WHY YOU NEED THIS PROGRAM. While the United States offers the most comprehensive medical care available, it is often complicated as well as very expensive. For the visitor to the United States or the recent immigrant, finding a program that is easy to understand and reasonably priced is often difficult.

 

As a solution, Inbound Immigrant was developed to provide a simple program to visitors and immigrants that will provide up to 5 years of protection. 

 

This is a brief description of the Inbound Immigrant program. Detailed wording is outlined in the Program Summary, which will be mailed to you once you have enrolled into Inbound Immigrant.

 

ELIGIBILITY. This program is available to non-United States citizens who are traveling to the United States for business, pleasure, to study, or to immigrate. The program must become effective within 24 months of arrival in the United States.

 

PERIOD OF COVERAGE

You may initially enroll into Inbound Immigrant for between 1 and 12 months.   If you initially purchase at least 3 months, you may continue to renew coverage for a minimum 3 months at a time, at the premium rate in force at the time of renewal. Total period of coverage for Inbound Immigrant cannot exceed 60 months and the product cannot be rewritten. 

 

Effective Date - Your coverage will begin on the latest of the following:

1.      Your departure from your Home Country; or

1.      The date your Application and premium are received by SRI; or

2.      The date your Application and premium are accepted by SRI; or

3.      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.      60 months after your original Effective Date; or

4.      The day an insured becomes a U.S. citizen; or

5.      The date of entry into active military service.

Upon each renewal, rates, benefits, and program in general are subject to change. 

 

RENEWAL. If Inbound Immigrant is initially purchased for at least three months, one month before the expiration date, SRI will send a renewal notice to the Address of Correspondence listed on the application.  Coverage may then be renewed for a period of time, depending upon your specific need.  If you renew the coverage for 3 or more months (up to 12 months at a time), SRI will continue to send renewal notices to you.  If you renew the coverage for only 1 or 2 months, SRI will assume that you no longer require the coverage and will not send another renewal notice.  Again, total period of coverage for Inbound Immigrant cannot exceed 60 months.  Additionally, the company may change aspects of the program, including rates, at any renewal date. 

 

SCHEDULE OF BENEFITS

When your covered Injury or Sickness requires treatment by a physician, this program will provide benefits for the Usual and Customary (U&C) charges scheduled below which exceed the chosen Per Person Deductible (either $75 or $150, or a $250 deductible for age 70 and over) for each Injury and each Sickness and which are incurred within the 52 weeks following the Injury or Sickness (within 32 weeks for those insureds age 70 and over).  Payment for any covered service will be no more than the Benefit Limit shown for it. The total payable by all Benefits will be no more than $50,000 or $100,000 for each Injury and each Sickness.

 

For persons age 70 and over, the maximum benefit limit is $50,000, the period in which covered expenses must be incurred is 32 weeks following the Injury or Sickness, and a separate schedule applies.

 

COVERED SERVICES INJURY AND SICKNESS BENEFIT LIMITS

 

 

Age 14 days to

Age 69
Age 14 days to

Age 69

 

 
Age 70 and over

INPATIENT

$50,000 Max per injury/sickness

$100,000 Max per injury/sickness

 

$50,000 Max per injury/sickness

Hospital Room & Board including miscellaneous

$1450/day, 30 day max

$2000 per day, 30 day max

 

$1050/day, 30 day max

Hospital Intensive Care Unit

Additional $600/day, 8 day max

Additional $850/day, 8 day max

 

Additional $450/day, 8 day max

Surgical Treatment

$3,500

$5,750

 

$2,850

Anesthetist

25% of surgical benefit

25% of surgical benefit

 

25% of surgical benefit

Assistant Surgeon

25% of surgical benefit

25% of surgical benefit

 

25% of surgical benefit

Physician’s Non-Surgical Visits

$60/visit, 1/day, 30 visits

$85/visit, 1/day, 30 visits

 

$55/visit, 1/day, 30 visits

Consultant Physician, when requested by attending Physician

$450

$500

 

$400

Pre-Admission Tests w/in 7 days before Hospital admission

$1150

$1150

 

$800

Private Duty Nurse

$575

$575

 

$575

OUTPATIENT

 

 

 

 

Surgical Treatment

$3,500

$5,750

 

$2,800

Anesthetist

25% of surgical benefit

25% of surgical benefit

 

25% of surgical benefit

Assistant Surgeon

25% of surgical benefit

25% of surgical benefit

 

25% of surgical benefit

Physician’s Non-Surgical Visits

$60/visit, 1/day, 10 visits

$85/visit, 1/day, 10 visits

 

$55/visit, 1/day, 10 visits

Diagnostic X-rays & Lab Services

$450

$500

 

$400

 

Additional $280 - One Cat scan, PET scan or MRI

Additional $850 - One Cat scan, PET scan or MRI

 

Additional $285 - One Cat scan, PET scan or MRI

Hospital Emergency Room

75% of U&C to $345 max

75% of U&C to $575 max

 

75% of U&C to $280 max

Prescription Drugs

$115

$175

 

$90

Day surgery miscellaneous, related to outpatient scheduled surgery performed at a Hospital or licensed outpatient surgery center; including the cost of operating room, anesthesia, drugs and medicines and medical supplies. 

$1000

$1150

 

$900

OTHERS

 

 

 

 

Ambulance Services

$450

$450

 

$450

Initial Orthopedic Prosthesis/brace

$1150

$1400

 

$900

Chemotherapy  and/or radiation therapy

$1150

$1425

 

$900

Dental Treatment for Injury to Sound, Natural Teeth

$575

$575

 

$575

Mental & Nervous Disorder & Substance Abuse

Same as any Sickness

Same as any Sickness

 

Same as any Sickness

Maternity (conception occurs at least 90 days after your effective date)

$2,500 max

$2,500 max

 

N/A

Physiotherapy

$40/visit, 1/day, 12 visits

$40/visit, 1/day, 12 visits

 

$40/visit, 1/day, 12 visits

Emergency Evacuation

$10,000

$10,000

 

$10,000

Repatriation of Remains

$7,500

$7,500

 

$7,500

AD&D Principal Sum

$25,000 Common Carrier

$25,000 Common Carrier

 

$25,000 Common Carrier

 

Should an insured person turn 70 during the purchased coverage period, the 70 and over benefit schedule becomes effective upon

the day the insured turns 70.

 

Emergency Medical Evacuation Expenses

If you or any covered dependents become sick or injured during the period of coverage and it has been determined that an Emergency Medical Evacuation is required to either the nearest medical facility, where appropriate medical treatment can be obtained, or to your Country of Residence, all eligible expenses incurred are covered up to $10,000.  An Emergency Medical Evacuation must be recommended by a legally licensed physician who certifies that the severity of the Injury or Sickness necessitates such Emergency Medical Evacuation, and agreed to by you or your representative. All arrangements must be coordinated by the Assistance Provider.

 

Repatriation of Mortal Remains Expenses

If Injury or Sickness 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 are covered up to a maximum of $7,500 provided that all arrangements are coordinated by the Assistance Provider.

 

Common Carrier Accidental Death and Dismemberment (AD&D)

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:

 

For Loss of:                                                                                    Indemnity

Life................................................................................................ Principal Sum

Both Hands or Both Feet or Sight of Both Eyes................................. Principal Sum

One Hand and One Foot.................................................................. Principal Sum

Either Hand or Foot and Sight of One Eye........................................ Principal Sum

Either Hand or Foot........................................................................ One-Half the Principal Sum

Sight of One Eye............................................................................ One-Half the Principal Sum

 

DEFINITIONS

“Injury” means: bodily injury: (1) directly and independently caused by specific accident which is unrelated to any pathological, functional, or structural disorder of injury, (2) treated by a Physician within 30 days after the date of accident; and (3) which causes loss during the term of the policy.

 

“Sickness” means: sickness or disease of the insured Person which causes loss and originates while the Insured Person is covered under the policy. All related conditions and recurrent symptoms of the same or a similar condition will be considered one sickness.

 

“Pre-Existing Condition” means: (1) the existence of symptoms within the 6 months (or 12 months for persons 70 and older) immediately prior to the Insured’s Effective Date under the policy, or, (2) any condition which originates, is diagnosed, treated or recommended for treatment within the 6 months (or 12 months for persons 70 and older) immediately prior to the Insured’s Effective Date under the policy; or (3) congenital conditions.

 

“Usual and Customary Charges” means: a reasonable charge which is: (1) usual and customary when compared with the charges made for similar services and supplies; and (2) made to persons having similar medical conditions in the locality of the Policyholder. No payment will be made under the policy for any expenses incurred which in the judgment of the Company are in excess of Usual and Customary Charges.

 

EXCLUSIONS

No benefits will be paid for loss or expense caused by, contributed to, or resulting from:

1.                Pre-existing Conditions;

2.                Any loss that occurs while traveling solely for the purpose of obtaining medical treatment while on a waiting list for a specific 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 physical or other examinations where there are no objective indications of impairment of normal health, or well baby care;

5.                Eye examinations; prescriptions or fitting of eyeglasses and contact lenses; 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 as stated in the Schedule of Benefits:

8.                Professional services rendered by a Member of the Insured Person’s immediate family, or anyone who lives with the Insured Person;

9.                Services or supplies not necessary for the medical care of the patient’s injury or sickness;

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.             <