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Premier Schedule of Benefits
| Benefits |
IC Premier |
| Overall Maximum Limit |
$1,000,000 Lifetime |
| Deductibles Available |
$250, $500, $1,000, $2,500 or $5,000 per Certificate Period |
| Family Deductible |
Maximum of 3 Deductibles per family per Certificate Period |
| Coinsurance -- Claims incurred in US or Canada |
No coverage in US or Canada |
| Coinsurance -- claims incurred outside US or Canada |
100% of Eligible Medical Expenses after the Deductible to the Overall Maximum Limit |
| Hospital Room and Board -- In US or Canada |
No coverage in US or Canada |
| Hospital Room and Board -- Outside US or Canada |
Average Private room rate |
| Intensive Care Unit -- In US or Canada |
No coverage in US or Canada |
| Intensive Care Unit -- Outside US or Canada |
Three times the Average Private room rate |
| Prescription Drugs |
Usual, Reasonable and Customary Subject to Deductible and Coinsurance |
| Mental Health Disorders |
$5,000 per Certificate Period, $10,000 Lifetime Maximum, $50 Maximum per visit per day for outpatient care (after 24 months of continuous coverage) |
| Maternity -- Normal Delivery |
$3,500 per Pregnancy (after 24 months of continuous coverage) including pre-natal, Delivery and post-natal care |
| Maternity -- Complicated Delivery |
$6,000 per Pregnancy (after 24 months of continuous coverage) including pre-natal, Delivery and post-natal care |
| Maximum for Maternity |
$10,000 Lifetime |
| Newborn Care |
$5,000 Maximum Limit for maximum of 31 days |
| Pre-existing Conditions |
$25,000 Lifetime Maximum if disclosed on Application (after 24 months of continuous coverage) |
| Local Ambulance |
$1,000 Lifetime Maximum |
| Physical Therapy |
No coverage |
| Wellness |
No coverage |
| Human Organ/Tissue Transplants* |
Same as any other Illness for Covered Transplants |
| All Other Eligible Expenses |
Usual, Reasonable and Customary |
| Emergency Medical Evacuation |
No coverage |
| Repatriation of Remains |
No coverage |
| Emergency Reunion |
No coverage |
| Pre-notification Penalty |
50% |
| *Covered transplants include Heart/Lung, Lung, Kidney/Pancreas, Liver and Allogenic and Autologous Bone Marrow. |
Plan Features:
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, Illness or Mental Health disorder that existed at or prior to your initial effective date, including chronic or recurring condition
Pre-Notification
All plans in The International Citizen Series contain pre-notification provisions. Pre-notification 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-notification 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-notification helps us help you.
International Assistance Services
The following Assistance Services are available to you 24 hours a day, 7 days a week while your International Citizen Plan is in effect.
- Pre-Trip Health and Safery Advisories (available after your purchase of the International Citizen Series, and before your departure) - call us for current passport, visa, inoculation and vaccine requirements, as well as up-to-date travel safety advisories.
- Livetravel Services - we will make emergency travel and itinerary changes for you including rebooking flights, hotel reservations and ground transportation arrangements.
- BagTrak - we are the industry leaders in tracking lost checked baggage. We will help you locate your lost checked baggage, and deliver it to you anywhere in the world.
- Emergency Message Relay - we will relay messages to your family, friends and co-workers, helping you to maintain contact during an emergency.
- Emergency Cash Transfers - we will assist you in arranging and obtaining cash transfers anywhere in the world.
Other International Citizen Assistance Services include:
- Medical referrals Up-to-the-minute travel medical advisories Assistance with prescription drug replacement Dispatch of a doctor or specialist Emergency travel arrangements for family members Lost passport or travel documents assistance Embassy and consulate referrals Legal and accounting referrals Bail bond assistance
- Translation and interpretation assistance
International Citizen Assistance Services are not insurance benefits and provision of any International Citizen Assistance Services is not a guarantee of any other benefit under the International Citizen Series.
Optional Term Life and ADD Insurance:
Age |
Basic Life Principal Sum |
Supplemental Life Principal Sum |
19 to 59 |
$50,000 |
$50,000 |
60 to 64 |
$25,000 |
$25,000 |
65 to 69 |
$10,000 |
Not Available |
Dependent Child |
$5,000 |
Not Available |
Accidental Death |
Principal Sum |
Accidental Loss of Two Members |
Principal Sum |
Accidental Loss of One Member |
50% of Principal Sum |
The Benefit is based on your age at time of Death or Dismemberment. "Member" means hand, foot or eye.
Optional Dental Rider:
|
Year 1 |
Year 2 |
Year 3 |
Preventative Dental Benefits Children age 9 through 16 (after 3 months of continuous coverage) |
100% |
100% |
100% |
Basic Dental Benefits (after 6 months of continuous coverage) |
50% |
65% |
80% |
Major Dental Benefits (after 6 months of continuous coverage) |
30% |
40% |
50% |
Dental Deductible |
$100.00 per Certificate Period |
$100.00 per Certificate Period |
$100.00 per Certificate Period |
Maximum Dental Benefits |
$500.00 per Certificate Period |
$750.00 per Certificate Period |
$1,000.00 per Certificate Period |
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International Citizens
