Schedule of Benefits
All amounts shown are in U.S. dollars. Click the orange headers for further information.
|
Coverage Area
|
Worldwide, 24 hours per day
|
|
Policy Maximum
|
$1,000,000 per insured per certificate period
|
|
Hospitalization
|
Average semi-private room rate
|
|
Intensive Care Unit
|
URC
|
|
Surgery
|
URC
|
|
Outpatient Care
|
URC
|
|
Supplemental Accident Benefit
|
$300 per covered accident, before application of deductible and coinsurance
|
|
Mental and Nervous Care
|
$20,000 lifetime maximum after 12 months of continuous coverage
|
|
Maternity and Newborn Care
|
Up to the policy maximum after 10 months of continuous coverage
|
|
Transplants
|
Up to a lifetime maximum of $1,000,000
|
|
Subject to special transplant pre-notification requirements, and only when treatment
is provided within the Managed Transplant System Network
|
|
Emergency Medical Evacuation
|
Up to a lifetime maximum of $1,000,000-must be approved and coordinated in advance
by IMG
|
|
Repatriation of Mortal Remains
|
Up to $25,000 - must be approved and coordinated in advance by IMG
|
|
Chiropractic Care
|
URC
|
With a physician’s referral URC Without a physician’s referral.
$25 per visit, up to 20 visits per year, not subject to deductible or coinsurance
|
|
Wellness Care
|
Up to $250 per calendar, not subject to deductible or coinsurance
|
|
Routine physical examinations, including pap smear and mammogram after 12 months
of continuous coverage
|
|
SCUBA Coverage
|
URC
|
|
Please contact your agent or representative for details
|
|
Physical Therapy
|
Up to $50 per visit, per charge
|
|
Amateur Sailboat Racing Coverage
|
$10,000 per policy period, $50,000 lifetime maximum
with a benefit specific deductible of $2,500 per calendar year
|
* This Web page contains only a brief summary of current benefits, conditions, limitations and exclusions, and is subject to all the terms and conditions of the full Certificate of Insurance. The complete Certificate of Insurance with all terms, conditions and exclusions will be included in the fulfillment kit sent to approved applicants. These plans are amended, modified or replaced from time to time, and IMG reserves the right to issue the most current Certificate of Insurance for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Samples of current Certificate wordings are available upon request.