INF Standard Policy Features
program eligibility
Enrollment Requirements
Insurance enrollment
Online Enrollment
Enrollment by Fax
Enrollment by Mail
Additional Information
Continuous coverage
INF Standard plan | Age 0-69
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Medical expense benefits
The Plan will pay Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident or Sickness.
Coverage effective dates
Insured's Effective Date:
Dependent's Effective Date:
Insured's Termination Date:
Dependent's Termination Date:
Termination of Coverage:
Definitions of policy terms
Country of Permanent Assignment - A country, other than your Home Country, in which the Policyholder requires you to work for a period of time that exceeds 364 continuous days.
Claims
Claims Procedure
Claims Office
INF Standard plan | Age 70-99+
Exclusions
We will not pay benefits for any loss or Injury that is caused by or results from:
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Other Policy Features
inf Member only Assistance Services
AXA Travel Assistance Services
- AXA Travel Assistance Services at 1-855-327-1414 will provide 24-hour access to the following services:
- Medical Assistance including referral to a doctor or medical specialist, medical monitoring when you are hospitalized, emergency medical evacuation to an adequate facility, medically necessary repatriation, and return of mortal remains.
- Personal Assistance including pre-trip medical referral information and while you are on a trip:
- emergency medication,
- embassy and consular information,
- lost document assistance,
- emergency referral to a lawyer, translator or interpreter access,
- medical benefits verification, and
- medical claims assistance.
- emergency medication,
- Travel Assistance including emergency travel arrangements, arrangements for the return of your traveling companion or dependents, and vehicle return.
- Access to a secure, web-based system for tracking global threats and health or location based risk intelligence.
- You will receive a Travel Assistance ID card that will provide you with emergency call numbers and information on how to access CHUBB’s Travel Assistance Web Portal.
- This information provides you with a brief outline of the services available to you. These services are subject to the terms and conditions of the Policy under which you are insured.
- Travel assistance services are not available if your coverage under the Policy providing insurance benefits is not in effect.
- This information provides you with a brief outline of the services available to you. These services are subject to the terms and conditions of the Policy under which you are insured.
- Medical Assistance including referral to a doctor or medical specialist, medical monitoring when you are hospitalized, emergency medical evacuation to an adequate facility, medically necessary repatriation, and return of mortal remains.
EMERGENCY MEDICAL EVACUATION AND REPATRIATION OF REMAINS BENEFITS
Emergency Medical Evacuation Benefit
- We will pay up to the maximum indicated above in the Schedule of Benefits for your medical evacuation if you:
- 1) suffer a Medical Emergency during the course of the Trip;
- 2) require Emergency Medical Evacuation; and
- 3) are traveling on a covered Trip.
- 1) suffer a Medical Emergency during the course of the Trip;
- Covered Expenses include;
- 1) Medical Transport: expenses for transportation under medical supervision to a different hospital, treatment facility or to your place of residence for Medically Necessary treatment in the event of your Medical Emergency and upon the request of the Doctor designated by Our assistance provider in consultation with the local attending Doctor.
- 2) Dispatch of a Doctor or Specialist: the Doctor’s or specialist’s travel expenses and the medical services provided on location, if, based on the information available, your condition cannot be adequately assessed to evaluate the need for transport or evacuation and a doctor or specialist is dispatched by Our service provider to your location to make the assessment.
- 3) Return of Dependent Child (ren): expenses to return each Dependent child who is under age 18 to his or her principal residence if:
- a) you are age 18 or older; and
- b) you are the only person traveling with the minor Dependent child(ren); and
- c) you suffer a Medical Emergency and must be confined in a Hospital.
- a) you are age 18 or older; and
- 4) Escort Services: expenses for an Immediate Family Member or companion who is traveling with you to join you during your emergency medical evacuation to a different hospital, treatment facility or your place of residence.
- 1) Medical Transport: expenses for transportation under medical supervision to a different hospital, treatment facility or to your place of residence for Medically Necessary treatment in the event of your Medical Emergency and upon the request of the Doctor designated by Our assistance provider in consultation with the local attending Doctor.
- Benefits for these Covered Expenses will not be payable unless:
- 1) the Doctor ordering the Emergency Medical Evacuation certifies the severity of your Medical Emergency requires an Emergency Medical Evacuation;
- 2) all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible;
- 3) the charges incurred are Medically Necessary and do not exceed the Usual and Customary Charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and
- 4) do not include charges that would not have been made if there were no insurance.
- 1) the Doctor ordering the Emergency Medical Evacuation certifies the severity of your Medical Emergency requires an Emergency Medical Evacuation;
- Benefits will not be payable unless We authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our assistance provider.
- In the event you refuse to be medically evacuated, we will not be liable for any medical expenses incurred after the date medical evacuation is recommended.
Repatriation of Remains Benefit
- We will pay up to the maximum indicated above in the Schedule of Benefits for the preparation and return of your body to your home if you die as a result of a Medical Emergency while traveling on a covered Trip.
- Covered expenses include:
- 1) expenses for embalming or cremation;
- 2) the least costly coffin or receptacle adequate for transporting the remains;
- 3) transporting the remains; and
- 4) Escort Services which include expenses for an Immediate Family Member or companion who is traveling with you to join your body during the repatriation to your place of residence.
- 1) expenses for embalming or cremation;
- All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the Usual and Customary Charges for similar transportation in the locality where the expense is incurred.
- Benefits will not be payable unless We authorize in writing, or by an authorized electronic or telephonic means, all expenses in advance, and services are rendered by Our assistance provider
Accident death benefit
Accident Death & Dismemberment Indemnity
- ACCIDENTAL DEATH DISMEMBERMENT of $25,000
- Definition of Injury and Scope of Coverage – 24 Hour Coverage
- Principal sum for Covered Injury: $25,000
- Accidental Death and Dismemberment Benefits - If your Injury results, within 365 days from 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.
- Principal Sum for you and your Dependents (if you have elected Dependent coverage and the required premium has been paid) is $25,000.
- If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.
- Principal Sum for you and your Dependents (if you have elected Dependent coverage and the required premium has been paid) is $25,000.
- Schedule of Covered Losses
- Covered Loss Benefit Amount
- Life - 100% of the Principal Sum
- Two or more Members - 100% of the Principal Sum
- One Member - 50% of the Principal Sum
- Covered Loss Benefit Amount
- “Member” means Loss of Hand or Foot, and Loss of Sight.
- “Loss of Hand or Foot” means complete Severance through or above the wrist or ankle joint.
- “Loss of Sight” means the total, permanent Loss of Sight of one eye. “Severance” means the complete separation and dismemberment of the part from the body.
- Aggregate Limit - We will not pay more than $125,000 for all losses.
- If, in the absence of this provision, We would pay more than this amount for all losses under the policy, then the benefits payable to each person with a valid claim will be reduced proportionately.
Schedule of Benefits
In-patient services | $50,000
Covered Medical Services |
Inpatient Medical Benefits |
Hospital Room (Average Semi-Private), Board, & Miscellaneous |
Charges up to $1,300 a day maximum Up to 30 days |
Hospital Intensive Care Unit |
Charges up to $525 maximum additional a day | Up to 8 Days |
Surgeon |
Up to $3,000 maximum |
Anesthetist |
Up to $750 maximum |
Assistant Surgeon |
Up to $750 maximum |
Doctor's Non-Surgical Visits |
Up to $60 maximum a visit, 1 visit a day, to 30 visits |
Consultant Doctor, when requested by attending Doctor |
Up to $400maximum |
Pre-Admission Tests within 14 days before hospital admission |
Up to $1,000 maximum |
Out-patient services | $50,000
Covered Medical Services |
Outpatient Medical Benefits |
Surgical Room & Supply Expenses |
Up to $1,000 maximum |
Hospital Emergency |
Up to $350 |
Surgeon |
Up to $3,000 maximum |
Anesthetist |
Up to $750 maximum |
Assistant Surgeon |
Up to $750 maximum |
Doctor's Non-Surgical Visits |
Up to $60 a visit maximum | 1 visit a day Up to 10 visits |
Diagnostic X-rays & Lab Services |
Up to $400 maximum |
CAT Scan, PET Scan, or MRI Scan |
Up to $400 additional |
Prescription Drugs |
Up to $100 maximum |
Other benefits | $50,000
Covered Medical Services |
Outpatient Medical Benefits |
Ambulance Services |
Up to $400 maximum |
Rehabilitative Braces or Appliances |
0Up to $1,200 maximum |
Dental Treatment Injury to Sound, Natural Teeth due to an Accident |
Up to $450. There are no benefits for dental services for immediate relief of pain. |
Chemotherapy and/or Radiation Therapy |
Up to $1,000 maximum |
Physical & Occupational Therapy |
Up to $35 a visit max, 1 Visit a day to 12 visits |
Private Duty Nurse |
Up to $400 maximum |
Pregnancy & Childbirth (Conception must Occur After Policy Effective Date) |
Up to $4,500 maximum |
Medical Evacuation |
$15,000 maximum |
Repatriation of Remains |
$10,000 maximum |
Accidental Death & Dismemberment |
$25,000 Principal Sum |
Intercollegiate Sports |
None |
In-patient services | $100,000
Covered Medical Services |
Inpatient Medical Benefits |
Hospital Room (Average Semi-Private), Board, & Miscellaneous |
Charges up to $1,750 a day maximum Up to 30 days |
Hospital Intensive Care Unit |
Charges up to $750 maximum additional a day | Up to 8 Days |
Surgeon |
Up to $5,000 maximum |
Anesthetist |
Up to $1,250 maximum |
Assistant Surgeon |
Up to $1,250 maximum |
Doctor's Non-Surgical Visits |
Up to $60 maximum a visit, 1 visit a day, to 30 visits |
Consultant Doctor, when requested by attending Doctor |
Up to $450 maximum |
Pre-Admission Tests within 14 days before hospital admission |
Up to $1,100 maximum |
Out-patient services | $100,000
Covered Medical Services |
Outpatient Medical Benefits |
Surgical Room & Supply Expenses |
Up to $1,100 maximum |
Hospital Emergency |
Up to $500 |
Surgeon |
Up to $5,000 maximum |
Anesthetist |
Up to $1,250 maximum |
Assistant Surgeon |
Up to $1,250 maximum |
Doctor's Non-Surgical Visits |
Up to $100 a visit maximum | 1 visit a day Up to 10 visits |
Diagnostic X-rays & Lab Services |
Up to $650 maximum |
CAT Scan, PET Scan, or MRI Scan |
Up to $650 additional |
Prescription Drugs |
Up to $150 maximum |
Other benefits | $100,000
Covered Medical Services |
Outpatient Medical Benefits |
Ambulance Services |
Up to $450 maximum |
Rehabilitative Braces or Appliances |
0Up to $1,100 maximum |
Dental Treatment Injury to Sound, Natural Teeth due to an Accident |
Up to $500. There are no benefits for dental services for immediate relief of pain. |
Chemotherapy and/or Radiation Therapy |
Up to $1,150 maximum |
Physical & Occupational Therapy |
Up to $45 a visit max, 1 Visit a day to 12 visits |
Private Duty Nurse |
Up to $500 maximum |
Pregnancy & Childbirth (Conception must Occur After Policy Effective Date) |
Up to $5,000 maximum |
Medical Evacuation |
$20,000 maximum |
Repatriation of Remains |
$15,000 maximum |
Accidental Death & Dismemberment |
$25,000 Principal Sum |
Intercollegiate Sports |
None |
In-patient services | $150,000
Covered Medical Services |
Inpatient Medical Benefits |
Hospital Room (Average Semi-Private), Board, & Miscellaneous |
Charges up to $1,900 a day maximum Up to 30 days |
Hospital Intensive Care Unit |
Charges up to $850 maximum additional a day | Up to 8 Days |
Surgeon |
Up to $6,000 maximum |
Anesthetist |
Up to $1,500 maximum |
Assistant Surgeon |
Up to $1,500 maximum |
Doctor's Non-Surgical Visits |
Up to $1250 maximum a visit, 1 visit a day, to 30 visits |
Consultant Doctor, when requested by attending Doctor |
Up to $500 maximum |
Pre-Admission Tests within 14 days before hospital admission |
Up to $1,200 maximum |
Out-patient services | $150,000
Covered Medical Services |
Outpatient Medical Benefits |
Surgical Room & Supply Expenses |
Up to $1,200 maximum |
Hospital Emergency |
Up to $750 |
Surgeon |
Up to $6,000 maximum |
Anesthetist |
Up to $1,500 maximum |
Assistant Surgeon |
Up to $1,500 maximum |
Doctor's Non-Surgical Visits |
Up to $125 a visit maximum | 1 visit a day Up to 10 visits |
Diagnostic X-rays & Lab Services |
Up to $750 maximum |
CAT Scan, PET Scan, or MRI Scan |
Up to $1,000 additional |
Prescription Drugs |
Up to $200 maximum |
Other benefits | $150,000
Covered Medical Services |
Outpatient Medical Benefits |
Ambulance Services |
Up to $500 maximum |
Rehabilitative Braces or Appliances |
0Up to $1,200 maximum |
Dental Treatment Injury to Sound, Natural Teeth due to an Accident |
Up to $550. There are no benefits for dental services for immediate relief of pain. |
Chemotherapy and/or Radiation Therapy |
Up to $1,250 maximum |
Physical & Occupational Therapy |
Up to $50 a visit max, 1 Visit a day to 12 visits |
Private Duty Nurse |
Up to $550 maximum |
Pregnancy & Childbirth (Conception must Occur After Policy Effective Date) |
Up to $5,500 maximum |
Medical Evacuation |
$25,000 maximum |
Repatriation of Remains |
$20,000 maximum |
Accidental Death & Dismemberment |
$25,000 Principal Sum |
Intercollegiate Sports |
None |
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.