Overview
There are an increasing number of global citizens, people who reside or travel outside of their home country. Seven Corners has developed the Reside Prime and Reside plans to address the global medical needs of these unique people. Healthcare can vary from country to country and having the ability to seek care worldwide provides added comfort in knowing Seven Corners health insurance is portable.
Plan Features
Global Coverage (Both Plans) – Coverage is available worldwide including the United States.
International Provider Access (Both Plans) – Members can log onto Seven Corners website and request an international provider search.
Hygeia PPO Network inside the U.S. (Both Plans) – Seven Corners uses the Hygeia network in the U.S. The network has approximately 400,000 physicians, 4,000 medical facilities and 150 Centers of Excellence contracted.
Preexisting Condition Coverage (Reside Prime) – The Reside Prime plan provides up to $50,000 ($5,000 per year) of lifetime coverage, after 24 months of continuous coverage, if an existing medical condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by an exclusionary rider.
Up to Six Months U.S. Residency (Both Plans) – You may reside in the U.S. up to 6 months out of a 12 month policy period, or up to the renewal date, whichever is first.
Rx Coverage (Both Plans) – Limited prescription drug coverage is offered under both plans.
Maternity Benefits (Both Plans) – Maternity coverage is included in both plans but the coverage is limited to $2,500 in U.S and $4,000 outside of the U.S. per delivery with the Reside plan. The Reside Prime offers a $1,000 benefit that is increased $1,000 per year to a maximum of $5,000. Both plans also have a 12-month waiting period for maternity. Pre-certification is required
Travel & Medical Assistance (Both Plans) – For traveling abroad, Seven Corners can assist with; Pre-trip information such as inoculation and visa requirements, embassy referrals, interpreter referrals, emergency message relay and more. If a member is in need of medical assistance, Seven Corners provides; 24-hour telephone contact to help locate medical care, second opinions, payment guarantee, arranging transfer of medical records and other excellent services.
Carrier Information
Seven Corners began offering international medical insurance to the worldwide community in 1993. Known as Specialty Risk International, Inc. (SRI) up until January 1st, 2007, the company was founded by international insurance professionals with a strong commitment to customer service and a belief that the public deserved reliability when purchasing international insurance.
Seven Corners is also actively involved in non-insurance related benefits services. This line of business includes self-funded programs for worldwide corporations, all segments of government programs, and organizations requiring a unique and customized approach to benefit management.
Both the Reside Prime and Reside plans are underwritten by Certain Underwriters at Lloyd’s of London and is rated an A “Excellent” rating by A.M. Best and an A+ (Strong) rating from Standard & Poor’s. In addition to being one of the largest insurance entities in the world, Lloyd’s of London has over 300 years of experience in the international insurance business.
Why Do I Need International Coverage?
If you are intending to reside overseas or planning a trip longer than six months, we encourage you to review your current health insurance policy for key residency and overseas coverage clauses. Ask your benefits specialist or insurance agent to clarify if necessary. These clauses typically apply to both individual and group health plans.
- Residency Clause – The primary function of a residency clause is to ensure people live in the state where they are purchasing the policy. Example: A resident of New York may not purchase insurance in Wyoming. These clauses typically require the member to be a resident at least 6 months during a 12-month policy period. If the residency clause is violated, the policy may be void and the insurance company no longer responsible for paying claims.
For American expatriates and long-term travelers, this creates a serious problem. International health insurance plans avoid this problem by allowing the member to reside outside the U.S. for indefinite periods of time.
- Coverage Outside the U.S. with Your Current U.S. Health Plan - The majority of U.S. health plans offer emergency care only when outside the U.S. In addition to this dramatic reduction in benefits, most U.S. health insurance companies are not able to assist members outside the U.S. It will be your responsibility to arrange care if you have a medical emergency and require medical evacuation or access to a doctor or hospital.
The advantage and purpose of purchasing travel medical and international health insurance is to avoid placing the burden of care on the member by offering services such as, 24/7 multilingual emergency assistance, networks of overseas providers and the ability to navigate foreign healthcare systems.
Benefits Summary
Seven Corners has created two variations of the Reside Prime medical insurance plan, (Reside Prime and Reside), to accommodate various needs and budgets. You may also choose the care area and benefit level that best fits your situation.
The Reside Prime plan may be issued with or without U.S. coverage.
Below are brief descriptions of the benefits and differences between the Reside and Reside Prime plan options.
Sample Policy
For more detailed information about Reside or Reside Prime, please contact ITG Worldwide for a sample policy.
Reside – Basic Coverage
The Reside offers expatriates a basic level of coverage for an affordable premium. It is a schedule of benefits plan, which means that there is an overall lifetime policy maximum and most benefits have their own lifetime or daily maximum benefits limit.
- Lifetime Maximum Benefit of $500,000 in the U.S. or Canada and $5,000,000 outside of the U.S and/or Canada.
- Hospitalization
- Surgery
- Maternity (after 12 months)
- Outpatient Treatment
- Laboratory Tests
- Emergency Room
- Emergency Medical Evacuation
- Return of Mortal Remains
Reside Prime – Value Plan
The Reside Prime includes all of the benefits of the Reside and increases most of the individual benefit levels. Note that after 36 months the plan benefits are changed into a schedule of benefits plan.
- Lifetime Maximum Benefit of $5,000,000 worldwide.
- URC Level Coverage – URC means Usual, Reasonable & Customary. URC plans pay up to the lifetime maximum rather than a reduced amount for specific benefits as found on schedule of benefit plans. The result is with a URC plan you are less likely to pay for additional costs not covered by a schedule of benefits plan.
- Transplants covered up to $1,000,000 lifetime
- Hospital Daily Indemnity - $50 per night for hospital admissions outside the U.S. and/or Canada.
Optional Benefits – Reside Prime Only
The Reside Prime offers a number of excellent optional benefits to enhance your coverage. These benefits are subject to approval and do require additional premium. Please see the brochure for more details about optional benefits.
AD&D Principal Sum Rider
Reside Prime includes a basic amount of Accidental Death and Dismemberment coverage. Additional amounts of coverage are available for you and your family. For the primary insured, additional amounts of $100,000; $200,000; $300,000; $400,000 or $500,000 are available. Additional amounts may not exceed 7 times your annual income. If you need more than 7 times your annual income in AD&D protection, please contact ITG Worldwide.
Dental Rider
Reside Prime offers an optional, international dental rider. Please consult the dental rider PDF for details.
Sports Rider
Hazardous sports such as mountaineering where ropes or guides are normally used, hang gliding, parachuting and bungee jumping are excluded by the Reside Prime policy. The optional Sport Rider removes the hazardous sport exclusion allowing you to enjoy these sports with peace of mind.
Hospital Indemnity Rider
Being hospitalized can result in financial hardship. To ease this burden, the Reside Prime offers the Hospital Indemnity Rider that pays $150 per night, should a covered insured person be admitted to a hospital for a covered condition in Geographic Treatment Area B (Area B refers to all countries except the U.S and/or Canada).
Providers & Services
Seven Corners has developed many services to assist Reside and Reside Prime members with quick access to care.
Emergency Assistance
Seven Corners members have access to multilingual emergency assistance 24 hours a day, 365 days a year. If you need to reach Seven Corners immediately please call;
Toll Free in the U.S: 800 690 6295
Collect Call outside the U.S: 317 818 2808
Global Physician Networks
International Providers
Outside the United States, members can seek care with any doctor or healthcare facility. Seven Corners does maintain a list of participating physicians and facilities in their International Network. To access the International Network please contact Seven Corners, Inc. Assist at 800 335 0477 or 317 575 2656 during normal business hours, or members can submit a request online by using the international provider request page.
U.S. In-Network Providers – Hygeia
Seven Corners uses the Hygeia PPO network in the United States. The Hygeia network offers access to thousands of medical facilities and over 400,000 physicians across the United States.
U.S. Out-of-Network Providers
Seven Corners’ members that seek care outside of the provider network should be aware they may incur additional expenses as out-of-network providers are not contracted with Seven Corners. For example, Seven Corners will not waive the coinsurance for members seeking care outside of the PPO network. In addition, benefits may be reduced by 25% or more if the member fails to pre-certify and/or utilize the U.S. PPO Network.
Appointments and Hospital Admissions
Physician Appointments
Reside and Reside Prime members are free to seek treatment with any provider they choose. Seven Corners is ready to assist the member with finding the appropriate provider for the situation and area.
During U.S. central time business hours;
Toll Free: 800 335 0477
Direct: 317 575 2656
Overseas physician requests
Pre-certification
Prior to receiving treatment for some conditions, you may need to contact Seven Corners to pre-certify treatment and/or verification of benefits. To pre-certify means contacting Seven Corners Assist to inform them of certain upcoming claims. Pre-certification may be undertaken by you, a family member or a provider representative.
It is important to note that Pre-certification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or a guarantee of payment. Not pre-certifying can result in decreased benefits, delays in reimbursement and all other expenses may be forfeited.
The following treatments and services must be pre-certified or certain reductions of benefits may result. Check with Seven Corners for a complete and up to date list of conditions that require Pre-certification.
- Medical expenses within the U.S. that exceed $1,000
- Hospital admission
- Surgery
- Diagnostic tests
- Inpatient care
- Medical evacuations
- Use of durable medical equipment
- Home nursing care
- Artificial limbs
- Within 48 hours after an emergency admission to the hospital
- Care in an extended care facility
- CAT scans, MRIs
- Maternity – first 90 days and within 48 hours following delivery.
- Transplants
To contact Seven Corners about Pre-certification, please call;
Toll Free in the U.S: 800 690 6295
Collect Call outside the U.S: 317 818 2808
Verification of Benefits
Verification of benefits is the process of verifying your general coverage and the available benefits under the plan. You may do this by contacting Seven Corners about whether or not your treatment or service require pre-certification. Verification of benefits is not a guarantee of payment or assurance of coverage, and all medical expenses must meet eligible payment guidelines in accordance with the terms and conditions of the plan. While Pre-certification and verification of benefits are separate determinations, both are made with the reliance on the completeness and accuracy of the information provided by you and your healthcare providers to Seven Corners.
Online Tools – MyPlan
The MyPlan web site is designed to allow secure access to your benefit plan and claim information. MyPlan requires account activation and information is displayed via a secure web browser connection.
Eligibility
General Eligibility
The Reside Prime and Reside plans are available to citizens of all countries of the world. Applicants must be 15 days old and no older than 74. U.S. citizens and non-U.S. citizens must reside outside the United States and/or Canada for at least 6 months a year or be departing the U.S. and/or Canada within 30 days of the effective date.
Eligible families will receive free coverage for the first two eligible dependent children between the ages of 14 days to 9 years when both parents are insured under either the Reside Prime or Reside plans. All family members that are requesting to be covered need to answer the questions on the application.
Members must also continue to reside outside the U.S. and/or Canada for 6 months out of the certificate period to renew coverage. In addition, members must depart the U.S. and/or Canada within 30 days of the effective date for renewing policies.
Certain other restrictions may also apply. If you have questions about eligibility, please contact ITG Worldwide.
Important Note
This is a description of Eligibility. Eligibility does not guarantee that a policy will be issued. An application must be submitted and applications are subject to Underwriting. Therefore, it is not guaranteed that a policy will be issued. Do not terminate any existing insurance until receipt of written approval from Seven Corners. It is the Insured Person’s responsibility to maintain all records regarding travel history, age and student status and provide any documentation to the Administrator, which would verify the Eligibility Requirements.
Claims
Filing Claims
If you need to be reimbursed for medical expenses, complete the claim form and submit your original itemized bills and paid receipts within 90 days to Seven Corners. Do not hold your bills or receipts until the end of the year. Mail the completed claim form and all required information to:
Seven Corners, Inc.
303 Congressional Blvd.
Carmel, In 46032
Phone: 800 335 0477 or 317 575 2656
Fax: 317 575 2256
Claim Form
PDF of claim form
Note that some conditions require members to pre-certify their claims.
Contact information
Seven Corners, Inc.
303 Congressional Blvd.
Carmel, In 46032
Phone: 800 335 0477 or 317 575 2656
Fax: 317 575 2256
How to Apply
Seven Corners’ Reside Prime and Reside international health insurance plans can be applied for either online or download an application right from this webpage. Either method is fairly straightforward. However you choose to apply, please provide accurate and current information.
Current Coverage – Please do not terminate any current health insurance coverage until you have received written confirmation by Seven Corners that your Reside Prime or Reside coverage is effective and you accept Seven Corners’ terms and conditions.
Online Application
To apply online, please click on the application link below. The link will first ask for general information in order to provide a quote. Select a premium and deductible that you are comfortable with. You will then start the online application process.
Before applying for coverage online, we encourage you to review the brochure and policy. If you have any questions, please feel free to contact us.
Reside Prime - apply online
Reside - apply online
Download Application
To download the application, click the application image below. Completed applications may be faxed or scanned and emailed to ITG Worldwide. Our staff will review your application for completeness and may contact you if additional information is required.
Reside Prime brochure with application (PDF)
Reside brochure with application (PDF)
Please mail the original application to our Novato office:
Mailing Address
ITG Worldwide
Attn: Application Department
500 Professional Center Drive
Suite 515
Novato, CA 94947
| Phone |
|
| Toll Free |
877 598 8646 |
| Novato Office |
415 898 0584 |
| San Diego Office |
858 271 5300 |
| Dallas Office |
972 722 6399 |
| Fax |
415 373 0786 |
Email
info@ITG Worldwide.com
The Underwriting Process
HTH’s underwriters will review applications for health history, eligibility and completeness. Before making a final decision, the underwriters may require additional information such as medical records.
Once the process is complete, the underwriters will issue one of three outcomes;
- approved as applied for;
- with an additional premium “load” and/or benefit change for health condition(s); or
- declined.
ITG Worldwide works hard to make sure applicants receive fair and equitable treatment in the underwriting process. Ultimately, it is Seven Corners’ final decision on whether or not applications are approved.
Please allow at least 5 business days while a decision is reached or a request for additional information is made.
Contact ITG Worldwide
If you have questions or concerns, we suggest contacting an ITG Worldwide broker before applying for coverage. We can help verify that the plan you are considering will best meet your needs. Our staff can also assist and advise you during the underwriting process. We’re here to answer questions and guide you through the process.
