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HCC

HCC Terms

Benefit

Platinum

Coverage Area

Worldwide

Overall Policy Maximum

$5,000,000 Lifetime

Deductibles Available

$250, $500, $1,000 or $2,500 per Certificate Period.

Coinsurance -- Claims incurred in US or Canada

80% of the next $5,000 of Eligible Medical Expenses after the Deductible, then 100% to the Overall Policy Maximum. The Coinsurance will be waived if expenses are incurred within the PPO.

Coinsurance -- claims incurred outside US or Canada

100% of Eligible Medical Expenses after the Deductible to the Overall Policy Maximum.

Hospital Room and Board -- In US or Canada

Average Semi-private room rate.

Hospital Room and Board -- Outside US or Canada

Average Private room rate.

Intensive Care Unit -- In US or Canada

Usual, Reasonable and Customary.

Intensive Care Unit -- Outside US or Canada

Usual, Reasonable and Customary.

Mental or Nervous Disorders

$10,000 per Certificate Period (after 12 months of continuous coverage); $25,000 Lifetime Maximum.

Maternity -- Normal Delivery

Same as any other Illness (after 12 months of continuous coverage) including pre-natal, Delivery and post-natal care.

Maternity -- Complicated Delivery

Same as any other Illness (after 12 months of continuous coverage).

Maximum for Maternity

$50,000 Lifetime

Newborn Care

$25,000 Maximum Limit for maximum of 31 days.

Pre-existing Conditions

Same as any other Injury or Illness if disclosed on Application and not excluded or limited by Rider.

Local Ambulance

Usual, Reasonable and Customary.

Physical Therapy

$50 Maximum per visit.

Wellness

$50 per visit(including immunizations), maximum of 3 visits per year for children under the age of 19(after 12 months of coninuous coverage). $150 per Certificate Period (after 12 months of continuous coverage) for Members age 35 or older. Not subject to Deductible.

Human Organ/Tissue Transplants

Same as any other Illness for Covered Transplants.

All Other Eligible Expenses

Usual, Reasonable and Customary.

Emergency Medical Evacuation

$50,000 Lifetime Maximum.

Repatriation of Remains

$25,000 Limit

Emergency Reunion

$10,000 Lifetime Maximum.

Pre-certification Penalty

50%

Prescription Drugs

Usual, reasonable and customary (subject to deductible and co-insurance)

 

What Are the Exclusions and Limitations?

The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:

This is a summary of the exclusions contained in the Master Policy. See the Master Policy for a complete list of exclusions.

Waiting Period for Certain Illnesses:

The following conditions which manifest themselves within the first 180 days of coverage are excluded: any condition of the breast, prostate, tonsils, adenoids, disease of sebaceous glands, acne, other acne, sebaceous cyst, seborrhea, unspecified disease of the sebaceous glands, moles, skin tags, hypertrophic and atrophic conditions of the skin, nervous, hemorrhoids, the reproductive system, hernia, gallstones or kidney stones. If you are insured under the Risk Share Plan, all illnesses are excluded for the first 90 days of coverage.

Wellness:

If you are insured under the Platinum plan, after 12 months of continuous coverage, and if you are at least 35 years old, you will be entitled to the following Wellness benefits: the benefit provides $150 per Certificate Period for a routine physical exam, including mammogram and OB/GYN visits for females. If you are under the age of 19, this benefit provides $50 per visit (including immunizations) with a maximum of 3 visits per Certificate Period.

Emergency Medical Evacuation:

If you are insured under the Platinum plan, you are covered for emergency medical evacuation to the nearest medical facility qualified to treat your life threatening condition. All emergency medical evacuations must be approved in advance and coordinated by MultiNational Underwriters, Inc. MultiNational Underwriters, Inc. is available 24 hours a day, 7 days a week, to approve and coordinate emergency medical evacuations. Emergency medical evacuations provide you with access to care when you need it most.

Emergency Reunion :

In the event of a covered Emergency Evacuation, the platinum plan will provide the following benefits: The cost of an economy round trip air or ground transportation ticket for one of your relatives (parent, spouse, sibling or child age 18 years or older) for transportation to the area where you are hospitalized following Emergency Evacuation, and reasonable expenses for lodging and meals for your relative for a period not to exceed 10 days.

Repatriation of Remains:

In the event of a covered injury or illness resulting in your death, the platinum plan will provide the following benefit: air or ground transportation of bodily remains or ashes to the area of your Principal Residence and reasonable cost of preparation of your remains necessary for transportation.

Other services provided by MultiNational Underwriters, Inc:

Hospital/Physician Referral: MultiNational Underwriters, Inc. maintains relationships with hospitals and physicians throughout the world, and this network is growing daily. If you need a referral, just contact MultiNational Underwriters, Inc. and one of our Customer Service Representatives will assist you.

Patient Advocacy Services:

If you are faced with a complex or severe medical condition, you will be assigned to one of MultiNational's Patient Advocates. Your Patient Advocate is your personal assistant at MultiNational Underwriters on all matters relating to your treatment and claim, with the goal of securing the best possible care for you in a convenient and cost-effective setting.

Pre-existing Conditions:

If you are insured under the Platinum plan, and your pre-existing conditions have been fully disclosed on your application and not excluded or restricted by a rider or any other provision of your certificate, your pre-existing conditions are covered the same as any other illness or injury as of your effective date. If you are insured under the Premier plan, your pre-existing conditions are covered up to a lifetime limit of $25,000 after you have been insured continuously for 24 months.

Pre-existing conditions include any injury or illness or mental/nervous condition that existed at or prior to your initial effective date, including chronic, recurring and congenital conditions.

Hospital Pre-certification

All plans in The International Citizen Series contain hospital pre-certification provisions. Pre-certification simply means that you must contact MultiNational Underwriters, Inc. as soon as possible before a planned hospitalization or surgical procedure, or within 48 hours of an emergency hospital admission, or within the first 90 days of pregnancy. Pre-certification allows us to establish contact and make payment arrangements with your providers, negotiate discounts which will benefit both you and us, pre-arrange future care, and plan for your claim. Pre-certification helps us help you.

 

 


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