GeoBlue Voyager Choice

Detail

Eligible Participants and their Eligible Dependents are the only people qualified to be covered by this Plan. An Eligible Participant is a member of a Group who has submitted an enrollment form, if applicable, and has paid the premium for the insurance. An Eligible Participant or an Eligible Dependent must also be: (a) a resident of the U.S., (b) under Age 85 and (c) enrolled in a Primary Plan. For more information on eligibility requirements for participants and dependents, please visit www.geobluetravelinsurance.com/products/single-trip/voyager-5-eligibility.cfm.

This Plan description provides a brief description of the types of benefits available under this Plan. It also contains many important terms (such as "Medically Necessary" and "Covered Expenses") that are defined in the Certificate of Coverage. This description should be used only as a quick reference tool The entire Certificate of Coverage sets forth, in detail, the rights and obligations of both the Insured Person and the Insurer. Therefore, it is important that the entire Certificate of Coverage be read carefully!

The "Insurer" of the Certificate of Coverage that funds this Plan is 4 Ever Life International Limited, Bermuda, rated A- (Excellent) by A.M. Best 4 Ever Life International Limited, Bermuda, is an independent licensee of the Blue Cross Blue and Blue Shield Association.

The "Administrator" is GeoBlue, 100 Matsonford Road, One Radnor Corporate Center, Suite 100, Radnor, PA 19087. The term "Insured Person" means the Eligible Participant who purchased the insurance plus his/her Dependents for whom coverage was purchased.

Benefit

Benefits: An Insured Person is eligible for benefits only during the Trip Coverage Period. The benefits purchased will be paid by this Plan for Covered Expenses after the Insured Person has satisfied any Deductible and prior to satisfaction of his/her Out-of-Pocket Maximum. Covered Expenses are based on Reasonable Charges which may be less than actual billed charges. Providers can bill the Insured Person for amounts exceeding Covered Expenses. The combined total of all medical benefits paid to the Insured Person is limited to the maximum amount purchased.

Medical Benefits
Maximum Benefit per Insured Person per period of coverage >	Four Options: $50,000; $100,000; $500,000; $1,000,000
Deductible per Insured Person per period of coverage >	Four Options: $0; $100; $250; $500
After the Deductible is satisfied, benefits are paid for	Covered Expenses as follows up to the Medical Limit:

Benefits	Insurer Pays - Essential
Professional Services: Surgery, anesthesia, radiation therapy, inpatient doctor visits, X-ray and lab	100%
Office visits, including X-rays and lab	100%
Inpatient Hospital Services: Surgery, X-rays and lab	100%
Inpatient medical emergency	100%
Ambulatory surgical center	100%
Ambulance service	100% up to $1,000
Claims resulting from downhill skiing and scuba diving	Maximum Benefit up to $10,000
Outpatient prescription drugs outside the U.S.	100% of Expenses up to $5,000
Dental care required due to an injury	100% of Covered Expenses up to $500 maximum per trip period
Dental care for relief of pain	100% of Covered Expenses up to $250 maximum per trip period
Physical and Occupational Therapy	6 visits per Period of Insurance. $100 Max payment per visit.
Other Benefits
Accidental Death and Dismemberment	Maximum Benefit Principal Sum up to $50,000
Repatriation of Mortal Remains	Maximum Benefit up to $25,000
Emergency Medical Transportation	Maximum Benefit per Trip Period for all Emergency Medical Transportation up to $500,000
Emergency Family Travel Arrangements	Maximum Benefit per Trip Period up to $2,500 for the cost of one economy round-trip airfare ticket to the place of the Hospital Confinement for one (1) person.
Baggage & Personal Effects Coverage	Maximum benefit of $500 per Trip Period and limited to $100 maximum benefit per bag or Personal Effect
Post Departure Trip Interruption	Maximum benefit of $500 per Trip Period

Exclusion

In addition to any of the general exclusions listed in Section VI. of this certificate, the following exclusions also apply to the Emergency Medical Transportation benefit:

Transportation shall not be considered Medically Necessary if We or Our designee's medical director determines that the Covered Person is receiving adequate care in their current location.
Transportation shall not be considered Medically Necessary if We or Our designee's medical director determines that the Covered Person can continue his/her trip or can use the original transportation arrangements that he/she purchased.
No more than one Emergency Medical Evacuation and/or Repatriation is allowed for any single medical condition of a Covered Member while covered under this Certificate.

No payment will be made for charges for:

services rendered without the authorization or intervention of Us or Our designee;
non-emergency, routine or minor medical problems, tests and exams where there is no clear or significant risk of death or imminent serious Injury or harm to You;
a condition which would allow for treatment at a future date convenient to You and which does not require emergency evacuation or repatriation;
expenses incurred if the original or ancillary purpose of Your trip is to obtain medical treatment;
Any expense for medical evacuation or repatriation if the Covered Member is not suffering from a Serious Medical Condition, and/or in the opinion of Our designee's medical director, the Covered Member can be adequately treated locally, or treatment can be reasonably delayed until the Covered Member returns to his/her Home Country or Country of Assignment.

Acute Pre-Ex Coverage

We provide coverage for pre-existing conditions for emergency medical transportation. Pre-existing conditions are also covered for medical services by our Choice plan.

Pre-existing Conditions: Benefits are not available for any services received on or within 6 months (0 months for the GeoBlue Voyager Choice plan) after the Insured Person became insured if those services are related to a Pre-existing Condition. Pre-existing Condition means a medical condition for which medical advice, diagnosis, care, or treatment was recommended or received during the 6 months (0 months for the GeoBlue Voyager Choice plan) immediately preceding the Insured Person’s Effective Date of Coverage. This exclusion does not apply to a Newborn who is enrolled within 31 days of birth or a newly adopted child who is enrolled within 31 days from either the date of placement of the child in the home or the date of the final decree of adoption. This exclusion does not apply to the Emergency Medical Transportation, Repatriation of Mortal Remains and Emergency Family Travel Arrangements Benefits.

Renew

This is a nonrenewable plan.

Cancel

We are so confident in our products that we offer the best guarantee in the business! If you are not completely satisfied with our product, simply return your Certificate or Policy of Insurance and Description of Emergency Medical Evacuation and Other Services within 10 days of receipt and include a letter indicating your desire to cancel. If you have not already left on your trip or incurred a claim, you will receive a full refund.

Claims

Notice of Claim: Within 20 days after an Insured Person receives Covered Services, or as soon as reasonably possible, he/she or someone on his/her behalf must notify the Administrator in writing of the claim.

Proof of Loss: Within 90 days after the Insured Person receives Covered Services, he/she must send the Administrator written proof of loss. If it is not reasonably possible to give written proof in the time required, the Administrator will not reduce or deny the claim for being late if the proof is filed as soon as reasonably possible. Unless the Insured Person is not legally capable, the required proof must always be given to the Administrator no later than one year from the date otherwise required.

Time Payment of Claims: Benefits for a loss covered under this Plan will be paid as soon as the Administrator receives proper written proof of such loss. Any benefits payable to the Insured Participant and unpaid at the Insured Participant's death will be paid to the Insured Person's estate.

Assignment of Claim Payments: The Administrator will recognize any assignment made under this Plan if it is duly executed on a form acceptable to the Administrator and a copy is on file with the Administrator. The Administrator assumes no responsibility for the validity or effect of an assignment. This is a summary of the benefits provided in the certificate of coverage. Any person who knowingly and with intent to defraud or deceive any insurance company submits an insurance application or statement of claim containing any false, incomplete or misleading information may be subject to civil or criminal penalties, depending upon state law. If you are a resident of California,Florida, Kentucky, New Jersey, New York, Ohio, Oklahoma or Pennsylvania see the FRAUD NOTICE at geobluetravelinsurance.com/purchase/fraudAgreement.cfm for additional information.

Scenario	Coverage Under Full Pre-Existing Plan
My father had a heart attack a few years ago. After his travel to the US, he started experiencing heart pain. I took him to the cardiologist. Is this covered?	Yes. Cardiologist visits are covered underneath a Full Pre-Existing coverage plan.
My mother-in-law has been experiencing heart pain for last few days, and had a heart attack on the last day. Is this covered?	Yes. Under a Full Pre-Existing Plan, there is not time limitation between symptoms and seeking care.
My uncle had cancer a few years ago. He is on a Green Card and has been living in the US. Recently, the cancer has come back. Is this covered?	Yes. Chemotherapy & Radiation treatment are covered under this plan. One note- the recurring cancer diagnosis must occur after the effective date.
My cousin had a back injury a few years back. He recently starting feeling back pain and went to seek the advise of a Chiropractor & get physical therapy. Is this covered?	Yes. Chiropractic care & physical therapy regarding pre-existing conditions are covered underneath full pre-existing plans.
My aunt had a sudden heart attack. After staying a few days in the hospital, she needs prescription drugs, follow up blood tests, and doctors visits. Are these covered?	Yes. Any sudden medical event, along with any follow up visits, i.e. blood tests, x-rays, EKG, etc., will be covered by full pre-existing plans.
My mother is diabetic. She was prescribed medication but often forgets to take it often. She experienced a diabetic shock and needed to visit the emergency room. Will this emergency visit be covered?	Yes. Our plans cover you no matter whether your visitor was taking their prescribed medication or not. Full pre-existing plans will cover no matter what happens.

Scenario	Coverage Under INF Acute Onset Plan
My father had a heart attack a few years ago. After his travel to the US, he started experiencing heart pain. I took him immediately to the emergency room. Is this covered?	Yes. Cardiologist visits are covered underneath a Full Pre-Existing coverage plan.
My mother-in-law had a sudden drop in blood sugar. I took her to the Urgent Care clinic. Is this covered?	Yes, as long as you seek medical attention within 12 hours you are covered.
My uncle was playing a game of cricket in the neighborhood and started to experience chest pain. He was hospitalized for 3 days and required several blood tests, and heart scans. Will this be covered?	Yes. Our plans will cover any sudden recurrence caused by a pre-existing conditions. Our plans have no pre-authorization, meaning the hospital can get the treatment your visitors needs faster.
My father-in-law had several kidney issues over the past few years. After several hours of pain, we took him to the hospital to have kidney stones removed. Is this covered?	Yes. As long as the treatment is sought within the first 12 hours of first exhibiting symptoms, any pre-existing condition will be covered. Our plans have no look back period for pre-existing conditions.
My cousin has diabetes. After a few days in the US, she contracted a Urinary Tract Infection which required hospitalization. Is this covered?	Yes. Under our plans, Urinary Tract Infections are considered new sicknesses and are covered by Acute Onset coverage plans.
My mother is a heart patient. She was prescribed medication but often forgets to take it often. She experienced a sudden heart attack and needed to visit the emergency room. Will this emergency visit be covered?	Yes, our plans cover any incident regardless if your visitor was taking their prescribed medication.