The Atlas Essential America plan is available almost anywhere you may travel internationally for vacation, study abroad, business, and mission work. Atlas Essential America represents the most economical version of our well-known Atlas Series.
What Does Atlas Essential America Cover?
Emergency Medical Evacuation
Would you know what to do if you found yourself in a life-threatening situation far from home? Atlas Essential America covers eligible expenses necessary to transport you to the nearest hospital qualified to treat your life-threatening condition.
Repatriation of Remains
What would your family do if disaster struck while you were away from home? The death of a loved one is never easy, no matter the circumstances. In the unfortunate event of your death while traveling abroad, the administrator will arrange for and cover eligible costs associated with the repatriation of your remains.
Terrorism
If you are in the wrong place at the wrong time, and the country or region you're visiting is NOT under a level 3 or higher travel advisory, Atlas Essential America offers coverage for eligible medical expenses resulting from those acts. Coverage excludes countries or regions for which the U.S. Department of State has issued a level 3 ("reconsider travel") or higher travel advisory in the 60 days prior to your arrival date.
Atlas Essential America* Quality Benefits
Hospitalization and Outpatient Treatment
If a covered illness or injury requires hospitalization, the plan provides coverage for costs associated with hospitalization, including intensive care unit and outpatient treatment.
Sports
Atlas Essential America includes coverage for eligible injuries and illnesses that could occur while participating in many popular vacation sports - skiing and snowboarding (recreational downhill and/or cross country), snorkeling, water skiing, and others - at no additional cost. Certain extreme sports are excluded from coverage.
*The description of coverage in these pages is for informational purposes only. Actual coverage will vary based the terms and conditions of the policy issued. The information described herein does not amend or otherwise affect the terms and conditions of any insurance policy issued by the administrator or its affiliates. In the event that a policy is inconsistent with the information described herein, the language of the policy will take precedence.
Atlas Essential America Schedule of Benefits and Limits
| Benefit | Limits |
|---|---|
| Deductibles | $0, $100, $250, $500, $1,000, $2,500, or $5,000 per certificate period. |
| Overall Maximum Limit Per Certificate Period | Age 80 or older - $10,000; Age 65 to 79 - $50,000, or $100,000; All others - $50,000, $100,000, $250,000, $500,000, or $1,000,000. |
| Coinsurance | Within the PPO: We will pay 70% of eligible expenses after the deductible to the overall maximum limit Outside the PPO: Usual, reasonable, and customary. You may be responsible for any charges exceeding the payable amount. |
| Eligible expenses are subject to deductible, coinsurance, overall maximum limit, and are per certificate period unless specifically indicated otherwise. | |
| Benefit | Limits |
| Hospital Room and Board | Average semi-private room rate, including nursing services. |
| Local Ambulance | Usual, reasonable and customary charges for covered illness or injury. Illness must result in hospitalization as inpatient. |
| Intensive Care Unit | Up to the overall maximum limit. |
| Emergency Room Co-payment | Claims incurred in the U.S. You shall be responsible for a $200 co-payment for the emergency room facility fee for each use of the emergency room for an illness unless you are admitted to the hospital. There will be no co-payment for emergency room treatment of an injury. Claims incurred outside the U.S. No co-payment |
| Urgent Care Center Co-payment | Claims incurred in the U.S. For each visit, the member shall be responsible for a $15 co-payment, after which coinsurance will apply. (not subject to deductible) - Co-payment waived if $0 deductible elected. Claims incurred outside the U.S. No co-payment |
| Terrorism | Up to $50,000 lifetime maximum, eligible medical expenses only. |
| Emergency Dental | Up to $300 (not subject to deductible). |
| All Other Eligible Medical Expenses | Up to the overall maximum limit. |
| Emergency Travel Benefits | Limits |
| Emergency Medical Evacuation | Up to $500,000 lifetime maximum (not subject to deductible, coinsurance, or overall maximum limit). |
| Repatriation of Remains | Up to $25,000 lifetime maximum (not subject to deductible, coinsurance, or overall maximum limit). |
| Local Burial or Cremation | Up to $5,000 lifetime maximum (not subject to deductible or coinsurance). |
Rates
Atlas Essential America ‐ For Non‐US Citizens traveling to the U.S.
| $0 Deductible | |||||
|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1,000,000 |
| Age | Daily | Daily | Daily | Daily | Daily |
| 14d-17y | $1.69 | $2.10 | $2.35 | $2.95 | $3.35 |
| 18-29 | $1.72 | $2.15 | $2.39 | $3.00 | $3.42 |
| 30-39 | $2.06 | $2.78 | $3.26 | $3.46 | $3.83 |
| 40-49 | $2.72 | $3.29 | $3.71 | $4.42 | $5.06 |
| 50-59 | $4.48 | $5.54 | $6.85 | $7.78 | $8.54 |
| 60-64 | $6.08 | $7.80 | $10.35 | $11.28 | $12.38 |
| 65-69 | $7.10 | $8.87 | N/A | N/A | N/A |
| 70-79* | $12.24 | $15.29 | N/A | N/A | N/A |
| 80+** | $18.18 | N/A | N/A | N/A | N/A |
*$100,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $100 Deductible | |||||
|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1,000,000 |
| Age | Daily | Daily | Daily | Daily | Daily |
| 14d-17y | $1.48 | $1.84 | $2.04 | $2.58 | $2.91 |
| 18-29 | $1.50 | $1.88 | $2.07 | $2.63 | $2.97 |
| 30-39 | $1.80 | $2.43 | $2.83 | $3.03 | $3.35 |
| 40-49 | $2.37 | $2.88 | $3.23 | $3.85 | $4.41 |
| 50-59 | $3.92 | $4.82 | $5.97 | $6.78 | $7.44 |
| 60-64 | $5.29 | $6.79 | $9.03 | $9.84 | $10.78 |
| 65-69 | $6.18 | $7.74 | N/A | N/A | N/A |
| 70-79* | $10.66 | $13.31 | N/A | N/A | N/A |
| 80+** | $15.83 | N/A | N/A | N/A | N/A |
*$100,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $250 Deductible | |||||
|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1,000,000 |
| Age | Daily | Daily | Daily | Daily | Daily |
| 14d-17y | $1.18 | $1.47 | $1.62 | $2.04 | $2.34 |
| 18-29 | $1.20 | $1.50 | $1.66 | $2.09 | $2.38 |
| 30-39 | $1.43 | $1.93 | $2.26 | $2.42 | $2.66 |
| 40-49 | $1.87 | $2.30 | $2.58 | $3.06 | $3.51 |
| 50-59 | $3.12 | $3.84 | $4.76 | $5.39 | $5.93 |
| 60-64 | $4.23 | $5.39 | $7.19 | $7.82 | $8.59 |
| 65-69 | $4.93 | $6.16 | N/A | N/A | N/A |
| 70-79* | $8.49 | $10.59 | N/A | N/A | N/A |
| 80+** | $12.59 | N/A | N/A | N/A | N/A |
*$100,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $500 Deductible | |||||
|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1,000,000 |
| Age | Daily | Daily | Daily | Daily | Daily |
| 14d-17y | $1.04 | $1.30 | $1.44 | $1.84 | $2.07 |
| 18-29 | $1.07 | $1.32 | $1.47 | $1.87 | $2.11 |
| 30-39 | $1.27 | $1.74 | $2.01 | $2.14 | $2.38 |
| 40-49 | $1.69 | $2.05 | $2.31 | $2.72 | $3.13 |
| 50-59 | $2.78 | $3.42 | $4.23 | $4.80 | $5.28 |
| 60-64 | $3.76 | $4.82 | $6.40 | $6.98 | $7.65 |
| 65-69 | $4.40 | $5.48 | N/A | N/A | N/A |
| 70-79* | $7.56 | $9.45 | N/A | N/A | N/A |
| 80+** | $11.23 | N/A | N/A | N/A | N/A |
*$100,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $1,000 Deductible | |||||
|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1,000,000 |
| Age | Daily | Daily | Daily | Daily | Daily |
| 14d-17y | $0.92 | $1.14 | $1.27 | $1.59 | $1.82 |
| 18-29 | $0.93 | $1.16 | $1.29 | $1.62 | $1.86 |
| 30-39 | $1.11 | $1.52 | $1.75 | $1.89 | $2.08 |
| 40-49 | $1.46 | $1.79 | $2.01 | $2.38 | $2.74 |
| 50-59 | $2.43 | $3.00 | $3.71 | $4.20 | $4.62 |
| 60-64 | $3.29 | $4.23 | $5.60 | $6.11 | $6.71 |
| 65-69 | $3.83 | $4.80 | N/A | N/A | N/A |
| 70-79* | $6.61 | $8.27 | N/A | N/A | N/A |
| 80+** | $9.82 | N/A | N/A | N/A | N/A |
*$100,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $2,500 Deductible | |||||
|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1,000,000 |
| Age | Daily | Daily | Daily | Daily | Daily |
| 14d-17y | $0.86 | $1.07 | $1.19 | $1.50 | $1.69 |
| 18-29 | $0.88 | $1.09 | $1.21 | $1.53 | $1.72 |
| 30-39 | $1.04 | $1.44 | $1.66 | $1.78 | $1.95 |
| 40-49 | $1.38 | $1.68 | $1.89 | $2.23 | $2.57 |
| 50-59 | $2.28 | $2.81 | $3.47 | $3.94 | $4.34 |
| 60-64 | $3.09 | $3.96 | $5.25 | $5.73 | $6.29 |
| 65-69 | $3.59 | $4.50 | N/A | N/A | N/A |
| 70-79* | $6.22 | $7.76 | N/A | N/A | N/A |
| 80+** | $9.21 | N/A | N/A | N/A | N/A |
*$100,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
| $5,000 Deductible | |||||
|---|---|---|---|---|---|
| Maximum Limit | $50,000 | $100,000 | $250,000 | $500,000 | $1,000,000 |
| Age | Daily | Daily | Daily | Daily | Daily |
| 14d-17y | $0.71 | $0.90 | $1.04 | $1.32 | $1.49 |
| 18-29 | $0.73 | $0.92 | $1.06 | $1.34 | $1.52 |
| 30-39 | $0.85 | $1.20 | $1.44 | $1.55 | $1.72 |
| 40-49 | $1.14 | $1.43 | $1.64 | $1.96 | $2.25 |
| 50-59 | $1.86 | $2.38 | $3.02 | $3.45 | $3.81 |
| 60-64 | $2.53 | $3.37 | $4.57 | $5.02 | $5.51 |
| 65-69 | $2.95 | $3.83 | N/A | N/A | N/A |
| 70-79* | $4.95 | $6.41 | N/A | N/A | N/A |
| 80+** | $7.56 | N/A | N/A | N/A | N/A |
*$100,000 Maximum Limit for ages 70-79; **$10,000 Maximum Limit for age 80 and over.
Rates are shown in US dollars and are effective 08/01/2024. Rates are subject to change. Rates will include Surplus Lines taxes and fees when applicable.
If for any reason you wish to cancel your policy, you must submit your cancellation request in writing to us in order to receive a refund or premium. Cancellation requests received after the policy effective date will be subject to the following conditions: 1) a $25 cancellation fee will apply; and 2) only the unused portion of the plan cost will be refunded; and 3) only members who have no claims are eligible for premium refund.
Administrator
WorldTrips4 Carter Green, Suite 400
Carmel, IN 46032
FOR ADDITIONAL INFORMATION
John F Stafford Insurance Agency Inc1000 N Main St
Fall River, MA 02720
United States
Phone: +1-5086735893
Fax:
+1-5086770792
Website: stafford.brokersnexus.com
This insurance is not subject to, and does not provide certain insurance benefits required by the United States' Patient Protection and Affordable Care Act ("PPACA"). PPACA requires certain US citizens or US residents to obtain PPACA compliant health insurance, or "minimum essential coverage." PPACA also requires certain employers to offer PPACA compliant insurance coverage to their employees. Tax penalties may be imposed on U.S. residents or citizens who do not maintain minimum essential coverage, and on certain employers who do not offer PPACA compliant insurance coverage to their employees. In some cases, certain individuals may be deemed to have minimum essential coverage under PPACA even if their insurance coverage does not provide all of the benefits required by PPACA. You should consult your attorney or tax professional to determine whether this policy meets any obligations you may have under PPACA.
The Atlas Series is underwritten by Lloyd's. WorldTrips is a service company and a member of the Tokio Marine HCC group of companies. WorldTrips has authority to enter into contracts of insurance on behalf of the Lloyd's underwriting members of Lloyd's Syndicate 4141, which is managed by HCC Underwriting Agency LTD.
Version:
KHE2FFFYH6SP-971744701-1242
08/01/2024