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 and canada: After you pay the deductible, the program pays 80% 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, up to a maximum of thirty (30) days
(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): $25,000 Principal Sum for Insured or Insured Spouse, $5,000 for Dependent Child(ren)
Note: In the event of a Common Carrier Accidental Death this benefit will not be paid.
common carrier accidental death: $50,000 per adult, $12,500 per child(ren) under age of 19; $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 up to $50,000
waiver of pre-existing conditions: Up to chosen Medical Maximum for U.S. citizens traveling outside the United States & Canada with a Primary Health Plan, otherwise up to $20,000
(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: 180 days
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 or by searching online, we can assist you in locating a provider. Seven Corners’ Assist is trained to help you locate appropriate care.
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.
Liaison
® Majestic provides coverage, as outlined in this brochure, for individuals and families
(including unmarried dependent child(ren) over fourteen (14) days and under nineteen (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.
It is the Insured Person’s responsibility to maintain all records regarding travel history and age and provide any documents, which would verify Eligibility Requirements, to the Administrator.
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 premium has been paid; or 3) The date you are no longer eligible under this plan; or 4) When the maximum benefit amount has been paid.
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, incurred within one hundred and eighty (180) days from the onset of an Injury or Illness, and not listed in the Exclusions, shall be considered as Covered Expenses:
- 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); provided, however, that expenses do not exceed the Hospital’s average charge for semi-private room and board accommodations, charges made for an operating room.
- Charges made for Intensive Care or Coronary Care charges and nursing services.
- Charges made for diagnosis, treatment and Surgery by a Physician; charges made for the cost and administration of anesthetics.
- 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.
- 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.
- Charges for physiotherapy, if recommended by a Physician for the treatment of a specific Disablement and administered by a licensed physiotherapist.
- Ground ambulance (within the metropolitan area) up to $5000 maximum 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.
- 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.
- Charges made for artificial limbs, eyes, larynx, and orthotic appliances, but not for replacement of such items.
If you are hospitalized while traveling outside of the United States and Canada, and the hospitalization is considered a Covered Expense, the program will indemnify you $150 for each night spent in the hospital, up to a maximum of thirty (30) days.
(This benefit is in addition to any other covered expenses of the program).
The Emergency Dental Benefit is available, provided you have purchased one (1) or more months of coverage. It covers 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 ($500). This benefit is subject to the Deductible and Coinsurance.
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.*
Incidental Trips to Your Home Country: This benefit covers you for incidental trips to your Home Country
(Sixty (60) days per twelve (12) months of purchased coverage or pro rata thereof- example: approximately five (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. You must first depart your Home Country in order to utilize this benefit and it does not apply to the final trip home. In the event of a claim, you may be required to provide proof of your travel intentions. Earned Home Country Coverage days for the current Policy year do not extend or carry over after a completed twelve (12) month Period of Coverage. If you choose to renew beyond a twelve (12) month Period of Coverage, the earning of incidental days will start over again, i.e. 5 days for every month that you purchase, allowing up to a maximum amount of sixty (60) days per twelve (12) month Period of Coverage.
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).
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.*
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 are covered up to a maximum of $50,000. Evacuation must occur within ten (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.*
The Political Evacuation and Repatriation of Remains Benefit will not pay, should the Insured not heed Travel Warnings issued by the State Department or the appropriate authorities recommending that travelers avoid a certain country.
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.
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 nineteen (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)).*
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.*
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 article limit of $50 (maximum benefit 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.
If a covered Injury renders you Comatose within ninety (90) days of the date of the accident that caused the Injury, and if the Coma continues for a period of thirty (30) consecutive days, the program will pay a monthly benefit equal to 1% of $50,000.
No benefit is provided for the first thirty (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.
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.
Coverage for Injuries and Illnesses up to $50,000 resulting from an Act of Terrorism, as defined in the program summary, provided all of the following conditions are met:
- You have no direct or indirect involvement in the Act of Terrorism.
- 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 six (6) months prior to your date of arrival.
- 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.
*NOTE: In the event that 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.
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
Your health and well-being are not the only aspects of concern with international travel. Upon enrollment into Liaison
® Majestic, you have access to identity theft assistance services which include:
- Assist identity theft victim by ordering and reviewing credit bureau records on their behalf
- Investigate financial accounts where identity theft is suspected
- Interact with law enforcement to pursue prosecution of criminals
- Review account activity to identify any suspicious activities
- Review and resolve victim’s issues
- Service not available in New York
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.
continuing coverage
For those who are intending longer international trips, an option is available to you. We will e-mail you a renewal notice prior to your program’s expiration date. Renewals can be processed
Online, or you can call us and have it processed over the phone.
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 (3) years (one (1) year for persons age 65 and over). Should you have a birthday, as of your renewal, rates and medical maximums will be adjusted accordingly at that time, as presented in the plan cost section of this brochure. 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 renewal 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).
hazardous sport coverage
To cover motorcycle/motor scooter riding (whether as a passenger or a driver), hang gliding, parachuting, bungee jumping, water skiing, snow skiing, snowmobiling, snowboarding, and spelunking.
Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute.
Coverage is not available for travel to or from the following countries*:
- Afghanistan
- Chechnya
- Cuba
- Iran
- Iraq
- Pakistan
- Palestine
- Somalia
*The above list is subject to change.
For Medical benefits, this Insurance does not cover:
-
Any Injury or Illness which meets the following criteria: a) condition(s), including any related conditions, associated complications or consequences, which manifested during the thirty-six (36) months prior to the Effective Date of coverage under this policy; (b) condition(s) including any related conditions, associated complications or consequences, that should 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; (c) condition(s) including any related conditions, associated complications or consequences, for which medical advice, diagnosis, care or treatment was recommended, received, or noticed during the thirty-six (36) months prior to the Effective Date of coverage under this Policy; (d) the symptoms which occurred during the thirty-six (36) months prior to the Effective Date of coverage under this policy would have allowed a person trained in medicine to make a diagnosis of the condition, including any associated complications or consequences, producing the symptoms.
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 Eligible Benefits incurred outside the United States and Canada as defined below:
- For persons less than age 65 with a Primary Health Plan as defined in the policy, Pre-Existing Conditions are waived up to the medical maximum selected.
- For persons less than age 65 without a Primary Health Plan as defined in the policy, Pre-Existing Conditions are waived up to the first $20,000.
- For persons age 65 and over, Pre-Existing Conditions are waived up to the first $2,500 regardless of whether there is a Primary Health Plan.
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.
The term "Primary Health Plan" is a Group Health Benefit Plan, an individual health benefit plan, or a governmental health plan (Medicare is excluded) designed to be the first payor of claims for an Insured Person in effect prior to the effective date of this Policy and continuing as long as this Policy is in effect. Such plans must have coverage limits in excess of $50,000 per incident or per year to be considered a Primary Health Plan. 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 the condition. The term "Stroke" shall mean an acute and emergent onset of the condition;
PLEASE NOTE: Your Primary Health Plan must be effective at the time of claim. Medicaid, Medicare, and V.A. health plans do not constitute primary health insurance.
- Charges for Treatment(s) of the following Illness(es) or Surgery(ies), which Manifest(ed) themselves or are recommended, or symptoms occur during the first one hundred and eighty (180) days of Coverage hereunder beginning on the initial Effective Date: any condition of the breast; any treatment of all forms of cancer/neoplasm; any condition of the prostate; disorders of the reproductive system; hysterectomy; gall stones or urologic stones (kidney, ureteral, bladder or urethral stones) and any associated complications; any acne diagnosis or acne related condition; asthma; allergies; tonsillectomy; back conditions; adenoidectomy; hemorrhoids; hemorrhoidectomy; hernia, or any Surgery(ies) that is(are) not Emergency in nature, as Emergency is defined hereunder. (Does not apply to United States citizens traveling outside of the United States and Canada);
- Claims not received by Seven Corners within ninety (90) days of the date of service;
- 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;
- Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician;
- Suicide or any attempt thereof, self destruction or any attempt thereof, intentionally self-inflicted Injury or Illness;
- Expenses as a result of, or in connection with, the commission of a felony offense or any other criminal or illegal activity as defined by the local governing body;
- 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;
- Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics;
- Routine physicals, inoculations, or other examinations where there are no objective indications or impairment in normal health;
- Treatment of the Temporomandibular joint;
- Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person;
- 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 refractions or examinations for the purpose of prescribing corrective lenses or for the fitting thereof, unless caused by Accidental bodily Injury incurred while insured hereunder;
- Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent; Injury sustained while under the influence of or Disablement due wholly or partly to the effects of intoxicating liquor or drugs or narcotic agent, unless administered under the advice of a Physician and said narcotic agent was taken in accordance with the proper dosing as directed by the Physician;
- Any Mental and Nervous disorders or rest cures;
- Congenital abnormalities and conditions arising out of or resulting therefrom;
- Weight reduction programs or the surgical treatment of obesity;
- Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
-
Injury sustained while taking part in mountaineering, hang gliding, parachuting, bungee jumping, zip lining, racing by any animal or motor vehicle, or motorcycle, snowmobiling, motorcycle / motor scooter riding (whether as a passenger or as a driver), scuba diving involving underwater breathing apparatus (unless PADI or NAUI certified), water skiing, snow skiing and snow boarding, luge, motocross, Moto X, skateboarding, and any other sport or athletic activity which is undertaken for thrill seeking and exposes the insured to abnormal or extreme risk of injury and/or is in violation of applicable laws, rules, or regulations. (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;
- Treatment paid for or furnished under any other individual, government, or group policy or charges provided at no cost to the Insured Person;
- Treatment of venereal or sexually transmitted disease;
- Sex change operations, or for treatment of sexual dysfunction or sexual inadequacy;
- Expenses resulting from Acquired Immune Deficiency Syndrome (AIDS), Aids-Related Complex (ARC) or the Human Immunodeficiency Virus (HIV);
- Pregnancy expenses or Illness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from an Accident;
- Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof;
- Expenses incurred while you are in your Home Country (except after approved Emergency Medical Evacuation / Repatriation or if treatment is a follow-up to a covered disablement during coverage (see Home Country Coverage benefit) or if the expenses pertain to the Home Country Coverage Benefit);
- 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;
- Expenses incurred as a result of the Insured’s failure to accept or follow a Physician’s advice, treatment, or recommended treatment.
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.
Filing a claim with Seven Corners is easy. When you receive treatment, send the itemized bills to Seven Corners within ninety (90) days via e-mail, fax, or postal mail. Please retain all original bills should there be a need for verification. 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.
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.
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.
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.
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.
| |
|
Age
|
$60,000
Monthly/Daily |
$125,000
Monthly/Daily |
$600,000
Monthly/Daily |
$1,000,000
Monthly/Daily |
| 19 to 29 |
$50 / $1.68 |
$77 / $2.56 |
$79 / $2.63 |
$85 / $2.83 |
| 30 to 39 |
$71 / $2.36 |
$95/ $3.15 |
$116 / $3.85 |
$123/ $4.11 |
| 40 to 49 |
$121 / $4.03 |
$142 / $4.73 |
$154 / $5.12 |
$163 / $5.43 |
| 50 to 59 |
$199 / $6.64 |
$258 / $8.59 |
$270 / $9.00 |
$279 / $9.31 |
| 60 to 64 |
$226 / $7.54 |
$311/ $10.35 |
$335 / $11.16 |
$336 / $11.21 |
| 65 to 69 |
$293 / $9.76 |
N/ A |
N/ A |
N/ A |
| 70 to 79 |
$411 / $13.69 |
N/ A |
N/ A |
N/ A |
| 80 plus* |
$550 / $18.33 |
N/ A |
N/ A |
N/ A |
| Child Alone |
$50 / $1.68 |
$77 / $2.56 |
$79 / $2.63 |
$85 / $2.83 |
| Dep Child** |
$48 / $1.60 |
$73 / $2.44 |
$75 / $2.50 |
$81 / $2.70 |
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.
| |
|
Age
|
$60,000
Monthly/Daily |
$125,000
Monthly/Daily |
$600,000
Monthly/Daily |
$1,000,000
Monthly/Daily |
| 19 to 29 |
$29 / $0.98 |
$35 / $1.17 |
$40 / $1.34 |
$44 / $1.45 |
| 30 to 39 |
$35 / $1.17 |
$43 / $1.44 |
$54 / $1.79 |
$60 / $2.01 |
| 40 to 49 |
$59 / $1.95 |
$65 / $2.18 |
$74 / $2.46 |
$79 / $2.63 |
| 50 to 59 |
$101 / $3.37 |
$114 / $3.80 |
$124 / $4.12 |
$125 / $4.18 |
| 60 to 64 |
$128 / $4.27 |
$152 / $5.05 |
$166 / $5.53 |
$180 / $5.99 |
| 65 to 69 |
$149 / $4.96 |
$160 / $5.32 |
$170 / $5.67 |
$186 /$6.20 |
| 70 to 79 |
$245 / $8.16 |
$326 / $10.88 |
N/A |
N/A |
| 80 plus* |
$428 / $14.28 |
N/A |
N/A |
N/A |
| Child Alone |
$29 / $0.98 |
$35 / $1.17 |
$40 / $1.34 |
$44 / $1.45 |
| Dep Child** |
$28 / $0.93 |
$33 / $1.11 |
$38 / $1.28 |
$41 / $1.38 |
* 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.
Premium: 35-year-old U.S. citizen traveling Outside the U.S. to Spain, from March 15th to April 19th
Example: $250 deductible and $60,000 maximum
| Monthly Rate for 35 year old; $35.00: |
$35.00 |
| (March 15th through April 14th equals 1 calendar month)
|
+ |
| Daily Rate for 35 year old;$1.17 x 5: |
$5.85 |
| (April 15th through April 19th equals 5 days) |
= |
| Total Premium Submitted: |
$40.85 |
Online Application:
Purchasing online on this secure web site with credit card is the best method to apply.
You do not need to send any papers or records.
Paper Application:
- Complete entire Liaison® Majestic application. Payment for the entire period of coverage is due at the time of application.
- If paying by check or money order, make payable to: "Seven Corners" and enclose it together with completed Application.
- If paying by credit card, complete Application and mail or fax to us. Be sure to sign Method of Payment section.
- Read the brochure and sign the application.
Return the Application with your payment for the total premium to:
Insubuy, Inc.,
4700 Dexter Dr.
Suite 100
Plano, TX 75093
Fax: (972) 767-4470
(You may fax if paying by credit card only. Originals are not required if application is faxed to Insubuy with credit card payment.)
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