| International Emergency Care |
Emergency Evacuation The plan
includes coverage for Emergency Medical Evacuations to the nearest
qualified medical facility or the country of residence and expenses
for reasonable travel and accommodations resulting from the
evacuation, up to US$10,000. |
To US$10,000 when coordinated through
IMG |
Repatriation If a covered
illness/injury results in death, expenses for Repatriation of bodily
remains or ashes to the country of residence will be covered up to a
maximum of US$7,500. |
To US$7,500 when coordinated through
IMG |
| Special Coverage's |
| Home Country Coverage (As
described below)
Incidental Home Country Coverage - During the Period
of Coverage an insured person may return to their country of
residence for incidental visits up to a cumulative two weeks total,
subject to: a. The insured person must have left their country of
residence, b. The total Period of Coverage must be for a minimum of
30 days, and c. The return to the country of residence may not be
taken to receive treatment for an illness or injury incurred while
traveling. |
| Common Carrier Accidental
Death |
US$25,000 to
Beneficiary |
| If accidental death should
occur while traveling on a commercial Common Carrier, US$25,000 will
be paid to the designated beneficiary. |
|
|
| US$50,000
Maximum Benefit - usual, reasonable and customary charges, subject
to deductible where applicable. |
| Inpatient
Treatment |
| Hospital room & board |
Up to US$1,275, per
day, 30 day maximum period of coverage (includes inpatient
prescriptions drugs) |
| Intensive care |
Additional US$575 per
day, 8 day maximum per period of coverage |
| Surgical treatment |
US$3,000 per surgical
session |
| Consult physician |
US$400 per period of
coverage |
| Pre-admission tests |
US$1,000 per period of
coverage |
| Private duty nurse |
US$500 per period of
coverage |
| Physician Visits |
US$50 allowable charge
per visit, 30 visits per period of coverage |
| Outpatient Treatment |
| Surgical treatment |
US$3,000 per surgical
session |
| Diagnostic x-ray & lab |
US$800 per period of
coverage, US$400 allowable charge per procedure |
| Hospital emergency room |
US$300 allowable charge
per visit |
| Prescription drugs |
US$250 per period of
coverage |
| Miscellaneous Inpatient & Outpatient
Services |
| Anesthetist |
US$750 per surgical
session |
| Assistant surgeon |
US$750 per surgical
session |
| Other Coverage's |
|
| Ambulance |
US$400 per period of
coverage |
| Dental for accident to sound natural
teeth |
US$500 per period
of coverage |
| Physiotherapy |
US$35 per visit per
day, 12 visits per period of coverage |
| Physician visits |
US$50 allowable charge
per visit, 10 visits per period of coverage |
| Medical
Benefits - US$100,000 |
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| US$100,000
Maximum Benefit - usual, reasonable and customary charges, subject
to deductible where applicable |
| Inpatient Treatment |
|
| Hospital room & board |
Up to US$1,750 per day,
30 day maximum per period of coverage |
| Intensive care |
Additional US$750 per
day, 8 day maximum per period of coverage |
| Surgical treatment |
US$5,000 per Surgical
Session |
| Consult physician |
US$450 per period of
coverage |
| Pre-admission tests |
US$1,000 per period of
coverage |
| Private duty nurse |
US$500 per period of
coverage |
| Outpatient Treatment |
|
| Surgical treatment |
US$5,000 per surgical
session |
| Diagnostic x-ray & lab |
US$800 per period of
coverage $400 allowable charge per procedure |
| Hospital emergency room |
US$500 allowable per
visit |
| Prescription drugs |
US$250 per period of
coverage |
| Physician visits
(non-surgical) |
US$50 allowable charge
per visit, 10 visits per period of coverage. |
| Miscellaneous Inpatient & Outpatient
Services |
| Anesthetist |
US$1,250 per surgical
Session |
| Assistant surgeon |
US$1,250 allowable
charge per visit |
| Other Coverage's |
|
| Ambulance |
US$400 per period of
coverage |
| Dental for accident to sound natural
teeth |
US$500 per period
of coverage |
| Physiotherapy |
US$35 per visit per
day, 12 visit maximum per period of coverage |
|
|
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1. Coverage and benefits are subject to the
applicable deductible and Scheduled limits, and the other terms of
the plan as contained in the complete Policy Wording. 2. Coverage
under the plan is secondary to any other coverage. 3. Coverage
and benefits are for medically necessary, usual, reasonable and
customary charges only. 4. Charges must be administered or
ordered by a physician. 5. Charges must be incurred during the
Period of Coverage. 6. Claims must be presented to IMG for
payment within the Period of Coverage or during the three months
immediately following the Period of Coverage. |
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|
Charges for the following services, treatments
and/or conditions are excluded from coverage under the Visitors Care
plan. 1. Pre-existing Conditions. Charges resulting
directly or indirectly from any Pre-existing Condition, defined as
any Injury, Illness, sickness, disease, or other physical or medical
disorder or ailment that existed at the time of Application or at
any time during the three years prior to the effective date of this
insurance, whether or not previously manifested or symptomatic,
diagnosed or treated, including any subsequent, chronic or recurring
complications or consequences related thereto or arising there
from. 2. Heart disease, cancer, and stroke - Charges resulting
directly or indirectly from heart and blood circulatory disorders
including without limitation arteriosclerosis and ischemic
cardiovascular disease; cancer, tumor, and stroke or central nervous
system hypoxia; and including any subsequent chronic or recurring
complications or consequences related thereto or arising there
from. 3. Treatment or surgeries which are elective,
investigational, experimental or for research
purposes. 4. War, political insurrection, protest, or any
act thereof. 5. Immunizations and routine physical exams. 6.
Treatment of Temporomandibular Joint or dental treatment, except as
provided for herein. 7. Venereal disease, AIDS virus, AIDS
related illness, ARC Syndrome, or AIDS, and the cost of testing for
these conditions, and charges for treatment or surgeries which are
incurred by any Insured who was HIV+ at time of enrollment into this
insurance. 8. Pregnancy, childbirth, birth control, artificial
insemination, treatment for infertility or impotency, sterilization
or reversal thereof, or abortion. 9. Any Injury or Illness
sustained while taking part in mountaineering activities where
specialized climbing equipment, ropes or guide are normally or
reasonably should have been used, Amateur Athletics or professional
athletics, aviation ( except when traveling solely as a passenger in
a commercial aircraft), hang gliding and parachuting, snow skiing
except for recreation downhill and/or cross country snow skiing( no
cover provided whilst skiing in violation of applicable laws, rules
or regulations; away from prepared and marked in-bound territories;
and/or against the advice of the local authoritative body), racing
of any kind including by horse, motor vehicle ( of any type), or
motorcycle, spelunking, and sub aqua pursuits involving underwater
breathing apparatus. 10. Vision or ear tests and the
provision of visual or hearing aids. 11. Vocational,
recreational, speech or music therapy. 12. Treatment while
confined primarily to receive custodial care, educational or
rehabilitative care, or nursing services. 13. Charges, injuries
and/or illnesses resulting or arising from or occurring during the
commission or continuing perpetration of a violation of law by the
insured, including without limitation, the engaging in an illegal
occupation or act, but excluding minor traffic
violations. 14. Treatment for, and injuries and/or
illnesses resulting or arising from, substance abuse or drug
addiction. 15. Injury and/or illness resulting or arising from or
sustained while under the influence of or disablement of drugs or
alcohol. 16. Willful self-inflicted injury or illness. 17.
Treatment required as a result of or arising from complications from
a treatment or condition not covered hereunder. 18. Any services
or supplies performed or provided by a relative of the Insured or
provided at no cost to Insured. 19. Treatment for mental and
nervous disorders. 20. Organ or tissue transplants or
related services. 21. Illness or injury where the trip to the
host country is undertaken for treatment or advice for such Illness
or injury, except as provided for herein. 22. Treatment incurred
as a result of or arising from exposure to nuclear radiation, and/or
radioactive material(s). |
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| This web material contains
only a consolidated and summary description of all current Visitors
Care benefits, conditions, limitations and exclusions. A certificate
containing the complete Policy Wording with all terms, conditions
and exclusions will be included with the fulfillment kit. IMG
reserves the right to issue the most current Policy Wording for this
insurance plan in the event this application and/or brochure has
expired, is modified, or is replaced with a newer version. Current
Policy Wordings are available upon request.
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