Global Medical Insurance covers the Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment. Each person will only need to satisfy their deductible once per policy period (12 months) with a maximum of three deductibles per family per calendar year.
There is a network of doctors and physicians for the Global Medical Insurance within the USA - to search this network, please visit:
| |
Silver
|
Gold
|
Platinum
|
| Coverage Area |
Two options:
- Worldwide
- Worldwide exc USA/ Canada
|
Two options:
- Worldwide
- Worldwide exc USA/ Canada |
Two options:
- Worldwide
- Worldwide exc USA/ Canada |
| Policy Maximum |
$5,000,000
lifetime per individual
|
$5,000,000
lifetime per individual |
$8,000,000
lifetime per individual |
| Deductible |
Deductible options:
- $250 to $10,000 per period of coverage
- 50% reduction within PPO |
Deductible options:
- $250 to $10,000 per period of coverage
- 50% reduction within PPO
- Carry forward deductible, last 30 days of certificate year
|
Deductible options:
- $100 to $10,000 per period of coverage
- 50% reduction within PPO
- Carry forward deductible, last 30 days of certificate year |
| Family
Deductible |
3x the single
|
3x the single |
2x the single |
Coinsurance
- within the USA & Canada |
80% up to $5,000, after that 100% up to policy max
|
80% up to $5,000, after that 100% up to policy max |
90% up to $5,000, after that 100% up to policy max |
Coinsurance
- within the PPO network
- outside the U.S. and Canada |
100% |
100% |
100% |
Hospitalization
Room & Board |
$600 per day
(maximum of 240 consecutive days per covered event)
|
Average semi-private room rate |
Private room rate |
| Intensive Care
Unit |
$1,500 per day
(maximum of 180 consecutive days per covered event)
|
URC |
URC |
| Surgery |
URC
|
URC |
URC |
| Anesthetist's Charges Associated with
Surgery |
20% of surgery benefit |
URC |
URC |
| Transplants |
$250,000
per transplant
|
$1,000,000
lifetime maximum |
$2,000,000
lifetime maximum |
| Outpatient |
Visits/Exams
25 visits per insured
person per period of coverage to the maximum limit as outlined:
- physician $70;
- specialist $70;
- psychiatrist $60;
- chiropractor $50;
- surgical intervention consultation $500;
- X-rays $250 per exam maximum limit;
- Lab Tests $300 per exam maximum limit |
URC |
URC |
| Rx Coverage |
URC
|
URC |
URC |
| Emergency Room Illness |
URC
subject to an additional $250 deductible if not admitted |
URC
subject to an additional $250 deductible if not admitted |
URC
subject to an additional $250 deductible if not admitted |
| Emergency Room Accident |
URC |
URC |
URC |
| Local Ambulance |
$1,500
per covered event - not subject to deductible or coinsurance |
URC |
URC |
| Emergency
Evacuation |
$50,000
per period of coverage - not subject to deductible or
coinsurance |
Limited to
policy maximum - not subject to deductible or coinsurance |
Limited to
policy maximum - not subject to deductible or coinsurance |
| Emergency
Reunion |
NA |
$10,000
lifetime maximum |
$10,000
lifetime maximum |
| Return of Mortal Remains |
$25,000
lifetime maximum per insured - not subject to deductible or
coinsurance
|
$25,000
lifetime maximum per insured -not
subject to deductible or coinsurance |
$50,000
lifetime maximum per insured -not subject to deductible or
coinsurance |
| Maternity |
Optional Rider
$50,000 lifetime
maximum, maximum of $5,000 for normal delivery, $7,500 for
C-section, $200 child wellness benefit for first 12 months - not
subject to deductible or coinsurance. Available after 10 months of
coverage benefits reduced by 50% for births that occur in11th or
12th month of continuous coverage
|
Optional Rider
$50,000 lifetime
maximum, maximum of $5,000 for normal delivery, $7,500 for
C-section, $200 child wellness benefit for first 12 months - not
subject to deductible or coinsurance. Available after 10 months of
coverage benefits reduced by 50% for births that occur in11th or
12th month of continuous coverage |
SAAI
$1,000 additional deductible, $50,000 lifetime
maximum, $200 child wellness benefit for first 12 months. Available after 10 months of
coverage |
| Supplemental
Accident |
NA |
$300
per occurrence - not subject to
deductible or coinsurance |
$500
per occurrence - not subject to deductible or coinsurance |
| Mental/Nervous |
Outpatient only
(see Outpatient) Available after 12 months of continuous coverage |
$10,000
per period of coverage up to a $50,000 lifetime maximum. Available after 12
months of continuous coverage
|
SAAI
$50,000 lifetime maximum. Available after 12 months of
continuous coverage |
| Adult Wellness |
NA |
$250 per coverage period
Not subject to deductible or coinsurance Available for those 30 years of
age and over after 12 months of continuous coverage
|
$500 per coverage period
Not subject to deductible or coinsurance Available for those 18 years of
age and over after 12 months of continuous coverage |
| Child Wellness |
Three visits per coverage period
Maximum $70 per visit. Available for children under 18
years of age after 12 months of continuous coverage |
$200 maximum per coverage period
Not subject to deductible or coinsurance Available for children
under 18 years of age after 12 months of continuous coverage
|
$400 maximum per coverage period
Not subject to deductible or coinsurance Available for children
under 18 years of age after 12 months of continuous coverage |
| Other Services |
Extended Care - limited to first 30 days
Radiation Treatment - URC
Home Nursing Care - limited 30 days per covered event
Hospice Care - limited 30 days percovered event
Prosthetic Devices - all URC
|
URC |
URC |
| Physical
Therapy |
Maximum $40 per
visit 30 visit maximum per period of coverage
|
Maximum $50 per visit |
Maximum $50 per visit |
| High School
Sports Injury |
NA |
NA |
Up to $5,000 maximum |
| Recreational
SCUBA |
NA |
URC |
URC |
| Remote
Transportation |
NA |
NA |
Limited to
$5,000 per certificate period up to a $20,000 lifetime maximum
|
| Political Evacuation and Repatriation |
NA |
NA |
Limited to $10,000 lifetime
maximum
|
| Complementary Medicine |
NA |
Acupuncture $150
Aroma Therapy $50
Herbal Therapy $50
Magnetic Therapy $75
Massage Therapy $150
Vitamin Therapy $100
Each per period
of coverage |
Acupuncture $150
Aroma Therapy $50
Herbal Therapy $50
Magnetic Therapy $75
Massage Therapy $150
Vitamin Therapy $100
Each per period
of coverage
|
| Non-emergency
Dental |
NA |
NA |
Calendar year
Individual deductible - $50
Schedule of benefits -
Class I: 90% Class II: 70%
Class III: 50% Ortho 0%
(6 month waiting period)
|
| Emergency Dental due to
Accident |
$1,000 per period of coverage |
URC |
URC |
| Emergency Dental due to Sudden
Unexpected Pain |
NA |
$100 per period of coverage |
See non-emergency dental
benefits |
| Vision |
NA |
NA |
Exams - up to
Materials - up to $150 per 24 months
|
| Global Concierge & Assistance Services |
NA |
NA |
Included |
| Pre-existing
Conditions |
$5,000 per
period of coverage up to a $50,000 lifetime maximum. Available after 24 months of
continuous coverage |
$5,000 per
period of coverage up to a $50,000 lifetime maximum. Available after 24 months of
continuous coverage
|
SAAI |
|
NA (Not Applicable)/ URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)
|
This is a summary of benefits. Please refer to the policy wording for a complete description. All benefits are subject to the deductible unless specified.
Global Concierge and Assistance Services are additional services offered under the Platinum plan option. They are not insurance benefits