Global Medical Insurance Platinum Benefit Schedule

International Medical & Travel Insurance
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International Health Insurance > International Medical Group

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Global Medical Insurance Platinum Benefits

Benefit Description	Global Medical Insurance Platinum Plan
Lifetime Maximum Limit	$8,000,000 lifetime per individual
Deductible (Per Period of Coverage)	$100 to $10,000 50% waived within PPO network
Family Deductible	Two times the individual deductible
Coinsurance within the PPO network	No coinsurance
Coinsurance outside the U.S. and Canada	No coinsurance
Coinsurance inside the U.S. and Canada	90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
Hospitalization / Room & Board	Private room rate
Intensive Care Unit	URC
Surgery	URC
Anesthetist's Charges Associated with Surgery	URC
Transplants	$2,000,000 lifetime maximum
Out-patient	URC
Emergency Room Illness (Additional $250 deductible if not admitted)	URC
Emergency Room Accident	URC
Supplemental Accident	$500 per occurrence
Local Ambulance	URC
Mental/Nervous	SAAI - $50,000 lifetime maximum - Available after 12 months of continuous coverage
Child Wellness	$400 maximum per period of coverage - Available after 6 months of continuous coverage
Adult Wellness	$500 per period of coverage - not subject to deductible or coinsurance - Available for those 18 years of age and over after 6 months of continuous coverage
Emergency Evacuation	Up to maximum limit - not subject to deductible or coinsurance
Emergency Reunion	$10,000 lifetime maximum
Return of Mortal Remains	$50,000 lifetime maximum per insured -not subject to deductible or coinsurance
Remote Transportation	Limited to $5,000 per certificate period up to a $20,000 lifetime maximum
Political Evacuation and Repatriation	Limited to $10,000 lifetime maximum
Rx Coverage	Outside U.S. - URC Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available
Other Services	URC
Physical Therapy	Maximum $50 per visit
Complementary Medicine	Acupuncture $150 Aroma Therapy $50 Herbal Therapy $50 Magnetic Therapy $75 Massage Therapy $150 Vitamin Therapy $100 Each per period of coverage
Recreational SCUBA	URC
Non-emergency Dental	Calendar year maximum - $750 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	URC
Emergency Dental due to Sudden Unexpected Pain	See non-emergency dental benefits
High School Sports Injury	Up to $20,000 per certificate period
Vision	Exams - up to $100 Materials - up to $150 per 24 months
Global Concierge & Assistance Services	Included
Pre-existing Conditions	SAAI
Maternity Delivery, wellness, new born care & congenital disorders (not subject to deductible or coinsurance - available after 10 months of coverage	SAAI - $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for the first 12 months, new born care & congenital illness maximum of $250,000 for the first 31 days
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

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International Health Insurance > International Medical Group

Global Medical Insurance Platinum Benefits