Emergency Accident & Health Benefit Plan For Visitors From Abroad

What is covered?

Benefits for Medical Expenses
If injury or illness occurs during the period of coverage and you or your covered dependents require medical and surgical treatment, the Plan will pay (subject to co-insurance and deductible) reasonable and customary charges for the following covered expenses, up to the selected Plan’s maximum. The covered charges shall in no event include any amount, which is in excess of reasonable and customary charges for the geographical area where the services are rendered, as determined by the LRFA, Inc. Benefits payable under this plan may not be assigned. Charges must be from a licensed physician or an accredited medical facility to be eligible for benefits. LRFA may require documentation prior to payment.

Covered Expenses:

1. Hospital room and board charges, up to the most common semi-private daily room rate, for each day of the hospital stay.
2. Intensive Care Unit charges, up to 2 times the most common semi-private daily room rate, for each day in ICU.
3. Hospital Miscellaneous Charges, during a hospital stay, up to the daily benefit for hospital room and board. Miscellaneous charges do not include charges for telephone, radio or television, extra beds, meals for guests, or other convenience items.
4. Outpatient charges, by a Hospital for:
   • A. pre-admission testing - confinement must occur within 7 days of the testing, or
   • B. emergency room treatment.
5. Surgical charges for:
   • A. physician, for primary performance of a surgical procedure,
   • B. physician, for assistant surgeon duties, a second surgical opinion, or consultation,
   • C. anesthesia and its administration,
   • D. use of surgical facilities.
6. Charges by a physician for other than pre- or post-operative care:
   • A. for home visits,
   • B. for office visits.
7. Charges for x-ray and laboratory tests.
8. Charges for physiotherapy services performed by a licensed chiropractor or licensed physiotherapist if referred by a licensed physician. Total treatment per injury or sickness not to exceed $50.00 and not to exceed 5 treatments for any one injury or sickness.
9. Ambulance from the place where the injury or sickness occurred to the hospital, up to the maximum benefit of $100.00.
10. Charges for medical services and supplies for:
    • A. oxygen and its administration,
    • B. blood and blood transfusions.

Accidental Death & Dismemberment Benefit
If injuries result directly in death or dismemberment within twelve months of the date of the accident, the Plan will pay for loss as follows:

Only one amount, the largest to which the covered person is entitled, is paid for all losses resulting from one accident.

Plan A - Maximum Benefit amount $30,000.00
Plan B - Maximum Benefit amount $50,000.00

These pages are designed to provide general descriptions of our benefit plans and further restrictions may apply or may have changed. For further information, please contact the LRFA office or refer to specific plan Regulations.