Reside Prime
Extended Coverage Schedule of Benefits |
After 36 months of continued coverage under Reside Prime, the following Extended Coverage Schedule of Benefits shall apply
to eligible expenses beginning on the 1st day of the 37th month. All other conditions of the policy shall continue to apply. |
| Lifetime Medical Maximum |
$2,500,000 per Insured Person. |
| Policy Period Deductible
Options |
$500, $750, $1,250, $2,750, $5,250
Maximum of 3 deductible payments for families enrolling on one application.
Any eligible charges incurred and applied to your policy period deductible
in the last 30 days prior to your renewal date will carry over and be applied
to the next policy period deductible. |
Inside of the US & Canada
(geographical treatment Area A) |
After the Deductible, the Policy pays 80% of the next $5,000 of Eligible Expenses, then 100% up to the Policy Maximum. Expenses incurred inside the United States and
Canada must be Pre-Notified using Seven Corners’ Pre-Notification Program.
If Services and Treatment eligible for coverage under this Certificate are received directly from
an approved PPO Service Provider while the Insured Person is in the United States: (a) the
Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits,
and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.
Failure to utilize an approved PPO Service Provider
facility, if one exists within a 50 mile radius of where the Insured Person is located, will result in a 25% reduction of the Eligible Benefits stated in the Schedule of Benefits.
|
Outside of the US & Canada
(geographical treatment Area B) |
After the Deductible, the Policy pays
90% of eligible expenses to the Policy Maximum. Hospital Admissions must
be Pre-Notified using Seven Corners Pre-Notification Program. |
| Inpatient Hospital Expenses |
Average Semi-Private room and board,
Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications,
Durable Medical Equipment, Nursing Services and X-Rays, up to a limit of $2,000 per day, up to the Policy
Maximum. |
| Intensive Care |
Intensive Care room and board, Usual,
Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable
Medical Equipment, Nursing Services and X-rays, up to a limit of $4,000 per day, up to the Policy Maximum. |
| Surgery |
Usual, Reasonable, and Customary (URC) Charges for Surgery, Physician and Anesthetics up
to the Policy Maximum. Anesthetics limited to one provider for a maximum benefit of 20% of the amount
billed and eligible primary surgeons charge. |
Hospital Daily Indemnity
Benefit
(geographical treatment Area A) |
$50 per day ($1,000 maximum per policy
period), for every Medically Necessary night spent in a Hospital (Hospital
Admission) outside of the United States and Canada. An additional Daily
Indemnity Benefit Rider may be purchased to increase this benefit limit to $200. |
| Outpatient Treatment |
Usual, Reasonable, and Customary (URC) Charges for Surgery up to the Policy Maximum.
Emergency Room Treatment:
- Physician Charges, limit of $150 per visit
- Hospital Charge, $100 co-pay unless admitted, then waived
- Urgent Care Facility, $25 co-pay
- Diagnostic Lab and X-Rays limited to $5,000 per Policy Period
|
| Physiotherapy, Chiropractic |
Up to $75 pervisit, $1,000 maximum per Policy Period ($10,000 Lifetime
Maximum), when referred in advance by a Physician |
| Medical Supplies |
Usual, Reasonable, and Customary (URC) Charges up to Policy Maximum. |
| Ambulance |
$100 per incident. |
| Well Child Care |
Up to $200 per Policy Period Maximum for checkups and routine visits after 12-month
waiting period. Up to age 18. Not subject to Deductible and Coinsurance. |
| Maternity |
Usual, Reasonable, and Customary (URC) Charges up to limits below per Pregnancy, must
be Pre-Notified within the first 90 days of Pregnancy. Waiting period of 12-months before
maternity benefit begins.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000 |
| Mental & Nervous |
$2,000 maximum per Policy Period. Inpatient limited to a maximum of 25 days per policy period. Outpatient limited to a maximum of 20 visits per policy period, at 70% of eligible expenses, up to $75 maximum per visit. Lifetime maximum of $30,000. |
| Newborn Benefit |
Maximums listed below per eligible pregnancy for the first 31 days after birth.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000 |
| Dental |
Usual, Reasonable, and Customary (URC) Charges for repair and replacement of sound,
natural teeth damaged as a result of an accident, limited to $500 per Policy Period. A Dental
Benefit Rider may be purchased to expand Dental Coverage. |
| Emergency Medical Evacuation |
$250,000 Limit per person per Policy Period – when adequate medical facilities and/or
treatment is not available when traveling outside your current Country of Residence. (Preapproval
required.) |
| Repatriation of Remains |
$15,000 Limit per person – when traveling outside your current Country of Residence. (Preapproval
required.) |
| Emergency Medical Reunion |
$10,000 Limit per person per Policy Period – when traveling outside your current Country of
Residence. (Pre-approval required). |
| Preventive Benefits |
Females and Males over the Age 19 up
to $175 Policy Period Maximum for checkups, routine physical exams, female
preventative exams and mammograms after 12 month waiting period. Not subject
to Deductible or Coinsurance. |
| Accidental Death &
Dismemberment (AD&D) |
Principal Sum: $10,000 Insured and Spouse,
$2,000 Dependent Children.
For Common Carrier, Principal Sum: $40,000 Insured and Spouse, $8,000 Dependent
Children. |
| Lifetime Transplant Benefit |
Up to $500,000 per Insured Person. |
| Prescription Medications |
Limit of $5,000 per Policy Period for each Insured Person, outpatient only. |
Reside Prime is underwritten by Certain Underwriters
at Lloyd's, London and is rated A "Excellent" by A.M. Best. In addition
to being one of the largest insurance entities in the world, Lloyd's has over
300 years of experience in the international insurance business.
Atlas
