International Major
Medical
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International
Major Medical
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For:
• Foreign Nationals Visiting the USA
• Foreign Nationals Working in the USA
• Foreign Nationals in their Home Country Working for a USA Company
• USA Citizens Returning to the USA
Uses:
• Tourism
• Immigration
• Religious Pursuits
• VISA Requirements
• Occupation Outsourcing
• Foreign Exchange Students
• Relatives Visiting From Abroad
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Agent Information:
MCIS Multichoice Insurance Services
40461 Fremont Blvd.,
Fremont, CA 94538, USA.
Ph: 1-800-507-1428
Ph: 1-510-456-5304
Fax: 1-510-402-4743
Website: www.insurancemultichioce.com
Email: contact@insurancemultichoice.com
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Age 0-69 $100, $250, $500,
$1,000, $2,500 or
$5,000
Age 70-79 $1,000, $2,500 or
$5,000
Age 80-84 $2,500 or $5,000
(Deductibles listed are per person,
per policy period)
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After Deductibles are paid,
Underwriters will reimburse 80% of
next $5,000 in eligible expenses and
then 100% of eligible expenses up to
the Maximum Benefit
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Age 0-69 up to $1,000,000
Age 70-74 up to $250,000
Age 75-79 up to $100,000
Age 80-84 up to $50,000
(Benefits ts listed are per person, per
policy period)
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Description of Policy Benefits
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The insurance being described is a temporary major medical insurance plan. Eligible expenses caused by an illness or injury and incurred from any
doctor or any hospital within a specified ed geographical area will be reimbursed to you. Benefits ts may be assignable directly to the providers
once a claim has been validated.
Eligible Expenses
Hospital Expenses: All medically necessary expenses while hospitalized.
Physician Services: All medically necessary expenses for treatment.
Skilled Nursing Facilities: All medically necessary expenses if confinement begins following a medically necessary hospital confinement of 3 days
or longer.
Home Health Care: All medically necessary expenses if hospitalization would have been required if Home Health Care was not provided and the
care is provided in accordance with a written plan established, approved and followed by a physician.
Ambulance Services Expenses: To and from a hospital within 100 miles in the same geographic area.
Prescription Drugs: Covered during and following a period of hospitalization.
Repatriation of Remains: In the event of death, Underwriters will reimburse the cost of delivery of your remains to a mortuary nearest your home
up to $100,000.
Common Accident Provision: In the event that you and any additional insured family members suffer after injuries from the same accident, only
one deductible and coinsurance shall be applied.
Global Medical Transportation: All medically necessary expenses for stabilization and transportation to the facility nearest your home, which can
provide the appropriate care up to $100,000.
Lost Luggage: In the event that your checked on luggage is completely and totally lost, Underwriters shall reimburse you to a maximum of $500,
excess of any and all other valid and collectible coverages.
Emergency Return Home: If, aft after you have departed, you learn of the death of an Immediate Family Member, or you learn of the substantial
destruction of your home by fire re, wind, fl flood, or earthquake, Underwriters shall reimburse you the cost of an economy one way air or ground
transportation ticket for you to your home, up to a maximum of $5,000.
Trip Cancellation Benefit: If within two weeks prior to your pre-paid ticketed or vouchered initial trip departure your entire trip must be cancelled
due to 1) your death, illness or injury causing hospitalization or outpatient surgery, or 2) the death of an Immediate Family member, or 3) the
substantial destruction of your home due to fire re, wind, fl flood, or earthquake, any unused and nonrefundable portion of expenses shall be
reimbursed up to a maximum of $1,000, excess of $100 each and every loss and excess of all other valid Insurances.
$25,000 Accidental Death: Double indemnity ($50,000 total) if accidental death occurs while riding as a passenger of a common carrier.
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This is not intended to be a complete outline of coverage. Actual wording may change without notice.
Underwriters reserve the right to modify terms and Benefits ts at time of underwriting.
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Sports or Activity Coverage
If you elect this option, underwriters will reimburse you for eligible expenses which are incurred due to an injury resulting from the participation in
a sport or activity that is specifically named on the Schedule of Coverage. (See exclusions for a list of commonly excluded sports and activities.)
Accidental Death & Dismemberment (AD&D)
Underwriters will pay you the principal sum insured (not to exceed $500,000) as designated on the Schedule of Coverage in the event of your
accidental death. Underwriters will also pay the principal sum insured in the event that you suffer after a loss resulting from an injury as shown in
the Schedule of Losses below.
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Schedule of Losses
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Loss of use of or loss of two or more limbs ................................................................. The Principal Sum
Loss of sight of both eyes ............................................................................................ The Principal Sum
Loss of or loss of use of one limb ............................................................ One Half of the Principal Sum
Loss of sight in one eye.............................................................................. One Half of the Principal Sum
Loss of speech............................................................................................ One Half of the Principal Sum
Loss of hearing of both ears....................................................................... One Half of the Principal Sum
War & Terrorism Coverage
If you elect this option Underwriters will reimburse You for Eligible Expenses which are incurred as a result of Injuries or Illnesses sustained due to
war/terrorism or act of war/terrorism. Injuries or Illnesses due to war/terrorism or act of war/terrorism involving the use or release of any nuclear
weapon or device or chemical or biological agent, regardless of any contributory cause(s) are not covered with this optional benefit. (War &
Terrorism coverage will add 20% to the Sub-Total premium)
Kidnap & Ransom Coverage (K&R)
If you elect this option Underwriters will reimburse you for the ransom expenses paid on your behalf in order to release you from a kidnapping
event which had taken place in the USA as well as reimburse you for the crisis response fees up to $100,000 in the aggregate. Although ransom
benefits appear to be the primary Benefits t, the core Benefits t of any plan is the Crisis Response Team that will assess and advise the family.
Most kidnappings are carried out in order to obtain a ransom, and in most cases a ransom is paid. The average percentage of deaths following a
kidnapping is 9%. In cases involving Th e Crisis Response Team, less than 2% of people are killed.
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Health care costs are different erent in the United States than other countries around the world. Th e United States health care system is
principally funded through private insurance. Access to socialized health care is typically restricted to United States Veterans, Medicare recipients
and legal residents using Medicaid. Reciprocity between some countries which both have socialized health care does not occur in the United States.
Examples of Coverage
- A Foreign National visiting the USA.
- A USA Citizen who is temporarily unable to purchase domestic coverage due to residence restrictions.
- A Foreign National working for a USA company in their home country or outside their home country.
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Daily Premium Rates
(Refer to the lower section of this page for proper calculation procedure)
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+If applying in conjunction with an adult, otherwise use the 0-18 rate.
* $1,000 minimum deductible only.
** $2,500 or $5,000 deductible only (Reminder: Multiply by deductible factor)
War & Terrorism coverage will add 20% to the Sub-Total premium. War & Terrorism rates based on coverage in the USA, additional fees may apply
for other countries.
Reminder: The $100 processing fee is not applied with the online enrollment.
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- Services and supplies for Cardiac Related Conditions and Cancer Related Conditions are limited to either (i) the medical costs of stabilizing
your condition and the transportation costs of returning you to your Home Country or (ii) a maximum reimbursement for Eligible Expenses of
$25,000, at the option of Underwriters.
- The maximum Eligible Expense for Repatriation of Remains or Global Medical Transportation is $100,000 in the aggregate.
- The maximum Eligible Expense for room and board charges for an intensive care unit is three times the Provider’s semi-private room.
- Insured age 70-74 is limited to $250,000 maximum Benefits t or as shown on the Schedule of Benefits ts page, whichever is the least. All
other terms and conditions apply.
- Insured age 75-79 is limited to $100,000 maximum Benefits t or as shown on the Schedule of Benefits ts page, whichever is the least. All
other terms and conditions apply.
- Insured age 80-84 is limited to $50,000 maximum Benefits t or as shown on the Schedule of Benefits ts page, whichever is the least. All
other terms and conditions apply.
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Pre-existing Conditions Limitations
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A preexisting condition means a condition, disease or Injury for which medical advice, diagnosis, care or treatment, including the use of
prescription medication including but not limited to ongoing condition(s), was recommended by or received from a licensed health care practitioner,
and/or any symptom(s) and/or any condition(s) which would have caused a reasonable prudent person to seek medical attention during the 12
months immediately preceding the Effective Date of the insurance described in this certificate cate, whether disclosed or not on Your application
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- Any expense which You are not legally obligated to pay.
- Services which are not Medically Necessary or are not furnished by and under supervision of a Physician.
- Expenses for services and supplies for which You are entitled to Benefits ts, services or reimbursement through the Veterans’ Administration,
Workers’ Compensation insurance, any private health plan or from any other source except Medicaid.
- Expenses in excess of UCR.
- Outpatient drugs, except following a hospitalization if prescribed for the same Illness or Injury.
- Self-infl icted injuries while sane or insane.
- Treatment for alcoholism, drug addiction, allergies, and/or Mental or Nervous Disorders.
- Rest cures, quarantine or isolation.
- Cosmetic surgery unless necessitated by an accidental Injury.
- Dental exams, dental x-rays and general dental care except as a result of an accidental Injury.
- Eye glasses or eye examinations.
- Hearing aids or hearing examinations.
- General or routine examinations.
- Injuries sustained from participation in Hazardous Sports or Activities.*
- Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage, abortion or
postpartum conditions.
- Injuries or Illnesses due to War or any act of War whether declared or undeclared.*
- Injuries or Illnesses due to Terrorism or any act of Terrorism whether declared or undeclared.*
- Injuries or Illnesses due to an act of Terrorism involving the use or release of any nuclear weapon or device or chemical or biological agent,
regardless of any contributory cause(s).
- Injuries or Illnesses sustained while committing a criminal or felonious act.
- Expenses incurred for or resulting from pain which is not supported by medical diagnosis.
- Cataract surgery.
- Any elective surgery, including but not limited to complications of previous elective or cosmetic surgeries.
- Custodial Care.
- Expenses for supplies and services that were not incurred with in the specified ed Geographic Area.
- Pre-existing conditions.
- Racing of any kind, all professional or semi-professional sports, and collegiate, sponsored, or interscholastic athletics.**
* This exclusion can be removed if the appropriate additional premium has been paid and the optional Benefits t is indicated on the Schedule or
attached by an endorsement.
** Th is exclusion can be removed if the appropriate additional premium has been paid and the optional Benefits t is indicated on the Schedule or
attached by an endorsement. Please note this exclusion cannot be removed with the online enrollment.
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This is not intended to be a complete outline of coverage. Actual wording may change without notice.
Underwriters reserve the right to modify terms and Benefits ts at time of underwriting.
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Petersen International Underwriters
Petersen International Underwriters want you to understand how they protect the confidentiality of non-public personal information they collected
about you.
Information PIU Collect
PIU collect non-public information about you from numerous sources including, but not limited to:
a) Information PIU receive from you on applications and other forms;
b) Information about your transactions with our affiliates, others or PIU;
c) Information PIU receive from consumer-reporting agencies; and
d) Financial and medical sources.
Information PIU Discloses
PIU does not disclose any non-public information about you to anyone except as is necessary in order to provide products or services to you or
otherwise as required or permitted by law (e.g. subpoena, fraud investigation, regulatory reporting, etc.).
Right to access or correct your personal information
You have a right to request access to or correction of your personal information in PIU's possession.
Confidentiality and Security
PIU restrict access to non-public personal information about you to PIU's employees, PIU's affiliates’ employees or others who need to know that
information to service your account. PIU maintains physical, electronic and procedural safeguards to protect your non-public personal information.
Contacting PIU
If you have any further questions about this privacy statement or would like to learn more about how PIU protect your privacy, please contact us.
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