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Reside Prime
Worldwide medical insurance
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2009
medical insurance that covers you no matter where you live.
comprehensive worldwide coverage • choice of deductibles • provides up to $5,000,000 in lifetime benefits • coverage for families & individuals
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The following is the Schedule of Benefits for the first 36 months of continuous coverage. After 36 months of continuous coverage, the Extended Coverage Schedule of Benefits shall apply.
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lifetime maximum benefit
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$5,000,000 per Insured Person.
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policy period deductible options
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$250; $500; $1,000; $2,500; $5,000
Maximum of 3 Deductible payments for families enrolling on one Application. Any Eligible Expenses incurred and applied to your Policy Period Deductible in the last 30 days prior to your renewal date will carry over and be applied to the next Policy Period Deductible.
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inside of the united states and canada (geographical treatment area a)
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After the Deductible, the Policy pays 80% of the next $5,000 of Eligible Expenses, then 100% up to the Policy Maximum. Expenses incurred inside the United States and Canada must be Pre-Notified using Seven Corners' Pre-Notification Program.
If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.
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outside of the united states and canada (geographical treatment area b)
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After the Deductible, the Policy pays 100% of Eligible Expenses to the Policy Maximum. Hospital Admissions must be Pre-Notified using Seven Corners' Pre-Notification Program.
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inpatient hospital expenses
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Average Semi-Private room and board; Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-Rays up to the Policy Maximum.
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intensive care
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Intensive Care room and board; Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-rays up to the Policy Maximum.
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surgery
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Usual, Reasonable, and Customary (URC) Charges for Surgery, Physician and Anesthetics up to the Policy Maximum.
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hospital daily indemnity benefit (geographical treatment area b)
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$50 per day ($1,000 maximum per Policy Period), for every Medically Necessary night spent in a Hospital (Hospital Admission) outside of the United States and Canada. An additional Daily Indemnity Benefit Rider may be purchased to increase this benefit limit to $200 per day.
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outpatient treatment
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Usual, Reasonable, and Customary (URC) Charges for Emergency Treatment, Surgery, Prescription Medication up to the Policy Maximum.
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physiotherapy, chiropractic
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Up to $75 per visit ($10,000 Lifetime Maximum), when referred in advance by a Physician.
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medical supplies
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Usual, Reasonable, and Customary (URC) Charges up to Policy Maximum.
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ambulance
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Usual, Reasonable, and Customary (URC) Charges up to Policy Maximum.
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well child care
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Up to $200 per Policy Period Maximum for checkups and routine visits after 12-month waiting period. Up to age 18. Not subject to Deductible and Coinsurance.
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maternity
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Usual, Reasonable, and Customary (URC) Charges up to limits below per Pregnancy, must be Pre-Notified within the first 90 days of Pregnancy. Waiting period of 12-months before maternity benefit begins.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000
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mental & nervous
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Usual, Reasonable, and Customary (URC) Charges up to a Maximum of $10,000 per Policy Period after 12-month waiting period. Inpatient limited to a maximum of 45 days per Policy Period. Outpatient limited to a maximum of 40 visits per Policy Period at 70% of Eligible Expenses. Lifetime Maximum of $30,000.
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newborn benefit
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Maximums listed below per eligible pregnancy for the first 31 days after birth.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000
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dental
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Usual, Reasonable, and Customary (URC) Charges for repair and replacement of sound, natural teeth damaged as a result of an accident, limited to $500 per Policy Period. A Dental Benefit Rider may be purchased to expand Dental Coverage.
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emergency medical evacuation
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$250,000 Limit per person per Policy Period – when adequate medical facilities and/or treatment is not available when traveling outside your current Country of Residence. (Pre-approval required.)
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repatriation of remains
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$25,000 Limit per person – when traveling outside your current Country of Residence. (Pre-approval required.)
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emergency medical reunion
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$10,000 Limit per person per Policy Period – when traveling outside your current Country of Residence. (Pre-approval required).
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preventive benefits
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Females and Males Age 19 and over up to $175 per Policy Period Maximum for checkups, routine physical exams, female preventative exams and mammograms after 12-month waiting period. Not subject to Deductible or Coinsurance.
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accidental death & dismemberment (ad&d)
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Principal Sum: $10,000 for Insured and Spouse, $2,000 for Dependent Children. For Common Carrier, Principal Sum: $40,000 for Insured and Spouse, $8,000 for Dependent Children.
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lifetime transplant benefit
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Up to $1,000,000 per Insured Person.
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Seven Corners offers additional benefit options for your review and possible selection. These are in addition to the standard Reside Prime program benefits and cannot be purchased independently.
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ad&d principal sum rider
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Reside Prime includes a standard Accidental Death & Dismemberment (AD&D) Principal Sum as mentioned above. Additional amounts are available to provide further protection should something happen to you or your family during your Policy Period.
For the primary insured, additional amounts of $100,000; $200,000; $300,000; $400,000 or $500,000 are available. Additional amounts may not exceed 7 times your annual income.
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dental rider
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Reside Prime offers an option for a Dental Rider. Whether you are at home or abroad, you now
have access to a dental package that will provide protection worldwide. Please see the Dental Rider below to see full benefit description.
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sports rider
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Your time spent abroad could include a few adventurous activities. The Sports Rider removes
the hazardous sport exclusion from Reside Prime. The optional Sports Rider provides coverage for mountaineering where ropes or guides are normally used, hang gliding, parachuting and bungee jumping.
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hospital daily indemnity rider
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The Hospital Daily Indemnity Rider protects you against unforeseen expenses worldwide
should you or a covered member of your family find yourself in the unfortunate position of a hospital admission. This option pays $150 (additional to standard benefit, if applicable) per night, should a covered Insured Person be admitted to a hospital for a covered condition in Geographical Treatment Area B under Reside Prime.
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who needs this plan?
U.S. Citizens: For U.S. citizens relocating or spending an extended amount of time overseas, security and flexibility are two essential ingredients of their medical program. There are thousands of medical insurance programs offered throughout the world, but there are many differences in the quality of both the programs and the insurance companies offering them. As U.S. citizens, we are accustomed to a certain degree of stability. Reside Prime is underwritten by an A "Excellent" rated insurance entity. Great care was taken to offer a program that gives insureds the same level of security abroad that they experience at home.
Foreign Nationals: A comprehensive plan providing protection in your home country, as well as the freedom to travel abroad is hard to find. Finding a program with these qualities offered by a secure company is next to impossible. The Reside Prime Worldwide Medical Plan combines the stability and financial strength of a superior underwriter with the flexibility of a universal policy.
eligibility
The Reside Prime program is available to persons of any country, who are at least 15 days of age and who have not yet reached age 75.
Applicants / Insured Person(s) in Geographical Treatment Area A must either be outside the United States and/or Canada at the time of Application, or must depart the United States and/or Canada within 30 days of the Certificate's Effective Date. In addition, the Insured Person(s) must reside outside the United States and/or Canada at least 6 months during any given 12-month period to meet the Eligibility Requirements of an Insured Person(s). If an Insured Person(s) resides in the United States and/or Canada longer than 6 months during any given 12-month period, their Coverage shall immediately terminate.
Applicants / Insured Person(s) in Geographical Treatment Area B must be outside the United States and/or Canada at the time of Application, or must depart the United States and/or Canada prior to the Certificate's Effective Date.
*It is the Insured Person's responsibility to maintain all records regarding travel history, age and student status and provide any documents to the Administrator, which would verify the Eligibility Requirements.
coverage locations
No matter where you live or travel, Reside Prime has the right solution to meet your needs. Reside Prime has two coverage areas from which to choose. If your plans include residing or traveling to the United States and Canada (Geographical Treatment Area A) and you would like to be covered in those two countries, that option is available. If your plans do not include residing in or traveling to the United States or Canada (Geographical Treatment Area B) and you would like to exclude coverage for any benefits available in those locations, a different premium schedule is available for purchase.
Make sure you are thorough in your selection. After a Geographical Treatment Area is chosen and purchased, changes are not available on the same certificate. If you believe you will spend any time in the United States or Canada, it is best to select the Worldwide Coverage option. (Geographical Treatment Areas A and B).
how long may i be covered under reside prime?
The Reside Prime program is annually renewable as long as the Eligibility Requirements are met and the renewal premium is received. There are no additional medical questions upon renewal.
The company cannot single out an individual for cancellation, they can only cancel coverage for an entire class * of insureds.
For those who continue coverage for an extended period of time (more than 36 months), Reside Prime provides for Extended Coverage Benefits. After an Insured Person is covered for 36 consecutive months and desires to continue coverage under Reside Prime, the Extended Coverage Schedule of Benefits shall become effective on the first day of the 37 th month of continuous coverage. The Extended Coverage Schedule of Benefits allows the Insured Person to continue coverage, as well as control premium increases for long-term coverage.
*A "class" is a group of people defined by a common characteristic, including but not limited to demographic group and geographic region.
applying for coverage
To apply, all you need to do is complete the application in full and pay the appropriate premium, given your age category, coverage area and desired deductible amount. Be sure to answer all sections and questions as completely, accurately, and as legibly as possible. The application you complete becomes part of your Certificate of Coverage should you be accepted. After the underwriters have had an opportunity to review the application, Seven Corners may request additional information from the applicant. If you are accepted, you will receive an ID Card confirming your effective date and conditions of acceptance, as well as a claim form and a Certificate of Coverage. The Certificate of Coverage describes the program in complete detail and how the insurance can be utilized. If you are ultimately not accepted, Seven Corners will return your premium without delay.
worldwide coverage
Reside Prime is designed to cover Insured Persons 24 hours a day, 7-days-a-week, regardless of where in the world they may be located (depending upon Geographical Treatment Area purchased). As an international citizen, you will no longer need to purchase multiple insurance programs in order to have seamless protection. Coverage
in the United States and/or Canada is limited to 6 months during any 12-month Policy Period.
renewability
The initial Period of Coverage cannot exceed twelve (12) months. The Insured Person may apply for renewal of coverage at the Renewal Rates in force at the time. The renewal Period of Coverage may not total more than twelve (12) months. Renewal(s) will be contingent upon the Insured Person submitting the applicable renewal premiums for their class, as determined by the Company. Renewal(s) will also be contingent upon the Insured Person declaring that they continue to meet the Eligibility Requirements.
After 36 months of continuous coverage, the Extended Coverage Schedule of Benefits shall become effective.
maternity
Reside Prime provides maternity and newborn child benefits to eligible Insured Persons. See Schedule of Benefits for limits and conditions. A pregnancy must be Pre-Notified during the first 90 days of the pregnancy. Failure to Pre-Notify a pregnancy will result in a 25% reduction in eligible benefits. The plan does not pay expenses related to a pregnancy within the first 12 months of coverage.
international traveler's benefit
When the Insured Person travels outside of their home country, in addition to the standard benefit, they will be covered for Emergency Medical Evacuation, Repatriation of Mortal Remains and Emergency Medical Reunion coverage (see Certificate of Coverage for details).
newborn child benefit
A Newborn Child(ren) will automatically be covered for the first thirty-one (31) days after birth, provided the mother remains eligible for coverage and the pregnancy was considered eligible as defined in the Certificate. In order to be considered for coverage beyond the first thirty-one (31) days and be accepted as any other Insured Person, Seven Corners must receive an application and any applicable premium within thirty-one (31) days of the birth of the Newborn Child(ren). If the application and premium are received within thirty-one (31) days and the Newborn Child(ren) meets the Eligibility Requirements, the Newborn Child(ren) will be accepted, subject to underwriting. In no event shall the Company's maximum liability exceed the maximum amount stated in the Schedule of Benefits.
limitations
Pre-existing Conditions: If an existing medical condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by an exclusionary rider, your pre-existing condition will be covered up to a lifetime maximum of $50,000 ($5,000 limit per year) after you have been continuously insured for 24 months.
Pre-existing conditions are any Injury or Illness that meets the following criteria: 1) A condition that would have caused a person to seek medical advice, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2) A condition for which manifestation, medical advice, diagnosis, care or treatment (including medication) was recommended or received prior to the Effective Date of coverage under this Certificate; 3) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate.
Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or in which symptoms occur during the first 180 days of coverage hereunder beginning on the initial effective date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne-related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder. Note: coverage for such illnesses or surgeries may be further limited under the pre-existing condition exclusion and definition contained herein, or other exclusions
contained herein.
The following conditions, treatments, supplies, services, and/or expenses are not covered. (This is a Summary of the Exclusions contained in the Certificate of Coverage.):
• Pre-existing conditions as defined above.
• Claims not presented to Company within ninety (90) days following incident.
• Treatment, that is not considered medically necessary, treatment that exceeds reasonable and customary charges, treatment provided at no cost to the Insured Person, or treatment performed by a relative or anyone who lives with the Insured Person.
• Experimental treatment.
• Suicide or any attempted suicide.
• War or warlike operations.
• Injury in organized, professional, amateur, or interscholastic athletics.
• Routine physicals or procedures.
• Treatment of Temporomandibular joint.
• Vocational, Speech, Recreational or Music Therapy.
• Cosmetic surgery except as a result of a covered accident.
• Dental or eye treatment unless otherwise covered.
• Injuries as a result of disablement due to liquor or drugs.
• Telephone consultations.
• Treatment or services relating to custodial, rehabilitative, or nursing home care.
• Congenital conditions.
• Non-medical expenses.
• Self-inflicted Injury or Illness.
• Expenses in connection with the commission or attempt of a criminal offense.
• Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing, SCUBA diving (unless PADI, NAUI, YMCA, SSI or PDIC certified). (A Sports Rider may be purchased to cover certain activities.)
• Treatment of venereal or sexually transmitted disease.
• Treatment due to HIV or AIDS.
• Drug treatment relating to infertility.
This brochure is only a brief description of Reside Prime. A complete description of the Master Policy Provisions and Benefits are contained in the Certificate of Coverage, which will be mailed to you after your application and premium have been received and approved by Seven Corners.
pre-notification program/ppo
To ensure you receive the best care possible, Reside Prime requires that the Insured Person (or someone on the Insured Person's behalf) contact Seven Corners Assist for notification prior to all hospital admissions worldwide and any medical expenses incurred within the United States that exceed $1,000 U.S. dollars. The methods of contacting Seven Corners Assist will appear on the back of your ID Card. Seven Corners Assist will also be able to assist you in locating the approved Seven Corners medical care providers in the United States.
Services and Treatment in the United States must be received at an approved PPO Service Provider facility, if one exists within a 50-mile radius of where the Insured Person is located. To obtain a list of approved PPO Service Providers contact Seven Corners Assist or visit the
approved PPO Service Provider website.
If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.
Failure to follow the Pre-Notification Program and to use an approved PPO Service Provider will result in a 25% reduction of the Eligible Benefits stated in the Schedule of Benefits.
Using a PPO Service Provider is not required when you are converted to Extended Coverage Schedule of Benefits. Seven Corners' Assistance Department is available to help you locate a provider in your area should you need Services and/or Treatment.
Annual Medical Premiums Effective February 1, 2009
worldwide coverage including united states and canada (geographical treatment areas a & b)
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If you choose a $250 Annual Deductible
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If you choose a $500 Annual Deductible
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If you choose a $1,000 Annual Deductible
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If you choose a $2,500 Annual Deductible
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If you choose a $5,000 Annual Deductible
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Age
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Male
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Female
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Male
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Female
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Male
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Female
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Male
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Female
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Male
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Female
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14 days through 18
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$483
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$483
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$394
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$394
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$309
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$309
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$279
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$279
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$250
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$250
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19 through 29
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$1,021
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$1,597
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$886
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$1,422
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$709
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$1,029
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$613
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$885
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$481
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$753
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30 through 39
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$1,101
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$1,763
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$942
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$1,588
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$762
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$1,150
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$662
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$1,010
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$520
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$838
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40 through 44
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$1,467
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$1,989
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$1,342
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$1,747
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$1,073
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$1,345
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$924
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$1,223
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$721
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$1,057
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45 through 49
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$1,698
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$2,039
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$1,531
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$1,885
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$1,182
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$1,474
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$1,063
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$1,307
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$869
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$1,082
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50 through 54
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$2,019
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$2,219
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$1,809
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$2,033
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$1,445
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$1,619
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$1,338
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$1,459
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$1,074
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$1,176
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55 through 59
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$2,629
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$2,554
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$2,327
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$2,319
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$1,900
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$1,773
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$1,609
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$1,564
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$1,350
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$1,308
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60 through 64
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$3,693
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$3,496
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$3,453
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$3,215
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$2,747
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$2,552
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$2,591
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$2,406
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$2,178
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$1,915
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65 through 69
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$7,386
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$6,641
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$7,125
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$6,242
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$6,622
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$5,675
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$5,119
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$4,724
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$4,496
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$4,144
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70
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$9,306
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$8,160
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$8,977
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$7,758
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$8,232
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$7,145
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$5,694
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$5,266
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$5,017
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$4,624
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71
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$9,865
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$8,650
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$9,516
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$8,223
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$8,725
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$7,574
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$6,035
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$5,582
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$5,318
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$4,901
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72
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$10,457
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$9,169
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$10,087
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$8,716
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$9,249
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$8,029
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$6,397
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$5,916
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$5,637
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$5,195
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73
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$11,084
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$9,719
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$10,692
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$9,239
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$9,804
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$8,510
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$6,781
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$6,271
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$5,975
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$5,507
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74
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$11,749
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$10,302
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$11,334
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$9,794
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$10,392
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$9,021
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$7,188
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$6,648
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$6,334
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$5,837
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Dep. Child
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$438
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$438
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$374
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$374
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$280
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$280
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$254
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$254
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$225
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$225
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worldwide coverage excluding united states and canada (geographical treatment area b)
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If you choose a $250 Annual Deductible
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If you choose a $500 Annual Deductible
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If you choose a $1,000 Annual Deductible
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If you choose a $2,500 Annual Deductible
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If you choose a $5,000 Annual Deductible
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Age
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Male
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Female
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Male
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Female
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Male
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Female
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Male
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Female
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Male
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Female
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14 days through 18
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$370
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$370
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$302
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$302
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$237
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$237
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$214
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$214
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$191
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$191
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19 through 29
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$771
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$1,206
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$670
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$1,074
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$535
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$776
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$463
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$669
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$363
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$569
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30 through 39
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$815
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$1,304
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$697
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$1,175
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$563
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$851
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$490
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$748
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$385
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$620
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40 through 44
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$1,093
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$1,482
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$999
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$1,302
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$799
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$1,002
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$689
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$911
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$537
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$788
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45 through 49
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$1,256
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$1,509
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$1,133
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$1,395
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$874
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$1,092
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$787
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$967
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$643
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$801
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50 through 54
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$1,524
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$1,676
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$1,365
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$1,535
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$1,091
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$1,223
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$1,010
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$1,102
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$810
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$888
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55 through 59
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$1,972
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$1,915
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$1,745
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$1,739
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$1,425
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$1,329
|
$1,207
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$1,173
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$1,013
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$980
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60 through 64
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$2,751
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$2,605
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$2,573
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$2,395
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$2,046
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$1,901
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$1,930
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$1,793
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$1,624
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$1,427
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65 through 69
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$5,465
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$4,914
|
$5,273
|
$4,620
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$4,901
|
$4,199
|
$3,788
|
$3,496
|
$3,327
|
$3,067
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|
70
|
$6,980
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$6,120
|
$6,733
|
$5,818
|
$6,174
|
$5,359
|
$4,270
|
$3,949
|
$3,763
|
$3,468
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|
71
|
$7,398
|
$6,488
|
$7,137
|
$6,167
|
$6,544
|
$5,681
|
$4,526
|
$4,189
|
$3,988
|
$3,676
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|
72
|
$7,842
|
$6,877
|
$7,565
|
$6,537
|
$6,937
|
$6,021
|
$4,798
|
$4,437
|
$4,228
|
$3,896
|
|
73
|
$8,313
|
$7,289
|
$8,019
|
$6,930
|
$7,353
|
$6,383
|
$5,806
|
$4,704
|
$4,481
|
$4,130
|
|
74
|
$8,812
|
$7,727
|
$8,500
|
$7,345
|
$7,794
|
$6,766
|
$5,391
|
$4,986
|
$4,750
|
$4,378
|
|
Dep. Child
|
$333
|
$333
|
$285
|
$285
|
$214
|
$214
|
$193
|
$193
|
$171
|
$171
|
premiums for optional benefits
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AD&D Principal Sum Rider:
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Dental Rider:
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Sports Rider:
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Hospital Indemnity Benefit Rider:
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Benefit
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Annual Premium
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$100,000
|
$143
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$200,000
|
$286
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$300,000
|
$429
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$400,000
|
$572
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$500,000
|
$715
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Child $10,000
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$15
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See application for limits per person
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For U.S. Citizens:
$359 annually per person
For non-U.S. Citizens:
$508 annually per person
(if selected for one, then all applicants must purchase the option)
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$240 annually per person
(if selected for one, then all applicants must purchase the option)
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Benefit is $150 per night for a
covered hospital admission, maximum 30 nights per policy
period.
$145 annually per person
(if selected for one, then all applicants
must purchase the option)
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*The Dependent Child Premium is only available when one parent (legal guardian), of a natural or legally adopted unmarried child over 14 days old and under 19 years of age (or under 24 years of age if attending a university full-time and must rely on parents
for support), is also covered under the same program. No medical premium is charged for the first two (2) Dependent Children between the ages of 14 days and 9 years old if both parents are also covered under the same program.
If the Applicant desires to pay premiums on a Semi-Annual, Quarterly or Monthly basis, they must do so by credit card payment only. Seven Corners will automatically debit the credit card on the due date of the premium installment. The Premium Installment Factors to be applied to the Annual Premium are as follows:
Annual 1 .00 / Semi-Annual 0.55 / Quarterly 0.28 / Monthly 0.10
IMPORTANT NOTICE: The premiums referenced above are applicable for the initial 12-month coverage period, only after the Applicant has been accepted by Seven Corners. Seven Corners reserves the right to increase the stated premiums based upon the Applicant's medical condition at the time of application and underwriting. Applicants with chronic and/or severe medical conditions may be declined. At each renewal period, Seven Corners will inform the Applicant of the renewal premium for each subsequent coverage period based upon the Applicant's age and deductible category.
Attention Applicants: Certain Underwriters at Lloyd's of London, operates as an approved Surplus Lines market in the United States. The premiums listed above include a general Surplus Lines Tax. Your State of Residence may warrant an additional Surplus Lines Tax, Stamping Fees and administration fee. Upon receipt and review of your application, Seven Corners will inform you if additional Surplus Lines Taxes and fees will apply. If so, Seven Corners will request the payment of the additional Surplus Lines Taxes and fees from you prior to issuing coverage. The additional Surplus Lines Taxes and fees shall be listed on the declaration page of your policy.
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After 36 months of continued coverage under Reside Prime, the following Extended Coverage Schedule of Benefits shall apply to eligible expenses beginning on the 1st day of the 37th month. All other conditions of the policy shall continue to apply.
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lifetime maximum benefit
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$2,500,000 per Insured Person.
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policy period deductible options
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$500; $750; $1,250; $2,750; $5,250
Maximum of 3 deductible payments for families enrolling on one application. Any eligible charges incurred and applied to your Policy Period deductible in the last 30 days prior to your renewal date will carry over and be applied to the next Policy Period Deductible.
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inside of the united states and canada (geographical treatment area a)
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After the Deductible, the Policy pays 80% of the next $5,000 of eligible expenses, then 100% up to the Policy Maximum. Expenses incurred inside the United States and Canada must be Pre-Notified using Seven Corners' Pre-Notification Program.
If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.
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outside of the united states and canada (geographical treatment area b)
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After the Deductible, the Policy pays 90% of eligible expenses to the Policy Maximum. Hospital Admissions must be Pre-Notified using Seven Corners' Pre-Notification Program.
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inpatient hospital expenses
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Average Semi-Private room and board; Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-Rays, up to a limit of $2,000 per day, up to the Policy Maximum.
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intensive care
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Intensive Care room and board; Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-rays, up to a limit of $4,000 per day, up to the Policy Maximum.
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surgery
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Usual, Reasonable, and Customary (URC) Charges for Surgery and Physician up to the Policy Maximum. Anesthetics limited to one provider for a maximum benefit of 20% of the amount billed and eligible primary surgeons charge.
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hospital daily indemnity benefit (geographical treatment area b)
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$50 per day ($1,000 maximum per Policy Period), for every Medically Necessary night spent in a Hospital (Hospital Admission) outside of the United States and Canada. An additional Daily Indemnity Benefit Rider may be purchased to increase this benefit limit to $200.
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outpatient treatment
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Usual, Reasonable, and Customary (URC) Charges for Surgery up to the Policy Maximum.
Emergency Room Treatment:
- Physician Charges, limit of $150 per visit
- Hospital Charge, $100 co-pay unless admitted, then waived
- Urgent Care Facility, $25 co-pay
- Diagnostic Lab and X-Rays limited to $5,000 per Policy Period
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physiotherapy, chiropractic
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Up to $75 per visit, $1,000 maximum per Policy Period ($10,000 Lifetime Maximum), when referred in advance by a Physician.
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medical supplies
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Usual, Reasonable, and Customary (URC) Charges up to Policy Maximum.
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ambulance
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$100 per incident.
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well child care
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Up to $200 per Policy Period Maximum for checkups and routine visits after 12-month waiting period. Up to age 18. Not subject to Deductible and Coinsurance.
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maternity
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Usual, Reasonable, and Customary (URC) Charges up to limits below per Pregnancy, must be Pre-Notified within the first 90 days of Pregnancy. Waiting period of 12 months before maternity benefit begins.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000
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mental & nervous
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$2,000 maximum per Policy Period. Inpatient limited to a maximum of 25 days per policy period. Outpatient limited to a maximum of 20 visits per policy period, at 70% of eligible expenses, up to $75 maximum per visit. Lifetime maximum of $30,000.
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newborn benefit
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Maximums listed below per eligible pregnancy for the first 31 days after birth.
After 12 months of continuous policy term: $1,000
After 24 months of continuous policy term: $2,000
After 36 months of continuous policy term: $3,000
After 48 months of continuous policy term: $4,000
After 60 months of continuous policy term: $5,000
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dental
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Usual, Reasonable, and Customary (URC) Charges for repair and replacement of sound, natural teeth damaged as a result of an accident, limited to $500 per Policy Period. A Dental Benefit Rider may be purchased to expand Dental Coverage.
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emergency medical evacuation
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$250,000 Limit per person per Policy Period – when adequate medical facilities and/or treatment is not available and when traveling outside your current Country of Residence. (Pre-approval required.)
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repatriation of remains
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$15,000 Limit per person – when traveling outside your current Country of Residence. (Pre-approval required.)
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emergency medical reunion
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$10,000 Limit per person per Policy Period – when traveling outside your current Country of Residence. (Pre-approval required.)
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preventive benefits
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Females and Males Age 19 and over up to $175 per Policy Period Maximum for checkups, routine physical exams, female preventative exams and mammograms after 12-month waiting period. Not subject to Deductible or Coinsurance.
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accidental death & dismemberment (ad&d)
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Principal Sum: $10,000 for Insured and Spouse, $2,000 for Dependent Children. For Common Carrier, Principal Sum: $40,000 for Insured and Spouse, $8,000 for Dependent Children.
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lifetime transplant benefit
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Up to $500,000 per Insured Person.
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chemotherapy or radiation therapy
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Up to $10,000 per year, Lifetime Maximum of $50,000.
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prescription medications
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Limit of $5,000 per Policy Period for each Insured Person, outpatient only.
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important information
It is important to note that Reside Prime is a program for international citizens and Lloyd's of London is an international entity. Thus, Lloyd's of London operates as an unauthorized insurer in most U.S. states. Coverage and benefits under Reside Prime are not regulated by any U.S. state insurance department.
The information concerning Reside Prime is not intended to be an offer to sell Reside Prime or a solicitation by Seven Corners, Inc. or Lloyd's of London in any jurisdiction where any such action would be unlawful or in which Seven Corners or Lloyd's of London is not qualified to do so. Reside Prime may not be available in all situations or jurisdictions. For U.S. citizens, Reside Prime is intended for persons living or traveling outside the United States.
the underwriter
Reside Prime is underwritten by Certain Underwriters at Lloyd's of London and is rated A "Excellent" by A.M. Best and an A+ (Strong) rating from Standard & Poor's. In addition to being one of the largest insurance entities in the world, Lloyd's of London has over 300 years of experience in the international insurance business.
the program administrator
Properly serving the medical needs of international citizens requires specialization. Most companies are not prepared to meet the unique requirements of these customers. An organization must be equipped to address foreign currencies, international doctors and hospitals, as well as unusual claim forms and documents. The Reside Prime Medical Plan is administered worldwide by Seven Corners, Inc. The professionals at Seven Corners have over 250 years of experience in claim processing and administration. Seven Corners currently serves the needs of thousands of policyholders throughout the world.
seven corners
Since 1993, Seven Corners, Inc. has provided international insurance plans to private citizens, governments, missionaries, students, and corporations of various nations around the globe. As a premier underwriter, Seven Corners has had the opportunity to provide innovative solutions to unique and challenging situations.
Their claims professionals are experienced in the complexity of processing international medical expenses. As an insured of Seven Corners, you can feel confident that there is someone ready to assist you with a medical situation 24 hours a day, 365 days a year.
Other services include proficient administration, responsive underwriting, and access to secure and stable insurance carriers and medical care providers worldwide.
seven corners assist
When Unpronounceable Diseases Occur In Unpronounceable Countries: 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.
Foreign Country – Familiar Service: In today's world, companies and international citizens must operate in strange lands and challenging environments. In some situations, individuals must travel to developing regions where the quality of care is in question. In effort to alleviate these concerns, proper worldwide medical assistance is essential.
Quality Of Care: With access to a network of emergency room physicians, Seven Corners Assist is able to effectively evaluate the quality of local care. The Seven Corners Assist physician will consult with the attending physician (if available) to review local standards and discuss the proposed course of treatment. If the quality of care is in question, Seven Corners Assist will arrange medical transportation to a location where adequate care can be rendered.
A Description Of Services: The following services are available 24 hours a day, 7 days a week from a multilingual staff of service professionals.
Assistance With Travel
pre-trip information: Provide information concerning inoculation and visa requirements for countries worldwide
weather information: Concerning local weather conditions
exchange rate information: Present day currency rates, etc.
embassy referral: Providing contact information for the nearest embassies around the world
interpreter referral: Contact information for interpreters around the world
lost passport: Provide directions for lost passport recovery to insureds while traveling outside of their home country
emergency message: In the event of a medical emergency, assistance in relaying urgent messages to family, friends, or business associates at the insured's request
hotel accommodation: In case of insured's hospitalization outside of their home country, assistance in locating hotel accommodation for insured's companion
Medical Assistance While Traveling
24-hour telephone contact: Should medical emergencies arise, there is help in locating medical care
conference calls: Arranging telephone conferences between your attending and home physicians
second opinions: Arranging second medical opinions in hospital cases
emergency messages: Relaying emergency messages to family and employer during medical emergencies
payment guarantee: Guarantee or payment of medical bills or authorizing medical benefits according to the program for eligible benefits only
ticketing services: 24-Hour ticketing service to arrange emergency family visits
medical evacuations: Arranging emergency medical evacuation from medically underserved areas
repatriation: Arranging medical transportation home after treatment
medical / travel escorts: Arranging escorts and transportation for unaccompanied children
medical records: Arranging transfer of medical records
remains return: Arranging repatriation of remains for deceased travelers
Seven Corners
303 Congressional Boulevard
Carmel, IN 46032
Certain Underwriters at Lloyd's of London
Rated A "Excellent" by A.M. Best
A+ "Strong" by Standard & Poor's
Insubuy ®, Inc.
4700 Dexter Dr, Suite 100
Plano, TX 75093
Phone: (866) INSU-BUY or (972) 985-4400
Fax: (972) 767-4470
Web site: insubuy.com
The benefits described in the three classes below are reimbursed subject to the limitations and limits stated in the Schedule of Benefits.
Class I: Preventative
• Oral exams, limit two per Policy Period
• Full mouth x-rays, limit one every six months
• Bitewing x-rays, limit one per Policy Period
• Cleaning and scaling of teeth (oral prophylaxis) limit one every six months
• Topical fluoride treatment limit one per Policy Period, children up to age 12
• Space maintainers
• Sealants, children up to age 12
Class II: Basic Restoration, Endodontic, Periodontal, Oral Surgery, Diagnostic Benefit Dental Services
• Fillings – amalgam, silicate, acrylic, synthetic porcelain or composite fillings
• X-rays
• Extractions
• Root canal treatment
• Treatment of periodontal disease and other disease of the gums and tissues of the mouth
• Oral surgery except procedures covered under any medical plan
• Administration of general anesthesia, when medically necessary in connection with oral surgery
• Emergency palliative treatment
• Injections of antibiotic drugs
Class III: Crowns, Bridges, Dentures
Include necessary supplies and services of a physician for installation or replacement of one or more natural teeth, which are lost for:
• Initial Installation of fixed bridgework
• Installation for the first time of: (a) a partial removable denture; or (b) a full removable denture
• Replacing an existing removable denture or fixed bridgework if: (a) it is needed because of loss of one or more natural teeth after the existing denture or bridgework was installed; or (b) it is needed because of the existing denture or bridgework can no longer be used and was installed at least 5 years prior to its replacement
• Replacing an existing immediate temporary full denture by a new permanent full denture when: (a) the existing denture cannot be made permanent; and (b) the permanent denture is installed within 12 months after the existing denture was installed
• Adding teeth to an existing partial removable denture or to bridgework when needed to replace one or more natural teeth removed after the existing denture or bridgework was installed
• Inlays and onlays
• Crowns and their replacements, but not more than one replacement per crown every five years
• Repair or re-cementing of: (a) crowns; or (b) inlays or onlays; or (c) dentures; or (d) bridgework
Exclusions
• Class II and Class III expenses during the first three months from the effective date
• Cosmetic surgery or supplies
• Services and expenses that are payable under the certificate, to which this option is attached
• Replacement of lost, missing or stolen crowns, bridges or dentures
• Repair or replacement of orthodontic appliances
• Plaque control programs, oral hygiene or dietary instructions
• Services and expenses that are not specifically defined as covered
• Services or supplies which do not meet general accepted dental standards
• Experimental treatment
• Services and expenses excluded under the certificate's exclusion section, unless otherwise covered herein
• Missing teeth
• Personalization of dentures
• Implantology
• Treatment for Temporomandibular joint disorders (TMJ) and complications therefrom
• Bleaching
Pre-Notification and Alternate Treatment
If dental expenses are expected to exceed the amount of $250, prior to commencing treatment, the insured person must notify Seven Corners for amounts to be covered or an approved alternate (which are customarily used, deemed by professions to be appropriate and less costly):
• Work to be done
• Cost of treatment
Scheulde of Benefits
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Policy Period Year 1
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Policy Period Year 2
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Policy Period Year 3
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Class I:
Preventative for Children ages 8 through 17 (after 3 months waiting period)
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Program pays up to 100% of Usual,Reasonable and Customary Charges
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Program pays up to 100% of Usual,Reasonable and Customary Charges
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Program pays up to 100% of Usual,Reasonable and Customary Charges
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Class II:
Standard Benefits (after 6 month waiting period)
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Program pays up to 55% of Usual,Reasonable and Customary Charges
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Program pays up to 70% of Usual,Reasonable and Customary Charges
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Program pays up to 85% of Usual,Reasonable and Customary Charges
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Class III:
Significant Dental Benefits(after 6 month waiting period)
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Program pays up to 30% of Usual,Reasonable and Customary Charges
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Program pays up to 40% of Usual,Reasonable and Customary Charges
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Program pays up to 50% of Usual,Reasonable and Customary Charges
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Dental Benefit Deductible
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$100 per policy period per insured person
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$100 per policy period per insured person
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$100 per policy period per insured person
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Dental Benefit Maximum
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$500 per policy period per insured person
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$750 per policy period per insured person
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$1000 per policy period per insured person
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Premiums
For U.S. citizens: $359 annually per person
For non-U.S. citizens: $508 annually per person
(if selected for one, then all family members must purchase the option)
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