RESIDE BROCHURE SCHEDULE OF BENEFITS All Eligible Benefits described in this section are excess of the chosen Deductible and applicable Coinsurance to the Maximum Benefit stated or in the case of percentages it shall be the Lifetime Maximum Benefit.
WHY RESIDE SHOULD BE YOUR INTERNATIONAL MEDICAL PROGRAM? There is an increasing population of global citizens, people who travel from country to country or continent to continent on a regular basis. Included among these global citizens are those less inclined to travel, however are discerning enough to know and demand the best care available worldwide. Whatever the reason, if you need to leave your home country, Reside Worldwide Medical Plan will follow you. Many foreign countries do have coverage options, but you will find that as a US citizen, you are either not eligible for coverage or the protection the plan offers is inadequate. For non-US citizens, the issue may be finding a comprehensive medical plan to provide coverage where your local plan may fall short. Whether you are a US citizens living abroad or a citizen of another country, Reside provides you with security at home and the freedom to seek care anywhere in the world. ARE YOU ELIGIBLE FOR THE RESIDE PROGRAM? The Reside program is available to persons of any country who are at least 15 days of age and who are not older then age 74. Non-US citizens may reside anywhere in the world, including their Home Country. US citizens must either reside outside the United States, or expect their departure from the United States within 30 days of the plan's effective date. In addition, US citizens must continue to reside outside the United States for at least 6 months during any given policy year in order to remain eligible. HOW LONG MAY I BE COVERED UNDER RESIDE? The Reside program is annually renewable as long as the eligibility requirements are met and the renewal premium paid. There are no additional medical questions upon renewal. The company cannot single out an individual for cancellation, they can only cancel coverage for an entire class* of insureds. For those who apply for coverage prior to their 65th birthday and remain continuously insured for ten consecutive years, you will automatically be converted to the Reside Senior Provider at age 75 as long as you continue your eligibility status. * A
"Class" is a group of people defined by a common
characteristic, including but not limited to demographic group and
geographic region. HOW DO I APPLY FOR COVERAGE? To apply for coverage under Reside, complete the enclosed application and submit the form to SRI along with the appropriate premium. SRI will review your application and respond within 48 hours (normal business days). In some situations, additional information or clarification may be required. Our underwriting department will contact the applicant to obtain any additional details necessary to determine acceptability. If accepted, SRI will mail the Insured's ID Card with effective date, Certificate of Coverage, claim form, and general procedures for the use of the insurance to the address of convenience listed on the application. If SRI is unable to offer coverage, the administrative department will return your premium without delay. Please be sure to
answer the questions on the application in complete detail. If accepted,
the application becomes part of the certificate and formal agreement
with the company. DEDUCTIBLES, COINSURANCE & POLICY MAXIMUMS You have your choice of five annual deductibles: US$250, US$500, US$1000, US$2500, US$5000. The annual deductible applies to each insured person with a limit of 3 annual deductibles per family. If the treatment is received in the United States or Canada, the plan will pay 80% of the next US$5000 of eligible expenses, according to the schedule, after the deductible up to the policy maximum. If treatment is received outside the United States or Canada, the plan pays 100% of eligible expenses, according to the schedule, after the deductible up to the policy maximum. The 3 limit per family applies to the coinsurance as well. The lifetime policy maximum of Reside is US$5,000,000 per insured person. WHAT DO I DO IF I NEED TO USE THE INSURANCE? For hospitalization and surgical procedures, contact SRI Assist to obtain pre-notification services. The quality and complexity of medical treatment varies from country to country, therefore pre-notification is a requirement of the program. It allows our professionals to locate a Preferred Provider facility if available, assist you in receiving the best course of treatment, and coordinate payment with the local facility. Our objective is for you to focus your attention on your medical condition and not on administrative details. For non-hospital or surgical related procedures, filing a claim under Reside is easy. Just complete the claim form that comes with your ID Card, sign it, and submit it along with all original, itemized bills (and receipts if you have already paid for the medical expenses) to SRI for processing. If acceptable with the facility, SRI will make the payment directly to the treating hospital or doctor. COVERAGE FOR CHILDREN If both parents are covered under Reside, the first two children under the age of 10 will also be covered free of charge. If there are more than two children under the age of 10 or if the children are 10 or over, the program will charge the dependent child rate. If only one parent will be covered under the program, each child will be charged the dependent child rate. ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) Reside automatically includes an Accidental Death & Dismemberment (AD&D) benefit for each insured, with a $10,000 Principal Sum for the Insured and Spouse, $2,000 for Dependent Children. On a Common Carrier, the Principal Sum increases to $40,000 for the Insured and Spouse, $8,000 for Dependent Children. LIMITATIONS OF THE RESIDE PROGRAM Pre-existing Conditions: If an existing condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by a rider, your pre-existing condition will be covered up to a lifetime maximum of $50,000 ($5,000 limit per year) after you have been continuously insured for 24 months. Pre-existing conditions are any Injury or Illness which meets the following criteria: 1) A condition that would have caused a person to seek medical advise, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2) A condition for which manifestation, medical advise, diagnosis, care or treatment (including medication) was recommended or received prior to the Effective Date of coverage under this Certificate; 3) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate. The following
conditions, treatments, supplies, services, and/or expenses are not
covered:
ADDITIONAL FEATURES AND SERVICES Assistance / Referral Services: SRI Assist is prepared to help you 24 hours a day, 365 days a year to locate medical professionals worldwide. Even if you are not calling to pre-notify a hospital admission or surgery, we encourage you to contact SRI Assist for support with any injury or sickness, so that our professionals will be involved to ensure you receive appropriate medical care. Emergency
Evacuation / Repatriation: Unfortunately, the medical professionals in
certain locations of the world are unable to provide adequate treatment
for a number of medical conditions. As a standard benefit of the Reside
program, we will transport you to a different medical facility if you
are located in a region where the medical professionals are not able to
treat your particular condition. THE UNDERWRITER The Reside Worldwide Medical Plan is underwritten by Certain Underwriters at Lloyds, London. As the largest insurance entity in the world, Lloyds has earned an A (Excellent) rating from AM Best and an A+ (Strong) rating from Standard and Poors. THE PROGRAM ADMINISTRATOR Properly serving the medical needs of international citizens requires specialization. Most companies are not prepared to meet the unique needs of these customers. An organization must be equipped to address foreign currencies, international doctors and hospitals, as well as unusual claim forms and documents. The Reside Worldwide Medical Plan is administered worldwide by SRI Administrators, Inc.. The professionals at SRI Administrators have over 80 years of experience in claim processing and administration. SRI currently serves the needs of thousands of policyholders throughout the world. ABOUT SPECIALTY RISK INTERNATIONAL Since 1993, Specialty Risk International, Inc. (SRI) has provided international insurance plans to private citizens, governments, missionaries, students, and corporations of various nations around the globe. As a premier underwriter, SRI has had the opportunity to provide innovative solutions to unique and challenging situations. Our claims professionals are experienced in the complexity of processing international medical expenses. As an insured of SRI, you can feel confident that there is someone ready to assist you with a medical situation 24 hours a day, 365 days a year. Other services including proficient administration, responsive underwriting, and access to secure and stable insurance carriers and medical care providers worldwide.
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