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?
- Yes, this policy can now provide coverage for emergency medical expenses related to the COVID-19 pandemic while traveling outside the US. See policy wording for full details.
Coverage applies while traveling 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 travelers 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 principal 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)
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