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Overseas Visitors InsuranceSM Exclusive Comprehensive Coverage Plan

Overseas Visitors InsuranceSM


The Overseas Visitors InsuranceSM plan provides coverage for non-US residents, while traveling outside of their Home Country whose name and travel dates have been submitted on the Application and have been accepted by the Administrator. Home Country is defined as - The country where an Insured person(s) has his/her true, fixed and permanent home and principal establishment. Coverage shall apply worldwide with the option to include the United States.

Highlights:

  • Physician Visits/ Urgent Care: $35 co pay.
  • Deductible options: $100; $250; $500; $1,000; $2,500.
  • United Healthcare PPO network
  • Plan A & C covers 90% up to first $5000 and thereafter 100% up to Policy max.
  • Plan B covers 100% up to the policy max.
  • Plan A & Plan B covers Acute Onset of an Existing condition up to age 79.
  • Plan C covers Acute Onset of an Existing condition up to age 69.

Schedule of Benefits

All Coverages and Plan Costs listed in this Evidence of Benefits are in U.S. Dollar amounts.

  PLAN A PLAN B PLAN C
U.S Coverage Included Included Included
Medical Maximum $25,000; $50,000; $100,000; $250,000; $25,000; $50,000; $100,000; $250,000; $50,000; $100,000; $250,000;
Deductible $100; $250; $500; $1,000; $2,500; $100; $250; $500; $1,000; $2,500; $100; $250; $500; $1,000; $2,500;
Physician Visits/ Urgent Care $35 co-pay per office visit.
Deductible is not applied.
$35 co-pay per office visit.
Deductible is not applied.
$35 co-pay per office visit.
Deductible is not applied.
Pre-Certification 50% reduction of eligible medical expenses if pre-certification provisions are not met 50% reduction of eligible medical expenses if pre-certification provisions are not met 50% reduction of eligible medical expenses if pre-certification provisions are not met
Misuse of Emergency Room Deductible $250 for each emergency room visit for treatment of an illness which does not result in a direct Hospital Admission. $250 for each emergency room visit for treatment of an illness which does not result in a direct Hospital Admission. $250 for each emergency room visit for treatment of an illness which does not result in a direct Hospital Admission.
Coinsurance Traveling Inside the United States:
For Treatment received within the UHC network: After You pay the $35 Physician Visits/ Urgent Care Co-pay or Deductible, the plan pays 90% of the next $5,000 of eligible expenses, then 100% to the selected Medical Maximum.

For Treatment received outside the UHC network:
After You pay the $35 Physician Visits/ Urgent Care Co-pay or Deductible, the plan pays 80% of the next $5,000 of eligible expenses, then 100% to the selected Medical Maximum.

Traveling Outside the United States:
After You pay the $35 Physician Visits/Urgent Care Co-pay or Deductible, the plan pays 100% to the selected Medical Maximum.
Traveling Inside the United States:
For Treatment received within the UHC network: After You pay the $35 Physician Visits/Urgent Care Co-pay or Deductible, the plan pays 100% to the selected Medical Maximum.

For Treatment received outside the UHC network:
After You pay the $35 Physician Visits/ Urgent Care Co-pay or Deductible, the plan pays 80% of the next $5,000 of eligible expenses, then 100% to the selected Medical Maximum.

Traveling Outside the United States:
After You pay the $35 Physician Visits/Urgent Care Co-pay or Deductible, the plan pays 100% to the selected Medical Maximum.
Traveling Inside the United States:
For Treatment received within the UHC network: After You pay the $35 Physician Visits/ Urgent Care Co-pay or Deductible, the plan pays 90% of the next $5,000 of eligible expenses, then 100% to the selected Medical Maximum.

For Treatment received outside the UHC network:
After You pay the $35 Physician Visits/ Urgent Care Co-pay or Deductible, the plan pays 80% of the next $5,000 of eligible expenses, then 100% to the selected Medical Maximum.

Traveling Outside the United States:
After You pay the $35 Physician Visits/Urgent Care Co-pay or Deductible, the plan pays 100% to the selected Medical Maximum.
Prescription Drug After you pay your deductible,the plan pays 80% of eligible Expenses up to $5,000 then 100% to the selected Medical Maximum, independent of Coinsurnace for all other expenses. After you pay your deductible,the plan pays 80% of eligible Expenses up to $5,000 then 100% to the selected Medical Maximum, independent of Coinsurnace for all other expenses. After you pay your deductible,the plan pays 80% of eligible Expenses up to $5,000 then 100% to the selected Medical Maximum, independent of Coinsurnace for all other expenses.
Dental (Accident Coverage) Reasonable and customary for necessary treatment due to an accident Reasonable and customary for necessary treatment due to an accident. Reasonable and customary for necessary treatment due to an accident.
Dental (Sudden Relief of Pain $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth. $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Emergency Medical Evacuation/Repatriation $100,000 (in addition to the Medical Maximum) $100,000 (in addition to the Medical Maximum) $500,000 Maximum limit per lifetime.
Return of Mortal Remains $20,000 $20,000 $50,000
Local Cremation or Burial $5,000 $5,000 $5,000
Return of Minor Children Up to $5,000 limit per lifetime. Must be app roved in advance and coordinated by the company Up to $5,000 limit per lifetime. Must be app roved in advance and coordinated by the company Up to $50,000 limit per lifetime. Must be app roved in advance and coordinated by the company
Emergency Medical Reunion US $15,000 per period of coverage when coordinated through the Company for a max of 15 days. US $15,000 per period of coverage when coordinated through the Company for a max of 15 days. $50,000 limit per lifetime. Must be approved in advance and coordinated by the Company
Local Ambulance Benefit Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum.
Accidental Death & Dismemberment (AD&D) $25,000 principal sum for Insured, $12,500 for accidental loss of another member Aggregate limit of $250,000 per family $25,000 principal sum for Insured, $12,500 for accidental loss of another member Aggregate limit of $250,000 per family $25,000 principal sum for Insured, $12,500 for accidental loss of another member Aggregate limit of $250,000 per family
Common Carrier Accidental Death $50,000 per insured person, max of $250,000 per family involved in the same accident $50,000 per insured person, max of $250,000 per family involved in the same accident $50,000 per Insured Person and $250,000 Maximum Limit per Lifetime and per Family.
Loss of Checked Baggage Up to $50 per item of luggage,$250 max per insured person per period of coverage. Not subject to deductible or coinsurance. Up to $50 per item of luggage,$250 max per insured person per period of coverage. Not subject to deductible or coinsurance. Up to $50 per item of luggage,$250 max per insured person per period of coverage. Not subject to deductible or coinsurance.
Durable Medical Equipment Reasonable and customary. Must be pre-certified for medical necessity by Seven Corners. Reasonable and customary. Must be pre-certified for medical necessity by Seven Corners. Reasonable and customary. Must be pre-certified for medical necessity by Seven Corners.
Interruption of Trip $5,000 $5,000 $5,000
Home Country Coverage Incidental Trips to The Home Country : $50,000
Home Country Extension of Benefits: $5,000
Incidental Trips to The Home Country : $50,000
Home Country Extension of Benefits: $5,000
Incidental Trips to The Home Country : $50,000
Home Country Extension of Benefits: $5,000
Acute Onset of Pre-existing Condition Ages up to 69: Up to lesser of Medical Maximum or $100,000

Ages 70-79: Up to lesser of Medical Maximum or $35,000

Must be Coordinated by Seven Corners Medical Management. Services and Treatment in the United States must be received at an approved PPO Service Provider facility, if one exists within a 50-mile radius of where the insured person is located.

$25,000 maximum per emergency medical evacuation related to an acute onset of a pre-existing condition.
Ages up to 69: Up to lesser of Medical Maximum or $100,000

Ages 70-79: Up to lesser of Medical Maximum or $35,000

Must be Coordinated by Seven Corners Medical Management. Services and Treatment in the United States must be received at an approved PPO Service Provider facility, if one exists within a 50- mile radius of where the insured person is located.

$25,000 maximum per emergency medical evacuation related to an acute onset of a pre-existing condition.
Ages up to 69: Up to the medical maximum

Ages 70-79: Not available

Must be Coordinated by Seven Corners Medical Management. Services and Treatment in the United States must be received at an approved PPO Service Provider facility, if one exists within a 50- mile radius of where the insured person is located.

$25,000 maximum per emergency medical evacuation related to an acute onset of a pre-existing condition.
Identity Theft N/A N/A $500 Maximum limit
Hospital Indemnity N/A N/A $100 per overnight and Maximum Limit of 10 overnights.
Political Evacuation N/A N/A $10,000 Maximum Limit per lifetime. Must be approved in advance and coordinated by the company
Terrorism N/A N/A $50,000 Maximum Limit per lifetime and Not subject to the deductible.
Natural Disaster N/A N/A $100 per day and maximum limit of 5 days for accommodations
Natural Disaster Evacuation/Repatriation N/A N/A $10,000 (only available for travel outside the United States).
Hospital Room & Board Average semi-private room rate up to the Policy Maximum Average semi-private room rate up to the Policy Maximum Average semi-private room rate up to the Policy Maximum
Physiotherapy/Physical Medicine/Chiropractic Physical Therapy prescribed & necessary Physical Therapy prescribed & necessary Physical Therapy prescribed & necessary
Intensive Care Usual, reasonable and customary up to the Policy Medical Maximum Usual, reasonable and customary up to the Policy Medical Maximum Usual, reasonable and customary up to the Policy Medical Maximum
Surgery Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum.
Outpatient Medical Expenses Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum.
Diagnostic Procedures Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum.
Home Nursing Care Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum. Reasonable and customary to the medical maximum.
Assistance Services Included Included Included
Benefit Period 180 Days 180 Days 180 Days

Exclusions and Limitations

No Benefit shall be payable for Accident Medical, Sickness Medical, In-Hospital Indemnity, Dental, Emergency Medical Evacuation/Repatriation, Return of Mortal Remains, Return of Minor Child, Emergency Medical Reunion, as the result of:

  1. Pre-existing Conditions which are excluded under this Certificate. This means that any claims for Pre-existing Conditions will not be covered for the duration of this Certificate. This exclusion is waived for Eligible Benefits incurred as defined below: Acute Onset of Pre-existing Condition as defined in this Certificate up to the maximum stated in the Schedule of Benefits, must be coordinated by Seven Corners Medical Management. Any reoccurrence within the same Policy Period will no longer be considered Acute Onset of a Pre-existing Condition and will not be eligible for additional coverage. A Pre-existing Condition which is a congenital condition or that gradually becomes worse over time and/or known, scheduled, required, or expected medical care, drugs or treatments existing or necessary prior to the Effective Date are not considered to be an Acute Onset. Acute Onset of a Pre-existing Condition Coverage expires upon medical advice that the condition and Onset is no longer acute or you are discharged from a medical facility.
  2. Injury or Illness which is not presented to the Underwriter for payment within 3 months of receiving Treatment;
  3. Charges for Treatment which is not Medically Necessary
  4. Charges provided at no cost to You;
  5. Charges for Treatment which exceeds Reasonable and Customary charges;
  6. Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes;
  7. 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;
  8. Suicide, or any attempt thereof, while sane or self destruction or any attempt thereof, while sane;
  9. War, hostilities or warlike operations (whether war be declared or not), Invasion, Act of an enemy foreign to the nationality of the insured person or the country in, or over, which the act occurs, Civil war, Riot, Rebellion, Insurrection, Revolution, Overthrow of the legally constituted government, Civil commotion assuming the proportions of, or amounting to, an uprising, Military or usurped power, Explosions of war weapons, Utilization of Nuclear, Chemical or Biological weapons of mass destruction howsoever these may be distributed or combined, Murder or Assault subsequently proved beyond reasonable doubt to have been the act of agents of a state foreign to the nationality of the insured person whether war be declared with that state or not, Terrorist activity. For the purpose of this Exclusion;
    1. Terrorist activity means an act, or acts, of any person, or group(s) of persons, committed for political, religious, ideological or similar purposes with the intention to influence any government and/or to put the public, or any section of the public, in fear. Terrorist activity can include, but not be limited to, the actual use of force or violence and/or the threat of such use. Furthermore, the perpetrators of terrorist activity can either be acting alone, or on behalf of, or in connection with any organization(s) or governments(s).
    2. Utilization of Nuclear weapons of mass destruction means the use of any explosive nuclear weapon or device or the emission, discharge, dispersal, release or escape of fissile material emitting a level of radioactivity capable of causing incapacitating disablement or death amongst people or animals.
    3. Utilization of Chemical weapons of mass destruction means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing incapacitating disablement or death amongst people or animals.
    4. Utilization of Biological weapons of mass destruction means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically synthesized toxins) which are capable of causing incapacitating disablement or death amongst people or animals.
    Also excluded hereon is any Loss or expense of whatsoever nature directly or indirectly arising out of, contributed to, caused by, resulting from, or in connection with any action taken in controlling, preventing, or suppressing any, or all, of the situations described above. In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect;
  10. Injury sustained while participating in professional athletics, including but not limited to the event, games, practice, conditioning and any other activity related to professional athletics.
  11. 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;
  12. Treatment of the temporomandibular joint;
  13. Vocational, speech, recreational or music therapy;
  14. Services or supplies performed or provided by a relative of Yours, or anyone who lives with You;
  15. 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;
  16. Elective Surgery which can be postponed until You return to Your Home Country, where the objective of the trip is to seek medical advice, treatment or Surgery;
  17. Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids;
  18. 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;
  19. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent;
  20. Injury sustained or Disablement due wholly or partly to the Insured being intoxicated as defined and determined by the laws of the state where the Injury occurred; or to the Insured being under the influence of any narcotic, unless administered on the advice of a Physician;
  21. Any Mental and Nervous disorders or rest cures;
  22. Congenital abnormalities and conditions arising out of or resulting there from;
  23. Expenses which are non-medical in nature;
  24. Expenses as a result of or in connection with intentionally self-inflicted Injury or Illness;
  25. Expenses as a result of or in connection with the commission of a felony offense;
  26. Treatment paid for or furnished under any other individual or group policy or other service or medical pre-payment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government plan or facility set up for treatment without any cost to You;
  27. Treatment of venereal disease, including all sexually transmitted diseases and conditions, and any and all consequences thereof;
  28. Dental care, except as the result of Injury to natural teeth caused by Accident, unless otherwise covered under this plan;
  29. Routine Dental Treatment;
  30. For Pregnancy or Illness resulting from Pregnancy, childbirth, or miscarriage;
  31. For miscarriage resulting from Accident or complications of Pregnancy;
  32. 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;
  33. Treatment for human organ tissue transplants and their related treatment;
  34. Expenses incurred while in Your Home Country, except as provided under the Home Country Coverage;
  35. Expenses incurred during a Hospital emergency visit which is not of an emergency nature;
  36. Covered Expenses incurred for which the Trip to the Host Country was undertaken to seek medical treatment for a condition;
  37. Covered Expenses incurred during a Trip after Your Physician has limited or restricted travel;
  38. This plan does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act.
  39. Sex change operations, or for treatment of sexual dysfunction or sexual inadequacy;
  40. Weight reduction programs or the surgical treatment of obesity;
  41. Expenses resulting from Acquired Immune Deficiency Syndrome (AIDS), Aids-Related Complex (ARC) or the Human Immunodeficiency Virus (HIV).
  42. Treatment for learning disabilities, altitudinal disorders, or disciplinary problems;
  43. Expenses incurred in the United States unless the expenses pertain to the Home Country Coverage Benefit, or unless the option has been selected and applicable premium has been paid in full.

No Benefit shall be payable for Accidental Death and Dismemberment as the result of:

  1. Suicide or attempt thereof while sane or self destruction or any attempt thereof while insane;
  2. Hernia of any kind;
  3. Injury sustained while You are riding as a pilot, student pilot, operator or crew member, in or on, boarding or alighting from, any type of aircraft;
  4. Injury sustained while You are riding as a passenger in any aircraft (a) not having a current and valid Airworthy Certificate and (b) not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft;
  5. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with:(a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war; (b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power. (c) any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the Government de jure or de facto or to the influencing of it by terrorism or violence; (d) martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege (hereinafter for the purposes of this Exclusion called the “Occurrences”). Any consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Occurrences shall be deemed to be consequences for which the Underwriter shall not be liable under this Policy except to the extent that the Insured Person shall prove that such consequence happened independently of the existence of such abnormal conditions;
  6. Service in the military, naval or air service of any country;
  7. Flying in any aircraft being used for or in connection with acrobatic or stunt flying, racing or endurance tests;
  8. Flying in any rocket-propelled aircraft;
  9. Flying in any aircraft being used for or in connection with crop dusting or seeding or spraying, fire fighting, exploration, pipe or power line inspection, any form of hunting or herding, aerial photography, banner towing or any experimental purpose;
  10. Flying in any aircraft which is engaged in any flight which requires a special permit or waiver from the authority having jurisdiction over civil aviation, even though granted;
  11. Sickness of any kind;
  12. Being under the influence of alcohol or having taken drugs or narcotics unless prescribed by a legally qualified Physician or surgeon;
  13. Injury occasioned or occurring while You are committing or attempting to commit a felony or to which a contributing cause was You being engaged in an illegal occupation;
  14. While riding or driving in any kind of competition;
  15. Pregnancy, childbirth, miscarriage or abortion;
  16. This plan does not insure against loss or damage (including death or injury) and any associated cost or expense resulting directly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act.

For Interruption of Trip: This insurance does not cover: (1) war or any act of war, whether declared or not; participation in a felony, riot or insurrection; participation in contests of speed; a Pre-existing Condition existing prior to the Insured’s departure from their Home Country that has the likelihood of causing death; the Insured Person or Traveling Companion or Traveling Companion’s family making changes to personal plans; having business or contractual obligations; being unable to obtain necessary travel documents (passports, visas, etc.); being detained or having property confiscated by customs authorities; carrier caused delays (including bad weather); prohibition or regulatory by any government; default of yacht charter companies; default of the organization from which the Insured Person purchased their trip arrangements.

For Loss of Checked 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 aids; prosthetic limbs; musical instruments; money or securities; tickets or documents; or sporting equipment if loss or damage results from the use thereof.

For Political Evacuation, this insurance does not cover: 1) Losses recoverable under any other insurance or through an employer; 2) Losses arising from or attributable to a) dishonest or criminal acts committed or attempted by the Insured, b) alleged violation of the laws of the Host Country, unless the Underwriter determines such allegations to be fraudulent, or c) failure to maintain required documents or visas; 3) Losses attributable to a ) debt, insolvency, commercial failure, or the repossession of any property, b) Insured's non-compliance with a contract or license or c) implementation of legally contributed exchange rates; 4) Losses due to liability assured by the Insured under any contract.