Page 3 - AtlasTravel_Specimen
P. 3
SPECIMENIMPORTANT NOTICE AND DISCLAIMER
CONCERNING THE UNITED STATES PATIENT
PROTECTION AND AFFORDABLE CARE ACT
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.
DESCRIPTION OF COVERAGE SUMMARY
This Description of Coverage is a summary of the provisions contained in Master Policy No.181920-
1.1. For a complete copy of the Master Policy, please contact Tokio Marine HCC Medical Insurance
Services Group.
This Description is to help you understand the insurance that your certificate provides. It details the
key features, benefits, limitations, exclusions, definitions, Schedule of Benefits and Limits, and any
endorsements, applying to your certificate.
The levels of coverage which apply to your coverage are detailed in the Schedule of Benefits and
Limits.
IMPORTANT FEATURES OF YOUR TRAVEL
INSURANCE
CANCELLATION
We hope you are happy with the cover this policy provides. However, if after reading it, this
insurance does not meet with your requirements, please notify us of your wish to cancel and we will
refund your premium.
Premiums will be refunded in full if a cancellation request is received prior to the certificate effective
date.
Premiums may be refunded after the certificate effective date subject to the following provisions:
a. A $25 cancellation fee will apply for administrative costs incurred by us; and
b. Only the unused portion of the plan cost will be refunded; and
c. You cannot have filed any claims to be eligible for a premium refund.
U.S. PREFERRED PROVIDER ORGANIZATION (PPO)
This insurance policy offers the option of a PPO network for medical treatment received in the United
States. If you choose to seek treatment from a PPO provider, billed charges for eligible expenses
may be reduced and we will remit payment directly to the provider.
You may review a listing of hospitals, physicians and other medical service providers included in
the PPO Network for the area where you will be receiving treatment by accessing the Internet website
for Tokio Marine HCC - MIS Group: www.hccmis.com. For assistance locating a provider, contact us
at 1-800-605-2282.
3 Atlas Travel Description of Coverage | Tokio Marine HCC - MIS Group
CONCERNING THE UNITED STATES PATIENT
PROTECTION AND AFFORDABLE CARE ACT
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.
DESCRIPTION OF COVERAGE SUMMARY
This Description of Coverage is a summary of the provisions contained in Master Policy No.181920-
1.1. For a complete copy of the Master Policy, please contact Tokio Marine HCC Medical Insurance
Services Group.
This Description is to help you understand the insurance that your certificate provides. It details the
key features, benefits, limitations, exclusions, definitions, Schedule of Benefits and Limits, and any
endorsements, applying to your certificate.
The levels of coverage which apply to your coverage are detailed in the Schedule of Benefits and
Limits.
IMPORTANT FEATURES OF YOUR TRAVEL
INSURANCE
CANCELLATION
We hope you are happy with the cover this policy provides. However, if after reading it, this
insurance does not meet with your requirements, please notify us of your wish to cancel and we will
refund your premium.
Premiums will be refunded in full if a cancellation request is received prior to the certificate effective
date.
Premiums may be refunded after the certificate effective date subject to the following provisions:
a. A $25 cancellation fee will apply for administrative costs incurred by us; and
b. Only the unused portion of the plan cost will be refunded; and
c. You cannot have filed any claims to be eligible for a premium refund.
U.S. PREFERRED PROVIDER ORGANIZATION (PPO)
This insurance policy offers the option of a PPO network for medical treatment received in the United
States. If you choose to seek treatment from a PPO provider, billed charges for eligible expenses
may be reduced and we will remit payment directly to the provider.
You may review a listing of hospitals, physicians and other medical service providers included in
the PPO Network for the area where you will be receiving treatment by accessing the Internet website
for Tokio Marine HCC - MIS Group: www.hccmis.com. For assistance locating a provider, contact us
at 1-800-605-2282.
3 Atlas Travel Description of Coverage | Tokio Marine HCC - MIS Group
