ELITE PLANS ECONOMY BASIC SILVER GOLD PLATINUM DIAMOND DIAMOND PLUS
Policy Maximum $25,000 per Incident Max $50,000 per Incident Max $75,000 per Incident Max $100,000 per Incident Max $175,000 per Incident Max $50,000 Annual Max $100,000 Annual Max
Physician’s Visits/ Urgent Care Limited to $55 per visit, one visit per day and 30 visits per Policy Period Limited to $75 per visit, one visit per day and 30 visits per Policy Period Limited to $75 per visit, one visit per day and 30 visits per Policy Period Limited to $100 per visit, one visit per day and 30 visits per Policy Period Limited to $130 per visit, one visit per day and 30 visits per Policy Period Limited to $75 per visit, one visit per day and 30 visits per Policy Period Limited to $75 per visit, one visit per day and 30 visits per Policy Period
Prescription drugs and medications $250 per Incident $350 per Incident $350 per Incident $350 per Incident $350 per Incident $250 per Incident $250 per Incident
Hospital Room and Board $1,400 per day to a maximum of 30 days $2,000 per day to a maximum of 30 days $2,000 per day to a maximum of 30 days $2,000 per day to a maximum of 30 days $3,000 per day to a maximum of 30 days $1,500 per day to a maximum of 15 days $1,500 per day to a maximum of 15 days
Hospital Intensive Care Unit $2,100 per day to a maximum of 10 days $2,500 per day to a maximum of 8 days $2,500 per day to a maximum of 8 days $3,000 per day to a maximum of 8 days $4,500 per day to a maximum of 8 days $2,300 per day to a maximum of 8 days $2,300 per day to a maximum of 8 days
Physician's Surgical Treatment $3,500 per Incident $5,000 per Incident $5,000 per Incident $6,000 per Incident $7,500 per Incident $3,500 per Incident $3,500 per Incident
Diagnostic X-rays and Lab Services $450 per Incident $750 per Incident $750 per Incident $750 per Incident $1,000 per Incident $750 per Incident $750 per Incident
Assistant Physician’s Surgical $850 per Incident $850 per Incident $1,200 per Incident $1,400 per Incident $1,800 per Incident $850 per Incident $850 per Incident
Ambulance Service $500 per Incident $650 per Incident $650 per Incident $650 per Incident $750 per Incident $650 per Incident $650 per Incident
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Plan Highlights

  • This is a LIMITED BENEFIT PLAN where the maximum amount paid to the provider is listed on the plan
  • Accident and Sickness Medical Policy Maximum Choices $25,000, $50,000, $75,000, $100,000, $175,000
  • Deductibles $0- Ages 0-69 and $100 or $200 Ages 70-89
  • COVID-19 EXPENSES are covered and treated as any other sickness
  • ACUTE ONSET OF A PRE-EXISTING CONDITION up to the policy maximum for ages 0-69, up to $25,000 for ages 70-79 and up to $15,000 Ages 80-89
  • Cardiac Conditions or Stroke are limited to $25,000 for Ages 0-69 and $15,000 Ages 70-89
  • Wellness Visit - covered up to $125 (restrictions apply)
  • Emergency Medical Evacuation/Medically Necessary Repatriation/Repatriation of Remains /Local Burial/Cremation
  • Return to Country Incidental Trip Coverage-Included
  • EXAMPLES OF PER INCIDENT LIMITED BENEFITS (varies by plan)
  • Hospital Room and Board Expenses $1,400 -$3,000 per day to a maximum of 30 days
  • Physician's Surgical Treatment $3,500 - $7,500 per Incident
  • Physician’s Non-Surgical Visits/Urgent Care $55 - $130 per visit/1 per day /30 visits per Policy Period
  • Outpatient Surgical Facility $1,000 - $1,400 per Incident
  • Diagnostic X-rays and Lab Services $450 - $1,000 per Incident
  • Ambulance Service Benefits $500 - $750 per Incident
  • Please view plan details for a complete list of limits by plan

Benefits of Coverage

Medical Benefits
Note
This plan pays a fixed amount for each service provided. Any charges over the eligible allowed amount is your responsibility. If you are over the age of 70, choose $50,000 or $100,000 maximum to choose a rate.
Accident and Sickness Medical Expense
Choices: Ages 0- 69 $25,000, $50,000, $75,000, $100,000, $175,000 Per Incident. Ages 70 - 89 $50,000 or $100,00 Per Policy Year. Coverage terminates upon reaching age 90.
  • Cardiac Conditions Limit: Up to $25,000 per Policy Period for ages up to 69 or $15,000 per Policy Period for ages 70 to 89
  • COVID-19, SARS-CoV-2 Conditions: Covered the same as any other illness
  • Prescription drugs and medications: $250 - $350 per Incident - depending on plan
  • Dental: $600 or $750 maximum per Policy Period for Injury ONLY to sound natural teeth
Deductible
Per Incident Deductible ages 0-69 $0, choice of $100 or $200 ages 70-89.
  • Scheduled Benefit Plan: This plan offers a set payment limit for all covered treatments. See brochures for a comparison of plan limits.
Acute Onset of a Pre-Existing Condition
Covered up to the policy maximum for ages 0-69 coverage related to Cardiac Conditions or Stroke are limited to $25,000/Covered up to $25,000 for ages 70-79 Cardiac Conditions or Stroke are limited to $25,000 and for ages 80 and above, up to $15,000 including Cardiac Conditions or Stroke.
Well Doctor Visit
Up to $125 - One Visit per Policy Period
Covid Coverage
Covered as any other Sickness
Emergency Evacuation Benefits
Emergency Medical Evacuation
$1,000,000 or Unlimited ages for ages up to 69/ Ages 70-89 $50,000 per Policy Period and $25,000 Lifetime Maximum for Acute Onset over age of 80
Political Evacuation
Up to $500 per Policy Period
Natural Disasters Evacuation
$500 per Policy Period
Return of Minor Children or Grandchildren
$5,000 per Policy Period
Repatriation of Mortal Remains
$7,500 per Policy Period
Local Burial/Cremation
$5,000 per Policy Period
24/7 Non-Insurance Benefits
Non Insurance Assistance Services
Included

Plan Definitions

  • Pre-Existing Condition

    “Pre-Existing Condition” means any medical condition, Sickness, Injury, Illness, disease, mental Illness or mental nervous disorder, for which medical advice, diagnosis, care or Treatment was recommended or received or for which a reasonably prudent person would have sought Treatment during the 36-month period immediately preceding the Effective Date of Coverage under this Policy.
    Pre-Existing shall also mean any Injury, Illness, Sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the 36 months prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or
    known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.
    Pre-Existing shall also include any Acute Onset of an Illness, Sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that is an exacerbation of, due to, or associated with an underlying condition. Underlying condition shall include any condition that has been monitored by a Physician due to possible deterioration of the Covered Person's diagnosis being changed, as a result of a previously known condition that can affect, degrade, and/or alter a Covered Person's underlying condition, including any changes in medication. Proof of Eligibility is required prior to any payment of Claim.

  • ACUTE ONSET OF PRE-EXISTING CONDITION

    Benefits are payable for an Acute Onset of a Pre-Existing
    Condition up to the maximum as stated in the Schedule of Benefits provided the condition or event: 1. occurs spontaneously and without advance warning either in the form of Physician recommendations or
    symptoms, is of short duration, is rapidly progressive, and requires urgent and immediate medical care; 2. occurs a minimum of 48 hours after the Effective Date of the Policy; and 3. treatment is obtained within 24 hours of the sudden and unexpected outbreak or recurrence.
    Any repeat/reoccurrence within the same Policy Period will no longer be considered Acute Onset of a Pre-Existing Condition and will not be eligible for additional coverage. This benefit covers only one (1) Acute
    Onset episode of a Pre-Existing Condition. Sudden and Acute Onset of a Pre-Existing Condition Coverage expires upon medical advice that the condition and onset is no longer acute, or the Covered Person is
    discharged from a medical facility. Pre-Existing shall also include any Acute Onset of an Illness, Sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that is an exacerbation of, due to, or associated with an underlying condition. Underlying condition shall include any condition that has been monitored by a Physician due to possible deterioration of the Covered Person's diagnosis being changed, as a result of a previously known condition that can affect, degrade, and/or alter a Covered Person's underlying condition, including any changes in medication. Proof of Eligibility is required prior to any payment of Claim.

  • Cancellation and Refund Procedure Provisions

    Full cancellation and refund will only be considered if We receive written request prior to or on the Effective Date of the coverage. If We receive a written request for cancellation and refund after the Effective Date of coverage, a partial cancellation and refund may be allowed. The following conditions apply: a) If any claims have been filed with Us, the premium is fully earned and is non-refundable. b) If no claims have been filed with the Company, then (i) a cancellation fee of US $25 will be charged; and (ii) only unused days premiums will be considered as refundable; and c) If after a refund is made, it is determined that a claim was presented to Us on a Covered Person’s behalf, the Covered Person will be fully responsible for that claim in its entirety.

This is a brief description of the important features of the plan. It is not a contract of insurance. This plan includes both insurance and non-insurance benefits. The terms and conditions of coverage are set forth in the Plan issued to with ITA Global Trust, LTD. For a detailed plan description, exclusions, and limitations please view the plan on file with ITA Global Trust, LTD. The Policy contains a complete description of all of the terms, conditions, and exclusions of the insurance plan as underwritten by Crum & Forster SPC. The Policy will prevail in the event of any discrepancy between this information and the Policy as a brief description of the important features of the plan. The Policy contains a complete description of all of the terms, conditions, and exclusions of the insurance plan as underwritten by Crum & Forster SPC. The Policy will prevail in the event of any discrepancy between this website and the Policy.