Diplomat International Plan Description
Disclaimer: Please note that Non-admitted carriers are usually referred to as "surplus" or "excess lines insurers". Non-admitted carriers are not regulated and do not contribute to the State Guaranty Fund, which protects policyholders from the bankruptcy of its insurance carrier. Non-Admitted Carriers are not regulated by state insurance authority, you cannot seek any recourse from Non-Admitted Carriers for unpaid claims.
Why Purchase International Accident & Sickness Insurance?
This travel insurance plan is designed to cover anyone traveling outside their home country. The flexibility of this plan makes it ideal for business and leisure travelers, expatriates, study abroad, work study programs, international exchange students, tourists, and church or missionary travelers.
Why do long-term international travelers need this coverage?
Problem for U.S. Travelers:
Most group and individual health plans sold in the United States provide limited coverage while traveling overseas. PPO’s do not extend their network’s abroad, so any difference in billing expenses or claims that are not considered eligible expenses will become the responsibility of the insured. Medicare provides no coverage outside the U.S. (see U.S. Passport for details).
Problem for Non - U.S. Citizens:
Nationalized or government sponsored health plans rarely provide adequate medical coverage for illnesses or injuries sustained while traveling outside your home country. Extreme sports, hazardous activities, emergency medical air evacuation and repatriation are usually not covered under nationalized health insurance schemes. Most travelers to the United States are innocently unaware of how expensive medical care and treatment can be in the U.S. Not to mention, that medical care in the U.S. is usually provided through HMO’s or managed care facilities, which may not recognize a “foreign insurance company” or government sponsored health plan.
Diplomat America Plan Features:
This plan is designed for:
Diplomat Long Term Benefits
Covered medical expenses (all policies)
Covered Expenses – Expenses that are incurred for medical care and supplies which are: (a) necessary and customary; (b) prescribed by a Physician for the therapeutic treatment of a disablement; (c) are not excluded under the policy; (d) are not more than the Reasonable and Customary charges (as determined by the Company); and (e) are incurred within 365 days for US Citizens or 180 days for Non US Citizens from the date of the disablement will be considered.
Plan A – $50,000
Plan B – $100,000
Plan C – $250,000
Plan D – $500,000
Plan E – $1,000,000
Persons up to age 69 are eligible for all plans;
Persons age 70-79 are eligible for plans A and B;
Persons age 80+ are eligible for plan A only.
$0, $50, $100, $250, $500, $1,000, $2,500, $5000 per person per policy period.
Other plan Benefits
Unexpected Recurrence of a Pre-Existing Condition (US Citizens Only) – Limited coverage under Your Medical Expense Benefit is provided for Medical Expenses that result from a sudden and unforeseen recurrence of a Pre-existing Condition.
Emergency Medical Evacuation – Benefits are paid for Covered Expense incurred up to $500,000 for any covered Injury or Illness that requires immediate transportation from the place where You are located (due to inadequate medical facilities).
Repatriation – If it is determined by the Assistance Company and your Physician that it is Medically Necessary for You to return to Your primary place of residence because of an unforeseen Sickness or Injury which is acute or life-threatening, the Transportation Expense incurred within 90 days from the date of the Covered Loss will be paid for Your return to Your Home Country or to a medical facility closest to Your primary place of residence.
Return of Mortal Remains – If death occurs, Benefits will be paid for Reasonable and Customary Covered Expenses to return Your remains to Your Home Country.
Emergency Medical Reunion – If it is determined by the Assistance Company and your Physician that it is necessary for You to have an Emergency Medical Evacuation, this Plan will arrange to bring an individual of Your choice, from Your current Home Country, to be at Your side while You are hospitalized and then accompany You during Your return home.
Return of Minor Child(ren) – Should the Insured Person be traveling alone with a Minor Child(ren) and be hospitalized because of a covered Illness or Injury and Your Minor Child(ren) is left unattended, the Assistance Company will arrange for a one way economy fare(s) to Your current Home Country.
In Hospital Indemnity (US Citizens only) – If You are confined to a Hospital as a registered Inpatient as the result of an Illness or Injury which first occurs during Your Period of Coverage and that Illness or Injury is covered under this Plan, this plan will pay benefits up to $100 per day of confinement up to a maximum of 10 days.
Interruption of Trip – If Your trip is interrupted due to the Death of an Immediate Family Member or serious damage to your residence, benefits will be paid up to $5,000 for the Expense of economy travel less the value of applied credit from an unused return travel ticket to return You home to Your area of principal residence.
Loss of Baggage – This plan will reimburse You for loss, theft, or damage to Your baggage or personal effects checked with a Common Carrier, after coverage provided by a Common Carrier.
Political and Natural Disaster Evacuation – Coverage is provided up to $50,000 if the Insured requires emergency evacuation due to situations which place him/her in Imminent Bodily Harm or due to a Natural Disaster.
Emergency Dental Treatment (Accident) – Benefits are paid for Reasonable and Customary Expense for emergency Dental Treatment to natural teeth.
Emergency Dental Treatment (Palliative) – Benefits are paid up to $100 for emergency Treatment for the relief of pain to natural teeth.
The Plan Document does not cover any loss resulting from any of the following unless otherwise covered under the Plan Document by Additional Benefits: 1) Suicide, attempted suicide (including drug overdose) self-destruction, attempted self-destruction or intentional self-inflicted Injury while sane or insane; 2) War or any act of war, declared or undeclared; Unless War Risk Rider is purchased; 3) An Accident which occurs while the Plan Participant is on Active Duty Service in any Armed Forces, National Guard, military, naval or air service or organized reserve corps; 4) Injury sustained while in the service of the armed forces of any country. When the Plan Participant enters the armed forces of any country, We will refund the unearned pro rata premium upon request; 5) Voluntary, active participation in a riot or insurrection; 6) Medical expenses resulting from a motor vehicle accident in excess of that which is payable under any other valid and collectible insurance; 7) Organ transplants; 8) Treatment for an Injury or Sickness caused by, contributed to or resulting from the Plan Participant's voluntary use of alcohol, illegal drugs or any drugs or medication that is intentionally not taken in the dosage recommended by the manufactur er or for the purpose prescribed by the Plan Participant's Physician; 9) Commission or attempt to commit an assault or felony, or that occurs while being engaged in an illegal occupation; 10) Eligible Expenses for which the Plan Participant would not be responsible in the absence of the Plan Document; 11) Treatment of acne; 12) Charges which are in excess of Usual, Reasonable and Customary charges; 13) Charges that are not Medically Necessary; 14) Charges provided at no cost to the Plan Participant; 15) Treatment of HIV infection, HIV related illness and AIDS (acquired immune deficiency syndrome); 16) Expenses incurred for treatment while in Your Home Country; except as provided under the Home Country Coverage Benefit; 17) Expenses incurred for an Accident or Sickness after the Benefit Period shown in the Schedule of Benefits or incurred after the termination date of coverage; 18) Regular health checkups; routine physical, immunizations or other examination where there are no objective indications or impairment in normal health; 19) Services or treatment rendered by a Physician, Registered Nurse or any other person who is employed or retained by the Participation Organization; or an Immediate family member of the Plan Participant; 20) Injuries paid under Workers’ Compensation, Employer’s liability laws or similar occupational benefits or while engaging in an occupation for monetary gain from sources other than the Participation Organization; 21) Benefits for enrolling solely for the purpose of obtaining Medical Treatment, while on a waiting list for a specific treatment, or while traveling against the advice of a Physician; 22) Aggravation or re-injury of a prior Injury that the Plan Participant suffered prior to his or her coverage Effective Date, unless We receive a written medical release from the Plan Participant’s Physician; 23) Pre-existing conditions as defined in the definitions (This exclusion does not apply to Emergency Evacuation, Repatriation or Return of Mortal Remains); 24) Treatment of a hernia, including sports hernia, whether or not caused by a Covered Accident; 25) Pregnancy or childbirth, miscarriage; elective abortion; elective cesarean section; or any complications of any of these conditions; 26) Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof; 27) Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes; 28) Expense incurred for treatment of temporomandibular joint (TMJ) disorders or craniomandibular joint dysfunction and associated myofacial pain; 29) Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury or pain resulting from an Accident while the Plan Participant is covered under the Plan Document, and rendered within 6 months of the Accident; 30) Eyeglasses, contact lenses, hearing aids braces, appliances, or examinations or prescriptions therefore; 31) Weak, strained or flat feet, corns, calluses, or toenails; 32) Private-duty nursing services; 33) The cost of the Covered Person’s unused airline ticket for the transportation back to the Plan Participant’s Home Country, where an Emergency Medical Evacuation or Repatriation and/or Return of Mortal Remains benefit is provided; 34) For the cost of a one way airplane ticket used in the transportation back to the Plan Participant's country where an air ambulance benefit is provided and medically necessary; 35) Treatment paid for or furnished under any other individual or group Plan Document, or other service or medical prepayment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for the treatment without cost to any individual; 36) Travel in or upon: A snowmobile; A water jet ski; Any two or three wheeled motor vehicle, other than a motorcycle registered for on-road travel; Any off-road motorized vehicle not requiring licensing as a motor vehicle; when used for recreation or competition. Unless Hazardous Activity Rider is purchased. 37) Injury sustained while taking part in: mountaineering; hang gliding; parachuting; bungee jumping; racing by horse, motor vehicle or motorcycle; snowmobiling; motorcycle/motor scooter riding; scuba diving, involving underwater breathing apparatus; water skiing; snow skiing; spelunking; parasailing; white water rafting; surfing, unless part of a school credit course; and snowboarding. Unless Hazardous Activity Rider is purchased. 38) Practice or play in any amateur, club, intramural, interscholastic, intercollegiate, sports contest or competition. Unless Athletic Sports Rider is purchased. 39) Practice or play in any professional or semiprofessional sports contest or competition; 40) Rest cures or custodial care; 41) Treatment of Mental and Nervous Disorders; 42) Weight reduction programs or surgical treatment of obesity or treatment of venereal disease; 43) Elective or Cosmetic surgery and Elective Treatment or treatment for congenital anomalies (except as specifically provided), except for reconstructive surgery on a diseased or injured part of the body (Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or Sickness); 44) Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from: a) While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or b) While being used for any test or experimental purpose; or c) While piloting, operating, learning to operate or serving as a member of the crew thereof; or d) while traveling in any such Aircraft or device which is owned or leased by or on behalf of the Participation Organization of any subsidiary or affiliate of the Participation Organization, or by the Plan Participant or any member of his household. e) A space craft or any craft designed for navigation above or beyond the earth's atmosphere; or f) An ultra light, hang-gliding, parachuting or bungi-cord jumping; Except as a fare paying passenger on a regularly scheduled commercial airline or as a passenger in a non-scheduled, private aircraft used for business or pleasure purposes. 45) Ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste, from combustion of nuclear fuel, the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component of such assembly. 46) Plan Participant being exposed to the Utilisation of nuclear, chemical or biological weapons of mass destruction. In addition to any of the exclusions listed above, for Eligible Expenses under Trip Interruption, this Insurance also does not cover the following: 1) The Plan Participant or Traveling Companion or Traveling Companion’s family making changes to personal plans; having business or contractual obligations; being unable to obtain necessary travel documents (passports, visas, etc.); being detained or having property confiscated by customs authorities; carrier caused delays (including bad weather); 2) Prohibition or regulatory by any government; default of yacht charter companies; default of the organization from which the Plan Participant purchased their trip arrangements; 3) A Pre-Existing Condition existing prior to the Plan Participant’s departure from their Home Country. In addition to any of the exclusions listed above, for Eligible Expenses under Baggage Loss and Delay, this Insurance also does not cover the following: 1) Animals; 2) Artificial teeth or limbs, hearing aids; 3) Sunglasses, contact lenses or eyeglasses; 4) Documents of any kind, including but not limited to documents, bills, currency, deeds, evidences of debt, letters of credit, stamps, credit cards, money, notes, securities, transportation or other tickets; 5) Professional or occupational equipment or property, whether or not electronic business equipment or; 6) Telephones or PDA devices, computer hardware or software. No Benefit will be payable for Home Alteration and Vehicle Modification, as the result of: Any condition for which the Plan Participant Person is entitled to benefits under any Workers’ Compensation Act or similar law.
Global Claims Administration
3195 Linwood Rd, Suite 201
Cincinnati OH 45208
Inside US and Canada: 800-513-2981
Outside US and Canada: 513-533-1330
Claim Forms – The Company, upon receipt of a written notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within 15 days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of this Plan by submitting, within the time fixed in this Plan for filing proofs of loss, written proof showing the occurrence, nature and extent of the loss for which claim is made.
Proofs of Loss – Written proof of loss must be furnished to The Company at its said office in case of claim for loss for which this plan provides any periodic payment contingent upon continuing loss within 90 days after termination of each period for which The Company is liable and in case of claim for any other loss within 90 days after the date of such loss. Failure to furnish proof within the time required shall not invalidate nor reduce any claim if it is not reasonably possible to give proof within such time, provided proof is furnished as soon as reasonably possible.
Time of Payment of Claims – Indemnities payable under the plan for any loss other than loss for which the plan provides any periodic will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which the plan provides periodic payment will be paid at the expiration of each four weeks during the continuance of the period for which The Company is liable, and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.
Payment of Claims – Indemnity for loss of life will be payable in accordance without the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the Insured Person. Any other accrued indemnities unpaid at the Insured Person’s death may, at the option of The Company, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the Insured Person. If any indemnity of the policy shall be payable to the estate of an Insured Person, or to an Insured Person who is a minor or otherwise not competent to give a valid release, The Company may pay such indemnity, up to an amount not exceeding $1000 to any relative by blood or connection by marriage of the Insured Person who is deemed by The Company to be equitably entitled thereto. Any payment made by The Company in good faith pursuant to this provision shall fully discharge The Company to the extent of such payment. Subject to any written direction of the Insured Person all or a portion of any indemnities provided by this plan on account of Hospital, nursing, medical or surgical service may, at The Company’s option and unless the Insured Person requests otherwise in writing not later than at the time for filing proof of such loss, be paid directly to the Hospital or person rendering such services, but it is not required that the service be rendered by a particular Hospital or person.
Premium refund / cancellation
Less a $25 processing fee, will be considered only when written request is received by Global Underwriters prior to the Effective Date of Individual coverage. After the Effective Date of Individual coverage, premium is considered fully earned and non-refundable. Partial refunds are not available.
Accident death & dismemberment benefits
Accidental Death, Dismemberment, Loss of Sight, and Speech and Hearing – The amount of the Principal Sum is $25,000 (unless the Enhanced AD&D Benefit is purchased). Enhanced AD&D Benefit (If Benefit Purchased) – The Principal Sum is increased from $25,000 to the selected amount not to exceed $1,000,000 of coverage. The Enhanced AD&D Benefit is not available to children under 18 years of age.
If within 365 days after the date of a covered accident, the Insured Person’s Injury results in death or dismemberment, this Plan provides the following benefits for loss of:
The term “loss” as used herein shall mean, with regard to hands and feet, actual severance through or above wrist or ankle joint, and with regard to eyes, entire irrecoverable loss of sight.
Paralysis Benefit – If a Covered Accident renders an Insured Person Paralyzed within 365 days of the date of the Covered Accident that caused the Injury, in any one of the types of paralysis specified below, the Company will pay the percentage of the Maximum Amount shown below for that type of paralysis: