FAQ
ProtExPlan FAQs:
Note: These questions and answers are meant to be helpful answers to complicated questions. If there is any ambiguity, please consult the applicable policy wordings or e-mail us with your questions.
Click on a topic to view the FAQs:
Eligibility
General
Deductible/Excess Questions
Dental Cover Questions
Pre-existing Conditions Questions
Hospitalization Questions
Maternity & Newborn Questions
Life Insurance & Daily Hospital Cash Benefit Questions
Who is eligible?
Anybody under age 75 is eligible provided they are not American living in the USA. With this policy and Area 3 cover, you can spend cumulatively 6 months per in the USA.
What is my home country limitation?
The only restriction is that you can't be American living in the USA; otherwise there are no geographical limitations.
What period of time can I be covered for and are the plans automatically renewable?
The policy is for one year and automatically and guaranteed renewable annually. You can continue to renew as long as the plan is available and you are eligible. The upper age limit for new applicants is 74. You will receive a renewal form by post as well as 60 and 30 day e-mail notices prior to your expiry date. You can renew on-line or by faxing the renewal form.
Can I be covered beyond age 75?
Yes provided you have been continuously covered from age 64 to 74, beyond that you can go on our seniors plan.
Will I be required to answer a medical questionnaire or have a medical exam?
We have medical questions on our applications that ask about pre-existing medical conditions, but no physical exam is required. If you are 55 or older you must have had a physical exam in the last 2 years in order to qualify for cover or you must get one and provide a note from your doctor.
Will my cover be affected if I return home?
If your geographical area contains your home country, then there is no limitation and you can continue to renew. The only restriction is that Americans must reside outside of the USA 6 months per year, and have a residential address outside of the USA.
How do I apply and how quickly can I be covered?
You can apply on-line and get same day cover paying by credit card. Or simply download an application form and fax or post it to us. If you are paying by credit card we can cover you immediately or on the date you specify up to 30 days in the future.
How can I pay?
You can pay by annually by credit card (Visa, MasterCard, JCB, American Express), check, postal money order, or bank draft in US$. You can only pay monthly or quarterly or semi-annually with a credit card.
How are price increases applied to this plan?
There is no international medical plan that we know of that penalizes individuals by raising their premium for claiming. There are two ways insurers apply premium increases. The way most people expect is to apply a percentage increase to premium tables across the board, so the price you pay is what everybody else pays in the same age band at all times. All British plans use this transparent system, and nobody ever asks questions about it.
The other way is to follow everybody joining in a year as a class, and apply increases to that group accordingly. This is an American way of doing things, and is how the underwriters at IMG apply increases to ProtExPlan. The entry premiums do not change much from year to year, and we've only had one 7% increase in 5 years. The bad thing about this is that people are confused when they see higher renewal prices, than on the premium table. The good thing about this is that you can quit and start a new policy at the entry price if you want the lower premium, so you do have a choice. The applied increases have kept pace with all of the other competitors, and are most often lower. So you start lower, have lower increases, and can restart the clock if you want. You can't do that with other plans that apply increases across the board.
What will I receive after I join?
You will receive a plastic membership ID card for your wallet with policy number and expiry date. On the back of the card are the contact numbers for IMG Assistance emergency response in the event of a problem. You will also receive a certificate of insurance, the policy wording, claim forms and procedures.
Can I change the Level or Area of cover?
Yes, but only at renewal. If you upgrade, wait periods for benefits such as maternity will apply anew. If you have a medical condition under treatment and want to change your geographical area to be treated in the US or Canada, then this will be at our discretion.
Am I covered if I travel outside of my country of residence?
You get full cover within your geographical Area. With Area 2 Worldwide excluding USA & Canada, you get and 30 days in the USA and Canada accident and emergency cover for travel or holidays.
What is the refund policy?
You can cancel and get a full refund within 15 days of starting. If you are claim free, you can get a pro rata refund anytime.
Can I seek treatment anywhere in the world?
Yes, so long as it is within the geographical area you paid for.
What is the compassionate/ reunion travel benefit?
Compassionate travel is a return home $3000 benefit that allows you to go home if an immediate family member under 75 dies unexpectedly, or becomes terminally ill. It also allows an immediate family member to come to your bedside if you become hospitalized. Under the Medical Evacuation benefit, reasonable transportation costs for an accompanying person will be paid if deemed necessary by IMG Assistance. In all circumstances these benefits must be pre-authorized and coordinated by the IMG Assistance.
What are the major exclusions?
STD's, immunizations, cosmetic surgery, contraceptives, vaccinations etc. are excluded. These exclusions are standard with most policies.
Are hazardous sports excluded?
Hazardous sports are excluded. Please see the policy wordings for a complete list. Downhill skiing and snowboarding on trail is not considered to be hazardous sports.
What is inpatient treatment?
This is when you are admitted to a hospital. It is usually for a serious medical condition.
What is outpatient treatment?
This is when you consult with a general practitioner (family doctor) or outpatient specialist (e.g. a cardiologist) without being admitted to a hospital. An example would be if you have the flu and visited your doctor's office for a consultation.
What is the difference between Travel and Medical Insurance?
Travel insurance is usually for short periods but can be for up to 3 years and does not cover urgent or elective medical problems. It covers only accidents and emergencies. Travel insurance companies expect you to end your trip and return home for elective or urgent treatment, and some policies require return home immediately once diagnosed. For example, if you were diagnosed with cancer while on a travel policy, there might be an urgent requirement to commence treatment, but it is not life or death to get on an airplane and return home. Travel insurance is also not renewable. If you do have a serious medical problem, your coverage will end at expiry, or when you return home. ProtExPlan medical insurance covers urgent and elective medical problems like cancer, and is guaranteed renewable. If you have expatriate medical insurance, you don't need travel insurance unless you are traveling outside your area of cover. The underlying assumption with travel cover is that you have proper medical insurance at home, or in your country of residence, to return to in the event of an urgent or elective medical problem.
What is a deductible or excess?
Deductible is American, and excess is British English usage for the same thing. This is the amount you must pay when claiming. You can get a discount off the base nil deductible prices in the premium table by choosing one of the deductible options. Please see the tables below for the options:
| Deductible | $100 | $250 | $500 | $1,000 | $2,500 | $5,000 | $10,000 |
| Discount % | 7% | 17% | 25% | 34% | 42% | 52% | 63% |
How is the deductible applied?
With the Bronze, Silver, and Gold benefit levels you can choose an annual deductible. Any medical expenses exceeding the deductible amount are payable in a policy year. You must file claims to prove that you have spent the deductible amount before the policy will start reimbursing.
Example: The nil deductible premium is $1000 and you choose the $500 deductible option for a 25% discount reducing the premium to $750. If your first claim was $250 you would get nothing back, but you still have to file the claim. Your second claim is $500, so you would get $250 back as you have exceeded the $500 deductible in medical expenses for the year. For the rest of the policy year, on all subsequent claims, you would get 100% reimbursed.
I am older and healthy and facing high premiums, what is my best option?
For this situation we find many people choose the Bronze benefit level inpatient plan. You can self insure (pay yourself) for any outpatient treatment and end up paying very little for insurance. This means you’d be covered for the big expenses yet not financially ruined if something bad happens. Don’t forget that Bronze cover includes $2000 of post-hospital outpatient treatment. You could also choose Silver or Gold with a big deductible. The money you save in years where you don’t need to claim, more than offsets the higher deductibles on the rare occasion that you do have to go to the hospital.
What is coinsurance?
Coinsurance is the percentage amount you must pay for a benefit in addition to any deductible you choose. In this policy there is only co-insurance if you visit a US hospital not in the PPO network, and fail to pre-certify the claim.
What is accidental dental?
This is a dental problem caused by a blow to the face or accident and injury to teeth and gums. The benefit is $1000 for Silver and Gold. The limit only applies to outpatient dental procedures.
Pre-existing Conditions Questions:
What if I have a Pre-existing Condition?
IMG won't enroll you if you have unacceptable pre-existing conditions. If you're accepted then after 2 years we will pay up to $50,000 lifetime to a maximum of $5,000 per year to treat these conditions. Our underwriters accept 95% of all applications. If we can't offer you cover with IMG then we'll offer you a British style plan with a different method of underwriting. They will exclude your condition but cover you for everything else, or load the premium rather than reject you entirely. We can almost always find a provider.
Can I go to any hospital?
No restrictions are made outside the USA. In the US, IMG has a preferred provider network of 4700 hospitals. If you attend one of these facilities and pre-authorize your claim, your deductible will be reduced by half. If you do not pre-authorize and attend a PPO facility in the USA, your benefit may be reduced by 50%. If you wish to find a hospital, clinic, or doctor in the USA near you, please search our Preferred Provider network list on-line: Search List
We don't have an approved hospital list except in the USA. All health insurance policies however, have the phrase "usual, reasonable and customary costs" (URC) in their policy wordings. They will not pay more than URC for treatment in the country where you are located. If you go to a hospital that charges ten times the going rate, there will be a problem. It is very important to contact IMG Assistance, and cooperate with them so that there are no surprises later. You must contact IMG Assistance if you expect a medical bill to be more than US $500 and pre-authorize the claim or your benefit may be reduced by 50% no matter what country you are in.
Will I be required to make down payments to a hospital?
No, if you call IMG Assistance and pre-authorize treatment as you are required to do, then IMG Assistance will make arrangements ahead of time to settle the hospital bill directly. In the event of an emergency, you are required to contact IMG Assistance within 48 hours. They will intervene with the hospital to advance funds and guarantee payment before you are discharged. The only thing we want you to worry about is getting better, not about money!
Maternity & Newborn Questions:
What does routine maternity cover?
It covers pre-natal & post-natal check ups and routine birth up to $3,500 for the Gold Benefit Level. There is a 10-month wait for maternity benefits with Gold. Pre-natal medical exams are not covered during the wait periods.
What does complicated maternity cover?
In addition to the routine maternity benefit, there is an additional benefit of up to $2,500 with Gold for a C-Section.
Life Insurance & Daily Hospital Indemnity Add-On Benefit Questions:
What is the Optional Life Insurance Benefit?
The optional Life Insurance Benefit is a 1-year term life insurance policy only available with Bronze, Silver and Gold benefit levels. For adults the cost is $240 for the first unit, and $180 for the second unit per year. For children 18 & under, the cost is $100. You can buy a maximum of 2 units per person, except if you're over 65 then you can only buy 1 unit.
What is the amount of Life Insurance cover I can buy per unit?
It depends on your age and the benefits can be found in the table below:
|
Age
|
Benefit/ unit
|
Age
|
Benefit / unit
|
|
31 days -18
|
$5000
|
50-54
|
$20,000
|
|
19-29
|
$75,000
|
55-59
|
$15,000
|
|
30-39
|
$50,000
|
60-64
|
$10,000
|
|
40-44
|
$35,000
|
65-69
|
$7,500
|
|
45-49
|
$25,000
|
70-74
|
n/a
|
What is the Accidental Death and Dismemberment benefit that comes with the Life Cover?
- This benefit pays double the above death benefit if you die accidentally.
- This benefit pays equivalent to the death benefit if you lose 2 members.
- This benefit pays 50% of the death benefit if you lose 1 member.
- A member is defined as a hand, foot, or eye.
What is the Daily Hospital Indemnity benefit?
The Daily Hospital Indemnity Benefit is an extra add-on benefit that pays $100 cash for every night spent in a hospital. This would replace your income up to $3100 per month while you are hospitalized. It is available with all benefit levels. It costs $100 extra per year. This does not include time spent in the hospital for maternity.
What is the Hospital Cash Benefit & How is it different from Daily Hospital Indemnity benefit?
The Hospital Cash Benefit is a standard benefit and pays $100 per night that you are hospitalized but only if the insurance policy is not paying anything for your hospital bills. Reading this you may think this doesn't make sense! Many people are double insured and can have another policy pay the hospital bills. If you can arrange this, then you get $100 from us per night. Also, many people prefer to return to their home countries and can immediately be back on their National Medical Insurance programs. If you can do this, then you get $100 per night from us. If you have purchased the extra add-on Daily Hospital Indemnity benefit, then you can double dip and get $200 per night by claiming both benefits.