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Global Medical

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The table below shows the plan benefits for the Global Medical insurance plan across all plans:

International Major Medical Insurance - Global Medical Benefits Table
Benefits Silver Gold (1st 36 months of continuous coverage) Gold (Beginning the 1st day of the 37th month) Gold Plus Platinum
Maternity
Delivery, wellness, new born care & congenital disorders,
Family Matters Maternity Program
(*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 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 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 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 that occur
in the 11th or 12th month of continuous coverage)
SAAI - $1,000 additional deductible,
$50,000 lifetime maximum,
$200 childwellness benefit for the first 12 months, new born care& congenital disorderes maximum of $250,000 for the first 31 days
Lifetime Maximum Limit $5,000,000 per individual $5,000,000 per individual $5,000,000 per individual $5,000,000 per individual $8,000,000 per individual
Deductible (Per Period of Coverage) $250 to $10,000 $250 to $10,000 $250 to $10,000 $250 to $10,000 $100 to $10,000
Family Deductible 3 times the individual deductible 3 times the individual deductible 3 times the individual deductible 3 times the individual deductible 2 times the individual deductible
Treatment outside the U.S.
and Canada
Subject to deductible
No coinsurance
Subject to deductible
No coinsurance
Subject to deductible
No coinsurance
Subject to deductible
No coinsurance
Subject to deductible
No coinsurance
Treatment inside the U.S.
(Out-patient/In-patient Emergency)
PPO Network - deductible 50% waived
(to a $2,500 maximum). No coinsurance.
PPO Network - deductible 50% waived
(to a $2,500 maximum). No coinsurance.
PPO Network - deductible 50% waived
(to a $2,500 maximum). No coinsurance.
PPO Network - deductible 50% waived
(to a $2,500 maximum). No coinsurance.
PPO Network - deductible 50% waived
(to a $2,500 maximum). No coinsurance.
Treatment inside the U.S.
(In-patient Non-emergency)
Medical Concierge - deductible 50%
waived (to a $2,500 maximum).
No coinsurance. PPO Network - subject
to deductible. No coinsurance.
Medical Concierge - deductible 50%
waived (to a $2,500 maximum).
No coinsurance. PPO Network - subject
to deductible. No coinsurance.
Medical Concierge - deductible 50%
waived (to a $2,500 maximum).
No coinsurance. PPO Network - subject
to deductible. No coinsurance.
Medical Concierge - deductible 50%
waived (to a $2,500 maximum).
No coinsurance. PPO Network - subject
to deductible. No coinsurance.
Medical Concierge - deductible 50%
waived (to a $2,500 maximum).
No coinsurance. PPO Network - subject
to deductible. No coinsurance.
Treatment inside the U.S.-
Non-PPO Network and Canada
Subject to deductible
Plan pays 80% of the next $5,000 of
eligible expenses, then 100% to the
overall maximum per period of coverage
Subject to deductible
Plan pays 80% of the next $5,000 of
eligible expenses, then 100% to the
overall maximum per period of coverage
Subject to deductible
Plan pays 80% of the next $5,000 of
eligible expenses, then 100% to the
overall maximum per period of coverage
Subject to deductible
Plan pays 80% of the next $5,000 of
eligible expenses, then 100% to the
overall maximum per period of coverage
Subject to deductible
Plan pays 90% of the next $5,000 of
eligible expenses, then 100% to the
overall maximum per period of coverage
Hospitalization/Room & Board In U.S./Canada - URC of average semi-
private room rate. Outside of U.S./
Canada - URC of private room rate (not to
exceed 150% of semi-private room rate)
All subject to $600 per day - 240 day max.
In U.S./Canada - URC of average semi-
private room rate. Outside of U.S./
Canada - URC of private room rate (not to
exceed 150% of semi-private room rate)
Up to a limit of $2,250 per day -
semi-private room rate
In U.S./Canada - URC of average semi-
private room rate. Outside of U.S./
Canada - URC of private room rate (not to
exceed 150% of semi-private room rate)
Private room rate
Intensive Care Unit $1,500 per day - 180 day per event URC Up to a limit of $4,500 per day URC URC
Surgery URC URC URC URC URC
Anesthetist's Charges
Associated with Surgery
20% of surgery benefit URC 20% of surgery benefit URC URC
Transplants $250,000 per transplant $1,000,000 lifetime maximum $500,000 lifetime maximum $1,000,000 lifetime maximum $2,000,000 lifetime maximum
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
URC Physician Charges - limit of $150 per visit;
Hospital Charge - $100 co-pay unless admitted;
Urgent Care Facility - $25 co-pay;
Diagnostic Lab and X-Rays limited to $5,000 per certificate period
URC URC
Emergency Room Illness
(Additional $250 deductible if not admitted)
URC URC URC URC URC
Emergency Room Accident URC URC URC URC URC
Supplemental Accident NA $300 per occurrence $300 per occurrence $300 per occurrence $500 per occurrence
Local Ambulance $1,500 per event - not subject to
deductible or coinsurance
URC $100 per event - not subject to deductible or coinsurance URC URC
Mental/Nervous Out-patient only after 12 months
of continuous coverage
$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
$10,000 per period - $50,000 maximum -
Available after 12 months of continuous coverage
SAAI - $50,000 lifetime maximum -
Available after 12 months of
continuous coverage
Emergency Evacuation $50,000 per period of coverage - not subject to deductible or coinsurance Up to maximum limit - not subject to deductible or coinsurance $250,000 limit per person per certificate period Up to maximum limit - not subject to deductible or coinsurance Up to maximum limit - not subject to deductible or coinsurance
Emergency Reunion NA $10,000 lifetime maximum $10,000 lifetime maximum $10,000 lifetime maximum $10,000 lifetime maximum
Return of Mortal Remains $25,000 lifetime maximum per insured - not subject to deductible or coinsurance $25,000 lifetime maximum per insured - not subject to deductible or coinsurance $15,000 lifetime maximum per insured - not subject to deductible or coinsurance $25,000 lifetime maximum per insured - not subject to deductible or coinsurance $50,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation NA NA NA NA Limited to $5,000 per certificate period up to $20,000 lifetime maximum
Political Evacuation and Repatriation NA NA NA NA Limited to $10,000 lifetime maximum
Child Wellness
(Under 18 years of age)
3 visits per period of coverage - $70
maximum per period - Available after 12 months of continuous coverage
$200 maximum per period of coverage - not subject to deductible or coinsurance.
Available after 12 months of continuous coverage
$200 maximum per period of coverage - not subject to deductible or coinsurance.
Available after 12 months of continuous coverage
$200 maximum per period of coverage - not subject to deductible or coinsurance.
Available after 12 months of continuous coverage
$400 maximum per period of coverage - not subject to deductible or coinsurance.
Available after 6 months of continuous coverage
Adult Wellness NA $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
$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
$500 per period of coverage - not subject
to deductible or coinsurance -
Available for those 18 years of age and
over after 6 months of continuous coverage
Rx Coverage URC URC $5,000 per certificate period for each
insured person, out-patient only
URC Outside U.S. - URC. Inside U.S. - Rx drug card co-pay: $20 for
generic / $40 for brand name where generic is not available
(Certain monthly per prescription amount limits may apply and
require pre-approval by the Company.)
Other Services Extended care: first 30 days; Radiation: URC; Home nursing: 30 days per covered event;
Hospice: 30 days; Prosthetic Devices: all URC
URC URC - Radiation & Chemotherapy treatments (in and out-patient)
limited to $10,000 per year;
$50,000 lifetime maximum
URC URC
Physical Therapy Maximum $40 per visit - 30 visit maximum Maximum $50 per visit Maximum $50 per visit - $1,000 max per cer-tificate period.
$10,000 lifetime maximum
Maximum $50 per visit Maximum $50 per visit
Complementary Medicine NA 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
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 NA URC URC URC URC
Non-emergency Dental NA NA NA NA Calendar year maximum: $750;
Individual deductible - $50 Schedule of Benefits-
Class I 90%; Class II 70%; Class III 50%; 6 month waiting period
Emergency Dental due to Accident $1,000 per period of coverage URC $500 per period of coverage URC URC
Emergency Dental due to Sudden Unexpected Pain NA $100 per period of coverage $100 per period of coverage $100 per period of coverage See Non-emergency Dental benefits
High School Sports Injury NA NA NA NA Up to $20,000 per certificate period
Vision NA NA NA NA Exams - up to $100
Materials - up to $150 per 24 months

The following is a summary schedule of benefits. Benefits are subject to the deductible and coinsurance unless otherwise noted. NA (Not Applicable); URC (Usual, Reasonable and Customary); SAAI (Same As Any Illness).

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For more information about the Global Medical Insurance plan, please see below:

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