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Brochure and
Application for the year 2009
WHY YOU NEED
THIS PROGRAM.
While the United States offers the most comprehensive medical care available, it
is often complicated as well as very expensive. For the visitor to the United
States or the recent immigrant, finding a program that is easy to understand and
reasonably priced is often difficult.
As a
solution, Inbound USA was developed to provide a simple program to visitors and
immigrants.
This
is a brief description of the Inbound USA program. Detailed wording is outlined
in the Program Summary, which will be mailed to you once you have enrolled into
Inbound USA.
ELIGIBILITY.
This program is
available to non-United States citizens who come to the U.S. for business,
pleasure, to study, or to immigrate. The program must become effective within 12
months of arrival in the United States.
PERIOD OF
COVERAGE. You may
initially enroll into Inbound USA for between 5 days and 12 months.
If you initially purchase at least 3 months, you may continue to renew coverage
for a minimum 3 months at a time, at the premium rate in force at the time of
renewal. Total period of coverage for Inbound USA cannot exceed 12 months (in
order to reapply after the 12 months, you must first return to your home
country).
Effective Date -
Your coverage will begin on the latest of the following:
1.
Your
departure from your Home Country; or
2.
The
date your Application and premium are received by Seven Corners; or
3.
The
date your Application and premium are accepted by Seven Corners; or
4.
The
date you request on the Application.
Expiration Date -
Your coverage will end on the earlier of the following:
1.
The
date shown on the Insurance Confirmation Card, for which premium has been paid;
or
2.
The
date you return to your Home Country; or
3.
12
months after your original Effective Date; or
4.
The
day an insured becomes a
U.S. citizen or is
considered a U.S. resident by the state where they are residing; or
5.
The
date of entry into active military service.
Upon
each renewal, rates, benefits, and program in general are subject to change.
RENEWAL.
If Inbound USA is
initially purchased for at least three months, one month before the expiration
date, Seven Corners will send a renewal notice to the Address of Correspondence
listed on the application. Coverage may then be renewed for a period of
time, depending upon your specific need. If you renew the coverage for 3
or more months (up to 12 months in total), Seven Corners will continue to send
renewal notices to you. If you initially apply online, you will have the
option to renew in whatever increment you choose (Minimum 5 day purchase). There
is a $5 admin fee each time you renew. If you renew the coverage for only
1 or 2 months, Seven Corners will assume that you no longer require the coverage
and will not send another renewal notice. Again, total period of coverage
for Inbound USA cannot exceed 12 months
SCHEDULE OF
BENEFITS. When your
covered Injury or Sickness requires treatment by a physician, this program will
provide benefits for the Usual and Customary (U&C) charges scheduled below which
exceed the chosen Per Person Deductible ($0, $50 or $100, or a $200 deductible
for age 70 and over) for each Injury and each Sickness and which are incurred
within the 26 weeks following the Injury or Sickness. Payment for any
covered service will be no more than the Benefit Maximum shown. The
maximum amount payable for all benefits will be no more than $50,000 or $100,000
(depending upon program purchased and availability) for each Injury and each
Sickness.
For persons
age 70 and over, the maximum benefit limit is $50,000, the period in which
covered expenses must be incurred is 26 weeks following the Injury or Sickness,
and a separate schedule applies.
optional
pre-existing conditions benefits InBound USA now offers the
following benefit: Should the Insured Person suffer a Myocardial
Infarction or Stroke during the Period of Coverage and it is determined to
be a "Pre-Existing Condition," coverage for those expenses will be covered
up to the Pre-Existing Condition Benefit maximum, according to the
Schedule of Benefits.
COVERED
SERVICES INJURY AND SICKNESS BENEFIT MAXIMUMS
If an insured person turns seventy (70) years old during the purchased
coverage period, the seventy (70) and over benefit schedule becomes
effective upon the day the insured turns seventy (70). Individuals with
the $100,000 or $130,000 per injury or sickness policy maximum will
receive the $70,000 per injury or sickness schedule for age seventy (70)
and older. Individuals with the $75,000 or $50,000 per injury or sickness
policy maximum will receive the $50,000 per injury or sickness schedule
for age seventy (70) and older.
* international travel coverage - An insured person
may travel to additional countries, other than the United States, up to a
maximum of thirty (30) days. You must purchase a minimum of one (1) month
of coverage. International travel coverage does not include travel back to
the insured person’s home country, and it does not extend after your
current expiration date. International travel must be utilized during your
current Period of Coverage.
* emergency medical
evacuation expenses - The program will pay up to $50,000 in Covered
Expenses incurred if any covered Injury or Sickness originating during the
Period of Coverage results in the Medically Necessary Emergency Medical
Evacuation or Repatriation of the Insured Person (the Insured Person’s
medical condition warrants immediate transportation from the medical
facility where the Insured Person is located to the nearest adequate
medical facility where medical treatment can be obtained). The benefit
must be ordered by the Assistance Company in consultation with the Insured
Person’s local attending Physician.
* repatriation of mortal
remains expenses - The program will pay for Covered Expenses incurred,
up to a maximum of $7,500, to return the Insured Person’s remains to
his/her Home Country if he or she dies.
* common carrier
accidental death and dismemberment (ad&d) - Accidental Death and
Dismemberment shall apply to covered accidents sustained by an insured
person while riding as a passenger in or on any land, water or air
conveyance operated under a license for the transportation of passengers
for hire. A loss must occur within 365 days after the date of accident
causing the loss: * NOTE: If event of an Emergency Medical Evacuation
or Repatriation of Mortal Remains benefit is needed or utilized,
arrangements must be made by the Assistance Service Provider.
exclusions - No
benefits will be paid for loss or expense caused by, contributed to, or
resulting from:
1. Pre-existing Conditions as
defined;
2. Any expenses incurred when
travel was undertaken solely for the purpose of obtaining medical
treatment or while traveling against the advice of a Physician;
3 .
Expense incurred within the Insured Person’s
Home Country or country of regular domicile;
4. Routine physicals, inoculations, or other examinations where there
are no objective indications of impairment of normal health, well baby
care, new-born baby care; well-baby nursery and related Physician charges;
5. Prescriptions or fitting of eyeglasses and contact lenses; eye
examinations; or other treatment for visual defects and problems. "Visual
defects": means any physical defect of the eye which does or can impair
normal vision;
6. Hearing examinations or hearing aids; or other treatment for hearing
defects and problems. "Hearing defects": means any physical defect of the
ear which does or can impair normal hearing:
7. Dental treatment, except as the result of injury to sound, natural
teeth;
8. Services or supplies performed or provided by a Member of the
Insured Person’s family, or anyone who lives with the Insured Person;
9. Expenses which were not recommended, approved and certified as
Medically Necessary and reasonable by a Physician;
10. Weak, strained or flat feet, corns, calluses, or toenails;
11. Cosmetic surgery, or treatment for congenital anomalies (except as
specifically provided), except reconstructive surgery as the result of a
covered Injury or Sickness. Correction of a deviated nasal septum is
considered cosmetic surgery unless it results from a covered Injury or
covered Sickness;
12. Elective Surgery and Elective Treatment;
13. Drug, treatment or procedure that either promotes or prevents
conception, or prevents childbirth;
14. Injury sustained while participating in professional, sponsored
and/or organized Amateur or Interscholastic Athletics;
15. Organ transplants;
16. Any consequence, whether directly or indirectly, proximately or
remotely occasioned by, contributed to by, or traceable to, or arising in
connection with war, invasion, act of foreign enemy hostilities, warlike
operations (whether war be declared or not), or civil war; terrorist
activity; nuclear, chemical, biological; (details in program summary)
17. Participation in a riot or civil disorder, commission of or attempt
to commit a felony in the country in which it was attempted or committed;
18. Suicide or attempted suicide (including drug overdose), while sane
or insane (while sane in Missouri), or an intentionally self-inflected
Injury;
19. Expenses of an institution, health service, or infirmary for whose
service payment is not required in the absence of insurance;
20. Treatment of nervous or mental disorders, except as stated in the
Schedule of Benefits, or treatment of alcoholism or drug abuse, except as
provided for treatment of mental or nervous disorders, according to the
Schedule of Benefits;
21. Loss incurred from riding in any aircraft, other than as a
passenger in an aircraft licensed for the transportation of passengers;
22. Treatment services, supplies or facilities in a hospital owned or
operated by: a) The Veteran’s Administration; or b) A national government
or any of its agencies. (This exclusion does not apply to treatment when a
charge is made which the Insured is required by law to pay);
23. Duplicate services actually provided by both a certified
nurse-midwife and Physician;
24. Expenses incurred during a hospital emergency room visit which is
not of an emergency nature;
25. Expenses incurred for outpatient treatment in connection with the
detection or correction by manual or mechanical means of structural
imbalance, distortion or sublimation in the human body for purposes of
removing nerve interference and the effects thereof, where such
interference is the result of or related to distortion, misalignment or
subluxation of or in the vertebral column;
26. Injury sustained while taking part in mountaineering where ropes or
guides are normally used, hang gliding, parachuting, bungee jumping,
racing by horse or motor vehicle or motorcycle, motorcycle/motor scooter
riding, scuba diving involving underwater breathing apparatus (unless PADI
or NAUI certified), water skiing, snow skiing, snow boarding and
snowmobiling;
27. Treatment paid for or furnished under any other individual,
government, or group policy; previous policy; payable under any Worker’s
Compensation or Occupational Disease Law or Act; or charges provided at no
cost to the Insured Person;
28. Expense incurred after the Expiration Date for an Insured Person
except as may be specifically provided;
29. Expenses for treatment in connection with alcoholism and drug
addiction, or use of any drug or narcotic agent or for Injury or Sickness
due wholly or partly to the effects of intoxicating liquor or drugs,
unless prescribed by a Physician;
30. Sexually transmitted diseases, including AIDS.
31. Pregnancy expenses or Sickness resulting from pregnancy,
childbirth, or miscarriage; or for miscarriage resulting from Injury; or
voluntary or elective abortion;
32. Treatment while confined primarily to receive custodial care,
educational or rehabilitative care and nursing services in a long term
facility, spa, hydroclinic, weight loss clinic, sanatorium, nursing home
or similar facilities;
33. Expenses for Speech therapy, Occupational therapy or Vocational
Rehabilitation
definitions
hospital
shall mean a place that 1.) Is legally
operated for the purpose of providing medical care and Treatment to Sick
or Injured persons for which a charge is made that the Insured Person is
legally obligated to pay in the absence of insurance 2.) Provides such
care and Treatment in medical, diagnostic, or surgical facilities on its
premises, or those prearranged for its use; 3.) Provides 24-hour nursing
service under the supervision of a Registered Nurse at all times; and 4.)
Operates under the supervision of a staff of one or more Physicians.
Hospital also means a place that is accredited as a Hospital by the Joint
Commission on Accreditation of Hospitals, American Osteopathic
Association, or the Joint Commission on Accreditation of Heath Care
Organizations (JCAHO). Hospital does not mean: A Convalescent, nursing, or
rest home or facility, or a home for the aged; A place mainly providing
Custodial, Educational, or Rehabilitative Care; or A facility mainly used
for the Treatment of drug addicts or alcoholics.
injury shall mean bodily Injury listed in the most
recent edition of the International Classification of Diseases and caused
solely and directly by Accidental, external, and visible means occurring
while this Certificate is in force and resulting directly and
independently of all other causes resulting in a Covered Event under this
Program.
inpatient
shall mean a person who is confined in an institution for a period of 24
hours or more and is charged for room and board.
myocardial
infarction shall mean an acute and emergent onset of any of the
conditions and/or diseases described and coded in the International Coding
of Diseases version 9 (ICD9).
outpatient shall mean a
person who receives care in a Hospital or another institution, including,
an ambulatory surgical center; a convalescent/skilled nursing facility or
a Physician’s office, for an Illness or Injury, but who is not confined
and is not charged for room and board.
pre-existing
condition shall mean: 1.) A condition that would have caused a person
to seek medical advice, diagnosis, care or Treatment within the six (6
)months (or twelve (12) months for persons seventy (70) and older) prior
to the Individual Effective Date of Coverage under this program; 2.) A
condition for which medical advice, diagnosis, care or Treatment,
including Medication, was sought, recommended or received within the six
(6) months (or twelve (12) months for persons age seventy (70) and older)
prior to the Individual Effective Date of Coverage under this program; 3.)
The symptoms which occurred within the six (6) months (or twelve (12)
months for persons seventy (70) and older) prior to the Individual
Effective Date of the Coverage under this Certificate would have allowed a
person trained in medicine to make a diagnosis of the condition producing
the symptom; 4.) A condition which manifested itself within the 6 months
(or twelve (12) months for persons seventy (70) and older) prior to the
Individual Effective Date of Coverage under this Certificate; Should the
Insured Person suffer a Myocardial Infarction or Stroke during the Period
of Coverage and it is determined to be a “Pre-Existing Condition,”
coverage for those expenses will be covered up to the Pre-Existing
Condition Benefit maximum, according to the Schedule of Benefits.
(Optional Coverage must be selected on the application, and appropriate
premium received.)
sickness
shall mean Illness or Disease of any kind listed in the most recent
edition of the International Classification of Diseases. All related
conditions and recurrent symptoms of the same or a similar condition will
be considered one Sickness.
stroke
shall mean an acute and emergent onset of any of the conditions and/or
diseases described and coded in the International Coding of Diseases
version 9 (ICD9).
GET A QUOTE and/or APPLY
PRINT A BROCHURE
AND APPLICATION
Please be aware that this is not a general health insurance policy, but
an interim program intended for temporary use. Inbound USA does not
guarantee payment to a facility or individual for medical expenses until
the Company determines that it is an eligible expense.
what
you will receive
Upon successful enrollment in Inbound USA, you will receive an
information packet from Seven Corners, if you choose written fulfillment.
If an email address is provided, you will receive electronic fulfillment
which provides complete policy details. Both methods will include your ID
Card and Program Summary. The Program Summary describes all the benefits
of Inbound USA in complete detail. In addition, the Program Summary
explains the procedure for submitting claims.
refund
of premium
Seven Corners realizes that there is uncertainty in international
travel. Refund of total plan cost will only be considered if written
request is received by Seven Corners prior to the Effective Date of
Coverage. If written request is received after the Effective Date of
coverage, the unused portion of the plan cost may be refunded minus a
cancellation fee, provided no claim has been submitted to Seven Corners
for reimbursement.
the insurance company
Inbound USA is underwritten by Certain Underwriters at Lloyd’s, London
and is rated A "Excellent" by A.M. Best. In addition to being one of the
largest insurance entities in the world, Lloyd’s has over 300 years of
experience in the international insurance business.
Inbound® is a registered
trademark of Seven Corners, Inc.
ENROLLING IN
INBOUND USA
1.
Print and Complete entire
application
2. Select method of payment.
3. If paying by check or
money order, make payable to: "Seven Corners" and enclose it
together with completed Application.
4. If paying by credit card,
complete Application and mail or fax to Seven Corners. Be sure to sign
Method of Payment section. You
can also
apply online.
|
Complete and return the
Application with your payment for the total premium to:
ISA
1757 E. Baseline Rd. # 126
Gilbert, AZ 85233
Fax: 480-821-9297
(You may fax if paying
by credit card only. Originals are not required if application is
faxed to ISA with credit card payment) |
Refund of Premium
Refund
of premium shall be considered only if written request is received by Seven
Corners prior to the Effective Date of Coverage. After the Effective Date
of Coverage, the premium is considered fully earned and non-refundable.
What You Will Receive
Upon
successful enrollment in Inbound USA, you will receive an information packet
from Seven Corners. This packet will include your ID Card and Program
Summary. The Program Summary describes all the benefits of Inbound USA in
complete detail. In addition, the Program Summary tells you the procedure
for submitting claims.
The
Insurance Company
Inbound
USA is underwritten by Certain Underwriters at Lloyd's, London and is rated A
"Excellent" by A.M. Best. In addition to being one of the largest insurance
entities in the world, Lloyd's has over 300 years of experience in the
international insurance business.
For more information please contact:
Insurance Services of America
1757 E. Baseline Road, Ste. 126,
Gilbert, AZ 85344
PH: 800-647-4589
Fax: 866-793-4779
health@worldwidemedical.com
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