International Marine Medical Insurance

Worldwide group coverage for professional marine crew

Group Proposal

Medical Benefits Summary

Coverage Limit/Maximum Amount for Eligible Medical Expenses
 
Maximum Limit $5,000,000 per period of coverage
Medical Concierge
  • Non-emergency services only

The Medical Concierge Service is a proprietary service of IMG that helps an insured person navigate the United States healthcare system to identify the highest quality providers for scheduled inpatient and certain outpatient treatments.

Refer to the MEDICAL CONCIERGE provision for further details.

Deductible for Eligible Medical Expenses
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Deductible$0$0$100 - $10,000$100 - $10,000
Family Deductible
  • Maximum 3 deductibles per family
$0$03 deductibles3 deductibles
Coinsurance for Eligible Medical Expenses
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Coinsurance
  • In addition to deductible
Plan pays 100%,
Insured pays 0%		Plan pays 100%,
Insured pays 0%		Plan pays 80%,
Insured pays 20%		Plan pays 100%,
Insured pays 0%
Out-of-Pocket Maximum$0$0$1,000$0
Precertification
 
  • Transplants: No coverage if precertification requirements are not met.
  • Interfacility Ambulance Transfer: No coverage if precertification requirements are not met.
  • Emergency Medical Evacuation: No coverage if precertification requirements are not met. Refer to the EMERGENCY MEDICAL EVACUATION provision for further details and requirements.
  • Maternity and Newborn Care: 50% reduction of eligible medical expenses if precertification requirements are not met.
  • All other Treatments & Supplies: 50% reduction of eligible medical expenses if precertification requirements are not met.
  • Deductible is taken after reduction.
  • Coinsurance is applied to remainder of the reduced amount.
  • Refer to PRECERTIFICATION REQUIREMENTS provision for a complete list of services that require precertification.
Pre-Existing Conditions -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Sudden and Unexpected Reoccurrence of Pre-Existing Conditions
  • Up to the calendar year maximum limit
  • Available for the first 12 months if no prior creditable coverage
Not applicable100%80%100%
Inpatient or Outpatient Services -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Eligible Medical Expenses100%100%80%100%
Physician Visits/ServicesNot applicable100%80%100%
Hospital Emergency Room: United States
  • Injury: Not subject to emergency room deductible
  • Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in a direct hospital admission
Not applicable100%80%Not applicable
Hospital Emergency Room: InternationalNot applicableNot applicableNot applicable100%
Hospitalization/Room & Board
  • Average semi-private room rate
  • Includes nursing, miscellaneous and ancillary services
100%100%80%100%
Intensive Care100%100%80%100%
COVID-19/SARS-CoV-2 CoverageCharges for treatment resulting from COVID-19/SARS-CoV-2 are covered as any other illness covered under the policy.
Outpatient Surgical/Hospital Facility100%100%80%100%
LaboratoryNot applicable100%80%100%
Radiology/X-Ray100%100%80%100%
Chemotherapy/Radiation Therapy100%100%80%100%
Pre-Admission TestingNot applicable100%80%100%
Surgery100%100%80%100%
Reconstructive Surgery
  • Surgery is incidental to and follows surgery that was covered under the plan
100%100%80%100%
Assistant Surgeon
  • 20% of the primary surgeon’s eligible fee
100%100%80%100%
Second Surgical Opinion
  • Payable at 100% if requested by the Company
  • 50% reduction of eligible medical expenses for failure to obtain a second surgical opinion when required by the Company
Not applicable100%80%100%
Anesthetists100%100%80%100%
Pregnancy and Newborn Care
  • After 10 months of continuous coverage
  • Result of natural insemination
  • Newborn routine care, diagnostic tests, and routine immunizations for the first 31 days of life
Not applicable100%80%100%
Pregnancy Complications
  • After 10 months of continuous coverage
Not applicable100%80%100%
Durable Medical EquipmentNot applicable100%80%100%
Podiatry Care
  • Maximum Limit: $750
Not applicable100%80%100%
Chiropractic Care (Outpatient)
  • Not subject to deductible and coinsurance
  • Maximum limit per visit: $75
  • Maximum visits: 20
  • Physician order not required
Not applicable100%100%100%
Chiropractic Care (Inpatient)
  • Must be part of recovery treatment plan for a covered illness or injury
  • Medical order or treatment plan required
Not applicable100%80%100%
Physical Therapy
  • Not subject to coinsurance
  • Maximum limit per visit: $75
  • Medical order or treatment plan required
Not applicable100%100%100%
Occupational Therapy
  • Not subject to coinsurance
  • Maximum limit per visit: $75
  • Medical order or treatment plan required
Not applicable100%80%100%
Extended Care Facility
  • Upon direct transfer from acute care facility
100%100%80%100%
Home Nursing Care
  • Provided by a home health care agency
  • Upon direct transfer from an acute care facility
100%100%80%100%
Transplant
  • Lifetime maximum: $1,000,000
  • Per period of coverage transplant maximum limit: 1
  • Organ procurement & harvesting costs lifetime maximum: $10,000
  • Travel & lodging lifetime maximum expense: $5,000
  • Covered transplants: cornea, heart, heart/lung, lung, kidney, kidney/pancreas, liver, allogeneic or autologous bone marrow
  • Subject to the TRANSPLANT PRECERTIFICATION provision and only when treatment is provided within the Company’s approved independent Managed Transplant System Network
100%100%80%100%
Preventative Care -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Adult Preventative Care
  • Ages 19 and over
  • Maximum limit: $250
  • Refer to the PREVENTATIVE CARE provision for further details and requirements
Not applicable100%100%100%
Child Preventative Care
  • Ages 18 and younger
  • Maximum limit: $250
  • Refer to the PREVENTATIVE CARE provision for further details and requirements
Not applicable100%100%100%
Vision Care -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Routine Eye Examination
  • Available after 12 months of continuous coverage
Maximum limit every 24 months: $100Maximum limit every 24 months: $100Maximum limit every 24 months: $100Maximum limit every 24 months: $100
Corrective Lenses, Contacts, Frames
  • Available after 12 months of continuous coverage
Maximum limit every 24 months: $150Maximum limit every 24 months: $150Maximum limit every 24 months: $150Maximum limit every 24 months: $150
Prescriptions -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Prescriptions
  • Dispensing maximum: 90 days per prescription
Not applicable80%80%100%
Mental or Nervous, Substance Abuse and Counseling -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Lifetime Maximum$20,000$20,000$20,000$20,000
Inpatient Mental or Nervous/Substance Abuse 100%100%80%100%
Outpatient Mental or Nervous/Substance Abuse
  • Maximum limit per visit: $100
  • Maximum visits: 52
Not applicable100%80%100%
Emergency Services -
(NOT Subject to Deductible or Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Emergency Local Ambulance
  • Subject to deductible and coinsurance
  • Injury
  • Illness resulting in an inpatient hospital admission
Not applicable100%80%100%
Emergency Medical Evacuation
  • Lifetime maximum: $1,000,000
  • Insured persons under 65 years of age
  • Approved in advance and coordinated by the Company
Not applicable100%100%100%
Emergency Reunion
  • Lifetime maximum: $10,000
  • Maximum days: 15
  • Maximum meal limit per day: $25
  • Reasonable and necessary travel costs and accommodations
  • Approved in advance by the Company
Not applicable100%100%100%
Interfacility Ambulance Transfer
  • Transfer must be a result of an inpatient hospital admission
Not applicable100%100%100%
Return of Mortal Remains
  • Maximum limit: $25,000
  • Local burial/Cremation maximum limit: $10,000
  • Return of insured person’s mortal remains to home country
  • Approved in advance by the Company
Not applicable100%100%100%
Other Services -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Accommodation Benefit
  • Maximum limit: $2,500
  • Refer to the ACCOMMODATION BENEFIT provisions for futher details and requirements
Not applicable100%100%100%
Amateur Sailboat Racing
  • Subject to deductible and coinsurance
Not applicable100%80%100%
Crew Member Return
  • Maximum limit: $2,500
Not applicable100%100%100%
Emergency Dental
  • Subject to deductible and coinsurance
  • Accident related
Not applicable80%80%100%
Traumatic Dental Injury
  • Treatment at a hospital facility due to an accident
  • Additional treatment for the same injury rendered by a dental provider will be paid at 100%
Not applicable100%80%100%
Hospital Indemnity
  • International only
  • Benefit is not available when the inpatient hospital treatment is part of the Medical Travel Management benefit
  • Inpatient hospitalization only
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
Remote Mental Health Service*
  • Employee Assistance Program
Company pays 100%Company pays 100%Company pays 100%Company pays 100%
Teleconsultation** Company pays 100%Company pays 100%Company pays 100%Company pays 100%
Medical Travel Management
  • Must be approved in advance by the Company

Medically necessary non-emergency treatment, including hospitalization and surgery for approved procedures; the Company will offer medical travel as a means to manage the costs.

If Medical Travel is approved, the Company will reimburse 10% of the cost savings, up to a maximum of $7,500 back to the Insured Person where such savings arise from Treatment outside of the United States.

Meal allowance maximum: $100

Refer to the MEDICAL TRAVEL MANAGEMENT provision for further details and requirements.

Non-Emergency Medical Evacuation
  • Lifetime maximum: $1,000,000
  • Insured persons under age 65
  • Approved in advance and coordinated by the Company
Not applicable100%100%100%
Recreational Underwater Activities
  • Subject to deductible and coinsurance
Not applicable100%80%100%
Supplemental Accident Benefit
  • Maximum limit per covered accident: $300
Not applicable100%100%100%

*Coverage for Remote Mental Health Service is not a determination that any specific condition discussed, raised or identified during such consultation is covered under this insurance. The Company reserves the right to decline future claims relating to or arising from any condition, raised, or identified during a Remote Mental Health Service consultation where the illness or injury is directly related to any pre-existing condition or is otherwise excluded under this Certificate of Insurance.

**Teleconsultations will not support a diagnosis for Mental or Nervous Disorders. Coverage for a Teleconsultation is not a determination that any specific condition discussed, raised or identified during such Consultation is covered under this insurance. We reserve the right to decline future claims relating to or arising from any condition discussed, raised or identified during a Teleconsultation where the illness or injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Certificate of Insurance.

Dental Benefits Summary

Coverage Limit/Maximum Amount for Eligible Dental Expenses
 
Calendar Year Maximum Limit $1,000 - $1,500 - $3,000
Calendar Year Orthodontia Maximum Limit $1,000 - $1,500 - $3,000
Deductible
  • Applies to minor restorative, major restorative, and orthodontia services
$50
Family Deductible
  • Maximum 3 deductibles per family
$150
Routine Services -
NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Benefit Coinsurance
Diagnostic and Preventative Services
  • Preventative visits and cleanings: 2 (1 every 6 months)
  • Radiographic examinations (including posterior bitewings): 2 (1 every 6 months)
  • Fluoride treatment: 1 for children under age 19
Plan pays 100% Insured pays 0%
Emergency Palliative Treatment Plan pays 100% Insured pays 0%
Minor Restorative -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Radiographs
  • Radiograph: 1 every 3 years
  • Full mouth x-rays including panographic x-rays
Plan pays 80% Insured pays 20%
Oral Surgery Plan pays 80% Insured pays 20%
Endodontics Plan pays 80% Insured pays 20%
Periodontics
  • Root planning: 1 every 2 years
  • Periodontal surgery: 1 every 3 years
Plan pays 80% Insured pays 20%
Minor Restorative Services
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 80% Insured pays 20%
Major Restorative -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Major Restorative Services
  • Crowns, jackets, inlays (on same tooth): 1 every 5 years
  • Limitations apply for children under age 12
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 50% Insured pays 50%
Prosthodontics
  • Dentures/bridges: 1 every 5 years
  • Replacement of denture base material or reline: 1 every 3 years
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 50% Insured pays 50%
Orthodontia Services -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Orthodontia
  • Children under age 19
Plan pays 50% Insured pays 50%

**If applicants can verify their prior health insurance, with no significant break in coverage (63 days), IMG may accept this as Creditable Coverage and provide a pre-existing conditions waiver (final decision is subject to Underwriters approval). Creditable Coverage is defined as a group health plan provided by a U.S. employer or Health Insurance Issuer, individual major medical health insurance provided by a Health Insurance Issuer, or other Public Health Plan (any health plan established or maintained by a State or the U.S. government).

Coverage Limit/Maximum Amount for Eligible Medical Expenses
 
Currency Options Available in $USD or €EUR
Maximum Limit $5,000,000 per period of coverage
Medical Concierge
  • Non-emergency services only

The Medical Concierge Service is a proprietary service of IMG that helps an insured person navigate the United States healthcare system to identify the highest quality providers for scheduled inpatient and certain outpatient treatments.

Refer to the MEDICAL CONCIERGE provision for further details.

Deductible for Eligible Medical Expenses
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Deductible$0$0$100 - $10,000$100 - $10,000
Family Deductible
  • Maximum 3 deductibles per family
$0$03 deductibles3 deductibles
Coinsurance for Eligible Medical Expenses
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Coinsurance
  • In addition to deductible
Plan pays 100%,
Insured pays 0%		Plan pays 100%,
Insured pays 0%		Plan pays 80%,
Insured pays 20%		Plan pays 100%,
Insured pays 0%
Out-of-Pocket Maximum$0$0$1,000$0
Precertification
 
  • Transplants: No coverage if precertification requirements are not met.
  • Interfacility Ambulance Transfer: No coverage if precertification requirements are not met.
  • Emergency Medical Evacuation: No coverage if precertification requirements are not met. Refer to the EMERGENCY MEDICAL EVACUATION provision for further details and requirements.
  • Maternity and Newborn Care: 50% reduction of eligible medical expenses if precertification requirements are not met.
  • All other Treatments & Supplies: 50% reduction of eligible medical expenses if precertification requirements are not met.
  • Deductible is taken after reduction.
  • Coinsurance is applied to remainder of the reduced amount.
  • Refer to PRECERTIFICATION REQUIREMENTS provision for a complete list of services that require precertification.
Inpatient or Outpatient Services -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Eligible Medical Expenses100%100%80%100%
Physician Visits/ServicesNot applicable100%80%100%
Teladoc Consultation*
  • Not subject to deductible and coinsurance
  • Services rendered in the United States
  • Teladoc consultations will not support a diagnosis for mental or nervous disorders
Company pays 100% within the U.S.Company pays 100% within the U.S.Company pays 100% within the U.S.Company pays 100% within the U.S.
Hospital Emergency Room: United States
  • Injury: Not subject to emergency room deductible
  • Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in a direct hospital admission
Not applicable100%80%Not applicable
Hospital Emergency Room: InternationalNot applicableNot applicableNot applicable100%
Hospitalization/Room & Board
  • Average semi-private room rate
  • Includes nursing, miscellaneous and ancillary services
100%100%80%100%
Intensive Care100%100%80%100%
COVID-19/SARS-CoV-2 CoverageCharges for treatment resulting from COVID-19/SARS-CoV-2 are covered as any other illness covered under the policy.
Outpatient Surgical/Hospital Facility100%100%80%100%
LaboratoryNot applicable100%80%100%
Radiology/X-Ray100%100%80%100%
Chemotherapy/Radiation Therapy100%100%80%100%
Pre-Admission TestingNot applicable100%80%100%
Surgery100%100%80%100%
Reconstructive Surgery
  • Surgery is incidental to and follows surgery that was covered under the plan
100%100%80%100%
Assistant Surgeon
  • 20% of the primary surgeon’s eligible fee
100%100%80%100%
Second Surgical Opinion
  • Payable at 100% if requested by the Company
  • 50% reduction of eligible medical expenses for failure to obtain a second surgical opinion when required by the Company
Not applicable100%80%100%
Anesthetists100%100%80%100%
Pregnancy and Newborn Care
  • After 10 months of continuous coverage
  • Result of natural insemination
  • Newborn routine care, diagnostic tests, and routine immunizations for the first 31 days of life
Not applicable100%80%100%
Pregnancy Complications
  • After 10 months of continuous coverage
Not applicable100%80%100%
Durable Medical EquipmentNot applicable100%80%100%
Podiatry Care
  • Maximum Limit: $750
Not applicable100%80%100%
Chiropractic Care (Outpatient)
  • Not subject to deductible and coinsurance
  • Maximum limit per visit: $75
  • Maximum visits: 20
  • Physician order not required
Not applicable100%100%100%
Chiropractic Care (Inpatient)
  • Must be part of recovery treatment plan for a covered illness or injury
  • Medical order or treatment plan required
Not applicable100%80%100%
Physical Therapy
  • Not subject to coinsurance
  • Maximum limit per visit: $75
  • Medical order or treatment plan required
Not applicable100%100%100%
Occupational Therapy
  • Not subject to coinsurance
  • Maximum limit per visit: $75
  • Medical order or treatment plan required
Not applicable100%100%100%
Extended Care Facility
  • Upon direct transfer from acute care facility
100%100%80%100%
Home Nursing Care
  • Provided by a home health care agency
  • Upon direct transfer from an acute care facility
100%100%80%100%
Transplant
  • Lifetime maximum: $1,000,000
  • Per period of coverage transplant maximum limit: 1
  • Organ procurement & harvesting costs lifetime maximum: $10,000
  • Travel & lodging lifetime maximum expense: $5,000
  • Covered transplants: cornea, heart, heart/lung, lung, kidney, kidney/pancreas, liver, allogeneic or autologous bone marrow
  • Subject to the TRANSPLANT PRECERTIFICATION provision and only when treatment is provided within the Company’s approved independent Managed Transplant System Network
100%100%80%100%
Preventative Care -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Adult Preventative Care
  • Ages 19 and over
  • Maximum limit: $250
  • Refer to the PREVENTATIVE CARE provision for further details and requirements
Not applicable100%100%100%
Child Preventative Care
  • Ages 18 and younger
  • Maximum limit: $250
  • Refer to the PREVENTATIVE CARE provision for further details and requirements
Not applicable100%100%100%
Vision Care -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Routine Eye Examination
  • Available after 12 months of continuous coverage
Maximum limit every 24 months: $100Maximum limit every 24 months: $100Maximum limit every 24 months: $100Maximum limit every 24 months: $100
Corrective Lenses, Contacts, Frames
  • Available after 12 months of continuous coverage
Maximum limit every 24 months: $150Maximum limit every 24 months: $150Maximum limit every 24 months: $150Maximum limit every 24 months: $150
Prescriptions -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Prescriptions
  • Dispensing maximum: 90 days per prescription
Not applicable80%80%100%
United States Retail Pharmacy
  • Not subject to deductible and coinsurance
  • Copayments are per 30-day supply
  • Dispensing maximum: 90 days per prescription
  • Prescriptions $3,000 and higher will require Universal RX (URX) to obtain prior authorization from the Company

Universal RX (URX) Prescription Drug Card MUST be utilized for all outpatient prescription drugs in the United States.

Retail Pharmacy Copayments:

Generic $5
Higher-cost generic and brand $15
Non-preferred brand name$30
International Prescriptions
  • Prescriptions $3,000 and higher will require Universal RX (URX) to obtain prior authorization from the Company
Coinsurance: 100%
Subject to deductible and coinsurance
Dispensing maximum: 90 days per prescription
Expatriate Prescription Services Program
Generic $5
Brand name$15
Copayments are per 30-day supply
Dispensing maximum: 90 days per prescription
Contact Information:
  • Enroll via the provider’s website: www.expatps.com
Prescription Submission:
  • Email (scan prescription): epsmanager@universalrx.com
  • Fax: +1.540.777.7184
Questions/Concerns:
  • Phone number: +1.540.777.1450
  • Email: epsmanager@universalrx.com
Mental or Nervous, Substance Abuse and Counseling -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Lifetime Maximum$20,000$20,000$20,000$20,000
Inpatient Mental or Nervous/Substance Abuse 100%100%80%100%
Outpatient Mental or Nervous/Substance Abuse
  • Maximum limit per visit: $100
  • Maximum visits: 52
Not applicable100%80%100%
Emergency Services -
(NOT Subject to Deductible or Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Emergency Local Ambulance
  • Subject to deductible and coinsurance
  • Injury
  • Illness resulting in an inpatient hospital admission
Not applicable100%80%100%
Emergency Medical Evacuation
  • Lifetime maximum: $1,000,000
  • Insured persons under 65 years of age
  • Approved in advance and coordinated by the Company
Not applicable100%100%100%
Emergency Reunion
  • Lifetime maximum: $10,000
  • Maximum days: 15
  • Maximum meal limit per day: $25
  • Reasonable and necessary travel costs and accommodations
  • Approved in advance by the Company
Not applicable100%100%100%
Interfacility Ambulance Transfer
  • Transfer must be a result of an inpatient hospital admission
Not applicable100%100%100%
Return of Mortal Remains
  • Maximum limit: $25,000
  • Local burial/Cremation maximum limit: $10,000
  • Return of insured person’s mortal remains to home country
  • Approved in advance by the Company
Not applicable100%100%100%
Other Services -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Accommodation Benefit
  • Maximum limit: $2,500
  • Refer to the ACCOMMODATION BENEFIT provisions for futher details and requirements
Not applicable100%100%100%
Amateur Sailboat Racing
  • Subject to deductible and coinsurance
Not applicable100%80%100%
Crew Member Return
  • Maximum limit: $2,500
Not applicable100%100%100%
Emergency Dental
  • Subject to deductible and coinsurance
  • Accident related
Not applicable80%80%100%
Traumatic Dental Injury
  • Treatment at a hospital facility due to an accident
  • Additional treatment for the same injury rendered by a dental provider will be paid at 100%
Not applicable100%80%100%
Hospital Indemnity
  • International only
  • Benefit is not available when the inpatient hospital treatment is part of the Medical Travel Management benefit
  • Inpatient hospitalization only
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
Remote Mental Health Service*
  • Employee Assistance Program
Company pays 100%Company pays 100%Company pays 100%Company pays 100%
Teleconsultation** Company pays 100%Company pays 100%Company pays 100%Company pays 100%
Medical Travel Management
  • Must be approved in advance by the Company

Medically necessary non-emergency treatment, including hospitalization and surgery for approved procedures; the Company will offer medical travel as a means to manage the costs.

If Medical Travel is approved, the Company will reimburse 10% of the cost savings, up to a maximum of $7,500 back to the Insured Person where such savings arise from Treatment outside of the United States.

Meal allowance maximum: $100

Refer to the MEDICAL TRAVEL MANAGEMENT provision for further details and requirements.

Non-Emergency Medical Evacuation
  • Lifetime maximum: $1,000,000
  • Insured persons under age 65
  • Approved in advance and coordinated by the Company
Not applicable100%100%100%
Recreational Underwater Activities
  • Subject to deductible and coinsurance
Not applicable100%80%100%
Supplemental Accident Benefit
  • Maximum limit per covered accident: $300
Not applicable100%100%100%

*Coverage for Remote Mental Health Service is not a determination that any specific condition discussed, raised or identified during such consultation is covered under this insurance. The Company reserves the right to decline future claims relating to or arising from any condition, raised, or identified during a Remote Mental Health Service consultation where the illness or injury is directly related to any pre-existing condition or is otherwise excluded under this Certificate of Insurance.

**Teleconsultations will not support a diagnosis for Mental or Nervous Disorders. Coverage for a Teleconsultation is not a determination that any specific condition discussed, raised or identified during such Consultation is covered under this insurance. We reserve the right to decline future claims relating to or arising from any condition discussed, raised or identified during a Teleconsultation where the illness or injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Certificate of Insurance.

Dental Benefits Summary

Coverage Limit/Maximum Amount for Eligible Dental Expenses
 
Calendar Year Maximum Limit $1,000 - $1,500 - $3,000
Calendar Year Orthodontia Maximum Limit $1,000 - $1,500 - $3,000
Deductible
  • Applies to minor restorative, major restorative, and orthodontia services
$50
Family Deductible
  • Maximum 3 deductibles per family
$150
Routine Services -
NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Benefit Coinsurance
Diagnostic and Preventative Services
  • Preventative visits and cleanings: 2 (1 every 6 months)
  • Radiographic examinations (including posterior bitewings): 2 (1 every 6 months)
  • Fluoride treatment: 1 for children under age 19
Plan pays 100% Insured pays 0%
Emergency Palliative Treatment Plan pays 100% Insured pays 0%
Minor Restorative -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Radiographs
  • Radiograph: 1 every 3 years
  • Full mouth x-rays including panographic x-rays
Plan pays 80% Insured pays 20%
Oral Surgery Plan pays 80% Insured pays 20%
Endodontics Plan pays 80% Insured pays 20%
Periodontics
  • Root planning: 1 every 2 years
  • Periodontal surgery: 1 every 3 years
Plan pays 80% Insured pays 20%
Minor Restorative Services
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 80% Insured pays 20%
Major Restorative -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Major Restorative Services
  • Crowns, jackets, inlays (on same tooth): 1 every 5 years
  • Limitations apply for children under age 12
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 50% Insured pays 50%
Prosthodontics
  • Dentures/bridges: 1 every 5 years
  • Replacement of denture base material or reline: 1 every 3 years
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 50% Insured pays 50%
Orthodontia Services -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Orthodontia
  • Children under age 19
Plan pays 50% Insured pays 50%

**If applicants can verify their prior health insurance, with no significant break in coverage (63 days), IMG may accept this as Creditable Coverage and provide a pre-existing conditions waiver (final decision is subject to Underwriters approval). Creditable Coverage is defined as a group health plan provided by a U.S. employer or Health Insurance Issuer, individual major medical health insurance provided by a Health Insurance Issuer, or other Public Health Plan (any health plan established or maintained by a State or the U.S. government).

Coverage Limit/Maximum Amount for Eligible Medical Expenses
 
Period of CoverageMaximum Limit: 365 days
Calendar Year Maximum Limit Unlimited
Medical Concierge
  • Non-emergency services only

The Medical Concierge Service is a proprietary service of IMG that helps an insured person navigate the United States healthcare system to identify the highest quality providers for scheduled Inpatient and certain outpatient treatments.

Refer to the MEDICAL CONCIERGE provision for further details.

Deductible for Eligible Medical Expenses
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Deductible$0$0$0$0
Coinsurance for Eligible Medical Expenses
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Coinsurance
  • In addition to deductible
Plan pays 100%,
Insured pays 0%		Plan pays 100%,
Insured pays 0%		Plan pays 80%,
Insured pays 20%		Plan pays 100%,
Insured pays 0%
Out-of-Pocket Maximum$0$0$1,000$0
Precertification
 
  • Transplants: No coverage if precertification requirements are not met.
  • Interfacility Ambulance Transfer: No coverage if precertification requirements are not met.
  • Emergency Medical Evacuation: No coverage if precertification requirements are not met. Refer to the EMERGENCY MEDICAL EVACUATION provision for further details and requirements.
  • Maternity and Newborn Care: 50% reduction of eligible medical expenses if precertification requirements are not met.
  • All other Treatments & Supplies: 50% reduction of eligible medical expenses if precertification requirements are not met.
  • Deductible is taken after reduction.
  • Coinsurance is applied to remainder of the reduced amount.
  • Refer to PRECERTIFICATION REQUIREMENTS provision for a complete list of services that require precertification.
Pre-Existing Conditions -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
Pre-existing conditions are covered the same as any other illness or injury.
Inpatient or Outpatient Services -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Eligible Medical Expenses100%100%80%100%
Physician Visits/ServicesNot applicable100%80%100%
Teladoc Consultation*
  • Not subject to deductible and coinsurance
  • Services rendered in the United States
  • Teladoc consultations will not support a diagnosis for mental or nervous disorders
Company pays 100% within the U.S.Company pays 100% within the U.S.Company pays 100% within the U.S.Company pays 100% within the U.S.
Hospital Emergency Room: United States
  • Injury: Not subject to emergency room deductible
  • Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in a direct hospital admission
Not applicable100%80%Not applicable
Hospital Emergency Room: InternationalNot applicableNot applicableNot applicable100%
Hospitalization/Room & Board
  • Average semi-private room rate
  • Includes nursing, miscellaneous and ancillary services
100%100%80%100%
Intensive Care100%100%80%100%
COVID-19/SARS-CoV-2 CoverageCharges for treatment resulting from COVID-19/SARS-CoV-2 are covered as any other illness covered under the policy.
Outpatient Surgical/Hospital Facility100%100%80%100%
LaboratoryNot applicable100%80%100%
Radiology/X-Ray100%100%80%100%
Chemotherapy/Radiation Therapy100%100%80%100%
Pre-Admission TestingNot applicable100%80%100%
Surgery100%100%80%100%
Reconstructive Surgery
  • Surgery is incidental to and follows surgery that was covered under the plan
100%100%80%100%
Assistant Surgeon
  • 20% of the primary surgeon’s eligible fee
100%100%80%100%
Second Surgical Opinion
  • Payable at 100% if requested by the Company
  • 50% reduction of eligible medical expenses for failure to obtain a second surgical opinion when required by the Company
Not applicable100%80%100%
Anesthetists100%100%80%100%
Pregnancy and Newborn Care
  • After 10 months of continuous coverage
  • Result of natural insemination
  • Newborn routine care, diagnostic tests, and routine immunizations for the first 31 days of life
Not applicable100%80%100%
Pregnancy Complications
  • After 10 months of continuous coverage
Not applicable100%80%100%
Durable Medical EquipmentNot applicable100%80%100%
Podiatry Care
  • Maximum Limit: $750
Not applicable100%80%100%
Chiropractic Care (Outpatient)
  • Not subject to deductible and coinsurance
  • Maximum limit per visit: $75
  • Maximum visits: 20
  • Physician order not required
Not applicable100%100%100%
Chiropractic Care (Inpatient)
  • Must be part of recovery treatment plan for a covered illness or injury
  • Medical order or treatment plan required
Not applicable100%80%100%
Physical Therapy
  • Not subject to coinsurance
  • Maximum limit per visit: $75
  • Medical order or treatment plan required
Not applicable100%100%100%
Occupational Therapy
  • Not subject to coinsurance
  • Maximum limit per visit: $75
  • Medical order or treatment plan required
Not applicable100%80%100%
Extended Care Facility
  • Upon direct transfer from acute care facility
100%100%80%100%
Home Nursing Care
  • Provided by a home health care agency
  • Upon direct transfer from an acute care facility
100%100%80%100%
Transplant
  • Lifetime maximum: $1,000,000
  • Per period of coverage transplant maximum limit: 1
  • Organ procurement & harvesting costs lifetime maximum: $10,000
  • Travel & lodging lifetime maximum expense: $5,000
  • Covered transplants: cornea, heart, heart/lung, lung, kidney, kidney/pancreas, liver, allogeneic or autologous bone marrow
  • Subject to the TRANSPLANT PRECERTIFICATION provision and only when treatment is provided within the Company’s approved independent Managed Transplant System Network
100%100%80%100%
Preventative Care -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Adult Preventative Care
  • Ages 19 and over
  • Maximum limit: $500
  • Refer to the PREVENTATIVE CARE provision for further details and requirements
Not applicable100%100%100%
Child Preventative Care
  • Ages 18 and younger
  • Maximum limit: $500
  • Refer to the PREVENTATIVE CARE provision for further details and requirements
Not applicable100%100%100%
Vision Care -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Routine Eye Examination
  • Available after 12 months of continuous coverage
Maximum limit every 24 months: $100Maximum limit every 24 months: $100Maximum limit every 24 months: $100Maximum limit every 24 months: $100
Corrective Lenses, Contacts, Frames
  • Available after 12 months of continuous coverage
Maximum limit every 24 months: $150Maximum limit every 24 months: $150Maximum limit every 24 months: $150Maximum limit every 24 months: $150
Prescriptions -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
United States Retail Pharmacy
  • Not subject to deductible and coinsurance
  • Copayments are per 30-day supply
  • Dispensing maximum: 90 days per prescription
  • Prescriptions $3,000 and higher will require Universal RX (URX) to obtain prior authorization from the Company

Universal RX (URX) Prescription Drug Card MUST be utilized for all outpatient prescription drugs in the United States.

Retail Pharmacy Copayments:

  • Generic: $5
  • Higher-cost generic and brand: $15
  • Non-preferred brand name: $30
International Prescriptions
  • Prescriptions $3,000 and higher will require Universal RX (URX) to obtain prior authorization from the Company

Coinsurance: 100%

  • Subject to deductible and coinsurance
  • Dispensing maximum: 90 days per prescription

Expatriate Prescription Services Program

  • Generic: $5
  • Brand name: $15
  • Copayments are per 30-day supply
  • Dispensing maximum: 180 days per prescription

Contact Information:

Prescription Submission:

Questions/Concerns:

Mental or Nervous, Substance Abuse and Counseling -
(Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Lifetime Maximum$20,000$20,000$20,000$20,000
Inpatient Mental or Nervous/Substance Abuse 100%100%80%100%
Outpatient Mental or Nervous/Substance Abuse
  • Maximum limit per visit: $100
  • Maximum visits: 52
Not applicable100%80%100%
Emergency Services -
(NOT Subject to Deductible or Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Emergency Local Ambulance
  • Subject to deductible and coinsurance
  • Injury
  • Illness resulting in an inpatient hospital admission
Not applicable100%80%100%
Emergency Medical Evacuation
  • Lifetime maximum: $1,000,000
  • Insured persons under 65 years of age
  • Approved in advance and coordinated by the Company
Not applicable100%100%100%
Emergency Reunion
  • Lifetime maximum: $10,000
  • Maximum days: 15
  • Maximum meal limit per day: $25
  • Reasonable and necessary travel costs and accommodations
  • Approved in advance by the Company
Not applicable100%100%100%
Interfacility Ambulance Transfer
  • Transfer must be a result of an inpatient hospital admission
Not applicable100%100%100%
Return of Mortal Remains
  • Maximum limit: $25,000
  • Local burial/Cremation maximum limit: $10,000
  • Return of insured person’s mortal remains to home country
  • Approved in advance by the Company
Not applicable100%100%100%
Other Services -
(NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime)
 
BenefitUnited States
Medical Concierge		United States
In-Network		United States
Out-of-Network		International
International
Accommodation Benefit
  • Maximum limit: $2,500
  • Refer to the ACCOMMODATION BENEFIT provisions for futher details and requirements
Not applicable100%100%100%
Amateur Sailboat Racing
  • Subject to deductible and coinsurance
Not applicable100%80%100%
Crew Member Return
  • Maximum limit: $2,500
Not applicable100%100%100%
Emergency Dental
  • Subject to deductible and coinsurance
  • Accident related
Not applicable80%80%100%
Traumatic Dental Injury
  • Treatment at a hospital facility due to an accident
  • Additional treatment for the same injury rendered by a dental provider will be paid at 100%
Not applicable100%80%100%
Hospital Indemnity
  • International only
  • Benefit is not available when the inpatient hospital treatment is part of the Medical Travel Management benefit
  • Inpatient hospitalization only
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
  • Overnight maximum limit: $100
  • Maximum overnight limit: 20
  • Maximum limit: $2,000
Remote Mental Health Service*
  • Employee Assistance Program
Company pays 100%Company pays 100%Company pays 100%Company pays 100%
Teleconsultation** Company pays 100%Company pays 100%Company pays 100%Company pays 100%
Medical Travel Management
  • Must be approved in advance by the Company

Medically necessary non-emergency treatment, including hospitalization and surgery for approved procedures; the Company will offer medical travel as a means to manage the costs.

If Medical Travel is approved, the Company will reimburse 10% of the cost savings, up to a maximum of $7,500 back to the Insured Person where such savings arise from Treatment outside of the United States.

Meal allowance maximum: $100

Refer to the MEDICAL TRAVEL MANAGEMENT provision for further details and requirements.

Non-Emergency Medical Evacuation
  • Lifetime maximum: $1,000,000
  • Insured persons under age 65
  • Approved in advance and coordinated by the Company
Not applicable100%100%100%
Recreational Underwater Activities
  • Subject to deductible and coinsurance
Not applicable100%100%100%
Supplemental Accident Benefit
  • Maximum limit per covered accident: $500
Not applicable100%100%100%

*Coverage for Remote Mental Health Service is not a determination that any specific condition discussed, raised or identified during such consultation is covered under this insurance. The Company reserves the right to decline future claims relating to or arising from any condition, raised, or identified during a Remote Mental Health Service consultation where the illness or injury is directly related to any pre-existing condition or is otherwise excluded under this Certificate of Insurance.

**Teleconsultations will not support a diagnosis for Mental or Nervous Disorders. Coverage for a Teleconsultation is not a determination that any specific condition discussed, raised or identified during such Consultation is covered under this insurance. We reserve the right to decline future claims relating to or arising from any condition discussed, raised or identified during a Teleconsultation where the illness or injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Certificate of Insurance.

Platinum Dental Benefits Summary

Coverage Limit/Maximum Amount for Eligible Dental Expenses
 
Calendar Year Maximum Limit $1,500 - $3,000
Calendar Year Orthodontia Maximum Limit $1,500 - $3,000
Deductible
  • Applies to minor restorative, major restorative, and orthodontia services
$50
Family Deductible
  • Maximum 3 deductibles per family
$150
Routine Services -
NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Benefit Coinsurance
Diagnostic and Preventative Services
  • Preventative visits and cleanings: 2 (1 every 6 months)
  • Radiographic examinations (including posterior bitewings): 2 (1 every 6 months)
  • Fluoride treatment: 1 for children under age 19
Plan pays 100% Insured pays 0%
Emergency Palliative Treatment Plan pays 100% Insured pays 0%
Minor Restorative -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Radiographs
  • Radiograph: 1 every 3 years
  • Full mouth x-rays including panographic x-rays
Plan pays 80% Insured pays 20%
Oral Surgery Plan pays 80% Insured pays 20%
Endodontics Plan pays 80% Insured pays 20%
Periodontics
  • Root planning: 1 every 2 years
  • Periodontal surgery: 1 every 3 years
Plan pays 80% Insured pays 20%
Minor Restorative Services
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 80% Insured pays 20%
Major Restorative -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Major Restorative Services
  • Crowns, jackets, inlays (on same tooth): 1 every 5 years
  • Limitations apply for children under age 12
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 50% Insured pays 50%
Prosthodontics
  • Dentures/bridges: 1 every 5 years
  • Replacement of denture base material or reline: 1 every 3 years
  • Refer to the ELIGIBLE DENTAL EXPENSES provision for further details and requirements
Plan pays 50% Insured pays 50%
Orthodontia Services -
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Maximum Limits per Calendar Year or, if indicated, per Lifetime
 
Orthodontia
  • Children under age 19
Plan pays 50% Insured pays 50%

Group Life Insurance (Optional)

  • Group Life benefit automatically includes:
    • Term Life Insurance Benefit
    • Accidental Death Benefit
    • Dismemberment Benefit
  • 10 or fewer IMG insured employees:
    • $10,000 minimum required
  • Automatically approved up to $100,000 if member is approved for the IMMI medical plan
    • Additional underwriting $100,001 - $250,000
  • Group Life can be issued as a flat amount (e.g. $50,000) or by salary (e.g. 2 x salary)
  • Group Life reduction schedule:
    • Less than age 65: Full amount payable
    • Ages 65-69: 35% reduction
    • Ages 70-74: 55% reduction
    • Ages 75-79: 70% reduction
    • Age 80+: 80% reduction

Disclaimer

This invitation to inquire allows eligible applicants an opportunity to inquire further about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract. The contract does contain a pre-existing condition exclusion and does not cover losses or expenses related to a pre-existing condition.

Emergency Travel Assistance

Even the smallest disruption can be an emergency when your group members are abroad. We offer a complete array of emergency travel assistance services so they can spend more time enjoying their international experience and spend less time worrying about the smaller issues. Some services provided include:

  • Emergency travel arrangements
  • Lost passport/travel documents assistance
  • Lost luggage assistance
  • Embassy or consulate referrals
  • Emergency message relay
  • Emergency prescription replacement
  • Medical referrals
  • 24-hour medical monitoring
  • Emergency cash transfer and emergency translations
  • Legal referrals
 

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  • "Although one hopes never to use travel insurance, IMG was a godsend throughout our ordeal. We couldn’t have done it without your continued assistance."
    Joan D. United States
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    Mark K. - United States

    While skiing in Chile, Mark, an IMG member, found himself on the brink of paralysis.