Travel & Medical Insurance Program
for Students, Scholars, Spouses, Families and Visitors
 

Call Us At 1-800-247-5575 or 1-703-660-9062 To Explore All Our Insurance Plan Options!

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TRADITIONAL Plans to the USA | NEW Plans to the USA | OUTGOING from the USA
 
Incoming to the USA Insurance Options
CoveragePremium ScheduleIncoming Application
 

Incoming to USA Schedule of Coverage
Traditional Plans AB, CD, E & S
(Rates are in US Dollars. Rates are Per Person)

After the Deductible, this Benefit will cover 80% of the first $5000 of covered medical expenses incurred at the regular and customary rate.  Excess of $5000, the policy will pay 100% up to the maximum stated below at the regular and customary rate.  
Please review the Plans carefully!  Coverage and Plan options have been Updated.

 Incoming Schedule of Coverages

Benefits
Coverage
Click here for definitions and answers to frequently asked questions.
Plan "S"
$100,000
No Maternity

Plan "AB"
$100,000
With Maternity

Plan "CD"
$250,000
With Maternity 

Plan "E"
$100,000
No Maternity

  Eligibility
Student/Scholar Requirement: 
Undergraduate or Graduate Students/Scholars holding a J1 or F1 visa, who are traveling to the United States and currently are enrolled in an accredited institution of higher learning on a full-time basis with no less than 6 credit hours, unless the institution’s full-time status requires less credit hours. No such requirement applies for Spouse, Children or Visitors.
Students/ 
Scholars 
(age 17-26)
Students/Scholars/
Spouses/Children
(age 0-69)
Students/Scholars/
Spouses/Children
(age 0-69)
Students/Scholars
Spouses/Children/
Visitor
(age 0-69)
  Deductible $100 
Annually
$100
Per Occurrence
$250
Per Occurrence

$100 
Annually

Benefit A
Medical Expenses (UCR)
for injury or illness occurring during the Period of Coverage.

The Plan does not cover routine office visits, routine vaccinations or pre-existing conditions.

Initial treatment of an injury must occur within 60 days of the accident or during the period of coverage, whichever is earlier.  Illness must first manifest itself during the period of coverage.

$100,000 $100,000
$250,000
$100,000
  Medical Evacuation $50,000 $50,000 $50,000 $50,000
  Prescription Drugs
80% of UCR
$1,000
(Max per 12 months of coverage)
$1,000
(Max per policy period)

$1,000
(Max per policy period)

$1,000
(Max per policy period)
  Dental Treatment 80% of the Usual, Customary and Reasonable (UCR) charge to a maximum of $1,000 per policy year as a result of injury to to natural teeth caused by an accident. $1,000
(Max per 12 months of coverage)
$1,000
(Max per policy period)
$1,000
(Max per policy period)
$1,000
(Max per policy period)
  Physiotherapy
Accident only, when prescribed by the attending physician, limited to one visit per day, $25 per visit, to a maximum of $500 per policy year
$500 $500 $500 $500
  Psychotherapy
The treatment of mental disorders, nervous disorders, alcoholism, and drug addiction, up to $30 per visit, one visit per day, to a maximum of 10 visits per policy year
Maximum of 10 visits  $5,000
(Max per policy year)
$5,000
(Max per policy year)
$5,000
(Max per policy year)
  Organ transplant, bone marrow transplant, skin grafts, kidney dialysis or similar treatments limited to $10,000 all UCR charges combined per policy year. $10,000 
(UCR per 12 months of coverage)
$10,000 $10,000 $10,000
  Surgery:  Physician fees for a surgical procedure to a $5,000 maximum per policy year $5,000 maximum per policy year $5,000 maximum per policy year $5,000 maximum per policy year $5,000 maximum per policy year
  Anesthetist Services 30% of the UCR charges of surgical allowance 30% of the UCR charges of surgical allowance 30% of the UCR charges of surgical allowance 30% of the UCR charges of surgical allowance
  Outpatient Day Surgery Miscellaneous Expenses when surgery is performed in a hospital emergency room, trauma center, physician's office, outpatient surgical center or clinic, for covered services and supplies, all charges combined to a maximum of $1,500 per day. Maximum of $1,500 per day Maximum of $1,500 per day Maximum of $1,500 per day Maximum of $1,500 per day
  Outpatient Miscellaneous Expenses - including medical emergency room expenses, diagnostic X-ray and laboratory expenses, MRIs, CAT Scans, Ultrasound, Amniocentesis, AFP Screening and Fetal Stress/Non Stress Tests, or similar procedures, when prescribed by the attending physician, to a $1,000 maximum per policy year.  Fertility testing is excluded and not a covered expense. $1,000 maximum per policy year  $1,000 maximum per policy year $1,000 maximum per policy year $1,000 maximum per policy year
  In-Patient Hospital miscellaneous Expenses for covered services and supplies, all UCR charges combined to a maximum of $1,500 per day. Maximum of $1,500 per day Maximum of $1,500 per day Maximum of $1,500 per day Maximum of $1,500 per day
  Ambulance Service, for transportation to or from a hospital, $400 per trip maximum $400 per trip maximum $400 per trip maximum $400 per trip maximum $400 per trip maximum
  Motor Vehicle Accidents, excess to the motor vehicle insurance to a maximum of $2,000 per policy year Maximum $2,000 per policy year Maximum of $2,000 per policy year Maximum of $2,000 per policy year Maximum of $2,000 per policy year
Benefit B Accidental Death & Dismemberment
(AD&D)
$15,000
$15,000
$15,000
$15,000
Benefit C Repatriation of Remains
$10,000 $10,000 $10,000
$10,000
Benefit D Pregnancy/ Childbirth/ Miscarriage
Maximum of $5,000 per policy year.  Benefits are only available if the enrollment has occurred at least 30 days prior to conception.
No maternity option available for Plan S $5,000
(maximum benefits)

$5,000
(maximum benefits)

No maternity option available for Plan E.

Cancellation Policy
All premiums are fully earned upon Application, and are Non-Refundable. Please apply only for the term of coverage you need, and re-apply as often as necessary as your plans may change.

What is Covered?

MEDICAL BENEFITS - ACCIDENT AND SICKNESS  

  1. Charges made by a hospital for room and board, floor nursing and other services exclusive of charges for professional service and with the exception of personal services of a non-medical nature; provided, however, that expenses do not exceed the hospital's average charge for semiprivate room and board accommodation or intensive care when medically necessary.  

  2. Charges made for diagnosis, treatment and surgery by a physician.

  3. Charges made for the cost and administration of anesthetics. 

  4. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusion, iron lungs, and medical treatment.

  5. Charges for physiotherapy, if recommended by a physician for the treatment of a specific disablement and administered by a licensed physiotherapist.  

  6. Dressings, drugs, and medicines that can only be obtained upon a written prescription of a physician.  

    The charges enumerated above shall in no event include any amount of such charges which are in excess of regular and customary charges.  A charge incurred by an Insured Person shall be deemed a regular and customary charge for the services and supplies for which the charge is made if it is not in excess of the average charge for such services and supplies in the locality where received, considering the nature and severity of the sickness of bodily injury in connection with which such services and supplies are received.  If the charge incurred is in excess of such average charge, such excess amount shall not be recognized as covered expenses.  All charges shall be deemed to be incurred on the date such services or supplies which give rise to the expense or charge are rendered or obtained.

Usual, Customary and Reasonable Charge (UCR) means the payment amount, as determined by the Company, for services rendered by a professional provider.  The Company (AIG) reserves the right of final determination of the amount payable for any service or supply.  

The following is the basis for determination of UCR:  
Usual
- an amount a professional provider usually charged for a given service.  
Customary
– an amount which falls within the range of charges for a given service billed by most professional providers in the same locality who have similar training and experience.  
Reasonable
– am amount which is usual and customary or which would not be considered excessive in a particular case because of unusual circumstances.  

If the charge is in excess of UCR, no payment will be made with respect to the excess, and the excess will not qualify as a Covered Expense under the Policy.  

For the purpose of this section, only such expenses, incurred as the result of and within 26 weeks of a disablement, which are specifically enumerated in the following list of charges, and which are not excluded in Exclusions, shall be considered as covered expenses.

Emergency Medical Evacuation
Emergency Medical Evacuation provides up to $50,000. for transportation of an Insured Person from a location having inadequate medical facilities to treat the Insured's condition to a facility which does.  
Repatriation of Remains
Up to $10,000. will be paid for the return of the remains of any Insured Person to the country of domicile in the event the Insured Person dies while this policy is in effect.
NOTE:    This is only a brief description of the benefits of this Plan and does not cover all the terms, conditions and limitations.  The Policy shall provide the only basis for coverage and claim.  If there is any conflict between this description and the Policy, the Policy will govern in all cases.   

To learn more about what is not covered, please Click Here

A Special Note to Seniors
* These rates are for persons traveling abroad and their family members traveling with them, 69 years of age.  Additional coverage is available for persons 70-80 years of age.  Please call 1-800-247-5575 for premium rates or Click Here for additional program options.

Underwritten by the Insurance Company of the State of Pennsylvania, a member of the company of the AIU Holdings, 
rated A "Excellent" by A.M. Best

Incoming to the USA Forms and Applications:

Apply Online or by Phone or Fax

Incoming Application -  (.pdf format)  

 Click Here for Premium Information


Home | FAQ | Claims | Contact Us | Travel Tips  | Privacy Policy  | Tell A Friend | Bookmark VISIT  

TRADITIONAL Plans to the USA | NEW Plans to the USA | OUTGOING from the USA


VISIT Travel & Medical Insurance Program, an Insurance program of PENTECO, LLC
Underwritten by the Insurance Company of the State of Pennsylvania, a member of the company of the AIU Holdings, rated A "Excellent" by A.M. Best
www.visitinsurance.com

Correspondence: P.O. Box 210, Mount Vernon, VA  22121 (703) 660-9062/ (800) 247-5575/ (703) 991-9164 fax
email:
 info@visitinsurance.com

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