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Rates: Worldwide Including US & Canada / Worldwide Excluding US & Canada
Rates: Worldwide Including US & Canada / Worldwide Excluding US & Canada
Missionary Medical Insurance > International Medical Group > Schedule of Benefits
Global Missionary Basic Insurance
| Coverage area | Worldwide & Worldwide excluding US and Canada |
| Policy maximum per individual | US$5,000,000 |
| Hospital room & board | US$600 per day (maximum of 240 consecutive days per covered event) |
| Intensive care unit | US$1,500 per day (maximum of 180 consecutive days per covered event) |
| Inpatient or outpatient surgery | Usual, reasonable, and customary charges |
| Anesthetist’s charges associated with surgery | 20% of the surgery benefit payable |
| Lab tests, X-rays, other tests associated with an inpatient covered event | Usual, reasonable, and customary charges |
| Transplants | US$250,000 all inclusive per transplant |
| Outpatient visits or exams | 25 visits, including prenatal and
postnatal care, per insured person per coverage period reimbursed to the
maximum limit as outlined below: Physician – US$70/visit Specialist – US$70/visit Psychiatrist-US$60/visit Chiropractor-US$50/visit Surgical intervention consultation-US$500/visit |
| Outpatient X-rays | US$250 per exam maximum limit |
| Outpatient lab tests | US$300 per exam maximum limit |
| Prescription medication related to a covered event | Usual, reasonable, and customary charges |
| Emergency room | Usual, reasonable, and customary charges |
| Emergency dental | US$1,000 per coverage period |
| Local ground ambulance | US$1,500 per covered event (not subject to deductible or coinsurance) |
| Emergency medical evacuation | US$50,000 per coverage period (not subject to deductible or coinsurance) |
| Repatriation | US$25,000 (not subject to deductible & coinsurance) |
| Supplemental accident | No coverage |
| Maternity | Limited to US$4,000 per pregnancy (not subject to coinsurance – available after 12 months of coverage) |
| Professional services related to inpatient maternity expenses | US$200 per day (not subject to coinsurance) |
| Newborns | US$15,000 lifetime maximum for the first 30 days after birth – newborns must be medically underwritten |
| Child wellness | 3 visits per coverage period (maximum limit of US$70 per visit) |
| Pre-existing conditions | US$50,000 lifetime (maximum of US$5,000 per period of coverage – available after 24 months of continuous coverage) |
| Mental/nervous care | Outpatient services covered only as indicated in the “Outpatient visits or exams” section |
| Wellness | No coverage available |
| Complementary medicine | No coverage available |
| Extended care facility services | Limited to the first 30 days of convalescent confinement |
| Home nursing care services | Limited to 30 days per covered event |
| Inpatient hospice care | Limited to 30 days per covered event |
| Chemotherapy & radiation therapy | Usual, reasonable, and customary charges |
| Physical therapy | Maximum US$40 per visit (30 visits per coverage period) |
| MRI, CAT scan, endoscopy, echocardiography, gastroscopy, colonoscopy, & cystoscopy | US$600 per exam maximum limit |
| Prosthetic devices | No coverage available |
The foregoing list is only a summary of available benefits and coverages, and is subject to the specific terms and conditions of the plan concerning eligible benefits, limitations, eligibility and exclusions. Please refer to the certificate wording for a complete description, which is available upon request.