TATA AIG Travel Guard Plus insurance

What are the coverage options under TATA AIG Travel Guard Plus insurance?

• Benefits	Silver
  Sublimits	With sublimit / Without Sublimit
  Age	3 months - 70 years
  Destination	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe
  Sum Insured for Accident & Sickness	Up to $50,000 Deductible : $100
  Pre Existing Disease Coverage (only in case of life threatening conditions)	Up to $2,500
  Emergency Medical Evacuation (covered within Accident & Sickness Sum Insured)	Up to $50,000 Deductible : $100
  Repatriation of Mortal Remains	Up to 25% of Accident & Sickness Sum Insured
  Accidental Death & Disablement (Overseas)	Accidental Death: Maximum $10,000 Accidental Disablement: Maximum $10,000 Benefit Total - Maximum $10,000
  Emergency Medical Dental Expenses	$300 Deductible : $50
  Delay of Checked-in Baggage	$40 Deductible : After 4 hours
  Loss of Checked-in Baggage	$200
  Loss of Passport	$250 Deductible : $25
  Personal Liability	$100,000 Deductible : $200
  Trip Curtailment	$500 Deductible : $50
  Trip Cancellation	$500 Deductible : $50
  Missed Flight/Connection	$250
  Bounced Hotel/Airline booking	$500 Deductible : $50
  Fraudulent Charges	Per Occurrence Limit $250; Maximum Limit $500
  Home Content Burglary (in INR)	₹50,000 Deductible : ₹5,000
  Accommodation Extension	$100 per day up to Maximum of 10 days
  Emergency Extension of the Policy	7 days

  
  Sublimits applicable on Inpatient Treatment / Day Care Treatment / Outpatient Treatment:

  Medical Sublimit	Amount
  Hospital Room Rent and Boarding expenses	$1,500 per Day up to 30 Days
  Emergency Room Services	$1,500
  ICU Charges	$3,000 per Day up to 7 Days
  Surgical Treatment Expenses	$12,500
  	25% of Surgical Treatment Expenses for Anesthetist Services
  Physician Consultation Charges	$125 per day up to 10 visits
  Diagnostic Tests	Up to $750
  Ambulance Service (Not applicable for Outpatient Treatment)	Up to $500
  Pharmacy	Up to $2,000
  Miscellaneous Expenses	Up to $500
  Emergency Room Services	$27,500
  Non-Surgical (Medical Management cases)	$13,000

  Benefits	Silver Plus	Silver Plus Plan A	Silver Plus Plan B
  Sublimits	With sublimit / Without Sublimit	With sublimit / Without Sublimit	With sublimit / Without Sublimit
  Age	3 months - 70 years	3 months - 70 years	3 months - 70 years
  Destination	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe	Worldwide	Worldwide
  Sum Insured for Accident & Sickness	Up to $100,000 Deductible : $100	Up to $100,000 Deductible : $100	Up to $100,000 Deductible : $100
  Pre Existing Disease Coverage (only in case of life threatening conditions)	Up to $5,000	Up to $5,000	Up to $5,000
  Emergency Medical Evacuation (covered within Accident & Sickness Sum Insured)	Up to $100,000 Deductible : $100	Up to $100,000 Deductible : $100	Up to $100,000 Deductible : $100
  Repatriation of Mortal Remains	Up to 25% of Accident & Sickness Sum Insured	Up to 25% of Accident & Sickness Sum Insured	Up to 25% of Accident & Sickness Sum Insured
  Accidental Death & Disablement (Overseas)	Accidental Death: Maximum $10,000 Accidental Disablement: Maximum $10,000 Benefit Total - Maximum $10,000	Accidental Death: Maximum $10,000 Accidental Disablement: Maximum $10,000 Benefit Total - Maximum $10,000	Accidental Death: Maximum $10,000 Accidental Disablement: Maximum $10,000 Benefit Total - Maximum $10,000
  Emergency Medical Dental Expenses	$400 Deductible : $50	$400 Deductible : $50	$400 Deductible : $50
  Delay of Checked-in Baggage	$40 Deductible : After 4 hours	- -	$40 Deductible : After 4 hours
  Loss of Checked-in Baggage	$200	-	$200
  Loss of Passport	$250 Deductible : $25	- -	$250 Deductible : $25
  Personal Liability	$100,000 Deductible : $200	- -	- -
  Trip Curtailment	$500 Deductible : $50	- -	$500 Deductible : $50
  Trip Cancellation	$500 Deductible : $50	- -	$500 Deductible : $50
  Missed Flight/Connection	$250	-	$250
  Bounced Hotel/Airline booking	$500 Deductible : $50	- -	$500 Deductible : $50
  Fraudulent Charges	Per Occurrence Limit $250; Maximum Limit $500	-	-
  Home Content Burglary (in INR)	₹50,000 Deductible : ₹5,000	- -	- -
  Accommodation Extension	$250 per day up to Maximum of 10 days	-	-
  Hijack/Kidnap Daily Allowance	$75 for every 12 hours, up to Max of 10 days	-	-
  Loss of International driving license	$100	-	-
  Flight Cancellation	$75	-	-
  Emergency Extension of the Policy	7 days	-	-

  Sublimits applicable on Inpatient Treatment / Day Care Treatment / Outpatient Treatment:

  Medical Sublimit	Silver Plus	Silver Plus Plan A	Silver Plus Plan B
  Hospital Room Rent and Boarding expenses	$1,500 per Day up to 30 Days	$1,500 per Day up to 30 Days	$1,500 per Day up to 30 Days
  Emergency Room Services	$1,500	$1,500	$1,500
  ICU Charges	$3,000 per Day up to 7 Days	$3,000 per Day up to 7 Days	$3,000 per Day up to 7 Days
  Surgical Treatment Expenses	$12,500	$12,500	$12,500
  	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services
  Physician Consultation Charges	$125 per day up to 10 visits	$125 per day up to 10 visits	$125 per day up to 10 visits
  Diagnostic Tests	Up to $750	Up to $750	Up to $750
  Ambulance Service (Not applicable for Outpatient Treatment)	Up to $500	Up to $500	Up to $500
  Pharmacy	Up to $2,000	Up to $2,000	Up to $2,000
  Miscellaneous Expenses	Up to $500	Up to $500	Up to $500
  Emergency Room Services	$27,500	$27,500	$27,500
  Non-Surgical (Medical Management cases)	$13,000	$13,000	$13,000

  Benefits	Gold	Gold Plan A	Gold Plan B
  Sublimits	With sublimit / Without Sublimit	With sublimit / Without Sublimit	With sublimit / Without Sublimit
  Age	3 months - 70 years	3 months - 70 years	3 months - 70 years
  Destination	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe	Worldwide	Worldwide
  Sum Insured for Accident & Sickness	Up to $250,000 Deductible : $100	Up to $250,000 Deductible : $100	Up to $250,000 Deductible : $100
  Pre Existing Disease Coverage (only in case of life threatening conditions)	Up to $10,000	Up to $10,000	Up to $10,000
  Emergency Medical Evacuation (covered within Accident & Sickness Sum Insured)	Up to $250,000 Deductible : $100	Up to $250,000 Deductible : $100	Up to $250,000 Deductible : $100
  Repatriation of Mortal Remains	Up to 25% of Accident & Sickness Sum Insured	Up to 25% of Accident & Sickness Sum Insured	Up to 25% of Accident & Sickness Sum Insured
  Accidental Death & Disablement (Overseas)	Accidental Death: Maximum $15,000 Accidental Disablement: Maximum $15,000 Benefit Total - Maximum $15,000	Accidental Death: Maximum $15,000 Accidental Disablement: Maximum $15,000 Benefit Total - Maximum $15,000	Accidental Death: Maximum $15,000 Accidental Disablement: Maximum $15,000 Benefit Total - Maximum $15,000
  Emergency Medical Dental Expenses	$500 Deductible : $50	$500 Deductible : $50	$500 Deductible : $50
  Delay of Checked-in Baggage	$45 Deductible : After 4 hours	-	$45 Deductible : After 4 hours
  Loss of Checked-in Baggage	$300	-	$300
  Loss of Passport	$250 Deductible : $25	-	$250 Deductible : $25
  Personal Liability	$200,000 Deductible : $200	-	-
  Trip Curtailment	$750 Deductible : $75	-	$750 Deductible : $75
  Trip Cancellation	$750 Deductible : $50	-	$750 Deductible : $50
  Flight Delay	$45 For all overseas flights taken during Insured Trip Deductible : After 4 hours	-	$45 For all overseas flights taken during Insured Trip Deductible : After 4 hours
  Missed Flight/Connection	$500	-	$500
  Bounced Hotel/Airline booking	$750 Deductible : $75	-	$750 Deductible : $75
  Fraudulent Charges	Per Occurrence Limit $500; Maximum Limit $1000	-	-
  Home Content Burglary (in INR)	₹1,50,000 Deductible : ₹5,000	-	-
  Accommodation Extension	$300 per day up to Maximum of 10 days	-	-
  Hijack/Kidnap Daily Allowance	$100 Per 12 hours, up to Maximum of 10 days	-	-
  Loss of International driving license	$100	-	-
  Flight Cancellation	$75	-	-
  Emergency Extension of the Policy	7 days	-	-
  Loss of Personal Baggage	$200 Deductible : $30	-	-
  Personal Accident in India (in INR)	₹15,00,000	-	-

  Sublimits applicable on Inpatient Treatment / Day Care Treatment / Outpatient Treatment:

  Medical Sublimit	Gold	Gold Plan A	Gold Plan B
  Hospital Room Rent and Boarding expenses	$1,750 per Day up to 30 Days	$1,750 per Day up to 30 Days	$1,750 per Day up to 30 Days
  Emergency Room Services	$1,750	$1,750	$1,750
  ICU Charges	$3,250 per Day up to 7 Days	$3,250 per Day up to 7 Days	$3,250 per Day up to 7 Days
  Surgical Treatment Expenses	$13,000	$13,000	$13,500
  	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services
  Physician Consultation Charges	$175 per day up to 10 visits	$175 per day up to 10 visits	$175 per day up to 10 visits
  Diagnostic Tests	Up to $1,000	Up to $1,000	Up to $1,000
  Ambulance Service (Not applicable for Outpatient Treatment)	Up to $600	Up to $600	Up to $600
  Pharmacy	Up to $2,000	Up to $2,000	Up to $2,000
  Miscellaneous Expenses	Up to $500	Up to $500	Up to $500
  Emergency Room Services	$30,000	$30,000	$30,000
  Non-Surgical (Medical Management cases)	$15,000	$15,000	$15,000

  Benefits	Platinum	Platinum Plan A	Platinum Plan B
  Sublimits	With sublimit / Without Sublimit	With sublimit / Without Sublimit	With sublimit / Without Sublimit
  Age	3 months - 70 years	3 months - 70 years	3 months - 70 years
  Destination	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe	Worldwide	Worldwide
  Sum Insured for Accident & Sickness	Up to $500,000 Deductible : $100	Up to $500,000 Deductible : $100	Up to $500,000 Deductible : $100
  Pre Existing Disease Coverage (only in case of life threatening conditions)	Up to $10,000	Up to $12,500	Up to $12,500
  Emergency Medical Evacuation (covered within Accident & Sickness Sum Insured)	Up to $500,000 Deductible : $100	Up to $500,000 Deductible : $100	Up to $500,000 Deductible : $100
  Repatriation of Mortal Remains	Up to 25% of Accident & Sickness Sum Insured	Up to 25% of Accident & Sickness Sum Insured	Up to 25% of Accident & Sickness Sum Insured
  Accidental Death & Disablement (Overseas)	Accidental Death: Maximum $25,000 Accidental Disablement: Maximum $25,000 Benefit Total - Maximum $25,000	Accidental Death: Maximum $25,000 Accidental Disablement: Maximum $25,000 Benefit Total - Maximum $25,000	Accidental Death: Maximum $25,000 Accidental Disablement: Maximum $25,000 Benefit Total - Maximum $25,000
  Emergency Medical Dental Expenses	$1,000 Deductible : $50	$1,000 Deductible : $50	$1,000 Deductible : $50
  Delay of Checked-in Baggage	$50 Deductible : After 4 hours	-	$50 Deductible : After 4 hours
  Loss of Checked-in Baggage	$300	-	$300
  Loss of Passport	$250 Deductible : $25	-	$250 Deductible : $25
  Personal Liability	$500,000 Deductible : $250	-	-
  Trip Curtailment	$1,000 Deductible : $100	-	$1,000 Deductible : $100
  Trip Cancellation	$1,000 Deductible : $100	-	$1,000 Deductible : $100
  Flight Delay	$50 For all overseas flights taken during Insured Trip Deductible : After 4 hours	-	$50 For all overseas flights taken during Insured Trip Deductible : After 4 hours
  Missed Flight/Connection	$750	-	$750
  Bounced Hotel/Airline booking	$1,000 Deductible : $100	-	$1,000 Deductible : $100
  Fraudulent Charges	Per Occurrence Limit $1000; Maximum Limit $2000	-	-
  Home Content Burglary (in INR)	₹2,50,000 Deductible : ₹5,000	-	-
  Accommodation Extension	$750 per day up to Maximum of 10 days	-	-
  Hijack/Kidnap Daily Allowance	$150 Per 12 hours, up to Maximum of 10 days	-	-
  Loss of International driving license	$100	-	-
  Flight Cancellation	$150	-	-
  Emergency Extension of the Policy	15 days	-	-
  Loss of Personal Baggage	$300 Deductible : $30	-	-
  Personal Accident in India (in INR)	₹20,00,000	-	-
  Compassionate Travel/Stay	Upto $3,500 covering Return Fare and Stay for any person - Spouse / Child / Immediate Family Member	-	-
  Loss of Cash	$125	-	-

  Sublimits applicable on Inpatient Treatment / Day Care Treatment / Outpatient Treatment:

  Medical Sublimit	Platinum	Platinum Plan A	Platinum Plan B
  Hospital Room Rent and Boarding expenses	$2,000 per Day up to 30 Days	$2,000 per Day up to 30 Days	$2,000 per Day up to 30 Days
  Emergency Room Services	$2,000	$2,000	$2,000
  ICU Charges	$3,750 per Day up to 10 Days	$3,750 per Day up to 10 Days	$3,750 per Day up to 10 Days
  Surgical Treatment Expenses	$15,000	$15,000	$15,000
  	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services
  Physician Consultation Charges	$250 per day up to 10 visits	$250 per day up to 10 visits	$250 per day up to 10 visits
  Diagnostic Tests	Up to $1,500	Up to $1,500	Up to $1,500
  Ambulance Service (Not applicable for Outpatient Treatment)	Up to $750	Up to $750	Up to $750
  Pharmacy	Up to $2,000	Up to $2,000	Up to $2,000
  Miscellaneous Expenses	Up to $500	Up to $500	Up to $500
  Emergency Room Services	$35,000	$35,000	$35,000
  Non-Surgical (Medical Management cases)	$17,500	$17,500	$17,500

  Benefits	Titanium	Titanium Plus
  Sublimits	With sublimit / Without Sublimit	With sublimit / Without Sublimit
  Age	3 months - 60 years	3 months - 60 years
  Destination	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe
  Sum Insured for Accident & Sickness	Up to $750,000 Deductible : $100	Up to $1,000,000 Deductible : $100
  Pre Existing Disease Coverage (only in case of life threatening conditions)	Up to $15,000	Up to $20,000
  Emergency Medical Evacuation (covered within Accident & Sickness Sum Insured)	Up to $750,000 Deductible : $100	Up to $1,000,000 Deductible : $100
  Repatriation of Mortal Remains	Up to 25% of Accident & Sickness Sum Insured	Up to 25% of Accident & Sickness Sum Insured
  Accidental Death & Disablement (Overseas)	Accidental Death: Maximum $50,000 Accidental Disablement: Maximum $50,000 Benefit Total - Maximum $50,000	Accidental Death: Maximum $75,000 Accidental Disablement: Maximum $75,000 Benefit Total - Maximum $75,000
  Emergency Medical Dental Expenses	$1,000 Deductible : $50	$1,200 Deductible : $50
  Delay of Checked-in Baggage	$50 Deductible : After 4 hours	$50 Deductible : After 4 hours
  Loss of Checked-in Baggage	$400	$500
  Loss of Passport	$500 Deductible : $25	$500 Deductible : $25
  Personal Liability	$500,000 Deductible : $250	$500,000 Deductible : $250
  Trip Curtailment	$1,000 Deductible : $100	$1,500 Deductible : $100
  Trip Cancellation	$1,000 Deductible : $100	$1,500 Deductible : $100
  Flight Delay	$50 For all overseas flights taken during Insured Trip Deductible : After 4 hours	$50 For all overseas flights taken during Insured Trip Deductible : After 4 hours
  Missed Flight/Connection	$750	$750
  Bounced Hotel/Airline booking	$2,500 Deductible : $100	$5,000 Deductible : $100
  Fraudulent Charges	Per Occurrence Limit $1,250; Maximum Limit $2,500	Per Occurrence Limit $1,250; Maximum Limit $2,500
  Home Content Burglary (in INR)	₹500,000 Deductible : ₹5,000	₹500,000 Deductible : ₹5,000
  Accommodation Extension	$1,000 per day up to Maximum of 10 days	$1,000 per day up to Maximum of 10 days
  Hijack/Kidnap Daily Allowance	$150 Per 12 hours, up to Maximum of 10 days	$200 Per 12 hours, up to Maximum of 10 days
  Loss of International driving license	$150	$150
  Flight Cancellation	$200	$250
  Emergency Extension of the Policy	15 days	15 days
  Loss of Personal Baggage	$400 Deductible : $30	$500 Deductible : $30
  Personal Accident in India (in INR)	₹2,500,000	₹5,000,000
  Compassionate Travel/Stay	Up to $5,000 covering Return Fare and Stay for any person - Spouse / Child / Immediate Family Member	Up to $5,000 covering Return Fare and Stay for any person - Spouse / Child / Immediate Family Member
  Loss of Cash	$250	$375
  Upgradation to Business Class	$750	$1,000
  Rental Vehicle Cover	$500	$500
  Rental Vehicle Return	$250	$500
  Alternative Transport Expenses	$750	$1,000
  Pandemic Cover	$500	$500
  Hospital Daily Cash (Per Day)	-	$75 Per day, up to Maximum of 10 days
  Missed Booking	-	$750
  Visa Rejection	-	$100

  Sublimits applicable on Inpatient Treatment / Day Care Treatment / Outpatient Treatment:

  Medical Sublimit	Titanium	Titanium Plus
  Hospital Room Rent and Boarding expenses	$2,000 per Day up to 30 Days	$2,500 per Day up to 30 Days
  Emergency Room Services	$2,000	$2,500
  ICU Charges	$3,750 per Day up to 10 Days	$4,000 per Day up to 10 Days
  Surgical Treatment Expenses	$15,000	$22,500
  	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services
  Physician Consultation Charges	$250 per day up to 10 visits	$350 per day up to 10 visits
  Diagnostic Tests	Up to $1,500	Up to $2,500
  Ambulance Service (Not applicable for Outpatient Treatment)	Up to $750	Up to $1,000
  Pharmacy	Up to $2,000	Up to $2,000
  Miscellaneous Expenses	Up to $500	Up to $500
  Emergency Room Services	$35,000	$40,000
  Non-Surgical (Medical Management cases)	$17,500	$20,000

• Benefits	Senior	Senior Plus	Super Senior
  Sublimits	With sublimit / Without Sublimit	With sublimit / Without Sublimit	With sublimit / Without Sublimit
  Age	71-80 years	71-80 years	81+ years
  Destination	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe	Worldwide / Rest of World excluding North & South America and Canada / Schengen Countries in Europe
  Sum Insured for Accident & Sickness	Upto $50,000 Deductible : $100	Upto $100,000 Deductible : $100	Upto $50,000 Deductible : $100
  Pre Existing Disease Coverage (only in case of life threatening conditions)	Upto $2,500	Upto $3,000	Upto $1,500
  Emergency Medical Evacuation (covered within Accident & Sickness Sum Insured)	Up to $50,000 Deductible : $100	Up to $100,000 Deductible : $100	Up to $50,000 Deductible : $100
  Repatriation of Mortal Remains	Upto 25% of Accident & Sickness Sum Insured	Upto 25% of Accident & Sickness Sum Insured	Upto 25% of Accident & Sickness Sum Insured
  Accidental Death & Disablement (Overseas)	Accidental Death: Maximum $10,000 Accidental Disablement: Maximum $10,000 Benefit Total - Maximum $10,000	Accidental Death: Maximum $10,000 Accidental Disablement: Maximum $10,000 Benefit Total - Maximum $10,000	Accidental Death: Maximum $10,000 Accidental Disablement: Maximum $10,000 Benefit Total - Maximum $10,000
  Emergency Medical Dental Expenses	$300 Deductible : $75	$500 Deductible : $75	Not Available Deductible : Not available
  Delay of Checked-in Baggage	$40 Deductible : After 4 hours	$40 Deductible : After 4 hours	$40 Deductible : After 4 hours
  Loss of Checked-in Baggage	$200	$200	$200
  Loss of Passport	$250 Deductible : $25	$250 Deductible : $25	$250 Deductible : $25
  Personal Liability	$1,00,000 Deductible : $200	$1,00,000 Deductible : $200	$1,00,000 Deductible : $200
  Trip Curtailment	$500 Deductible : $100	$500 Deductible : $100	$500 Deductible : $100
  Trip Cancellation	$250 Deductible : $50	$500 Deductible : $50	$250 Deductible : $50
  Flight Delay	$40 For all overseas flights taken during Insured Trip Deductible : After 4 hours	$40 For all overseas flights taken during Insured Trip Deductible : After 4 hours	$40 For all overseas flights taken during Insured Trip Deductible : After 4 hours
  Missed Flight/Connection	$250	$250	$250
  Bounced Hotel/Airline booking	$500 Deductible : $50	$500 Deductible : $75	$250 Deductible : $50
  Home Content Burglary (in INR)	₹50,000 Deductible : ₹5,000	₹50,000 Deductible : ₹5,000	₹50,000 Deductible : ₹5,000
  Accommodation Extension	$50 per day upto Maximum of 10 days	$100 per day upto Maximum of 10 days	$50 per day upto Maximum of 10 days
  Hijack/Kidnap Daily Allowance	$75 Per 12 hours, upto Maximum of 10 days	$100 Per 12 hours, upto Maximum of 10 days	$75 Per 12 hours, upto Maximum of 10 days
  Loss of International driving license	-	-	-
  Flight Cancellation	-	$75	-
  Emergency Extension of the Policy	7 days	7 days	7 days
  Loss of Personal Baggage	Not Available Deductible : Not Available	$200 Deductible : $30	Not Available Deductible : Not Available
  Compassionate Travel/Stay	Upto $2,500 covering Return Fare and Stay for any person - Spouse / Child / Immediate Family Member	Upto $5,000 covering Return Fare and Stay for any person - Spouse / Child / Immediate Family Member	Upto $2,500 covering Return Fare and Stay for any person - Spouse / Child / Immediate Family Member

  Sublimits applicable on Inpatient Treatment / Day Care Treatment / Outpatient Treatment

  Medical Sublimit	Senior	Senior Plus	Super Senior Plus
  Hospital Room Rent and Boarding expenses	$1,500 per Day up to 30 Days	$1,500 per Day up to 30 Days	$1,500 per Day up to 30 Days
  Emergency Room Services	$1,500	$1,500	$1,500
  ICU Charges	$3,000 per Day up to 7 Days	$3,000 per Day up to 7 Days	$3,000 per Day up to 7 Days
  Surgical Treatment Expenses	$12,500	$12,500	$12,500
  	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services	25% of Surgical Treatment Expenses for Anesthetist Services
  Physician Consultation Charges	$125 per day upto 10 visits	$125 per day upto 10 visits	$125 per day upto 10 visits
  Diagnostic Tests	Up to $750	Up to $750	Up to $750
  Ambulance Service (Not applicable for Outpatient Treatment)	Up to $500	Up to $500	Up to $500
  Pharmacy	Up to $2,000	Up to $2,000	Up to $2,000
  Miscellaneous Expenses	Up to $500	Up to $500	Up to $500
  Emergency Room Services (Total)	$27,500	$27,500	$27,500
  Non-Surgical (Medical Management cases)	$13,000	$13,000	$13,000