Liaison Intenational Travel Medical Insurance

Schedule of Benefits

All amounts listed are in U.S. dollars. Click the titles to see further information.

SCHEDULE of COVERAGE All coverages and plan costs listed in this brochure are in U.S. Dollar amounts.
Deductible $0; $100; $250; $500; $1000; $2500
Deductible is per person per Period of Coverage, maximum of three (3) Period of Coverage Deductibles per family. The selected Deductible and Coinsurance amount must be met for each six (6) month period. (see Continuing Coverage)
Medical maximum $50,000; $100,000; $500,000; $1,000,000 (ages 80+, maximum limited to $15,000)
Coinsurance More information
Class 1: U.S. or Canadian citizen traveling outside the United States. After You pay the Deductible, the plan pays 100% to the selected Medical Maximum.
Class 1: Non U. S. citizens traveling to the United States.
  • option 1: After You pay the Deductible, the plan pays 80% of the next $5,000 of eligible expenses, then 100% to the selected Medical Maximum
  • option 2: After You pay the Deductible, the plan pays 100% of the next $2,500 of eligible expenses, then 80% to the selected Medical Maximum
Hospital indemnity * Class 1: $150 per night, up to a maximum of thirty (30) days
dental (sudden relief of pain) * Class 1: $100
dental (accident coverage) To a maximum of $500
Emergency medical evacuation/repatriation $300,000 (in addition to the Medical Maximum)
Home country coverage Incidental Trips to The Home Country: Up to $50,000; Extension of Benefits: Up to $5,000
Emergency Reunion $50,000
Return of Minor Children $50,000
Interruption of Trip $5,000
Loss of Checked Luggage $250
Local Ambulance Expense $5,000
Accidental Death & Dismemberment $25,000 principal sum for Insured or Insured Spouse
  • $5,000 for Dependent Child(ren)
  • Note: In the event of a Common Carrier Accidental Death, this benefit will not be paid.
Common Carrier Accidental Death $50,000 Principal Sum for Insured or Insured Spouse
$10,000 per Dependent child(ren) under age of eighteen (18)
$250,000 Maximum per family
Hospital Room and Board Usual, reasonable and customary to the selected Medical Maximum
Intensive Care Usual, reasonable and customary to the selected Medical Maximum
Outpatient Medical Expenses Usual, reasonable and customary to the selected Medical Maximum
Terrorism Usual, reasonable and customary to the selected Medical Maximum
(This benefit not available for states underwritten by Certain Underwriters at Lloyd’s of London)
Optional Hazardous Sport Coverage Rider More Information
The following are covered if the required premium has been paid:
  • motorcycle/motor scooter riding (whether as a driver or passenger)
  • hang gliding
  • parachuting
  • bungee jumping
  • water skiing
  • snow skiing
  • snowmobiling
  • snowboarding
  • spelunking
Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute.
Sudden Recurrence of a Pre-existing Condition * class 1: Up to $20,000 for U.S. and Canadian citizens traveling outside the United States (Age 65+, up to $2,500, refer to exclusion #1 for details)
Benefit Period 180 Days

* This Web page contains only a consolidated and summary description of all current benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.