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Who is eligible?
Anybody under age 75 is generally eligible provided they are not American living in the USA, or any dependent territory of the USA like Puerto Rico. Once you have joined, you can generally renew to age 80. There are only two policies we know of that you can join as a new applicant beyond age 75. With most policies and worldwide geographical cover, you can spend cumulatively 6 months per year in the USA and return there for medical treatment. If you are an expat living in the USA, there are limited policies available for you to choose from. If you are in that situation wanting cover in the USA, please consult with us directly. There are no geographical limitations outside of the USA for all policies.
What period of time can I be covered for, and are the plans automatically renewable?
Medical insurance policies are annual and guaranteed to be renewable no matter what claims are pending. You can continue to renew as long as the plan is available, and you are eligible. The upper age limit for new applicants is generally 74, but each provider has limits age 64, 69 etc. Generally, you will receive a 30-day e-mail notice prior to your expiration date if your credit card is still valid. You will be renewed automatically unless you tell the insurer otherwise. If you are renewed in error, you can cancel for a full refund.
Will I be required to answer a medical questionnaire or have a medical exam?
Generally, applications have medical questions that ask about pre-existing medical conditions, but no physical exam is required. However, with some policies, if you are 55 or older, you must have had a physical exam in the last 2 years in order to qualify, or you must have a physical exam and provide a note from the doctor.
How do I apply and how quickly can I be covered?
You can apply on-line and get same day cover paying by credit card. Or, simply download an application scan & e-mail it to us. If you are paying by credit card, you can get immediate cover or on the date you specify in the future.
How can I pay?
You can pay annually by credit card (Visa, MasterCard, or sometimes additionally with JCB, American Express), wire transfer etc. You can pay monthly, quarterly, or semi-annually only with a credit card.
How do I know I’m covered, and what will I receive after joining?
You will receive all policy documents by e-mail and can opt for hard copies to follow to your postal address. You should receive a policy certificate, membership card, and policy wording at the least.
Can I change the Level or Area of cover?
Yes, but only at renewal. If you upgrade benefit levels, wait periods for benefits such as maternity will apply anew. If you have a medical condition under treatment and want to change your geographical area to be treated in the US or Canada, then this is at the insurer’s discretion.
Can I cancel and get a refund?
You can cancel and get a full refund within 15 days, if you are claim free, you can usually get a pro rata refund any time.
What is the Compassionate/ Reunion travel benefit?
Compassionate travel is a return home benefit typically up to $3000 USD allowing travel home if an immediate family member under 75 dies unexpectedly, or becomes terminally ill. It can also allow an immediate family member to travel to your bedside if you are hospitalized. Under the Medical Evacuation benefit, reasonable transportation costs for an accompanying person can be paid if deemed necessary by the insurer. In all circumstances these benefits must be pre-authorized and arranged by the insurer.
What are the Major Exclusions?
STD's, immunizations, cosmetic surgery, contraceptives, podiatry, vaccinations etc. are generally excluded. Unless specifically named as benefits. These exclusions are standard with most policies. The policy wording regarding pre-existing conditions specifies that any pre-existing conditions you have had, or must have been reasonably aware of are excluded.
Are hazardous sports excluded?
This is provider dependent and it is not possible to generalize, but hazardous sports are usually excluded. Please see your policy wording for specifics. Downhill skiing and snowboarding on trail are generally not considered to be hazardous sports, neither is Scuba diving by certified divers (PADI, BSAC, NAUI etc.).
What is the difference between Travel and Medical Insurance?
Travel insurance is usually for short periods but can be for up to 3 years, and does not cover urgent or elective medical problems. It covers only accidents and emergencies. Travel insurance companies expect you to end your trip and return home for elective or urgent treatment, and some policies require return home immediately once you are diagnosed or seriously injured. For example, if you were diagnosed with cancer, there might be an urgent requirement to commence treatment, but it is not life or death to get on an airplane and return home after several weeks. Travel insurance is not renewable, but only extendable at the discretion of the insurer. If you do have a serious medical problem, your cover will end at the expiration date, or when you return home. Medical insurance covers urgent and elective medical problems like cancer, and is guaranteed renewable. If you have expatriate medical insurance, you don't need travel insurance except perhaps if you are travelling outside your area of cover. The underlying assumption with travel cover is that you have proper medical insurance at home, or in your country of residence, to return home to in the event of an urgent or elective medical problem.
What is a Deductible or Excess?
With all benefit levels you can choose an annual deductible or excess to reduce premiums. Excess is the British word for deductible, which is the American term, they mean the same thing. Any medical expenses exceeding the deductible/excess amount are payable in a policy year. You must file claims to prove that you have spent the deductible amount before the policy will start reimbursing. Most policies have an annual deductible structure.
I am older and healthy and facing high premiums, what is my best option?
For this situation we find many choose an inpatient plan. You can pay yourself for any outpatient treatment, and end up paying very little for insurance. This means you’d be covered for big expenses, yet not financially ruined if something bad happens. Most inpatient benefit levels cover include 90 days of post-hospital outpatient treatment. The money you save in years where you don’t need to claim, more than offsets the higher deductible on the rare occasion you are hospitalized. Also, many expats live in places where outpatient treatment is inexpensive. Pay for that yourself and insure for the big hits with a hospital plan and save big money.
What is coinsurance?
Coinsurance is the percentage amount you must pay for a benefit in addition to any deductible you choose. Some policies have deductible options for inpatient claims and have co-insurance options for outpatient claims. We like that structure rather than a fixed deductible across all inpatient and outpatient claims.
What is accidental dental?
This is a dental problem caused by an injury or accident typically by a blow to the face, teeth, or gums. The benefit only applies to outpatient dental procedures.
What if I have a Pre-existing Condition?
The underwriters won't accept some pre-existing conditions; they have a list. The default method of intake underwriting is called FULL MEDICAL UNDERWRITING. If you have a pre-existing condition to underwrite, let us know and we will advise on the best options. For about a 10% surcharge, there is another method of intake underwriting available called MORATORIUM. A two-year moratorium is imposed upon all pre-existing conditions. So long as you can go two years without a recurrence, or symptoms, take medication, or have a medical consultation for them, it will be deemed a new condition in the 3rd policy year and subsequently if there is a recurrence it will then be covered by the policy. You will never have two clear years if your condition is chronic like diabetes. Follow up routine consultations for things like cancer do not affect the moratorium. With cancer, providers generally have a 5-year moratorium period.
When do I have to contact the insurer Assistance Services number in the event of a claim?
There is no approved hospital list except in the USA. All health insurance policies have the phrase "usual, reasonable and customary costs" (URC) in their policy wordings. They will not pay more than URC for treatment in the country where you are located. If you go to a hospital that charges ten times the going rate, there will be a problem. It is very important to contact the Assistance service early and cooperate with them so that there are no surprises later. You should contact the insurer if you expect a medical bill to be more than US $500 and pre-authorize the claim or your benefit may be reduced no matter what country you are in. All hospitals negotiate with insurers, let them handle it so there are no surprises. Some insurers have a hospital black list in Mexico where they charge 40% co-insurance because these hospitals gouge. It is very important to communicate with the insurer, that is what you want to do to avoid problems and have trouble free claims paid quickly.
Will my policy be affected if I return home?
If your geographical area contains your home country, then there is no limitation and you can continue to renew and return home for medical treatment. For worldwide US cover and Americans, the only restrictions generally are you must reside outside of the USA 6 months per year. We do have special policies for those non-Americans that wish to live as expats in the USA.
Am I covered if I travel outside of my country of residence?
You get full cover within your Geographical Area, and you can live and work in any country in that Area. If you travel to a country outside that Area most polices have 30- or 60-day accident and emergency out-of-area cover which saves you from having to buy travel insurance for that trip.
Can I seek treatment anywhere in the world?
Yes, so long as it is within your Geographical Area of Cover.
What is my home country limitation?
This is policy and provider dependent; some firms will only let you renew for a limited number of years if you return home. Certainly, there is no firm that will cover American citizens living in the USA, or resident in the USA; otherwise, there are no geographical limitations beyond your geographical area of cover. If you want to live in the USA as an expat resident, please contact us as we do have policy options for you to consider.
What is inpatient treatment?
This is when you are admitted to a hospital typically staying overnight. It is usually for a serious medical condition. However, hernias for example, used to be a 5-day hospital stay, now with new surgical procedures they are now a 3 hour hospital stay and you can walk out afterwards. This would still be covered under an inpatient plan.
What is outpatient treatment?
This is when you consult with a general practitioner (i.e., a family doctor) or outpatient specialist (e.g., a cardiologist) without being admitted to a hospital. An example would be if you have the flu and visited your family doctor's office for a consultation.
Can I go to any hospital?
It doesn’t matter who your insurer is, they all have restrictions in the USA restricting you to a network of provider hospitals. No restrictions are made outside the USA generally beyond usual reasonable customary (URC) costs.
Will I be required to make down payments to a hospital?
Not if you call the Assistance service of the insurer and pre-authorize treatment as you are required to do, then the insurer will make arrangements ahead of time to settle the hospital bill directly. In the event of an emergency, you are required to contact insurers within 48 hours. They will intervene with the hospital to advance funds and guarantee payment before you are discharged. The only thing they want you to worry about is getting better, not about money!
Can I be held hostage by a Mexican hospital?
We have experienced several instances of this, and it has always gone badly for the patient because they were scared and intimidated and consequently made bad decisions under duress. The scenario is that the patient receives treatment and the hospital has not submitted any bill to the insurer, and of course the insurer won't finalize payment until the paperwork is done. There might have even been a front payment by the insurer, so good faith has already been demonstrated. The hospital will prevent you from leaving until the bill is paid unless you sign documents that put a lien on your house or property until the bill is paid. Then they demand an unreasonable amount from the insurer because they have your security and the insurer won't pay the unreasonable amount because it is extortion. It is illegal to force or intimidate you to sign documents by holding you hostage. They can't do this, and if they try it, you better not sign anything. Stay calm and call us and we will refer a lawyer to stop this nonsense if it does happen.
What is the Daily Hospital Indemnity benefit?
The Daily Hospital Indemnity Benefit is an extra add-on benefit the one provider IMG has that pays $100 cash for every night spent in a hospital. This would replace your income up to $3000 per month while you are hospitalized. It is available with all benefit levels. It costs $100 extra per year and pays up to $25,000 for 250 days in hospital. This does not include time spent in the hospital for maternity. You can buy up to 2 units for a maximum cash benefit of $50,000 per year.
What is the Hospital Cash Benefit & how is it different from Daily Hospital Indemnity benefit?
The Hospital Cash Benefit is a standard benefit typically paying $100 per over-night stay in hospital, but only if the insurance policy is not paying anything out for your hospitalization. Reading this you may think this doesn't make sense! Many people are double insured and can have another policy pay the hospital bill. If you can arrange this, then you get $100 cash per night. Also, many people prefer to return to their home country for treatment and can immediately be back on their National Medical Insurance programs at no cost. If you can do this, then you get $100 per night from the insurer. If you have purchased the extra add-on Daily Hospital Indemnity benefit from IMG, then you can double dip and get $200 or $300 cash per night by claiming both benefits.
Am I covered for pandemics like Covid-19?
Yes, provided it is not a pre-existing condition when you join. A pandemic is official when it is declared by the WHO or the US CDC, or UK Health. After you join, you cannot travel out of your country of residence during a pandemic emergency and continue to be covered for the virus. So long as you don’t travel and stay in place, you are covered. Each insurer has different specific policies in this regard. You have to check with the insurer that you buy from to confirm.