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Alonso CornejoASA, Inc.4425 E. Agave Rd. Suite 101Phoenix, AZ 85044Phone: 480-753-1333Fax: 480-753-1330E-mail: insurance@asaincor.comAtlas MultiTripTMThe Atlas MultiTrip plan from Tokio Marine HCC - MIS Group, a member of Tokio Marine HCC, is with youalmost anywhere you may travel internationally for vacation, business, visits with family, sports adventures orother pursuits. It covers multiple trips, up to 30 or 45 days in length for the 364-day certificate period.
TMWhether traveling for businessor pleasure, international travelshould be a fulfilling experience. However, complicationssuch as natural disasters, illnesses, and injuries can arise.While we may do everythingpossible to guard against it,sometimes the unexpectedstill occurs. Fortunately, TokioMarine HCC - MIS Group ishere to help if it does.Atlas MultiTrip offers coverageincluding inpatient and outpatient medical expenses, emergency medical evacuation,accidental death and dismemberment, and lost checkedbaggage for frequent international travelers.I have medical insurance in myhome country; do I need multi-tripmedical insurance?Tokio Marine HCC is a leading specialtyMany times the primary medicalunderwriting more than 100 classes ofinsurance in your home country will notspecialty insurance. Headquartered incover you while traveling abroad andHouston, Texas, the company is made upoften will not provide essential servicesof highly entrepreneurial teams equippedin the event of an illness or injury.to underwrite special situations, compa-Atlas MultiTrip provides importantnies and individuals, acting independentlybenefits such as translation assistanceto deliver effective solutions. Our prod-during treatment, doctor and hospitalucts and capabilities set the standard forreferrals, and assistance replacingthe industry, as many of our nearly 2,500lost prescriptions. Coverage appliesemployees are industry-leading experts.to multiple trips up to 30 or 45 days inTokio Marine HCC is part of Tokio Marine,length (as elected) during the 364-daya premier global company with a marketcontract period.cap of approximately 30 billion. *Tokioinsurance group conducting businessin approximately 180 countries andMarine HCC holds a financial strengthAfter purchasing coverage, howcan I trust the company to be thereif I need them?Tokio Marine HCC - MIS Group, headquartered in the United States in Indianapolis,Indiana, is a full-service company offeringinternational medical insurance productsdesigned to meet needs of consumersworldwide.rating of AA- for Standard & Poor’s andFitch Ratings and A (Superior) by A.M.Best Company.*At the time of printing For more information onthese ratings, please visit: www.standardandpoors.com, www.ambest.com, and www.fitchratings.com.
PLAN DETAILSDeductibleOverall Maximum LimitCoinsurance – Claims incurred in U.S.In-Network PaymentOut-of-Network PaymentCoinsurance – Claims incurred outside U.S. 250 per covered trip 1,000,000Within the PPO: We will pay 100% of eligible expenses, after the deductible, to the overall maximum limitOutside 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 limitYou shall be responsible for a 200 co-payment for each use of emergency room for an illness unless you are admitted tothe hospital. There will be no co-payment for emergency room treatment of an injury.For each visit, you shall be responsible for a 50 co-payment, after which coinsurance will apply.– Co-payment is waived for members with a 0 deductible.– not subject to deductibleEmergency Room Co-payment –Claims incurred in U.S.Urgent Care Center- Claims incurred in U.S.Outpatient Physical Therapy and Chiropractic CareAcute Onset of Pre-existing Condition (excludes chronicand congenital conditions) (only available to membersunder age70)Emergency Dental (acute onset of pain)All Other Eligible Medical ExpensesEMERGENCY TRAVEL BENEFITSUp to 50 maximum per day. Must be ordered in advance by a physician.Up to the overall maximum limit 25,000 lifetime maximum for Emergency Medical EvacuationUp to 250 - not subject to deductible or coinsuranceUp to the overall maximum limitLIMITHospital IndemnityReturn of Minor ChildrenPet ReturnRepatriation of RemainsUp to 1,000,000 lifetime maximum, except as provided under Acute Onset of Pre-existing Condition- not subject to deductible, coinsurance, or overall maximum limit 100 per day of inpatient hospitalization - not subject to deductible or coinsuranceUp 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 coinsuranceEmergency ReunionUp to 50,000, subject to a maximum of 15 days -not subject to deductible or coinsuranceNatural Disaster – Replacement AccommodationsTrip InterruptionUp to 100 a day for 5 days -not subject to deductible or coinsuranceUp to 5,000 - 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 2 days. not subject to deductible or coinsuranceUp to 500 - not subject to deductible or coinsuranceUp to 10,000 lifetime maximum - not subject to deductible or coinsuranceEmergency Medical EvacuationTravel DelayLost Checked LuggagePolitical EvacuationAccidental Death & Dismemberment (excludes loss dueto Common Carrier Accident)Ages 18 through 69Under age 18Ages70 through 74Ages 75 and olderCommon Carrier Accidental DeathAges 18 through 69Under age 18Ages 70 through 74Ages 75 and olderBedside VisitCrisis Response- Ransom, Personal Belongings, andCrisis Response Fees and ExpensesPersonal LiabilityLifetime Maximum - 50,000Death - 50,000Loss of 2 Limbs - 50,000Loss of 1 Limb - 25,000Lifetime Maximum - 5,000Death - 5,000Loss of 2 Limbs - 5,000Loss of 1 Limb - 2,500Lifetime Maximum - 12,500Death - 12,500Loss of 2 Limbs - 12,500Loss of 1 Limb - 6,250Lifetime Maximum - 6,250Death - 6,250Loss of 2 Limbs - 6,250Loss of 1 Limb - 3,125 250,000 maximum benefit any one family or group.- not subject to deductible, coinsurance, or overall maximum limit 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 1,500 - not subject to deductible or coinsuranceUp to 10,000 - not subject to deductible, coinsurance, or overall maximum limitUp 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,000
TMInternational CoverageEmergency Medical Evacuation and Emergency ReunionWould you know what to do if you foundyourself in a life-threatening situationfar from home? Tokio Marine HCC - MISGroup is experienced in arrangingEmergency Medical Evacuations. AtlasMultiTrip will cover eligible expensesnecessary to transport you to thenearest medical facility qualified to treatyour life-threatening condition. We alsounderstand the importance of familyTrip Interruptionthe wrong place at the wrong time, andOne of a traveler’s biggest worries is thethe country you’re visiting is NOT undersafety of his or her home while away. Ifa travel advisory, Atlas MultiTripl offersyou learn that a catastrophic event like acoverage for eligible medical expensestornado, hurricane or flood has causedresulting from those acts. Coveragesevere damage to your home while travelingexcludes countries for which the U.S.abroad, Atlas MultiTrip will cover the costDepartment of State has issued a travelof a one-way, economy class ticket to thewarning.airport nearest your home.support in these difficult situations.AtlasMultiTrip Quality BenefitsAtlas MultiTrip will also cover the trans-Natural Disaster- Replacement Accommo-Acute Onset of Pre-Existing Conditionsportation, lodging, and meal costs for adationsAtlas MultiTrip provides a limited benefitNatural disasters can happen anywhereup to the medical coverage lifetimeand at any time. If a natural disastermaximum for eligible medical expenses.occurs while on your trip, causing you toIf you are younger than 70, you mayRepatriation of Remainsbecome displaced from your accommo-be covered for an acute onset of aWhat would your family do if disasterdations, Atlas MultiTrip will provide reliefpre-existing condition. This also includesrelative to join you after an emergencymedical evacuation, up to the lifetimelimit.strikes while you are away from home?of a maximum of 100 a day for 5 daysup to a 25,000 lifetime maximum forThe death of a loved one is never easy,to help cover the costs of alternativeemergency medical evacuation.no matter the circumstances. In theaccommodations.An acute onset of a pre-existing conditionunfortunate event of your death whileHospital Indemnityis a sudden and unexpected outbreak ortraveling abroad, Atlas MultiTrip willarrange for and cover eligible costsassociated with the repatriation of yourremains.If you are hospitalized, the world around youdoes not stop. What’s more, in some placeshospitals do not provide their patients basicnecessities like meals, toothpaste or soap.Political EvacuationIf you are hospitalized as an inpatient forIf, during the coverage period andtreatment of a covered illness or injury, Atlasafter your arrival, the United StatesMultiTrip will provide 100 for each night yougovernment issues a travel warning forspend in the hospital.recurrence of a pre-existing condition whichoccurs spontaneously and without advancewarning either in the form of physicianrecommendations or symptoms. Treatmentmust be obtained within 24 hours of thesudden and unexpected outbreak or recurrence. Chronic and congenital conditions areexcluded from coverage.Hospitalization & Outpatient Treatmentyour destination country, Atlas MultiTripwill coordinate your alternate departureTerrorismIf a covered illness or injury requiresarrangements from that country andIn these turbulent times, the risk of ahospitalization, the plan provides cov-cover eligible associated costs.terrorist attack is a reality. If you are inerage for eligible costs associated with*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 doesnot amend or otherwise affect the terms 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 informationdescribed herein, the language of the policy will take precedence.
hospitalization, including intensive careGroup for a copy. Complete the form,unit, and outpatient treatment.attach all itemized invoices and paymentSports Coveragereceipts, and send them to the addressshown on the claimant’s statement.Atlas MultiTrip includes coverage foreligible injuries and illnesses that couldoccur while participating in many popularvacation sports - skiing, snowboarding,snorkeling, water skiing, and others - atHome Country Coverageno additional cost. Certain extremeBenefit Period Medical Coveragesports are excluded from coverage.While the certificate is in effect, theCrisis Responsebenefit period does not apply. UponAtlas MultiTrip offers up to 10,000 (or upto 100,000 **if additional coverage isselected) to offset costs associated withkidnapping, such as ransom, crisis responseexpenses, and loss of personal belongings.This benefit includes access to the servicesof Unity Crisis Group for advice, coordination with law enforcement, and negotiationsduring a kidnapping.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 whilePersonal LiabilityAtlas MultiTrip offers up to 10,000 (orPatient Protection and Affordable Care Act(“PPACA”): This insurance is not subject to, anddoes not provide certain of the insurance benefitsrequired by, the United States PPACA. In no eventwill Underwriters provide benefits in excess ofthose specified in the policy documents, and thisinsurance is not subject to guaranteed issuance orrenewal. PPACA requires certain U.S. residentsand citizens to obtain PPACA compliant insurancecoverage. In certain circumstances penalties maybe imposed on U.S. residents and citizens who donot maintain PPACA compliant insurance coverage.You should consult your attorney or tax professionalto determine if PPACA’s requirements are applicable to you. The policy contains the plan benefits, including a lifetime maximum that you have selected.Please review your choices to ensure that you havesufficient coverage to meet your medical needs.Atlas MultiTrip 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 UnderwritingAgencythe certificate was in effect.Enrollmentup to 100,000 if additional coverage isselected) to offset the following typesof court-entered eligible judgments orapproved settlements incurred by themember.You may access the online quoting andpurchasing system or you may completean application and mail or fax along withyour payment to your agent or to TokioMarine HCC - MIS Group. Third-party injury;Claim Filing Damage/loss of a third party’s personalproperty;You may file a claim by submitting a Damage/loss of a related third party’sform. This form may be found online, orpersonal property.claimant’s statement and authorizationyou may contact Tokio Marine HCC -MIS**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 ServiceClient Zone and World Service CenterTokio Marine HCC - MIS Group ClientZone is an online account managementand resource tool available to: Extend coverage and reprint ID cards Obtain details about claim filing anddownloading forms Locate providers within the PPONetworkLog In to Client Zone at:https://zone.hccmis.com/clientzone24/7 Worldwide Travel and MedicalAssistanceTravel Document ReplacementAtlas MultiTrip includes valuable travel andpassports,medical assistance services, which areairline tickets, and other travel-relatedavailable 24 hours a day, 7 days a week.documents.access any of these services.visas,Lost Luggage Assistancegage or other items lost in transit.Up-to-date information regarding requiredvaccinations, health risks, travel restric-Other Travel Assistance Services*tions, and weather conditions specific to Prescription Drug Replacementthe destination country.Medical MonitoringMarine HCC - MIS Group World ServiceConsultations with attending medicalCenter by calling toll-free from variousprofessionals during hospitalization andcountries or by calling collect. The Worldestablishment of a single point-of-contactService Center can provide service infor family members to receive ongoingmany different languages.updates regarding medical status.Provider ReferralsContact information for Western-stylemedical facilities, medical and dentalpractices, and pharmacies in the destination country.Contaactt UsTokio Marine HCC - Medical Insurance Services Group251 North Illinois Street, Suite 600, Indianapolis, IN 46204Tel: 1 (800) 605 2282Fax: 1 (317) 262 2140KHE2FFFYH6SP-152-1023certificates,Tracking service to assist in locating lugPre-Trip Destination Informationservice representative, contact the TokioA member of the Tokio Marine HCC group of companiesbirthContact Tokio Marine HCC - MIS Group toIf you prefer to speak to a professionalhccmis.comAssistance with obtaining replacement Emergency Travel Arrangements Dispatch of Physician Translation Assistance Credit Card / Traveler’s CheckReplacement* 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 MultiTrip plan from Tokio Marine H CC - MI S G roup, a member of Tokio Marine H CC , is with you almost anywhere you may travel internationally for vacation, business, visits with family, sports adventures or other pursuits. It covers multiple trips, up to 30 or 45 days in length for the 364-day certi cate period . Atlas MultiTrip TM
