Medical Coverage for Foreign Nationals Visiting the USA
Why you may need International Medical Coverage Get a Quote
The increase in international travel has highlighted the need for health coverage specifically designed to provide insurance while you are traveling outside your home country. In many cases your primary insurer will not cover you while you are outside your home country of residence. This could present a dilemma.
Global Underwriters Agency Inc. has a solution. Briefly detailed in this brochure is a medical program specifically designed to cover individuals, their spouse and any unmarried dependent children while traveling inside the United States for fifteen days up to twelve months.
This brochure is a brief description of the benefits of the Diplomat America program. A complete description is contained in the plan summary, which is mailed to you upon your enrollment in the program. All coverages are in US Dollar amounts. Coverage can only begin when the correct premium and a complete application are received by Global Underwriters Agency Inc. Please keep this brochure for reference. If you should have any questions, please contact your agent.
Diplomat America provides accident and sickness medical coverage, travel assistance, and accidental death and dismemberment benefits to foreign nationals while visiting the United States. Coverage is available for you, your spouse and unmarried dependent children ages 14 days to 18 years, while in the United States.
Period of Coverage
The minimum period of coverage that can be purchased under this program is fifteen days and maximum is twelve months. Coverage can be purchased in fifteen day and/or monthly increments to suit your travel needs.
Coverage will begin on the later of the following:
a) Your departure from your Home Country or Country of Residence, or
b) The date your complete application and correct premium are received by Global Underwriters Agency Inc,; or
c) The effective date requested on the application.
Coverage will end on the earlier of the following:
a) Your return to your Home Country or Country of Residence; or
b) Twelve months after your coverage's effective date; or
c) The termination date shown on the certificate, for which premium as neen paid.
Refund of premium, less a $10 processing fee, will be considered only if written request is received by Global Underwriters prior to the effective date of coverage. After that date, the premium is considered fully earned and non-refundable. Partial refunds are not available.
Coverage for traveling outside the United States is available through the Diplomat International and Diplomat LT programs. Brochures and rates are available from your agent. Group Coverage is also available.
SCHEDULE OF BENEFITS - DIPLOMAT AMERICA
All coverages, benefits and premiums are in U.S. Dollar amounts.
* Policy Maximum Choices - Plan A $50,000 Plan B $100,000 Plan C$250,000 Plan D
$100,000 maximum benefit for persons age 60 - 69; $50,000 maximum benefit for persons age 70
- 79; $$10,000 maximum benefit for persons age 80+
* Deductible Options - $250, $500, $1,000, or $2,500 per person per policy period ;maximum
of 3 deductibles per family
* Co-insurance - after you pay your selected deductible the plan pays 80% of the next $5,000
of eligible charges, then 100% to the selected policy maximum.
Eligible expenses are based on Usual, Customary & Reasonable charges (UCR)
* Hospital Room and Board - Average semi-private room rate up to selected policy maximum.
* Local Ambulance Expense - Up to selected policy maximum.
* Outpatient Medical Expenses - UCR up to selected policy maximum.
* Intensive Care - 2x average semi-private room rate.
* Emergency Medical Evacuation - Maximum per person of $50,000.
* Emergency Reunion - Maximum per person of $10,000.
* Repatriation - Maximum per person of $20,000.
* Accidental Death and Dismemberment - $25,000 Principal Sum.
* 24 hour Assistance Service
DESCRIPTION OF BENEFITS
If injury or illness occurs during the period of coverage and you or your covered dependents require medical or surgical treatment, the plan will pay subject to the co-insurance and selected deductible, reasonable and customary charges for the following covered expenses, up to the selected policy maximum. The covered charges shall in no event include any amount which is in excess of reasonable and customary charge for the geographical area where the services are rendered, as determined by The Insurance Company.
Benefits payable under this plan may not be assigned.
1. Charges made by a hospital for room and board, floor nursing and other services includive of
charges for professional services and with the exception of personal services of a non-medical
nature provided, however, that expenses do not exceed the hospital's average for semi-private
room and board accommodation, or two times the average semi-private room charge made by
the servicing hospital if confinement to an intensive care unit is required, or the average charge
for intensive care unit made by servicing hospital, whichever is less.
2. Charges made for diagnosis, treatment and surgery by a physician.
3. Charges made for the cost and administration of anesthetics.
4. Charges for medication, x-ray services, laboratory tests and services, the use of radium and
radioactive isotopes, oxygen, blood transfusion, iron lungs, and medical treatment.
5. Charges for physiotherapy, if recommended by a physician, for the treatment of specific
disablement, and administered by a licensed physiotherapist.
6. Dressings, drugs, and medicines that can only be obtained upon a written prescription of a
Emergency Medical Evacuation - If you or any covered dependents become ill or injured during the period of coverage and it has been determined that an Emergency Medical Evacuation is required to either the nearest medical facility, where appropriate medical treatment can be obtrained, or to your Home Country or Country of Residence, all eligible expenses incurred are covered up to a maximum of $50,000. An Emergency Medical Evacuation must be recommended by a legally licensed physician who certifies that the severity of the injury or illness necessitates such an Emergency Medical Evacuation, and approved in advance by The Insurance Company.
Emergency Reunion - In the event of an Emergency Medical Evacuation due to a covered injury or illness, where the physician feels that it would be beneficial for you to have a family member at your side during transport, you will be reimbursed for travel and lodging expenses, for that relative up to US $10,000 provided that all travel arrangements are coordinated in advance by the assistance provider. Benefits payable include economy air ticket and other travel related expanses not to exceed $250.00 a day for a maximum of five days.
Repatriation of Remains Expenses - If injury or illness commencing during the period of coverage results in death, all reasonable expenses incurred for preparation and return of the remains to your Home Country or Country of Residence, are covered up to a maximum of $20,000.
Policy Period - The period of coverage for which premium has been paid. This plan is not renewable.
Excess Benefits - All Coverage except Accidental Death & Dismemberment, shall be in excess of all other valid and collectible insurance.
EXCLUSIONS - DIPLOMAT AMERICA
For the Medical Expense, Emergency Medical Evacuation and Repatriation of Remains benefits, no benefit shall be payable with respect to expenses incurred:
1. PRE-EXISTING CONDITIONS, defined as: That within a three-year period immediately preceding the Insured Person's effective date: a) there was the existence of symptoms, whether or not a diagnosis has been made, which would cause an ordinarily prudent person to have an examination or to seek diagnosis, care or treatment, or b) there was a condition, illness or injury for which an examination or diagnostic test was done, or for which medical advise or treatment was recommended by or received from a physician; 2. For services supplies, or treatment; including hospital confinement, which were not recommended, approved and certified as necessary and reasonable by a physician; or expenses which are non-medical in nature. 3. For suicide or attempted suicide while sane or insane; 4. For loss incurred as a result of declared or undeclared war; or any act thereof; 5. a) For injury sustained while participating in an amateur, club, intramural, interscholastic or intercollegiate sport; b) For injury sustained while participating in a professional or semi-professional sport; 6. For loss incurred as a result of pregnancy, childbirth, or miscarriage, or complications thereof; 7. For miscarriage resulting from an accident; 8. For routine physicals; 9. For cosmetic or plastic surgery; except as the result of an accident; 10. for elective surgery; 11. For any mental and nervous disorder or rest cures; 12. For dental care; except as the result of injury to natural teeth caused by an accident; 13. For eye refractions or eye examinations for the purpose of prescribing corrective lenses or for the fitting thereof; unless caused by accidental bodily injury incurred while insured hereunder; 14. In connection with alcoholism or drug addiction; or the use of any drug or narcotic except as prescribed by a physician; 15. For expenses as a result of or in connection with intentionally self inflicted injury; 16. For expenses as a result of or in connection with the commission of a felony offense; 17. For specific named hazards ; motorcycling, scuba diving, jet, snow and water skiing, mountain climbing, sky diving, amateur racing, piloting an aircraft, bungee jumping, spelunking, whitewater rafting, surfing, parasailing; 18. For treatment furnished under any other individual or group policy, or other service or medical pre-payment plan to the extend so furnished; or under any government program or facility set up for treatment without cost to any individual; 19 For treatment by a family member; 20. For treatment relating to birth defects and congenital conditions; or complications arising from those conditions; 21. For treatment of sexually transmitted diseases; immune system disorders including, but not limited to AIDS, ARC, or tested positive for the HIV Virus. 22. For any injury or illness that occurs while the insured has been determined to be legally intoxicated, or under the influence of any narcotic, barbiturate, or hallucinatory drug, unless administered by a physician and taken in accordance with the prescribed dosage.
For Accidental Death and Dismemberment
Indemnity this plan does not cover any loss caused by or resulting from:
1. Intentionally self-inflicted injury; 2. Suicide or attempted suicide; while sane or insane; 3. War or any act of war, declared or undeclared; 4. Service in the military, naval, or air service of any country; 5. Illness, disease, pregnancy, childbirth, miscarriage or any bacterial infection other than bacterial infection occurring from an accidental cut or wound; 6. Piloting or acting as a crew member or riding in any aircraft; except as a fare paying passenger on a scheduled airline.
* Home Country Coverage - Provides coverage for eligible medical expenses incurred while an insured person is in their Home Country or Country of Residence. Such coverage is available up to a maximum of 2 months per 12 months of coverage. Coverage shall be pro rated in the event that an insured person's coverage is less than 12 months.
* Hazardous Activity Coverage - motorcycling, scuba diving, jet, snow, and water skiing, mountain climbing, sky diving, amateur racing, piloting an aircraft, bungee jumping, spelunking, whitewater rafting, surfing, and parasailing coverage.
* Athletic Coverage - for participation in amateur, club, intramural, interscholastic or intercollegiate tennis, swimming, cross country, track, baseball, softball, volleyball and golf sports only. All other sports are excluded. Purchase of this rider will remove Exclusion 5 a) above.
Combined Insurance Company of America
Rated "A" Excellent by A.M.Best
Rated "AA" Very Strong by Standard and Poors
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Global Underwriters Agency Inc.
3195 Linwood Rd. Suite 201
Cincinnati, Ohio USA 45208