Plan Administrator: Trawick International | AM Best Rating: A "Excellent" | Underwriter: GBG Insurance Limited
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Pre-Existing Conditions (Covered after 6 months) |
In Network: 80% of the Preferred Allowance Out of Network: 70% of UCR |
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Doctor Visit |
In Network: 80% of the Preferred Allowance (subject to copayment) Out of Network: 70% of UCR (subject to copayment) |
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Ambulance Benefit |
In Network: 80% of the Preferred Allowance Out of Network: 80% of UCR |
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Hospital Room and Board |
In Network: 80% of the Preferred Allowance Out of Network: 70% of the Semi-Private Room Rate |
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Emergency Room |
In Network: 80% of the Preferred Allowance subject to a $350 Copayment Out of Network: 70% of the Semi-Private Room Rate subject to a $350 Copayment |
The “Pre-existing Condition Waiting Period” is 6 months. If you receive treatment or service for a PreExisting Condition: a) No benefits will be paid for such condition until the day after a 6 consecutive month period has passed from your effective date; and b) The plan will pay only for Covered Expenses incurred after such 6 consecutive month period.
Pre-Existing Condition means an Injury, Sickness, disease, or other condition during the 365 day period immediately prior to the date the Plan Participant’s coverage is effective 1) received or received a recommendation for a test, examination, or medical treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or 2) took or received a prescription for drugs or medicine. Item (2) of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the 365 day period before coverage is effective under the Plan Participant’s Plan.
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.
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.
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.