The Diplomat America provides Accident and Sickness Medical Coverage, Travel Assistance, and Accidental Death and Dismemberment benefits to Individuals while traveling outside their Home Country to the United States. 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 15 days, the maximum is 364 days.
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 364 days from the Effective Date of Coverage; or 4) The date shown on the Schedule of Insurance issued by the Company.
Maximum: Plan A - $50,000, Plan B - $100,000, Plan C -$250,000, Plan D -$500, 000, Plan E -$1,000,000; Persons age 60-69 are eligible for plan A, B and C; Persons age 70 – 79 are eligible for plans A and B; Persons age 80+ are eligible for a maximum benefit of $20,000.
Deductible Choices: $0, $50, $100, $250, $500, $1,000, $2,500, $5,000 per person/plan period
Co - Insurance : 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 emergency room deductible will be waived if hospital admittance is within 12 hours of the incident.
Pre - Existing Condition Exclusion: 24 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.
Athletic & Hazardous Activity Benefit Available
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:
a) While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or
b) While being used for any test or experimental purpose; or
c) While piloting, operating, learning to operate or serving as a member of the crew thereof; or
d) 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.
e) A space craft or any craft designed for navigation above or beyond the earth's atmosphere; or
f) 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.
Excess Benefits: If an Injury or Sickness to the Plan Participant results in his incurring Eligible Expenses for any of the services in the SCHEDULE OF BENEFITS, We will pay the Eligible Expenses incurred, subject to any applicable Deductible Amount, and Coinsurance Percentage, that are in excess of Expenses payable by any other Health Care Plan, regardless of any Coordination of Benefits provision contained in such Health Care Plan.
The Plan Participant must be under the care of a Physician when the Eligible Expenses are incurred. The Expense must be incurred solely for the treatment of a covered Injury or Sickness:
- While the person is a Plan Participant under the Plan Document; and
- During the Benefit Period stated on the SCHEDULE OF BENEFITS.
The first Expense must be incurred within the time frame shown on the SCHEDULE OF BENEFITS.
The total of all medical benefits payable under the Plan Document is shown on the SCHEDULE OF BENEFITS and is subject to the specific maximums shown on the SCHEDULE OF BENEFITS.
Patient Protection and Affordable Care Act: This insurance is not subject to, and does not provide certain insurance benefits required by the United States Patient Protection and Affordable Care Act (‘PPACA’). The insurance benefits provided by this policy are stated in your policy documents and do not include additional benefits required be PPACA. The PPACA requires certain US residents and citizens to obtain PPACA compliant insurance coverage. In certain circumstances penalties may be imposed on U.S. residents and citizens who do not maintain PPACA compliant insurance coverage. You should consult your attorney, insurance agent or tax professional to determine if the PPACA’s requirements are applicable to you.
Acute Pre-Ex Coverage
Pre-Existing Condition means an Injury, Sickness, disease, or other condition during the 24 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.
Coverage under this Plan is not renewable. If additional coverage time is needed, a new application must be completed and correct Premium submitted to Global Underwriters Agency. A new Deductible, Coinsurance, and Pre-existing Condition Exclusion will apply at each succeeding or subsequent Period of Coverage.
A refund of the plan cost, less a $25 processing fee, will be considered only when written request is received by Global Underwriters prior to the Effective Date of Individual coverage. After the Effective Date of Individual coverage, the plan cost is considered fully earned and non-refundable. Partial refunds are not available.
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 Illness for which a claim is being made.
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.