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Atlas Premium America

5 Days to 364 Days

The Atlas Premium America plan is available almost anywhere you may travel internationally for vacation, study abroad, business, and mission work. Atlas Premium America provides the highest levels coverage among the Atlas plans.

What Does Atlas Premium 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 Premium 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.

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 Premium America 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 or region you're visiting is NOT under a level 3 or level 4 travel advisory, the Atlas Premium 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.

Political Evacuation

If, during the coverage period and after your arrival, the United States government issues a level 3 or level 4 travel advisory for your destination country, Atlas Premium 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 accommodations, Atlas Premium America will provide relief of a maximum of $250 a day for 5 days to help cover the costs of alternative accommadations.

Atlas Premium America Quality Benefits

Acute Onset of Pre-Existing Conditions

Atlas Premium America provides a limited benefit up to the medical coverage life-time 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 costs associated with hospitalization, including intensive care unit and outpatient treatment.

Sports

Atlas Premium 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.

Complications of Pregnancy

Atlas Premium America offer coverage for complications of pregnancy during the first 26 weeks of gestation.

Crisis Response

Atlas Premium America offers upto $100,000 per certificate period 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.

Personal Liability

Atlas Premium America offers upto $100,000 per certificate period 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.

Atlas Premium 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 - $20,000; 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.
CoinsuranceWe 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.
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.
- Co-payment waived if $0 deductible elected.
- Not subject to deductible.
Claims incurred outside the U.S.
No co-payment
Hospital Indemnity$100 per day of inpatient hospitalization (not subject to deductible.
Acute Onset of Pre-existing Condition (Excludes chronic and congenital conditions. Only available to members under age 80.)Age 70 to 79: Up to $100,000
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).
Emergency Eye Exam for a Covered LossUp to $150. $50 deductible per occurrence (plan deductible is waived).
Outpatient Physical Therapy and Chiropractic CareUp to $50 maximum per day. Must be ordered in advance by a physician.
All Other Eligible Medical ExpensesUp to the overall maximum limit.
Emergency Travel BenefitsLimits
Emergency Medical EvacuationUp 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 ChildrenUp to $50,000 (not subject to deductible).
Pet ReturnUp to $1,000 (not subject to deductible).
Repatriation of RemainsUp to the overall maximum limit (not subject to deductible).
Emergency ReunionUp to $150,000, subject to a maximum of 15 days (not subject to deductible).
Natural Disaster – Replacement AccommodationsUp to $500 a day for 5 days (not subject to deductible).
Trip InterruptionUp to $15,000 (not subject to deductible).
Trip DelayUp to $200 a day after a 12-hour delay period requiring an unplanned overnight stay (2 days maximum. Not subject to deductible).
Lost Checked LuggageUp to $1,000 (not subject to deductible).
Political Evacuation Up to $150,000 lifetime maximum (not subject to deductible).
Accidental Death and Dismember- carrier accident)Not subject to deductible, or overall maximum limit $250,000 maximum benefit for any one family or group.
      Members up to age 18 Lifetime max. - $5,000; Death - $5,000; Loss of 2 limbs - $5,000; Loss of 1 limb - $2,500.
      Members age 18 through 69Lifetime max. - $100,000; Death - $100,000; Loss of 2 limbs - $100,000; Loss of 1 limb - $50,000.
      Members age 70 through 74Lifetime max. - $12,500; Death - $12,500; Loss of 2 limbs - $12,500; Loss of 1 limb - $6,250.
      Members age 75 and olderLifetime max. - $6,250; Death - $6,250; Loss of 2 limbs - $6,250; Loss of 1 limb - $3,125.
Common Carrier Accidental Death ($250,000 maximum benefit per any one family or group)Not subject to deductible, or overall maximum limit.
Up to age 18 - $25,000 per member;
Age 18 to 69 - $50,000 per member;
Age 70 to 74 - $12,500 per member;
Age 75 and older - $6,250.
Crisis Response - Ransom, Personal Belongings, and Crisis Response Fees and ExpensesUp to $100,000 per certificate period, with $10,000 maximum for Natural Disaster Evacuation (not subject to deductible, or overall maximum limit).
Personal LiabilityUp to:
$100,000 lifetime maximum
$100,000 third person injury
$100,000 third person property
$2,500 related third person property
- not subject to deductible, or overall maximum limit
Border Entry ProtectionUp to $500 if traveling on a valid B-2 visa and denied entrance at the U.S. border (not subject to deductible)
Bedside VisitUp to $1,500 (not subject to deductible)
Local Burial or CremationUp to $5,000 lifetime maximum (not subject to deductible).

Rates

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

$0 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million$2 Million
AgeDailyDailyDailyDailyDailyDaily
14d-17y2.923.453.634.154.485.17
18-293.714.244.454.985.305.99
30-394.395.375.905.956.277.15
40-495.616.557.077.728.419.72
50-597.458.9110.4611.1311.7813.76
60-648.3810.4213.0813.4714.2616.75
65-699.2411.3214.3914.7915.6418.39
70-7912.1915.3017.47N/AN/AN/A
80+*27.37N/AN/AN/AN/AN/A
$100 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million$2 Million
AgeDailyDailyDailyDailyDailyDaily
14d-17y2.693.153.323.784.064.67
18-293.493.954.144.604.885.49
30-394.084.955.415.475.736.51
40-495.165.986.447.027.628.77
50-596.788.059.4310.0110.5812.33
60-647.599.3911.7312.0812.7714.95
65-698.3610.1912.8813.2313.9916.41
70-7910.8613.5915.55N/AN/AN/A
80+*24.20N/AN/AN/AN/AN/A
$250 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million$2 Million
AgeDailyDailyDailyDailyDailyDaily
14d-17y2.552.963.113.533.794.35
18-293.343.763.934.354.625.17
30-393.884.675.085.145.386.09
40-494.865.616.026.557.098.14
50-596.337.498.749.279.7911.38
60-647.088.7110.8411.1511.7813.76
65-697.769.4211.8812.2012.8815.09
70-799.9612.4514.26N/AN/AN/A
80+*22.10N/AN/AN/AN/AN/A
$500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million$2 Million
AgeDailyDailyDailyDailyDailyDaily
14d-17y2.402.772.903.283.524.01
18-293.203.573.724.114.344.84
30-393.674.394.764.805.045.67
40-494.555.235.606.086.577.51
50-595.886.938.068.529.0010.43
60-646.558.029.9410.2210.7912.58
65-697.188.6710.8811.1611.7813.76
70-799.0811.3213.01N/AN/AN/A
80+*19.99N/AN/AN/AN/AN/A
$1,000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million$2 Million
AgeDailyDailyDailyDailyDailyDaily
14d-17y2.252.582.693.033.243.68
18-293.043.383.513.854.064.50
30-393.474.114.434.484.675.24
40-494.254.865.195.606.056.89
50-595.436.367.367.788.209.47
60-646.027.349.039.299.7911.38
65-696.587.919.8710.1310.6712.44
70-798.2010.1811.78N/AN/AN/A
80+*17.89N/AN/AN/AN/AN/A
$2,500 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million$2 Million
AgeDailyDailyDailyDailyDailyDaily
14d-17y2.102.392.482.782.963.34
18-292.893.193.303.613.784.17
30-393.263.824.124.154.334.82
40-493.964.484.775.145.526.26
50-594.985.806.677.057.418.52
60-645.516.658.148.368.8010.19
65-695.997.168.879.099.5711.11
70-797.319.0610.64N/AN/AN/A
80+*15.79N/AN/AN/AN/AN/A
$5,000 Deductible
Maximum Limit$50,000$100,000$250,000$500,000$1 Million$2 Million
AgeDailyDailyDailyDailyDailyDaily
14d-17y1.762.062.202.482.653.00
18-292.422.752.933.223.383.74
30-392.713.303.643.703.884.31
40-493.303.884.214.594.945.60
50-594.155.025.906.296.637.64
60-644.595.767.207.467.879.13
65-694.996.207.858.118.579.95
70-796.107.849.42N/AN/AN/A
80+*13.19N/AN/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.
*$20,000Maximum 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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