Global Medical Insurance Gold Benefit Schedule

Benefit Description	Gold (1st 36 months of continuous coverage)	Gold (Beginning the 1st day of the 37th month)
Lifetime Maximum Limit	$5,000,000 lifetime per individual	$5,000,000 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
Family Deductible	Three times the individual deductible	Three times the individual deductible
Coinsurance within the PPO network	No coinsurance	No coinsurance
Coinsurance outside the U.S. and Canada	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
Hospitalization / Room & Board	Average semi-private room rate	Up to a limit of $2,250 per day
Intensive Care Unit	URC	Up to a limit of $4,500 per day
Surgery	URC	URC
Anesthetist's Charges Associated with Surgery	URC	20% of surgery benefit
Transplants	$1,000,000 lifetime maximum	$500,000 lifetime maximum
Out-patient	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
Emergency Room Illness (Additional $250 deductible if not admitted)	URC	URC
Emergency Room Accident	URC	URC
Supplemental Accident	$300 per occurrence	$300 per occurrence
Local Ambulance	URC	$100 per event - not subject to deductible or coinsurance
Mental/Nervous	$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
Child Wellness	$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
Adult Wellness	$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
Emergency Evacuation	Up to maximum limit - not subject to deductible or coinsurance	$250,000 limit per person per certificate period
Emergency Reunion	$10,000 lifetime maximum	$10,000 lifetime maximum
Return of Mortal Remains	$25,000 lifetime maximum per insured - not subject to deductible or coinsurance	$15,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation	NA	NA
Political Evacuation and Repatriation	NA	NA
Rx Coverage	URC	$5,000 per certificate period for each insured person, out-patient only
Other Services	URC	URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum
Physical Therapy	Maximum $50 per visit	Maximum $50 per visit
Complementary Medicine	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	URC	URC
Non-emergency Dental	NA	NA
Emergency Dental due to Accident	URC	$500 per period
Emergency Dental due to Sudden Unexpected Pain	$100 per period of coverage	$100 per period of coverage
High School Sports Injury	NA	NA
Vision	NA	NA
Global Concierge & Assistance Services	NA	NA
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
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)
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

Travel Health Insurance

US Visitor & Immigrant Plans

International Health Insurance

Trip Cancellation Coverage

Other International Coverage

Help Me Choose!

International Health Insurance > International Medical Group

Global Medical Insurance Gold Benefits