The Atlas America plan is with you almost anywhere in the world you may travel for vacation, study abroad, corporate travel, or mission work.
Why Choose Atlas America?
Whatever your reason, international travel should be a pleasant experience. Complications and emergencies such as illness, injury, and natural disasters are a fact of life. While we hope none of these incidents happen, we're here to help if they do.
That's why Atlas America provides coverage for unexpected medical expenses as well as emergency travel benefits and multilingual travel assistance services.
Do I need travel medical insurance?
Many times the primary medical insurance in your home country offers little or no coverage for medical expenses incurred as you travel outside of your home country. Atlas America provides international coverage as well as important benefits like Emergency Medical Evacuation, Hospital Room and Board, and Crisis Response for kidnap and ransom situations abroad.
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 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 please contact us.
*At the time of publishing. For more information on these ratings, please visit: www.standardandpoors.com, www.ambest.com, and www.fitchratings.com.
Atlas America Schedule of Benefits and Limits
| Plan Details | |
|---|---|
| Deductibles | $0, $100, $250, $500, $1,000, $2,500 or $5,000 per certificate period. |
| Overall Maximum Limit | Age 80 or older - $10,000; Age 70 to 79 - $50,000, $100,000, or $150,000; All others - $50,000, $100,000, $250,000, $500,000, $1,000,000, or $2,000,000. |
| Coinsurance | We will pay 100% of eligible expenses, after the deductible, to the overall maximum limit. |
| Eligible expenses are subject to deductible, overall maximum limit, and are per certificate period unless specifically indicated otherwise. | |
| Benefit | Limit |
| Hospital Room and Board | Average semi-private room rate, including nursing services. |
| Local Ambulance | Usual, reasonable and customary charges, when covered illness or injury results in hospitalization as inpatient. |
| Intensive Care Unit | Up to the overall maximum limit. |
| Emergency Room Co-payment | Claims incurred in the 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 Center Co-payment | Claims incurred in the U.S. For each visit, you shall be responsible for a $15 co-payment. - 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 Care | Up to $50 maximum per day. Must be ordered in advance by a physician. |
| All Other Eligible Medical Expenses | Up to the overall maximum limit. |
| Acute Onset of Pre-existing Condition (excludes chronic and congenital conditions) (only available to members under age 80) | Age 70 to 79: Up to the overall maximum limit or $100,000, whichever is lower. Under age 70: Up to the overall maximum limit. Up to $25,000 lifetime maximum for Emergency Medical Evacuation. |
| Emergency Dental (Acute Onset of Pain) | Up to $300 - not subject to deductible |
| Emergency Eye Exam for a Covered Loss | Up to $150, $50 deductible per occurrence (plan deductible is waived). |
| Emergency Travel Benefits | Limit |
| Emergency Medical Evacuation | Up to $1,000,000 lifetime maximum, except as provided under Acute Onset of Pre-existing Condition. - not subject to deductible, or overall maximum limit |
| Return of Minor Children | Up to $50,000 - not subject to deductible |
| Pet Return | Up to $1,000 - not subject to deductible |
| Repatriation of Remains |
Equal to the elected overall maximum limit - not subject to deductible or coinsurance This limit is for this benefit only and is not included in or subject to the overall maximum limit. |
| Emergency Reunion | Up to $100,000 subject to a maximum of 15 days - not subject to deductible |
| Natural Disaster - Replacement Accommodations | Up to $250 a day for 5 days - not subject to deductible |
| Trip Interruption | Up to $10,000 - not subject to deductible |
| Travel Delay | Up 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 |
| Lost Checked Luggage | Up to $1,000 - not subject to deductible |
| Lost or Stolen Passport/Travel Visa | Up to $100 - not subject to deductible |
| Political Evacuation | Up to $100,000 lifetime maximum - not subject to deductible |
|
Accidental Death and Dismemberment (excludes loss due to common carrier accident) $250,000 maximum benefit any one family or group. - not subject to deductible or overall maximum limit | |
| Ages 18 through 69 | Lifetime Maximum - $25,000 Death - $25,000 Loss of 2 Limbs - $25,000 Loss of 1 Limb - $12,500 |
| Under age 18 | Lifetime Maximum - $5,000 Death - $5,000 Loss of 2 Limbs - $5,000 Loss of 1 Limb - $2,500 |
| Ages 70 through 74 | Lifetime Maximum - $12,500 Death - $12,500 Loss of 2 Limbs - $12,500 Loss of 1 Limb - $6,250 |
| Ages 75 and older | Lifetime Maximum - $6,250 Death - $6,250 Loss of 2 Limbs - $6,250 Loss of 1 Limb - $3,125 |
| Optional Accidental Death & Dismemberment Rider (only available to members age 18 through age 69) |
Lifetime Maximum - $25,000 Death - $25,000 Loss of 2 Limbs - $25,000 Loss of 1 Limb - $12,500 - not subject to deductible or overall maximum limit |
| Common Carrier Accidental Death Ages 18 through 69 Under age 18 Ages 70 through 74 Ages 75 and older | $50,000 $10,000 $25,000 $12,500 Subject to a maximum of $250,000 any one family or group. - not subject to deductible, or overall maximum limit |
| Crisis Response - Ransom, Personal Belongings, and Crisis Response Fees and Expenses | Up to $10,000 - not subject to deductible, or overall maximum limit Optional Crisis Response buy-up with Natural Disaster Evacuation Coverage. $90,000 per certificate period, with $10,000 maximum for Natural Disaster Evacuation. |
| Hospital Indemnity | $100 per day of inpatient hospitalization - not subject to deductible |
| Personal Liability | Up to: $25,000 lifetime maximum $25,000 third person injury $25,000 third person property $2,500 related third person property - not subject to deductible, or overall maximum limit Optional Personal Liability Rider of up to $75,000 lifetime maximum - not subject to deductible, or overall maximum limit |
| Bedside Visit | Up to $1,500 - not subject to deductible |
| Border Entry Protection | Up to $500 if traveling on a valid B-2 visa and denied entrance at the U.S. border - not subject to deductible |
What's Covered by Atlas America
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 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 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 will arrange for and cover eligible 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 will cover the eligible 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 or region you're visiting is NOT under a level 3 or level 4 travel advisory, Atlas America offers coverage for eligible medical expenses resulting from those acts. Coverage excludes countries or regions for which the U.S. Department of State has issued a level 3 ("reconsider travel") or level 4 ("do not travel") advisory in the 6 months prior to your arrival date.
Political Evacuation
If, during the coverage period and after your arrival, the U.S. Department of State issues a level 3 or level 4 travel advisory for your destination country, Atlas America will coordinate your alternate departure arrangements from that country and cover eligible associated costs.
Natural Disaster - Replacement Accommodations
Natural disasters can happen anywhere and at any time. If a natural disaster occurs on your trip, causing you to become displaced from your planned and paid accommodations, Atlas America will provide relief of a maximum of $250 a day for 5 days to help cover the costs of alternative accommodations.
Atlas America* Quality Benefits
Acute Onset of Pre-Existing Conditions
Atlas America provides a limited benefit up to the medical coverage lifetime maximum for eligible medical expenses. If you are younger than 80, 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.
*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
Hospitalization and 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 includes coverage for eligible injuries and illnesses that could occur while participating in many popular vacation sports - skiing and snowboarding (recreational downhill and/or cross country), snorkeling, water skiing, and others - at no additional cost. Certain extreme sports are excluded from coverage.
Complications of Pregnancy
Atlas America offers coverage for complications of pregnancy during the first 26 weeks of gestation.
Crisis Response
Atlas America 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 offers up to $25,000 (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.
Enrollment & Filing a Claim
Home Country Coverage
Incidental Home Country Coverage
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 for any three month period.
Any benefit accrued under a single 3 month period does not accumulate to another period. Failure of the member to continue his or her international trip or the members returning 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. This period begins on the first day of diagnosis or treatment of a covered injury or illness incurred while the member was 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
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 and Authorization Form.
Outstanding Customer Service
MyAccount and World Service Center
MyAccount 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
Log In to MyAccount here. 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.
Worldwide Travel and Medical Assistance
Atlas America includes valuable travel and medical assistance services, which are available 7 days a week, 365 days a year.
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 us. 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 America® - For Non-US Citizens traveling to the U.S.
| $0 Deductible | ||||||
|---|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1 Million | $2 Million |
| Age | Daily | Daily | Daily | Daily | Daily | Daily |
| 14d-29y | 1.71 | 2.19 | 2.48 | 3.27 | 3.71 | 3.79 |
| 30-39 | 2.31 | 3.19 | 3.80 | 4.25 | 4.70 | 4.79 |
| 40-49 | 3.32 | 4.13 | 4.75 | 5.90 | 6.76 | 6.90 |
| 50-59 | 5.32 | 6.72 | 8.48 | 10.07 | 11.06 | 11.28 |
| 60-64 | 6.66 | 8.75 | 11.86 | 13.53 | 14.85 | 15.14 |
| 65-69 | 7.55 | 9.67 | 13.25 | 15.07 | 16.49 | 16.82 |
| 70-79* | 11.32 | 14.48 | 16.55 | N/A | N/A | N/A |
| 80+** | 17.83 | N/A | N/A | N/A | N/A | N/A |
*$150,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $100 Deductible | ||||||
|---|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1 Million | $2 Million |
| Age | Daily | Daily | Daily | Daily | Daily | Daily |
| 14d-29y | 1.51 | 1.93 | 2.18 | 2.89 | 3.26 | 3.33 |
| 30-39 | 2.03 | 2.82 | 3.35 | 3.75 | 4.14 | 4.22 |
| 40-49 | 2.92 | 3.64 | 4.18 | 5.20 | 5.95 | 6.06 |
| 50-59 | 4.69 | 5.90 | 7.46 | 8.86 | 9.73 | 9.91 |
| 60-64 | 5.85 | 7.69 | 10.44 | 11.92 | 13.06 | 13.32 |
| 65-69 | 6.64 | 8.51 | 11.65 | 13.25 | 14.52 | 14.81 |
| 70-79* | 9.96 | 12.74 | 14.57 | N/A | N/A | N/A |
| 80+** | 15.68 | N/A | N/A | N/A | N/A | N/A |
*$150,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $250 Deductible | ||||||
|---|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1 Million | $2 Million |
| Age | Daily | Daily | Daily | Daily | Daily | Daily |
| 14d-29y | 1.31 | 1.67 | 1.89 | 2.49 | 2.84 | 2.89 |
| 30-39 | 1.76 | 2.44 | 2.90 | 3.25 | 3.58 | 3.66 |
| 40-49 | 2.52 | 3.16 | 3.62 | 4.49 | 5.15 | 5.25 |
| 50-59 | 4.06 | 5.12 | 6.46 | 7.67 | 8.43 | 8.60 |
| 60-64 | 5.09 | 6.66 | 9.04 | 10.31 | 11.31 | 11.53 |
| 65-69 | 5.76 | 7.37 | 10.09 | 11.47 | 12.57 | 12.81 |
| 70-79* | 8.62 | 11.02 | 12.63 | N/A | N/A | N/A |
| 80+** | 13.58 | N/A | N/A | N/A | N/A | N/A |
*$150,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $500 Deductible | ||||||
|---|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1 Million | $2 Million |
| Age | Daily | Daily | Daily | Daily | Daily | Daily |
| 14d-29y | 1.15 | 1.47 | 1.66 | 2.21 | 2.50 | 2.55 |
| 30-39 | 1.54 | 2.16 | 2.55 | 2.85 | 3.17 | 3.23 |
| 40-49 | 2.23 | 2.78 | 3.20 | 3.96 | 4.55 | 4.63 |
| 50-59 | 3.57 | 4.51 | 5.69 | 6.75 | 7.44 | 7.58 |
| 60-64 | 4.47 | 5.88 | 7.97 | 9.09 | 9.98 | 10.18 |
| 65-69 | 5.08 | 6.49 | 8.90 | 10.13 | 11.08 | 11.30 |
| 70-79* | 7.60 | 9.74 | 11.20 | N/A | N/A | N/A |
| 80+** | 11.99 | N/A | N/A | N/A | N/A | N/A |
*$150,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $1000 Deductible | ||||||
|---|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1 Million | $2 Million |
| Age | Daily | Daily | Daily | Daily | Daily | Daily |
| 14d-29y | 1.02 | 1.31 | 1.48 | 1.95 | 2.22 | 2.27 |
| 30-39 | 1.38 | 1.92 | 2.26 | 2.55 | 2.82 | 2.87 |
| 40-49 | 1.97 | 2.47 | 2.84 | 3.52 | 4.04 | 4.12 |
| 50-59 | 3.18 | 4.01 | 5.07 | 6.00 | 6.60 | 6.73 |
| 60-64 | 3.97 | 5.23 | 7.08 | 8.09 | 8.88 | 9.04 |
| 65-69 | 4.50 | 5.77 | 7.91 | 9.00 | 9.85 | 10.04 |
| 70-79* | 6.75 | 8.65 | 10.01 | N/A | N/A | N/A |
| 80+** | 10.64 | N/A | N/A | N/A | N/A | N/A |
*$150,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $2500 Deductible | ||||||
|---|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1 Million | $2 Million |
| Age | Daily | Daily | Daily | Daily | Daily | Daily |
| 14d-29y | 0.96 | 1.22 | 1.39 | 1.84 | 2.07 | 2.12 |
| 30-39 | 1.29 | 1.81 | 2.14 | 2.39 | 2.64 | 2.69 |
| 40-49 | 1.86 | 2.32 | 2.66 | 3.30 | 3.79 | 3.87 |
| 50-59 | 2.98 | 3.76 | 4.74 | 5.64 | 6.19 | 6.31 |
| 60-64 | 3.74 | 4.91 | 6.64 | 7.58 | 8.32 | 8.48 |
| 65-69 | 4.22 | 5.42 | 7.42 | 8.43 | 9.23 | 9.42 |
| 70-79* | 6.34 | 8.12 | 9.55 | N/A | N/A | N/A |
| 80+** | 9.98 | N/A | N/A | N/A | N/A | N/A |
*$150,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $5000 Deductible | ||||||
|---|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1 Million | $2 Million |
| Age | Daily | Daily | Daily | Daily | Daily | Daily |
| 14d-29y | 0.77 | 1.00 | 1.17 | 1.56 | 1.77 | 1.81 |
| 30-39 | 1.02 | 1.48 | 1.80 | 2.03 | 2.26 | 2.29 |
| 40-49 | 1.48 | 1.91 | 2.24 | 2.81 | 3.23 | 3.30 |
| 50-59 | 2.37 | 3.09 | 4.00 | 4.78 | 5.28 | 5.39 |
| 60-64 | 2.97 | 4.05 | 5.61 | 6.45 | 7.08 | 7.24 |
| 65-69 | 3.36 | 4.47 | 6.25 | 7.16 | 7.87 | 8.04 |
| 70-79* | 5.05 | 6.70 | 8.05 | N/A | N/A | N/A |
| 80+** | 7.94 | N/A | N/A | N/A | N/A | N/A |
*$150,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
Rates are shown in US dollars and are effective 09/09/2019. Rates are subject to change. Charges will include Surplus Lines taxes and fees when applicable.
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 Group251 North Illinois Street, Suite 600
Indianapolis, IN 46204
FOR ADDITIONAL INFORMATION
Insubuy®, Inc.4200 Mapleshade Ln, Suite 200
Plano, TX 75093
Toll Free:
+1 (866) INSUBUY
Phone:
+1 (972) 985-4400
Fax:
+1 (972) 767-4470
Website:
www.insubuy.com
Patient Protection and Affordable Care Act
("PPACA"): 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 America is underwritten by Lloyd's. 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-152-1592
09/09/2019