USAway International Major Medical Plan

Detail

Plan Administrator: Petersen International Underwriters

Eligibility: US Citizen/ Non US Citizen Age 0-84 traveling outside USA.
Coverage Length: Maximum term length of 11 months.
Eligible expenses caused by an illness or injury and incurred from any doctor or any hospital within a specified geographic area will be reimbursed to you.
This insurance is not subject to, and does not provide certain of the insurance benefits required by, the United States’ Patient Protection and Affordable Care Act (‘ACA’). This insurance does not provide, and Insurers do not intend to provide, minimum essential coverageunder ACA.
Benefits may be assignable directly to the providers once a claim has been reviewed and completed.
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Benefit

Choice of Deductible Maximum Benefit

$5,000,000

Age 0-69  $0, $250, $500, $1,000, or $2,500 Age 70-74  up to $250,000

Age 70-79  $1,000, $2,500 or $5,000 Age 75-79  up to $100,000

Age 80-84  $2,500 or $5,000 Age 80-84  up to $50,000

(Deductibles listed are per policy period) One policy will be issued for each person. (Benefits listed are per policy period) One policy will be issued for each person.

Exclusion

Expenses for supplies and services that were incurred in the United States of America or any of its territories after the follow Me Home Provision has been exhausted.
Any expense which You are not legally obligated to pay.
Services which are not Medically Necessary or are not furnished by and under supervision of a Physician.
Expenses for services and supplies for which You are entitled to benefits, services or reimbursement through the Veterans’ Administration, Workers’ Compensation insurance, any private health plan or from any other source except Medicaid.
Expenses in excess of UCR.
Self-inflicted injuries while sane or insane.
Treatment for alcoholism, drug addiction, allergies, and/or Mental or Nervous Disorders.
Rest cures, quarantine or isolation.
Cosmetic surgery unless necessitated by an accidental Injury.
Dental exams, dental x-rays and general dental care except as a result of an accidental Injury.
Eye glasses or eye examinations.
Hearing aids or hearing examinations.
General or routine examinations.
Injuries sustained from participation in Hazardous Sports or Activities.*
Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage, abortion or postpartum conditions.
Injuries or Illnesses due to War or any act of War whether declared or undeclared.*
Injuries or Illnesses due to Terrorism or Act of Terrorism whether declared or undeclared.*
Injuries or Illnesses due to an Act of Terrorism involving the use or release of any nuclear weapon or device or chemical or biological agent, regardless of any contributory cause(s).
Injuries or Illnesses sustained while committing a criminal or felonious act.
Expenses incurred for or resulting from pain which is not supported by medical diagnosis.
Cataract surgery.
Any elective surgery, including but not limited to complications of previous elective or cosmetic surgeries.
Custodial Care.
Expenses for supplies and services that were not incurred with in the specified Geographic Area.
Pre-existing conditions.
Racing of any kind, all professional or semi-professional sports, and collegiate, sponsored, or interscholastic athletics.**

* This exclusion can be removed if the appropriate additional premium has been paid and the optional benefit is indicated on the Schedule or attached by an endorsement.

** This exclusion can be removed if the appropriate additional premium has been paid and the optional benefit is indicated on the Schedule or attached by an endorsement. Please note this exclusion cannot be removed with the online enrollment.

Acute Pre-Ex Coverage

Pre-existing condition means a physical mental or chemical condition which arose from any accident or sickness for which you sought medical advice or treatment within twelve months prior to the effective date of this certificate or which caused symptoms for which an ordinarily prudent person would have sought medical advice within that twelve months.

Important Notice regarding the Patient Protection and Affordable Care Act:

This insurance is not subject to, and does not provide certain of the insurance benefits required by, the United States’ Patient Protection and Affordable Care Act (‘ACA’). This insurance does not provide, and Insurers do not intend to provide, minimum essential coverage under ACA. In no event will benefits be provided in excess of those specified in the contract documents. This insurance is not subject to guaranteed issuance or renewability other than as specified in the policy. ACA requires certain US citizens and US residents to obtain ACA compliant health insurance coverage. In some circumstances penalties maybe imposed on persons who do not maintain ACA-compliant coverage. You should consult your attorney or tax professional to determine if ACA’s requirements are applicable to you.

Renew

This insurance is not subject to guaranteed issuance or renewability other than as specified in the policy.

Claim

Benefits may be assignable directly to the providers once a claim has been reviewed and completed.

Offline Form

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.

Choice of Deductible	Maximum Benefit
	$5,000,000
Age 0-69 $0, $250, $500, $1,000, or $2,500	Age 70-74 up to $250,000
Age 70-79 $1,000, $2,500 or $5,000	Age 75-79 up to $100,000
Age 80-84 $2,500 or $5,000	Age 80-84 up to $50,000
(Deductibles listed are per policy period) One policy will be issued for each person.	(Benefits listed are per policy period) One policy will be issued for each person.