International Major Medical Insurance | Benefits
The Global Medical Insurance plan provides you with four plan levels to choose from: Bronze, Silver, Gold, and Platinum. Each level of the plan offers different coverage benefits and amounts to suit different health insurance needs.
We also encourage you to contact our customer support team who will be able to assist you with finding the correct plan to fit your needs and explain the different levels in more detail.
| Benefits | Bronze | Silver | Gold | Platinum |
|---|---|---|---|---|
| Lifetime Maximum Limit | $1 million per individual | $5 million per individual | $8 million per individual | |
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Deductible Per Period of Coverage |
$250 to $10,000 | $250 to $25,000 | $100 to $25,000 | |
| Provider Network | UnitedHealthcare Network | |||
| Treatment outside the U.S. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance | |||
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Treatment inside the U.S. Using Medical Concierge |
50% of deductible waived, up to a maximum of $2,500. No coinsurance | |||
| Treatment inside the U.S. PPO Network | Subject to deductible No coinsurance | |||
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Treatment inside the U.S. Non-PPO Network |
Subject to deductible — Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage. | |||
| Coinsurance |
International — 100% U.S. In-Network — 100% U.S. Out of Network — 80% |
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| Outpatient |
$300 maximum per visit — lab tests; $250 maximum per visit – diagnostic X-rays $500 maximum limit — specialists/ physician charges (pre-inpatient / post-inpatient) Subject to deductible and coinsurance |
$300 maximum per visit — lab tests; $250 maximum per visit — diagnostic X-rays 25 combined maximum visits $70 per visit/examination — specialists/physician charges $50 per visit/examination — chiropractor charges (medical order or treatment plan required) $500 per consultation — surgery intervention consultation charges Subject to deductible and coinsurance |
Subject to deductible and coinsurance | |
| CareClix Consultation | N/A | N/A |
Not subject to Deductible and Coinsurance CareClix Consultations will not support a diagnosis for Mental or Nervous disorders Coverage for a CareClix Consultation is not a determination that any specific condition discussed, raised or identified during such consultation is covered under this insurance. The Company reserves the right to decline future claims relating to or arising from any condition discussed, raised or identified during a CareClix Consultation where the Illness or Injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Certificate of Insurance. |
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| Mental/Nervous | N/A | Subject to deductible and coinsurance. Outpatient after 12 months of continuous coverage | Subject to deductible and coinsurance. $10,000 maximum. Available after 12 months of continuous coverage | Subject to deductible and coinsurance. $50,000 lifetime maximum. Available after 12 months of continuous coverage. |
| Hospital Emergency Room Injury | Subject to deductible and coinsurance | |||
| Hospital Emergency Room Illness | Subject to deductible and coinsurance. Covered only if admitted as inpatient. | Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient. | ||
| Hospitalization / Room & Board | Subject to deductible and coinsurance for average semi-private room rate. | Subject to deductible and coinsurance for average semi-private room rate. All subject to $600 per day; 240 day maximum | Subject to deductible and coinsurance for average semi-private room rate. | |
| Intensive Care Unit | Subject to deductible and coinsurance | Subject to deductible and coinsurance. $1,500 limit per day — 180 days of coverage per event | Subject to deductible and coinsurance | |
| CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy | Subject to deductible and coinsurance. $600 maximum limit per examination | Subject to deductible and coinsurance | ||
| Surgery | Subject to deductible and coinsurance. | |||
| Assistant Surgeon | 20% of primary surgeon’s charge | |||
| Chemotherapy or Radiation Therapy | Subject to deductible and coinsurance. | |||
| Maternity Delivery, preventative care, newborn care & congenital disorders, Family Matters Maternity Program (available after 10 months of coverage) | N/A |
$2,500 additional deductible per pregnancy. $50,000 lifetime maximum. $200 newborn preventative care benefit for the first 31 days – 12 months after birth. $250,000 maximum for newborn care & congenital disorders for the first 31 days after birth. |
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| Podiatry Care | NA | $750 max limit | ||
| Physical Therapy | Subject to deductible and coinsurance. $40 maximum per visit – 10 visit limit per event. Available for 90 days following inpatient treatment or outpatient surgery | Subject to deductible and coinsurance. $40 maximum per visit – 30 visit limit | Subject to deductible and coinsurance. $50 maximum per visit | |
| Transplants | $250,000 lifetime max. | $1 million lifetime max. | $2 million lifetime max. | |
| Prescription Drugs, Dressing, and Durable Medical Equipment | Subject to deductible and coinsurance. Available for 90 days following related inpatient treatment or outpatient surgery. $600 maximum limit per event (includes dressing and durable medical equipment) |
Subject to deductible and coinsurance. 90 day supply per prescription following related covered event. U.S Retail Pharmacy out-of-network: 80% International Retail Pharmacy: 100% |
U.S Retail Pharmacy: prescription drug card required. Copay per 30-day supply: $20 for generic/ $40 for brand name where generic is not available. International Retail Pharmacy (subject to deductible): $100% |
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| Expatriate Prescription Services Program | N/A |
Copay per 30-day supply: $20 for generic/$40 for non-preferred brand name. Must enroll via provider website: www.expatps.com Dispensing maximum: 180 days |
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Orphan or Biologic Drugs
Available when all conditions are met:
Max limit applies towards lifetime max. |
Inpatient Treatment maximum limit: $250,000. Outpatient Surgery: up to the maximum limit. Subject to deductible and coinsurance. Does not apply to maximum limit per event |
Outpatient and Emergency Department Treatment maximum limit: $250,000. Subject to deductible and coinsurance. |
Inpatient & Outpatient Treatment maximum limit: $250,000. Subject to deductible and coinsurance. |
Maximum limit: $250,000. U.S. Retail Pharmacy & expatriate prescription services program: Subject to copayments. International retail pharmacy: Subject to deductible and coinsurance. Inpatient & Outpatient medical Treatment: Subject to deductible and coinsurance. |
| Healthy Travel Preventative Coverage | $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the Insured person's initial effective date and before departing to any destination. | |||
| Vision | Optional Rider |
Exams: up to $100 per 24 months Materials: up to $150 per 24 months |
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| Emergency Local Ambulance (Injury or illness resulting in hospitalization) | $1,500 maximum limit per event Not subject to deductible or coinsurance | Subject to deductible or coinsurance | Not subject to deductible or coinsurance | |
| Emergency Evacuation | $50,000 maximum per period of coverage. Not subject to deductible or coinsurance | Up to lifetime maximum limit. Not subject to deductible or coinsurance | ||
| Emergency Reunion | $10,000 lifetime maximum. Not subject to deductible or coinsurance | N/A | $10,000 lifetime maximum. Not subject to deductible or coinsurance | |
| Interfacility Ambulance Transfer (Transfer from one licensed health care facility to another licensed health care facility- Applies only in the U.S.) | $1,500 maximum limit per event. Not subject to deductible or coinsurance | Subject to deductible and coinsurance | Not subject to deductible and coinsurance | |
| Political Evacuation and Repatriation | N/A | $10,000 lifetime maximum | ||
| Remote Transportation | N/A | $5,000 per period of coverage up to $20,000 lifetime maximum. Not subject to deductible or coinsurance | ||
| Return of Mortal Remains |
Maximum Limit: $25,000 Local Burial / Cremation Maximum Limit: $5,000 Not subject to deductible or coinsurance |
$50,000 lifetime maximum. Not subject to deductible or coinsurance | ||
| Complementary Medicine | N/A | $500 maximum limit per period of coverage | ||
| Traumatic Dental Injury (Treatment at a hospital facility) | $1,000 per period of coverage | Up to the lifetime maximum limit | ||
| Treatment Due to Unexpected Pain to Sound, Natural Teeth | N/A | $100 per period of coverage | 100% | |
| Non-Emergency Treatment at a Dental Provider due to an Accident | N/A | $500 per period of coverage | See Non-Emergency Dental benefit | |
| Non-Emergency Dental | Optional Rider | $750 maximum per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services. | ||
| Hospital Indemnity (Outside the U.S. only) |
Private Hospital: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage. Public Hospital: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance |
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| Supplemental Accident | N/A | $300 of eligible medical expenses following an accident. Not subject to deductible or coinsurance | $500 maximum limit per accident. Not subject to deductible or coinsurance | |
| Adult Preventative Care (Age 19 or older) | N/A | $250 per period of coverage. Not subject to deductible or coinsurance | $500 per period of coverage. Not subject to deductible or coinsurance | |
| Child Preventative Care (Through age 18) | N/A | $70 maximum per visit, 3 visit limit per period of coverage. Not subject to deductible or coinsurance | $200 per period of coverage. Not subject to deductible or coinsurance | $400 per period of coverage. Not subject to deductible or coinsurance |
| Pre-Existing Conditions | Excluded | $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage* | Covered if disclosed and not excluded by rider | |
| Lifeworks Consultation | N/A | N/A | N/A | LifeWorks will provide 24/7 counseling services through a master’s level counselor. Through virtual counseling services, individuals are able to get immediate counseling in crisis situations. Additional services available through the EAP program include an in-person counseling option while within the United States, LifeWorks services, legal and financial advice, management consultations, and access to many other support resources. |
| Optional Coverage | ||||
| Individual Term Life Insurance (Amounts shown are the Principal Sums per unit) |
Age 31 days – 18 years: $5,000 Age 19–29 years: $75,000 Age 30–39 years: $50,000 Age 40–44 years: $35,000 Age 45–49 years: $25,000 Age 50–54 years: $20,000 Age 55–59 years: $15,000 Age 60–64 years: $10,000 Age 65–69 years: $7,500 |
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| Accidental Death & Dismemberment (AD&D) Included with Individual Term Life Insurance |
Accidental Loss of Life: Principal Sum* Accidental Total Loss of 2 body parts**: Principal Sum* Accidental Total Loss of 1 body part**: 50% of Principal Sum* (Benefit based on age at time of death** ”body part” means hand, foot, or eye) |
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| Terrorism (Platinum plan option) | $50,000 lifetime maximum for Eligible Medical Expenses arising out of injury or illness incurred by the Insured as a result of or in connection with an act of terrorism (Refer to rider for more details) | |||
| Sports (Gold and Platinum plan options) (Refer to rider for a comprehensive list of sports excluded) |
$10,000 lifetime maximum for amateur athletics Adventure Sports:
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| Dental & Vision (Bronze, Silver, and Gold plan options) |
Dental
$750 per period of coverage $50 deductible (max. 2 per family) Routine services — 90% (deductible is waived) Minor restorative — 70% Major restorative — 50% 6-month waiting period |
Vision
Exams: up to $100 per 24 months Materials: up to $150 per 24 months |
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Pre-existing Conditions
Pre-existing conditions coverage is excluded from the Bronze level of the plan. On the Silver, Gold, and Platinum plan options, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are known and not fully disclosed on the application will not be covered.
On the Silver, Gold, and Platinum plan options, unknown pre-existing conditions that existed at or prior to the effective date can be covered after 24 months of continuous coverage. These levels will provide a $50,000 lifetime benefit for eligible pre-existing conditions, subject to a maximum of $5,000 per period of coverage.
On the Silver and Gold levels, if applicants can verify their prior comprehensive health insurance, with no significant break in coverage (63 days), IMG may accept this as Creditable Coverage and provide a pre-existing conditions waiver (final decision is subject to Underwriter approval). Creditable Coverage is defined as a group health plan provided by a U.S. employer or Health Insurance Issuer, individual major medical health insurance provided by a Health Insurance Issuer, or other Public Health Plan. (any comprehensive health plan established or maintained by a State or the U.S. government).
The following illnesses which existed, manifest themselves, or are treated, or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions and are subject to the waiting period and other limitation of coverage described above: acne, asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders or the reproductive system, hysterectomy, hernia, gall bladder or gall stones and kidney stones, any condition of the breast, and any condition of the prostate.
The above is a summary schedule of benefits. Benefits are subject to the deductible and coinsurance unless otherwise noted. NA (Not Applicable); URC (Usual, Reasonable and Customary); SAAI (Same As Any Illness). For a further description of benefits, please refer to the Master Certificates of the plan.
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