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Atlas Group Travel Insurance Plan 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):

Medical:

1. Inpatient and Outpatient charges made by a Hospital.
2. Charges made by a Physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the Physician has referred the case.
3. Charges made for dressings, sutures, casts or other supplies prescribed by the attending Physician or specialist, but excluding nebulizers, oxygen tanks, diabetic supplies and all devices for repeat use at home.
4. Charges for diagnostic testing using radiology, ultrasonographic or laboratory services.
5. Charges for oxygen and other gases and anesthetics and their administration.
6. Charges for prescription drugs for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs.
7. Charges made by a licensed Extended Care Facility upon direct transfer from an acute care Hospital.
8. Emergency local ambulance transport incurred in connection with Injury or Illness resulting in inpatient hospitalization.

Complications of Pregnancy:

Treatment of Complications of Pregnancy during the first 26 weeks of Pregnancy is covered under this insurance. Complications of Pregnancy is defined as: Illnesses whose diagnoses are distinct from Pregnancy, but are adversely affected by Pregnancy or caused by Pregnancy, and not associated with a normal Pregnancy. This includes: ectopic Pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed abortion and conditions of comparable severity.

Hospital Indemnity:

If a member of your group is hospitalized as an Inpatient for treatment of a covered Illness or Injury, the Atlas Group Travel Series will provide $100 for each night the member spends in the hospital. This benefit is in addition to payments for other covered expenses and is not subject to Deductible or Coinsurance.

Acute Onset of a Pre-Existing Condition:

Group members who are US Citizens under age 70 are covered for an Acute Onset of a Pre-existing Condition. Coverage is available up to $15,000 Maximum for Eligible Medical Expenses and up to $25,000 for Emergency Medical Evacuation. An Acute Onset of a Pre-existing 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.

Emergency Dental:

The following Emergency Dental expenses are covered: Emergency Dental treatment and Dental surgery necessary to restore or replace sound natural teeth lost or damaged in an Accident which is covered under this insurance subject to the Overall Maximum Limit; and Emergency Dental treatment necessary to resolve acute, spontaneous and unexpected onset of pain subject to a maximum benefit of $100.

Emergency Medical Evacuation:

If recommended by your attending Physician, who certifies that Evacuation is necessary to safeguard your life and that Medically Necessary treatment is not available locally, and if approved in advance and coordinated by MultiNational Underwriters®, the Atlas Group Travel Series will provide the following benefits: Emergency air and/or ground transportation to the nearest Hospital that is qualified to provide the Medically Necessary treatment.

Terrorism:

The Atlas Group Travel 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:

1. The Injury or Illness does not result from chemical, nuclear or biological weapons or events.
2. The member has no direct or indirect involvement in the Act of Terrorism.
3. 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.
4. The member has not unreasonably failed or refused to depart a country or location following the date a 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.

For additional benefits covering Acts of Terrorism, including high limit AD&D and Permanent Total Disability coverage, review the MultiNational Accident Plan (MAP). Contact your representative for additional information about this exciting new product offered by MultiNational Underwriters®

Accidental Death and Dismemberment:

In the event of your Accidental Death (except while traveling on a common carrier) or Dismemberment resulting from a covered Injury, the Atlas Group Travel Series will provide the following benefit:

• Accidental Death – Principal Sum to the Beneficiary
• Loss of 2 eyes or 2 or more limbs – Principal Sum to the member
• Loss of 1 eye or 1 limb – One Half of the Principal Sum to the member

The Accidental Death and Dismemberment benefit is not available for losses incurred during participation in a Hazardous Sport or in respect to losses resulting from an Act of Terrorism.

The Beneficiary for members age 18 or older will be as follows:
1. Spouse (if any) 2. Children (if any) 3. Estate of the member.
The Beneficiary for members under age 18 will be as follows:
1. Custodial Parent(s) 2. Siblings (if any) 3. Estate of the member.

Common Carrier Accidental Death:

In the event of Accidental Death while traveling on board a commercial common carrier, the Atlas Group Travel 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 group to the Beneficiary, as described above. This benefit is not available in respect to losses resulting from an Act of Terrorism.

Repatriation of Remains:

In the event of a covered Injury or Illness resulting in a member’s death, the Atlas Group Travel Series will provide the following benefit: Air and/or ground transportation of bodily remains or ashes to the area of the member’s Principal Residence, and reasonable costs of preparation of remains necessary for transportation.

Natural Disaster:

In the event of natural disaster (hurricane, flood, tornado, tsunami, etc) the Atlas Group Travel Series will provide up to $100 a day for 5 days if you are displaced from your planned, paid accommodations due to evacuation from forecasted disaster or following a disaster strike. Displaced is defined as required to depart your destination due to an evacuation ordered by prevailing authorities. Proof of paid accommodations must be submitted at time of claim.