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The Visitors Care plan provides travel medical
insurance coverage for individuals traveling
outside their country of citizenship for a minimum
of one month up to 24 months. If the initial
purchase is for a period of 1 month or longer,
the plan is renewable for a minimum of 1 month
at a time for a total of 24 months.
This plan offers Lifetime benefit maximums
of US$25,000, US$50,000 and US$100,000. You
have your choice of deductibles of US$75 or
US$150 per period of insurance. When you incur
eligible medical expenses , the plan will provide
benefits for Usual, Reasonable and Customary
charges as outlined in the Schedule of Benefits
below.
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Plan A - One Month Rates - US$25,000 Maximum benefit
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Age
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Option 1
$0 deductible |
Option 2
$50 deductible |
Option 3
$100 deductible |
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Price for one
month |
Price for one
month |
Price for one month |
| 2 weeks - 49 |
$31 |
$26 |
$23 |
| 50 - 69 |
$47 |
$39 |
$36 |
| 70-79 |
N/A |
$61 |
$58 |
| 80 +* |
N/A |
$122 |
$116 |
| Dependent child |
$24 |
$20 |
$18 |
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* Maximum
benefit for 80+ is $10,000 Lifetime
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Plan B - One Month Rates - US$50,000 Maximum benefit
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Age
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Option 4
$0 deductible |
Option 5
$50 deductible |
Option 6
$100 deductible |
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Price for one
month |
Price for one
month |
Price for one
month |
| 2 weeks - 49 |
$47 |
$39 |
$36 |
| 50 - 69 |
$71 |
$59 |
$55 |
| 70-79 |
N/A |
$91 |
$86 |
| 80 +* |
N/A |
N/A |
N/A |
| Dependent child |
$36 |
$30 |
$28 |
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* Maximum
benefit for 80+ is $10,000 Lifetime
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Plan C - One Month Rates - US$100,000 Maximum benefit
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Age
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Option 7
$0 deductible |
Option 8 Option 8
$50 deductible |
Option 9
$100 deductible |
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Price for one
month |
Price for one
month |
Price for one
month |
| 2 weeks - 49 |
$70 |
$58 |
$54 |
| 50 - 69 |
$104 |
$87 |
$85 |
| 70-79 |
N/A |
$136 |
$132 |
| 80 +* |
N/A |
N/A |
N/A |
| Dependent child |
$59 |
$49 |
$45 |
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* Maximum
benefit for 80+ is $10,000 Lifetime
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| All premium rates are
in US dollars and are effective through 12/31/06.
Rates include 2.5% surplus lines tax. A dependent
child is your child shown on the Enrollment
Form over 14 days and under 18 years of age,
traveling with you, and for whom premium has
been paid. |
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N T E R N A T I O N A L E M E R G E N C Y
C A R E |
Emergency Evacuation
The plan includes coverage for Emergency Medical
Evacuations to the nearest qualified medical facility
or the country of residence and expenses for reasonable
travel and accommodations resulting from the evacuation,
up to US$50,000. |
To US$50,000 when coordinated
through IMG |
Repatriation
If a covered illness/injury results in death, expenses
for Repatriation of bodily remains or ashes to the country
of residence will be covered up to a maximum of US$7,500. |
To US$7,500 when coordinated
through IMG |
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P E C I A L C O V E R A G E S |
| Home Country Coverage (As
described below)
Incidental Home Country Coverage - During the Period
of Coverage an insured person may return to their country
of residence for incidental visits up to a cumulative
two weeks total, subject to: a. The insured person must
have left their country of residence, b. The total Period
of Coverage must be for a minimum of 30 days, and c.
The return to the country of residence may not be taken
to receive treatment for an illness or injury incurred
while traveling.
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| Common Carrier Accidental Death |
US$25,000 to Beneficiary |
| If accidental death should
occur while traveling on a commercial Common Carrier,
US$25,000 will be paid to the designated beneficiary. |
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PLAN A
M E D I C A L B E N E F I T S- US$25,000
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US$25,000 Maximum Benefit
per life of plan - usual, reasonable and customary charges, subject to
deductible where applicable. |
| Inpatient Treatment
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| Hospital room & board |
Up to US$825, per
day, 30 day maximum period of coverage
(includes inpatient prescriptions drugs) |
| Intensive care |
Additional US$400 per
day, 8 day maximum per period of coverage |
| Surgical treatment |
US$2,000 per surgical
session |
| Consult physician |
US$350 per period of
coverage |
| Pre-admission tests |
US$750 per period
of coverage |
| Private duty nurse |
US$400 per period of
coverage |
| Physician Visits |
US$40 allowable charge
per visit, 30 visits per period of coverage |
| Outpatient Treatment
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| Surgical treatment |
US$2,000 per surgical
session |
| Diagnostic x-ray & lab |
US$650 per period of
coverage, US$325 allowable charge per procedure. |
| Hospital emergency room |
75% of URC to
US$200 |
| Prescription drugs |
US$150 per period of
coverage |
| Physician visits |
US$50 allowable charge per visit, 10 visits per period of coverage |
| Miscellaneous
Inpatient & Outpatient Services |
| Anesthetist |
25% of surgical
benefit |
| Assistant surgeon |
25% of surgical
benefit |
| Other Coverage's |
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| Ambulance |
US$250 per period of
coverage |
| Dental for accident to sound natural
teeth |
US$350 per period of
coverage |
| Physiotherapy |
US$25 per visit per
day, 12 visits per period of coverage |
PLAN B
M E D I C A L B E N E F I T S- US$50,000
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US$50,000 Maximum Benefit
per life of plan - usual, reasonable and customary charges, subject to
deductible where applicable. |
| Inpatient Treatment
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| Hospital room & board |
Up to US$1,400, per
day, 30 day maximum period of coverage
(includes inpatient prescriptions drugs) |
| Intensive care |
Additional US$660 per
day, 8 day maximum per period of coverage |
| Surgical treatment |
US$3,300 per surgical
session |
| Consult physician |
US$450 per period of
coverage |
| Pre-admission tests |
US$1,100 per period
of coverage |
| Private duty nurse |
US$550 per period of
coverage |
| Physician Visits |
US$55 allowable charge
per visit, 30 visits per period of coverage |
| Outpatient Treatment
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| Surgical treatment |
US$3,300 per surgical
session |
| Diagnostic x-ray & lab |
US$800 per period of
coverage, US$400 allowable charge per procedure. |
| Hospital emergency room |
75% of URC to
US$330 |
| Prescription drugs |
US$250 per period of
coverage |
| Physician visits |
US$55 allowable charge per visit, 10 visits per period of coverage |
| Miscellaneous
Inpatient & Outpatient Services |
| Anesthetist |
25% of surgical
benefit |
| Assistant surgeon |
25% of surgical
benefit |
| Other Coverage's |
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| Ambulance |
US$450 per period of
coverage |
| Dental for accident to sound natural
teeth |
US$550 per period of
coverage |
| Physiotherapy |
US$40 per visit per
day, 12 visits per period of coverage |
PLAN C
M E D I C A L B E N E F I T S- US$100,000
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US$100,000 Maximum
Benefit per life of plan - usual, reasonable and customary charges, subject
to deductible where applicable |
| Inpatient Treatment |
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| Hospital room & board |
Up to US$1,950 per
day, 30 day maximum per period of coverage |
| Intensive care |
Additional US$850 per
day, 8 day maximum per period of coverage |
| Surgical treatment |
US$5,500 per Surgical
Session |
| Consult physician |
US$500 per period of
coverage |
| Pre-admission tests |
US$1,100 per period
of coverage |
| Private duty nurse |
US$550 per period of
coverage |
| Physician visits |
US$85 allowable charge per visit, 30 visits per period of coverage |
| Outpatient Treatment |
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| Surgical treatment |
US$5,500 per surgical
session |
| Diagnostic x-ray & lab |
US$950 per period of
coverage $475 allowable charge per procedure |
| Hospital emergency room |
75% of URC to
US$550 |
| Prescription drugs |
US$250 per period of
coverage |
| Physician visits |
US$85 allowable charge
per visit, 10 visits per period of coverage. |
| Miscellaneous
Inpatient & Outpatient Services |
| Anesthetist |
25% of surgical
benefit |
| Assistant surgeon |
25% of surgical
benefit |
| Other Coverage's |
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| Ambulance |
US$450 per period of
coverage |
| Dental for accident to sound natural
teeth |
US$550 per period of
coverage |
| Physiotherapy |
US$40 per visit per
day, 12 visit maximum per period of coverage |
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Your satisfaction is very important to the
plan underwriter, and to IMG as the administrator. If,
for any reason, you are not pleased with the Visitors
Care product, you may submit a written request of cancellation
and refund of premium. In order to be considered for
a full refund, your request for cancellation must be
received by IMG prior to the effective date. You may
cancel your plan after the effective date, however,
the following conditions will apply: 1) You will be
required to pay a US $25 cancellation fee and 2) only
full month premiums will be considered for refunds (i.e.:
if you decide to cancel your coverage 2 months and two
weeks prior to your coverage ending, IMG will only consider
the 2 full months for a refund). If you have filed claims,
your premium is non-refundable
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- Coverage and benefits are subject to the applicable
deductible and Scheduled limits, and the other terms
of the plan as contained in the complete Policy
Wording.
- Coverage under the plan is secondary to any
other coverage.
- Coverage and benefits are for medically necessary,
usual, reasonable and customary charges only.
- Charges must be administered or ordered by a
physician.
- Charges must be incurred during the Period of
Coverage.
- Claims must be presented to IMG for payment
within the Period of Coverage or during the three
months immediately following the Period of Coverage.
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Charges for the following services, treatments
and/or conditions are excluded from coverage under the
Visitors Care plan.
- Pre-existing Conditions. Charges resulting directly
or indirectly from any Pre-existing Condition, defined
as any Injury, Illness, sickness, disease, or other
physical or medical disorder or ailment that existed
at the time of Application or at any time during
the three years prior to the effective date of this
insurance, whether or not previously manifested
or symptomatic, diagnosed or treated, including
any subsequent, chronic or recurring complications
or consequences related thereto or arising therefrom.
- Heart disease, cancer, and stroke - Charges
resulting directly or indirectly from heart and
blood circulatory disorders including without limitation
arteriosclerosis and ischemic cardiovascular disease;
cancer, tumor, and stroke or central nervous system
hypoxia; and including any subsequent chronic or
recurring complications or consequences related
thereto or arising therefrom.
- Treatment or surgeries which are elective, investigational,
experimental or for research purposes.
- War, political insurrection, protest, or any
act thereof.
- Immunizations and routine physical exams.
- Treatment of Temporomandibular Joint or dental
treatment, except as provided for herein.
- Venereal disease, AIDS virus, AIDS related illness,
ARC Syndrome, or AIDS, and the cost of testing for
these conditions, and charges for treatment or surgeries
which are incurred by any Insured who was HIV+ at
time of enrollment into this insurance.
- Pregnancy, childbirth, birth control, artificial
insemination, treatment for infertility or impotency,
sterilization or reversal thereof, or abortion.
- Any Injury or Illness sustained while taking
part in mountaineering activities where specialized
climbing equipment, ropes or guide are normally
or reasonably should have been used, Amateur Athletics
or professional athletics, aviation ( except when
traveling solely as a passenger in a commercial
aircraft), hang gliding and parachuting, snow skiing
except for recreation downhill and/or cross country
snow skiing( no cover provided whilst skiing in
violation of applicable laws, rules or regulations;
away from prepared and marked in-bound territories;
and/or against the advice of the local authoritative
body), racing of any kind including by horse, motor
vehicle ( of any type), or motorcycle, spelunking,
and sub aqua pursuits involving underwater breathing
apparatus.
- Vision or ear tests and the provision of visual
or hearing aids.
- Vocational, recreational, speech or music therapy.
- Treatment while confined primarily to receive
custodial care, educational or rehabilitative care,
or nursing services.
- Charges, injuries and/or illnesses resulting
or arising from or occurring during the commission
or continuing perpetration of a violation of law
by the insured, including without limitation, the
engaging in an illegal occupation or act, but excluding
minor traffic violations.
- Treatment for, and injuries and/or illnesses
resulting or arising from, substance abuse or drug
addiction.
- Injury and/or illness resulting or arising from
or sustained while under the influence of or disablement
of drugs or alcohol.
- Willful self-inflicted injury or illness.
- Treatment required as a result of or arising
from complications from a treatment or condition
not covered hereunder.
- Any services or supplies performed or provided
by a relative of the Insured or provided at no cost
to Insured.
- Treatment for mental and nervous disorders.
- Organ or tissue transplants or related services.
- Treatment incurred as a result of or arising
from exposure to nuclear radiation, and/or radioactive
material(s).
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| This web material
contains only a consolidated and summary description
of all current Visitors Care benefits, conditions, limitations
and exclusions. A certificate containing the complete
Policy Wording with all terms, conditions and exclusions
will be included with the fulfillment kit. IMG reserves
the right to issue the most current Policy Wording for
this insurance plan in the event this application and/or
brochure has expired, is modified, or is replaced with
a newer version. Current Policy Wordings are available
upon request. |
