This plan is improved and updated as of March 30, 2020. If you have questions about a policy purchased before March 30, 2020 , click here.
CA-G

CoverAmerica - Gold

Comprehensive Coverage,  Rated A (Excellent)Sirius International
AM Best Rating
A (Excellent)
Administrator/Underwriter
IMG
Sirius International
100%
In Network

After deductible, the plan pays 100% up to the policy maximum.

80%
Out of Network

Plan pays 80% of the first $5,000 then 100% up to the policy maximum.

acute-onset-pre-existing-condition
Acute onset of Pre-Existing Conditions
medical-coverage-during-travel
Medical Coverage During Travel
renewable-cancelable
Renewable & Cancelable
comprehensive
Comprehensive Coverage Plan
coverage-days
Coverage from 5 days to 365 days
urgent-care
Urgent Care
COVID-19 Included
BUY

CoverAmerica - Gold is a visitor insurance plan that provides medical insurance coverage and emergency services for non US citizens and non US residents traveling to the USA. It also covers incidental trips to Canada, Mexico, Bahamas, Latin America and South America, while visiting the USA. After the deductible is satisfied, within the PPO network , the plan will pay 100% of eligible medical expenses up to the policy maximum. Outside the PPO network, the plan will pay 80% of the first $1,000 in eligible medical expenses than 100% thereafter . Outside the USA, after the deductible is satisfied, the plan will pay 100% up to the chosen policy maximum.

Out-Patient

Dr. / Physician Visit

After deductible is met:


Within PPO Network

100% covered for eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses than 100% thereafter up to the policy maximum

Urgent Care

$15

For all other services after deductible is met:

Within PPO network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

Surgical Treatment

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

Prescription Drugs / Medicines

After deductible is met:

URC up to the policy maximum

Lab & X-rays

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

Physical Therapy

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

In-Patient

Hospital Room

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

Surgical Treatment

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

Hospital Intensive Care Unit

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

Emergency Services

Ambulance Expenses

Reasonable and Customary up to policy maximum

Emergency Room(ER)

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum


For ER visits for illness, that does not lead to in-patient hospitalization, there is an extra $250 deductible.

This deductible does not apply to accidents/injuries or sickness that lead to in-patient hospitalization

Dental

Acute, spontaneous and unexpected pain

Up to $250. (Deductible per occurrence $50)

Accidental emergency

After deductible is met:


Within PPO Network

100% covered for all eligible medical expenses up to policy maximum


Outside PPO Network

80% of the first $5,000 for all eligible medical expenses, then 100% thereafter up to the policy maximum

Travel

Emergency Medical Evacuation / Repatriation

Up to $1,000,000. Covered for any sickness or injury, including pre-existing conditions

Return of Remains

Up to $25,000

Emergency Reunion

Up to $100,000

Return of minor Child(ren)

Up to $100,000

Trip Interruption

Up to $10,000

Loss of checked Baggage

Up to $1,000 ($50 per item)

Life

AD&D

Up to $25,000 for primary insured and spouse.
(Dependents children: $5,000); $250,000 Family max

Common Carrier Accidental Death

Up to $50,000
(Dependents $25,000 each; $250,000 Max for Family)

Other

Acute Onset

Coverage is available for acute onset of pre-existing conditions

Up to age 69

Up to policy maximum selected

Ages 70-79: Maximum coverage $30,000

Maternity

Not Covered

General Physical full Checkup

Not Covered

Terrorism Coverage

Up to policy maximum chosen

Brochure

Support

24-Hrs Emergency Assistance

Yes. Contact Number and details can be found on the ID card.

Plan Administrator Company

IMG

Carrier / Underwriter

Sirius International

AM Best Rating

A (Excellent)

Eligibility

Available for Non US Citizens and Non US Residents, traveling to the USA for a short trip.

Plan Type

Comprehensive Coverage Plan
Percentage based coverage.

Coverage in U.S.A.

Covered

Coverage outside U.S.A.

Covered

Co-Pay

Urgent care consultation copay $15

Co-Insurance

After the deductible is satisfied, the plan pays 100% of all eligible medical expenses up to the medical maximum within the UnitedHealth Care PPO network.

How the Benefits are Paid

After the deductible is satisfied, the plan pays 100% of eligible medical expenses up to the selected policy maximum within the UnitedHealth Care PPO network.

Coverage Type

Lifetime of the policy

Deductible Type

Once Annually or Per Policy Period.

Renewability

Renewable up to a maximum period of 365 days. There is no Admin Fee for renewals.

Cancellation

No Cancellation Fee Full refund available if cancelled before start date. Pro-rated refund available after start date if no claims have been made

PPO Network

United Healthcare

Coverage Length

Min 5 Days to 365 days

Available Deductibles

Age up to 79 Choose from:$100; $250; $500; $1,000; $2,500; $5,000
Age 70-79 with a policy maximum of $100,000 or more, choose from: $1,000; $2,500; $5,000

Available Coverage

Choose From: $50,000; $100,000; $250,000
Ages 65 to 79: Limited to $50,000; $100,000
Ages 80 and over: No coverage available

Provider Directory

By Provider, Phone Nos. : 1 (800) 628-4664 or 1 (317) 655-4500

Plan Brochure

CoverAmerica Gold Insurance Brochure brochure

Home Country Definition

The country where the covered person has his/her true, fixed, permanent home and principal establishment.

US States Restrictions

No Restrictions

Country Restrictions

Paper applications are needed for residents of the following countries: Gambia, Ghana, Nigeria, Sierra Leone, Niger, Botswana

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.