This insurance plan is currently unavailable on Squaremouth
$250,000 per person international and $25,000 per person while in USA
Provides reimbursement for the cost of treatment associated with a medical emergency incurred while traveling.
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 un-replaced 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:
a. ordered by a Physician;
b. of no further use when medical need ends;
c. usable only by the patient;
d. not primarily for the Insured Person?s comfort or hygiene;
e. not for environmental control;
f. not for exercise; and
g. 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.
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 general anesthesia are not considered Medically Necessary.
Dental Care for Relief of Pain
Benefits are payable for dental care for Relief of Pain to the teeth that occurs while the Insured Person is covered under this Plan. Services must be received while covered during the Trip Coverage Period. The Insurer pays 100% per Trip Period and $100 per tooth.
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.
For Individuals aged 70 – 84, the Maximum International Medical Benefit for TravelGap Gold is $100,000.