Atlas MultiTrip Benefit Description
All benefits, except Hospital Indemnity, Lost Checked Luggage, Natural Disaster, Accidental Death & Dismemberment and Common Carrier Accidental Death, are subject to the Deductible and Coinsurance. Limits apply to all benefits (See Schedule of Benefits and Limits)
Click here for a copy of the policy certificate.
Eligible Medical Expenses:
- Charges made by a Hospital for:
- Daily room and board and nursing services not to exceed the average semi-private room rate; and
- Daily room and board and nursing services in Intensive Care Unit; and
- Use of operating, treatment or recovery room; and
- Services and supplies which are routinely provided by the Hospital to persons for use while Inpatients; and
- Emergency treatment of an Injury, even if Hospital confinement is not required; and
- Emergency treatment of an Illness; subject to emergency room co-pay as outlined in the Schedule of Benefits and Limits. ER co-payment is waived when the Member is directly admitted to the Hospital as Inpatient for further treatment of that Illness.
- For Surgery at an Outpatient surgical facility, including services and supplies.
- For charges made by a Physician for professional services, including Surgery. Charges for an assistant surgeon are covered up to 20% of the Usual, Reasonable and Customary charge of the primary surgeon, but standby availability will not be deemed to be a professional service and therefore is not covered hereunder.
- For dressings, sutures, casts or other supplies which are Medically Necessary and administered by or under the supervision of a Physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except Durable Medical Equipment as herein defined.
- For diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included).
- For artificial limbs, eyes or larynx, breast prosthesis or basic functional artificial limbs, but not the replacement or repair thereof.
- For reconstructive Surgery when the Surgery is directly related to Surgery which is covered hereunder.
- For hemodialysis and the charges by the Hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components.
- For oxygen and other gasses and their administration by or under the supervision of a Physician.
- For anesthetics and their administration by a Physician.
- For drugs which require prescription by a Physician for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs, and for a maximum supply of 60 days per prescription.
- For care in a licensed Extended Care Facility upon direct transfer from an acute care Hospital.
- Home Nursing Care in bed by a qualified licensed professional, provided by a Home Health Care Agency upon direct transfer from an acute care Hospital and only in lieu of Medically Necessary Inpatient hospitalization.
- Emergency Local Ambulance transport necessarily incurred in connection with Injury or Illness resulting in Inpatient hospitalization.
- Emergency Dental Treatment and Dental Surgery necessary to restore or replace sound natural teeth lost or damaged in an Accident which was covered under this insurance.
- Emergency Dental Treatment necessary to resolve Acute Onset of Pain, provided treatment is obtained within 24 hours of the Acute Onset of Pain.
- Medically Necessary rental of Durable Medical Equipment (consisting of a standard basic hospital bed and or a standard basic wheelchair) up to the purchase prices.
- Physical Therapy if prescribed by a Physician who is not affiliated with the Physical Therapy practice, necessarily incurred to continue recovery from a covered Injury or Illness.
- Injury or Illness resulting from participation in sports or athletic activities not otherwise excluded under this insurance.
Home Country Coverage:
In the event a Member begins a Benefit Period while the Certificate is in effect, Underwriters will pay Eligible Medical Expenses, as defined herein, which are incurred in the Member’s Home Country during the Benefit Period. Home Country Coverage applies only to Eligible Medical Expenses related to the Injury or Illness that began during the covered trip.
Coverage provided under this Certificate is for a maximum duration of 364 days, except for a Benefit Period as provided hereunder. Any extension is based upon the eligibility rules in force and is solely at the discretion of Underwriter.
Notwithstanding the foregoing, coverage under all Plans shall terminate on the date Underwriters, at their sole option, elect to cancel all Members of the same sex, age, class or geographic location, provided Underwriters give no less than 30 days advance written notice by mail to the Member’s last known address.
Acute Onset of a Pre-Existing Condition:
Limited benefit up to the medical coverage maximum (excludes chronic and congenital conditions). $25,000 lifetime maximum for emergency medical evacuation.
Atlas MultiTrip includes coverage for eligible injuries and illnesses that could occur while participating in many popular vacation sports - skiing, snowboarding, snorkeling, water skiing, and others - at no additional cost. Certain extreme sports are excluded from coverage.
In these turbulent times, the risk of a terrorist attack is a reality. If you are in the wrong place at the wrong time, Atlas MultiTrip off ers terrorism coverage, providing protection from medical expenses due to injuries resulting from these acts..
Emergency Medical Evacuation and Emergency Reunion:
Would you know what to do if you found yourself in a lifethreatening situation far from home? HCCMIS is experienced in arranging Emergency Medical Evacuations. Atlas MultiTrip will cover the necessary expenses to transport you to the nearest medical facility qualifi ed to treat your life-threatening condition. We also understand the importance of family support in these diffi cult situations. Atlas MultiTrip will also cover the transportation, lodging, and meal costs for a relative to join you after an emergency medical evacuation.
If, during the coverage period and after your arrival, the United States government issues a travel warning for your destination country, Atlas MultiTrip will coordinate your alternate departure arrangements from that country and cover the associated costs.
In the event of a covered Emergency Medical Evacuation, the Atlas MultiTrip will provide the following benefits: The cost of an economy round-trip air and/or ground transportation ticket for one of your relatives (parent, spouse, sibling or child age 18 or older) for transportation to the area where you are hospitalized following Emergency Medical Evacuation and reasonable expenses for lodging and meals for your relative, for a period not to exceed 15 days.
Return of Minor Children:
If you are the only person age 18 or older, traveling with one or more children under the age of 18, who are also covered by the Atlas MultiTrip, and you are Hospitalized for treatment of a covered Illness or Injury resulting in the children being left unattended for a period of time expected to exceed 36 hours, the Atlas MultiTrip will provide the following benefit: The cost of a one-way economy air and/or ground transportation ticket for each covered child to the terminal serving the area of Principal Residence of each covered child.
Repatriation of Remains:
What would your family do if disaster strikes while you are away from home? The death of a loved one is never easy, no matter the circumstances. In the unfortunate event of your death while traveling abroad, Atlas MultiTrip will arrange for and cover the costs associated with the repatriation of your remains.
Natural disasters can happen anywhere and at anytime. If a natural disaster occurs while on your trip, causing you to become displaced from your accommodations, Atlas MultiTrip will provide relief of a maximum of $100 a day for 5 days to help cover the costs of alternative accommodations.
One of a traveler’s biggest worries is the safety of his or her home while away. If you learn that a catastrophic event like a tornado, hurricane or fl ood has caused severe damage to your home while traveling abroad, Atlas MultiTrip will cover the cost of a one-way, economy class ticket to the airport nearest your home.
Atlas Travel off ers up to $10,000 to off set costs associated with kidnapping such as ransom, crisis response expenses, and loss of personal belongings. This benefi t includes access to the services of Unity Crisis Group for advice, coordination with law enforcement, and negotiations during a kidnapping.
To receive full benefits, pre-certification is required for hospitalization, surgery, emergency medical and political evacuations, emergency reunions, trip interruptions, repatriation of remains, CAT scans, and MRIs. Pre-certification may be done by contacting HCCMIS by phone, e-mail or through Client Zone. Please see the certificate for more details. The precertification is not a guarantee of any benefits.
You may fi le a claim by submitting a claimant’s statement and authorization form. This form may be found online, or you may contact HCCMIS for a copy. Complete the form, attach all itemized invoices and payment receipts, and send them to the address shown on the claimant’s statement.
The description of coverage in these pages is for informational purposes only. Actual coverage will vary based on the terms and conditions of the policy issued. The information described herein does not amend or otherwise aff ect the terms and conditions of any insurance policy issued by HCCMIS or its affi liates. In the event that a policy is inconsistent with the information described herein, the language of the policy will take precedence.
HCC Medical Insurance Services, LLC (HCCMIS) is a service company that is a subsidiary of HCC Insurance Holdings Inc. HCCMIS is regulated by the State of Indiana in our capacity as Third Party Administrator. HCCMIS has authority to enter into contracts of insurance on behalf of the Lloyd’s underwriting members of Lloyd’s Syndicate 4141, which is managed by HCC Underwriting Agency Ltd.
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.