What are the DETAILS of the Goose International Plan? – Goose Insurance - USA

ELIGIBILITY: In order to be eligible and qualified for coverage under this insurance, a person must:

be an individual at least fourteen (14) days old and under eighty (80) years of age
be an individual whose Country of Residence is the United States
on the Effective Date and on subsequent renewal dates, must have legally departed the Country of Residence and legally entered the Destination Country
not be Hospitalized or Disabled on the Initial Effective Date
not be HIV + on the Initial Effective Date
not have established a permanent residency in the Destination Country

Does this policy cover COVID-19?

Currently, there is no coverage for expenses related to the COVID-19 pandemic under this plan.

Coverage applies while travelling anywhere in the world outside of the United States, up to the limits below:

Coverage Details - Goose International Plan
*Medical Benefits subject to deductible and coinsurance when applicable**		For travellers aged 70 to 79
Maximum Limit	$5,000,000	$250,000
Acute Onset of a pre-existing condition	$100,000 & $25,000 for medical evacuation
Hospital Room and Board	Semi private room
Intensive Care Unit	$5,000,000	$250,000
Medical Expenses	$5,000,000	$250,000
Out-Patient Medical	$5,000,000	$250,000
Local Ambulance	$5,000,000	$250,000
Prescription Drugs	$5,000,000 (dispensing limit per prescription 90 days)	$250,000
Dental - Injury due to accident	$5,000,000	$250,000
Dental - Sudden dental emergency	Up to $300
International Emergency Care (When coordinated through the Plan Administrator)
Emergency Evacuation	$5,000,000	$250,000
Emergency Reunion	$100,000
Bedside Visit (Hospitalized in an intensive care unit)	$1,500
Return of Mortal Remains	$5,000,000	$250,000
Cremation/Burial	$5,000
Return of Minor Children	$100,000
Political Evacuation & Repatriation	Up to $250,000
Natural Disaster Evacuation	Up to $250,000
Additional Benefits
Terrorism Coverage	Up to $50,000 lifetime maximum
Sports and Leisure Activities	Up to the Maximum Limit for basic sports
Trip Interruption	$10,000 *see certificate wordings for the 3 scenarios where this coverage would apply
Common Carrier Accident Death	$25,000 per insured child, $100,000 per insured adult; maximum of $250,000 per family
Accidental Death and Dismemberment	$50,000 principle sum
Identity Theft Assistance	Up to $500 per Period of Coverage
Emergency Eye Exam	$150 maximum limit $50 deductible per occurrence
Emergency Prescription	$250 maximum benefit including doctor visit and cost of prescription
Personal Liability	$25,000 combined maximum limit.
Small Pet Common Carrier Accidental Death Benefit	$500 maximum limit
Pet Return	$1,000 maximum limit
*Conditions, limitations and exclusions may apply. See certificate wording for more details.

The full certificate wordings for this plan can be found here.

Who underwrites this coverage?

This plan is underwritten by Sirius International Insurance Corporation and claims are administered by IMG (International Medical Group Inc)