International Exchange Center - 2021 Group Brochure Group Number: FSG21-210301-01TM - Amazon AWS
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International Exchange Center
2021 Group Brochure
Group Number: FSG21-210301-01TM
Seven Corners 24-Hour Assistance
Toll Free: 1-800-690-6295
Direct: +1 317-818-2808 (Collect)
or via email at: assist@sevencorners.com
Page 1 of 5Using Your Insurance
If you need to seek medical treatment, please follow these basic guidelines:
1. Seek care appropriately for the condition/situation that you are experiencing.
CLAIMS
When you seek care from within
2. Choose an in-network medical provider to make billing easier.
the plans network and provide
3. Follow up with any claims, these are your responsibility!
your ID card at the time of
treatment, your claims will be sent
Further information about seeking care is below:
to the claims team directly for
processing.
NON-EMERGENCY CARE For claims outside of the network
If you do not have a medical emergency, you SHOULD go to a walk-in
clinic or local doctor who can assist you with your medical needs. or any prescription medications,
You SHOULD NOT go to the Emergency Room (ER). you will need to pay the provider,
and then submit your itemized bills
You can call the assistance team prior to receiving any treatment and and receipts to the claims team for
they will assist in locating a medical provider, or you can visit the online processing.
provider search tool in your student zone. Examples of non-emergency
care include cold, flu, minor injuries and sickness. We recommend submitting a claim
form for each new injury/illness to
speed up processing.
EMERGENCY CARE
The Emergency Room (ER) is designed for medical emergencies. If you You can download a copy of the
need emergency care for any reason, please get to the nearest claim form from the student zone
Emergency Room (ER) or call the emergency services (911 in the USA) and submit it with your receipts to:
for immediate treatment.
claims@sevencorners.com
As with anything, we ask you to use your judgment with a situation. If
you feel you need immediate emergency attention, please do not delay or by mail or fax to:
and go straight to the Emergency Room. However if you are unsure, or Seven Corners, Inc.
your condition is not severe, then either call the emergency services for 303 Congressional Blvd
assistance or visit a local doctor, urgent care center or walk-in clinic in Carmel, IN 46032
your area. Fax 317-575-2659
Please Note – an additional $250 Deductible will apply for each
Emergency Room visit for an illness which does not result in a direct
Hospital admission. Injuries are not subject to the deductible STUDENT ZONE
The student zone is your one-stop
resource for information, advice
ID CARD and assistance with your insurance
It is extremely important that you carry your insurance ID card with you plan.
at all times as this will identify to the provider treating you who your
insurance is with. Your ID card will be given to you before you travel • Video Overviews
and should be kept with you at all times. • Healthcare Tips
• Seeking Treatment
• Provider Search
PROVIDERS • Claim Forms
You can search for providers online in your student zone, or you may • Claims Tracking
seek treatment from any provider you wish to visit. In-network • MyDocuments
providers will be able to submit your claims directly to the claims team
for processing, however when you seek care outside of the network,
you will need to pay for these services upfront and submit for
https://egi.zone/iec
reimbursement.
If you have been hospitalized, you need to contact the assistance team
as soon as possible so they can monitor your medical care and
arrange direct payment to the hospital.
Page 2 of 5Benefit Summary
Plan Benefits Coverage Amount
US Coverage Included
Lifetime Maximum $100,000
Medical Maximum $100,000 per person, per occurrence
Deductible $200 per person, per occurrence
ER Deductible $300 for illness and not admitted
After You pay the Deductible, the plan pays 80% of the next $5,000 of
Coinsurance
eligible expenses, then 100% to the selected Medical Maximum.
Outpatient Medical Expenses Usual, Reasonable, and Customary to the medical maximum
Hospital Room and Board Usual, Reasonable, and Customary to the medical maximum
Intensive Care Usual, Reasonable, and Customary to the medical maximum
Local Ambulance $5,000
Dental (Accident Coverage) To a maximum of $500
Dental (Sudden Relief of Pain) To a maximum of $250
Emergency Medical Evacuation/ Repatriation $50,000 (in addition to medical maximum)
Return of Mortal Remains $25,000
Terrorism $50,000
Assistance Services Included
Benefit Period 180 days
Page 3 of 5Plan Exclusions
No Benefit shall be payable for Accident Medical, Sickness Medical, Dental, Emergency Medical Evacuation/Repatriation, Return of Mortal
Remains, Emergency Medical Reunion, as the result of:
1. Pre-existing Conditions which are excluded under this policy. the situations described above. In the event any portion of
This means that any claims for Pre-existing Conditions will not this exclusion is found to be invalid or unenforceable, the
be covered for the duration of this policy. This exclusion does remainder shall remain in full force and effect;
not apply to Emergency Evacuation/Repatriation or Return of 10. Terrorist Activity. For the purpose of this Exclusion, Terrorist
Mortal Remains. Activity means an act, or acts, of any person, or group(s) of
2. Injury or Illness which is not presented to the Underwriter for persons, committed for political, religious, ideological or similar
payment within ninety (90) days of receiving Treatment; purposes with the intention to influence any government and/
3. Charges for Treatment which is not Medically Necessary; or to put the public, or any section of the public, in fear.
4. Charges provided at no cost to You; Terrorist Activity can include, but not be limited to, the actual
5. Charges for Treatment which exceeds Reasonable and use of force or violence and/or the threat of such use.
Customary charges; Furthermore, the perpetrators of terrorist activity can either be
6. Charges incurred for Surgery or Treatments which are, acting alone, or on behalf of, or in connection with any
Experimental/Investigational, or for research purposes; organization(s) or governments(s). The Company shall not be
7. Services, supplies or Treatment, including any period of liable for and will not provide coverage or benefits in excess of
Hospital confinement, which were not recommended, the maximum stated in the SCHEDULE OF BENEFITS for any
approved and certified as Medically Necessary and reasonable claim or charges, Illness, Injury or other consequence, whether
by a Physician; directly or indirectly, proximately or remotely occasioned by,
8. Suicide, or any attempt thereof, while sane or self-destruction contributed to by, or traceable to or arising in connection with
or any attempt thereof, while sane; any act of Terrorism; and provided, further, the Company shall
9. War, hostilities or warlike operations (whether war be declared not be liable for and will not provide any coverage or benefits
or not), Invasion, Act of an enemy foreign to the nationality of for any claim, charges, Illness, Injury or other consequence,
the Insured whether directly or indirectly, proximately or remotely
Person or the country in, or over, which the act occurs, Civil occasioned by, contributed to by, or traceable to or arising in
war, Riot, Rebellion, Insurrection, Revolution, Overthrow of the connection with the following:
legally constituted government, Civil commotion assuming the 10.1. The Insured Person’s direct or indirect involvement in
proportions of, or amounting to, an uprising, Military or the Terrorist Activity.
usurped power, Explosions of war weapons, Utilization of 10.2. The Terrorist Activity takes place in a country or
Nuclear, Chemical or Biological weapons of mass destruction location where the United States government has
howsoever these may be distributed or combined, Murder or issued a Level 3 Terrorism, Level 3
Assault subsequently proved beyond reasonable doubt to Civil Unrest or any Level 4 Travel Advisory that has
have been the act of agents of a state foreign to the nationality been in effect within the six (6) months prior to the
of the Insured Person whether war be declared with that state Insured Person’s date of arrival.
or not. For the purpose of this Exclusion; 10.3. The Insured Person unreasonably fails or refuses to
9.1. Utilization of Nuclear weapons of mass destruction depart a country or location following the date a
means the use of any explosive nuclear weapon or warning to leave that country or
device or the emission, discharge, dispersal, release or location is issued by the United States government.
escape of fissile material emitting a level of radioactivity 11. Injury sustained while participating in professional athletics,
capable of causing incapacitating disablement or death including but not limited to the event, games, practice,
amongst people or animals. conditioning and any other activity related to professional
9.2. Utilization of Chemical weapons of mass destruction athletics.
means the emission, discharge, dispersal, release or 12. Injury sustained while participating in amateur or
escape of any solid, liquid or gaseous chemical interscholastic athletics, including but not limited to the event,
compound which, when suitably distributed, is capable games, practice, conditioning and any other activity related to
of causing incapacitating disablement or death amateur or interscholastic athletics, unless otherwise covered
amongst people or animals. under this certificate; this exclusion does not apply to non-
9.3. Utilization of Biological weapons of mass destruction competitive, recreational or intramural activities. Note: A
means the emission, discharge, dispersal, release or sponsored and/or organized Amateur or Interscholastic
escape of any pathogenic (disease producing) micro- Athletic event includes training camps, team sports, or any
organism(s) and/or biologically produced toxin(s) formal grouping of people participating in one or multiple
(including genetically modified organisms and events that may/may not require a fee for participation.
chemically synthesized toxins) which are capable of 13. Routine physicals, immunizations or other examinations where
causing incapacitating disablement or death amongst there are no objective indications or impairment in normal
people or animals. health, and laboratory diagnostic or x-ray examinations,
Also excluded hereon is any Loss or expense of whatsoever except in the course of a Disablement established by a prior
nature directly or indirectly arising out of, contributed to, call or attendance of a Physician;
caused by, resulting from, or in connection with any action 14. Treatment of the temporomandibular joint;
taken in controlling, preventing, or suppressing any, or all, of 15. Vocational, speech, recreational or music therapy;
Page 4 of 516. Services or supplies performed or provided by a Relative of 29. Treatment paid for or furnished under any other individual or
Yours, or anyone who lives with You; group policy or other service or medical pre-payment plan
17. Cosmetic or plastic Surgery, except as the result of a covered arranged through the employer to the extent so furnished or
Accident; for the purposes of this plan, treatment of a deviated paid, or under any mandatory government plan or facility set
nasal septum shall be considered a cosmetic condition; up for Treatment without any cost to You;
18. Elective Surgery which can be postponed until You return to 30. Treatment and or diagnosis of venereal disease;
Your Home Country, where the objective of the trip is to seek 31. Dental care, except as the result of Injury to natural teeth
medical advice, Treatment or Surgery; caused by Accident, unless otherwise covered under this plan;
19. Treatment and the provision of false teeth or dentures, normal 32. Routine Dental Treatment;
ear tests and the provision of hearing aids; 33. Pregnancy or Illness resulting from Pregnancy, childbirth, or
20. Eye refractions or eye examinations for the purpose of miscarriage;
prescribing corrective lenses for eyeglasses or for the fitting 34. Miscarriage resulting from Accident;
thereof, unless caused by Accidental bodily Injury incurred 35. Drug, treatment or procedure that either promotes or prevents
while covered hereunder; conception, or prevents childbirth, including but not limited to:
21. Treatment in connection with alcohol, drug or chemical abuse, artificial insemination, treatment for infertility or impotency,
misuse, illegal use, overuse or dependency or use of any drug sterilization or reversal thereof;
or narcotic agent; 36. Treatment for human organ tissue transplants and their related
22. Injury sustained or Disablement due wholly or partly to the treatment;
Insured being intoxicated as defined and determined by the 37. Expenses incurred while in Your Home Country;
laws of the state where the Injury occurred; or to the Insured 38. Covered Expenses incurred for which the Trip to the Host
being under the influence of any narcotic, unless administered Country was undertaken to seek medical treatment for a
on the advice of a Physician; condition;
23. Any Mental and Nervous disorders or rest cures; 39. Covered Expenses incurred during a Trip after Your Physician
24. Congenital abnormalities and conditions arising out of or has limited or restricted travel;
resulting there from; 40. This plan does not insure against loss or damage (including
25. Expenses which are non-medical in nature; death or Injury) and any associated cost or expense resulting
26. Expenses as a result of or in connection with intentionally self- directly from the discharge, explosion or use of any device,
inflicted Injury or Illness; weapon or material employing or involving nuclear fission,
27. Expenses as a result of or in connection with the commission nuclear fusion or radioactive force, or chemical, biological,
of a felony offense; radiological or similar agents, whether in time of peace or war,
28. Injury sustained while taking part in mountaineering, hang and regardless of who commits the act.
gliding, parachuting, bungee jumping, racing by any animal or 41. Sex change operations, or for treatment of sexual dysfunction
motor vehicle or motorcycle, snowmobiling, motorcycle/motor or sexual inadequacy;
scooter riding, scuba diving involving underwater breathing 42. Weight reduction programs or the surgical treatment of
apparatus (unless PADI or NAUI certified), water skiing, snow obesity;
skiing and snowboarding (except for recreational downhill and/ 43. Expenses resulting from Acquired Immune Deficiency
or cross country snow skiing or snowboarding. No cover Syndrome (AIDS), Aids-Related Complex (ARC) or the Human
provided while skiing/boarding in any violation of applicable Immunodeficiency Virus (HIV)
laws, rules or regulations, away from prepared and market in- 44. Treatment for learning disabilities, altitudinal disorders, or
bound territories; and/or against the advice of the local ski disciplinary problems;
school or local authoritative body); and any sport or athletic 45. Expenses for Durable medical equipment.
activity which is undertaken for thrill seeking and exposes the
insured to abnormal or extreme risk of injury;
Please note: this brochure is a consolidated summary of the plan benefits, the official policy certificate is available in your
student zone and will be the overriding document for claims adjudication. Any discrepancies between this brochure and the
policy certificate, the policy certificate will override this brochure.
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