| Travel
Gap Multi Trip Benefits |
| Medical
Benefits |
Silver |
Gold |
| Maximum
International Benefits per Insured Person per policy
period |
$50,000 |
$250,000* |
| *For
Individuals aged 70 - 84, the Maximum International
Medical Benefit for TravelGap Gold is $100,000. |
| Maximum
Domestic Benefits per Insured Person per policy period |
$2,500 |
$25,000 |
| Deductible
per Insured Person per policy period* |
$50 |
| *Deductible
waived for physician and hospital services delivered by
HTH International Healthcare Community Providers. |
| After
the Deductible is satisfied, benefits are paid for Covered
Expenses as follows up to the Medical Limit: |
| Benefits |
Insurer
Pays After Medical Benefit Deductible is Paid |
| Professional
Services: |
| a.
Surgery, anesthesia, radiation therapy, in-hospital doctor
visits, diagnostic X-ray and lab |
100% |
| b.
Office Visits: including X-rays and lab work billed by the
attending physician. |
100% |
| Inpatient
Hospital Services: |
| a.
Surgery, X-rays, In-hospital doctor visits |
100% |
| b.
In-patient medical emergency |
100% |
| Ambulatory
Surgical Center |
100% |
| Ambulance
Service (non Medical Evacuation) |
100%
up to $1000 |
| Benefits
for claims resulting from downhill (alpine) skiing and
scuba diving (certification by the Professional
Association of Diving Instructors (PADI) or the National
Association of Underwater Instructors (NAUI) required or
diving under the supervision of a certified instructor) |
Maximum
Benefit up to $10,000 |
| Outside
the U.S. Outpatient prescription drugs |
100%
of Covered Expenses |
| Dental
Care required due to an Injury |
100%
of Covered Expenses up to $200 maximum per Trip Period and
$200 per tooth |
| Dental
Care for Relief of Pain |
100%
of Covered Expenses up to $100 maximum per Trip Period and
$100 per tooth |
| Other
Benefits |
Insurer
Pays Without a Deductible Being Applicable |
| Silver |
Gold |
| Accidental
Death And Dismemberment |
$0 |
$25,000 |
| Repatriation
Of Remains |
$15,000 |
$25,000 |
| Medical
Evacuation |
$250,000 |
$500,000 |
| Bedside
Visit |
Maximum
Benefit per Trip Period up to $1,500 for the cost of one
economy round trip air fare ticket to the place of the
Hospital Confinement for one (1) person |
Travel
Medical
