Quantcast
International Health and Travel Insurance
contact us
International Medical & Travel Insurance
Call 888.708.0812 or
+1.503.642.4646
FAX - +1.541.284.2994
International Health Insurance > HTH Worldwide > Global Navigator Benefit Schedule

Global Citizen International Health Insurance

Global Navigator Health Plan Benefit Schedule

Global Navigator has three tiers of coinsurance: 100% outside the U.S. , 80% in network in the U.S. , 60% out of network inside the U.S. All Global Navigator plans have a $5,000,000 lifetime maximum and a $250,000 maximum benefit for emergency medical evacuation.

  Outside the U.S. In Network, U.S. Out-of-Network, U.S.
Preventative and Primary Care Deductible is not applicable
Primary Care Office Visits
as many as 4 visits per Calendar Year
All except a $10 copay per visit
All except a $30 copay per visit
60% to Coinsurance Maximum then 100%
Preventative Care for Babies/Children:
(Birth to Age 18)
  1. Office Visits/examination
  2. Immunizations, Lab work & X-rays
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
Preventative Care For Adults: (Age 19 and Older)
  1. Routine Pap Smears, annual mammogram
  2. PSA For Men
100%
80% to Coinsurance Maximum then 100%
80% to Coinsurance Maximum then 100%
Annual Physical Examination/Health Screening
100%
Maximum Covered Expense of $250 and limited to one per Calendar Year.
80% to Coinsurance Maximum then 100%
Maximum Covered Expense of $250 and limited to one per Calendar Year.
60% to Coinsurance Maximum then 100%
Maximum Covered Expense of $250 and limited to one per Calendar Year.
Outpatient Services Insurer pays after the Deductible is Met
Outpatient Medical Care
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
Inpatient Hospital Services Insurer pays after the Deductible is Met
Surgery, X-rays, In-hospital doctor visits, Organ/Tissue Transplant
The Insurer will pay 100% of Covered Expenses.
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
In-patient medical emergency
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
Professional Services
Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
Other Services Insurer pays after the Deductible is Met, unless noted
Ambulatory Surgical Center
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
Physical/Occupational Therapy/Medicine Deductible is waived. Covered Expenses up to $50 per visit, and as many as 6 visits per Calendar Year
Ambulance Service
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
Durable Medical Equipment
100%
80% to Coinsurance Maximum then 100%
80% to Coinsurance Maximum then 100%
Mental, Emotional or Functional Nervous Disorders, Alcoholism or Drug Abuse
a. Mental, Emotional or Functional Nervous Disorders - Inpatient: Up to 20 days of inpatient confinement per Calendar Year
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
b. Mental, Emotional or Functional Nervous Disorders - Outpatient: First 10 visits per Calendar Year
50%
50%
50%
c. Alcoholism or Drug Abuse - Inpatient in a Hospital, Non-hospital Residential Treatment Center or Day Care Center Up to 10 days per Calendar Year
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
c. Alcoholism or Drug Abuse - Outpatient: Up to 10 visits per Calendar Year
100%
80% to Coinsurance Maximum then 100%
60% to Coinsurance Maximum then 100%
Outpatient prescription drugs 100% of actual charge up to an annual maximum of $1,000.
Maximum 90 - day supply
Dental Care required due to an Injury 100% of Covered Expenses up to $500 per Calendar Year maximum
Accidental Death and Dismemberment Maximum Benefit: Principal Sum up to $10,000
Repatriation of Remains Maximum Benefit up to $25,000
Medical Evacuation Maximum Lifetime Benefit for all Evacuations up to $250,000
DEDUCTIBLE OPTIONS
Global Navigator Plan1,2,3,4,5,6 Deductible
Coinsurance Maximum
Outside U.S.
U.S. in Network
U.S. out of Network
250
$125
$250
$500
$2,000
1,000
$500
$1,000
$2,000
$4,000
2,500
$1,250
$2,500
$5,000
$8,000
5,000
$2,500
$5,000
$10,000
$10,000
1. Copay waived when visiting an HTH Worldwide contracted provider.
2. Deductibles are Per Person per calendar year.
3. The Out of Pocket Maximum is calculated by adding the deductible and coinsurance maximum together. A family is charged a maximum of 2.5 deductibles.
4. Amounts paid to satisfy a deductible are credited to all other deductibles, both inside and outside the U.S. For example, if you satisfy your Outside U.S. deductible, this amount is credited to the U.S. (In Network) and U.S. (Outside Network) deductible requirement.
5. An Insured Person only has to satisfy his/her Out of Pocket Maximum once a Year for all services received outside of the U.S. and in the U.S.
6. Emergency room visits that do not result in inpatient admissions will be subject to a $100 penalty

Maternity Benefits

After 12 months of continuous coverage, Global Navigator members may renew their coverage or apply for a new plan that covers maternity costs in the same way as all other medical conditions.

To be eligible for the maternity benefit, a member must not be pregnant at the time of upgrade.

Ten Day Money Back Guarantee
YOUR SATISFACTION IS GUARANTEED. We are so confident in our products that we offer the best guarantee in the business! If you are not completely satisfied with our Global Navigator Product, simply return your Certificate of Insurance and your ID Card to HTH within 10 days of your policy effective date. If you have not already used your insurance benefits, you will receive a full refund.

CDA Privacy Policy | ©1998-2013 CDA Insurance LLC |