Coverage
|
INBOUND to U.S.
Plans A, B, C
|
OUTBOUND from U.S.
Plans A, B, C
|
| Minimum Stay |
5 days |
5 days |
| Maximum Stay |
364 days |
364 days |
Medical Expense (Accident & Sickness)
Benefit limits may apply to certain conditions.
See the Description of Coverage for details. |
Plan A: $500,000
Plan B: $1,000,000
Plan C: $2,000,000 |
Plan A: $500,000
Plan B: $1,000,000
Plan C: $2,000,000 |
| Deductible |
$0, $250, $500, $1,000, or $2,500 |
$0, $250, $500, $1,000, or $2,500 |
|
Emergency Room Co‑pay
|
$250 (Waived if admitted to hospital) |
In addition to deductible, $250 co‑payment for each use of an emergency room for an illness unless admitted to hospital. No co‑payment for an injury. |
|
Urgent Care Co‑pay
|
$25 co‑pay within the U.S. |
No co‑pay outside the U.S. |
Coinsurance In‑Network Payment
(Claims incurred in the U.S.)
|
100% after deductible, up to the overall maximum |
100% after deductible, up to the overall maximum |
Coinsurance Out‑of‑Network Payment
(Claims incurred in the U.S.)
|
Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount. |
Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount. |
|
Emergency Medical Evacuation
|
$1,000,000 |
$1,000,000 |
Acute Onset of Pre‑existing Condition
(Excludes chronic and congenital conditions)
|
Age 60‑64: $20,000, Under age 60: $200,000 |
Age 60‑64: $20,000, Under age 60: $200,000 |
Accidental Death and Dismemberment
AD&D Benefits are based on age |
Under age 18: $5,000; Age 18‑64: $50,000 |
Under age 18: $5,000; Age 18‑64: $50,000 |
| Emergency Reunion
|
$100,000 |
$100,000 |
| Repatriation of Remains |
$50,000 |
$50,000 |
| Trip Interruption |
$10,000 |
$10,000 |
| Terrorism |
$50,000 |
$50,000 |
| |
Non-Insurance Services
24/7 Emergency Assistance
Provided by AssistCard |
Included |
Included |