Plan Administrator: USI Affinity Travel Insurance Services | AM Best Rating: A+ "Superior" | Underwriter: Lloyd's of London
| 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.
Complete details are given in certificate of insurance.
| 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 |
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.
Non Renewable.
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:
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.