Diplomat Long Term - Excluding USA
The Diplomat LT provides Accident and Sickness Medical Coverage, Travel Assistance, and Accidental Death and Dismemberment benefits to Individuals while traveling outside their Home Country. Coverage is available for you, a second adult, unmarried dependent Children, or Children traveling alone. The minimum period of coverage that can be purchased is 3 months, the maximum is 36 months.
Coverage will begin at 12:00 A.M. Eastern Standard Time on the latest of the following: 1) The date the Company receives a completed application or enrollment form; or 2) The moment Plan Participant exits their Home Country airspace; or 3) The Date the Company approves the Application; or 4) The Date requested by the Plan Participant.
Coverage will end at 11:59 P.M. Eastern Standard Time on the earliest of the following: 1) The date Plan Participant is no longer in an Eligible Class; or 2) The date the Plan Participant returns to his or her Home Country unless otherwise covered under the Plan Document; or; 3) The expiration of 36 months from the Effective Date of Coverage; or 4) The date shown on the Schedule of Insurance issued by the Company.
|Traveling to the United States:|
|Traveling Outside the United States:|
|Persons age 70 – 79||maximum benefit of $100,000;|
|Persons age 80+||maximum benefit of $20,000.|
|Deductible Choices:||$0, $50, $100, $250, $500, $1,000, $2,500, $5,000 per person/plan period|
|Traveling to the United States:||After you pay the selected deductible, the plan pays 80% up to $5,000 of eligible costs, then 100% to the Medical Maximum. There will be an additional $250 deductible for each emergency room visit as a result of an Illness. The ER deductible will be waived if hospital admittance is within 12 hours of the incident.|
|Traveling Outside the United States:||After you pay your selected deductible this plan will pay 100% of Covered Expenses outside the USA up to the selected plan maximum.|
|Pre-Existing Condition Exclusion:||18 Months prior to the start date of coverage|
|Emergency Medical Evacuation and Repatriation:||$500,000|
|Return of Mortal Remains:||$50,000|
|Emergency Medical Reunion:||$50,000|
|Return of Minor Child:||$50,000|
|Interruption of Trip:||$5,000|
|Loss of Baggage:||$50 per article; up to a maximum of $250|
|Emergency Dental Treatment:||$100|
|Accidental Death and Dismemberment:||$25,000 (Enhanced Benefit Amounts available) with paralysis and coma, seat belt and airbag, felonious assault and home alteration and vehicle modification benefits.|
|In-Hospital Indemnity (US Citizens only):||$100 per day to a maximum of 10 days|
|Unexpected Recurrence of a Pre-existing Condition (US Citizens only):||up to $20,000; ($2,500 for age 65 and older)|
|Optional Plan Enhancements:||Athletic & Hazardous Activity Benefit
Home Country Coverage
War Risk Coverage Available outside the USA, call for a quote.
|Political and Natural Disaster Evacuation:||$50,000|
The Plan Document does not cover any loss resulting from any of the following unless otherwise covered under the Plan Document by Additional Benefits:
- Suicide, attempted suicide (including drug overdose) self-destruction, attempted self-destruction or intentional self-inflicted Injury while sane or insane;
- War or any act of war, declared or undeclared; Unless War Risk Rider is purchased;
- An Accident which occurs while the Plan Participant is on Active Duty Service in any Armed Forces, National Guard, military, naval or air service or organized reserve corps;
- Injury sustained while in the service of the armed forces of any country. When the Plan Participant enters the armed forces of any country, We will refund the unearned pro rata premium upon request;
- Voluntary, active participation in a riot or insurrection;
- Medical expenses resulting from a motor vehicle accident in excess of that which is payable under any other valid and collectible insurance;
- Organ transplants;
- Treatment for an Injury or Sickness caused by, contributed to or resulting from the Plan Participant's voluntary use of alcohol, illegal drugs or any drugs or medication that is intentionally not taken in the dosage recommended by the manufacturer or for the purpose prescribed by the Plan Participant's Physician;
- Commission or attempt to commit an assault or felony, or that occurs while being engaged in an illegal occupation;
- Eligible Expenses for which the Plan Participant would not be responsible in the absence of the Plan Document;
- Treatment of acne;
- Charges which are in excess of Usual, Reasonable and Customary charges;
- Charges that are not Medically Necessary;
- Charges provided at no cost to the Plan Participant;
- Treatment of HIV infection, HIV related illness and AIDS (acquired immune deficiency syndrome);
- Expenses incurred for treatment while in Your Home Country; except as provided under the Home Country Coverage Benefit;
- Expenses incurred for an Accident or Sickness after the Benefit Period shown in the Schedule of Benefits or incurred after the termination date of coverage;
- Regular health checkups; routine physical, immunizations or other examination where there are no objective indications or impairment in normal health;
- Services or treatment rendered by a Physician, Registered Nurse or any other person who is employed or retained by the Participation Organization; or an Immediate family member of the Plan Participant;
- Injuries paid under Workers' Compensation, Employer's liability laws or similar occupational benefits or while engaging in an occupation for monetary gain from sources other than the Participation Organization;
- Benefits for enrolling solely for the purpose of obtaining Medical Treatment, while on a waiting list for a specific treatment, or while traveling against the advice of a Physician;
- Aggravation or re-injury of a prior Injury that the Plan Participant suffered prior to his or her coverage Effective Date, unless We receive a written medical release from the Plan Participant's Physician;
- Pre-existing conditions as defined in the definitions; This exclusion does not apply to Emergency Evacuation/Repatriation.
- Treatment of a hernia, including sports hernia, whether or not caused by a Covered Accident;
- Pregnancy or childbirth, miscarriage; elective abortion; elective cesarean section; or any complications of any of these conditions;
- Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof;
- Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes;
- Expense incurred for treatment of temporomandibular joint (TMJ) disorders or craniomandibular joint dysfunction and associated myofacial pain;
- Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury or pain resulting from an Accident while the Plan Participant is covered under the Plan Document, and rendered within 6 months of the Accident;
- Eyeglasses, contact lenses, hearing aids braces, appliances, or examinations or prescriptions therefore;
- Private-duty nursing services;
- The cost of the Covered Person's unused airline ticket for the transportation back to the Plan Participant's Home Country, where an Emergency Medical Evacuation or Repatriation and/or Return of Mortal Remains benefit is provided;
- For the cost of a one way airplane ticket used in the transportation back to the Plan Participant's country where an air ambulance benefit is provided and medically necessary;
- Treatment paid for or furnished under any other individual or group Plan Document, or other service or medical prepayment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for the treatment without cost to any individual;
- Travel in or upon: A snowmobile; A water jet ski; Any two or three wheeled motor vehicle, other than a motorcycle registered for on-road travel; Any off-road motorized vehicle not requiring licensing as a motor vehicle; when used for recreation or competition. Unless Hazardous Activity Rider is purchased.
- Injury sustained while taking part in: mountaineering; hang gliding; parachuting; bungee jumping; racing by horse, motor vehicle or motorcycle; snowmobiling; motorcycle/motor scooter riding; scuba diving, involving underwater breathing apparatus; snorkeling; water skiing; snow skiing; spelunking; parasailing; white water rafting; surfing, unless part of a school credit course; and snow boarding. Unless Hazardous Activity Rider is purchased.
- Practice or play in any amateur, club, intramural, interscholastic, intercollegiate, sports contest or competition. Unless Athletic Sports Rider is purchased.
- Practice or play in any professional or semiprofessional sports contest or competition;
- Rest cures or custodial care;
- Treatment of Mental and Nervous Disorders;
- Weight reduction programs or surgical treatment of obesity or treatment of venereal disease;
- Elective or Cosmetic surgery and Elective Treatment or treatment for congenital anomalies (except as specifically provided), except for reconstructive surgery on a diseased or injured part of the body (Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or Sickness);
- Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from:
- While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or
- While being used for any test or experimental purpose; or
- While piloting, operating, learning to operate or serving as a member of the crew thereof; or
- while traveling in any such Aircraft or device which is owned or leased by or on behalf of the Participation Organization of any subsidiary or affiliate of the Participation Organization, or by the Plan Participant or any member of his household.
- A space craft or any craft designed for navigation above or beyond the earth's atmosphere; or
- An ultra light, hang-gliding, parachuting or bungi-cord jumping;
Except as a fare paying passenger on a regularly scheduled commercial airline or as a passenger in a non-scheduled, private aircraft used for business or pleasure purposes.
- Ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste, from combustion of nuclear fuel, the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component of such assembly.
- Plan Participant being exposed to the Utilisation of nuclear, chemical or biological weapons of mass destruction.
In addition to any of the exclusions listed above, for Eligible Expenses under Trip Interruption, this Insurance also does not cover the following:
- The Plan Participant or Traveling Companion or Traveling Companion's family making changes to personal plans; having business or contractual obligations; being unable to obtain necessary travel documents (passports, visas, etc.); being detained or having property confiscated by customs authorities; carrier caused delays (including bad weather);
- Prohibition or regulatory by any government; default of yacht charter companies; default of the organization from which the Plan Participant purchased their trip arrangements;
- A Pre-Existing Condition existing prior to the Plan Participant's departure from their Home Country.
In addition to any of the exclusions listed above, for Eligible Expenses under Baggage Loss and Delay, this Insurance also does not cover the following:
- Artificial teeth or limbs, hearing aids;
- Sunglasses, contact lenses or eyeglasses;
- Documents of any kind, including but not limited to documents, bills, currency, deeds, evidences of debt, letters of credit, stamps, credit cards, money, notes, securities, transportation or other tickets.
No Benefit will be payable for Home Alteration and Vehicle Modification, as the result of: Any condition for which the Plan Participant Person is entitled to benefits under any Workers' Compensation Act or similar law.
Acute Pre-Ex Coverage
|Pre-Existing Condition Exclusion:||18 Months prior to the start date of coverage|
Pre-Existing Condition means an Injury, Sickness, disease, or other condition during the 18 month period immediately prior to the date the Plan Participant's coverage is effective for which the Plan Participant 1) received medical advice 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.
Renewal - Coverage under the Diplomat LT is renewable if: 1) The Insured Person(s) meet all the eligibility requirements of the policy; 2) The Insurance Plan has not lapsed or terminated for any reason; and 3) The renewal coverage does not exceed the maximum allowable period of coverage. Maximum allowable period of coverage is defined as follows: thirty-six continuous months for ages 14 days to 69 years, twenty-four continuous months for ages 70 to 79, and twelve continuous months for ages 80+.
NOTE: 1) If an Insured Person has been insured under the Plan for twelve continuous months, a new deductible and co-insurance apply; 2) The chosen Medical Maximum is a Policy Lifetime Maximum; and 3) The Company reserves the right to change premium rates for each twelve months of continuous coverage.
Premiums will be refunded in full if cancellation request is received prior to the certificate effective date.
- $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.
After the Effective Date of Individual coverage, premium is considered fully earned and non-refundable. Partial refunds are not available.
Mail claims with original receipts and completed claim form to:
Global Claims Administration / 3195 Linwood Avenue, Suite 201; Cincinnati OH 45208
Inside US and Canada 800-513-2981, Outside US and Canada 513-533-1330
9am – 5pm Eastern Standard Time Monday through Friday
Notice of Claim - Written notice of claim must be given to the Company within 60 days after the occurrence or commencement of any Disablement covered by the Policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the claimant to the Company or to any authorized agent of the Company, with information sufficient to identify the Plan Participant Person will be deemed notice to the Company.
Claim Forms - The Company, upon receipt of a written notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within 15 days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of this Plan by submitting, within the time fixed in this Plan for filing proofs of loss, written proof showing the occurrence, nature and extent of the loss for which claim is made. Claim forms can be obtained by calling 800-513-2981 or online at www.globalunderwriters.com. One claim form is needed for each Injury or Sickness for which a claim is being made.
Proofs of Loss - Written proof of loss must be furnished to the Company at its said office in case of claim for loss for which this plan provides any periodic payment contingent upon continuing loss within 90 days after termination of each period for which The Company is liable and in case of claim for any other loss within 90 days after the date of such loss. Failure to furnish proof within the time required shall not invalidate nor reduce any claim if it is not reasonably possible to give proof within such time, provided proof is furnished as soon as reasonably possible.
Time of Payment of Claims - Indemnities payable under the plan for any loss other than loss for which the plan provides any periodic will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which the plan provides periodic payment will be paid at the expiration of each four weeks during the continuance of the period for which The Company is liable, and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.
Payment of Claims - Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity will be payable to your estate. If any indemnity of the Plan will be payable to a minor or otherwise not competent to give a valid release, the plan will pay such indemnity, up to an amount not exceeding $1,000, to any Relative by blood or connection by marriage of you who is deemed to be equitably thereto. Any payment made by the Plan in good faith pursuant to this provision will fully discharge the Plan to the extent of such payment. Subject to any written direction by you or a portion of any indemnities provided by this Plan on account of Hospital, nursing, medical or Surgical service may, at the Plan's option and unless you request otherwise in writing not later than the time for filing proof of such loss, be paid directly to the Hospital or person rendering such services, but is not required the service be rendered by a particular Hospital or person.