Plan Details
Administrator
INF Visitor Care
Coverage Type
Limited Or Fixed Benefits Coverage
Plan Underwriter
Tideview Risk, SPC
Plan Eligibility
Eligibility
All non-US residents 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
Plan A : $50,000
Plan B : $100,000
Plan C : $150,000
Age 70-99
Plan A : $50,000
Plan B : $100,000
Deductible options
Age 0-69 :
Class 1 Options: $75, $100, $250, $500, $1,000, $2,500, or 5,000
Class 2 Options: $100, $250, $500, $1,000, $2,500, or $5,000
Age 70-99 : Options: $100, $250, $500, $1,000, $2,500, or $5,000
Coinsurance
100% of the Usual and Customary Charges
Out-Patient
Surgical Room and Supply Expenses
Age 0-69 :
Plan A : Up to $1,000
Plan B : Up to $1,100
Plan C : Up to $1,200
Age 70-99 :
Plan A : Up to $1,000
Plan B : Up to $1,100
Doctor Surgical Expenses:
Age 0-69 :
Plan A : Up to $3,000
Plan B : Up to $5,000
Plan C : Up to $6,000
Age 70-99 :
Plan A : Up to $3,000
Plan B : Up to $5,000
X-rays, laboratory procedures
Age 0-69 :
Plan A : Up to $400
Plan B : Up to $650
Plan C : Up to $750
Age 70-99 :
Plan A : Up to $400
Plan B : Up to $650
Hospital Emergency Room
Age 0-69 :
Plan A : Up to $350
Plan B : Up to $500
Plan C : Up to $750
Age 70-99 :
Plan A : Up to $350
Plan B : Up to $500
Prescription Drug Expenses
Age 0-69 :
Plan A : Up to $100
Plan B : Up to $150
Plan C : Up to $200
Age 70-99 :
Plan A : Up to $100
Plan B : Up to $150
In-Patient
Room & Board Charges:
Age 0-69:
Plan A: Up to $1,300 per day to a maximum of 30 days
Plan B: Up to $1,750 per day to a maximum of 30 days
Plan C: Up to $1,900 per day to a maximum of 30 days
Age 70-99 :
Plan A: Up to $1,300 per day to a maximum of 30 days
Plan B: Up to $1,750 per day to a maximum of 30 days
Doctor Surgical Expenses:
Age 0-69:
Plan A : Up to $3,000
Plan B : Up to $5,000
Plan C : Up to $6,000
Age 70-99 :
Plan A : Up to $3,000
Plan B : Up to $5,000
Travel Coverage
Emergency Medical Evacuation Benefit
Age 0-69 :
Plan A : Up to $15,000
Plan B : Up to $20,000
Plan C : Up to $25,000
Age 70-99 :
Plan A : Up to $15,000
Plan B : Up to $20,000
Repatriation of Remains Benefit
Age 0-69 :
Plan A : Up to $10,000
Plan B : Up to $15,000
Plan C : Up to $20,000
Age 70-99 :
Plan A : Up to $10,000
Plan B : Up to $15,000
Trip Interruption Benefit
$1,000
Additional Coverage Options
Accidental Death and Dismemberment Benefit
$25,000
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