|INF Advantage Enrollment||Plan Brochure: No Pre-ex Coverage
Plan Brochure: Pre-ex coverage
|Definitions||Accidental Death Dismemberment|
|Insurance Enrollment||Medical Evacuation And Repatriation|
|Covered Services||Assistance Services (Insured Members Only)|
|Exclusions||First Health Network|
MEDICAL EXPENSE BENEFITS – ACCIDENT AND SICKNESS
PRE-EXISTING CONDITIONS COVERAGE OPTION (LIMITED TO ACUTE ONSET)
This feature of the India Network Foundation’s Accident and Sickness Insurance Program provides coverage for Pre-Existing Conditions, defined as an illness, disease, injury or other condition of the Insured Person that in the 365 day period before the Insured Person’s coverage became effective under the Policy:
1. Was treated by a Physician or treatment had been recommended by a Physician.
2. Required taking prescribed drugs or medicines, or
3. first manifested itself, worsened, became acute or exhibited symptoms that would have caused an ordinarily prudent person to seek diagnosis.
Pre-Existing Conditions coverage is limited to Acute Onset coverage. If you experience an acute onset of a pre-existing condition, benefits are payable according to your policy benefits. Treatment for said condition must be obtained within 12 hours of the sudden and unexpected outbreak or reoccurrence.
MEDICAL EXPENSE BENEFITS
We will pay Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident or Sickness. These benefits are subject to Deductible of $250, $500 or $1000 for $75,000 policy maximum (ages 70-89) or $250,$500 or $1000 for $150,000 policy maximum (ages 69 and under) per person for each Injury and each Sickness. The Policy Maximum for all Accident and Sickness Benefits and Pre-existing conditions is $150,000 and $75,000 for above 70 years. Benefits are also subject to the following:
In-Network: 80% of covered Network charges up to a policy maximum per Insured Person per Covered Injury or Sickness.
Out-of-Network: 80% of Usual and Customary Charges up to a policy maximum per Insured Person per Covered Injury or Sickness.
Network Provider: First Health Network
Click Here to Search for Providers Near You Medical Expense Benefits are only payable: (1) for Usual and Customary Charges incurred after the Deductible, if any, has been met; (2) for those Medically Necessary Covered Expenses that the Covered Person incurs; (3). for charges incurred for services rendered to the Covered Person while on a covered Trip; and (4) provided the first charge is incurred within 90 days of the Covered Accident or Sickness. Payment for Covered Expenses will not exceed the Policy Maximum shown above.
- Hospital Room (semi private) and Board and Miscellaneous Hospital Expenses. Covered Expenses charged 1) daily semi private room rate when Hospital confined; and 2) general nursing care provided and charged by the Hospital. Miscellaneous Expenses include, while Hospital confined; or 2) for preadmission expenses for being Hospital confined but are not limited to, the cost of the operating room, X-ray examination , laboratory tests, in-hospital physiotherapy, anesthesia; drugs (excluding take home drugs) or medicines, therapeutic services; and supplies, registered nurse services and all necessary charges other than room and board, for services received during a Hospital Stay
- Hospital Intensive Care Unit Covered Expenses charged when an Insured Person becomes confined as an Inpatient to a Hospital in an Intensive Care Unit, the Company will pay an additional benefit equal to the Daily Intensive Care Unit Benefit Amount shown in the Rider Schedule of benefits. Only one Daily Intensive Care Unit Benefit is provided for any one day of Intensive Care Unit confinement, regardless of the number of Covered Injuries or Sickness for which the confinement is required.
- Surgeon Services (Inpatient) - Covered Expenses charge for performing in-patient surgical procedure. Two or more surgical procedures through the same incision will be considered as one procedure. . However, the Company will pay up to 50% of the benefit for a surgical procedure when more than one surgical procedure through different operating fields is performed during the same surgical session. Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both.
- Anesthetist Services (Inpatient) - Covered Expenses charged by a Physician in connection with inpatient surgery for anesthesia and its administration. . Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both
- Assistant Surgeon (inpatient) – Covered Expenses charged by a Physician in connection with inpatient surgery. . Covered Expenses will be paid under this inpatient surgery benefit; or under the Out Patient surgery benefit, but not for both
- Physician’s (non Surgical Inpatient visit) – Covered Expenses charged by a Physician for other than pre or post operative care, second opinion or consultation: for 1) in Hospital visits and office visits. Benefits are limited to one Physician visit per day. Covered Expenses will be paid under the impatient benefit or outpatient benefit for Physicians Office visits but not both.
- Consulting Physician Services- Covered Expenses charges by a Physician for a second surgical opinion or consultation that has been that must be requested by the attending Physician.
- Physiotherapy Benefits (inpatient) Covered Expenses charges by a Physician for Physiotherapy that must be requested by the attending Physician
- Pre – Admission Tests- Covered Expenses charged for pre- admission tests limited to routine test such as complete blood count; urinalyses and chest X ray. If otherwise payable under this Policy, major diagnostic procedures such as Cat-Scans; NMR’s and blood chemistries will be paid under the Hospital Miscellaneous benefit.
- Surgeon Services (Outpatient) – Covered Expenses charge for performing outpatient surgical procedure. Two or more surgical procedures through the same incision will be considered as one procedure. . However, the Company will pay up to 50% of the benefit for a surgical procedure when more than one surgical procedure through different operating fields is performed during the same surgical session. Covered Expenses will be paid under this inpatient surgery benefit; or under the surgeon services benefit (Outpatient), but not for both.
- Day Surgery Miscellaneous Expenses(Outpatient) – Covered Expense related to a major surgery performed at Hospital or licensed Outpatient surgery center including the actual cost of the operating room, laboratory tests and x ray examination anesthesia, drugs, medicines and medical supplies related to the surgery. Does not include non scheduled surgery and surgery performed in a Hospital emergency room; trauma center; Physician’s office; or clinic.
- Anesthetist Services (Outpatient) - Covered Expenses charged by a Physician in connection with Anesthetist Services for Outpatient surgery for anesthesia and its administration. . Covered Expenses will be paid under this Outpatient benefit; or under the Inpatient surgery benefit, but not for both
- Assistant Surgeon (Outpatient) – Covered Expenses charged by a Physician in connection with Outpatient surgery. Covered Expenses will be paid under this Outpatient surgery benefit; or under the Inpatient surgery benefit, but not for both.
- Diagnostic X Rays and Lab tests except dental x-rays (Outpatient) – Covered Expenses incurred for the treatment of a Covered Injury or Sickness as prescribed by a Physician.
- CAT Scan, PET Scan or MRI tests (Outpatient) -Covered Expenses incurred for the treatment of a Covered Injury or Sickness as prescribed by a Physician
- Hospital Emergency Room services – Covered Expenses incurred for the Outpatient emergency room treatment performed in a Hospital. When emergency room treatment is immediately followed by admission to a Hospital, such treatment will be a Hospital Room and Board and Miscellaneous Hospital Covered Medical Service.
- Prescriptions (outpatient) – Covered Expenses incurred for the treatment of a Covered Accident or Sickness prescribed by a Physician.
- Ambulance Services Covered Expenses incurred for ground or air ambulance service to transport the Insured Person from the place where the Covered Accident or occurs. The Company will pay Covered Expenses incurred for ground or air ambulance transportation from the nearest medical facility to another appropriate medical facility, if a Physician specifies in writing that specialized care not available in the first facility to which the Insured Person was transported is necessary to treat His Covered Injury or Sickness.
- Initial Orthopedic Prosthesis or Brace - Covered Expenses incurred for the initial purchase, fitting, and needed adjustment of such appliances or devices, including the components of prosthetic appliances. Orthopedic prosthesis or brace include durable medical equipment which is equipment that 1) is primarily and customarily used to serve a medical purpose; 2) can withstand repeated use; and 3) generally is not useful to a person in the absence of Injury or Sickness. The Orthopedic Prosthesis or Brace must be prescribed by a Physician and a written prescription must accompany the claim when submitted. Replacement prosthesis and braces are not covered and no benefits will be paid for rental charges in excess of the purchase price.
- Dental Injury Treatment - Covered Expenses incurred for dental treatment (does not include dental services for the immediate relief of pain), including X-rays, for injury to a tooth: 1) with no fillings or cavities or only fillings or cavities that do not undermine the tooth cusps; and 2.for which pulpal tissues are healthy and intact; and 3. for which periodontal tissue shows little or no signs of active or chronic inflammation. For insurance review purposes, each tooth unit is evaluated under these criteria rather than a blanket rating of the whole mouth. Covered Expenses include examinations, x-rays, restorative treatment, endodontic, oral surgery, initial braces required for treatment of a Covered Injury and treatment of gingivitis resulting from trauma. If there is more than one way to treat a dental problem, The Company will pay based on the least expensive procedure if that procedure meets commonly accepted standards of the American Dental Association. Routine dental care and treatment to the gums are not covered.
- Chemotherapy and/or Radiation Services – Covered Expenses incurred for chemotherapy or radiation prescribed by a Physician for the treatment of a Sickness Benefits. Chemotherapy and Radiation means Cobalt Therapy, EX- ray therapy or chemotherapy administered to an Insured Person as treatment of cancer. This includes Injections 1) when administered in the Physician’s office; and 2) charged on the Physician statement. It does not include laboratory and diagnostic tests.
- Physical and Occupational Therapy Covered Expenses incurred for Outpatient physical and occupational therapy
- Private Duty Nursing Benefit Covered Expenses incurred for services rendered by a 1) private duty nurse care only; 2) while Hospital Confined; 3) ordered by a licensed Physician; and 4) medically necessary. General nursing care provided by the Hospital is not covered under this benefit.
- Maternity Benefit Covered Expenses incurred for the treatment of a pregnancy when conception occurs after the trip begins under this Policy. This does not include any benefits for the unborn child.
All non-US citizens and their eligible dependents Child(ren) or Spouse (if coverage has been elected), while visiting the United States. Eligible dependents Child means the insured Member's unmarried child who meets the following requirements: 1) a child from birth to 17 years old; 2) a child who is 17 or more years old but less than 30 years old, enrolled in school as a full-time student and primarily supported by the Insured Person. Coverage will continue during and period between school terms or school years as long as the Company is provided satisfactory proof that he or she has enrolled for the next following school term or year; or 3) a child who is 17 or more years old, primarily supported by the Insured Person, and incapable of self-sustaining employment by reason of mental or physical handicap. For purposes of this definition, a Dependent Child includes: a natural child; an adopted child, beginning with any waiting period pending finalization of the child's adoption; a stepchild that resides with the Insured Person; and a child for whom the Insured Person is the legal guardian, as long as the child resides with the Insured Person and depends on him for financial support. Spouse means the Insured Person's lawful spouse.
Members may enroll for coverage, subject to the following rules: Minimum Period of Enrollment is 30 days. The maximum period is 300 days. The full premium for the entire stay in the US is payable at the time of enrollment.
Coverage for an Insured Person will be considered as continuous during consecutive periods of insurance under this Policy when premium payment is received by the administrator on or before the termination of the last coverage period. This continuation of coverage will not establish a new benefit period, nor affect any lifetime or specifically stipulated benefit limits or maximums under the Policy.
To enroll in the India Network Accident & Sickness Insurance Program, you may enroll online or download the forms and send the completed forms to India Network Services. You must be a Member to purchase insurance. Please enroll online.
1. Complete the India Network Membership Form (1st Form under Online Forms Link)
2. Complete the Insurance Enrollment Form
3. Submit the forms either electronically or as shown below.
Fax the membership and enrollment forms (fax versions of the forms are available under download link) with charge authorization to 408-520-4967
Mail a check for the exact amount with completed enrollment forms: the membership form & insurance form. Prepare two checks:
(i) Membership fee of $10 made payable to India Network Foundation, and
(ii) Premium amount made payable to 'India Network Services' and mail the package to:
India Network Services
7065 Westpointe Blvd, Suite 209
Orlando, FL 32835-8758
On successful completion of online application, ID cards will be produced on the webpage for your record and as proof of insurance.
Membership and INF Advantage Insurance forms can also be downloaded from our websites and faxed to (408)-520-4967 with proper credit card authorization for membership and premium.
The India Network Foundation Group Policy Effective date is 6/1/2018.
Coverage of Insured Person and any eligible Dependent Child(ren) or Spouse enrolled in this plan will begin at 12:01 AM on the latest of the following dates: the Policy's Effective Date; the departure date from the Insured Person's Home Country; or the date that India Network Services receives the insurance enrollment form and the required premium.
The Company will pay benefits while an Insured Person is traveling:
1. Outside of his or her Home Country in the United States or during a Personal Deviation as listed in the Policy; and 2. up to 300 days.
This Coverage will start on the actual start of the Covered Trip and will end on the first of the following dates to occur: the date the Insured Person returns to his or her Home Country; the date the Insured Person makes a Personal Deviation for more than 2 days; the date the Insured Person is no longer eligible; or the last day of the period for which the required premium is paid. Coverage of an Insured Person's Dependent Child(ren) or Spouse will end when the Insured Person's coverage ends.
NOTE: If coverage is purchased after the Insured Person’s arrival in the United States, coverage under this Rider is limited to Accident only during an Insured Person’s 14 days of coverage commencing on the Insured Person’s Effective Date. Full coverage will take place after the 14th day.
Benefit Period as used in this Rider means the maximum period that benefits are payable under this Rider.
Complication(s) of Pregnancy mean(s) conditions which require Hospital Stays before the pregnancy ends and whose diagnoses are distinct from but are caused or affected by pregnancy. These conditions are
Delivery by cesarean section is considered a eco of Pregnancy if the cesarean section is non elective. A cesarean section will be considered non elective if the fetus or the mother is determined to be in distress and is in immediate danger of death, Sickness or Covered Injury if the cesarean section is not performed. A cesarean section beyond one performed in any previous pregnancy will also be considered non elective if vaginal delivery is medically inappropriate, or vaginal delivery is attempted but discontinued due to immediate danger of death, Sickness or injury to child or mother.
Not included: (a) false labor, occasional spotting or Physician prescribed rest during the period of pregnancy; (b) morning sickness; (c) hyperemesis gravidarum and (d) similar conditions not medically distinct from a difficult pregnancy.
Covered Expenses as used in this Rider means expenses actually incurred by or on behalf of an Insured Person for treatment, services and supplies covered by this Policy. Coverage under the Policyholders’ Policy must remain continually in force from the date of the Covered Accident or Sickness until the date of treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date treatment, service or supply that gave rise to the expense or the charge, was rendered or obtained.
Covered Injury as used in this Rider means bodily Injury; 1) directly and independently caused by specific accident which is unrelated to any pathological, functional, or structural disorder to Injury; 2) treated by a Physician within 30 days after the Covered Accident; and 3) which caused loss during the term of this Rider.
Covered Trip as used in this Rider, means travel by air, land or sea from the Insured Person’s Home Country.
Deductible as used in this Rider means the amount that must be paid for Covered Medical Services by the Insured Person before benefits will become payable under this Rider. A separate deductible shall apply to each Covered Loss.
Home Country as used in this Rider means a country from which the Insured Person holds a passport or where the Insured Person has primary residency. If the Insured Person holds passports from more than one Country, his or her Home Country will be the country that he has declared to Us in writing as his Home Country
Hospital ‑ as used in this Rider, means a facility that:
A Hospital does not include:
Hospital Confined as used in this Rider means a stay of 48 or more consecutive hours as a registered resident bed-patient in a Hospital.
Intensive Care Unit (ICU) as used in this Rider means specifically designated facility of the Hospital that is designed to provide intensive care services on an interdisciplinary basis to critically ill inpatients. provides the highest level of medical care and that is restricted to those patients who are critically ill or injured and need constant medical care. Such care must be ordered by a Physician. The facility must provide: room and board, registered nursing care, and special equipment and supplies on a standby basis. Such facilities must be separate and apart from the surgical recovery room and from rooms, beds, and wards customarily used for patient confinement.
Medically Necessary ‑ as used in this Rider refers to a Covered Medical Service that:
Physiotherapy as used in this Rider means any form of the following: physical or mechanical therapy, diathermy, ultrasonic therapy; heat treatment in any form; manipulation or massage administered by a Physician. It does not include chiropractic care.
Prescription Drugs as used in this Rider means 1) prescription legend drugs; 2) compound medications of which at least one ingredient is a prescription legend drug; 3) any other drugs which under the applicable state or federal law may be dispensed only upon written prescription of a Physician; and 4 Injectable insulin.
Physician as used in this Rider means a licensed health care provider practicing within the scope of his license and rendering care and treatment to the Insured Person that is appropriate for the condition and locality, and who is not:
Sickness as used in this Rider means disease or illness, including related conditions and recurrent symptoms, which begin after the effective date of an Insured Person’s coverage and while coverage is in force under this Rider.
Usual and Customary Charge(s) ‑ as used in this Rider means a charge that:
The Company will not pay Covered Medical Services for any loss, treatment or services resulting from the following.
In addition, benefits will not be paid for services or treatment rendered by any person who is:
1. employed or retained by the Policyholder;
2. living in the Insured Person’s household;
3. an Immediate Family Member of either the Insured Person or the Insured Person’s Spouse;
4. the Insured Person.
If we determine the benefits paid under this Rider are eligible benefits under any Other Health Care Plan, We may seek to recover any expenses covered by the Other Health Care Plan to the extent that the Insured person is eligible for reimbursement.
This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit US companies from proving insurance, including but not limited to, the payment of claims. All other terms and conditions of the Policy and this Rider remain unchanged.
Europ TRAVEL ASSISTANCE SERVICES
Europ Assistance can help travelers with medical emergencies by:
The Europ Assistance communications network is available 24 hours a day, seven days a week to provide assistance to the Insured Person.
Inside the United States/Canada call (877) 243-4134
Outside United States/Canada call collect 240-330-1528
or email OPS@europassistance-usa.com
OTHER BENEFITS - MEDICAL EVACUATION AND REPATRIATION BENEFITS
EMERGENCY MEDICAL EVACUATION AND REPATRIATION: These Benefits will not be payable unless We (or Our authorized travel assistance provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our a travel assistance provider. Contact Europ Assistance for these services at (877) 243-4134 or call collect from outside the United States at (240) 330-1528 (24 hours a day, 7 days a week). Email: OPS@europassistance-usa.com
EMERGENCY MEDICAL EVACUATION BENEFIT: We will pay Emergency Medical Evacuation Benefits as shown for Covered Expenses incurred for the Emergency Evacuation of a Insured Person. Benefits are payable up to the Benefit Maximum shown, if the Insured Person suffers a Covered Injury or Emergency Sickness during the course of the Covered Trip that requires Emergency Evacuation.
REPATRIATION OF REMAINS BENEFIT: We will pay Repatriation Benefits up to the Benefit Maximum shown for preparation and return of a Insured Persons body to his or her place of primary residence if he or she dies as a result of a Covered Injury or Emergency Sickness while traveling on a Covered Trip.
ACCIDENTAL DEATH AND DISMEMBERMENT: If Injury to the Insured Person results, within 365 days of the date of a Covered Accident, in any one of the losses shown below, We will pay the Benefit Amount shown below for that loss. The Aggregate Sum is $500,000 as shown. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.
Loss of Life
100% of the Aggregate Sum
Loss of Two or More Hands or Feet
100% of the Aggregate Sum
Loss of Sight of Both Eyes
100% of the Aggregate Sum
Loss of One Hand and Foot
100% of the Aggregate Sum
Loss of One Hand or Foot and Sight in One Eye
100% of the Aggregate Sum
Loss of One Hand or Foot
50% of the Aggregate Sum
Loss of Sight in One Eye
Exposure and Disappearance
50% of the Aggregate Sum
Refund of premium, less a $25 processing fee, will be considered only if the Cancellation Form is received by the India Network Services prior to the effective date of coverage. After that date, the premium is considered fully earned and non-refundable. All cancellation requests should be submitted by completing the Cancellation Form found under 'Members Area' section of the web pages. The form can be faxed to 408-520-4967. Policy changes cannot be made under any circumstances once the policy becomes effective.
(877) 563-7492, fax (469) 417-1989