Disclaimer:
The Answers below apply to the most popular policies that we sell, but not necessarily to the one you buy. So please ask us for clarification if you need an answer!Q: Who is eligible?
A: Anybody under age 75 is eligible provided they are not American living in the USA, or any dependent territory of the USA like Puerto Rico. With most policies and Worldwide geographical cover, you can spend cumulatively 6 months per year in the USA and return there for medical treatment.
Back to TopQ: What period of time can I be covered for, and are the plans automatically renewable?
A: Policies are annual and guaranteed to be renewable no matter what claims are pending. You can continue to renew as long as the plan is available, and you are eligible. The upper age limit for new applicants is 74. You will receive a 30-day e-mail notice prior to your expiration date. You will be renewed automatically unless you tell the insurer otherwise. If you are renewed in error, you can cancel for a full refund.
Back to TopQ: Will I be required to answer a medical questionnaire or have a medical exam?
A: Our application has medical questions that ask about pre-existing medical conditions, but no physical exam is required. If you are 55 or older, you must have had a physical exam in the last 2 years in order to qualify, or you must have a physical exam and provide a note from the doctor.
Back to TopQ: How do I apply and how quickly can I be covered?
A: You can apply on-line and get same day cover paying by credit card. Or, simply download an application scan & e-mail, or post it to us. If you are paying by credit card, you can get immediate cover or on the date you specify up to 30 days in the future. If you are in the USA when you apply, your start date must be the day you leave.
Back to TopQ: How can I pay?
A: You can pay annually by credit card (Visa, MasterCard, JCB, American Express), check, postal money order, or bank draft in US$. You can only pay monthly, quarterly, or semi-annually only with a credit card.
Back to TopQ: How do I know I’m covered, and what will I receive after joining?
A: You will receive all policy documents by e-mail and can opt for hard copies to follow to your postal address.
Back to TopQ: Can I change the Level or Area of cover?
A: Yes, but only at renewal. If you upgrade, wait periods for benefits such as maternity will apply anew. If you have a medical condition under treatment and want to change your geographical area to be treated in the US or Canada, then this is at the insurer’s discretion.
Back to TopQ: Can I cancel and get a refund?
A: You can cancel and get a full refund within 15 days, if you are claim free, you can get a pro rata refund any time.
Back to TopQ: What is the Compassionate/ Reunion travel benefit?
A: Compassionate travel is a return home up to $3000 USD benefit allowing travel home if an immediate family member under 75 dies unexpectedly, or becomes terminally ill. It also allows an immediate family member to travel to your bedside if you are hospitalized. Under the Medical Evacuation benefit, reasonable transportation costs for an accompanying person will be paid if deemed necessary by the insurer. In all circumstances these benefits must be pre-authorized and arranged by the insurer.
Back to TopQ: What are the Major Exclusions?
A: STD's, immunizations, cosmetic surgery, contraceptives, vaccinations etc. are excluded. These exclusions are standard with most policies. The pre-existing condition policy wording specifies that any pre-existing conditions you could or must have been reasonably aware of are excluded.
Back to TopQ: Are hazardous sports excluded?
A: Hazardous sports are excluded. Please see the policy wordings for a complete list. Downhill skiing and snowboarding on trail is not considered to be a hazardous sport, neither is Scuba diving by certified divers (PADI, BSAC, NAUI etc.).
Back to TopQ: What is the difference between Travel and Medical Insurance?
A: Travel insurance is usually for short periods but can be for up to 3 years, and does not cover urgent or elective medical problems. It covers only accidents and emergencies. Travel insurance companies expect you to end your trip and return home for elective or urgent treatment, and some policies require return home immediately once you are diagnosed or seriously injured. For example, if you were diagnosed with cancer, there might be an urgent requirement to commence treatment, but it is not life or death to get on an airplane and return home. Travel insurance is also not renewable but only extendable at the discretion of the insurer. If you do have a serious medical problem, your cover will end at the expiration date, or when you return home. Medical insurance covers urgent and elective medical problems like cancer, and is guaranteed renewable. If you have expatriate medical insurance, you don't need travel insurance unless you are traveling outside your area of cover. The underlying assumption with travel cover is that you have proper medical insurance at home, or in your country of residence, to return home to in the event of an urgent or elective medical problem.
Back to TopQ: What is a Deductible or Excess?
A: With all benefit levels you choose an annual deductible or excess. Excess is the British word for deductible which is the American term, they mean the same thing. Any medical expenses exceeding the deductible/excess amount are payable in a policy year. You must file claims to prove that you have spent the deductible amount before the policy will start reimbursing. There are two types of deductible structure, annual, and per course of treatment. Most polices we offer have an annual deductible structure.
Back to TopQ: I am older and healthy and facing high premiums, what is my best option?
A: For this situation we find many choose an inpatient plan like the Bronze benefit level. You can pay yourself for any outpatient treatment, and end up paying very little for insurance. This means you’d be covered for big expenses, yet not financially ruined if something bad happens. Don’t forget that Bronze cover includes 90 days of post-hospital outpatient treatment. The money you save in years where you don’t need to claim, more than offsets the higher deductible on the rare occasion you are hospitalized. Also, many expats live in places where outpatient treatment is inexpensive. Pay for that yourself and insure for the big hits with a hospital plan and save big money.
Back to TopQ: What is coinsurance?
A: Coinsurance is the percentage amount you must pay for a benefit in addition to any deductible you choose. There is no co-insurance ever applicable if you visit a US hospital in the PPO network in the USA, and pre-certify the claim. Outside of the USA, it doesn’t apply.
Back to TopQ: What is accidental dental?
A: This is a dental problem caused by an injury or accident by a blow to the face, teeth, or gums. The benefit is generally about $1000. The benefit only applies to outpatient dental procedures.
Back to TopQ: What if I have a Pre-existing Condition?
A: The underwriters won't accept some pre-existing conditions; they have a list. The default method of intake underwriting is called FULL MEDICAL UNDERWRITING. If you have a pre-existing condition to underwrite, let us know and we will advise on the best options. For about a 10% surcharge there is another method of intake underwriting available called MORATORIUM. A two-year moratorium is imposed upon all pre-existing conditions. So long as you can go two years without a recurrence, or symptoms, take medication for them, or have a medical consultation for them, it will be deemed a new condition in the 3rd policy year if there is a recurrence and it will be covered by the policy. You will never have two clear years if your condition is chronic like diabetes. Follow up routine consultations for things like cancer do not affect the moratorium. We had one client that had a hip replacement when she was young because of injury in a car accident. She was able to get the hip replaced with a moratorium policy when it went bad after the 2-year moratorium expired. With cancer, providers generally have a 5-year moratorium period.
Back to TopQ: When do I have to contact the insurer Assistance Services number in the event of a claim?
A: There is no approved hospital list except in the USA. All health insurance policies have the phrase "usual, reasonable and customary costs" (URC) in their policy wordings. They will not pay more than URC for treatment in the country where you are located. If you go to a hospital that charges ten times the going rate, there will be a problem. It is very important to contact the Assistance service early and cooperate with them so that there are no surprises later. You must contact the insurer if you expect a medical bill to be more than US $500 and pre-authorize the claim or your benefit may be reduced no matter what country you are in. All hospitals negotiate with insurers, let them handle it so there are no surprises. Some insurers have a hospital black list in Mexico where they charge 40% co-insurance because these hospitals gouge. It is very important to communicate with the insurer, that is what we want to do to avoid problems and have trouble free claims paid quickly.
Back to TopQ: Will my policy be affected if I return home?
A: If your geographical area contains your home country, then there is no limitation and you can continue to renew. The only restriction is you must reside outside of the USA 6 months per year, and have a residential address outside of the USA. We do have special policies for those non-Americans that wish to live as expats in the USA.
Back to TopQ: Am I covered if I travel outside of my country of residence?
A: You get full cover within your Geographical Area, and you can live and work in any country in that Area. If you travel to a country outside that Area you have 30 days accident and emergency there which saves you from having to buy travel insurance for that trip.
Back to TopQ: Can I seek treatment anywhere in the world?
A: Yes, so long as it is within your Geographical Area of Cover.
Back to TopQ: What is my home country limitation?
A: The only restriction is that you can't be an American citizen living in the USA, or resident in the USA; otherwise there are no geographical limitations beyond your geographical area of cover. If you want to live in the USA as an expat resident, please contact us as we have other policy options for you to consider.
Back to TopQ: What is inpatient treatment?
A: This is when you are admitted to a hospital typically staying overnight. It is usually for a serious medical condition.
Back to TopQ: What is outpatient treatment?
A: This is when you consult with a general practitioner (i.e. a family doctor) or outpatient specialist (e.g. a cardiologist) without being admitted to a hospital. An example would be if you have the flu and visited your family doctor's office for a consultation.
Back to TopQ: Can I go to any hospital?
A: No restrictions are made outside the USA. In the USA there is a preferred provider network of 3600 hospitals. This network includes 2/3rds of all private hospitals in the USA, so there is more than sufficient abundance of choice. If you attend one of these facilities and pre-authorize your claim, your deductible will be reduced by half. If you do not pre-authorize treatment with the insurer, and attend a PPO network facility in the USA, your benefit may be reduced by 50%.
Back to TopQ: Will I be required to make down payments to a hospital?
A: No, if you call the Assistance service and pre-authorize treatment as you are required to do, then the insurer will make arrangements ahead of time to settle the hospital bill directly. In the event of an emergency, you are required to contact the insurer within 48 hours. They will intervene with the hospital to advance funds and guarantee payment before you are discharged. The only thing we want you to worry about is getting better, not about money!
Back to TopQ: Can I be held hostage by a Mexican hospital?
A: We have experienced several instances of this, and it has always gone badly for the patient because they were scared and intimidated and consequently made bad decisions under duress. The scenario is that the patient receives treatment and the hospital has not submitted any bill to the insurer, and of course the insurer won't finalize payment until the paperwork is done. There might have even been a front payment by the insurer, so good faith has already been demonstrated. The hospital will prevent you from leaving until the bill is paid unless you sign documents that put a lien on your house or property until the bill is paid. Then they demand an unreasonable amount from the insurer because they have your security and the insurer won't pay the unreasonable amount because it is extortion. It is illegal to force or intimidate you to sign documents by holding you hostage. They can't do this, and if they try it, you better not sign anything. Stay calm and call us and we will refer a lawyer to stop this nonsense if it does happen.
Back to TopQ: What is the Daily Hospital Indemnity benefit?
A: The Daily Hospital Indemnity Benefit is an extra add-on benefit that pays $100 cash for every night spent in a hospital. This would replace your income up to $3100 per month while you are hospitalized. It is available with all benefit levels. It costs $100 extra per year and pays up to $25,000 for 250 days in hospital. This does not include time spent in the hospital for maternity. You can buy up to 2 units for a maximum cash benefit of $50,000 per year.
Back to TopQ: What is the Hospital Cash Benefit & how is it different from Daily Hospital Indemnity benefit?
A: The Hospital Cash Benefit is a standard benefit paying $100 per over night stay in hospital, but only if the insurance policy is not paying anything out for your hospitalization. Reading this you may think this doesn't make sense! Many people are double insured and can have another policy pay the hospital bill. If you can arrange this, then you get $100 cash per night. Also, many people prefer to return to their home country for treatment and can immediately be back on their National Medical Insurance programs at no cost. If you can do this, then you get $100 per night from the insurer. If you have purchased the extra add-on Daily Hospital Indemnity benefit, then you can double dip and get $200 or $300 cash per night by claiming both benefits.
Back to TopQ: Am I covered for pandemics like Covid-19?
A: Yes, provided it is not a pre-existing condition when you join. A pandemic is official when it is declared by the WHO or the US CDC, or UK Health. After you join, you cannot travel out of your country of residence during a pandemic emergency and continue to be covered for the virus. So long as you don’t travel and stay in place, you are covered.
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