| Print | Close This Window |
|
Liaison® International Program
Summary
Administered By: Seven Corners, Inc. 303 Congressional Blvd. Carmel, IN 46032 USA Hospital and Doctor Network in the U.S. - To locate a network facility in the United States, search online at www.sevencorners.com/findproviders or contact Seven Corners Assist at 800-690-6295. Advise Seven Corners Assist once you have established an appointment. Use of the network does not guarantee benefits. Please see Pre-Notification / Referral section for additional details and requirements.
Claims - It is important to submit your claims to Seven Corners quickly. To be considered, all claims must be submitted to the Seven Corners Claim Department within 90 days after the date of service. The Company hereby insures all persons whose Application has been accepted by the Administrator, Seven Corners, Inc., on behalf of the Company and whose name is identified on the ID Card, subject to all of the exclusions, limitations and provisions as set forth herein and in the Master Policy of insurance issued by the Company. Coverage is afforded only with respect to the person, coverage, amounts and limits specified herein and as identified on the ID Card for the insurance requested on such Application and for which their specified plan costs has been paid to the Administrator. Note: All coverage and benefit amounts herein are in United States Dollars.
Part I - INDIVIDUAL INSURANCE PROVISIONS
Eligibility Liaison® International provides coverage as outlined in this brochure for individuals and families (including unmarried dependent children over 14 days and under 19 years of age) while traveling outside of their Home Country. Home Country is defined as - The country where an Insured person(s) has his/her true, fixed and permanent home and principal establishment.
Effective Date of Individual Insurance Your coverage will begin on the latest of the following:
Termination Date of Individual Insurance Individual coverage will end on the earlier of the following:
Home Country Coverage Incidental Trips to Your Home Country: This benefit covers you for incidental trips to your Home Country (60 days per 12 months of purchased coverage or pro rata thereof - example: approximately 5 days per month of purchased coverage). Maximum benefit is reduced to $50,000 for any illness or injury occurring while on an incidental trip to your Home Country. Follow Me Home Coverage: This plan shall pay for Covered Expenses incurred in your Home Country up to $5,000 for conditions that are first diagnosed and treated outside Your Home Country (Does not apply for Emergency Medical Evacuation or Repatriation).
Refund of Premium Refund of total plan cost will only be considered if written request is received by Seven Corners 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, provided no claim has been submitted to Seven Corners for reimbursement.
PART II - DESCRIPTION OF BENEFITS
ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) The Company shall pay an indemnity determined from the Table if an Insured Person sustains a Loss stated therein resulting from Injury and subject to the limitations contained in PART IV - EXCLUSIONS, provided that:
For Loss of: Insured or Spouse Each Child Loss of Life Principal Sum $5,000 Loss of two Members Principal Sum $5,000 Loss of one Member 50% of Principal Sum $2,500 Quadriplegia Principal Sum $5,000 (total paralysis of both upper and lower limbs) Paraplegia 75% of the Principal Sum $3,750 (total paralysis of both lower limbs) Hemiplegia 50% the Principal Sum $2,500 (total paralysis of both upper and lower limbs of one side of the body) Uniplegia 25% of the Principal Sum $1,250 (total paralysis of one limb) The term "Loss", in reference to quadriplegia, paraplegia, hemiplegia and uniplegia, shall mean the complete and irreversible paralysis of such limbs and with regard to hands and feet, actual severance through or above the wrist or ankle joints, and with regard to eyes, entire irrecoverable Loss of sight. The term "Principal Sum" as used herein shall mean the amount stated on the ID Card.
Common Carrier Benefit Benefits will be paid to you as per the schedule of benefits if you sustain an Accidental Death. Death must occur during the period of coverage while the Insured person is riding as a passenger (but not a pilot, operator or member of the crew) in or on a Common Carrier.
MEDICAL EXPENSE BENEFITS If the Insured Person is traveling inside the United States and Canada: When a covered Injury or Illness is incurred by the Insured Person, the Company will pay 80% of the first $5,000 of Reasonable and Customary medical charges for Covered Expenses, excess of the Policy Period Deductible as stated on the ID Card. Thereafter, the Company will pay 100% of Reasonable and Customary medical charges for Covered Expenses up to the Medical Maximum as stated on the ID Card. If the Insured Person is traveling outside the United States and Canada: the Company will pay 100% of Reasonable and Customary medical charges for Covered Expenses, excess of the Policy Period Deductible as stated on the ID Card, up to the Medical Maximum as stated on the ID Card. In no event shall the Company's maximum liability exceed the Medical Maximum as stated on the ID Card. The Deductible and Coinsurance amount consists of Covered Expenses which would otherwise be payable under this Policy. These expenses must be borne by each Insured Person. A maximum of 3 Policy Period deductibles per family under the same application will apply.
Only such expenses, incurred as the result of and within twenty-six (26) weeks from a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in PART IV - EXCLUSIONS, shall be considered as Covered Expenses: 1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service and (with the exception of personal services of a non-medical nature); charges made for an operating room. 2. Charges made for Intensive Care or Coronary Care charges and nursing services. 3. Charges made for diagnosis, treatment and Surgery by a Physician; charges made for the cost and administration of anesthetics. 4. Charges made for Outpatient treatment, same as any other treatment covered on an Inpatient basis. This includes ambulatory Surgical centers, Physicians' Outpatient visits/examinations, clinic care, and Surgical opinion consultations. 5. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, iron lungs, and medical treatment; dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon. 6. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist. 7. Ground ambulance (within the metropolitan area, up to a $ 2,500 maximum) to and from the nearest Hospital with facilities for required treatment. If the Insured Person is in a rural area and unreachable by ground ambulance, then licensed air ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense. 8. Hotel room charge, when the Insured Person, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond control of the Insured Person. 9. Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.
The charges enumerated herein shall in no event include any amount of such charges which are in excess of Reasonable and Customary charges. If the charge incurred is in excess of such average charge, such excess amount shall not be recognized as a Covered Expense. All charges shall be deemed to be incurred on the date such services or supplies which give rise to the expense or charge are rendered or obtained.
Pre-Notification / Referral - Seven Corners Assist must be contacted prior to:
HOSPITAL INDEMNITY Should the Insured Person be hospitalized while traveling outside the United States or Canada, and the hospitalization is considered a Covered Expense, the Company will indemnify the Insured $150 for each night spent in the hospital.
EMERGENCY MEDICAL EVACUATION/REPATRIATION The Company shall pay benefits for Covered Expenses incurred up to $300,000, if any covered Injury or Illness commencing during the Period of Coverage results in the Medically Necessary Emergency Medical Evacuation or Repatriation of the Insured Person. The Emergency Medical Evacuation or Repatriation must be arranged by the Assistance Company in consultation with the Insured Person's local attending Physician.
Emergency Medical Evacuation or Repatriation means:
RETURN OF MORTAL REMAINS The Company will pay the reasonable Covered Expenses incurred up to $50,000 to return the Insured Person's remains to his/her Home Country, if he or she dies. Covered Expenses include, but are not limited to, expenses for embalming, a minimally necessary container appropriate for transportation, shipping costs, and the necessary government authorizations. EMERGENCY MEDICAL REUNION When Emergency Medical Evacuation or Repatriation occurs, the Company will arrange and pay, up to $50,000, for round-trip economy-class transportation for one individual selected by the Insured Person, from the Insured Person's Home Country to the location where the Insured Person is hospitalized and return to the Home Country. Emergency Medical Reunion must be recommended by the attending Physician. The benefits payable will include:
RETURN OF MINOR CHILDREN(REN) Should the Insured Person be traveling alone with a Minor Child(ren) and is hospitalized because of a covered Illness or Injury and the Minor Child(ren), under age 19, is left unattended, the Company will arrange and pay, up to $50,000, for one-way economy fares to their Home Country. These arrangements will be made at no cost to the Insured Person. Meals and lodging are the responsibility of the Insured Person. If an attendant/escort is necessary to ensure the safety and welfare of Minor Child(ren), the Company will arrange and pay for these services to the limit stated in the Schedule of Benefits. INTERRUPTION OF TRIP If the Insured is unable to continue the Trip due to the death of a parent, spouse, sibling or child; or due to serious damage to the Insured's principal residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane, etc.), the program will reimburse (up to $5,000), the Insured for the cost of economy travel, less the value of applied credit from an unused return travel ticket, to return home to their area of principal residence. LOSS OF CHECKED LUGGAGE If the Insured's checked luggage is permanently lost by the airline, the program will reimburse the Insured for the replacement of clothing and personal hygiene items lost to a maximum per article limit of $50. This benefit is secondary to any other (including airline) coverage available. The Insured must furnish proof to the Company that full reimbursement has been obtained from the airline. This policy will reimburse the Insured up to a maximum benefit of $250 under this provision. DENTAL - EMERGENCY ONLY Emergency Dental treatment necessary to resolve acute, spontaneous and unexpected inception of pain to sound natural teeth (up to a maximum of $100) or Dental treatment necessary to restore or replace sound natural teeth lost or damaged in an Accident which is covered under the program (up to a maximum of $500). The Deductible and Coinsurance amounts apply to the dental benefit. *Only available to programs purchased for 1 month or more. NOTE:In the event of an Emergency Medical Evacuation/Repatriation, Return of Mortal Remains, Emergency Medical Reunion, Return of Minor Child(ren), or Interruption of Trip benefit is needed, arrangements must be made by the Assistance Company. Failure to utilize the Assistance Company (Seven Corners Assist) for these benefits will void any payment by the Company. Complete details about required notification of the Assistance Company are listed below. PART III - DEFINITIONS The term "Accident" or "Accidental" shall mean an event, independent of Illness or self inflicted means, which is the direct cause of bodily Injury to an Insured Person. The term "Airworthiness Certificate" shall mean the "Standard" Airworthiness Certificate issued by the Federal Aviation Agency of the United States or its foreign equivalent issued by the government authority having jurisdiction over civil aviation in the country of its registry.
The term "Company" shall mean Virginia Surety Company, Inc. The term "Coinsurance" shall mean the percentage amount of eligible Covered Expenses, after the Deductible, which are the responsibilities of the Insured Person and must be paid by the Insured Person. The Coinsurance amount is stated in Section II, Schedule of Benefits, under each stated benefit. The term "Common Carrier" shall mean any public air conveyance operating under a valid license providing for the transportation of passengers for hire. The term "Covered Expense" shall mean "Eligible Benefit". The term "Deductible" shall mean the amount of eligible Covered Expenses which are the responsibility of each Insured Person and must be paid by each Insured Person before benefits under the Policy are payable by the Company. The term "Disablement" as used with respect to medical expenses shall mean an Illness or an Accidental bodily Injury necessitating medical treatment by a Physician as defined in this Policy. The term "Eligible Benefit(s)" shall mean benefits payable by the Company to reimburse expenses which are for Medically Necessary services, supplies, care, or treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician; Reasonable and Customary charges; incurred while insured under this program and which do not exceed the maximum benefit. The term "Emergency" shall mean a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Insured Person's life or limb in danger if medical attention is not provided within 24 hours. The term "Experimental / Investigational" means all services or supplies associated with:
The term "Hospital" as used in this Policy shall mean, except as may otherwise be provided, a Hospital (other than an institution for the aged, chronically ill or convalescent, resting or nursing homes) operated pursuant to law for the care and treatment of sick or Injured persons with organized facilities for diagnosis and Surgery and having 24-hour nursing service and medical supervision. The term "Home Country" shall mean the country where an Insured Person has his or her true, fixed and permanent home and principal establishment. The term "Host Country" shall mean any country other than the country where an Insured Person has his or her true, fixed and permanent home and principal establishment. The term "Illness" wherever used in this Policy shall mean sickness or disease of any kind. The term "Injury" wherever used in this Policy shall mean bodily Injury caused solely and directly by violent, Accidental, external, and visible means occurring while this Policy is in force and resulting directly and independently of all other causes in Disablement covered by this Policy. The term "Insured" or "Insured Person" shall mean a person eligible for benefits under the Policy who has applied for coverage and is named on the application and for whom the company has accepted premium. The term "Intensive Care" shall mean a cardiac care unit or other unit or area of a Hospital which meets the required standards of the Joint Commission on Accreditation of Hospitals for Special Care Units. The term "Loss" in reference to quadriplegia, paraplegia, hemiplegia, and uniplegia, shall mean the complete and irreversible paralysis of such limbs and with regard to hands and feet, actual severance through and above the wrist or ankle joints, and with regard to eyes, entire irrecoverable Loss of sight. The term "Medically Necessary" shall mean services and supplies received while insured that are determined by the Company to be:
The term "Mental Illness" shall mean any condition or disease listed in the most recent edition of the International Classification of Diseases as a mental disorder, with clinically significant behavioral or psychological disorder marked by a pronounced deviation from a normal healthy state and associated with a present painful symptom or impairment in one or more important areas of functioning. This disease must not be merely an expectable response to a particular stimulus. Mental Illness does not mean learning disabilities, attitudinal disorders or disciplinary problems. The term "Mountaineering" shall mean the sport, hobby or profession of walking, hiking, and climbing up mountains either:
The term "Outpatient" shall mean an Insured Person who receives care in a Hospital or another institution, including: ambulatory surgical center; convalescent/skilled nursing facility; or Physician's office, for an Illness or Injury, but who is confined and is not charged for room and board. The Term "Parachuting" shall mean an activity involving the breaking of a free fall from an airplane using a parachute. The term "Policy Period or Period of Coverage" shall mean the period of coverage issued by the Company to the Insured Person, typically beginning with the Effective Date and ending with the Termination Date or the date coverage is renewed by the Company.
The term "Physician" as used in this Policy shall mean a doctor of medicine or a doctor of osteopathy licensed to render medical services or perform Surgery in accordance with the laws of the jurisdiction where such professional services are performed, however, such definition will exclude chiropractors and physiotherapists. The term "Reasonable and Customary" shall mean the maximum amount that the Company determines is Reasonable and Customary for Covered Expenses the Insured Person receives, up to but not to exceed charges actually billed. The Company's determination considers:
The term "Relative" shall mean
The term "Service Provider" shall mean a Hospital, convalescent/skilled nursing facility, ambulatory surgical center, psychiatric Hospital, community mental health center, residential treatment facility, psychiatric treatment facility, alcohol or drug dependency treatment center, birthing center, Physician, Dentist, chiropractor, licensed medical practitioner, nurse, medical laboratory, assistance service company, air/ground ambulance firm, or any other such facility that the Company approves. The term "Surgery" shall mean an invasive diagnostic procedure; or the treatment of Illness or Injury by manual or instrumental operations performed by a Physician while the patient is under general or local anesthesia. The term "Traveling Companion" shall mean
PART IV - EXCLUSIONS For Medical benefits, this Insurance does not cover:
Any Injury or Illness which meets the following
criteria:
For Insured Persons traveling outside the United States and Canada, the period is 12 months instead of 36 months. If you are a United States citizen and the United States is your Home Country, this exclusion is waived for the first $20,000 in eligible medical expenses incurred outside the United States and Canada (for persons age 65 and over, the amount is $2,500). This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this program. 2. Charges for treatment which exceed Reasonable and Customary charges; or charges incurred for Surgeries or treatments which are Investigational, Experimental, or for research purposes; expenses which are non-medical in nature; expenses for Vocational, Speech, Recreational or Music Therapy; 3. Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician; 4. Suicide or any attempt there of, while sane or self destruction or any attempt there of, while insane; intentionally self-inflicted Injury or Illness; or expenses as a result of, or in connection with, the commission of a felony offense; 5. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war; 6. Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics; 7. Routine physicals, inoculations, or other examinations where there are no objective indications or impairment in normal health; 8. Treatment of the Temporomandibular joint; 9. Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person; 10. Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids, cosmetic or plastic Surgery (including deviated nasal septum), routine dental expenses, eye refractions or eye examinations for the purpose of prescribing corrective lenses for eye-glasses or for the fitting thereof, unless caused by Accidental bodily Injury incurred while insured hereunder; 11. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent; any Mental and Nervous disorders or rest cures; Injury sustained while under the influence of or Disablement due to wholly or partly to the effects of intoxicating liquor or drugs; 12. Congenital abnormalities and conditions arising out of or resulting therefrom; 13. Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
Injury sustained while taking part in mountaineering,
hang gliding, parachuting, bungee jumping, racing by
horse or motor vehicle or motorcycle, snowmobiling,
motorcycle / motor scooter riding, scuba diving
involving underwater breathing apparatus (unless PADI
or NAUI certified), water skiing, snow skiing and snow
boarding (except as provided under the Optional
Hazardous Sports Coverage)
Mountaineering shall mean the sport, hobby or profession of walking, hiking, and climbing up mountains either: 1) utilizing harnesses, ropes, crampons or ice axes; or 2) ascending 4500 meters or above. Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute. 15. Treatment paid for or furnished under any other individual, government, or group policy or charges provided at no cost to the Insured Person; 16. Treatment of venereal or sexually transmitted disease; 17. Pregnancy expenses or Illness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from an Accident; 18. Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof; 19. Expenses incurred while the Insured Person is in their Home Country (except as provided under the Home Country Coverage Benefit); 20. Expenses incurred for which travel was undertaken to seek medical treatment for a condition; or incurred after the Insured Person's physician has limited or restricted travel.
With regards to Accidental Death and Dismemberment, Emergency Medical Evacuation/Repatriation, Return of Mortal Remains, Emergency Medical Reunion, and Return of Minor Child, this Insurance does not cover: 1. Suicide or attempt thereof by the Insured Person while sane, or self destruction or any attempt thereof by the Insured Person while insane; 2. Disease or sickness of any kind; (only applicable to AD&D) 3. Bacterial infections except pyogenic infection which shall occur through an accidental cut or wound; (only applicable to AD&D) 4. Hernia of any kind; (only applicable to AD&D) 5. Injury sustained while the Insured Person is riding as a pilot, student pilot, operator or crew member, in or on, boarding or alighting, from any type of aircraft; 6. Injury sustained while the Insured Person is riding as a passenger in any aircraft
7. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with:
8. Service in the military, naval or air service of any country; 9. Flying in any aircraft being used for or in connection with acrobatic or stunt flying, racing, endurance tests, rocket-propelled aircraft, crop dusting or seeding or spraying, fire fighting, exploration, pipe or power line inspection, any form of hunting or herding, aerial photography, banner towing or any experimental purpose; 10. Being under the influence of alcohol or having taken drugs or narcotics unless prescribed by a legally qualified physician or surgeon; 11. Injury occasioned or occurring while the Insured Person is committing or attempting to commit a felony or to which a contributing cause was the Insured Person being engaged in an illegal occupation; 12. Riding or driving in any kind of competition; 13. Pregnancy, childbirth, miscarriage or abortion; 14. Covered Expenses incurred after the Insured Person's physician has limited or restricted travel; or Covered Expenses incurred as a result of a change in prescribed treatment during, or within the three months prior to the effective date of coverage. For Interruption of Trip, this insurance does not cover:
|