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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 Platinum Benefits
Benefit Description
Subject to deductible and coinsurance unless otherwise noted
GMMI Platinum
Coverage Area Two options: worldwide or worldwide excluding the U.S. and Canada
Policy Maximum $8,000,000 lifetime per individual
Deductible Ranges from $100 to $10,000 per period of coverage
50% reduction within PPO, Carry forward deductible - last 30 days of certificate year
Family Deductible 2x the single
Coinsurance within 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
Coinsurance within the PPO network and outside the U.S. and Canada 100%
Hospitalization / Room & Board Private room rate
Intensive Care Unit Usual, Reasonable and Customary (URC)
Surgery URC
Anesthetist's Charges Associated with Surgery URC
Transplants $2,000,000 lifetime maximum
Outpatient URC
Rx Coverage URC
Emergency Room Illness URC  
subject to an additional $250 deductible if not admitted
Emergency Room Accident URC
Local Ambulance URC
Emergency Evacuation Limited to policy maximum
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
Maternity Same As Any Illness (SAAI)
$1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for first 12 months. Available after 10 months of coverage
Supplemental Accident $500 per occurrence
not subject to deductible or coinsurance
Mental/Nervous SAAI
$50,000 lifetime maximum. Available after 12 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 12 months of continuous coverage
Child Wellness $400 maximum per period of coverage - not subject to deductible or coinsurance
Available for children under 18 years of age after 12 months of continuous coverage
Other Services URC
Physical Therapy Maximum $50 per visit
High School Sports Injury Up to $5,000 maximum
Recreational SCUBA URC
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
Complementary Medicine Acupuncture $150
Aroma Therapy $50
Herbal Therapy $50
Magnetic Therapy $75
Massage Therapy $150
Vitamin Therapy $100
Each per period of coverage
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
Vision Exams - up to $100 per 24 months
Materials - up to $150 per 24 months
Global Concierge & Assistance Services Included
Pre-existing Conditions SAAI
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.