| Coinsurance | We will pay 100% of eligible expenses after the deductible up to the overall maximum limit. |
| Intensive Care | Usual, reasonable and customary charges |
| Local Ambulance | Usual, reasonable and customary charges, when covered illness or injury results in hospitalization as inpatient |
| Return of minor children | $50,000 per certificate period (not subject to deductible or coinsurance) |
| Repatriation of remains | Overall maximum limit (not subject to deductible or coinsurance) |
| Emergency Medical Evacuation | $1,000,000 lifetime maximum, except as provided under acute onset of pre-existing condition. |
| Hospital room and board | Average semi-private room rate, including nursing services. |
| Intensive care unit | Up to the overall maximum limit. |
| Emergency room co-payment | Claims incurred in the U.S. - Up to $200 co-payment for each use of emergency room for an illness unless you are admitted to the hospital. (no co-payment for emergency room treatment of an injury) Claims incurred outside the U.S. - No co-payment. |
| Urgent care center co-payment | Claims incurred in the U.S. - Up to $15 co-payment. (co-payment is waived for members with a $0 deductible) Claims incurred outside the U.S. - No co-payment. |
| Emergency Reunion | Up to $100,000, maximum of 15 days (not subject to deductible or coinsurance). |
| Accidental death & dismemberment |
Accidental death & dismemberment buy up : $25,000 |
| Common carrier accidental death | Up to $50,000 for ages 18 through 69 Up to $10,000 under age 18 Up to $25,000 for ages 70 through 74 Up to $12,500 for ages 75 and older Maximum of $250,000 for any one family or group. |
| Emergency Eye Exam for a Covered Loss | Up to $150. $50 deductible per occurrence (plan deductible is waived). |
| Lost checked luggage | Up to $1000 (not subject to deductible or coinsurance). |
| Trip interruption | Up to $10,000 (not subject to deductible or coinsurance). |
| Travel delay | Up to $100 a day after a 12-hour delay period, maximum of 2 days. |
| Natural disaster | Up to $250 a day for 5 days (not subject to deductible or coinsurance). |
| Political evacuation | Up to $100,000 lifetime maximum (not subject to deductible or coinsurance). |
| Terrorism | Up to $50,000 lifetime maximum for eligible medical expenses only. |
| Hospital indemnity | $100 per day of inpatient hospitalization (not subject to deductible or coinsurance). |
| Personal liability | Up to $25,000 lifetime maximum Up to $25,000 third person injury Up to $25,000 third person property Up to $2,500 related third person property Personal Liability buy up : $75,000. |
| Lost or Stolen Passport/Travel Visa | Up to $100 – not subject to deductible |
| Outpatient physical therapy and chiropractic care | Up to $50 maximum per day. Must be ordered in advance by a physician (not subject to deductible or coinsurance). |
| Pet return | Up to $1,000 (not subject to deductible or coinsurance). |
| Bedside visit | Up to $1,500 (not subject to deductible or coinsurance). |
| Crisis Response (Ransom, Personal Belongings, and Crisis Response Fees and Expenses) | Up to $10,000 (not subject to deductible or overall maximum limit). |
| Maternity care for a covered pregnancy | Covers for complications of pregnancy during the first 26 weeks of gestation. |
| Emergency dental (acute onset of pain) | $300 limit per certificate period (not subject to deductible or coinsurance) |
| Sports Coverage | Covers for eligible injuries and illnesses that occur while participating in many popular vacation sports - skiing, snowboarding, snorkeling, water skiing, and others - at no additional cost. Certain extreme sports are excluded from coverage. |
