Insubuy Insurance

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PRIMARY SCHEDULE OF BENEFITS

The following is a brief summary of your benefits. Please note: a Policy Period is 364 days in length.


Lifetime Maximum Benefit $5,000,000 per insured person.
Policy Period Deductible Options $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.
Inside Of The United States After the deductible, we pay 80% of the next $5,000 of eligible expenses, then 100% to the policy maximum.
If treatment is received from an approved PPO service provider while you are in the U.S., we will reduce the applicable deductible by 50% & waive coinsurance.
Expenses must be pre-notified using Seven Corners' pre-notification program.
Outside Of The United States After the deductible, we pay 100% of eligible expenses to the policy maximum.
Expenses must be pre-notified using Seven Corners' pre-notification program.
Inpatient Hospital Expenses Average semi-private room and board; usual, reasonable, and customary physician charges, prescription medications, durable medical equipment, nursing services and x-rays up to the policy maximum.
Intensive Care Intensive Care room and board; usual, reasonable, and customary physician charges, prescription medications, durable medical equipment, nursing services and x-rays up to the policy maximum.
Surgery Usual, reasonable, and customary charges for surgery, physician and anesthetics up to the policy maximum.
Hospital Daily Indemnity Benefit $50 per day ($1,000 maximum per policy period) while hospitalized outside of the U.S. & Canada. This payment is not related to the hospital charges & is paid in addition to other eligible benefits. Please see the Benefit Options section of this brochure for an optional rider to increase this benefit to $200 per day.
Outpatient Treatment Usual, reasonable, and customary charges for emergency treatment, surgery, and prescription medication up to the policy maximum.
Physiotherapy, Chiropractic Up to $75 per visit ($10,000 Lifetime Maximum), when referred in advance by a physician.
Medical Supplies Usual, reasonable, and customary charges up to the policy maximum.
Ambulance Usual, reasonable, and customary charges up to the policy maximum.
Mental & Nervous Usual, reasonable, and customary charges up to a maximum of $10,000 per policy period after a 364-day 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.
Supplemental Accident Benefit Up to $300 reimbursement per covered injury due to accident. This is provided before applying any deductible.
Amateur Sailboat Racing Benefit Up to $15,000 per policy period for covered accidents or illness subject to a $60,000 lifetime maximum. An additional deductible of $1,500 applies per policy period. Also provides accidental death and dismemberment benefits (AD&D) calculated at 25% of the principal sum percentage for 24-hour AD&D, according to the Table of Losses in the certificate and limited to $25,000 Lifetime Maximum.
Dental Usual, reasonable, and customary 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. Please see details included in this brochure.
Emergency Medical Evacuation $250,000 limit per person per policy period - when adequate medical facilities and/or treatment are not available - (Pre-approval required).
Repatriation Of Remains $25,000 limit per person - (Pre-approval required).
Emergency Medical Reunion $10,000 limit per person per policy period - (Pre-approval required).
Preventive Benefits Females and males up to $250 per policy period for checkups, routine physical exams, inoculations and vaccinations, female preventative exams and mammograms after a 180-day waiting period. Not subject to deductible or coinsurance.
Well Child Care (Under age 19) Up to $200 per policy period for checkups and routine visits after a 180-day waiting period.
Accidental Death & Dismemberment (AD&D) 24-hour AD&D: Principal Sum: $10,000 for insured and spouse, $2,000 for dependent children.
Common Carrier AD&D: Principal Sum: $40,000 for insured and spouse, $8,000 for dependent children.
Lifetime Transplant Benefit Up to $1,000,000 per insured person.

BENEFIT OPTIONS

Seven Corners offers additional benefit options for your review and possible selection. These are in addition to the standard Reside Blue program benefits and cannot be purchased independently.


AD&D Principal Sum Rider Reside Blue 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.
Dental Rider Our optional dental plan provides limits per person as follows: $500 for Policy Period 1, $750 for Policy Period 2, $1,000 for Policy Period 3 and subsequent years. Each policy period requires a $100 deductible per person per policy period. Covered percentages are below.

Benefits Policy Period 1 Policy Period 2 Policy Period 3 & After
Class I Preventative Benefits
(90-day waiting period)
100% 100% 100%
Class II Standard Benefits
(180-day waiting period)
55% 70% 85%
Class III Significant Dental Benefits
(180-day waiting period)
30% 40% 50%

Class I - 2 oral exams, bitewing x-rays, & 1 topical fluoride treatment (through age 19) per policy period, 1 full mouth x-ray & 1 cleaning every 180 day, sealants for children through age 12.

Class II - Fillings (amalgam, silicate, acrylic, synthetic porcelain, composite); x-rays; extractions; treatment for root canal, periodontal & other gum disease; oral surgery (unless covered by medical plan); general anesthesia when necessary for oral surgery; emergency palliative treatment; antibiotic injections.

Class III - Initial installation of fixed bridgework, partial removable denture, full removable denture; replacement of existing removable denture or fixed bridgework, temporary full denture; add teeth to existing partial removable denture or bridgework; inlays & onlays; crowns & replacements; repair/recementing of crowns, inlays, onlays, dentures, bridgework

Sports Rider $25,000 lifetime maximum for mountaineering up to 4500 meters where ropes or guides are normally used, hang gliding, kite surfing, whitewater rafting, snowmobiling (does not include racing), parachuting & bungee jumping and $7,500 lifetime maximum for amateur sports or interscholastic athletics sponsored by a school or organization when not engaged for wage or profit.
Hospital Daily Indemnity Rider $150 per night (in addition to the standard benefit of $50) when you are hospitalized outside the U.S. and Canada. This benefit is not related to the hospital charges & is paid in addition to all other eligible benefits.
Professional Sailboat Racing Rider This rider pays eligible benefits incurred as a result of a covered accident or Illness while participating in professional sailboat racing, to a maximum of $100,000 per policy period. You will also receive Accidental Death and Dismemberment (AD&D) benefits calculated at 25% of the principal sum percentage for 24-Hour AD&D according to the Table of Losses in the certificate, limited to $25,000 Lifetime Maximum.
Professional Sailboat Racing is defined as: The pursuit of sailboat racing for profit or gain as a hired or professional crewmember in a race sanctioned or sponsored by a recognized governing organization.
Pregnancy & Newborn Benefit Rider Usual, reasonable, and customary charges up to $7,500 per pregnancy with newborn coverage of $25,000 for the first 31 days after birth. Must be selected at time of initial coverage purchase. May be discontinued at renewal but may not be added at a later date. Available to primary insured or spouse only. Waiting period of 364 days before the benefit begins. Requires pre-notification within the first 90 days of pregnancy.

ABOUT RESIDE® BLUE
WHY CHOOSE RESIDE BLUE?

Mariners require coverage that provides security, flexibility and benefits unique to the demands of today's marine industry. With coverage on-board the vessel and when signed off, you have a true universal policy, created for the mariner lifestyle. Sail and travel anywhere with the confidence that you are protected with comprehensive, marinespecific coverage providing the safety you deserve.

All members must be at least 14 days old and younger than 75 at application time.

With a worldwide network of providers, a 24-hour assistance team, and a seasoned administrative staff, we are here to ensure you receive the care you need.


HOW LONG WILL I BE COVERED?

If coverage begins before your 75th birthday, you may renew, at the discretion of the underwriter, as long as you remain eligible and pay your renewal premium. You will not be required to answer medical questions to renew, and you cannot be singled out for cancellation.


WHO CAN PURCHASE RESIDE BLUE?

You must currently or usually be an employee aboard a sea-going vessel or consider a sea-going vessel as your primary residence. You must also not be eligible and/or able to secure adequate U.S. domestic health insurance providing continuous coverage worldwide. Finally, you must complete the Declaration of Residence or provide a non- U.S. residence address.


WORLDWIDE COVERAGE

You may choose from two coverage areas, each with different pricing. With both options, your time in the U.S. must be limited to 180 days during any given 364-day period.

If you are residing in or traveling to the U.S. or Canada, you may choose Geographical Treatment Area A (worldwide coverage including the U.S. and Canada).

If you will not spend time in the U.S. or Canada, you may select Geographical Treatment Area B (worldwide coverage excluding the U.S. and Canada). Please note there is no coverage in the U.S. and Canada if you purchase Area B. Once a Geographical Treatment Area is purchased, changes are not available on the same certificate.

*It is your responsibility to maintain all records regarding travel history, age and student status. These may be required by Seven Corners to verify plan eligibility.

For U.S. Citizens: If you select and purchase coverage in Geographical Treatment Area A, you must either be outside the United States at the time of application or must depart the United States within 30 days of your effective date.

If you select and purchase coverage in Geographical Treatment Area B, you must be outside the United States at the time of application or must depart the United States prior to your effective date.

For Non-U.S. Citizens: If you select and purchase coverage in Geographical Treatment Area A, you are not required to be outside the United States at the time of application, nor are you required to depart the United States within 30 days of your effective date.

If you select and purchase coverage in Geographical Treatment Area B, you are not required to be outside the United States at the time of application, nor are you required to depart the United States prior to your effective date.


HOW DO I APPLY FOR COVERAGE?

Simply complete the online application and submit it with your payment. If you would like a paper application, please look at the link towards the top of this web page. We will review your application and request additional information if needed. If you are accepted, you will receive an ID card with your effective date and conditions of acceptance along with a certificate of coverage. The certificate describes the program in detail. If you are not accepted for coverage, your premium will be returned without delay.


FILING A CLAIM

Simply complete our claim form (available online), sign it, and submit it with itemized bills and receipts (if you already paid for the expenses). If acceptable with the facility, we will pay the treating hospital or physician direct.


PRE-NOTIFICATION PROGRAM/PPO

To ensure you receive appropriate care, we require that you or someone on your behalf contact Seven Corners Assist at least 48 hours before receiving medical treatment and no later than 48 hours after an emergency. Contact information for Seven Corners Assist is on your ID Card.

Services and treatment in the U.S. must be received at an approved PPO Service Provider, if available within 50 miles of your location. To obtain a list of approved PPO Service Providers, see our Client Center. If treatment is received from an approved PPO Service Provider while in the U.S., your deductible will be reduced by 50% and your coinsurance will be waived.


YOUR UNDERWRITER

Reside Blue is underwritten by Certain Underwriters at Lloyd's of London. With over 300 years of experience in the international insurance business, Lloyd's is one of the largest insurance entities in the world. Please visit www.lloyds.com for details.


SEVEN CORNERS, PROGRAM ADMINISTRATOR

Seven Corners, Inc.* has administered Reside Blue since its inception. With 20 years of experience, we have the innovative solutions necessary to handle the demands of the international insurance arena. We service thousands of policyholders throughout the world and provide international insurance plans for private citizens, governments, missionaries, students, and corporations. You can feel confident knowing Seven Corners is working for you from the time you complete your application through the claims payment process.
*In California, operating under the name Seven Corners Insurance Services.


IMPORTANT BENEFIT DETAILS

We offer a variety of benefits with Reside Blue. We highlight a few key coverages below that may be especially important as part of your international health insurance program. For more details, you may review the sample certificate available online.

Preventive Benefits & Child Wellness - We offer coverage for checkups and routine visits for all members after 180 days.

Emergency Medical Evacuation - We will transport you to receive proper care if it is not available in your area. If it is medically necessary, we will return you home.

Emergency Reunion - We will fly a person of your choice to your bedside.

Return of Remains - We will transport your remains home should you die while traveling.


LIMITATIONS

Pre-existing Conditions: If an existing medical condition is disclosed on your application and not excluded or restricted by a rider, it is covered for a lifetime maximum of $50,000 ($5,000 per Policy Period), after you have been continuously insured for two consecutive and continuous policy periods. Otherwise, pre-existing conditions are not covered.

Pre-existing conditions are defined as any medical condition, sickness, injury, illness, disease, mental illness or mental nervous disorder, regardless of the cause, including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time prior to your effective date of coverage under this certificate, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed. This specifically includes but is not limited to any medical condition, sickness, injury, illness, disease, mental illness or mental nervous disorder for which medical advice, diagnosis, care or treatment was recommended or received, or for which a reasonably prudent person would have sought treatment prior to the effective date of coverage.


Exclusions*: The following conditions, treatments, supplies, services, and/or expenses are not covered.

  • Treatment of the following which manifest themselves or are recommended, or in which symptoms occur during the first 180 days of coverage: any breast condition, any prostate condition, reproductive system disorders, gall stones, kidney stones, any acne diagnosis or acne-related condition, any surgery that is not emergency in nature.
  • Pre-existing conditions as defined above.
  • Expenses for pregnancy within the first 364 days of coverage.
  • Claims not presented to us within 90 days of treatment.
  • Treatment that is not medically necessary or exceeds reasonable & customary charges; treatment provided at no cost to you; non-medical expenses; treatment performed by a relative or anyone who lives with you; experimental treatment.
  • Suicide or attempted suicide; self-inflicted injury or illness.
  • War or warlike operations.
  • Injuries due to organized, professional, amateur, or interscholastic athletics.
  • Temporomandibular joint.
  • Flat feet, fallen arches, corns, bunions, calluses, toenails.
  • Vocational, occupational, speech, recreational or music therapy.
  • Cosmetic surgery unless due to a covered accident.
  • Dental or eye treatment unless otherwise covered.
  • Injuries/illnesses due to alcohol, chemical, or drug use.
  • Telephone consultations or failure to keep an appointment.
  • Custodial, rehabilitative, or nursing home care.
  • Congenital conditions.
  • 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.)
  • Venereal or sexually transmitted disease, HIV, AIDS.
  • Treatment, medication, & procedures to promote or prevent conception or childbirth.
  • Chronic Fatigue Syndrome; occupational diseases; weight control.
  • Pregnancy expenses incurred by a dependent child.

*This is a review of the exclusions in the certificate. This brochure is intended as a brief summary of benefits and services and is not your policy. A complete description of the provisions, benefits, and exclusions are contained in the certificate of coverage, which is provided to you after your coverage has been issued. To view a sample certificate of coverage, go to: certificate wording. If there is any difference between this brochure and your certificate of coverage, the provisions of the certificate will prevail.


RESIDE®BLUE WORLDWIDE MEDICAL PLAN

Effective September 16, 2013


WORLDWIDE COVERAGE INCLUDING UNITED STATES (GEOGRAPHICAL TREATMENT AREA A)


  If you choose a $250 Policy Period Deductible If you choose a $500 Policy Period Deductible If you choose a $1,000 Policy Period Deductible If you choose a $2,500 Policy Period Deductible If you choose a $5,000 Policy Period Deductible
Age Male Female Male Female Male Female Male Female Male Female
19 through 29 $1,134 $1,633 $975 $1,502 $780 $1,139 $678 $991 $532 $804
30 through 39 $1,155 $1,776 $993 $1,559 $795 $1,160 $691 $1,009 $543 $819
40 through 44 $1,517 $1,982 $1,388 $1,805 $1,111 $1,332 $956 $1,261 $746 $961
45 through 49 $1,757 $2,125 $1,598 $1,949 $1,231 $1,477 $1,108 $1,329 $903 $1,038
50 through 54 $2,088 $2,251 $1,880 $2,049 $1,504 $1,639 $1,391 $1,516 $1,113 $1,213
55 through 59 $2,720 $2,643 $2,420 $2,348 $1,973 $1,913 $1,666 $1,617 $1,400 $1,358
60 through 64 $3,819 $3,602 $3,571 $3,345 $2,856 $2,642 $2,685 $2,483 $2,255 $1,996
65 through 69 $7,639 $6,868 $7,429 $6,424 $6,891 $5,892 $5,340 $4,913 $4,700 $4,324
70 through 74 Contact Us for Rates
Dep. Child* $1,015 $1,015 $873 $873 $698 $698 $604 $604 $472 $472
Child Alone** Age 14 Days to 18 $1,069 $1,069 $919 $919 $735 $735 $636 $636 $497 $497


WORLDWIDE COVERAGE EXCLUDING UNITED STATES (GEOGRAPHICAL TREATMENT AREA B)

  If you choose a $250 Policy Period Deductible If you choose a $500 Policy Period Deductible If you choose a $1,000 Policy Period Deductible If you choose a $2,500 Policy Period Deductible If you choose a $5,000 Policy Period Deductible
Age Male Female Male Female Male Female Male Female Male Female
19 through 29 $839 $1,209 $721 $1,111 $578 $843 $502 $733 $395 $595
30 through 39 $855 $1,314 $735 $1,154 $588 $859 $511 $747 $401 $607
40 through 44 $1,122 $1,467 $1,027 $1,336 $822 $986 $707 $933 $551 $711
45 through 49 $1,300 $1,573 $1,183 $1,442 $910 $1,093 $820 $984 $668 $769
50 through 54 $1,546 $1,666 $1,391 $1,516 $1,113 $1,213 $1,029 $1,121 $823 $898
55 through 59 $2,013 $1,956 $1,791 $1,738 $1,460 $1,415 $1,234 $1,196 $1,036 $1,005
60 through 64 $2,826 $2,665 $2,642 $2,476 $2,114 $1,955 $1,987 $1,838 $1,670 $1,477
65 through 69 $5,653 $5,082 $5,483 $4,753 $5,099 $4,360 $3,952 $3,636 $3,478 $3,199
70 through 74 Contact Us for Rates
Dep. Child* $751 $751 $646 $646 $517 $517 $447 $447 $349 $349
Child Alone** Age 14 Days to 18 $791 $791 $680 $680 $544 $544 $470 $470 $368 $368


PREMIUMS FOR OPTIONAL BENEFITS

AD&D Principal Sum Rider: Dental Rider: Sports Rider: Hospital Indemnity Benefit Rider: Professional Sailboat Racing Rider: Pregnancy & Newborn Rider:
Benefit Annual Premium
$100,000 $143
$200,000 $286
$300,000 $429
$400,000 $572
$500,000 $715
Child $10,000 $15
For U.S. Citizens: $359 per person per policy period

For Non-U.S. Citizens: $508 per person per policy period

(if selected for one, then all applicants must purchase the option)
$240 per person per policy period

(if selected for one, then all applicants must purchase the option)
$145 per person per policy period

Benefit is $150 per night for a covered hospital admission, maximum 30 nights per policy period.

(if selected for one, then all applicants must purchase the option)
$250 per person per policy period

Maximum amount payable per policy period of $100,000 for medical expenses.
$4,000 per person per policy period

(may be selected for females only, for the primary insured or the spouse)


*The Dependent Child Premium is available when at least one parent (legal guardian) of a natural or legally adopted unmarried child at least 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 on the same certificate. No medical premium is charged for the first 2 Dependent Children between the ages of 14 days and 9 years old if both parents are also covered under the same certificate. **Children applying without an insured parent or guardian on the same certificate must use the Child Alone rates.


If the Applicant desires to pay premiums in two, four, or twelve installments per policy period, they must do so by credit/debit card payment only. We will automatically debit the credit/debit card on the due date of the premium installment. The Premium Installment Factors to be applied to the Annual Premium are as follows:


One Payment per Policy Period 1.00 / Two Payments per Policy Period 0.55 / Four Payments per Policy Period 0.28 / Twelve Payments per Policy Period 0.10


IMPORTANT NOTICE: The premiums referenced above are applicable for the initial 364-day coverage period, after you have been accepted. The administrator reserves the right to increase the stated premiums based upon underwriting & your medical condition at the time of application. Applicants with chronic and/or severe medical conditions may be declined. At each renewal period, the administator will inform you of your renewal premium based upon your age and deductible.


Attention Applicants: Certain Underwriters at Lloyd's of London, operates as an approved Surplus Lines market in most U.S. states. The premiums listed above include Surplus Lines Taxes and Fees where applicable.


Administrator

Seven Corners

303 Congressional Boulevard
Carmel, IN 46032


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

Web site: insubuy.com


This brochure is intended as a brief summary of benefits and services. It is not your policy. If there is any difference between this brochure and your policy, the provisions of the policy will prevail. Benefits and premiums are subject to change.


Copyright 1998 - 2013 by Seven Corners, Inc.
Reside® is a registered trademark of Seven Corners, Inc.
Seven Corners® is a registered trademark of Seven Corners, Inc.
v.01.26.14