CitizenSecure Health Insurance

What Are the Plan Features?

Pre-existing Conditions:

If your Pre-existing Conditions have been fully disclosed on your Application and not excluded or restricted by a Rider or any other provision of your Certificate, your Pre-existing Conditions are covered the same as any other Illness or Injury as of your effective date. Pre-existing Conditions include any Injury, Illness or Mental Health Disorder that existed at or prior to your initial effective date, including chronic or recurring conditions.

What Are the Exclusions and Limitations?

The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:

• Charges not incurred during the certificate period
  
• Services or treatment payable by another insurance or government
  
• Substance abuse
  
• Charges which exceed usual, reasonable and customary
  
• Investigational or experimental surgeries or treatment
  
• Custodial, educational or rehabilitative care
  
• Weight modification
  
• Cosmetic surgery, unless reconstructive surgery is directly relating to a covered Injury or Illness
  
• Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
  
• Individuals HIV+ at effective date
  
• Charges relating to congenital conditions
  
• Drugs or treatment for sexual dysfunction
  
• Drugs or treatment to promote or prevent conception
  
• Devices or procedures to correct sight or hearing
  
• Self inflicted injury or illness
  
• Foot care, unless related to a covered accidental injury
  
• Treatment or supplies not ordered by a Physician or not Medically Necessary, except for Wellness Benefits provided under the plan
  
• Organ transplants, except for covered transplants
  
• Speech, acupuncture, occupational or sleep therapy
  
• Acts of terrorism, war, insurrection, riot or any variation thereof
  
• Dental treatment, except emergency treatment following covered accident, or unless Dental Rider is purchased

The following are excluded from the Optional Dental Rider:

• Orthodontia
• Sealants, Bleaching and oral hygiene expenses

This is a summary of the exclusions contained in the Certificate of Insurance. See the Certificate of Insurance for a complete list of exclusions.

Special Illiness Exclusion:

The following conditions which manifest themselves within the first 180 days of coverage are excluded: Any condition of the breast, prostate, reproductive system, tonsils, adenoids, hemorrhoids, hernia, gallstones, kidney stones, glaucoma, cataracts, disk disease, varicose veins, all types of cysts, arthritis, and repetitive motion disorders, and any disorder or disease of the skin.

Wellness:

After 12 months of continuous coverage, you may be eligible for Wellness benefits that are not subject to the Deductible. If you are at least 30 years of age, you will be entitled to the following Wellness benefit: $250 per Certificate Period for a Routine Physical Exam, including OB/GYN visits for females. Additionally, females who are at least 40 years of age will be entitled to the following benefit: $100 per Certificate Period for a screening mammogram. If you are under the age of 19, you will be entitled to the following Wellness benefit: $50 per visit (including immunizations) with a maximum of three visits per Certificate Period.

Emergency Medical Evacuation:

CitizenSecure provides coverage for Emergency Medical Evacuation to the nearest medical facility qualified to treat your life-threatening condition or potential loss of limb. All Emergency Medical Evacuations must be approved in advance and coordinated by HCCMIS. Emergency Medical Evacuations provide you with access to care when you need it most. HCCMIS is available 24 hours a day, 7 days a week, to approve and coordinate Emergency Medical Evacuations.

Emergency Reunion:

In the event of a covered Emergency Medical Evacuation, CitizenSecure will provide the following benefits: the cost of an economy round-trip air and/or ground ticket for one of your Relatives (parent, spouse, sibling or child age 18 or above) for travel to the area where you are hospitalized following an Emergency Medical Evacuation and reasonable expenses for lodging and meals for your Relative for a period not to exceed 15 days.

Repatriation of Remains:

In the event of a covered Injury or Illness resulting in your death, the plan will provide the following benefit: air and/or ground transportation of bodily remains or ashes to the area of your principal residence and reasonable cost of preparation of the remains necessary for transportation.
 

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Be sure to always carry your personal doctor's name and contact information (phone and fax numbers) with you when traveling abroad.

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CitizenSecure Senior Plan

Eligibility for the standard CitizenSecure plan ends at age 75, but for those members who joined before age 65 and have maintained coverage for at least 10 years, the CitizenSecure Senior Plan is available with no medical questions. The CitizenSecure Senior Plan offers many of the same benefits and limits as the standard CitizenSecure plan. The Senior Plan deductibles available are $5,000, $7,500, and $10,000. On the Senior plan, the Overall Maximum Limit is reduced to $1 million. Additionally, the Human Organ Transplant and Emergency Medical Evacuation benefits are deleted.

Pre-certification

CitizenSecure plans require Pre-certification, which simply means that you must contact HCCMIS as soon as possible before a planned hospitalization or surgical procedure, within 48 hours of an emergency hospital admission, or within the first 90 days of pregnancy. Pre-certification allows us to establish contact and make payment arrangements with your providers, negotiate discounts which will benefit both you and us, pre-arrange future care, and plan for your claim. Pre-certification helps us help you.

Optional Dental Rider

If you purchase the Optional Dental Rider, children age 9 to 16 are covered for Preventative Dental Benefits, including routine oral exams every 6 months, fluoride treatment every 12 months and bitewing x-rays every 24 months. All covered family members receive Basic and Major Dental Benefits. Basic Benefits include periodontics, endodontics, extractions and fillings. Major Benefits include crowns, bridges and dentures. The CitizenSecure Optional Dental Rider is useful for families as well as individuals. Coverage is provided in most countries of the world at your choice of dentists.

Optional Sports Rider

The Optional Sports Rider provides additional coverage for your extreme sports lifestyle. Whether your interests include mountaineering, skydiving, or whitewater rafting, electing the Sports Rider option will add coverage up to a lifetime maximum of $25,000 for these activities excluded by the standard plan. Coverage for Contact Sports, such as soccer or hockey, is added up to a lifetime maximum of $5,000. The Sports Rider adds coverage for sports and athletics except those activities engaged in for wage, reward, or profit.

Optional Term Life and AD&D Insurance

If you reside outside the US, you may be able to purchase the Optional Term Life and Accidental Death and Dismemberment insurance to protect your family and provide cash benefits in the event of your death. The amount of coverage under Option 1 ranges from $5,000 to $50,000, depending on your age at the time of your death or dismemberment. If you are at least 19, but not yet 65, you may purchase Option 2 coverage, which doubles the benefits available to you.


What Travel Assistance Services are Included:

The following Travel Assistance Services are available to you 24 hours a day, 7 days a week while your CitizenSecure plan is in effect.
Pre-trip Destination Information (available after your purchase of the CitizenSecure Series, but before your departure) – Up-to-date information regarding the required vaccinations, health risks, travel restrictions, and weather conditions specific to your destination country.
Provider Referrals Contact information for Western-style medical facilities and medical and dental practices and pharmacies in your destination country where English is spoken.
Lost Luggage Assistance Tracking service to assist in locating luggage or other items lost in transit.
Travel Document Replacement Assistance with obtaining replacement passports, birth certificates, visas, airline documents, and other travel-related documents.
Medical Monitoring Consultations with attending medical professionals during your hospitalization and establishment of a single point-of-contact for family members to receive ongoing updates regarding your medical status.

Other important CitizenSecure Travel Assistance Services include:

• Assistance with prescription drug replacement
• Dispatch of a physician
• Emergency travel arrangements
• Embassy and consulate referrals
• Legal and accounting referrals
• Bail bond assistance
• Credit Card/Traveler Check Replacement
• Translation and interpretation assistance

CitizenSecure Travel and Medical Assistance Services are not insurance benefits. Any Assistance Service provided is not a guarantee of any other benefit under the CitizenSecure Series.

Client Zone: Login to your own control panel

Client Zone is an online account management and resource tool that allows you to:

• Change personal information
• Renew coverage and reprint ID cards
• Obtain details about claim filing, including downloading necessary forms
• Pre-certify for certain medical procedures and hospitalizations
• Locate providers within the PPO Network
• Study destination, weather and travel security information using our Travel Intelligence and Planning System (TIPS)
• Access health and wellness information
• View and download brochures, obtain policy information, or get quotes for other products

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CitizenSecure overseas insurance plans feature low cost premiums with excellent health benefits and coverage. If you live or work overseas, be sure you are well protected by a good overseas insurance plan.

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