Seven Corners
Terms & Conditions
SCHEDULE OF BENEFITS
| Lifetime Medical Maximum | $5,000,000 per Insured Person. |
| Policy Period Deductible Options | $500,
$1000, $2500, $5000 Maximum of 3 deductible payments for families enrolling on one application. Any eligible charges incurred and applied to your policy period deductible in the last 30 days prior to your renewal date will carry over and be applied to the next policy period deductible. |
| Outside of the United States | After the Deductible, the Policy pays 100% of eligible expenses to the Policy Maximum. Hospital Admissions must be Pre-Notified using Seven Corners's Utilization Management (U.M.) Program. |
| Inside of the United States | After the Deductible, the Policy pays 80% of the next $5,000 of eligible expenses, then 100% up to the Policy Maximum. Outpatient surgery, any expenses above $1,000, and Hospital Admissions must be Pre-Certified using Sri's U.M. Program. |
| Hospital Expenses | Average Semi-Private room and board, Usual, Reasonable, and Customary Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-Rays up to the Policy Maximum. |
| Intensive Care | Intensive Care room and board, Usual, Reasonable, and Customary Physician Charges, Prescription Medications, Durable Medical Equipment, Nursing Services and X-rays up to the Policy Maximum. |
| Surgery | Usual, Reasonable, and Customary Charges for Surgery, Physician and Anesthetics up to the Policy Maximum. |
| Outpatient Treatment | Usual, Reasonable, and Customary Charges for Emergency Treatment, Surgery, Prescription Medication up to the Policy Maximum. |
| Physiotherapy | Usual, Reasonable, and Customary Charges up to the Policy Maximum, when referred by a Physician. |
| Medical Supplies | Usual, Reasonable, and Customary Charges up to Policy Maximum. |
| Ambulance | Usual, Reasonable, and Customary Charges up to Policy Maximum. |
| Well Child Care | Usual, Reasonable, and Customary Charges up to Policy Maximum are Covered, limited to 3 visits per Policy Period. |
| Maternity | Usual, Reasonable, and Customary Charges up to $7500 per Pregnancy, must be Pre-Notified within the first 90 days of Pregnancy. |
| Mental & Nervous | Usual, Reasonable, and Customary Charges up to a Maximum of $10,000 per Policy Period. |
| Dental | Usual, Reasonable, and Customary Charges for repair and replacement of sound, natural teeth damaged as a result of an accident, limited to $500 per Policy Period. |
| Chiropractic | Usual, Reasonable, and Customary Charges up to a $5,000 Lifetime Max. when referred by a Physician. |
| Emergency Medical Evacuation | $50,000 Limit - when adequate medical facilities and/or treatment is not available. (pre-approval required). |
| Repatriation of Remains | $20,000 Limit - when traveling outside your current Country of Residence. (Pre-approval required). |
| Emergency Reunion | $10,000 Limit - when traveling outside your current Country of Residence. (Pre-approval required). |
| Preventive Benefits | $50 Policy Period Maximum for checkups and routine visits after 6 month waiting period. |
| Accidental Death & Dismemberment (AD&D) | Principal
Sum: $10,000 Insured and Spouse, $2,000 Dependent Children. For Common Carrier, Principal Sum: $40,000 Insured and Spouse, $8,000 Dependent Children. |
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