|
SCHEDULE OF BENEFITS
All Eligible Benefits described in this section are excess
of the chosen Deductible to the Maximum Benefit stated. Each Benefit Maximum is "per sickness or injury".
| |
Treatment received inside the
United States and Canada (Treatment Area A) |
Treatment received outside the
United States and Canada (Treatment Area B) |
| Lifetime Maximum Benefit |
$500,000 per Insured Person
|
$5,000,000 per Insured Person
|
Deductibles Available
Deductible Options, per person per Injury/Sickness |
$70, $100, $150, $250, $500, $1,000
After the per Injury / Sickness Deductible, the program will pay up to the
amount listed below for each Injury / Sickness. |
| Inpatient |
Maximum Benefit
|
Maximum Benefit
|
| Private or semi-private room, per day (maximum
of 240 consecutive days) |
$600
|
$900
|
| Intensive care room, per day (maximum of
180 consecutive days) |
$1,500
|
$2,000
|
| Surgical Treatment |
$3,000
|
$5,000
|
| Anesthetist's charges, payable as a percentage
of surgery |
$600
|
$1,000
|
| Assistant Surgeon |
$600
|
$1,000
|
| Physician’s Non-Surgical / Urgent Care Visit |
$60/visit, max 10
|
$75/visit, max 10
|
| Laboratory Tests, X-rays, other treatment |
$450
|
$600
|
| Prescription medication during hospitalization |
$100
|
$125
|
| Chemotherapy and radiation therapy |
$1,000
|
$1,250
|
| Organ Transplant |
$100,000
|
$130,000
|
| Durable Medical Equipment |
$100
|
$200
|
| Maternity |
| Normal & complicated child delivery
maximum. including pre and post
natal care is reimbursed according to the other medical treatment benefit
schedule. Waiting period of 364 days before maternity benefit
begins. |
$2,500 per pregnancy
|
$4,000 per pregnancy
|
| Professional service related to hospitalization, per day |
$200
|
$250
|
| Outpatient |
| Surgical Treatment |
$3,000
|
$5,000
|
| Anesthetist's charges |
$600
|
$1,000
|
| Assistant Surgeon |
$600
|
$1,000
|
| Physician's Non-Surgical / Urgent Care Visit |
$60/visit, max 10
|
$75/visit, max 10
|
| Hospital Emergency Room** (all expenses incurred therein) |
$350
|
$500
|
| Prescription medication |
$100
|
$125
|
| Chemotherapy and radiation |
$1,000 |
$1,250 |
| Laboratory Tests and X-Rays |
$450
|
$600
|
| Other Treatment |
| Dental treatment for Injury to sound, natural teeth |
$500
|
$500
|
| Psychiatrist |
$60/visit, max 10
|
$75/visit, max 10
|
| Various Scans (MRI, CAT, Echocardiography,
maximum per exam) |
$450
|
$600
|
| Endoscopy, (ie. Gastroscopy, Colonoscopy,
Cystoscopy) |
$450
|
$600
|
| Chiropractors |
$60/visit, max 3
|
$75/visit, max 3
|
| Physiotherapy |
$60/visit, max 10
|
$75/visit, max 10
|
| Well Child Care (not subject to Deductible) 180-day waiting period, under age 19 |
$60/visit, max 2
|
$75/visit, max 2
|
| Preventative Benefit (females and males, age 19 and over) for checkups, routine physical exams, female preventative exams and mammograms, (not subject to Deductible) 180-day waiting period |
$60/visit, max 1
|
$75/visit, max 1
|
| Newborn Benefit |
| Lifetime maximum for the first 31 days
after birth, per limits as stated in the Certificate of Coverage |
$5,000
|
$10,000
|
| Transportation |
| Local ground ambulance |
$1,500
|
$2,000
|
| Emergency Evacuation, when treatment not available locally, pre-approved
transportation to a location where appropriate treatment is available. Includes
cost of return trip. |
$25,000
|
$50,000
|
| Return of Mortal Remains |
$20,000
|
$25,000
|
| 24 Hour Accidental Death and Dismemberment |
Principal Sum
|
Principal Sum
|
| - Insured and Spouse |
$10,000
|
$10,000
|
| - Dependent Children |
$2,000
|
$2,000
|
| Common Carrier Accidental Death and Dismemberment |
|
|
| - Insured and Spouse |
$40,000
|
$40,000
|
| - Dependent Children |
$8,000
|
$8,000
|
You have your choice of six per Injury / Sickness Deductibles:
$70, $100, $150, $250, $500, $1000.
**Emergency Room Coverage Illness at an emergency room outside the United States is covered even if the insured is not admitted to the hospital. Illness treated at an emergency room inside the United States is covered subject to an additional deductible of $50 if not admitted.
Reside does not have a coinsurance amount, apart from the chosen
deductible and the limits described in the Schedule of Benefits. The
Lifetime Maximum amount is listed in the Schedule of Benefits.
Should you travel during the course of treatment from one area to
another (whether being treated inside the United States and Canada
or outside the United States and Canada), the limitations of the new area shall apply.
Reside Worldwide is underwritten by Certain Underwriters at Lloyd's of London and Tramont Insurance Company Limited. Your residence address determines which insurance carrier will provide your coverage. Pricing and benefits are identical for both Lloyd's of London and Tramont Insurance Company Limited.
|
