Plan Administrator: Trawick International | AM Best Rating: A "Excellent" | Underwriter: GBG Insurance Limited
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Preventative Care & Annual Exams |
In Network Preventative Care & Annual Exams Out of Network : No Benefit |
|
Doctor Visit |
In Network: 80% of the Preferred Allowance (subject to copayment) Out of Network: 70% of UCR (subject to copayment) |
|
Ambulance Benefit |
In Network: 80% of the Preferred Allowance Out of Network: 70% of UCR |
|
Hospital Room and Board |
In Network: 80% of the Preferred Allowance Out of Network: 70% of UCR |
|
Emergency Room |
In Network: 80% of the Preferred Allowance subject to a $150 copayment per visit, waived if admitted Out of Network: 70% of UCR subject to a $150 copayment per visit, waived if admitted |
The insurance coverage term begins on the Effective Date as shown on the Medical Identification Card and ends at midnight on the date shown, but no longer than 365 days later. The coverage is not subject to guaranteed issuance or renewal.
Claims must be filed within 180 days of treatment to be eligible for reimbursement of covered expenses. Claim forms should be submitted only when the medical service Provider does not bill the Insurer directly, and when you have out-of-pocket expenses to submit for reimbursement. All claims worldwide are subject to Usual, Customary, and Reasonable charges as determined by GBG and are processed in the order in which they are received. In order for claims payment to be made, claims must be submitted in a form acceptable to Insurer.
The Insurer may at any time terminate an Insured Person, or modify coverage to different terms, if the Insured Person has at any time:
• Misled the Insurer by misstatement or concealment,
• Knowingly claimed benefits for any purpose other than are provided for under this Plan,
• Agreed to any attempt by a third party to obtain an unreasonable pecuniary advantage to the Insurer’s detriment,
• Failed to observe the terms and conditions of this Plan or failed to act with utmost good faith.