Reside Prime from SevenCorners

The following is the Schedule of Benefits for the first three Policy Periods. After completion of three (3) consecutive and continuous Policy Periods, the Extended Coverage Schedule of Benefits applies. A Policy Period is 364 days in length.

Reside Prime Benefits
Lifetime Medical Maximum $5,000,000 per Insured Person.
Policy Period Deductible Options $250, $500, $1000, $2500, $5000
Maximum of 3 deductible payments for families enrolling on one application.
Inside of the US & Canada After the Deductible, the Policy pays 80% of the next $5,000 of Eligible Expenses, then 100% up to the Policy Maximum. Expenses incurred inside the United States and Canada must be Pre-Notified using Seven Corners’ Pre-Notification Program.

If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.
Outside of the US & Canada
(geographical treatment Area B)
After the Deductible, the Policy pays 100% of eligible expenses to the Policy Maximum. Hospital Admissions must be Pre-Notified using Seven Corners Pre-Notification Program.
Inpatient Hospital Expenses Average Semi-Private room and board, Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-Rays up to the Policy Maximum.
Intensive Care Intensive Care room and board, Usual, Reasonable, and Customary Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-rays up to the Policy Maximum.
Surgery Usual, Reasonable, and Customary (URC) Charges for Surgery, Physician and Anesthetics up to the Policy Maximum.
Hospital Daily Indemnity Benefit $50 per day ($1,000 maximum per policy period), for every Medically Necessary night spent in a Hospital (Hospital Admission) outside of the United States and Canada.  An additional Daily Indemnity Benefit Rider may be purchased to increase this benefit limit to $200.
Outpatient Treatment Usual, Reasonable, and Customary (URC) Charges for Emergency Treatment, Surgery, Prescription Medication up to the Policy Maximum.
Physiotherapy, Chiropractic Up to $75 per visit ($10,000 Lifetime Maximum), when referred in advance by a Physician
Medical Supplies Usual, Reasonable, and Customary (URC) Charges up to Policy Maximum.
Ambulance Usual, Reasonable, and Customary (URC) Charges up to Policy Maximum.
Well Child Care Up to $200 per Policy Period Maximum for checkups and routine visits after a one hundred and eighty (180)-day waiting period. Under age nineteen (19). Not subject to Deductible or Coinsurance.
Maternity Usual, Reasonable, and Customary (URC) Charges up to limits below per Pregnancy, must be Pre-Notified within the first 90 days of Pregnancy. Waiting period of 12-months before maternity benefit begins.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000
Mental & Nervous Usual, Reasonable, and Customary (URC) Charges up to a Maximum of $10,000 per Policy Period after 12-month waiting period. Inpatient limited to a maximum of 45 days per Policy Period. Outpatient limited to a maximum of 40 visits per Policy Period at 70% of Eligible Expenses. Lifetime Maximum of $30,000.
Newborn Benefit Maximums listed below per eligible pregnancy for the first 31 days after birth.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000
Dental Usual, Reasonable, and Customary (URC) Charges for repair and replacement of sound, natural teeth damaged as a result of an accident, limited to $500 per Policy Period. A Dental Benefit Rider may be purchased to expand Dental Coverage.
Emergency Medical Evacuation $250,000 Limit per person per Policy Period – when adequate medical facilities and/or treatment is not available when traveling outside your current Country of Residence. (Preapproval required.)
Repatriation of Remains $25,000 Limit per person – when traveling outside your current Country of Residence. (Preapproval required.)
Emergency Room Illness at an emergency room outside the United States is covered even if the insured is not admitted to the hospital.

Illness treated at an emergency room inside the United States is covered subject to an additional deductible of $250 if not admitted.
Emergency Medical Reunion $10,000 Limit per person per Policy Period – when traveling outside your current Country of Residence. (Pre-approval required).
Preventive Benefits Females and Males Age nineteen (19) and over up to $175 per Policy Period Maximum for checkups, routine physical exams, female preventative exams and mammograms after a one hundred and eighty (180)-day waiting period. Not subject to Deductible or Coinsurance.
Accidental Death & Dismemberment (AD&D) Principal Sum: $10,000 Insured and Spouse, $2,000 Dependent Children.
For Common Carrier, Principal Sum: $40,000 Insured and Spouse, $8,000 Dependent Children.
Lifetime Transplant Benefit Up to $1,000,000 per Insured Person.

Optional Benefits

Seven Corners offers additional benefit options for your review and possible selection. These are in addition to the standard Reside Prime program benefits and cannot be purchased independently.

Reside Prime Optional Benefits
AD&D Principal Sum Rider Reside Prime includes a standard Accidental Death & Dismemberment (AD&D) Principal Sum as mentioned above. Additional amounts are available to provide further protection should something happen to you or your family during your Policy Period.

For the primary insured, additional amounts of $100,000; $200,000; $300,000; $400,000 or $500,000 are available. Additional amounts may not exceed 7 times your annual income.
Dental Rider Reside Prime offers an option for a Dental Rider. Whether you are at home or abroad, you now have access to a dental package that will provide protection worldwide. Please see attached Dental Rider for details or visit our website to see full benefit description.
Sports Rider Your time spent abroad could include a few adventurous activities. If you plan to participate in sporting activities, our Optional Sports Rider provides $25,000 Lifetime Maximum coverage for mountaineering where ropes or guides are normally used up to 4500 meters, hang gliding, parachuting and bungee jumping. It also provides $7,500 Lifetime Maximum coverage while participating in amateur sports or interscholastic athletics sponsored by a school or organization when not engaged for wage or profit.
Hospital Daily Indemnity Rider The Hospital Daily Indemnity Rider protects you against unforeseen expenses worldwide should you or a covered member of your family find yourself in the unfortunate position of a hospital admission. This option pays $150 (additional to standard benefit, if applicable) per night, should a covered Insured Person be admitted to a hospital for a covered condition in Geographical Treatment Area B under Reside Prime.

Important Information

It is important to note that Reside Prime is a program for international citizens, and Lloyd's of London and Tramont Insurance Company Limited are both international insurance entities. Lloyd's of London operates as a surplus lines insurer in most U.S. states. Tramont Insurance Company Limited operates as an authorized insurer worldwide (coverage with Tramont cannot be initiated and purchased in the British Virgin Islands, U.S. Virgin Islands, and the United States, although you will be covered in these areas per the plan requirements). Coverage and benefits under Reside Prime are not regulated by any U.S. state insurance department.

The information concerning Reside Prime is not intended to be an offer to sell Reside Prime or a solicitation by Seven Corners, Inc., Lloyd's of London, or Tramont Insurance Company Limited in any jurisdiction where any such sale would be unlawful, or in which Seven Corners, Lloyd's of London, and Tramont Insurance Company Limited are not qualified to do so. Reside Prime may not be available in all situations or jurisdictions. Reside Prime is intended for persons living or traveling outside the United States.

Exclusions Regarding the AD&D benefit are listed in the Certificate of Insurance.

This brochure is only a brief description of the Reside PrimeSMMedical Plan. A complete description of the Master Policy Provisions and Benefits is contained in the Certificate of Insurance, which will be mailed to you once your application and premium have been received and approved by Seven Corners.

Reside Prime is underwritten by Certain Underwriters at Lloyd's of London and Tramont Insurance Company Limited. Your residence address determines which insurance carrier will provide your coverage. Pricing and benefits are identical for both Lloyd's of London and Tramont Insurance Company Limited.

Administered By: Seven Corners

Patient Protection and Affordable Care Act (“PPACA”): This insurance is not subject to, and does not provide certain of the insurance benefits required by, the United States PPACA. PPACA requires certain U.S. 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 or tax professional to determine if PPACA’s requirements are applicable to you. The policy contains the plan benefits, including a lifetime maximum that you have selected. Please review your choices to ensure that you have sufficient coverage to meet your medical needs.