TRAVMED Choice - Visitors Insurance Quote

TRAVMED Choice
Do you have a global
travel insurance plan in
place?
TravMed Choice allows
you to choose your
features and
benefits, creating a
comprehensive—yet
affordable—travel
protection plan.
Administered by:
MEDEX Insurance Services, Inc.
P.O. Box 19056 | Baltimore, MD 21284 | USA
1 800 732 5309 | 1 410 453 6300 | fax 1 410 308 7905
www.frontiermedex.com
TRAVMED CHOICE 0611
HOW FAR WILL YOU BE
FROM THE COMFORTS
OF HOME?
Unexpected illnesses, accidents, and emergencies
are an unfortunate reality that can occur any time,
any place. Language barriers, questionable local
medical care and evacuation logistics can add to an
already stressful emergency when far from home.
What will you do in a travel emergency?
• Will you know where to find high quality health
care?
• Will your domestic insurance cover you?
• Will language differences be a barrier?
• Will you be able to provide up-front payment to a
foreign hospital?
• What will you do if adequate care is not available
in your locale?
With TravMed Choice, you have insurance
protection for emergency situations and the peace
of mind that comes with FrontierMEDEX.
TRAVMED CHOICE:
HOW DOES IT WORK?
One toll-free or collect call does it all. Whether
you need assistance with a lost passport, or
require a complex medical evacuation, the 24-hour,
multilingual FrontierMEDEX Emergency Response
Center is here for you.
Expert care, anywhere. FrontierMEDEX takes
charge of your case, putting our proprietary global
network to work for you. If adequate care is not
available locally, your TravMed Choice plan will pay
to transport you to a pre-approved facility with a
higher level of care.
International standards of medicine.
FrontierMEDEX will monitor your medical care
and consult with your treating physician to
ensure proper diagnosis, plan of treatment, and
medical procedures. Our Physicians are trained in
international medicine and familiar with local medical
practices.
WHY TRAVMED CHOICE IS
THE QUALITY CHOICE FOR YOU:
TravMed Choice includes FrontierMEDEX for
peace of mind. The standard for quality care,
FrontierMEDEX has been providing the best
emergency assistance available to travelers since
1977. From the first call to a FrontierMEDEX
Assistance Coordinator until your situation is
completely resolved, we are looking out for your best
interests.
The FrontierMEDEX network of 59,000 international
resources is unmatched. FrontierMEDEX has built
the industry’s strongest worldwide assistance
network, including physicians and specialists,
hospitals, clinics, dentists, embassies, air
ambulances, specialized security providers and
more – chosen for their ability to deliver first-class
care.
CUSTOMIZE
YOUR INSURANCE PLAN
TravMed Choice gives you the ability to design your
own insurance plan with customizable features and
benefits. Programs are rated specifically for you
based on the following:
• International Medical Insurance Limits – choose
from $50,000, $100,000, $250,000, or $500,000.
• Travel out of the U.S. and into the U.S.
• Age
• Deductible options of $250 or $100
TravMed Choice coverage is customizable, yet
affordable. With TravMed Choice, you pay only for
the coverage you need. In addition to the essential
24/7 FrontierMEDEX services, you choose your
deductible level, as well as trip interruption, lost
baggage protection, AD&D coverage, and even
sports coverage for more active travelers.
TravMed Choice will make direct payments to
international providers. Foreign doctors and
hospitals often require up-front payment, which can
delay treatment and drastically deplete a traveler’s
funds. Whenever possible, TravMed Choice protects
you by making direct payments to international
providers. You won’t have to worry about unnecessary
delays in treatment due to payment issues.
• Sports Coverage option – add Sports Coverage
to your plan to cover injuries while participating in
sports such as snow skiing and snow boarding,
mountaineering, bungee jumping, scuba diving (must be PADI or NAUI certified), and others.
(Sports Coverage not available to residents of
Washington.)
Note: The minimum Period of Coverage under this Plan
is 7 days, the maximum is 365 days.
PROTECT YOURSELF AND
THE ONES YOU CARE
ABOUT
How can you protect yourself or your loved ones?
Make sure they’re covered by TravMed Choice
with FrontierMEDEX. Travel abroad with the same
confidence you have at home. To learn more about
TravMed Choice and FrontierMEDEX, call toll-free
1-800-732-5309.
OUTLINE OF COVERAGE
Medical Expenses
TravMed Choice pays for usual and customary
charges for covered expenses incurred by you due
to accidental injury or illness which occurred during
the period of coverage outside your Home Country.
Benefits are paid up to the amount selected by you for
your program.
Emergency Medical Evacuation and Medical
Repatriation
Benefits are paid up to $100,000 for medically
necessary medical evacuations and medical
repatriations.
Return of Mortal Remains
Benefits are paid up to $20,000 to return your remains
to your Home Country.
Emergency Medical Reunion
Benefits are paid up to $10,000 to bring an individual
of your choice to your side while you are hospitalized.
Return of Minor Child(ren)
Benefits are paid up to $5,000 if you are hospitalized
and your minor child(ren) are left unattended. TravMed
Choice will pay to bring them back to your Home
Country with an escort, if necessary.
Accidental Death and Dismemberment
Benefits are paid up to the principal sum benefit of
$25,000 if you sustain an accidental injury.
Emergency Assistance Services
Available 24 hours a day 7 days a week, a multilingual
specialist will help locate the nearest and most
appropriate medical care, coordinate direct payment
of covered medical expenses, monitor your progress
during the course of your treatment and recovery,
establish and maintain contact with family, personal
physician, and employer as necessary, and offer
guidance in other medical, legal or travel situations.
Additional Benefits
• Emergency Dental Treatment (included in Medical
Expenses)
• Sudden Recurrence of a Pre-Existing Condition
• Interruption of Trip
• Loss of Baggage
• Home Country Coverage is also incorporated in
this plan for incidental trips and for extension of
benefits for an injury or illness that was originally
diagnosed or treated outside your home country.
SCHEDULE OF BENEFITS
Accident and Sickness Medical
Policy Maximums
$50,000/$100,000
$250,000/$500,000
Age 70-79 - $50,000
Age 80+ - $10,000
Deductible – Per Policy
$100/$250
Benefit Period
Covered Expenses
incurred during the
Period of Coverage
Dental (emergency)
$200 per tooth to a
maximum of $1,000
Emergency Medical Evacuation
$100,000
Repatriation of Mortal Remains
$20,000
Emergency Reunion
$10,000
ACCIDENTAL DEATH AND
DISMEMBERMENT BENEFIT
Description of Loss
Percent of Principal Sum
Life
100%
Both Hands or Both Feet or
Sight of Both Eyes
One Hand and One Foot
100%
Either Hand or Foot and Sight
of One Eye
100%
Either Hand or Foot
50%
Two or more Members
100%
One Member
50%
100%
3 EASY WAYS TO ENROLL
FrontierMEDEX Emergency Response Center:
United States, Baltimore, MD +1-410-453-6330 (COLLECT)
Return of Minor Children
$5,000
Trip Interruption
up to $5,000
Loss of Baggage
$250
Accidental Death &
Dismemberment
$25,000
Home Country Coverage
Incidental Trips to Your
Home Country
Extension of Benefits
60 days per 12 months
of coverage up to
$25,000
30 days per 12 months
of coverage up to
$5,000
Optional Hazardous Sports
Coverage
Available up to Plan
Maximum
Assistance
24 hours – Worldwide
Coinsurance
U.S. Residents
Non-U.S. Residents
0%
20% to $5,000, then 0%
to Policy Maximum
All Coverage and Benefits are in U.S. Dollar Amounts
TOLL FREE ACCESS - The numbers below must be dialed from within the country
If your location is not listed or the call will not go through, call the 24-hour Emergency Response Center COLLECT
Notice to Physicians/Hospitals: Call FrontierMEDEX immediately for benefits verification and procedures.
Call 24 hours a day (multilingual). If you do not have access to a phone, email for assistance:
operations@frontiermedex.com | www.frontiermedex.com
1 800 127 907
Australia
0800 891 2734
Brazil
China (northern) 108888*800 527 0218
China (southern) 10811*800 527 0218
1 888 567 0977
Dominican Republic
0800 90 8505
France
0800 1 811401
Germany
800 96 4421
Hong Kong
1 809 41 0172
Israel
800 877 204
Italy
00531 11 4065
Japan
001 800 101 0061
Mexico
1 800 1 111 0503
Philippines
800 1100 452
Singapore
0800 9 92379
South Africa
900 98 4467
Spain
0800 55 6029
Switzerland
Thailand 001 800 11 471 0661
0800 252 074
U.K.
U.S. & Canada 1 800 527 0218
* Dial the first portion of phone number, wait for tone, and then dial remaining numbers.
For a complete list, go to the FrontierMEDEX website or your company’s Member Center (if eligible).
1
Complete the
application on our
website and mail to:
2
3
Fax it to us directly: 1-410-308-7905
MEDEX Insurance Services, Inc.
P.O. Box 19056
Baltimore, MD 21284
Call 1-800-732-5309 between
8:00 am – 5:00 pm EST
Monday – Friday for telephone assistance.
NOTICE: Coverage is underwritten by ACE American
Insurance Company (a Pennsylvania corporation.
NAIC #22667). This brochure provides a brief
description of the important features of the insurance
program under form AH-18102 or AH-22281-WA. It is
not a contract of insurance. Complete details of the
terms and conditions of coverage including eligibility
requirements, terms of coverage, and a complete
list of exclusions and limitations are included in
the description of coverage, Coverage may not be
available in all states or certain terms may be different
if required by state law. Please keep this information
as a reference.
Premium Calculation
Please use daily rates from fee chart associated with
response to (I.) under Coverage Specifics on the
application form.
$250 Deductible
AGE
US Residents — Daily Rates
$50,000
$250 Deductible
AGE
Non-US Residents — Daily Rates
$50,000
$100,000
$250,000
$100,000
$250,000
$500,000
Child Alone (0-17) 1.22
1.35
1.42
1.55
Child Alone (0-17) 1.55
1.82
2.07
18 to 29
1.22
1.42
1.57
1.62
18 to 29
1.72
2.02
2.27
30 to 39
1.42
1.62
1.93
2.15
30 to 39
2.22
2.63
3.03
40 to 49
2.22
2.50
2.65
2.75
40 to 49
3.27
3.70
4.27
50 to 59
3.57
4.12
4.35
4.58
50 to 59
4.52
5.48
6.05
60 to 64
4.12
4.85
5.25
5.73
60 to 64
5.38
6.70
7.52
65 to 69
4.85
5.18
5.50
5.93
65 to 69
7.17
8.53
10.13
70 to 79
7.07
N/A
N/A
N/A
70 to 79
9.10
N/A
N/A
80 plus
14.13
N/A
N/A
N/A
80 plus
15.17
N/A
N/A
Accompanied
Child (0-17)
0.68
0.88
0.95
1.02
Accompanied
Child (0-17)
0.93
1.08
1.23
WHAT TRAVMED CHOICE DOES NOT
COVER
The following is a brief list of the exclusions and
limitations for the insurance program. It is not a
complete list. For complete information about what
is not covered, refer to the website: frontiermedex.
com. The description of coverage will also contain
the full text of the policy’s exclusions and limitations.
Residents of the state of Washington are subject
to exclusions as outlined in their specified policy.
Travelers into the U.S. are subject to exclusions and
limitations as outlined in their specified policy. For
actual policy language, please contact 1-800-7325309.
1. intentionally self-inflicted Injury, suicide, or
attempted suicide, while sane or insane (in
Missouri, while sane);
2. war or any act of war, whether declared or not,
civil disturbance or insurrection;
3. military duty or service; while serving as a
member of the naval, air or Armed Services of any
country;
4. bodily contact sports; skydiving; hang gliding;
parachuting; mountaineering (the ascent or
descent of a mountain requiring the use of
specialized equipment, including, but not
limited to, pick-axes, anchors, bolts, crampons,
carabineers and lead or top-rope anchoring
equipment); any race; bungee cord jumping;
speed contest; scuba diving; spelunking or
caving; heliskiiing; (Mountaineering, bungee cord
jumping, scuba diving, spelunking, and caving are
not excluded, if the additional premium is paid for
these sports activities);
5. participation in professional athletic events;
6. operating, or learning to operate, any Aircraft, as a
student, pilot or crew;
7. Injury or loss or Sickness that occurs while
the Covered Person is legally intoxicated (as
determined by that state’s law) or while under the
influence of any drug unless administered under
the advice and consent of a Doctor;
8. Injury sustained while committing or attempting to
commit a felony or misdemeanor;
9. pregnancy or childbirth, or elective abortion, other
than Complications of Pregnancy;
10. routine dental care; dental treatment, except as a
result of Injury to sound natural teeth;
11. mental and nervous disorders (except as provided
in the Policy);
12. any non-emergency treatment or surgery;
13. Elective Treatment, or medical treatment during or
arising from a Trip undertaken for the purpose or
intent of securing medical treatment;
14. any treatment, service or supply not specifically
covered by the Policy;
15. elective or cosmetic surgery except for necessary
treatment due to covered Injury;
16. venereal disease or syphilis.
17. covered medical expenses for which the Covered
Person would not be responsible for in the
absence of the Policy.
18. Injury or sickness where the Covered Person
is traveling against the advice of a medical
professional.
securities, accounts, bills, currency, deeds, food
stamps or other evidence of debt, credit cards and
other travel documents except passports and visas.
Additional Exclusions: The Insurer will not pay this
benefit for loss due to: normal wear and tear; gradual
deterioration; rodents, animals or insects; damage
while being worked on; natural defect or damage
sustained due to any process or repair; civil war,
insurrection, rebellion, revolution or warlike act
by a military force, whether war is declared or not
declared; confiscation or expropriation by order of
any government; nuclear reaction, nuclear radiation,or
radioactive contamination; sporting equipment
damaged while being used; theft or pilferage while left
unattended in any vehicle; mysterious disappearance.
If We determine the benefits paid under this Policy are
eligible benefits under any other benefit plan, We may
seek to recover any expenses covered by another
plan to the extent that the Covered Person is eligible
for reimbursement.
This insurance does not apply to the extent that trade
or economic sanctions or other laws or regulations
prohibit Us from providing insurance, including, but
not limited to, the payment of claims.
The following exclusions apply to Part B - Baggage
Protection only.
Property Not Covered: The Insurer will not pay for
damage or loss of animals; bicycles except when
checked with a Common Carrier; motor vehicles and
equipment; boats, motorcycles, motors or any other
vehicles; artificial limbs, artificial teeth, dental bridges/
appliances, any type of eyeglasses, sunglasses or
contact lenses; hearing aids; tickets, money, notes,
When you are traveling with TravMed Choice,
FrontierMEDEX will provide you with 24/7 assistance
services even if your condition is excluded from the
stated insurance coverages.