BROCHURE, RATES and APPLICATION
 iaison®  nternational
Underwritten by Virginia
Surety Company, Inc Rated A
"Excellent" by A.M. Best
Medical Insurance for Persons Traveling
Outside of their Home Country
5 DAYS TO 12 MONTHS (Renewable up to 3 years)
OF
COVERAGE FOR:
 NON-CITIZENS VISITING THE UNITED STATES.
UNITED STATES CITIZENS TRAVELING OVERSEAS.
INTERNATIONAL TRAVELERS REQUIRING CONTINUING COVERAGE
Click here for Online Quotes & Online Application
Please read the Scheduled
Benefits and Exclusions carefully before applying for this plan.
|
SCHEDULE OF COVERAGE
All coverages and plan costs listed in this
brochure are
in U.S. dollar amounts. |
|
Benefits |
Limits |
|
Medical
Coverage Maximum |
$50,000;
$100,000; $500,000; and $1,000,000 (ages 80+, maximum limited to $15,000) |
|
Deductible: |
$0;
$100; $250; $500; $1000; and $2500 Deductible is per person per policy period, maximum of 3
Policy Period deductibles per family. The selected Deductible and Coinsurance amount must
be met for each 12-month period (see Continuing Coverage) |
|
Coinsurance: |
Inside
the United States and Canada: After you pay the deductible, the program pays 80% of the
next $5,000 of eligible expenses, then 100% to the selected Maximum.
Outside the United
States and Canada: After you pay the deductible, the program pays 100% to the selected
Maximum. |
|
Hospital
Indemnity: |
$150 / night (traveling
outside the U.S. and Canada) In addition to any other Covered
Expense. |
|
Dental
(Emergency): |
$100
(or $500 for accidents) Only available to programs purchased for 1 month or more. |
|
Emergency
Medical Evacuation/ Repatriation: |
$300,000
(in addition to the Medical Maximum) |
|
Home
Country Coverage |
Incidental
Trips to The Home Country: $50,000 Follow Me Home Coverage: $5,000 |
|
Return
of Mortal Remains: |
$50,000 |
|
Emergency
Reunion: |
$50,000 |
|
Return
of Minor Child(ren): |
$50,000 |
|
Interruption
of Trip: |
$5,000 |
|
Loss
of Checked Luggage: |
$250 |
|
Local
Ambulance Expense: |
$5,000 |
|
Accidental
Death & Dismemberment (AD&D): |
$25,000
Principal Sum for Insured or Insured Spouse, $5,000 for Dependent Child. |
|
Common
Carrier Accidental Death |
$50,000
per adult, $25,000 per children under age of 18; $250,000 Maximum per family |
|
Hospital
Room & Board: |
Usual,
reasonable and customary to the selected Policy Maximum |
|
Intensive
Care: |
Usual,
reasonable and customary to the selected Policy Maximum |
|
Outpatient
Medical Expenses: |
Usual,
reasonable and customary to the selected Policy Maximum |
|
Terrorism |
Usual,
reasonable and customary to the selected Policy Maximum
(This
benefit not available for states underwritten by certain Underwriters at
Lloyd's of London) |
|
Waiver
of Pre-Existing Conditions: |
Up to
$20,000 for U.S. citizens traveling outside the United States and Canada (refer to
exclusion #1 for details) |
|
Benefit
Period: |
Six
months
|
-
 WHY INTERNATIONAL MEDICAL INSURANCE?
Each year, millions of people travel outside of their Home Country, beyond the boundaries
of their medical insurance. If you are concerned with the potential out-of-pocket expenses
that could result from an injury or illness while traveling, Liaison International offers
medical coverage and emergency services to individuals and families traveling outside
their Home Country. This brochure is a brief description of Liaison International.
Once you
are approved for coverage a complete Program Summary will be mailed to you.
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.
PERIOD OF COVERAGE
The minimum period of coverage under Liaison International is 5 days, maximum is 12
months (see Continuing Coverage section). Coverage can be purchased in a combination of
monthly and/or daily periods by paying the appropriate plan cost.
If you are traveling for a long period of time, please refer to "Continuing
Coverage" section.
- Effective Date
Your coverage will begin on the latest of the following: 1) The moment you depart your
Home Country; or 2) The date and time the Application and full plan cost is received and
accepted by Seven Corners, Inc.; or 3) The date requested on the Application.
Expiration Date
Coverage will end on the earlier of the following: 1) Your return to your Home Country *;
or 2) The date shown on the ID Card, for which plan cost has been paid; 3) The date you
are no longer eligible under this plan *See Home Country Coverage Section.
Please read the Scheduled
Benefits and Exclusions carefully before applying for this plan.
DESCRIPTION OF COVERAGE
 Medical
When you incur a covered Injury or Illness, the program will pay Usual, Reasonable and
Customary medical charges for Covered Expenses, excess of the chosen Deductible and
Coinsurance, up to the selected Policy Maximum. Only such expenses, incurred as the result
of a disablement, which are specifically enumerated in the following list of charges, are
incurred within six months from the onset of an Injury or Illness, and which are not
excluded in the Exclusions, shall be considered as Covered Expenses:
- 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.
- Charges made for Intensive Care or Coronary Care
charges and nursing services.
- Charges made for diagnosis, treatment and Surgery by
a Physician; charges made for the cost and administration of anesthetics.
- 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.
- 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.
- Charges for physiotherapy, if recommended by a
Physician for the treatment of a specific Disablement and administered by a licensed
physiotherapist.
- Ground ambulance (within the metropolitan area) to
and from the nearest Hospital with facilities for required treatment. If the Insured
Person is in a rural area, then licensed air ground ambulance transportation to the
nearest metropolitan area shall be considered a Covered Expense.
- 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.
- Charges made for artificial limbs, eyes, larynx, and
orthotic appliances, but not for replacement of such items.
Dental - Emergency Only -
The Emergency Dental Benefit is
available to you provided you have purchased 1 or more months of coverage . Treatment
necessary to resolve acute, spontaneous and unexpected inception of pain to sound natural
teeth ($100) or Dental treatment necessary to restore or replace sound natural teeth lost
or damaged in an Accident which is covered under the program ($500). This benefit is
subject to the Deductible and Coinsurance.
Emergency Medical Evacuation/Repatriation -
The program will pay
Covered Expenses incurred if any covered Injury or Illness commences during the Period of
Coverage that results in the Medically Necessary Emergency Medical Evacuation or
Repatriation (your medical condition warrants immediate transportation from the medical
facility where you are located to the nearest adequate medical facility where medical
treatment can be obtained). The benefit must be ordered by the Assistance Company in
consultation with the local attending Physician.*
Return of Mortal Remains -
The Program will pay the reasonable
Covered Expenses incurred up to a maximum of $50,000 to return your remains to your Home
Country, if you should die.*
Emergency Medical Reunion -
When Emergency Medical Evacuation or
Repatriation is ordered and the attending Physician recommends that a family member travel
with you, the program will arrange and pay, up to $50,000, for a round trip economy-class
transportation for one individual of your choice, from your Home Country, to be at your
side while you are hospitalized and then accompany you during your return to your Home
Country.
Return of Minor Child(ren) -
Should you 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 program will arrange and pay up to
$50,000 for one way economy fare to their Home Country (including the cost of an
attendant/escort, if necessary to insure the safety and welfare of a Minor Child(ren)).*
Hospital Indemnity - If you are hospitalized while traveling
outside of the United States or Canada, and the hospitalization is considered a Covered
Expense, the program will indemnify you a $150 for each night spent in the hospital
(this
benefit is in addition to any other covered expenses of the program).
Interruption of Trip - If you are unable to continue the Trip due
to the death of an Immediate Family member (parent, spouse, sibling, or child) or due to
serious damage to your principal residence from fire, flood or similar natural disaster
(tornado, earthquake, hurricane, etc.). The program will reimburse you (up to $5,000) for
the cost of economy travel, less the value of applied credit from an unused return travel
ticket, to return you home to your area of principal residence. *
Loss of Checked Luggage -
If your checked luggage is permanently
lost by the airline, the program will reimburse you for the replacement of clothing and
personal hygiene items lost to a maximum per bag limit of $50 (up to $250). This benefit
is secondary to any other (including airline) coverage available. You must furnish proof
to the Company that full reimbursement has been obtained from the airline. *
Assistance Services -
Upon enrollment into Liaison
International, you are eligible to use any of the assistance services provided by the
Assistance Services Provider. Additional information is contained in the Program Summary.
Open 24 hours / day, 365 days a year, Multilingual personnel, Physicians / Nurses on
staff, Locate local facilities to Help with emergency situations.
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 first diagnosed outside Your Home Country
(Does not apply for Emergency
Evacuation or Repatriation).
* :
In the event of an Emergency Medical Evacuation,
Repatriation, Return of Mortal Remains, Emergency Reunion, Return of Minor Child(ren),
Interruption of Trip, Loss of Checked Luggage benefit is needed or utilized, arrangements
must be made by the Assistance Service Provider. Complete details about the benefits and
about the required notification of the Assistance Service Provider are contained in the
Program Summary.
OPTIONS
Continuing Coverage
For those who are intending longer international trips, an option is available to you. If
you choose this option on the application and enroll for at least three (3) months of
coverage, a notice will be sent to your address of correspondence, allowing you to
purchase an additional period of coverage (minimum of 1 month, maximum of 12 months). If
you purchase at least three months of coverage, SRI will continue to send notices to your
address of correspondence. If you choose to purchase less than three months of coverage,
SRI will assume that your international trip is complete and will not send any further
notices.
While a new period of coverage will be issued, your
original effective date will be used with regards to calculating your deductible and
coinsurance (for up to a total of 12 months, then both will begin again), as well as
determining any pre-existing conditions. Since SRI's Benefit Period states that the
program will pay up to a total of 6 months for any one eligible condition, you can be
protected beyond your period of coverage.
The maximum period of time SRI will offer this
feature is three years (one year for persons age 65 and over). It is important to note
that rates and benefits may change for each subsequent period of coverage. A $5.00
Administrative Fee will be included on each notice. This option is not available if you
allow coverage to expire prior to reapplying. If this happens, an entirely new program
must be purchased (pre-existing condition begins again).
Continuing Coverage is available in periods as short
as 5 days at a time when purchased using Seven Corners' online system.
Hazardous Sport Coverage - To cover motorcycle/motor scooter
riding, mountaineering (4500 meter limit), hang gliding, parachuting, bungee jumping,
water skiing, snow skiing, snowmobiling, and snow boarding.
PRE-NOTIFICATION / REFERRAL
In order to ensure your claims are addressed as efficiently as possible, you or the
provider of service must contact the Assistance Company for pre-notification prior to any
medical treatment in the U.S., as well as hospital admissions and inpatient / outpatient
surgeries incurred worldwide. The Assistance Company has trained personnel available 24
hours a day, 7 days a week throughout the year to answer your questions, provide
assistance, and guide you to an appropriate facility if necessary. In the case of an
Emergency Admission, the Assistance Company must be contacted within 48 hours, or as soon
as reasonably possible. Pre-notification does not guarantee that benefits will be paid.
Failure to pre-notify will result in a 20% reduction in Eligible Benefits.
Please be aware that this is not a general health insurance policy, but an interim,
limited benefit period, travel medical program intended for use while away from your Home
Country. Liaison International does not guarantee payment to a facility or
individual for medical expenses until the Plan Administrator determines that it is an eligible expense.
REFUND OF PREMIUM
The Plan Administrator realizes that there is uncertainty in international travel. Refund
of total plan cost will only be considered if written request is received by the
Plan Administrator 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 the Plan Administrator
for reimbursement.
CLAIM SUBMISSION
Filing a claim is easy. You will receive a Liaison International identification card and
claim form once you are approved for insurance. When you receive treatment, send the
original, itemized bills to the Plan Administrator within 90 days. Eligible
bills are automatically converted from local currencies to US dollars. For payments of
eligible medical expenses, notify the Plan Administrator of pending treatments and we can
refer you to approved health care providers worldwide. You're only responsible for your
deductible, coinsurance amounts and non-eligible expenses. For more details, consult the
Program Summary that is provided with your insurance kit, or contact the Claim Department.
EXCLUSIONS
For Medical benefits, this Insurance does not cover:
- Any Injury or Illness which meets the following
criteria: a) condition(s) that would have caused a person to seek medical advise,
diagnosis, care or treatment during the 36 months prior to the Effective Date of coverage
under this Policy;
b) condition(s) for which manifestation, medical advise, diagnosis,
care or treatment was recommended, received, or noticed during the 36 months prior to the
Effective Date of coverage under this Policy;
- If you are 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.
- 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.
- Expenses which were not recommended, approved and
certified as Medically Necessary and reasonable by a Physician.
- Suicide or any attempt there at, while sane or self
destruction or any attempt there at, while insane; intentionally self-inflicted Injury or
Illness; or expenses as a result or in connection with the commission of a felony offense.
- 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.
- Injury sustained while participating in professional,
sponsored and/or organized Amateur or Interscholastic Athletics.
- Routine physicals, inoculations, or other
examinations where there are no objective indications or impairment in normal health.
- Treatment of the Temporomandibular joint.
- Services or supplies performed or provided by a
Relative of yours, or anyone who lives with you.
- 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 care or eye related
expenses, unless caused by Accidental bodily Injury incurred while insured hereunder.
- 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.
- Congenital abnormalities and conditions arising out
of or resulting therefrom.
- Expenses incurred during a hospital emergency room
visit which is not of an emergency nature.
- Injury sustained while taking part in mountaineering
where ropes or guides are normally used, 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. *
- Treatment paid for or furnished under any other
individual, government, or group policy or charges provided at no cost to you.
- Treatment of venereal or sexually transmitted
disease.
- Pregnancy expenses or Illness resulting from
pregnancy, childbirth, or miscarriage; or for miscarriage resulting from an Accident.
- Drug, treatment or procedure that either promotes or
prevents conception, or prevents childbirth.
- Expenses incurred while you are in your Home Country
(except as provided under the Home Country Coverage benefit).
- 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.
* Options are available to include all or part of these risks.
THE INSURANCE COMPANY
Liaison International is underwritten by Virginia Surety Company, Inc., rated A-
"Excellent" by A.M. Best and located in Illinois.
(In NY, OR, KS, the plan is
underwritten by Certain Underwriters at Lloyd's, London.)
INFORMATION
This Insurance, under Policy HTP01158B is underwritten by: Virginia Surety Company, Inc.
Policy terms and conditions are briefly outlined in
this brochure.
Complete provisions pertaining to this insurance are
contained in the Master Policy on file with the trustee, American Consumer Insurance
Trust, and Liaison International. In the event of any conflict between this brochure and
the Master Policy, the Policy will govern. A Program Summary, listing more detailed
exclusions, will be mailed to you along with Your ID Card once coverage is purchased.
Notice to Florida residents:
the benefits of this policy providing your coverage are governed by the law of a state
other than Florida. Your Homeowners policy, if any, may provide coverage for loss of
personal effects provided by the Loss of Checked Luggage coverage. This insurance is not
required in connection with the purchase of your travel arrangements.
Click here for Online Quotes & Online Application
Please read the Scheduled
Benefits and Exclusions carefully before applying for this plan.
If you have
any questions or concerns, please contact us .
info@internationalriskmanagement.com
877-211-3654 or
559-294-0316
|
