| Limit/Other (Limit/Amount for Eligible Medical Expenses) |
| Period of Coverage |
12 Months with maximum of 30 days per trip |
| Area of Coverage |
Outside the United States |
| Maximum Limit per Period of Coverage Age: 65-79 |
$1,000,000 |
| Maximum Limit per Period of Coverage Age: 80+ |
$100,000 |
| Deductible |
$250 per Illness/ Injury |
| Coinsurance |
No coinsurance |
| Sudden & Unexpected Reoccurrence of Pre-existing Condition |
Eligible medical expenses: $5,000 maximum limit. Emergency medical evacuation: $25,000 maximum limit. |
| Inpatient/Outpatient Benefits Charges for(Maximum Limits per Period of Coverage, or if indicated, per lifetime) |
| Hospital Room & Board |
Average semi-private room rate |
| Intensive Care Unit |
URC |
| Surgery |
URC |
| Physician Visits |
URC |
| Diagnostic Procedures |
URC |
| Prescription Medication |
URC |
| Home Nursing Care |
URC |
| Durable Medical Equipment |
URC |
| Continuation of Treatment Period |
$5,000 maximum limit before earlier of a) 30 day per injury or illness or b) upon return to home country |
| Evacuation Benefits (Must be approved in advance and coordinated by the company. Not subject to the deductible) |
MAXIMUM LIMITS PER PERIOD OF COVERAGE OR IF INDICATED, PER LIFETIME |
| Emergency Medical Evacuation |
$250,000 lifetime maximum |
| Emergency Reunion |
$50,000 lifetime maximum |
| Non-Emergency Medical Evacuation |
$25,000 lifetime maximum |
| Return of Mortal Remains |
$50,000 lifetime maximum |
| Local Burial/Cremation |
$5,000 lifetime maximum |
| Political Evacuation |
$50,000 lifetime maximum |
| Inter-facility Transportation |
$2,500 lifetime maximum |
| Natural Disaster |
$100 per day for five days, $5,000 lifetime maximum for evacuations |
| ADDITIONAL BENEFITS(Maximum Limits per Period of Coverage or if Indicated, per Lifetime) |
| Terrorism |
$50,000 lifetime maximum. Not subject to the deductible |
| Accidental Death and Dismemberment |
$25,000 principal sum |
| Common Carrier Accidental Death |
$100,000 per adult/ $250,000 per family lifetime maximum |
| Trip Interruption |
$5,000 |
| Lost Luggage |
$50 maximum per item of personal property, $250 overall maximum |
| Hospital Indemnity |
$250 per night, 30 overnights maximum |
| Identity Theft |
$500 |
| Felonious Battery |
$10,000 lifetime maximum |
| Local Ambulance Expense |
$5,000 |
| Emergency Room - Due to Accident or Illness with Inpatient Admission |
URC |
| Emergency Room - without Inpatient Admission |
URC. Subject to additional $250 deductible |
| Dental Emergency - Treatment due to Accident |
URC |
| Dental Emergency - Treatment of Unexpected Pain to Natural Teeth |
$100 |