| I
N T E R N A T I O N A L E M E R G E N C
Y C A R E |
Emergency
Evacuation
The plan includes coverage for Emergency
Medical Evacuations to the nearest qualified
medical facility or the country of residence
and expenses for reasonable travel and
accommodations resulting from the evacuation,
which must be approved and coordinated in
advance. |
To US$50,000 when
coordinated through IMG |
Return of
Mortal Remains
If a covered illness/injury results in death,
expenses for Repatriation of bodily remains or
ashes to the country of residence will be
covered up to a maximum of US$7,500. |
To US$7,500 when
coordinated through IMG |
| S
P E C I A L C O V E R A G E S |
| Home
Country Coverage (As described below)
Incidental Home Country
Coverage - During the Period of Coverage an
insured person may return to their country of
residence for incidental visits up to a
cumulative two weeks total, subject to: a. The
insured person must have left their country of
residence, b. The total Period of Coverage
must be for a minimum of 30 days, and c. The
return to the country of residence may not be
taken to receive treatment for an illness or
injury incurred while traveling.
|
| Common Carrier
Accidental Death |
US$25,000
to Beneficiary |
| If
accidental death should occur while traveling
on a commercial Common Carrier, US$25,000 will
be paid to the designated beneficiary. |
|
M E D I C A
L B E N E F I T S- US$25,000
|
US$25,000
Maximum Benefit - usual, reasonable and
customary charges, subject to deductible where
applicable. |
| Inpatient Treatment |
|
| Hospital room
& board |
Up
to US$825, per day, 30 day maximum per period
of coverage |
| Intensive care |
Additional
US$400 per day, 8 day maximum per period of
coverage |
| Surgical
treatment |
US$2,000
per surgical session |
| Consult physician |
US$350
per period of coverage |
| Pre-admission
tests |
US$750
per period of coverage |
| Private duty
nurse |
US$400
per period of coverage |
| Physician Visits |
US$40
allowable charge per visit, 30 visits per
period of coverage |
| Outpatient Treatment |
|
| Surgical
treatment |
US$2,000
per surgical session |
| Diagnostic x-ray
& lab |
US$650
per period of coverage, US$325 allowable
charge per procedure. |
| Hospital
emergency room |
75% of URC to US$200 |
| Prescription
drugs |
US$150
per period of coverage |
|
Physician Visits |
US$50
allowable charge per visit, 10 visits per period
of coverage |
| Miscellaneous
Inpatient & Outpatient Services |
| Anesthetist |
25%
of surgical benefit |
| Assistant surgeon |
25%
of surgical benefit |
| Other Coverage's |
|
| Ambulance |
US$250
per period of coverage |
| Dental for
accident to sound natural teeth |
US$350 per
period of coverage |
| Physiotherapy |
US$25
per visit per day, 12 visits per period of
coverage |
M E D I C A
L B E N E F I T S- US$50,000
|
US$50,000
Maximum Benefit - usual, reasonable and
customary charges, subject to deductible where
applicable. |
| Inpatient Treatment |
|
| Hospital room
& board |
Up
to US$1,400 per day, 30 day maximum per period of coverage |
| Intensive care |
Additional
US$660 per day, 8 day maximum per period of
coverage |
| Surgical
treatment |
US$3,300
per surgical session |
| Consult physician |
US$450
per period of coverage |
| Pre-admission
tests |
US$1,100
per period of coverage |
| Private duty
nurse |
US$550
per period of coverage |
| Physician Visits |
US$55
allowable charge per visit, 30 visits per
period of coverage |
| Outpatient Treatment |
|
| Surgical
treatment |
US$3,300
per surgical session |
| Diagnostic x-ray
& lab |
US$800
per period of coverage, US$400 allowable
charge per procedure. |
| Hospital
emergency room |
75% of URC to
US$330 |
| Prescription
drugs |
US$250
per period of coverage |
| Physician Visits |
US$55
allowable charge per visit, 10 visits per period
of coverage |
| Miscellaneous
Inpatient & Outpatient Services |
| Anesthetist |
25%
of surgical benefit |
| Assistant surgeon |
25%
of surgical benefit |
| Other Coverage's |
|
| Ambulance |
US$450
per period of coverage |
| Dental for
accident to sound natural teeth |
US$550 per
period of coverage |
| Physiotherapy |
US$40
per visit per day, 12 visits per period of
coverage |
M E D I C A
L B E N E F I T S- US$100,000
|
US$100,000
Maximum Benefit - usual, reasonable and
customary charges, subject to deductible where
applicable |
| Inpatient Treatment |
|
| Hospital room
& board |
Up
to US$1,950 per day, 30 day maximum per period
of coverage |
| Intensive care |
Additional
US$850 per day, 8 day maximum per period of
coverage |
| Surgical
treatment |
US$5,500
per Surgical Session |
| Consult physician |
US$500
per period of coverage |
| Pre-admission
tests |
US$1,100
per period of coverage |
| Private duty
nurse |
US$550
per period of coverage |
| Physician visits |
US$85
allowable charge per visit, 30 visits per period
of coverage |
| Outpatient Treatment |
|
| Surgical
treatment |
US$5,500
per surgical session |
| Diagnostic x-ray
& lab |
US$950
per period of coverage $475 allowable charge
per procedure |
| Hospital
emergency room |
75% of URC to US$550 |
| Prescription
drugs |
US$250
per period of coverage |
| Physician visits
(non-surgical) |
US$85
allowable charge per visit, 10 visits per
period of coverage. |
| Miscellaneous
Inpatient & Outpatient Services |
|
| Anesthetist |
25% of surgical
benefit
|
| Assistant surgeon |
25% of surgical benefit |
| Other Coverage's |
|
| Ambulance |
US$450
per period of coverage |
| Dental for
accident to sound natural teeth |
US$550 per
period of coverage |
| Physiotherapy |
US$40
per visit per day, 12 visit maximum per period
of coverage |
|
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1. Coverage and benefits are
subject to the applicable deductible and
Scheduled limits, and the other terms of the
plan as contained in the complete Policy
Wording.
2. Coverage under the plan is secondary to any
other coverage.
3. Coverage and benefits are for medically
necessary, usual, reasonable and customary
charges only.
4. Charges must be administered or ordered by
a physician.
5. Charges must be incurred during the Period
of Coverage.
6. Claims must be presented to IMG for payment
within the Period of Coverage or during the
three months immediately following the Period
of Coverage.
|
|
|
Charges for the following
services, treatments and/or conditions are
excluded from coverage under the Visitors Care
plan.
1. Pre-existing Conditions. Charges resulting
directly or indirectly from any Pre-existing
Condition, defined as any Injury, Illness,
sickness, disease, or other physical or
medical disorder or ailment that existed at
the time of Application or at any time during
the three years prior to the effective date of
this insurance, whether or not previously
manifested or symptomatic, diagnosed or
treated, including any subsequent, chronic or
recurring complications or consequences
related thereto or arising therefrom.
2. Heart disease, cancer, and stroke - Charges
resulting directly or indirectly from heart
and blood circulatory disorders including
without limitation arteriosclerosis and
ischemic cardiovascular disease; cancer,
tumor, and stroke or central nervous system
hypoxia; and including any subsequent chronic
or recurring complications or consequences
related thereto or arising therefrom.
3. Treatment or surgeries which are elective,
investigational, experimental or for
research purposes.
4. War, political insurrection, protest, or
any act thereof.
5. Immunizations and routine physical exams.
6. Treatment of Temporomandibular Joint or
dental treatment, except as provided for
herein.
7. Venereal disease, AIDS virus, AIDS related
illness, ARC Syndrome, or AIDS, and the cost
of testing for these conditions, and charges
for treatment or surgeries which are incurred
by any Insured who was HIV+ at time of
enrollment into this insurance.
8. Pregnancy, childbirth, birth control,
artificial insemination, treatment for
infertility or impotency, sterilization or
reversal thereof, or abortion.
9. Any Injury or Illness sustained while
taking part in mountaineering activities where
specialized climbing equipment, ropes or guide
are normally or reasonably should have been
used, Amateur Athletics or professional
athletics, aviation ( except when traveling
solely as a passenger in a commercial
aircraft), hang gliding and parachuting, snow
skiing except for recreation downhill and/or
cross country snow skiing( no cover provided
whilst skiing in violation of applicable laws,
rules or regulations; away from prepared and
marked in-bound territories; and/or against
the advice of the local authoritative body),
racing of any kind including by horse, motor
vehicle ( of any type), or motorcycle,
spelunking, and sub aqua pursuits involving
underwater breathing apparatus.
10. Vision or ear tests and the provision of
visual or hearing aids.
11. Vocational, recreational, speech or music
therapy.
12. Treatment while confined primarily to
receive custodial care, educational or
rehabilitative care, or nursing services.
13. Charges, injuries and/or illnesses
resulting or arising from or occurring during
the commission or continuing perpetration of a
violation of law by the insured, including
without limitation, the engaging in an illegal
occupation or act, but excluding minor traffic
violations.
14. Treatment for, and injuries and/or
illnesses resulting or arising from, substance
abuse or drug addiction.
15. Injury and/or illness resulting or arising
from or sustained while under the influence of
or disablement of drugs or alcohol.
16. Willful self-inflicted injury or illness.
17. Treatment required as a result of or
arising from complications from a treatment or
condition not covered hereunder.
18. Any services or supplies performed or
provided by a relative of the Insured or
provided at no cost to Insured.
19. Treatment for mental and nervous
disorders.
20. Organ or tissue transplants or related
services.
21. Illness or injury where the trip to the
host country is undertaken for treatment or
advice for such Illness or injury, except as
provided for herein.
22. Treatment incurred as a result of or
arising from exposure to nuclear radiation,
and/or radioactive material(s).
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| This
web material contains only a consolidated and
summary description of all current Visitors
Care benefits, conditions, limitations and
exclusions. A certificate containing the
complete Policy Wording with all terms,
conditions and exclusions will be included
with the fulfillment kit. IMG reserves the
right to issue the most current Policy Wording
for this insurance plan in the event this
application and/or brochure has expired, is
modified, or is replaced with a newer version.
Current Policy Wordings are available upon
request. |