Atlas Group® Benefit Description
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.
If you are hospitalized, the world around you does not stop. What’s more, in some places hospitals do not provide their patients basic necessities like meals, toothpaste or soap. If you are hospitalized as an inpatient for treatment of a covered illness or injury, Atlas Group will provide $100 for each night you spend in the hospital.
Acute Onset of a Pre-Existing Condition:
If you are younger than 70, you may be covered for an acute onset of a pre-existing condition. Atlas Travel provides a limited benefit up to the medical coverage maximum lifetime for eligible medical expenses. This also includes a $25,000 lifetime maximum for emergency medical evacuation.
An acute onset of a preexisting condition is a sudden and unexpected outbreak or recurrence of a pre-existing condition which occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms.
Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. Chronic and congenital conditions are excluded from coverage.
Incidental Home Country Coverage:
For each three (3) months during which a Member is covered hereunder, Medical Expenses only are covered during incidental trips totaling no more than 15 days duration per three-month period of coverage. Incidental visit time must be used within the three-month period earned, and the Member must continue his or her international trip in order to be eligible for this benefit. Return to the Member’s Home Country must not be taken for the purpose of obtaining treatment of an Illness or Injury that began while traveling.
Emergency Dental treatment necessary to resolve acute, spontaneous and unexpected onset of pain subject to a maximum benefit of $250.
Emergency Medical Evacuation and Emergency Reunion:
Would you know what to do if you found yourself in a life-threatening situation far from home? HCCMIS is experienced in arranging emergency medical evacuations. Atlas Group will cover the necessary expenses to transport you to the nearest medical facility qualified to treat your life-threatening condition. We also understand the importance of family support in these difficult situations. Atlas Group will also cover the transportation, lodging, and meal costs for a relative to join you after an emergency medical evacuation.
**Special Note: If, following a covered Emergency Medical Evacuation, the attending Physician states that it is Medically Necessary for your return to your Home Country or to the area from which you were initially evacuated for continued treatment, recuperation and recovery, the Atlas Series will provide the following benefit: The cost of a one-way economy air and/or ground transportation ticket for your transportation from the area where you were hospitalized following the Emergency Evacuation, to the area where you were initially evacuated from, or to the terminal serving the area of your Principal Residence. (Part of the Trip Interruption Benefit listed below)
Return of Minor Children:
If you are expected to be hospitalized for more than 36 hours due to a covered injury or illness and covered children under 18 years of age will be left unattended as a result, Atlas Group will cover the transportation cost for the children to return home.
The Atlas Series provides Medical coverage for Injuries and Illnesses resulting from an Act of Terrorism, subject to a $50,000 lifetime maximum, provided all of the following conditions are met:
- The Injury or Illness does not result from chemical, nuclear or biological weapons or events.
- You have no direct or indirect involvement in the Act of Terrorism.
- The Act of Terrorism is not in a country or location where the United States government has issued a travel warning that has been in effect within the 6 months prior to your date of arrival.
- You have not unreasonably failed or refused to depart a country or location following the date an warning to leave that country or location is issued by the United States government.
An Act of Terrorism is defined as: an act, including but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
Complications of Pregnancy:
Atlas Group offers coverage for complications of pregnancy during the first 26 weeks of gestation.
If, during the coverage period and after your arrival, the United States government issues a travel warning for your destination country, Atlas Group will coordinate your alternate departure arrangements from that country and cover the associated costs.
Atlas Group 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.
Common Carrier Accidental Death:
In the event of your Accidental Death while traveling on board a commercial common carrier, the Atlas Series will provide the following benefit: Principal Sum of $50,000 ($25,000 for children under age 18), subject to a maximum of $250,000 per family, to the Beneficiary designated on your Application. This benefit is not available in respect to losses resulting from an Act of Terrorism.
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 Group 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 Group will provide relief of a maximum of $100 a day for 5 days to help cover the costs of alternative accommodations.
- If, after you have departed, you learn of the death of a parent, spouse, sibling or child, or you learn of the substantial destruction of your Principal Residence by fire or weather, the Atlas Series will provide the following benefit: The cost of an economy one way air and/or ground transportation ticket for you to the area of your Principal Residence; or
- If, following a covered Emergency Medical Evacuation, the attending Physician states that it is Medically Necessary for your return to your Home Country or to the area from which you were initially evacuated for continued treatment, recuperation and recovery, the Atlas Series will provide the following benefit: The cost of a one-way economy air and/or ground transportation ticket for your transportation from the area where you were hospitalized following the Emergency Evacuation, to the area where you were initially evacuated from, or to the terminal serving the area of your Principal Residence.
Lost Checked Luggage:
In the event your checked luggage is permanently lost by the carrier, the Atlas Plan will provide the following benefit: Up to $500 for replacement of clothes and personal hygiene items, not to exceed $50 for any one item. You must file a formal claim with the transportation provider and provide copies of all claim forms and proof that the transportation provider has paid you its normal reimbursement for the lost checked luggage.
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.
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.