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| Visitors
Medical Protection – Updated Worldwide Benefit |
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Each year, the That is why Community
Insurance Agency Inc., in conjunction with the underwriting company Sirius
International Insurance Corporation (publ)(Company),
acting by and through its managing general underwriter and the Plan Administrator,
International Medical Groupsm, Inc. (IMGSM) has designed the Visitors Medical Protection™
Plan (the "Plan"). It is a medical plan for travelers visiting
the  
BENEFITS: Deductible – Your choice of US$250, $500, $1,000 or $2,500 deductible per insured person, per coverage period Coinsurance (After deductible paid by insured) Plan A: Pays 80% of eligible expenses up to policy maximum, or Plan B: Pays 80% of the next US $5,000 then 100% of eligible expenses up to the Policy Maximum Benefit Period – If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-month Benefit Period may provide continued coverage. When the certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than six months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Policy Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness. Period of Coverage – Minimum 15 days and maximum 12 consecutive months for any one policy period Emergency Evacuation – Up to US$25,000 when coordinated through the Plan Administrator. This Plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the country of residence or the country where the evacuation occurred, up to US$25,000. Repatriation – Up to US$20,000 per adult, US$5,000 per child when coordinated through the Plan Administrator. 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$20,000 per adult and US$5,000 per child. Emergency Local Ambulance – To Policy Maximum Accidental Death and Dismemberment – US$25,000 principal sum. The Plan includes US$25,000 principal sum benefit for Accidental Death and Dismemberment occurring during the Period of Coverage: Accidental Loss of life – principal sum; •Accidental Loss of two Members – principal sum; • Accidental Loss of one Member – 50% of principal sum. “Member” means hand, foot or eye. For additional information please see the Conditions of Coverage section. Hospital Room and Board – Average semi-private room rate up to the Policy Maximum Intensive Care - Two times the average semi-private room rate up to the Policy Maximum Medical Expenses – Usual, reasonable and customary up to the Policy Maximum Outpatient Medical – Usual, reasonable and customary up to the Policy Maximum Emergency Room – Charges incurred for the use of the Emergency Room due to an accident are covered up to the Policy Maximum. Charges incurred for the use of the Emergency Room for the treatment of an illness are subject to an additional (extra) US$250 deductible if treatment does not require admittance to the hospital. Dental – Injury due to an accident: The Plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Policy Maximum. Sudden dental pain: The Plan will pay up to US$100 for the necessary treatment of sudden, unexpected pain to sound natural teeth. Returning Minor Children – To US$5,000 when coordinated through the Plan Administrator. If an insured person is hospitalized due to a covered illness/ injury and is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Plan will pay up to US$5,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren). Special Coverages Incidental Home Country Coverage - During the Period of Coverage an insured person may return to his/her 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. End of Trip Home Country Coverage - For every six months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s). Trip Interruption - To US$5,000. If, during a covered trip, there is a death of an immediate family member (spouse, child, parent or sibling) or the substantial destruction of the insured’s principal residence, the Plan will pay to return the insured to the area of principal residence. The Plan will pay for a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket. Lost Luggage - To US$50 per item of personal property; maximum of US$250 per Period of Coverage. This benefit will be paid in the event that the Common Carrier permanently loses an insured person’s checked luggage. This coverage is secondary to any other available coverage, including the Carrier’s. Common Carrier Accidental Death - US$50,000 to Beneficiary; maximum of US$250,000 per family. If accidental death should occur while traveling on a commercial Common Carrier, US$50,000 will be paid to the designated beneficiary, to a maximum of US$250,000 per family. Sports & Activities Coverage - To Policy Maximum for basic sports as described here: The Plan covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. However, activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, windsurfing and whitewater rafting. EXCLUSIONS: Charges for or arising from the following services, treatments, events and/or conditions are excluded from coverage under the plan.
VISIT
ANY DOCTOR-ANY HOSPITAL:
You may visit any doctor in the USA or outside the USA. There
is no provider network for the following plans: Visitors Medical Protection
(VMP) and Patriot Travel Medical. If you are having difficulty locating
a provider, IMG may be able to provide assistance. When you go to the
doctor, you should present the IMG identification card. This card contains
information the doctor’s office needs to bill IMG directly, and contains
a toll-free number where they can call to verify the coverage etc. If Pre-certification guidelines are not followed, eligible claims and expenses will be reduced by 50%. Plan Administrator:CHOOSE THE MEDICAL PROTECTION PLAN THAT PROVIDES DEDICATED PROFESSIONAL STAFF AND 24-HOUR AVAILABILITY. International Medical Groupsm, Inc. (IMG) headquartered
in Indianapolis, Indiana is an organization that understands the medical
insurance needs of international travelers and citizens. Focused exclusively on the international insurance
market, IMG has delivered specialized medical, life and health programs
to hundreds of thousands of individuals, families and groups in more than
150 countries. IMG presents a unique full-service approach to the international
community by offering worldwide coverage and multilingual capabilities,
and provides a complete staff of trained international claims administrators,
products specialists and medical professionals. IMG is available 24 hours
a day, 7 days a week for emergencies, medical evacuations and pre-certifications. |
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