FAQ

Frequently asked questions about Protexplan International medical insurance.

 

Eligibility

The only restriction is that you can’t live in the USA or spend more than 6 months per year cumulatively there; otherwise there are no geographical limitations.

Anybody under age 75 is eligible provided they are not living in the USA or spending cumulatively more than 6 months per year there. With this policy and Area 3 cover, you can return to the USA for medical treatment.

 

General

IMG Europe’s policies are governed by UK law and the Financial conduct Authority there. If you are not satisfied…

Step 1: Contact us, and we will get IMG to have a 2nd look at the decision with their review procedure.

If you are not satisfied…

Step 2: The UK Insurance Ombudsman can review the decision and order a settlement. They rule in favour of the consumer in 58% of all cases.

If you are not satisfied…

Step 3: A functionary called the Independent Assessor can review the Ombudsman’s decision.

Step 4: None of the above steps precludes your right to litigation.

The advantage to buying a policy governed by UK law is you have Step 2 & 3 available to you before resorting to litigation. That is a real consumer advantage.

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 the underwriter’s discretion.

The reunion benefit applies when you have been evacuated and pays for the travel and accommodation expenses of a friend or relative to come to your hospital bedside. In all circumstances, these benefits must be pre-authorized and coordinated by IMG Assistance Services. See the policy wording for more details.

 

Travel insurance is usually for short periods but can be for up to 2 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 or seriously injured. For example, if you were diagnosed with cancer, there might be an urgent requirement to commence treatment, but it is usually not life or death to take several weeks to wind up your affairs before returning home. Travel insurance is also not renewable. If you do have a serious medical problem, your cover will end at the expiry date, or when you return home. Our medical insurance covers urgent and elective medical problems like cancer, and is guaranteed to be renewable. If you have international medical insurance, you don’t need to buy 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.

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.

 

This is when you are admitted to a hospital. It is usually for a serious medical condition resulting in an overnight stay. However, increasingly surgery that used to result in hospitalization for days such as hernia surgery now can be done on a day patient basis. This is still admitted inpatient treatment and you would still be covered by all benefit levels. Visiting a hospital emergency room is not necessarily inpatient treatment if it doesn’t result in admission.

Hazardous sports are excluded. Please see the policy wordings for a complete list. Downhill skiing and snowboarding on trail are not considered to be hazardous sports.

Pre-existing Conditions you know about or should have been reasonably aware of, STD’s, immunizations, cosmetic surgery, contraceptives, vaccinations etc. are excluded. These exclusions are standard with most policies.

Yes, so long as it is within the geographical area of coverage. The policy will not pay for you to travel to seek medical treatment unless it is an evacuation.

 

You can cancel and get a full refund within 15 days of starting with the Level 1 plan and 30 days starting with a Level 2 or 3 plan, if you are claim free. You can get a pro rata refund according to the refund table anytime.

You get full cover within your geographical Area. With Worldwide excluding USA, Canada, China, Hong Kong, Macau, Japan, Singapore and Taiwan you receive accident and emergency coverage for 30 days for travel and holidays out of Area for all benefit levels except Bronze where you only get 15 days. This saves you having to buy travel insurance.

 

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.

 

You will receive a plastic membership wallet ID card 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.

 

There is no international medical plan 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.

The other method is to follow a cohort joining in a year as a class, and apply increases to that pooled group accordingly. Global Fusion premium increases are administered this way. Entry premiums do not change much from year to year. The bad thing about this is that people get 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 low entry price if you want the lower premium. The applied increases have kept pace with the competition, and are most often lower typically for the first 5 years. 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.

You can pay annually by debit/credit card (Visa, MasterCard, JCB, American Express, China Union Pay), check, postal money order, or bank draft in US$. You can only pay monthly or quarterly or semi-annually with a credit card.

You can apply on-line and get same day cover paying by debit/credit card. Or simply download an application form and fax, email, or post it to us. If you are paying by card, we can cover you immediately, or on the date you specify up to 30 days in the future.

If your geographical area of cover contains your home country, then there is no limitation and you can continue to renew. The only restriction is that you must reside outside of the USA 6 months per year, and have a residential address outside of the USA.

We have medical questions on our applications asking 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. If you are applying for Bronze you don’t need a physical exam. Our Full Medical Underwriting Application asks an exhaustive list of questions, our Moratorium Underwriting application has a much shorter list of questions.

Yes, provided you have been continuously covered from age 64 to 74, beyond that you can go on the Seniors Plan. For various reasons the cover provided beyond age 75 by IMG we deem to be inadequate or impossible to qualify for. We have another expat plan for seniors that you can start up to age 85 and continue to renew for life but they are not inexpensive.

The policy is for one year and is guaranteed to be annually renewable. 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 expiration date. You can renew on-line or by faxing the renewal form.

Deductible/Excess Questions

 Coinsurance is the percentage amount you must pay for a benefit in addition to any deductible you choose. In our policies, co-insurance only applies if you visit a US hospital not in the PPO network, and fail to pre-certify the claim. As long as you follow the hospital policy rules in the USA, you will never pay co-insurance which is a maximum of $1,000.

The best option many choose the Bronze inpatient plan with a big annual deductible. You can self-insure (pay yourself) for any outpatient treatment and end up paying very little for insurance.  In many countries local outpatient clinic treatment is inexpensive. This means you’d be covered for big expenses and be able to travel home for medical treatment if you want, yet not financially ruined if something bad happens. Don’t forget that Bronze cover includes $2000 of post-hospital outpatient treatment and pre-admission outpatient specialist cover as well. The money you save in years where you don’t need to claim, more than offsets the higher deductible on the rare occasion you are hospitalized. You can also offset the risk of paying a high deductible and other expenses with the daily hospital cash add-on benefit for an extra $100 per year. This could pay up to $25,000 per year if you are hospitalized for a lengthy period.

 

This is the amount you must pay when claiming. Please see the table below for the options:

Deductible Options

$250

$500

$1,000

$2,500

$5,000

$10,000

How is the Deductible/ Excess applied?

With all benefit levels you choose an annual deductible or excess. Any medical expenses exceeding the deductible/excess amount are reimbursable in a policy year. You must file claims proving you have spent the deductible amount before the policy will start reimbursing. Deductible is American usage, and Excess is British English usage meaning the same thing.

Dental coverage Questions

This is an additional add-on benefit you can buy that provides cover for routine and complicated dental procedures. Please see the brochure for details.

This is a dental problem caused by an injury or accident to the face, teeth or gums. The benefit is $1000 for Silver and Full Cover for Gold and higher. The limit only applies to outpatient dental procedures.

Pre-existing Conditions Questions

The policy covers pre-existing conditions that you could not have been reasonably aware of. So, if you had bowel cancer before policy inception for example, and you could not have been reasonably aware of it because you had no symptoms, then you would be covered for that. If you had blood in your stool though, and did nothing about it, then you there would be an issue.

Option A: Full Medical Underwriting (FMU)

Our underwriters 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 pre-existing conditions. You could have pre-existing conditions excluded under this option as a condition of acceptance. Our underwriters accept 98% of all applications.

 

Option B: Moratorium Underwriting

Our underwriters won’t enroll you if you have unacceptable pre-existing conditions, but if you have pre-existing medical conditions you want covered without limitation, for a small additional premium, the Moratorium Underwriting Option is available. The Moratorium is a 2 year wait period where pre-existing conditions are not covered. So long as you have 2 clear years where you haven’t had treatment, a consultation, symptoms, or taken medication, or had a recurrence, the condition can be deemed as if it was a new condition after the 2nd year on the policy.

If you have a chronic condition, obviously you’ll never complete a 2 year Moratorium period. An example where this method of underwriting would be useful is if you had a hip replacement in the past and it deteriorated after the moratorium period was completed. Another example would be if you had cancer in the past, a recurrence could be potentially covered without limit under Moratorium underwriting. It could be very useful to have cover greater than $5000 per year for a pre-existing condition. In all cases if you have a pre-existing condition you’re concerned about, please discuss this with us so we can get some specific direction from the underwriter on your case. The Moratorium option is not available for the Bronze benefit level and is limited to age 54.

 

Hospitalization Questions

In this case there is no dispute about medical necessity and if you’re already in hospital the insurer will quickly contact them to guarantee payment if you’re covered.

Pre-certification: Is a review of the proposed course of treatment and claim by IMG the insurer such that they agree there is medical necessity and there is a bona fide requirement for medical treatment.

Verification of Benefits: Is a procedure that confirms that proposed treatment is covered. For both insureds and facilities (clinics/hospitals) direct billing, please confirm verification of benefits with IMG. Just because there is a medical need, does not necessarily mean that there is a benefit payable under the policy.

Guarantee of Payment Letter: This is a letter to a hospital guaranteeing payment for a course of treatment, this can be requested after benefits have been verified.

Pre-Authorization: You and any hospital can consider this Pre-certification plus Verification of Benefits and a Guarantee that the insurer will pay for the proposed course of treatment.

The State Hospital Cash Benefit is a standard benefit paying $300 per night that you are hospitalized up to 60 nights ($18,000) but only if there are no costs to you or the insurer. It does not apply in cases where you are in an emergency or accident ward. So if you get cancer for example, and return home for treatment where you can be in a government hospital on your home country national health insurance plan, then you can claim this benefit. Many people prefer to return home for medical treatment, and this is an incentive to do so.

If you have purchased the extra add-on Daily Hospital Indemnity benefit, then you can double dip and get an additional $100 per night, up to $25,000 per year per unit, by claiming both benefits.

The Daily Hospital Indemnity Benefit is an extra add-on benefit costing $100 extra 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 up to $25,000 per year. It is available with all benefit levels. It costs $100 extra per year and you can buy multiple units. It also goes a long way to offset a deductible. This does not include time spent in the hospital for maternity.

 

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!

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.

 

 


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Do you need some help? Please contact us, we will be happy to answer any of your questions. Message Center: 1 800 507 0545 Email: info@protexplan.com