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Benefits: Benefit Comparison Silver Gold Gold Plus Platinum

Worldwide Rates: Silver Gold Gold Plus Platinum

Rates Excluding U.S., Canada, China, Hong Kong, Japan, Macau, Singapore & Taiwan: Silver Gold Gold Plus Platinum

Global Medical Insurance Silver Benefits
Benefit Description GMI Silver
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

Optional Rider

Provides coverage for non-Emergency Dental up to a $750 maximum with a $50 deductible for:

  • Class I: Preventative and Diagnostic Services - Plan Pays 90%; Deductible waived
  • Class II: Basic Services - Plan Pays 70% after Deductible
  • Class III: Major Services - Plan Pays 50% after Deductible
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 Optional Dental Rider also covers Vision Care expenses up to $100 every 24 months for Routine Eye exams and up to $150 every 24 months for corrective lenses, contacts to correct vision and frames.
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) $4,000 additional premium per year.
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

Patient Protection and Affordable Care Act (“PPACA”): This insurance is not subject to, and does not provide certain of the insurance benefits required by, the United States PPACA. PPACA requires certain U.S. residents and citizens to obtain PPACA compliant insurance coverage. In certain circumstances penalties may be imposed on U.S. residents and citizens who do not maintain PPACA compliant insurance coverage. You should consult your attorney or tax professional to determine if PPACA’s requirements are applicable to you. The policy contains the plan benefits, including a lifetime maximum that you have selected. Please review your choices to ensure that you have sufficient coverage to meet your medical needs.