Regence BlueShield   LifeWise of WA   HSA Plans   Individual Dental   Group Medical   Group Dental   Grp Life & Disability   About the Plan   Premiums   Application   US Citizens   Foreign Nationals   Long Term     Eligibility     Benefits     Exclusions     A D & D     Optional Riders     Coverage Periods     Premiums     Application     Apply Online		DESCRIPTION OF BENEFITS All coverage, benefits and premiums are in U.S. Dollar amounts. If an Injury or Illness occurs outside your Home Country during the Period of Coverage and the Insured Person requires medical or surgical treatment; this plan will pay, subject to the selected deductible and applicable co-insurance, the following Covered Expenses, up to the selected policy maximum. Covered Expenses Only such expenses incurred as the result of and within 52 weeks from a Disablement, which shall mean an Illness or an accidental bodily Injury necessitating medical treatment, and which are specifically enumerated in the following list of charges: Charges made by a Hospital for room and board, floor nursing and other services, including charges for professional services, except personal services of a non-medical nature, provided, however, that expenses do not exceed the Hospital's average charge for semi-private room and board accommodation, or two (2) times the average semi-private room charge if confinement to an intensive care unit is required, or the actual charge for an intensive care unit made by the servicing Hospital, whichever is less; 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 radio-active 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; Hotel room charge, when the Insured, otherwise necessarily confined in a Hospital, shall be under the care of a duly qualified Physician in a hotel room owing to the unavailability of a Hospital room by reason of capacity or distance or to any other circumstances beyond the control of the Insured; Dressings, drugs, and medicines that can only be obtained upon written prescription of a Physician. With regard to chiropractic care, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed chiropractor, 80% of eligible charges up to $35.00 per visit, with a maximum of 10 visits per Injury or Illness is allowable. The charges enumerated above shall in no event include any amount of such charges which are in excess of regular and customary charges. A charge incurred by an Insured shall be deemed a Regular & Customary charge for the services and supplies for which the charge is made if it is not in excess of the average charge for such services and supplies in the locality where received, considering the nature and severity of the Illness or bodily Injury in connection with which such services and supplies are received. If the charge incurred is in excess of such average charge such excess amount shall not be recognized as Covered Expenses. All charges shall be deemed to be incurred on the date such services or supplies which give rise to the expense or charge are rendered or obtained. The maximum total payment under the policy for an Illness that is first manifested, treated or diagnosed during an Insured Person’s first thirty (30) days of coverage, commencing as of the Insured Person’s effective date, is $1,000. Policy Maximum Choices Plan A - $500,000, Plan B - $1,000,000 Persons up to age 69 are eligible for both plans; Persons age 70-79 are eligible for Plan A with a $100,000 Maximum Persons age 80+ are eligible for Plan A with a $50,000 Maximum. Deductible Choices $100, $250, $500, $1,000, $2,500 per person per policy period. Co-insurance After you pay your selected deductible this plan will pay 100% of Covered Expenses outside the USA and Canada up to the selected policy maximum. Any Covered Expenses incurred in the USA and Canada are paid at 80% of the first $5000 then 100% to the policy maximum. Eligible expenses are based on Regular & Customary charges. Lost Baggage Coverage is provided if a checked baggage is lost due to theft or misdirection if the Insured is a ticketed passenger on any land, water or air conveyance licensed for the transportation of passengers. Benefits will be paid only in excess of amounts paid or payable by the Common Carrier or any other valid and collectible insurance. $50 per Bag/$250 Maximum. Trip Interruption Coverage is provided if an Insured is unable to continue his/her trip due to; a) death, occurring prior to the Insured’s return to his/her Home Country, of an Insured Person’s Immediate Family Member; b) serious damage to the Insured Person’s principal residence from fire, flood or similar natural disaster (tornado, earthquake, hurricane, etc.) $5,000 Maximum. In Hospital Benefit If you are in the Hospital while traveling outside of the United States or Canada, and the Hospital is considered a Covered Expense, the program will pay the covered Insured $100 for each night spent in the Hospital for a maximum of 10 consecutive days (this benefit is in addition to any other expenses of the program). Emergency Medical Evacuation The Company will pay benefits for Covered Expenses incurred for the necessary Emergency Medical Evacuation of an Insured Person up to a $100,000 maximum. Emergency Medical Evacuation means: a) the Insured Person’s medical condition warrants immediate transportation from the place where the Insured Person is Injured or Ill, to the nearest Hospital where appropriate medical treatment can be obtained; or b) after being treated at a local Hospital, the Insured Person’s medical condition warrants transportation to his/her Home Country to obtain further medical treatment or to recover. Covered Expenses are expenses for the transportation, medical services and supplies recommended by the attending Physician and necessarily incurred, in connection with an Insured Person’s Emergency Medical Evacuation. All transportation for an Insured Person’s Emergency Medical Evacuation must be arranged by AIG Assist utilizing the most direct and economical conveyance. Emergency Reunion In the event of an Emergency Medical Evacuation due to a covered Injury or Illness, where the Physician feels that it would be beneficial for the Insured to have a Family Member at their side during transport, the Company will reimburse the Insured for travel and lodging expenses, up to a maximum of $10,000.00. AIG Assist must make all arrangements and must authorize all expenses in advance. The Company reserves the right to determine the benefit payable, including reductions, if it is not reasonably possible to contact AIG Assist in advance. Repatriation of Remains Expenses 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 your Home Country are covered up to a maximum of $20,000. The Repatriation must be arranged by AIG Assist utilizing the most direct and economical conveyance. Emergency Dental Benefit With regard to dental care up to $100 per tooth for the necessary treatment of sudden, unexpected pain to sound natural teeth is allowable. Click here to view a list of the definition of terms. E-mail us for more information and a free quote or CALL TOLL FREE 1-800-875-4490 (in the U.S.) or 1-253-854-0199 (outside the U.S.) Fax: 1-253-896-9411 Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424 Serving all of Washington at 800-875-4490, Seattle at 206-682-1628, Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291. 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