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Atlas Essential America

5 Days to 364 Days

The Atlas Essential America plan is available almost anywhere you may travel internationally for vacation, study abroad, business, and mission work. Atlas Essential America represents the most economical version of our well-known Atlas line.

What Does Atlas Essential America Cover?

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 Essential America covers eligible expenses necessary to transport you to the nearest medical facility qualified to treat your life-threatening condition. We also understand the importance of family support in these difficult situations.

Repatriation of Remains

What would your family do if disaster struck while you were 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, the administrator will arrange for and cover eligible costs associated with the repatriation of your remains.

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, the Atlas Essential 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.

Atlas Essential America Quality Benefits

Hospitalization and Outpatient Treatment

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

Sports

Atlas Essential America 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.

*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.

Atlas Essential America Schedule of Benefits and Limits

BenefitLimits
Deductibles$0, $100, $250, $500, $1,000, $2,500, or $5000 per certificate period.
Overall Maximum Limit Per Certificate PeriodAge 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, or $1,000,000.
Coinsurance – Claims incurred in U.S.
Within the PPO: We will pay 75% of eligible expenses after the deductible to the overall maximum limit
Outside the PPO: Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount.
Coinsurance – Claims incurred outside U.S.Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount.
Eligible expenses are subject to deductible, coinsurance, overall maximum limit, and are per certificate period unless specifically indicated otherwise.
BenefitLimits
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.
The member shall be responsible for a $200 co-payment for each use of emergency room for an Illness unless the member is admitted to the hospital.
There will be no co-payment 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, the member shall be responsible for a $15 co-payment, after which coinsurance will apply.
- Co-payment waived if $0 deductible elected.
- Not subject to deductible.
Claims incurred outside the U.S.
No co-payment
TerrorismUp to $50,000 lifetime maximum, eligible medical expenses only.
All Other Eligible Medical ExpensesUp to the overall maximum limit.
Emergency Travel BenefitsLimits
Emergency Medical EvacuationUp to $500,000 lifetime maximum (not subject to deductible or coinsurance).
Repatriation of RemainsUp to $25,000 lifetime maximum (not subject to deductible or coinsurance).
Local Burial or CremationUp to $5,000 lifetime maximum (not subject to deductible or coinsurance).

Rates

Atlas Essential America ‐ For Non‐US Citizens traveling to the U.S.

$0 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million
AgeDailyDailyDailyDailyDaily
14d-29y1.191.521.662.002.21
30-391.612.242.582.622.82
40-492.392.993.333.754.19
50-593.564.495.505.936.34
60-644.165.457.177.437.93
65-694.716.038.018.268.81
70-796.788.699.92N/AN/A
80+*10.80N/AN/AN/AN/A
$100 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million
AgeDailyDailyDailyDailyDaily
14d-29y1.041.341.461.761.94
30-391.421.972.272.312.48
40-492.112.632.933.303.68
50-593.133.954.845.215.58
60-643.664.806.316.536.97
65-694.145.317.057.277.75
70-795.977.658.75N/AN/A
80+*9.50N/AN/AN/AN/A
$250 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million
AgeDailyDailyDailyDailyDaily
14d-29y0.951.211.331.601.77
30-391.291.792.062.102.26
40-491.912.392.673.003.35
50-592.853.594.404.745.07
60-643.334.365.745.946.34
65-693.764.826.416.617.05
70-795.436.957.96N/AN/A
80+*8.64N/AN/AN/AN/A
$500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million
AgeDailyDailyDailyDailyDaily
14d-29y0.861.091.201.441.59
30-391.161.611.861.892.03
40-491.722.152.402.703.01
50-592.563.233.974.264.57
60-642.993.935.175.355.71
65-693.394.345.775.956.34
70-794.886.257.80N/AN/A
80+*7.78N/AN/AN/AN/A
$1,000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million
AgeDailyDailyDailyDailyDaily
14d-29y0.760.971.061.281.41
30-391.031.441.651.681.80
40-491.531.912.132.402.68
50-592.282.873.523.794.05
60-642.663.494.594.755.07
65-693.013.865.125.295.64
70-794.345.556.90N/AN/A
80+*6.91N/AN/AN/AN/A
$2,500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million
AgeDailyDailyDailyDailyDaily
14d-29y0.660.850.931.121.23
30-390.901.261.451.471.58
40-491.341.671.862.102.35
50-591.992.513.083.323.55
60-642.333.064.024.164.44
65-692.633.384.494.634.93
70-793.804.876.03N/AN/A
80+*6.05N/AN/AN/AN/A
$5,000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million
AgeDailyDailyDailyDailyDaily
14d-29y0.560.730.821.001.10
30-390.751.091.281.311.42
40-491.121.451.651.882.10
50-591.662.182.732.963.18
60-641.942.653.553.713.97
65-692.192.923.974.134.42
70-793.174.225.34N/AN/A
80+*5.05N/AN/AN/AN/A

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

The Atlas Series is underwritten by Lloyd's, London. Tokio Marine HCC Medical Insurance Services Group (MIS Group) is 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-152-1239
07/10/2018

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