Plan Administrator: USI Affinity Travel Insurance Services | AM Best Rating: A+ "Superior" | Underwriter: Lloyd's of London

  • Eligibility:Non US citizen age 0-99 traveling to USA and traveling outside their home country.
  • Coverage Length:Min 5 days up to max 364 days.
  • Renew Online:Non-Renewable.
  • Acute Onset of Pre-existing No Coverage: Under Age 65:- Up to $20,000 & Age (65 to 99):-$2,500.
  • Co-Insurance: Not Applicable.
  • PPO Network: No PPO Network, visit any doctor/Hospital.
  • ID Card & Visa Letter comes in email instantly.
  • Note: Plan Pays Fixed amount up to policy maximum.

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Age and Policy Maximum

PLAN A: Age(0-69):$50,000

Age(70-79):$50,000

Age(80-99):$20,000

PLAN B: Age(0-69):$1,50,000

Doctor Visit

PLAN A: $75 per visit,10 visits max

PLAN B: $150 per visit,10 visits max

Urgent Care

PLAN A: $75 per visit,10 visits max

PLAN B: $150 per visit,10 visits max

Hospital Room and Board

PLAN A: $1,500 per visit,30 visits max

PLAN B: $2,750 per visit,30 visits max

Ambulance

PLAN A&B: $500

Prescription

PLAN A: $150

PLAN B: $300

Complete details are given in certificate of insurance.

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  • Pre-existing conditions, except acute onset of pre-existing condition.
  • Pregnancy, termination of pregnancy, routine prenatal care, child birth, postnatal care, and charges incurred by a child under the age of 14 days.
  • Treatment, services or supplies that are not administered by or under the supervision of a Physician, and products that can be purchased without a doctor's prescription.
  • Diagnosis or treatment for HIV+, have AIDS or ARC, and all diseases caused by and/or related to HIV.
  • Eye surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
  • Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinestherapy.
  • Diagnosis or treatment for acne, other acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus.

Complete details are given in certificate of insurance.

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Pre-x Coverage

Acute Onset of Pre-existing Conditions

PLAN A

Ages 65 and above: $2,500

All others: $20,000

$25,000 Lifetime Maximum for Emergency Medical Evacuation

 

PLAN B

Ages 65 and above: $2,500

All others: $20,000

$25,000 Lifetime Maximum for Emergency Medical Evacuation

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Members may review a listing of Hospitals, Physicians and other medical service providers included in the PPO Network for the area where the Member will be receiving treatment by accessing the Internet website for HCC Medical Insurance Services, LLC at: www.hccmis.com.

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Non Renewable.

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Premiums will be refunded in full if cancellation request is received prior to the certificate effective date. Premiums may be refunded after the certificate effective date subject to the following provisions:

  • $25 cancellation fee will apply for administrative costs incurred by us; and
  • Only the unused portion of the plan cost will be refunded; and
  • You cannot have filed any claims to be eligible for premium refund.

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A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments, original itemized bills from Physicians, Hospitals and other medical providers, original receipts for any expenses which have already been paid by or on behalf of the Member, and any other documentation that is deemed necessary by the Underwriters.

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