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
Limited Coverage
PPO Network
United Healthcare PPO Network
Plan Eligibility
Eligibility
For international travelers traveling anywhere outside their home country including the U.S.
Age for Coverage
14 days to 89 years
Coverage Duration
Minimum of 5 days to a maximum of 364 days
Extendable
Yes, up to 364 days
Purchase Restrictions
Not available if Home Country/Country of Residences are: Cuba (CUB), Iran (IRN), Myanmar (MMR), North Korea (PRK), Syria (SYR) & Ukraine (UKR)
Not available for Citizens of: Cuba (CUB), Iran (IRN), Myanmar (MMR), North Korea (PRK) & Ukraine (UKR)
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)
For individuals coming to the US who are over age 65, coverage must begin within 30 days of arrival
Overall Policy Maximum
Ages 14 Days - 59 Years
Plan A : $50,000
Plan B : $75,000
Plan C : $100,000
Plan D : $130,000
Ages 60 - 69 Years
Plan A : $50,000
Plan B : $75,000
Plan C : $100,000
Ages 70 - 79 Years
Plan A : $50,000
Plan B : $75,000
Ages 80 - 89 Years
Plan A : $10,000
Deductible Options
Ages 14 Days - 59 Years
Plan A : $0, $50, or $100
Plan B : $0, $50, or $100
Plan C : $0, $50, or $100
Plan D : $0, $50, or $100
Ages 60 - 69 Years
Plan A : $0, $50, or $100
Plan B : $0, $50, or $100
Plan C : $0, $50, or $100
Ages 70 - 79 Years
Plan A : $100 or $200
Plan B : $100 or $200
Ages 80 - 89 Years
Plan A : $100 or $200
Pre-Existing Conditions
*Acute Onset of **Pre-Existing Condition(only available to members under age 70)
Plan A : $50,000 lifetime maximum for eligible expenses
Plan B : $75,000 lifetime maximum for eligible expenses
Plan C : $100,000 lifetime maximum for eligible expenses
Plan D : $100,000 lifetime maximum for eligible expenses
Emergency Coverage
Emergency Room(ER)
Plan A : $375 maximum
Plan B : $485 maximum
Plan C : $600 maximum
Plan D : $785 maximum
Local Ambulances
$500 maximum
Out-Patient
Dr. / Physician Visit
Plan A : $70 per visit, 10 visits max
Plan B : $85 per visit, 10 visits max
Plan C : $100 per visit, 10 visits max
Plan D : $130 per visit, 10 visits max
Urgent Care
Plan A : $70 per visit, 10 visits max
Plan B : $85 per visit, 10 visits max
Plan C : $100 per visit, 10 visits max
Plan D : $130 per visit, 10 visits max
Surgical Treatment
Plan A : $3,300 per session
Plan B : $4,400 per session
Plan C : $5,500 per session
Plan D : $7,150 per session
Prescription Drugs / Medicines
Plan A : $150 maximum
Plan B : $200 maximum
Plan C : $250 maximum
Plan D : $300 maximum
Lab & X-rays
Plan A : $500, plus $400 for one CAT Scan, MRI or PET
Plan B : $550, plus $450 for one CAT Scan, MRI or PET
Plan C : $600, plus $500 for one CAT Scan, MRI or PET
Plan D : $750, plus $650 for one CAT Scan, MRI or PET
Physical Therapy
$40 maximum per visit, 12 visits maximum
In-Patient
Hospital Room and Board,Including Miscellaneous
Plan A : $1,450 per day, maximum 30 days
Plan B : $1,725 per day, maximum 30 days
Plan C : $2,000 per day, maximum 30 days
Plan D : $2,585 per day, maximum 30 days
Intensive Care Unit, including miscellaneous
Plan A : $2,200 per day, maximum 8 days
Plan B : $2,600 per day, maximum 8 days
Plan C : $3,000 per day, maximum 8 days
Plan D : $3,800 per day, maximum 8 days
Surgical Treatment
Plan A : $3,600 per session
Plan B : $4,800 per session
Plan C : $6,000 per session
Plan D : $7,800 per session
Dental Coverage
Accident
Plan A : $550
Plan B : $550
Plan C : $550
Plan D : $550
Travel Coverage
Emergency Medical Evacuation
$50,000 lifetime maximum, except as provided under *acute onset of **pre-existing condition
Available only to members under age 70
Repatriation of remains
$25,000 per member
Local burial & cremation
$5,000 per member
Additional Coverage Options
Common carrier accidental death & dismemberment
$25,000 lifetime maximum principal sum per member
Death or loss of two limbs – principal sum
Loss of one limb – one-half the principal sum
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