Global Medical Insurance

Annually renewable worldwide medical insurance program for individuals and families

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
$500 maximum limit – surgery intervention consultation charges

Subject to deductible and coinsurance
Subject to deductible and coinsuranceSubject to deductible and coinsurance
Mental/Nervous NAOutpatient 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 - Available after 12 months of continuous coverage
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 coinsuranceSubject to deductible and coinsurance. $1,500 limit per day – 180 days of coverage per eventSubject to deductible and coinsuranceSubject to deductible and coinsurance
CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, CystoscopySubject to deductible and coinsurance. $600 maximum per examinationSubject to deductible and coinsurance. $600 maximum per examinationSubject 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)
NANANA$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 CareNANA$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 surgerySubject to deductible and coinsurance. $40 maximum per visit – 30 visit limitSubject to deductible and coinsurance. $50 maximum per visitSubject 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 CoverageSubject to deductible and coinsurance.
Available for 90 days following related inpatient treatment or outpatient surgery.
$600 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.
Co-pay 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 ProgramNANANACo-pay 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
Inpatient & Outpatient 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
Adult Preventative Care (Age 19 or older)NANA$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) NA$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.
Healthy Travel Preventative CoverageUp to $250 for vaccinations and preventative prescription drugs within 30 days prior to the Initial Effective Date and before departing to any destination. Not subject to deductible or coinsurance.Up to $250 for vaccinations and preventative prescription drugs within 30 days prior to the Initial Effective Date and before departing to any destination. Not subject to deductible or coinsurance.Up to $250 for vaccinations and preventative prescription drugs within 30 days prior to the Initial Effective Date and before departing to any destination. Not subject to deductible or coinsurance.Up to $250 for vaccinations and preventative prescription drugs within 30 days prior to the Initial Effective Date and before departing to any destination. Not subject to deductible or coinsurance.
Vision Optional RiderOptional RiderOptional RiderExams - up to $100 maximum per 24 months.
Materials - up to $150 per 24 months.
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 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 coinsuranceNA$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. onlyNot subject to deductible or coinsurance. U.S. onlyNot subject to deductible or coinsurance. U.S. only
Political Evacuation and Repatriation NA NA NA Up to $10,000 lifetime maximum
Remote Transportation 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.$50,000 lifetime maximum - not subject to deductible or coinsurance.
Complementary Medicine NANA$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 TeethNA NA $100 per period of coverage 100%
Non-Emergency Treatment at a Dental Provider due to an AccidentNA NA $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 (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 NANA$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. *Will be covered same as any other illness as of the effective date if proof of creditable coverage is provided and accepted. $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage. *Will be covered same as any other illness as of the effective date if proof of creditable coverage is provided and accepted. NA

**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).

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)

Sports Rider

Gold and Platinum plan options

(Refer to rider for a comprehensive 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

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 and Gold 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 body parts** Principal Sum*
    Accidental Total Loss of 1 body part** 50% of Principal Sum*
    p>*Benefit based on age at time of death.
    **"body part" means hand, foot or eye.

     

     

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