Atlas Group America

Detail

U.S. Citizens and Non-U.S. Citizens who are at least 14 days of age and traveling with a group of at least five (5) members are eligible for coverage outside of their home countries, except as provided under home country coverage. U.S. Citizens and residents are not eligible for coverage within the U.S, except as provided under home country coverage or an eligible benefit period. Individuals age 70 to 79 as of the certificate effective date are subject to a $100,000 overall maximum limit or less. Individuals age 80 and over as of the certificate effective date are subject to a $10,000 overall maximum limit.

Benefit

Except as specifically indicated otherwise, all benefits are subject to deductible, coinsurance, and are per certificate period.

BENEFIT	LIMIT
Overall Maximum Limit (Excludes Emergency Medical Evacuation, Accidental Death and Dismemberment, Common Carrier Accidental Death, Personal Liability, and Crisis Response)	Age 80 or older $10,000. Age 70 to 79: $50,000, $100,000. All others: $50,000, $100,000, $200,000, $500,000,or $1,000,000
Maximum per Injury / Illness	Age 80 or older $10,000. Age 70 to 79: $50,000, $100,000. All others: $50,000, $100,000, $200,000, $500,000, or $1,000,000
Deductibles	$0, $100, $250, $500, $1,000 or $2,500 per certificate period
Coinsurance – Claims incurred in U.S. or Canada	We will pay 80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum limit. Coinsurance will be waived if expenses are incurred within the Preferred Provider Organization (PPO).
Coinsurance – Claims incurred outside U.S. or Canada	We will pay 100% of eligible expenses after the deductible up to the overall maximum limit.
Subject To Deductible, Coinsurance, and per Certificate Period unless specifically indicated otherwise
Hospital Room and Board	Average semi-private room rate, including nursing services
Intensive Care Unit	Usual, reasonable and customary charges
Local Ambulance	Usual, reasonable and customary charges, when covered illness or injury results in hospitalization as inpatient.
Emergency Room Co-payment – Claims incurred in U.S. or Canada	You shall be responsible for a $200 co-payment for each use of emergency room for an illness unless you are admitted to the hospital. There will be no co-payment for emergency room treatment of an injury.
Urgent Care Center – Claims incurred in U.S. or Canada	Claims incurred in U.S. For each visit, you shall be responsible for a $15 co-payment, after which coinsurance will apply. – Co-payment is waived for members with a $0 deductible. – not subject to deductible
Acute Onset of Pre-existing Condition (excludes chronic and congenital conditions) (only available to members under age 70)	Overall maximum limit $25,000 lifetime maximum for Emergency Medical Evacuation
Terrorism	$50,000 lifetime maximum, eligible medical expenses only.
Physical Therapy and Chiropractic Care	$50 maximum per day. Must be ordered in advance by a physician.
All Other Eligible Medical Expenses	Usual, reasonable and customary charges
BENEFIT	LIMIT
Not Subject to Deductible or Coinsurance
Emergency Medical Evacuation	$1,000,000 lifetime maximum, except as provided under Acute Onset of Pre-existing Condition
Repatriation of Remains	Overall maximum limit
Local Burial or Cremation	$5,000 lifetime maximum
Crisis Response- Ransom, Personal Belongings, and Crisis Response Fees and Expenses	$10,000
Optional Crisis Response Rider with Natural Disaster Evacuation	$90,000 per certificate period, with $10,000 maximum for Natural Disaster Evacuation
Emergency Reunion	$50,000, subject to a maximum of 15 days
Bedside Visit	$1,500
Return of Minor Children	$50,000
Pet Return	$1,000
Political Evacuation	$10,000 lifetime maximum
Trip Interruption	$5,000
Accidental Death & Dismemberment (excludes loss due to Common Carrier Accident)
Ages 18 through 69	Lifetime Maximum - $50,000 Death - $50,000 Loss of 2 Limbs - $50,000 Loss of 1 Limb - $25,000
Under age 18	Lifetime Maximum - $5,000 Death - $5,000 Loss of 2 Limbs - $5,000 Loss of 1 Limb - $2,500
Ages 70 through 74	Lifetime Maximum - $12,500 Death - $12,500 Loss of 2 Limbs - $12,500 Loss of 1 Limb - $6,250
Ages 75 and older	Lifetime Maximum - $6,250 Death - $6,250 Loss of 2 Limbs - $6,250 Loss of 1 Limb - $3,125 $250,000 maximum benefit any one family or group.
Optional Accidental Death & Dismemberment Rider (only available to members age 18 through age 69)	Lifetime Maximum - $50,000 Death - $50,000 Loss of 2 Limbs - $50,000 Loss of 1 Limb - $25,000
Common Carrier Accidental Death Ages 18 through 69 Under age 18 Ages 70 through 74 Ages 75 and older	$50,000 $25,000 $12,500 $6,250 Subject to a maximum of $250,000 any one family or group.
Lost Checked Luggage	$500
Travel Delay	Maximum $100 a day after a 12-hour delay period requiring an unplanned overnight stay. Subject to a maximum of 2 days.
Emergency Dental (Acute Onset of Pain)	$250
Natural Disaster - Replacement Accommodations	Maximum $100 a day for 5 days
Hospital Indemnity	$100 per day of inpatient hospitalization
Personal Liability	$10,000 lifetime maximum $10,000 third person injury $10,000 third person property $2,500 related third person property
Optional Personal Liability Rider	$90,000 lifetime maximum

Exclusion

Excluded Conditions, Treatments (includes Diagnoses, Tests, and Examinations), Services, Supplies, Acts, Omissions, and/or Events:

Pre-existing Conditions, except charges resulting directly from an Acute Onset of Pre-existing Condition, as herein defined, subject to the limits set forth in the Schedule of Benefits and Limits.
Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
Mental health disorders.
Pregnancy except as covered under Complications of Pregnancy, as herein defined, termination of pregnancy except in connection with covered Complications of Pregnancy, all charges related to pregnancy after the 26th week of pregnancy, routine prenatal care, child birth, postnatal care, and charges incurred by a child under the age of 14 days.
Impotency or sexual dysfunction.
Venereal disease, including all sexually transmitted diseases and conditions.
HIV, AIDS, or ARC, and all diseases caused by and/or related to HIV.
All forms of cancer / neoplasm.
Substance abuse or addiction or conditions that may be attributed to substance abuse or addictions and direct consequences thereof.
Acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, hypertrophic and atrophic conditions of skin, nevus.
Sleep apnea or other sleep disorders.
Obesity or weight modification, including but not limited to wiring of the teeth and all forms of intestinal bypass surgery.
Self-inflicted injury or illness and/or suicide or attempted suicide whether sane or insane.
Injury sustained that is due wholly or partially to the effects of intoxication or drugs other than drugs taken in accordance with treatment prescribed by a physician and except drugs prescribed for the treatment of substance abuse.
Injury sustained while operating any motorized vehicle, aircraft or watercraft whether registered or not while under the influence of alcohol as defined under the law of the jurisdiction where the injury occurs or with a .08 BAC whichever is lower.
Routine medical examinations, including but not limited to vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to the suitability of employment or travel.
Dental treatment and treatment of the temporomandibular joint, except for emergency dental treatment necessary to replace sound natural teeth lost or damaged in an accident covered hereunder or for the emergency relief of acute onset of pain.
Promotion or prevention of conception including but not limited to: artificial insemination, treatment for infertility, sterilization or reversal of sterilization.
Organ or tissue transplants or related services.
Eye surgery, such as corrective refractory surgery, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and any examination or fitting related to these devices, dentures or dental appliances, and all vision and hearing tests and examinations.
Orthoptics and visual eye training.
Orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails.
Hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed.
Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinestherapy.
Psychometric, intelligence, competency, behavioral and educational testing.
Cosmetic or aesthetic reasons, except for reconstructive surgery when such surgery is directly related to and follows a surgery which was covered hereunder.
Modifications of the physical body intended to improve the psychological, mental or emotional well-being, including but not limited to sex-change surgery.
Exercise programs, whether or not prescribed or recommended by a physician.
Incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
Cryo preservation and implantation or re-implantation of living cells.
Genetic or predictive testing.
Investigational, experimental or for research purposes.
While confined primarily to receive custodial care, educational or rehabilitative care, or any medical treatment in any establishment for the care of the aged, except rehabilitative care received upon direct transfer from an acute care hospital.
Not medically necessary.
Not administered by or under the supervision of a physician, and products that can be purchased without a doctor's prescription.
Provided by a relative, family member or any person who ordinarily resides with you.
Provided at no cost to you.
Telephone consultations or failure to keep a scheduled appointment.
Payable under any government system, including the Australian Medicare system.
Charges exceeding usual, reasonable and customary.
Charges resulting from or occurring during the commission of a violation of law, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
Charges resulting from a disease outbreak in a country or location for which the U.S. Centers for Disease Control and Prevention (CDC) has issued a Level 3 Travel Warning if a) the warning has been in effect within the 6 months immediately prior to your date of arrival, or b) within 10 days following the date the warning is issued you have failed to depart the country or location.
War, military action or while on duty as a member of a police or military force unit.
Travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, Emergency Reunion, Natural Disaster, Return of Minor Children, Political Evacuation, and Trip Interruption sections of this insurance.
Incurred outside your certificate period.
Submitted to us for payment more than 60 days after the last day of the certificate period.
When departure from the home country is to obtain treatment in the destination country/countries.
Complications or consequences of a treatment or condition not covered hereunder.
Not included as Eligible Expenses as described herein.

Acute Pre-Ex Coverage

This policy does not cover pre-existing conditions, except charges resulting directly from an Acute Onset of Pre-existing Condition subject to the limits set forth in the Schedule of Benefits and Limits.

Pre-existing Condition means any

Condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the certificate effective date; or
Condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the certificate effective date; or
Injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the certificate effective date. For the purposes of the Complications of Pregnancy coverage offered hereunder, pregnancy will not be included within the definition of a pre-existing condition.

ACUTE ONSET OF PRE-EXISTING CONDITION

YOU ARE COVERED

Charges for a sudden and unexpected outbreak or recurrence of a pre-existing condition(s) which:
1. Occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms; and
2. Is of short duration; and
3. Is rapidly progressive; and
4. Requires urgent care.

YOU ARE NOT COVERED

unless you fulfill the following condition:

Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

YOU ARE NOT COVERED IF:

The Acute Onset of a Pre-existing Condition(s) occurs before the certificate effective date; or
The pre-existing condition is a chronic or congenital condition or that gradually becomes worse over time; or
The charges are for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the certificate effective date; or
Expenses arise directly or indirectly from anything in the General Exclusions.

Cancel

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.

Claim

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.

Offline Form Online 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.