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

  • PPO Network (Within PP0 Network): Within the PPO: We will pay 80% of the next $25,000 of eligible expenses, after the deductible, then 100% up to the overall maximum limit.
  • PPO Network (Outside PP0 Network): Outside the PPO: Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount.Eligibility: Non US Citizen Age 14 to 65 travelling to USA.
  • Coverage length: Min 5 days to 364 days.
  • Renew Online: Any extension or renewal is based upon the eligibility rules in force at the time of renewal and is solely at the  discretion of Underwriter.
  • Provider Network: Member will be receiving treatment by accessing the Internet website for HCC Medical Insurance Services, LLC at: www.hccmis.com.
  • ID card & Visa Letter comes in email instantly.

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Age and Policy Maximum

Age 0-65 :2,00,000

Doctor Visit Up to the overall maximum limit
Surgical Treatment Up to the overall maximum limit
Hospital Room and Board Average semi-private room rate, including nursing services.
Ambulance Up to $350 per injury or illness, when covered illness or injury results in hospitalization as inpatient. - not subject to coinsurance
Prescription Generic Drugs: $10 deductible per prescription Brand Name Drugs: $20 deductible per prescription.

Complete details are given in certificate of insurance.

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Exclusion

  • Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as herein defined, are excluded from this insurance during the first 180 days of coverage.
  • Routine pre-natal care, Pregnancy, child birth, post natal care, and routine nursery care of a newborn, unless directly related to a Covered Pregnancy as defined.
  • Diagnosis, testing, treatment, services or supplies which are not Medically Necessary.
  • Routine check-ups
  • Diagnosis, testing, or treatment of Members who are HIV+ or have AIDS or ARC.
  • Eye surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness.
  • Diagnosis, testing, or treatment of sleep disorders.
  • Willfully self-inflicted Injury or Illness.
  • Complete details are given in certificate of insurance.

Complete details are given in certificate of insurance.

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Acute Onset of Pre-existing Condition (excludes chronic and congenital conditions)

Up to $25,000 lifetime maximum for eligible medical expenses

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To comply with the United States Preferred Provider Organization requirements, the Member must receive medical treatment from PPO providers while in the United States. If the Member chooses to comply with the PPO requirements, and the expenses are incurred in a PPO provider, Underwriters will waive the Coinsurance applicable to the expenses.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.

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Any extension or renewal is based upon the eligibility rules in force at the time of renewal and is solely at the discretion of Underwriter.

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  • 1. A $25 cancellation fee will apply for administrative costs incurred by us; and
  • 2. Only premium for unused whole-months, if paying in monthly installments, or unused days, if paid
  • in full, of the plan will be refunded; and
  • 3. You cannot have filed any claims to be eligible for a premium refund; and
  • 4. No refund of premium shall be granted after 60 days.

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You must submit a claim for any expenses to be paid by us. This includes treatment or services for which you expect the medical provider is to bill us directly. No payments will be made by us without you first submitting a claim.

Notice of claim, Claimant's Statement and Authorization, and proof of claim must be mailed to: Tokio Marine HCC MIS Group

P.O.Box No 2005

Farmington Hills,MI-48333-2005

Offline Form

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