Plan Administrator: International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International

  • Coverage Area: Non-US citizens (age 0 to 80+) traveling outside country of residence.
  • Coverage Length: Min 5 days up to 12 months.
  • Renew Online: Renewable up to a max of 24 months. $5 Renewal fees apply.
  • Acute Onset of Pre-existing Condition: Under 70 years of age, up to the maximum limit. $25,000 maximum limit for medical evacuation.
  • Coinsurance: In Network USA: After deductible, plan pays 100 % up to policy maximum.
  • Out-of-Network USA: After the deductible, plan pays 80%.
  • PPO Network: United Healthcare Network & First Health Network.
  • ID card: Link comes in email to download.

Complete details are given in certificate of insurance.

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Age and Policy Maximum

Through age 65: $50,000, $100,000, $500,000 or $1,000,000

Ages 65 to 69: $50,000 or $100,000

Ages 70 to 79: $50,000

Ages 80 and older: $10,000

Doctor Visit

In-Network 100%. Out-of-Network 80%. International 100%

Urgent Care

$25 co-pay. Co-pay is not applicable when the $0 deductible is selected. Not subject to deductible

In-Network 100%. Out-of-Network 80%. International 100%

Hospital Room and Board

Injury not subject to emergency room deductible,

Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in direct inpatient hospital admission.

In-Network 100%. Out-of-Network 80%. International N/A

Ambulance

In-Network 100%. Out-of-Network 80%. International 100%

Complete details are given in certificate of insurance.

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  • PRE-EXISTING CONDITIONS: Charges resulting directly or indirectly from or relating to any Pre-existing Condition are excluded from coverage under this insurance except and unless the Charges resulted directly from an Acute Onset of Pre- existing Condition, in which case the Charges will be covered only according to the Terms of the ACUTE ONSET OF PRE- EXISTING CONDITIONS provision.
  • MATERNITY AND NEWBORN CARE: Charges for pre-natal care, delivery, post-natal care, and care of Newborns, including complications of Pregnancy, miscarriage, complications of delivery and/or of Newborns are excluded from this insurance.
  • MENTAL OR NERVOUS DISORDERS: Charges for Treatment of Mental or Nervous Disorders are excluded from coverage under this insurance
  • PREVENTATIVE CARE: Charges for Routine Physical Examinations and immunizations are excluded from coverage under this insurance.
  • Elective Surgery or Treatment of any kind

Complete details are given in certificate of insurance.

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Acute Onset of Pre-existing Conditions

Subject to Deductible and Coinsurance unless otherwise noted Eligible Medical Expenses are limited to Usual, Reasonable and Customary

Limits per Period of Coverage unless stated as Maximum Limit
 

Acute Onset of Pre-existing Conditions

· Insured Person must be under 70 years of age

· Refer to the ACUTE ONSET OF PRE- EXISTING CONDITIONS provision for further details and requirements
Up to the Period of Coverage limit

Emergency Medical Evacuation

·Arises or results directly from a covered Acute Onset of a Pre-existing Condition

·Insured Person must be under 70 years of age
Maximum Limit: $25,000

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PPO Providers are contracted separately through United States Preferred Provider Organization.

https://providerlocator.firsthealth.com/LocateProvider/SelectNetworkType

Complete details are given in certificate of insurance

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Renew

Subject to the Terms of the TERMINATION OF MASTER POLICY and TERMINATION OF COVERAGE FOR INSURED PERSONS subparagraphs of the CONDITIONS AND GENERAL PROVISIONS, an Insured Person can request coverage under this insurance plan to be extended a minimum of five (5) days for up to a three hundred sixty-five (365) day period until reaching a maximum of twenty-four (24) continuous months in accordance with and subject to the Terms of the plan then in effect (including the Terms of the then applicable Master Policy) and so long as extension Premium is paid when due and the Insured Person otherwise continues to meet the applicable eligibility requirements of the plan.

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The Insured Person shall have three (3) days from the Initial Effective Date of Coverage (the “Review Period”) to review the benefits, conditions, limitations, exclusions and all other Terms of the Master Policy as evidenced and outlined by this Certificate. If not completely satisfied, the Insured Person may request cancellation of this insurance retroactive to the Initial Effective Date of Coverage by sending a written request to the Company by email, mail or fax and received by the Company within the Review Period, thereby qualifying to receive a full refund of Premium paid. Upon effectuation of such cancellation and refund, neither the Company nor the Insured Person shall have any further rights, liabilities or obligations under this insurance. After the Review Period, the Insured person may request cancellation by sending a written request to the Company by email, mail or fax. However, the following conditions apply for Premium refund: (a) If any claims have been filed with the Company, the Premium is fully earned and is non-refundable. (b) If no claims have been filed with the Company: (i) a cancellation fee of fifty dollars ($50.00 USD) will be charged (ii) only Premium covering time periods after cancellation are refundable

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 Proof of Claim: When the Insured Person receives Treatment or the Company receives notice of a claim for benefits under this insurance, the Insured Person shall submit an International Medical Group (IMG) Claim Form as a necessary component of the Proof of Claim. An IMG Claim Form may be completed online via the MyIMG customer portal atwww.imglobal.com/member or obtained by contacting the Company.

Complete details are given in certificate of insurance

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