Global Mission Medical Insurance Benefits & Exclusions

Medical Insurance	Benefit
Coverage Area	Two options: Worldwide or worldwide excluding U.S. and Canada
Policy Maximum Per Individual	US$5,000,000 lifetime
Hospital Room & Board	US$600 per day (maximum of 240 consecutive days per covered event)
Intensive Care Unit	US$1,500 per day (maximum of 180 consecutive days per covered event)
Inpatient or outpatient surgery	URC up to lifetime maximum benefit
Anesthetist's charges associated with surgery	20% of the surgery benefit payable
Laboratory tests, X-rays, & other treatment associated with an inpatient covered event	URC up to lifetime maximum benefit
Emergency Medical Evacuation	US$50,000 per period of coverage (not subject to deductible or coinsurance)
Local ground ambulance	US$1,500 per covered event (not subject to deductible or coinsurance)
Emergency Room Treatment Due To Accident	URC up to lifetime maximum benefit
Emergency Dental Due To Accident	US$1,000 per period of coverage
Well Child Care Only available after 12 months of continuous coverage	3 visits per period of coverage (Maximum limit of $70 per visit)
Outpatient visits or exams 25 visits per insured person per period of coverage reimbursed to the maximum limit as outlined below:
Physician Specialist Psychiatrist Chiropractor Surgical Intervention Consultation	US US US US US	$70 per visit/exam $70 per visit/exam $60 per visit/exam $50 per visit/exam $500 per visit/exam
Outpatient X-rays	US$250 per exam maximum limit
Outpatient Lab Tests	US$300 per exam maximum limit
Pre-existing conditions Only available after 24 months of continuous coverage	US$50,000 lifetime maximum benefit (maximum of US$5,000 per period of coverage)
Prescription medication related to a covered event	URC up to lifetime maximum benefit
Extended care facility services	Limited to the first 30 days of convalescent confinement
Home nursing care services	Limited to 30 days per covered event
Inpatient hospice care	Limited to the first 30 days of hospice confinement
Chemotherapy & radiation therapy	URC up to lifetime maximum benefit
Physical therapy	30 visits per period of coverage (maximum limit of $40 per visit)
MRI, CAT scan, endoscopy, echocardiography, gastroscopy, colonoscopy & cystoscopy	US$600 per exam maximum limit
Transplants Certain precertification provisions must be met	US$250,000 all inclusive per transplant
Return of mortal remains	US$25,000 lifetime maximum (not subject to deductible or coinsurance)
Optional Maternity Rider	US$50,000 lifetime maximum
Benefits include: •Pre- and post-natal care •Maximum of US$5,000 for normal delivery for each pregnancy •Maximum of US$7,500 for C-section delivery for each pregnancy •Well baby care and treatment of newborn for first 31 days •Child wellness benefits of up to US$200 maximum per period of coverage (not subject to deductible or coinsurance) for eligible newborn children for the first 12 months Must be selected at time of initial purchase of plan • Benefits available after 10 months of continuous coverage • Eligible newborn children may be added without evidence of insurability as long as an application form is submitted within 31 days of birth • Benefits will be reduced by 50% for births that occur the 11th or 12th month of continuous coverage • See the application form for the cost of this optional rider