BENEFITS AT A GLANCE (Per Person)
Medical Maximum: $50,000, $100,000, $250,000, $500,000, $1,000,000
Deductible Options: $0, $50, $100, $250, $500, $1,000, $2,500, $5,000
Co-insurance: 80% of the first $5,000 of Covered Expenses then 100% up to the policy maximum
Medical Expense Benefits
(subject to Policy Maximum, Deductible and Co-Insurance)
Hospital Room and Board Charges: the average semi private room rate
ICU Room and Board Charges: three times the average semi private room rate
Outpatient Medical: Usual customary charge to the selected Medical Maximum
Emergency Medical Treatment of Pregnancy: $1,000
Mental or Nervous Disorders: $2,500
Physiotherapy/Physical Medicine/Chiropractic: $50 per visit per day; up to 10 visits per Policy Period
Dental Treatment (Injury and emergency alleviation of pain): $250
Doctor Visits, X-rays and Prescriptions, Ambulance: Usual customary charge to the selected Medical Maximum
Unexpected recurrence of a pre-existing condition: the first $1,000 of Covered Expenses
Additional Benefits (not subject to Policy Maximum, Deductible or Co-Insurance)
Accidental Death & Dismemberment Principal Sum: $25,000
Coma Benefit: $10,000
Felonious Assault and Violent Crime: 100% up to $50,000
Adaptive Home and Vehicle: $5,000
Seatbelt Benefit: 10% up to $50,000
Airbag Benefit: 10% up to $50,000
Hijacking and Air or Water Piracy: Covered
Emergency Medical Evacuation: 100% of Covered Expenses
Political Evacuation: $25,000
Repatriation of Remains: 100% of Covered Expenses
Emergency Reunion: $15,000
Return of Minor Child(ren) or Travel Companion: $5,000
Hospital Confinement: $50 per day 10 day Maximum
Lost Baggage: $300
Trip Interruption: $5,000
Benefit Period: 1 year from the date of the Covered Accident or Sickness
OPTIONAL BENEFITS
Upgrade AD&D up to $500,000
Home Country/Follow Me Home Coverage
Athletic Sports Coverage
Extreme Sports/Hazardous Activities
• Medical Insurance
• AD&D and Travel Related Benefits for persons traveling to the USA
• Coverage from 5 days to 1 year
• Renewable up to 2 years
ELIGIBILITY
Safe Travels USA plan provides Accident and Sickness Medical,Accidental Death and Dismemberment, Emergency Medical Evacuation,Emergency Reunion, Political Evacuation, Trip Interruption, Repatriation,and Travel Assistance to individuals while visiting the United States.It can provide coverage for you, your spouse/domestic,partner/traveling,companion dependent children/grandchildren up to age 21 years. Coverage for travelers who are not visiting the United States is available through the Safe Travels International. Customized coverage for groups of 3 or more people is available under the Safe Travels for Groups.
Refund Procedure
Refund of total plan cost minus the processing fee will only be considered if written request is received by Us prior to the Effective Date of Coverage. If written request is received after the Effective Date of coverage, the unused portion of the plan cost may be refunded minus a cancellation fee of $10, provided no claim has been submitted to Us.
DESCRIPTION OF BENEFITS
All coverage, benefits and premiums are in U.S. Dollar amounts. If a covered Injury or Illness occurs during the period of coverage and you require medical or surgical treatment; this plan will pay, subject to the selected deductible, applicable co-insurance and benefit maximums, the following Covered Expenses, up to the selected policy maximum. The first charges must be incurred within 90 days after the date of the Covered Accident or Sickness. No benefits will be paid for any expenses incurred which are in excess of Usual and Customary Charges. This plan pays Covered Medical Expenses without regard to any other Health Care Plan Benefits or to any Coordination of Benefits provision in any other Health Care Plan.
"Pre-existing Condition" means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within the 3 year period before the Covered Person's coverage became effective under the Policy. The term does not include genetic information in the absence of a diagnosis of the condition related to such information.
"Related Costs" means food, lodging and, if necessary, physical protection for the Covered Person during the Transport to the Nearest Place of Safety.
"Sickness" means an illness, disease or condition of the Covered Person that causes a loss for which a Covered Person incurs medical expenses while covered under the Policy. All related conditions and recurrent symptoms of the same or similar condition will be considered one Sickness.PLEASE SEE THE FULL BROCHURE AT THE TOP OF THIS PAGE FOR A COMPLETE DESCRIPTION INCLUDING ALL THE EXCLUSIONS
Athletic Coverage
You can cover the following by increasing the per person per day rate by 1.20 (20%): Coverage for injuries incurred during amateur athletic activities which are non-contact and engaged in solely for entertainment, fitness, leisure or recreation purposes. 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 competitions. Coverage may be purchased for participation in amateur, club, intramural, interscholastic or intercollegiate tennis, swimming, cross country, track, volleyball and golf. Sports not listed here must be rated and approved in writing by the Company prior to policy issue. All professional and semi-professional sports are excluded.
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