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Included
Benefits
Optional Benefit
Policy
Exclusions
Benefits Included in All WorldMed Plans:
| Benefit |
Limit |
| Emergency Medical Evacuation |
$100,000 |
| Accidental Death & Dismemberment (AD&D) |
$25,000 |
| Repatriation of Remains |
$20,000 |
| Emergency Reunion |
$10,000 |
| Lost Baggage |
$250 |
| Trip Interruption |
$5,000 |
| Emergency Travelers Assistance |
Included |
| Home Country Coverage |
Included |
Medical Expense (Accident & Sickness) -
Limits Vary Based On Plan Choice*
Plan A |
Plan B |
Lite |
Benefit |
Limit |
Benefit |
Limit |
Benefit |
Limit |
Accident
& Sickness
|
$500,000 |
Accident
& Sickness
|
$1,000,000 |
Accident Only |
$100,000 |
Sickness Only |
$5,000 |
If Injury or Illness
occurs during the Period of Coverage and you, your insured spouse or dependent
children require medical treatment, after you pay the selected annual deductible,
the policy will pay 80% of the first $5,000 annually for covered medical expenses incurred. Then the policy will pay 100% up to the policy maximum amount
as stated in Limits of Coverage. Please note: For the Lite Plan Outbound policy there is no co-insurance. The policy will pay 100% up to
the policy maximum amount as stated in Limits of Coverage.
DEDUCTIBLE: The above medical expenses are excess of an annual deductible per Confirmation number. The Confirmation number will remain the same
provided there is no lapse of coverage. Please note: For the Lite Plan policies, the illness deductible is $75.00 per incident. The
deductible amount consists of covered expenses which would otherwise be payable under this policy. These expenses must be borne by the Insured Person.
*The maximum benefit for ages 70 - 79 is $100,000
and the maximum benefit for ages 80+ is $15,000.
Covered
Expenses 1) Charges made by a hospital for room and board, floor nursing
and other services, including charges for professional services 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 diagnosis, treatment and surgery by a physician;
3) Charges made for the cost and administration of anesthetics; 4) 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;
5) Charges for physiotherapy, if recommended by a physician for the treatment
of a specific disablement and administered by a licensed physiotherapist; 6) Dressings,
drugs and medicines that can only be obtained upon a written prescription of a
physician or surgeon.
Illness must be contracted
and manifest itself, or Injury must occur, during the Period of Coverage. The
first expense must be incurred within 30 days of the commencement of covered Injury
or Illness. Benefit period is 26 weeks.
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All Other Benefit Limits Are The Same for All Three Plans
Emergency
Medical Evacuation Expense A / B: $100,000 If Injury or
Illness commencing during the Period of Coverage requires emergency evacuation
to either the nearest medical facility where appropriate medical treatment can
be obtained, or to the Country of Residence, all expenses incurred are covered
up to the maximum benefit selected. An emergency evacuation must be recommended
by a legally licensed physician who certifies that the severity of Injury or Illness
necessitates such emergency evacuation and agreed to by you or your representative.
Arrangements must be made by AIGAssist. Accidental
Death & Dismemberment (AD&D) A / B: $25,000 If
an Injury occurs during your Period of Coverage and results in one of the following
losses within 365 days after an accident, the Policy will pay as follows: Loss
of Life - A / B: $25,000; Loss of two Members - A / B: $25,000; Loss of one Member
- A / B: $12,500. Repatriation of
Remains Expense A / B: $20,000 If Injury or Illness commencing
during the Period of Coverage results in death, all reasonable expenses incurred
for preparation and return of the remains to the Country of Residence will be
paid up to the maximum per person. Arrangements must be made by AIGAssist. Emergency
Reunion A / B: $10,000 In the event of an Emergency Medical
Evacuation due to a covered injury or illness, where the physician feels that
it would be beneficial for the Insured to have a family member at their side during
transport, the Company will reimburse the Insured for travel and lodging expenses,
up to a maximum of $10,000. Arrangements must be made by AIGAssist. To
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Travelers Assistance • 24-hour verification of medical
coverage for hospitals and physicians
• 24-hour medical care location service
• Medical case monitoring, arranging communication between patient, family, physicians,
employer, consulate or embassy
• Emergency medical transportation or repatriation
of remains arrangements
• Multilingual services
• Legal referral, to help you
locate a consular official or attorney
Lost
Baggage A / B: $250
If the Insured is a ticketed passenger
on any land, water or air conveyance licensed for the transportation of passengers,
coverage is provided if checked baggage is lost due to theft or misdirection.
Benefits are paid only in excess of amounts paid or payable by the Common Carrier
or any other valid and collectible insurance, maximum: $50/article, $250/confirmation.
Trip
Interruption A / B: $5,000
The Company will pay benefits
if an Insured Person is unable to continue his/her trip due to; 1) Death, occurring
prior to the Insured's return to his/her Home Country, or of an Insured Person's
Immediate Family Member; or 2) Serious damage to the Insured Person's principal
residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane,
etc.). The Company will reimburse the Insured Person for the cost of travel, less
the value of applied credit from an unused return travel ticket to return home
to his/her area of principal residence. This benefit is limited to the cost of
a one-way economy airfare or ground transportation and is subject to a maximum
amount of $5,000 per confirmation.
Home Country Coverage - Included
Coverage for eligible medical expenses incurred while an insured person is in his Home Country. Eligible medical expenses are those eligible expenses associated with an accident or sickness that has occurred during the insured's visit outside his home country.
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of page Optional Benefit: Hazardous
Activity Coverage Medical Expense coverage for motorcycling,
scuba diving, jet, snow & water skiing, mountain climbing, sky diving, amateur
racing, piloting an aircraft, bungee jumping, spelunking, whitewater rafting,
surfing or parasailing.
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of page Exclusions For
Medical Expense & Trip Interruption, this insurance does not cover:
1)
Pre-Existing Conditions, defined as any injury or illness which was contracted
or which manifested itself, or for which treatment or medication was prescribed
within three years prior to the effective date of this insurance; 2) Services,
supplies or treatment, including any period of hospital confinement, which are
not recommended, approved and certified as necessary and reasonable by a physician,
or expenses which are non-medical in nature; 3) Expenses incurred as a result
of or in connection with: a) Declared or undeclared war, or any act thereof; b)
Injury sustained while participating in professional athletics; c) Intentionally
self-inflicted injury, suicide while sane or attempted suicide while insane; d)
Motorcycling, scuba diving, jet, snow and water skiing, mountain climbing, sky
diving, professional or amateur racing, piloting an aircraft, bungee jumping,
spelunking, whitewater rafting, surfing or parasailing; or e) Commission of a
felony; 4) Expenses for: a) Pregnancy, childbirth, or miscarriage; b) Routine
physicals; c) Cosmetic or plastic surgery, except as the result of an accident;
d) Elective surgery; e) Any mental or nervous disorders or rest cures; f) Dental
care, except as the result of injury to natural teeth caused by accident; g) Eye
refractions or eye examinations for the purpose of prescribing corrective lenses
for eyeglasses or contact lenses or for the fitting thereof, unless caused by
accidental bodily injury incurred while insured hereunder; h) Alcoholism, drug
addiction, or use of any drug or narcotic agent; or i) Treatment by the Insured's
Immediate Family.
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& Dismemberment, this insurance does not cover: Any loss, fatal or
non-fatal, caused by or resulting from: 1) Intentionally self-inflicted injury,
suicide while sane or attempted suicide while insane; 2) War or any act of war,
declared or undeclared, or service in the military, naval or air service of any
country; 3) Piloting or acting as a crew member, or riding in any aircraft except
as a fare paying passenger on a scheduled airline; 4) Illness, disease, pregnancy,
childbirth, miscarriage; 5) Any bacterial infection other than one occurring from
an accidental cut or wound; 6) Hernia; or 7) The insured being under the influence
of drugs (unless taken under the advice of a physician and within the amounts
prescribed by a physician) or intoxicants of any type including alcohol. For
Emergency Medical Evacuation and Repatriation of Remains Expense, this insurance
does not cover: Any loss fatal or non-fatal caused by or resulting from
(1), (2) or (3) above. For Lost Baggage, this insurance
does not cover: Animals; automobiles or automobile equipment; boats; motors;
motorcycles; other conveyances or their appurtenances (except bicycles while checked
as baggage with a Common Carrier); household furniture; eye glasses or contact
lenses; artificial teeth or dental bridges; hearing aides; prosthetic limbs; musical
instruments; money or securities; tickets or documents; or sporting equipment
if loss or damage results from the use thereof. All
coverages, except Accidental Death and Dismemberment, shall be in excess of
all other valid and collectible insurance indemnity and shall apply only when
such benefits are exhausted.
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