Plan Administrator: Trawick International | Underwriter: Zurich Insurance Europe AG Belgian branch | AM Best Rating: A+ ‘Superior’
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COVERED TREATMENT OR SERVICE |
MAXIMUM BENEFIT |
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HOSPITAL ROOM AND BOARD EXPENSES |
The average semi-private room rate |
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PHYSICIAN’S NON-SURGICAL VISITS |
Covered |
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OUTPATIENT MEDICAL EXPENSES |
Covered |
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PHYSICIANS VISITS |
Covered |
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PRESCRIPTION DRUGS |
If your Maximum Limit is $10,000, $20,000, $50,000, $100,000, or $250,000 the limit is up to the plan Maximum per Period of Insurance. If your Maximum Limit is $500,000 or $1,000,000, the Limit is up to $250,000 per Period of Insurance, for Treatment of a Covered Sickness or Injury. |
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AMBULANCE SERVICE BENEFITS |
Covered |
Charges for Chronic, Congenital, or recurrent Sicknesses.
Charges for immunizations, Routine Physical or other examinations where there are no objective indications or impairment in normal health, or laboratory diagnostic or x-ray examinations except in the course of a disability established by the prior call or attendance of a Physician, except as specifically provided for by the Well Visit.
Complete details are given in certificate of insurance.
For ages up to and including 69 the limit is up to the Medical Policy Maximum purchased per Policy Period except for any coverage related to Cardiac Conditions or Stroke, which will be limited to $25,000. Upon attaining age 70 Acute Onset of Pre-existing Condition benefits are not available.
Emergency medical evacuation for Acute Onset of a Pre-existing: Limit of $25,000 Maximum per Policy Period for any condition covered under Acute Onset of a Pre-existing Condition Benefit
we will no longer charge a penalty for out of network providers! You are free to use any doctor or hospital. We still feature the First Health network and strongly suggest that your clients utilize it whenever possible as there is still repricing available from in network providers. But the choice is yours, any doctor any hospital, any time! After the deductible the plan pays per the product description below.
An extension notice will be sent to the Covered Person before the Period of Insurance ends and includes links to extend prior to the Termination Date. The Covered Person is subject to the following rules at extension: In order to extend, the Period of Insurance must be initially purchased for a minimum of 5 days. If available, an extension period can be purchased
1. at the Premium rate in force at the time of the extension;
2. for a minimum of 5 days;
3. for up to a maximum of 364 days, provided the Covered Person’s Period of Insurance does not exceed 364 days in total.
There are no grace periods for extension. Once the coverage has lapsed, reapplication may be allowed provided you meet the ELIGILBILTY requirements. Please note, upon application for a new coverage, the Pre-Existing Condition exclusion, deductible and coinsurance start over.
Full cancellation and refund will only be considered if We receive written request prior to or on the Effective Date of the Coverage. If We receive a written request for cancellation and refund after the Effective Date of Coverage, a partial cancellation and refund may be allowed. The following conditions apply a) If any claims have been filed with Us, the Premium is fully earned and is non-refundable. If no claims have been filed with the Company, then (i) a cancellation fee of US $50 will be charged; and (ii) only unused days b) Premiums will be considered as refundable; and c) If after a refund is made, it is determined that a claim was presented to Us on a Covered Person’s behalf, the Covered Person will be fully responsible for that claim in its entirety. Upon effectuation of such cancellation and refund, neither the Company nor the Covered Person shall have any further rights, liabilities, or obligations under this insurance.
NOTICE OF CLAIM: A Claimant must give Us or Our authorized representative written (or authorized electronic or telephonic) notice of claim within 90 days after any loss covered by the Certificate of Coverage occurs. If the Claimant or Covered Person is incapacitated within the 90 days after the loss, must be given as soon as reasonably possible. This notice should identify the Covered Person and the Certificate Number. All claims must be submitted within 90 days from date of Incident, or they will be denied. Reasonable circumstances may exist in which this is not always possible. Any submissions after 90 days will be reviewed by Us to determine if the delay is reasonable.