Plan Administrator: USI Affinity Travel Insurance Services | AM Best Rating: A+ "Superior" | Underwriter: Lloyd's of London
Age and Policy Maximum |
Up through age 69: $75,000 or $200,000 Age 70 to 79: $75,000 Age 80+: $20,000 |
Doctor Visit |
Up to the overall maximum limit |
Urgent Care |
Claims incurred outside the U.S. No co-payment Claims incurred in U.S. For each visit, you shall be responsible for a $50 co-payment, after which coinsurance will apply. – Co-payment is waived for members with a $0 deductible. – not subject to deductible |
Hospital Room and Board |
Average semi-private room rate, including nursing services. |
Ambulance |
Usual, reasonable and customary charges, when covered illness or injury results in hospitalization as inpatient. |
Prescription |
Up to the overall maximum limit |
Complete details are given in certificate of insurance.
Complete details are given in certificate of insurance.
Acute Onset of Pre-existing Condition (excludes chronic and congenital conditions) | Ages 65 and above: $2,500 All others: $20,000 |
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 a 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.