Global Medical Insurancesm covers the Usual, Reasonable
and Customary (URC) charge for eligible expenses in the area where you receive treatment.
Each person will only need to satisfy their deductible once per policy period (12 months).
After the deductible, Global Medical Insurancesm pays 80% of the next US$5,000 in eligible expenses and then 100% of
eligible expenses to the policy maximum.
| MEDICAL
INSURANCE
|
BENEFIT
Subject to
deductible and
coinsurance |
Coverage Area
Policy Maximum Per Individual
Hospitalization
Semi-private room and board l Nursing services
l Prescription
medication l
Physician charges l
Diagnostic and laboratory testing l X-rays
l Chemotherapy and radiation l Durable medical equipment
l Treatment, services and supplies routinely provided |
Worldwide
US$5,000,000 lifetime
100% |
Intensive Care Unit
Surgical care l
Second surgical opinion l Anesthetics
l
Physician charges for surgery l Treatment, services and supplies routinely provided |
3
times semi-private
room and board
Surgery 100% |
Transplants
Covered only within IMG's PPO Transplant Facilities |
US$500,000
lifetime |
Outpatient
Emergency treatment of illness or injury l Surgery
l Rehabilitative treatment
l Treatment, services or supplies routinely provided
l Prescription medication |
100% |
Emergency
Surgery or dental treatment following an accident l Emergency room following an accident |
100% |
Emergency Transportation
by
Ground Ambulance |
US$2,500
per cause |
| Emergency Medical
Evacuation |
US$25,000
lifetime |
Maternity
Pre and Post-natal care l
Normal delivery or C-section l Well baby care and treatment of newborn for first 31 days |
US$25,000
lifetime
(after 12 months of
coverage) |
Mental/Nervous Care
Inpatient and outpatient care l Treatment by a licensed psychiatrist |
US$10,000 per period,
US$20,000 lifetime
(after 12 months
of coverage) |
Wellness
Females age 35 and over after 24 months on the plan. Routine physicals l Mammogram, ob/gyn visit, etc. (exams must be separated
by 12 months)Males age 40 and over, after 24 months
on the plan. Routine physicals (exams must be separated by 12 months) |
US$100 per period
(not subject to
deductible or coinsurance) |
Pre-existing Conditions
After 24 months of continuous coverage |
US$25,000
lifetime |
Other
Chiropractor when referred by a physician l Radiation treatment l Home nursing care l Hospice care l Physical therapy (maximum
US$50 per visit) l Prosthetic devices |
100% |
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 200,000 physicians and 2,300 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.
|
