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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
$$0	$0	$0	$0	$0	$0
$$100	$0	$0	$0	$0	$0
$$250	$0	$0	$0	$0	$0
$$500	$0	$0	$0	$0	$0
$$1000	$0	$0	$0	$0	$0
$$2500	$0	$0	$0	$0	$0
$$5000	$0	$0	$0	$0	$0

Plan Details

Plan Administrator: WorldTrips | Underwriters: Lloyd’s Syndicate 4141 | A M Best Rating: A ‘Excellent’

Coverage Area: Non-US citizens (age 0 to 99) traveling to USA (outside home country).
Coverage Length: Min 5 days up to max 12 months.
Co-Insurance:: Within the PPO - Plan pays 70% of eligible expenses after the deductible to the overall maximum limit. Outside the PPO - Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount.
PPO Network:United Healthcare Network
ID Card: Link comes in email to download.