Internships Colombia Insurance Plan Information

Transcription

1 Internships Colombia Insurance Plan Information national Policy Number: G WORLDWIDE COVERAGE OUTSIDE YOUR HOME COUNTY Standard Enhanced Benefits Coverage in USD Coverage in USD MEDICAL EXPENSES $600,000; Medical 100% of customary charges per person per Period of Coverage Intensive Care Outpatient Medical Expenses Usual, Reasonable and Customary charges to the Medical Usual, Reasonable and Customary charges to the Medical HOSPITAL ROOM $150 per night, up to a maximum of 30 days (applicable to individuals travelling outside of the US and Canada) DEDUCTIBLE $100; Deductible is per person per claim COINSURANCE After you pay the deductible, the plan pays 100% to the Medical DENTAL TREATMENT Accidental Coverage; 100% of customary charges up to maximum of $500 Pain Relieving: 100% of customary charges up to a maximum of $100 EMERGENCY MEDICAL EVACUATION or repatriation home (must be pre-approved ) $250,000 (in addition to Medical ) REPATRIATION of REMAINS or BURIAL Up to $50,000 Up to $50,000 Return of Minor Children Up to $50,000 Up to $50,000 Local AMBULANCE transportation $5.000 $5.000 Loss of CHECKED BAGGAGE $250 $250 TRIP INTERUPTION $5,000 $5,000 HOME COUNTRY Coverage Incidental Trip to the Home Country : Up to 50,000 Home Country Extension of Benefits: Up to $5,000 $1,000,000; Medical 100% of customary charges per person per Period of Coverage Usual, Reasonable and Customary charges to the Medical Usual, Reasonable and Customary charges to the Medical $150 per night, up to a maximum of 30 days (applicable to individuals travelling outside of the US and Canada) Nil After you pay the deductible, the plan pays 100% to the Medical Accidental Coverage; 100% of customary charges up to maximum of $500 Pain Relieving: 100% of customary charges up to a maximum of $100 $250,000 (in addition to Medical ) Incidental Trip to the Home Country : Up to 50,000 Home Country Extension of Benefits: Up to $5,000 POLITICAL and NATURAL DISASTER $50,000 $50,000 EVACUATION TERRORISM $50,000 $50,000 ASSISTANCE Services Included Included MATERNITY N/A Serious complications up to 26 weeks of pregnancy Acute Onset of Pre-existing condition N/A Up to a maximum of $500 per lifetime PERSONAL ACCIDENT Accidental death, loss of sight, loss of limb(s), permanent total disablement N/A $20,000 PERSONAL LIABILITY Physical injury and N/A $100,000 property damage LUGGAGE DELAY N/A Up to $300 ($100 per 24 hours up to 3 days) LOST DOCUMENTS or MONEY N/A Up to $300 TRAVEL DELAY N/A Up to $350 ($70 per day) Premium up to age 40 $1.27 per day $1.52 per day Premium ages $1.58 per day $1.89 per day

2 AVAILABLE FOR ADDITIONAL PREMIUM: LOSS of PERSONAL BELONGINGS including theft and loss or damage by fire or natural disaster Pre-trip CANCELLATION Up to $ 3,000 Association for Student Contact Information Emergency Assistance Services Up to $1,000. Sub limited to $250 single article limit (including laptop computers, mobile and handheld electronic devices) This plan provides 24-hour worldwide assistance services for emergencies anywhere in the World through World Travel Assist. The following are some services included with this coverage: Medical Assistance Medical, Dental, and Pharmacy Referrals Medical Monitoring Emergency Medical Payments Emergency Medical Evacuation Emergency Reunion For Worldwide Emergency Assistance Services: To obtain assistance, please contact WORLD TRAVEL ASSIST at one of the following numbers: USA Germany: Argentina: Brazil: Canada: Costa Rica: China (South): China (North): Colombia , Spain (Madrid): Spain (other cities): France: Italy: México: Dominican Republic: England: Venezuela: For the rest of the world: , collect call. Assistance can also be requested by sending an to: assistance@wt-assist.com with details of the emergency and telephone numbers where the insured can be reached. For Non-Emergency Medical Claims All non-emergency claims should be notified to WORLD TRAVEL ASSIST at the contact numbers or listed above. Please provide full supporting documentation to avoid delays in processing your claim. Claim forms can be returned to: World Travel Assist Claims 2893 Executive Park Drive Suite 201 2

3 Weston Florida, Fax: Claims forms may be found by visiting: Frequently Asked Questions What is the insurance company that underwrites this plan? This plan is underwritten by Inter Hannover which is one of the leading insurers in the marketplace. Wholly owned by Hannover Re, they specialize in chosen markets such as student, youth exchange, and travel. What is the baggage upgrade? The insurance company will pay You up to the amount stated in the Benefit Table in relation to Loss of Personal Belongings if Your Personal Belongings are lost or stolen less a consideration, if applicable, for wear, tear and depreciation. What is a trip cancellation upgrade? The trip cancellation upgrade is a pre-trip benefit that provides reimbursement up to the stated amount for any nonrefundable costs you may incur as a result of having to cancel your trip for a covered cause which includes: the direct and necessary result of Your Accidental Bodily Injury or Illness or the death or Accidental Bodily Injury or Illness of Your Partner, Dependents or Close Relative or the destruction of your Principal Residence by fire or storm following departure from Your Home Country. What do I do if I m sick or injured? You are free to visit any doctor or medical facility for an appointment. You can ask local contacts for a referral to a physician or medical provider or you can contact World Travel Assist for a referral to a local doctor. If your medical condition is an emergency, please visit the nearest appropriate medical facility. How can I find a doctor or specific medical provider? Insureds may contact World Travel Assist with any questions about locating a doctor or provider although insureds are free to visit any licensed medical provider for a covered injury or illness. What do I do if I require treatment and I don t have my insurance ID card? Even though you may not have your ID card, you can still seek treatment. Please remember that for nonemergency medical claims, the standard procedure is to visit the doctor, pay for the visit and any necessary medications, and then submit a claim for reimbursement. Is pre-certification required for medical procedures? Pre-certification is not required for general office visits to a medical doctor. Simply visit a doctor, pay the required fee, and submit a claim for reimbursement. Pre-certification is required for the following procedures: Inpatient care 3

4 Any surgery or surgical procedure Care in an extended care facility Home nursing care Durable medical equipment and artificial limbs CAT scans and MRI To comply with precertification requirements, you must contact World Travel Assist at the number listed above before the expense is to be incurred and comply with all instructions provided by World Travel Assist. Is a direct payment to a medical provider option available? The typical procedure when visiting a doctor for an office visit is to simply visit the doctor, pay the required fee, and then submit a claim for reimbursement. If you would like to request a direct payment option, you may contact World Travel Assist to see if this can be arranged. Please understand this cannot be arranged for all office visits. For pre-scheduled surgeries and procedures, direct payment will most often be arranged during the pre-certification process. What is covered under my travel insurance policy? Travel insurance is designed to cover the cost of medical expenses resulting from unexpected or unforeseen accidents and illnesses. What is not covered under my policy? It is important to read your policy carefully to understand the exclusions. The following is a list of some items that are excluded from coverage. For a full list of exclusions, please refer to your insurance policy. Pre-existing Conditions Routine medical or dental examinations Treatment for mental health Eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy Mountaineering where ropes or guides are normally used or at elevations of 4,500 meters or higher Treatment by a chiropractor Hang gliding, sky diving, parachuting or bungee jumping Self-inflicted injuries What is the difference between Standard Plan and Enhanced Plan? The maximum medical expenses for the Standard plan is $600,000 with a $100 deductible per person per claim. The Enhanced plan has a medical maximum of $1,000,000 and no deductible. For a full list of benefits, please refer to the benefit table in your insurance policy: Acute Onset of Pre-existing condition Personal Liability Luggage Delay Lost Documents or Money 4

5 Travel Delay Is there a deductible? A deductible is the amount of money that you are responsible for paying to a medical provider before the insurance company will pay. There is a $100 deductible per claim as a part of the Standard plan while there is no deductible on the Enhanced plan. Where can I find a claim form? Claim forms can be found online at: What information do I need to provide when filing a claim? You must mail or the following items to your Claim Administrator: Completed claim form including your name, address, identification number, and name of your affiliated organization. All itemized medical and hospital bills including procedures and/or diagnosis codes. Copies of receipts if the bill has been paid and you are to be reimbursed. Be sure to keep a copy of all claims documents for your own records. How do I file a claim? World Travel Assistance should be notified within 30 days after the occurrence or commencement of any accident or illness, or as soon thereafter as is reasonably possible. Return the completed claim form and all supporting documentation (itemized medical and hospital bills and any copies of receipts) by mail, fax, or to: World Travel Assist Claims 2893 Executive Park Drive Suite 201 Weston Florida, Fax: assistance@wt-assist.com How can I check the status of a claim? Pending or processed claims information can be obtained by contacting World Travel Assist claims customer service at the address listed above. 5