VISIT USA HEALTH CARE™
INSURANCE
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Purchase this Plan Online
Paper Application
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Doctor and hospital cost are very expensive in the United States.
If you get sick or injured during your visit...
...how will you pay?
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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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Summary
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Yes, it can happen to you.
Every year, thousands of international visitors to the United States require emergency medical treatment, hospitalization or medical evacuation to
their home country. Most health care facilities in the United States are privately owned and medical care is very expensive. Hospital costs can
average $2,000 per day, and a major illness or injury could cost you as much as $100,000. Medical evacuation to your home country is also costly.
For example, U.S. to Asia can easily cost $90,000. You will also have to pay for your medical care at the time of treatment unless you have health
care insurance coverage acceptable in the United States.
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An inexpensive solution!
VISIT USA-HEALTHCARE™ is designed for foreign nationals while in the United States, and is available for up to 12 months. It provides
excellent illness and accident expense protection at a low cost.
VISIT USA-HEALTHCARE™ will help you find a doctor or hospital and pay for treatment. You pay the deductible and coinsurance.
After you pay the deductible per policy period and 20 percent of the first $5,000 covered medical expenses per incident, the insurance
covers 100 percent of most other health care costs (see Brief Outline of Coverages for details).
With VISIT USA-HEALTHCARE™ insurance, the possibility of a large, unexpected medical expense or even being denied medical attention
can be avoided.
Two Visit USA-HealthCare™ Plans
Depending on your needs, you can choose from two insurance plans to protect you. The plans differ in their benefit limits. Each plan offers a
choice of deductibles.
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This is a descriptive brochure, not a Policy. Upon receipt of your Certificate of Insurance, please read it carefully as it will describe the provisions of
the Master Policy which will prevail. Your benefit limits depend upon your choice of coverage Plan A or Plan B, plus your purchase of the Optional
Benefits.
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Illness and Injury Medical Expense/Incident*
* The Medical Expense Benefit Limit for ages 80+ is $10,000.
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Emergency Medical Evacuation
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Accidental Death & Dismemberment (AD&D)
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Incidental Travel (to Canada, Mexico, U.S. Territories,
maximum 14 days)
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Emergency Travelers Assistance Service
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Additional AD&D
Flight Insurance AD&D Due to Other Accidents
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Hazardous Activity Coverage
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Medical Expense coverage for activities normally excluded from coverage
such as motorcycling, scuba diving, skiing and whitewater rafting.
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Services Provided By...
The insurance benefits in this policy are underwritten by The Insurance Company of the State of Pennsylvania, Philadelphia, PA, NAIC # 012-
19429, a member of the American International Group of Companies (AIG), which is highly rated for financial strength.
The policy is exclusively administered by Travel Insurance Services, Walnut Creek, CA, a provider of travel/health insurance since 1973.
Emergency assistance is provided by AIGAssist, Houston, TX.
Claims are adjusted by AIG Life Insurance Company, Wilmington, DE.
Visit USA-HealthCare™ is a registered trademark of Travel Insurance Services and is also available through certain insurance agents and brokers
throughout the U.S.
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Medical Expense* A: $50,000 / B: $100,000 per incident
No Per Policy Maximum Limit
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If Injury or Illness occurs during the Period of Coverage and you, your insured spouse or dependent children require medical or surgical
treatment, the policy will pay, after you pay the selected deductible per period of coverage, 80 percent of all reasonable and customary charges
per incident for Covered Expenses up to $5000, then 100 percent up to the maximum amount applicable to the insurance plan selected. *The
Medical Expense Benefit Limit is reduced to $10,000 for Insureds who are ages 80+ on the effective date. Covered Expenses
- Charges made by a hospital for room and board, floor nursing and other services, including charges for professional services and with the
exception of personal services of a non-medical nature; provided, however, that expenses do not exceed the hospital’s average charge for
semiprivate room and board accommodation.
- Charges made for diagnosis, treatment and surgery by a physician.
- Charges made for the cost and administration of anesthetics.
- 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.
- Charges for physiotherapy, if recommended by a physician for the treatment of a specific disablement and administered by a licensed
physiotherapist.
- Dressings, drugs and medicines that can only be obtained upon a written prescription of a physician or surgeon. Illness must be contracted
and manifest itself, or Injury must occur, during the Period of Coverage. The first expense must be incurred within 30 days of the
commencement of covered Injury or Illness. Benefit period is 26 weeks. However, all benefits will cease when an insured person arrives in
his home country from the United States, or from Incidental Travel (14 days maximum) to Canada, Mexico, or U.S. territories.
Emergency Medical Evacuation Expense A: $50,000 / B: $100,000
If Injury or Illness commencing during the Period of Coverage requires emergency evacuation to either the nearest medical facility where
appropriate medical treatment can be obtained, or to the Country of Residence, all expenses incurred are covered up to the maximum benefit
selected. An emergency evacuation must be recommended by a legally licensed physician who certifies that the severity of Injury or Illness
necessitates such emergency evacuation and agreed to by you or your representative. Arrangements must be made by AIGAssist.
Accidental Death & Dismemberment (AD&D) A: $50,000 / B: $100,000
If an Injury occurs during your Period of Coverage and results in one of the following losses within 365 days after an accident, the Policy will pay as
follows: Loss of Life - A: $50,000 / B: $100,000; Loss of two Members - A: $50,000 / B: $100,000; Loss of one Member - A: $25,000 / B: $50,000
Regarding this Included coverage, “Member” means hand, foot or eye. Only one amount, the largest to which you are entitled, will be paid for all
losses resulting from one accident.
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Repatriation of Remains Expenses A: $10,000 / B: $20,000
If Injury or Illness commencing during the Period of Coverage results in death, all reasonable expenses incurred for preparation and return of the
remains to the Country of Residence will be paid up to the maximum selected. Arrangements must be made by AIGAssist.
Family Travel Benefit A: $10,000 / B: $10,000
- When covered Emergency Medical Evacuation is necessary and the attending physician considers it beneficial for the Insured Person to
have a family member join him, the company will pay for the family member’s economy fare travel and lodging (maximum $5,000).
- When covered hospitalization of the Insured Person causes accompanying minor child(ren) to be unattended, the Company will pay up to
the one way economy fare (maximum $5,000) less the applied value of the child’s/children’s unused travel tickets to their country of origin.
Emergency Travelers Assistance
- 24-hour verification of medical coverage for hospitals and physicians
- 24-hour medical care location service
- Medical case monitoring, arranging communication between patient, family, physicians, employer, consulate or embassy
- Emergency medical transportation arrangements
- Emergency message service for medical situations
- Multilingual services
- 24-hour contact for legal emergencies
- Legal referral, to help you locate a consular official or attorney
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Flight Only AD&D - $250,000 and AD&D - $100,000
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This optional benefit may be purchased in addition to Basic Plan A or Plan B. If the optional benefit is selected and the premium paid in advance of
the Period of Coverage, the policy will pay, in addition to Basic Plan limits, as follows:
Flight Only AD&D In the event injury is sustained while riding as a fare paying passenger on a scheduled airline: Loss of Life - $250,000;
Loss of two Members - $250,000; Loss of one Member - $125,000.
AD&D In the event injury is sustained by any other cause, and not otherwise excluded from the policy: Loss of Life - $100,000; Loss of two
Members - $100,000; Loss of one Member - $50,000.
Regarding this Optional coverage, “Member” means hand, foot or eye. Only one amount, the largest to which you are entitled, will be paid for all
losses resulting from one accident.
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In the event injury is sustained while riding as a fare paying
passenger on a scheduled airline:
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In the event injury is sustained by any other cause, and not
otherwise excluded from the policy:
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Optional Benefit: Hazardous Activity Coverage
This optional benefit may be purchased in addition to Basic Plan A or Plan B. If the optional benefit is selected and the premium paid in advance of
the Period of Coverage, Medical Expense Coverage will be provided for motorcycling, scuba diving, jet, snow and water skiing, mountain climbing,
sky diving, amateur racing, piloting an aircraft, bungee jumping, spelunking, whitewater rafting, surfing or parasailing.
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For Medical Expense, this insurance does not cover:
- Pre-Existing Conditions, defined as any injury or illness which was contracted or which manifested itself, or for which treatment or
medication was prescribed within three years prior to the effective date of this insurance.
- Services, supplies or treatment, including any period of hospital confinement, which are not recommended, approved and certified as
necessary and reasonable by a physician, or expenses which are non-medical in nature.
- Expenses incurred as a result of or in connection with: a) Declared or undeclared war, or any act thereof; b) Injury sustained while
participating in professional athletics; c) Intentionally self-inflicted injury, suicide while sane or attempted suicide while insane; d)
Motorcycling, scuba diving, jet, snow and water skiing, mountain climbing, sky diving, professional or amateur racing, piloting an aircraft,
bungee jumping, spelunking, whitewater rafting, surfing or parasailing; or e) Commission of a felony.
- Expenses for: a) Pregnancy, childbirth, or miscarriage; b) Routine physicals; c) Cosmetic or plastic surgery, except as the result of an
accident; d) Elective surgery; e) Any mental or nervous disorders or rest cures; f) Dental care, except as the result of injury to natural teeth
caused by accident; g) Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or contact lenses
or for the fitting thereof, unless caused by accidental bodily injury incurred while insured hereunder; h) Alcoholism, drug addiction, or use of
any drug or narcotic agent; i) Treatment by the Insured’s Immediate Family; or j) Expenses incurred within the Insured’s home country.
- Traveling expressly for the purpose of obtaining medical treatment.
- All coverages, except Accidental Death and Dismemberment, shall be in excess of all other valid and collectible insurance indemnity and
shall apply only when such benefits are exhausted.
For Accidental Death and Dismemberment this insurance does not cover:
Any loss, fatal or non-fatal, caused by or resulting from: a) Intentionally self-inflicted injury, suicide while sane or attempted suicide while insane;
b) War or any act of war, declared or undeclared, or service in the military, naval or air service of any country; or c) Piloting or acting as a crew
member, or riding in any aircraft except as a fare paying passenger on a scheduled airline; d) Illness, disease, pregnancy, childbirth, miscarriage;
e) Any bacterial infection other than one occurring from an accidental cut or wound; f) Hernia; or g) The insured being under the influence of drugs
(unless taken under the advice of a physician and within the amounts prescribed by a physician) or intoxicants of any type including alcohol.
For Emergency Medical Evacuation and Repatriation of Remains Expense, this insurance does not cover:
Any loss fatal or non-fatal caused by or resulting from (a), (b) or (c) above.
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ENROLLMENT DETAILS
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ELIGIBILITY Apply early to begin coverage when you leave your home country. Coverage is available to international visitors who come to the
U.S. for pleasure, business or study, and to new immigrants to the U.S.
EFFECTIVE DATE
Coverage begins at 12:01 a.m. on the latest of:
- the departure of the Insured Person from his home country for his trip to the United States;
- the date after the Insured Person’s completed enrollment form and correct premium are postmarked to Travel Insurance Services; or
- the requested effective date on the enrollment form.
EXPIRATION DATE
Coverage will terminate on the earliest of:
- the return of the Insured Person to his home country from his trip to the United States;
- twelve (12) months after the effective date of coverage; or
- the requested termination date on the Insured Person’s enrollment form for which premium has been paid.
PROOF OF INSURANCE will be sent by mail to your U.S. address on the Enrollment Form unless otherwise instructed. Correctly completed
enrollments are processed and Certificates of Insurance are normally mailed within 1-3 business days after receipt. Please keep this brochure for
reference.
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BASIC PLAN MONTHLY PREMIUMS
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Plan B
$100,000 / incident
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Deductible Per Policy Period:
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* The Medical Expense benefit is reduced to $10,000 for ages 80+.
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BASIC PLAN 15-DAY PREMIUMS
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Plan B
$100,000 / incident
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Deductible Per Policy Period:
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* The Medical Expense benefit is reduced to $10,000 for ages 80+.
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Optional Benefits Rates
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- Additional Accidental Death & Dismemberment Coverage
- Hazardous Activity Coverage
This will increase your Basic Plan Premium as follows:
Add ONE Optional Benefit - Multiply Basic Plan Premium by 1.20
Add TWO Optional Benefits - Multiply Basic Plan Premium by 1.30
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Program Details
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Visit USA-HealthCare™ is exclusively administered by Travel Insurance Services.
Visit USA-HealthCare™ is underwritten by The Insurance Company of the State of Pennsylvania, Philadelphia, Pennsylvania, A++ rated by A.M.
Best Company and a member of the American International Group of Companies (AIG).
Visit USA-HealthCare™ emergency assistance is provided by AIGAssist, Houston, Texas.
Visit USA-HealthCare™ claims are adjusted by AIG Life Insurance Company, Wilmington, Delaware.
Visit USA-HealthCare™ is a registered trademark of Travel Insurance Services and is also available through certain insurance agents and
brokers throughout the U.S.
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