| Eligibility Requirements: |
| The Atlas Series is available to you if you are at least 14 days old and traveling outside of your home country. If you are a US citizen, your home country is always the United States, regardless of the location of your principal residence. If you are not a US citizen, home country is the country where you principally reside and receive regular mail. |
| Enter only individuals who will be traveling. It is not necessary to enter family members who will not be traveling. The Atlas Series is not available to individuals who are physically located in the states of New York, Maryland, or Washington; or in the countries of Canada or Australia at time of purchase. |
| Will your trip include the U.S. or U.S. territories as a destination country? |
| If you are a non-U.S. citizen and non-U.S. resident and any part of your travel includes the U.S., you must answer “Yes” to this question. |
| U.S. Territories – Major U.S. territories include Puerto Rico and the U.S. Virgin Islands. You may answer “No” to this question for travel that includes Guam, American Samoa, and Northern Mariana Islands. |
| Layovers – If you are a US citizen or U.S. resident with a layover in the U.S. prior to your departure from the U.S., your coverage will begin when you depart the U.S. You should answer “No” to this question. If you are a non-U.S. citizen or non-U.S. resident and your travel will include a layover in the U.S., you should answer “Yes” to this question. |
| Incidental Trips Home – For each three (3) months during which a Member is covered hereunder, medical expenses are only covered during incidental trips totaling no more than 15 days duration per three-month period of coverage. Incidental visit time must be used within the three-month period earned, and the Member must continue his or her international trip in order to be eligible for this benefit. Return to the Member’s home country must not be taken for the purpose of obtaining treatment of an illness or injury that began while traveling. U.S. citizens whose travel will include an incidental trip to the U.S. may answer “No” to this question. |
| Coverage Start Date and Coverage End Date |
| Your coverage becomes effective on the latest of: the date we receive your application and correct premium, the moment you depart from your home country, or the date you request on your application. |
| Your coverage will end on the earliest of: the end of the period for which you have paid a premium, the date requested on your application, or the moment of your arrival upon return to your home country (unless you have started a benefit period or are eligible for home country coverage). |
| Coverage Amount |
| The maximum amount of all benefits, except for Emergency Medical Evacuation, Accidental Death and Dismemberment and Common Carrier Accidental Death. |
| Optional Crisis Response Benefit Rider |
| This rider allows you to purchase an additional $90,000 in Crisis Response coverage. As Atlas Travel provides $10,000 in Crisis Response coverage in the base plan, purchasing this rider would increase the total Crisis Response benefit to $100,000. |
| Base CR Coverage |
Additional CR Coverage Available |
Total CR Coverage Amount |
| $10,000 |
$90,000 |
$100,000 |
|
| Optional Personal Liability Benefit Rider |
| This rider allows you to purchase an additional $90,000 in Personal Liability coverage. As Atlas Travel provides $10,000 in Personal Liability coverage in the base plan, purchasing this rider would increase the total Personal Liability benefit to $100,000. |
| Base PL Coverage |
Additional PL Coverage Available |
Total PL Coverage Amount |
| $10,000 |
$90,000 |
$100,000 |
|
| Optional Accidental Death & Dismemberment Benefit Rider |
| This rider, available to Members age 18 to 69, allows purchase of additional Accidental Death and Dismemberment (AD&D) coverage. Coverage may be increased to equal the medical maximum coverage amount. The AD&D benefit is not subject to the overall policy maximum. |
| Accidental Death and Dismemberment coverage provides benefits in the event of your death or loss of limb due to an accident. It does not cover certain activities and conditions, as listed in the policy. |
| As Atlas Travel provides $50,000 in AD&D coverage to Members age 18 to 69 in the base plan, this rider would increase the total AD&D benefit to $100,000. |
| Base AD&D Coverage |
Additional AD&D Coverage Available |
Total AD&D Coverage Amount |
| $50,000 |
$50,000 |
$100,000 |
|
| Deductible |
| The dollar amount of eligible expenses that the Member must pay per certificate period before the plan begins to pay covered expenses. |
| Passport |
| If you require a confirmation of coverage letter and wish for your passport number to be included, you may enter it in the field provided. After purchasing your policy, the letter will be available for download in PDF format through HCCMIS’s Client Zone at https://zone.hccmis.com/clientzone. If you do not have your passport number available at this time, you may enter it in Client Zone prior to downloading the document. |
| Citizenship |
| The legal status of being a citizen of a country. |
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