CA

ChoiceAmerica

Limited Coverage,  Rated A- (Excellent)By: IMG,  UW: Sirius SpecialitySirius Specialty Insurance Corporation
AM Best Rating
A- (Excellent)
Carrier/Underwriter
Sirius Specialty Insurance Corporation
Administrator
IMG
COVID-19 Included
extendable-cancelable
Extendable & Cancelable
urgent-care
Urgent Care
medical-coverage-during-travel
Medical Coverage During Travel
extendable-cancelable
Basic Coverage Plan
Coverage from 5 days to 365 days
BUY

ChoiceAmerica is travel medical insurance for non-U.S. citizens traveling to the United States, Mexico or Canada.
ChoiceAmerica insurance is a basic travel medical insurance plan that has fixed pre defined limit for each medical service.
You visit any doctor or hospital of your choice.

Note: Choice America is not available for citizens or residents of the U.S.A. For Canadian and Mexican citizens and residents, the plan will not cover in their home country and country of citizenship.

The following benefit table shows how much insurance pays for the given covered medical service. If the actual bill is more, the difference will be your responsibility.
Please review ChoiceAmerica Insurance Brochure brochure and Description of Coverage brochure (policy document) for complete and accurate coverage and exclusions.

Applicant's Age 14 days - 79 years

CA

$50,000

Policy Maximum
CA

$100,000

Policy Maximum
CA

$150,000

Policy Maximum
Out-Patient  
Dr. / Physician Visit  
$65/visit, 10 visits max$90/visit, 10 visits max$130/vist, 10 visits max
Urgent Care  
$65/visit, 10 visits max$90/visit, 10 visits max$130/vist, 10 visits max
Surgical Treatment  
$3,500$6,000$7,500
Prescription Drugs / Medicines  
Up to max $350 per certificate periodUp to max $350 per certificate periodUp to max $350 per certificate period
Lab & X-rays  
$1,000$1,250$1,500
Physical Therapy  
Insurance covers up to $60 per visit, 15 visits maximum per certificate periodInsurance covers up to $60 per visit, 15 visits maximum per certificate periodInsurance covers up to $60 per visit, 15 visits maximum per certificate period
 
In-Patient  
Hospital Room  
$1,400 per day/ 30 days max$2,000 per day/ 30 days max$3,000 per day/ 30 days max
Surgical Treatment  
Up to $4,000Up to $6,000Up to $7,500
Hospital Intensive Care Unit  
Up to $700 per day/ 8 Days maxUp to $1,000 per day/ 8 Days maxUp to $1,500 per day/ 8 Days max
 
Emergency Services  
Ambulance Expenses  
Up to $650Up to $650Up to $650
Emergency Room(ER)  
Up to $400 maximum per visitUp to $600 maximum per visitUp to $800 maximum per visit
 
Dental  
Acute, spontaneous and unexpected pain  
Optional Coverage with additional premium
1 exam: Up to $100
Tooth Removal : Up to $200
Optional Coverage with additional premium
1 exam: Up to $100
Tooth Removal : Up to $200
Optional Coverage with additional premium
1 exam: Up to $100
Tooth Removal : Up to $200
Accidental emergency  
Up to $700 per certificate periodUp to $700 per certificate periodUp to $700 per certificate period
 
Travel  
Emergency Medical Evacuation / Repatriation  
Up to $50,000Up to $50,000Up to $100,000
Return of Remains  
Up to $7,500Up to $7,500Up to $7,500
Emergency Reunion  
Not covered
Return of minor Child(ren)  
Not CoveredNot CoveredNot Covered
Trip Interruption  
Not CoveredNot CoveredNot Covered
Loss of checked Baggage  
Not CoveredNot CoveredNot Covered
 
Life  
AD&D  
Not CoveredNot CoveredNot Covered
Common Carrier Accidental Death  
Up to $5,000 per insured and Max $25,000 Max per familyUp to $5,000 per insured and Max $25,000 Max per familyUp to $5,000 per insured and Max $25,000 Max per family
 
Other  
Pre-Existing Conditions  
Optional Coverage with Additional Premium Additional Deductible: $50 per incident
Physician visit: Insurance pays $150 per visit/3 visits maximum
Lab work & X-ray: $1,000
Emergency Room & Hospitalization: $1,500
Prescription : $100
Optional Coverage with Additional Premium Additional Deductible: $50 per incident
Physician visit: Insurance pays $150 per visit/3 visits maximum
Lab work & X-ray: $1,000
Emergency Room & Hospitalization: $1,500
Prescription : $100
Optional Coverage with Additional Premium Additional Deductible: $50 per incident
Physician visit: Insurance pays $150 per visit/3 visits maximum
Lab work & X-ray: $1,000
Emergency Room & Hospitalization: $1,500
Prescription : $100
Local Burial or Cremation  
Up to $5,000Up to $5,000Up to $5,000
Maternity  
Not CoveredNot CoveredNot Covered
Incidental Home Country Coverage  
Not CoveredNot CoveredNot Covered
Terrorism Coverage  
$50,000 per coverage period$50,000 per coverage period$50,000 per coverage period
Brochure  
Choice America Insurance Brochure brochureChoice America Insurance Brochure brochure
 
Support  
24-Hrs Emergency Assistance  
Yes. Contact number and details can be found on the ID card.Yes. Contact number and details can be found on the ID card.Yes. Contact number and details can be found on the ID card.
 

Plan Administrator Company

IMG

Carrier / Underwriter

Sirius Specialty Insurance Corporation

AM Best Rating

A- (Excellent)

Eligibility

1) Can be purchased by non-US citizens and non-US Resident.
2) Available ages 15 days to 79 years.
3) For people 65 and over, the plan has to be purchased within 30 days, after arriving in the USA.

Policy Content

What is Policy Maximum?

Policy Maximum is the maximum amount that an insurance policy will pay for covered expenses. If you choose a policy with maximum coverage of say $50,000, and your actual bills are $120,000, the insurance will pay only up to $50,000 for the covered expenses as per the policy.


Note: Policy maximum is the outer limit of the insurance company's liability for the covered expenses only. Do not assume that insurance pays for everything up to policy maximum. All applicable limits and exclusions will apply.

What policy maximum should I choose?

This type of plan pays based on fixed pre-defined benefits. Higher the policy maximum, better are the benefits. It is a good idea to select a higher policy maximum such as $100,000 or more for better benefits.

Note: These suggestions are based on generic guidelines of how the insurance policy works and what can be the best possible combination for maximum benefit from this type of policy.

Deductible Content

Deductible Per Incident
What is Deductible?

Deductible is the amount that you are responsible for, before insurance company starts paying for any covered expenses. Deductible for this type of plan is applicable once per incident.


For example: If you visit a doctor for a medical problem, and after consultation, the doctor prescribes Medicines, X-rays, and Lab tests, then since all these services are part of one incident, your deductible will be applicable for these services only once. If you visit a doctor again after a few days for a new problem, the deductible will be applicable again for that new incident.
What deductible to choose with this Plan?

Since deductible is per incident for these type of plans. It is a good idea to select a lower deductible such as “0“.

Note : For Age 70 and above, lower deductible like Zero “0“ is not available.

Plan Type

Limited Coverage Plan
Plan pays by a pre-defined fixed benefit table.

Coverage in U.S.A.

Covered

Coverage outside U.S.A.

Only Canada and Mexico

Co-Pay

No Co-pay
(You pay the difference of the fixed benefits defined by the benefit table)

Co-Insurance

No Co-Insurance
(You pay the difference of the fixed benefits defined by the benefit table)

How the Benefits are Paid

After the deductible, plan pays fixed amount based on a pre-defined benefit table for each type of service or treatment.

Coverage Type

Per Life of Plan

Deductible Type

Per Period of Coverage

Renewability

Can be extended only before policy expires. A $5 extension fee applies for every extension. Can be extended for up to 12 months

Cancellation

1) No refund available if you need to visit doctors with the policy.
2) Full refund available if cancelled before start date.
3) Pro-rated refund available after start date only if no claims is submitted by you or the service provider.
4) $20 Cancellation Fee Applicable.
5) Written request or e-mail is required for any cancellation and refund

PPO Network

First Health Network

Coverage Length

Minimum 5 days to Maximum 12 months

Available Deductibles

Choose From: $0, $50, $100

Available Coverage

Plan A: $50,000
Plan B: $100,000
PlanC: $150,000

Provider Directory

By Provider, Phone Nos. : 800-628-4664 or 317-655-4500

Plan Brochure

Choice America Insurance Brochure brochure

Home Country Definition

For United States citizens, the Home Country is the United States. For non-United States citizens, the Home Country is the country of which the Insured Person is a citizen or national; including any country where the Insured Person maintains his/her primary residence or usual place of abode and any country of which the Insured Person pays income taxes or is the possessor of a validly issued passport. In the event there is more than one Home Country under the above-listed criteria or the person has dual citizenship, the Home Country is the country meeting the above-listed criteria and listed by the Insured Person as his or her Home Country on the Application.

US States Restrictions

Maryland

Disclaimer

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.