Xplorer Health Plan Insurance | Benefits

GeoBlues Xplorer Health Plan provides worldwide, comprehensive health insurance to international students coming to the US or US citizens going overseas. This plan offers concierge-level medical assistance and direct payment to any doctor, hospital, or clinic in the Blue Cross Blue Shield network in the US or in their extensive, yet carefully selected provider network outside the U.S. This plan can be purchased for as little as 6 months up to a year.


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Benefits Premier Essential
U.S. In-Network U.S. Outside Network Outside the US Outside the US Only
Lifetime Maximum Limit Unlimited
Annual Maximum Limit Unlimited
Preventative and Office Visits — Insurer Waives Deductible
Physician Office Visits
(Adults)
All except a $30 copay per visit 60% to Out-of-Pocket Maximum then 100% All except a $10 copay per visit
Physician Office Visits
(Children 0-18)
80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Unlimited Well Baby Visit
(Birth to Age 18)
80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Child Immunizations, Labs and X-rays 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Women (19+) Routine Pap Smears, Annual Mammogram 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
PSA (Prostate-Specific Antigen) for Men 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Immunizations as recommended by the Center for Disease Control (CDC) 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
One Routine Physical Per Year 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Travel Vaccinations 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100% up to $500 per Calendar Yea
Professional Services — Insurer Pays After the Deductible is Met
Surgery, Anesthesia, Radiation Therapy, In-hospital Doctor V\isits, Diagnostic X-ray and Lab Work 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Inpatient Hospital Services — Insurer Pays After the Deductible is Met
Surgery, X-ray, In-hospital Doctor Visits, Organ/Tissue Transplants 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Inpatient Medical Emergency 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Inpatient Drugs 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Ambulatory and Therapeutic Services — Insurer Pays After the Deductible is Met
Ambulatory Surgical Center 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Ambulance Service 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Accidental Dental $1,000 per year, $200 per tooth
Acupuncture and Chiropractic Services 80% up to $2,000 60% up to $2,000 100% up to $2,000
Durable Medical Equipment 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Infusion Therapy 80% to Coinsurance Maximum then 100% 60% to Out-of-Pocket Maximum then 100% 100%
Physical/Occupational Therapy $50 max each visit, 12 visits per year Deductible is waived.
Inpatient Mental Health 80% up to 60 days 60% to Out-of-Pocket Maximum then 100% 100%
Outpatient Mental Health 75% up too 40 visits/ 60% thereafter
Inpatient Substance Abuse 80% up to 60 days detox 60% up to 60 days detox 100% up to 60 days detox
Outpatient Substance Abuse 75% up too 40 visits/ 60% thereafter
Prescription Drug Benefit Options — Insurer Waives Deductible
Basic Prescription Drug Benefit 100% of actual charges up to $1,000 Maximum per Insured Person per Coverage Period (Pay and claim benefit only)
Global Travel Benefits — Insurer Waives Deductible
Emergency Medical Transportation N/A Up to $250,000
Repatriation of Mortal Remains N/A Up to $250,000
Accidental Death and Dismemberment Up to $50,000
Other Benefits — Insurer Pays After the Deductible is Met
Home Health Care 100% Covered Expenses, as many as 30 visits per year
Skilled Nursing Facilities 100% with a maximum Covered Expense of $250 per day, as many as 50 days per year
Hospice 100% with a maximum Covered Expense of $5,000 per lifetime
Geoblue Xplorer Premier Options
Plan Deductible Coinsurance Maximum
U.S. In-Network U.S. Out-of-Network Outside U.S.
Elite $0 $1,000 $0 $2,000
1000 $1,000 $2,000 $500 $4,000
2000 $2,000 $4,000 $1,000 $8,000
5000 $5,000 $10,000 $2,500 $10,000
Geoblue Xplorer Essential Options
Plan Deductible
U.S. In-Network U.S. Out-of-Network Outside U.S.
Elite N/A N/A $0
1000 N/A N/A $1,000
2000 N/A N/A $2,500
5000 N/A N/A $5,000
Benefit Optional Riders
Enhanced Prescriptions Rider
Premier Plan Only
  • Includes the US: Subject to $25,000 Maximum per Insured Person per Policy Period. Max 90 day supply.
  • Generics: 100% after $10 copay
  • Brand name: 100% after $10 copay
  • Injectables: 70%

Excludes the US: Subject to $25,000 Maximum per Insured Person per Policy Period. Max 90 day supply.

100% of actual charges up to $25,000
Dental and Vision Rider
Available only for Elite or $1,000 Deductible
Dental Benefits Not subject to Deductible
  • Annual Max — $1,500
  • Diagnostic and Preventative Dental Services — 100%
  • Basic Dental Services — 80%
  • Major Dental Services — 50%
  • Orthodontic Dental Care (Under age 19 only) — 50% up to $1,000 Lifetime Max
Vision Benefits Not subject to Deductible
  • Annual Max — $250
  • Vision Examination — 70%
  • Frames or Lenses — 70%
Optional Basic U.S. Benefits
Essential Plan Only
Basic travel accident and sickness coverage inside the U.S. for short trips to the U.S. Covers incidental illness and injury. Not designed to cover preventive, elective care or extended stays in the U.S.
N/A 100%, 80%, or 60% (depending upon services received) of actual charges up to $1,000,000/$500 maximum for pre-existing conditions Subject to Deductible
Please note: The benefit table listed above is a consolidated version of the full plan benefits. Please view the plan certificate for the full benefits and limitations of the plan. Limits apply to all benefits.

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