Global Mission Medical Insurance

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Global Mission Medical Insurance covers the Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment. Each person will only need to satisfy their deductible once per period of coverage (12 months) with a maximum of three deductibles per family. For eligible expenses incurred in the U.S. and Canada (if applicable): once the deductible is met, Global Mission Medical Insurance pays 80% of the next $5000 in eligible expenses then 100% of eligible expenses up to the Policy Maximum. For eligible expenses incurred outside the U.S. and Canada: once the deductible is met, Global Mission Medical Insurance will pay 100% of eligible expenses up to the Policy Maximum.

Benefit Description Subject to deductible and coinsurance unless otherwise noted	Silver	Gold	Platinum
Coverage Area	Two options: worldwide or worldwide excluding the U.S. and Canada	Two options: worldwide or worldwide excluding the U.S. and Canada	Two options: worldwide or worldwide excluding the U.S. and Canada
Policy Maximum	$5,000,000 lifetime per individual	$5,000,000 lifetime per individual	$8,000,000 lifetime per individual
Deductible	Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO	Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO, Carry forward deductible - last 30 days of certificate year	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	Three times the individual deductible	Three times the individual deductible	Two times the individual deductible
Coinsurance within the U.S. and Canada	80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage	80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage	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%	100%	100%
Hospitalization / Room & Board	$600 per day (maximum of 240 consecutive days per covered event)	Average semi-private room rate	Private room rate
Intensive Care Unit	$1,500 per day (maximum of 180 consecutive days per covered event)	Usual, Reasonable and Customary (URC)	Usual, Reasonable and Customary (URC)
Surgery	URC	URC	URC
Anesthetist's Charges Associated with Surgery	20% of surgery benefit	URC	URC
Transplants	$250,000 per transplant	$1,000,000 lifetime maximum	$2,000,000 lifetime maximum
Outpatient	*Visits/Exams - 25 visits per insured person per period of coverage to the maximum limit as outlined: physician* $70; specialist $70; psychiatrist $60; chiropractor $50;** surgical intervention consultation $500; X-rays - $250 per exam maximum limit; Lab Tests - $300 per exam maximum limit	URC	URC
Rx Coverage	URC	URC	Prescription drug card - Copay: $20 for generic / $40 for brand name when a generic is not available
Emergency Room Illness	URC - subject to an additional $250 deductible if not admitted	URC - subject to an additional $250 deductible if not admitted	URC - subject to an additional $250 deductible if not admitted
Emergency Room Accident	URC	URC	URC
Local Ambulance	$1,500 per covered event - not subject to deductible or coinsurance	URC	URC
Emergency Evacuation	$50,000 per period of coverage - not subject to deductible or coinsurance	Limited to policy maximum - not subject to deductible or coinsurance	Limited to policy maximum - not subject to deductible or coinsurance
Emergency Reunion	NA (Not Applicable)	$10,000 lifetime maximum	$10,000 lifetime maximum
Return of Mortal Remains	$25,000 lifetime maximum per insured - not subject to deductible or coinsurance	$25,000 lifetime maximum per insured -not subject to deductible or coinsurance	$50,000 lifetime maximum per insured -not subject to deductible or coinsurance
Maternity	Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in11th or 12th month of continuous coverage	Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in11th or 12th month of continuous coverage	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	NA	$300 per occurrence - not subject to deductible or coinsurance	$500 per occurrence - not subject to deductible or coinsurance
Mental/Nervous	Outpatient only - (see Outpatient) Available after 12 months of continuous coverage	$10,000 per period of coverage up to a $50,000 lifetime maximum. Available after 12 months of continuous coverage	SAAI $50,000 lifetime maximum. Available after 12 months of continuous coverage
Adult Wellness	NA	$250 per period of coverage - not subject to deductible or coinsurance Available for those 30 years of age and over after 12 months of continuous coverage	$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	Three visits per period of coverage -maximum $70 per visit. Available for children under 18 years of age after 12 months of continuous coverage	$200 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	$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	Extended Care - limited to first 30 days of confinement Radiation Treatment - URC Home Nursing Care - limited 30 days per covered event Hospice Care - limited 30 days per covered event Prosthetic Devices - all URC	URC	URC
Physical Therapy	Maximum $40 per visit 30 visit maximum per period of coverage	Maximum $50 per visit	Maximum $50 per visit
High School Sports Injury	NA	NA	Up to $20,000 per certificate period
Recreational SCUBA	NA	URC	URC
Remote Transportation	NA	NA	Limited to $5,000 per certificate period up to a $20,000 lifetime maximum
Political Evacuation and Repatriation	NA	NA	Limited to $10,000 lifetime maximum
Complementary Medicine	NA	Acupuncture $150 Aroma Therapy $50 Herbal Therapy $50 Magnetic Therapy $75 Massage Therapy $150 Vitamin Therapy $100 Each per period of coverage	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	NA	NA	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	$1,000 per period of coverage	URC	URC
Emergency Dental due to Sudden Unexpected Pain	NA	$100 per period of coverage	See non-emergency dental benefits
Vision	NA	NA	Exams - up to $100 per 24 months Materials - up to $150 per 24 months
Global Concierge & Assistance Services	NA	NA	Included
Pre-existing Conditions	$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage	$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage	SAAI
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

This website contains only a consolidated and summary description of some of the current Global Medical Insurance benefits,conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

Global Concierge and Assistance Services^SM

DEDICATED SERVICE LINE
An international toll-free number accessible worldwide 24/7.

DEDICATED CLAIMS TEAM
Provides members with expedited claims processing.

BAG TRACKING
Assistance in locating lost checked baggage and arranging the delivery of it to you anywhere in the world.

DRUG TRANSLATION SERVICES
24/7 online access that provides country specific brand names of common prescription and over-the-counter medications.

EMBASSY & CONSULATE REFERRALS
Provides the location and contact information of the nearest U.S. Embassy or Consulate.

EMERGENCY CASH TRANSFERS
Assists in arranging and obtaining cash transfers anywhere in the world.

EMERGENCY MESSAGE RELAY
Relay messages to your family, friends and co-workers, helping you maintain contact during an emergency.

EMERGENCY TRAVEL ARRANGEMENTS
Assists in making the appropriate travel arrangements in the event you must interrupt your travel and return home.

LEGAL REFERRALS
Provides the contact information for an attorney located in your country of travel.

LOST PASSPORT/TRAVEL DOCUMENTS ASSISTANCE
Assists in reporting, retrieval or replacement of lost or stolen travel documents.

PRESCRIPTION DRUG REPLACEMENT ASSISTANCE
Assists in the replacement and shipment of lost or damaged medication.

PRE-TRIP HEALTH AND SAFETY ADVISORIES
24/7 online access to information concerning current passport and visa requirements; information regarding inoculations and vaccinations; and up-to-date travel safety advisories.

SECURITY UPDATES AND COUNTRY PROFILES
24/7 online access to the latest advisories and travel warnings.

Global Concierge and Assistance Services are additional services offered under the Platinum plan option. They are not insurance benefits.

Global Mission Medical Insurance

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Global Concierge and Assistance ServicesSM

Global Concierge and Assistance Services^SM