Emergency Medical Coverage – Squaremouth
travel medical expenses
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we will pay a benefit to reimburse you for reasonable and customary charges, up to the maximum limit shown in the schedule of benefits (and after paying the deductible), if you sustain an injury or illness during covered travel that requires treatment by a physician . the injury must occur or the illness must begin during a covered trip. the documented initial treatment must be administered by a physician during the covered trip.
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Covered travel medical expenses:
We will pay a benefit to reimburse you for medically necessary expenses incurred for:
a. Physician or registered nurse (RN) services and related tests or treatments;
c. medications prescribed to treat the injury or illness;
d. charges for anesthesia (including administration), x-ray examinations or treatments, and laboratory tests;
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e. local ambulance services to and from a hospital;
f. room and board in the hospital subject to the daily limit shown in the schedule of benefits;
g. artificial limbs, artificial eyes, artificial teeth, or other prosthetic devices;
h. the cost of emergency dental treatment for accidental injury to sound natural teeth occurring during a covered trip limited to the maximum limit shown in the schedule of benefits.
Coverage for emergency dental treatment does not apply if the treatment or expenses are incurred after you have arrived at your return destination, regardless of the reason. treatment must be administered by a physician or dentist.
We will pay a benefit to reimburse you for these expenses for all treatment related to the initial injury or illness for thirty (30) days from the date of first treatment during the covered trip, or until the date of return, whichever is later. otherwise, we will not pay for any expenses incurred after the coverage termination date, as shown in the effective and termination dates section of this policy, regardless of the reason.
We will not pay benefits in excess of reasonable and customary charges. We will not cover any expenses incurred by another party at no cost to you or that are already included in the cost of the covered trip.
Advance payment: If you require admission to a hospital during a covered trip for an injury or illness, we or our designated representative will arrange advance payment, if required by the hospital, directly to the hospital. the hospital stay must be certified as medically necessary by the treating physician on site.
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This amount will be deducted from the travel medical expense benefit limit shown in the schedule of benefits. you agree to reimburse us for this payment if:
a. you do not complete the claims process as described in the claims payment section; or
we will provide payment in advance when you require and request it. however:
a. we reserve the right to refuse an advance payment request if we confirm that your claim is not covered by the policy; and
Advance payment benefits will not duplicate any other benefits payable under the policy.
travel medical expense exclusions:
In addition to the general limitations and exclusions, the following exclusions apply to the travel medical expense benefit. no benefits will be paid for any loss caused by or resulting from:
a. any services provided by you, a member of your family or your traveling companion; b. alcohol or substance abuse or treatment for the same; c. experimental or investigational treatments or procedures; d. expenses incurred by any child born during the covered trip; me. care or treatment that is not medically necessary, except for related reconstructive surgery resulting from trauma, infection, or disease; F. mental health care; or g. physical therapy or occupational therapy.