How Do I File a Claim?
Filing a claim is easy. Once your Application is accepted, you will receive a kit which contains Claimant's Statement and Authorization forms. Just complete the Claimant's Statement and Authorization form, attach original, itemized bills, and forward them to MultiNational Underwriters®. Be sure to complete your Claimant's Statement entirely, sign it, and indicate a convenient time and location to contact you in the event questions arise. If you have already paid certain expenses, attach copies of your paid receipts. You will be reimbursed for eligible medical or dental expenses. In many cases, MultiNational Underwriters® will make payment directly to the hospital or physician who treated you. Remember, you are responsible for the Deductible, Coinsurance, and any ineligible charges.

Pre-notification
All plans in The Maritime Citizen Series contain hospital Pre-notification provisions. Pre-notification simply means that you must contact MultiNational Underwriters® as soon as possible before a planned hospitalization or surgical procedure, or within 48 hours of an emergency hospital admission, or within the first 90 days of Pregnancy. Pre-notification 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-notification helps us help you.

Maritime Citizen Senior Plan
Eligibility for the standard Maritime Citizen plans ends at age 75, but for those members who joined before age 65 and have maintained coverage for at least 10 years, the Maritime Citizen Senior Plan is available with no medical questions. The Maritime Citizen Senior Plan offers many of the same great benefits and limits as the standard Maritime Citizen plan. The Deductibles available on the Maritime Senior plan are $5,000, $7,500, and $10,000. On the Maritime Senior Platinum plan, the Overall Maximum Limit is reduced to $1 million. Additionally, the Human Organ Transplant and Emergency Medical Evacuation benefits are deleted. On the Maritime Senior Premier plan, the Overall Maximum Limit is reduced to $250,000 and the Human Organ Transplant benefit is deleted.

What Are the Plan Features?

Pre-existing Conditions:
If you are insured under the Platinum plan, and 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. If you are insured under the Premier plan, your Pre-existing Conditions are covered up to a Lifetime limit of $25,000 after you have been insured continuously for 24 months.

Pre-existing Conditions include any Injury or 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 related 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

• 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

• 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 a covered Accident, or unless Dental Rider is purchased

• Orthodontia (Dental Rider Exclusion)

• Sealants, Bleaching and oral hygiene expenses (Dental Rider Exclusion)

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

Wellness:
If you are insured under the Platinum plan, 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 35 years old, you will be entitled to the following Wellness benefits: $250 per Certificate Period for a routine physical exam, including mammogram and OB/GYN visits for females. 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 3 visits per Certificate Period.

Emergency Medical Evacuation:
If you are insured under the Platinum plan, you are covered 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 MultiNational Underwriters®. MultiNational Underwriters® 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, the Platinum Plan will provide the following benefits: the cost of an economy round-trip air or ground transportation ticket for one of your relatives (parent, spouse, sibling or child age 18 or older) for transportation to the area where you are hospitalized following 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 Platinum plan will provide the following benefit: air or ground transportation of bodily remains or ashes to the area of your Principal Residence and reasonable cost of preparation of your remains necessary for transportation.

Optional Sports Rider:
The Optional Sports Rider is a must-have addition 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 Dental Insurance:
The Optional Dental Rider provides important benefits for families including Preventative care for children and Basic and Major Dental benefits for both children and adults. Preventative benefits include routine oral exams and x-rays, cleaning and fluoride treatments. Basic benefits include Periodontics, Endodontics, Extractions and Fillings. Major benefits include crowns, bridges and dentures. The Maritime Citizen Optional Dental Rider is a must for families as well as individuals. Coverage is provided worldwide at your choice of dentists. The Optional Dental Insurance Rider is available with both the Platinum and Premier plans.

Maritime Citizen Assistance Services:
All Assistance Services are available to you 24 hours a day, 7 days a week while your Maritime Citizen Plan is in effect.

»Pre-Trip Health and Safety Advisories (available after your purchase of the Maritime Citizen Series, and before your departure) – Call us for current passport, visa, inoculation and vaccine requirements, as well as up-to-date travel safety advisories.
»Livetravel Services – We will make emergency travel and itinerary changes for you including rebooking flights, hotel reservations and ground transportation arrangements.

»BagTrak – We are the industry leaders in tracking lost checked baggage. We will help you locate your lost checked baggage, and deliver it to you anywhere in the world.
»Emergency Message Relay – We will relay messages to your family, friends and co-workers, helping you to maintain contact during an emergency.
»Emergency Cash Transfers – We will assist you in arranging and obtaining cash transfers anywhere in the world.

Maritime Citizen Assistance Services also include:

• Medical referrals
• Up-to-the-minute travel medical advisories
• Assistance with prescription drug replacement
• Dispatch of a doctor or specialist
• Emergency travel arrangements for family members
• Lost passport or travel documents assistance
• Embassy and consulate referrals
• Legal and accounting referrals
• Bail bond assistance
• Translation and interpretation assistance

Maritime Citizen Assistance Services are not insurance benefits, and provision of any Maritime Citizen Assistance Services is not a guarantee of any other benefit under the Maritime Citizen Series.

Apply online 24/7 at www.nauticalhealth.com
e-mail us at info@nauticalhealth.com
or call (239) 591-1199

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