Flat Rate Plan

Summary of Benefits

Plan Information

Maximum Limits

$50,000, $100,000, $500,000, $1,000,000, $2,000,000

Individual Deductible

Your choice of $0, $100, $250, $500, $1,000 or $2,500

On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.

Coinsurance

For treatment received outside the U.S. & Canada: No coinsurance

For treatment received within the U.S. & Canada:

In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit

Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit

Benefit Period

Six months

If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-month Benefit Period may offer continued coverage for that injury or illness. When the Certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than six months before the Period of Coverage expired, benefits for the covered injury or illness continues. This is subject to the Maximum Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.

Medical Benefits — Usual, reasonable and customary charges, subject to deductible and coinsurance when applicable.

Hospital Room and Board

Up to the Maximum Limit for average semi-private room rate

Intensive Care

Up to the Maximum Limit

Medical Expenses

Up to the Maximum Limit

Out-patient Medical

Up to the Maximum Limit

Local Ambulance

Up to the Maximum Limit

Prescription Drugs

Up to the Maximum Limit

Emergency Room Accident

Up to the Maximum Limit

Charges incurred for the use of the Emergency Room due to an accident are covered up to the Maximum Limit.

Emergency Illness - with In-patient Admission

Up to the Maximum Limit

Emergency Illness - without In-patient Admission

Up to the Maximum Limit

Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admission to the hospital.

Dental

Injury due to an accident: Each Outreach plan covers the cost of emergency dental treatment and dental surgical procedures necessary to restore or replace sound natural teeth lost or damaged in an accident up to the Maximum Limit.

Sudden dental emergency: Each plan will pay up to $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.

Hospital Daily Indemnity

Each plan pays $100 directly to the insured person for each night of a required overnight stay in a hospital up to a maximum of 10 days. The hospital stay must be covered under this plan in order to receive this benefit. This benefit is not available for Outreach America (non-U.S. citizens) if the hospitalization is due to the Sudden Recurrence of a Pre-existing Condition.

International Emergency Care — (when coordinated through the Plan Administrator)

Emergency Evacuation

Up to $500,000 lifetime maximum (independent of the Maximum Limit)

The Outreach plans offer coverage for Emergency Medical Evacuation to the nearest qualified medical facility; expenses for reasonable transportation resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to $500,000.

Emergency Reunion

Up to $50,000

Each Outreach plan also offers Emergency Reunion coverage, up to $50,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.

Return of Mortal Remains Cremation/Burial

Up to $50,000 for Return of Mortal Remains, or $5,000 for Cremation/Burial

If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the home country will be covered up to a maximum of $50,000; or up to $5,000 for the preparation, local burial or cremation of your mortal remains at the place of death.

Return of Minor Children

Up to $50,000

If a covered illness/injury results in a hospitalization and/or death and the insured person is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Outreach plans will pay up to $50,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren).

Political Evacuation

Up to $10,000

If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the insured person’s home country, orders the evacuation of all non-emergency government personnel from the host country, due to political unrest, that becomes effective on or after the insured person’s date of arrival in the host country, the Company will pay up to a $10,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the insured person’s home country or country of residence provided that:

  1. The insured person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs, or similar government organization of the insured person’s home country, issuance of the evacuation order; and
  2. The evacuation order pertains to persons from the same home country as the insured person; and
  3. Political Evacuation and Repatriation is approved and coordinated by the Company;

In no event will the Company pay for a political evacuation if there is a travel warning in effect on or within six (6) months prior to the insured person’s date of arrival in the host country.

To be eligible for the Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG.

Natural Disaster

$100 per day for five days

This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued by prevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the population for its safety.

Identity Theft Assistance

Up to $500 per Period of Coverage

If an imposter obtains key personal information such as a Social Security or Driver’s License number, or other method of identifying an insured person in order to impersonate or obtain credit, merchandise or services in the insured person’s name, the Outreach plans provide coverage for up to $500 for the reasonable, customary and necessary costs incurred by the insured for: re-filing a loan or other credit application that is rejected solely as a result of the stolen identity event; notarization of legal documents, long-distance telephone calls, and postage that has resulted solely as a result of reporting, amending and/or rectifying records as a result of the stolen identity event; up to three credit reports obtained within one year of the insured person’s knowledge of the stolen identity event; and stop payment orders placed on missing or unauthorized checks as a result of the stolen identity event.

The identity theft event must occur during the Period of Coverage.

Additional Benefits

Terrorism Coverage

Up to $50,000 lifetime maximum

Each Outreach plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan reimburses eligible medical claims subject to a $50,000 lifetime maximum. Terrorism includes criminal acts, including against civilians, committed with the intent to cause death or serious bodily injury, or taking of hostages, with the purpose to provide a state of terror in the general public or in a group of persons or particular persons, intimidate a population, or compel a government of international organization to do or to abstain from doing an act. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the six months prior to the insured person’s date of arrival. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.

This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person’s arrival date, and the insured person unreasonably fails or refuses to heed such warning or depart the country or location.

Sports & Activities Coverage

Up to the Maximum Limit for basic sports Coverage as described below

Each Outreach plan covers injuries incurred during athletic activities which are non-organized, non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. Some of these sports and activities include, but are not limited to, motor cycle/motorscooter riding, recreational downhill and/or cross country snow skiing, horseback riding, sub-aquatic activities (to 10m), wakeboarding, and water skiing. However, activities not covered include amateur or professional sports or other athletic activity which is organized and/orsanctioned by the National Collegiate Athletic Association (and/or any other collegiate sanctioning or government body), or the International Olympic Committee, and or Adventure Sports.

Please note this is only a summary of sports and activities and exclusions. For additional information, please refer to the Certificate of Insurance.

Sudden and Unexpected Recurrence of a Pre-existing Condition - Medical (for U.S. citizens only)

(U.S. citizens only) For those up to age 65 with a primary health plan, Outreach International will pay the Usual, Reasonable and Customary charges of a sudden and unexpected recurrence of a Pre-existing Condition (defined on the Exclusions page) up to the plan maximum. For those without a primary health plan, Outreach International will pay up to a $20,000 lifetime maximum. For those age 65 and older, with or without a primary health plan, Outreach International will pay up to a $2,500 lifetime maximum. The primary health plan must have existed prior to the effective date and during coverage of the Outreach plan, and the Pre-existing Condition must be covered under the primary health plan

Sudden and Unexpected Recurrence of a Pre-existing Condition - Medical (for non-U.S. citizens only)

(Non-U.S. citizens only) For those under age 65, Outreach America will pay up to a $50,000 lifetime maximum for eligible medical expenses. For those age 65 and older, Outreach America will pay up to $2,500 lifetime maximum.

Sudden and Unexpected Recurrence of a Pre-existing Condition - Emergency Medical Evacuation

Up to a cumulative two weeks

Incidental Home Country Coverage – During the Period of Coverage an insured person may return to their home country for incidental visits up to a cumulative two weeks total, subject to: a. The insured person must have left their home country, b. The total Period of Coverage must be for a minimum of 30 days, and c. The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling.

End of Trip Home Country Coverage

End of Trip Home Country Coverage – For every five months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s).

Trip Interruption

Up to $5,000

If, during a covered trip, there is an unexpected death of an immediate family member (spouse, child, parent or sibling), a break-in at the insured’s principle residence, or the substantial destruction of the insured’s principal residence due to a fire or natural disaster, each Outreach plan pays to return the insured to the area of principal residence. The plan pays for a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.

Common Carrier Accidental Death

$50,000 to Beneficiary; maximum of $250,000 per family

If accidental death should occur while traveling on a commercial Common Carrier, $50,000 is payable to the designated beneficiary, to a maximum of $250,000 per family.

Accidental Death & Dismemberment

$25,000 principal sum

Each Outreach plan offers a $25,000 principal sum benefit for Accidental Death and Dismemberment occurring during the Period of Coverage:

  • Accidental Loss of life – principal sum
  • Accidental Loss of two Members – principal sum
  • Accidental Loss of one Member – 50% of principal sum

“Member” means hand, foot or eye.

Lost Luggage

Up to $50 per item of personal property; maximum of $250

A benefit of $50 per luggage item, up to a maximum of $250, is payable in the event that the Common Carrier permanently loses an insured person’s checked luggage while in transit. This coverage is secondary to any other available reimbursement, including the Carrier’s.

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