• Doctor Visit: Up to policy max.
• Urgent care: $15 co-payment, after which coinsurance will apply (No deductible).
• Hospital room and board: Up to policy max.
• Emergency room: Up to policy max ($200 co-payment for each use of emergency room for an illness unless you are admitted to hospital).
• Ambulance: Up to policy max.
• Physical Therapy: $50 per day
• Loss of Checked Baggage: $500

Complete details are given in certificate of insurance.

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• Pre-existing conditions, except acute onset of pre-existing condition.
• Routine physical exam.
• Preventive care services such as flu shots.
• Pregnancy except as covered under Complications of Pregnancy after 26th week of pregnancy.
• Charges resulting from violation of law.
• Eye surgery, such as corrective refractory surgery.
• Eyeglasses, contact lenses, hearing aids.
• Services provided by a chiropractor.

Complete details are given in certificate of insurance.

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• Limited benefit up to the medical coverage maximum (excludes chronic and congenital condi- tions). $25,000 lifetime maximum for emergency medical evacuation.

Acute Onset of Pre-Existing Conditions

• If you are younger than 70, you may be covered for an acute onset of a pre-existing condition. Atlas Group provides a limited benefit up to the medical coverage maximum lifetime for eligible medical expenses. This also includes a $25,000 lifetime maximum for emergency medical evacuation. An acute onset of a pre-existing condition is a sudden and unexpected outbreak or recurrence of a pre-existing condition which occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms.
• Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

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Please notify us of your wish to cancel and we will refund your premium. 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:

• A $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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This insurance policy has in it a Claims Procedure which tells you what steps you must take to file a claim, and explains our obligations to you. You shall have 60 days beginning on the last day of the certificate period to submit proof of claim to us.

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