| TravelGap Mutltrip Benefits |
| Medical Benefits |
| Maximum Benefit per Insured Person per policy period |
Options include $75,000; $150,000; $500,000; $1,000,000 |
| Deductible per Insured Person per policy period |
Options include $50; $100; $250; $500 |
| After the Deductible is satisfied, benefits are paid for Covered Expenses as follows up to the Medical Limit: |
| Benefits |
Insurer Pays After Medical Benefit Deductible is Paid: |
| Professional Services: |
| a. Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab |
100% |
| b. Office Visits: including X-rays and lab work billed by the attending physician. |
100% |
| Inpatient Hospital Services: |
| a. Surgery, X-rays, In-hospital doctor visits |
100% |
| b. In-patient medical emergency |
100% |
|
| Ambulatory Surgical Center |
100% |
| Ambulance Service (non Medical Evacuation) |
100% up to $1000 |
| Benefits for claims resulting from downhill (alpine) skiing and scuba diving (certification by the Professional Association of Diving Instructors (PADI) or the National Association of Underwater Instructors (NAUI) required or diving under the supervision of a certified instructor) |
Maximum Benefit up to $10,000 |
| Outside the U.S. Outpatient prescription drugs |
50% of Covered Expenses |
| Dental Care required due to an Injury |
100% of Covered Expenses up to $200 maximum per Trip Period and $200 per tooth |
| Dental Care for Relief of Pain |
100% of Covered Expenses up to $100 maximum per Trip Period and $100 per tooth |
| Other Benefits |
Insurer Pays Without a Deductible Being Applicable |
| Accidental Death and Dismemberment |
Maximum Benefit Principal Sum up to $25,000 |
| Repatriation Of Remains |
Maximum Benefit up to $25,000 |
| Medical Evacuation |
Maximum Benefit per Trip Period for all Evacuations up to $500,000 |
| Bedside Visit |
Maximum Benefit per Trip Period up to $1,500 for the cost of one economy round trip air fare ticket to the place of the Hospital Confinement for one (1) person |
