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Reside Worldwide
schedule of benefits
why Reside® for your international medical program? There is an increasing population of global citizens, people who travel from country to country or continent to continent. Included among these global citizens are those less inclined to travel, yet discerning enough to know and demand the best care available worldwide. Whatever the reason you need to leave your home country, Reside® Worldwide Medical Plan will follow you. Many foreign countries have coverage options, but as a U.S. citizen you are either not eligible for coverage or the protection the plan offers is inadequate. For non-U.S. citizens, it may be difficult to find a comprehensive medical plan, which provides coverage where your local plan may fall short. Whether you are a U.S. citizen living abroad or a citizen of another country, Reside® provides you with security at home and the freedom to seek care anywhere in the world. are you eligible for the Reside® program? The Reside® program is available to persons of any country who are at least 15 days of age and who are not older than age 74. For U.S. Citizens: Applicants / Insured Persons must either be outside the United States at the time of application, or plan to depart the United States within 30 days of the Certificate's Effective Date. In addition, the Insured Person must Reside® outside the United States at least 6 months during any given 12-month Policy Period in order to be considered an Insured Person. If an Insured Person Reside®s in the United States longer than 6 months during any given 12-month Policy Period, their coverage shall immediately terminate. For Non-U.S. Citizens: Applicants / Insured Persons must be outside the United States at the time of application, or plan to depart the United States within 30 days of the Certificate's Effective Date. If the Insured Person is located in the United States for more than 30 days after the Effective Date and cannot obtain other health insurance, a Proof of Eligibility Form must be submitted with the Application. *It is the Insured Person's responsibility to maintain all records regarding travel history, age and student status and provide any documentation to the Administrator, which would verify the Eligibility Requirements. how long are you covered under Reside®? The Reside® program is annually renewable as long as the eligibility requirements are met and the renewal premium is received. There are no additional medical questions upon renewal. The company cannot single out an individual for cancellation, they can only cancel coverage for an entire class* of insureds. * A "class" is a group of people defined by a common characteristic, including but not limited to demographic group and geographic region. how do you apply for coverage? To apply for coverage under Reside®, complete the enclosed application and submit the form to Seven Corners along with the appropriate premium. Seven Corners will review your application and respond within 48 hours (normal business days). In some situations, additional information or clarification may be required. Our underwriting department will contact the applicant to obtain any additional details necessary to determine acceptability. If accepted, Seven Corners will mail the Insured's ID Card with Effective Date, Certificate of Coverage, claim form, and general procedures for the use of the insurance to the address of convenience listed on the application. If Seven Corners is unable to offer coverage, the administrative department will return your premium without delay. Please be sure to answer the questions on the application in complete detail. If accepted, the application becomes part of the certificate and formal agreement with the company. deductibles, coinsurance & policy maximums You have your choice of six per Injury /
Sickness Deductibles: Reside® does not have a coinsurance amount, apart from the chosen deductible and the limits described in the Schedule of Benefits. The Lifetime Maximum amount is listed in the Schedule of Benefits. Should you travel during the course of treatment from one area to another (whether being treated inside the United States and Canada or outside the United States and Canada), the limitations of the new area shall apply.
what to do if you need to use the insurance? For hospitalization and surgical procedures, contact Seven Corners Assist to obtain pre-notification services. The quality and complexity of medical treatment varies from country to country, therefore pre-notification is a requirement of the program. It allows our professionals to locate a Preferred Provider facility if available, assist you in receiving the best course of treatment, and coordinate payment with the local facility. Our objective is for you to focus your attention on your medical condition and not on administrative details. For non-hospital or surgical related procedures, filing a claim under Reside® is easy. Just complete the claim form that comes with your ID Card, sign it, and submit it along with all original, itemized bills (and receipts if you have already paid for the medical expenses) to Seven Corners for processing. If acceptable with the facility, Seven Corners will make the payment directly to the treating hospital or doctor.
coverage for children If both parents are covered under Reside®, the first two (2) Dependent Children between 14 days through 9 years of age will also be covered free of charge. If there are more than two (2) Dependent Children between the age of 14 days through 9 years of age, or if the children are 10 or over, the program will charge the applicable premium. If only one parent will be covered under the program, each child will be charged the appropriate rate. newborn child coverage When a parent remains eligible for coverage and the Pregnancy is considered an eligible pregnancy, newborn children are automatically covered for the first thirty-one (31) days after birth. In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits, as to Eligible Benefits during the first thirty-one (31) days following birth for Newborn Coverage and Treatment. In order to continue coverage beyond the first thirty-one (31) days and be accepted as any other new Insured Person subject to the Insurance Provisions, Scope of Coverage and Exclusions sections of this Certificate or other sections relating to a Newborn Child (or Children) up to the maximum amount of this Certificate the following conditions must be met: 1) An Application and any applicable premium is submitted and Approved by the Company within thirty-one (31) days of the birth of a Newborn Child (or Children); 2) The Pregnancy that led to the birth of a Newborn Child (or Children) was an eligible Pregnancy covered under this Certificate; 3) The mother of the Newborn Child (or Children) remain covered under this Certificate; 4) The mother and Newborn Child (or Children) meet and will continue to meet the Eligibility Requirements of this Certificate of Coverage. limitations of the Reside® program Pre-Existing Conditions: All Pre-Existing Conditions will be considered, provided the Insured Person has not:
Meaning, at the time that you submit a possible pre-existing claim to Seven Corners for processing, we will look back 24 months from the date of service and determine if you had been treated, medicated or diagnosed for the condition within the last 24 months. If you have not been treated, medicated or diagnosed for the condition in the last 24 months, the eligible claim expense will be payable under the provisions and benefit limits of the Certificate. However, if you have been treated, medicated or diagnosed for the condition within the last 24 months, the claim expense shall be considered pre-existing and the expenses will not be considered eligible under the provisions of the Certificate. Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or symptoms occur during the first 180 days of coverage hereunder beginning on the initial Effective Date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne-related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder. Note: coverage for such illnesses or surgeries may be further limited under the pre-existing condition exclusion and definition contained herein, or other exclusions contained herein; The following conditions, treatments, supplies, services, and/or expenses are not covered resulting from: (This is a Summary of the Exclusions contained in the Certificate of Coverage.)
pre-notification program To ensure that you receive the best care possible, Reside® requires that the Insured Person (or someone on the Insured Person's behalf) contact Seven Corners Assist for notification prior to all hospital admissions worldwide and any medical expenses incurred within the United States. The methods of contacting Seven Corners Assist will appear on the back of your ID Card. Seven Corners Assist will also be able to assist you in locating the approved Seven Corners medical care providers in the United States. additional features & services Assistance / Referral Services: Seven Corners Assist is prepared to help you 24-hours a day, 365 days a year to locate medical professionals worldwide. Even if you are not calling to pre-notify a hospital admission or surgery, we encourage you to contact Seven Corners Assist for support with any injury or sickness, so that our professionals will be involved to ensure you receive appropriate medical care. Emergency Evacuation / Repatriation: Unfortunately, the medical professionals in certain locations of the world are unable to provide adequate treatment for a number of medical conditions. As a standard benefit of the Reside® program, we will transport you to a different medical facility if you are located in a region where the medical professionals are not able to treat your particular condition. important information It is important to note that Reside® is a program for international citizens and Lloyd's of London is an international entity. Thus, Lloyd's of London operates as an unauthorized insurer in most U.S. States. Coverage and benefits under Reside® are not regulated by any U.S. state insurance department. The information concerning Reside® is not intended to be an offer to sell Reside® or a solicitation by Seven Corners, Inc. or Lloyd's of London in any jurisdiction where such an action would be unlawful or in which Seven Corners or Lloyd's of London is not qualified to do so. Reside® may not be available in all situations or jurisdictions. For U.S. citizens, Reside® is intended for persons living or traveling outside the United States. the underwriter The Reside® Worldwide Medical Plan is underwritten by Certain Underwriters at Lloyd's of London. As the largest insurance entity in the world, Lloyd's of London has earned an A "Excellent" rating from A.M. Best and an A+ (Strong) rating from Standard & Poor's. seven corners assist When Unpronounceable Diseases Occur In
Unpronounceable Countries Foreign Country - Familiar Service Quality of Care a description of our services The following services are available 24-hours a day, 7 days a week from a multilingual staff of service professionals. Assistance With Travel Pre-Trip Information: Provide information concerning inoculation and visa requirements for countries worldwide
Medical Assistance While Traveling 24-Hour Telephone Contact: Should medical emergencies arise, there is help in locating medical care
the program administrator Properly serving the medical needs of international citizens requires specialization. Most companies are not prepared to meet the unique needs of these customers. An organization must be equipped to address foreign currencies, international doctors and hospitals, as well as unusual claim forms and documents. The Reside® Worldwide Medical Plan is administered worldwide by Seven Corners, Inc. The professionals at Seven Corners have over 250 years of experience in claim processing and administration. Seven Corners currently serves the needs of thousands of policyholders throughout the world. seven corners Since 1993, Seven Corners, Inc. has provided international insurance plans to private citizens, governments, missionaries, students, and corporations of various nations around the globe. As a premier underwriter, Seven Corners has had the opportunity to provide innovative solutions to unique and challenging situations. Our claims professionals are experienced in the complexity of processing international medical expenses. As an insured of Seven Corners, you can feel confident that there is someone ready to assist you with a medical situation 24-hours a day, 365 days a year. Other services including proficient administration, responsive underwriting, and access to secure and stable insurance carriers and medical care providers worldwide.
WHY RESIDE SHOULD BE YOUR INTERNATIONAL MEDICAL PROGRAM? There is an increasing population of global citizens, people who travel from country to country or continent to continent on a regular basis. Included among these global citizens are those less inclined to travel, however are discerning enough to know and demand the best care available worldwide. Whatever the reason, if you need to leave your home country, Reside Worldwide Medical Plan will follow you. Many foreign countries do have coverage options, but you will find that as a US citizen, you are either not eligible for coverage or the protection the plan offers is inadequate. For non-US citizens, the issue may be finding a comprehensive medical plan to provide coverage where your local plan may fall short. Whether you are a US citizens living abroad or a citizen of another country, Reside provides you with security at home and the freedom to seek care anywhere in the world. ARE YOU ELIGIBLE FOR THE RESIDE PROGRAM? The Reside program is available to persons of any country who are at least 15 days of age and who are not older than age 74. For US Citizens: Applicants / Insured Persons must either be outside the United States at the time of application, or plan to depart the United States within 30 days of the Certificate's Effective Date. In addition, the Insured Person must reside outside the United States at least 6 months during any given 12-month period in order to be considered an Insured Person. Should any Insured Person reside in the United States longer than 6 months during any given 12-month period, their coverage shall immediately terminate. For Non-US Citizens: Applicants / Insured Persons must be outside the United States at the time of application, or plan to depart the United States within 30 days of the Certificate's Effective Date. If the Insured Person is located in the United States for more than 30 days after the Effective Date and cannot obtain other health insurance, a Proof of Eligibility Form must be submitted with the Application. *It is the Insured Person's responsibility to maintain all records regarding travel history, age and student status and provide any documents to the Administrator, which would verify the Eligibility Requirements. HOW LONG MAY I BE COVERED UNDER RESIDE? The Reside program is annually renewable as long as the eligibility requirements are met and the renewal premium paid. There are no additional medical questions upon renewal. The company cannot single out an individual for cancellation, they can only cancel coverage for an entire class* of insureds. For those who apply for coverage prior to their 65th birthday and remain continuously insured for ten consecutive years, you will automatically be converted to the Reside Senior Provider at age 75 as long as you continue your eligibility status. * A "Class" is a group of people defined by a common characteristic, including but not limited to demographic group and geographic region. HOW DO I APPLY FOR COVERAGE? To apply for coverage under Reside, complete the enclosed application and submit the form to SRI along with the appropriate premium. SRI will review your application and respond within 48 hours (normal business days). In some situations, additional information or clarification may be required. Our underwriting department will contact the applicant to obtain any additional details necessary to determine acceptability. If accepted, SRI will mail the Insured's ID Card with effective date, Certificate of Coverage, claim form, and general procedures for the use of the insurance to the address of convenience listed on the application. If SRI is unable to offer coverage, the administrative department will return your premium without delay. Please be sure to answer the questions on the application in complete detail. If accepted, the application becomes part of the certificate and formal agreement with the company. DEDUCTIBLES, COINSURANCE & POLICY MAXIMUMS You have your choice of five annual deductibles: US$250, US$500, US$1000, US$2500, US$5000. The annual deductible applies to each insured person with a limit of 3 annual deductibles per family. If the treatment is received in the United States or Canada, the plan will pay 80% of the next US$5000 of eligible expenses, according to the schedule, after the deductible up to the policy maximum. If treatment is received outside the United States or Canada, the plan pays 100% of eligible expenses, according to the schedule, after the deductible up to the policy maximum. The 3 deductible limit per family applies to the coinsurance as well. The lifetime maximum benefit of Reside is US$5,000,000 per insured person. WHAT DO I DO IF I NEED TO USE THE INSURANCE? For hospitalization and surgical procedures, contact SRI Assist to obtain pre-notification services. The quality and complexity of medical treatment varies from country to country, therefore pre-notification is a requirement of the program. It allows our professionals to locate a Preferred Provider facility if available, assist you in receiving the best course of treatment, and coordinate payment with the local facility. Our objective is for you to focus your attention on your medical condition and not on administrative details. For non-hospital or surgical related procedures, filing a claim under Reside is easy. Just complete the claim form that comes with your ID Card, sign it, and submit it along with all original, itemized bills (and receipts if you have already paid for the medical expenses) to SRI for processing. If acceptable with the facility, SRI will make the payment directly to the treating hospital or doctor. COVERAGE FOR CHILDREN If both parents are covered under Reside, the first two children under the age of 10 will also be covered free of charge. If there are more than two children under the age of 10 or if the children are 10 or over, the program will charge the dependent child rate. If only one parent will be covered under the program, each child will be charged the dependent child rate. NEWBORN CHILD COVERAGE When a parent remains eligible for coverage and the pregnancy is considered an eligible pregnancy, newborn children are automatically covered for the first thirty one (31) days after birth. In no event shall the Company's maximum liability exceed the maximum stated in the Schedule of Benefits, as to Eligible Benefits during the first thirty one (31) days following birth for Newborn Coverage and Treatment. In order to continue coverage beyond the first thirty one (31) days and be accepted as any other new Insured Person subject to the Insurance Provisions, Scope of Coverage and Exclusions sections of this Certificate or other sections relating to a Newborn Child up to the maximum amount of this Certificate the following conditions must be met: (1) An Application and any applicable premium is submitted and Approved by the Company within thirty one (31) days of the birth of a Newborn Child(ren); (2) The Pregnancy which led to the birth of a Newborn Child was an eligible pregnancy covered under this Certificate; (3) That the mother of the Newborn Child remain covered under this Certificate; (4) The mother and Newborn Child meets and will continue to meet the Eligibility Requirements of this Certificate. ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) Reside automatically includes an Accidental Death & Dismemberment (AD&D) benefit for each insured, with a $10,000 Principal Sum for the Insured and Spouse, $2,000 for Dependent Children. On a Common Carrier, the Principal Sum increases to $40,000 for the Insured and Spouse, $8,000 for Dependent Children. LIMITATIONS OF THE RESIDE PROGRAM Pre-existing Conditions: Pre-existing conditions are any Injury or Illness which meets the following criteria: 1) A condition that would have caused a person to seek medical advise, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2) A condition for which manifestation, medical advise, diagnosis, care or treatment (including medication) was recommended or received prior to the Effective Date of coverage under this Certificate; 3) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate. Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or symptoms occur during the first 180 days of coverage hereunder beginning on the initial effective date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder. Note: coverage for such illnesses or surgeries may be further limited under the pre existing condition exclusion and definition contained herein, or other exclusions contained herein; The following conditions, treatments, supplies, services, and/or
expenses are not covered:
PRE-NOTIFICATION PROGRAM/PPO So that you receive the best care possible, RESIDE requires that the Insured Person (or someone on the Insured Person's behalf) contact SRI Assist for notification prior to all hospital admissions worldwide and any medical expenses incurred within the United States. The methods of contacting SRI Assist will appear on the back of your ID Card. SRI Assist will also be able to assist you in locating the approved SRI medical care providers in the United States. Utilize an approved PPO Service Provider within the United States If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits. Failure to follow the Pre-Notification Program and to utilize an approved PPO Service Provider will result in a 25% reduction of the Eligible Benefits stated in the Schedule of Benefits. ADDITIONAL FEATURES AND SERVICES Assistance / Referral Services: SRI Assist is prepared to help you 24 hours a day, 365 days a year to locate medical professionals worldwide. Even if you are not calling to pre-notify a hospital admission or surgery, we encourage you to contact SRI Assist for support with any injury or sickness, so that our professionals will be involved to ensure you receive appropriate medical care. Emergency Evacuation / Repatriation: Unfortunately, the medical professionals in certain locations of the world are unable to provide adequate treatment for a number of medical conditions. As a standard benefit of the Reside program, we will transport you to a different medical facility if you are located in a region where the medical professionals are not able to treat your particular condition. IMPORTANT INFORMATION It is important to note that Reside is a program for international citizens and Lloyd's is an international entity. Thus, Lloyd's operates as an unauthorized insurer in most U.S. States. Coverage and benefits under the Reside are not regulated by any U.S. state insurance department. The information concerning Reside is not intended to be an offer to sell Reside or a solicitation by Specialty Risk International, Inc. or Lloyd's, London in any jurisdiction where such an action would be unlawful or in which SRI or Lloyd's, London is not qualified to do so. Reside may not be available in all situations or jurisdictions. For U.S. citizens, Reside is intended for persons living or traveling outside the United States. THE UNDERWRITER The Reside Worldwide Medical Plan is underwritten by Certain Underwriters at Lloyds, London. As the largest insurance entity in the world, Lloyds has earned an A- (Excellent) rating from AM Best and an A+ (Strong) rating from Standard and Poors. SRI ASSIST When Unpronounceable Diseases Occur In Unpronounceable Countries Foreign Country - Familiar Service Quality of Care THE PROGRAM ADMINISTRATOR Properly serving the medical needs of international citizens requires specialization. Most companies are not prepared to meet the unique needs of these customers. An organization must be equipped to address foreign currencies, international doctors and hospitals, as well as unusual claim forms and documents. The Reside Worldwide Medical Plan is administered worldwide by SRI Administrators, Inc.. The professionals at SRI Administrators have over 150 years of experience in claim processing and administration. SRI currently serves the needs of thousands of policyholders throughout the world. SPECIALTY RISK INTERNATIONAL Since 1993, Specialty Risk International, Inc. (SRI) has provided international insurance plans to private citizens, governments, missionaries, students, and corporations of various nations around the globe. As a premier underwriter, SRI has had the opportunity to provide innovative solutions to unique and challenging situations. Our claims professionals are experienced in the complexity of processing international medical expenses. As an insured of SRI, you can feel confident that there is someone ready to assist you with a medical situation 24 hours a day, 365 days a year. Other services including proficient administration, responsive
underwriting, and access to secure and stable insurance carriers and
medical care providers worldwide. |
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For more information please contact:
John K. Arnold
Managing General Agent
International Insurance Website www.insurance-network.com
E-Mail: John K. Arnold
PH: 1-(407) 830-0259
Fax: 1-(407)
830-4785
Fax: 1-(407) 830-4828