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Atlas America®

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

5 Days to 364 Days

If travel excludes USA, see Atlas International Group – Travel Medical Insurance.

The Atlas America Group plan is with you and your group of 5 or more almost anywhere you may travel in the world. Atlas America Group coverage is designed for mission trips, large family vacations, student groups, corporate groups, and overseas excursions for other large organizations.

Why Choose Atlas America Group?

Whatever the reason, traveling internationally with a large group should be a pleasant experience. Emergencies and complications such as natural disasters, injury, and illness are a fact of life, and can be even tougher to manage for a large group of people. While we hope none of these incidents happen... we’re here to help if they do. Coverage for medical expenses in case of hospitalization – including a stay in an intensive care unit or outpatient treatment – Emergency Medical Evacuation, and Lost Checked Luggage are just some of the benefits you can count on from Atlas America Group.

My family has medical insurance in our home country; do we need group travel medical insurance?

Often, the primary medical insurance in your home country will not cover you and your family while traveling internationally, and medical expenses can be very costly while abroad. Atlas America Group plans offer budget-friendly coverage—plans start at less than $1 a day!

Additionally, Atlas America Group includes important travel assistance services such as translation assistance while being treated, doctor and hospital referrals, and assistance replacing lost prescriptions.

After purchasing coverage, how can I trust the company to be there if I need them?

Tokio Marine HCC – MIS Group, headquartered in the United States in Indianapolis, Indiana, is a full-service company offering international medical insurance products designed to meet needs of consumers worldwide.

Tokio Marine HCC is a leading specialty insurance group conducting business in approximately 180 countries and underwriting more than 100 classes of specialty insurance. Headquartered in Houston, Texas, the company is made up of highly entrepreneurial teams equipped to underwrite special situations, companies and individuals, acting independently to deliver effective solutions. Our products and capabilities set the standard for the industry, as many of our nearly 2,500 employees are industry-leading experts. Tokio Marine HCC is part of Tokio Marine, a premier global company with a market cap of approximately $30 billion.* Tokio Marine HCC holds a financial strength rating of AA- for Standard & Poor’s and Fitch Ratings and A++ (Superior) by A.M. Best Company.

For more information about Atlas America Group , please call us.

*At the time of printing. For more information on these ratings, please visit: www.standardandpoors.com, www.ambest.com, and www.fitchratings.com.

Atlas America Group Schedule of Benefits and Limits

PLAN DETAILS
Deductibles$0, $100, $250, $500, $1,000, $2,500 or $5,000 per certificate period.
Overall Maximum LimitAge 80 or older - $10,000; Age 70 to 79 - $50,000, $100,000 or $250,000; All others - $50,000, $100,000, $250,000, $500,000, $1,000,000 or $2,000,000.
Coinsurance – Claims Incurred in U.S.
      In-Network PaymentWithin the PPO: We will pay 100% of eligible expenses, after the deductible, to the overall maximum limit.
      Out-of-Network PaymentOutside the PPO: Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount.
Coinsurance – Claims Incurred Outside U.S.We will pay 100% of eligible expenses after the deductible up to the overall maximum limit.
Eligible expenses are subject to deductible, coinsurance, overall maximum limit, and are per certificate period unless specifically indicated otherwise.
BENEFITLIMIT
Hospital Room and BoardAverage semi-private room rate, including nursing services.
Local AmbulanceUsual, reasonable and customary charges, when covered illness or injury results in hospitalization as inpatient.
Intensive Care UnitUp to the overall maximum limit.
Emergency Room Co-paymentClaims Incurred in U.S
You shall be responsible for a $200 co-payment for each use of emergency room for an illness unless you are admitted to the hospital. There will be no copayment for emergency room treatment of an injury.
Claims incurred outside the U.S.
No co-payment
Urgent Care CenterClaims Incurred in U.S.
For each visit, you shall be responsible for a $25 co-payment, after which coinsurance will apply.
– co-payment is waived for members with a $0 deductible
– not subject to deductible

Claims incurred outside the U.S.
No co-payment
Outpatient Physical Therapy and Chiropractic CareUp to $50 maximum per day. Must be ordered in advance by a physician – not subject to coinsurance.
All Other Eligible Medical ExpensesUp to the overall maximum limit.
Acute Onset of Pre-existing Condition (excludes chronic and congenital conditions) (only available to members under age 70)Up to the overall maximum limit.
Up to $25,000 lifetime maximum for Emergency Medical Evacuation.
TerrorismUp to $50,000 lifetime maximum. Eligible medical expenses only.
Emergency Dental (Acute Onset of Pain)Up to $250 – not subject to deductible or coinsurance
Emergency Eye Exam for a Covered LossUp to $150. $50 deductible per occurrence (plan deductible is waived). – not subject to coinsurance
EMERGENCY TRAVEL BENEFITSLIMIT
Emergency Medical EvacuationUp to $1,000,000 lifetime maximum, except as provided under Acute Onset of Pre-existing Condition.
– not subject to deductible, coinsurance, or overall maximum limit
Return of Minor ChildrenUp to $50,000 – not subject to deductible or coinsurance
Pet ReturnUp to $1,000 – not subject to deductible or coinsurance
Repatriation of RemainsUp to the overall maximum limit – not subject to deductible or coinsurance
Emergency ReunionUp to $100,000, subject to a maximum of 15 days – not subject to deductible or coinsurance
Natural Disaster – Replacement AccommodationsUp to $250 a day for 5 days – not subject to deductible or coinsurance
Trip InterruptionUp to $10,000 – not subject to deductible or coinsurance
Trip DelayUp to $100 a day after a 12-hour delay period requiring an unplanned overnight stay. Subject to a maximum of 2 days. – not subject to deductible or coinsurance
Lost Checked LuggageUp to $500 – not subject to deductible or coinsurance
Political EvacuationUp to $100,000 lifetime maximum – not subject to deductible or coinsurance
Accidental Death and Dismemberment (excludes loss due to common carrier accident)
$250,000 maximum benefit any one family or group.
– not subject to deductible, coinsurance, or overall maximum limit
      Ages 18 through 69Lifetime Maximum - $50,000
Death - $50,000
Loss of 2 Limbs - $50,000
Loss of 1 Limb - $25,000
      Under age 18Lifetime Maximum - $5,000
Death - $5,000
Loss of 2 Limbs - $5,000
Loss of 1 Limb - $2,500
      Ages 70 through 74Lifetime Maximum - $12,500
Death - $12,500
Loss of 2 Limbs - $12,500
Loss of 1 Limb - $6,250
      Ages 75 and olderLifetime Maximum - $6,250
Death - $6,250
Loss of 2 Limbs - $6,250
Loss of 1 Limb - $3,125
Common Carrier Accidental Death
      Ages 18 through 69
      Under age 18
      Ages 70 through 74
      Ages 75 and older

$50,000
$25,000
$12,500
$6,250
Subject to a maximum of $250,000 any one family or group.
- not subject to deductible, coinsurance, or overall maximum limit
Crisis Response - Ransom, Personal Belongings, and Crisis Response Fees and ExpensesUp to $10,000 – not subject to deductible, coinsurance, or overall maximum limit
Hospital Indemnity$100 per day of inpatient hospitalization – not subject to deductible or coinsurance
Personal LiabilityUp to:
$10,000 lifetime maximum
$10,000 third person injury
$10,000 third person property
$2,500 related third person property
– not subject to deductible, coinsurance, or overall maximum limit
Bedside VisitUp to $1,500 – not subject to deductible or coinsurance
Border Entry ProtectionUp to $500 if traveling on a valid B-2 visa a at the U.S. border
not subject to deductible or coinsurance

What's Covered by Atlas America Group?

International Coverage

Emergency Medical Evacuation and Emergency Reunion

Would you know what to do if you found yourself in a life-threatening situation far from home? We are experienced in arranging emergency medical evacuations. Atlas America Group will cover eligible expenses necessary to transport you from an initial treating facility to the nearest hospital qualified to treat your life-threatening condition. We also understand the importance of family support in these difficult situations. Atlas America Group will also cover the transportation, lodging, and meal costs for a relative to join you after a covered emergency medical evacuation, up to the lifetime limit.

Repatriation of Remains

What would your family do if disaster strikes while you are away from home? The death of a loved one is never easy, no matter the circumstances. In the unfortunate event of your death while traveling abroad, Atlas America Group will arrange for and cover the costs associated with the repatriation of your remains.

Return of Minor Children

If you are expected to be hospitalized for more than 36 hours due to a covered injury or illness, and covered children under 18 years of age will be left unattended as a result, Atlas America Group will cover the transportation cost for the children to return home.

Terrorism

In these turbulent times, the risk of a terrorist attack is a reality. If you are in the wrong place at the wrong time, and the country you’re visiting is NOT under a level 3 or level 4 travel advisory, Atlas America Group offers coverage for eligible medical expenses resulting from those acts. Coverage excludes countries for which the U.S. Department of State has issued a a level 3 (“reconsider travel”) or level 4 (“do not travel”) advisory.

Political Evacuation

If, during the coverage period and after your arrival, the United States government issues level 3 or level 4 travel advisory for your destination country, Atlas America Group will coordinate your alternate departure arrangements from that country and cover eligible associated costs.

Natural Disaster Benefit – Replacement Accommodations

Natural disasters can happen anywhere and at any time. If a natural disaster occurs while on your trip, causing you to become displaced from your accommodations, Atlas America Group will provide relief of a maximum of $250 a day for 5 days to help cover the costs of alternative accommodations.

Hospital Indemnity

If you are hospitalized, the world around you does not stop. What’s more, in some places hospitals do not provide their patients basic necessities like meals, toothpaste or soap. If you are hospitalized as an inpatient for treatment of a covered illness or injury, Atlas America Group will provide $100 for each night you spend in the hospital.

Atlas America Group* Quality Benefits

Acute Onset of Pre-Existing Conditions

Atlas America Group* provides a limited benefit up to the medical coverage lifetime maximum for eligible medical expenses. If you are younger than 70, you may be covered for an acute onset of a pre-existing condition. This also includes up to a $25,000 lifetime maximum for emergency medical evacuation.

An acute onset of a pre-existing condition is a sudden and unexpected outbreak or recurrence of a pre-existing condition which occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. Chronic and congenital conditions are excluded from coverage.

Hospitalization & Outpatient Treatment

If a covered illness or injury requires hospitalization, the plan provides coverage for eligible costs associated with hospitalization, including intensive care unit and outpatient treatment.

Sports Coverage

Atlas America Group includes coverage for eligible injuries and illnesses that could occur while participating in many popular vacation sports - skiing, snowboarding, snorkeling, water skiing, and others - at no additional cost. Certain extreme sports are excluded from coverage.

Complications of Pregnancy

Atlas America Group offers coverage for complications of pregnancy during the first 26 weeks of gestation.

Crisis Response

Atlas America Group offers up to $10,000 (or up to $100,000 if **additional coverage is selected) to offset costs associated with kidnapping, such as ransom, crisis response expenses, and loss of personal belongings. This benefit includes access to the services of Unity Crisis Group for advice, coordination with law enforcement, and negotiations during a kidnapping.

** A buy-up of an additional $90,000 is available for selection, which includes the added benefit of a $10,000 maximum for natural disaster evacuation

Personal Liability

Atlas America Group offers up to $10,000 (or up to $100,000 if additional coverage is selected) to offset the following types of court-entered eligible judgments or approved settlements incurred by the member:

  • Third-party injury
  • Damage/loss of a third party’s personal property
  • Damage/loss of a related third party’s personal property

Home Country Coverage

Incidental Home Country Coverage

For individuals with U.S. as home country, for every three-month period during which the Member is covered hereunder, medical expenses incurred in the U.S. are covered up to a maximum of 15 days.

For individuals with a home country other than the U.S., for every three-month period during which the Member is covered hereunder, medical expenses incurred in the member’s home country are covered up to a maximum of 30 days.

Any benefit accrued under a single three-month period does not accumulate to another period. Failure of the member to continue his or her international trip or the members return to their home country for the sole purpose of obtaining treatment for an illness or injury that began while traveling shall void any home country coverage provided under the terms of this agreement.

Benefit Period Medical Coverage

While the certificate is in effect, the benefit period does not apply. Upon termination of the certificate, underwriters will pay eligible medical expenses, as defined herein, for up to 90 days beginning on the first day of diagnosis or treatment of a covered injury or illness while the member is outside his or her home country and while the certificate was in effect. The benefit period applies only to eligible medical expenses related to the injury or illness that began while the certificate was in effect.

Enrollment and Filing a Claim

Enrollment

You may access the online quoting and purchasing system or you may complete an application and mail or fax along with your payment to us.

Claim Filing

You may file a claim by submitting a claimant’s statement and authorization form. This form may be found online or you may contact us for a copy. Complete the form, attach all itemized invoices and payment receipts, and send them to the address shown on the claimant’s statement.

*The description of coverage in these pages is for informational purposes only. Actual coverage will vary based the terms and conditions of the policy issued. The information described herein does not amend or otherwise affect the terms and conditions of any insurance policy issued by the administrator or its affiliates. In the event that a policy is inconsistent with the information described herein, the language of the policy will take precedence.
**A pre-existing condition is any condition:
• for which medical advice, diagnosis, care, or treatment was recommended or received within 2 years prior to your effective date of coverage
• which would cause a reasonably prudent person to seek medical advice, diagnosis, care, or treatment within 2 years prior to your effective date of coverage
• that existed (with reasonable medical certainty) with 2 years prior to your effective date of coverage, whether or not it was known to you
***A buy-up of an additional $90,000 is available for selection, which includes the added benefit of a $10,000 maximum for natural disaster evacuation.

Outstanding Customer Service

Client Zone and World Service Center

Client Zone is an online account management and resource tool available to:

  • Extend coverage and reprint ID cards
  • Obtain details about claim filing and downloading forms
  • Locate providers within the PPO Network

You can access Client Zone by logging in the Client Center

If you prefer to speak to a professional service representative, contact us by calling toll-free from various countries. The World Service Center can provide service in many different languages.

7 days a week, 365 days a year Worldwide Travel and Medical Assistance

Atlas America Group includes valuable travel and medical assistance services, which are available 7 days a week, 365 days a year.

Pre-Trip Destination Information

Up-to-date information regarding required vaccinations, health risks, travel restrictions, and weather conditions specific to the destination country.

Medical Monitoring

Consultations with attending medical professionals during hospitalization and establishment of a single point-of-contact for family members to receive ongoing updates regarding medical status.

Provider Referrals

Contact information for Western-style medical facilities, medical and dental practices, and pharmacies in the destination country.

Travel Document Replacement

Assistance with obtaining replacement passports, birth certificates, visas, airline tickets, and other travel-related documents.

Lost Luggage Assistance

Tracking service to assist in locating luggage or other items lost in transit.

Other Travel Assistance Services*

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

*For a complete list of available assistance services or for more information, please contact the administrator. Travel and Medical Assistance Services are not insurance benefits. Any travel or medical assistance service provided is not a guarantee of any insurance benefit.

Rates

Atlas Group® America - For Non-US Citizens traveling to the U.S. (Groups of 5-24 People)

$0 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.481.892.142.692.922.98
30-392.022.793.323.543.743.81
40-492.993.734.285.075.545.65
50-594.455.617.078.008.408.56
60-645.186.809.2310.0310.5010.71
65-695.877.5210.3111.1611.6611.89
70-798.4610.8412.38N/AN/AN/A
80+*13.47N/AN/AN/AN/AN/A
$100 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.311.671.882.382.572.62
30-391.772.472.933.123.293.35
40-492.633.283.774.464.884.97
50-593.924.926.237.047.397.52
60-644.555.988.128.839.239.41
65-695.176.629.069.8210.2610.47
70-797.449.5310.90N/AN/AN/A
80+*11.85N/AN/AN/AN/AN/A
$250 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.191.511.712.152.342.39
30-391.612.232.662.842.993.05
40-492.392.993.434.054.434.52
50-593.564.485.666.406.726.85
60-644.155.447.388.028.408.56
65-694.706.018.248.929.339.51
70-796.778.669.92N/AN/AN/A
80+*10.77N/AN/AN/AN/AN/A
$500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.061.361.541.942.112.14
30-391.442.022.392.542.702.75
40-492.152.683.093.654.004.07
50-593.204.035.095.756.056.17
60-643.734.906.647.227.567.71
65-694.235.417.428.048.408.56
70-796.097.808.97N/AN/AN/A
80+*9.70N/AN/AN/AN/AN/A
$1000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y0.951.221.371.721.871.91
30-391.291.792.122.272.392.44
40-491.902.392.743.243.553.62
50-592.843.584.535.115.365.47
60-643.314.365.906.426.726.85
65-693.754.816.597.147.467.61
70-795.416.938.02N/AN/AN/A
80+*8.61N/AN/AN/AN/AN/A
$2500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y0.831.051.201.511.631.67
30-391.131.581.861.992.102.13
40-491.672.092.392.843.113.17
50-592.483.133.964.484.704.79
60-642.913.825.175.625.885.99
65-693.294.215.776.256.536.66
70-794.746.087.14N/AN/AN/A
80+*7.54N/AN/AN/AN/AN/A
$5000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y0.690.911.061.351.461.49
30-390.941.361.651.771.881.91
40-491.401.812.122.532.782.84
50-592.072.713.504.004.204.29
60-642.423.304.575.015.265.37
65-692.743.655.105.575.845.97
70-793.965.266.32N/AN/AN/A
80+*6.30N/AN/AN/AN/AN/A

Atlas Group® America - For Non-US Citizens traveling to the U.S. (Groups of 25+ People)

$0 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.391.792.022.542.752.81
30-391.902.643.143.343.533.60
40-492.823.524.054.795.245.34
50-594.205.306.687.567.938.08
60-644.906.438.719.479.9210.12
65-695.547.109.7310.5411.0211.23
70-797.9910.2311.69N/AN/AN/A
80+*12.72N/AN/AN/AN/AN/A
$100 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.231.571.782.242.422.47
30-391.672.332.762.953.103.16
40-492.483.093.564.224.614.69
50-593.704.655.886.656.987.11
60-644.305.647.678.348.728.89
65-694.886.258.569.279.699.89
70-797.039.0010.29N/AN/AN/A
80+*11.19N/AN/AN/AN/AN/A
$250 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.121.431.622.032.212.25
30-391.522.112.512.682.822.88
40-492.252.823.243.834.184.27
50-593.364.235.356.046.356.47
60-643.925.136.977.577.938.08
65-694.445.687.788.428.818.98
70-796.398.189.37N/AN/AN/A
80+*10.17N/AN/AN/AN/AN/A
$500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y1.001.281.451.841.992.02
30-391.361.902.252.402.552.59
40-492.032.532.923.443.773.84
50-593.023.814.815.435.715.82
60-643.524.626.276.827.147.28
65-694.005.117.007.597.938.08
70-795.757.378.47N/AN/AN/A
80+*9.16N/AN/AN/AN/AN/A
$1000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y0.891.151.291.621.771.80
30-391.221.692.002.142.262.30
40-491.792.252.583.063.353.42
50-592.683.384.284.835.075.17
60-643.134.115.586.066.356.47
65-693.544.546.226.747.057.18
70-795.116.557.57N/AN/AN/A
80+*8.13N/AN/AN/AN/AN/A
$2500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y0.780.991.131.431.541.57
30-391.061.491.761.881.982.01
40-491.581.972.262.682.932.99
50-592.352.963.744.234.444.52
60-642.753.604.885.305.555.66
65-693.103.985.455.906.166.29
70-794.485.746.74N/AN/AN/A
80+*7.12N/AN/AN/AN/AN/A
$5000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1,000,000$2,000,000
AgeDailyDailyDailyDailyDailyDaily
14d-29y0.650.861.001.281.381.41
30-390.881.281.561.671.781.80
40-491.321.712.002.392.632.68
50-591.962.563.313.773.974.05
60-642.293.124.324.734.965.07
65-692.583.444.825.265.525.64
70-793.744.965.97N/AN/AN/A
80+*5.95N/AN/AN/AN/AN/A

Rates are shown in US dollars and are effective 04/01/2018. Rates are subject to change. Charges will include Surplus Lines taxes and fees when applicable.
*$10,000 Maximum Limit for age 80 and over.

If for any reason you wish to cancel your policy, you must submit your cancellation request in writing to us in order to receive a refund or premium. Cancellation requests received after the policy effective date will be subject to the following conditions: 1) a $25 cancellation fee will apply; and 2) only the unused portion of the plan cost will be refunded; and 3) only members who have no claims are eligible for premium refund.

Administrator

Tokio Marine HCC - MIS Group
251 North Illinois Street, Suite 600
Indianapolis, IN 46204

FOR ADDITIONAL INFORMATION

Insubuy®, Inc.
4200 Mapleshade Ln, Suite 200
Plano, TX 75093

Toll Free: (866) INSUBUY
Phone: (972) 985-4400
Fax: (972) 767-4470
Website: www.insubuy.com

This insurance is not subject to, and does not provide certain insurance benefits required by the United States’ Patient Protection and Affordable Care Act (“PPACA”). PPACA requires certain US citizens or US residents to obtain PPACA compliant health insurance, or “minimum essential coverage.” PPACA also requires certain employers to offer PPACA compliant insurance coverage to their employees. Tax penalties may be imposed on U.S. residents or citizens who do not maintain minimum essential coverage, and on certain employers who do not offer PPACA compliant insurance coverage to their employees. In some cases, certain individuals may be deemed to have minimum essential coverage under PPACA even if their insurance coverage does not provide all of the benefits required by PPACA. You should consult your attorney or tax professional to determine whether this policy meets any obligations you may have under PPACA.

Atlas Group is underwritten by Lloyd’s, London. Tokio Marine HCC - Medical Insurance Services Group (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies. Tokio Marine HCC - MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd’s underwriting members of Lloyd’s Syndicate 4141, which is managed by HCC Underwriting Agency Ltd.

Version: KHE2FFFYH6SP-152-1095
4/1/2018

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