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

  • PPO Network (Within USA): 80% of Eligible Expenses after the Deductible up to $25,000, then 100% up to policy max.
  • Outside PPO Network (Within USA): 70% of Eligible Expenses after the Deductible up to $25,000, then 100% up to policy max.
  • Co-insurance (Outside USA): 100% of eligible expenses after the deductible up to the overall maximum limit.
  • Eligibility: Non US Citizen Age 14-64 travelling to USA.
  • Coverage length: Min 5 days to 364 days.
  • Provider Network: Member will be receiving treatment by accessing the Internet website for HCC Medical
  • Insurance Services, LLC at: www.hccmis.com.
  • Renew Online: Any extension or renewal is based upon the eligibility rules in force at the time of renewal and is solely at the discretion of Underwriter.
  • ID card & Visa Letter comes in email instantly.

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Age and Policy Maximum

Age 0-65 :5,00,000

Doctor Visit Up to the overall maximum limit
Surgical Treatment Up to the overall maximum limit
Hospital Room and Board Average semi-private room rate, including nursing services.
Ambulance Up to $350 per injury or illness, when covered illness or injury results in hospitalization as inpatient. - not subject to coinsurance
Prescription Generic Drugs: $10 deductible per prescription Brand Name Drugs: $20 deductible per prescription

Complete details are given in certificate of insurance.

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  • Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as herein defined, are excluded from this insurance during the first 180 days of coverage.
  • Routine pre-natal care, Pregnancy, child birth, post natal care, and routine nursery care of a newborn, unless directly related to a Covered Pregnancy as defined.
  • Diagnosis, testing, treatment, services or supplies which are not Medically Necessary.
  • Routine check-ups
  • Diagnosis, testing, or treatment of Members who are HIV+ or have AIDS or ARC.
  • Eye surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness.
  • Diagnosis, testing, or treatment of sleep disorders.
  • Willfully self-inflicted Injury or Illness.

Complete details are given in certificate of insurance.

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Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 12 months immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 12 months immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 12 months immediately preceding the Certificate Effective Date.

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PPO Network

To comply with the United States Preferred Provider Organization requirements, the Member must receive medical treatment from PPO providers while in the United States. If the Member chooses to comply with the PPO requirements, and the expenses are incurred in a PPO provider, Underwriters will waive the Coinsurance applicable to the expenses.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

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Any extension or renewal is based upon the eligibility rules in force at the time of renewal and is solely at the discretion of Underwriter.

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  • 1. A $25 cancellation fee will apply for administrative costs incurred by us; and
  • 2. Only premium for unused whole-months, if paying in monthly installments, or unused days, if paid in full, of the plan will be refunded; and
  • 3. You cannot have filed any claims to be eligible for a premium refund; and
  • 4. No refund of premium shall be granted after 60 days.

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When Underwriters receive notice of claim, they will provide the Member with forms for filing Proof of Claim. The following is considered to be Proof of Claim:

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

The Member shall have 60 days beginning on the last day of the Certificate Period to submit Proof of Claim to Underwriters, unless medical services were rendered after the Certificate Termination Date, in which case the Member shall have 60 days from the date the claim is incurred to submit Proof of Claim to Underwriters. Time Limit – In the event Underwriters deny all or part of a claim under this insurance, the Member shall have 90 days from the date notice. Appeal Procedure – Within 60 days of Underwriters’ receipt of the appeal, Underwriters’ will review the claim. A written response will be forwarded to the Member.

Offline Form

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