Global Medical Insurance

Comprehensive worldwide medical insurance program for individuals and families

Summary of Benefits

Subject to deductible and coinsurance unless otherwise noted

Plan Information
 
Benefit Bronze Silver Gold
(1st 36 months of continuous coverage)
Gold
(Beginning the 1st day of the 37th month)
Gold Plus Platinum
Lifetime Maximum Limit $1,000,000 per individual $5,000,000 per individual $5,000,000 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 $250 to $25,000 $250 to $25,000 $100 to $25,000
Deductible Carry Forward Included Included Included Included Included Included
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. 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 Concierge 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. 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 Network Subject to deductible. No coinsurance. Subject to deductible. No coinsurance. Subject 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 Network 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. 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.
Coinsurance 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%
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 $500 maximum limit – specialists/physician charges (pre-inpatient / post-inpatient)
$300 maximum per visit – lab tests; $250 maximum per visit – diagnostic x-rays
$70 maximum limit; 25 visit limit – specialists/physician charges
$50 maximum limit – chiropractor charges
$500 maximum limit – surgery intervention consultation charges
$300 maximum per visit – lab tests;
$250 maximum per visit – diagnostic x-rays
Subject to deductible and coinsurance Physician charges - $150 per visit; Hospital charge - $100 co-pay unless admitted; urgent care facility - $25 co-pay
$5,000 maximum per period of coverage for diagnostic lab and x-rays
Subject to deductible and coinsurance Subject to deductible and coinsurance
Mental/Nervous NA Outpatient after 12 months of continuous coverage. $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage. $30,000 lifetime maximum, and $2,500 maximum per period of coverage.
Additional Sub-limit:
Inpatient: limited to 25 days per period of coverage.
Outpatient: Plan pays 70% of Eligible Medical Expenses up to $75 maximum per visit. Limited to 20 visits per period of 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 - Available after 12 months of continuous coverage
Hospital Emergency Room Injury Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance
Hospital Emergency Room Illness Subject to deductible and coinsurance. Covered only if admitted as inpatient Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient Subject 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 rate Subject to deductible and coinsurance for average semi-private room rate. All subject to $600 per day/240 day maximum Subject to deductible and coinsurance for average semi-private room rate Subject to deductible and coinsurance for average semi-private room rate. $2,250 limit per day Subject to deductible and coinsurance for average semi-private room rate Subject 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 coinsurance Subject to deductible and coinsurance. $4,500 limit per day Subject to deductible and coinsurance Subject 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 coinsurance. Subject to deductible and coinsurance. $5,000 maximum limit for outpatient labs Subject to deductible and coinsurance Subject to deductible and coinsurance
Surgery Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance
Assistant Surgeon 20% of primary surgeon’s charge 20% of primary surgeon’s charge 20% of primary surgeon’s charge 20% of primary surgeon’s charge 20% of primary surgeon’s charge 20% of primary surgeon’s charge
Chemotherapy or Radiation Therapy Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible and coinsurance $10,000 maximum per period of coverage, $50,000 lifetime maximum Subject to deductible and coinsurance Subject to deductible and coinsurance
Maternity
Delivery, preventative, newborn care & congenital disorders, Family Matters Maternity Program (available after 10 months of coverage)
NA NA NA NA NA $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 Care NA NA $750 maximum limit $750 maximum limit $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 - $1,000 maximum per period of coverage
$10,000 lifetime maximum
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 $500,000 lifetime maximum $1,000,000 lifetime maximum $2,000,000 lifetime maximum
Prescription Coverage Subject to deductible and coinsurance. Available for 90 days following related inpatient treatment or outpatient surgery. $600 outpatient maximum limit per event Subject to deductible and coinsurance. 90-day supply per prescription following related covered event Subject to deductible and coinsurance. 90-day supply per prescription. Outpatient only Subject to deductible and coinsurance. $5,000 per period of coverage – outpatient only. 90-day supply per prescription Subject to deductible and coinsurance. 90-day supply per prescription International - 100%.
Inside U.S. - Prescription drug card co-pay: $20 for generic / $40 for brand name where generic is not available. 90-day supply per prescription
Adult Preventative Care (Age 19 or older) NA NA $250 per period of coverage - not subject to deductible or coinsurance. Available after 12 months of continuous coverage. $250 per period of coverage - not subject to deductible or coinsurance. $250 per period of coverage - not subject to deductible or coinsurance. Available after 12 months of continuous coverage. $500 per period of coverage - not subject to deductible or coinsurance . Available after 6 months of continuous coverage.
Child Preventative Care (Through age 18) NA $70 maximum per visit, 3 visit limit per period of coverage. Not subject to deductible or coinsurance. Available after 12 months of continuous coverage $200 maximum per period of coverage - not subject to deductible or coinsurance.
Available after 12 months of continuous coverage.
$200 maximum per period of coverage - not subject to deductible or coinsurance. $200 maximum per period of coverage - not subject to deductible or coinsurance.
Available after 12 months of continuous coverage.
$400 maximum per period of coverage - not subject to deductible or coinsurance.
Available after 6 months of continuous coverage.
Vision Optional Rider Optional Rider Optional Rider Optional Rider Optional Rider Exams - up to $100 maximum per 24 months.
Materials - up to $150 per 24 months.
Local Ambulance due to Injury or Illness resulting in Hospitalization $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 coinsurance $100 maximum limit per event - not subject to deductible or coinsurance. Subject to deductible and coinsurance Not 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 policy lifetime maximum limit.
Not subject to deductible or coinsurance.
$250,000 maximum per period of coverage.
Not subject to deductible or coinsurance.
Up to maximum limit.
Not subject to deductible or coinsurance.
Up to maximum limit.
Not subject to deductible or coinsurance.
Emergency Reunion $10,000 lifetime maximum. Not subject to deductible or coinsurance NA $10,000 lifetime maximum. Not subject to deductible or coinsurance $10,000 lifetime maximum. Not subject to deductible or coinsurance $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 $100 maximum limit per event. Not subject to deductible or coinsurance. U.S. only Not subject to deductible or coinsurance. U.S. only Not subject to deductible or coinsurance. U.S. only
Political Evacuation and Repatriation NA NA NA NA NA Up to $10,000 lifetime maximum
Remote Transportation NA NA NA NA NA $5,000 per period of coverage up to $20,000 lifetime maximum. Not subject to deductible or coinsurance
Return of Mortal Remains $10,000 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. $15,000 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 NA NA $500 maximum limit per period of coverage $500 maximum limit per period of coverage $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 coverage Up to the lifetime maximum limit $5,000 per period of coverage Up to the lifetime maximum limit Up to the lifetime maximum limit
Treatment Due to Unexpected Pain to Sound, Natural Teeth NA NA $100 per period of coverage $100 per period of coverage $100 per period of coverage 100%
Non-Emergency Treatment at a Dental Provider due to an Accident NA NA $500 per period of coverage $500 per period of coverage $500 per period of coverage See Non-Emergency Dental benefit
Non-emergency Dental Optional Rider Optional Rider Optional Rider Optional Rider Optional Rider $750 maximum per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services
Hospital Indemnity (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.
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 NA NA $300 of Eligible Medical Expenses following an accident $300 of Eligible Medical Expenses following an accident $300 of Eligible Medical Expenses following an accident $500 of Eligible Medical Expenses following an accident
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 $50,000 lifetime maximum; $5,000 per period of coverage $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage NA

Terrorism Rider

$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)

Adventure Sports Rider

Gold Plus and Platinum plan options

$25,000 lifetime coverage for adventure sports. (Refer to rider for a comprehensive list of adventure sports excluded)

Global Term Life Insurance

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

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.

Dental/Vision Rider

Bronze, Silver, Gold and Gold Plus plan options

Dental:

  • $750 calendar maximum
  • $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

    Accidental Death & Dismemberment

    Accidental Loss of Life Principal Sum*
    Accidental Total Loss of 2 Members** Principal Sum*
    Accidental Total Loss of 1 Members** 50% of Principal Sum*

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

     

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