How Does the Plan Pay
Inbound USA is a fixed dollar based limited coverage plan. The policy maximum is just the outer limit, but there are limits to every service or treatment also. The plan pays a pre-defined fixed dollar amount for every service or treatment. These specific amounts are mentioned in the plan brochure and the Description of Coverage. The policy maximum is just the outer limit.
How Does the Deductible Work
The deductible is the first amount of the covered bill that is the insured person's responsibility, before the insurance starts paying. The insured person has to first satisfy the deductible, before the insurance starts paying.
Deductible Applied to the Fixed Benefits
The Inbound USA plan pays a limited amount for every service and treatment. The deductible for limited coverage plans, is applied to the fixed benefit amounts, and not the amount that the doctor's charge. For example, for a $50,000 policy maximum, the plan pays $3,300 for covered surgeries, for people below 70 years of age. Now the surgery can cost $15,000 or $40,000, the insurance would pay a maximum up to $3,300. If you choose a $100 deductible, the deductible would apply to the fixed amount $3,300, and not the bill amount that the providers charge. The insurance would pay $3,300 (fixed benefit amount)-$100 (deductible) = $3,200
The Inbound USA has a per-incident deductible, i.e. deductible applies once to each separate sickness or injury.
So for example if you need to go to the doctor for a fever, you are responsible for one deductible for the fever, then the plan would pay the fixed amounts for every service or treatment related to the fever (doctors visit, lab work, x-ray etc). You do not have to pay any more deductible for follow up visits of the same sickness or injury. Now if you need to go to the doctor for a different sickness or injury e.g. hip injury, not related to the fever, then, you would be responsible for a new deductible. The plan would again cover the same fixed limited dollar amounts for every service and treatment related to the hip injury.
Visit Any Doctor or Hospital
Inbound USA Insurance is a limited coverage plan, which means there is no PPO Network. When using your Inbound USA Insurance policy, you may visit any doctor or hospital of your choice. The doctor, hospital, or other service provider may send the bill directly to the insurance company, or they may require you to pay upfront and file your claim for reimbursement later.
Where Does the Plan Cover
The Inbound USA is essentially a USA only plan. The start date of the policy should be the date that the insured person reaches the USA, and the end date should be the date that he/she leaves the USA. It does not cover for the International flight or layover from the home country to the USA, or back to home country from USA.
Limited International Coverage
The Inbound USA offers very limited and restrictive International travel coverage. If the insured person has the Inbound USA policy for more than a month, and takes a short trip during their stay in the USA, to additional International countries, then the plan would cover for that. For example if you are travelling to the USA for two months, and have the Inbound USA policy, and you decide to take a 15 day trip to Mexico or Canada, the plan would cover for that. The following are the conditions for the trips outside the USA for short trips with the Inbound USA Plan:
- The trip has to start in the USA and end in the USA. The trip outside the USA should be sometime between the start date and end date in the USA.
- The total period of coverage for the policy has to be more than a month.
- In the additional countries, outside the USA, the plan would cover for a maximum of one month only.
First: You satisfy accumulated medical expenses until your deductible is met.
Then: Insurance pays fixed amount per eligible medical service as outlined in the benefit table below, up to the policy maximum.
All expenses beyond the policy maximum are the responsibility of the insured.
Read the Inbound USA Insurance brochure for complete details.