| |
| BENEFITS - Apply per person per policy year |
|
| POLICY LIMITS |
$1,000,000 |
| CO-INSURANCE |
Outside country of residence 10% of the first $10,000 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 |
| PHYSICIAN OR SPECIALIST |
100% |
| HOSPITALIZATION |
100% |
| Private room |
100% |
| Intensive care |
100% |
| OUTPATIENT TREATMENT |
100% |
| CANCER TREATMENT |
100% |
| MATERNITY AND PRENATAL CARE |
80% of charges with no deductible |
| PRESCRIPTION DRUGS |
| Hospitalization |
100% |
| Outpatient |
$500 |
| CONGENITAL ILLNESS |
$500,000 lifetime |
| ORGAN TRANSPLANT |
$500,000 lifetime |
| BONE MARROW TRANSPLANTS |
$250,000 lifetime |
| EMERGENCY AIR EVACUATION |
$100,000 |
| 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 |
| ACCIDENTAL DENTAL INJURY |
$500 after $50 deductible |
| In country of residence while Hospitalized |
| DAILY CASH BENEFIT |
$200 per day. Maximum of 10 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. |
SUPERIOR 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
$1,127
$2,741
$3,433
$4,295
$5,500
$6,862
$9,785 |
|
$0
$863
$2,241
$2,728
$3,563
$4,660
$5,943
$7,893 |
|
$0
$607
$1,616
$2,049
$2,646
$3,348
$4,514
$5,943 |
|
$0
$576
$1,390
$1,753
$2,211
$2,821
$3,809
$4,441 |
|
$0
$430
$1,173
$1,470
$1,917
$2,456
$3,269
$3,837 |
|
$0
$321
$880
$1,103
$1,439
$1,843
$2,452
$2,877 |
|
| |
·Students are considered dependents to age 23 and pay rates of age group 11-17 (proof of student must be supplied).
·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.
|
|
