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Atlas Travel Insurance Benefits
Plan Overview | Provider Network | Brochure
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Atlas International Rates | Atlas
America Rates | Benefits
| Benefit Description
| Exclusions
Schedule of Benefits and Limits
| Deductibles: |
$0, $100, $250, $500, $1,000 or
$2,500 per Certificate Period. |
| Coinsurance - Claims incurred in US or Canada: |
After the Deductible, HCCMIS will pay 80% of the next $5,000 of Eligible Expenses, then 100% to the Overall Maximum Limit. Coinsurance
will be waived if expenses are incurred within the PPO and expenses are submitted to HCCMIS for review and payment directly to the provider.
(Limits are per Certificate Period) |
| Coinsurance - Claims incurred
outside US or Canada: |
After the Deductible,
HCCMIS will pay 100% of Eligible Expenses after the Deductible up
to the Overall Maximum Limit.
(Limits are per Certificate Period) |
| Hospital Room and Board: |
Average Semi-private room rate,
including nursing services. |
| Local Ambulance: |
Usual, Reasonable and Customary
charges. |
| Hospital Indemnity |
$100 per day (not subject to
Deductible or Coinsurance.) |
| Intensive Care Unit: |
Usual, Reasonable and Customary
charges. |
| Outpatient Treatment: |
Usual, Reasonable and Customary
charges |
| Physical Therapy |
$50 per visit |
| All Other Eligible Expenses: |
Usual, Reasonable and Customary
charges. |
| Acute Onset of Pre-existing Condition: |
$15,000 Maximum for Eligible Medical Expenses
$25,000 Maximum for Emergency Medical Evacuation
Only available to Members under age 70 |
| Emergency Dental: |
Accident - Overall Maximum
Limit
Acute Onset of Pain - $100 limit per Certificate Period |
| Emergency Evacuation: |
$500,000 Lifetime Maximum (except as provided under Acute Onset of Pre-existing Condition)
Does not accumulate toward Overall Maximum Limit |
| Emergency Reunion: |
$15,000 limit per Certificate
Period |
| Repatriation of Remains: |
Overall Maximum Limit |
| Return of Minor Children |
$5,000 limit |
| Terrorism: |
$50,000 Maximum Lifetime Limit, Medical
Expenses only |
| Accidental Death and Dismemberment: |
Principal Sum
$25,000 Adults age 18-69
$12,500 Adults age 70-74
$ 6,250 Adults age 75 and above
$ 5,000 Children age 17 and below
|
| Natural Disaster Benefit: |
Up to $100 a day for 5 days
when Displaced from planned, paid accommodations due to evacuation from
forecasted disaster or following a disaster strike |
| Common Carrier Accidental Death: |
$50,000 per adult, $25,000
children under age 18; $250,000 Maximum per family |
| Repatriation of Remains: |
Overall Maximum Limit |
| Trip Interruption: |
$5,000 limit per Certificate
Period |
| Lost Checked Luggage: |
$250 limit per Certificate
Period (not subject to Deductible or Coinsurance) |
| Hospital Pre-Certification Penalty: |
50% of Eligible Medical Expenses. |
| Optional Hazardous Sports Rider: |
Overall Maximum Limit |
| Political Evacuation : |
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| Overall Maximum Limit
per Certificate Period (includes all benefits except Accidental Death
and Dismemberment and Common Carrier Accidental Death): |
Age 14 days to 69
- $50,000, $100,000, $250,000, $500,000 or $1,000,000.
Age 70 to 79 - $50,000
Age 80 or older - $10,000. |
Benefit Period Medical Coverage
If you started a Benefit Period while this insurance was in effect, you are
covered for Medical expenses only for the duration of the Benefit Period, regardless
of whether you are at home or abroad. Your Benefit Period begins on the first
date you receive a diagnosis or treatment of a covered Illness or Injury while
outside your Home Country and lasts for 180 days.
End of Trip Home Country Medical Coverage
If you are covered under the Atlas Series and outside of your Home Country
continuously (except for covered Incidental Trips as described above) for six
(6) months or more you may purchase an additional 30 days of End of Trip Home
Country Medical Coverage.
Home Country Defined
If you are a US citizen, your Home Country is the United States, regardless
of the location of your Principal Residence. If you are not a US citizen, your
Home Country is the country where you principally reside and receive regular
mail.
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