BROCHURE, RATES and APPLICATION
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Renewable Long-Term International Medical Insurance
for U.S. Expatriates , International Students, Visiting Families, Missionaries,
Foreign Dignitaries, Non-US Citizens, Retirees Overseas, MultiNational Employees
Rates and Application at the bottom of
this page.
 Why Buy International Medical Insurance?
The answer is easy. If you are a US citizen living abroad, traditional sources of US
private health insurance will not meet your needs. Geographical exclusions and provider
limitations common to these policies will restrict or even eliminate the coverage
available to you while you are outside the US. At the same time, you may not be eligible
for participation in the government sponsored plans in the country where you reside. Or
you may wish to have access to health care in other countries, including the US, in the
event you become seriously ill. If you are a non-US citizen, you may need an international
medical insurance policy to supplement the coverage available to you through a plan
sponsored by your government or to provide coverage while you are outside your home
country. If your lifestyle knows no geographic limits, you need health insurance that
knows no boundaries. International Citizen Economy has been designed to meet the needs of
budget conscious International Citizens who want reliable, affordable coverage.
Who is the Insurer?
These plans are underwritten by Lloyd's, London, the largest and oldest insurance market
in the world, with 317 years of experience insuring individuals and corporations
internationally. Rated A by AM Best Company and A by Standard and Poor's, Lloyd's provides
financial strength and security that is unparalleled in the worldwide insurance market.
Lloyd's is recognized as a market leader in the accident and health insurance arena and is
well known for its innovative products and services. Presently, Lloyd's provides accident
and health insurance to millions of individuals in almost every country of the world.
Am I Eligible for International Citizen Economy?
International Citizen Economy is available to citizens of all countries of the world who
are at least age 14 days and not older than age 74. If you are a US citizen, you must
reside outside the US or plan to depart the US within 30 days of the Effective Date. If
you are a US citizen, you must also reside outside the US for at least 6 months within
each Certificate period. Citizens of other countries may reside anywhere, including their
country of citizenship.
 If you reside reside in Florida or have a
mailing address in Florida, please contact us at 877-211-3654 or Info@internationalriskmanagement.com
before submit your application for ICE.
Is Coverage Under International Citizen
Economy Renewable?
Yes. International Citizen Economy is annually renewable. There are no medical questions
at renewal. Renewal is only subject to your continued eligibility and payment of premiums.
Your renewal premium will be the same as all persons of the same Certificate origination
year, age and gender. If you purchase coverage before you reach the age of 65, and
maintain coverage continuously for 10 years, subject to continued eligibility, you will
automatically be eligible to apply for the International Citizen Senior Plan with no
medical questions.
How Do I Apply for International Citizen Economy?
Click
here for Instant Quotes & Online Application
If you reside in Florida or have a
mailing address in Florida, please contact us at 877-211-3654 or Info@internationalriskmanagement.com
before submit your application for this plans.
Within 5 business days of receipt of
your Application, you will be informed as to the acceptance of your Application and your
Effective Date, or of any additional information required to continue the evaluation of
your Application. Answer each question thoroughly and legibly, and attach additional
sheets if necessary.
If your Application is not accepted, our
Underwriters will promptly refund your premium.
If your Application is accepted, you will receive a fulfillment kit containing your
Certificate of Coverage, an identification card, a claim form, and instructions on how to
use your insurance.
How Do I File a Claim?
Filing a claim is easy. Once your Application is accepted, you will receive a kit which
contains a Claimant's Statement and Authorization form. Just complete this Claimant's
Statement and Authorization form, attach original, itemized bills, and forward them to the plan Administrator. Be sure to complete your
claim form entirely, sign it, and indicate a convenient time and location to contact you
in the event questions arise. If you have already paid certain expenses, attach copies of
your paid receipts. You will be reimbursed for eligible expenses. In many cases, the plan
Administrator will make payment directly to the hospital or physician who treated you.
Remember, you are responsible for the deductible, coinsurance, and any ineligible charges.
Pre-certification
International Citizen Economy contains Pre-notification provisions. Pre-notification
simply means that you must contact the
plan Administrator as soon as possible before a
planned hospitalization or surgical procedure, or within 48 hours of an emergency hospital
admission, or within the first 90 days of pregnancy. Pre-notification allows us to
establish contact and make payment arrangements with your providers, negotiate discounts
which will benefit both you and us, pre-arrange future care, and plan for your claim.
Pre-notification helps us help you.
What Are the Plan Features?
Pre-existing
Conditions:
If your Pre-existing Conditions have been fully disclosed on your Application and not
excluded or restricted by any other provision of your Certificate, your Pre-existing
Conditions are covered up to $5,000 per Certificate Period and $50,000 Lifetime limit
after you have been insured continuously for 24 months. Pre-existing Conditions include
any Injury, Illness or Mental Health disorder that existed at or prior to your initial
Effective Date, including chronic or recurring conditions.
Acute
Onset of Pre-existing Condition:
If your Pre-existing Conditions have been fully disclosed on your Application and the
conditions are not excluded or restricted by any other provision of your Certificate, you
are covered for an Acute Onset of Pre-existing Condition up to $1,000 during the first 12
months of coverage and up to $2,500 during the second 12 months of coverage hereunder. An
Acute Onset of a Pre-existing Condition is a sudden, unexpected outbreak or recurrence of
a Pre-existing Condition, which occurs spontaneously and without advance warning, either
in the form of Physician recommendations or symptoms which would have caused a prudent
person to seek medical attention prior to the outbreak or recurrence. Treatment must be
obtained within 24 hours of the sudden and unexpected outbreak or recurrence.
|
Schedule of Benefits
& Limits |
|
Benefits |
Limits |
|
Coverage Area |
Worldwide |
|
Overall Maximum Limit |
$5,000,000 Lifetime |
|
Deductibles Available |
$250, $500, $1,000, $2,500 or
$5,000 per person per Certificate Period |
|
Coinsurance -- Claims
incurred in US or Canada |
80% of the next $5,000 of
Eligible Medical Expenses after the Deductible, then 100% to the
Overall Maximum Limit. The Coinsurance will be waived if
expenses are incurred within the PPO |
|
Coinsurance -- Claims
incurred outside US or Canada |
100% of Eligible Medical
Expenses after the Deductible to the Overall Maximum Limit |
|
Acute Onset of
Pre-existing Condition |
$1,000 during the first
Certificate Period and $2,500 during the second Certificate
Period |
|
Pre-existing Conditions |
$5,000 per Certificate Period
subject to a Lifetime Maximum of $50,000 (including Acute Onset
claims) after 24 months of continuous coverage hereunder |
|
Maternity |
$5,000 per Pregnancy after 12
months of continuous coverage hereunder, including Inpatient,
Outpatient and other benefits as herein provided. Not subject to
Coinsurance |
|
Newborn care |
$15,000 per covered
Pregnancy, including Inpatient, Outpatient and other benefits as
herein provided, during the first 31 days of life |
|
Organ Transplants |
$250,000 Lifetime maximum for
covered transplants* |
|
INPATIENT BENEFITS
(All Subject to Deductible and Coinsurance) |
|
Hospital Room and Board |
$600 per day, maximum of 240
days per Hospitalization (including ICU days) |
|
Intensive Care Unit (ICU) |
$1,500 per day, maximum of
240 days per Hospitalization (including non ICU days) |
|
Lab, x-rays and other
covered Inpatient services & supplies |
Usual, Reasonable and
Customary Charges (except as limited herein) |
|
OUTPATIENT BENEFITS
(All Subject to Deductible and Coinsurance) |
|
Office Visits (Including
Physician, Specialist Physicial, Psychiatrist, Chiropractor,
Surgical Consultant, Physical or Occupational Therapist) |
25 visits per Certificate
Period per person as provided herein |
|
Physician |
$70 per visit |
|
Specialist Physician |
$70 per visit |
|
Psychiatrist |
$60 per visit, after 12
months of continuous coverage hereunder |
|
Chiropractors |
$50 per visit (must be
prescribed by another non-Chiropractor Physician) |
|
Surgical Consultant |
$500 per consultation prior
to Surgery |
|
Physical or Occupational
Therapy |
$50 per visit (must be
prescribed by a Physician who is not affiliated with the
Physical Therapy practice) |
|
X-rays |
$250 per exam (includes
Sonograms, Ultrasounds and diagnostic Mammograms) |
|
Laboratory |
$300 per exam (includes all
procedures carried out on one specimen) |
|
Emergency Room |
Usual, Reasonable and
Customary |
|
Local Ambulance |
$1,500 per Certificate Period
per person |
|
INPATIENT or OUTPATIENT
BENEFITS (All Subject to Deductible and Coinsurance) |
|
Prescription Medications |
Usual, Reasonable and
Customary |
|
Surgery |
Usual, Reasonable and
Customary |
|
Assistant Surgeon |
20% of Surgeon benefit |
|
Anesthesiologist |
20% of Surgeon benefit |
|
Midwife Services |
$500 per covered Pregnancy |
|
MRI, CAT Scan,
Echocardiography, Endoscopy, Gastroscopy, Colonoscopy and
Cystoscopy |
$600 per exam |
|
Chemotherapy and Radiation
Therapy |
Usual, Reasonable and
Customary |
|
WELLNESS BENEFITS (Not
Subject to Deductible) |
|
Well Child (under age 19) |
$50 per visit for a maximum
of 3 visits per Certificate Period (included in Office Visit
limit), after 12 months of continuous coverage hereunder |
|
Wellness (Adult 19+) |
$250 per Certificate Period,
after 24 months of continuous coverage hereunder, including
Office Visit for $70 and X-Ray and Lab for $180 |
|
OTHER BENEFITS (All
Subject to Deductible and Coinsurance) |
|
Durable Medical Equipment |
Usual, Reasonable and
Customary charges for Wheelchair, Hospital Bed, and/or Toilet |
|
Emergency Medical
Evacuation |
$50,000 Per Certificate
Period |
|
Repatriation of Remains |
$25,000 Lifetime Maximum |
|
Emergency Reunion |
$5,000
Lifetime Maximum |
*Covered transplants include
Heart, Heart/Lung, Lung, Kidney, Kidney/Pancreas, Liver and Allogenic and Autologous Bone
Marrow.
Optional Term Life
Insurance and Accidental Death and Dismemberment
Term Life Insurance
Age |
Basic Life
Principal Sum |
Supplemental Life
Principal Sum |
| 19 to 59 |
$50,000 |
$50,000 |
| 60 to 64 |
$25,000 |
$25,000 |
| 65 to 69 |
$10,000 |
Not Available |
| Dependent Child |
$5,000 |
Not Available |
Accident
Death and Dismemberment
|
Accidental
Death |
Principal
Sum |
Accidental
Loss of Two Members |
Principal Sum |
| Accidental Loss of One
Member |
50% of Principal Sum |
"Member" means
hand, foot or eye. The Benefit is based on your age at time of Death or Dismemberment.
Optional Dental Rider |
Year 1 |
Year 2 |
Year 3
and after |
Preventative
Dental Benefits
Children age 9 through 16 (after 3 months of continuous coverage) |
100% |
100% |
100% |
| Basic Dental
Benefits (after 6 months of continuous coverage) |
50% |
65% |
80% |
| Major Dental
Benefits (after 6 months of continuous coverage) |
30% |
40% |
50% |
| Dental
Deductible |
$100.00 per Certificate Period |
$100.00 per Certificate Period |
$100.00 per Certificate Period |
| Maximum Dental
Benefits |
$500.00 per Certificate Period |
$750.00 per Certificate Period |
$1,000.00 per Certificate Period |
Exclusions and Limitations:
The following charges, treatments, care, services, supplies and/or conditions are excluded
from coverage:
Charges not incurred during the
Certificate Period
Services or treatment payable by another insurance or government
Substance abuse
Charges which exceed usual, reasonable and customary
Investigational or experimental surgeries or treatment
Custodial, educational or rehabilitative care
Weight modification
Cosmetic surgery, unless reconstructive surgery is directly relating to a covered
Illness or Injury
Individuals HIV+ at effective date
Drugs or treatment for sexual dysfunction
Charges for use of Emergency Room for treatment of Illness unless the patient is
directly
admitted to the Hospital as Inpatient for further treatment of that Illness
Drugs or treatment to promote or prevent conception
Devices or procedures to correct sight or hearing
Self-inflicted Injury or Illness
Foot care, unless related to a covered accidental Injury
Treatment or supplies not ordered by a Physician or not Medically Necessary, except for
Wellness benefits provided herein.
Organ transplants, except for covered transplants
Speech, acupuncture or sleep therapy
Acts of terrorism, war, insurrection, riot or any variation thereof
Dental treatment, except emergency treatment following a covered accident, or unless
Dental
Rider is purchased
Orthodontia (Dental Rider Exclusion)
Sealants, Bleaching and oral hygiene expenses (Dental Rider Exclusion)
This is a summary of the exclusions
contained in the Certificate of Insurance. See the Certificate of Insurance for a complete
list of exclusions.
Special Illness Exclusion:
The following conditions which manifest themselves within the first 180 days of coverage
are excluded: any condition of the breast, prostate, the reproductive system, hernia,
gallstones, kidney stones, glaucoma, cataracts, disk disease, tonsils, adenoids,
hemorrhoids, all types of cysts and any disorder or disease of the skin.
Wellness:
After 12 months of continuous coverage, children under the age of 19 are eligible for
Wellness benefits that are not subject to the Deductible. After 24 months of continuous
coverage, adults age 19 and older are eligible for Wellness benefits that are not subject
to the Deductible. Wellness benefits include routine physical exams, tests and
immunizations, as well as mammogram and OB/GYN visits for adult females.
Emergency Medical Evacuation:
International Citizen Economy provides coverage for Emergency Medical Evacuation to the
nearest medical facility qualified to treat your life threatening condition or potential
loss of limb. All Emergency Medical Evacuations must be approved in advance and
coordinated by the Plan Administrator. Emergency Medical Evacuations provide you with
access to care when you need it most. The Plan Administrator, MultiNational Underwriters,
Inc. is available 24 hours a day, 7 days a week to approve and coordinate Emergency
Medical Evacuations as well as other valuable assistance services needed during an
Emergency.
Emergency Reunion:
In the event of a covered Emergency Medical Evacuation, the International Citizen Economy
will provide the following benefits: the cost of an economy round-trip air and/or ground
transportation ticket for one of your relatives (parent, spouse, sibling or child age 18
or older) for transportation to the area where you are hospitalized following Emergency
Medical Evacuation, and reasonable expenses for lodging and meals for your relative for a
period not to exceed 15 days.
Repatriation of Remains:
In the event of a covered Injury or Illness resulting in your death, International Citizen
Economy will provide the following benefit: air or ground transportation of bodily remains
or ashes to the area of your Principal Residence and reasonable cost of preparation of
your remains necessary for transportation.
Optional Dental Insurance:
If you purchase the Dental Rider, children age 9 to 16 are covered for Preventative Dental
care, including routine oral exams every 6 months, fluoride treatment every 12 months and
bitewing x-rays every 24 months. All family members are covered for Basic and Major Dental
procedures. Basic Dental procedures include Periodontics, Endodontics, fillings and
extractions. Major Dental procedures include restorations, crowns, bridges and dentures.
All benefits are subject to Deductible, Coinsurance, and Certificate Period maximums.
Optional Term Life and AD&D Insurance:
If you reside outside the US, you may purchase the Optional Term Life and Accidental Death
and Dismemberment insurance to protect your family and provide cash benefits in the event
of your death. The amount of Basic coverage ranges from $5,000 to $50,000, depending on
your age at the time of your death or dismemberment. If you are at least 19, but not yet
65, you may purchase Supplemental coverage, which doubles the benefits available to you.
International Citizen Assistance Services:
The following Assistance Services are available to you 24 hours a day, 7 days a week while
your International Citizen plan is in effect.
Pre-Trip Health and Safety Advisories (available after your purchase of
the International Citizen Series, and before your departure) - call us for current
passport, visa, inoculation and vaccine requirements, as well as up-to-date travel safety
advisories.
Livetravel Services - we will make emergency travel and itinerary changes
for you including rebooking flights, hotel reservations and ground transportation
arrangements.
BagTrak - we are the industry leaders in tracking lost checked baggage.
We will help you locate your lost checked baggage, and deliver it to you anywhere in the
world.
Emergency Message Relay - we will relay messages to your family, friends
and co-workers, helping you to maintain contact during an emergency.
Emergency Cash Transfers - we will assist you in arranging and obtaining
cash transfers anywhere in the world.
Other International Citizen Assistance Services include:
Medical referrals
Up-to-the-minute travel medical advisories
Assistance with prescription drug replacement
Dispatch of a doctor or specialist
Emergency travel arrangements for family members
Lost passport or travel documents assistance
Embassy and consulate referrals
Legal and accounting referrals
Bail bond assistance
Translation and interpretation assistance
Click
here for Instant Quotes & Online Application
If you reside in Florida or have a mailing address in Florida,
please contact us at 877-211-3654 or Info@internationalriskmanagement.com
before submit your application for this plans.
Click here for Rates of International Economy Citizen
If you have any questions or concerns, please contact us
today.
info@internationalriskmanagement.com
877-211-3654 or
559-294-0316
Thank you for
visiting our website.
www.InternationalRiskManagement.com
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