Benefits
Exclusions
Claims
FAQ
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Reside Prime is long-term health coverage for international citizens who do not reside in the United States. A relatively new product to the industry, worldwide health is designed for those people who desire U.S. style health insurance benefits, but do not actually live in the United States. The plan covers the person in his home country, and protects him abroad as well. This program offers true global protection. The primary advantage of this type of coverage is that the insured is allowed to travel to other countries in order to receive treatment. As an example, this flexibility allows a permanent resident of Argentina to travel to the United States in order to receive treatment.

BENEFITS:
  - Lifetime Maximum Benefit $5,000,000 per Insured Person.
  - Hospital Expenses: Average Semi-Private room and board, Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-Rays up to the Policy Maximum.
  - Intensive Care: Intensive Care room and board, Usual, Reasonable, and Customary Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-rays up to the Policy Maximum.
  - Surgery: URC Charges for Surgery, Physician and Anesthetics up to the Policy Maximum.
  - Hospital Daily Indemnity Benefit: $50 per day ($1,000 maximum per policy period), for every Medically Necessary night spent in a Hospital (Hospital Admission) outside of the United States and Canada.
  - Outpatient Treatment: URC Charges for Emergency Treatment, Surgery, Prescription Medication up to the Policy Maximum.
  - Physiotherapy, Chiropractic: Up to $75 per visit ($10,000 Lifetime Maximum), when referred in advance by a Physician.
  - Medical Supplies: URC Charges up to Policy Maximum.
  - Ambulance: URC Charges up to Policy Maximum.
  - Well Child Care: Up to $200 Policy Period Maximum for checkups and routine visits after 12 month waiting period. Up to age 18. Not subject to deductible and coinsurance.
  - Maternity: URC Charges up to limits below per Pregnancy. Must be Pre-Notified within the first 90 days of Pregnancy. Waiting period of 12 months before maternity benefit begins.
    - After 12 months of continues policy term: $1,000.
    - After 24 months of continues policy term: $2,000.
    - After 36 months of continues policy term: $3,000.
    - After 48 months of continues policy term: $4,000.
    - After 60 months of continues policy term: $5,000.
  - Newborn Benefit: Maximum listed below per eligible pregnancy for the first 31 days after birth.
    - After 12 months of continues policy term: $1,000.
    - After 24 months of continues policy term: $2,000.
    - After 36 months of continues policy term: $3,000.
    - After 48 months of continues policy term: $4,000.
    - After 60 months of continues policy term: $5,000.
  - Mental & Nervous: URC Charges up to a Maximum of $10,000 per Policy Period after 12 month waiting period. Lifetime Maximum of $30,000.
  - Dental: URC Charges for repair and replacement of sound, natural teeth damaged as a result of an accident, limited to $500 per Policy Period.
  - Emergency Medical Evacuation: $250,000 Limit per person per policy period - when adequate medical facilities and/or treatment is not available. (pre-approval required).
  - Repatriation of Remains: $25,000 Limit - when traveling outside your current Country of Residence. (Pre-approval required).
  - Emergency Medical Reunion: $10,000 Limit - when traveling outside your current Country of Residence. (Pre-approval required).
  - Preventive Benefits: Females and Males over the Age 30 up to $175 Policy Period Maximum for checkups, routine physical exams, female preventative exams and mammograms after 12 month waiting period. Not subject to Deductible or Coinsurance.
  - Accidental Death & Dismemberment (AD&D): Principal Sum: $10,000 for Insured and Spouse, $2,000 for Dependent Children. For Common Carrier, Principal Sum: $40,000 for Insured and Spouse, $8,000 for Dependent Children.
  - Lifetime Transplant Benefit: Up to $1,000,000 per Insured Person.

EXCLUSIONS: Your coverage is subject to various exclusions, which are completely set out in the Exclusions section of the policy document. The following, although not an exhaustive list, are some of these exclusions:
Coverage in the United States is limited to 6 months during any 12 month Policy Period.

Eligibility:
The Reside Prime program is available to persons of any country who are at least 15 days of age and who have not yet reached age 75.
For US Citizens: Applicants / Insured Persons must either be outside the United States at the time of application , or must depart the United States within 30 days of the Certificate's Effective Date . In addition, the Insured Person must reside outside the United States at least 6 months during any given 12-month period to meet the Eligibility Requirements of an Insured Person. Should any Insured Person reside in the United States longer than 6 months during any given 12-month period, their Coverage shall immediately terminate.
For Non-US Citizens: Applicants / Insured Persons must be outside the United States at the time of application or must depart the United States within 30 days of the Certificate's Effective Date . In addition, the Insured Person must reside outside the United States at least 6 months during any given 12-month period to meet the Eligibility Requirements of an Insured Person. Should any Insured Person reside in the United States longer than 6 months during any given 12-month period, their Coverage shall immediately terminate.
*It is the Insured Person's responsibility to maintain all records regarding travel history, age and student status and provide any documents to the Administrator, which would verify the Eligibility Requirements.

Deductible Options: $250, $500, $1000, $2500, $5000. Maximum of 3 deductible payments for families enrolling on one application. Any eligible charges incurred and applied to your policy period deductible in the last 30 days prior to your renewal date will carry over and be applied to the next policy period deductible. There is 50% reduction of the deductible for eligible medical expenses if PPO service provider has been used.

Coinsurance:
Outside of the United States After the Deductible, the Policy pays 100% of eligible expenses to the Policy Maximum. Hospital Admissions must be Pre-Notified using SRI's Pre-Notification Program.
Inside of the United States After the Deductible, the Policy pays 80% of the next $5,000 of eligible expenses, then 100% up to the Policy Maximum. Expenses incurred inside the United States must be Pre-Notified using SRI's Pre-Notification Program. Coinsurance will be waived in PPO network.

Pre-existing Conditions:
If an existing condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by a rider, your pre-existing condition will be covered up to a lifetime maximum of $50,000 ($5,000 limit per year) after you have been continuously insured for 24 months.
Pre-existing conditions are any Injury or Illness which meets the following criteria: 1) A condition that would have caused a person to seek medical advice, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2) A condition for which manifestation, medical advice, diagnosis, care or treatment (including medication) was recommended or received prior to the Effective Date of coverage under this Certificate; 3) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate.

Other Exclusions:
  - Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or symptoms occur during the first 180 days of coverage hereunder beginning on the initial effective date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder. Note: coverage for such illnesses or surgeries may be further limited under the pre-existing condition exclusion and definition contained herein, or other exclusions contained herein.
  - Claims not presented to Company within ninety (90) days following incident.
  - Treatment not medically necessary, treatment which exceeds reasonable and customary charges, treatment provided at no cost to the Insured Person, or treatment performed by a relative or anyone who lives with the Insured Person.
  - Experimental treatment.
  - Suicide or any attempted suicide.
  - War or warlike operations.
  - Injury in organized, professional, amateur, or interscholastic athletics.
  - Routine physicals or procedures.
  - Treatment of Temporomandibular joint.
  - Vocational, Speech, Recreational or Music Therapy.
  - Cosmetic surgery except as a result of a covered accident.
  - Dental or eye treatment unless otherwise covered.
  - Injuries as a result of disablement due to liquor or drugs.
  - Telephone consultations.
  - Treatment or services relating to custodial, rehabilitative, or nursing home care.
  - Congenital conditions.
  - Non-medical expenses.
  - Self-inflicted injury or illness.
  - Expenses in connection with the commission or attempt of a criminal offense.
  - Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing, scuba diving (unless PADI, NAUI, YMCA, SSI or PDIC certified).
  - Treatment of venereal or sexually transmitted disease.
  - Treatment due to HIV or AIDS.
  - Drug treatment relating to infertility.

This is a Summary of the Exclusions contained in the Certificate of Coverage. A complete description of the Master Policy Provisions and Benefits is contained in the Certificate of Insurance, which will be mailed to you once your application and premium have been received and approved by SRI.

CLAIMS:
Pre-notification:
RESIDE Prime requires that the Insured Person (or someone on the Insured Person's behalf) contact SRI Assist for notification prior to all hospital admissions worldwide and any medical expenses incurred within the United States. The methods of contacting SRI Assist will appear on the back of your ID Card. SRI Assist will also be able to assist you in locating the approved SRI medical care providers in the United States.
PPO
Services and Treatment in the United States must be received at an approved PPO Service Provider facility, if one exists within a 50-mile radius of where the Insured Person is located. To obtain a list of approved PPO Service Providers contact the Administrator or visit the approved PPO Service Provider website at: www.specialtyrisk.com/ppo
If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.
Failure to follow the Pre-Notification Program and to utilize an approved PPO Service Provider will result in a 25% reduction of the Eligible Benefits stated in the Schedule of Benefits.
Claim Submission:
Filing a claim with SRI is easy. You will receive an identification card and claim form once you are approved for insurance. When you receive treatment, send the original, itemized bills to SRI within 90 days. Eligible bills are automatically converted from local currencies to US dollars. For payments of eligible medical expenses, notify SRI of pending treatments and we can refer you to approved health care providers worldwide. You're only responsible for your deductible, coinsurance amounts and non-eligible expenses. For more details, consult the Program Summary that is provided with your insurance kit, or contact the SRI Claim Department.

F.A.Q.:
The Underwriter:
Reside Prime is underwritten by Certain Underwriters at Lloyd's, London and is rated A- "Excellent" by A.M. Best and an A+ (Strong) rating from Standard and Poors. In addition to being one of the largest insurance entities in the world, Lloyd's has over 300 years of experience in the international insurance business.
The Program Administrator:
Since 1993, Specialty Risk International, Inc. (SRI) has provided international insurance plans to private citizens, governments, missionaries, students, and corporations of various nations around the globe. As a premier underwriter, SRI has had the opportunity to provide innovative solutions to unique and challenging situations.
Our claims professionals are experienced in the complexity of processing international medical expenses. As an insured of SRI, you can feel confident that there is someone ready to assist you with a medical situation 24 hours a day, 365 days a year.
Other services including proficient administration, responsive underwriting, and access to secure and stable insurance carriers and medical care providers worldwide.

Reside® is a registered trademark of Seven Corners, Inc.

DOWNLOADS:

Reside Prime BROCHURE PDF

Reside Prime CERTIFICATE PDF

Reside Prime CLAIM FORM PDF

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