VisitorSecure from HCC

All benefits, except Emergency Medical Evacuation, Repatriation of Remains, and Common Carrier Accidental Death and Dismemberment, are subject to deductible and are per injury or illness, up to the overall policy maximum, unless stated otherwise.

Schedule of Benefits and Limits
  Plan A Plan B Plan C Plan D
Deductible
Ages 70 and above
$200 per Injury or Illness Not available
All others $0, $50, or $100 per Injury or Illness $0, $50, or $100 per Injury or Illness
Overall Policy Maximum
Ages 80 and above
$10,000 Not available Not available Not available
Ages 70-79 $25,000 $50,000 Not available Not available
Maximum per Injury / Illness
Ages 14 days through 69
$50,000 $75,000 $100,000 $130,000
Penalty for failure to Pre-certify 50% of Eligible Medical Expenses
Inpatient Treatment
Hospital Room & Board including miscellaneous $1,450/day, 30 day max $1,725/day, 30 day max $2,000/day, 30 day max $2,585/day, 30 day max
Hospital Intensive Care Unit $2,110/day, 8 day max $2,480/day, 8 day max $2,850/day, 8 day max $3,690/day, 8 day max
Surgery $3,300 per session $4,400 per session $5,500 per session $7,150 per session
Consultant Physician $450 $475 $500 $650
Private Duty Nurse $550 $550 $550 $700
Physician Visits $55/visit, 1/day, 30 visits max $70/visit, 1/day, 30 visits max $85/visit, 1/day, 30 visits max $110/visit, 1/day, 30 visits max
Outpatient Treatment
Surgery $3,300 $4,400 $5,500 $7,150
Outpatient Surgical Facility $1,000 $1,050 $1,100 $1,400
Pre-admission Testing $1,100 $1,100 $1,100 $1,450
Diagnostic X-rays & Lab Services $450, plus $250 for one CAT scan, PET scan or MRI $475, plus $375 for one CAT scan, PET scan or MRI $500, plus $500 for one CAT scan, PET scan or MRI $650, plus $600 for one CAT scan, PET scan or MRI
Emergency Room (all expenses incurred therein) $355 $465 $575 $750
Outpatient Prescription Drugs $100 $125 $150 $200
Office Visits, including Urgent Care $60 per visit,
10 visits max
$70 per visit,
10 visits max
$90 per visit,
10 visits max
$115 per visit,
10 visits max
Miscellaneous Inpatient & Outpatient Treatment
Anesthesiologist $825 $1,110 $1,375 $1,775
Assistant Surgeon $825 $1,110 $1,375 $1,775
Ambulance Services $475 $475 $475 $475
Dental Accident $550 $550 $550 $550
Physical Therapy $40 maximum/visit, 1 visit/day, 12 visits max
Durable Medical Equipment $1,100 maximum $1,200 maximum $1,300 maximum $1,700 maximum
Acute Onset of Pre-existing Condition (only available to Members under age 70) $50,000 Lifetime Maximum for Eligible Medical Expenses $75,000 Lifetime Maximum for Eligible Medical Expenses $100,000 Lifetime Maximum for Eligible Medical Expenses $100,000 Lifetime Maximum for Eligible Medical Expenses
$25,000 Lifetime Maximum for Emergency Medical Evacuation
Other Benefits
Emergency Evacuation $50,000 Lifetime Maximum, except as provided under Acute Onset of Pre-existing Condition. Available only to Members under age 70.
Repatriation of Remains $7,500 per Member
Common Carrier Accidental Death & Dismemberment $25,000 Lifetime Maximum Principal Sum per Member
Death or Loss of Two Limbs – Principal Sum
Loss of One Limb – One-half the Principal Sum

Covered Expenses

Medical
Subject to the coverage outlined in the Schedule of Benefits and Limits, Visitor SecureSM will provide benefits for the following:

  1. Hospital room and board expenses including:
    1. Daily room and board and nursing services not to exceed the amount and duration specified in the Schedule of Benefits and Limits; and
    2. Services, supplies, and other hospital miscellaneous which are routinely provided by the Hospital to persons for use while Inpatient; and
    3. Diagnostic testing using radiology, ultrasonic or laboratory services (psychometric, intelligence, competency, behavioral and educational testing are not included); and
    4. Care in an Extended Care Facility following direct transfer from an acute care Hospital, provided such care is recommended by the attending Physician for convalescence related to the Illness or Injury for which the Member was hospitalized as Inpatient. Extended Care Facility benefits accrue toward the limits for Hospital Room and Board.
  2. Intensive Care Unit:
    1. a. Daily room and board and nursing services in Intensive Care Unit not to exceed the amount and duration specified in the Schedule of Benefits and Limits; and
    2. Services, supplies, and other hospital miscellaneous which are routinely provided by the Hospital to persons for use while Inpatient; and
    3. Diagnostic testing using radiology, ultrasonic or laboratory services.
  3. Inpatient Surgery: Professional services provided by a Physician, Specialist Physician, and/or surgeon for diagnosis, treatment, and surgery of a covered condition. All covered expenses relating to an inpatient surgery, including Physician consultations prior to and after surgery, will be paid under the Inpatient Surgery benefit.
  4. Inpatient professional fees for a consultant Physician when the consultant Physician has been requested and approved by the attending Physician.
  5. Routine pre-admission testing consisting of major diagnostic procedures, including but not limited to CAT scans, NMR’s, and blood chemistries, will be payable under the “Hospital Miscellaneous” benefit.
  6. Private duty nursing care while hospitalized as Inpatient, when ordered by a licensed Physician, and if Medically Necessary, but not to include general nursing care provided by the Hospital.
  7. Physician visits while the Member is hospitalized as Inpatient, limited to one visit per day and when hospitalization is not related to Surgery.

Emergency Medical Evacuation Expenses

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 HCC Medical Insurance Services, Visitor SecureSM will provide the following benefits: Emergency air and/or ground transportation to the nearest Hospital that is qualified to provide the Medically Necessary treatment.

Repatriation of Mortal Remains Expenses

In the event of a covered Injury or Illness resulting in your death, Visitor SecureSM will provide the following benefit: Air and/or ground transportation of bodily remains or ashes to the area of your Principal Residence, and reasonable costs of preparation of your remains necessary for transportation.

Common Carrier Accidental Death & Dismemberment (AD&D)

In the event of your Accidental Death while traveling on board a commercial common carrier (airplane or cruiseline), Visitor SecureSM will provide the following benefit, subject to a maximum of $125,000 per family:

  • Accidental Death – $25,000 to the Beneficiary designated on your Application
  • Loss of 2 eyes or 2 or more limbs – $25,000 to you
  • Loss of 1 eye or 1 limb – $12,500 to you

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.