Liaison Majestic
2007
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Purchase this Plan Online
Brochure & Paper Application
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medical insurance that covers you outside your home country
5 days to 12 months* of coverage for:
• non-citizens visiting the united states
• united states citizens traveling overseas
*renewable up to 3 years
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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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All coverages and plan costs listed in this brochure are in U.S. Dollar amounts.
medical maximum: $60,000; $125,000; $600,000; $1,000,000 (ages 80+, maximum limited to $20,000)
deductible: $0; $100; $250; $500; $1000; $2500 Deductible is per person per Policy Period, maximum of 3 Policy Period deductibles per family.
The selected Deductible and Coinsurance amount must be met for each 12-month Policy Period (see Continuing Coverage)
coinsurance: inside the united states: After you pay the deductible, the program pays 90% of the next $5,000 of eligible expenses, then 100% to
the selected Medical Maximum.
outside the united states and canada: After you pay the deductible, the program pays 100% to the selected Medical Maximum.
hospital indemnity: $150 / night (traveling outside the U.S. and Canada) In addition to any other Covered Expense.
dental (emergency): $100 ($500 for accidents) Only available to programs purchased for one (1) month or more.
emergency medical evacuation/ repatriation: $300,000 (in addition to the Medical Maximum)
home country coverage:
incidental trips to the home country: $50,000
follow me home coverage: $5,000
return of mortal remains: $50,000
political evacuation and repatriation: $50,000
emergency reunion: $50,000
return of minor child(ren): $50,000
interruption of trip: $5,000
loss of checked luggage: $250
local ambulance expense: $5,000
accidental death & dismemberment (ad&d): $50,000 Principal Sum for Insured or Insured Spouse, $5,000 for Dependent Child(ren).
common carrier accidental death: $100,000 per adult, $25,000 per child(ren) under age of 18; $250,000 Maximum per family
coma benefit: $50,000
felonious assault benefit: $10,000
hospital room & board: Usual, reasonable and customary to the selected Medical Maximum
intensive care: Usual, reasonable and customary to the selected Medical Maximum
outpatient medical expenses: Usual, reasonable and customary to the selected Medical Maximum
terrorism: Usual, reasonable and customary to the selected Medical Maximum
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Up to $20,000 for U.S. citizens traveling outside the United States (refer to exclusion #1 for details)
For foreign nationals visiting the United States, up to $200 per day for each night spent in the hospital after being admitted for either a heart
attack or stroke. Max. Benefit of $3,000 (refer to exclusion #1 for details)
benefit period: Six months
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value
Seven Corners utilizes widely recognized and reputable insurance organizations to underwrite our programs. We realize that the value of an
insurance program is in the professionalism of the underlying organization. Seven Corners continually invests in its people, systems, and solutions
in order to make the insurance buying experience a favorable one for our clientele.
convenience
Our program brochures and documentation offer a detailed description of the product and underlying coverage.
doctors & hospitals worldwide
Seven Corners has access to over 12,000 doctors and hospitals worldwide. With one phone call, we can assist you in locating a provider. Seven
Corners’ Assist is trained to help you locate appropriate care.
why worldwide medical insurance?
Each year, millions of people travel beyond the boundaries of their medical insurance. If you are concerned with the potential out-of-pocket
expenses that could result from an Injury or Illness while traveling, Liaison® Majestic offers medical coverage and emergency services to
individuals and families traveling outside their Home Country. This brochure is a brief description of Liaison® Majestic. Once you have purchased
the program a complete Program Summary will be e-mailed to you.
eligibility
Liaison® Majestic provides coverage, as outlined in this brochure, for individuals and families (including unmarried dependent child(ren) over 14 days
and under 19 years of age) while traveling outside of their Home Country.
Home Country is defined as - The country where a covered person(s) has his/her true, fixed and permanent home and principal establishment.
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description of coverage
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period of coverage
The minimum period of coverage under Liaison® Majestic is five (5) days, maximum is twelve (12) months (see Continuing Coverage section). If
you are traveling for a long period of time, please refer to “Continuing Coverage” section.
effective date
Your coverage will begin on the latest of the following: 1) The moment you depart your Home Country; or 2) The date and time the Application and
full plan cost is received and accepted by Seven Corners; or 3) The date requested on the Application.
expiration date
Coverage will end on the earlier of the following: 1) Your return to your Home Country (except as provided under the Home Country Coverage); or 2)
The date shown on the ID Card, for which plan cost has been paid; 3) The date you are no longer eligible under this plan.
medical
When you incur a covered Injury or Illness, the program will pay Usual, Reasonable and Customary medical charges for Covered Expenses, excess
of the chosen Deductible and Coinsurance, up to the selected Medical Maximum. Only such expenses, incurred as the result of an Injury or Illness,
which are specifically enumerated in the following list of charges, are incurred within six (6) months from the onset of an Injury or Illness, and
which are not excluded in the Exclusions, shall be considered as Covered Expenses:
1. Charges made by a Hospital for room and board, floor nursing and other services inclusive of charges for professional service (with the
exception of personal services of a non-medical nature); charges made for an operating room.
2. Charges made for Intensive Care or Coronary Care charges and nursing services.
3. Charges made for diagnosis, treatment and Surgery by a Physician; charges made for the cost and administration of anesthetics.
4. Charges made for Outpatient treatment, same as any other treatment covered on an Inpatient basis. This includes ambulatory Surgical centers,
Physicians’ Outpatient visits/examinations, clinic care, and Surgical opinion consultations.
5. Charges for medication, x-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions,
iron lungs, and medical treatment; dressings, drugs, and medicines that can only be obtained upon a written prescription of a Physician or
Surgeon.
6. Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed
physiotherapist.
7. Ground ambulance (within the metropolitan area) to and from the nearest Hospital with facilities for required treatment. If the covered person is
in a rural area and unreachable by ground ambulance, then licensed air ambulance transportation to the nearest metropolitan area shall be
considered a Covered Expense.
8. Hotel room charge, when the Covered person, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician
in a hotel room due to unavailability of a Hospital room by reason of capacity or distance or any other circumstances beyond control of the Covered
person.
9. Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.
dental - emergency only
The Emergency Dental Benefit is available to you provided you have purchased one (1) or more months of coverage. Treatment necessary to
resolve acute, spontaneous and unexpected inception of pain to sound natural teeth ($100) or Dental treatment necessary to restore or replace
sound natural teeth lost or damaged in an Accident which is covered under the program ($500). This benefit is subject to the Deductible and
Coinsurance.
emergency medical evacuation/repatriation
The program will pay Covered Expenses incurred if any covered Injury or Illness commences during the Period of Coverage that results in a
Medically Necessary Emergency Medical Evacuation or Repatriation (your medical condition warrants immediate transportation from the medical facility
where you are located to the nearest adequate medical facility where medical treatment can be obtained). This benefit must be arranged by the
Assistance Company in consultation with the local attending Physician.*
return of mortal remains
The Program will pay the reasonable Covered Expenses incurred up to a maximum of $50,000 to return your remains to your Home Country, if you
should die.*
political evacuation and repatriation
If due to political or military events in a host country, a formal recommendation from the appropriate authorities is issued for you to leave the host
country, or you are expelled or declared persona non-grata by the host country, all reasonable expenses incurred for transportation to the
nearest place of safety or for repatriation to your Home Country is covered up to a maximum of $50,000. Evacuation must occur within 10 days of
any such event. Coverage will apply to the most appropriate and economical means consistent, under the circumstances, with your health and
safety. Evacuation costs will be paid once per insured per occurrence.*
emergency medical reunion
When Emergency Medical Evacuation or Repatriation is arranged and the attending Physician recommends that a family member travel with you,
the program will arrange and pay, up to $50,000, for round-trip economy-class transportation for one individual of your choice, from your Home
Country, to be at your side while you are hospitalized and then accompany you during your return to your Home Country.
return of minor child(ren)
If you are traveling alone with a Minor Child(ren) and are hospitalized because of a covered Illness or Injury and the Minor Child(ren), under age
19, is left unattended, the program will arrange and pay up to $50,000 for one-way economy fare to their Home Country (including the cost of an
attendant/escort, if necessary to ensure the safety and welfare of a Minor Child(ren)).*
hospital indemnity
If you are hospitalized while traveling outside of the United States or Canada, and the hospitalization is considered a Covered Expense, the
program will indemnify you $150 for each night spent in the hospital (this benefit is in addition to any other covered expenses of the program).
interruption of trip
If you are unable to continue the Trip due to the death of an Immediate Family member (parent, spouse, sibling or child) or due to serious damage
to your principal residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane, etc.), the program will reimburse you (up to
$5,000) for the cost of economy travel, less the value of applied credit from an unused return travel ticket, to return you home to your area of
principal residence*
loss of checked luggage
If your checked luggage is permanently lost by the airline, the program will reimburse you for the replacement of clothing and personal hygiene
items lost to a maximum per bag limit of $50 (up to $250). This benefit is secondary to any other (including airline) coverage available. You must
furnish proof to the Company that full reimbursement has been obtained from the airline.
felonious assault benefit
If you are Injured as a result of a Felonious Assault while traveling outside of your Home Country, the program will pay $10,000. This benefit is in
addition to any other benefit available under this program. Refer to the Program summary for full description and conditions.
coma benefit
If a covered Injury renders you Comatose within 90 days of the date of the accident that caused the Injury, and if the Coma continues for a period
of 30 consecutive days, the program will pay a monthly benefit equal to 1% of $50,000. No benefit is provided for the first 30 days of the Coma.
The benefit is payable monthly as long as you remain Comatose due to that Injury, but ceases on the earliest of: (1) the date you cease to be
Comatose due to that Injury; (2) the date the Insured dies; or (3) the date the total amount of monthly Coma benefits paid for all Injuries caused
by the same accident equals the maximum amount. This benefit is in addition to any other benefit available under this program. See Program
Summary for full description and conditions.
assistance services
Upon enrollment into Liaison® Majestic, you are eligible to use any of the assistance services provided by the Assistance Services Provider.
Additional information is contained in the Program Summary.
• Open 24 hours / day, 365 days a year
• Multilingual personnel
• Physicians / nurses on staff
• Locate local facilities
• Help with emergency situations
home country coverage
Incidental Trips to Your Home Country: This benefit covers you for incidental trips to your Home Country (60 days per 12 months of purchased
coverage or pro rata thereof - example: approximately 5 days per month of purchased coverage). Maximum benefit is reduced to $50,000 for any
Illness or Injury occurring while on an incidental trip to your Home Country.
Follow Me Home Coverage: This plan shall pay for Covered Expenses incurred in your Home Country up to $5,000 for conditions that are first
diagnosed and treated outside Your Home Country (Does not apply for Emergency Medical Evacuation or Repatriation).
*NOTE: In the event of Emergency Medical Evacuation, Repatriation, Return of Mortal Remains, Emergency Reunion, Return of Minor Child(ren) or
Interruption of Trip benefit is needed or utilized, all arrangements must be made by the Assistance Service Provider. Complete details about the benefits
and about the required notification of the Assistance Service Provider are contained in the Program Summary.
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options
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continuing coverage
For those who are intending longer international trips, an option is available to you. Seven Corners will email you a renewal notice prior to your
program’s expiration date.
While a new period of coverage will be issued, your original effective date will be used with regards to calculating your deductible and coinsurance
(for up to a total of twelve (12) months, then both will begin again), as well as determining any Pre-existing Conditions.
hazardous sport coverage
To cover motorcycle/motor scooter riding, hang gliding, parachuting, bungee jumping, water skiing, snow skiing, snowmobiling, and snow boarding.
Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute.
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For those who are intending longer international trips, an option is available to you. Seven Corners will email you a renewal notice prior to your
program’s expiration date.
While a new period of coverage will be issued, your original effective date will be used with regards to calculating your deductible and coinsurance
(for up to a total of twelve (12) months, then both will begin again), as well as determining any Pre-existing Conditions.
The maximum period of time Seven Corners will offer this feature is three years (one year for persons age 65 and over). It is important to note
that rates and benefits may change for each subsequent period of coverage. A $5.00 Administrative Fee will be included on each notice. This
option is not available if you allow coverage to expire prior to reapplying. If this happens, an entirely new program must be purchased (Pre-
existing Condition begins again). You may also renew your coverage online
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pre-notification / referral
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In order to ensure your claims are addressed as efficiently as possible,you or the provider of service must contact the Assistance Company for
Pre-notification prior to any medical treatment in the US, as well as hospital admissions and inpatient / outpatient surgeries incurred worldwide.
The Assistance Company has trained personnel available twenty-four (24) hours a day, seven (7) days a week throughout the year to answer
your questions, provide assistance, and guide you to an appropriate facility. In the case of an Emergency Admission, the Assistance Company
must be contacted within forty-eight (48) hours, or as soon as reasonably possible. Pre-notification does not guarantee that benefits will be paid.
Failure to pre-notify will result in a 20% reduction in Eligible Benefits.
Please be aware that this is not a general health insurance policy, but an interim, limited benefit period, travel medical program intended for
use while away from your Home Country. Liaison® Majestic does not guarantee payment to a facility or individual for medical expenses
until Seven Corners determines that it is an eligible expense.
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Seven Corners realizes that there is uncertainty in international travel. Refund of total plan cost will only be considered if written request is
received by Seven Corners prior to the Effective Date of Coverage. If written request is received after the Effective Date of coverage, the unused
portion of the plan cost may be refunded minus a cancellation fee, provided no claim has been submitted to Seven Corners for reimbursement.
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claim submission
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Filing a claim with Seven Corners is easy. You will receive a Liaison® Majestic identification card and claim form via e-mail after your application has
been processed. When you receive treatment, send the original, itemized bills to Seven Corners within ninety (90) days. Eligible bills are
automatically converted from local currencies to U.S. dollars. For payments of eligible medical expenses, notify Seven Corners of pending
treatments and we can refer you to approved healthcare providers worldwide. You’re only responsible for your deductible, coinsurance and non-
eligible expenses. For more details, consult the Program Summary that is provided via e-mail, or contact the Seven Corners Claim Department.
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For Medical benefits, this Insurance does not cover:
1. Any Injury or Illness which meets the following criteria: a) condition(s) that would have caused a person to seek medical advice, diagnosis, care
or treatment during the thirty-six (36) months prior to the Effective Date of coverage under this Policy; b) condition(s) for which manifestation,
medical advice, diagnosis, care or treatment was recommended, received, or noticed during the thirtysix (36) months prior to the Effective Date of
coverage under this Policy;
If you are traveling outside the United States and Canada, the period is twelve (12) months instead of thirty-six (36) months.
If you are a United States citizen and the United States is your Home Country, this exclusion is waived for the first $20,000 in eligible medical
expenses incurred outside the United States and Canada (for persons age 65 and over, the amount is $2,500). This waiver does not include
coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this
program.
If you are a non-United States citizen visiting the United States and suffer a Myocardial Infarction or Stroke and are admitted to a Hospital, this
exclusion is waived in order to pay a $200 per night benefit for each night spent in the Hospital, up to a maximum benefit of $3,000. The term
“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), code sequences 410.0 – 410.9 and 414.1 – 419.9. The term “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), code sequence 430-
438.9. This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or
necessary prior to the effective date of this program.
2. Charges for treatment which exceed Reasonable and Customary charges; or charges incurred for Surgeries or treatments which are
Investigational, Experimental, or for research purposes; expenses which are non-medical in nature; expenses for Vocational, Speech, Recreational
or Music Therapy.
3. Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician.
4. Suicide or any attempt thereof, while sane, or self destruction or any attempt thereof, while insane; intentionally self-inflicted Injury or Illness;
or expenses as a result of, or in connection with, the commission of a felony offense.
5. 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.
6. Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics.
7. Routine physicals, inoculations, or other examinations where there are no objective indications or impairment in normal health.
8. Treatment of the Temporomandibular joint.
9. Services or supplies performed or provided by a Relative of yours, or anyone who lives with you.
10. Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids, cosmetic or plastic Surgery
(including deviated nasal septum), routine dental expenses, eye care or eye-related expenses, unless caused by Accidental bodily Injury incurred
while insured hereunder.
11. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent; any Mental and Nervous disorders or rest
cures; Injury sustained while under the influence of or Disablement due wholly or partly to the effects of intoxicating liquor or drugs.
12. Congenital abnormalities and conditions arising out of or resulting therefrom.
13. Expenses incurred during a hospital emergency room visit which is not of an emergency nature.
14. Injury sustained while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing by horse or motor vehicle or
motorcycle, snowmobiling, motorcycle / motor scooter riding, scuba diving involving underwater breathing apparatus (unless PADI or NAUI certified),
water skiing, snow skiing and snow boarding. (Please see Optional Hazardous Sports Coverage to include some of these sports)
• Mountaineering shall mean the sport, hobby or profession of walking, hiking, and climbing up mountains either: 1) utilizing harnesses, ropes,
crampons or ice axes; or 2) ascending 4500 meters or above.
• Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute.
15. Treatment paid for or furnished under any other individual, government, or group policy or charges provided at no cost to you.
16. Treatment of venereal or sexually transmitted disease.
17. Pregnancy expenses or Illness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from an Accident.
18. Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth.
19. Expenses incurred while you are in your Home Country (except as provided under the Home Country Coverage benefit).
20. Expenses incurred for which travel was undertaken to seek medical treatment for a condition; or incurred after the Covered person’s physician
has limited or restricted travel.
seven corners assist
Seven Corners Assist is a leading provider of customized emergency assistance services to international organizations, corporations, government
entities, insurance companies, and individual travelers. Regardless of the location, Seven Corners Assist provides valuable assistance in locating
the best possible medical treatment.
the insurance company
Liaison® Majestic is underwritten by The Insurance Company of the State of Pennsylvania, a member company of the American International
Group of Companies (AIG) and is rated A+ “Superior” by the A.M. Best Company.
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the program administrator
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Medical care is different throughout the world and providing quality medical attention should be the ultimate goal of any program. Most companies
are not prepared to meet the unique needs of international travelers. An organization must be equipped to address foreign currencies,
international doctors and hospitals, as well as unusual claim forms and documents. Liaison® Majestic is designed and administered by Seven
Corners, Inc. The claim and assistance professionals at Seven Corners collectively have over 250 years of experience in claim processing and
administration.
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seven corners
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Since 1993, Seven Corners, Inc. has alleviated many of the concerns with international travel by providing insurance plans to private citizens,
governments, missionaries, students, and corporations of various nations around the globe. Each year, thousands of insureds purchase coverage
from Seven Corners in order to obtain the most comprehensive and reliable products in the international insurance industry. Our assistance
professionals are experienced in the complexity and importance of receiving medical care internationally. As an insured of Seven Corners, you can
feel confident that there is someone ready to assist you with a medical situation 24 hours a day, 7 days a week, 365 days a year.
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Rates based on a $250 Deductible
Effective March 1, 2011
Traveling to the United States
If the applicant is traveling to, temporarily residing in, or visiting the United States, please use these rates.
Policy Maximum Option
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Traveling Outside the U.S.
If the applicant is traveling outside the United States, use these rates. This includes U.S. citizens traveling overseas as well as persons traveling between
countries i.e., a Brazilian traveling to Spain.
Policy Maximum Option
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* Ages 80+ limited to $20,000.
** Dep. Child rate is applicable when at least one parent will also be covered under Liaison® Majestic. Child Alone rate is used when a child will be insured
by themselves.
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insurance carrier:
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Liaison® Majestic is underwritten by The Insurance Company of the State of Pennsylvania, a member company of Chartis Insurance and is rated A
“Excellent” by the A.M. Best Company
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