Group Blanket

International Group Medical Benefits

If an injury or illness occurs during the period of coverage and the insured person requires medical or surgical treatment, this plan will pay, subject to the co-insurance and selected deductible, reasonable and customary charges for the following covered expenses, up to the selected policy maximum. The covered charges shall in no event include any amount which is in excess of reasonable and customary charges for the geographical area where the services are rendered, as determined by The Company.

Maximum Medical Benefit (Accident and Sickness)

From $25,000 to $1,000,000

• Charges made by a hospital for room and board, floor nursing, and other services inclusive of charges for professional services, and with the exception of personal services of a non-medical nature provided. The expenses cannot, however, exceed the hospital's average cost for semi-private room and board, or two times the average semi-private room charge made by the servicing hospital if confinement to an intensive care unit is required, or the average charge for 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 radioactive isotopes, oxygen, blood transfusion, 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.
• Dressings, drugs, and medicines that can only be obtained upon a written prescription of a physician.

Accidental Death & Dismemberment

From $10,000 to $1,000,000 Principal Sum

If the Insured Person’s Injury results in death or dismemberment, this Plan provides the following benefits for loss of:

Emergency Medical Evacuation

From $15,000 to $300,000 (optional)

Benefits are paid for Covered Expense incurred for any covered Injury or Illness that requires immediate transportation from the place where You are located (due to inadequate medical facilities).

Return of Mortal Remains

From $10,000 to $50,000 (optional)

If death occurs, Benefits will be paid for Reasonable and Customary Covered Expense incurred to return Your remains to Your Home Country.

Emergency Reunion

From $2,000 to $5,000 (Optional)

If it is determined by the Assistance Company and your Physician that it is necessary for You to have an Emergency Medical Evacuation, this Plan will arrange to bring an individual of Your choice, from Your current Home Country, to be at Your side while You are hospitalized and then accompany You during Your return home.

Optional Riders

• Hazardous Activity
• Athletic/Sports
• Home Country Coverage
• Political & Natural Disaster Evacuation
• Trip Delay
• Trip Interruption
• Lost Baggage
• War Risk
• Palliative Dental
• Unexpected Recurrence of Pre-Existing Condition
• Maternity
• Disability

Worldwide Assistance*

Provides referral to the nearest, most appropriate medical facility and provider. Medical monitoring by board certified emergency physicians. Urgent message relay between family, friends, personal physician, and the insured. Arranging and coordinating Emergency Medical Evacuations, Emergency Reunions, and Repatriations. Referral to legal assistance. Assistance in locating lost or stolen items including lost ticket application processing.

*This is not an insurance benefit.

FOR ADDITIONAL INFORMATION

Phone: 4086430110
Website: srvisitorinsurance.brokersnexus.com

Version: 04/2018
Release: 06/26/2018