Online Application

Details: Index Exclusions Eligibility Provider Directory Application Download

Benefits: Benefit Comparison Silver Gold Gold Plus Platinum

Worldwide Rates: Silver Gold Gold Plus Platinum

Rates Excluding U.S., Canada, China, Hong Kong, Japan, Macau, Singapore & Taiwan: Silver Gold Gold Plus Platinum

Global Mission Medical Insurance Gold Benefits
Benefit Description GMMI Gold
(1st 36 months of continuous coverage)
GMMI Gold
(Beginning the 1st day of the 37th month)
Lifetime Maximum Limit $5,000,000 lifetime per individual $5,000,000 lifetime per individual
Deductible
(Per Period of Coverage)
$250 to $10,000
50% waived within PPO network
$250 to $10,000
50% waived within PPO network
Family Deductible Three times the individual deductible Three times the individual deductible
Coinsurance within the PPO network No coinsurance No coinsurance
Coinsurance outside the U.S. and Canada No coinsurance No coinsurance
Coinsurance inside the U.S. and Canada 80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage 80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
Hospitalization / Room & Board Average semi-private room rate Up to a limit of $2,250 per day
Intensive Care Unit URC Up to a limit of $4,500 per day
Surgery URC URC
Anesthetist's Charges Associated with Surgery URC 20% of surgery benefit
Transplants $1,000,000 lifetime maximum $500,000 lifetime maximum
Out-patient URC Physician Charges - limit of $150 per visit; 
Hospital Charge
 - $100 co-pay unless admitted; 
Urgent Care Facility - $25 copay;
Diagnostic Lab
 and X-Rays limited to $5,000 per certificate period;
Physiotherapy
 - up to $75 per visit, $1,000 max per certificate period $10,000 lifetime maximum
Emergency Room Illness
(Additional $250 deductible if not admitted)
URC URC
Emergency Room Accident URC URC
Supplemental Accident $300 per occurrence $300 per occurrence
Local Ambulance URC $100 per event - not subject to deductible or coinsurance
Mental/Nervous $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage $2,500 maximum per certificate period; In-patient limited to 25 days per certificate period; Out-patient limited to max of 20 visits per certificate period at 70% eligible expenses, up to $75 maximum per visit; Lifetime maximum of $30,000
Child Wellness $200 maximum per period of coverage - Available after 12 months of continuous coverage $200 maximum per period of coverage - Available after 12 months of continuous coverage
Adult Wellness $250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage $250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage
Emergency Evacuation Up to maximum limit - not subject to deductible or coinsurance $250,000 limit per person per certificate period
Emergency Reunion $10,000 lifetime maximum $10,000 lifetime maximum
Return of Mortal Remains $25,000 lifetime maximum per insured - not subject to deductible or coinsurance $15,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation NA NA
Political Evacuation and Repatriation NA NA
Rx Coverage URC $5,000 per certificate period for each insured person, out-patient only
Other Services URC URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum
Physical Therapy Maximum $50 per visit 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
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 URC
Non-emergency Dental NA NA
Emergency Dental due to Accident URC $500 per period
Emergency Dental due to Sudden Unexpected Pain $100 per period of coverage $100 per period of coverage
High School Sports Injury NA NA
Vision NA NA
Global Concierge & Assistance Services NA NA
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
Maternity
Delivery, wellness, new born care & congenital disorders (not subject to deductible or coinsurance - available after 10 months of coverage
Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th 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 the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th or 12th month of continuous coverage)

NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

Note: Beginning in month 37 some benefits illustrated above (far right column) decrease. We have highlighted the decreased benefits by making them bold.

Patient Protection and Affordable Care Act (“PPACA”): This insurance is not subject to, and does not provide certain of the insurance benefits required by, the United States PPACA. PPACA requires certain U.S. residents and citizens to obtain PPACA compliant insurance coverage. In certain circumstances penalties may be imposed on U.S. residents and citizens who do not maintain PPACA compliant insurance coverage. You should consult your attorney or tax professional to determine if PPACA’s requirements are applicable to you. The policy contains the plan benefits, including a lifetime maximum that you have selected. Please review your choices to ensure that you have sufficient coverage to meet your medical needs.