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The USAway
International major medical plan
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FOR
People traveling or temporarily residing outside of the United States
USES
Business Assignments
Pleasure
Educational Pursuits
Religious Activities
NOW, up to $5 million maximum benefit and all cause deductible. It includes
emergency return home, trip cancellation, lost luggage, accidental death with double indemnity.
DEDUCTIBLE
Choice of a $250, $500, $1,000 or $2,500 deductible per person
COINSURANCE
After the deductible is paid, 80%
of the next $5,000 of the eligible
expenses are paid by Underwriters
and then 100% of eligible expense
to the maximum benefit
MAXIMUM BENEFIT
Up to $5,000,000 for all eligible expenses (see limitations)
The insurance being described is a temporary major medical plan to be used by United States residents while traveling internationally. Eligible expenses caused by an illness or injury and are incurred from any doctor or any hospital outside the USA, and for which are not excluded will be reimbursed to you based upon usual, customary and reasonable charges.
Benefits may be assignable directly to the providers once a Claim Review has been completed.
Hospital Expenses: All medically necessary expenses while hospitalized.
Physician Services: All medically necessary expenses for treatment.
Skilled Nursing Facilities: All medically necessary expenses if confinement begins following a medically necessary hospital
confinement of 3 days or longer.
Home Health Care: All medically necessary expenses if hospitalization would have been required if Home Health Care was not provided and the care is provided in accordance with a written plan established, approved and followed by a physician.
Ambulance Services Expenses: To and from a hospital within 100 miles in the same geographic area.
Prescription Drugs: Covered during and following a period of hospitalization.
Repatriation of Remains: In the event of death, Underwriters will reimburse the cost of delivery of your remains to a mortuary
nearest your home.
Common Accident Provision: In the event that you and any additional insured family members suffer injuries from the same
accident, only one deductible and coinsurance shall be applied.
Global Medical Transportation: All medically necessary expenses for stabilization and transportation to the facility nearest your
home, which can provide the appropriate care.
Lost Luggage: In the event that your checked on luggage is completely and totally lost, Underwriters shall reimburse you to a
maximum of $500, excess of any and all other valid and collectible coverages.
Trip Cancellation Benefit: If within two weeks prior to Your pre-paid ticketed or vouchered trip departure Your trip must be cancelled due to 1) Your death, illness or injury causing hospitalization or outpatient surgery, or 2) the death of an Immediate Family member, or 3) the substantial destruction of Your home due to fire, wind flood, or earthquake, any unused and non-refundable portion of expenses,
shall be reimbursed up to a maximum of $1,000, excess of $100 each and every loss and excess of all other valid Insurances.
Emergency Return Home: If, after You have departed, You learn of the death of an Immediate Family Member, or You learn of
the substantial destruction of Your home by fire, wind, flood, or earthquake, Underwriters shall reimburse You the cost of an economy
one way air or ground transportation ticket for You to Your home, up to a maximum of $5,000.
$25,000 Accidental Death: Double indemnity ($50,000 total) if accidental death occurs while riding as a passenger of a
common carrier.
Follow Me Home: Provides benefits for any injury or illness which occurs while in the USA. Benefits are limited to 2 weeks for
every 3 months of time outside the USA.
If you elect this option, underwriters will reimburse you for eligible expenses which are incurred due to an injury resulting from the participation in a Hazardous Sport or Activity that is specifically named on the Schedule of Coverage.
(See exclusions for list of commonly excluded sports and activities.)
If you elect this option, underwriters will reimburse you for eligible expenses
which are incurred as a result of injuries sustained due to war or act of war.
Please Note: War and acts of war does not include acts of terrorism. Acts of
terrorism is included in the base plan at no extra charge.
This option allows you to purchase
a specified number of days of coverage, within the next 12 months,
to allow you to leave the U.S.A. as
frequently as you desire without
applying for coverage each time.
This option makes cardiac and cancer related conditions the same as any other
expense. This option is available only to U.S. residents under the age of 60.
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1 MONTH
(For periods other than 1 month, see "To Calculate")
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AGE
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$250 Deductible
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$500 Deductible
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$1000 Deductible
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$2500 Deductible
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0-17*
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$31
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$31
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$31
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$31
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18-29*
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$48
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$46
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$42
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$37
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30-39
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$62
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$59
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$53
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$47
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40-49
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$92
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$87
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$78
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$69
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50-59
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$113
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$107
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$95
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$84
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60-64
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$171
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$162
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$145
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$127
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65-69
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$243
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$195
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$173
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$154
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70-74
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N/A
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N/A
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$173
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$154
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75-79
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N/A
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N/A
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$205
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$195
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80-84
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N/A
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N/A
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N/A
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$284
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* If applying with an adult, otherwise use 18-29 rates
- Determine the deductible you want.
- Using actual age, add up the total 1 month premium for each person to be insured.
- For 2 weeks or less of coverage, multiply the 1 month premium total by 0.70. For all other calculations,
multiply the 1 month premium by the total months of coverage needed (to 12 months maximum).
- Sub-total
- Add any optional coverages to this sub-total
- Add a $100 processing fee
- Do not send money until AFTER approval by Underwriters
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Cardiac/Cancer Limitation Removal
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=
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add 10%
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Frequent Traveler
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Determine the number of months you will be traveling within the next 12 months. Add one (1) extra month to this time. Calculate premiums based upon the adjusted time. Example: 3 months of coverage over the next 12 months, would be calculated as a 4 month premium.
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Recreational Snow Skiing
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=
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add 10% or $80 whichever is greater
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Recreational Scuba Diving
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=
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add 10% or $80 whichever is greater
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All other Hazardous Sports/Activities
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=
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call
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War Coverage
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=
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call
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Expenses which have limitations are as follows:
- Services and supplies for Cardiac Related Conditions and Cancer Related Conditions are limited to either
- the
medical costs of stabilizing your condition and the transportation costs of returning you to your Home Country or
- a maximum reimbursement for Eligible Expenses of $25,000, at the option of Underwriters.
- The maximum Eligible Expense for Global Medical Transportation is $100,000.
- The maximum Eligible Expense for room and board charges is $450 per day.
- The maximum Eligible Expense room and board charge for an intensive care unit is the lesser of three times the
Provider's semi-private room and board charge or $1350 per day.
- Insured ages 70-74 are limited to $250,000 maximum benefit, all other terms and conditions apply.
- Insured ages 75-79 are limited to $100,000 maximum benefit, all other terms and conditions apply.
- Insureds ages 80-84 are limited to $50,000 maximum benefit, all other terms and conditions apply.
A Preexisting Condition will not be covered until the insurance described in this certificate has been in effect for a period of 12 months. A preexisting condition is one in which an insured sought medical attention or was advised to seek medical attention during the 12 month period preceding the effective date of the coverage.
Expenses which are not eligible for reimbursement are as follows:
- 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 Usual, Customary and Reasonable (UCR).
- Outpatient drugs, except following a hospitalization if prescribed for the same Illness or Injury.
- 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 which in part include mountaineering, snow skiing, scuba diving, hang gliding, sky diving, racing of any kind, and all professional or semi-professional sports.
- Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage,
pre-mature births, or abortion or complications from pregnancy to either mother or baby.
- Injuries or illnesses due to war or any act of war whether declared or undeclared. (Note: Terrorism however is
included in the base policy of benefits.)
- 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 or any elective surgery.
- Custodial Care.
- Expenses for supplies and services that were not incurred within the specified Geographic Area.
- Pre-existing Conditions.
Petersen International Underwriters want you to understand how they protect the confidentiality of non-public
personal information they collected about you.
PIU collects non-public information about you from numerous sources including, but not limited to:
- Information PIU receives from you on applications and other forms;
- Information about your transactions with the affiliates, others or PIU;
- Information PIU receives from consumer-reporting agencies; and
- Financial and medical sources.
PIU does not disclose any non-public information about you to anyone except as is necessary in order to provide
the products or services to you or otherwise as required or permitted by law (e.g. subpoena, fraud
investigation, regulatory reporting, etc.).
You have a right to request access to or correction of your personal information in PIU's possession.
PIU restricts access to non-public personal information about you to PIU's employees, PIU's affiliates' employees or others who need to know that information to service your account. PIU maintains physical, electronic and procedural safeguards to protect your non-public personal information.
If you have any further questions about this privacy statement or would like to learn more about how PIU protects
your privacy, please contact us.
This plan is administered by
Petersen International Underwriters
23929 Valencia Boulevard, Suite 215
Valencia, CA 91355-2186
It is underwritten by Certain Underwriters at Lloyd's that is rated A "Excellent" by A.M. Best.
This is a brief description of the insurance provided by this plan.
The Certificate of Insurance is the complete description of coverage.
Rates and Wording may change without notice.
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