Only such expenses incurred as a 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:
- 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;
- Charges made for diagnosis, treatment and surgery by a Physician;
- Charges made for the cost and administration of anesthetics;
- 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;
- Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist;
- 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;
- 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 and 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.
After you pay your selected deductible this plan will pay 100% of Covered Expenses outside the USA and Canada up to the selected policy maximum. Any Covered Expenses incurred in the USA and Canada are paid at 80% of the first $5000 then 100% to the policy maximum. Eligible expenses are based on Regular & Customary charges.
In Hospital Benefit
If you are in the Hospital while traveling outside of the United States or Canada, and the Hospital is considered a Covered Expense, the program will pay the covered Insured $100 for each night spent in the Hospital for a maximum of 10 consecutive days (this benefit is in addition to any other expenses of the program).
For the Medical Expense Benefit, no benefit shall be payable with respect to expenses incurred:
- For services, supplies, or treatment; including any period of Hospital confinement, which were not recommended, approved and certified as necessary and reasonable by a Physician;
- For suicide or any attempt thereat while sane or self-destruction or any attempt thereat while insane;
- For Injury sustained while participating in professional athletics;
- For sickness resulting from pregnancy, childbirth, or miscarriage;
- For miscarriage resulting from an accident;
- For routine physicals or other examinations where there are no objective indications or impairment in normal health, and laboratory diagnostic or x-ray examinations except in the course of a disability established by the prior call or attendance of a Physician;
- For cosmetic or plastic surgery; except as the result of an accident;
- For elective surgery which can be postponed until the Insured returns to his/her Home Country;
- For any mental or nervous disorders or rest cures;
- For dental care; except as the result of Injury to natural teeth caused by an accident;
- For eye refractions or eye examinations for the purpose of prescribing corrective lenses or for the fitting thereof; unless caused by accidental bodily Injury incurred while Insured hereunder;
- In connection with alcoholism or drug addiction; or the use of any drug or narcotic agent;
- For congenital anomalies and conditions arising out of or resulting therefrom;
- For expenses which are non-medical in nature;
- For the ordinary cost of a one-way airplane ticket used in the transportation back to the Insured’s country where an air ambulance benefit is provided;
- A result of any intentionally self-inflicted Injury;
- A result of the commission of a felony offense;
- For specific named hazards: motorcycle driving, scuba diving, skiing, mountain climbing, sky diving, professional or amateur racing, and piloting any aircraft;
- Treatment paid for or furnished under any other individual or group policy, or other service or medical pre-payment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for treatment without cost to any individual;