Page 2 - Atlas_Premium_Specimen
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CONTENTS APPEAL AND COMPLAINTS PROCEDURE................ 10
APPEALING A CLAIM ........................................... 10
IMPORTANT NOTICE AND DISCLAIMER
CONCERNING THE UNITED STATES PATIENT COMPLAINTS PROCEDURE................................ 10
PROTECTION AND AFFORDABLE CARE ACT.............3
DESCRIPTION OF COVERAGE SUMMARY..................3 PRE-EXISTING MEDICAL CONDITIONS .................... 11
IMPORTANT FEATURES OF YOUR TRAVEL ACUTE ONSET OF PRE-EXISTING CONDITION 11
INSURANCE....................................................................3
MEDICAL & REPATRIATION EXPENSES ................... 11
CANCELLATION ......................................................3 MEDICAL EXPENSES........................................... 11
U.S. PREFERRED PROVIDER ORGANIZATION
(PPO)........................................................................3 EMERGENCY MEDICAL EVACUATION............... 13
CLAIMS ....................................................................4SPECIMEN
APPEALS AND COMPLAINTS ................................4 TRIP INTERRUPTION ........................................... 13
DEFINITIONS ...........................................................4
PRE-EXISTING CONDITIONS .................................4 RETURN OF MINOR CHILDREN.......................... 14
DATA PROTECTION................................................4
RIGHTS OF THIRD PARTIES ..................................4 POLITICAL EVACUATION .................................... 14
LAW AND JURISDICTION .......................................4
TOKIO MARINE HCC MEDICAL INSURANCE REPATRIATION OF REMAINS ............................. 14
SERVICES GROUP (“MIS GROUP”) .......................4
MEMBER ELIGIBILITY ....................................................5 LOCAL BURIAL OR CREMATION ........................ 15
CERTIFICATE EFFECTIVE & TERMINATION DATES...5
CERTIFICATE EFFECTIVE DATE ...........................5 INDEMNITY BENEFIT & VISITATION EXPENSES...... 15
CERTIFICATE TERMINATION DATE ......................5 HOSPITAL INDEMNITY......................................... 15
BENEFIT PERIOD & HOME COUNTRY COVERAGE ....5
BENEFIT PERIOD....................................................5 EMERGENCY REUNION ...................................... 15
INCIDENTAL HOME COUNTRY COVERAGE.........5
SCHEDULE OF BENEFITS AND LIMITS........................6 BEDSIDE VISIT ..................................................... 16
U.S. PREFERRED PROVIDER ORGANIZATION (PPO)
REQUIREMENTS ............................................................8 TRAVEL ASSISTANCE 16
CLAIM PROCEDURES....................................................9
PROOF OF CLAIM ...................................................9 TRAVEL DELAY .................................................... 16
CLAIMS COOPERATION .........................................9
ACCESS TO ADDITIONAL MATERIALS .................9 LOST CHECKED LUGGAGE ................................ 16
OTHER INSURANCE ...............................................9
ARBITRATION..........................................................9 NATURAL DISASTER - REPLACEMENT
ACCOMMODATIONS ............................................ 17
BORDER ENTRY PROTECTION .......................... 17
PET RETURN ........................................................ 18
PERSONAL ACCIDENT ............................................... 18
ACCIDENTAL DEATH AND DISMEMBERMENT.. 18
COMMON CARRIER ACCIDENTAL DEATH
BENEFIT................................................................ 19
SPORTS AND ACTIVITIES .......................................... 19
CRISIS RESPONSE ..................................................... 21
KIDNAPPING AND EXPRESS KIDNAPPING ....... 21
NATURAL DISASTER EVACUATION ................... 22
PERSONAL LIABILITY ................................................. 23
TERRORISM................................................................. 24
GENERAL EXCLUSIONS ............................................. 25
DEFINITIONS ............................................................... 27
2 Atlas Premium Description of Coverage | Tokio Marine HCC - MIS Group
APPEALING A CLAIM ........................................... 10
IMPORTANT NOTICE AND DISCLAIMER
CONCERNING THE UNITED STATES PATIENT COMPLAINTS PROCEDURE................................ 10
PROTECTION AND AFFORDABLE CARE ACT.............3
DESCRIPTION OF COVERAGE SUMMARY..................3 PRE-EXISTING MEDICAL CONDITIONS .................... 11
IMPORTANT FEATURES OF YOUR TRAVEL ACUTE ONSET OF PRE-EXISTING CONDITION 11
INSURANCE....................................................................3
MEDICAL & REPATRIATION EXPENSES ................... 11
CANCELLATION ......................................................3 MEDICAL EXPENSES........................................... 11
U.S. PREFERRED PROVIDER ORGANIZATION
(PPO)........................................................................3 EMERGENCY MEDICAL EVACUATION............... 13
CLAIMS ....................................................................4SPECIMEN
APPEALS AND COMPLAINTS ................................4 TRIP INTERRUPTION ........................................... 13
DEFINITIONS ...........................................................4
PRE-EXISTING CONDITIONS .................................4 RETURN OF MINOR CHILDREN.......................... 14
DATA PROTECTION................................................4
RIGHTS OF THIRD PARTIES ..................................4 POLITICAL EVACUATION .................................... 14
LAW AND JURISDICTION .......................................4
TOKIO MARINE HCC MEDICAL INSURANCE REPATRIATION OF REMAINS ............................. 14
SERVICES GROUP (“MIS GROUP”) .......................4
MEMBER ELIGIBILITY ....................................................5 LOCAL BURIAL OR CREMATION ........................ 15
CERTIFICATE EFFECTIVE & TERMINATION DATES...5
CERTIFICATE EFFECTIVE DATE ...........................5 INDEMNITY BENEFIT & VISITATION EXPENSES...... 15
CERTIFICATE TERMINATION DATE ......................5 HOSPITAL INDEMNITY......................................... 15
BENEFIT PERIOD & HOME COUNTRY COVERAGE ....5
BENEFIT PERIOD....................................................5 EMERGENCY REUNION ...................................... 15
INCIDENTAL HOME COUNTRY COVERAGE.........5
SCHEDULE OF BENEFITS AND LIMITS........................6 BEDSIDE VISIT ..................................................... 16
U.S. PREFERRED PROVIDER ORGANIZATION (PPO)
REQUIREMENTS ............................................................8 TRAVEL ASSISTANCE 16
CLAIM PROCEDURES....................................................9
PROOF OF CLAIM ...................................................9 TRAVEL DELAY .................................................... 16
CLAIMS COOPERATION .........................................9
ACCESS TO ADDITIONAL MATERIALS .................9 LOST CHECKED LUGGAGE ................................ 16
OTHER INSURANCE ...............................................9
ARBITRATION..........................................................9 NATURAL DISASTER - REPLACEMENT
ACCOMMODATIONS ............................................ 17
BORDER ENTRY PROTECTION .......................... 17
PET RETURN ........................................................ 18
PERSONAL ACCIDENT ............................................... 18
ACCIDENTAL DEATH AND DISMEMBERMENT.. 18
COMMON CARRIER ACCIDENTAL DEATH
BENEFIT................................................................ 19
SPORTS AND ACTIVITIES .......................................... 19
CRISIS RESPONSE ..................................................... 21
KIDNAPPING AND EXPRESS KIDNAPPING ....... 21
NATURAL DISASTER EVACUATION ................... 22
PERSONAL LIABILITY ................................................. 23
TERRORISM................................................................. 24
GENERAL EXCLUSIONS ............................................. 25
DEFINITIONS ............................................................... 27
2 Atlas Premium Description of Coverage | Tokio Marine HCC - MIS Group
