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Outreach Group Travel Medical InsuranceSM
Outreach Group Travel Medical InsuranceSM

All amounts shown are in U.S. dollars.
SUMMARY OF BENEFITS
Maximum Limits Individual: $50,000, $100,000, $500,000, $1,000,000, $2,000,000
Group: $100,000, $250,000, $1,000,000
Individual Deductible

Individual: $0, $100, $250, $500, $1,000 or $2,500
Group: $0, $100, $250

On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.

Coinsurance

For treatment received outside the U.S. & Canada: No coinsurance

For treatment received within the U.S. & Canada:

In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit

Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit

Benefit Period

Three months

If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the three-month Benefit Period may offer continued coverage for that injury or illness. When the Certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than three months before the Period of Coverage expired, benefits for the covered injury or illness continues. This is subject to the Maximum Limits and the other terms of the plan until there have been three months of continuous coverage for the covered injury or illness.

INPATIENT OR OUTPATIENT SERVICES
Eligible Medical Expenses Up to the maximum limit
COVID-19 / SARS-CoV-2 Coverage COVID-19/SARS-CoV-2 shall be considered by the Company the same as any other Illness or Injury, subject to all other Terms and conditions of this insurance
Physician Visits / Services Up to the maximum limit
Hospital Emergency Room: Inside the U.S. Up to the maximum limit
Injury: not subject to additional deductible
Illness: additional $250 deductible if not admitted
Hospital Emergency Room: Outside the U.S. Up to the Maximum Limit
Hospitalization / Room & Board Average semi-private room rate up to the maximum limit. Includes nursing service
Intensive Care Up to the maximum limit
Outpatient Surgical / Hospital Facility UUp to the maximum limit
Laboratory Up Up to the maximum limit
Radiology / X-ray Up to the maximum limit
Chemotherapy / Radiation Therapy Up to the maximum limit
Pre-Admission Testing Up to the maximum limit
Surgery Up to the maximum limit
Reconstructive Surgery
Surgery is incidental to and follows surgery that was covered under the plan
Up to the maximum limit
Assistant Surgeon 20% of the primary surgeons eligible fee
Anesthesia Up to the maximum limit
Durable Medical Equipment Up to the maximum limit
Chiropractic Care
Medical order or treatment plan required
Up to the maximum limit
Physical Therapy Treatment
Medical order or treatment plan required
Up to the maximum limit
Extended Care Facility
Upon direct transfer from an acute facility
Up to the maximum limit
Home Nursing Care
Upon direct transfer from an acute facility Provided by a home health care agency
Up to the maximum limit
PRESCRIPTION DRUGS and MEDICATIONS
Prescription Drugs and Medications
Obtained through Retail Pharmacy, Inpatient and Outpatient Surgery, Emergency Room and Outpatient Office Visits

Dispensing maximum for Retail Pharmacy: 90 days per prescription Dispensing limit per perscription: 90 days
EMERGENCY SERVICES Not subject to deductible and coinsurance unless otherwise noted.
Emergency Medical Evacuation
Must be approved in advance and coordinated by the company
$500,000 maximum limit
Emergency Reunion
Must be approved in advance by the company
Up to $50,000 lifetime maximum
Political Evacuation & Repatriation
Must be approved in advance by the company
Up to $10,000
Return of Minor Children
Must be approved in advance by the company
Up to $50,000
Return of Mortal Remains or Cremation/Burial
Must be approved in advance by the company
Up to $50,000 for return of mortal remains or $5,000 for cremation/burial
OTHER SERVICES
Accidental Death & Dismemberment (AD&D)
Death must occur within 90 days of the accident
$25,000 principal sum. Not subject to deductible.
Common Carrier Accidental Death $50,000 per insured adult and $250,000 maximum limit per family. Not subject to deductible.
Dental Treatment - Accident $100 Limit
Treatment due to an Accidental Injury and obtained at a Dental Provider’s office
Traumatic Dental Injury
Treatment at a hospital due to an accident
Up to the maximum limit. Additional treatment for the same injury rendered by a dental provider will be paid at 100%.
Hospital Indemnity $100 per overnight inpatient hospitaization, maximum limit of 10 overnights. Not subject to deductible.
Identity Theft Assistance Up to $500. Not subject to deductible
Lost Luggage Limit $250, $50 maximum per item
Natural Disaster $100 per day and maximum limit of 5 days for accommodations. Not subject to deductible.
Terrorism $ $50,000 maximum limit. Not subject to deductible.
Trip Interruption Up to $5,000. Not subject to deductible

* This Web page contains only a consolidated and summary description of all current benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.