Provider Group Insurance
(For GROUPS of 5 or More People)
a Quote & Apply Online /
/ Print Application
The International Provider group travel plan is
underwritten by Certain Underwriters at Lloyd’s, London. As the largest
insurance entity in the world, Lloyd’s has earned a Standard & Poor’s
rating of A+ (Strong) and an A (Excellent) rating from AM Best.
Insurance Services of America (ISA) is your full-service
agency. As an independent nationwide leader in the international health
and travel insurance industry with over 41 years of experience, ISA is
equipped to guide you through selection of the best benefit package for
your needs. Please feel free to contact us with any questions or
if we can be of personal service. Your telephone call will always
be answered by a live person who will assist you.
Insurance Services of America
1757 E. Baseline Road, Suite 126
Gilbert, AZ 85233
(480) 821-9052 / 1-800-647-4589 (Toll Free within the USA
(480) 821-9297 FAX / (866) 793-4779 (Toll Free FAX)
Description of Benefits
This plan pays for covered expenses up to the selected
medical maximum after you pay your deductible and coinsurance percentage. Benefits are noted below for
which the deductible and coinsurance apply. Expenses related to pre-existing conditions are not
covered except as stated under the Unexpected Recurrence of a Pre-Existing Condition benefit.
You receive payment if hospitalized due to a
covered illness or injury while traveling outside the United States and Canada. This is in
addition to other covered expenses.
Dental Accident Coverage:
You receive emergency treatment to repair or
replace sound natural teeth if damaged as the result of a covered accident (coinsurance
and deductible apply).
Dental Sudden Relief of Pain:
You receive emergency treatment for the
relief of pain to natural teeth (coinsurance and deductible apply).
Emergency Medical Evacuation/Repatriation:
This benefit pays if any covered injury or
illness results in your medically necessary emergency medical evacuation
Return of Mortal Remains:
This benefit pays to return your remains to
your then home country if you die.
Return of Minor Children:
If you are traveling alone with a minor
child(ren) and are hospitalized due to a covered illness/injury, leaving the minor child(ren)
unattended, we will arrange and pay for a one-way economy fare to the home country for the child(ren) with
an attendant if necessary.
Emergency Medical Reunion:
When an emergency medical
evacuation/repatriation occurs, and the attending physician recommends a family member accompany
you, we will arrange and pay for the cost of a roundtrip economy transportation and reasonable
accommodation expenses for an individual of your choice to be at your side. (Benefit limit of $200 per
day and time limit of 10 days applies)
If political or military events in a host
country result in a formal recommendation for you to leave or if you are expelled or declared persona
non-grata by the host country, reasonable expenses incurred for transportation to the nearest
place of safety or for repatriation to your home country or country of residence are covered. This benefit will
not pay should you not heed travel warnings or travel alerts issued by the State Department or
appropriate authorities recommending travel to certain countries be avoided.
Accidental Death & Dismemberment:
Benefits are paid according to the schedule
below if you sustain an accidental injury and if the resulting
death/dismemberment occurs within 365 days of the accident date. (If
more than one loss occurs as the result of one accident, only the
largest amount is payable). See the
Schedule of AD&D benefits.
Baggage Loss: We
will reimburse you for lost baggage/personal effects ($50 per article
limit) checked with a common carrier (secondary to coverage provided by
the common carrier).
Interruption of Trip:
If unable to continue your trip due to the
death of an immediate family member or due to serious damage to your principal residence from
fire, flood or similar natural disaster, we will reimburse you for the cost of economy travel (less the
value of applied credit from an unused return travel ticket) to return you to your area of principal
Home Country Coverage (Incidental
Trips to the Home Country):
You are covered for incidental trips to your home country based on 30 days per 6 months of
purchased coverage or pro rata thereof (example - approximately 5 days per month). This benefit
is not available for purchases less than 30 days and does not apply to final trip home.
Home Country Extension of Benefits (Follow Me Home
Coverage): You are covered for
expenses incurred in your home country due to an injury/illness
which occurred and was diagnosed and treated outside your home country during your coverage period
(does not apply to emergency evacuation/repatriation).
Unexpected Recurrence of a Pre-Existing Condition:
This benefit provides coverage for expenses resulting from a sudden, unexpected recurrence of a
pre-existing condition. If you are younger than age 65, coverage is provided up to $20,000. If you are 65
years or older, coverage is provided up to the first $2,500 (coinsurance and deductible apply).
receive coverage for injuries and illnesses resulting from an act of
Hazardous Sports Coverage:
This optional coverage provides benefits for
the following activities provided the coverage is selected and appropriate
premium is paid.
This is a brief description of the plan benefit. The
policy shall provide the only basis for coverage and claim. Please be aware that this is not a general health
insurance policy, but an interim, limited benefit period, travel medical plan intended for use while away from your Home
Country. The plan cannot guarantee payment to an individual or a facility for medical expenses until
it has been determined that it is an eligible expense and a signed agreement has been received from the
appropriate medical facility.
streamlined claims process is easy to use. When you receive medical
treatment, simply submit your itemized bill to Seven Corners within 90
days. Eligible bills are automatically converted from local currencies to U.S. dollars.
Pre-Notification / Referral
Seven Corners Assist must be contacted prior
to: (1) any medical treatment being received in the the United States;
or (2) hospital admissions worldwide; or (3) inpatient or outpatient
surgeries worldwide. Additionally, the Company’s appointed network
provider must be utilized for medical expenses incurred inside the
United States (when available – contact Seven Corners Assist with
questions). A listing of network facilities can be found at
http://www.sevencorners.com/networkproviders/insuredproducts/ on the worldwide web. Pre-notification does
not guarantee that benefits will be paid. Failure to follow
Pre-Notification / Referral will result in a 20% reduction of Eligible
Benefits. (For Emergency admissions and situations, Seven Corners
Assist must be contacted within 48 hours, or as soon as reasonably
For Medical Expense
Benefits covered under this policy, this insurance does not cover:
Any Injury or
Illness which meets the following criteria a) condition(s) that would
have caused a person to seek medical advise, diagnosis, care or
treatment during the 36 months prior to the Effective Date of coverage
under this Policy; b) condition(s) for which manifestation, medical
advise, diagnosis, care or treatment was recommended, received, or
noticed during the 36 months prior to the Effective Date of coverage
under this Policy; If the Injury or Illness is an Unexpected
Recurrence and the Insured Person is traveling outside the United
States, the program will reimburse up to $1000 for treatment of that
particular condition. An Unexpected Recurrence is a sudden and
unexpected outbreak or recurrence of a condition defined in a & b above.
The condition must occur spontaneously and without advanced warning,
for example: prior symptoms, Physician visit, failing to take
medication. For Insured Persons traveling outside the United States and
Canada, the period is 12 months instead of 36 months.
specimen policy for a list of exclusions.
Establishing coverage with us
To establish your selected coverage, please return the
Enrollment Form and Census Form to Insurance Services of America at the contact information shown
above. Please note that premium must be received prior to departure on your international trip.
Upon enrollment, you will receive a Program Summary
providing detailed evidence of coverage and an ID card for each enrolled member. We offer two methods to
We offer an Online Group Enrollment System
which allows the group representative to enroll participants 24 hours a day. Once you complete
the necessary screens, an email confirmation containing each insured’s Virtual ID card and a link to
the Program Summary will be provided via email.
Apply Online Now
for instant enrollment.
To utilize this method, simply e-mail, fax,
or mail Insurance Services of America the group census and include the following: name of insured,
effective date, expiration date, age or date of birth, premium amount.
brochure and application
Understanding your eligibility
You are considered an eligible person under this plan if
you are a participant, employee, or member of the assured group, while traveling outside of your home
country, provided your name and travel dates have been submitted on the group application and
accepted by Seven Corners along with payment of premium. (Home Country is defined as the country where
you have your true, fixed, and permanent home and principal establishment). Your coverage shall apply
worldwide excluding or including the United States depending on the coverage option you have
It is your responsibility as the insured to maintain all
records regarding travel history and age and provide any documents which would verify eligibility requirements.