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Premiums Organized by Age Group

EasySelect Quote is designed to provide you a quick overview of available plans and their premiums for 30 days. Network PPO and Premier plans are Underwritten by CHUBB American Insurance Company, USA and AXIS Insurance Company, Chicago, IL, USA. These Plans require you to purchase the plan for a minimum duration of 90 days irrespective of visitor’s lenth of stay in the United States. This is non-negotiable. Please note Network Benefits are far more valuable as they use negotiated prices and pay 80 percent of Covered expenses. First Health PPO Network is used with Network Plan.

Premiums
Advantages and Limitations
Plan Benefits
Dental and Vision
Premiums
Non Pre-Exisiting
Pre-Exisiting
Non Pre-Exisiting
1 0-17
2 18-29
3 30-39
4 40-49
5 50-59
6 60-69
7 70-79
8 80+
1 0-17

INF SelectCare Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$16.00$25.00$31.25$37.00  
$75$26.97$35.19$43.41$51.63$68.07 
$250$24.01$30.87$37.73$44.59$58.31 
$500$22.34$28.72$35.10$41.48$54.24$79.76
$1,000   $36.71$48.00$70.58
$5,000     $37.24
$10,000    $21.58 


INF Advantage Plan* | Teladoc Benefit | FirstHealth PPO Network Benefits

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$250    $92.63 
$500    $78.00 


INF Standard | Fixed Benefits

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$75 $36.19 $53.10$61.85 
$250 $31.75 $45.86$52.92 


INF ELITE Network (80/20) (Recommended Plan)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$500    $97.50 

2 18-29

INF SelectCare Plan | Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$18.00$30.00$37.50$42.00  
$75$30.87$39.11$47.34$55.58$72.05 
$250$27.44$34.30$41.16$48.02$61.74 
$500$25.53$31.91$38.29$44.67$57.43$82.95
$1,000   $39.53$50.82$73.40
$5,000     $38.73
$10,000     $22.48


INF Advantage Plan* | FirstHealth PPO Network Benefits | Teladoc Benefit

$250    $113.62 
$500    $95.68 


INF Standard | Fixed Benefits

$75 $40.22 $57.15$73.38 
$250 $35.28 $49.39$62.80 


INF Elite Network (80/20)**(recommended)

$500    $119.60 

3 30-39

INF SelectCare Plan | Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$19.00$31.00$38.75$43.00  
$75$34.75$43.02$51.28$59.55$76.08 
$250$30.87$37.73$44.59$51.45$65.17 
$500$28.72$35.10$41.48$47.86$60.62$86.14
$1,000   $42.36$53.66$76.26
$5,000     $40.22
$10,000     $23.34


INF Advantage Plan* | FirstHealth PPO Network Benefit

$250    $135.67 
$500    $114.25 


INF Standard | Fixed Benefits

$75 $44.25 $61.24$81.64 
$250 $38.81 $52.92$69.86 


INF Elite (80/20) *(recommended)

$500    $142.81 

4 40-49

INF SelectCare Plan | Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$28.00$43.00$53.75$59.00  
$75$43.03$56.94$70.85$84.76$112.58 
$250$36.02$48.02$60.02$72.02$96.02 
$500$33.51$44.67$55.83$66.99$89.31$133.95
$1,000   $59.29$79.05$118.57
$5,000     $62.49
$10,000     $36.30


INF Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit

$250    $203.49 
$500    $171.36 


INF Standard | Fixed Benefits

$75 $58.57 $87.18$109.22 
$250 $49.39 $74.09$91.73 


INF Elite (80/20) *(recommended)

$500    $214.20 


5 50-59

INF SelectCare Plan | Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$28.00$43.00$53.75$59.00  
$75$43.03$56.94$70.85$84.76$112.58 
$250$36.02$48.02$60.02$72.02$96.02 
$500$33.51$44.67$55.83$66.99$89.31$133.95
$1,000   $59.29$79.05$118.57
$5,000     $62.49
$10,000     $36.30


INF Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit

$250    $203.49 
$500    $171.36 


INF Standard | Fixed Benefits

$75 $58.57 $87.18$109.22 
$250 $49.39 $74.09$91.73 


INF Elite Network (80/20)* (recommended)

$500    $214.20 

6 60-69

INF SelectCare Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000 Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)$250,000 Max (per Sickness)
$100$35.00$54.00$67.50$84.00  
$75$51.24$65.10$78.96$92.82$120.54 
$250$42.87$54.88$66.89$78.90$102.92 
$500$39.88$51.05$62.22$73.39$95.73$140.41
$1,000   $64.96$84.74$124.30
$5,000     $65.50
$10,000     $38.03


INF Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit

$75 $66.96 $95.46$117.66 
$250 $56.45 $81.14$98.78 


INF Standard | Fixed Benefits

$75 $58.57 $87.18$109.22 
$250 $49.39 $74.09$91.73 


INF Elite Network (80/20)* (recommended)

$500    $307.93 

7 70-79

INF SelectCare Plan Fixed Benefits | Teladoc, First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000 Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$250$145.09$161.21$177.33$193.45 
$500$134.97$149.97$164.96$179.96 
$1,000   $159.25 


INF Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit

$250  $681.26  
$500  $573.70  


INF Standard, Fixed Benefits

$250 $230.00 $276.36 
$500 $196.00 $235.20 


INF Elite Network (80/20)* (recommended)

$500  $717.12  

8 80+

INF SelectCare Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH

*(pre-ex acute onset coverage included)

New Sickness Deductible$25,000 Max (Per Sickness)$50,000 Max (Per Sickness)$75,000 Max (Per Sickness)$100,000 Max (Per Sickness)$150,000 Max (Per Sickness)
$250$176.99$202.37$227.75$253.13 
$500$164.64$188.25$211.86$235.47 
$1,000   $208.39 


INF Advantage Plan*, FirstHealth PPO Network Benefit, Teladoc Benefit

250  $875.91  
$500  $737.61  


INF Standard, Fixed Benefits

$250 $289.10 $361.62 
$500 $258.72 $323.40 


INF Elite Network (80/20)* (recommended)

$500  $922.01  

Pre-Exisiting
1 0-17
2 18- 29
3 30-39
4 40-49
5 50-59
6 60-69
7 70-79
8 80+
1 0-17

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$24.83
 $250$1,500$250$22.30
 $500$1,750$500$20.74
$50,000$75$1,500$75$31.11
 $250$2,000$250$27.44
 $500$2,500$500$25.53
$75,000$75$2,500$75$37.38
 $250$3,500$250$32.58
 $500$4,500$500$30.31
$100,000$75$3,500$75$43.66
  $250$4,500$250
  $500$5,500$500
  $1,000$6,500$1,000
$150,000$75$4,500$75$56.21
  $250$5,500$250
  $500$6,500$500
  $1,000$7,500$1,000
$250,000$500$7,000$500$63.81
  $1,000$9,000$1,000
  $5,000$13,000$5,000
  $10,000$15,000$10,000


INF Advantage Plan* | FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$112.39
 $500$25,000$1,500$94.64


INF Premier Plan | Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$62.88
 $75$40,000$5,000$61.98
 $250$20,000$1,000$54.33
 $250$40,000$5,000$53.56
$150,000$75$30,000$1,000$81.26
  $75$60,000$5,000
  $250$30,000$1,000
  $250$60,000$5,000


INF ELITE Network (80/20) (Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$118.30

2 18- 29

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$26.97
 $250$1,500$250$24.01
 $500$1,750$500$22.34
$50,000$75$1,500$75$35.19
 $250$2,000$250$30.87
 $500$2,500$500$28.72
$75,000$75$2,500$75$43.41
 $250$3,500$250$37.73
 $500$4,500$500$35.10
$100,000$75$3,500$75$51.63
 $250$4,500$250$44.59
 $500$5,500$500$41.48
 $1,000$6,500$1,000$36.71
$150,000$75$4,500$75$68.07
 $250$5,500$250$58.31
 $500$6,500$500$54.24
 $1,000$7,500$1,000$48.00
$250,000$500$7,000$500$79.76
 $1,000$9,000$1,000$70.58
 $5,000$13,000$5,000$37.24
 $10,000$15,000$10,000$21.58


INF Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$120.41
 $500$25,000$1,500$101.40


INF Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$74.35
 $75$40,000$5,000$73.28
 $250$20,000$1,000$64.21
 $250$40,000$5,000$63.29
$150,000$75$30,000$1,000$86.59
 $75$60,000$5,000$85.35
 $250$30,000$1,000$74.09
 $250$60,000$5,000$73.03


INF ELITE Network (80/20) (Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$126.75

3 30-39

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$30.87
 $250$1,500$250$27.44
 $500$1,750$500$25.53
$50,000$75$1,500$75$39.11
 $250$2,000$250$34.30
 $500$2,500$500$31.91
$75,000$75$2,500$75$47.34
 $250$3,500$250$41.16
 $500$4,500$500$38.29
$100,000$75$3,500$75$55.58
 $250$4,500$250$48.02
 $500$5,500$500$44.67
 $1,000$6,500$1,000$39.53
$150,000$75$4,500$75$72.05
 $250$5,500$250$61.74
 $500$6,500$500$57.43
 $1,000$7,500$1,000$50.82
$250,000$500$7,000$500$82.95
 $1,000$9,000$1,000$73.40
 $5,000$13,000$5,000$38.73
 $10,000$15,000$10,000$22.48


INF Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$147.71
 $500$25,000$1,500$124.38


INF Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$80.01
 $75$40,000$5,000$78.87
 $250$20,000$1,000$69.15
 $250$40,000$5,000$68.16
$150,000$75$30,000$1,000$102.74
 $75$60,000$5,000$101.27
 $250$30,000$1,000$87.92
 $250$60,000$5,000$86.66


INF ELITE Network (80/20) (Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$155.48

4 40-49

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$34.75
 $250$1,500$250$30.87
 $500$1,750$500$28.72
$50,000$75$1,500$75$43.02
 $250$2,000$250$37.73
 $500$2,500$500$35.10
$75,000$75$2,500$75$51.28
 $250$3,500$250$44.59
 $500$4,500$500$41.48
$100,000$75$3,500$75$59.55
 $250$4,500$250$51.45
 $500$5,500$500$47.86
 $1,000$6,500$1,000$42.36
$150,000$75$4,500$75$76.08
 $250$5,500$250$65.17
 $500$6,500$500$60.62
 $1,000$7,500$1,000$53.66
$250,000$500$7,000$500$86.14
 $1,000$9,000$1,000$76.26
 $5,000$13,000$5,000$40.22
 $10,000$15,000$10,000$23.34


INF Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
150,000$250$25,000$1,500$176.37
 $500$25,000$1,500$148.52


INF Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$85.74
 $75$40,000$5,000$84.51
 $250$20,000$1,000$74.09
 $250$40,000$5,000$73.03
$150,000$75$30,000$1,000$114.30
 $75$60,000$5,000$112.66
 $250$30,000$1,000$97.80
 $250$60,000$5,000$96.40


INF ELITE Network (80/20) (Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$185.65

5 50-59

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$43.03
 $250$1,500$250$36.02
 $500$1,750$500$33.51
$50,000$75$1,500$75$56.94
 $250$2,000$250$48.02
 $500$2,500$500$44.67
$75,000$75$2,500$75$70.85
 $250$3,500$250$60.02
 $500$4,500$500$55.83
$100,000$75$3,500$75$84.76
 $250$4,500$250$72.02
 $500$5,500$500$66.99
 $1,000$6,500$1,000$59.29
$150,000$75$4,500$75$112.58
 $250$5,500$250$96.02
 $500$6,500$500$89.31
 $1,000$7,500$1,000$79.05
$250,000$500$7,000$500$133.95
 $1,000$9,000$1,000$118.57
 $5,000$13,000$5,000$62.49
 $10,000$15,000$10,000$36.30


INF Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$262.64
 $500$25,000$1,500$221.17


INF Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$122.05
 $75$40,000$5,000$120.30
 $250$20,000$1,000$103.72
 $250$40,000$5,000$102.24
$150,000$75$30,000$1,000$152.91
 $75$60,000$5,000$150.73
 $250$30,000$1,000$128.42
 $250$60,000$5,000$126.58


INF ELITE Network (80/20) (Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$278.46

6 60-69

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$75$1,000$75$51.24
 $250$1,500$250$42.87
 $500$1,750$500$39.88
$50,000$75$1,500$75$65.10
 $250$2,000$250$54.88
 $500$2,500$500$51.05
$75,000$75$2,500$75$78.96
 $250$3,500$250$66.89
 $500$4,500$500$62.22
$100,000$75$3,500$75$92.82
 $250$4,500$250$78.90
 $500$5,500$500$73.39
 $1,000$6,500$1,000$64.96
$150,000$75$4,500$75$120.54
 $250$5,500$250$102.92
 $500$6,500$500$95.73
 $1,000$7,500$1,000$84.74
$250,000$500$7,000$500$140.41
 $1,000$9,000$1,000$124.30
 $5,000$13,000$5,000$65.50
 $10,000$15,000$10,000$38.03


INF Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$250$25,000$1,500$380.29
 $500$25,000$1,500$320.25


INF Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$75$20,000$1,000$133.65
 $75$40,000$5,000$131.74
 $250$20,000$1,000$113.60
 $250$40,000$5,000$111.98
$150,000$75$30,000$1,000$164.73
 $75$60,000$5,000$162.38
 $250$30,000$1,000$138.30
 $250$60,000$5,000$136.32


INF ELITE Network (80/20)(Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$150,000$500$25,000$1,500$400.31

7 70-79

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$250$1,500$250$145.09
 $500$1,750$500$134.97
$50,000$250$2,000$250$161.21
 $500$2,500$500$149.97
$75,000$250$3,500$250$177.33
 $500$4,500$500$164.96
$100,000$250$4,500$250$193.45
 $500$5,500$500$179.96
 $1,000$6,500$1,000$159.25


INF Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$250$20,000$1,500$919.70
 $500$20,000$1,500$774.49


INF Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$250$15,000$1,000$373.09
 $250$25,000$5,000$367.56
 $500$15,000$1,000$317.52
 $500$25,000$5,000$312.82


INF ELITE Network (80/20) (Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$500$20,000$1,500$968.11

8 80+

INF Choice Plan Fixed Benefits | Teladoc | First Health

MINIMUM PURCHASE REQUIRED 1 MONTH.

*Acute onset definition for pre-existing

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$25,000$250$1,500$250$145.09
 $500$1,750$500$134.97
$50,000$250$2,000$250$161.21
 $500$2,500$500$149.97
$75,000$250$3,500$250$177.33
 $500$4,500$500$164.96
$100,000$250$4,500$250$193.45
 $500$5,500$500$179.96
 $1,000$6,500$1,000$159.25


INF Advantage Plan*| FirstHealth PPO Network Benefit | Teladoc Benefit

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$250$20,000$1,500$919.70
 $500$20,000$1,500$774.49


INF Premier Fixed Benefits

MINIMUM PURCHASE REQUIRED 3 MONTHS (90 days),

Broad pre-ex new and pre-ex considered the same.

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$100,000$250$15,000$1,000$373.09
 $250$25,000$5,000$367.56
 $500$15,000$1,000$317.52
 $500$25,000$5,000$312.82


INF ELITE Network (80/20) (Recommended Plan)

Maximum New Sickness CoverageNew Sickness DeductibleMaximum Pre- Existing CoveragePre-Existing Deductible30 Days Premium
$75,000$500$20,000$1,500$1,244.71

Advantages and Limitations
1 Choice Plan
2 SelectCare Plan
3 Advantage Plan
4 ELITE Network Plan
5 CHUBB Premier Plan
6 CHUBB Standard Plan
1 Choice Plan
ADVANTAGESLIMITATIONS
Low Cost - AXIS Premiums are low cost!AXIS Plans Only Cover Acute
  Onset.
No Medical Exam - No prior medical examination needed to purchase.AXIS Plans do
  not provide Full Pre-Existing coverage.
Online Claims Submission - AXIS Has online claims submission!AXIS Plans are
  only valid for travel within the US.
Teledoc -When you
request a visit, Teladoc will connect you with a doctor. The doctor has the
ability to write your prescriptions. Teledoc Doctors also advise on
Pre-Existing Conditions.
First Health Provider Network - a national network of providers contracted to provide services to members at a reduced fee. The First Health Network provides access to more than 5,000 hospitals, over 90,000 ancillary facilities and over 1 million health care professional service locations in all 50 states and the District of Columbia.
Claims with First Health - Health Care Providers will file health insurance claims for you. They will collect only your deductible, not the full amount of the charges. Their services will most likely cost you less because of our contract rates with them because AXIS health insurance pays higher benefits for using network providers.
Flexibility - AXIS Programs are incredibly flexibility in terms of Deductibles & Coverage Maximums.
Choose the Plan Right for you - With Coverage Maximums ranging from as low as $25,000 to $250,000 and deductibles from $75 to $10,000 pick plan best suites you.
$500,000 - AXIS Plans Offer $500,000 Accidental Death &
Dismemberment Coverage.
Medical Evacuation
- AXIS Plans come with Medical Evacuation in case
your loved one needs to travel to get the emergency medical care they need.
100% Claims Paid - Rest easy knowing 100% of eligible Claims are Paid within 6
Weeks.
Available for all Non-US Residents - Available for all H1B visa, F1 visa, Students,
temporary workers, Americans living abroad, and Visitors to the U.S.
2 SelectCare Plan
ADVANTAGESLIMITATIONS
Low Cost – AXIS Premiums are low cost!AXIS BasicCare plan doesn’t cover pre-existing conditions.
No Medical Exam – No prior medical examination needed to purchase.AXIS BasicCare Plan is only valid for travel within the US.
Online Claims Submission – AXIS Has online claims submission!
Teledoc – When you request a visit, Teladoc will connect you with a doctor. The doctor has the ability to write your prescriptions.
First Health Provider Network – a national network of providers contracted to provide services to members at a reduced fee. The First Health Network provides access to more than 5,000 hospitals, over 90,000 ancillary facilities and over 1  million health care professional service locations in all 50 states and
the District of Columbia.
Claims with First Health – Health Care Providers will file health insurance claims for you. They will collect only your deductible, not the full amount of the charges.
Their services will most likely cost you less because of our contract
rates with them because AXIS health insurance pays higher benefits for
using network providers.
Flexibility – AXIS Programs are incredibly flexibility in terms of Deductibles & Coverage Maximums.
Choose the Plan Right for you – With Coverage Maximums ranging from as low as $25,000 to $100,000 and deductibles from $75 to $250 pick plan best suites you.
$25,000 – AXIS Plans Offer $25,000 Accidental Death & Dismemberment Coverage.
Medical Evacuation – AXIS Plans come with Medical Evacuation in case your loved one needs to travel to get the emergency medical care they need.
100% Claims Paid – Rest easy knowing 100% of eligible Claims are Paid within 6 Weeks.
Available for all Non-US Residents – Available for all H1B visa, F1 visa, Students, temporary workers, Americans living abroad, and Visitors to the U.S.
3 Advantage Plan
ADVANTAGESLIMITATIONS
Best Comprehensive Coverage - AXIS Comprehensive Plan pays 80% of all eligible claims, leaving you with a medical bill at a fraction of the total.AXIS Plans Only cover Acute Onset.
Negotiated Medical Bills - Take advantage of the First Health Provider network to get lowered medical bills at a negotiated rate. For example, if you have a bill for $10,000, AXIS negotiates down to $2,000, then pays 80%. This means you only pay $400 for a $10,000 billAXIS Plans do not provide Full Pre-Existing coverage
Flexibility of Providers - The AXIS Comprehensive Plan covers 80% of all eligible claims at ANY health care provider.AXIS Plan are only valid for travel within the US.
100% Claims Paid - Rest easy knowing 100% of eligible Claims are Paid within 6 weeks.
Available for all Non-US Residents - Available for all H1B visa, F1 visa, Students, Temporary workers, Americans living abroad, and visitors to the US.
Online Claims Submission - AXIS has online claims submission.
Teledoc - When you request a visit, Teledoc will connect you with a doctor. The doctor has the ability to write your prescriptions. Teledoc Doctors also advise on Pre-Existing Conditions.
$500,000 - AXIS Plans offer $500,000 Accidental Death and Dismemberment Coverage.
Medical Evacuation - AXIS Plans come with Medical Evacuation in case your loved ones needs to travel to get the emergency medical care they need.
4 ELITE Network Plan
ADVANTAGESLIMITATIONS
Most Comprehnsive Coverage - CHUBB Network Plan pays 80% of all eligible claims, leaving you with a medical bill a fraction of the total.CHUBB Network plan requires 90 days purchase.
Negotiated Medical Bills - Take advantage of the First Health Provider Network to get lowered medical bills at a negotiated rate.CHUBB Network plan has higher premiums.
Full Pre-Existing Coverage - CHUBB Network Plan is the only provider of Full Pre-Existing Coverage. Full Pre-Existing allows visitors to see a doctor when pre-existing conditions cause discomfort. For example, if your has high blood pressue, and begins to have heart pain, you can take them to the cardiologist. All other visitors insurance only provide acute onset, meaning coverage only applies in emergency situations.
Inclusions NOT Exclusion - CHUBB Network Plan covers medical issues such as UTI which is common in older visitors travelling to the United States.
100% Claims Paid - Rest easy knowing 100% of eligible Claims are Paid within 6 Weeks.
$25,000 - CHUBB Netwrk Plan Offers $25,000 Accidental Death & Dismemberment Coverage.
Medical Evacuation - CHUBB Network plan comes with Medical Evacuation in case your loved one needs to travel to get the emergency medical care they need.
Cashless Claims - Claims are handled between the First Health Provider and CHUBB, meaning no out of pocket expense.
Available for all Non-US Residents - Available for all H1B visa, F1 visa, Students, temporary workers, Americans living abroad, and Visitors to the U.S.
Travel with Freedom - CHUBB Network Plan is available in USA, Canada, & Mexico. You can travel with the confidence knowing you are covered.
5 CHUBB Premier Plan
ADVANTAGESLIMITATIONS
Best Fixed Benefit Plan - CHUBB Premier Plan offers the best Fixed Benefit Visitors Coverage in the Market. Higher benefits means lower costs & medical bills.CHUBB Premier plan requires 90 days purchase.
All Age Groups Covered - CHUBB Premier Plan offers coverage for all age groups 0-99+. Unlike most visitors insurance plans, CHUBB Premier plan covers pre-existing conditions for age 80+. Rest easy knowing you are covered when visiting loved ones.CHUBB Premier plan has a little bit higher premiums.
Full Pre-Existing Coverage - CHUBB Premier is the only provider of Full Pre-Existing Coverage. Full Pre-Existing allows visitors to see a doctor when pre-existing conditions cause discomfort. For example, if your has high blood pressue, and begins to have heart pain, you can take them to the cardiologist. All other visitors insurance only provide acute onset, meaning coverage only applies in emergency situations.
Inclusions NOT Exclusion - CHUBB Premier Plan covers medical issues such as UTI which is common in older visitors travelling to the United States.
100% Claims Paid - Rest easy knowing 100% of eligible Claims are Paid within 6 Weeks.
$25,000 - CHUBB Premier Plan Offers $25,000 Accidental Death & Dismemberment Coverage.
Medical Evacuation - CHUBB Premier plan comes with Medical Evacuation in case your loved one needs to travel to get the emergency medical care they need.
Available for all Non-US Residents - Available for all H1B visa, F1 visa, Students, temporary workers, Americans living abroad, and Visitors to the U.S.
Travel with Freedom - CHUBB Network Plan is available in USA, Canada, & Mexico. You can travel with the confidence knowing you are covered.
6 CHUBB Standard Plan
ADVANTAGESLIMITATIONS
Best Fixed Benefit Plan - CHUBB Standard Plan offers Fixed Benefit Visitors Coverage. Higher benefits means lower costs & medical bills.CHUBB Standard plan doesn't cover pre-existing conditions.
All Age Groups Covered - CHUBB Standard Plan offers coverage for all age groups 0-99+. Rest easy knowing you are covered when visiting loved ones.CHUBB Standard plan doesn't provide cashless claim settlement.
Low Cost - CHUBB Standard Premiums are low cost!
Available for all Non-US Residents - Available for all H1B visa, F1 visa, Students, temporary workers, Americans living abroad, and Visitors to the U.S.
Travel with Freedom - CHUBB Network Plan is available in USA, Canada, & Mexico. You can travel with the confidence knowing you are covered.
100% Claims Paid - Rest easy knowing 100% of eligible Claims are Paid within 6 Weeks.
$25,000 - CHUBB Standard Plan Offers $25,000 Accidental Death & Dismemberment Coverage.
Medical Evacuation - CHUBB Standard plan comes with Medical Evacuation in case your loved one needs to travel to get the emergency medical care they need.
Plan Benefits
1 AXIS Plan
2 AXIS BasicCare
3 AXIS Network
4 CHUBB Network
5 CHUBB Premier
6 CHUBB Standard
1 AXIS Plan
25K, 50K and 75K
100K, 150K and 250K
25K, 50K and 75K
AXIS Plan 25K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charge incurred, Up to $900 a day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charge incurred, Up to $400 a day, to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charge incurred, Up to $2,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $500 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $500 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charge incurred, Up to $40 per visit, 1 visit per day, Up to 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charge incurred, Up to $375 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charge incurred, Up to $950 max, test must occur within 14 days prior to Hospital Admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charge incurred, Up to $375 max
Surgeon Services100% of Usual & Customary Charge incurred, Up to $2,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $500 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $500 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charge incurred, Up to $40 per visit, 1 visit per day, Up to 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charge incurred, Up to $275 max
CAT Scan, PET Scan or MRI100% of Usual & Customary incurred, Up to an additional $275 of the Diagnostic X-Ray and Lab Services Benefits
Hospital Emergency Room100% of Usual & Customary Charge incurred, Up to $275 max
Prescription Drug100% of Usual & Customary Charge incurred, Up to $75 max
Ambulance Services100% of Usual & Customary Charge incurred, Up to $375 max
Initial Orthopedic Prosthesis or Brace100% of Usual & Customary Charge incurred , Up to $950 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charge incurred, Up to $425 max
Chemotherapy and/or Radiation Therapy100% of Usual & Customary Charge incurred, Up to $925 max
Physical and Occupational Therapy100% of Usual & Customary Charge incurred, Up to $30 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charge incurred, Up to $350 max
Pregnancy and Childbirth100% of Usual & Customary Charge incurred, Up to $4,250; conception must occur after the trip begins
Emergency Medical Evacuation100% of Usual & Customary Charges incurred, Up to a maximum of $10,000 max
Repatriation of Remains100% of Usual & Customary Charges incurred, Up to a maximum of $10,000
Accidental Death and Dismemberment$500,000 Aggregate Sum

AXIS Plan 50K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charge incurred, Up to $1,300 a day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charge incurred, Up to $525 a day, to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charge incurred, Up to $3,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $750 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $750 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charge incurred, Up to $60 max per visit, 1 visit per day, Up to 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charge incurred, Up to $400 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charge incurred, Up to $1,000 max, test must occur within 14 days prior to Hospital Admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charge incurred, Up to $1,000 max
Surgeon Services100% of Usual & Customary Charge incurred, Up to $3,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $750 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $750 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charge incurred, Up to $60 max per visit, 1 visit per day, Up to 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charge incurred, Up to $400 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charge incurred, Up to an additional $400 of the Diagnostic X-Ray and Lab Services Benefits
Hospital Emergency Room100% of Usual & Customary Charge incurred, Up to $350 max
Prescription Drug100% of Usual & Customary Charge incurred, Up to $100 max
Ambulance Services100% of Usual & Customary Charge incurred, Up to to $400 max
Initial Orthopedic Prosthesis or Brace100% of Usual & Customary Charge incurred, Up to $1,000 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charge incurred, Up to $450 max
Chemotherapy and/or Radiation Therapy100% of Usual & Customary Charge incurred, Up to $1,000 max
Physical and Occupational Therapy100% of Usual & Customary Charge incurred, Up to $35 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charge incurred, Up to $400 max
Pregnancy and Childbirth100% of Usual & Customary Charge incurred, Up to $4,500 max; conception must occur after the trip begins
Emergency Medical Evacuation100% of Usual & Customary Charge incurred, Up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charge incurred, Up to $10,000 max
Accidental Death and Dismemberment$500,000 Aggregate Sum

AXIS Plan 75K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charge incurred, Up to $1,525 a day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charge incurred, Up to $625 a day, to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charge incurred, Up to $4,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $1,000 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $1,000 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charge incurred, Up to $80 max per visit, 1 visit per day, Up to 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charge incurred, Up to $425 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charge incurred, Up to $1,050 max, test must occur within 14 days prior to Hospital Admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charge incurred, Up to $1,050 max
Surgeon Services100% of Usual & Customary Charge incurred, Up to $4,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $1,000 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $1,000 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charge incurred, Up to $80 max per visit, 1 visit per day, Up to 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charge incurred, Up to $525 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charge incurred, Up to an additional $525 of the Diagnostic X-Ray and Lab Services Benefits
Hospital Emergency Room100% of Usual & Customary Charge incurred, Up to $425 max
Prescription Drug100% of Usual & Customary Charge incurred, Up to $125 max
Ambulance Services100% of Usual & Customary Charge incurred, Up to $425 max
Initial Orthopedic Prosthesis or Brace100% of Usual & Customary Charge incurred, Up to $1,050 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charge incurred, Up to $475 max
Chemotherapy and/or Radiation Therapy100% of Usual & Customary Charge incurred, Up to $1,075 max
Physical and Occupational Therapy100% of Usual & Customary Charge incurred, Up to $40 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charge incurred, Up to $450 max
Pregnancy and Childbirth100% of Usual & Customary Charge incurred, Up to $4,750; conception must occur after the trip begins
Emergency Medical Evacuation100% of Usual & Customary Charge incurred, Up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charge incurred, Up to $10,000 max
Accidental Death and Dismemberment$500,000 Aggregate Sum
100K, 150K and 250K
AXIS Plan 100K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charges incurred, Up to $1,750 per day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charge incurred, Up to $750 a day, to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charges incurred, Up to $5,000 max
Anesthetics100% Usual & Customary Charge incurred, Up to $1,250 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $1,250 max
Physician Non-Surgical Treatment/Examination Visits100% Usual & Customary Charge incurred, Up to $100 per visit, 1 visit per day, Up to 30 visits max
Consultant visits, when requested by a Physician100% Usual & Customary Charge incurred, Up to $450 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charge incurred, Up to $1,100 max, test must occur within 14 days prior to Hospital Admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charge incurred , Up to $1,100 max
Surgeon Services100% of Usual & Customary Charge incurred, Up to $5,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $1,250
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $1,250 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charge incurred, Up to $100 per visit, 1 visit per day, Up to 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charge incurred, Up to $650 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charge incurred, Up to $650 of the Diagnostic X-Ray and Lab Services Benefits
Hospital Emergency Room100% of Usual & Customary Charge incurred, Up to $500 max
Prescription Drug100% of Usual & Customary Charge incurred, Up to $150 max
Ambulance Services100% of Usual & Customary Charge incurred, Up to $450 max
Initial Orthopedic Prosthesis or Brace100% of Usual & Customary Charge incurred, Up to $1,100 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charge incurred, Up to $500 max
Chemotherapy and/or Radiation Therapy100% of Usual & Customary Charge incurred, Up to $1,150 max
Physical and Occupational Therapy100% of Usual & Customary Charge incurred, Up to $45 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charge incurred, Up to $500 max
Pregnancy and Childbirth100% of Usual & Customary Charge incurred, Up to $5,000; conception must occur after the trip begins
Emergency Medical Evacuation100% of Usual & Customary Charge incurred, Up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charges incurred, Up to $10,000 max
Accidental Death and Dismemberment$500,000 Aggregate Sum

AXIS Plan 150K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charge incurred, Up to $1,900 per day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charge incurred, up to $850 per day, to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charge incurred, Up to $6,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $1,500 max
Assistant Surgeon100% Usual & Customary Charge incurred, Up to $1,500 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charge incurred, Up to $125 per visit, 1 visit per day, Up to 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charge incurred, Up to $500 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charge incurred, Up to $1,200 max, within 14 days prior to Hospital admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charge incurred, Up to $1,200 max
Surgeon Services100% of Usual & Customary Charge incurred, Up to $6,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $1,500 max
Assistant Surgeon100% of Usual & Customary Charge incurred , Up to $1,500 max
Physician Non-Surgical Treatment/Exam Visits100% of the Usual & Customary Charge incurred, Up to $125 per visit, 1 visit per day, Up to 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charge incurred, Up to $750 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charge incurred, Up to an additional $1,000 of the Diagnostic X-Ray and Lab Services Benefits
Hospital Emergency Room100% of Usual & Customary Charge incurred, Up to $750 max
Prescription Drug100% of Usual & Customary Charge incurred, Up to $200 max
Ambulance Services100% of Usual & Customary Charge incurred, Up to $500 max
Initial Orthopedic Prosthesis or Brace100% of Usual & Customary Charge incurred, Up to $1,200 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charge incurred, Up to $550 max
Chemotherapy and/or Radiation Therapy100% of Usual & Customary Charge incurred , Up to $1,250 max
Physical and Occupational Therapy100% of Usual & Customary Charge incurred, Up to $50 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charge incurred , Up to $550 max
Pregnancy and Childbirth100% of Usual & Customary Charge incurred, Up to $5,500; conception must occur after the trip begins
Emergency Medical Evacuation100% of Usual & Customary Charge incurred, Up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charge incurred, Up to $10,000 max
Accidental Death and Dismemberment$500,000 Aggregate Sum

AXIS Plan 250K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charge incurred, Up to $2,200 a day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charge incurred, up to $950 a day, to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charge incurred, Up to $7,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $1,750 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $1,750 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charge incurred, Up to $150 max per visit, 1 visit per day, Up to 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charge incurred, Up to $550 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charge incurred, Up to $1,350 max, within 14 days prior to Hospital admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charge incurred, Up to $1,350 max
Surgeon Services100% of Usual & Customary Charge incurred, Up to $7,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $1,750 max
Assistant Surgeon100% of Usual & Customary Charge incurred , Up to $1,750 max
Physician Non-Surgical Treatment/Exam Visits100% of the Usual & Customary Charge incurred, Up to $150 max per visit, 1 visit per day, Up to 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charge incurred, Up to $900 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charge incurred, Up to an additional $1,250 of the Diagnostic X-Ray and Lab Services Benefits
Hospital Emergency Room100% of Usual & Customary Charge incurred, Up to $1,000 max
Prescription Drug100% of Usual & Customary Charge incurred, Up to $250 max
Ambulance Services100% of Usual & Customary Charge incurred, Up to $600 max
Initial Orthopedic Prosthesis or Brace100% of Usual & Customary Charge incurred, Up to $1,350 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charge incurred, Up to $650 max
Chemotherapy and/or Radiation Therapy100% of Usual & Customary Charge incurred , Up to $1,400 max
Physical and Occupational Therapy100% of Usual & Customary Charge incurred, Up to $55 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charge incurred , Up to $600 max
Pregnancy and Childbirth100% of Usual & Customary Charge incurred, Up to $6,000; conception must occur after the trip begins
Emergency Medical Evacuation100% of Usual & Customary Charge incurred, Up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charge incurred, Up to $10,000 max
Accidental Death and Dismemberment$500,000 Aggregate Sum
2 AXIS BasicCare
AXIS BasicCare Plan 25K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charge incurred, Up to $900 a day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charge incurred, Up to $400 a day, to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charge incurred, Up to $2,000 max
Anesthetics100% of Usual & Customary Charge incurred, Up to $500 max
Assistant Surgeon100% of Usual & Customary Charge incurred, Up to $500 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charge incurred, Up to $40 per visit, 1 visit per day, Up to 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charge incurred, Up to $375 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charge incurred, Up to $950 max, test must occur within 14 days prior to Hospital Admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charges Up to $950max
Surgeon Services100% of Usual & Customary Charges Up to $2,000 max
Anesthetics100% of Usual & Customary Charges Up to $500 max
Assistant Surgeon100% of Usual & Customary Charges Up to $500 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charges Up to $50 max per visit, 1 visit per day, 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charges Up to $275 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charges Up to an additional $275 of the Diagnostic X-Ray and Lab
Hospital Emergency Room100% of Usual & Customary Charges Up to $275 max
Prescription Drug100% of Usual & Customary Charges Up to $75 max
Ambulance Services100% of Usual & Customary Charges Up to $375 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charges Up to $475 max
Physical and Occupational Therapy100% of Usual & Customary Charges Up to $30 max per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charges Up to $350 max
Emergency Medical Evacuation100% of Usual & Customary Charges Up to $1,000 max
Repatriation of Remains100% of Usual & Customary Charges Up to $1,000 max
Accidental Death and Dismemberment$25,000 Aggregate Sum

AXIS BasicCare Plan 50K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charges up to $1,300 per day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charges up to an additional $525 per day to a maximum of 8 days
Surgeon Services100% of Usual & Customary Charges up to $3,000 max
Anesthetics100% of Usual & Customary Charges up to $750 max
Assistant Surgeon100% of Usual & Customary Charges up to $750 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charges up to $60 max per visit, 1 visit per day, 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charges up to $400 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charges up to $1,000 max; test must occur within 14 days prior to Hospital admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charges up to $1,000 max
Surgeon Services100% of Usual & Customary Charges up to $3,000 max
Anesthetics100% of Usual & Customary Charges up to $750 max
Assistant Surgeon100% of Usual & Customary Charges up to $750 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charges up to $60 max per visit, 1 visit per day, 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charges up to $400 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charges up to an additional $400 of the Diagnostic X-Ray and Lab
Hospital Emergency Room100% of Usual & Customary Charges up to $350 max
Prescription Drug100% of Usual & Customary Charges up to $100 max
Ambulance Services100% of Usual & Customary Charges up to $400 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charges up to $450 max
Physical and Occupational Therapy100% of Usual & Customary Charges up to $35 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charges up to $400 max
Emergency Medical Evacuation100% of Usual & Customary Charges up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charges up to $10,000 max
Accidental Death and Dismemberment$25,000 Aggregate Sum

AXIS BasicCare Plan 75K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charges up to $1,525 per day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charges up to an additional $625 per day to a maximum of 8 day
Surgeon Services100% of Usual & Customary Charges up to $4,000 max
Anesthetics100% of Usual & Customary Charges up to $1,000 max
Assistant Surgeon100% of Usual & Customary Charges up to $1,000 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charges up to $80 max per visit, 1 visit per day, 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charges up to $425 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charges up to $1,050 max; test must occur within 14 days prior to Hospital admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charges up to $1,050 max
Surgeon Services100% of Usual & Customary Charges up to $4,000 max
Anesthetics100% of Usual & Customary Charges up to $1,000 max
Assistant Surgeon100% of Usual & Customary Charges up to $1,000 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charges up to $80 max per visit, 1 visit per day, 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charges up to $525 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charges up to an additional $525 of the Diagnostic X-Ray and Lab
Hospital Emergency Room100% of Usual & Customary Charges up to $425 max
Prescription Drug100% of Usual & Customary Charges up to $125 max
Ambulance Services100% of Usual & Customary Charges up to $425 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charges up to $475 max
Physical and Occupational Therapy100% of Usual & Customary Charges up to $40 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charges up to $450 max
Emergency Medical Evacuation100% of Usual & Customary Charges up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charges up to $10,000 max
Accidental Death and Dismemberment$25,000 Aggregate Sum

AXIS BasicCare Plan 100K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board100% of Usual & Customary Charges up to $1,750 per day, to a maximum of 30 days
Hospital Intensive Care Unit Room and Board100% of Usual & Customary Charges up to an additional $750 per day to a maximum of 8 day
Surgeon Services100% of Usual & Customary Charges up to $5,000 max
Anesthetics100% of Usual & Customary Charges up to $1,250 max
Assistant Surgeon100% of Usual & Customary Charges up to $1,250 max
Physician Non-Surgical Treatment/Examination Visits100% of Usual & Customary Charges up to $100 max per visit, 1 visit per day, 30 visits max
Consultant visits, when requested by a Physician100% of Usual & Customary Charges up to $450 max
Pre-admission Tests, when requested by Physician100% of Usual & Customary Charges up to $1,100 max; test must occur within 14 days prior to Hospital admission
Outpatient Medical ServicesOutpatient Medical Benefits
Day Surgery (including the cost of the operating room, anesthesia, drugs, medicines and medical supplies)100% of Usual & Customary Charges up to $1,100 max
Surgeon Services100% of Usual & Customary Charges up to $5,000 max
Anesthetics100% of Usual & Customary Charges up to $1,000 max
Assistant Surgeon100% of Usual & Customary Charges up to $1,250 max
Physician Non-Surgical Treatment/Exam Visits100% of Usual & Customary Charges up to $100 max per visit, 1 visit per day, 10 visits max
Diagnostic X-Rays and Laboratory Procedures100% of Usual & Customary Charges up to $650 max
CAT Scan, PET Scan or MRI100% of Usual & Customary Charges up to an additional $650 of the Diagnostic X-Ray and Lab
Hospital Emergency Room100% of Usual & Customary Charges up to $500 max
Prescription Drug100% of Usual & Customary Charges up to $150 max
Ambulance Services100% of Usual & Customary Charges up to $450 max
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)100% of Usual & Customary Charges up to $500 max
Physical and Occupational Therapy100% of Usual & Customary Charges up to $45 per visit, 1 visit per day, 12 visits max
Private Duty Nursing100% of Usual & Customary Charges up to $500 max
Emergency Medical Evacuation100% of Usual & Customary Charges up to $10,000 max
Repatriation of Remains100% of Usual & Customary Charges up to $10,000 max
Accidental Death and Dismemberment$25,000 Aggregate Sum

3 AXIS Network
AXIS Network Plan 75K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board80% of Usual & Customary Charges up to the policy maximum
Hospital Intensive Care Unit Room and Board80% of Usual & Customary Charges up to the policy maximum
Surgeon Services80% of Usual & Customary Charges up to the policy maximum
Anesthetics80% of Usual & Customary Charges up to the policy maximum
Assistant Surgeon Expenses80% of Usual & Customary Charges up to the policy maximum
Physician Non-Surgical Treatment/Examination Expenses80% of Usual & Customary Charges up to the policy maximum
Consultant visits, when requested by a Physician80% of Usual & Customary Charges up to the policy maximum
Pre-admission Tests, when requested by Physician80% of Usual & Customary Charges up to the policy maximum; test must occur within 14 days prior to Hospital admission
Surgical Room and supply expenses80% of Usual & Customary Charges up to the policy maximum
Surgeon Services80% of Usual & Customary Charges up to the policy maximum
Anesthetics80% of Usual & Customary Charges up to the policy maximum
Assistant Surgeon expenses80% of Usual & Customary Charges up to the policy maximum
Physician Non-Surgical Treatment/Exam Visits80% of Usual & Customary Charges up to the policy maximum; 1 visit a day, to 10 visits
Diagnostic X-Rays and Laboratory Procedures80% of Usual & Customary Charges up to the policy maximum
CAT Scan, PET Scan or MRI80% of Usual & Customary Charges up to the policy maximum
Hospital Emergency Room80% of Usual & Customary Charges up to the policy maximum
Prescription Drug80% of Usual & Customary Charges up to the policy maximum
Ambulance Services80% of Usual & Customary Charges up to the policy maximum
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)80% of Usual & Customary Charges up to the policy maximum
Physical and Occupational Therapy80% of Usual & Customary Charges up to the policy maximum; 1 visit a day, to 12 visits
Private Duty Nursing80% of Usual & Customary Charges up to the policy maximum
Emergency Medical Evacuation100% of Usual & Customary Charges up to the policy maximum; up to a maximum of $25,000
Repatriation of Remains100% of Usual & Customary Charges up to the policy maximum; up to a maximum of $25,000
Accidental Death and Dismemberment$500,000 Aggregate Sum

AXIS Network Plan 150K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and Board80% of Usual & Customary Charges up to the policy maximum
Hospital Intensive Care Unit Room and Board80% of Usual & Customary Charges up to the policy maximum
Surgeon Services80% of Usual & Customary Charges up to the policy maximum
Anesthetics80% of Usual & Customary Charges up to the policy maximum
Assistant Surgeon Expenses80% of Usual & Customary Charges up to the policy maximum
Physician Non-Surgical Treatment/Examination Expenses80% of Usual & Customary Charges up to the policy maximum
Consultant visits, when requested by a Physician80% of Usual & Customary Charges up to the policy maximum
Pre-admission Tests, when requested by Physician80% of Usual & Customary Charges up to the policy maximum; test must occur within 14 days prior to Hospital admission
Surgical Room and supply expenses80% of Usual & Customary Charges up to the policy maximum
Surgeon Services80% of Usual & Customary Charges up to the policy maximum
Anesthetics80% of Usual & Customary Charges up to the policy maximum
Assistant Surgeon expenses80% of Usual & Customary Charges up to the policy maximum
Physician Non-Surgical Treatment/Exam Visits80% of Usual & Customary Charges up to the policy maximum; 1 visit a day, to 10 visits
Diagnostic X-Rays and Laboratory Procedures80% of Usual & Customary Charges up to the policy maximum
CAT Scan, PET Scan or MRI80% of Usual & Customary Charges up to the policy maximum
Hospital Emergency Room80% of Usual & Customary Charges up to the policy maximum
Prescription Drug80% of Usual & Customary Charges up to the policy maximum
Ambulance Services80% of Usual & Customary Charges up to the policy maximum
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain)80% of Usual & Customary Charges up to the policy maximum
Physical and Occupational Therapy80% of Usual & Customary Charges up to the policy maximum; 1 visit a day, to 12 visits
Private Duty Nursing80% of Usual & Customary Charges up to the policy maximum
Emergency Medical Evacuation100% of Usual & Customary Charges up to the policy maximum; up to a maximum of $25,000
Repatriation of Remains100% of Usual & Customary Charges up to the policy maximum; up to a maximum of $25,000
Accidental Death and Dismemberment$500,000 Aggregate Sum
4 CHUBB Network
CHUBB Network Plan 75K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room(average semi-private) and Board and Miscellaneous80% of covered Network changes up to the overall maximum benefit
Hospital Intensive Care Unit80% of covered Network changes up to the overall maximum benefit
Surgeon80% of covered Network changes up to the overall maximum benefit
Anesthetics80% of covered Network changes up to the overall maximum benefit
Assistant Surgeon80% of covered Network changes up to the overall maximum benefit
Doctor's Non-Surgical Visits80% of covered Network changes up to the overall maximum benefit
Consultant Doctor, when requested by attending Doctor80% of covered Network changes up to the overall maximum benefit
Pre-admission Tests within 14 days before hospital admission80% of covered Network changes up to the overall maximum benefit
Outpatient Medical ServicesOutpatient Medical Benefits
Surgical Room and Supply Expenses80% of covered Network changes up to the overall maximum benefit
Surgeon80% of covered Network changes up to the overall maximum benefit
Anesthetics80% of covered Network changes up to the overall maximum benefit
Assistant Surgeon80% of covered Network changes up to the overall maximum benefit
Doctor's Non-Surgical Visits80% of covered Network changes up to the overall maximum benefit
Diagnostic X-Rays and Laboratory Servives80% of covered Network changes up to the overall maximum benefit
CAT Scan, PET Scan or MRI80% of covered Network changes up to the overall maximum benefit
Hospital Emergency Room80% of covered Network changes up to the overall maximum benefit
Prescription Drug80% of covered Network changes up to the overall maximum benefit
Other ServicesOther Benefits
Ambulance Services80% of covered Network changes up to the overall maximum benefit
Rehabilitative Braces or Appliances80% of covered Network changes up to the overall maximum benefit
Dental Treatment Injury to sound, natural teeth due to accident80% of covered Network changes up to the overall maximum benefit
Chemotherapy and/or Radiation Therapy80% of covered Network changes up to the overall maximum benefit
Physical and Occupational Therapy80% of covered Network changes up to the overall maximum benefit
Private Duty Nursing80% of covered Network changes up to the overall maximum benefit
Pregnancy and childbirth (conception must occur after the Trip begins)80% of covered Network changes up to the overall maximum benefit
Medical Evacuation$25,000 maximum
Repatriation of Remains$20,000 maximum
Intercollegiate SportsNo Benefits
Accidental Death and Dismemberment$25,000

CHUBB Network Plan 150K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room(average semi-private) and Board and Miscellaneous80% of covered Network changes up to the overall maximum benefit
Hospital Intensive Care Unit80% of covered Network changes up to the overall maximum benefit
Surgeon80% of covered Network changes up to the overall maximum benefit
Anesthetics80% of covered Network changes up to the overall maximum benefit
Assistant Surgeon80% of covered Network changes up to the overall maximum benefit
Doctor's Non-Surgical Visits80% of covered Network changes up to the overall maximum benefit
Consultant Doctor, when requested by attending Doctor80% of covered Network changes up to the overall maximum benefit
Pre-admission Tests within 14 days before hospital admission80% of covered Network changes up to the overall maximum benefit
Outpatient Medical ServicesOutpatient Medical Benefits
Surgical Room and Supply Expenses80% of covered Network changes up to the overall maximum benefit
Surgeon80% of covered Network changes up to the overall maximum benefit
Anesthetics80% of covered Network changes up to the overall maximum benefit
Assistant Surgeon80% of covered Network changes up to the overall maximum benefit
Doctor's Non-Surgical Visits80% of covered Network changes up to the overall maximum benefit
Diagnostic X-Rays and Laboratory Servives80% of covered Network changes up to the overall maximum benefit
CAT Scan, PET Scan or MRI80% of covered Network changes up to the overall maximum benefit
Hospital Emergency Room80% of covered Network changes up to the overall maximum benefit
Prescription Drug80% of covered Network changes up to the overall maximum benefit
Other ServicesOther Benefits
Ambulance Services80% of covered Network changes up to the overall maximum benefit
Rehabilitative Braces or Appliances80% of covered Network changes up to the overall maximum benefit
Dental Treatment Injury to sound, natural teeth due to accident80% of covered Network changes up to the overall maximum benefit
Chemotherapy and/or Radiation Therapy80% of covered Network changes up to the overall maximum benefit
Physical and Occupational Therapy80% of covered Network changes up to the overall maximum benefit
Private Duty Nursing80% of covered Network changes up to the overall maximum benefit
Pregnancy and childbirth (conception must occur after the Trip begins)80% of covered Network changes up to the overall maximum benefit
Medical Evacuation$25,000 maximum
Repatriation of Remains$20,000 maximum
Intercollegiate SportsNo Benefits
Accidental Death and Dismemberment$25,000
5 CHUBB Premier
CHUBB Premier Plan 100K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room(average semi-private) and Board and MiscellaneousCharges up to $1,750 a day maximum, to 30 days
Hospital Intensive Care UnitCharges up to $750 maximum additional a day, to 8 days
SurgeonCharges up to $5,000 maximum
AnestheticsCharges up to $1,250 maximum
Assistant SurgeonCharges up to $1,250 maximum
Doctor's Non-Surgical VisitsCharges up to $100 maximum a visit, 1 visit a day, to 30 visits
Consultant Doctor, when requested by attending DoctorCharges up to $450 maximum
Pre-admission Tests within 14 days before hospital admissionCharges up to $1,100 maximum
Outpatient Medical ServicesOutpatient Medical Benefits
Surgical Room and Supply ExpensesCharges up to $1,100 maximum
SurgeonCharges up to $5,000 maximum
AnestheticsCharges up to $1,250 maximum
Assistant SurgeonCharges up to $1,250 maximum
Doctor's Non-Surgical VisitsCharges up to $100 a visit maximum, 1 visit a day, to 10 visits
Diagnostic X-Rays and Laboratory ServivesCharges up to $650 maximum
CAT Scan, PET Scan or MRICharges up to $650 additional
Hospital Emergency RoomCharges up to $500
Prescription DrugCharges up to $150 maximum
Other ServicesOther Benefits
Ambulance ServicesCharges up to $450 maximum
Rehabilitative Braces or AppliancesCharges up to $1,100 maximum
Dental Treatment Injury to sound, natural teeth due to accidentCharges up to $500 maximum. There are no benefits for dental services for immediate relief of pain.
Chemotherapy and/or Radiation TherapyCharges up to $1,150 maximum
Physical and Occupational TherapyCharges up to $45 a visit max, 1 visit a day to 12 visits
Private Duty NursingCharges up to $500 maximum
Pregnancy and childbirth (conception must occur after the Trip begins)Charges up to $5,000 maximum
Medical Evacuation$20,000 maximum
Repatriation of Remains$15,000 maximum
Intercollegiate SportsNo Benefits
Accidental Death and Dismemberment$25,000

CHUBB Premier Plan 150K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room(average semi-private) and Board and MiscellaneousCharges up to $1,900 a day maximum, to 30 days
Hospital Intensive Care UnitCharges up to $850 maximum additional a day, to 8 days
SurgeonCharges up to $6,000 maximum
AnestheticsCharges up to $1,500 maximum
Assistant SurgeonCharges up to $1,500 maximum
Doctor's Non-Surgical VisitsCharges up to $125 maximum a visit, 1 visit a day, to 30 visits
Consultant Doctor, when requested by attending DoctorCharges up to $500 maximum
Pre-admission Tests within 14 days before hospital admissionCharges up to $1,200 maximum
Outpatient Medical ServicesOutpatient Medical Benefits
Surgical Room and Supply ExpensesCharges up to $1,200 maximum
SurgeonCharges up to $6,000 maximum
AnestheticsCharges up to $1,500 maximum
Assistant SurgeonCharges up to $1,500 maximum
Doctor's Non-Surgical VisitsCharges up to $125 a visit maximum, 1 visit a day, to 10 visits
Diagnostic X-Rays and Laboratory ServivesCharges up to $750 maximum
CAT Scan, PET Scan or MRICharges up to $1,000 additional
Hospital Emergency RoomCharges up to $750
Prescription DrugCharges up to $200 maximum
Other ServicesOther Benefits
Ambulance ServicesCharges up to $500 maximum
Rehabilitative Braces or AppliancesCharges up to $1,200 maximum
Dental Treatment Injury to sound, natural teeth due to accidentCharges up to $550 maximum. There are no benefits for dental services for immediate relief of pain.
Chemotherapy and/or Radiation TherapyCharges up to $1,250 maximum
Physical and Occupational TherapyCharges up to $50 a visit max, 1 visit a day to 12 visits
Private Duty NursingCharges up to $550 maximum
Pregnancy and childbirth (conception must occur after the Trip begins)Charges up to $5,500 maximum
Medical Evacuation$25,000 maximum
Repatriation of Remains$20,000 maximum
Intercollegiate SportsNo Benefits
Accidental Death and Dismemberment$25,000 maximum
6 CHUBB Standard
CHUBB Standard Plan 50K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and BoardCharges up to $1,300 maximum a day, to 30 days
Hospital Intensive Care Unit Room and BoardCharges up to $525 maximum additional a day, to 8 days
Doctor Surgical ExpensesCharges up to $3,000 maximum
AnestheticsCharges up to $750 maximum
Assistant Surgeon ExpensesCharges up to $750 maximum
Doctor's Non-Surgical Treatment/Examination ExpensesCharges up to $60 a visit, 1 visit a day, to 30 visits
Consultant Doctor, when requested by attending DoctorCharges up to $400 maximum
Pre-admission Tests within 14 days before hospital admissionCharges up to $1,000 maximum
Outpatient Medical ServicesOutpatient Medical Benefits
Surgical Room and Supply ExpensesCharges up to $1,000 maximum
Doctor Surgical ExpensesCharges up to $3,000 maximum
AnestheticsCharges up to $750 maximum
Assistant Surgeon ExpensesCharges up to $750 maximum
Doctor Non-Surgical Treatment ExaminationCharges up to $60 a visit, 1 visit a day, to 10 visits
X-Rays and Laboratory ProceduresCharges up to $400 maximum
CAT Scan, PET Scan or MRICharges up to $400 additional
Hospital Emergency RoomCharges up to $350
Prescription Drug ExpensesCharges up to $100 maximum
Other ServicesOther Benefits
Ambulance ServicesCharges up to $400 maximum
Rehabilitative Braces or AppliancesCharges up to $1,000 maximum
Dental Treatment Injury to sound, natural teeth due to accidentCharges up to $450 maximum. There are no benefits for dental services for immediate relief of pain.
Chemotherapy and/or Radiation TherapyCharges up to $1,000 maximum
Physical and Occupational TherapyCharges up to $35 a visit maximum, 1 visit a day to 12 visits
Private Duty NursingCharges up to $400 maximum
Pregnancy and childbirth (conception must occur after the Trip begins)Charges up to $4,500 maximum
Emergency Medical Evacuation$15,000 maximum
Repatriation of Remains$10,000 maximum
Accidental Death and Dismemberment$25,000 Principal Sum
Pre-existing ConditionsNo Benefits

CHUBB Standard Plan 100K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and BoardCharges up to $1,750 maximum a day, to 30 days
Hospital Intensive Care Unit Room and BoardCharges up to $750 maximum additional a day, to 8 days
Doctor Surgical ExpensesCharges up to $5,000 maximum
AnestheticsCharges up to $1,250 maximum
Assistant Surgeon ExpensesCharges up to $1,250 maximum
Doctor's Non-Surgical Treatment/Examination ExpensesCharges up to $100 maximum a visit, 1 visit a day, to 30 visits
Consultant Doctor, when requested by attending DoctorCharges up to $450 maximum
Pre-admission Tests within 14 days before hospital admissionCharges up to $1,000 maximum
Outpatient Medical ServicesOutpatient Medical Benefits
Surgical Room and Supply ExpensesCharges up to $1,000 maximum
Doctor Surgical ExpensesCharges up to $5,000 maximum
AnestheticsCharges up to $1,250 maximum
Assistant Surgeon ExpensesCharges up to $1,250 maximum
Doctor Non-Surgical Treatment ExaminationCharges up to $100 maximum a visit, 1 visit a day, to 10 visits
X-Rays and Laboratory ProceduresCharges up to $650 maximum
CAT Scan, PET Scan or MRICharges up to $650 additional
Hospital Emergency RoomCharges up to $500
Prescription Drug ExpensesCharges up to $150 maximum
Other ServicesOther Benefits
Ambulance ServicesCharges up to $450 maximum
Rehabilitative Braces or AppliancesCharges up to $1,100 maximum
Dental Treatment Injury to sound, natural teeth due to accidentCharges up to $500 maximum. There are no benefits for dental services for immediate relief of pain.
Chemotherapy and/or Radiation TherapyCharges up to $1,150 maximum
Physical and Occupational TherapyCharges up to $45 a visit maximum, 1 visit a day to 12 visits
Private Duty NursingCharges up to $500 maximum
Pregnancy and childbirth (conception must occur after the Trip begins)Charges up to $5,000 maximum
Emergency Medical Evacuation$20,000 maximum
Repatriation of Remains$15,000 maximum
Accidental Death and Dismemberment$25,000 Principal Sum
Pre-existing ConditionsNo Benefits

CHUBB Standard Plan 150K Coverage Maximum Benefits
Inpatient Medical ServicesInpatient Medical Benefits
Hospital Room and BoardCharges up to $1,900 maximum a day, to 30 days
Hospital Intensive Care Unit Room and BoardCharges up to $850 maximum additional a day, to 8 days
Doctor Surgical ExpensesCharges up to $6,000 maximum
AnestheticsCharges up to $1,500 maximum
Assistant Surgeon ExpensesCharges up to $1,500 maximum
Doctor's Non-Surgical Treatment/Examination ExpensesCharges up to $125 maximum a visit, 1 visit a day, to 30 visits
Consultant Doctor, when requested by attending DoctorCharges up to $500 maximum
Pre-admission Tests within 14 days before hospital admissionCharges up to $1,200 maximum
Outpatient Medical ServicesOutpatient Medical Benefits
Surgical Room and Supply ExpensesCharges up to $1,200 maximum
Doctor Surgical ExpensesCharges up to $6,000 maximum
AnestheticsCharges up to $1,500 maximum
Assistant Surgeon ExpensesCharges up to $1,500 maximum
Doctor Non-Surgical Treatment ExaminationCharges up to $125 maximum a visit, 1 visit a day, to 10 visits
X-Rays and Laboratory ProceduresCharges up to $750 maximum
CAT Scan, PET Scan or MRICharges up to $1,000 additional
Hospital Emergency RoomCharges up to $750
Prescription Drug ExpensesCharges up to $200 maximum
Other ServicesOther Benefits
Ambulance ServicesCharges up to $500 maximum
Rehabilitative Braces or AppliancesCharges up to $1,200 maximum
Dental Treatment Injury to sound, natural teeth due to accidentCharges up to $550 maximum. There are no benefits for dental services for immediate relief of pain.
Chemotherapy and/or Radiation TherapyCharges up to $1,250 maximum
Physical and Occupational TherapyCharges up to $50 a visit maximum, 1 visit a day to 12 visits
Private Duty NursingCharges up to $500 maximum
Pregnancy and childbirth (conception must occur after the Trip begins)Charges up to $5,500 maximum
Emergency Medical Evacuation$25,000 maximum
Repatriation of Remains$20,000 maximum
Accidental Death and Dismemberment$25,000 Principal Sum
Pre-existing ConditionsNo Benefits
Dental and Vision
Dental and Vision Plans
Dental Insurance Plans and Discount Cards There are discount cards for Dental, Vision, and Rx coverage for all visitors during their stay in the United States. This is a not insurance and members will directly pay the discounted amount to the providers. Below are some of the companies that offer dental insurance plans and discount cards:
A dental insurance plan from Humana can help keep you smiling bright. With coverage for preventive care services like regular checkups and cleanings, you can save on services that keep your teeth in tip-top shape. And saving money on other dental care will help keep you smiling, too. Humana also offers health and vision insurance plans but you always can buy dental insurance plan separately. To apply please go here and click on 'Find dental plans'.

 



  • The total cost includes all applicable dues and fees.

  • The total cost does not include a one-time enrollment fee.

  • The insurance coverage is available only to members of Communicating for America, Inc.

  • Group association dental insurance under the IHC Dental plans is underwritten by Madison National Life Insurance Company, Inc. in all states except Maine, New Hampshire and New York where IHC Dental is underwritten by Standard Security Life Insurance Company of New York.

  • The application must be received by the administrator prior to the requested effective date, and the initial premium must be received by the administrator prior to issuing coverage. If a monthly billing method has been selected, future premium will be due on the first of each month.

  • Do not lapse or cancel current insurance coverage unless you receive a written notice from the insurance company that your application for coverage has been approved.

  • Spouse includes domestic partner in the following states: DC, NY


Discount dental plans are an easy and reliable way to help you save money at the dentist. These plans give members access to significant discounts at in-network dental offices for a wide range of procedures. These are great plans that can help you save money while offering you the quality dental care you need. Discount dental plan members save on preventive treatments like cleanings and x-rays, and on major treatments like root canals and bridges. Additionally, the dentists in our network have agreed to treat our members with the same quality care, but at significantly discounted rates. When you become a member of a discount dental plan, you’ll pay the dentist directly when you go in for your appointment, but at a discounted rate. You don’t need to worry about filling out complex paperwork or waiting for reimbursements. Click here for more information and application.

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