Worldwide Major Medical Plan
Plan Highlights | Outline of Coverages | Approximate Premium Rates | Application
Outline
The Worldwide Major Medical Plan Works Like This
Deductibles - You may choose a $500, $1,000, $2,500, or $5,000 per person per period of insurance.
Coinsurance - After the deductible is paid, Underwriters will reimburse 80% of the next $5,000 in Eligible Expenses and then 100% up to the Maximum Benefit.
Maximum
Benefit - $5,000,000 per person per lifetime (Ages 0 - 69)
Maximum Benefit - $500,000 per person per lifetime (Ages 70 - 74)
Eligible Expenses
Treatment may be received almost anywhere in the world excluding the US. For an additional premium, the US may be covered as well. This coverage is secondary to medical benefits, services or reimbursements from any other source except Medicaid. Underwriters will reimburse the Eligible Expenses incurred, listed below, when Medically Necessary for the diagnosis and treatment of an Illness or Injury, subject to the terms and limitations described in the Certificate.
- Hospital room and board (limited to the semi-private daily rate).
- Hospital intensive care unit.
- Other Medically Necessary Hospital services and supplies, such as emergency room care, outpatient surgery, diagnostic services, supplies and therapy.
- Skilled Nursing Facility room and board, if confinement begins within 30 days following a Medically Necessary Hospital confinement of three days or longer.
- Home Health Care, if hospitalization would have been required if Home Health Care were not provided and the care is provided in accordance with a written plan established and approved by a Physician.
- Physician Services consisting of home, office, hospital visits and any other medical care and treatment.
- Local area ambulance service.
- Diagnostic services, supplies, and therapy.
- Outpatient medications prescribed by the treating physician following any hospitalization.
Renewal Agreement
This coverage is conditionally renewable based upon residency requirements and payment of premium. Underwriters reserve the right to modify coverage by class.
10 Day Free Look
If, for any reason, you are not satisfied with the insurance described in the Certificate you have the right to return the Certificate within 10 days of its delivery to you. Your premium will then be fully refunded.
Optional Coverage
Hazardous Sports or Activities - If you elect this option, Underwriters will reimburse you for eligible expenses which are incurred due to an injury resulting from the participation in a Hazardous Sport or Activity that is specifically named on the Schedule of Benefits.
War or Act of War Coverage
If you elect this option, underwriters will reimburse you for eligible expenses which are incurred as a result of injuries sustained due to war or act of war.
Global Medical Transportation
If you elect this option, underwriters will reimburse you for all medically necessary expenses for stabilization and transportation to the facility nearest your home, which can provide the approximate care.
Limitations
Expenses which have limitations are as follows:
- Maternity, normal delivery and/or will baby care covered after 15 months, to a maximum of $5,000 per year. Complications of pregnancy covered as any other condition after 15 months.
- Mental and Nervous Disorders covered to $5,000 lifetime maximum for outpatient visits. Disorders necessitating hospitalization shall be covered as any other condition.
Exclusions
Expenses which are not eligible for reimbursement are as follows:
- Any expense which you are not legally obligated to pay.
- Services which are not Medically Necessary and are not furnished by or under supervision of a Physician.
- Expenses for services and supplies for which you are entitled to benefits, services, or reimbursement through the Veterans' Administration, Workers' Compensation insurance, any private heath plan, or from any other source, except Medicaid.
- Expenses in excess of Usual, Customary and Reasonable fees.
- Outpatient drugs, except following a hospitalization if prescribed for the same Illness or Injury.
- Self-inflicted injuries while sane or insane.
- Treatment for alcoholism, drug addiction, and/or allergies.
- Rest cures, quarantine, or isolation.
- Cosmetic surgery, unless necessitated by an accidental injury.
- Dental exams, dental x-rays, and general dental care except as the result of an accidental injury.
- Eye glasses or eye examinations.
- Hearing aids or hearing examinations.
- General or routine examinations.
- Injuries sustained from participation in hazardous sports or activities which include: Professional or recreational: mountaineering, snow skiing, scuba diving, hang gliding, sky diving, bungee jumping, racing of any kind, and all professional and semiprofessional sports.
- Pregnancy and pregancy-related conditions including, but not limited to, fertility, pre-natal care, childbirth, miscarriage, or abortion until a minimum of 15 months has elapsed, subject to the Terms and Limitations in the Certificate.
- Injuries due to war or any act of war whether declared or undeclared.
- Injuries sustained while committing a criminal or felonious act.
- Expenses incurred for, or resulting from, pain which is not supported by medical diagnosis.
- Cataract surgery which is not considered an emergency and/or which is performed at Your discretion.
- Any elective surgery.
- Custodial care.
- Pre-existing conditions not disclosed on the application.
This is not intended to be a complete outline of coverage. Actual wording and premiums may change without notice.