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

  • Eligibility:Non US citizen age 0-99 traveling to USA and traveling outside their home country.
  • Coverage Length:Min 5 days up to max 364 days.
  • Renew Online:Non-Renewable.
  • Acute Onset of Pre-existing No Coverage: Under Age 65:- Up to $25,000 & Age (65 to 99):-$2,500.
  • Co-Insurance:
    In-Network: After Deductible, Plan pays 100% up to policy maximum
    Out-of-Network: After Deductible, Plan pays as per URC up to policy Maximum.
  • PPO Network: Provides First Health Network.
  • ID Card & Visa Letter comes in email instantly.

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Age and Policy Maximum

Up to Age 79: $250,000;

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.

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  • Pre-existing Conditions, except charges resulting directly from an Acute Onset of Pre-existing Condition, as herein defined, subject to the limits set forth in the Schedule of Benefits and Limits.
  • Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
  • Mental health disorders.
  • Pregnancy, termination of pregnancy, routine prenatal care, child birth, postnatal care, and charges incurred by a child under the age of 14 days.
  • Impotency or sexual dysfunction
  • All sexually transmitted diseases and conditions.
  • HIV, AIDS, or ARC, and all diseases caused by and/or related to HIV.
  • All forms of cancer / neoplasm.

Complete details are given in certificate of insurance.

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Pre-x Coverage

Acute Onset of Pre-existing Condition Ages 65 and above: $2,500 All others: $25,000

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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.

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Non Renewable.

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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:

  • $25 cancellation fee will apply for administrative costs incurred by us; and
  • Only the unused portion of the plan cost will be refunded; and
  • You cannot have filed any claims to be eligible for premium refund.

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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.

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