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International Health Insurance > HTH Worldwide

Global Citizen International Health Insurance

Global Citizen Benefit Schedule

  Outside U.S. U.S.(In Network) U.S.(Outside Network)
Lifetime Maximum per Insured Person
$5,000,000
$5,000,000
$5,000,000
Preventive and Office Visits
Deductible is not applicable
Primary Care Office Visits
All except a $10 copay per visit1
All except a $30 copay per visit
60% to Out-of-Pocket Maximum then 100%
Preventative Care For Babies/Children: (Birth to Age 18)
  1. Office Visits/examination
  2. Immunizations, Lab work & X-rays
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Preventative Care For Adults: (Age 19 and Older)
  1. Routine Pap Smears, annual mammogram
  2. PSA For Men
  3. Annual Physical Examination/Health Screening
  4. Diagnostic lab work & X-rays
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Professional Services
Insurer Pays After Deductible is Met
Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work.
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Inpatient Hospital Services
Insurer Pays After Deductible is Met
Surgery, X-rays, in-hospital doctor visits, Organ/Tissue Transplant
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
In-patient medical emergency6
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
In-patient drugs
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Ambulatory and Therapeutic Services
Insurer Pays After Deductible is Met
Ambulatory Surgical Center
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Ambulance Service
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Accidental Dental
$1,000 per year, $200 per tooth
$1,000 per year, $200 per tooth
$1,000 per year, $200 per tooth
Acupuncture and Chiropractic Services
100% up to $2000
100% up to $2000
100% up to $2000
Durable Medical Equipment
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Infusion Therapy
100%
80% to Out-of-Pocket Maximum then 100%
60% to Out-of-Pocket Maximum then 100%
Physical/Occupational Therapy
$30/visit, 12 visits per year
$30/visit, 12 visits per year
$30/visit, 12 visits per year
Basic Prescription Drug Benefit
50% of actual charges up to $500
$0
$0
Optional Prescription Drug Benefit
Insurer Waives Deductible
Subject to $5,000 Maximum Benefit per Insured Person per Policy Period. 100% of actual charges Generics: 100% after $10 copay
Brandname: 100% after $25 copay
Injectables: 70% 		Generics: 100% after $10 copay
Brandname: 100% after $25 copay
Injectables: 70%
Global Travel Benefits
Insurer Waives Deductible
Medical Evacuation
Up to $100,000
n/a
n/a
Repatriation of Remains
Up to $25,000
n/a
n/a
Accidental Death and Dismemberment
$50,000
$50,000
$50,000

Maternity Benefits

After 12 months of continuous coverage, Global Citizen members may renew their coverage or apply for a new plan that covers maternity costs in the same way as all other medical conditions.

To be eligible for the maternity benefit, a member must not be pregnant at the time of upgrade.
Global Citizen
Plan 1,2,3,4,5 		Deductible
Out-of-Pocket
Maximum
Outside U.S.
U.S.in Network
U.S.out of Network
Elite
$0
$0
$1,000
$2,000
500
$250
$500
$1,000
$3,000
1,000
$500
$1,000
$2,000
$4,000
2,000
$1,000
$2,000
$4,000
$8,000
5,000
$2,500
$5,000
$10,000
$10,000
10,000
$10,000
$10,000
$10,000
$10,000
25,000
$25,000
$25,000
$25,000
$10,000
  1. Copay waived when visiting an HTH Worldwide contracted provider.
  2. Deductibles are Per Person per Policy Period.
  3. The Out of Pocket Maximum is calculated by adding the deductible and coinsurance maximum together. A family is charged a maximum of 2.5 deductibles.
  4. Amounts paid to satisfy a deductible are credited to all other deductibles, both inside and outside the U.S. For example, if you satisfy your Outside U.S. deductible, this amount is credited to the U.S. (In Network) and U.S. (Outside Network) deductible requirement.
  5. An Insured Person only has to satisfy his/her Out of Pocket Maximum once a Year for all services received outside of the U.S. and in the U.S.
  6. Emergency room visits that do not result in inpatient admissions will be subject to a $50 penalty
Participating and Non-Participating Providers
Inpatient Benefit
Outpatient Benefit
Mental Health
100% up to 20 days per year
80% up to 30 visits per year
Substance Abuse
100% up to 12 days of detox
80% up to 30 visits per year
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