Atlas America Insurance Plan

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Atlas America Visitor Travel Medical Insurance Plan

• Why Buy Atlas Travel Insurance?
  
• Am I Eligible for the Atlas Series?
  
• When Does Coverage Become Effective and When Does It End?
  
• Does The Atlas Series Provide Any Home Country Coverage?
  
• How is "Home Country" Defined?
  
• Which Plan Should I Purchase?
  
• What Is Covered?
  
• What Are The Policy Limits?
  
• What Is Excluded?
  
• What If I Plan to Participate in a Sport or Athletic Activity that is Excluded?
  
• What If I Have an Acute Onset of a Pre-Existing Condition?
  
• What Are the Pre-Notification Requirements?
  
• Who Is The Plan Administrator?
  
• Who Is The Insurer?
  

 
Why Buy Atlas Travel Insurance?

 
Am I Eligible For The Atlas Series?

 
When Does Coverage Become Effective and When Does It End?

 
Does The Atlas Series Provide Any Home Country Coverage?

 
How is "Home Country" Defined?

 
Which Plan Should I Purchase?

 
What Is Covered?

Medical:

1. Inpatient and Outpatient charges made by a Hospital.
2. Charges made by a Physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the Physician has referred the case.
3. Charges made for dressings, sutures, casts or other supplies prescribed by the attending Physician or specialist.
4. Charges for diagnostic testing using radiology, ultrasonographic or laboratory services.
5. Charges for oxygen and other gases and anesthetics and their administration.
6. Charges for prescription drugs, for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs.
7. Charges made by a licensed Extended Care Facility upon direct transfer from an acute care Hospital.
8. Emergency local ambulance transport incurred in connection with Injury or Illness resulting in hospitalization.

Emergency Dental:

1. Emergency Dental treatment and Dental surgery necessary to restore or replace sound natural teeth lost or damaged in an Accident which is covered under this insurance.
2. Emergency Dental treatment necessary to resolve acute, spontaneous and unexpected onset of pain.

Emergency Evacuation:

If recommended by your attending Physician, who certifies that Evacuation is necessary to safeguard your life and that Medically Necessary treatment is not available locally, and if approved in advance and coordinated by MultiNational Underwriters, Inc., the Atlas Series will provide the following benefits: Emergency air and/or ground transportation to the nearest Hospital that is qualified to provide the Medically Necessary treatment.

Emergency Reunion:

In the event of a covered Emergency Evacuation, the Atlas Series 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 Evacuation and reasonable expenses for lodging and meals for your relative, for a period not to exceed 10 days.

Trip Interruption:

1. If, after you have departed, you learn of the death of a parent, spouse, sibling or child, or you learn of the substantial destruction of your Principal Residence by fire or weather, the Atlas Series will provide the following benefit: The cost of an economy one way air and/or ground transportation ticket for you to the area of your Principal Residence; or
2. Following a covered Emergency Evacuation, the attending Physician states that it is Medically Necessary for your return to your Home Country or to the area from which you were initially evacuated for continued treatment, recuperation and recovery, the Atlas Series will provide the following benefit: The cost of a one way economy air and/or ground transportation ticket for your transportation from the area where you were hospitalized following the Emergency Evacuation, to the area where you were initially evacuated from, or to the terminal serving the area of your Principal Residence.

Repatriation of Remains:

Lost Checked Luggage:

In the event your checked luggage is permanently lost by the carrier, the Atlas Plan will provide the following benefit: Up to $250 for replacement of clothes and personal hygiene items, not to exceed $50 for any one item. You must file a formal claim with the transportation provider and provide the Plan Administrator with copies of all claim forms and proof that the transportation provider has paid you its normal reimbursement for the lost checked luggage.

Accidental Death and Dismemberment:

1. Accidental Death - Principal Sum of $25,000 to the Beneficiary designated on your Application. The Principal Sum shall reduce by 50% (to $12,500) if you are age 70 to 74 at time of Death, and an additional 50% (to $6,250) if you are age 75 or older at time of Death.
2. Accidental Dismemberment
   a. Loss of 2 eyes or 2 or more limbs -- Principal Sum of $25,000 to you.
   b. Loss of 1 eye or limb - One-half of the Principal Sum ($12,500) to you.
   c. The Principal Sum(s) shall reduce by 50% if you are age 70 to 74 at time of Dismemberment, and an additional 50% if you are age 75 or older at time of Dismemberment.
3. The Accidental Death Dismemberment benefit is deleted during participation in a hazardous sport

Common Carrier Accidental Death:

Return of Minor Child(ren):

Atlas Travel Assistance Services:

Other important Atlas Travel 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

 
Schedule of Benefits and Limits

 
What Is Excluded?

1. Pre-existing Conditions - Charges resulting directly or indirectly from any Pre-existing Condition are excluded from this insurance, except, if you purchase Atlas Extra or Atlas International, you are covered for charges resulting from an Acute Onset of a Pre-existing Condition, up to the limit set forth in the Schedule of Benefits and Limits. A Pre-existing Condition is any Illness, Injury or medical condition or chronic or recurring Illness or Injury or medical condition, including any associated complications or consequences, which existed at or during the 5 years immediately preceding your effective date. An Acute Onset is a sudden and 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. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.
2. Treatment for or related to any congenital condition.
3. Pregnancy, child birth, birth control, artificial insemination, infertility, impotency or sexual dysfunction, sterilization or reversal thereof.
4. Mental Health Disorders or Substance Abuse.
5. Not incurred during the Certificate Period or the applicable Benefit Period, and charges which are not presented to Underwriters for payment within 60 days from the end of the Certificate Period or the applicable Benefit Period.
6. 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.
7. Not Medically Necessary and administered or ordered by a Physician.
8. Provided at no cost, or by a family member, or by a person who ordinarily resides with you, or which are attributable to or recoverable from any other party including government sponsored plans.
9. Charges which exceed Usual, Reasonable and Customary.
10. Investigational, Experimental or for Research purposes.
11. While confined primarily to receive Custodial Care, Educational or Rehabilitative care.
12. Venereal Disease, AIDS or ARC.
13. Dental treatment, including treatment of the temporomandibular joint, except for Emergency Dental treatment necessary to replace sound natural teeth lost or damaged in an Accident covered hereunder or for the relief of Acute, spontaneous and unexpected onset of pain.
14. Eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, orthoptics or visual eye training or eye surgery (including cataract surgery and radial keratotomy) or for any examination or fitting related to these devices or procedures.
15. Injury sustained while taking part in the following activities: Amateur or professional sports or athletics, except this does not include Amateur sports or athletics which are non-contact and undertaken solely for leisure, recreational, entertainment or fitness purposes unless such sports or athletics are otherwise excluded by this provision. The following are excluded: Mountaineering where ropes or guides are normally used or at elevations of 4,500 meters or higher. Aviation, except when traveling solely as a passenger in a commercial aircraft. Hang gliding, sky diving, parachuting or bungee jumping; Snow skiing or snowboarding, except for recreational downhill and/or cross-country snow skiing or snowboarding (no cover provided whilst skiing away from prepared and marked in-bound territories and/or against the advice of the local ski school or local authoritative body); Racing by any animal or motorized vehicle; and spelunking; and subaqua pursuits involving underwater breathing apparatus unless NAUI/PADI certified, accompanied by a certified instructor, and at depths of less than 10 meters; jet skiing; and any other sport or athletic activity which is undertaken for thrill seeking and exposes you to abnormal or extreme risk of injury.
16. Injury sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician but not for the treatment of Substance Abuse.
17. Willfully self-inflicted Injury or Illness and immunizations and Routine Physical Exams.
18. The Deductible, and Coinsurance and charges which are not included as Eligible Expenses as described in the Master Policy, and charges which exceed the policy limits.
19. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder.
20. Charges for travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, Emergency Reunion and Trip Interruption sections of this insurance.
21. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
22. Organ or tissue transplants or related services.
23. Acts of terrorism, war, insurrection, riot or any variation thereof.
24. Treatment by a Chiropractor.
25. Diseases of the skin.

 
What If I Plan to Participate in a Sport or Athletic Activity that is Excluded?

 
What If I Have an Acute Onset of a Pre-Existing Condition?

 
What Are the Pre-Notification Requirements?

 
Who Is The Plan Administrator?

 
Who Is The Insurer?

*Times expressed above are based on US Eastern Time.

Incidental Home Country Coverage – The Atlas Series will provide you 15 days of incidental coverage for trips to your Home Country for every 3 months of coverage purchased. Incidental visit time must be used within the three-month period earned, and you must continue your international trip in order to be eligible for this benefit, which covers Medical expenses only. Return to your Home Country must not be taken for the purpose of obtaining treatment of an Illness or Injury that began while traveling.

Benefit Period Medical Coverage – A Benefit Period begins on the first date you receive a diagnosis or treatment of a covered Illness or Injury while outside your Home Country and lasts for 180 days. If you started a Benefit Period while this insurance was in effect, you are covered only for Medical expenses related to that covered Illness or Injury for the duration of the Benefit Period, regardless of whether you are at home or abroad.

End of Trip Home Country Medical Coverage – If you are covered under the Atlas Series and outside of your Home Country continuously (except for covered Incidental Trips as described above) for six (6) months or more you may purchase an additional 30 days of End of Trip Home Country Medical Coverage.

Home Country Defined – If you are a US citizen, your Home Country is the United States, regardless of the location of your Principal Residence. If you are not a US citizen, your Home Country is the country where you principally reside and receive regular mail.

Medical:

1. Inpatient and Outpatient charges made by a Hospital
2. Charges made by a Physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the Physician has referred the case
3. Charges made for dressings, sutures, casts or other supplies prescribed by the attending Physician or specialist, but excluding nebulizers, oxygen tanks, diabetic supplies and all devices for repeat use at home
4. Charges for diagnostic testing using radiology, ultrasonographic or laboratory services
5. Charges for oxygen and other gases and anesthetics and their administration
6. Charges for prescription drugs for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs
7. Charges made by a licensed Extended Care Facility upon direct transfer from an acute care Hospital
8. Emergency local ambulance transport incurred in connection with Injury or Illness resulting in inpatient hospitalization

Treatment of Complications of Pregnancy during the first 26 weeks of Pregnancy is covered under this insurance. Complications of Pregnancy is defined as: Illnesses whose diagnoses are distinct from Pregnancy, but are adversely affected by Pregnancy or caused by Pregnancy, and not associated with a normal Pregnancy. This includes: ectopic Pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed abortion and conditions of comparable severity.

If you are hospitalized as an Inpatient for treatment of a covered Illness or Injury, the Atlas Series will provide $100 for each night you spend in the hospital. This benefit is in addition to payments for other covered expenses and is not subject to Deductible or Coinsurance.

If you are under age 70, you are covered for an Acute Onset of a Pre-existing Condition. Coverage is available up to $15,000 Lifetime Maximum for Eligible Medical Expenses and up to $25,000 Lifetime for Emergency Medical Evacuation. An Acute Onset of a Pre-existing Condition is a sudden and 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. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

The following Emergency Dental expenses are covered: Emergency Dental treatment and Dental surgery necessary to restore or replace sound natural teeth lost or damaged in an Accident that is covered under this insurance subject to the Overall Maximum Limit; and Emergency Dental Treatment necessary to resolve acute, spontaneous and unexpected onset of pain subject to a maximum benefit of $100.

If the United States government issues a travel warning that becomes effective after your arrival in your destination country, the plan will provide for transportation to the nearest place of safety or for return to your Home Country. You must contact HCCMIS within 10 days of the date the travel warning is issued and the evacuation must be approved in advance and coordinated by HCCMIS.

If recommended by your attending Physician, who certifies that Evacuation is necessary to safeguard your life and that Medically Necessary treatment is not available locally, and if approved in advance and coordinated by HCCMIS, the Atlas Series will provide the following benefits: Emergency air and/or ground transportation to the nearest Hospital that is qualified to provide the Medically Necessary treatment.

In the event of a covered Emergency Medical Evacuation, the Atlas Series 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 travel 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.

If you are the only person age 18 or older, traveling with one or more children under the age of 18, who are also covered by the Atlas Series, and you are Hospitalized for treatment of a covered Illness or Injury resulting in the children being left unattended for a period of time expected to exceed 36 hours, the Atlas Series will provide the following benefit: The cost of a one-way economy air and/or ground transportation ticket for each covered child to the terminal serving the area of Principal Residence of each covered child.

The Atlas Series provides Medical coverage for Injuries and Illnesses resulting from an Act of Terrorism, subject to a $50,000 Lifetime Maximum, provided all of the following conditions are met:

1. The Injury or Illness does not result from chemical, nuclear or biological weapons or events.
2. You have no direct or indirect involvement in the Act of Terrorism.
3. The Act of Terrorism is not in a country or location where the United States government has issued a travel warning that has been in effect within the 6 months prior to your date of arrival.
4. You have not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United States government.

An Act of Terrorism is defined as: an act, including but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.

• Accidental Death – Principal Sum to the Beneficiary designated on your Application
• Loss of 2 eyes or 2 or more limbs – Principal Sum to you
• Loss of 1 eye or 1 limb – One-half of the Principal Sum to you

The Accidental Death and Dismemberment benefit is not available for losses incurred during participation in a Hazardous Sport or in respect to losses resulting from an Act of Terrorism.

In the event of your Accidental Death while traveling on board a commercial common carrier, the Atlas Series will provide the following benefit: Principal Sum of $50,000 ($25,000 for children under age 18), subject to a maximum of $250,000 per family, to the Beneficiary designated on your Application. This benefit is not available in respect to losses resulting from an Act of Terrorism.

In the event of a covered Injury or Illness resulting in your death, the Atlas Series will provide the following benefit: Air and/or ground transportation of bodily remains or ashes to the area of your Principal Residence, and reasonable costs of preparation of your remains necessary for transportation.

In the event of natural disaster (hurricane, flood, tornado, tsunami, etc) the Atlas Series will provide you up to $100 a day for 5 days if you are Displaced from planned, paid accommodations due to evacuation from forecasted disaster or following a disaster strike. Displaced is defined as required to depart the destination due to an evacuation ordered by prevailing authorities. Proof of paid accommodations must be submitted at time of claim.

1. If, after you have departed, you learn of the death of a parent, spouse, sibling or child, or you learn of the substantial destruction of your Principal Residence by fire or weather, the Atlas Series will provide the following benefit: The cost of an economy, one way air and/or ground transportation ticket for your travel to the area of your Principal Residence; or
2. If, following a covered Emergency Medical Evacuation, the attending Physician states that it is Medically Necessary for your return to your Home Country or to the area from which you were initially evacuated for continuing treatment, recuperation and recovery, the Atlas Series will provide the following benefit: The cost of an economy, one-way air and/or ground transportation ticket for your travel from the area where you were hospitalized following the Emergency Medical Evacuation to the area where you were initially evacuated from, or to the terminal serving the area of your Principal Residence.

In the event your checked luggage is permanently lost by the transportation provider, the Atlas Series will provide the following benefit: Up to $250 for replacement of clothes and personal hygiene items, not to exceed $50 for any one item. You must file a formal claim with the transportation provider and submit copies of all claim forms and proof that the transportation provider has paid you its normal reimbursement for the lost checked luggage.

1. Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition are excluded from this insurance. If you are under age 70, you are covered for Medical and Emergency Evacuation charges resulting from an Acute Onset of a Pre-existing Condition, up to the limit set forth in the Schedule of Benefits and Limits. A Pre-existing Condition is any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Pre-existing Condition. An Acute Onset is a sudden and unexpected outbreak or recurrence of a Pre-existing Condition, that occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence
2. Treatment for or related to any congenital condition
3. Routine pre-natal care, childbirth, care of newborns, post-natal care, birth control, artificial insemination, infertility, impotency or sexual dysfunction, sterilization or reversal thereof
4. False labor, edema, prolonged labor, prescribed rest during the period of Pregnancy, morning sickness and conditions of comparable severity associated with management of a difficult Pregnancy, and not constituting a medically distinct Complication of Pregnancy, and all charges related to Pregnancy after the 26th week of Pregnancy
5. Mental Health Disorders or Substance Abuse
6. Charges which are not Incurred during the Certificate Period or the applicable Benefit Period, and charges which are not presented to Underwriters for payment within 60 days from the end of the Certificate Period or the applicable Benefit Period
7. Charges for treatment of any condition when the purpose of departing the Home Country was to obtain treatment in the destination country/countries
8. Charges for use of Emergency Room within the US for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
9. Not Medically Necessary and administered or ordered by a Physician
10. Provided at no cost, by a family member, or by a person who ordinarily resides with you, or which are attributable to or recoverable from any other party including government-sponsored plans
11. Charges which exceed Usual, Reasonable and Customary
12. Investigational, Experimental or for Research Purposes
13. While confined primarily to receive Custodial Care, Educational or Rehabilitative care
14. Venereal Disease, and treatment of individuals who are HIV+ or have AIDS or ARC
15. Treatment by a Chiropractor
16. Treatment for acne, other acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus
17. Dental treatment, including treatment of the temporomandibular joint, except for Emergency Dental Treatment necessary to replace sound natural teeth lost or damaged in an Accident covered hereunder or for the relief of acute, spontaneous and unexpected onset of pain
18. Eyeglasses, vision exams, contact lenses, hearing tests, hearing aids, hearing implants, eye refraction, visual therapy, orthoptics or visual eye training or eye surgery (including cataract surgery and radial keratotomy) or for any examination or fitting related to these devices or procedures
19. Injury resulting from participation in the following activities: Amateur Athletics, Contact Sports, and professional sports or athletic activities. Non-contact and non-organized/non-sanctioned amateur sports or athletic activities engaged in by the Member solely for leisure, recreational, entertainment or fitness purposes are not excluded except the following which are excluded: Mountaineering where a reasonably prudent person would use ropes or guides or at elevations of 4,500 meters or higher. Aviation, except when traveling solely as a passenger in a commercial aircraft. Hang gliding, sky diving, parachuting or bungee jumping; Snow skiing or snowboarding, except for recreational downhill and/or cross-country snow skiing or snowboarding (no cover provided whilst skiing away from prepared and marked in-bound territories and/or against the advice of the local ski school or local authoritative body); Racing by any animal or motorized vehicle; and spelunking; and subaqua pursuits involving underwater breathing apparatus unless NAUI/PADI certified, accompanied by a certified instructor, and at depths of less than 10 meters; jet skiing; and any other sport or activity which is undertaken for thrill seeking and exposes you to abnormal risk of injury
20. Injury sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician but not for the treatment of Substance Abuse
21. Willfully self-inflicted Injury or Illness and immunizations and Routine Physical Exams
22. The Deductible, Coinsurance and charges which are not included as Eligible Expenses as described in the Master Policy, and charges which exceed the limits set forth in the Schedule of Benefits and Limits
23. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder
24. Charges for travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical or Political Evacuation, Repatriation of Remains, Emergency Reunion, Return of Minor Children, Natural Disaster and Trip Interruption sections of this insurance
25. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s)
26. Organ or tissue transplants or related services
27. Acts of Terrorism, except as provided for herein, war, insurrection, riot or any variation thereof
28. Treatment of all forms of cancer/neoplasm

If you are covered under Atlas International, after 12 months of continuous coverage you may renew your coverage for up to 12 additional months. If 24 months of continuous coverage is maintained, a final period of up to 12 months may be purchased. Deductible and Coinsurance must be re-satisfied as of each renewal date.

After 36 months of continuous coverage under Atlas International, or 12 months of continuous coverage under Atlas America, or any break in coverage, a new plan must be purchased. A new Application is required and you must re-satisfy your Deductible, Coinsurance and Pre-existing Condition provisions.

Extensions or renewals must be made online with payment by credit card. For additional information on extending or renewing your plan, please visit Client Zone.

1. a $25 cancellation fee will apply; and
2. only the unused portion of the plan cost will be refunded; and
3. only members who have no claims are eligible for premium refund.

• Change personal information
• Renew coverage and reprint ID cards
• Obtain details about claim filing, including downloading necessary forms
• Pre-certify for certain medical procedures and hospitalizations
• Locate providers within the PPO Network
• Study destination, weather and travel security information using our Travel Intelligence and Planning System (TIPS)
• Access health and wellness information
• View and download brochures, obtain policy information, or get quotes for other products offered by HCCMIS

You may access Client Zone by logging in at https://zone.hccmis.com/clientzone/.

If you prefer to speak to one of our professional representatives, you may contact our World Service Center by calling toll-free from various countries around the world or by calling collect. Our World Service Center can provide you with service in many different languages.