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Visitors Care® Low-Cost Limited Schedule of Benefits Plan

Visitors Care®


Visitors Care® Insurance is a Low-Cost Insurance with Limited scheduled of benefits, which has life time benefit limits for non-US citizens traveling outside their home country. Visitors Care® offers benefit maximums of $25,000, $50,000 or $100,000 for the life of the plan with various deductible options such as $0, $50 or $100. Visitors Coverage is 100% of the covered amount as per Scheduled of Benefits The Visitors Care® insurance plan will be covered in USA/Worldwide,as long as they are outside their country of citizenship. The overseas travel health insurance plans are administered by International Medical Group (IMG) and underwritten by Sirius International Insurance Corporation. The Visitors Care® plan offers 24-hour assistance from a multilingual, international customer service center, which can handle transactions in any language and work with any type of currency. If the policy holder becomes hurt or ill when he is away from home, qualified professionals at the Customer Service Center can help him locate excellent medical care through the 17,000 providers in Visitors Care® International Providers Access (IPA) system. However, it is not necessary to use the medical providers in the IPA system but this service is available if needed.

The plan is renewable (without break in coverage) for 5 days up to 12 months and up to a maximum total of 24 continuous months. For each renewal, you will be charged a fee of $5 in addition to the premium costs.

International travel can quickly turn into a frightening situation if you’re not prepared for a medical emergency. Most travelers assume they will be covered by their standard medical plan, but that isn’t the case. While traditional plans may offer adequate domestic coverage, they are not designed for international travel. Without even realizing it, you may be putting your health at risk. Don’t let your medical coverage be an uncertainty. Travel with one of IMG’s Travel Medical Insurance® plans so you can spend more time enjoying your international experience and less time worrying about medical coverage.

The plan offers benefit maximums of US$25,000, US$50,000 or US$100,000 for the life of the plan, and a choice of deductibles of US$0, US$50, or US$100 applied per illness/injury. When you incur eligible medical expenses, the plan will provide benefits for Usual, Reasonable and Customary charges up to the limits outlined in the Schedule of Benefits below, with no coinsurance.


MEDICAL BENEFITS
Usual, reasonable and customary charges, subject to deductible where applicable
Medical Benefits Plan A - $25,000 maximum benefit per illness/injury Plan B - $50,000 maximum
benefit per illness/injury
Plan C - $100,000 maximum benefit per illness/injury
Inpatient Treatment
Hospital room & board Up to US$825 per day, 30 day maximum per period of coverage Up to US$1,400 per day, 30 day maximum per period of coverage Up to US$2,000 per day, 30 day maximum per period of coverage
Intensive Care Up to an additional $400 per day, 8 day maximum per period of coverage Up to an additional $660 per day, 8 day maximum per period of coverage Up to an additional $850 per day, 8 day maximum per period of coverage
Surgical Treatment Up to $2,000 per surgical session Up to $3,300 per surgical session Up to $5,500 per surgical session
Pre-admission tests Up to $750 per period of coverage Up to $1,100 per period of coverage Up to $1,100 per period of coverage
Physician visits Up to $50 per visit, 10 visits per period of coverage Up to $60 per visit, 10 visits per period of coverage Up to $85 per visit, 10 visits per period of coverage
Outpatient Treatment
Surgical treatment Up to $2,000 per surgical session Up to $3,300 per surgical session Up to $5,500 per surgical session
Surgical facility fee Up to $750 per surgical session Up to $900 per surgical session Up to $1,000 per surgical session
Laboratory

Radiology/X-ray
Up to $400 max per period of coverage
($200 per procedure)
Up to $450 max per period of coverage
($250 per procedure)
Up to $500 max per period of coverage
($500 per procedure)
Hospital emergency room Up to $200 per visit Up to $330 per visit Up to $550 per visit
Prescription drugs Up to $250 per period of coverage Up to $250 per period of coverage Up to $250 per period of coverage
Miscellaneous Inpatient & Outpatient Services
Anesthetist Up to $450 per surgical session Up to $825 per surgical session Up to $1,375 per surgical session
Assistant surgeon Up to $450 per surgical session Up to $825 per surgical session Up to $1,375 per surgical session
Other Coverages
Emergency Local Ambulance Up to $250 max per period of coverage Up to $450 max per period of coverage Up to $475 max per period of coverage
Dental Injury Up to $550 max per period of coverage Up to $550 max per period of coverage Up to $550 max per period of coverage
Physical therapy Up to $40 per visit per day, 12 visits per period of coverage Up to $40 per visit per day, 12 visits per period of coverage Up to $40 per visit per day, 12 visits per period of coverage
Extended care facility Covered under Hospital Room & Board Covered under Hospital Room & Board Covered under Hospital Room & Board
Acute Onset of Pre-Existing Conditions $25,000 max per coverage period
subject to sub-limits below)
$50,000 max per coverage period
subject to sub-limits below)
$100,000 max per coverage period
subject to sub-limits below)
Urgent Care Center $40 max per visits/10 max visits $60 max per visits/10 max visits $85 max per visits/10 max visits
Chemotherapy/Radiation Therapy $550 max per visit $1,100 max per visit $1,350 max per visit
Durable Medical Equipment $550 max per period of coverage $1,000 max per period of coverage $1,300 max per period of coverage
Home Nursing Care $550 max per period of coverage $550 max per period of coverage $550 max per period of coverage
Common Carrier Accidental Death $25,000 max per period of coverage $25,000 max per period of coverage $25,000 max per period of coverage
Emergency Medical Evacuation (Pre-Existing Condition) $25,000 max per period of coverage $25,000 max per period of coverage $25,000 max per period of coverage
Emergency Medical Evacuation Up to $25,000 max Up to $50,000 max Up to $50,000 max
Acute Onset of Pre-Existing Conditions Up to $25,000 max Up to $50,000 max Up to $50,000 max

The period of coverage is the period of time for which premium has been timely paid. At each renewal, a new period of coverage will begin.


INTERNATIONAL EMERGENCY CARE
Return of Mortal Remains $25,000 max with $5,000 max for Cremation/Burial $25,000 max with $5,000 max for Cremation/Burial $25,000 max with $5,000 max for Cremation/Burial
SPECIAL COVERAGE
Home Country Coverage As described below

Incidental Home Country Coverage - During the period of coverage, an insured person may return to his/her home country for incidental visits up to a cumulative two weeks total, and retain continuing coverage during such visit(s), subject to: 1) The insured person must have left their home country, 2) The total Period of Coverage must be for a minimum of 30 days, and 3) The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling.

Renewal Of Coverage

If your Visitors Care® plan is purchased for a minimum of five days, coverage may be renewed (unless there is a break in coverage) for a total of up to two years. Renewals are available in whole month or daily increments and may be completed online. For each renewal you will be charged an additional $5 processing fee. Each insured person must only satisfy one deductible and coinsurance within each 12 month coverage period. Please note: Renewal rates may differ from initial rates.

Eligibility to purchase, extend or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including the Patient Protection and Affordable Care Act (PPACA).


PLEASE NOTE : This web page contains only a consolidated and summary description of all current Visitors Care® benefits, conditions, limitations and exclusions. A certificate of insurance containing the complete Policy Wording with all terms, conditions, limits and exclusions will be included with the fulfillment kit. Please review the Policy Wording carefully upon receipt and contact IMG if you have any questions concerning available coverages and benefits. The plan underwriter reserves the right to amend or modify the Policy Wording, and issue the most current Policy Wording for the Visitors Care® plan, in the event an Application Form and/or this brochure has expired, is modified, or is replaced with a newer version. Current Policy Wordings are available upon request.