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Atlas Series Group Benefits
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Overall Maximum Limit
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$50,000, $100,000, $200,000, $500,000 or $1,000,000 Up to age 69
Age 70-79 $50,000 or $100,000
Age 80+- $10,000
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Deductibles
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$,0, $100, $250, $500, $1,000, $2,500
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Coinsurance- Claims incurred in U.S. or Canada
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Plan pays 80% of the next $5,000 of eligible medical expenses after the deductible, then 100% to overall maximum limit. Coinsurance waived if expenses are incurred within the PPO and expenses are submitted for review and payment directly to provider.
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Coinsurance- Claims incurred outside U.S. or Canada
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100% of eligible expenses after the deductible up to the overall maximum limit
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Hospital Room & Board
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Average semi-private room rate, including nursing services
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Intensive Care Unite
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URC
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Local Ambulance
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URC, when covered illness or injury results in hospitalization as inpatient
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Emergency Room co-payment: Claims incurred in U.S. or Canada
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$200 co-payment for each use of the emergency room for an illness unless you are admitted to the hospital. There will be no co-payment for emergency room treatment of an injury.
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Urgent Care Center- Claims incurred in U.S. or Canada
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Each visit you are responsible for a $50 co-payment, after which coinsurance will apply. Not subject to deductible.
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Acute Onset of Pre-existing Conditions (only available to members under 70)
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Overall maximum limit $25,000 lifetime maximum for Emergency Medical Evacuation
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Terrorism
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$50,000 lifetime maximum, eligible medical expenses only.
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Physical Therapy
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$50 maximum per day
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All Other Eligible Medical Expenses
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URC
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Emergency Medical Evacuation
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$1,000,000 lifetime maximum, except as provided under Acute Onset of Pre-Existing Condition
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Repatriation of Remains
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Overall maximum limit
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Local Burial or Cremation
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$5,000 lifetime maximum
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Crisis Response- Ransom, Personal Belongings, and Crisis Response Fees and Expenses
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$10,000
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Optional Crisis Response Rider
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$90,000
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Emergency Reunion
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$50,000, subject to a maximum of 15 days
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Bedside Visit
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$1,500
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Return of Minor Children
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$50,000
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Pet Return
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$1,000
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Political Evacuation
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$10,000 lifetime maximum
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Trip Interruption
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$5,000
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Accidental Death & Dismemberment
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Under 18: $5,000 Lifetime Maximum
Ages 18-69: $50,000 Lifetime Maximum
Ages 70-74: $12,000 Lifetime Maximum
Ages 75+: $6,250 Lifetime Maximum
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Optional Accidental Death & Dismemberment Rider (only available to members age 18-69)
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$50,000 Lifetime Maximum
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Common Carrier Accidental Death
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Ages:0-17: $25,000
Ages: 18-69: $50,000
Ages: 70-74: $12,500
Ages:75+: $6,250
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Lost checked luggage
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$500
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Travel Delay
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Maximum $100/day after 12 hour delay period requiring an unplanned overnight stay. Subject to a maximum of 2 days
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Emergency Dental (Acute onset of pain)
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$250
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Natural Disaster
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Maximum $100/day for 5 days
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Hospital Indemnity
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$100/day of inpatient hospitalization
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Personal Liability
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$10,000 lifetime maximum
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Optional Personal Liability Rider
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$90,000 lifetime maximum
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