Eligibility 

You may be covered under this plan if you are a U.S. citizen, permanent resident of the U.S., or an international student in the U.S., enrolled as a full-time student, faculty or staff member in a U.S. institution and are temporarily pursuing educational activities outside the United States.  International students, faculty, and staff members are not eligible for coverage in their Home Country, except as provided by the Optional Home Country Benefit, if selected.  You may also enroll your lawful spouse and unmarried children including adopted children under age 19, who are traveling and residing with you, provided they are dependent upon you for maintenance and support.   Any children born to you and your spouse while you are covered under the plan will be insured from the moment of birth.  Coverage on a newborn child will cease 31 days after the date of birth unless the Company receives notification of the birth, a completed enrollment form and required premium.

Period of Coverage 

Coverage will begin at 12:01 a.m. Local Time on the latest of the following:  a) your departure from the United States; b) the date your enrollment form and premium are received by the Company or its designated administrator; or c) the date you requested on the enrollment form for coverage to begin.  Coverage will end on the latest of the following: a) the date of a covered person’s return to their Home Country or the United States (there is no continuation of coverage upon return home, except as specifically indicated in the Extended Home Country Benefit Option; b) the termination date as shown on your ID card; or c) the date through which premium has been paid.  Coverage is not available once you or any covered dependent has returned to the United States, unless the Home Country Benefit Option is purchased.

Medical Expense Benefits

If a covered Injury or Sickness occurs during the Period of Coverage and you or any covered dependent requires medical or surgical treatment, the Company will pay according to the following schedule for the plan in which you enrolled.  The plan will be indicated on your enrollment form and your confirmation of coverage.

Plan A, Accident & Sickness Basic Plan
The Company will pay 100% of covered expenses up to $5,000, after the covered person has paid the first $50 (deductible) per covered Sickness or Injury.  For covered expenses in excess of $5,000 up to $15,000, the Company will pay 80%.  For covered expenses in excess of $15,000 up to the $500,000 maximum, the Company will pay 100%.  The deductible amount consists of covered expenses which would otherwise be payable under the Policy. This deductible is the covered person’s responsibility.

Plan B, Accident & Sickness High Option Plan
The Company will pay 100% of covered expenses up to $500,000, after the covered person has paid the first $50 (deductible) per covered Sickness or Injury.  The deductible amount consists of covered expenses which would otherwise be payable under the Policy.  This deductible is the covered person’s responsibility.
 
Under either Plan A or Plan B, the Covered Expenses shall in no event include any amount which is in excess of the usual and customary charges for similar treatment, services or supplies in the locality where the expense is incurred.  In no event shall the Company’s liability for each covered person exceed $500,000.

Covered Expenses
To be considered a covered expense under this Plan, it must: a) have been incurred as the result of, and within 52 weeks of, a covered Sickness or Injury outside of the United States during the Period of Coverage (except as specifically provided by the Optional Home Country, if purchased); b) not he excluded by provisions of this Plan; c) be Medically Necessary; and d) be specifically included in the following list of expenses:
1. Expenses made by a hospital for room and board, including general nursing services and any other medically necessary hospital services, but not including personal services of a non-medical nature.  However, allowable expenses may not exceed the hospital’s average charge for semiprivate room and board accommodation.
2. Expenses made for diagnosis, treatment and surgery by a doctor.
3. Expenses made for anesthetics and their administration.
4. Expenses for x-ray services, laboratory tests and services, and durable medical equipment, both inpatient and outpatient.
5. Expenses for physiotherapy, if recommended by a doctor for the treatment of an Injury or Sickness, and administered by a licensed physiotherapist.  Chiropractic care is limited to 80% of eligible charges up to $35 per visit and a maximum of 10 visits per Injury or Sickness. 
6. Expenses for prescription drugs including dressings, drugs and medicines prescribed by a doctor.  The Company will pay 100% of the inpatient expenses incurred, and 50% of outpatient expenses incurred.
7. Expenses for dental expenses resulting from an accident, up to $100 per tooth, $500 maximum benefit.
8. Expenses for therapeutic termination of pregnancy, up to a $500 maximum.
9. Expenses for newborn nursery care, up to a $500 maximum.
10. Expenses incurred for treatment of nervous or mental disorders:  up to $300 for outpatient treatment, up to 50% of eligible expenses for inpatient treatment with a maximum of 30 days.

If you have selected the Home Country Benefit Option as indicated in the Plan selection of your confirmation, your coverage will be continued on a limited basis, for a period of 30 days, after your return to the United States.  Benefits will be paid for Covered Expenses incurred only for the recurrence or continuance a covered Sickness or Injury for which treatment was received during the time you were abroad.  Under the Home Country Benefit Option, if selected, benefits will be payable up to a maximum of $10,000. In no event will the total maximum benefit for Covered Expenses incurred under the Medical Expense Benefit and the Home Country Benefit Option exceed $500,000. There is a separate deductible of $100 per covered Sickness or Injury.  These extended benefits are only provided if the Home Country Option is selected and indicated on your confirmation.

Emergency Medical Evacuation Benefit

The Company will pay Emergency Medical Evacuation Benefits up to the maximum of $250,000 for expenses incurred for the medical evacuation of you and your covered dependents.  Benefits are payable if the covered person: 1) is traveling outside of his or her Home Country; 2) suffers an Injury or Sickness during the course of the trip; and 3) requires Emergency Medical Evacuation.  Benefits will not be payable unless: 1) the doctor ordering the Emergency Medical Evacuation certifies the severity of the covered person’s Injury or Sickness requires an Emergency Medical Evacuation; 2) all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible; 3) the charges incurred are Medically Necessary and do not exceed the usual level of charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and 4) do not include charges that would not have been made if there were no insurance.  “Emergency Medical Evacuation” means: 1) the covered person’s immediate transportation from the place where he or she suffers an Injury or Sickness to the nearest hospital or other medical facility where appropriate medical treatment can be obtained; or 2) the covered person’s transportation to his or her Home Country to obtain further medical treatment in a Hospital or other medical facility or to recover after suffering an Injury or Sickness. An Emergency Medical Evacuation also includes Medically Necessary medical treatment, medical services and medical supplies necessarily received in connection with such transportation.   An Emergency Medical Evacuation of a covered person to their Home Country will terminate all benefits except Accidental Death and Dismemberment Benefits and benefits provided under the Home Country Benefit Rider, if selected, under the Plan. All arrangements must be made by the Assistance Provider and approved by the Company in order for expenses to be considered eligible.

Repatriation of Remains

The Company will pay the usual and customary covered expenses, up to a maximum of $50,000, to return a covered person’s body to his or her Home Country if he or she dies while covered by this Plan.  Covered expenses include, but are not limited to, expenses for embalming, cremation, coffins and transportation.  All arrangements must be made by the Assistance Provider and approved by the Company in order for expenses to be considered eligible.

Emergency Reunion Benefit

In the event of an Emergency Medical Evacuation due to a covered Injury or Sickness, where the doctor feels it would be beneficial for the covered person to have a family member at his or her side during transport, the Company will pay the expenses incurred for travel and lodging for that relative, up to a maximum of $12,500.  Covered Expenses include an economy airline ticket and other travel related expenses not to exceed $300 a day for a maximum of ten days.  All arrangements must be made by the Assistance Provider and approved by the Company in order for expenses to be considered eligible.

Accidental Death and Dismemberment Benefit

If Injury to the covered person results, within 365 days of the date of a covered accident, in any one of the losses shown below, the Company will pay the Benefit Amount shown below for that loss.   If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same accident.

Principal Sum: $15,000

 Description of Loss                                                                  Indemnity
       Life                                                                         100% of the Principal Sum
      Quadriplegia                                                             100% of the Principal Sum
      Two or more Members                                               100% of the Principal Sum
      One Member                                                               50% of the Principal Sum
      Hemiplegia                                                                  50% of the Principal Sum
      Paraplegia                                                                   50% of the Principal Sum
      Uniplegia                                                                     25% of the Principal Sum
      Thumb and Index Finger of the Same Hand                    25% of the Principal Sum

“Quadriplegia” means total Paralysis of both upper and lower limbs.  “Hemiplegia” means total Paralysis of the upper and lower limbs on one side of the body.  “Uniplegia” means total Paralysis of one lower limb or one upper limb.  “Paraplegia” means total Paralysis of both lower limbs or both upper limbs.  “Paralysis” means total loss of use.  A Doctor must determine the loss of use to be complete and not reversible at the time the claim is submitted.  “Member” means Loss of Hand or Foot, Loss of Sight, Loss of Speech, and Loss of Hearing.  “Loss of Hand or Foot” means complete Severance through or above the wrist or ankle joint.  “Loss of Sight” means the total, permanent Loss of Sight of one eye.  “Loss of Speech” means total and permanent loss of audible communication that is irrecoverable by natural, surgical or artificial means.  “Loss of Hearing” means total and permanent Loss of Hearing in both ears that is irrecoverable and cannot be corrected by any means.  “Loss of a Thumb and Index Finger of the Same Hand” means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the hand).  “Severance” means the complete separation and dismemberment of the part from the body.

Coordination of Benefits

If a covered person is covered by more than one insurance program, benefits will be subject to a Coordination of Benefits Provision.  A plan, which does not have such a provision, would pay benefits first.  In all other instances, the plan that will pay benefits first is:  a) the plan which covers the covered person as an employee rather than as a full or part-time student; b)  if a) does not apply, the plan which covers the covered person as a full or part-time student rather than as a dependent; c)  if a) and b) do not apply, the plan which covers the person as a dependent, subject to specific rules contained in the policy; d)  if a), b) and c) do not apply, the plan which has covered the covered person for the longer time. If the benefits of this plan are reduced to these rules, such reduction will be done in proportion.  Any benefits paid by this plan on a reduced basis will be charged against the benefit limits of this Plan. 

 24 Hour Assistance Services, offered by Worldwide Assistance Services, Inc.

In addition to this health insurance program is the availability of the 24-hour Assistance network for emergency assistance anywhere in the world. Simply call the assistance center toll-free or collect. The telephone numbers from around the world will be supplied to you when you enroll in the plan. The multilingual staff will answer your call and immediately provide reliable, professional and thorough assistance.
The following services are included:
1.  Referral to the nearest, most appropriate medical facility and/or provider.
2.  Medical monitoring by board-certified emergency doctors.
3.  Urgent message relay between family, friends, personal doctor, and insured.
4.  Guarantee of payment to provider and assistance in coordinating insurance benefits.
5.  Arranging and coordinating Emergency Medical Evacuations, Emergency Reunions, and Repatriations.
6.  Emergency travel arrangements for disrupted travel as a consequence of a medical emergency.
7.  Referral to legal assistance.
8.  Assistance in locating lost or stolen items including lost ticket application processing. These services are included in the services provided by Worldwide Assistance Services, Inc.