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Xplorer Premier Benefits
  Outside U.S. U.S.
(In Network)
U.S.
(Outside Network)
Lifetime Maximum per Insured Person Unlimited Unlimited Unlimited
Annual Maximum per Insured Person Unlimited Unlimited Unlimited
Preventive and Office Visits Insurer waives deductible
Primary Care Office Visits All except a $10 copay per visit1 All except a $30 copay per visit 60% to Out-of-Pocket Maximum then 100%

Preventative Care For Babies/Children:
Birth to Age 18

  1. Office Visits/examination
  2. Immunizations, Lab work & X-rays
100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%

Preventative Care For Adults:
Age 19 and Older

  1. Routine Pap Smears, annual mammogram
  2. PSA For Men
  3. Annual Physical Examination/Health Screening
  4. Diagnostic lab work & X-rays
100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Professional Services Insurer Pays After Deductible is Met
Surgery, anesthesia, radiation therapy, in-hospitaldoctor visits, diagnostic X-ray and lab work. 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Inpatient Hospital Services Insurer Pays After Deductible is Met
Surgery, X-rays, in-hospital doctor visits, Organ/TissueTransplant 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
In-patient medical emergency6 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
In-patient drugs 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Ambulatory and Therapeutic Services Insurer Pays After Deductible is Met
Ambulatory Surgical Center 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Ambulance Service 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Accidental Dental $1,000 per year, $200 per tooth $1,000 per year, $200 per tooth $1,000 per year, $200 per tooth
Acupuncture and Chiropractic Services 100% up to $2000 100% up to $2000 100% up to $2000
Durable Medical Equipment 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Infusion Therapy 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Physical/Occupational Therapy $30/visit, 12 visits per year $30/visit, 12 visits per year $30/visit, 12 visits per year
Basic Prescription Drug Benefit 50% of actual charges up to $500 $0 $0
Optional Prescription Drug Benefit Insurer Waives Deductible
Subject to $5,000 MaximumBenefit per Insured Person per Policy Period. 100% of actual charges Generics:100% after $10 copay
Brandname: 100% after $25 copay
Injectables: 70%
Generics:100% after $10 copay
Brandname: 100% after $25 copay
Injectables: 70%
Global Travel Benefits Insurer Waives Deductible
Medical Evacuation Up to $100,000 n/a n/a
Repatriation of Remains Up to $25,000 n/a n/a
Accidental Death and Dismemberment $50,000 $50,000 $50,000

Maternity Benefits

After 12 months of continuous coverage, Global Citizen members may renew their coverage or apply for a new plan that covers maternity costs in the same way as all other medical conditions.

To be eligible for the maternity benefit, a member must not be pregnant at the time of upgrade.

  1. Copay waived when visiting an HTH Worldwide contracted provider.
  2. Emergency room visits that do not result in inpatient admissions will be subject to a $50 penalty.
  3. Deductibles are Per Person per Calendar Year. A family is charged a maximum of 2.5 deductibles.