International Medical Group

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Benefit Description
Subject to deductible and coinsurance unless otherwise noted

Global Medical Insurance - 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)