Emergency Medical & Dental

This is a Scheduled Benefit Plan. Please refer to certificate for full benefit details.

MEDICAL EXPENSE BENEFITS – INJURY AND SICKNESS

When a covered Injury or Sickness requires treatment by a Physician, this program will provide benefits for the Usual and Customary Charges for Medically Necessary Covered Medical Expenses which exceed the deductible per person for each Injury or Sickness and which are incurred within 26 weeks following the Injury or Sickness. Payment for any Covered Medical Expense will be no more than the Benefit Limit shown for it in the Schedule of Benefits. The total payable for all Covered Medical Expenses will be no more than the Maximum Benefit Limit per Sickness or Injury. Benefits are subject to the Excess Benefits Provision.

If a benefit is designated in the Schedule of Benefits, Covered Medical Expenses include:

1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional services and (with the exception of personal services of a non-medical nature; charges made for an operating room.
2. Charges made for Intensive Care of Coronary Care charges and nursing services.
3. Hospital Miscellaneous Expenses: 1) while Hospital Confined; or 2) for pre-admission expenses for being Hospital Confined. Benefits will be paid for services and supplies such as: the cost of the operating room; laboratory tests; x-ray examination; anesthesia; drugs (excluding take home drugs) or medicines; therapeutic services; and supplies.
4. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Injury and administered by a licensed physiotherapist (inpatient).
5. Charges made for diagnosis, treatment and Surgery by a Physician for inpatient surgery. Payment will be made based upon the surgical schedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this inpatient surgery benefit; or under the outpatient surgery benefit, but not for both.
6. Charges made for the cost and administration of anesthetics: in connection with inpatient surgery.
7. Private Duty Nurse’s Services: 1) private duty nursing care only; 2) while Hospital Confined; 3) ordered by a licensed Physician; and 4) a Medical Necessity. General nursing care provided by the Hospital is not covered under this benefit.
8. Physician’s Visits: when Hospital Confined. Benefits are limited to one Physician’s visit per day. Benefits do not apply when related to surgery. Covered medical expenses will be paid under the inpatient benefit or under the outpatient benefit for Physician’s Visits but not both.
9. Pre-admission Testing: limited to routine tests such as: complete blood count; urinalysis; and chest x-ray. If otherwise payable under the policy, major diagnostic procedures such as: cat-scans; NMR’s; and blood chemistries will be paid under the “Hospital Miscellaneous” benefit.
10. Mental and Nervous Disorder (inpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits. Benefits are limited to one Physician’s visit per day.
11. Charges made for diagnosis, treatment and Surgery by a Physician for outpatient surgery. Payment will be made based upon the surgical schedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this outpatient surgery benefit; or under the inpatient surgery benefit, but not both.
12. Day Surgery Miscellaneous (Outpatient Surgical Facility): in connection with outpatient day surgery; excluding non-scheduled surgery, and surgery performed in a Hospital emergency room, trauma center, Physician’s office, or clinic. Benefits will be paid for services and supplies such as: the cost of the operating room, laboratory tests and x-ray examinations including professional fees, anesthesia, drugs or medicines, therapeutic services and supplies.
13. Anesthetist (Outpatient): in connection with outpatient surgery.
14. Physician’s Visits (Outpatient): Includes injections administered during visit. Benefits do not apply when related to surgery or Physiotherapy. Covered medical expenses will be paid under the outpatient benefit or under the inpatient benefit for Physician’s visits but not both.
15. Medical Emergency Expenses (Outpatient): only in connection with a Medical Emergency as defined. Benefits will be paid for the use of the emergency room and supplies.
16. Radiation Therapy (Outpatient)
17. Chemotherapy (Outpatient)
18. Prescription Drugs (Outpatient)
19. Mental and Nervous Disorder (Outpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits. Benefits are limited to one Physician’s visit per day.
20. Ground ambulance (within the metropolitan area) to and from the nearest Hospital with facilities for required treatment. If the Insured Person is in a rural area, then licensed group ambulance transportation to the nearest metropolitan area shall be considered.
21. Braces and Appliances: 1) when prescribed by a Physician; and 2) a written prescription accompanies the claim when submitted. Replacement braces and appliances are not covered. Braces and appliances include durable, medical equipment which is equipment that: 1) is primarily and customarily used to serve a medical purpose; 2) can withstand repeated use; and 3) generally is not useful to a person in the absence of Injury or Sickness. No benefits will be paid for rental charges in excess of purchase price.
22. Consultant Physician Fees: when requested and approved by the attending Physician.
23. Dental Treatment: 1) performed by a Physician; and 2) made necessary by Injury to Sound, Natural Teeth. Routine dental care and treatment to the gums are not covered.
24. Alcoholism/Drug Abuse Treatment: the benefits and the maximum amounts are specified in the Schedule of Benefits.

This is a Scheduled Benefit Plan. Please refer to certificate for full benefit details.

MEDICAL EXPENSE BENEFITS – INJURY AND SICKNESS

When a covered Injury or Sickness requires treatment by a Physician, the policy will provide benefits for the Usual and Customary Charges for Medically Necessary Covered Medical Expenses which exceed the deductible per person for each Injury or Sickness. Payment for any Covered Medical Expense will be no more than the Benefit Limit shown for it. The total payable for all Covered Medical Expenses will be no more than the Maximum Benefit Limit per Sickness or Injury. Benefits are subject to the Excess Provision.

Covered Medical Expenses will be paid under the Schedule of Benefits for loss:

1. Due to Injury to an Insured Person provided that treatment by a Physician: a) begins within 30 days after date of Injury; and b) is received within 12 months (32 weeks for Insured Persons age 70 and over) after date of Injury; or
2. Due to Sickness of an Insured Person provided Covered Medical Expenses are incurred within 12 months (32 weeks for Insured Persons age 70 and over) after the date of first treatment for such Sickness.

1. Room and Board Expense: 1) daily semi-private room rate when Hospital Confined; and 2) general nursing care provided and charged for by the Hospital.
2. Intensive Care.
3. Hospital Miscellaneous Expenses: 1) while Hospital Confined; or 2) for pre-admission expenses for being Hospital Confined. Benefits will be paid for services and supplies such as: the cost of the operating room; laboratory tests; x-ray examination; anesthesia; drugs (excluding take home drugs) or medicines; therapeutic services; and supplies.
4. Physiotherapy (inpatient).
5. Surgery: Physician’s fees for inpatient surgery. Payment will be made based upon the surgical schedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this inpatient surgery benefit; or under the outpatient surgery benefit, but not for both.
6. Anesthetist Services: in connection with inpatient surgery.
7. Private Duty Nurse’s Services: 1) private duty nursing care only; 2) while Hospital Confined; 3) ordered by a licensed Physician; and 4) a Medical Necessity. General nursing care provided by the Hospital is not covered under this benefit.
8. Physician’s Visits: when Hospital Confined. Benefits are limited to one Physician’s visit per day. Benefits do not apply when related to surgery. Covered medical expenses will be paid under the inpatient benefit or under the outpatient benefit for Physician’s Visits but not both.
9. Pre-admission Testing: limited to routine tests such as: complete blood count; urinalysis; and chest x-ray. If otherwise payable under the policy, major diagnostic procedures such as: cat-scans; Nmr; and blood chemistries will be paid under the “Hospital Miscellaneous” benefit.
10. Mental and Nervous Disorder (inpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits. Benefits are limited to one Physician’s visit per day.
11. Surgery (outpatient): Physician’s fees for outpatient surgery. Payment will be made based upon the surgical schedule as specified in the Schedule of Benefits. Covered medical expenses will be paid under this outpatient surgery benefit; or under the inpatient surgery benefit, but not both.
12. Day Surgery Miscellaneous (Outpatient): in connection with outpatient day surgery; excluding non-scheduled surgery, and surgery performed in a Hospital emergency room, trauma center, Physician’s office, or clinic. Benefits will be paid for services and supplies such as: the cost of the operating room, laboratory tests and x-ray examinations including professional fees, anesthesia, drugs or medicines, therapeutic services and supplies.
13. Anesthetist (Outpatient): in connection with outpatient surgery.
14. Physician’s Visits (Outpatient): Includes injections administered during visit. Benefits do not apply when related to surgery or Physiotherapy. Covered medical expenses will be paid under the outpatient benefit or under the inpatient benefit for Physician’s visits but not both.
15. Medical Emergency Expenses (Outpatient): only in connection with a Medical Emergency as defined. Benefits will be paid for the use of the emergency room and supplies.
16. Radiation Therapy (Outpatient)
17. Chemotherapy (Outpatient)
18. Prescription Drugs (Outpatient)
19. Mental and Nervous Disorder (Outpatient): the benefits and the maximum amounts are specified in the Schedule of Benefits. Benefits are limited to one Physician’s visit per day.
20. Ambulance Service.
21. Braces and Appliances: 1) when prescribed by a Physician; and 2) a written prescription accompanies the claim when submitted. Replacement braces and appliances are not covered. Braces and appliances include durable, medical equipment which is equipment that: 1) is primarily and customarily used to serve a medical purpose; 2) can withstand repeated use; and 3) generally is not useful to a person in the absence of Injury or Sickness. No benefits will be paid for rental charges in excess of purchase price.
22. Consultant Physician Fees: when requested and approved by the attending Physician.
23. Dental Treatment: 1) performed by a Physician; and 2) made necessary by Injury to Sound, Natural Teeth. Routine dental care and treatment to the gums are not covered.
24. Alcoholism/Drug Abuse Treatment: the benefits and the maximum amounts are specified in the Schedule of Benefits.

The Company will pay Covered Expenses due to Accident and Sickness as per the limits stated in Your Schedule of Coverage and Service, Accident and Sickness Medical. Coverage is limited to Covered Expenses incurred subject to Section III, Exclusions. All bodily Injuries sustained in any one Accident or Sickness shall be considered one Disablement; all bodily disorders existing simultaneously which are due to the same or related causes shall be considered one Disablement. If a Disablement is due to causes which are the same or related to the cause of a prior Disablement (including complications arising there from), the Disablement shall be considered a continuation of the prior Disablement and not a separate Disablement. When a covered Injury is incurred by the Insured Person the Company will pay Reasonable and Customary medical expenses of the Deductible and Coinsurance as stated in Your Schedule of Coverage and Service, Accident and Sickness Medical. In no event shall the Company’s maximum liability exceed the maximum stated in Your Schedule of Coverage and Service for Accident and Sickness Medical, as to Covered Expenses during any one period of individual coverage.

The Deductible and Coinsurance amount consists of Covered Expenses which would otherwise be payable under the policy. These expenses must be borne by the Insured Person.

Covered Accident and Sickness Medical Expenses: For the purpose of this section, only such expenses, incurred as the result of a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in Section III, Exclusions, shall be considered as Covered Expenses:

1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service and with the exception of personal services of a non-medical nature; provided, however, that expenses do not exceed the Hospital’s average charge for semiprivate room and board accommodation.
2. Charges made for Intensive Care or Coronary Care charges and nursing services.
3. Charges made for diagnosis, Treatment and Surgery by a Physician.
4. Charges made for an operating room.
5. Charges made for Outpatient Treatment, same as any other Treatment covered on an Inpatient basis. This includes ambulatory Surgical centers, Physicians’ Outpatient visits/examinations, clinic care, and Surgical opinion consultations.
6. Charges made for the cost and administration of anesthetics.
7. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood, transfusions, and medical Treatment.
8. Charges for physiotherapy, if recommended by a Physician for the Treatment of a specific Disablement and administered by a licensed physiotherapist.
9. Dressings, Medicines and Medications that can only be obtained upon a written prescription of a Physician.
10. Local transportation to or from the nearest Hospital or to and from the nearest Hospital with facilities for required Treatment. Such transportation shall be by licensed ground ambulance only within the metropolitan area in which the Insured Person is located at that time the service is used. If the Insured Person is in a rural area, then licensed ground ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense.

INCIDENTAL HOME COUNTRY BENEFIT
Accident and Sickness Medical Incidental Home Country Benefit Period. As an accommodation and supplemental benefit, the Insured Person will be covered under this insurance during incidental return trips to his/her Home Country ("Incidental Trips") up to a cumulative total of sixty (60) days during the Period of Coverage, provided that:

1. The Insured Person has departed his/her Home Country prior to any Incidental Trip; and
2. The Insured Person has timely paid applicable Premium for at least thirty (30) days of continuous coverage; and
3. The intention or purpose of the Insured Person's return trip to the Home Country is not to receive Treatment for an Illness or Injury incurred or sustained while traveling outside of his/her Home Country; and
4. The Insured Person's return trip to the Home Country does not result in receiving Treatment for an Injury incurred or sustained while traveling outside of his/her Home Country.

EXTENSION OF BENEFITS
Extension of Benefits: Those Covered Expenses that are incurred inside the Insured Person’s Home Country related to an Illness or Injury which occurred outside the Insured Person’s Home Country and during the period of coverage shall be paid. Covered Expenses described in (1 through 10) above which are incurred in the Insured Person’s Home Country are limited to 30 days, and the maximum stated in Your Schedule of Coverage and Service, Accident and Sickness Medical, Extension of Benefits.

DENTAL
When covered Dental expenses are incurred by the Insured Person the Company will pay Reasonable and Customary expenses in excess of the Deductible and Coinsurance as stated in Your Schedule of Coverage and Service, Dental. In no event shall the Company’s maximum liability exceed the maximum stated in Your Schedule of Coverage and Service, Dental, as to Covered Expenses during any one period of individual coverage.
For the purpose of this section, only such expenses, incurred as the result of an eligible Dental condition, in which services or Medications are prescribed, performed, or ordered by a Dentist and enumerated below, and which are not excluded in Section III, Exclusions, shall be considered as Covered Expenses. With respect to Accidental Dental, an eligible Dental condition shall mean emergency dental repair or replacement to sound, natural teeth damaged as a result of a covered Accident.

An Insured Person must follow the Pre-Certification Program in order to receive full benefits under the Policy. If the Insured Person does not properly follow the Pre-Certification Program, their benefits under the Policy will be reduced, as described below. The Insured Person is responsible for obtaining any required Pre-Certification for all Hospital admissions or transplants worldwide, or for any Outpatient Surgery or Covered Expenses. The Insured Person or someone on his behalf, must notify the Company prior to Treatment, by telephoning the Company’s Assistance Company. The telephone number of the Assistance Company is shown on the Insured Person’s Identification Card.

The Pre-Certification Program requires that the Insured Person obtain Pre-Certification (unless otherwise noted herein) for the following: For Scheduled Hospital Admissions, Outpatient Treatments or Covered Expenses, and transplants: The Pre-Certification Program requires that the Insured Person, or someone on their behalf, contact the Assistance Company as soon as possible, but not less than 48 hours, prior to the date of admission for any Scheduled Hospital Confinement or Scheduled Treatment , to obtain the following:
If additional days of Hospital confinement are necessary beyond the initial number of Pre-Certified days, the attending Physician or an official representative of the facility where the Insured Person is confined, must contact the Company (no later than the last day originally Pre- Certified) to obtain Pre-Certification for any additional days of Hospital confinement. The Company will review with the attending Physician the request for the additional days of Hospital confinement.
A list with the name(s) and address(es) of the United States Hospitals that are members of the Participating Provider Network, to which the Insured Person will have access as an Insured Person under the Policy. The Insured Person must use a Hospital which is a member of the Participating Provider Network in order to receive full benefits under the Policy, as described below
. For Emergency Hospital confinements: The Pre-Certification Program requires that the Insured Person, or someone on their behalf, contact the Company as soon as possible, but no later than 48 hours after the date of admission to a Hospital in case of Emergency. For Transplants Worldwide: The Insured Person, or someone on their behalf, must contact the Company immediately, but not later than 48 hours after the Insured Person is identified by the attending Physician, as a candidate for a bone marrow, cornea, heart, heart and lung, single lung, pancreas and kidney, or liver transplant, and at least 2 days prior to any scheduled admission to a Hospital.

PRE-CERTIFICATION. PROGRAM EFFECT ON BENEFITS: Subject to all provisions of the Policy, when the requirements of the Pre-Certification Program are properly followed and the Hospital admission or transplant Treatment is Pre-Certified, benefits for Covered Expenses will be payable as described in Your Schedule of Coverage and Service and in any amendments of endorsements to the Policy.

If an Insured Person does not properly follow the Pre- Certification Program and if the required Pre-Certification is not obtained, the benefit percentage payable for Covered Expenses incurred for all Treatment, services, and supplies related to the Disablement will be reduced to and payable at 60% (whether or not the Coinsurance has been met), after any Deductible amount which may apply. The reduction in the benefit percentage payable will not apply where there is no Participating Provider Network Hospital in the city or immediate vicinity where the Insured Person is to be Hospitalized, provided the Insured Person complied with the Pre-Certification requirements.

The additional amounts an Insured Person is required to pay as a result of the lower percentage payable due to not following this Pre-Certification Program will not be used to satisfy any Deductible amount or the Coinsurance in the Policy.

PRE-CERTIFICATION DOES NOT GUARANTEE BENEFITS: Benefits payable under the Policy are still subject to eligibility at the time charges are actually incurred, and to all other terms, limitations, and exclusions of the Policy. Pre- Certification does not guarantee or confirm benefits under the Policy.

For the Certificate Period, Underwriters will pay 80% of the next $5,000 of Eligible Expenses after the deductible, then 100% to the overall Maximum Limit.

Medical Coverage

1. Inpatient and Outpatient charges made by a Hospital.
2. Charges made by a Physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the Physician has referred the case.
3. Charges made for dressings, sutures, casts or other supplies prescribed by the attending Physician or specialist, but excluding nebulizers, oxygen tanks, diabetic supplies and all devices for repeat use at home.
4. Charges for diagnostic testing using radiology, ultrasonographic or laboratory services.
5. Charges for oxygen and other gases and anesthetics and their administration.
6. Charges for prescription drugs, for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs.
7. Charges made by a licensed Extended Care Facility upon direct transfer from an acute care Hospital.
8. Emergency local ambulance transport incurred in connection with Injury or Illness resulting in inpatient hospitalization.
   
   

   Complications of Pregnancy
   Treatment of Complications of Pregnancy during the first 26 weeks of Pregnancy is covered under this insurance. Complications of Pregnancy is defined as: Illnesses whose diagnoses are distinct from Pregnancy, but are adversely affected by Pregnancy or caused by Pregnancy, and not associated with a normal Pregnancy. This includes: ectopic Pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed abortion and conditions of comparable severity.

   Hospital Indemnity
   If you are hospitalized as an Inpatient for treatment of a covered Illness or Injury, the Atlas Series will provide $100 for each night you spend in the hospital. This benefit is in addition to payments for other covered expenses and is not subject to Deductible or Coinsurance.

   Acute Onset of a Pre-Existing Condition
   If you are a US citizen under age 70, you are covered for an Acute Onset of a Pre-existing Condition. Coverage is available up to $15,000 Maximum for Eligible Medical Expenses and up to $25,000 for Emergency Medical Evacuation. An Acute Onset of a Pre-Existing Condition is a sudden and unexpected outbreak or recurrence of a Pre-Existing Condition which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

   What Is Excluded?
   The following charges, treatments, surgeries, medications, conditions and circumstances:

   1. Pre-existing Conditions - Charges resulting directly or indirectly from any Pre-existing Condition are excluded from this insurance. If you are a US citizen, have purchased an initial coverage period of at least 3 months, and are under age 70, you are covered for Medical and Emergency Evacuation charges resulting from an Acute Onset of a Pre-existing Condition, up to the limit set forth in the Schedule of Benefits and Limits. A Pre-existing Condition is any Illness, Injury or medical condition or chronic or recurring Illness or Injury or medical condition, including any associated complications or consequences, which existed at or during the 2 years immediately preceding your Effective date. An Acute Onset is a sudden and unexpected outbreak or recurrence of a Pre-existing Condition, that occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.
   2. Treatment for or related to any congenital condition.
   3. Routine pre-natal care, childbirth, care of newborns, post-natal care, birth control, artificial insemination, infertility, impotency or sexual dysfunction, sterilization or reversal thereof.
   4. False labor, edema, prolonged labor, prescribed rest during the period of Pregnancy, morning sickness and conditions of comparable severity associated with management of a difficult Pregnancy, and not constituting a medically distinct Complication of Pregnancy, and all charges related to Pregnancy after the 26th week of Pregnancy.
   5. Mental Health Disorders or Substance Abuse.
   6. Charges which are not incurred during the Certificate Period or the applicable Benefit Period, and charges which are not presented to Underwriters for payment within 60 days from the end of the Certificate Period or the applicable Benefit Period. Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness.
   7. Not Medically Necessary and administered or ordered by a Physician.
   8. Provided at no cost, or by a family member, or by a person who ordinarily resides with you, or which are attributable to or recoverable from any other party including government sponsored plans.
   9. Charges which exceed Usual, Reasonable and Customary. Investigational, Experimental or for Research purposes.
   10. While confined primarily to receive Custodial Care, Educational or Rehabilitative care. V
   11. enereal Disease, AIDS or ARC.
   12. Treatment by a Chiropractor.
   13. Diseases of the skin.
   14. Dental treatment, including treatment of the temporomandibular joint, except for Emergency Dental treatment necessary to replace sound natural teeth lost or damaged in an Accident covered hereunder or for the relief of Acute, spontaneous and unexpected onset of pain.
   15. Eyeglasses, vision exams, contact lenses, hearing tests, hearing aids, hearing implants, eye refraction, visual therapy, orthoptics or visual eye training or eye surgery (including cataract surgery and radial keratotomy) or for any examination or fitting related to these devices or procedures.
   16. Excluded Hazardous Sports - Injury sustained while taking part in the following activities: Amateur or professional sports or athletics, except this does not include Amateur sports or athletics which are non-contact and undertaken solely for leisure, recreational, entertainment or fitness purposes unless such sports or athletics are otherwise excluded by this provision. The following are excluded:
       • Mountaineering where ropes or guides are normally used or at elevations of 4,500 meters or higher.
       • Aviation, except when traveling solely as a passenger in a commercial aircraft.
       • Hang gliding, sky diving, parachuting or bungee jumping;
       • Snow skiing or snowboarding, except for recreational downhill and/or cross-country snow skiing or snowboarding (no cover provided whilst skiing away from prepared and marked in-bound territories and/or against the advice of the local ski school or local authoritative body); R
       • acing by any animal or motorized vehicle;
       • and spelunking;
       • and subaqua pursuits involving underwater breathing apparatus unless NAUI/PADI certified, accompanied by a certified instructor, and at depths of less than 10 meters;
       • jet skiing;
       • and any other sport or athletic activity which is undertaken for thrill seeking and exposes you to abnormal or extreme risk of injury.
   17. Injury sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician but not for the treatment of Substance Abuse.
   18. Willfully self-inflicted Injury or Illness and immunizations and Routine Physical Exams.
   19. The Deductible, Coinsurance and charges which are not included as Eligible Expenses as described in the Master Policy, and charges which exceed the limits set forth in the Schedule of Benefits and Limits.
   20. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder.
   21. Charges for travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation,
   22. Repatriation of Remains, Emergency Reunion and Trip Interruption sections of this insurance.
   23. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
   24. Organ or tissue transplants or related services.
   25. Acts of Terrorism, except as provided for herein, war, insurrection, riot or any variation thereof.

Medical Expenses: Up to USD 12,500 per occurrence

When a covered Injury or Illness is incurred by the Insured Person, the Company will pay 100% of Reasonable and Customary medical charges for Covered Expenses, excess of the Per Occurrence deductible, up to the Per Occurrence Maximum of USD 12,500. In no event shall the Company's maximum liability exceed the maximum as stated on the ID Card. The Deductible and Coinsurance amount consists of Covered Expenses which would otherwise be payable under this Policy. These expenses must be borne by each Insured Person. A maximum of 3 Policy Period deductibles per family under the same application will apply.

Only such expenses, incurred as the result of and within twenty-six (26) weeks from a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in PART IV - EXCLUSIONS, shall be considered as Covered Expenses:

1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service and (with the exception of personal services of a non-medical nature); charges made for an operating room.
2. Charges made for Intensive Care or Coronary Care charges and nursing services..
3. Charges made for diagnosis, treatment and Surgery by a Physician; charges made for the cost and administration of anesthetics..
4. Charges made for Outpatient treatment, same as any other treatment covered on an Inpatient basis. This includes ambulatory Surgical centers, Physicians’ Outpatient visits/examinations, clinic care, and Surgical opinion consultations..
5. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, iron lungs, and medical treatment; dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon..
. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist..
6. Ground ambulance (within the metropolican area) to and from the nearest Hospital with facilities for required treatment. If the Insured Person is in a rural area, then licensed ground ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense..
7. Hotel room charge, when the Insured Person, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond control of the Insured Person..
8. Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items..

Medical Expenses: Up to USD 150,000 per occurrence

When a covered Injury or Illness is incurred by the Insured Person, the Company will pay 100% of Reasonable and Customary medical charges for Covered Expenses, excess of the Per Occurrence deductible, up to the Per Occurrence Maximum of USD 150,000. In no event shall the Company's maximum liability exceed the maximum as stated on the ID Card. The Deductible and Coinsurance amount consists of Covered Expenses which would otherwise be payable under this Policy. These expenses must be borne by each Insured Person. A maximum of 3 Policy Period deductibles per family under the same application will apply.

Only such expenses, incurred as the result of and within twenty-six (26) weeks from a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in PART IV - EXCLUSIONS, shall be considered as Covered Expenses:

1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service and (with the exception of personal services of a non-medical nature); charges made for an operating room.
2. Charges made for Intensive Care or Coronary Care charges and nursing services..
3. Charges made for diagnosis, treatment and Surgery by a Physician; charges made for the cost and administration of anesthetics..
4. Charges made for Outpatient treatment, same as any other treatment covered on an Inpatient basis. This includes ambulatory Surgical centers, Physicians’ Outpatient visits/examinations, clinic care, and Surgical opinion consultations..
5. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, iron lungs, and medical treatment; dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon..
. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist..
6. Ground ambulance (within the metropolican area) to and from the nearest Hospital with facilities for required treatment. If the Insured Person is in a rural area, then licensed ground ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense..
7. Hotel room charge, when the Insured Person, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond control of the Insured Person..
8. Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items..

Medical Expenses: Up to USD 1,000,000 per occurrence

When a covered Injury or Illness is incurred by the Insured Person, the Company will pay 100% of Reasonable and Customary medical charges for Covered Expenses, excess of the Per Occurrence deductible, up to the Per Occurrence Maximum of USD 1,000,000. In no event shall the Company's maximum liability exceed the maximum as stated on the ID Card. The Deductible and Coinsurance amount consists of Covered Expenses which would otherwise be payable under this Policy. These expenses must be borne by each Insured Person. A maximum of 3 Policy Period deductibles per family under the same application will apply.

Only such expenses, incurred as the result of and within twenty-six (26) weeks from a Disablement, which are specifically enumerated in the following list of charges, and which are not excluded in PART IV - EXCLUSIONS, shall be considered as Covered Expenses:

1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service and (with the exception of personal services of a non-medical nature); charges made for an operating room.
2. Charges made for Intensive Care or Coronary Care charges and nursing services..
3. Charges made for diagnosis, treatment and Surgery by a Physician; charges made for the cost and administration of anesthetics..
4. Charges made for Outpatient treatment, same as any other treatment covered on an Inpatient basis. This includes ambulatory Surgical centers, Physicians’ Outpatient visits/examinations, clinic care, and Surgical opinion consultations..
5. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, iron lungs, and medical treatment; dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or Surgeon..
. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist..
6. Ground ambulance (within the metropolican area) to and from the nearest Hospital with facilities for required treatment. If the Insured Person is in a rural area, then licensed ground ambulance transportation to the nearest metropolitan area shall be considered a Covered Expense..
7. Hotel room charge, when the Insured Person, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond control of the Insured Person..
8. Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items..

Following is a general description of the supplies and services for which the Insured Person’s Plan will pay benefits, if such supplies and services are Medically Necessary:

Services and Supplies Provided by a Hospital
For any eligible condition other than for Mental, Emotional or Functional Nervous Conditions or Disorders, Alcoholism or Drug Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.
2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.
2. Services are provided only for the number of days required to treat the Insured Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Professional and Other Services
The Insurer will pay Covered Expenses for:

1. Services of a Physician.
2. Services of an anesthesiologist or an anesthetist.
3. Outpatient diagnostic radiology and laboratory services.
4. Radiation therapy and hemodialysis treatment.
5. Surgical implants.
6. Artificial limbs or eyes.
7. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.
8. Self-Administered injectable drugs.
9. Syringes when dispensed with self-administered injectable drugs (except insulin).
10. Blood transfusions, including blood processing and the cost of unreplaced blood and blood products.
11. Services for the detection and prevention of osteoporosis for qualified individuals.
12. Rental or purchase of medical equipment and/or supplies that are all of the following:

1. ordered by a Physician;
2. of no further use when medical need ends;
3. usable only by the patient;
4. not primarily for the Insured Person’s comfort or hygiene;
5. not for environmental control;
6. not for exercise; and
7. manufactured specifically for medical use. 

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Plan. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services
The following ambulance services are covered under this Plan:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.
2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

Dental Care for An Accidental Injury
Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Insured Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;
2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and
3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Plan.

In addition, the Plan provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering generalanesthesia are not considered Medically Necessary.

Complications of Pregnancy
Complications of Pregnancy are covered under this Plan as any other medical condition. Benefits for complications of pregnancy shall be provided for all Insured Persons.

Treatment received from Foreign Country Providers
Benefits for services and supplies received from Foreign Country Providers are covered. The Insured Person may seek the assistance of HTH in locating a provider.

Following is a general description of the supplies and services for which the Insured Person’s Plan will pay benefits, if such supplies and services are Medically Necessary:

Services and Supplies Provided by a Hospital
For any eligible condition other than for Mental, Emotional or Functional Nervous Conditions or Disorders, Alcoholism or Drug Abuse, the Insurer will pay indicated benefits on Covered Expenses for:

1. Inpatient services and supplies provided by the Hospital except private room charges above the prevailing two-bed room rate of the facility.
2. Outpatient services and supplies including those in connection with outpatient surgery performed at an Ambulatory Surgical Center.

Payment of Inpatient Covered Expenses are subject to these conditions:

1. Services must be those which are regularly provided and billed by the Hospital.
2. Services are provided only for the number of days required to treat the Insured Person’s Illness or Injury

Note: No benefits will be provided for personal items, such as TV, radio, guest trays, etc.

Professional and Other Services
The Insurer will pay Covered Expenses for:

1. Services of a Physician.
2. Services of an anesthesiologist or an anesthetist.
3. Outpatient diagnostic radiology and laboratory services.
4. Radiation therapy and hemodialysis treatment.
5. Surgical implants.
6. Artificial limbs or eyes.
7. The first pair of contact lenses or the first pair of eyeglasses when required as a result of a covered eye surgery.
8. Self-Administered injectable drugs.
9. Syringes when dispensed with self-administered injectable drugs (except insulin).
10. Blood transfusions, including blood processing and the cost of unreplaced blood and blood products.
11. Services for the detection and prevention of osteoporosis for qualified individuals.
12. Rental or purchase of medical equipment and/or supplies that are all of the following:

1. ordered by a Physician;
2. of no further use when medical need ends;
3. usable only by the patient;
4. not primarily for the Insured Person’s comfort or hygiene;
5. not for environmental control;
6. not for exercise; and
7. manufactured specifically for medical use. 

Note: Medical equipment and supplies must meet all of the above guidelines in order to be eligible for benefits under this Plan. The fact that a Physician prescribes or orders equipment or supplies does not necessarily qualify the equipment or supply for payment. The Insurer determines whether the item meets these conditions. Rental charges that exceed the reasonable purchase price of the equipment are not covered.

Ambulance Services
The following ambulance services are covered under this Plan:

1. Base charge, mileage and non-reusable supplies of a licensed ambulance company for ground or air service for transportation to and from a Hospital.
2. Monitoring, electrocardiograms (EKGs or ECGs), cardiac defibrillation, cardiopulmonary resuscitation (CPR) and administration of oxygen and intravenous (IV) solutions in connection with ambulance service. An appropriate licensed person must render the services.

Dental Care for An Accidental Injury
Benefits are payable for dental care for an Accidental Injury to natural teeth that occurs while the Insured Person is covered under this Plan, subject to the following:

1. services must be received during the six months following the date of Injury;
2. no benefits are available to replace or repair existing dental prostheses even if damaged in an eligible Accidental Injury; and
3. damage to natural teeth due to chewing or biting is not considered an Accidental Injury under this Plan.

In addition, the Plan provides benefits for up to three days of Inpatient Hospital services when a Hospital stay is ordered by a Physician and a Dentist for dental treatment required due to an unrelated medical condition. The Insurer determines whether the dental treatment could have been safely provided in another setting. Hospital stays for the purpose of administering generalanesthesia are not considered Medically Necessary.

Complications of Pregnancy
Complications of Pregnancy are covered under this Plan as any other medical condition. Benefits for complications of pregnancy shall be provided for all Insured Persons.

Treatment received from Foreign Country Providers
Benefits for services and supplies received from Foreign Country Providers are covered. The Insured Person may seek the assistance of HTH in locating a provider.

All coverage, benefits and premiums are in U.S. Dollar amounts. If an Injury or Illness occurs outside your Home Country during the Period of Coverage and the Insured Person requires medical or surgical treatment; this plan will pay, subject to the selected deductible and applicable co-insurance, the following Covered Expenses, up to the selected policy maximum.

Covered Expenses
Only such expenses incurred as the result of and within 52 weeks from a Disablement, which shall mean an illness or an accidental bodily Injury necessitating medical treatment, and which are specifically enumerated in the following list of charges:

1. Charges made by a Hospital for room and board, floor nursing and other services, including charges for professional services, except personal services of a non-medical nature, provided, however, that expenses do not exceed the Hospital’s average charge for semi-private room and board accommodation, or two (2) times the average semi-private room charge if confinement to an intensive care unit is required, or the actual charge for an intensive care unit made by the servicing Hospital, whichever is less;
2. Charges made for diagnosis, treatment and surgery by a Physician;
3. Charges made for the cost and administration of anesthetics;
4. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radio-active isotopes, oxygen, blood transfusions, iron lungs, and medical treatment;
5. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist;
6. Hotel room charge, when the Insured, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to the unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond the control of the Insured;
7. Dressings, drugs, and medicines that can only be obtained upon written prescription of a Physician.

With regard to chiropractic care, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed chiropractor, 80% of eligible charges up to $35.00 per visit, with a maximum of 10 visits per Injury or Illness is allowable. The charges enumerated above shall in no event include any amount of such charges which are in excess of regular and customary charges. A charge incurred by an Insured shall be deemed a Regular & Customary charge for the services and supplies for which the charge is made if it is not in excess of the average charge for such services and supplies in the locality where received, considering the nature and severity of the Illness or bodily Injury in connection with which such services and supplies are received. If the charge incurred is in excess of such average charge such excess amount shall not be recognized as Covered Expenses. All charges shall be deemed to be incurred on the date such services or supplies which give rise to the expense or charge are rendered or obtained. The maximum total payment under the policy for an Illness that is first manifested, treated or diagnosed during an Insured Person’s first thirty (30) days of coverage, commencing as of the Insured Person’s effective date, is $1,000.

Emergency Dental Benefit
With regard to dental care up to $100 per tooth for the necessary treatment of sudden, unexpected pain to sound natural teeth is allowable.

In Hospital Benefit
If you are in the Hospital while traveling outside of the United States or Canada, and the Hospital is considered a Covered Expense, the program will pay the covered Insured $100 for each night spent in the Hospital for a maximum of 10 consecutive days (this benefit is in addition to any other expenses of the program).