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
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 prescrption |
|
|
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. (link to Goose US Site-Policy wordings)
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