Pre-Existing Conditions :
If you are insured under the Platinum plan, and your pre-existing conditions
have been fully disclosed on your application and not excluded or restricted
by a rider or any other provision of your certificate, your pre-existing
conditions are covered the same as any other illness or injury as of your
effective date. If you are insured under the Premier plan, your pre-existing
conditions are covered up to a lifetime limit of $25,000 after you have
been insured continuously for 24 months. If you are insured under the
Risk-Share plan, your pre-existing conditions are not covered.
Pre-existing conditions include any injury or illness or mental/nervous
condition that existed at or prior to your initial effective date, including
chronic, recurring and congenital conditions.
What Are The Exclusions and Limitations?
The following charges, treatments, care, services, supplies and/or
conditions are excluded from coverage:
- Charges not incurred during the certificate period
- Services or treatment payable by another insurance or government
- Substance abuseCharges which exceed reasonable and customary
- Investigational or experimental surgeries or treatment
- Custodial, educational or rehabilitative care
- Weight modification
- Cosmetic surgery, unless reconstructive surgery is directly relating
to a covered surgery
- Individuals HIV+ at effective date
- Drugs or treatment for sexual dysfunction
- Drugs or treatment to promote or prevent conception
- Dental treatment, except emergency treatment following covered accident
- Devices or procedures to correct sight or hearing
- Self inflicted injury or illness
- Foot care, unless related to a covered accidental injury
- Treatment or supplies not ordered by a physician or not medically
necessary
- Organ transplants, except for covered transplants
- Speech, acupuncture, occupational or sleep therapy
- Acts of terrorism, war, insurrection, riot or any variation thereof
This is a summary of the exclusions contained in the Master Policy. See
the Master Policy for a complete list of exclusions.
Special Illness Exclusion :
The following conditions which manifest themselves within the first 180
days of coverage are excluded: any condition of the breast, prostate,
tonsils, adenoids, disease of sebaceous glands, acne, other acne, sebaceous
cyst, seborrhea, unspecified disease of the sebaceous glands, moles, skin
tags, hypertrophic and atrophic conditions of the skin, nervous, hemorrhoids,
the reproductive system, hernia, gallstones or kidney stones. If you are
insured under the Risk Share Plan, all illnesses are excluded for the
first 90 days of coverage.
Wellness :
If you are insured under the Platinum plan, after 12 months of continuous
coverage, and if you are at least 35 years old, you will be entitled to
the following Wellness benefits: the benefit provides $150 per Certificate
Period for a routine physical exam, including mamogram and OB/GYN visits
for females. If you are under the age of 19, this benefit provides $50
per visit (including immunziations) with a maxmium of 3 visits per Certificate
Period.
Emergency Medical Evacuation :
If you are insured under the Platinum plan, you are covered for emergency
medical evacuation to the nearest medical facility qualified to treat
your life threatening condition. All emergency medical evacuations must
be approved in advance and coordinated by MultiNational Underwriters,
Inc. MultiNational Underwriters, Inc. is available 24 hours a day, 7 days
a week, to approve and coordinate emergency medical evacuations. Emergency
medical evacuations provide you with access to care when you need it most.
Emergency Reunion :
In the event of a covered Emergency Evacuation, the platinum plan will
provide the following benefits:the cost of an economy round trip air or
ground transportation ticket for one of your relatives (parent, spouse,
sibling or child age 18 years or older) for transportation to the area
where you are hospitalized following Emergency Evacuation, and reasonable
expenses for lodging and meals for your relative for a period not to exceed
10 days.
Repatriation of Remains :
In the event of a covered injury or illness resulting in your death, the
platinum plan will provide the following benefit: air or ground transporation
of bodily remains or ashes to the area of your Principal Residence and
reasonable cost of preparation of your remains necessary for transporation.
Hospital Pre-notification :
All plans in The International Citizen Series contain hospital pre-certification
provisions. Pre-certification simply means that you must contact MultiNational
Underwriters, Inc. as soon as possible before a planned hospitalization
or surgical procedure, or within 48 hours of an emergency hospital admission,
or within the first 90 days of pregnancy. Pre-certification allows us
to establish contact and make payment arrangements with your providers,
negotiate discounts which will benefit both you and us, pre-arrange future
care, and plan for your claim. Pre-certification helps us help you.
Other Services and Products Provided by MultiNational Underwriters,
Inc.
Hospital/Physician Referral: MultiNational Underwriters, Inc. maintains
relationships with hospitals and physicians throughout the world, and
this network is growing daily. If you need a referral, just contact MultiNational
Underwriters, Inc. and one of our Customer Service Representatives will
assist you.
Patient Advocacy Services: If you are faced with a complex or
severe medical condition, you will be assigned to one of MultiNational's
Patient Advocates. Your Patient Advocate is your personal assistant at
MultiNational Underwriters on all matters relating to your treatment and
claim, with the goal of securing the best possible care for you in a convenient
and cost-effective setting.
General Customer Service: You've lost your ID card or your Certificate.
Or, you have a question about your insurance. Or, you have filed a claim
and you want to know the status of payment. These and many more questions
may arise from time to time. MultiNational Underwriters, Inc. Customer
Service Team is ready to respond. If you do not speak English, your Customer
Service Representative will arrange for a telephone translator to monitor
your call and assist in providing the answers you need.
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