What
Is
Covered?
All
benefits,
except
Lost
Checked
Luggage,
Accidental
Death
&
Dismemberment
and
Common
Carrier
Accidental
Death,
are
subject
to
the
Deductible
and
Coinsurance.
Policy
Limits
apply
to
all
benefits:
Medical:
Inpatient
and
Outpatient
charges
made
by
a
Hospital.
- Charges
made
by
a
Physician,
surgeon,
radiologist,
anesthesiologist,
and
any
other
medical
specialist
to
whom
the
Physician
has
referred
the
case.
- Charges
made
for
dressings,
sutures,
casts
or
other
supplies
prescribed
by
the
attending
Physician
or
specialist.
- Charges
for
diagnostic
testing
using
radiology,
ultrasonographic
or
laboratory
services.
- Charges
for
oxygen
and
other
gases
and
anesthetics
and
their
administration.
- Charges
for
prescription
drugs,
for
treatment
of
a
covered
Injury
or
Illness,
but
not
for
the
replacement
of
lost,
stolen,
damaged,
expired
or
otherwise
compromised
drugs.
- Charges
made
by
a
licensed
Extended
Care
Facility
upon
direct
transfer
from
an
acute
care
Hospital.
- Emergency
local
ambulance
transport
incurred
in
connection
with
Injury
or
Illness
resulting
in
hospitalization.
Emergency
Dental:
- Emergency
Dental
treatment
and
Dental
surgery
necessary
to
restore
or
replace
sound
natural
teeth
lost
or
damaged
in
an
Accident
which
is
covered
under
this
insurance.
- Emergency
Dental
treatment
necessary
to
resolve
acute,
spontaneous
and
unexpected
onset
of
pain.
Emergency
Evacuation:
If
recommended
by
your
attending
Physician,
who
certifies
that
Evacuation
is
necessary
to
safeguard
your
life
and
that
Medically
Necessary
treatment
is
not
available
locally,
and
if
approved
in
advance
and
coordinated
by
MultiNational
Underwriters,
Inc.,
the
Atlas
Series
will
provide
the
following
benefits:
emergency
air
and
ground
transportation
to
the
nearest
Hospital
that
is
qualified
to
provide
the
Medically
Necessary
treatment.
Emergency
Reunion:
In
the
event
of
a
covered
Emergency
Evacuation,
the
Atlas
Series
will
provide
the
following
benefits:
The
cost
of
an
economy
round
trip
air
or
ground
transportation
ticket
for
one
of
your
relatives
(parent,
spouse,
sibling
or
child
age
18
or
older)
for
transportation
to
the
area
where
you
are
hospitalized
following
Emergency
Evacuation,
and
reasonable
expenses
for
lodging
and
meals
for
your
relative,
for
a
period
not
to
exceed
10
days.
Trip
Interruption:
If,
after
you
have
departed,
you
learn
of
the
death
of
a
parent,
spouse,
sibling
or
child,
or
you
learn
of
the
substantial
destruction
of
your
Principal
Residence
by
fire
or
weather,
the
Atlas
Series
will
provide
the
following
benefit:
the
cost
of
an
economy
one
way
air
or
ground
transportation
ticket
for
you
to
the
area
of
your
Principal
Residence.
Repatriation
of
Remains:
In
event
of
a
covered
Injury
or
Illness
resulting
in
your
death,
the
Atlas
Series
will
provide
the
following
benefit:
air
or
ground
transportation
of
bodily
remains
or
ashes
to
the
area
of
your
Principal
Residence,
and
reasonable
costs
of
preparation
of
your
remains
necessary
for
transportation.
Lost
Checked
Luggage:
In
the
event
your
checked
luggage
is
permanently
lost
by
the
carrier,
the
Atlas
Plan
will
provide
the
following
benefit:
replacement
of
clothes
and
personal
hygiene
items,
not
to
exceed
$50
for
any
one
item.
You
must
file
a
formal
claim
with
the
transportation
provider,
and
provide
the
Plan
Administrator
with
copies
of
all
claim
forms,
and
proof
that
the
transportation
provider
has
paid
you
its
normal
reimbursement
for
the
lost
checked
luggage.
Accidental
Death
and
Dismemberment:
In
the
event
of
your
Accidental
Death
(except
while
traveling
on
a
common
carrier)
or
Dismemberment
resulting
from
a
covered
Injury,
the
Atlas
Series
will
provide
the
following
benefit:
- Accidental
Death
-
Principal
Sum
of
$25,000
to
the
Beneficiary
designated
on
your
Application.
The
Principal
Sum
shall
reduce
by
50%
(to
$12,500)
if
you
are
age
70
to
74
at
time
of
Death,
and
an
additional
50%
(to
$6,250)
if
you
are
age
75
or
older
at
time
of
Death.
- Accidental
Dismemberment
- Loss
of
2
or
more
eyes
or
limbs
-
Principal
Sum
of
$25,000
to
you.
- Loss
of
1
eye
or
limb
-
One-half
of
the
Principal
Sum
($12,500)
to
you.
- The
Principal
Sum(s)
shall
reduce
by
50%
if
you
are
age
70
to
74
at
time
of
Dismemberment,
and
an
additional
50%
if
you
are
age
75
or
older
at
time
of
Dismemberment.
Common
Carrier
Accidental
Death:
In
the
event
of
your
accidental
death
while
traveling
on
board
a
commercial
common
carrier,
the
Atlas
Series
will
provide
the
following
benefit:
Principal
Sum
of
$50,000
to
the
Beneficiary
designated
on
your
Application.