All foreign nationals 14 days or older and
75 years of age or younger who are visiting
within the boundaries of the United States
with valid visa are eligible to enroll.
An individual BENEFIT PERIOD /
EXTENSION OF BENEFITS benefit period ends
when the term of insurance expires. There
will be a 10 day extension of benefits for
those insured who are hospital confined when
said coverage expires.
The initial period of this coverage
cannot exceed six months. You may, however,
purchase additional coverage. The additional
coverage period(s) plus the original period
of coverage may not total more than twelve
(12) months. Purchasing of additional
coverage will be contingent upon you
warranting that you are in good health and
that the reason for your continuing to stay
in the US is not for medical reasons. Any
additional coverage purchased shall not be
considered the continuation of an existing
coverage, but an unrelated new coverage.
These rates are valid for
coverage which has an effective date on or
after August 1, 2009 and until August 1,
2010. Any rate change after these dates will be made public.
EMERGENCY
MEDICAL BENEFITS COVERAGE IS PROVIDED FOR
EMERGENCY CONDITIONS ONLY!
EMERGENCY CONDITION means an accidental
injury or sudden onset of a medical
condition that first manifests itself while
the insured is covered under the policy.
Such a condition is evidenced by the sudden
appearance of acute symptoms of severity
that would cause a reasonable person to
expect a serious impairment or dysfunction
of a bodily part or organ.
If injury or sickness occurs and you require
medical or surgical treatment, including
hospitalization and the services of
physicians, registered or licensed nurse,
the Plan will pay, subject to the Deductible
selected, 100% of all usual and reasonable
charges for covered medical and surgical
expenses, up to $50,000, 80% thereafter to
the maximums listed below.
A maximum benefit of $10,000.00 will be
payable for pulmonary malfunction, heart
attack, stroke, embolism, (cerebrovascular
or cardiovascular disease or disorders.) All
other terms and conditions of the Policy
apply
A pre-existing condition shall be defined as
an Injury or Illness which was contracted or
first manifested itself or was treated or
recommended for treatment by a licensed
physician, or for which medication was
prescribed, 24 months prior to the effective
date of the insured person's coverage under
this Policy. Pre-existing conditions are not
covered (except for heart related
emergencies, which is covered to a
$10,000.00 maximum).
If bodily injury occurs within 365 days
after an accident, the Plan will pay for
loss as follows:
Loss of Life
$10,000.00
Lost of two members
$10,000.00
Loss of one member
$10,000.00
"Member" means hand, foot or eye.
"Loss of hand or foot" means complete
severance through or above the wrist or
ankle joint, and "loss of sight" means the
entire and irrecoverable loss of sight.
Only one amount, the largest to which the
Insured is entitled, is paid for all losses
resulting from one accident. The maximum
amount payable for all insured individuals
injured in any one accident, is
$1,000,000.00.
If injury or sickness commencing during the
period of coverage requires necessary
emergency evacuation to
(a) the nearest hospital where appropriate
medical treatment can be obtained, or
(b) to the country of residence;
all expenses incurred are covered up to a
maximum of $15,000.
An emergency evacuation must be ordered by a
legally licensed physician who certifies
that the severity of the injury or sickness
warrants such emergency evacuation.
If injury or sickness commencing during the
period of coverage results in death, all
reasonable expenses incurred to return the
body to the country of residence are covered
up to a maximum of $10,000. Covered expenses
include, but are not limited to, expenses
for embalming, cremation, coffins and
transportation.
ALL MEDICAL
EVACUATION AND REPATRIATION EXPENSES MUST
HAVE PRIOR APPROVAL OF THE INSURING COMPANY.
For approval, please call AIG Assist at
1-800-626-2427. No expenses, including
transportation, are provided for relatives
or visitors to participate in the medical
evacuation of an Insured, or to accompany
the remains to the country of residence.
No refunds are allowed unless the Insured
becomes ineligible for coverage. All refund
requests must be in writing with proper
documentation. If a claim has been filed
(not necessarily paid), no refund will be
made. All approved refunds will be made on a
pro-rata basis rounded to the month, less a
processing fee.
This policy does not cover medical expenses
that are not emergency conditions as defined
in the policy. Coverage is not provided for
routine care including but not limited to
physical exams, check-ups, well baby care,
routine doctor visits, routine medications,
therapies or services of any kind.
Attempted suicide, self-destruction,
or intentionally self-inflicted injury
while sane or insane;
Cancer in any form;
Pregnancy, childbirth, miscarriage,
or any other complication of pregnancy;
Congenital anomalies and conditions
arising therefrom;
Cosmetic or plastic surgery except
as a result of an accident;
Elective treatment of any kind;
Mental or nervous disease or
disorders; or disease of the nervous
system;
Alcoholism or complications
therefrom,; drug addiction or use of
narcotics, except those prescribed by a
physician, or complications therefrom;
Participation in motorcycle driving,
scuba diving, bunji jumping, skiing,
mountain climbing, sky diving,
professional or amateur auto racing, or
piloting an aircraft;
Injury sustained as a result of or
in connection with the commission of a
felony;
Dental Care except as a result of a
covered injury to sound , natural teeth;
Medical Treatment received outside
of the United States;
Injury sustained as a result of
participation in a riot, civil strife,
commotion, organized protest or march,
or acts of war whether declared or
undeclared;
Medical Expenses resulting from a
motor vehicle accident to the extent
that said expenses are paid or payable
by other insurance;
Injury sustained while flying except
as a fare-paying passenger in a
regularly scheduled commercial aircraft;
Treatment paid for or furnished
under any other individual or group
policy, or other service or medical
pre-payment plan, or under any mandatory
government program or facility set-up
for treatment without cost to any
individual;
Pre-existing conditions;
Routine eye care, eye examinations,
corrective lenses (prescription for or
fitting thereof) unless caused by an
accidental bodily injury.
In event of Sickness or Injury, the Insured should :
Report to
nearest Hospital Emergency Room.
Present your insurance ID card to the
doctor(s) and follow their instruction.
Complete a Claim Form and attach all itemized bills, statements and receipts and mail to the Claims Department :
Please send your claim form and all your itemized bills to this address below :
MCA Administrators, Inc. P. O. Box 6540 Harrisburg, PA 17112 1-800-427-9308
Underwriting Company
Insurance Company of the State of Pennsylvania Member Company of
Chartis
Policy Number : GLB9124048
Customer Support:
If you are experiencing a problem with our website or have any questions about
any of our insurance products, please email us at
info@american-mgmt.com.
PO Box 366 - 600 N Woodbourne Road - Langhorne, PA
19047 / (888) 533-7654
Copyright 2007 - American Management Advisors, Inc. - All rights reserved
