| |
| BENEFITS - Apply per person per policy year |
|
| POLICY LIMITS |
$1,000,000 |
| CO-INSURANCE |
Outside country of residence 20% of the first $5,000 No co-insurance in country of residence |
| DEDUCTIBLE |
Applies per person per policy year. Max 3 deductibles per family |
| In country of residence while Hospitalized |
| Deductibles $250-$2,500 |
NO DEDUCTIBLE |
| Deductibles $5,000 and above |
Deductible may be waived at the administrators discretion with an advanced request |
| HOSPITALIZATION |
100% |
| Private room |
100% |
| Intensive care |
100% |
| Physician or Specialist |
100% |
| OUTPATIENT TREATMENT |
$2,000 |
| CANCER TREATMENT |
| Hospitalization |
100% |
| Outpatient |
$100,000 Lifetime |
| PRESCRIPTION DRUGS |
| Hospitalization |
100% |
| Outpatient |
$250 |
| MATERNITY AND PRE-NATAL CARE |
80% to $5,000 after deductible |
| CONGENITAL ILLNESS |
$25,000 Lifetime |
| ORGAN TRANSPLANT |
$500,000 Lifetime |
| BONE MARROW TRANSPLANTS |
$250,000 Lifetime |
| EMERGENCY AIR EVACUATION |
$50,000 |
| EMERGENCY MEDICAL REUNION |
$10,000 |
| EMERGENCY GROUND TRANSPORTATION |
$1,500 |
| RETURN OF MORTAL REMAINS |
$10,000 |
| RECONSTRUCTIVE SURGERY DUE TO AN ACCIDENT OR ILLNESS |
$20,000 |
| In country of residence while Hospitalized |
| DAILY CASH BENEFIT |
$100 per day. Maximum of 7 days |
| Hospitalization: Defined as admission to a hospital for a period of 24 hours. The above description is for information purposes only. For a full legal description of benefits, limits and exclusions please refer to the policy contract. |
PREMIUM ANUAL RATES |
| |
DEDUCTIBLE |
|
$ 250 |
|
$ 500 |
|
$ 1,000 |
|
$ 2,500 |
|
$ 5,000 |
|
$ 10,000 |
|
| |
Annually
Renewable Limits |
|
$1,000,000 |
|
$1,000,000 |
|
$1,000,000 |
|
$1,000,000 |
|
$1,000,000 |
|
$1,000,000 |
|
| |
Age
0-10
11-17*
18-29
30-39
40-49
50-59
60-64
65-69 |
|
$ 0
$ 828
$ 2,146
$ 2,608
$ 3,261
$ 4,163
$ 5,175
$ 7,105 |
|
$ 0
$ 679
$ 1,717
$ 2,083
$ 2,724
$ 3,527
$ 4,491
$ 6,077 |
|
$ 0
$ 549
$ 1,166
$ 1,596
$ 2,017
$ 2,549
$ 3,357
$ 4,584 |
|
$ 0
$ 417
$ 1,081
$ 1,354
$ 1,696
$ 2,156
$ 2,902
$ 3,438 |
|
$ 0
$ 331
$ 921
$ 1,139
$ 1,481
$ 1,891
$ 2,487
$ 2,969 |
|
$ 0
$ 247
$ 692
$ 853
$ 1,112
$ 1,418
$ 1,865
$ 2,228 |
|
| |
·Students are considered dependents to age 23 and pay rates of age group 11-17 (proof of student must be supplied).
· Two Children under 11 years are included free when both parents are enrolled, or pay rate of $214
·To calculate semi annual premium factor multiply by 0.55, quarterly by 0.28, monthly by 0.1.
·Individual non-cancelable after issuance date, no age limits on renewals.
·Add $100.00 administration/policy fee per application.
·Smokers are subject to a 10% loaded premium.
·Rates apply to both sexes.
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