| |
| BENEFITS - Apply per person per policy year |
|
| POLICY LIMITS |
$1,000,000 |
| CO-INSURANCE DEDUCTIBLE |
Outside country of residence 20% of the first $5,000 No co-insurance in country of residence |
| DEDUCTIBLE |
Applies per person per policy year |
| In country of residence while Hospitalized |
Max 3 deductibles per family |
| Deductibles $2,50 - $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% |
| Prescription Drugs |
100% |
| CANCER TREATMENT |
|
| While Hospitalized |
100% |
| Outpatient |
$35,000 Life Time |
| Outpatient benefits including prescription drugs |
$800 per each post hospitalization period |
| ORGAN TRANSPLANT |
$500,000 life time |
| BONE MARROW TRANSPLANTS |
$250,000 life time |
| EMERGENCY AIR EVACUATION |
$50,000 |
| 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 5 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. |
QUALITY ANUAL RATES |
| |
DEDUCTIBLE |
|
$ 1,000 |
|
$ 2,500 |
|
$ 5,000 |
|
$ 7,500 |
|
$ 10,000 |
| |
Annually
Renewable Limits |
|
$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 |
|
$ 0
$ 410
$ 1,054
$ 1,280
$ 1,604
$ 2,045
$ 2,544 |
|
$ 0
$ 334
$ 842
$ 1,023
$ 1,333
$ 1,732
$ 2,206 |
|
$ 0
$ 269
$ 573
$ 784
$ 990
$ 1,251
$ 1,685 |
|
$ 0
$ 206
$ 531
$ 665
$ 835
$ 1,060
$ 1,425 |
|
$ 0
$ 162
$ 452
$ 560
$ 726
$ 929
$ 1,224 |
| |
·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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