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Home Country :

Destination Country :

Coverage Start Date :

Coverage End Date :

Applicant Age :

Spouse Age :

Dependent Children Age

0-9 Yrs :

10-17 Yrs :

Deductible	Maximum Limit 50,000 Premium	Maximum Limit 100,000 Premium	Maximum Limit 250,000 Premium	Maximum Limit 500,000 Premium	Maximum Limit 1,000,000 Premium	Maximum Limit 2,000,000 Premium
$$0	-	-	-	-	-	-
$$100	-	-	-	-	-	-
$$250	-	-	-	-	-	-
$$500	-	-	-	-	-	-
$$1000	-	-	-	-	-	-
$$2500	-	-	-	-	-	-
$$5000	-	-	-	-	-	-

Plan Details

Plan Administrator: WorldTrips| Underwriter: Lloyd's Syndicate 4141 | AM Best Rating: A 'Excellent'

Coverage Area: Non-US citizens (age 0 to 99) traveling to USA and outside home country.
Coverage Length: Min 5 days up to max 12 months.
Acute Onset of Pre-existing Condition under age 80: Up to the overall maximum limit. Up to $25,000 lifetime maximum for Emergency Medical Evacuation.
Co-Insurance: After deductible, plan pays 100% eligible expenses up to policy maximum.
PPO Network: United Healthcare Network
ID Card: Link comes in email to download.