International Family Insurance, International Spouse Insurance, International Dependent Insurance, Maternity Coverage

VISIT^® Travel & Medical Insurance Program
for International Students, Scholars, Spouses, Families and Visitors

Call Us Today 1-800-247-5575 or 1-703-660-9062 or

The Trusted Name in International Health and Travel Medical Insurance for over 30 Years!

VISIT^® International Student/Scholar & Family Plans Are Ideal For:

International Students & Scholars (F1, J1, H, M or Q)
Spouse and/or Dependents

ESL or High School Students
Visiting Faculty
OPT/AT Students

Any Study/Research in USA & Canada
Includes Maternity

Choose from 9 different International Student/Scholar & Family Insurance Plans:


Choose $100K or $250K Medical Maternity included up to $10,000 $100 deductible per illness/injury (reduced to $50 if Student Health) 80/20 co-insurance to $10,000 Pre-existing conditions covered after 12 months Medical Lifetime Maximum - $1 million As low as $44 per month	Choose $100K or $250K Medical Maternity included up to $10,000 $100 deductible per illness/injury (reduced to $50 if Student Health) 80/20 co-insurance to $5000 Pre-existing conditions covered after 12 months Medical Lifetime Maximum - $1 million As low as $46 per month	Choose $100K or $250K Medical Maternity covered to policy max $100 deductible per illness/injury (reduced to $50 if Student Health) 80/20 co-insurance to $5000 Pre-existing conditions covered after 12 months Medical Lifetime Maximum - $1 million As low as $51 per month	Choose $100K or $250K Medical Maternity covered as any other illness Unlimited Medical Evacuation $100 deductible per illness/injury (reduced to $50 if Student Health) 80/20 co-insurance to $5000 Pre-existing conditions covered after 6 months Medical Lifetime Maximum - $1 million As low as $50 per month	Choose $100K Medical No maternity coverage $100 deductible per policy period 80/20 co-insurance to $5000 As low as $43 per month

Economy, Standard, Super & Platinum Plan Benefits
Underwritten by Virginia Surety Company, Inc. (VSC), rated A- “Excellent” by A.M. Best. The VSC Master Policies are filed under form numbers IN/OUT-EOC (01/2004) and Liability AIFS LIAB (IL 09/98R)

Economy, Standard, Super and E^PLUS plans meet or exceed U.S. State Department DS2019 requirements
Choose your own doctor or hospital; you are not required to use doctors within a specific network
Deductible reduced to $50 per occurrence if the university student health center is used first
Maternity coverage included - limits vary by plan
Pre-existing conditions covered after 12 months of continuous coverage (6 months for Platinum)
Sports & hazardous sports coverage included

**A Student must be the primary insured in order for the Spouse and Child to be eligible for ECONOMY, STANDARD, SUPER & PLATINUM PLANS. Please choose a plan for each person in your family that requires coverage (Student, Spouse and child).

ECONOMY Insurance Plans
Choose $100K or $250K (maternity included)

ECONOMY Plan Monthly Rates

Rates effective July 1, 2011

Age	Economy $100K Student	Economy $100K Spouse	Economy $250K Student	Economy $250K Spouse
12-18	$44	$121	$48	$133
19-23	$55	$152	$58	$161
24-30	$119	$333	$128	$356
31-40	$191	$535	$203	$567
41-49	$276	$769	$292	$816
50-64	$376	$1,048	$399	$1,112
Dependent Child 30 days to 18 years old (or 25 if a full-time student)	$104		$115
**A Student must be the primary insured in order for the Spouse and Child to be eligible for ECONOMY, STANDARD, SUPER & PLATINUM PLANS. Please choose a plan for each person in your family that requires coverage (Student, Spouse and child).

ECONOMY Plan Coverages
Coverage	Economy $100K	Economy $250K
Accident & Sickness Medical Routine physical exams and vaccinations are not covered	Student - $100,000 per injury or illness maximum Student - $50,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)	Student - $250,000 per injury or illness maximum Student - $100,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)
Deductible	$50 Student Health / $100 non-Student Health per injury or illness	$50 Student Health / $100 non-Student Health per injury or illness
Co-insurance	80% to $10,000, 100% thereafter to policy maximum	80% to $10,000, 100% thereafter to policy maximum
Medical Lifetime Maximum	$1,000,000 per Student / $100,000 Spouse/Child	$1,000,000 per Student / $100,000 Spouse/Child
Emergency Medical Evacuation	$100,000	$100,000
Repatriation of mortal remains	$25,000	$25,000
Pre-existing condition coverage	Pre-existing Conditions 12 months prior to Effective Date, waived after 12 consecutive months of coverage	Pre-existing Conditions 12 months prior to Effective Date, waived after 12 consecutive months of coverage
AD&D - Accidental Death & Dismemberment	$10,000	$10,000
Maternity Coverage	up to $10,000 (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)	up to $10,000 (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)
Home Country Coverage	30 days of coverage up to a max. of $25,000 per policy period	30 days of coverage up to a max. of $25,000 per policy period
Sports Coverage (non-interscholastic sports)	$10,000 per policy period	$10,000 per policy period
Hazardous sports coverage	$10,000 per policy period	$10,000 per policy period
View Policy Details

STANDARD Insurance Plans
Choose $100K or $250K (maternity included)

STANDARD Plan Monthly Rates

Rates effective July 1, 2011

Age	Standard $100K Student	Standard $100K Spouse	Standard $250K Student	Standard $250K Spouse
12-18	$46	$128	$49	$137
19-23	$57	$158	$60	$168
24-30	$122	$340	$128	$359
31-40	$200	$560	$212	$590
41-49	$297	$828	$313	$872
50-64	$405	$1,128	$426	$1,187
Dependent Child 30 days to 18 years old (or 25 if a full-time student)	$111		$118
**A Student must be the primary insured in order for the Spouse and Child to be eligible for ECONOMY, STANDARD, SUPER & PLATINUM PLANS. Please choose a plan for each person in your family that requires coverage (Student, Spouse and child).

STANDARD Plan Coverages

Coverage	Standard $100K	Standard $250K
Accident & Sickness Medical Routine physical exams and vaccinations are not covered	Student - $100,000 per injury or illness maximum Student - $50,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)	Student - $250,000 per injury or illness maximum Student - $100,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)
Deductible	$50 Student Health / $100 non-Student Health per injury or illness	$50 Student Health / $100 non-Student Health per injury or illness
Co-insurance	80% to $5000, 100% thereafter to policy maximum	80% to $5000, 100% thereafter to policy maximum
Medical Lifetime Maximum	$1,000,000 per Student / $100,000 Spouse/Child	$1,000,000 per Student / $100,000 Spouse/Child
Emergency Medical Evacuation	$100,000	$100,000
Repatriation of mortal remains	$25,000	$25,000
Pre-existing condition coverage	Pre-existing Conditions 12 months prior to Effective Date, waived after 12 consecutive months of coverage	Pre-existing Conditions 12 months prior to Effective Date, waived after 12 consecutive months of coverage
AD&D - Accidental Death & Dismemberment	$10,000	$10,000
Maternity Coverage	up to $10,000 (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)	up to $10,000 (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)
Home Country coverage	30 days of coverage up to a max. of $25,000 per policy period	30 days of coverage up to a max. of $25,000 per policy period
Sports Coverage (non-interscholastic sports)	$10,000 per policy period	$10,000 per policy period
Hazardous sports coverage	$10,000 per policy period	$10,000 per policy period
View Policy Details

SUPER Insurance Plans
Choose $100K or $250K (maternity included)

SUPER Plan Monthly Rates

Rates effective July 1, 2011

Age	Super $100 K Student	Super $100K Spouse	Super $250K Student	Super $250K Spouse
12-18	$51	$143	$55	$155
19-23	$62	$174	$70	$193
24-30	$143	$399	$158	$441
31-40	$252	$704	$276	$771
41-49	$298	$830	$324	$904
50-64	$405	$1,131	$441	$1,231
Dependent Child 30 days to 18 years old (25 if a full-time student)	$124		$135
**A Student must be the primary insured in order for the Spouse and Child to be eligible for ECONOMY, STANDARD, SUPER & PLATINUM PLANS. Please choose a plan for each person in your family that requires coverage (Student, Spouse and child).

SUPER Plan Coverages

Coverages	Super $100K	Super $250K
Accident & Sickness Medical Routine physical exams and vaccinations are not covered	Student - $100,000 per injury or illness maximum Student - $50,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)	Student - $250,000 per injury or illness maximum Student - $100,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)
Deductible	$50 Student Health / $100 non-Student Health per injury or illness	$50 Student Health / $100 non-Student Health per injury or illness
Co-insurance	80% to $5000, 100% thereafter to policy maximum	80% to $5000, 100% thereafter to policy maximum
Medical Lifetime Maximum	$1,000,000 per Student / $100,000 Spouse/Child	$1,000,000 per Student / $100,000 Spouse/Child
Emergency Medical Evacuation	$100,000	$100,000
Repatriation of mortal remains	$25,000	$25,000
Pre-existing condition coverage	Pre-existing Conditions 12 months prior to Effective Date, waived after 12 consecutive months of coverage	Pre-existing Conditions 12 months prior to Effective Date, waived after 12 consecutive months of coverage
AD&D - Accidental Death & Dismemberment	$10,000	$10,000
Maternity coverage	up to policy maximum (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)	up to policy maximum (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)
Home Country coverage	30 days of coverage up to a max. of $25,000 per policy period	30 days of coverage up to a max. of $25,000 per policy period
Sports Coverage (non-interscholastic sports)	$10,000 per policy period	$10,000 per policy period
Hazardous sports coverage	$10,000 per policy period	$10,000 per policy period
View Policy Details

PLATINUM Insurance Plans
Choose $100K or $250K (maternity included)

PLATINUM Plan Monthly Rates

Rates effective July 1, 2011

Age	Platinum $100 K Student	Platinum $100K Spouse	Platinum $250K Student	Platinum $250K Spouse
12-18	$50	$140	$53	$150
19-23	$68	$191	$77	$212
24-30	$159	$441	$175	$486
31-40	$277	$773	$305	$850
41-49	$328	$913	$356	$993
50-64	$445	$1,243	$485	$1,353
Dependent Child 30 days to 18 years old (25 if a full-time student)	$137		$150
**A Student must be the primary insured in order for the Spouse and Child to be eligible for ECONOMY, STANDARD, SUPER & PLATINUM PLANS. Please choose a plan for each person in your family that requires coverage (Student, Spouse and child).

PLATINUM Plan Coverages

Coverages	Platinum $100K	Platinum $250K
Accident & Sickness Medical Routine physical exams and vaccinations are not covered	Student - $100,000 per injury or illness maximum Student - $50,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)	Student - $250,000 per injury or illness maximum Student - $100,000 (Age 50-64) Spouse/Child - $50,000 Spouse - $25,000 (Age 50-64)
Deductible	$50 Student Health / $100 non-Student Health per injury or illness	$50 Student Health / $100 non-Student Health per injury or illness
Co-insurance	80% to $5000, 100% thereafter to policy maximum	80% to $5000, 100% thereafter to policy maximum
Medical Lifetime Maximum	$1,000,000 per Student / $100,000 Spouse/Child	$1,000,000 per Student / $100,000 Spouse/Child
Emergency Medical Evacuation	unlimited	unlimited
Repatriation of mortal remains	unlimited	unlimited
Pre-existing condition coverage	6 months prior to Effective Date, waived after 6 consecutive months of coverage	6 months prior to Effective Date, waived after 6 consecutive months of coverage
AD&D - Accidental Death & Dismemberment	$10,000	$10,000
Maternity coverage	Covered as any other Illness (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)	Covered as any other Illness (must be insured for a minimum of 30 days prior to conception to receive maternity benefits)
Home Country coverage	30 days of coverage up to a max. of $25,000 per policy period	30 days of coverage up to a max. of $25,000 per policy period
Sports Coverage (non-interscholastic sports)	$10,000 per policy period	$10,000 per policy period
Hazardous sports coverage	$10,000 per policy period	$10,000 per policy period
View Policy Details

Plan E^PLUS
Underwritten by Virginia Surety Company, Inc. (VSC), rated A- “Excellent” by A.M. Best. The VSC Master Policies are filed under form numbers IN/OUT-EOC (01/2004) and Liability AIFS LIAB (IL 09/98R)

Plan E^PLUS Monthly Rates

EPLUS Plan Rates Remain the Same for 2011-2012!

Age	Plan E^PLUS	Plan E^PLUSHazardous Sports
0-29	$43	$50
30-39	$57	$66
40-49	$90	$95
50-59	$135	$155
60-64	$169	$195
65-69	$210	$242
70-79	$265	$305

Plan E^PLUS Coverages

Coverages	E^PLUS	E^PLUSHazardous Sport
Accident & Sickness Medical Routine physical exams and vaccinations are not covered	$100,000 per injury or illness medical maximum	$100,000 per injury or illness medical maximum
Deductible	$100 per policy period	$100 per policy period
Co-insurance	80% to $5000, 100% thereafter to policy maximum	80% to $5000, 100% thereafter to policy maximum
Medical Lifetime Maximum	$100,000 Age 0-69 / $50,000 Age 70-79	$100,000 Age 0-69 / $50,000 Age 70-79
Emergency Medical Evacuation	up to $100,000	up to $100,000
Repatriation of mortal remains	up to $25,000	up to $25,000
Pre-existing condition coverage	no coverage	no coverage
AD&D - Accidental Death & Dismemberment	$25,000 per Insured/Spouse $5000 per Dependent Child	$25,000 per Insured/Spouse $5000 per Dependent Child
Maternity coverage	no coverage	no coverage
Home Country coverage	60 days per 12 months of coverage up to $50,000	60 days per 12 months of coverage up to $50,000
Sports Coverage (non-interscholastic sports)	up to policy maximum	up to policy maximum
Hazardous Sports coverage	no coverage	included
Trip Interruption	up to $5000	up to $5000
Return of minor child	up to $10,000	up to $10,000
Lost baggage	up to $250	up to $250
View Policy Details

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 necessary as your plans may change.

VISIT Travel & Medical Insurance Program, an Insurance program of PENTECO, LLC
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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