Mission Trip Insurance, Short-term & Long-term Plans

Popular Plans
For Mission & Social Good Trips

Recommended

Global Mission Medical Insurance

Annually renewable worldwide medical insurance program for missionaries

Highlights

Long-term (1+ year) worldwide medical insurance for missionaries
Annually renewable medical coverage
Deductible options from $0 to $25,000
Maximum limit options from $1,000,000 to $8,000,000

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Trip Protection

Medical Benefits

Summary of Benefits

Subject to deductible and coinsurance unless otherwise noted

Plan Information

**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).

Outreach Travel Medical Insurance

Temporary health insurance for missionaries and mission groups

Highlights

Travel medical insurance for missionaries and mission groups
Renewable up to 24 months
Deductible options from $0 to $2,500
Maximum limits from $50,000 to $1,000,000
Coverage for medical expenses, evacuation, and repatriation

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Trip Protection

Medical Benefits

MP+ International

Worldwide employer-sponsored group health insurance for mission groups

Highlights

Worldwide employer-sponsored group health insurance for mission groups
Unique plan features that promote premium stability
Continuous coverage overseas and while on furlough
Direct billing to overseas medical providers

Group Proposal

Trip Protection

Medical Benefits

NGO+International

Worldwide Medical Insurance for International Volunteers and Social Good Workers

Highlights

Worldwide employer-sponsored group health insurance for social good organizations
Unique plan features that promote premium stability
Continuous coverage overseas
Direct billing to overseas medical providers

Group Proposal

Trip Protection

Medical Benefits

Maximum Limits	Individual: $50,000, $100,000, $500,000, $1,000,000, $2,000,000 Group: $100,000, $250,000, $1,000,000
Individual Deductible	Individual: $0, $100, $250, $500, $1,000 or $2,500 Group: $0, $100, $250 On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.
Coinsurance	For treatment received outside the U.S. & Canada: No coinsurance For treatment received within the U.S. & Canada: In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit
Benefit Period	Three months If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the three-month Benefit Period may offer continued coverage for that injury or illness. When the Certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than three months before the Period of Coverage expired, benefits for the covered injury or illness continues. This is subject to the Maximum Limits and the other terms of the plan until there have been three months of continuous coverage for the covered injury or illness.

Eligible Medical Expenses	Up to the maximum limit
COVID-19 / SARS-CoV-2 Coverage	COVID-19/SARS-CoV-2 shall be considered by the Company the same as any other Illness or Injury, subject to all other Terms and conditions of this insurance
Physician Visits / Services	Up to the maximum limit
Hospital Emergency Room: Inside the U.S.	Up to the maximum limit Injury: not subject to additional deductible Illness: additional $250 deductible if not admitted
Hospital Emergency Room: Outside the U.S.	Up to the Maximum Limit
Hospitalization / Room & Board	Average semi-private room rate up to the maximum limit. Includes nursing service
Intensive Care	Up to the maximum limit
Outpatient Surgical / Hospital Facility	UUp to the maximum limit
Laboratory Up	Up to the maximum limit
Radiology / X-ray	Up to the maximum limit
Chemotherapy / Radiation Therapy	Up to the maximum limit
Pre-Admission Testing	Up to the maximum limit
Surgery	Up to the maximum limit
Reconstructive Surgery Surgery is incidental to and follows surgery that was covered under the plan	Up to the maximum limit
Assistant Surgeon	20% of the primary surgeons eligible fee
Anesthesia	Up to the maximum limit
Durable Medical Equipment	Up to the maximum limit
Chiropractic Care Medical order or treatment plan required	Up to the maximum limit
Physical Therapy Treatment Medical order or treatment plan required	Up to the maximum limit
Extended Care Facility Upon direct transfer from an acute facility	Up to the maximum limit
Home Nursing Care Upon direct transfer from an acute facility Provided by a home health care agency	Up to the maximum limit

Emergency Medical Evacuation Must be approved in advance and coordinated by the company	$500,000 maximum limit
Emergency Reunion Must be approved in advance by the company	Up to $50,000 lifetime maximum
Political Evacuation & Repatriation Must be approved in advance by the company	Up to $10,000
Return of Minor Children Must be approved in advance by the company	Up to $50,000
Return of Mortal Remains or Cremation/Burial Must be approved in advance by the company	Up to $50,000 for return of mortal remains or $5,000 for cremation/burial

Accidental Death & Dismemberment (AD&D) Death must occur within 90 days of the accident	$25,000 principal sum. Not subject to deductible.
Common Carrier Accidental Death	$50,000 per insured adult and $250,000 maximum limit per family. Not subject to deductible.
Dental Treatment - Accident	$100 Limit Treatment due to an Accidental Injury and obtained at a Dental Provider’s office
Traumatic Dental Injury Treatment at a hospital due to an accident	Up to the maximum limit. Additional treatment for the same injury rendered by a dental provider will be paid at 100%.
Hospital Indemnity	$100 per overnight inpatient hospitaization, maximum limit of 10 overnights. Not subject to deductible.
Identity Theft Assistance	Up to $500. Not subject to deductible
Lost Luggage	Limit $250, $50 maximum per item
Natural Disaster	$100 per day and maximum limit of 5 days for accommodations. Not subject to deductible.
Terrorism $	$50,000 maximum limit. Not subject to deductible.
Trip Interruption	Up to $5,000. Not subject to deductible

Area of Coverage	Worldwide
Maximum Limit per Lifetime	$1,000,000 standard, $5,000,000 option available
Deductible per Calendar Year	All deductibles apply worldwide and are per Insured person
Family Deductible per Calendar Year	Two deductibles per family
U.S. Hospital Emergency Room Injury	Not subject to emergency room deductible
U.S. Hospital Emergency Room Illness	Subject to a $250 deductible for each emergency room visit for treatment that does not result in a direct hospital admission
International Hospital Emergency Room	Company pays 100%
Coinsurance per Calendar Year	For Treatment received outside of the U.S.: 0% U.S. Treatment: Inside the PPO Network: Member pays 20% of eligible medical expenses until reaching $5,000, then 0% Utilizing Medical Concierge Provider: Member pays 15% of eligible medical expenses until reaching $5,000, then 0% Outside the PPO Network: Member pays 40% of eligible medical expenses until reaching $5,000, then 0%
Eligible Medical Expenses	Up to the maximum limit. The maximum limit is not in addition to any other maximum limit for any other covered illness or injury
Hospital Room & Board	Up to the average semi-private room rate, including nursing service
Intensive Care Unit	Maximum of three times (3x) average semi-private room rate
Mental or Nervous Disorders	Outpatient Treatment: Member pays 50% of eligible medical expenses and maximum of 40 visits per insured person per calendar year Inpatient Treatment: Maximum of 30 days per Insured Person per Calendar Year
Physical Therapy	$2,500 Maximum per Calendar Year U.S.: Medical order or treatment plan required Outside of the U.S.: Medical order or treatment plan required only for expenses over $1,000
Chiropractic Care	Member pays 50% of eligible medical expenses up to $500 maximum per calendar year
Hospice	$7,500 lifetime maximum per Insured Person
Home Nursing Care	Limited to 30 days per Calendar Year
Extended Care Facility	Limited to 60 days per Calendar Year
Podiatry	$750 maximum per Calendar Year
Adult or Child Preventative Care	Up to $1,000 per calendar year. Not subject to deductible or coinsurance
Transplant	$500,000 lifetime maximum for covered transplants
Hospital Indemnity Benefit	Outside of the U.S. Private Hospitals: $400 per overnight and $4,000 Maximum per Calendar Year Public Hospitals: $500 per overnight and $5,000 Maximum per Calendar Year
Outpatient Physician/ Specialist Visit (Office Visit Charge Only)	$25 copay within the U.S. PPO network
Physician Visits/Services	Subject to deductible and coinsurance
Inter Facility Ambulance Transfer	Must be the result of an inpatient hospital admission Not subject to deductible and coinsurance
Pregnancy and Newborn Care	Result of natural insemination. Dependent child’s pregnancy not covered Newborn routine care, diagnostic tests, and routine immunizations for the first 31 days of life. Subject to deductible and coinsurance
Pregnancy Complications	Subject to deductible and coinsurance
Sleep Disorders	Up to $2,500 sleep aid per person per calendar year
Prescription and Medication	$250,000 limit per person annually Subject to deductible and coinsurance Outside the U.S.: Covered at 100% Inside the U.S.: Must utilize the Universal Rx card Copay (per 30-day supply): Tier 1 - $15; Tier 2 - $30; Tier 3 - $60 Maximum limit of 90-day supply per prescription Not subject to deductible and coinsurance Prescriptions $3,000 and higher will require Universal RX (URX) to obtain prior authorization from the company Expatriate Prescription Services Program: Maximum limit of 180-day supply per prescription Copayments are per 30-day supply Prescriptions $3,000 and higher will require Universal RX (URX) to obtain prior authorization from the company

Benefit	Bronze	Silver	Gold	Platinum
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 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.
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.
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.
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%
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 coinsurance	Subject to deductible and coinsurance
Mental/Nervous	N/A	Outpatient 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 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
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 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
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
Surgery	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
Chemotherapy or Radiation Therapy	Subject to deductible and coinsurance	Subject to deductible and coinsurance	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)	N/A	N/A	N/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 Care	N/A	N/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 Program	N/A	N/A	N/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 Rider	Optional Rider	Optional 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 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 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 coinsurance	N/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	$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	N/A	N/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 coverage	Up to the lifetime maximum limit	Up to the lifetime maximum limit
Treatment Due to Unexpected Pain to Sound, Natural Teeth	N/A	N/A	$100 per period of coverage	100%
Non-Emergency Treatment at a Dental Provider due to an Accident	N/A	N/A	$500 per period of coverage	See Non-Emergency Dental benefit
Non-emergency Dental	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 (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/A	N/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/A	N/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

Emergency Hospital Admission Direct Transfer from Emergency Medical Evacuation	$20,000 maximum limit The maximum limit is not in addition to any other maximum limit for any other covered illness or injury
Emergency Reunion	Maximum limit: $15,000 Day maximum: 15 Meal maximum per day: $25 Reasonable and necessary travel costs and accommodations Approved in advance by the company

Period of Coverage	Maximum Limit: 365 days
Lifetime Maximum	$1,000,000 standard, $5,000,000 option available
Extension of Benefits	Maximum Limit beginning on the first day of Total Disability: 90 days Maximum Limit for a Spouse and/or Dependent in the event of the death of an Employee or Associated Representative: 60 days
Bridge Coverage	Maximum Limit when an Employee, Associated Representative and/or Dependent no longer meets the eligibility requirements: 90 days
Medical Concierge Non-emergency services only	The Medical Concierge Service is a proprietary service of IMG that helps an Insured Person navigate the United States healthcare system to identify the highest quality providers for scheduled Inpatient and certain Outpatient Treatments. Refer to the MEDICAL CONCIERGE provision for further details.

Benefit Levels	United States Medical Concierge	United States In-Network	United States Out-of-Network	International International
Deductible	All deductibles apply worldwide and are per insured person
Family Deductible	Maximum Accumulative Deductibles per Family: 2
Coinsurance In addition to Deductible	Plan pays 85% Insured pays 15%	Plan pays 80% Insured pays 20%	Plan pays 60% Insured pays 40%	Plan pays 100% Insured pays 0%
Out of Pocket Maximum	$750	$2,000	$4,000	$0
Precertification	Transplants: No coverage if Precertification requirements are not met. Interfacility Ambulance Transfer: No coverage if Precertification requirements are not met. All other Treatments & supplies: 50% reduction of Eligible Medical Expenses if Precertification requirements are not met. Maximum Penalty: $1,000 Deductible is taken after reduction. Coinsurance is applied to remainder of the reduced amount. Refer to PRECERTIFICATION REQUIREMENTS provision for a complete list of services that require Precertification.

Benefit	United States Medical Concierge (non-emergency)	United States In-Network	United States Out-of-Network	International International
Eligible Medical Expenses	Not Applicable	80%	60%	100%
Outpatient Physician / Specialist Visit Office visit charge only	Not Applicable	Copayment: $25.00	Not Applicable	Not Applicable
Physician Visits / Services	Not Applicable	80%	60%	100%
Hospital Emergency Room: United States Injury: Not subject to Emergency Room Deductible Illness: Subject to a $250 Deductible for each Emergency Room visit for Treatment that does not result in a direct Hospital admission	Not Applicable	80%	60%	Not Applicable
Hospital Emergency Room: International	Not Applicable	Not Applicable	Not Applicable	100%
Hospitalization / Room & Board Average semi-private room rate Includes nursing, miscellaneous and Ancillary Services	85%	80%	60%	100%
Intensive Care 3 times the average semi-private room rate	85%	80%	60%	100%
Outpatient Surgical / Hospital Facility	85%	80%	60%	100%
Laboratory	Not Applicable	80%	60%	100%
Radiology / X-ray	85%	80%	60%	100%
Chemotherapy / Radiation Therapy	85%	80%	60%	100%
Pre-admission Testing	Not Applicable	80%	60%	100%
Surgery	85%	80%	60%	100%
Second Surgical Opinion Payable at 100% if requested by the Company 50% reduction of Eligible Medical Expenses for failure to obtain a Second Surgical Opinion when required by the Company	Not Applicable	80%	60%	100%
Reconstructive Surgery Surgery is incidental to or follows Surgery that was covered under the plan	85%	80%	60%	100%
Assistant Surgeon 20% of the primary surgeon’s eligible fee	85%	80%	60%	100%
Anesthesia	85%	80%	60%	100%
Pregnancy and Newborn Care Result of Natural Insemination Dependent Child’s Pregnancy not covered Newborn routine care, diagnostic tests and routine immunizations for the first 31 days of life	Not Applicable	80%	60%	100%
Pregnancy Complications	Not Applicable	80%	60%	100%
Durable Medical Equipment	Not Applicable	80%	60%	100%
Sleep Disorders Maximum Limit: $2,500	Not Applicable	80%	60%	100%
Podiatry Care Maximum Limit: $750	Not Applicable	80%	60%	100%
Chiropractic Care Maximum Limit: $500	Not Applicable	50%	50%	50%
Physical Therapy: United States Maximum Benefit: $2,500 combined United States and International Medical order and Treatment plan required	Not Applicable	80%	60%	Not Applicable
Physical Therapy: International Maximum Benefit: $2,500 combined International and United States Medical order and Treatment plan not required for Eligible Medical Expenses under $1,000 Medical order and Treatment plan required for all expenses over $1,000	Not Applicable	Not Applicable	Not Applicable	100%
Extended Care Facility Maximum Days: 60 Upon direct transfer from an acute care Facility	85%	80%	60%	100%
Home Nursing Care Maximum Days: 30 Provided by a Home Health Care Agency Upon direct transfer from an acute care Facility	85%	80%	60%	100%
Hospice Lifetime Maximum: $7,500 Terminally ill - 6 months to live Inpatient Hospice Facility Insured Person’s home	Not Applicable	80%	60%	100%
Transplant Lifetime Maximum: $250,000 er Period of Coverage Transplant Maximum: 1 Organ procurement & harvesting costs Lifetime Maximum: $10,000 Travel & lodging Lifetime Maximum Expense: $5,000 Covered Transplants: cornea, heart, heart/lung, lung, kidney, kidney/pancreas, liver, allogeneic or autologous bone marrow Subject to the TRANSPLANT PRECERTIFICATION provision and only when Treatment is provided within the Company’s approved independent Managed Transplant System Network	85%	80%	Not Applicable	100%

Remote Mental Health Service	Optional telemedicine for mental health that offers support with financial, physical, and emotional wellbeing. Whether you have questions about handling stress at work or home, parenting and childcare, managing money or health issues, you can turn to this valuable and confidential service that you can trust.
Teleconsultation**	Optional online and telephonic access to a network of medical professionals available to diagnose treat and prescribe for non-emergency medical issues. The best medicine brought to you and your family 24 hours a day, seven days a week.

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