Short-Term Travel (1-30) Days | Benefits
| SCHEDULE OF BENEFITS | |
| MEDICAL BENEFITS | Usual reasonable and customary charges, subject to deductible and coinsurance |
| Hospital Room and Board | Up to the Maximum Limit for average semi-private room rate |
|---|---|
| Intensive Care | Up to the Maximum Limit |
| Medical Expenses | Up to the Maximum Limit |
| Outpatient Medical | Up to the Maximum Limit |
| Local Ambulance | Up to the Maximum Limit |
| Prescription Drugs | Up to the Maximum Limit |
| Emergency Room | As described below |
| Charges incurred for the use of the Emergency Room due to an accident are covered up to the Maximum Limit. Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital. |
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| Dental | As described below |
| Injury due to an accident: Each Outreach plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Maximum Limit. Sudden dental pain: Each plan will pay up to $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth. |
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| INTERNATIONAL EMERGENCY CARE | |
| Emergency Evacuation | Up to $500,000 lifetime maximum (independent of maximum limit) when coordinated through the Plan Administrator |
| Each Patriot plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to a $500,000 lifetime maximum (independent of the Maximum Limit). | |
| Emergency Reunion | Up to $50,000 when coordinated through the Plan Administrator |
| Each Outreach plan also provides emergency reunion coverage, up to $50,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the country of residence to be reunited with the insured. |
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| Return of Mortal Remains | Up to $50,000 when coordinated through the Plan Administrator |
| 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 $50,000. | |
| Returning Minor Children | Up to $50,000 when coordinated through the Plan Administrator |
| If an insured person is hospitalized due to a covered illness/injury and is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Outreach plans will pay up to $50,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren). | |
| Political Evacuation | Up to $10,000 when coordinated through the Plan Administrator |
| If the United States Department of State, Bureau of Consular Affairs issues a travel advisory that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to $10,000 for transportation to the nearest place of safety or for repatriation to the Insured Person’s home country or country of residence provided that: | |
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| PLAN INFORMATION | |
| Deductible | Your choice of $0, $100, $250, $500, $1,000 or $2,500 |
| On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information. | |
| Coinsurance | As described below |
| For treatment received outside the U.S. & Canada: No coinsurance For treatment received within the U.S. & Canada: In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit |
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| Benefit Period | Six months |
| If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-month Benefit Period may provide continued coverage. When the certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than six months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Policy Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness. | |
| SPECIAL COVERAGES | |
| 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. End of Trip Home Country Coverage - For every five months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s). |
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| Trip Interruption | Up to $5,000 |
| If, during a covered trip, there is a death of an immediate family member (spouse, child, parent or sibling) or the substantial destruction of the insured’s principal residence, each Outreach plan will pay to return the insured to the area of principal residence. The plan will pay for a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket. | |
| Natural Disaster | $100 per day for five days |
| This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued be prevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the population for its safety. | |
| Lost Luggage | Up to $50 per item or personal property; maximum of $250 per Period of Coverage |
| This benefit will be paid in the event that the Common Carrier permanently loses an insured person’s checked luggage. This coverage is secondary to any other available coverage, including the Carrier’s. | |
| Common Carrier Accidental Death | $50,000 to Beneficiary; maximum of $250,000 per family |
| If accidental death should occur while traveling on a commercial Common Carrier, $50,000 will be paid to the designated beneficiary, to a maximum of $250,000 per family. | |
| Sports & Activities Coverage | Up to the Maximum Limit for basic sports Coverage as described below |
| Each Outreach plan covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. However,activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded unless the Adventure Sports Rider is purchased: abseiling, aviation (except when traveling as a passenger in a commercial aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, paracending, rappelling, rock climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, wind-surfing and whitewater rafting. Racing of any kind, BASE jumping, mountaineering, climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty; and/or adventure sports not expressly covered hereunder are excluded regardless of which plan or rider is selected. | |
| Accidental Death & Dismemberment | $25,000 principal sum |
| Each Outreach plan includes $25,000 principal sum benefit for Accidental Death and Dismemberment occurring during the Period of Coverage: • Accidental Loss of life - principal sum; • Accidental Loss of two Members - principal sum; • Accidental Loss of one Member - 50% of principal sum. “Member” means hand, foot or eye. | |
| Additional Benefits for U.S. Citizens | |
| Sudden Recurrence of a Pre-existing Condition | |
| Up to $15,000 will be paid for the eligible expenses of a sudden and unexpected recurrence of a Pre-existing Condition while traveling outside of the U.S. In addition, up to $25,000 will be paid for the eligible costs and expenses of an Emergency Medical Evacuation arising or resulting from a sudden and unexpected recurrence of a Pre-existing Condition. For the definition of a Pre-existing Condition, please see Exclusion number 1 on page 12 of the brochure. | |
| Indemnity | |
| Outreach International will pay directly to the insured person $100 for each night of a required overnight stay in a hospital. However, the hospital stay must be covered under this plan in order to receive this benefit. | |
| This web page contains only a consolidated and summary description of all current Outreach Travel Medical Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate 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 Certificate Wordings are available upon request. | |
Option 1: Basic Coverage with IMG Outreach
- Lowest rates on the market
- Medical evacuation and repatriation
- Choice of deductibles $0.00, $100, $250
- Terrorism & political evacuation coverate included
- From international medical group (IMG) an "A" rated company
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