Global Medical Insurance Silver Benefit Schedule

International Medical & Travel Insurance
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International Health Insurance > International Medical Group

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Global Medical Insurance Silver Benefits

Benefit Description	Global Medical Insurance Silver Plan
Lifetime Maximum Limit	$5,000,000 lifetime per individual
Deductible (Per Period of Coverage)	$250 to $10,000 50% waived within PPO network
Family Deductible	Three times the individual deductible
Coinsurance within the PPO network	No coinsurance
Coinsurance outside the U.S. and Canada	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
Hospitalization / Room & Board	$600 per day - 240 day maximum
Intensive Care Unit	$1,500 per day - 180 day per event
Surgery	URC
Anesthetist's Charges Associated with Surgery	20% of surgery benefit
Transplants	$250,000 per transplant
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
Emergency Room Illness (Additional $250 deductible if not admitted)	URC
Emergency Room Accident	URC
Supplemental Accident	NA
Local Ambulance	$1,500 per covered event - not subject to deductible or coinsurance
Mental/Nervous	Outpatient only after 12 months
Child Wellness	3 visits per period of coverage - $70 maximum per period - Available after 12 months of continuous coverage
Adult Wellness	NA
Emergency Evacuation	$50,000 per period of coverage - not subject to deductible or coinsurance
Emergency Reunion	NA
Return of Mortal Remains	$25,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation	NA
Political Evacuation and Repatriation	NA
Rx Coverage	URC
Other Services	Extended care: first 30 days; Radiation: URC; Home nursing: 30 days per covered event; Hospice: 30 days; Prosthetic Devices: all URC
Physical Therapy	Maximum $40 per visit - 30 visit maximum
Complementary Medicine	NA
Recreational SCUBA	NA
Non-emergency Dental	NA
Emergency Dental due to Accident	$1,000 per period of coverage
Emergency Dental due to Sudden Unexpected Pain	NA
High School Sports Injury	NA
Vision	NA
Global Concierge & Assistance Services	NA
Pre-existing Conditions	$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)
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

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International Health Insurance > International Medical Group

Global Medical Insurance Silver Benefits