Global Medical Insurance
Benefits
Global Medical Insurance is designed to meet your total needs. The program offers you the flexibility to select from four unique benefit options, Silver, Gold, Gold Plus and Platinum - each with specialized coverages. To accommodate your financial means, you can customize your length and area of coverage with the flexibility to select from multiple deductibles and modes of payment.
| Benefit Description | Silver |
Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
|---|---|---|---|---|---|
| Lifetime Maximum Limit |
$5,000,000
lifetime per individual |
$5,000,000
lifetime per individual |
$5,000,000
lifetime per individual |
$5,000,000
lifetime per individual |
$8,000,000
lifetime per individual |
|
Deductible (Per Period of Coverage) |
$250 to $10,000 50% waived within PPO network |
$250 to $10,000 50% waived within PPO network |
$250 to $10,000 50% waived within PPO network |
$250 to $10,000 50% waived within PPO network |
$100 to $10,000 50% waived within PPO network |
| Family Deductible | Three times the individual deductible | Three times the individual deductible | Three times the individual deductible | Three times the individual deductible | Two times the individual deductible |
| Coinsurance within the PPO network | No coinsurance | No coinsurance | No coinsurance | No coinsurance | No coinsurance |
| Coinsurance outside the U.S. and Canada | No coinsurance | No coinsurance | No coinsurance | No coinsurance | No coinsurance |
| Coinsurance inside 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 | 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 |
| Hospitalization / Room & Board | $600 per day - 240 day maximum | Average semi-private room rate | Up to a limit of $2,250 per day | Average semi-private room rate | Private room rate |
| Intensive Care Unit | $1,500 per day - 180 day per event | URC | Up to a limit of $4,500 per day | URC | URC |
| Surgery | URC | URC | URC | URC | URC |
| Anesthetist's Charges Associated with Surgery | 20% of surgery benefit | URC | 20% of surgery benefit | URC | URC |
| Transplants |
$250,000
per transplant |
$1,000,000
lifetime maximum |
$500,000
lifetime maximum |
$1,000,000
lifetime maximum |
$2,000,000
lifetime maximum |
| Out-patient | 25 visits: $70 doctor/specialist; $60 psychiatrist; $50 chiropractor; $250 X-ray per exam maximum limit; $500 surgery intervention consultation; $300 lab tests per exam maximum limit | URC | Physician Charges - limit of $150 per visit; Hospital Charge - $100 co-pay unless admitted; Urgent Care Facility - $25 copay; Diagnostic Lab and X-Rays limited to $5,000 per certificate period; Physiotherapy - up to $75 per visit, $1,000 max per certificate period $10,000 lifetime maximum | URC | URC |
|
Emergency Room Illness (Additional $250 deductible if not admitted) |
URC | URC | URC | URC | URC |
| Emergency Room Accident | URC | URC | URC | URC | URC |
| Supplemental Accident | NA |
$300
per occurrence |
$300
per occurrence |
$300
per occurrence |
$500
per occurrence |
| Local Ambulance |
$1,500
per covered event - not subject to deductible or coinsurance |
URC | $100 per event - not subject to deductible or coinsurance | URC | URC |
| Mental/Nervous | Outpatient only after 12 months | $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage | $2,500 maximum per certificate period; In-patient limited to 25 days per certificate period; Out-patient limited to max of 20 visits per certificate period at 70% eligible expenses, up to $75 maximum per visit; Lifetime maximum of $30,000 | $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage | SAAI - $50,000 lifetime maximum - Available after 12 months of continuous coverage |
| Child Wellness | 3 visits per period of coverage - $70 maximum per period - Available after 12 months of continuous coverage | $200 maximum per period of coverage - Available after 12 months of continuous coverage | $200 maximum per period of coverage - Available after 12 months of continuous coverage | $200 maximum per period of coverage - Available after 12 months of continuous coverage | $400 maximum per period of coverage - Available after 6 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 | $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 | $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 6 months of continuous coverage |
| Emergency Evacuation |
$50,000
per period of coverage - not subject to deductible or coinsurance |
Up to maximum limit - not subject to deductible or coinsurance | $250,000 limit per person per certificate period | Up to maximum limit - not subject to deductible or coinsurance | Up to maximum limit - not subject to deductible or coinsurance |
| Emergency Reunion | NA | $10,000 lifetime maximum | $10,000 lifetime maximum | $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 |
$15,000 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 |
| Remote Transportation | NA | NA | NA | NA | Limited to $5,000 per certificate period up to a $20,000 lifetime maximum |
| Political Evacuation and Repatriation | NA | NA | NA | NA | Limited to $10,000 lifetime maximum |
| Rx Coverage | URC | URC | $5,000 per certificate period for each insured person, out-patient only | URC |
Outside U.S. - URC Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available |
| Other Services | Extended care: first 30 days; Radiation: URC; Home nursing: 30 days per covered event; Hospice: 30 days; Prosthetic Devices: all URC | URC | URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum | URC | URC |
| Physical Therapy | Maximum $40 per visit - 30 visit maximum | Maximum $50 per visit | Maximum $50 per visit | Maximum $50 per visit | Maximum $50 per visit |
| 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 |
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 |
| Recreational SCUBA | NA | URC | URC | URC | URC |
| Non-emergency Dental | NA | NA | 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 | $500 per period | URC | URC |
| Emergency Dental due to Sudden Unexpected Pain | NA | $100 per period of coverage | $100 per period of coverage | $100 per period of coverage | See non-emergency dental benefits |
| High School Sports Injury | NA | NA | NA | NA | Up to $20,000 per certificate period |
| Vision | NA | NA | NA | NA | Exams - up to $100 Materials - up to $150 per 24 months |
| Global Concierge & Assistance Services | NA | NA | 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 | $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 |
|
Maternity Delivery, wellness, new born care & congenital disorders (not subject to deductible or coinsurance - available after 10 months of coverage |
Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th 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 the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th 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 the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th 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 the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th or 12th month of continuous coverage) | SAAI - $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for the first 12 months, new born care & congenital illness maximum of $250,000 for the first 31 days |
| NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness) | |||||
This Web page contains only a consolidated and summary description of all current 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 Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.
Exclusions
Global Medical Insurance provides flexible underwriting methods to extend coverage to you. Your application may be underwritten by Standard Underwriting or the Flexible Underwriting Option.
Standard Underwriting - All disclosed medical conditions which have not been specifically excluded or restricted by a rider, will be covered after coverage has been in effect for 24 continuous months (subject to the foregoing limits and the other terms of the plan*).
The Silver, Gold and Gold Plus plan options provide a $50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of $5,000 per period of coverage. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period of continuous coverage.
The following illnesses which exist, 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 limitations of coverage described above: asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall stones or kidney stones, any condition of the breast, and any condition of the prostate.
On the Platinum plan option, 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 not fully disclosed on the application will not be covered.
Flexible Underwriting Option - Where you may have otherwise been declined for coverage, the Flexible Underwriting Option allows us to extend coverage to you. After 24 months of continuous coverage, a pre-existing condition which has not been specially excluded by a rider will be covered the same as any other pre-existing condition so long as in that 24 month period no treatment has been received for that condition. If treatment has been sought, then the 24 month period starts over from the treatment date. Treatment includes: 1) Consulted any physician for Medical Treatment or Advice (other than routine check-ups); or 2) Taken medication (including prescription drugs, special diets or injections).
Other Exclusions and Limitations*
- Adult routine physical examinations are excluded under the Silver plan option and for the first 12 months for the Gold, Gold Plus and Platinum plan options- Out-patient mental and nervous for the first 12 months on all plan options
- In-patient mental and nervous is excluded under the Silver plan option and for the first 12 months for the Gold, Gold Plus and Platinum plan options
- Maternity, newborn and congenital disorders (unless the maternity rider or Platinum plan option is purchased)
- Maternity expenses (including prenatal, delivery, postnatal, newborn and congenital care) when the pregnancy is a result of Invitro
- Organ transplants not specifically listed
- Devices to correct sight or hearing are excluded under the Silver, Gold and Gold Plus plan options
- Treatment or supplies not medically necessary
- Treatment not ordered or received by a physician
- Treatment by a relative or family member
- Treatment as a result of war or riot
- Treatment resulting from illegal activities
- Organized amateur or professional sports
- Services and treatment eligible for payment by any government or other insurance
- Investigational, experimental or research procedures
- Routine foot care
- Elective cosmetic or plastic surgery
- Drug and alcohol abuse treatment
- Speech therapy
- Custodial care
- Weight modification
- Treatment of impotency
- Contraceptive medication or treatment
- Persons HIV+ at effective date
*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.