Atlas America - Visitors Insurance

Non-U.S. citizens traveling to the U.S. 5 days-364 days.

The industry-leading Atlas Travel Series includes many benefits, services and features making it a leading option for individuals and families who travel internationally. Coverage for Emergency Medical Evacuations, Acts of Terrorism, Complications of Pregnancy, and many more are included with every Atlas Travel Series Policy. Also, this innovative product allows you the choice of deductible and maximum coverage limit so that you may tailor the policy to your needs. Additionally, state-of-the-art travel and emergency medical assistance services are part of every Atlas Travel Series plan. These features are accompanied by the same astonishing service you have come to expect from HCC Medical Insurance Services (HCCMIS), a leader in international travel medical insurance.

The answer is easy. Whether you travel for business or pleasure, international travel involves risk. You may arrive at your destination to find that your luggage with personal items has disappeared. A personal emergency may necessitate your early return to your Home Country. A medical emergency may require hospitalization or even air evacuation. In most cases, your existing insurance will not provide adequate protection for these and other risks. Without appropriate travel insurance, you may be in jeopardy of significant financial liability. HCCMIS can't take the risk out of international travel, but if the unforeseen happens, we will be there to help you.

If you are traveling outside of your Home Country and are at least 14 days old, you are eligible for coverage. If you are under age 70, you may select your Overall Maximum Limit, ranging from $50,000 to $1,000,000. If you are age 70 to 79, the Overall Maximum Limit available is $50,000. Coverage is not available for 80+. The minimum coverage period is 5 days and the maximum initial coverage period is 364 days.

Your coverage becomes effective on the latest of: the moment we receive your Application and correct premium (if Application and payment is made online or by fax), 12:01am* on the date we receive your Application and payment (if Application and payment is made by mail), the moment you depart from your Home Country, or 12:01am on the date you request on your Application. Your coverage will end on the earliest of: 11:59pm on the last day of the period for which you have paid a premium, 11:59pm on the date requested on your Application, or the moment of your arrival upon return to your Home Country (unless you have started a Benefit Period or are eligible for Home Country Coverage).
*Times expressed above are based on US Eastern Time.

Yes. Under certain circumstances, the Atlas Series will provide limited Home Country Coverage.

Incidental Home Country Coverage - The Atlas Series will provide you 15 days of incidental coverage for trips to your Home Country for every 3 months of coverage purchased. Incidental visit time must be used within the three-month period earned, and you must continue your international trip in order to be eligible for this benefit, which covers Medical expenses only. Return to your Home Country must not be taken for the purpose of obtaining treatment of an Illness or Injury that began while traveling.

Benefit Period Medical Coverage - A Benefit Period begins on the first date you receive a diagnosis or treatment of a covered Illness or Injury while outside your Home Country and lasts for 90 days. If you started a Benefit Period while this insurance was in effect, you are covered only for Medical expenses related to that covered Illness or Injury for the duration of the Benefit Period, regardless of whether you are at home or abroad.

Home Country Defined - If you are a US citizen, your Home Country is the United States, regardless of the location of your Principal Residence. If you are not a US citizen, your Home Country is the country where you principally reside and receive regular mail.

US citizens, as well as non-US citizens traveling outside of the US, should purchase Atlas International, which provides coverage outside of the US. Non-US citizens traveling to the United States should purchase Atlas America. For the purpose of this insurance, the United States also includes Puerto Rico and the US Virgin Islands.

Limits apply to all benefits (See Schedule of Benefits and Limits): Medical:

1. Inpatient and Outpatient charges made by a Hospital
2. Charges made by a Physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the Physician has referred the case
3. Charges made for dressings, sutures, casts or other supplies prescribed by the attending Physician or specialist, but excluding nebulizers, oxygen tanks, diabetic supplies and all devices for repeat use at home
4. Charges for diagnostic testing using radiology, ultrasonographic or laboratory services
5. Charges for oxygen and other gases and anesthetics and their administration
6. Charges for prescription drugs for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs
7. Charges made by a licensed Extended Care Facility upon direct transfer from an acute care Hospital
8. Emergency local ambulance transport incurred in connection with Injury or Illness resulting in inpatient hospitalization
9. Injury or Illness resulting from participation in sports or athletic activities not otherwise excluded under this insurance

Treatment of Complications of Pregnancy during the first 26 weeks of Pregnancy is covered under this insurance. Complications of Pregnancy is defined as: Illnesses whose diagnoses are distinct from Pregnancy, but are adversely affected by Pregnancy or caused by Pregnancy, and not associated with a normal Pregnancy. This includes: ectopic Pregnancy, spontaneous abortion, hyperemesis gravidarum, pre-eclampsia, eclampsia, missed abortion and conditions of comparable severity.

If you are hospitalized as an Inpatient for treatment of a covered Illness or Injury, the Atlas Series will provide $100 for each night you spend in the hospital. This benefit is in addition to payments for other covered expenses and is not subject to Deductible or Coinsurance.

If you are under age 70, you are covered for an Acute Onset of a Pre-existing Condition. Coverage is available up to $20,000 Lifetime Maximum for Eligible Medical Expenses and up to $25,000 Lifetime for Emergency Medical Evacuation. An Acute Onset of a Pre-existing Condition is a sudden and unexpected outbreak or recurrence of a Pre-existing Condition which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. Certain Cardiovascular Events are not covered under this provision; please review policy exclusions for more details.

The following Emergency Dental expenses are covered: Emergency Dental treatment and Dental surgery necessary to restore or replace sound natural teeth lost or damaged in an Accident that is covered under this insurance subject to the Overall Maximum Limit; and Emergency Dental Treatment necessary to resolve acute, spontaneous and unexpected onset of pain subject to a maximum benefit of $250.

If the United States government issues a travel warning that becomes effective after your arrival in your destination country, the plan will provide for transportation to the nearest place of safety or for return to your Home Country. You must contact HCCMIS within 10 days of the date the travel warning is issued and the evacuation must be approved in advance and coordinated by HCCMIS.

If recommended by your attending Physician, who certifies that Evacuation is necessary to safeguard your life and that Medically Necessary treatment is not available locally, and if approved in advance and coordinated by HCCMIS, the Atlas Series will provide the following benefits: Emergency air and/or ground transportation to the nearest Hospital that is qualified to provide the Medically Necessary treatment.

In the event of a covered Emergency Medical Evacuation, the Atlas Series will provide the following benefits: The cost of an economy round-trip air and/or ground transportation ticket for one of your Relatives (parent, spouse, sibling or child age 18 or older) for travel to the area where you are hospitalized following Emergency Medical Evacuation and reasonable expenses for lodging and meals for your relative, for a period not to exceed 15 days.

If you are the only person age 18 or older, traveling with one or more children under the age of 18, who are also covered by the Atlas Series, and you are Hospitalized for treatment of a covered Illness or Injury resulting in the children being left unattended for a period of time expected to exceed 36 hours, the Atlas Series will provide the following benefit: The cost of a one-way economy air and/or ground transportation ticket for each covered child to the terminal serving the area of Principal Residence of each covered child.

The Atlas Series provides Medical coverage for Injuries and Illnesses resulting from an Act of Terrorism, subject to a $50,000 Lifetime Maximum, provided all of the following conditions are met:

1. The Injury or Illness does not result from chemical, nuclear or biological weapons or events.
2. You have no direct or indirect involvement in the Act of Terrorism.
3. The Act of Terrorism is not in a country or location where the United States government has issued a travel warning that has been in effect within the 6 months prior to your date of arrival.
4. You have not unreasonably failed or refused to depart a country or location following the date a warning to leave that country or location is issued by the United States government.

An Act of Terrorism is defined as: an act, including but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.

In the event of your Accidental Death (except while traveling on a common carrier) or Dismemberment resulting from a covered Injury, the Atlas Series will provide the following benefit:

• Accidental Death - Principal Sum to the Beneficiary designated on your Application
• Loss of 2 eyes or 2 or more limbs - Principal Sum to you
• Loss of 1 eye or 1 limb - One-half of the Principal Sum to you

Age	Principal Sum
14 days to 17 years	$5,000
18 to 69	$25,000
70 to 74	$12,500
75+	$6,250

The Accidental Death and Dismemberment benefit is not available for losses incurred during participation in sports and athletic activities not covered under the standard Atlas plan or in respect to losses resulting from an Act of Terrorism.

In the event of your Accidental Death while traveling on board a commercial common carrier, the Atlas Series will provide the following benefit: Principal Sum of $50,000 ($25,000 for children under age 18), subject to a maximum of $250,000 per family, to the Beneficiary designated on your Application. This benefit is not available in respect to losses resulting from an Act of Terrorism.

In the event of a covered Injury or Illness resulting in your death, the Atlas Series will provide the following benefit: Air and/or ground transportation of bodily remains or ashes to the area of your Principal Residence, and reasonable costs of preparation of your remains necessary for transportation.

In the event of natural disaster (hurricane, flood, tornado, tsunami, etc) the Atlas Series will provide you up to $100 a day for up to 5 days for replacement accommodations if you are Displaced from planned, paid accommodations due to evacuation from forecasted disaster or following a disaster strike. Displaced is defined as required to depart the destination due to an evacuation ordered by prevailing authorities. Proof of paid accommodations must be submitted at time of claim.

1. If, after you have departed, you learn of the death of a parent, spouse, sibling or child, or you learn of the substantial destruction of your Principal Residence by fire or weather, the Atlas Series will provide the following benefit: The cost of an economy, one way air and/or ground transportation ticket for your travel to the area of your Principal Residence; or
2. If, following a covered Emergency Medical Evacuation, the attending Physician states that it is Medically Necessary for your return to your Home Country or to the area from which you were initially evacuated for continuing treatment, recuperation and recovery, the Atlas Series will provide the following benefit: The cost of an economy, one-way air and/or ground transportation ticket for your travel from the area where you were hospitalized following the Emergency Medical Evacuation to the area where you were initially evacuated from, or to the terminal serving the area of your Principal Residence.

In the event your checked luggage is permanently lost by the transportation provider, the Atlas Series will provide the following benefit:Up to $250 for replacement of clothes and personal hygiene items, not to exceed $50 for any one item. You must file a formal claim with the transportation provider and submit copies of all claim forms and proof that the transportation provider has paid you its normal reimbursement for the lost checked luggage.

Unless indicated otherwise, all benefits are subject to the Deductible and Coinsurance, and are per Certificate Period.

Benefit	Limit
Deductibles:	$0, $100, $250, $500, $1,000 or $2,500 per Certificate Period
Coinsurance - Claims incurred in US or Canada:	For the Certificate Period, Underwriters will pay 80% of the next $5,000 of Eligible Expenses after the Deductible, then 100% to the Overall Maximum Limit Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider
Coinsurance - Claims incurred outside US or Canada:	For the Certificate Period, Underwriters will pay 100% of Eligible Expenses after the Deductible up to the Overall Maximum Limit
Hospital Room and Board:	Average Semi-private room rate, including nursing services
Local Ambulance:	Usual, Reasonable and Customary charges
Hospital Indemnity:	$100 per day (not subject to Deductible or Coinsurance)
Intensive Care Unit:	Usual, Reasonable and Customary charges
Outpatient Treatment:	Usual, Reasonable and Customary charges
Acute Onset of Pre-existing Condition:	$20,000 Lifetime Limit per Certificate Period for Eligible Medical Expenses $25,000 Lifetime Limit per Certificate Period for Emergency Medical Evacuation (Only available to Members under age 70)
Physical Therapy:	$50 Maximum per visit
All Other Eligible Medical Expenses:	Usual, Reasonable and Customary charges
Emergency Dental:	Accident - Overall Maximum Limit Acute Onset of Pain - $250 limit per Certificate Period (not subject to Deductible or Coinsurance)
Emergency Medical Evacuation:	$500,000 Maximum Lifetime Limit (not subject to Deductible or Coinsurance)
Emergency Reunion:	$15,000 limit per Certificate Period (not subject to Deductible or Coinsurance)
Return of Minor Children:	$5,000 limit per Certificate Period (not subject to Deductible or Coinsurance)
Political Evacuation:	$10,000 Maximum Lifetime Limit (not subject to Deductible or Coinsurance)
Terrorism:	$50,000 Maximum Lifetime Limit, Eligible Medical Expenses only (Not subject to Deductible or Coinsurance)
Accidental Death and Dismemberment:	Lifetime Maximum- $25,000 Principal Sum $25,000 Adults age 18-69 $12,500 Adults age 70-74 $ 6,250 Adults age 75 and above Lifetime Maximum- $5,000 $ 5,000 Children age 17 and below (Not subject to Deductible or Coinsurance)
Common Carrier Accidental Death:	$50,000 per adult, $25,000 children under age 18; $250,000 Maximum per family
Repatriation of Remains:	Overall Maximum Limit (not subject to Deductible or Coinsurance)
Natural Disaster Benefit:	Maximum$100 a day for 5 days (not subject to Deductible or Coinsurance)
Trip Interruption:	$5,000 limit per Certificate Period (not subject to Deductible or Coinsurance)
Lost Checked Luggage:	$250 limit per Certificate Period (not subject to Deductible or Coinsurance)
Hospital Pre-certification Penalty:	50% of Eligible Medical Expenses
Maximum per Injury / Illness	Age 14 days to 69 - $50,000, $100,000, $200,000, $500,000 or $1,000,000; Age 70 to 79 - $50,000; Age 80 or older (Atlas International Only) -- $10,000
Overall Maximum Limit per Certificate Period (includes all benefits except Accidental Death and Dismemberment, Emergency Medical Evacuation and Common Carrier Accidental Death):	Age 14 days to 69 - $50,000, $100,000, $200,000, $500,000 or $1,000,000; Age 70 to 79 - $50,000; Age 80 or older (Atlas International Only) - $10,000

The following charges, treatments, surgeries, medications, conditions and circumstances are excluded:

1. Pre-existing Conditions - Charges resulting directly or indirectly from any Pre-existing Condition are excluded from this insurance. If you are under age 70, you are covered for Medical and Emergency Evacuation charges resulting from an Acute Onset of a Preexisting Condition, up to the limit set forth in the Schedule of Benefits and Limits; however, charges resulting directly or indirectly from a Cardiovascular Event, as herein defined, are not covered for Members age 55 and above who, within the two years immediately preceding the Certificate Effective Date: (i) have diabetes mellitus; (ii) and/or were prescribed or taking prescription medication to control or lower blood pressure; (iii) and/or were prescribed or taking prescription medication to control or lower cholesterol. A Pre-existing Condition is any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Pre-existing Condition.
2. Treatment related to birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions
3. Routine pre-natal care, childbirth, care of newborns, post-natal care, birth control, artificial insemination, infertility, impotency or sexual dysfunction, sterilization or reversal thereof
4. False labor, edema, prolonged labor, prescribed rest during the period of Pregnancy, morning sickness and conditions of comparable severity associated with management of a difficult Pregnancy, and not constituting a medically distinct Complication of Pregnancy, and all charges related to Pregnancy after the 26th week of Pregnancy
5. Mental Health Disorders or Substance Abuse
6. Charges which are not Incurred during the Certificate Period or the applicable Benefit Period, and charges which are not presented to Underwriters for payment within 60 days from the end of the Certificate Period or the applicable Benefit Period
7. Charges for treatment of any condition when the purpose of departing the Home Country was to obtain treatment in the destination country/countries.
8. Charges for use of Emergency Room within the US for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
9. Not Medically Necessary and administered or ordered by a Physician
10. Provided at no cost, by a family member, or by a person who ordinarily resides with you, or which are attributable to or recoverable from any other party including government-sponsored plans
11. Charges which exceed Usual, Reasonable and Customary
12. Investigational, Experimental or for Research Purposes
13. While confined primarily to receive Custodial Care, Educational or Rehabilitative care
14. Diagnosis and treatment of venereal disease, including all Sexually Transmitted Diseases and treatment of individuals who are HIV+ or have AIDS or ARC, and all diseases caused by and/or related to HIV
15. Treatment by a Chiropractor
16. Treatment for acne, other acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus
17. Dental treatment, including treatment of the temporomandibular joint, except for Emergency Dental Treatment necessary to replace sound natural teeth lost or damaged in an Accident covered hereunder or for the relief of acute, spontaneous and unexpected onset of pain
18. Corrective devices and medical appliances, including dentures or dental appliances, eyeglasses, vision exams, contact lenses, hearing tests, hearing aids, hearing implants, eye refraction, visual therapy, orthoptics or visual eye training or eye surgery (including cataract surgery and radial keratotomy) or for any examination or fitting related to these devices or procedures
19. Injury resulting from participation in intercollegiate, intracollegiate, interscholastic, or intrascholastic sports or athletic activities and Professional Sports.
20. Injury sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician but not for the treatment of Substance Abuse
21. Costs resulting from self-inflicted Injury or Illness and/or suicide or attempted suicide whether sane or insane and routine medical examinations, including but not limited to vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to the suitability of employment or travel
22. The Deductible, Coinsurance and charges which are not included as Eligible Expenses as described in the Master Policy, and charges which exceed the limits set forth in the Schedule of Benefits and Limits
23. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder
24. Charges for travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical or Political Evacuation, Repatriation of Remains, Emergency Reunion, Natural Disaster and Trip Interruption sections of this insurance
25. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s)
26. Organ or tissue transplants or related services
27. Acts of Terrorism, except as provided for herein, war, insurrection, riot or any variation thereof
28. Diagnosis and treatment of all forms of cancer/neoplasm

This is a summary of exclusions. For more details please see the Description of Coverage or the Master Policy

Hospitalizations, Surgeries, Emergency and Political Evacuations, Emergency Reunions, Trip Interruptions, Repatriation of Remains, Computerized Tomography (CAT Scan) and Magnetic Resonance Imaging (MRI) must be Pre-certified. Simply call, or have your Physician call, HCCMIS with the information relative to your claim. You may also pre-certify by submitting details through Client Zone. Be sure to have your ID number available. If you do not Precertify, medical expenses will be reduced by 50% and all other expenses will be forfeited.

HCC Medical Insurance Services LLC (HCCMIS), headquartered in the United States in Indianapolis, Indiana, is a full-service company offering international medical insurance and short-term medical insurance products designed to meet needs of consumers worldwide. HCCMIS is a subsidiary of HCC Insurance Holdings, Inc. (NYSE:HCC), a leading Specialty Insurance group. HCC's major companies have a financial strength rating of AA (Very Strong) by Standard & Poor's and Fitch Ratings and A+ (Superior) by A.M. Best Company.

The Atlas Series is insured by Syndicate 4141 at Lloyd's, London. Lloyd's is the largest and oldest insurance market in the world and is rated "A (Excellent)" by A.M. Best Company and "A+ (Strong)" by Standard & Poor's. Lloyd's provides financial strength and security that is unparalleled in the worldwide insurance market. Lloyd's is recognized as a market leader in the accident and health insurance arena and is well known for its innovative products and services. Presently, Lloyd's provides accident and health insurance to millions of individuals in almost every country of the world.

After your initial purchase, you may extend your coverage (5 day minimum) up to a maximum of 364 days from the initial effective date. Provided there is no break in coverage, you will not be required to re-satisfy the Deductible and Coinsurance nor will benefit limits be reset.

After 364 days of continuous coverage, or any break in coverage, a new plan must be purchased. A new Application is required and you must re-satisfy your Deductible, Coinsurance and Pre-existing Condition provisions.

Extensions or renewals must be made online with payment by credit card. For additional information on extending or renewing your plan, please visit Client Zone.

If for any reason you wish to cancel your policy, you must submit your cancellation request in writing to HCCMIS in order to receive a refund of premium. To be eligible for a full refund, the request for cancellation must be received prior to your effective date. Cancellation requests received after the effective date will be subject to the following conditions:

1. a $25 cancellation fee will apply; and
2. only the unused portion of the plan cost will be refunded; and
3. only members who have no claims are eligible for premium refund.

Whether you have misplaced your ID card or benefit booklet, need assistance with a claim, or have a question about benefits, HCCMIS is ready to respond. Frequently, these and other issues can be addressed with a short visit to Client Zone. Client Zone is an online account management and resource tool that allows you to:

• Change personal information
• Renew coverage and reprint ID cards
• Obtain details about claim filing, including downloading necessary forms
• Pre-certify for certain medical procedures and hospitalizations
• Locate providers within the PPO Network
• Study destination, weather and travel security information using our Travel Intelligence and Planning System (TIPS)
• Access health and wellness information
• View and download brochures, obtain policy information, or get quotes for other products offered by HCCMIS

You may access Client Zone by logging in at Current Clients .

The Atlas Travel Series includes valuable travel and medical assistance services, which are available to you 24 hours a day, 7 days a week.

• Pre-Trip Destination Information -- Up-to-date information regarding the required vaccinations, health risks, travel restrictions, and weather conditions specific to your destination country
• Medical Monitoring -- Consultations with attending medical professionals during your hospitalization and establishment of a single point-of-contact for family members to receive ongoing updates regarding your medical status
• Provider Referrals -- Contact information for Western-style medical facilities and medical and dental practices and pharmacies in your destination country where English is spoken
• Travel Document Replacement - Assistance with obtaining replacement passports, birth certificates, visas, airline documents, and other travel-related documents
• Lost Luggage Assistance - Tracking service to assist in locating luggage or other items lost in transit

Other travel and medical assistance services available include:

• Prescription Drug Replacement
• Emergency Travel Arrangements
• Dispatch of Physician
• Translation Assistance
• Credit Card/Traveler Check Replacement

For a complete list of available assistance services or for more information, please see the Description of Coverage.

Travel and Medical Assistance Services are not insurance benefits. Any travel or medical assistance service provided is not a guarantee of any insurance benefit under the Atlas Travel Series.

For Non-U.S. citizens traveling to the U.S.

$0 Deductible Age 50,000 100,000 200,000 500,000 1,000,000 0-17 $1.50 $1.75 $2.00 $2.31 $2.63 18-29 $2.19 $2.95 $3.34 $3.73 $3.91 30-39 $2.97 $4.36 $4.63 $4.91 $5.00 40-49 $4.41 $5.81 $6.41 $7.02 $7.42 50-59 $6.56 $8.73 $9.91 $11.08 $11.23 60-64 $7.66 $10.61 $12.11 $13.89 $14.05 65-69 $8.67 $11.72 $13.50 $15.45 $15.61 70-79 $12.50 - - - -	$100 Deductible Age 50,000 100,000 200,000 500,000 1,000,000 0-17 $1.32 $1.54 $1.76 $2.04 $2.31 18-29 $1.93 $2.60 $2.74 $3.29 $3.44 30-39 $2.61 $3.84 $4.25 $4.32 $4.40 40-49 $3.88 $5.12 $5.49 $6.17 $6.53 50-59 $5.78 $7.69 $9.06 $9.75 $9.89 60-64 $6.74 $9.34 $11.81 $12.22 $12.36 65-69 $7.63 $10.31 $13.19 $13.60 $13.74 70-79 $11.00 - - - -	$250 Deductible Age 50,000 100,000 200,000 500,000 1,000,000 0-17 $1.20 $1.40 $1.60 $1.85 $2.10 18-29 $1.27 $1.89 $1.99 $2.39 $2.50 30-39 $1.72 $2.79 $3.09 $3.14 $3.20 40-49 $2.55 $3.72 $3.99 $4.49 $4.75 50-59 $3.72 $5.59 $6.59 $7.09 $7.19 60-64 $4.70 $6.79 $8.59 $8.89 $8.99 65-69 $5.34 $7.50 $9.59 $9.89 $9.99 70-79 $7.20 - - - -
$500 Deductible Age 50,000 100,000 200,000 500,000 1,000,000 0-17 $1.08 $1.26 $1.44 $1.67 $1.89 18-29 $1.22 $1.65 $1.74 $2.09 $2.18 30-39 $1.66 $2.44 $2.70 $2.74 $2.79 40-49 $2.46 $3.25 $3.48 $3.92 $4.15 50-59 $3.67 $4.88 $5.75 $6.19 $6.28 60-64 $4.28 $5.93 $7.50 $7.76 $7.85 65-69 $4.85 $6.55 $8.37 $8.63 $8.72 70-79 $6.98 - - - -	$1000 Deductible Age 50,000 100,000 200,000 500,000 1,000,000 0-17 $0.86 $1.01 $1.15 $1.33 $1.51 18-29 $1.02 $1.22 $1.39 $1.57 $1.88 30-39 $1.37 $1.65 $1.84 $2.04 $2.39 40-49 $2.04 $2.35 $2.74 $3.14 $3.49 50-59 $2.98 $3.61 $4.02 $4.43 $5.10 60-64 $3.76 $4.59 $5.02 $5.45 $6.55 65-69 $4.27 $5.49 $5.72 $5.96 $7.10 70-79 $5.76 - - - -	$2500 Deductible Age 50,000 100,000 200,000 500,000 1,000,000 0-17 $0.84 $0.98 $1.12 $1.30 $1.47 18-29 $0.89 $1.06 $1.22 $1.37 $1.65 30-39 $1.20 $1.44 $1.61 $1.78 $2.09 40-49 $1.78 $2.06 $2.40 $2.74 $3.05 50-59 $2.61 $3.16 $3.52 $3.88 $4.46 60-64 $3.29 $4.01 $4.39 $4.77 $5.73 65-69 $3.74 $4.80 $5.01 $5.21 $6.21 70-79 $5.04 - - - -

1000-AT-277-8968
05/01/2012