Parents visiting USA 
Non-US Citizens visiting USA 
B1/B2 Visa Holders to the USA Plan Details
Insurance Provider
WorldTrips
Plan Underwriter
Lloyd’s of London
Plan Rating
A.M. Best Rating: A
Plan Category
Travel Medical Insurance
Plan Type
Comprehensive Coverage
PPO Network
United Healthcare PPO Network
Plan Eligibility
Eligibility
For non U.S residents and non U.S citizens traveling to the U.S.
Age for Coverage
14 days to 99 years
Coverage Duration
Minimum of 5 days to a maximum of 364 days
Extendable
Yes, up to 364 days
Purchase Restrictions
Purchase Restrictions
Not Available for the following Destination Countries: Belarus (BLR), Cuba (CUB), Iran (IRN), Mayotte (MYT), North Korea (PRK), Russia (RUS), Syria (SYR) & Ukraine (UKR)
Not available if Home Country/Country of Residences are: Cuba (CUB), Iran (IRN), Myanmar (MMR), North Korea (PRK), Puerto Rico (PRI), Syria (SYR), Ukraine (UKR), United States (USA) & Virgin Islands (USA) (VIR)
Not available for Citizens of: Cuba (CUB), Iran (IRN), Myanmar (MMR), North Korea (PRK), Puerto Rico (PRI), Ukraine (UKR), United States (USA) & Virgin Islands (USA) (VIR)
Not available to individuals who are physically located in the states of: Washington (WA), New York (NY) & Maryland (MD)
Note: These U.S state restrictions are only applicable for purchase. The policy will still cover travelers visiting and temporarily staying in these U.S states
Not available to individuals who are physically located in the country of Australia (AUS) & Canada (CAN)
Policy Maximum, Deductibles & Medical Coverage Limits
Overall Maximum Limit
Age 80 or older: $10,000
Age 65 to 79: $50,000 or $100,000
All others: $50,000, $100,000, $250,000, $500,000, or $1,000,000
Deductible Options
$0, $100, $250, $500, $1,000, $2,500, or $5,000 per certificate period
Coinsurance
Within the PPO: 75% of eligible expenses after the deductible to the overall maximum limit
Outside the PPO: Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount
Pre-Existing Conditions
Acute Onset of Pre-Existing Conditions
No Benefits
Emergency Coverage
Ambulance Expenses
Usual, reasonable and customary charges when covered illness or injury results in hospitalization as inpatient
Emergency Room(ER)
Claims incurred in the U.S. The member shall be responsible for a $200 co-payment for each use of emergency room for an Illness unless the member is admitted to the hospital. There will be no co-payment for emergency room treatment of an injury
Out-Patient
Dr. / Physician Visit
After deductible, the plan pays 100% up to policy maximum for eligible expenses
Urgent Care
Claims incurred in the U.S. For each visit, the member shall be responsible for a $15 co-payment, after which coinsurance will apply (not subject to deductible). -Co-payment waived if $0 deductible elected
Surgical Treatment
After deductible, the plan pays 75% up to policy maximum for eligible expenses
Prescription Drugs / Medicines
After deductible, the plan pays URC for prescription drugs/medicines
Lab & X-rays
After deductible, the plan pays 75% up to policy maximum for eligible expenses
In-Patient
Hospital Room
Average semi-private room rate, including nursing services
Surgical Treatment
After deductible, the plan pays 75% up to policy maximum for eligible expenses
Hospital Intensive Care Unit
Up to the overall maximum limit
Dental Coverage
Accidental emergency
No benefit
Travel Coverage
Emergency Medical Evacuation
Up to $500,000 lifetime maximum (not subject to deductible, coinsurance, or overall maximum limit
Repatriation of Remains
Up to $25,000 lifetime maximum (not subject to deductible, coinsurance, or overall maximum limit)
Additional Coverage Options
Local Burial or Cremation
Up to $5,000 lifetime maximum (not subject to deductible or coinsurance)
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