Global Mission Medical Insurance

Schedule of Benefits

All amounts shown are in U.S. dollars. Click the orange headers for further information.

Summary of Benefits Subject to deductible and coinsurance unless otherwise noted
Lifetime Maximum Limit
Deductible (Per Period of Coverage)
Family Deductible
Treatment Outside the U.S. and Canada
Treatment Inside the U.S. (Out-Patient/In-Patient Emergency)
Treatment Inside the U.S. (In-Patient Non-Emergency))
Treatment inside the U.S.- Non-PPO Network and Canada
Hospitalization / Room & Board
Intensive Care Unit
Anesthetist's Charges Associated with Surgery
Emergency Room Illness (Additional $250 deductible if not admitted)
Emergency Room Accident
Supplemental Accident
Local Ambulance
Emergency Evacuation
Emergency Reunion
Return of Mortal Remains
Remote Transportation
Political Evacuation and Repatriation
Child Wellness (Under 18 years of age)
Adult Wellness
Rx Coverage
Other Services
Physical Therapy
Complementary Medicine
Recreational Scuba
Non-emergency Dental
Emergency Dental due to Accident
Emergency Dental due to Sudden Unexpected Pain
High School Sports Injury
Delivery, wellness, new born care & congenital disorders, Family Matters Maternity Program (*not subject to deductible or coinsurance - available after 10 months of coverage)

NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

* 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.