Plan Administrator: INF Healthcare I AM Best Rating : "A+"(Superior) I Underwriter: Axis Insurance Company.

  • Eligibility: Non-US citizen or US Expatriate age 0-89 traveling to USA and traveling outside their home country.
  • Coverage Length: Min 30 days up to max 300 days..
  • Renew Online: It can be renewed up to 300 days after the initial enrollment period, $5 application fee will charged for re-enrollment.
  • Acute Onset of Pre-existing Condition:
    For Policy Maximum $25,000:-$1,000; $1,500; $1,750
    For Policy Maximum $50,000:-$1,500; $2,000; $2,500
    For Policy Maximum $75,000:-$2,500; $,3500; $4,500
    For Policy Maximum $100,000:-$3,500; $4,500; $5,500; $6,500
    For Policy Maximum $150,000:-$4,500; $5,500; $6,500; $7,500
    For Policy Maximum $250,000:-$7,000; $9,000; $13,000; $15,000
    .
  • Includes Coverage for Dental, Prescription Drug, Vision issues such as eye irritations & Pregnancy & Childbirth (inception must occur after start date).
  • PPO Network: Provides First Health PPO Network.
  • Includes Telemedicine from Teladoc. Teladoc can be used for Pre-Existing Conditions & has no deductible.
  • ID card, Visa Letter, Certificate, & Dental Card are Emailed Instantly.

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SCHEDULE OF BENEFITS

This Policy is intended to be read in its entirety. In order to understand all the conditions, exclusions and limitations applicable to its benefits, PLEASE READ ALL THE POLICY PROVISIONS CAREFULLY.

The Schedule of Benefits provides a brief outline of the coverage and benefits provided by this Policy. Please read the Conditions of Coverage and Description of Benefits sections for full details.

Eligible Persons: An Eligible Person is an individual who meets all of the requirements of one of the covered classes shown below:

Class Principal Sum

Class 1

All non-US Citizens who are members of the INF, ages

89 and under who are traveling to the United States.

$25,000

Class 2

All Dependent Children or Spouses of Class 1, who are

traveling to the United States with an Eligible Person in

Class 1. (If coverage for Dependents has been

elected by the member).

$25,000

Coverage for an Insured Person will be considered as continuous during consecutive periods of insurance under this Policy when premium payment is received by the administrator on or before the termination of the last coverage period. This continuation of coverage will not establish a new benefit period, nor affect any lifetime or specifically stipulated benefit limits or maximums under the Policy

 

CONDITIONS OF COVERAGE

Coverage for an Insured Person will be considered as continuous during consecutive periods of insurance under this Policy when premium payment is received by the administrator on or before the termination of the last coverage period. This continuation of coverage will not establish a new benefit period, nor affect any lifetime or specifically stipulated benefit limits or maximums under the Policy.

 

The benefits provided by this Policy will be paid, subject to applicable conditions, limitations and exclusions, under the following coverages:

 

Class 1& 2

 

24-HOUR ACCIDENT COVERAGE

 

Covered Activities: While travelling to and from their home country to the united states and while visiting the united states up to a maximum of 300 days.

 

Personal Deviations Covered Yes

BENEFITS

Aggregate Limit of Indemnity

 

Applies to: Benefit Amount

Accidental Death and Dismemberment $500,000 each covered accidenrt

 

Not more than the Aggregate Limit of Indemnity specified above will be paid for all Covered Losses, Covered Accidents and Covered Injuries suffered by all Insured Persons as the result of any one Covered Accident that occurs under one of the Conditions of Coverage, as specified above. This Aggregate Limit of Indemnity is payable only once, should more than one Condition of Coverage apply, We will pay the greater amount. If this amount does not allow all Insured Persons to be paid the amounts this Policy otherwise provides, the amount paid will be the proportion of the Insured Person’s loss to the total of all losses, multiplied by the Aggregate Limit of Indemnity.

 

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

 

Covered Loss must occur within 365 days of the Covered Accident

(Loss period does not apply to Loss of Life)

Covered Loss Benefit Amount

Loss of Life 100% of the Principal Sum

Loss of Two or More Hands or Feet 100% of the Principal Sum

Loss of Sight of Both Eyes 100% of the Principal Sum

Loss of One Hand and Foot 100% of the Principal Sum

Loss of One Hand or Foot and Sight in One Eye 100% of the Principal Sum

Loss of One Hand or Foot 100% of the Principal Sum

Loss of Sight in One Eye 100% of the Principal Sum

Exposure and Disappearence Included

MEDICAL EVACUATION BENEFIT

Benefit Amount 100% of Usual & Customary Charges, up to a maximum of $10,000

REPATRIATION BENEFIT

Benefit Amount 100% of Usual & Customary Charges, up to a maximum of $10,000

DESCRIPTION OF BENEFITS

This Description of Benefits Section describes the Benefits provided by this Policy. Benefit amounts, benefit periods and any applicable aggregate and benefit-specific maximums are shown in the Schedule of Benefits. Please read these and the Common Exclusions section in order to understand all of the terms, conditions and limitations applicable to these Benefits.

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

Covered Losses

The Company will pay the Benefit Amount for any one of the Covered Losses listed in the Schedule of Benefits, subject to all applicable conditions and exclusions, if the Insured Person suffers a loss as a result of a Covered Injury within the applicable time period specified in the Schedule of Benefits.

If the Insured Person sustains more than one Covered Loss as a result of the same Covered Accident, the Company will pay the Benefit Amount for the Covered Loss for which the largest benefit is payable.

Exposure and Disappearance

If by reason of an Accident occurring while an Insured Person’s coverage is in force under this Policy, the Insured Person is unavoidably exposed to the elements and as a result of such exposure suffers a Covered Loss for which an Accidental Death or Accidental Dismemberment Benefit is otherwise payable under the Policy, the Covered Loss will be covered under the terms of this Policy.

If the body of an Insured Person has not been found, within 180 days of the disappearance, forced landing, stranding, sinking or wrecking of a Conveyance in which the Insured Person was an occupant while covered under this Policy, then it will be deemed, subject to all other terms and provisions of this Policy, that the Insured Person has suffered an Accidental Death that would have been payable under the Policy.

Definitions

For purposes of this Benefit:

Loss of a Hand or Foot means complete Severance through or above the wrist or ankle joint.

Loss of Sight means the total, permanent Loss of Sight of one eye. The Loss of Sight must be irrecoverable by natural, surgical or artificial means

Severance means complete separation and dismemberment of the part from the body.

Exclusions

Exclusions that apply to this Benefit are in the Common Exclusions Section.

MEDICAL EVACUATION BENEFIT

The Company will pay the Benefit Amount shown in the Schedule of Benefits, subject to all applicable conditions and exclusions, if the Insured Person suffers a Covered Injury or an Emergency Sickness that warrants His Emergency Evacuation while He is outside a 100 mile radius from His current place of primary residence. The Company will pay for Covered Emergency Evacuation Expenses reasonably incurred for all Emergency Evacuations from the same Covered Accident or all Emergency Sicknesses from the same or related causes.

The Physician ordering the Emergency Evacuation must certify that the severity of the Insured Person's Covered Injury or an Emergency Sickness warrants His Emergency Evacuation. All transportation arrangements made for the Emergency Evacuation must be by the most direct and economical Conveyance and route possible. AXIS’s travel assistance service provider must make all arrangements and must authorize all expenses in advance for this Benefit to be payable. However, the Company reserves the right to determine the benefit payable, including any reductions, if it was not reasonably possible to contact AXIS’s travel assistance service provider in advance.

Definitions

For purposes of this Benefit:

Covered Emergency Evacuation Expenses means an expense that: (1) is charged for a medically neccesary emergency evacuation service; (2) does not exceed the usual level of charges for similar transportation, treatment, services, or supplies in the locality where the expense is incurred; and (3) does include charges that would not have been made if no insurance existed; or (4)Usual and customary charges.

Emergency Evacuation means, if warranted by the severity of the insured person's covered injury or emergency sickness: (1) the Insured Person's immediate transportation from the place where he suffers a covered injury or emergency sickness to the nearest hospital or other medical facility where appropriate medical treatment can be obtained; (2) the insured person's transportation to his current place of primary residence to obtain further medical treatment in a hospital or other medical facility or to recover after suffering a covered injury or emergency sickness and being treated at a local hospital or other medical facility; or (3) both (1) and (2) above. An emergency evacuation also includes medical treatment, medical services and medical supplies necessarily received in connection with such transportation.

Emergency Sickness means an illness or disease diagnosed by a physician which:

1. cause a severe or acute symptom that, if not provided with immediate treatment would reasonably be expected to result in serious deterioration of the insured person's health or place his life in jeopardy; and

2. first manifests itself suddenly and unexpectedly while the insured person is covered under this policy and is participating in a covered activity.

Exclusions Exclusions that apply to this benefit are in the common exclusions section.

REPATRIATION BENEFIT

The Company will pay the Benefit Amount shown in the Schedule of Benefits, subject to all applicable conditions and exclusions, if an Insured Person suffers Loss of Life due to a Covered Injury or an Emergency Sickness while outside a 100 mile radius from His current place of primary residence. The Company will pay for Covered Expenses reasonably incurred to return His body to His current place of primary residence.

Covered Expenses include, but are not limited to, expenses for: (1) embalming or cremation; (2) the most economical coffins or receptacles adequate for transportation of the remains; and (3) transportation of the remains by the most direct and economical Conveyance and route possible; or (4) Usual and Customary Charges.

AXIS’s travel assistance service provider must make all arrangements and must authorize all expenses in advance for this Benefit to be payable. However, the Company reserves the right to determine the benefit payable, including any reductions, if it was not reasonably possible to contact AXIS’s travel assistance service provider in advance

Definitions For purposes of this Benefit:

Emergency Sickness means an illness or disease diagnosed by a Physician which:

1. causes a severe or acute symptom that, if not provided with immediate treatment, would reasonably be expected to result in serious deterioration of the Insured Person's health or place His life in jeopardy; and

2. first manifests itself suddenly and unexpectedly while the Insured Person is covered under this Policy and is participating in a Covered Activity.

 

Exclusions Exclusions that apply to this Benefit are in the Common Exclusions Section.

OUT OF COUNTRY BENEFIT RIDER

This Rider is attached to and made part of the Policy as of the Effective Date shown above. It applies only with respect to Covered Injury or Sickness that occurs on or after that date. It is subject to all of the provisions, limitations and exclusions of the Policy except as they are specifically modified by this Rider. See the Schedule of Benefits of the Policy for the applicability of this Rider with respect to each class of Insured Persons and each Condition of Coverage.

RIDER SCHEDULE

Out of Country Medical Benefit

Full Excess

Medical Benefit

100% of Usual & Customary Charge incurred up to a maximum of 25,000 - $250,000 per Insured Person per Covered Injury or Sickness

First Covered Expenses must be incurred within

90 days after the Covered Accident or the initial onset of the Sickness

Benefit Period

the earlier of the date the Insured Person returns to his Home Country, or 365 days from the date of the Covered Accident or the initial onset of the Sickness

Deductible

$ 75.00 - $10,000

Must be satisfied Within

Benefit Period

Maximum Benefit Amount for Acute onset

Of Pre-existing Condition

100% of Usual & Customary Charge incurred up to $1,000 - $15,000

Treatment must be obtained within

12 hours of the sudden and unexpected outbreak or reoccurrence.

INPATIENT BENEFITS (Covered Services)

BENEFIT AMOUNT

Hospital Room (semi private) and Board and

Miscellaneous Expenses

100% of Usual & Customary Charge incurred, Up to $900 - $2,200 a day

Maximum Number of days

30 days

Hospital Intensive Care Unit

100% of Usual & Customary Charge incurred, Up to $400 - $950 a day

Maximum Number of days

8 days

Surgeon Services

100% of Usual & Customary Charge incurred, Up to $2,000 - $7,000

Anesthetist Benefit

100% of Usual & Customary Charge incurred, Up to $500 - $1,750

Assistant Surgeon Benefit

100% of Usual & Customary Charge incurred, Up to $500 - $1,750

Physician’s (Non Surgical Visits)

100% of Usual & Customary Charge incurred, Up to $40 - $150 per visit

Maximum Number of Visits per day

1 per day

Total Maximum Physician Non Surgical Visits

30 per Covered Injury or Sickness

Consulting Physician Benefit

100% of Usual & Customary Charge incurred, up to $375 - $550

(Must be requested by the attending Physician)

 

Pre – Admission Tests

100% of Usual & Customary Charge incurred, up to $950 - $1,350

Tests must occur

Within 14 days prior to Hospital Admissio

OUTPATIENT (Covered Services)

BENEFIT AMOUNT

Day Surgery Miscellaneous Expense

100% of Usual & Customary Charge incurred, up to $950 - $1,350

(including the actual cost of the operating

room, anesthesia, drugs, medicines

and medical supplies)

 

Surgeon Services

100% of Usual & Customary Charge incurred, up to $2,000 - $7,000

Anesthetist Benefit

100% of Usual & Customary Charge incurred, up to $500 - $1,750

Assistant Surgeon Benefit

100% of Usual & Customary Charge incurred, up to $500 - $1,750

Total Maximum Physician Non Surgical

Treatment/Exam Benefits

100% of the Usual & Customary Charge incurred, up to $40 - $150 per Day

Maximum Number of Visits per day

1

Maximum Number of Visits per

Covered Accident

10

Diagnostic X Rays and Lab Services Benefit

100% of Usual & Customary Charge incurred, up to $275 - $900

CAT Scan, PET Scan or MRI Benefit

100% of Usual & Customary Charge incurred, up to an additional $275 - $1,250 of the Diagnostic X-Ray and Lab Services Benefits

Hospital Emergency Room Benefit

100% of Usual & Customary Charge incurred, up to $275 - $1,000

Prescription Benefit

100% of Usual & Customary Charge incurred, up to $75 - $250

Ambulance Services

100% of Usual & Customary Charge incurred, up to $375 - $600

Initial Orthopedic Prosthesis or Brace

100% of Usual & Customary Charge incurred, up to $950 - $1,350

Dental Injury Treatment to a sound tooth due to a

Covered Accident (does not include dental services

for immediate relief of pain)

100% of Usual & Customary Charge incurred, up to $425 - $650

Chemotherapy and/or Radiation Benefits

100% of Usual & Customary Charge incurred, up to $925 - $1,400

Physical and Occupational Therapy Benefit

100% of Usual & Customary Charge incurred, up to $30 - $55 per visit

Maximum Number of Visits per day

1 per day

Total Maximum Physical and Occupational

Therapy Visits

12 per Covered Injury or Sickness

Private Duty Nursing Benefit

100% of Usual & Customary Charge incurred, up to $350 - $600

Maternity Benefit

100% of Usual & Customary Charge incurred, up to $4,250 - $6,000

Conception must occur

after the trip begins

Covered Activity

The Company will pay the benefits described in this Rider only while an Insured Person is traveling:

1. Outside of his or her Home Country in the United States or during a Personal Deviation as listed in the Policy; and

2. up to 300 days

This Coverage will start on the actual start of the Covered Trip and will end on the first of the following dates to occur;

1. The date the Insured Person returns to his or her Home Country;

2. The date the Insured Person makes a Personal Deviation for more than 2 days;

3. The date of the termination date of insurance.

DESCRIPTION OF BENEFIT(S)

The Company will pay the Benefits described in this Rider after any applicable Deductible is satisfied.

Any benefit limits and benefit percentages apply, unless otherwise specified, on a per Insured Person – per Covered Accident or Sickness basis. Any applicable Deductibles must be satisfied within the time periods specified before benefits are payable. This Rider only provides benefits for medical expenses incurred in the United States or in the location of where the Personal Deviation has occurred, subject to the limits, conditions and exclusions contained herein. In no event will the Company pay for medical expenses incurred before the Insured commences Covered Activities or after the Insured Person leaves the United States or the location of the Personal Deviation.

This is a Limited Rider. It is not a major medical or comprehensive medical healthcare policy

Full Excess Medical Benefit This Rider is designed to supplement your other health insurance.

The Company will pay the Benefits under this Rider:

1. after the Insured Person satisfies any Deductible; and

2. only when they are in excess of amounts payable by any Other Health Care Plan whether or not claim has been made for benefits it provides.

The Company will pay benefits excess of any Other Health Care Plan without regard to any Coordination of Benefits provision in such Other Health Care Plan.

Other Health Care Plan as used in this Rider means any arrangement, whether individually purchased or incident to employment or membership in an association or other group, which provides benefits or services for healthcare, dental care disability benefits or repatriations of remains. An Other Health Care Plan includes group, blanket, franchise, family or individual:

1. insurance policies;

2. subscriber contracts;

3. uninsured agreements or arrangements;

4. coverage provided through Health Maintenance Organizations, Preferred Providers Organizations and other prepayment, group practices and individual practice plans;

5. medical benefits provided under automobile “fault” and “no-fault” type contracts;

6. medical benefits provided by any governmental plan or coverage or other benefit law, except:

a. a state sponsored Medicaid plan; or

b. a plan or law providing benefits only in excess of any private or nongovernmental plan.

Out of Country Medical Benefit

If, while traveling outside his or her Home Country, during the course of any Covered Trip of less than 300 days an Insured Person suffers a Covered Injury or contracts a Sickness that requires treatment by a Physician, the Company will pay the Usual and Customary Charges incurred, after the Deductible, for Covered Medical Services received due to that Covered Injury or Sickness up to the maximum of any Benefit Amount shown in the Rider Schedule. For benefits to be payable under this Rider the first treatment for the Covered Injury or Sickness must be received within the time frame set forth in the Rider Schedule.

No payments will be made for expenses not incurred within the Benefit Period.

Covered Medical Service(s) - as used in this Rider, means any of the following services, if the service is Medically Necessary:

1. Hospital Room (semi private) and Board and Miscellaneous Hospital Expenses. Covered Expenses charged 1) daily semi private room rate when Hospital confined; and 2) general nursing care provided and charged by the Hospital. Miscellaneous Expenses include, while Hospital confined; or 2) for preadmission expenses for being Hospital confined but are not limited to, the cost of the operating room, X-ray examination , laboratory tests, in-hospital physiotherapy, anesthesia; drugs (excluding take home drugs) or medicines, therapeutic services; and supplies, registered nurse services and all necessary charges other than room and board, for services received during a Hospital Stay

2. Hospital Intensive Care Unit Covered Expenses charged when an Insured Person becomes confined as an Inpatient to a Hospital in an Intensive Care Unit, the Company will pay an additional benefit equal to the Daily Intensive Care Unit Benefit Amount shown in the Rider Schedule of benefits. Only one Daily Intensive Care Unit Benefit is provided for any one day of Intensive Care Unit confinement, regardless of the number of Covered Injuries or Sickness for which the confinement is required.

3. Surgeon Services (Inpatient) - Covered Expenses charge for performing in-patient surgical procedure. Two or more surgical procedures through the same incision will be considered as one procedure. . However, the Company will pay up to 50% of the benefit for a surgical procedure when more than one surgical procedure through different operating fields is performed during the same surgical session. Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both.

4. Anesthetist Services (Inpatient) - Covered Expenses charged by a Physician in connection with inpatient surgery for anesthesia and its administration. . Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both

5. Assistant Surgeon (inpatient) – Covered Expenses charged by a Physician in connection with inpatient surgery. . Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both

6. Physician’s (non Surgical Inpatient visit) – Covered Expenses charged by a Physician for other than pre or post operative care, second opinion or consultation: for 1) in Hospital visits and office visits. Benefits are limited to one Physician visit per day. Covered Expenses will be paid under the impatient benefit or outpatient benefit for Physicians Office visits but not both.

7. Consulting Physician Services- Covered Expenses charges by a Physician for a second surgical opinion or consultation that has been that must be requested by the attending Physician.

8. Physiotherapy Benefits (inpatient) Covered Expenses charges by a Physician for Physiotherapy that must be requested by the attending Physician

9. Pre – Admission Tests- Covered Expenses charged for pre- admission tests limited to routine test such as complete blood count; urinalyses and chest X ray. If otherwise payable under this Policy, major diagnostic procedures such as Cat-Scans; NMR’s and blood chemistries will be paid under the Hospital Miscellaneous benefit.

10. Surgeon Services (Outpatient) – Covered Expenses charge for performing outpatient surgical procedure. Two or more surgical procedures through the same incision will be considered as one procedure. . However, the Company will pay up to 50% of the benefit for a surgical procedure when more than one surgical procedure through different operating fields is performed during the same surgical session. Covered Expenses will be paid under this inpatient surgery benefit; or under the surgeon services benefit (Outpatient), but not for both.

11. Day Surgery Miscellaneous Expenses(Outpatient) – Covered Expense related to a major surgery performed at Hospital or licensed Outpatient surgery center including the actual cost of the operating room, laboratory tests and x ray examination anesthesia, drugs, medicines and medical supplies related to the surgery. Does not include non scheduled surgery and surgery performed in a Hospital emergency room; trauma center; Physician’s office; or clinic.

12. Anesthetist Services (Outpatient) - Covered Expenses charged by a Physician in connection with Anesthetist Services for Outpatient surgery for anesthesia and its administration. . Covered Expenses will be paid under this Outpatient benefit; or under the Inpatient surgery benefit, but not for both

13. Assistant Surgeon (Outpatient) – Covered Expenses charged by a Physician in connection with Outpatient surgery. Covered Expenses will be paid under this Outpatient surgery benefit; or under the Inpatient surgery benefit, but not for both.

14. Diagnostic X Rays and Lab tests except dental x-rays (Outpatient) – Covered Expenses incurred for the treatment of a Covered Injury or Sickness as prescribed by a Physician.

15. CAT Scan, PET Scan or MRI tests (Outpatient) -Covered Expenses incurred for the treatment of a Covered Injury or Sickness as prescribed by a Physician

16. Hospital Emergency Room services – Covered Expenses incurred for the Outpatient emergency room treatment performed in a Hospital. When emergency room treatment is immediately followed by admission to a Hospital, such treatment will be a Hospital Room and Board and Miscellaneous Hospital Covered Medical Service.

17. Prescriptions (outpatient) – Covered Expenses incurred for the treatment of a Covered Accident or Sickness prescribed by a Physician.

18. Ambulance Services Covered Expenses incurred for ground or air ambulance service to transport the Insured Person from the place where the Covered Accident or occurs. The Company will pay Covered Expenses incurred for ground or air ambulance transportation from the nearest medical facility to another appropriate medical facility, if a Physician specifies in writing that specialized care not available in the first facility to which the Insured Person was transported is necessary to treat His Covered Injury or Sickness.

19. Initial Orthopedic Prosthesis or Brace - Covered Expenses incurred for the initial purchase, fitting, and needed adjustment of such appliances or devices, including the components of prosthetic appliances. Orthopedic prosthesis or brace include durable medical equipment which is equipment that 1) is primarily and customarily used to serve a medical purpose; 2) can withstand repeated use; and 3) generally is not useful to a person in the absence of Injury or Sickness. The Orthopedic Prosthesis or Brace must be prescribed by a Physician and a written prescription must accompany the claim when submitted. Replacement prosthesis and braces are not covered and no benefits will be paid for rental charges in excess of the purchase price.

20. Dental Injury Treatment - Covered Expenses incurred for dental treatment (does not include dental services for the immediate relief of pain), including X-rays, for injury to a tooth: 1) with no fillings or cavities or only fillings or

cavities that do not undermine the tooth cusps; and 2.for which pulpal tissues are healthy and intact; and 3. for which periodontal tissue shows little or no signs of active or chronic inflammation. For insurance review purposes, each tooth unit is evaluated under these criteria rather than a blanket rating of the whole mouth. Covered Expenses include examinations, x-rays, restorative treatment, endodontic, oral surgery, initial braces required for treatment of a Covered Injury and treatment of gingivitis resulting from trauma. If there is more than one way to treat a dental problem, The Company will pay based on the least expensive procedure if that procedure meets commonly accepted standards of the American Dental Association. Routine dental care and treatment to the gums are not covered.

21. Chemotherapy and/or Radiation Services – Covered Expenses incurred for chemotherapy or radiation prescribed by a Physician for the treatment of a Sickness Benefits. Chemotherapy and Radiation means Cobalt Therapy, EX- ray therapy or chemotherapy administered to an Insured Person as treatment of cancer. This includes Injections 1) when administered in the Physician’s office; and 2) charged on the Physician statement. It does not include laboratory and diagnostic tests.

22. Physical and Occupational Therapy Covered Expenses incurred for Outpatient physical and occupational therapy

23. Private Duty Nursing Benefit Covered Expenses incurred for services rendered by a 1) private duty nurse care only; 2) while Hospital Confined; 3) ordered by a licensed Physician; and 4) medically necessary. General nursing care provided by the Hospital is not covered under this benefit.

24. Maternity Benefit Covered Expenses incurred for the treatment of a pregnancy when conception occurs after the trip begins under this Policy. This does not include any benefits for the unborn child.

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Exclusion

  • intentionally self-inflicted injury; suicide or attempted suicide.
  • Commission or attempt to commit a felony or an assault.
  • Routine physical or other examinations where there is not objective indications of impairment for normal health or well-baby care
  • Dental treatment, except as the result of Covered Injury to sound, natural teeth as stated in the Rider Schedule
  • commission of or active participation in a riot or insurrection
  • Birth defects and congenital anomalies, or complications which arise from such conditions. 

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You may review a listing of hospitals, physicians and other medical service providers included in the PPO Network for the area where you will be receiving treatment by accessing the Internet website for INF Plans at:

https://www.firsthealthinternational.com/LocateProvider/SelectNetworkType

Complete details are given in certificate of insurance

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Policy Maximum Pre-Existing Maximum

$25,000

$50,000

$75,000

$100,000

$150,000

$250,000

$1,000; $1,500; $1,750

$1,500; $2,000; $2,500

$2,500; $,3500; $4,500

$3,500; $4,500; $5,500; $6,500

$4,500; $5,500; $6,500; $7,500

$7,000; $9,000; $13,000; $15,000

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INF Plans can be renewed up to a maximum of 12 months or 364 days, after the initial enrollment period. To extend coverage for you or your visitor.

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Refund of premium, less a $25 processing fee, will be considered only if Cancellation Form is received by the INF Health Care Services prior to the effective date of coverage

After that date, the premium is considered fully earned and non-refundable.

All cancellation requests should be submitted by completing the Cancellation Form found under 'Members Area' section of the web pages.

The form can be faxed to 408-520-4967. Policy changes can not be made under any circumstances once the policy becomes effective.

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Claims may be submitted to the Claims Administrator (WEBTPA.) by the provider of service directly or by you. Please visit our Claims section for more details. All claims must be submitted using the applicable claim form, which can be found online or requested from the Claims Administrator. Completed claim forms must be furnished to Administrative Concepts, Inc. within 90 days after the date of such loss. Failure to furnish such proof within the time required will not invalidate or reduce any claim if it was not reasonably possible to furnish proof.

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