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Safe Travels for visitors to the USA Low Cost Schedule of Benefit Plan

Safe Travels for visitors to the USA


Safe Travels for Visitors to the USA Insurance plan provides accident and sickness medical coverage which will take care of your covered expenses, regardless of other insurance, with flexible deductible options, medical maximums and coverage for specific needs. When traveling to the USA, it is important to consider the medical care and coverage you may need during your stay. The USA offers the best of health care in the world, but if you don't have primary insurance that covers you outside of your home country, or if other insurance does not cover all required fees, it can be extraordinarily expensive to get the treatment you need. Medical providers in the US work on a "fee for service" basis. Put another way, a physician expects to be paid when he or she treats you for a medical condition. You are eligible for this travel insurance coverage if you are a foreign resident traveling to the United States from another country. This plan is not available to US citizens or US residents. Your coverage must begin within 12 months of your arrival in the United States and can be renewed one time. This travel insurance is available for ages 14 to 89. The minimum period of coverage is 5 days, Maximum is 364 days. It is renewable one time. Total program length available is 364 days. Coverage cannot begin until you depart from your home country and Trawick International both receives and accepts your application and correct premium. Green card holders are not eligible for this plan. Please view the specific coverage details for each of the plans available to suit just about any need and budget. Our plans include; Safe Travels for Visitors Basic, Safe Travels for Visitors Silver, Safe Travels for Visitors Gold, Safe Travels for Visitors Platinum, and Safe Travels for Visitors Senior (Ages 50-89).

MEDICAL SCHEDULE OF BENEFITS
  ECONOMY
AGE 14 DAYS TO AGE 69
BASIC
AGE 14 DAYS TO AGE 69
SILVER
AGE 14 DAYS TO AGE 69
GOLD
AGE 14 DAYS TO AGE 69
PLATINUM
AGE 14 DAYS TO AGE 69
DIAMOND and DIAMOND Plus
AGE 70 TO AGE 89
Policy Maximums $25,000 Max per Injury/Sickness
Cardiac Conditions/Treatment $25,000 per Policy Period Limit
$50,000 Max per Injury/Sickness
Cardiac Conditions/Treatment $25,000 per Policy Period Limit
$75,000 Max per Injury/Sickness
Cardiac Conditions/Treatment $25,000 per Policy Period Limit
$100,000 Max per Injury/Sickness
Cardiac Conditions/Treatment $25,000 per Policy Period Limit
$175,000 Max per Injury/Sickness
Cardiac Conditions/Treatment $25,000 per Policy Period Limit
$50,000 Max Diamond $100,000 Max Diamond Plus Annual Policy Max
Cardiac Conditions/Treatment $25,000 per Policy Period Limit up to age 69 at age 70 it is limited to $15,000
Deductible options (per Incidence) $0, $50 $100 $100 or $200
Well Doctor Visit Pays up to $75 - One Visit per person per Policy Period. The Well Doctor Visit must occur within the first 21 days from the effective date of coverage. To be eligible you must purchase at least 30 days of coverage initially.
INPATIENT
Hospital Room & Board including Laboratory Tests, X-Rays, Prescription Medical and other miscellaneous Up to $1400/day, 30 day max Up to $1400/day, 30 day max Up to $1750/day, 30 day max Up to $2000/day, 30 day max Up to $2700/day, 30 day max Up to $1500/day, 15 day max
Hospital Intensive Care Unit Additional $700/day, 8 day Max Additional $700/day, 8 day Max Additional $800/day, 8 day Max Additional $900/day, 8 day Max Additional $1150/day, 10 day Max Additional $800/day, 8 day Max
Surgical Treatment Up to $3500 Up to $3500 Up to $4750 Up to $6000 Up to $7500 Up to $3500
Anesthetist Up to $850 Up to $850 Up to $1200 Up to $1400 Up to $1800 Up to $850
Assistant Surgeon Up to $850 Up to $850 Up to $1200 Up to $1400 Up to $1800 Up to $850
Physician's Non-Surgical Visits Up to $55/visit, 1/day, 30 visits Max Up to $55/visit, 1/day, 30 visits Max Up to $70/visit, 1/day, 30 visits Max Up to $85/visit, 1/day, 30 visits Max Up to $115/visit, 1/day, 30 visits Max Up to $55/visit, 1/day, 30 visits Max
A Consulting Physician, when requested by attending Physician Up to $450 Up to $450 Up to $550 Up to $550 Up to $700 Up to $450
Private Duty Nurse Up to $450 Up to $450 Up to $550 Up to $550 Up to $700 Up to $450
Pre-Admission Tests w/in 7 days before admission Up to $1100 Up to $1100 Up to $1100 Up to $1200 Up to $1500 Up to $1100
OUTPATIENT Maximum Daily Benefit All Services $10,000
Surgical Treatment Up to $3500 Up to $3500 Up to $4750 Up to $6000 Up to $7500 Up to $3000
Anesthetist Up to $850 Up to $850 Up to $1200 Up to $1400 Up to $1800 Up to $700
Assistant Surgeon Up to $850 Up to $850 Up to $1200 Up to $1400 Up to $1800 Up to $700
Physician’s Visits/Urgent Care Up to $55/visit, 1/day, 30 visits Max Up to $55/visit, 1/day, 30 visits Max Up to $70/visit, 1/day, 30 visits Max Up to $85/visit, 1/day, 30 visits Max Up to $115/visit, 1/day, 30 visits Max Up to $55/visit, 1/day, 30 visits Max
Diagnostic X-rays & Lab Services $450 $450 $475 $500 $675 $450
Scans, PET scan or MRI Up to $650 Scan PET scan or MRI Up to $650 Scan PET scan or MRI $875 scan, PET scan or MRI Up to $1050 scan, PET scan or MRI Up to $1300 Scan, PET scan or MRI Up to $650 Scan PET scan or MRI
Hospital Emergency Room (all expenses incurred therein) For Emergency Room Illness with no direct Hospital Admission Up to $350 and an additional $200 Deductible per visit - Only applies when receiving care in an Emergency room for an Illness that does not result in a hospital admittance. Up to $350 and an additional $200 Deductible per visit - Only applies when receiving care in an Emergency room for an Illness that does not result in a hospital admittance. Up to $450 and an additional $200 Deductible per visit - Only applies when receiving care in an Emergency room for an Illness that does not result in a hospital admittance. Up to $550 and an additional $200 Deductible per visit - Only applies when receiving care in an Emergency room for an Illness that does not result in a hospital admittance. Up to $800 and an additional $200 Deductible per visit - Only applies when receiving care in an Emergency room for an Illness that does not result in a hospital admittance. Up to $350 and an additional $200 Deductible per visit - Only applies when receiving care in an Emergency room for an Illness that does not result in a hospital admittance.
Hospital Emergency Room (all expenses incurred therein) For Injury/Accident or Illness with direct Hospital Admission Up to $350 Up to $350 Up to $450 Up to $550 Up to $800 Up to $350
Prescription Drugs (outpatient) Per Sickness/Injury Up to $100 Up to $100 Up to $125 Up to $150 Up to $200 Up to $90
Outpatient Surgical Facility Up to $1000 Up to $1000 Up to $1150 Up to $1275 Up to $1400 Up to $1000
Ambulance Services Up to $500 Up to $500 Up to $500 Up to $500 Up to $750 Up to $500
Initial Orthopedic Prosthesis/brace Up to $1,100 Up to $1,100 Up to $1225 Up to $1,350 Up to $1,750 Up to $1100
Chemotherapy &/or radiation therapy Up to $1,100 Up to $1,100 Up to $1,225 Up to $1,350 Up to $1,750 Up to $1100
Dental Treatment for Injury to Sound, Natural Teeth Up to $600 Up to $600 Up to $600 Up to $600 Up to $600 Up to $600
Mental & Nervous Disorder & Substance Abuse Up to $5,000 Up to $5,000 Up to $5,000 Up to $5,000 Up to $20,000 30 days Max Up to $5,000
Outpatient Physical Therapy Up to $40/visit, 1/day, 12 visits max Up to $40/visit, 1/day, 12 visits max Up to $40/visit, 1/day, 12 visits max Up to $40/visit, 1/day, 12 visits max Up to $60/visit, 1/day, 12 visits max Up to $40/visit, 1/day, 12 visits max
Emergency Medical Evacuation* $100,000 $100,000 $100,000 Unlimited Unlimited $50,000
Repatriation of Remains* $7,500 $7,500 $10,000 $20,000 $25,000 $7,500
Local Burial/Cremation $5,000 Maximum Limit per person for preparation, local burial or cremation of the Insured Person’s mortal remains at the time of death. Must be approved in advance and coordinated by GBG Assist.
Natural Disaster, Political, Evacuation & Repatriation* Up to $500 Up to $500 Up to $1,000 Up to $1,500 Up to $2,000 Up to $500
Return of Minor Children or Grand-Children* Up to $5,000 Up to $5,000 Up to $7,500 Up to $7,500 Up to $10,000 Up to $5,000
Felonious Assault AD&D* Up to $5,000 Up to $5,000 Up to $7,500 Up to $7,500 Up to $10,000 Up to $5,000
Return to Home Coverage* Up to 30 days per 12 months Max $2,000 Up to 30 days per 12 months Max $2,000 Up to 60 days per 12 months Max $2,500 Up to 60 days per 12 months Max $5,000 Up to 90 days per 12 months Max $7,500 N/A
AD&D Principal Sum* $25,000 Common Carrier $25,000 Common Carrier $35,000 Common Carrier $35,000 Common Carrier $35,000 Common Carrier N/A
Acute Onset of Pre-Existing Condition(s) per Policy Period
Subject to the sub limits for each benefit listed
For ages up to and including 69 the limit is up to the Medical Policy Maximum purchased per Period of Coverage except for any coverage related to cardiac disease or conditions, which will be limited to $25,000 up to and including age 69 and $15,000 for ages 70 and above. Upon attaining ages 70-79 Acute Onset benefits will be reduced to a Maximum of $35,000, upon attaining age 80 Acute Onset benefits will be reduced to a Maximum of $15,000 with a $25,000 Maximum Lifetime Limit for Emergency Medical Evacuation. Provides coverage for an Acute Onset of a Pre-Existing Condition. Any repeat/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 chronic or 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. This benefit covers only ONE (1) Acute Onset episode of a Pre-Existing condition. Sudden and 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.
Pre-certification Requirement 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 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
Travel Assistance by GBG Assist Included
*Not Subject to the Deductible
  1. Medical Insurance
  2. AD&D and Travel Related Benefits for persons traveling to the USA
  3. Coverage 5 days up to maximum period of 364 days
  4. Renewable up to 2 years
ELIGIBILITY

Safe Travels For Visitors To The USA plan provides Accident and Sickness Medical, Accidental Death and Dismemberment, Emergency Medical Evacuation, Emergency Reunion, Political Evacuation, Repatriation, and Travel Assistance to individuals while visiting the United States. It can provide coverage for you, your spouse/domestic partner/traveling companion and dependent children/grandchildren up to age 21 years. Coverage for Travel with Trip Cancellation is available through the Safe Travel USA or Safe Travel Care 360. Customized coverage for groups of 5 or more people is available under the Safe Travels for Groups

EFFECTIVE DATE

Effective Date under the program shall become effective at 12:01 AM North American Central Time on the latest of the following dates:

  1. your departure from your Home Country; or
  2. The date the application and premium are received by the Administrator; or
  3. The date the application and premium are accepted by the Administrator; or
  4. The date requested on the application.
EXPIRATION DATE

The coverage provided with respect to the Named Insured shall terminate at 12:01 AM North American Central Time on the earliest of the following dates:

  1. The date shown on the insurance confirmation card, for which the premium is paid; or
  2. The date the Insured Person returns to his Home Country; or
  3. Three hundred and sixty four (364) days after the Insured Person's original effective date; or
  4. The date the Insured Person becomes a United States citizen;