Reside Worldwide - US major medical insurance for non-US residents

why reside for your international medical program?
There is an increasing population of global citizens, people who travel from country to country or continent to continent. Included among these global citizens are those less inclined to travel, yet discerning enough to know and demand the best care available worldwide. Whatever the reason you need to leave your home country, Reside Worldwide Medical Plan will follow you. Many foreign countries have coverage options, but as a U.S. citizen you are either not eligible for coverage or the protection the plan offers is inadequate. For non-U.S. citizens, it may be difficult to find a comprehensive medical plan, which provides coverage where your local plan may fall short. Whether you are a U.S. citizen living abroad or a citizen of another country, Reside provides you with security at home and the freedom to seek care anywhere in the world.

are you eligible for the reside program?
The Reside program is available to persons of any country who are at least 15 days of age and who are not older than age 74.

For U.S. Citizens: Applicants / Insured Persons must either be outside the United States at the time of application, or plan to depart the United States within 30 days of the Certificate’s Effective Date. In addition, the Insured Person must reside outside the United States at least 6 months during any given 12-month Policy Period in order to be considered an Insured Person. If an Insured Person resides in the United States longer than 6 months during any given 12-month Policy Period, their coverage shall immediately terminate.

For Non-U.S. Citizens: Applicants / Insured Persons must be outside the United States at the time of application, or plan to depart the United States within 30 days of the Certificate’s Effective Date. If the Insured Person is located in the United States for more than 30 days after the Effective Date and cannot obtain other health insurance, a Proof of Eligibility Form must be submitted with the Application.

*It is the Insured Person’s responsibility to maintain all records regarding travel history, age and student status and provide any documentation to the Administrator, which would verify the Eligibility Requirements.

how long are you covered under reside?
The Reside program is annually renewable as long as the eligibility requirements are met and the renewal premium is received. There are no additional medical questions upon renewal. The company cannot single out an individual for cancellation, they can only cancel coverage for an entire class^* of insureds.

*A "class" is a group of people defined by a common characteristic, including but not limited to demographic group and geographic region.

how do you apply for coverage?
To apply for coverage under Reside, complete the enclosed application and submit the form to Seven Corners along with the appropriate premium. Seven Corners will review your application and respond within 48 hours (normal business days). In some situations, additional information or clarification may be required. Seven Corners' underwriting department will contact the applicant to obtain any additional details necessary to determine acceptability. If accepted, Seven Corners will mail the Insured’s ID Card with Effective Date, Certificate of Coverage, claim form, and general procedures for the use of the insurance to the address of convenience listed on the application. If Seven Corners is unable to offer coverage, the administrative department will return your premium without delay. Please be sure to answer the questions on the application in complete detail. If accepted, the application becomes part of the certificate and formal agreement with the company.

deductibles, coinsurance & policy maximums
You have your choice of six per Injury / Sickness Deductibles: US $70, US $100, US $150, US $250, US $500, US $1000.

Reside does not have a coinsurance amount, apart from the chosen deductible and the limits described in the Schedule of Benefits. The Lifetime Maximum amount is listed in the Schedule of Benefits.

Should you travel during the course of treatment from one area to another (whether being treated inside the United States and Canada or outside the United States and Canada), the limitations of the new area shall apply.

what to do if you need to use the insurance?
For hospitalization and surgical procedures, contact Seven Corners Assist to obtain pre-notification services. The quality and complexity of medical treatment varies from country to country, therefore pre-notification is a requirement of the program. It allows Seven Corners' professionals to locate a Preferred Provider facility if available, assist you in receiving the best course of treatment, and coordinate payment with the local facility. Seven Corners' objective is for you to focus your attention on your medical condition and not on administrative details.

For non-hospital or surgical related procedures, filing a claim under Reside is easy. Just complete the claim form that comes with your ID Card, sign it, and submit it along with all original, itemized bills (and receipts if you have already paid for the medical expenses) to Seven Corners for processing. If acceptable with the facility, Seven Corners will make the payment directly to the treating hospital or doctor.

Annual Premiums Effective April 1, 2007

*No premium is charged for the first two (2) Dependent Children between 14 days through 9 years of age, if both parents are also covered under the same program.

If the Applicant desires to pay premiums on a Semi-Annual, Quarterly or Monthly basis, they must do so by credit card payment only. Seven Corners will automatically debit the credit card on the due date of the premium installment. The Premium Installment Factors to be applied to the Annual Premium are as follows:
Annual 1.00 / Semi-Annual 0.55 / Quarterly 0.28 / Monthly 0.10

IMPORTANT NOTICE: The premiums referenced above are applicable for the initial 12-month coverage period, only after the Applicant has been accepted by Seven Corners. Seven Corners reserves the right to increase the stated premiums based upon the Applicant’s medical condition at the time of application and underwriting. Applicants with chronic and/or severe medical conditions may be declined. At each renewal period, Seven Corners will inform the Applicant of the renewal premium for each subsequent coverage period based upon the Applicant’s age and deductible category.

coverage for children
If both parents are covered under Reside, the first two (2) Dependent Children between 14 days through 9 years of age will also be covered free of charge. If there are more than two (2) Dependent Children between the age of 14 days through 9 years of age, or if the children are 10 or over, the program will charge the applicable premium. If only one parent will be covered under the program, each child will be charged the appropriate rate.

newborn child coverage
When a parent remains eligible for coverage and the Pregnancy is considered an eligible pregnancy, newborn children are automatically covered for the first thirty-one (31) days after birth. In no event shall the Company’s maximum liability exceed the maximum stated in the Schedule of Benefits, as to Eligible Benefits during the first thirty-one (31) days following birth for Newborn Coverage and Treatment.

In order to continue coverage beyond the first thirty-one (31) days and be accepted as any other new Insured Person subject to the Insurance Provisions, Scope of Coverage and Exclusions sections of this Certificate or other sections relating to a Newborn Child (or Children) up to the maximum amount of this Certificate the following conditions must be met: 1) An Application and any applicable premium is submitted and Approved by the Company within thirty-one (31) days of the birth of a Newborn Child (or Children); 2) The Pregnancy that led to the birth of a Newborn Child (or Children) was an eligible Pregnancy covered under this Certificate; 3) The mother of the Newborn Child (or Children) remain covered under this Certificate; 4) The mother and Newborn Child (or Children) meet and will continue to meet the Eligibility Requirements of this Certificate of Coverage.

limitations of the reside program
Pre-Existing Conditions: Pre-Existing Conditions, which are any Injury(ies) or Illness(es) that meets any of the following criteria: 1) A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment(s) prior to the Individual Effective Date of Coverage under this Certificate; 2) A condition for which medical advice, diagnosis, care or Treatment(s), including Medication, was sought, recommended or received prior to the Individual Effective Date of Coverage under this Certificate; 3) The symptoms that occurred prior to the Individual Effective Date of the Coverage under this Certificate would have allowed a person trained in medicine to make a diagnosis of the condition producing the symptoms; 4) A condition that manifested prior to the Individual Effective Date of Coverage under this Certificate; 5) Expenses for Pregnancy within twelve (12) months after the Individual Effective Date of Coverage under this Certificate.

All Pre-Existing Conditions will be considered, provided the Insured Person has not:
a. suffered symptoms, consulted any Physician for Treatment, advice or check-ups for these Pre-Existing Conditions
b. taken Medication (including drugs, Medicines, special diets or injections) for a continuous period of twenty-four (24) months prior to the date of the Treatments and Expenses, that are being considered for Coverage under this Certificate.

Meaning, at the time that you submit a possible pre-existing claim to Seven Corners for processing, Seven Corners will look back 24 months from the date of service and determine if you had been treated, medicated or diagnosed for the condition within the last 24 months. If you have not been treated, medicated or diagnosed for the condition in the last 24 months, the eligible claim expense will be payable under the provisions and benefit limits of the Certificate. However, if you have been treated, medicated or diagnosed for the condition within the last 24 months, the claim expense shall be considered pre-existing and the expenses will not be considered eligible under the provisions of the Certificate.

Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or symptoms occur during the first 180 days of coverage hereunder beginning on the initial Effective Date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney 4 stones, any acne diagnosis or acne-related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder. Note: coverage for such illnesses or surgeries may be further limited under the pre-existing condition exclusion and definition contained herein, or other exclusions contained herein;

The following conditions, treatments, supplies, services, and/or expenses are not covered resulting from: (This is a Summary of the Exclusions contained in the Certificate of Coverage.)
· Pre-existing conditions as defined above.
· Claims not presented to Company within ninety (90) days following incident.
· Treatment not medically necessary, which exceeds reasonable and customary charges, provided at no cost to the Insured Person, or performed by a relative or anyone who lives with the Insured Person.
· Experimental treatment.
· Suicide or any attempted suicide.
· War or warlike operations.
· Injury in organized, professional, amateur, or interscholastic athletics.
· Routine physicals or procedures, unless otherwise listed in the Schedule of Benefits.
· Treatment of Temporomandibular joint.
· Vocational, Speech, Recreational or Music Therapy.
· Cosmetic surgery except as a result of a covered accident.
· Dental or eye treatment unless otherwise covered.
· Injuries as a result of disablement due to liquor or drugs.
· Telephone consultations.
· Treatment or services relating to custodial, rehabilitative, or nursing home care.
· Congenital conditions.
· Non-medical expenses.
· Self-inflicted injury or illness.
· Expenses in connection with the commission of a felony offense.
· Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing, SCUBA diving (unless PADI, NAUI, YMCA, SSI or PDIC certified).
· Treatment of venereal or sexually transmitted disease.
· Treatment due to HIV or AIDS.
· Drug treatment relating to infertility.

pre-notification program
To ensure that you receive the best care possible, Reside requires that the Insured Person (or someone on the Insured Person’s behalf) contact Seven Corners Assist for notification prior to all hospital admissions worldwide and any medical expenses incurred within the United States. The methods of contacting Seven Corners Assist will appear on the back of your ID Card. Seven Corners Assist will also be able to assist you in locating the approved Seven Corners medical care providers in the United States.

additional features & services
Assistance / Referral Services: Seven Corners Assist is prepared to help you 24-hours a day, 365 days a year to locate medical professionals worldwide. Even if you are not calling to pre-notify a hospital admission or surgery, Seven Corners encourages you to contact Seven Corners Assist for support with any injury or sickness, so that their professionals will be involved to ensure you receive appropriate medical care.

Emergency Evacuation / Repatriation: Unfortunately, the medical professionals in certain locations of the world are unable to provide adequate treatment for a number of medical conditions. As a standard benefit of the Reside program, Seven Corners will transport you to a different medical facility if you are located in a region where the medical professionals are not able to treat your particular condition.

important information
It is important to note that Reside is a program for international citizens and Lloyd’s of London is an international entity. Thus, Lloyd’s of London operates as an unauthorized insurer in most U.S. States. Coverage and benefits under Reside are not regulated by any U.S. state insurance department.

The information concerning Reside is not intended to be an offer to sell Reside or a solicitation by Seven Corners, Inc. or Lloyd’s of London in any jurisdiction where such an action would be unlawful or in which Seven Corners or Lloyd’s of London is not qualified to do so. Reside may not be available in all situations or jurisdictions. For U.S. citizens, Reside is intended for persons living or traveling outside the United States.

the underwriter
The Reside Worldwide Medical Plan is underwritten by Certain Underwriters at Lloyd’s of London. As the largest insurance entity in the world, Lloyd’s of London has earned an A "Excellent" rating from A.M. Best and an A+ (Strong) rating from Standard & Poor’s.

seven corners assist
When Unpronounceable Diseases Occur In Unpronounceable Countries
Seven Corners Assist is a leading provider of customized emergency assistance services to international organizations, corporations, government entities, insurance companies, and individual travelers. Regardless of the location, Seven Corners Assist provides valuable assistance in locating the best possible medical treatment.

Foreign Country – Familiar Service
In today’s world, companies and international citizens must operate in strange lands and challenging environments. In some situations, individuals must travel to developing regions where the quality of care is in question. To alleviate this concern, proper worldwide medical assistance is required to evaluate the quality of care available locally and to take appropriate action.

Quality of Care
With access to a network of emergency room physicians, Seven Corners Assist is able to effectively evaluate the quality of care available locally. The Seven Corners Assist physician will consult with the attending physician (if available) to review local standards and discuss the proposed course of treatment. If the quality of care is in question, Seven Corners Assist will arrange medical transportation to a location where appropriate care is available.

a description of services
The following services are available 24-hours a day, 7 days a week from a multilingual staff of service professionals.

Assistance With Travel
Pre-Trip Information: Provide information concerning inoculation and visa requirements for countries worldwide
Weather Information: Concerning local weather conditions
Exchange Rate Information: Current currency rates, etc.
Embassy Referral: Providing contact information for the nearest embassies around the world
Interpreter Referral: Contact information for interpreters around the world
Lost Passport: Provide directions for lost passport recovery to insureds while traveling outside of their home country
Emergency Message: In the event of a medical emergency, assistance in relaying urgent messages to family, friends, or business associates at the insured’s request
Hotel Accommodation: In case of insured’s hospitalization outside of their home country, assistance in locating hotel accommodation for insured’s companion

Medical Assistance While Traveling
24-Hour Telephone Contact: Should medical emergencies arise, there is help in locating medical care
Conference Calls: Arranging telephone conferences between your attending and home physicians
Second Opinions: Arranging second medical opinions in hospital cases
Emergency Messages: Relaying emergency messages to family and employer during medical emergencies
Payment Guarantee: Guarantee or payment of medical bills or authorizing medical benefits according to the program
Ticketing Services: 24-Hour ticketing service to arrange emergency family visits
Medical Evacuations: Arranging emergency medical evacuation from medically underserved areas
Repatriation: Arranging medical transportation home after treatment
Medical / Travel Escorts: Arranging escorts and transportation for unaccompanied children
Medical Records: Arranging transfer of medical records
Remains Return: Arranging repatriation of remains for deceased travelers

the program administrator
Properly serving the medical needs of international citizens requires specialization. Most companies are not prepared to meet the unique needs of these customers. An organization must be equipped to address foreign currencies, international doctors and hospitals, as well as unusual claim forms and documents. The Reside Worldwide Medical Plan is administered worldwide by Seven Corners, Inc. The professionals at Seven Corners have over 250 years of experience in claim processing and administration. Seven Corners currently serves the needs of thousands of policyholders throughout the world.

seven corners
Since 1993, Seven Corners, Inc. has provided international insurance plans to private citizens, governments, missionaries, students, and corporations of various nations around the globe. As a premier underwriter, Seven Corners has had the opportunity to provide innovative solutions to unique and challenging situations.

Their claims professionals are experienced in the complexity of processing international medical expenses. As an insured of Seven Corners, you can feel confident that there is someone ready to assist you with a medical situation 24-hours a day, 365 days a year.

Other services including proficient administration, responsive underwriting, and access to secure and stable insurance carriers and medical care providers worldwide.