|
Each year, the United States hosts
millions of foreign visitors from all over the world. While the United
States healthcare system is recognized as one of the best in the
world, many visitors are concerned about the potential out-of-pocket
expenses that could result from an injury or sickness during their
visit to the United States of America. Healthcare costs are different
in the United States than any other country around the world. That is
why foreign national visiting the United States of America require
VISITORS medical insurance to protect them and their family.
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 U.S.A.
Rates: VMP Plan Monthly/Daily Rates:
|
PLAN A
VMP MONTHLY RATES
90%/10% in PPO Network up to the Policy Maximum after deductible
met (Options 1, 2, 3, 4)
(80/20% out of PPO Network )
|
|
PLAN A
VMP DAILY RATES
(10 day minimum) 90%/10% in PPO Network up to the
Policy Maximum after deductible met (Options 1, 2, 3,4)
(80%/20% out of PPO Network)
|
|
Option 1 - US$25,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$23
|
$21
|
$19
|
$17
|
$14
|
|
18 - 29
|
$36
|
$33
|
$30
|
$26
|
$23
|
|
30 - 39
|
$46
|
$42
|
$38
|
$34
|
$30
|
|
40 - 49
|
$71
|
$65
|
$57
|
$52
|
$46
|
|
50 - 59
|
$101
|
$92
|
$84
|
$73
|
$65
|
|
60 - 64
|
$118
|
$107
|
$97
|
$86
|
$75
|
|
65 - 69
|
$135
|
$123
|
$111
|
$99
|
$86
|
|
70 - 79
|
$181
|
$165
|
$147
|
$132
|
$115
|
|
80+*
|
$343
|
$312
|
$282
|
$249
|
$219
|
|
*$15,000
policy maximum |
|
|
|
Option 1 - US$25,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$0.77
|
$0.70
|
$0.64
|
$0.58
|
$0.46
|
|
18 - 29
|
$1.20
|
$1.09
|
$1.00
|
$0.88
|
$0.76
|
|
30 - 39
|
$1.53
|
$1.40
|
$1.27
|
$1.12
|
$1.00
|
|
40 - 49
|
$2.37
|
$2.15
|
$1.91
|
$1.73
|
$1.52
|
|
50 - 59
|
$3.37
|
$3.06
|
$2.79
|
$2.43
|
$2.15
|
|
60 - 64
|
$3.94
|
$3.58
|
$3.25
|
$2.88
|
$2.49
|
|
65 - 69
|
$4.50
|
$4.10
|
$3.70
|
$3.31
|
$2.88
|
|
70 - 79
|
$6.04
|
$5.49
|
$4.91
|
$4.40
|
$3.82
|
|
80+*
|
$11.44
|
$10.40
|
$9.40
|
$8.30
|
$7.30
|
|
*$15,000
policy maximum |
|
|
Option 2 - US$50,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$25
|
$23
|
$21
|
$19
|
$15
|
|
18 - 29
|
$40
|
$36
|
$33
|
$29
|
$25
|
|
30 - 39
|
$51
|
$46
|
$42
|
$37
|
$33
|
|
40 - 49
|
$78
|
$71
|
$63
|
$57
|
$50
|
|
50 - 59
|
$111
|
$101
|
$92
|
$80
|
$71
|
|
60 - 64
|
$130
|
$118
|
$107
|
$95
|
$82
|
|
65 - 69
|
$149
|
$135
|
$122
|
$109
|
$95
|
|
70 - 79
|
$199
|
$181
|
$162
|
$145
|
$126
|
|
80+*
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
|
|
Option 2 - US$50,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$0.84
|
$0.77
|
$0.70
|
$0.63
|
$0.50
|
|
18 - 29
|
$1.32
|
$1.20
|
$1.10
|
$0.97
|
$0.83
|
|
30 - 39
|
$1.69
|
$1.53
|
$1.40
|
$1.23
|
$1.10
|
|
40 - 49
|
$2.60
|
$2.37
|
$2.10
|
$1.90
|
$1.67
|
|
50 - 59
|
$3.70
|
$3.37
|
$3.07
|
$2.67
|
$2.37
|
|
60 - 64
|
$4.33
|
$3.93
|
$3.57
|
$3.17
|
$2.73
|
|
65 - 69
|
$4.95
|
$4.50
|
$4.07
|
$3.63
|
$3.17
|
|
70 - 79
|
$6.64
|
$6.03
|
$5.40
|
$4.83
|
$4.20
|
|
80+*
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
|
Option 3 - US$100,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$29
|
$26
|
$24
|
$22
|
$18
|
|
18 - 29
|
$46
|
$42
|
$38
|
$34
|
$30
|
|
30 - 39
|
$62
|
$56
|
$50
|
$44
|
$40
|
|
40 - 49
|
$88
|
$80
|
$72
|
$64
|
$56
|
|
50 - 59
|
$136
|
$124
|
$112
|
$100
|
$86
|
|
60 - 64
|
$161
|
$146
|
$132
|
$116
|
$102
|
|
65 - 69
|
$194
|
$176
|
$158
|
$140
|
$124
|
|
70 - 79
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80+*
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
|
|
Option 3 - US$100,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$0.95
|
$0.87
|
$0.80
|
$0.73
|
$0.60
|
|
18 - 29
|
$1.54
|
$1.40
|
$1.27
|
$1.13
|
$1.00
|
|
30 - 39
|
$2.05
|
$1.87
|
$1.67
|
$1.47
|
$1.33
|
|
40 - 49
|
$2.93
|
$2.67
|
$2.40
|
$2.13
|
$1.87
|
|
50 - 59
|
$4.55
|
$4.13
|
$3.73
|
$3.33
|
$2.87
|
|
60 - 64
|
$5.35
|
$4.87
|
$4.40
|
$3.87
|
$3.40
|
|
65 - 69
|
$6.45
|
$5.87
|
$5.27
|
$4.67
|
$4.13
|
|
70 - 79
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80+*
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
|
Option 4 - US$250,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$33
|
$30
|
$28
|
$24
|
$20
|
|
18 - 29
|
$64
|
$58
|
$52
|
$46
|
$40
|
|
30 - 39
|
$79
|
$72
|
$66
|
$58
|
$50
|
|
40 - 49
|
$117
|
$106
|
$94
|
$84
|
$74
|
|
50 - 59
|
$183
|
$166
|
$150
|
$132
|
$116
|
|
60 - 64
|
$213
|
$194
|
$176
|
$156
|
$136
|
|
65 - 69
|
$249
|
$226
|
$204
|
$180
|
$158
|
|
70 - 79
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80+*
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
|
|
Option 4 - US$250,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$1.10
|
$1.00
|
$0.93
|
$0.80
|
$0.67
|
|
18 - 29
|
$2.13
|
$1.93
|
$1.73
|
$1.53
|
$1.33
|
|
30 - 39
|
$2.64
|
$2.40
|
$2.20
|
$1.93
|
$1.67
|
|
40 - 49
|
$3.89
|
$3.53
|
$3.13
|
$2.60
|
$2.47
|
|
50 - 59
|
$6.09
|
$5.53
|
$5.00
|
$4.40
|
$3.87
|
|
60 - 64
|
$7.11
|
$6.47
|
$5.87
|
$5.20
|
$4.53
|
|
65 - 69
|
$8.29
|
$7.53
|
$6.80
|
$6.00
|
$5.27
|
|
70 - 79
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80+*
|
N/A
|
N/A
|
N/A
|
N/A
|
N/A
|
|
|
|
|
|
PLAN B
90%/10% in PPO Network up to US$5,000 then 100% up to
the Policy Maximum after deductible met (Options 5,6,7,8) (80%/20%
out of PPO Network)
|
|
PLAN B
90%/10% in PPO Network up to US$5,000 then 100% up to
the Policy Maximum after deductible met (Options 5,6,7,8) (80%/20%
out of PPO Network )
|
|
Option 5 - US$25,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$29
|
$26
|
$24
|
$21
|
$18
|
|
18 - 29
|
$45
|
$41
|
$37
|
$33
|
$29
|
|
30 - 39
|
$58
|
$53
|
$48
|
$42
|
$37
|
|
40 - 49
|
$88
|
$80
|
$72
|
$64
|
$56
|
|
50 - 59
|
$126
|
$115
|
$103
|
$92
|
$80
|
|
60 - 64
|
$148
|
$135
|
$121
|
$108
|
$94
|
|
65 - 69
|
$169
|
$154
|
$138
|
$123
|
$108
|
|
70 - 79
|
$229
|
$208
|
$188
|
$167
|
$146
|
|
80+*
|
$436
|
$396
|
$356
|
$317
|
$277
|
|
*$15,000 policy maximum |
|
|
|
Option 5 - US$25,000 Policy Limit |
|
Deductible
|
US$100
|
US$250
|
US$500
|
US$1,000
|
US$2,500
|
|
Under 18
|
$0.97
|
$0.88
|
$0.79
|
$0.70
|
$0.62
|
|
18 - 29
|
$1.50
|
$1.37
|
$1.23
|
$1.09
|
$0.96
|
|
30 - 39
|
$1.94
|
$1 | | |