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Rates: $50,000 max / $100,000 max / $50,000 max (70+ years)
US Visitor/Immigrant Insurance > SevenCorners
InBound Hospital
SCHEDULE OF BENEFITS
When your covered Injury or Sickness requires overnight, Inpatient treatment in a Hospital, this program will provide benefits for the Usual and Customary (U&C) charges scheduled below which exceed the chosen Per Person Deductible (either $75 or $150, or a $250 deductible for age 70 and over) for each Injury and each Sickness and which are incurred within the 26 weeks following the Injury or Sickness. Payment for any covered service will be no more than the Benefit Maximum shown. The maximum amount payable for all benefits will be no more than $50,000 or $100,000 (depending upon program purchased and availability) for each Injury and each Sickness.
For persons age 70 and over, the maximum benefit limit is $50,000, the period in which covered expenses must be incurred is 26 weeks following the Injury or Sickness, and a separate schedule applies.
COVERED SERVICES INJURY AND SICKNESS BENEFIT MAXIMUMS
| Age 14 days to Age 69 | Age 14 days to Age 69 | Age 70 and over | ||
|---|---|---|---|---|
| INPATIENT | $50,000 Max per Policy Period | $100,000 Max per Policy Period | $50,000 Max per Policy Period | |
| Hospital Room & Board including other expenses relating to an overnight hospital admission | Up to $2000/day, 30 day max | Up to $2500 per day, 30 day max | Up to $1450/day, 30 day max | |
| Hospital Intensive Care Unit | Additional $525/day, 8 day max | Additional $750/day, 8 day max | Additional $425/day, 8 day max | |
| Emergency Evacuation | $10,000 | $10,000 | $10,000 | |
| Repatriation of Remains | $7,500 | $7,500 | $7,500 | |
| AD&D Principal Sum | $25,000 Common Carrier | $25,000 Common Carrier | $25,000 Common Carrier |
PRE-EX BENEFIT
| Age 14 days to Age 69 | Age 14 days to Age 69 | Age 70 and over | ||
|---|---|---|---|---|
| PRE-EXISTING CONDITIONS(the above maximum schedule still applies) | Up to $5,000 in coverage for Myocardial Infarction (heart attack) or Stroke | Up to $5,000 in coverage for Myocardial Infarction (heart attack) or Stroke | Up to $3,000 in coverage for Myocardial Infarction (heart attack) or Stroke |
Should an insured person turn 70 during the purchased coverage period, the 70 and over benefit schedule becomes effective upon the day the insured turns 70.
Emergency Medical Evacuation Expenses
The program will pay up to $10,000 in Covered Expenses incurred if any covered
Injury or Illness commencing during the Period of Coverage results in the Medically
Necessary Emergency Medical Evacuation or Repatriation of the Insured Person
(the Insured Person's medical condition warrants immediate transportation from
the medical facility where the Insured Person is located to the nearest adequate
medical facility where medical treatment can be obtained). The benefit must
be ordered by the Assistance Company in consultation with the Insured Person's
local attending Physician. *
Repatriation of Mortal Remains Expenses
The program will pay the reasonable Covered Expenses incurred up to a maximum
of $7,500 to return the Insured Person's remains to his/her Home Country, if
he or she dies.*
Common Carrier Accidental Death and Dismemberment (AD&D) Accidental Death and Dismemberment shall apply to covered accidents sustained by an insured person while riding as a passenger in or on any land, water or air conveyance operated under a license for the transportation of passengers for hire. A loss must occur within 365 days after the date of accident causing the loss:
-
For Loss of: Indemnity Life Principal Sum Both Hands or Both Feet or Sight of Both Eyes Principal Sum One Hand and One Foot Principal Sum Either Hand or Foot and Sight of One Eye Principal Sum Either Hand or Foot One-Half the Principal Sum Sight of One Eye One-Half the Principal Sum
* NOTE: In the event of an Emergency Medical Evacuation or Repatriation of Mortal Remains benefit is needed or utilized, arrangements must be made by the Assistance Service Provider.
DEFINITIONS
The term "Hospital" shall mean a place that 1.) Is legally operated for the purpose of providing medical care and Treatment to Sick or Injured persons for which a charge is made that the Insured Person is legally obligated to pay in the absence of insurance 2.) Provides such care and Treatment in medical, diagnostic, or surgical facilities on its premises, or those prearranged for its use; 3.) Provides 24-hour nursing service under the supervision of a Registered Nurse at all times; and 4.) Operates under the supervision of a staff of one or more Physicians. Hospital also means a place that is accredited as a Hospital by the Joint Commission on Accreditation of Hospitals, American Osteopathic Association, or the Joint Commission on Accreditation of Heath Care Organizations (JCAHO). Hospital does not mean: -A Convalescent, nursing, or rest home or facility, or a home for the aged; A place mainly providing Custodial, Educational, or Rehabilitative Care; or -A facility mainly used for the Treatment of drug addicts or alcoholics.
The term "Injury" shall mean bodily Injury listed in the most recent edition of the International Classification of Diseases and caused solely and directly by Accidental, external, and visible means occurring while this Certificate is in force and resulting directly and independently of all other causes resulting in a Covered Event under this Program.
The term "Inpatient" shall mean a person who is confined in an institution for a period of 24 hours or more and is charged for room and board.
The term "Myocardial Infarction" shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International Coding of Diseases version 9 (ICD9), code sequences 410.0 - 410.9 and 414.1 - 419.9.
The term "Outpatient" shall mean a person who receives care in a Hospital or another institution, including; ambulatory surgical center; convalescent/skilled nursing facility; or Physician's office, for an Illness or Injury, but who is not confined and is not charged for room and board.
The term "Pre-Existing Condition" shall mean 1) A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment within the 6 months (or 12 months for persons 70 and older) prior to the Individual Effective Date of Coverage under this program; 2) A condition for which medical advice, diagnosis, care or Treatment, including Medication, was sought, recommended or received within the 6 months (or 12 months for persons age 70 and older) prior to the Individual Effective Date of Coverage under this program; 3) the symptoms which occurred within the 6 months (or 12 months for persons 70 and older) 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 which manifested within the 6 months (or 12 months for persons 70 and older) prior to the Individual Effective Date of Coverage under this Certificate; Should the Insured Person suffer a Myocardial Infarction or Stroke during the Period of Coverage and it is determined to be a "Pre-Existing Condition", coverage for those expenses will be covered up to the Pre-Existing Condition Benefit maximum, according to the Schedule of Benefits.
The term "Sickness" shall mean Illness or Disease of any kind listed in the most recent edition of the International Classification of Diseases. All related conditions and recurrent symptoms of the same or a similar condition will be considered one Sickness.
The term "Stroke" shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International Coding of Diseases version 9 (ICD9), code sequence 430-438.9.