Plan Details
Administrator
INF Visitor Care
Coverage Type
Limited Or Fixed Benefits Coverage
Plan Underwriter
Tideview Risk, SPC
Plan Eligibility
Eligibility
All non-US resident plan members ages 69 and under of the Policyholder who
are traveling outside of their Home Country.
All non-US residents plan members ages 70 to 99 of the Policyholder who are
traveling outside of their Home Country.
Policy Maximum, Deductibles & Medical Coverage Limits
Maximum Period of Coverage
364 days
Total Maximum for all Accident or Sickness Expense Benefits:
Age 0-69 : $300,000
Age 70-99 : $100,000
Deductible options
Age 0-69 : $75, $100, $250, $500, $1,000, $2,500, or 5,000
Age 70-99 : $100, $250, $500, $1,000, $2,500, or $5,000
Coinsurance
100% of the Usual and Customary Charges
Pre-Existing Conditions
Pre-existing Conditions
Age 0-69:
OPTION 1:
$50,000 Maximum Benefit
Subject to a $1,000 deductible
OPTION 2:
$100,000 Maximum Benefit
Subject to a $5,000 deductible
Age 70-99:
OPTION 1:
$15,000 Maximum Benefit
Subject to a $1,000 deductible
OPTION 2:
$25,000 Maximum Benefit
Subject to a $5,000 deductible
Out-Patient
Surgical Room and Supply Expenses
Age 0-69 : Up to $1,800
Age 70-99 : Up to $1,100
Doctor Surgical Expenses:
Age 0-69 : Up to $8,000
Age 70-99 : Up to $5,000
X-rays, laboratory procedures
Age 0-69 : Up to $1,150
Age 70-99 : Up to $650
Hospital Emergency Room
Age 0-69 : Up to $2,500
Age 70-99 : Up to $500
Prescription Drug Expenses
Age 0-69 : Up to $300
Age 70-99 : Up to $150
In-Patient
Room & Board Charges
Age 0-69 : Up to $3,000 per day
Age 70-99 : Up to $1,750 per day
Doctor Surgical Expenses
Age 0-69 : Up to $8,000
Age 70-99 : Up to $5,000
Travel Coverage
Emergency Medical Evacuation Benefit
Age 0-69 : Up to $45,000
Age 70-99 :Up to $20,000
Repatriation of Remains Benefit
Age 0-69 : Up to $30,000
Age 70-99 : Up to $15,000
Trip Interruption Benefit
$1,000
Additional Coverage Options
Accidental Death and Dismemberment Benefit
$25,000
Wellness Medical Expense Benefit
$200 (Annual)
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