Liaison International Travel Medical Insurance

Schedule of Benefits and Limits
Medical Maximum: $50,000; $100,000; $500,000; $1,000,000 (ages 80+, maximum limited to $15,000)
Deductible: $0; $100; $250; $500; $1000; $2500    Deductible is per person per policy period, maximum of 3 Policy Period deductibles per family. The selected Deductible and Coinsurance amount must be met for each 12-month period (see Continuing Coverage)
Coinsurance: Traveling outside the United States: After you pay the deductible, we pay 100% to the selected medical maximum.

Traveling to the United States: After you pay the deductible, we pay 80% of the next $5,000 of eligible expenses, then 100% to the selected medical maximum.
Hospital Indemnity*: class 1: $150 / night (traveling outside the US and Canada) In addition to any other Covered Expense.
Dental (Emergency)*: class 1: $100 or ($500 for accidents) Only available to programs purchased for 1 month or more.
Emergency Medical Evacuation / Repatriation: $300,000 (in addition to the Medical Maximum)
Home Country Coverage : Incidental Trips to The Home Country: Up to $50,000; Extension of Benefits: Up to $5,000
Return of Mortal Remains: $50,000
Emergency Reunion: $50,000
Return of Minor Child(ren): $50,000
Interruption of Trip: $5,000
Loss of Checked Luggage: $250
Local Ambulance Expense: $5,000
Accidental Death & Dismemberment: $25,000 Principal Sum for Insured or Insured Spouse, $5,000 for Dependent Child. Note: In the event of a Common Carrier Accidental Death, this benefit will not be paid.
Common Carrier AD&D: $50,000 Principal Sum for Insured or Insured Spouse; $10,000 per Dependent child(ren) under age of eighteen (18); $250,000 Maximum per family.
Hospital Room & Board: Usual, reasonable and customary to the selected Policy Maximum.
Intensive Care: Usual, reasonable and customary to the selected Policy Maximum.
Outpatient Medical Expense: Usual, reasonable and customary to the selected Policy Maximum.
Terrorism: Usual, reasonable and customary to the selected Policy Maximum
(This benefit not available for states underwritten by Certain Underwriters at Lloyd's of London)
Unexpected Recurrence of a Pre-Existing Condition $20,000 per coverage period for U.S. residents under 70 traveling outside the U.S. & Canada.
(Age 70+, up to $5, 000, refer to exclusion #1 for details)
Acute Onset of a Pre-Existing Condition $15,000 per coverage period for non-U.S. residents under age 70 traveling in the U.S. (age 70+, no benefit) for medical expenses & $25,000 for emergency medical evacuation.
Benefit Period: 180 days

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.