International Medical Group

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Benefit Description
Subject to deductible and coinsurance unless otherwise noted

Global Medical Insurance - Silver

Coverage Area

Two options: worldwide or worldwide excluding the U.S. and Canada

Policy Maximum
$5,000,000
lifetime per individual
Deductible

Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO

Family Deductible

3x the single

Coinsurance within 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

Coinsurance within the PPO network and outside the U.S. and Canada

100%

Hospitalization / Room & Board

$600 per day
(maximum of 240 consecutive days per covered event)

Intensive Care Unit

$1,500 per day
(maximum of 180 consecutive days per covered event)

Surgery

URC

Anesthetist's Charges Associated with Surgery

20% of surgery benefit

Transplants

$250,000
per transplant

Outpatient

Visits/Exams - 25 visits per insured person per period of coverage to the maximum limit as outlined: physician $70; specialist $70; psychiatrist $60; chiropractor $50; surgical intervention consultation $500; X-rays - $250 per exam maximum limit; Lab Tests - $300 per exam maximum limit

Rx Coverage

URC

Emergency Room Illness

URC  
subject to an additional $250 deductible if not admitted

Emergency Room Accident

URC

Local Ambulance

$1,500 per covered event
not subject to deductible or coinsurance

Emergency Evacuation

$50,000 per period of coverage
not subject to deductible or coinsurance

Emergency Reunion

NA
(Not Applicable)

Return of Mortal Remains

$25,000 lifetime maximum per insured
not subject to deductible or coinsurance

Maternity

Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in11th or 12th month of continuous coverage

Supplemental Accident

NA

Mental/Nervous

Outpatient only - (see Outpatient) Available after 12 months of continuous coverage

Adult Wellness

NA

Child Wellness

Three visits per period of coverage -maximum $70 per visit.
Available for children under 18 years of age after 12 months of continuous coverage

Other Services

Extended Care - limited to first 30 days of confinement
Radiation Treatment - URC
Home Nursing Care - limited 30 days per covered event
Hospice Care - limited 30 days per covered event
Prosthetic Devices - all URC

Physical Therapy

Maximum $40 per visit 30 visit maximum per period of coverage

High School Sports Injury

NA

Recreational SCUBA

NA

Remote Transportation

NA

Political Evacuation and Repatriation

NA

Complementary Medicine

NA

Non-emergency Dental

NA

Emergency Dental due to Accident

$1,000 per period of coverage

Emergency Dental due to Sudden Unexpected Pain

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

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