GLOBAL MEDICAL I
NSURANCEsm
Benefits |
| MEDICAL INSURANCE
|
BENEFIT
Subject to deductible and
coinsurance |
Coverage Area
|
Worldwide
|
Policy Maximum Per Individual
Hospitalization
Semi-private room and board | Nursing services | Prescription medication | Physician charges
| Diagnostic and laboratory testing | X-rays | Chemotherapy
and radiation | Durable medical equipment | Treatment,
services and supplies routinely provided |
US$5,000,000 lifetime
|
Intensive Care Unit
|
URC |
|
Surgery
Surgical care | Second surgical opinion
| Anesthetics | Physician charges for surgery | Treatment,
services and supplies routinely provided
|
URC |
Transplants
Covered only within IMG's PPO Transplant Facilities |
US$500,000 lifetime |
Outpatient
Emergency treatment of illness or injury |
Surgery | Rehabilitative treatment | Treatment, services
or supplies routinely provided | Prescription medication |
URC |
Emergency
Surgery or dental treatment following an accident |
Emergency room following an accident |
URC |
Emergency Transportation by
Ground Ambulance |
URC |
Emergency Medical Evacuation
Included with Emergency Medical Evacuation
is an Emergency Reunion benefit of US$10,000 lifetime
|
US$50,000
lifetime |
| Repatriation |
US$25,000 |
Supplemental Accident
The first $300 will be covered for each accidental injury |
US$300
per occurrence (not subject to
the deductible or coinsurance) |
Maternity
After 12 months of continuous coverage|
Pre and Post-natal care | Normal delivery or C-section
| Well baby care and treatment of newborn coverage)
for first 31 days |
US$25,000 lifetime
maximum of US$5,000 for normal
delivery for each pregnancy lmaximum of US$7,500 for
C-Section delivery for each pregnancy |
Newborns
Eligible newborn children may be
added without evidence of insurability. An application
must be submitted within 31 days of child's birth |
URC |
Child Wellness
Available for eligible children from 14 days to 18 years
of age after 12 months of continuous coverage |
US$50
maximum per visit; US$150 per policy period (not
subject to deductible or coinsurance) |
|
Pre-existing Conditions
After 24 months of continuous coverage
|
US$50,000
lifetime (maximum of US$5,000
per policy period) |
Mental/Nervous Care
After 12 months of continuous coverage | Inpatient and outpatient care by a licensed psychiatrist |
US$10,000 per period,
US$25,000 lifetime
|
Wellness
Females and Males age 35 and over after 24 months on
the plan. Routine physicals | Mammogram,
ob/gyn visit, etc. (exams must be separtated by 12 months)
|
US$250 per period
(not subject to deductible
or coinsurance) |
| Complimentary Medicine |
|
| Acupuncture |
US$150 |
| Aroma Therapy |
US$50 |
| Herbal Therapy |
US$50 |
| Magnetic Therapy |
US$75 |
| Massage Therapy |
US$150 |
| Vitamin therapy |
US$100 |
Other
Chiropractor when referred by a physician |
Radiation treatment | Home nursing care | Hospice care
| Physical therapy (maximum US$50 per visit) | Prosthetic
devices |
URC |
This is a summary of benefits. Please refer to the policy
wording for a complete description.
IMG'sSM Preferred Provider
Organization (PPO)
You may seek treatment under Global Medical InsuranceSM
worldwide, including the United States, at the hospital
or doctor of your choice. When seeking treatment in the
U.S, you may use IMG'ssm PPO, a network of over
325,000 physicians and 3,500 hospitals. The IMGsm network
reaches across the country and includes some of the most
recognized university medical centers and transplant facilities
in the United States.
Using the provider network will significantly reduce your
out-of-pocket expenses. Your deductible will be reduced
by 50% and any coinsurance applicable to that charge is
waived when eligible treatment is received by a network
provider. When a U.S. hospital outside the network is used,
a co-payment of US$250 is required in addition to the regular
deductible and coinsurance. This co-payment is waived if
there is not a network provider within 50 miles from the
location of treatment.
|
PRE-EXISTING CONDITIONS
After coverage has been in effect for 24 continuous months,
Global Medical Insurancesm provides a US$50,000
lifetime benefit with a maximum of US$5,000 per policy period
for pre-existing conditions that existed at or prior to
the effective date. This benefit is payable whether or not
you have received consultation or treatment for the condition(s)
during the 24-month period. This is important since few
pre-existing conditions remain free from consultation or
treatment and often do not qualify for coverage in standard
plans. Global Medical Insurancesm does not “rider”
or charge additional premium for pre-existing conditions.
If you disclose a pre-existing condition at the time of
application, and we accept you into the plan, you will be
covered for eligible medical expenses, after 24 months.
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: tonsillectomy,
adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders
of the reproductive system, hysterectomy, hernia, gall stones
or kidney stones, any condition of the breast, any condition
of the prostate.
.OTHER EXCLUSIONS AND LIMITATIONS*
- Routine physical examinations first 24 months
- Maternity and newborn first 12 months
- Mental and nervous first 12 months
- Dental treatment unless accident related
- Organized amateur or professional sports
- Treatment not ordered or received by a physician
- Treatment or supplies not medically necessary
- Investigational, experimental or research
procedures
- Custodial care
- Weight modification
- Elective cosmetic or plastic surgery
|
- Treatment of impotency
- Contraceptive medication or treatment
- Drug and alcohol abuse treatment
- Organ transplants not specifically listed
- Devices to correct sight or hearing
- Routine foot care
- Treatment by a relative or family member
- Treatment as a result of war or riot
- Treatment resulting from illegal activities
- Speech or acupuncture therapy
- Persons HIV+ at effective date
- Services and treatment eligible for payment
by any government or other insurance
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*See policy wording for complete list of exclusions
and limitations.
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