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Diplomat America Insurance - Plan DetailsDiplomat America Insurance - Included BenefitsDiplomat America Insurance is an excellent visitor medical insurance policy. Diplomat America Insurance provides Accident and Sickness medical coverage, travel assistance, and Accidental Death and Dismemberment benefits to foreign nationals while visiting the United States. Eligibility Period of Coverage Description of Benefits Covered Expenses Policy Maximums Deductible Choices Co-insurance Additional Benefits Definitions Exclusions Accidental Death & Dismemberment Benefits Accidental Death & Dismemberment Exclusions Optional Riders ELIGIBILITYDiplomat America provides Accident and Sickness medical coverage, travel assistance, and Accidental Death and Dismemberment benefits to foreign nationals while visiting the United States. Coverage is available for you, your spouse and unmarried dependent children, ages 14 days up to 18 years, while traveling to the United States. Coverage for traveling outside the United States is available through the Diplomat America and Diplomat LT programs. Brochures and rates are available from your agent. Customized Group Coverage is also available. PERIOD OF COVERAGEThe minimum period of coverage that can be purchased under this plan is 15 days and the maximum is 12 months. You can also combine these two increments to suit your travel needs. Rates are listed on the back of this brochure. This plan is not renewable. EFFECTIVE DATECoverage will begin on the latest of the following: a) Your departure from your Home Country ; or b) The date your completed enrollment form and correct premium are received by Global Underwriters; or c) The effective date requested on the enrollment form. EXPIRATION DATECoverage will end on the earlier of the following: a) Your permanent return to your Home Country; or b) Twelve months after your coverage's effective date; or c) The termination date shown on the enrollment form, for which premium has been paid. REFUND OF PREMIUMRefund of premium, less a $25 processing fee, will be considered only if written request is received by Global Underwriters prior to the effective date of coverage. After that date, the premium is considered fully earned and non-refundable. Partial refunds are not available. Description of BenefitsAll coverage, benefits and premiums are in U.S. Dollar amounts. If an Injury or Illness occurs in the USA during the Period of Coverage and the Insured Person requires medical or surgical treatment; this plan will pay, subject to the selected deductible and co-insurance, the following Covered Expenses, up to the selected policy maximum. Covered ExpensesOnly such expenses incurred as the result of and within 52 weeks from a Disablement, which shall mean an illness or an accidental bodily Injury necessitating medical treatment, and which are specifically enumerated in the following list of charges: 1. Charges made by a Hospital for room and board, floor nursing and other services, including charges for professional services, except personal services of a non-medical nature, provided, however, that expenses do not exceed the Hospital's average charge for semi-private room and board accommodation, or two (2) times the average semi-private room charge if confinement to an intensive care unit is required, or the actual charge for an intensive care unit made by the servicing Hospital, whichever is less; 2. Charges made for diagnosis, treatment and surgery by a Physician; 3. Charges made for the cost and administration of anesthetics; 4. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radio-active isotopes, oxygen, blood transfusions, iron lungs, and medical treatment; 5. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist; 6. Hotel room charge, when the Insured, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to the unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond the control of the Insured; 7. Dressings, drugs, and medicines that can only be obtained upon written prescription of a Physician. With regard to chiropractic care, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed chiropractor, 80% of eligible charges up to $35.00 per visit, with a maximum of 10 visits per Injury or Illness is allowable. The charges enumerated above shall in no event include any amount of such charges which are in excess of Regular & Customary charges. A charge incurred by an Insured shall be deemed a regular and customary charge for the services and supplies for which the charge is made if it is not in excess of the average charge for such services and supplies in the locality where received, considering the nature and severity of the Illness or bodily Injury in connection with which such services and supplies are received. If the charge incurred is in excess of such average charge such excess amount shall not be recognized as Covered Expenses. 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. The maximum total payment under the policy for an Illness that is first manifested, treated or diagnosed during an Insured Person's first thirty (30) days of coverage, commencing as of the Insured Person's effective date, is $1,000. Policy Maximum ChoicesPlan A - $50,000 Plan B - $100,000 Plan C - $250,000 Plan D - $500,000 Persons up to age 59 are eligible for all plans; Persons age 60-69 are eligible for plans A, B, and C; Presons age 70+ are eligible for plan A only. Deductible Choices$100, $250, $500, $1,000, $2,500 per person per policy period. Co-insuranceAfter you pay your selected deductible this plan will pay: 80% of Covered Expenses up to $5,000 and 100% thereafter up to the selected policy maximum. Eligible expenses are based on Regular & Customary charges. Emergency Medical EvacuationThe Company will pay benefits for Covered Expenses incurred for the necessary Emergency Medical Evacuation of an Insured Person up to a $100,000 maximum. Emergency Medical Evacuation means: a) the Insured Person's medical condition warrants immediate transportation from the place where the Insured Person is Injured or Ill, to the nearest Hospital where appropriate medical treatment can be obtained; or b) after being treated at a local Hospital, the Insured Person's medical condition warrants transportation to his/her Home Country to obtain further medical treatment or to recover. Covered Expenses are expenses for the transportation, medical services and supplies recommended by the attending Physician and necessarily incurred, in connection with an Insured Person's Emergency Medical Evacuation. All transportation for an Insured Person's Emergency Medical Evacuation must be arranged by AIG Assist utilizing the most direct and economical conveyance. Emergency ReunionIn the event of an Emergency Medical Evacuation due to a covered Injury or Illness, where the Physician feels that it would be beneficial for the Insured to have a Family Member at their side during transport, the Company will reimburse the Insured for travel and lodging expenses, up to a maximum of $10,000.00. AIG Assist must make all arrangements and must authorize all expenses in advance. The Company reserves the right to determine the benefit payable, including reductions, if it is not reasonably possible to contact AIG Assist in advance. Repatriation of Remains ExpensesIf Injury or Illness commencing during the period of coverage results in death, all reasonable expenses incurred for preparation and return of the remains to your Home Country are covered up to a maximum of $20,000. The Repatriation must be arranged by AIG Assist utilizing the most direct and economical conveyance. DefinitionsThe term "Home Country" shall mean, the country where an eligible person(s) has his/her fixed and permanent home establishment and to which he/she has the intention of returning. The term "Hospital" shall mean, a facility that: (1) is operated according to law for the care and treatment of Injured people; (2) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis; (3) has 24hour nursing service by registered nurses (R.N.'s); and (4) is supervised by one or more Physicians. A Hospital does not include: (1) a nursing, convalescent or geriatric unit of a Hospital when a patient is confined mainly to receive nursing care; (2) a facility that is, other than incidentally, a rest home, nursing home, convalescent home or home for the aged; nor does it include any ward, room, wing, or other section of the Hospital that is used for such purposes; or (3) any military or veterans Hospital or soldiers home or any Hospital contracted for or operated by any national government or government agency for the treatment of members or exmembers of the armed forces. The term "Illness" shall mean, sickness or disease of any kind first manifested, treated or diagnosed after the effective date of coverage for an Insured Person; and causing loss covered by this Plan. The term "Injury" shall mean, bodily Injury caused solely and directly by violent, accidental, external, and visible means occurring while the Policy is in force; and resulting directly and independently of all other causes of loss covered by this Plan. The term "Physician" shall mean, a licensed practitioner of the healing arts acting within the scope of his or her license who is not: (1) the Insured; (2) an Immediate Family Member; or (3) retained by the Policyholder. Such definition will exclude chiropractors and physiotherapists. In the event services are provided by chiropractors or physiotherapists these healthcare professionals must be licensed and acting within the scope of their license and may not be (1) the Insured; (2) an Immediate Family Member; or (3) retained by the Policyholder. The term "Immediate Family Member" means a person who is related to the Insured in any of the following ways: spouse, brother-in-law, sister-in-law, daughter-in-law, son-in-law, mother-in-law, father-in-law, parent (includes stepparent), brother or sister (includes stepbrother or stepsister), or child (includes legally adopted or stepchild). The term "Pre Existing Condition" means any Injury or Illness which was contracted or which manifested itself, or for which treatment or medication was prescribed three (3) years prior to the effective date of this insurance. ExclusionsNo benefit shall be payable for any expenses or losses incurred for: 1. Illnesses first manifested, treated or diagnosed while you are visiting your Home Country; 2. Injuries incurred while you are visiting your Home Country; 3. Treatments or services rendered in your Home Country. With respect to Medical Expense, no benefit shall be payable with respect to expenses incurred:
Accidental Death and DismembermentThe amount of the Principal Sum is $25,000 If Injury to the Insured results, within 365 days of the date of the accident that caused the Injury, in any one of the types of losses specified below, the Company will pay the percentage of the Principal Sum shown below for that type of loss: Description of Loss/Indemnity - Percentage of the Principal Sum Life - 100% Both Hands or Both Feet or Sight of Both Eyes - 100% One Hand and One Foot - 100% Either Hand or Foot and Sight of One Eye - 100% Either Hand or Foot - 50% Sight of One Eye - 50% The term "loss" as used herein shall mean, with regard to hands and feet, actual severance through or above wrist or ankle joint, and with regard to eyes, entire irrecoverable loss of sight. Paralysis Benefit If Injury to the Insured results, within 365 days of the date of the accident that caused the Injury, in any one of the types of paralysis specified below, the Company will pay the percentage of the Principal Sum shown below for that type of paralysis:
"Quadriplegia" means the complete and irreversible paralysis of both upper and both lower limbs. "Paraplegia" means the complete and irreversible paralysis of both lower limbs. "Hemiplegia" means the complete and irreversible paralysis of the upper and lower limbs of the same side of the body. "Uniplegia" means the complete and irreversible paralysis of one limb. "Limb" means entire arm or entire leg. If the Insured suffers more than one type of paralysis as a result of the same accident, only one amount, the largest, will be paid. Excess BenefitsAll Coverage, except Accidental Death & Dismemberment, shall be in excess of all other valid and collectible insurance. Accidental Death and Dismemberment ExclusionsFor Accidental Death and Dismemberment Indemnity this plan does not cover any loss caused by or resulting from: 1. For suicide or any attempt thereat by the Insured Person while sane or self-destruction or any attempt thereat by the Insured Person while insane; 2. Disease of any kind; 3. Bacterial infections except pyogenic infection which shall occur through an accidental cut or wound; 4. Hernia of any kind; 5. Flying in any aircraft being used for or in connection with acrobatic or stunt flying, racing or endurance tests; flying in any rocket propelled aircraft; flying in any aircraft being used for or in connection with crop dusting, or seeding or spraying, firefighting, exploration, pipe or power line inspection, any form of hunting bird or fowl herding, aerial photography, banner towing or any test or experimental purpose; flying any aircraft which is engaged in flight which requires a special permit or waiver from the authority having jurisdiction over civil aviation, even if granted; 6. Declared or undeclared war or any act thereof; 7. Service in the military, naval, or air service of any country. Optional RidersHazardous Activity Coverage - Motorcycling, scuba diving, jet, snow, and water skiing, mountain climbing, sky diving, amateur racing, piloting any aircraft, bungee jumping, spelunking, whitewater rafting, surfing, and parasailing coverage. Athletic Coverage - For participation in amateur, club, intramural, interscholastic or intercollegiate tennis, swimming, cross country, track, baseball, softball, volleyball and golf sports only. All other sports must be approved in advance by the Company. 
Diplomat America Insurance
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