Visitors Protect Travel Insurance

• Home Nursing Care help	Provided by a Home Health Care Agency Upon direct transfer from an acute care Facility United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Eligible Medical Expenses	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Assistant Surgeon help	20% of the primary surgeon’s eligible fee United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Outpatient Prescription Drugs help	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Outpatient Surgical / Hospital Facility help	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Laboratory help	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Pre-Admission Testing	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Surgery	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Reconstructive Surgery help	Surgery is incidental to and follows Surgery that was covered under the plan United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Anesthesia help	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Chiropractic Care help	Medical order or Treatment plan required United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Extended Care Facility help	Upon direct transfer from an acute care Facility United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Radiology / X-ray help	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Physician visits help	Physician Visits / Services: United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Physical Therapy help	Inpatient and outpatient Medical order or treatment plan required United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Walk-In Clinic help	Not subject to deductible and coinsurance In-network copayment: $15 Out-of-network copayment: $25 United States (In-Network), Canada, Mexico: 100% United States (Out-of-Network): 100%
  Hospitalization / Room & Board help	Average semi-private room rate Includes nursing services United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Urgent Care Clinic help	Not subject to deductible and coinsurance In-network copayment: $25 Out-of-network copayment: $50 United States (In-Network), Canada, Mexico: 100% United States (Out-of-Network): 100%
  Traumatic Dental Injury help	Subject to Deductible and Coinsurance Treatment at a Hospital due to an Accident Additional Treatment for the same Injury rendered by a Dental Provider will be paid at 100% United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Intensive care unit help	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Hospital Ancillary Services	Maximum limit: $40,000 Includes laboratory, x-rays, drugs, and miscellaneous services United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Durable Medical Eequipment help	United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Dental Treatment help	Subject to Deductible and Coinsurance Limit: $300 Unexpected pain or treatment due to an accident United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Hospital emergency room help	Injury: not subject to emergency room deductible Illness: subject to a $250 deductible for each emergency room visit for treatment that does not result in a direct hospital admission United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%

• Interfacility Ambulance Transfer help	Transfer must be a result of an inpatient hospital admission United States (In-Network), Canada, Mexico: 100% United States (Out-of-Network): 100%
  Emergency Medical Evacuation help	Maximum limit: $25,000 Approved in advance and coordinated by the company United States (In-Network), Canada, Mexico: 100% United States (Out-of-Network): 100%
  Return of Mortal Remains or Cremation/Burial help	Maximum limit: $25,000 Local Burial / Cremation Maximum Limit: $5,000 Return of Insured Person’s Mortal Remains to Country of Residence Approved in advance and coordinated by the company United States (In-Network), Canada, Mexico: 100% United States (Out-of-Network): 100%
  Emergency Local Ambulance help	Subject to Deductible and Coinsurance Injury Illness resulting in an Inpatient Hospital admission United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Return of Minor Children help	Maximum limit: $100,000 Approved in advance by the Company United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%
  Emergency Reunion help	Maximum limit: $100,000 Maximum days: 15 Meal maximum per day: $25 Reasonable and necessary travel costs and accommodations Approved in advance by the Company United States (In-Network), Canada, Mexico: 75% United States (Out-of-Network): 60%

• Accidental Death & Dismemberment

  Principal Sum Maximum Limit: $25,000 Death must occur within 90 days of the Accident Accidental Death: 100% of Principal Sum Dismemberment Accidental Loss: Percent of Principal Sum Sight of one eye: 50% One hand or one foot: 100% One hand and the loss of sight of one eye: 100% One foot and the loss of sight of one eye: 100% One hand and one foot: 100% Both hands or both feet: 100% Sight of both eyes: 100%

• Precertification

  Interfacility Ambulance Transfer: No coverage if Pre-certification requirements are not met. Emergency Medical Evacuation: No coverage if not approved by the Company. Refer to the EMERGENCY MEDICAL EVACUATION provision for complete requirements and coverage. All other Treatments & supplies: 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met. Deductible is taken after reduction. Coinsurance is applied to remainder of the reduced amount. Refer to the PRE-CERTIFICATION REQUIREMENTS provision for a complete list of services that require Pre-certification.

• Pre-Existing Condition

  In-Network: Maximum limit through age 69: $25,000 Out-Network: Maximum limit ages 70 and older: $20,000

*Note: Benefit amounts shown are based on In-Network coverage. Please consult your specific policy documents for precise coverage limits, benefits and exclusions. Optional add-on benefits are available for an additional charge.