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Medical |
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Health and Sickness |
Covered |
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Accidents |
Covered |
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Out-Patient |
|
Surgical Treatment |
Plan A($50,000 limit Policy) : $3,300 per Incident Plan B ($75,000 limit Policy) : $4,400 per Incident Plan C ($100,000 limit Policy) : $5,500 per Incident Plan D($130,000 limit Policy): $7,150 per Incident Plan J ($50,000 limit Policy): $2,750 per Incident Plan K($70,000 limit Policy): $3,850 per Incident |
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Dr. / Physician Visit |
Plan A($50,000 limit Policy) : $55 per visit Plan B ($75,000 limit Policy) : $70 per visit Plan C ($100,000 limit Policy) : $85 per visit Plan D($130,000 limit Policy): $110 per visit Plan J ($50,000 limit Policy): $55 per visit Plan K($70,000 limit Policy): $75 per visit |
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|
Prescription Drugs / Medicines |
Plan A($50,000 limit Policy) : $100 per Incident Plan B ($75,000 limit Policy) : $125 per Incident Plan C ($100,000 limit Policy) : $150 per Incident Plan D($130,000 limit Policy): $200 per Incident Plan J ($50,000 limit Policy): $80 per Incident Plan K($70,000 limit Policy): $110 per Incident |
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Physical Therapy |
$40 per visit |
 |
|
Lab & X-rays |
Plan A($50,000 limit Policy) : $450 per Incident Plan B ($75,000 limit Policy) : $475 per Incident Plan C ($100,000 limit Policy) : $500 per Incident Plan D($130,000 limit Policy): $650 per Incident Plan J ($50,000 limit Policy): $400 per Incident Plan K($70,000 limit Policy): $560 per Incident |
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|
In-Patient |
|
Hospital Intensive Care Unit |
Plan A($50,000 limit Policy) : $660 per day Plan B ($75,000 limit Policy) : $755 per day Plan C ($100,000 limit Policy) : $850 per day Plan D($130,000 limit Policy): $1,105 per day Plan J ($50,000 limit Policy): $460 per day Plan K($70,000 limit Policy): $640 per day |
 |
|
Surgical Treatment |
Plan A($50,000 limit Policy) : $3,300 per Incident Plan B ($75,000 limit Policy) : $4,400 per Incident Plan C ($100,000 limit Policy) : $5,500 per Incident Plan D($130,000 limit Policy): $7,150 per Incident Plan J ($50,000 limit Policy): $2,750 per Incident Plan K($70,000 limit Policy): $3,850 per Incident |
 |
|
Hospital Room and Board |
Plan A($50,000 limit Policy) : $1,400 per day Plan B ($75,000 limit Policy) : $1,675 per day Plan C ($100,000 limit Policy) : $1,950 per day Plan D($130,000 limit Policy): $2,535 per day Plan J ($50,000 limit Policy): $1,050 per day Plan K($70,000 limit Policy): $1,470 per day |
 |
|
Emergency Services |
|
Ambulance Expenses |
$450 per Incident |
 |
|
Emergency Room(ER) |
Plan A($50,000 limit Policy) : $330 per Incident Plan B ($75,000 limit Policy) : $440 per Incident Plan C ($100,000 limit Policy) : $550 per Incident Plan D($130,000 limit Policy): $700 per Incident Plan J ($50,000 limit Policy): $250 per Incident Plan K($70,000 limit Policy): $350 per Incident |
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|
Dental |
|
Acute, spontaneous and unexpected pain |
Not covered |
 |
|
Accidental emergency |
$550 per Incident |
 |
|
Travel |
|
Emergency Medical Evacuation / Repatriation |
Up to $50,000 |
 |
|
Return of mortal Remains |
Up to $7,500 |
 |
|
Emergency Reunion |
Not covered |
 |
|
Return of minor Child(ren) |
Not covered |
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|
Trip Interruption |
Not Covered |
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|
Loss of checked Baggage |
Not Covered |
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|
Life |
|
Common Carrier Accidental Death |
Up to $25,000 |
 |
|
AD&D |
Not Covered |
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|
Other |
|
Plan Exclusions |
What is not covered |
 |
|
More Details |
Please check Policy Details |
 |
|
Pre-Existing Conditions |
Optional Coverage of $5,000 for Myocardial infarction/ heart attack and stroke |
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|
Maternity |
Not covered |
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|
General Physical full Checkup |
Not covered |
 |
|
Terrorism Coverage |
Not covered |
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|
Support |
|
24-Hrs Emergency Assistance |
Yes. Contact number and details can be found on the ID card. |
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<<
Back  |
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Note
: Plan features
listed here are high
level, provided for
your convenience and
information purpose
only. Please review
the Evidence of Coverage
and Plan Contract
(Policy) for a detailed
description of Coverage
Benefits, Limitations
and Exclusions. Must
read the Policy Brochure
and Plan Details for
complete and accurate
details. Only the
Terms and Conditions
of Coverage Benefits
listed in the policy
are binding. |
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