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Thursday, March 11th, 2010
LIAISON INTERNATIONAL
Global Travel Insurance
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Benefits

Exclusions
Claims
FAQ
Rates
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Liaison International provides up to $1,000,000 in medical benefits for individuals and families while traveling outside of their home country. Additionally, Liaison International has other valuable benefits such as Emergency Evacuation coverage up to $300,000 (in addition to the medical maximum) and 24-Hour, 365 Day Assistance Services to provide access to care when you are in a foreign country.
5 DAYS TO 12 MONTHS (Renewable up to 3 years) OF COVERAGE FOR:
- NON-CITIZENS VISITING THE UNITED STATES.
- UNITED STATES CITIZENS TRAVELING OVERSEAS.
- INTERNATIONAL TRAVELERS REQUIRING CONTINUING COVERAGE

BENEFITS:
Hospital room and board: up to the selected policy maximum for usual, reasonable and customary charges for professional service and (with the exception of personal services of a non-medical nature); charges made for an operating room. Charges made for diagnosis, treatment and surgery by a physician; charges made for the cost and administration of anesthetics; floor nursing and other services.
Intensive Care or Coronary Care charges and nursing services.
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.
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.
Physiotherapy, if recommended by a physician.
Local Ambulance Expense:$5,000 to and from the nearest Hospital.
Hospital Indemnity: $150 for each night spent in the hospital, in addition to any other covered expenses of the program (traveling outside the U.S. and Canada)
Accidental Dental: Dental treatment necessary to restore or replace sound natural teeth lost or damaged in an Accident which is covered under the program ($500). Only available to programs purchased for 1 month or more.
Emergency Dental:Treatment necessary to resolve acute, spontaneous and unexpected inception of pain to sound natural teeth ($100). Only available to programs purchased for 1 month or more.
Emergency Medical Evacuation/ Repatriation: $300,000 (in addition to the Medical Maximum) for transportation from the medical facility where you are located to the nearest adequate medical facility where medical treatment can be obtained. The benefit must be ordered by the Assistance Company in consultation with the local attending Physician.*
Home Country Coverage Incidental Trips to The Home Country: $50,000 (60 days per 12 months of purchased coverage or pro rata thereof - example: approximately 5 days per month of purchased coverage).
Follow Me Home Coverage: This plan shall pay for Covered Expenses incurred in your Home Country up to $5,000 for conditions first diagnosed outside Your Home Country (Does not apply for Emergency Evacuation or Repatriation).
Return of Mortal Remains: up to $50,000 to return your remains to your Home Country, if you should die.*
Emergency Reunion: When Emergency Medical Evacuation or Repatriation is ordered and the attending Physician recommends that a family member travel with you, the program will arrange and pay, up to $50,000, for a round trip economy-class transportation for one individual of your choice, from your Home Country, to be at your side while you are hospitalized and then accompany you during your return to your Home Country.
Return of Minor Child(ren): Should you be traveling alone with a Minor Child(ren) and are hospitalized because of a covered Illness or Injury and the Minor Child(ren), under age 19, is left unattended, the program will arrange and pay up to $50,000 for one way economy fare to their Home Country (including the cost of an attendant/escort, if necessary to insure the safety and welfare of a Minor Child(ren)).*
Interruption of Trip: If you are unable to continue the Trip due to the death of an Immediate Family member (parent, spouse, sibling or child) or due to serious damage to your principal residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane, etc.). The program will reimburse you (up to $5,000) for the cost of economy travel, less the value of applied credit from an unused return travel ticket, to return you home to your area of principal residence. *
Loss of Checked Luggage: up to $250 ($50 per bag) for permanently lost by the airline checked luggage.
Accidental Death & Dismemberment (AD&D): $25,000 principal sum for insured or insured spouse, $5,000 for dependent child.
Common Carrier Accidental Death: $50,000 per adult, $25,000 per children under age of 18; $250,000 Maximum per family
Terrorism: Usual, reasonable and customary to the selected policy maximum (not covered in FL, NC, NY, OR, KS).
Waiver of Pre-Existing Conditions:Up to $20,000 for U.S. citizens traveling outside the United States and Canada.
Benefit Period:Six months
Hazardous Sport Coverage - To cover motorcycle/motor scooter riding, mountaineering (4500 meter limit), hang gliding, parachuting, bungee jumping, water skiing, snow skiing, snowmobiling, and snow boarding.

 * NOTE: In the event of an Emergency Medical Evacuation, Repatriation, Return of Mortal Remains, Emergency Reunion, Return of Minor Child(ren), Interruption of Trip or Loss of Checked Luggage benefit is needed or utilized, arrangements must be made by the Assistance Service Provider. Complete details about the benefits and about the required notification of the Assistance Service Provider are contained in the Program Summary.

EXCLUSIONS
Deductible: $0; $100; $250; $500; $1,000; $2,500. Deductible is per person per policy period, maximum of 3 Policy Period deductibles per family. The selected Deductible and Coinsurance amount must be met for each 12-month period.
Coinsurance: Inside the United States and Canada: After you pay the deductible, the program pays 80% of the next $5,000 of eligible expenses, then 100% to the selected Maximum.
Outside the United States and Canada: After you pay the deductible, the program pays 100% to the selected Maximum.
Pre-existing Conditions: Any Injury or Illness which meets the following criteria: a) condition(s) that would have caused a person to seek medical advise, diagnosis, care or treatment during the 36 months prior to the Effective Date of coverage under this Policy; b) condition(s) for which manifestation, medical advise, diagnosis, care or treatment was recommended, received, or noticed during the 36 months prior to the Effective Date of coverage under this Policy;
If you are traveling outside the United States and Canada, the period is 12 months instead of 36 months.
If you are a United States citizen and the United States is your Home Country, this exclusion is waived for the first $15,000 in eligible medical expenses incurred outside the United States and Canada (for persons age 65 and over, the amount is $2500). This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this program.
Other Exclusions:
- Charges for treatment which exceed Reasonable and Customary charges; or Charges incurred for Surgeries or treatments which are Investigational, Experimental, or for research purposes; expenses which are non-medical in nature; expenses for Vocational, Speech, Recreational or Music Therapy.
- Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician.
- Suicide or any attempt there at, while sane or self destruction or any attempt there at, while insane; intentionally self-inflicted Injury or Illness; or expenses as a result or in connection with the commission of a felony offense.
- Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
- Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics.
- Routine physicals, inoculations, or other examinations where there are no objective indications or impairment in normal health.
- Treatment of the Temporomandibular joint.
- Services or supplies performed or provided by a Relative of yours, or anyone who lives with you.
- Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids, cosmetic or plastic Surgery (including deviated nasal septum), routine dental expenses, eye care or eye related expenses, unless caused by Accidental bodily Injury incurred while insured hereunder.
- Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent; any Mental and Nervous disorders or rest cures; Injury sustained while under the influence of or Disablement due to wholly or partly to the effects of intoxicating liquor or drugs.
- Congenital abnormalities and conditions arising out of or resulting therefrom.
- Expenses incurred during a hospital emergency room visit which is not of an emergency nature.
- Injury sustained while taking part in mountaineering where ropes or guides are normally used, hang gliding, parachuting, bungee jumping, racing by horse or motor vehicle or motorcycle, snowmobiling, motorcycle / motor scooter riding, scuba diving involving underwater breathing apparatus (unless PADI or NAUI certified), water skiing, snow skiing and snow boarding. *
- Treatment paid for or furnished under any other individual, government, or group policy or charges provided at no cost to you.
- Treatment of venereal or sexually transmitted disease.
- Pregnancy expenses or Illness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from an Accident.
- Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth.
- Expenses incurred while you are in your Home Country (except as provided under the Home Country Coverage benefit).
- Expenses incurred for which travel was undertaken to seek medical treatment for a condition; or incurred after the Insured Person’s physician has limited or restricted travel.
* Options are available to include all or part of these risks.

CLAIMS:
Prenotification:
In order to ensure your claims are addressed as efficiently as possible, you or the provider of service must contact the Assistance Company for prenotification prior to any medical treatment in the US, as well as hospital admissions and inpatient / outpatient surgeries incurred worldwide. The Assistance Company has trained personnel available 24 hours a day, 7 days a week throughout the year to answer your questions, provide assistance, and guide you to an appropriate facility if necessary. In the case of an Emergency Admission, the Assistance Company must be contacted within 48 hours, or as soon as reasonably possible. Prenotification does not guarantee that benefits will be paid. Failure to prenotify will result in a 20% reduction in Eligible Benefits.

Please be aware that this is not a general health insurance policy, but an interim, limited benefit period, travel medical program intended for use while away from your Home Country. Liaison International does not guarantee payment to a facility or individual for medical expenses until SRI determines that it is an eligible expense.

Claim Submission:
Filing a claim with SRI is easy. You will receive a Liaison International 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.:
Refund of premium:
Refund of total plan cost will only be considered if written request is received by SRI prior to the Effective Date of Coverage. If written request is received after the Effective Date of coverage, the unused portion of the plan cost may be refunded minus a cancellation fee, provided no claim has been submitted to SRI for reimbursement.

The insurance company:
Liaison International is underwritten by Virginia Surety Company, Inc., rated A- “Excellent” by A.M. Best and located in Illinois. (In FL, NC, NY, OR, KS, the plan is underwritten by Certain Underwriters at Lloyd’s, London.)

Plan Administrator:
Since 1993, Seven Corners has provided medical insurance to corporations, international travelers, expatriates, students, overseas visitors, immigrants and global citizens. With expertise an deficiency, we’ve served clients in more than a hundred countries.

Complete provisions pertaining to this insurance are contained in the Master Policy on file with the trustee, American Consumer Insurance Trust, and Liaison International. In the event of any conflict between this brochure and the Master Policy, the Policy will govern. A Program Summary, listing more detailed exclusions, will be mailed to you along with Your ID Card once coverage is purchased.

Notice to Florida residents: the benefits of this policy providing Your coverage are governed by the law of a state other than Florida. Your Homeowners policy, if any, may provide coverage for loss of personal effects provided by the Loss of Checked Luggage coverage. This insurance is not required in connection with the purchase of Your travel arrangements.

RATES:

U.S. or Canadian Citizens Traveling Outside the United States

 

$50,000

$100,000

$500,000

$1,000,000

Age

One Month

Daily

One Month

Daily

One Month

Daily

One Month

Daily

19-29

$26.00

$0.87

$31.00

$1.03

$36.00

$1.20

$41.00

$1.37

30-39

$31.00

$1.03

$36.00

$1.20

$48.00

$1.60

$55.00

$1.83

40-49

$52.00

$1.73

$58.00

$1.93

$65.00

$2.17

$73.00

$2.43

50-59

$89.00

$2.97

$102.00

$3.40

$109.00

$3.63

$115.00

$3.83

60-64

$112.00

$3.73

$134.00

$4.47

$146.00

$4.87

$165.00

$5.50

65-69

$130.00

$4.33

$143.00

$4.77

$150.00

$5.00

$170.00

$5.67

70-79

$195.00

$6.50

$275.00

$9.17

N/A

N/A

N/A

N/A

80+*

$341.00

$11.37

N/A

N/A

N/A

N/A

N/A

N/A

Dependent child

$18.00

$0.60

$23.00

$0.77

$25.00

$0.83

$27.00

$0.90

Child alone

$29.00

$0.97

$33.00

$1.10

$36.00

$1.20

$39.00

$1.30

* Ages 80+ limited to $15,000. Dep. Child rates is applicable when at least one parent will also be covered uner Liaison Internatonal. Child alone rate is used when a child will be insured by themselves.

 

Non U.S. citizens traveling to the United States
Option 1 - 80% Coinsurance to $5,000, than 100% to Plan Maximum

 

$50,000

$100,000

$500,000

$1,000,000

Age

One Month

Daily

One Month

Daily

One Month

Daily

One Month

Daily

19-29

$41.00

$1.37

$48.00

$1.60

$65.00

$2.17

$73.00

$2.43

30-39

$55.00

$1.83

$65.00

$2.17

$86.00

$2.87

$96.00

$3.20

40-49

$82.00

$2.73

$92.00

$3.07

$126.00

$4.20

$138.00

$4.60

50-59

$126.00

$4.20

$153.00

$5.10

$183.00

$6.10

$216.00

$7.20

60-64

$153.00

$5.10

$192.00

$6.40

$237.00

$7.90

$272.00

9.07

65-69

$195.00

$6.50

N/A

N/A

N/A

N/A

N/A

N/A

70-79

$246.00

$8.20

N/A

N/A

N/A

N/A

N/A

N/A

80+*

$428.00

$14.27

N/A

N/A

N/A

N/A

N/A

N/A

Dependent child

$25.00

$0.83

$29.00

$0.97

$38.00

$1.27

$41.00

$1.37

Child alone

$41.00

$1.37

$49.00

$1.63

$61.00

$2.03

$68.00

$2.27

* Ages 80+ limited to $15,000. Dep. Child rates is applicable when at least one parent will also be covered uner Liaison Internatonal. Child alone rate is used when a child will be insured by themselves.

Non U.S. citizens traveling to the United States
Option 2 - 100% Coinsurance to $2,500, then 80% to Plan Maximum

 

$50,000

$100,000

$500,000

$1,000,000

Age

One Month

Daily

One Month

Daily

One Month

Daily

One Month

Daily

19-29

$38.00

$1.27

$43.00

$1.43

$59.00

$1.97

$66.00

$2.20

30-39

$50.00

$1.67

$59.00

$1.97

$78.00

$2.60

$87.00

$2.90

40-49

$75.00

$2.50

$84.00

$2.80

$115.00

$3.83

$126.00

$4.20

50-59

$115.00

$3.83

$139.00

$4.63

$167.00

$5.57

$197.00

$6.57

60-64

$139.00

$4.63

$175.00

$5.83

$216.00

$7.20

$248.00

8.27

65-69

$178.00

$5.93

N/A

N/A

N/A

N/A

N/A

N/A

70-79

$224.00

$7.47

N/A

N/A

N/A

N/A

N/A

N/A

80+*

$389.00

$12.97

N/A

N/A

N/A

N/A

N/A

N/A

Dependent child

$23.00

$0.77

$26.00

$0.87

$35.00

$1.17

$37.00

$1.23

Child alone

$38.00

$1.27

$43.00

$1.43

$59.00

$1.97

$66.00

$2.20

* Ages 80+ limited to $15,000. Dep. Child rates is applicable when at least one parent will also be covered uner Liaison Internatonal. Child alone rate is used when a child will be insured by themselves.

DOWNLOADS:

Liaison International BROCHURE PDF

Liason International CERTIFICATE Lloyds PDF

Liason International CERTIFICATE Nationwide PDF

Liaison International CLAIM FORM PDF


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