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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 Plus Benefits
Benefit Description GMMI Gold Plus
Lifetime Maximum Limit $5,000,000 lifetime per individual
Deductible
(Per Period of Coverage)
$250 to $10,000
50% waived within PPO network
Family Deductible Three 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 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
Intensive Care Unit URC
Surgery URC
Anesthetist's Charges Associated with Surgery URC
Transplants $1,000,000 lifetime maximum
Out-patient URC
Emergency Room Illness
(Additional $250 deductible if not admitted)
URC
Emergency Room Accident URC
Supplemental Accident $300 per occurrence
Local Ambulance URC
Mental/Nervous $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage
Child Wellness $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
Emergency Evacuation Up to maximum limit - not subject to deductible or coinsurance
Emergency Reunion $10,000 lifetime maximum
Return of Mortal Remains $25,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation NA
Political Evacuation and Repatriation NA
Rx Coverage URC
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 NA
Emergency Dental due to Accident URC
Emergency Dental due to Sudden Unexpected Pain $100 per period of coverage
High School Sports Injury NA
Vision NA
Global Concierge & Assistance Services NA
Pre-existing Conditions $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)
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

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.