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International Citizens Group Inc.18 Shipyard Drive Suite 2AHingham, MA 02043Phone: 617-500-6738E-mail: info@internationalinsurance.comWeb: InternationalInsurance.comAtlas Group The Atlas Group plan from Tokio Marine HCC – MIS Group, a member of Tokio Marine HCC, is with you andyour group of 5 or more almost anywhere you may travel in the world. Atlas Group coverage is designed formission trips, large family vacations, student groups, corporate groups, and overseas excursions for other largeorganizations.
Whatever the reason,traveling internationallywith a large group shouldbe a pleasant experience.Emergencies andcomplications such as naturaldisasters, injury, and illnessare a fact of life, and can beeven tougher to managefor a large group of people.While we hope none of theseincidents happen. we’re hereto help if they do. Coveragefor medical expenses in caseof hospitalization – includinga stay in an intensive careunit or outpatient treatment– Emergency MedicalEvacuation, and Lost CheckedLuggage are just some of thebenefits you can count onfrom Atlas GroupMy family has medical insurance in ourinsurance group conducting businesshome country; do we need group travelin approximately 180 countries andmedical insurance?underwriting more than 100 classes ofOften, the primary medical insurance inspecialty insurance. Headquartered inyour home country will not cover you andyour family while traveling internationally,and medical expenses can be very costlywhile abroad. Atlas Group plans offerbudget-friendly coverage—plans start atless than 1 a day!Additionally, Atlas Group includesimportant travel assistance services suchas translation assistance while beingtreated, doctor and hospital referrals, andassistance replacing lost prescriptions.Houston, Texas, the company is made upof highly entrepreneurial teams equippedto underwrite special situations, companies and individuals, acting independentlyto deliver effective solutions. Our products and capabilities set the standard forthe industry, as many of our nearly 2,500employees are industry-leading experts.Tokio Marine HCC is part of Tokio Marine,a premier global company with a marketcap of approximately 30 billion.* TokioMarine HCC holds a financial strengthAfter purchasing coverage, how can Irating of AA- for Standard & Poor’s andtrust the company to be there if I needFitch Ratings and A (Superior) by A.M.them?Best Company.Tokio Marine HCC – MIS Group,For more information about Atlas Group,headquartered in the United States inplease visit hccmis.com.Indianapolis, Indiana, is a full-service*At the time of printing. For more information onthese ratings, please visit: www.standardandpoors.com, www.ambest.com, and www.fitchratings.com.company offering international medicalinsurance products designed to meetneeds of consumers worldwide.Tokio Marine HCC is a leading specialty
PLAN DETAILSDeductiblesOverall Maximum LimitCoinsurance – Claims Incurred in U.S.In-Network PaymentOut-of-Network PaymentCoinsurance – Claims Incurred Outside U.S. 0, 100, 250, 500, 1,000, 2,500 or 5,000 per certificate period.Age 80 or older - 10,000; Age 70 to 79 - 50,000, 100,000, or 250,000; All others - 50,000, 100,000, 250,000, 500,000, 1,000,000, or 2,000,000.Within the PPO: We will pay 100% of eligible expenses, after the deductible, to the overall maximum limit.Outside the PPO: Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount.We will pay 100% of eligible expenses after the deductible up to the overall maximum limit.Eligible expenses are subject to deductible, coinsurance, overall maximum limit, and are per certificate period unless specifically indicated otherwise.BENEFITLIMITHospital Room and BoardLocal AmbulanceIntensive Care UnitAverage semi-private room rate, including nursing services.Usual, reasonable and customary charges when covered illness or injury results in hospitalization as inpatient.Up to the overall maximum limit.Claims incurred in U.S.You shall be responsible for a 200 co-payment for each use of emergency room for an illness you are admitted tothe hospital.Emergency Room Co-paymentThere will be no copayment for emergency room treatment of an injury.Claims incurred outside the U.S.No co-paymentClaims incurred in U.S.For each visit, you shall be responsible for a 25 co-payment, after which coinsurance will apply.– co-payment is waived for members with a 0 deductibleUrgent Care Center– not subject to deductibleClaims incurred outside the U.S.No co-paymentOutpatient Physical Therapy and Chiropractic CareUp to 50 maximum per day. Must be ordered in advance by a physician. – not subject to coinsuranceAll Other Eligible Medical ExpensesUp to the overall maximum limit.Acute Onset of Pre-existing Condition (excludes chronic and congen- Up to the overall maximum limit.ital conditions) (only available to members under age 70)Up to 25,000 lifetime maximum for Emergency Medical Evacuation.TerrorismUp to 50,000 lifetime maximum. Eligible medical expenses only.Emergency Dental (Acute Onset of Pain)Up to 250 – not subject to deductible or coinsuranceEmergency Eye Exam for a Covered LossUp to 150. 50 deductible per occurrence (plan deductible is waived). – not subject to coinsuranceEMERGENCY TRAVEL BENEFITSEmergency Medical EvacuationReturn of Minor ChildrenPet ReturnRepatriation of RemainsEmergency ReunionNatural Disaster – Replacement AccommodationsTrip InterruptionTravel DelayLost Checked LuggagePolitical EvacuationLIMITUp to 1,000,000 lifetime maximum, except as provided under Acute Onset of Pre-existing Condition.– not subject to deductible, coinsurance, or overall maximum limitUp to 50,000 – not subject to deductible or coinsuranceUp to 1,000 – not subject to deductible or coinsuranceUp to the overall maximum limit – not subject to deductible or coinsuranceUp to 100,000, subject to a maximum of 15 days – not subject to deductible or coinsuranceUp to 250 a day for 5 days – not subject to deductible or coinsuranceUp to 10,000 – not subject to deductible or coinsuranceUp to 100 a day after a 12-hour delay period requiring an unplanned overnight stay. Subject to a maximum of 2days.– not subject to deductible or coinsuranceUp to 500 – not subject to deductible or coinsuranceUp to 100,000 lifetime maximum – not subject to deductible or coinsuranceAccidental Death & Dismemberment (excludes loss due to common carrier accident) 250,000 maximum benefit any one family or group.– not subject to deductible, coinsurance, or overallmaximum limitCommon Carrier Accidental DeathAges 18 through 69Under age 18Ages 70 through 74Ages 75 and olderCrisis Response - Ransom, Personal Belongings, and CrisisResponse Fees and ExpensesHospital IndemnityPersonal LiabilityBedside VisitBorder Entry ProtectionAges 18 through 69Lifetime Maximum - 50,000Death - 50,000Loss of 2 Limbs - 50,000Loss of 1 Limb - 25,000Under age 18Lifetime Maximum - 5,000Death - 5,000Loss of 2 Limbs - 5,000Loss of 1 Limb - 2,500Ages 70 through 74Lifetime Maximum - 12,500Death - 12,500Loss of 2 Limbs - 12,500Loss of 1 Limb - 6,250Ages 75 and olderLifetime Maximum - 6,250Death - 6,250Loss of 2 Limbs - 6,250Loss of 1 Limb - 3,125 50,000 25,000 12,500 6,250Subject to a maximum of 250,000 any one family or group.- not subject to deductible, coinsurance, or overall maximum limitUp to 10,000 – not subject to deductible, coinsurance, or overall maximum limit 100 per day of inpatient hospitalization – not subject to deductible or coinsuranceUp to: 10,000 lifetime maximum 10,000 third person injury 10,000 third person property 2,500 related third person property– not subject to deductible, coinsurance, or overall maximum limitUp to 1,500 – not subject to deductible or coinsuranceUp to 500 if traveling on a valid B-2 visa and denied entrance at the U.S. border– not subject to deductible or coinsurance
International CoverageEmergency Medical Evacuation andEmergency Reunionwrong place at the wrong time, and theup to the medical coverage life timecountry or region you’re visiting is NOTmaximum for eligible medical expenses.under a level 3 or level 4 travel advisory,If you are younger than 70, you may beAtlas Group offers coverage for eligiblecovered for an acute onset of a **pre-ex-medical expenses resulting from thoseisting condi tion. This also includesWould you know what to do if you foundacts. Coverage excludes countries orup to a 25,000 lifetime maximum foryourself in a life-threatening situationregions for which the U.S. Departmentemergency medical evac-uation.far from home? Tokio Marine HCC - MISof State has issued a level 3 (“reconsiderGroup is experienced in arranging emer-travel”) or level 4 (“do not travel”) advisory.An acute onset of a pre-existing conditiongency medical evacuations. Atlas GroupPolitical Evacuationwill cover eligible expenses necessaryto transport you from an initial treatingfacility to the nearest hospital qualified totreat your life-threatening condition. Wealso understand the importance of familysupport in these difficult situations. AtlasGroup will also cover the transportation,lodging, and meal costs for a relative toIf, during the coverage period and afteryour arrival, the United States governmentissues a level 3 or level 4 travel advisoryfor your destination country, Atlas Groupwill coordinate your alternate departurearrangements from that country and covereligible associated costs.join you after a covered emergency medi-Natural Disaster Benefit – Replacementcal evacuation, up to the lifetime limit.AccommodationsRepatriation of RemainsNatural disasters can happen anywhereWhat would your family do if disasterstrikes while you are away from home?The death of a loved one is never easy,no matter the circumstances. In theunfortunate event of your death whiletraveling abroad, Atlas Group will arrangeand at any time. If a natural disaster occurswhile on your trip, causing you to becomeTerrorismIn these turbulent times, the risk of aterrorist attack is a reality. If you are in thesudden and unexpected outbreak or recurrence. Chronic and congenital conditions areexcluded from coverage.Hospitalization & Outpatient TreatmentIf a covered illness or injury requireshos pitalization, the plan providescoverage for eligible costs associated withhospitalization, including intensive care unitinjuries and illnesses that could occurthe costs of alternative accommodations.while participating in many popularyou does not stop. What’s more, in sometation cost for the children to return home.must be obtained within 24 hours of themum of 250 a day for 5 days to help coverReturn of Minor Childrenresult, Atlas Group will cover the transpor-recommendations or symptoms. TreatmentAtlas Group includes coverage for eligibleIf you are hospitalized, the world aroundyears of age will be left unattended as awarning either in the form of physicianAtlas Group will provide relief of a maxi-the repatriation of your remains.or illness, and covered children under 18occurs spontaneously and without advanceand outpatient treatment. Sports CoverageHospital Indemnitymore than 36 hours due to a covered injuryrecurrence of a pre-existing condition whichdisplaced from your accommodations,for and cover eligible costs associated withIf you are expected to be hospitalized foris a sudden and unexpected outbreak orplaces hospitals do not provide theirpatients basic necessities like meals, tooth-vacation sports - skiing, snowboarding,snorkeling, water skiing, and others - atno additional cost. Certain extremesports are excluded from coverage.Sports Coveragepaste or soap. If you are hospitalized as anAtlas Group includes coverage for eligibleinpatient for treatment of a covered illnessinjuries and illnesses that could occur whileor injury, Atlas Group will provide 100 forparticipating in many popular vacationeach night you spend in the hospital.sports- skiing, snowboarding, snorkeling,Atlas Group* Quality Benefitswater skiing, and others- at no additionalAcute Onset of Pre-Existing ConditionsAtlas Group provides a limited benefitcost. Certain extreme sports are excludedfrom coverage.
termination of the certificate, underwriters will pay eligible medical expenses,as defined herein, for up to 90 daysbeginning on the first day of diagnosis ortreatment of a covered injury or illnesswhile the member is outside his or herhome country and while the certificatewas in effect. The benefit period appliesonly to eligible medical expenses relatedto the injury or illness that began whileComplications of Pregnancythe certificate was in effect.Atlas Group offers coverage for compli-Enrollmentcations of pregnancy during the first 26You may access the online quoting andweeks of gestation.purchasing system or you may completeCrisis Responsean application and mail or fax along withAtlas Group offers up to 10,000 (or upto 100,000 if ***additional coverageyour payment to your agent or to TokioHome Country CoverageMarine HCC - MIS Group.Incidental Home Country CoverageClaim Filingresponse expenses, and loss of personalFor individuals with U.S. as home country,You may file a claim by submitting abelongings. This benefit includesfor every three-month period duringaccess to the services of Unity Crisiswhich the Member is covered hereunder,Group for advice, coordination with lawmedical expenses incurred in the U.S. areenforcement, and negotiations during acovered up to a maximum of 15 days.kidnapping.For individuals with a home country otheris selected) to offset costs associatedwith kidnapping, such as ransom, crisisthan the U.S., for every three-monthPersonal Liabilityperiod during which the Member isAtlas Group offers up to 10,000 (or upcovered hereunder, medical expensesto 100,000 if additional coverage isincurred in the member’s home countryselected) to offset the following typesare covered up to a maximum of 30 days.of court-entered eligible judgments orAny benefit accrued under a singleapproved settlements incurred by thethree-month period does not accumulatemember:to another period. Failure of the member Third-party injuryto continue his or her international trip Damage/loss of a third party’s personalproperty Damage/loss of a related third party’spersonal propertyor the members return to their homecountry for the sole purpose of obtainingtreatment for an illness or injury thatbegan while traveling shall void anyhome country coverage provided underthe terms of this agreement.Benefit Period Medical CoverageWhile the certificate is in effect, thebenefit period does not apply. Uponclaimant’s statement and authorizationform. This form may be found online,in ClientZone, or you may contact TokioMarine HCC - MIS Group for a copy.Complete the form, attach all itemizedinvoices and payment receipts, andsend them to the address shown on theclaimant’s statement.This insurance is not subject to, and does not providecertain insurance benefits required by the UnitedStates’ Patient Protection and Affordable Care Act(“PPACA”). PPACA requires certain US citizens or USresidents to obtain PPACA compliant health insurance,or “minimum essential coverage.” PPACA alsorequires certain employers to offer PPACA compliantinsurance coverage to their employees. Tax penaltiesmay be imposed on U.S. residents or citizens whodo not maintain minimum essential coverage, and oncertain employers who do not offer PPACA compliantinsurance coverage to their employees. In some cases,certain individuals may be deemed to have minimum essential coverage under PPACA even if theirinsurance coverage does not provide all of the benefitsrequired by PPACA. You should consult your attorneyor tax professional to determine whether this policymeets any obligations you may have under PPACA.Atlas Group is underwritten by Lloyd’s, London.Tokio Marine HCC - Medical Insurance ServicesGroup (MIS Group) is a service company and amember of the Tokio Marine HCC group of companies. Tokio Marine HCC - MIS Group has authorityto enter into contracts of insurance on behalf of theLloyd’s underwriting members of Lloyd’s Syndicate4141, which is managed by HCC UnderwritingAgency Ltd.*The description of coverage in these pages is for informational purposes only. Actual coverage will vary based the terms and conditions of the policy issued. The information described herein does not amend or otherwise affect theterms and conditions of any insurance policy issued by Tokio Marine HCC -MIS Group or its affiliates. In the event that a policy is inconsistent with the information described herein, the language of the policy will take precedence.**A pre-existing condition is any condition: for which medical advice, diagnosis, care, or treatment was recommended or received within 2 years prior to your effective date of coverage which would cause a reasonably prudent person to seek medical advice, diagnosis, care, or treatment within 2 years prior to your effective date of coverage that existed (with reasonable medical certainty) with 2 years prior to your effective date of coverage, whether or not it was known to you***A buy-up of an additional 90,000 is available for selection, which includes the added benefit of a 10,000 maximum for natural disaster evacuation.
Outstanding Customer ServiceWorldwide Travel and MedicalAssistanceAssistance with obtaining replacementClient Zone and World Service CenterTokio Marine HCC - MIS Group ClientAtlas Group includes valuable travel andtickets, and other travel-related documents.Zone is an online account managementmedical assistance services, which areLost Luggage Assistanceand resource tool available to:available 7 days a week, 365 days a year. Extend coverage and reprint ID cardsContact Tokio Marine HCC - MIS Group to Obtain details about claim filing anddownloading forms Locate providers within the PPONetworkaccess any of these services.Pre-Trip Destination InformationUp-to-date information regarding requiredvaccinations, health risks, travel restrictions,Log In to Client Zone at:and weather conditions specific to thehttps://zone.hccmis.com/clientzonedestination country.If you prefer to speak to a professionalMedical Monitoringservice representative, contact the TokioConsultations with attending medicalMarine HCC - MIS Group World ServiceCenter by calling toll-free from variouscountries or by calling collect. The WorldService Center can provide service inmany different languages.professionals during hospitalization andestablishment of a single point-of-contactfor family members to receive ongoingupdates regarding medical status.Provider ReferralsContact information for Western-style medical facilities, medical and dental practices,and pharmacies in the destination country.Travel Document ReplacementContaactt UsTokio Marine HCC- Medical GroupInsuranceServices ianapolis,Hingham,MA 02043251North IllinoisStreet,SuiteSuite 600,IN 46204Phone:617-500-6738Tel: 1 (800)605 2282E-mail:info@internationalinsurance.comFax: 1 (317)262 2140Web: www.InternationalInsurance.comhccmis.comA member of the Tokio Marine HCC group of companiesKHE2FFFYH6SP-152-1095passports, birth certificates, visas, airlineTracking service to assist in locatingluggage or other items lost in transit.Other Travel Assistance Services* Prescription Drug Replacement Emergency Travel Arrangements Dispatch of Physician Translation Assistance Credit Card / Traveler’s Check Replacement* For a complete list of available assistance services or for moreinformation, please contact Tokio Marine HCC - MIS Group.Travel and Medical Assistance Services are not insurancebenefits. Any travel or medical assistance service provided isnot a guarantee of any insurance benefit.
The Atlas Group plan from Tokio Marine HCC - MIS Group, a member of Tokio Marine HCC, is with you and your group of 5 or more almost anywhere you may travel in the world. Atlas Group coverage is designed for mission trips, large family vacations, student groups, corporate groups, and overseas excursions for other large organizations. Atlas .
