Atlas Group® Travel Medical Insurance

Schedule of Benefits and Limits
Deductibles: $0, $100, $250, $500, $1,000 or $2,500 per Certificate Period.
Coinsurance - Claims incurred in US or Canada: For the certificate period, underwriters will pay 80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum limit. Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to underwriters for review and payment directly to the provider
Coinsurance - Claims incurred outside US or Canada: For the certificate period, underwriters will pay 100% of eligible expenses after the deductible up to the overall maximum limit
Hospital Room and Board: Average semi-private room rate, including nursing services
Local Ambulance: Usual, reasonable and customary charges, when covered illness or injury results in hospitalization as inpatient
Intensive Care Unit: Usual, reasonable and customary charges
Emergency Room Co-payment: In addition to coinsurance, the member shall be responsible for a $200 copayment for each use of emergency room for an Illness unless the member is admitted to the hospital. There will be no copayment for emergency room treatment of an injury
Urgent Care Center: For each visit, the member shall be responsible for a $50 co-payment, after which coinsurance will apply. Not subject to Deductible.
Hospital Indemnity $100 per day (not subject to Deductible or Coinsurance.)
Physical Therapy $50 maximum per day
All Other Eligible Expenses: Usual, reasonable and customary charges
Acute Onset of Pre-existing Condition
(only available to members under age 70)
$100,000 lifetime maximum for eligible medical expenses for overall maximum limits of $100,000, $200,000, $500,000 or $1,000,000; otherwise $50,000.
$25,000 lifetime maximum for emergency medical evacuation
Emergency Dental:
(acute onset of pain)
$250 limit per certifi cate period (not subject to deductible or coinsurance)
Emergency Medical Evacuation: $500,000 lifetime maximum, except as provided under acute onset of preexisting condition (not subject to deductible or coinsurance)
Return of Minor Children $50,000 per certifi cate period (not subject to deductible or coinsurance)
Repatriation of Remains: Overall maximum limit (not subject to deductible or coinsurance)
Emergency Reunion: $50,000 limit per certifi cate period, subject to a maximum of 15 days (not subject to deductible or coinsurance)
Natural Disaster Benefit: Maximum $100 a day for 5 days (not subject to deductible or coinsurance)
Trip Interruption: $5,000 limit per certifi cate period (not subject to deductible or coinsurance)
Lost Checked Luggage: $250 limit per certifi cate period (not subject to deductible or coinsurance)
Political Evacuation : $10,000 lifetime maximum (not subject to deductible or coinsurance)
Terrorism: $50,000 maximum lifetime limit, eligible medical expenses only
Accidental Death and Dismemberment
(excludes loss due to common carrier accident; $250,000 maximum benefit per any one family or group)
Not subject to deductible or coinsurance
Members up to age 18 Lifetime max. - $5,000; Death - $5,000; Loss of 2 limbs - $5,000; Loss of 1 limb - $2,500
Members age 18 through 69 Lifetime max. - $50,000; Death - $50,000; Loss of 2 limbs - $50,000; Loss of 1 limb - $25,000
Members age 70 through 74 Lifetime max. - $12,500; Death - $12,500; Loss of 2 limbs - $12,500; Loss of 1 limb - $6,250
Members age 75 and older Lifetime max. - $6,250; Death - $6,250; Loss of 2 limbs - $6,250; Loss of 1 limb - $3,125
Common Carrier Accidental Death
($250,000 maximum benefi t per any one family or group)
Not subject to deductible or coinsurance
Up to age 18 - $25,000 per member;
Age 18 through 69 - $50,000 per member;
Age 70 to 74 - $12,500 per member;
Age 75 and older - $6,250
Hospital Pre-Certification Penalty: 50% of eligible medical expenses
Overall Maximum Limit per Certificate Period

Age 80 or older - $10,000;
Age 70 to 79 - $50,000, $100,000;
All others - $50,000, $100,000, $200,000, $500,000 or $1,000,000

Benefit Period

While the Certificate is in effect, the Benefit Period does not apply. Upon termination of the Certificate, Underwriters will pay Eligible Medical Expenses, as defined herein, for up to 90 days beginning on the first day of diagnosis or treatment of a covered Injury or Illness while the Member is outside his or her Home Country and while the Certificate was in effect. The Benefit Period applies only to Eligible Medical Expenses related to the Injury or Illness that began while the Certificate was in effect.

Home Country Coverage

Benefit Period – In the event a Member begins a Benefit Period while the Certificate is in effect, and the Certificate terminates because the Member returns to his/her Home Country, 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 while the Certificate was in effect.

Incidental Home Country Coverage – For Citizens and legal residents of the U.S, for every three month period during which the Member is covered hereunder, Medical Expenses incurred in the U.S. are covered up to a maximum of 15 days for any three month period.. For Non-U.S. residents or Non-U.S Citizens, for every three month period during which the Member is covered hereunder, Medical Expenses incurred in the member’s home country are covered up to a maximum of 30 days for any three month period. Any benefit accrued under a single 3 month period does not accumulate to another period. Failure of the member to continue his or her international trip or the members return to their home country for the sole purpose of obtaining treatment for an illness or injury that began while traveling shall void any home country coverage provided under the terms of this agreement.

Home Country Defined

If you are a US citizen, your Home Country is the United States, regardless of the location of your Principal Residence. If you are not a US citizen, your Home Country is the country where you principally reside and receive regular mail.

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.