| Deductible: |
$250 per person, per trip |
| Coinsurance – Claims incurred in US or Canada: |
For each trip,
Underwriters will pay 80% of the next $5,000 of Eligible Expenses after
the Deductible, then 100% to the Overall Maximum Limit |
| Coinsurance – Claims incurred outside US or Canada: |
For each trip, Underwriters will pay 100% of Eligible Expenses after the Deductible up to the Overall Maximum Limit |
| Hospital Room and Board: |
Average Semi-private room rate, including nursing services |
| Local Ambulance: |
Usual, Reasonable and Customary charges when Covered Illness or Injury results in hospitalization |
| Hospital Indemnity: |
$100 per day (not subject to Deductible or Coinsurance) |
| Intensive Care Unit: |
Usual, Reasonable and Customary charges |
| Outpatient Treatment: |
Usual, Reasonable and Customary charges |
| Acute Onset of Pre-existing Condition: |
$5,000 limit per Certificate Period for Eligible Medical Expenses
$25,000 limit per Certificate Period for Emergency Medical Evacuation (only available to US Citizens) |
| Emergency Dental: |
Accident – Overall Maximum Limit
Acute Onset of Pain – $100 limit per Certificate Period |
| Emergency Medical Evacuation: |
Overall Maximum Limit |
| Emergency Reunion: |
$15,000 limit per Certificate Period |
| Return of Minor Children: |
$5,000 limit per Certificate Period |
| Accidental Death and Dismemberment: |
Death - $25,000 adult, $5,000 children under age 18; Loss of 2 Limbs - $25,000 adult, $5,000 children under age 18; Loss of 1 Limb - $12,500 adult, $2,500 children under age 18;
$250,000 Maximum per family |
| Common Carrier Accidental Death: |
$50,000 per adult, $25,000 children under age 18; $250,000 Maximum per family |
| Repatriation of Remains: |
Overall Maximum Limit |
| Natural Disaster Benefit: |
Up to $100 a day for 5 days when Displaced from planned, paid accommodations due to evacuation from forecasted disaster or following a disaster strike |
| Trip Interruption: |
$5,000 limit per Certificate Period |
| Lost Checked Luggage: |
$250 limit per Certificate Period (not subject to Deductible or Coinsurance) |
| Hospital Pre-Notification Penalty: |
50% of Eligible Medical Expenses |
| Optional Hazardous Sports Rider: |
Overall Maximum Limit |
| Terrorism: |
$50,000 Maximum Lifetime Limit, Medical Expenses only |
| Overall Maximum Limit per Certificate
Period |
$1,000,000 |
