Diplomat Long Term plan provides Accident and Sickness medical coverage, Accidental Death and Dismemberment benefits, Travel Assistance and more. This plan is designed for anyone traveling outside their home country for undetermined or extended periods of time.
Traveling to the United States: After you pay the selected deductible, the plan pays 80% up to $5,000 of eligible costs, then 100% to the Medical Maximum. There will be an additional $250 deductible for each emergency room visit as a result of an Illness. The ER deductible will be waived if hospital admittance is within 12 hours of the incident.
Traveling Outside the United States: After you pay your selected deductible this plan will pay 100% of Covered Expenses outside the USA up to the selected plan maximum.
Diplomat Long Term (LT) provides Accident and Sickness medical coverage, Accidental Death and Dismemberment benefits and Travel Assistance to Non-US citizens while visiting the United States or for those traveling internationally outside their home country. Coverage is available for 2 adults, any unmarried dependent children ages 14 days until their 18th birthday, or children traveling alone. Coverage is not available for travel in Iran, for citizens of Australia or residents of New York, Maryland and South Dakota.
Unexpected Recurrence of a Pre-Existing Condition (US Citizens Only) – Limited coverage under Your Medical Expense Benefit is provided for Medical Expenses that result from a sudden and unforeseen recurrence of a Pre-existing Condition.
The Plan Document does not cover any loss resulting from any of the following unless otherwise covered under the Plan Document by Additional Benefits:
- Suicide, attempted suicide (including drug overdose) self-destruction, attempted self-destruction or intentional self-inflicted Injury while sane or insane;
- War or any act of war, declared or undeclared; unless War Risk Benefit was purchased;
- An Accident which occurs while the Plan Participant is on Active Duty Service in any Armed Forces, National Guard, military, naval or air service or organized reserve corps;
- Injury sustained while in the service of the armed forces of any country. When the Plan Participant enters the armed forces of any country, We will refund the unearned pro rata premium upon request;
- Voluntary, active participation in a riot or insurrection;
- Medical expenses resulting from a motor vehicle accident in excess of that which is payable under any other valid and collectible insurance;
- Organ transplants;
- Treatment for an Injury or Sickness caused by, contributed to or resulting from the Plan Participant’s voluntary use of alcohol, illegal drugs or any drugs or medication that is intentionally not taken in the dosage recommended by the manufacturer or for the purpose prescribed by the Plan Participant’s Physician;
- Violation or in violation or attempt to violate any duly-enacted law or regulation, or commission or attempt to commit an assault or felony, or that occurs while engaged in an illegal occupation;
- Eligible Expenses for which the Plan Participant would not be responsible in the absence of the Plan Document;
- Treatment of acne;
- Charges which are in excess of Usual and Customary charges;
- Charges that are not Medically Necessary;
- Charges provided at no cost to the Plan Participant;
- Treatment of HIV infection, HIV related illness and AIDS (acquired immune deficiency syndrome);
- Expenses incurred for treatment while in Your Home Country; except as provided under the Home Country Coverage Benefit;
- Expenses incurred for an Accident or Sickness after the Benefit Period shown in the Schedule of Benefits or incurred after the termination date of coverage;
- Regular health checkups; routine physical, immunizations or other examination where there are no objective indications or impairment in normal health;
- Services or treatment rendered by a Physician, Registered Nurse or any other person who is employed or retained by the Participation Organization; or an Immediate family member of the Plan Participant;
- Injuries paid under Workers’ Compensation, Employer’s liability laws or similar occupational benefits or while engaging in an occupation for monetary gain from sources other than the Participation Organization;
- Benefits for enrolling solely for the purpose of obtaining Medical Treatment, while on a waiting list for a specific treatment, or while traveling against the advice of a Physician;
- Aggravation or re-injury of a prior Injury that the Plan Participant suffered prior to his or her coverage Effective Date, unless We receive a written medical release from the Plan Participant’s Physician;
- Pre-existing conditions as defined in the definitions;
- Treatment of a hernia, including sports hernia, whether or not caused by a Covered Accident;
- Pregnancy or childbirth, miscarriage; elective abortion; elective cesarean section; or any complications of any of these conditions;
- Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof;
- Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes;
- Expense incurred for treatment of temporomandibular joint (TMJ) disorders or craniomandibular joint dysfunction and associated myofascial pain;
- Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury resulting from an Accident while the Plan Participant is covered under the Plan Document, and rendered within 6 months of the Accident; unless otherwise provided by the plan document;
- Eyeglasses, contact lenses, hearing aids braces, appliances, or examinations or prescriptions therefore;
- Private-duty nursing services;
- The cost of the Covered Person’s unused airline ticket for the transportation back to the Plan Participant’s Home Country, where an Emergency Medical Evacuation or Repatriation and/or Return of Mortal Remains benefit is provided;
- For the cost of a one way airplane ticket used in the transportation back to the Plan Participant’s country where an air ambulance benefit is provided and medically necessary;
- Treatment paid for or furnished under any other individual or group Plan Document, or other service or medical prepayment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for the treatment without cost to any individual;
- Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste, from combustion of nuclear fuel, the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component of such assembly.
- Plan Participant being exposed to the utilization of nuclear, chemical, or biological weapons of mass destruction.
- Travel in or upon: (a) A snowmobile; (b) A water jet ski; (c) Any two or three wheeled motor vehicle, other than a motorcycle registered for onroad travel; (d) Any off-road motorized vehicle not requiring licensing as a motor vehicle; when used for recreation or competition. Unless Hazardous Activity Benefit is purchased.
- Injury sustained while taking part in: mountaineering; hang gliding; parachuting; bungee jumping; racing by horse, motor vehicle or motorcycle; snowmobiling; motorcycle/motor scooter riding; scuba diving, involving underwater breathing apparatus; water skiing; snow skiing; spelunking; parasailing; white water rafting; surfing, unless part of a school credit course; and snowboarding. Unless Hazardous Activity Benefit is purchased.
- Practice or play in any amateur, club, intramural, interscholastic, intercollegiate, sports contest or competition; Unless Athletic Sports Activity Benefit is purchased.
- Practice or play in any professional or semiprofessional contest or competition;
- Rest cures or custodial care;
- Treatment of Mental and Nervous Disorders;
- Weight reduction programs or surgical treatment of obesity or venereal disease;
- Elective or Cosmetic surgery and Elective Treatment or treatment for congenital anomalies (except as specifically provided), except for reconstructive surgery on a diseased or injured part of the body (Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or Sickness);
- Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from:
- While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or
- While being used for any test or experimental purpose; or
- While piloting, operating, learning to operate or serving as a member of the crew thereof; or
- while traveling in any such Aircraft or device which is owned or leased by or on behalf of the Participation Organization of any subsidiary or affiliate of the Participation Organization, or by the Plan Participant or any member of his household.
- A space craft or any craft designed for navigation above or beyond the earth’s atmosphere; or
- An ultralight, hang-gliding, parachuting or bungee-cord jumping. Unless Hazardous Activity Benefit is purchased. Except as a fare paying passenger on a regularly scheduled commercial airline or as a passenger in a non-scheduled, private aircraft used for business or pleasure purposes.