Lifeboat Medical Insurance provides worldwide coverage. As an international traveler, you will no longer have to purchase multiple insurance programs in order to have seamless coverage. Once enrolled, you will be covered worldwide, even in your country of residence.
Kuffel, Collimore & Company, and the Administrator – Seven Corners Inc., has designed LIFEBOAT Medical Insurance Plan for Yacht Society members, their employees and their dependents. Members include Full Member, Associate Member or Beneficiary Member.
Any member of the sponsoring society is eligible to apply. You can join as a Beneficiary Member for $25 per year. As a member, you, your dependents, and your employees may apply. You must be under age 75 and meet the underwriting requirements listed on the application.
To apply, complete the application, answering all questions, and mail to the Marketing Agent Kuffel, Collimore & Company along with the appropriate premium.
Dependents are the Primary Insured’s Spouse and natural or legally adopted unmarried children over 14 days old and under 19 years of age (or under 24 years of age if attending a university full time and relying on parents for support).
Insured persons must reside outside the United States* for at least 180 days out of any given 364 day policy period. The Plan does not cover permanent residents of the United States or green card holders while in the U.S. for more than 180 days per 346 day policy period.**
*United States is considered the 50 contiguous states including Alaska and Hawaii. U.S. territories (example: U.S. Virgin Islands) are considered outside the U.S. for purposes of this insurance.
**Alternate insurance plans are available.
Please contact Kuffel, Collimore & Company for further details.
SCHEDULE OF BENEFITS
A. Deductible and Coinsurance
When a covered ilness(es) or Injury(ies) is incurred by the Insured Person(s), the Company will pay for the Eligible Benefits in excess of the Deductible and Coinsurance as stated below.
Medical Benefits Deductible for each
Period of Coverage: Per Insured Person(s): Amount Stated on the ID Card
Per Insured Family Units: 3x per person (or max. 3 per family)
Eligible Benefit Percentage Payable after Deductible has been satisfied:
Eligible Benefits Incurred Outside the United States:
The Company pays 80% of the next $5,000 of Eligible Benefits and then 100% up to the Medical Maximum. All Hospital admissions and expenses above $1,000 must utilize the Pre-Notification program, see Section 4, M. Pre-Notification program. Each Insured Person(s) is responsible for the Coinsurance amount
Eligible Benefits Incurred Inside the United States:
The Company pays 60% of the next $5,000 of Eligible Benefits and then 100% up to the Medical Maximum. All Hospital admissions and expenses above $1,000 must utilize the Pre-Notification program, see Section 4, J. Pre-Notification program. Each Insured Person(s) is responsible for the Coinsurance amount
If the Insured Person(s) follow the Pre-Notification Program the maximum out of pocket expenses that and Insured Person(s) in the United States will be required to pay after satisfying their Individual Deductible is $2,000. The maximum out of pocket expenses that a family unit in the United States will be required to pay after satisfying their Family Deductible is $6,000.
B. Eligible Benefits and Maximum Limits
Subject to the Deductible and Coinsurance as described in SECTION 2, A, the Eligible Benefits and Maximum Limits for the following Benefits shall be as follows:
I. Medical Benefit
$5,000,000 Lifetime each Insured Person(s)
Subject to the Deductible and Coinsurance as described within Benefits II through V, the Eligible Benefits and Maximum Limits for Benefits II through V shall be as follows:
II. Mental and Nervous Benefit
$10,000 Coverage Period maximum after a 364-day waiting period. Inpatient limited to a maximum of 45 days per Coverage Period.
Outpatient Benefit limited to a maximum of 40 visits per Coverage Period at 70% (separate from overall Coinsurance) of Eligible Benefits.
Lifetime Maximum of $30,000
III. Chiropractic/Physiotherapy Benefit
IV. Dental Benefit (due to Accident only)
V. Transplant Benefit
$10,000 Lifetime benefit combined, limited to 12 visits per Coverage Period and $75 per visit. There is a 364-day waiting period for these benefits.
$500.00 per Coverage period subject to a $50.00 per occurrence Deductible.
$1,000,000 Lifetime Maximum. To cover Bone Marrow, Liver, Heart, Pancreas, Heart/Lung, Kidney/Pancreas, Lung
Benefits VI through IX are not subject to a Deductible or Coinsurance, the Eligible Benefits and Maximum Limits for Benefits VI through IX shall be as follows:
VI. Emergency Medical Evacuation Benefit
VII. Return of Mortal Remains Benefit
VIII. Emergency Medical Reunion Benefit
$50,000 per Coverage Period
$10,000 per occurrence
IX. Accidental Death and Dismemberment 24 Hour Accidental Death and Dismemberment
Insured and Spouse
$10,000 Principal Sum
$2,000 Principal Sum
Common Carrier Accidental Death and Dismemberment
Insured and Spouse
$40,000 Principal Sum
$8,000 Principal Sum
X. Amateur and Interscholastic Atheletic Benefit
$25,000 Lifetime, subject to a $5,000 Coverage Period Deductible.
A. Eligibility Requirements
For all Applicants /Insured Person(s): Primary and named Dependent Insured Person(s) must be at least 14 days old and have not yet reached their 75th birthday.
For US Citizens: Applicants / lnsured Person(s) must reside outside the United States at least one hundred and eighty (180) days during any given three hundred and sixty-four (364) day Certificate Period to meet the Eligibility Requirements of an Insured Person(s). Should any Insured Person(s) reside in the United States longer than one hundred and eighty (180) days during any given three hundred and sixty-four (364) day Certificate Period, their Coverage shall immediately terminate.
For Non-US Citizens: Applicants / lnsured Person(s) must reside outside the United States at least one hundred and eighty (180) days during any given three hundred and sixty-four (364) day Certificate Period to meet the Eligibility requirements of an Insured Person(s). Should any Insured Person(s) reside in the United States longer than one hundred and eighty (180) days during any given three hundred and sixty-four (364) day Certificate period, their Coverage shall immediately terminate.
It is the Insured Person(s)’s responsibility to maintain all records regarding travel history, age and student status and provide any documents to the Administrator, which would verify the Eligibility Requirements.
For Insured Person(s) who apply and are accepted for Coverage prior to their 65th birthday and remain continuously insured for ten consecutive years under this program, the Insured Person(s) will automatically be converted to the Lifeboat senior Provider upon the renewal date after their 75th birthday. This conversion is contingent upon the Insured Person(s) continuing to meet the Eligibility Requirements.
B. Individual Effective Date of Coverage
After review and Approval of each Applicant by the Administrator, Coverage will become effective on the later of the following dates: (1.) The date requested on the Application, (2.) The date the appropriate Premium and Application are received by the Administrator, or (3) The date the Applicant is Approved by the Administrator. The Insured’s ID Card will state the official Effective Date of Coverage, as issued by the Administrator.
C. Individual Termination Date of Coverage
Coverage will terminate upon the earlier of the following: (1.) The end of the period for which Premium has been paid, (2.) The date the Insured Person(s) fails to meet the Eligibility Requirements described in SECTION 3, A; (3.) The date the company cancels Coverage for a specific Class(es) of Insured Person(s), which the individual Insured Person(s) may be included.
A. Medical Benefit Exclusions
This Insurance does not cover any Treatment(s), Medication, charges or the consequences thereof, related to the following Exclusions, unless specifically included or modified on the Schedule of Benefits numbers I through VIII and number X in this Certificate. With regards to Medical Benefits, this Insurance does not cover expenses from, related to or in connection with:
1. Pre-Existing Conditions which are any Injury(ies) or IIIness(es) which meets the following criteria: 1) A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment(s) prior to the Individual Effective Date of Coverage under this Certificate; 2) A condition for which medical advice, diagnosis, care or Treatment(s), including Medication, was sought, recommended or received prior to the Individual Effective Date of Coverage under this Certificate; 3) the symptoms which occurred prior to the Individual Effective Date of the Coverage under this Certificate would have allowed a person trained in medicine to make a diagnosis of the condition producing the symptoms: 4) a condition which Manifest(ed) prior to the Individual Effective Date of Coverage under this Certificate;
2. Exclusionary Rider(s) may be issued by the Administrator, for certain Pre-Existing Conditions. Pre-Existing Conditions that are fully and accurately disclosed on the Application and Approved and accepted by the Administrator, without an Exclusionary Rider(s) or other restriction, will be covered up to a lifetime maximum of $50,000 ($5,000 limit per Period of Coverage) after the Insured Person(s) has been continuously insured for two (2) consecutive and continuous Coverage Periods (seven hundred and twenty-eight (728) days);
2. Charges for Treatment(s) ofthe following IIlness(es) or Surgery(ies), which Manifest(ed) themselves or are recommended, or symptoms occur during the first one hundred and eighty (180) days of Coverage hereunder beginning on the initial Effective Date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne related condition, or any Surgery(ies) that is not Emergency in nature, as Emergency is defined hereunder. Note: Coverage for such IIIness(es) or Surgery(ies) may be further limited under the Pre-existing Condition exclusion and definition contained herein, or other exclusions contained herein; 3. Injury(ies) or IIlness(es) which is not presented to the Company for payment within ninety (90) days. immediately following the Incident, which gave rise to the expenses;
4. Treatment(s), which is not Medically Necessary;
5. Services provided at no cost to the Insured Person(s);
6. Treatment(s), which exceed Reasonable and Customary charges;
7. Surgery(ies) or Treatment(s) which are Investigational, Experimental, or for Research purposes;
8. Services, supplies or Treatment(s), including any period of Hospital confinement, which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician(s);
9. Suicide or any attempt there atwhether the Insured Person(s) committing them is sane or insane;
10. War, hostilities or warlike operations (whether war be declared or not), Invasion, Act of an enemy foreign to the nationality of the Insured Person(s) or the country in, or over, which the act occurs, Civil war, Riot, Rebellion, Insurrection, Revolution, Overthrow of the legally constituted government, Civil commotion assuming the proportions of, or amounting to, an uprising, Military or usurped power, Explosions of war weapons, Utilization of Nuclear, Chemical or Biological weapons of mass destruction howsoever these may be distributed or combined, Murder or Assault subsequently proved beyond reasonable doubt to have been the act of agents of a state foreign to the nationality of the Insured Person(s) whether war be declared with that state or not, Terrorist activity;
For the purpose of this Exclusion;
i) Terrorist activity means an act, or acts, of any person, or group(s) of persons, committed for political, religious, ideological or similar purposes with the intention to influence any government and/or to put the public, or any section of the public, in fear. Terrorist activity can include, but not be limited to, the actual use of force or violence and/or the threat of such use. Furthermore, the perpetrators of terrorist activity can either be acting alone, or on behalf of, or in connection with any organization(s) or governments(s).
ii) Utilization of Nuclear weapons of mass destruction means the use of any explosive nuclear weapon or device or the emission, discharge, dispersal, release or escape of fissile material emitting a level of radioactivity capable of causing incapacitating disablement or death amongst people or animals.
iii) Utilization of Chemical weapons of mass destruction means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing incapacitating disablement or death amongst people or animals.
iv) Utilization of Biological weapons of mass destruction means the emission, discharge, dispersal, release or escape of any pathogenic (Disease(s) producing) micro-organism(s) and/or biologically produced toxin(s) (including genetically modified organisms and chemically synthesized toxins) which are capable of causing incapacitating disablement or death amongst people or animals. Also excluded hereon is any Loss(es) or expense of whatsoever nature directly or indirectly arising out of, contributed to, caused by, resulting from, or in connection with any action taken in controlling, preventing, or suppressing any, or all, of the situations described above. In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect;
11. Injury(ies) sustained while participating in professional athletics
12. Vaccinations, inoculations, routine physicals or other examinations where there are no objective indications of impairment in normal health, and laboratory diagnostic or x-ray examinations, except in the course of a Covered Event(s) established by a prior call or attendance of a Physician(s); unless otherwise covered under this Certificate; .
13. Treatment(s) of the Temporomandibular Joint (TMJ) or for maxillary and/or mandibular hypoplasia and/or hyperplasia;
14. Vocational, occupational, speech, recreational, or music therapy;
16. Services performed or supplies or Treatment(s) recommended or rendered by a Relative of the Insured Person(s) or any person who ordinarily resides with the Insured Person(s). This exclusion includes any Treatment(s)as the result of a referral to or by a Relative of the Insured Person(s) or any person who ordinarily resides with the insured, to another Physician(s);
16. Cosmetic or plastic Surgery(ies) and any related Hospital admission, except as the result of a covered Injury(ies). For the purposes of this Insurance, Treatment(s) of a deviated nasal septum shall be considered a cosmetic condition;
17. Treatment(s), purchase and fitting of false teeth or dentures and hearing aids;
18. Eye refractions or eye examinations for the purpose of prescribing corrective lenses or eye glasses or for the fitting thereof, and radial keratotomy, unless caused by Accidental bodily Injury(ies) incurred while insured hereunder;
19.. Injury(ies) sustained while under the influence of or disablement due to wholly or partly to the effects of intoxicating liquor or drugs, other than drugs taken in accordance with Treatment(s) prescribed and directed by a Physician(s) for a condition which is covered hereunder, but not for the Treatment(s) of drug addiction;
20. Telephone Consultation(s) or failure to keep a scheduled appointment; 21. Treatment(s) while confined primarily to receive Custodial Care, Educational or Rehabilitative Care and nursing services in a long term care facility, spa, hydroclinic, weight loss clinic, sanatorium, nursing home or similar facilities; .
22. Congenital abnormalities and conditions arising out of or resulting therefrom; unless otherwise covered under this Certificate;
23. Services and supplies, which are non-medical in nature;
24. The Insured Person(s)’s unused airline ticket for the transportation back to the Insured Person(s)’s Home Country, where an Emergency Medical Evacuation or Repatriation and/or Return of Mortal Remains benefit is provided;
25. Intentionally self-inflicted Injury(ies) or Illness(es) whether the Insured Person(s) committing them is sane or insane;
26. Commission or attempt to commit a felony offense or from the Insured Person(s) being engaged in an illegal occupation or activity;
27. Injury(ies) sustained while taking part in mountaineering where ropes or guides are normally used, hang gliding, parachuting, bungee jumping, racing by horse, motor or motorcycle, scuba diving, involving underwater breathing apparatus – unless PADI, NAUI, YMCA, SSI or PDIC certified;
28. Treatment(s) paid for or furnished under any other individual or group policy or other service or medical prepayment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for Treatment(s) without cost to any individual;
29. Injury(ies) for which benefits are payable under any no-fault automobile insurance policy;
30. Treatment(s) of venereal disease, sexually transmitted disease, or expenses for a sex change;
31. Routine Dental Treatment(s) and services for Dental care of the teeth or periodontium or the surrounding tissue or structure, except as the result of Injury(ies) to sound, natural teeth caused by Accident;
32. Pregnancy expenses, including Complications of Pregnancy;
33. Treatment(s), Medications or procedures that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, in vitro fertilization, gamete intra fallopian transfer(GIFT), Treatment(s) for infertility or impotency, sterilization or reversal thereof, or abortion;
34. Treatment(s) in connection with alcoholism and drug addiction, or use of any drug or narcotic agent
35. Any Mental and Nervous disorders or rest cures, unless otherwise covered in this Certificate;
36. Treatment(s) which is incurred by Insured Person(s) who were HIV Positive at the time of Application for this Insurance, or testing for the following: HIV, seropositivity to the AIDS virus, AIDS related IIIness(es), ARC Syndrome, or AIDS;
37. Treatment(s) for the AIDS virus, AIDS related IIIness(es), ARC Syndrome, AIDS, and/or any Illness(es) arising as complications from these conditions;
38. Treatment(s) for Chronic Fatigue Syndrome, including but not limited to diagnostic workups.
39. Service or Treatment(s) for any form of food supplement or augmentation or for any program for weight control, whether for obesity or any diagnosis, by diet, injection of any fluid, or use of any Medications or Surgery(ies) of any kind including but not limited to gastric bypass, gastric stapling. or gastroplastyprocedures whether or not in connection with morbid obesity. Additionally, procedures for removal of excess skin are considered cosmetic and are excluded from Coverage;
40. Chiropractic care, unless otherwise covered under this Certificate;
41. Purchase or rental of durable medical equipment outside of a Hospital, including but not limited to wheelchairs, crutches, oxygen tanks and walkers;
42. Land and/or sea rescues;
43. Treatment(s) for IIIness(es) or Injury(ies) resulting from or in the course of any employment for wage or profit by the Insured Person(s);
44. Treatment(s), services and supplies for flat feet, fallen arches, corns, bunions, callouses and care of toenails;
45. Treatment(s), services and supplies for Convalescent, Hospice and Home Health Care which exceed 30 days in duration for anyone Incident;
46. Newborn Child(ren) who are not Approved by the Administrator;
47. Occupational Diseases, including but not limited to Disease(s) related to asbestos exposure, and the complications thereof, including asbestosis and mesothelioma related to asbestos exposure