Inbound USA
2009
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Purchase this Plan Online
Brochure & Paper Application
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Medical coverage
for non-us citizens visiting the us
foreign visitors traveling to the u.s.:
emergency • medical evacuation
repatriation • 24 hour assistance service
scheduled benefit coverage & premiums
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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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The United States offers the most comprehensive medical care, but is often complicated as well as very expensive. For a visitor to the United
States or a recent immigrant, finding an insurance program that is easy to understand and reasonably priced is often difficult.
As a solution, Inbound USA was developed to provide a simple program to visitors and immigrants.
This is a brief description of the Inbound USA program. Detailed wording is outlined in the Program Summary, which will be mailed to you once you
have enrolled in Inbound USA.
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ELIGIBILITY
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This program is available to non-United States citizens who come to the U.S. for business, pleasure, to study, or to immigrate. The program must
become effective within 12 months of arrival in the United States.
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PERIOD OF COVERAGE
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You may initially enroll in Inbound USA for as little as 5 days and up to maximum of 12 months. If you initially purchase at least 3 months, you may
continue to renew coverage for a minimum of 3 months at a time, at the premium rate in force at the time of renewal. Total period of coverage for
Inbound USA cannot exceed 12 months (in order to reapply after the 12 months, you must first return to your home country).
Effective date - Your coverage will begin on the latest of the following:
1. Your departure from your Home Country; or
2. The date your Application and premium are received by Seven Corners; or
3. The date your Application and premium are accepted by Seven Corners; or
4. The date you request on the Application.
Expiration date - Your coverage will end on the earlier of the following:
1. The date shown on the Insurance Confirmation Card, for which premium has been paid; or
2. The date you return to your Home Country; or
3. 12 months after your original Effective Date; or
4. The day an insured becomes a U.S. citizen or is considered a U.S. resident by the state where they are residing; or
5. The date of entry into active military service.
Upon each renewal, the rates, benefits, and program in general are subject to change.
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If Inbound USA is initially purchased for at least three months, one month before the expiration date, Seven Corners will send a renewal notice to
the Address of Correspondence listed on the application. If you renew the coverage for 3 or more months (up to 12 months in total), Seven
Corners will continue to send renewal notices to you. If you initially apply online, you will have the option to renew in whatever increment you
choose (Minimum 5 day purchase). There is a $5 administration fee each time you renew. If you renew the coverage for only 1 or 2 months, Seven
Corners will assume that you no longer require the coverage and will not send another renewal notice. Again, the total period of coverage for
Inbound USA cannot exceed 12 months. Renew Online
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InBound USA now offers the following benefit: Should the Insured Person suffer a Myocardial Infarction or Stroke during the Period of Coverage
and it is determined to be a “Pre-Existing Condition,” coverage for those expenses will be covered up to the Pre-Existing Condition Benefit
maximum, according to the Schedule of Benefits.
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Optional PRE-EXISTING CONDITIONS
(the above maximum schedule still applies)
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Age below 70: Up to $5,000 in
coverage for Myocardial Infarction (heart
attack) or Stroke
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Age 70 or above: Up to $3,000 in
coverage for Myocardial Infarction (heart
attack) or Stroke
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If your covered Injury or Sickness requires treatment by a physician, this program will provide benefits up to the Scheduled amount, as listed in
the Schedule of Benefits which exceed the chosen Per Person Deductible ($0, $50 or $100, and a $100 or $200 deductible for age seventy (70)
and over) for each Injury and each Sickness and which are incurred within the twenty-six (26) weeks following the Injury or Sickness. Payment for
any covered service will not exceed the Benefit Maximum shown. The maximum amount payable for all benefits will be no more than $50,000,
$75,000, $100,000, or $130,000 for each Injury and each Sickness.
For persons age seventy (70) and over, the maximum benefit limit is $50,000 or $70,000 for each Injury or Sickness. The period in which covered
expenses must be incurred is twenty-six (26) weeks following the Injury or Sickness, and a separate schedule applies.
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Age 14 days to Age 69 years old
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Plan A
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Plan B
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Plan C
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Plan D
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INPATIENT
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$50,000 Max
per Injury/Sickness
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$75,000 Max
Per Injury/Sickness
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$100,000 Max
per Injury/Sickness
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$130,000 Max
per Injury/Sickness
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Hospital Room & Board including
miscellaneous
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Up to $1400/day,
30 day max
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Up to $1675/day,
30 day max
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Up to $1950/day,
30 day max
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Up to $2535/day,
30 day max
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Hospital Intensive Care Unit
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Additional $660/day,
8 day max
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Additional $755/day,
8 day max
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Additional $850/day,
8 day max
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Additional $1105/day,
8 day max
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Surgical Treatment
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Up to $3300
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Up to $4400
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Up to $5500
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Up to $7150
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Anesthetist
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Up to $825
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Up to $1100
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Up to $1375
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Up to $1775
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Assistant Surgeon
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Up to $825
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Up to $1100
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Up to $1375
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Up to $1775
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Physician’s Non-Surgical Visits
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Up to $55/visit,
1/day, 30 visits max
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Up to $70/visit,
1/day, 30 visits max
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Up to $85/visit,
1/day, 30 visits max
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Up to $110/visit,
1/day, 30 visits max
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A Consulting Physician, when
requested by attending Physician
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Up to $450
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Up to $475
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Up to $500
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Up to $650
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Private Duty Nurse
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Up to $550
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Up to $550
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Up to $550
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Up to $700
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Pre-Admission Tests w/in 7 days
before Hospital admission
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Up to $1100
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Up to $1100
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Up to $1100
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Up to $1450
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OUTPATIENT
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Surgical Treatment
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Up to $3300
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Up to $4400
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Up to $5500
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Up to $7150
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Anesthetist
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Up to $825
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Up to $1100
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Up to $1375
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Up to $1775
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Assistant Surgeon
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Up to $825
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Up to $1100
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Up to $1375
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Up to $1775
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Physician’s Non-Surgical / Urgent
Care Visits
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Up to $55/visit, 1/day, 10
visits max
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Up to $70/visit, 1/day, 10
visits max
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Up to $85/visit, 1/day,
10 visits max
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Up to $110/visit, 1/day,
10 visits max
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Diagnostic X-rays & Lab Services
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Up to $450 - Additional
$250 - One Cat scan, PET
scan or MRI
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Up to $475 – additional
$375 - One Cat scan, PET
scan or MRI
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Up to $500 - Additional
$500 - One Cat scan,
PET scan or MRI
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Up to $650 - Additional
$600 - One Cat scan, PET
scan or MRI
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Hospital Emergency Room (all
expenses incurred therein)
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Up to $330
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Up to $440
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Up to $550
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Up to $700
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Prescription Drugs
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Up to $100
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Up to $125
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Up to $150
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Up to $200
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Outpatient Surgical Facility
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Up to $1000
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Up to $1050
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Up to $1100
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Up to $1400
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OTHER TREATMENT AND
SERVICES
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Ambulance Services
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Up to $450
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Up to $450
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Up to $450
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Up to $450
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Initial Orthopedic Prosthesis/brace
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Up to $1100
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Up to $1200
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Up to $1300
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Up to $1700
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Chemotherapy and/or radiation
therapy
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Up to $1100
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Up to $1225
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Up to $1350
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Up to $1750
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Dental Treatment for Injury to
Sound, Natural Teeth
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Up to $550
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Up to $550
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Up to $550
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Up to $550
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Mental & Nervous Disorder &
Substance Abuse
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Same as any Sickness
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Same as any Sickness
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Same as any Sickness
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Same as any Sickness
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Physiotherapy
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Up to $40/visit,
1/day, 12 visits max
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Up to $40/visit,
1/day, 12 visits max
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Up to $40/visit,
1/day, 12 visits max
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Up to $40/visit,
1/day, 12 visits max
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Emergency Evacuation
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$50,000
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$50,000
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$50,000
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$50,000
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Repatriation of Remains
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$7,500
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$7,500
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$7,500
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$7,500
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AD&D Principal Sum
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$25,000 Common Carrier
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$25,000 Common Carrier
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$25,000 Common Carrier
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$25,000 Common Carrier
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OPTIONAL PRE-EX BENEFIT
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PRE-EXISTING CONDITIONS
(the above maximum schedule still
applies)
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Up to $5,000 in coverage
for Myocardial Infarction
(heart attack) or Stroke
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Up to $5,000 in coverage
for Myocardial Infarction
(heart attack) or Stroke
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Up to $5,000 in coverage
for Myocardial Infarction
(heart attack) or Stroke
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Up to $5,000 in coverage
for Myocardial Infarction
(heart attack) or Stroke
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If an insured person turn 70 years old during the purchased coverage period, the 70 and over benefit schedule becomes effective upon the day
the insured turns 70. Individuals with the $100,000 or $130,000 per injury or sickness policy maximum will receive the $70,000 per injury or
sickness schedule for age 70 and older. Individuals with the $75,000 or $50,000 per injury or sickness policy maximum will receive the $50,000 per
injury or sickness schedule for age 70 and older.
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Age 70 to Age 99 years old
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Plan J
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Plan K
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INPATIENT
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$50,000 Max
per Injury/Sickness
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$70,000 Max
Per Injury/Sickness
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Hospital Room & Board including miscellaneous
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Up to $1050/day, 30 day max
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Up to $1470/day, 30 day max
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Hospital Intensive Care Unit
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Additional $460/day, 8 day max
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Additional $640/day, 8 day max
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Surgical Treatment
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Up to $2750
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Up to $3850
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Anesthetist
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Up to $685
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Up to $960
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Assistant Surgeon
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Up to $685
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Up to $960
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Physician’s Non-Surgical Visits
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Up to $55/visit, 1/day, 30 visits max
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Up to $75/visit, 1/day, 30 visits max
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A Consulting Physician, when requested by
attending Physician
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Up to $400
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Up to $560
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Private Duty Nurse
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Up to $450
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Up to $450
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Pre-Admission Tests w/in 7 days before Hospital
admission
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Up to $775
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Up to $775
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OUTPATIENT
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Surgical Treatment
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Up to $2750
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Up to $3850
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Anesthetist
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Up to $685
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Up to $960
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Assistant Surgeon
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Up to $685
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Up to $960
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Physician’s Non-Surgical / Urgent Care Visits
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Up to $55/visit, 1/day, 10 visits max
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Up to $75/visit, 1/day, 10 visits max
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Diagnostic X-rays & Lab Services
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Up to $400 - Additional $250 - One
Cat scan, PET scan or MRI
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Up to $560 – additional $300 - One
Cat scan, PET scan or MRI
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Hospital Emergency Room (all expenses incurred
therein)
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Up to $250
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Up to $350
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Prescription Drugs
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Up to $80
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Up to $110
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Outpatient Surgical Facility
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Up to $850
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Up to $1190
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OTHER TREATMENT AND SERVICES
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Ambulance Services
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Up to $450
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Up to $450
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Initial Orthopedic Prosthesis/brace
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Up to $850
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Up to $1190
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Chemotherapy and/or radiation therapy
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Up to $850
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Up to $1190
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Dental Treatment for Injury to Sound, Natural Teeth
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Up to $550
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Up to $550
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Mental & Nervous Disorder & Substance Abuse
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Same as any Sickness
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Same as any Sickness
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Physiotherapy
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Up to $40/visit,
1/day, 12 visits max
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Up to $40/visit,
1/day, 12 visits max
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Emergency Evacuation
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$50,000
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$50,000
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Repatriation of Remains
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$7,500
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$7,500
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AD&D Principal Sum
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$25,000 Common Carrier
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$25,000 Common Carrier
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OPTIONAL PRE-EX BENEFIT
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PRE-EXISTING CONDITIONS
(the above maximum schedule still applies)
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Up to $3,000 in coverage for
Myocardial Infarction (heart attack)
or Stroke
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Up to $3,000 in coverage for
Myocardial Infarction (heart attack)
or Stroke
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Emergency Medical Evacuation Expenses
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The program will pay up to $50,000 in Covered Expenses incurred if any covered Injury or Sickness originating during the Period of Coverage
results in the Medically Necessary Emergency Medical Evacuation or Repatriation of the Insured Person (the Insured Person’s medical condition
warrants immediate transportation from the medical facility where the Insured Person is located to the nearest adequate medical facility where
medical treatment can be obtained). The benefit must be ordered by the Assistance Company in consultation with the Insured Person’s local
attending Physician. *
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Repatriation of Mortal Remains Expenses
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The program will pay the reasonable Covered Expenses incurred, up to a maximum of $7,500, to return the Insured Person’s remains to his/her
Home Country if he or she dies.*
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Common Carrier Accidental Death and Dismemberment (AD&D)
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Accidental Death and Dismemberment shall apply to covered accidents sustained by an insured person while riding as a passenger in or on any
land, water or air conveyance operated under a license for the transportation of passengers for hire. A loss must occur within 365 days after the
date of accident causing the loss:
* NOTE: If event of an Emergency Medical Evacuation or Repatriation of Mortal Remains benefit is needed or utilized, arrangements must be made
by the Assistance Service Provider.
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Both Hands or Both Feet or Sight of Both Eyes
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Either Hand or Foot and Sight of One Eye
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One-Half the Principal Sum
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One-Half the Principal Sum
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DEFINITIONS
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hospital shall mean a place that 1.) Is legally operated for the purpose of providing medical care and Treatment to Sick or Injured persons for
which a charge is made that the Insured Person is legally obligated to pay in the absence of insurance 2.) Provides such care and Treatment in
medical, diagnostic, or surgical facilities on its premises, or those prearranged for its use; 3.) Provides 24-hour nursing service under the
supervision of a Registered Nurse at all times; and 4.) Operates under the supervision of a staff of one or more Physicians. Hospital also means a
place that is accredited as a Hospital by the Joint Commission on Accreditation of Hospitals, American Osteopathic Association, or the Joint
Commission on Accreditation of Heath Care Organizations (JCAHO). Hospital does not mean: A Convalescent, nursing, or rest home or facility, or a
home for the aged; A place mainly providing Custodial, Educational, or Rehabilitative Care; or A facility mainly used for the Treatment of drug
addicts or alcoholics.
injury shall mean bodily Injury listed in the most recent edition of the International Classification of Diseases and caused solely and directly by
Accidental, external, and visible means occurring while this Certificate is in force and resulting directly and independently of all other causes
resulting in a Covered Event under this Program.
inpatient shall mean a person who is confined in an institution for a period of 24 hours or more and is charged for room and board.
myocardial infarction shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International
Coding of Diseases version 9 (ICD9).
outpatient shall mean a person who receives care in a Hospital or another institution, including, an ambulatory surgical center; a
convalescent/skilled nursing facility or a Physician’s office, for an Illness or Injury, but who is not confined and is not charged for room and board.
pre-existing condition shall mean: 1.) A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment within
the six (6 )months (or twelve (12) months for persons seventy (70) and older) prior to the Individual Effective Date of Coverage under this
program; 2.) A condition for which medical advice, diagnosis, care or Treatment, including Medication, was sought, recommended or received within
the six (6) months (or twelve (12) months for persons age seventy (70) and older) prior to the Individual Effective Date of Coverage under this
program; 3.) The symptoms which occurred within the six (6) months (or twelve (12) months for persons seventy (70) and older) prior to the
Individual Effective Date of the Coverage under this Certificate would have allowed a person trained in medicine to make a diagnosis of the
condition producing the symptom; 4.) A condition which manifested itself within the 6 months (or twelve (12) months for persons seventy (70) and
older) prior to the Individual Effective Date of Coverage under this Certificate; Should the Insured Person suffer a Myocardial Infarction or Stroke
during the Period of Coverage and it is determined to be a “Pre-Existing Condition,” coverage for those expenses will be covered up to the Pre-
Existing Condition Benefit maximum, according to the Schedule of Benefits. (Optional Coverage must be selected on the application, and
appropriate premium received.)
sickness shall mean Illness or Disease of any kind listed in the most recent edition of the International Classification of Diseases. All related
conditions and recurrent symptoms of the same or a similar condition will be considered one Sickness.
stroke shall mean an acute and emergent onset of any of the conditions and/or diseases described and coded in the International Coding of
Diseases version 9 (ICD9).
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No benefits will be paid for loss or expense caused by, contributed to, or resulting from:
1. Pre-existing Conditions as defined;
2. Any expenses incurred when travel was undertaken solely for the purpose of obtaining medical treatment or while traveling against the advice
of a Physician;
3. Expense incurred within the Insured Person’s Home Country or country of regular domicile;
4. Routine physicals, inoculations, or other examinations where there are no objective indications of impairment of normal health, or well baby
care, new-born baby care; well-baby nursery and related Physician charges;
5. Prescriptions or fitting of eyeglasses and contact lenses; eye examinations; or other treatment for visual defects and problems. “Visual defects:
means any physical defect of the eye which does or can impair normal vision;
6. Hearing examinations or hearing aids; or other treatment for hearing defects and problems. “Hearing defects: means any physical defect of the
ear which does or can impair normal hearing:
7. Dental treatment, except as the result of injury to sound, natural teeth;
8. Services or supplies performed or provided by a Member of the Insured Person’s family, or anyone who lives with the Insured Person;
9. Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician;
10. Weak, strained or flat feet, corns, calluses, or toenails;
11. Cosmetic surgery, or treatment for congenital anomalies (except as specifically provided), except reconstructive surgery as the result of a
covered Injury or Sickness. Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or covered
Sickness;
12. Elective Surgery and Elective Treatment;
13. Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth;
14. Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics;
15. Organ transplants;
16. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in
connection with war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war; terrorist
activity; nuclear, chemical, biological; (details in program summary)
17. Participation in a riot or civil disorder, commission of or attempt to commit a felony in the country in which it was attempted or committed;
18. Suicide or attempted suicide (including drug overdose), while sane or insane (while sane in Missouri), or an intentionally self-inflected Injury;
19. Expenses of an institution, health service, or infirmary for whose service payment is not required in the absence of insurance;
20. Treatment of nervous or mental disorders, except as stated in the Schedule of Benefits, or treatment of alcoholism or drug abuse, except as
provided for treatment of mental or nervous disorders, according to the Schedule of Benefits;
21. Loss incurred from riding in any aircraft, other than as a passenger in an aircraft licensed for the transportation of passengers;
22. Treatment services, supplies or facilities in a hospital owned or operated by: a) The Veteran’s Administration; or b) A national government or
any of its agencies. (This exclusion does not apply to treatment when a charge is made which the Insured is required by law to pay);
23. Duplicate services actually provided by both a certified nurse-midwife and Physician;
24. Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
25. Expenses incurred for outpatient treatment in connection with the detection or correction by manual or mechanical means of structural
imbalance, distortion or sublimation in the human body for purposes of removing nerve interference and the effects thereof, where such
interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column;
26. Injury sustained while taking part in mountaineering where ropes or guides are normally used, hang gliding, parachuting, bungee jumping,
racing by horse or motor vehicle or motorcycle, motorcycle/motor scooter riding, scuba diving involving underwater breathing apparatus (unless
PADI or NAUI certified), water skiing, snow skiing, snow boarding and snowmobiling;
27. Treatment paid for or furnished under any other individual, government, or group policy; previous policy; payable under any Worker’s
Compensation or Occupational Disease Law or Act; or charges provided at no cost to the Insured Person;
28. Expense incurred after the Expiration Date for an Insured Person except as may be specifically provided;
29. Expenses for treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent or for Injury or Sickness due
wholly or partly to the effects of intoxicating liquor or drugs, unless prescribed by a Physician;
30. Sexually transmitted diseases, including AIDS.
31. Pregnancy expenses or Sickness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from Injury; or voluntary or
elective abortion;
32. Treatment while confined primarily to receive custodial care, educational or rehabilitative care and nursing services in a long term facility, spa,
hydroclinic, weight loss clinic, sanatorium, nursing home or similar facilities;
33. Expenses for Speech therapy, Occupational therapy or Vocational Rehabilitation.
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ENROLLING IN INBOUND USA
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- Complete entire application
- Select method of payment.
- If paying by check or money order, make payable to: "Seven Corners" and enclose it together with completed Application.
- If paying by credit card, complete Application and mail or fax to us. Be sure to sign Method of Payment section.
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Complete and return the Application with your payment for the total premium to:
Contact Us
(You may fax if paying by credit card only. Originals are not required if applications is faxed to us with credit card payment)
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Monthly Rates Effective April 1, 2009
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$0 Per Injury / Sickness Deductible Per Person
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Age 14 days to Age 69 years old
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Plan A
$50,000 Maximum
Monthly Rate / Daily Rate
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Plan B
$75,000 Maximum
Monthly Rate / Daily Rate
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Plan C
$100,000 Maximum
Monthly Rate / Daily Rate
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Plan D
$130,000 Maximum
Monthly Rate / Daily Rate
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Dependent Child (Age 2 weeks - 18)*
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* Dependent Child rate is applicable when at least one parent will also be covered under Inbound USA.
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$50 Per Injury / Sickness Deductible Per Person
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Age 14 days to Age 69 years old
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Plan A
$50,000 Maximum
Monthly Rate / Daily Rate
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Plan B
$75,000 Maximum
Monthly Rate / Daily Rate
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Plan C
$100,000 Maximum
Monthly Rate / Daily Rate
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Plan D
$130,000 Maximum
Monthly Rate / Daily Rate
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Dependent Child (Age 2 weeks - 18)*
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* Dependent Child rate is applicable when at least one parent will also be covered under Inbound USA.
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$100 Per Injury / Sickness Deductible Per Person
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Age 14 days to Age 69 years old
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Plan A
$50,000 Maximum
Monthly Rate / Daily Rate
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Plan B
$75,000 Maximum
Monthly Rate / Daily Rate
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Plan C
$100,000 Maximum
Monthly Rate / Daily Rate
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Plan D
$130,000 Maximum
Monthly Rate / Daily Rate
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Dependent Child (Age 2 weeks - 18)*
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* Dependent Child rate is applicable when at least one parent will also be covered under Inbound USA.
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$100 Per Injury / Sickness Deductible Per Person
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$200 Per Injury / Sickness Deductible Per Person
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Plan J
$50,000 Maximum
Monthly Rate / Daily Rate
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Plan K
$70,000 Maximum
Monthly Rate / Daily Rate
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Plan J
$50,000 Maximum
Monthly Rate / Daily Rate
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Plan K
$70,000 Maximum
Monthly Rate / Daily Rate
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Please be aware that this is not a general health insurance policy, but an interim program intended for temporary use. Inbound USA does not
guarantee payment to a facility or individual for medical expenses until the Company determines that it is an eligible expense.
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What You Will Receive
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Upon successful enrollment in Inbound USA, you will receive an information packet from Seven Corners. This packet will include
your ID Card and Program Summary. The Program Summary describes all the benefits of Inbound USA in complete detail. In addition,
the Program Summary explains the procedure for submitting claims.
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Refund of premium shall be considered only if written request is received by Seven Corners prior to the Effective Date of Coverage. After the
Effective Date of Coverage, the premium is considered fully earned and non-refundable.
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The Insurance Company
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Inbound USA is underwritten by Certain Underwriters at Lloyd’s, London and is rated A “Excellent” by A.M. Best. In addition to being one of the
largest insurance entities in the world, Lloyd’s has over 300 years of experience in the international insurance business.
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