Global Medical Insurance

Annually renewable worldwide medical insurance program for individuals and families

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Summary of Benefits

Subject to deductible and coinsurance unless otherwise noted

Plan Information
 
BenefitBronzeSilverGoldPlatinum
Lifetime Maximum Limit$1,000,000 per individual$5,000,000 per individual$5,000,000 per individual$8,000,000 per individual
Deductible (Per period of coverage)$250 to $10,000$250 to $10,000$250 to $25,000$100 to $25,000
Treatment Outside the U.S.50% of deductible waived, up to a maximum of $2,500. No coinsurance.50% of deductible waived, up to a maximum of $2,500. No coinsurance.50% of deductible waived, up to a maximum of $2,500. No coinsurance.50% of deductible waived, up to a maximum of $2,500. No coinsurance.
Treatment inside the U.S. using Medical Concierge50% of deductible waived, up to a maximum of $2,500. No coinsurance.50% of deductible waived, up to a maximum of $2,500. No coinsurance.50% of deductible waived, up to a maximum of $2,500. No coinsurance.50% of deductible waived, up to a maximum of $2,500. No coinsurance.
Treatment inside the U.S. - PPO NetworkSubject to deductible. No coinsurance.Subject to deductible. No coinsurance.Subject to deductible. No coinsurance.Subject to deductible. No coinsurance.
Treatment inside the U.S. - Non-PPO NetworkSubject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.
CoinsuranceInternational – 100%
U.S. in-network – 100%
U.S. out-of-network – 80% 		International – 100%
U.S. in-network – 100%
U.S. out-of-network – 80% 		International – 100%
U.S. in-network – 100%
U.S. out-of-network – 80% 		International – 100%
U.S. in-network – 100%
U.S. out-of-network – 80%
Outpatient

$300 maximum per visit – lab tests; $250 maximum per visit – diagnostic x-rays

$500 maximum limit – specialists/physician charges (pre-inpatient / post-inpatient)

Subject to deductible and coinsurance

$300 maximum per visit – lab tests; $250 maximum per visit – diagnostic x-rays

25 combined maximum visits
$70 per visit/examination – specialists/physician charges
$50 per visit/examination – chiropractor charges (medical order or treatment plan required)
$500 maximum limit – surgery intervention consultation charges

Subject to deductible and coinsurance

Subject to deductible and coinsuranceSubject to deductible and coinsurance
Mental/Nervous N/AOutpatient after 12 months of continuous coverage.$10,000 maximum per period of coverage with a $50,000 lifetime maximum - Available after 12 months of continuous coverage.$50,000 lifetime maximum
Hospital Emergency Room Injury Subject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsurance
Hospital Emergency Room IllnessSubject to deductible and coinsurance. Covered only if admitted as inpatientSubject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatientSubject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatientSubject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient
Hospitalization / Room & Board Subject to deductible and coinsurance for average semi-private room rateSubject to deductible and coinsurance for average semi-private room rate. All subject to $600 per day/240 day maximumSubject to deductible and coinsurance for average semi-private room rateSubject to deductible and coinsurance for average private room rate
Intensive Care Unit Subject to deductible and coinsurance

Subject to deductible and coinsurance.

$1,500 limit per day – 180 days of coverage per event

Subject to deductible and coinsuranceSubject to deductible and coinsurance
CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy

Subject to deductible and coinsurance.

$600 maximum per examination

Subject to deductible and coinsurance.

$600 maximum per examination

Subject to deductible and coinsuranceSubject to deductible and coinsurance
Surgery Subject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsurance
Assistant Surgeon20% of primary surgeon’s charge20% of primary surgeon’s charge20% of primary surgeon’s charge20% of primary surgeon’s charge
Chemotherapy or Radiation TherapySubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsurance
Maternity
Delivery, preventative, newborn care & congenital disorders, Family Matters Maternity Program (available after 10 months of coverage) 		N/AN/AN/A

$2,500 additional deductible per pregnancy.

$50,000 lifetime maximum. $200 newborn preventative care benefit for the first 31 days – 12 months after birth.

$250,000 maximum for newborn care & congenital disorders for the first 31 days after birth

Podiatry CareN/AN/A$750 maximum limit$750 maximum limit
Physical Therapy

Subject to deductible and coinsurance.

$40 maximum per visit – 10 visit limit per event. Available for 90 days following inpatient treatment or outpatient surgery

Subject to deductible and coinsurance.

$40 maximum per visit – 30 visit limit

Subject to deductible and coinsurance.

$50 maximum per visit

Subject to deductible and coinsurance.

$50 maximum per visit

Transplants $250,000 lifetime maximum$250,000 lifetime maximum$1,000,000 lifetime maximum$2,000,000 lifetime maximum
Prescription Drugs, Dressings, and Durable Medical Equipment

Subject to deductible and coinsurance.

Available for 90 days following related inpatient treatment or outpatient surgery.

$600 outpatient maximum limit per event
(includes dressings and durable medical equipment)

Subject to deductible and coinsurance.

90-day supply per prescription following related covered event.

U.S. Retail Pharmacy
out-of-network: 80%
International Retail Phamacy: 100%

Subject to deductible and coinsurance.

90-day supply per prescription.

U.S. Retail Pharmacy
out-of-network: 80%
International Retail Phamacy: 100%

U.S. Retail Pharmacy: prescription drug card required.

Copay per 30-day supply: $20 for generic/$40 for brand name where generic is not available.

International Retail Pharmacy (subject to deductible): 100%

Expatriate Prescription Services ProgramN/AN/AN/A

Copay per 30-day supply: $20 for generic/$40 for non-preferred brand name. Must enroll via provider website: www.expatps.com

Dispensing maximum: 180 days

Orphan or Biologic Drugs
(Available when all conditions are met)
  • Approved in writing by company
  • Medically necessary
  • Not experimental or investigational
Applies to period of coverage max. Max limit applies towards lifetime max.

Inpatient Treatment maximum limit: $250,000.

Outpatient Surgery: up to the maximum limit.

Subject to deductible and coinsurance.

Does not apply to maximum limit per event

Outpatient and Emergency Department Treatment maximum limit: $250,000.

Subject to deductible and coinsurance

Inpatient & Outpatient Treatment maximum limit: $250,000.

Subject to deductible and coinsurance

Maximum limit $250,000.

U.S. Retail Pharmacy & expatriate prescription services program: Subject to copayments.

International retail pharmacy: Subject to deductible and coinsurance.

Inpatient/outpatient medical treatment: Subject to deductible and coinsurance

Healthy Travel Preventative Coverage$250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination 		$250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination 		$250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination 		$250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination
Vision Optional RiderOptional RiderOptional Rider$100 maximum per 24 months for exams. $150 per 24 months for materials
Emergency Local Ambulance
(Injury or illness resulting in an inpatient hospital admission) 		$1,500 maximum limit per event - not subject to deductible or coinsurance.$1,500 maximum limit per event - not subject to deductible or coinsurance.Subject to deductible and coinsuranceNot subject to deductible and coinsurance
Emergency Evacuation $50,000 maximum per period of coverage.
Not subject to deductible or coinsurance. 		$50,000 maximum per period of coverage.
Not subject to deductible or coinsurance. 		Up to lifetime maximum limit.
Not subject to deductible or coinsurance. 		Up to lifetime maximum limit.
Not subject to deductible or coinsurance.
Emergency Reunion $10,000 lifetime maximum. Not subject to deductible or coinsuranceN/A$10,000 lifetime maximum. Not subject to deductible or coinsurance$10,000 lifetime maximum. Not subject to deductible or coinsurance
Interfacility Ambulance Transfer (Transfer from one licensed health care Facility to another licensed health care Facility)$1,500 maximum limit per event.
Not subject to deductible or coinsurance. U.S. only		$1,500 maximum limit per event.
Not subject to deductible or coinsurance. U.S. only		Subject to deductible and coinsurance.
U.S. only 		Not subject to deductible or coinsurance.
U.S. only
Political Evacuation and Repatriation N/A N/A N/A $10,000 lifetime maximum
Remote Transportation N/A N/A N/A $5,000 per period of coverage up to $20,000 lifetime maximum.
Not subject to deductible or coinsurance
Return of Mortal Remains $25,000 lifetime maximum - not subject to deductible or coinsurance.$25,000 lifetime maximum - not subject to deductible or coinsurance.$25,000 lifetime maximum - not subject to deductible or coinsurance.$50,000 lifetime maximum - not subject to deductible or coinsurance.
Complementary Medicine N/AN/A$500 maximum limit per period of coverage $500 maximum limit per period of coverage
Traumatic Dental Injury
Treatment at a hospital facility		$1,000 per period of coverage$1,000 per period of coverageUp to the lifetime maximum limitUp to the lifetime maximum limit
Treatment Due to Unexpected Pain to Sound, Natural TeethN/A N/A $100 per period of coverage 100%
Non-Emergency Treatment at a Dental Provider due to an AccidentN/A N/A $500 per period of coverageSee Non-Emergency Dental benefit
Non-emergency Dental Optional RiderOptional RiderOptional Rider$750 maximum per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services
Hospital Indemnity
(Inpatient hospitalization outside the U.S. only) 		Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. 		Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. 		Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. 		Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage.
Supplemental Accident N/AN/A$300 of Eligible Medical Expenses following an accident.
Not subject to deductible or coinsurance 		$500 of Eligible Medical Expenses following an accident.
Not subject to deductible or coinsurance
Adult Preventative Care
(Age 19 or older)		N/AN/A$250 per period of coverage.
Not subject to deductible or coinsurance 		$500 per period of coverage.
Not subject to deductible or coinsurance
Child Preventative Care
(Through age 18) 		N/A$70 maximum per visit, 3 visit limit per period of coverage.
Not subject to deductible or coinsurance.		$200 maximum per period of coverage.
Not subject to deductible or coinsurance.		$400 maximum per period of coverage.
Not subject to deductible or coinsurance.
Pre-Existing Conditions Limitation**Excluded$50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage.** $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage.** Covered if disclosed and not excluded by rider
Teleconsultation*N/AN/AYesYes
Remote Mental Health ServiceN/AN/AN/AYes
Travel Intelligence PortalYesYesYesYes

*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 Policy.

**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).

Optional Coverage

Global Medical Insurance is designed to help protect individuals and families from the high cost of medical expenses. In addition to tailored benefits packages, the program offers several optional coverages. You may review and choose any from the following list that meet your needs. To apply, simply add in the appropriate information and premiums, as outlined in the application, into the calculation for the total.

Individual Term Life Insurance

(Amounts shown are the Principal Sums per unit)

Age Principal Sum
31 days - 18 $5,000
19-29 $75,000
30-39 $50,000
40-44 $35,000
45-49 $25,000
50-54 $20,000
55-59 $15,000
60-64 $10,000
65-69 $7,500

Accidental Death & Dismemberment (AD&D)

(included with Individual Term Life Insurance)

Accidental Loss of Life Principal Sum*
Accidental Total Loss of 2 body parts** Principal Sum*
Accidental Total Loss of 1 body part** 50% of Principal Sum*

*Benefit based on age at time of death.
**"body part" means hand, foot or eye.

Sports

(Gold and Platinum plan options)

(Refer to rider for a list of sports excluded)

$10,000 lifetime maximum for amateur athletics

Adventure Sports:
Through age 49 years: $50,000 lifetime maximum
Age 50 years through age 59 years: $30,000 lifetime maximum
Age 60 years through age 64 years: $15,000 lifetime maximum

Terrorism

(Platinum plan option)

$50,000 lifetime maximum for Eligible Medical Expenses arising out of Injury or Illness incurred by the Insured as a result of or in connection with an act of terrorism. (Refer to rider for more details)

Dental/Vision

(Bronze, Silver and Gold plan options)

Dental:

  • $750 per period of coverage
  • $50 deductible (max. 2 per family)
  • Class I - 90% (deductible is waived),
  • Class II - 70%, Class III - 50%
  • 6 month waiting period

Vision:

  • Exams - up to $100
  • per 24 months
  • Materials - up to $150
  • per 24 months

 

    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.

     

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