Reside Prime

From SevenCorners

Annually renewable, Reside Prime is a comprehensive international medical insurance plan that provides coverage for people living outside of the US for at least 184 days per year.

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Reside Prime Extended Coverage Benefit Schedule

**Note: After 36 months of continued coverage under Reside Prime, the following Extended Coverage Schedule of Benefits shall apply to eligible expenses beginning on the 1st day of the 37th month. All other conditions of the policy shall continue to apply. We have highlighted the decreased benefits by making them bold.

Benefit

Description

Lifetime Medical Maximum
$2,500,000 per Insured Person;
Policy Period Deductible Options

$500, $750, $1,250, $2,750, $5,250

Maximum of 3 deductible payments for families enrolling on one application. Any eligible charges incurred and applied to your policy period deductible in the last 30 days prior to your renewal date will carry over and be applied to the next policy period deductible.

Inside of the US & Canada
geographical treatment Area A

After the Deductible, the Policy pays 80% of the next $5,000 of Eligible Expenses, then 100% up to the Policy Maximum. Expenses incurred inside the United States and Canada must be Pre-Notified using Seven Corners’ Pre-Notification Program.

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:

  1. the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and
  2. the Company will waive any and all Coinsurance applicable to such Eligible Benefits.

Failure to utilize an approved PPO Service Provider facility, if one exists within a 50 mile radius of where the Insured Person is located, will result in a 25% reduction of the Eligible Benefits stated in the Schedule of Benefits.

Outside of the US & Canada
geographical treatment Area B
After the Deductible, the Policy pays 90% of eligible expenses to the Policy Maximum. Hospital Admissions must be Pre-Notified using Seven Corners Pre-Notification Program.
Inpatient Hospital Expenses
Average Semi-Private room and board, Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-Rays, up to a limit of $2,000 per day, up to the Policy Maximum.
Intensive Care
Intensive Care room and board, Usual, Reasonable, and Customary (URC) Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-rays, up to a limit of $4,000 per day, up to the Policy Maximum.
Surgery
Usual, Reasonable, and Customary (URC) Charges for Surgery, Physician and Anesthetics up to the Policy Maximum. Anesthetics limited to one provider for a maximum benefit of 20% of the amount billed and eligible primary surgeons charge.
Hospital Daily Indemnity Benefit
geographical treatment Area A
$50 per day ($1,000 maximum per policy period), for every Medically Necessary night spent in a Hospital (Hospital Admission) outside of the United States and Canada. An additional Daily Indemnity Benefit Rider may be purchased to increase this benefit limit to $200.
Outpatient Treatment
Usual, Reasonable, and Customary (URC) Charges for Surgery up to the Policy Maximum.
Emergency Room Treatment:
  • Physician Charges, limit of $150 per visit
  • Hospital Charge, $100 co-pay unless admitted, then waived
  • Urgent Care Facility, $25 co-pay
  • Diagnostic Lab and X-Rays limited to $5,000 per Policy Period
Physiotherapy, Chiropractic
Up to $75 pervisit, $1,000 maximum per Policy Period ($10,000 Lifetime Maximum), when referred in advance by a Physician
Medical Supplies
Usual, Reasonable, and Customary (URC) Charges up to Policy Maximum.
Ambulance
$100 per incident.
Well Child Care
Up to $200 per Policy Period Maximum for checkups and routine visits after 12-month waiting period. Up to age 18. Not subject to Deductible and Coinsurance.
Maternity
Usual, Reasonable, and Customary (URC) Charges up to limits below per Pregnancy, must be Pre-Notified within the first 90 days of Pregnancy. Waiting period of 12-months before maternity benefit begins.
  • After 12 months of continuous policy term: $1,000
  • After 24 months of continuous policy term: $2,000
  • After 36 months of continuous policy term: $3,000
  • After 48 months of continuous policy term: $4,000
  • After 60 months of continuous policy term: $5,000
Mental & Nervous
$2,000 maximum per Policy Period. Inpatient limited to a maximum of 25 days per policy period. Outpatient limited to a maximum of 20 visits per policy period, at 70% of eligible expenses, up to $75 maximum per visit. Lifetime maximum of $30,000.
Newborn Benefit
Maximums listed below per eligible pregnancy for the first 31 days after birth.
  • After 12 months of continuous policy term: $1,000
  • After 24 months of continuous policy term: $2,000
  • After 36 months of continuous policy term: $3,000
  • After 48 months of continuous policy term: $4,000
  • After 60 months of continuous policy term: $5,000
Dental
Usual, Reasonable, and Customary (URC) Charges for repair and replacement of sound, natural teeth damaged as a result of an accident, limited to $500 per Policy Period. A Dental Benefit Rider may be purchased to expand Dental Coverage.
Emergency Medical Evacuation
$250,000 Limit per person per Policy Period – when adequate medical facilities and / or treatment is not available when traveling outside your current Country of Residence. (Preapproval required.)
Repatriation of Remains
$15,000 Limit per person – when traveling outside your current Country of Residence. (Preapproval required.)
Emergency Medical Reunion
$10,000 Limit per person per Policy Period – when traveling outside your current Country of Residence. (Pre-approval required).
Preventive Benefits
Females and Males over the Age 19 up to $175 Policy Period Maximum for checkups, routine physical exams, female preventative exams and mammograms after 12 month waiting period. Not subject to Deductible or Coinsurance.
Accidental Death & Dismemberment (AD&D)
Principal Sum: $10,000 Insured and Spouse, $2,000 Dependent Children. For Common Carrier, Principal Sum: $40,000 Insured and Spouse, $8,000 Dependent Children.
Lifetime Transplant Benefit
Up to $500,000 per Insured Person.
Prescription Medications
Limit of $5,000 per Policy Period for each Insured Person, outpatient only.

Reside Prime is underwritten by Certain Underwriters at Lloyd's of London and Tramont Insurance Company Limited. Your residence address determines which insurance carrier will provide your coverage. Pricing and benefits are identical for both Lloyd's of London and Tramont Insurance Company Limited.

Administered By: Seven Corners

Patient Protection and Affordable Care Act

(“PPACA”): This insurance is not subject to, and does not provide certain of the insurance benefits required by, the United States PPACA. PPACA requires certain U.S. residents and citizens to obtain PPACA compliant insurance coverage. In certain circumstances penalties may be imposed on U.S. residents and citizens who do not maintain PPACA compliant insurance coverage. You should consult your attorney or tax professional to determine if PPACA’s requirements are applicable to you. The policy contains the plan benefits, including a lifetime maximum that you have selected. Please review your choices to ensure that you have sufficient coverage to meet your medical needs.

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