre-existing sickness under the Unexpected
Recurrence benefit. Unexpected shall mean an acute onset of an illness. This
exclusion does not apply to Emergency Evacuation/Repatriation or Return of
Mortal Remains;
Injury or
Illness which is not presented to the Company for payment within 3 months of
receiving treatment;
Charges
for Treatment which is not Medically Necessary;
Charges
for Treatment which exceeds Reasonable and Customary charges;
Charges
incurred for Surgery or Treatments which are Experimental/Investigational,
or for research purposes;
Services,
supplies or Treatment, including any period of hospital confinement, which
were not recommended, approved and certified as Medically Necessary and
reasonable by a Physician;
Suicide
or any attempts thereof, while sane; or self destruction or any attempt
thereof, while insane;
Any
consequence, whether directly or indirectly, proximately or remotely
occasioned by, contributed to by, or traceable to, or arising in connection
with war, invasion, act of foreign enemy hostilities, warlike operations
(whether war be declared or not), or civil war;
Injury
sustained while participating in professional athletics;
Injury
sustained while participating in Amateur or Interscholastic Athletics;
Routine
physicals, immunizations or other examinations where there are no objective
indications or impairment in normal health, and laboratory diagnostic or
X-ray examinations, except in the course of a Disablement established by a
prior call or attendance of a Physician;
Treatment
of the Temporomandibular joint;
Services
or supplies performed or provided by a Relative of yours, or anyone who
lives with you;
Cosmetic
or plastic Surgery, except as the result of a covered Accident; for the
purposes of this Plan, Treatment of a deviated nasal septum shall be
considered a cosmetic condition;
Treatment
and the provision of false teeth or dentures, normal ear tests and the
provision of hearing aids;
Eye
refractions or eye examinations for the purpose of prescribing corrective
lenses for eyeglasses or for the fitting thereof, unless caused by
Accidental Bodily Injury incurred while covered hereunder;
Injury
sustained while under the influence of or Disablement due wholly or partly
to the effects of intoxicating liquor or drugs other than drugs taken in
accordance with Treatment prescribed and directed by a Physician for a
condition which is covered hereunder, but not for the Treatment of drug
addiction;
Any
Mental and Nervous disorders or rest cures;
Congenital abnormalities and conditions arising out of or resulting there
from;
Expenses
which are non-medical in nature;
Expenses
as a result of, or in connection with, intentionally self-inflicted Injury
or Illness;
Expenses
as a result of, or in connection with, the commission of a felony offense;
Injury
sustained while taking part in mountaineering, hang gliding, parachuting,
bungee jumping, racing by horse, motor vehicle or motorcycle, snowmobiling,
motorcycle/motor scooter riding, scuba diving, involving underwater
breathing apparatus, unless PADI or NAUI certified, snorkeling, water
skiing, snow skiing, spelunking, parasailing and snow boarding. Hazardous
Sport Coverage: the following are covered if the required premium has been
paid: Hang gliding, Parachuting, bungee jumping, snowmobiling, snorkeling,
jet skiing, water skiing, snow skiing, spelunking, parasailing and snow
boarding.
Dental
care, except as the result of Injury to natural teeth caused by Accident;
Routine
Dental Treatment;
For
Pregnancy or Illness resulting from Pregnancy, childbirth, or miscarriage;
For
miscarriage resulting from Accident;
Drug,
Treatment or procedure that either promotes or prevents conception, or
prevents childbirth, including but not limited to: artificial insemination,
Treatment for infertility or impotency, sterilization or reversal thereof;
Treatment
for human organ tissue transplants and their related Treatment;
Expenses
incurred while in your Home Country, except as provided under the Home
Country Coverage and Home Country extension of Benefits Coverage;
Covered
Expenses incurred during a Trip after your Physician has limited or
restricted travel.
For a complete listing of the Overseas Travel Medical Plan Exclusions,
including those for Accidental Death and Dismemberment and Interruption of
Trip, please refer to your Certificate of Insurance.
Effective Date of Protection the Plan Cost is considered fully earned and
nonrefundable.
WHO TO
CONTACT?
Please be prepared to state Your passport number. Customer Service and
Claims Administration:
Direct all related customer service inquiries, benefits verification
requests, Plan payments, and Claims to be made to HPA at the address and
numbers listed below.
Mailing Address:
Health Plan Administrators, Inc. (HPA)
P.O. Box 15250
Rockford, IL 61132-5250
Telephone:
1-800-397-5800 (in the U.S.)
1-815-633-5800 (outside the U.S.)
Travel Assistance: Telephone operators are available 24 hours a day, seven
days a week, from anywhere in the world. The Assistance Company operators
may be accessed by calling the numbers listed on your ID card.
Travel assistance is available for, but not limited to: locating medical
providers and services; consultative and advisory services; coordinating
emergency medical evacuation or repatriations; assisting in the replacement
of lost passports; locating legal assistance and local interpreters; and
other incidental aid that may be required.
Who is the Administrator?
Health Plan
Administrators, Inc. (HPA) is a fully licensed, full-service Third Party
Administrator transacting business worldwide. HPA provides state-of-the-art
industry leading insurance services.
Benefits Provided by: American Consumer Insurance Trust
This website contains an overview of the Overseas Travel Medical Plan
benefit descriptions, definitions and exclusions. If you apply for this
Plan, the Administrator will provide you a Certificate of Insurance.
|
|
