INF SelectCare Policy Features
program eligibility
Medical Expense benefits
We will pay Medical Benefits for Covered Medical Services that result directly, and from no other cause, from a Covered Accident or Sickness.
Insurance enrollment
Online Enrollment
Enrollment by Fax
Enrollment by Mail
Additional Information
INF Choice Plan | $25,000 Policy max
INF CHOICE PLAN | $75,000 POLICY MAX
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Group policy EFFECTIVE date
Definitions of policy terms
Exclusions
We will not pay benefits for any loss or Injury that is caused by or results from:
INF CHOICE PLAN | $50,000 POLICY MAX
INF CHOICE PLAN | $100,000 POLICY MAX
Claims
Claims Procedure
Claims Questions
Claims Office
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Other Policy Features
europ travel Assistance Services
Europ TRAVEL ASSISTANCE SERVICES
- Europ Assistance can help travelers with medical emergencies by:
- Emergency Medical Evacuation & treatment en-route if necessary
- Repatriation of remains in the event of Insured Persons death
- Medical emergencies and many other services (see web)
- Emergency Medical Evacuation & treatment en-route if necessary
- The Europ Assistance communications network is available 24 hours a day, seven days a week to provide assistance to the Insured Person.
- Inside the United States/Canada call (877) 243-4134
- Outside United States/Canada call collect 240-330-1528
- or email [email protected]
- Inside the United States/Canada call (877) 243-4134
EMERGENCY MEDICAL EVACUATION AND REPATRIATION OF REMAINS BENEFITS
Emergency Medical Evacuation Benefit
- EMERGENCY MEDICAL EVACUATION AND REPATRIATION:
- These Benefits will not be payable unless We (or Our authorized travel assistance provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and
- Services are rendered by Our a travel assistance provider.
- Contact Europ Assistance for these services at (877) 243-4134
- Call collect from outside the United States at (240) 330-1528 (24 hours a day, 7 days a week).
- Email: [email protected]
- These Benefits will not be payable unless We (or Our authorized travel assistance provider) authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and
- EMERGENCY MEDICAL EVACUATION BENEFIT:
- We will pay Emergency Medical Evacuation Benefits as shown for Covered Expenses incurred for the Emergency Evacuation of a Insured Person.
- Benefits are payable up to the Benefit Maximum shown, if the Insured Person suffers a Covered Injury or Emergency Sickness during the course of the Covered Trip that requires Emergency Evacuation.
- We will pay Emergency Medical Evacuation Benefits as shown for Covered Expenses incurred for the Emergency Evacuation of a Insured Person.
Repatriation of Remains Benefit
- REPATRIATION OF REMAINS BENEFIT:
- We will pay Repatriation Benefits up to the Benefit Maximum shown for preparation and return of a Insured Persons body to his or her place of primary residence if he or she dies as a result of a Covered Injury or Emergency Sickness while traveling on a Covered Trip.
Accident death benefit
Accident Death & Dismemberment Indemnity
- ACCIDENTAL DEATH AND DISMEMBERMENT:
- If Injury to the Insured Person results, within 365 days of the date of a Covered Accident, in any one of the losses shown below, We will pay the Benefit Amount shown below for that loss.
- The Aggregate Sum is $500,000 as shown. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.
- If Injury to the Insured Person results, within 365 days of the date of a Covered Accident, in any one of the losses shown below, We will pay the Benefit Amount shown below for that loss.
Covered Loss |
Benefit Amount |
Loss of Life |
100% of the Aggregate Sum |
Loss of Two or More Hands or Feet |
100% of the Aggregate Sum |
Loss of Sight of Both Eyes |
100% of the Aggregate Sum |
Loss of One Hand and Foot |
100% of the Aggregate Sum |
Loss of One Hand or Foot and Sight in One Eye |
100% of the Aggregate Sum |
Loss of One Hand or Foot |
50% of the Aggregate Sum |
Loss of Sight in One Eye |
50% of the Aggregate Sum |
Exposure and Disappearance |
Included |
Schedule of Benefits
IN-PATIENT BENEFITS SCHEDULE | $25,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Hospital Room (semi private) and Board and Miscellaneous Hospital |
Usual & Customary Charges up to $900 per day, to a maximum of 30 days |
Hospital Intensive Care Unit |
Usual & Customary Charges up to an additional $400 per day to a maximum of 8 days |
Surgeon |
Usual & Customary Charges up to $2,000 max |
Anesthetist |
Usual & Customary Charges up to $500 max |
Assistant Surgeon |
Usual & Customary Charges up to $500 max |
Physician’s (non Surgical Inpatient visit) |
Usual & Customary Charges up to $40 max per visit, 1 visit per day, 30 visits max |
Consulting Physician Services |
Usual & Customary Charges up to $375 max |
Pre–Admission Tests |
Usual & Customary Charges up to $950 max; test must occur within 14 days prior to Hospital admission |
OUT-PATIENT BENEFITS SCHEDULE | $25,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Surgeon |
Usual & Customary Charges up to $2,000 max |
Day Surgery Miscellaneous |
Usual & Customary Charges up to $950 max |
Anesthetist |
Usual & Customary Charges up to $500 max |
Assistant Surgeon |
Usual & Customary Charges up to $500 max |
Physician Non-Surgical Treatment/Exam Visits |
Usual & Customary Charges up to $50 max per visit, 1 visit per day, 10 visits max |
Diagnostic X Rays and Lab tests except dental x-rays |
Usual & Customary Charges up to $275 max |
CAT Scan, PET Scan or MRI tests |
Usual & Customary Charges up to an additional $275 of the Diagnostic X-Ray and Lab |
Hospital Emergency Room |
Usual & Customary Charges up to $275 max |
Prescription Drugs |
Usual & Customary Charges up to $75 max |
Other benefits | $25,000 Policy Max
Covered Medical Services |
Outpatient Medical Benefits |
Ambulance Services |
Usual & Customary Charges up to $375 max |
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain) |
Usual & Customary Charges up to $425 max |
Physical and Occupational Therapy |
Usual & Customary Charges up to $30 per visit, 1 visit per day, 12 visits max |
Private Duty Nursing |
Usual & Customary Charges up to $350 max |
Emergency Medical Evacuation |
Usual & Customary Charges up to $10,000 max |
Repatriation of Remains |
Usual & Customary Charges up to $10,000 max |
Accidental Death and Dismemberment |
$25,000 Aggregate Sum |
IN-PATIENT BENEFITS SCHEDULE | $50,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Hospital Room (semi private) and Board and Miscellaneous Hospital |
Usual & Customary Charges up to $1,300 per day, to a maximum of 30 days |
Hospital Intensive Care Unit |
Usual & Customary Charges up to an additional $525 per day to a maximum of 8 days |
Surgeon |
Usual & Customary Charges up to $3,000 max |
Anesthetist |
Usual & Customary Charges up to $750 max |
Assistant Surgeon |
Usual & Customary Charges up to $750 max |
Physician’s (non Surgical Inpatient visit) |
Usual & Customary Charges up to $60 max per visit, 1 visit per day, 30 visits max |
Consulting Physician Services |
Usual & Customary Charges up to $400 max |
Pre–Admission Tests |
Usual & Customary Charges up to $1,000 max; test must occur within 14 days prior to Hospital admission |
OUT-PATIENT BENEFITS SCHEDULE | $50,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Surgeon |
Usual & Customary Charges up to $3,000 max |
Day Surgery Miscellaneous |
Usual & Customary Charges up to $1,000 max |
Anesthetist |
Usual & Customary Charges up to $750 max |
Assistant Surgeon |
Usual & Customary Charges up to $750 max |
Physician Non-Surgical Treatment/Exam Visits |
Usual & Customary Charges up to $60 max per visit, 1 visit per day, 10 visits max |
Diagnostic X Rays and Lab tests except dental x-rays |
Usual & Customary Charges up to $400 max |
CAT Scan, PET Scan or MRI tests |
Usual & Customary Charges up to an additional $400 of the Diagnostic X-Ray and Lab |
Hospital Emergency Room |
Usual & Customary Charges up to $350 max |
Prescription Drugs |
Usual & Customary Charges up to $100 max |
Other benefits | $50,000 Policy Max
Covered Medical Services |
Outpatient Medical Benefits |
Ambulance Services |
Usual & Customary Charges up to $400 max |
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain) |
Usual & Customary Charges up to $450 max |
Physical and Occupational Therapy |
Usual & Customary Charges up to $35 per visit, 1 visit per day, 12 visits max |
Private Duty Nursing |
Usual & Customary Charges up to $400 max |
Emergency Medical Evacuation |
Usual & Customary Charges up to $10,000 max |
Repatriation of Remains |
Usual & Customary Charges up to $10,000 max |
Accidental Death and Dismemberment |
$25,000 Aggregate Sum |
IN-PATIENT BENEFITS SCHEDULE | $75,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Hospital Room (semi private) and Board and Miscellaneous Hospital |
Usual & Customary Charges up to $1,525 per day, to a maximum of 30 days |
Hospital Intensive Care Unit |
Usual & Customary Charges up to an additional $625 per day to a maximum of 8 day |
Surgeon |
Usual & Customary Charges up to $4,000 max |
Anesthetist |
Usual & Customary Charges up to $1,000 max |
Assistant Surgeon |
Usual & Customary Charges up to $1,000 max |
Physician’s (non Surgical Inpatient visit) |
Usual & Customary Charges up to $80 max per visit, 1 visit per day, 30 visits max |
Consulting Physician Services |
Usual & Customary Charges up to $425 max |
Pre–Admission Tests |
Usual & Customary Charges up to $1,050 max; test must occur within 14 days prior to Hospital admission |
OUT-PATIENT BENEFITS SCHEDULE | $75,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Surgeon |
Usual & Customary Charges up to $4,000 max |
Day Surgery Miscellaneous |
Usual & Customary Charges up to $1,050 max |
Anesthetist |
Usual & Customary Charges up to $1,000 max |
Assistant Surgeon |
Usual & Customary Charges up to $1,000 max |
Physician Non-Surgical Treatment/Exam Visits |
Usual & Customary Charges up to $80 max per visit, 1 visit per day, 10 visits max |
Diagnostic X Rays and Lab tests except dental x-rays |
Usual & Customary Charges up to $525 max |
CAT Scan, PET Scan or MRI tests |
Usual & Customary Charges up to an additional $525 of the Diagnostic X-Ray and Lab |
Hospital Emergency Room |
Usual & Customary Charges up to $425 max |
Prescription Drugs |
Usual & Customary Charges up to $125 max |
Other benefits | $75,000 Policy Max
Covered Medical Services |
Outpatient Medical Benefits |
Ambulance Services |
Usual & Customary Charges up to $425 max |
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain) |
Usual & Customary Charges up to $475 max |
Physical and Occupational Therapy |
Usual & Customary Charges up to $40 per visit, 1 visit per day, 12 visits max |
Private Duty Nursing |
Usual & Customary Charges up to $450 max |
Emergency Medical Evacuation |
Usual & Customary Charges up to $10,000 max |
Repatriation of Remains |
Usual & Customary Charges up to $10,000 max |
Accidental Death and Dismemberment |
$25,000 Aggregate Sum |
IN-PATIENT BENEFITS SCHEDULE | $100,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Hospital Room (semi private) and Board and Miscellaneous Hospital |
Usual & Customary Charges up to $1,750 per day, to a maximum of 30 days |
Hospital Intensive Care Unit |
Usual & Customary Charges up to an additional $750 per day to a maximum of 8 day |
Surgeon |
Usual & Customary Charges up to $5,000 max |
Anesthetist |
Usual & Customary Charges up to $1,250 max |
Assistant Surgeon |
Usual & Customary Charges up to $1,250 max |
Physician’s (non Surgical Inpatient visit) |
Usual & Customary Charges up to $100 max per visit, 1 visit per day, 30 visits max |
Consulting Physician Services |
Usual & Customary Charges up to $450 max |
Pre–Admission Tests |
Usual & Customary Charges up to $1,100 max; test must occur within 14 days prior to Hospital admission |
OUT-PATIENT BENEFITS SCHEDULE | $100,000 POLICY MAX
Covered Medical Services |
Inpatient Medical Benefits |
Surgeon |
Usual & Customary Charges up to $5,000 max |
Day Surgery Miscellaneous |
Usual & Customary Charges up to $1,100 max |
Anesthetist |
Usual & Customary Charges up to $1,000 max |
Assistant Surgeon |
Usual & Customary Charges up to $1,250 max |
Physician Non-Surgical Treatment/Exam Visits |
Usual & Customary Charges up to $100 max per visit, 1 visit per day, 10 visits max |
Diagnostic X Rays and Lab tests except dental x-rays |
Usual & Customary Charges up to $650 max |
CAT Scan, PET Scan or MRI tests |
Usual & Customary Charges up to an additional $650 of the Diagnostic X-Ray and Lab |
Hospital Emergency Room |
Usual & Customary Charges up to $500 max |
Prescription Drugs |
Usual & Customary Charges up to $150 max |
Other benefits | $100,000 POLICY MAX
Covered Medical Services |
Outpatient Medical Benefits |
Ambulance Services |
Usual & Customary Charges up to $450 max |
Dental Treatment Injury to Sound, Natural Teeth Due to Accident (does not include dental services for immediate relief of pain) |
Usual & Customary Charges up to $500 max |
Physical and Occupational Therapy |
Usual & Customary Charges up to $45 per visit, 1 visit per day, 12 visits max |
Private Duty Nursing |
Usual & Customary Charges up to $500 max |
Emergency Medical Evacuation |
Usual & Customary Charges up to $10,000 max |
Repatriation of Remains |
Usual & Customary Charges up to $10,000 max |
Accidental Death and Dismemberment |
$25,000 Aggregate Sum |
Notice Information
INDIA NETWORK ACCIDENT AND SICKNESS MEDICAL INSURANCE PROGRAM
Description of Health Insurance Program
This Description of Coverage is a brief description of the important features of the insurance plan. It is not a contract of insurance. The terms and conditions of coverage are set forth in the Policy issued to the Policyholder on Form # AH-15090. The Policy is subject to the laws of the state in which it is issued. Coverage may not be available in all states or certain terms or conditions may be different if required by state law. Please keep this information as a reference.
Patient Protection and Affordable Care Act
Insurance policies providing certain health insurance coverage issued or renewed on or after September 23, 2010 are required to comply with all applicable requirements of the Patient Protection and Affordable Care Act (“PPACA"). However, there are a number of insurance coverages that are specifically exempt from the requirements of PPACA (See §2791 of the Public Health Services Act). CHUBB maintains this insurance is short-term, limited duration insurance and is not subject to PPACA.
CHUBB continues to monitor federal and state laws and regulations to determine any impact on its products. In the event these laws and regulations change, your plan and rates will be modified accordingly.
Please understand that this is not intended as legal advice. For legal advice on PPACA, please consult with your own legal counsel or tax advisor directly.
CHUBB continues to monitor federal and state laws and regulations to determine any impact on its products. In the event these laws and regulations change, your plan and rates will be modified accordingly.
Please understand that this is not intended as legal advice. For legal advice on PPACA, please consult with your own legal counsel or tax advisor directly.
Cancellation Policy
- Refund of premium, less a $25 processing fee, will be considered only if Cancellation Form is received by the India Network Services prior to the effective date of coverage.
- After that date, the premium is considered fully earned and non-refundable.
- All cancellation requests should be submitted by completing the Cancellation Form found under 'Members Area' section of the web pages.
- The form can be faxed to 408-520-4967. Policy changes can not be made under any circumstances once the policy becomes effective.