The following is a brief description of the Benefits of the Diplomat L.T. Health program. A complete description is contained in the plan Summary, which is mailed or faxed to you upon your enrollment in the program. Please take a moment to familiarize yourself with Pre-Existing Conditions & Exclusion provisions prior to applying for this policy.
Diplomat LT provides Accident and Sickness medical coverage, Accidental Death and Dismemberment benefits and Travel Assistance to any individual(s) while traveling outside of their Home Country. Coverage may be available to you, your spouse, and any unmarried dependent children ages 14 days to 18 years.
Period of Coverage:
The minimum initial period of coverage that can be purchased under this plan is 3 months, the maximum is 12 months. Additional coverage may be available for up to 12 months at a time, to a maximum of 36 consecutive months.
Lifetime policy maximums for Accident and Sickness Medical Coverage are:
|Persons Traveling In The USA||Persons Traveling Outside The USA|
A $500,000 U.S.
Plan B $1,000,000 U.S.
C $500,000 U.S.
Plan D $1,000,000 U.S.
24 Hour Worldwide Assistance:
Is provided to all insureds and is available 24 hours a day, 7 days a week Toll-Free.
Emergency Medical Evacuation:
Maximum per person is $50,000 not subject to deductible and co-insurance.
$10,000 maximum, not subject to deductible and co-insurance.
Local Ambulance Expense:
Up to selected policy maximum
Hospital Room and Board:
Average semi-private room rate up to selected policy maximum.
2x average semi-private room rate
Outpatient Medical Expense:
Usual and Customary Rates (UCR) up to selected policy maximum.
Accidental Death & Dismemberment:
$25,000 Principal Sum.
Repatriation of Remains:
$20,000 maximum, not subject to deductible and co-insurance.
$250, $500, $1,000 & $2,500
(per person per policy period. Maximum of 3 per family)
After satisfying the selected deductible the insured is responsible for 20% of the first $5,000 of eligible charges, then Diplomat LT will pay 100% of eligible charges up to the Selected Policy Maximum.
Home Country Coverage Hazardous Activity Coverage Athletic 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.
Is designed to cover 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 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.
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Home Country Coverage
Hazardous Activity Coverage