| Benefit |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | Choice of Coverage Area | 1) Worldwide
2) Worldwide excluding U.S., Canada, China, Hong Kong, Japan, Macau, Singapore & Taiwan
3) Country of Assignment | 1) Worldwide
2) Worldwide excluding U.S., Canada, China, Hong Kong, Japan, Macau, Singapore & Taiwan
3) Country of Assignment | 1) Worldwide
2) Worldwide excluding U.S., Canada, China, Hong Kong, Japan, Macau, Singapore & Taiwan
3) Country of Assignment | 1) Worldwide
2) Worldwide excluding U.S., Canada, China, Hong Kong, Japan, Macau, Singapore & Taiwan
3) Country of Assignment | | Maximum Lifetime Benefit per person | $50,000 - $8,000,000 | $50,000 - $8,000,000 | $50,000 - $8,000,000 | $50,000 - $8,000,000 | |
| Deductible/Coinsurance |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | Deductible - Calendar Year | $0 - $25,000 | $0 - $25,000 | $0 - $25,000 | $0 - $25,000 | | Family Deductibles | 2 or 3 | 2 or 3 | 2 or 3 | 2 or 3 | | Teatment outside the U.S. & Canada | Subject to deductible. No coinsurance | Subject to deductible. No coinsurance | Subject to deductible. Plan pays 90% of the next $10,000 - 100% thereafter | Subject to deductible. Plan pays 90% of the next $10,000 - 100% thereafter | Treatment inside the U.S.
(Out-patient/In-patient Emergency) | PPO Network – deductible 50% waived (to a $2,500 maximum). No coinsurance | PPO Network – deductible 50% waived (to a $2,500 maximum). No coinsurance | PPO Network – deductible 50% waived (to a $2,500 maximum). Plan pays 80% of the next $10,000 of eligible expenses - 100% thereafter | PPO Network – deductible 50% waived (to a $2,500 maximum). Plan pays 80% of the next $10,000 of eligible expenses - 100% thereafter | Treatment inside the U.S.
(In-patient Non-Emergency) | Medical Concierge – deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network- Subject to deductible. No coinsurance | Medical Concierge – deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network- Subject to deductible. No coinsurance | Medical Concierge – deductible 50% waived (to a $2,500 maximum). Plan pays 80% of the next $10,000 of eligible expenses- 100% thereafter. PPO Network- Subject to deductible. Plan pays 80% of the next $10,000 of eligible expenses - 100% thereafter | Medical Concierge – deductible 50% waived (to a $2,500 maximum). Plan pays 80% of the next $10,000 of eligible expenses- 100% thereafter. PPO Network- Subject to deductible. Plan pays 80% of the next $10,000 of eligible expenses - 100% thereafter | | Treatment inside the U.S.- Non-PPO Network and Canada | Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses - 100% thereafter | Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses - 100% thereafter | Subject to deductible. Plan pays 70% of the next $10,000 of eligible expenses - 100% thereafter | Subject to deductible. Plan pays 70% of the next $10,000 of eligible expenses - 100% thereafter | |
| In-patient/ Out-patient Services |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | Hospitalization/ Room & Board | In U.S./Canada - URC of average semi-private room rate. Outside of U.S./Canada - URC of private room rate (not to exceed 150% of semi-private room rate). | In U.S./Canada - URC of average semi-private room rate. Outside of U.S./Canada - URC of private room rate (not to exceed 150% of semi-private room rate). | Semi-private room rate Semi | Semi-private room rate Semi | | Intensive Care Unit | URC | URC | URC | URC | | Out-patient | URC | URC | Following In-patient Treatment up to $2,000 per period of insurance and/or 90 days | Following In-patient Treatment up to $2,000 per period of insurance and/or 90 days | | Emergency Room | URC Additional $250 deductible applied if not admitted for treatment of an illness | URC Additional $250 deductible applied if not admitted for treatment of an illness | URC Additional $250 deductible applied if not admitted for treatment of an illness | Hospital admission required | | Prescription Drugs | URC | Up to $1,500 annual maximum | Up to $1,500 annual maximum | URC (In-patient expenses only) | | Local Ambulance | URC | URC | URC | URC | | Chronic Condition | URC | 60 days per condition | 60 days per condition | 60 days per condition | | Transplants | $1,000,000 lifetime | $250,000 lifetime | NA | $250,000 lifetime | |
| Wellness |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | Adult Wellness Benefit Not subject to deductible and coinsurance | $250 per calendar year | $250 per calendar year | NA | NA | | Child Wellness Benefit Not subject to deductible and coinsurance | $150 per calendar year | $150 per calendar year | NA | NA | |
| Physician Services |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | Illness or Accident Benefit | URC | URC | Following In-patient Treatment Up to $2,000 per period of insurance and/or 90 days | URC (In-patient expenses only) | Supplemental Accident Benefit
Not subject to deductible and coinsurance | $300 per covered accident | NA | NA | NA | |
| Emergency Services |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | Return of Mortal Remains to Home Country | $25,000 | $10,000 | NA | $25,000 included in Emergency Evacuation Benefit | | Political Evacuation & Repatriation | $10,000 lifetime | $10,000 lifetime | $10,000 lifetime | $10,000 lifetime | | Emergency Medical Evacuation | Up to plan maximum lifetime benefit per person | $25,000 lifetime benefit per person | NA | $25,000 lifetime benefit per person | | Emergency Reunion | $10,000 lifetime benefit | $5,000 lifetime benefit | NA | $25,000 included in Emergency Evacuation Benefit | |
| Maternity |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | *Maternity Coverage Available after 10 months of continuous coverage | SAAI | SAAI | NA | SAAI | | Pre-natal Care - Delivery of Newborn - Post-natal Care | URC | $5,000 - Normal Delivery $7,500 - Complications | NA | $5,000 - Normal Delivery $7,500 - Complications | Newborn Baby Care
(Well-Baby) | Routine care for the first 31 days of life | Routine care for the first 31 days of life | NA | Routine care for the first 31 days of life | |
| Additional Benefits |
| | Plan 1 | Plan 2 | Plan 3 | Plan 4
(Hospital Plan) | | Physical Therapy | $50 per visit | $50 per visit | NA | URC (In-patient expenses only) | Chiropractic Care
Not subject to deductible and coinsurance | $25 per visit (maximum of 20 visits per policy period) | NA | NA | NA | | Complementary Medicine | Acupuncture - $150; Aroma Therapy -$50; Herbal - $50; Magnetic - $75; Massage -$150; Vitamin - $100 | Acupuncture - $150; Aroma Therapy -$50; Herbal - $50; Magnetic - $75; Massage -$150; Vitamin - $100 | NA | NA | |
| Additional Benefits Available on Plan 1 |
*Mental & Nervous Disorders / Alcohol & Substance Abuse
Available after 12 months of continuous coverage | In-patient Treatment - $10,000 Calendar year; $20,000 Lifetime Out-patient Treatment - 50% of a maximum charge of $100 per visit of 52 visits per calendar year | Vision
Not subject to deductible and coinsurance | Exams - Up to $100 per 24 months Materials, frames, lenses, contacts - Up to $150 per 24 months | |