LRFA

Latvian Relief Fund of America


LRFA is a professionally managed, non-profit, mutual assistance organization, designed to provide our members with affordable health care plans and financial assistance in emergencies. We support other Latvian-American organizations and education in the U.S. and abroad.
Membership Benefit Plans About Us Forms Contact Us
Medicare Supplemental
Health Supplemental
Hospital Supplemental
Visitors from Abroad
Travel Medical Plan
Mortuary Benefit Plan

Medical Plan for Visitors from Abroad benefits

What is covered?

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 plan 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 LRFA. 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.

Not Covered
Participants are not eligible for benefits if you are hospitalized due to a mental illness, AIDS, war injuries, or injuries resulting from participation in demonstrations or police actions. Benefits do not apply if you are receiving medical care in nursing homes, convalescent residences, mental institutions, extended care facilities, state hospitals, VA hospitals, or drug and alcohol rehabilitation clinics. Other limitations may apply.

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:

  Individual A/B Spouse A/B Each Child A/B
Loss of Life $12,000 / $13,000 $5,500 / $6,500 $2,000 / $3,000
Loss of two members* ** $12,000 / $13,000 $5,500 / $6,500 $2,000 / $3,000
Loss of one member* ** $5,500 / $6,500 $2,250 / $3,250 $1,000 / $1,500
* "Member" means hand, foot or eye.
** "Loss of hand or foot" means complete severance through or above the wrist or ankle joint, and "loss of sight" means the entire and irrecoverable loss of sight.

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

© 2017 LRFA   -   P.O. Box 8857, Elkins Park, PA 19027-0857   -   info @ lrfa.org

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