The table below shows the plan benefits for the Global Medical insurance plan across all plans:
|Lifetime Maximum Limit||$1 million per individual||$5 million per individual||$8 million per individual|
Per Period of Coverage
|$250 to $10,000||$250 to $25,000||$100 to $25,000|
|Deductible Carry Forward||Included|
|Provider Network||UnitedHealthcare Network|
|Treatment outside the U.S.||
50% of deductible waived, up to a maximum of $2,500.
Treatment inside the U.S.
Using Medical Concierge
50% of deductible waived, up to a maximum of $2,500
Treatment inside the U.S.
Subject to deductible
Treatment inside the U.S.
|Subject to deductible — Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage|
International – 100%
U.S. In-Network – 100%
U.S. Out of Network – 80%
|Hospitalization / Room & Board||Subject to deductible and coinsurance for average semi-private room rate.||Subject to deductible and coinsurance for average semi-private room rate. All subject to $600 per day / 240 day max.||Subject to deductible and coinsurance for average semi-private room rate.||Subject to deductible and coinsurance for average private room rate.|
|Hospital Emergency Room Injury||Subject to deductible and coinsurance|
Hospital Emergency Room Illness
Additional $250 deductible if not admitted
|Subject to deductible and coinsurance. Covered only if admitted as inpatient.||Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient.|
due to injury or illness resulting in hospitalization
$1,500 max limit per event
– not subject to deductible or coinsurance
|Subject to deductible or coinsurance||Not subject to deductible or coinsurance|
$300 of eligible medical expenses following an accident.
– Not subject to deductible or coinsurance.
|$500 max limit per accident – Not subject to deductible or coinsurance.|
|Intensive Care Unit||Subject to deductible and coinsurance||Subject to deductible and coinsurance. $1,500 limit per day – 180 days of coverage per event||Subject to deductible and coinsurance|
|CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy||Subject to deductible and coinsurance. $600 max limit per exam||Subject to deductible and coinsurance|
|Surgery||Subject to deductible and coinsurance.|
|Assistant Surgeon||20% of primary surgeon’s charge|
|Transplants||$250k lifetime max.||$1 million lifetime max.||$2 million lifetime max.|
|Chemotherapy or Radiation Therapy||Subject to deductible and coinsurance|
$500 max limit – specialists/physician charges (pre-inpatient / post-inpatient)
$300 max per visit – lab tests; $250 max per visit – diagnostic x-raysSubject to deductible and coinsurance
25 combined maximum visits
$70 per visit/examination — specialists/physician charges
$50 per visit/examination — chiropractor charges
$500 per consultation — surgery intervention consultation charges
$300 maximum per visit — lab tests;
$250 maximum per visit — diagnostic X-raysSubject to deductible and coinsurance
|Subject to deductible and coinsurance|
|Mental/ Nervous||NA||Subject to deductible and coinsurance. Out-patient only after 12 months of continuous coverage||Subject to deductible and coinsurance. $10,000 maximum. Available after 12 months of continuous coverage||Subject to deductible and coinsurance. $50,000 lifetime max. - Available after 12 months of continuous coverage.|
Delivery, preventative care, newborn care & congenital disorders, Family Matters Maternity Program (available after 10 months of coverage)
$2,500 additional deductible per pregnancy.
$50,000 lifetime maximum.
$200 newborn preventative care benefit for the first 31 days – 12 months after birth.
$250,000 maximum for newborn care & congenital disorders for the first 31 days after birth.
|Podiatry Care||NA||$750 max limit|
|Physical Therapy||Subject to deductible and coinsurance. $40 max per visit – 10 visit limit per event. Available for 90 days following inpatient treatment or outpatient surgery||Subject to deductible and coinsurance. $40 max per visit – 30 visit limit||Subject to deductible and coinsurance. $50 maximum per visit|
|Prescription Coverage||Subject to deductible and coinsurance. Available for 90 days following related inpatient treatment or outpatient surgery. $600 outpatient maximum limit per event||Subject to deductible and coinsurance. 90 day supply per prescription following related covered event.||
International – 100%
Inside U.S. – Prescription drug card copay: $20 for generic / $40 for brand name where generic is not available. 90 day supply per prescription
|Healthy Travel Preventative Coverage||$250–lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the Insured person's initial effective date and before departing to any destination|
Child Preventative Care
(Through age 18)
|NA||3 visits per period of coverage — $70 max. per visit — Not subject to deductible or coinsurance||$200 max. per period of coverage — not subject to deductible or coinsurance||$400 max. per period of coverage — not subject to deductible or coinsurance|
Adult Preventative Care
(Age 19 or older)
|NA||$250 per period of coverage — Not subject to deductible or coinsurance||$500 per period of coverage — not subject to deductible or coinsurance|
|Emergency Evacuation||$50,000 max per period of coverage — not subject to deductible or coinsurance||Up to max. limit — not subject to deductible or coinsurance|
|Emergency Reunion||$10,000 lifetime max. Not subject to deductible or coinsurance.||NA||$10,000 lifetime max. Not subject to deductible or coinsurance.|
Interfacility Ambulance Transfer
(Transfer from one licensed health care facility to another licensed health care facility- Applies only in the U.S.)
|$1,500 max limit per event – Not subject to deductible or coinsurance||Subject to deductible and coinsurance||Not subject to deductible and coinsurance|
|Return of Mortal Remains||$10,000 lifetime max – not subject to deductible or coinsurance||$25,000 lifetime max – not subject to deductible or coinsurance||$50,000 lifetime max – not subject to deductible or coinsurance|
|Remote Transportation||NA||Limited to $5,000 per certificate period up to $20,000 lifetime max. Not subject to deductible or coinsurance|
|Political Evacuation and Repatriation||NA||Limited to $10,000 lifetime max.|
|Complementary Medicine||NA||$500 max limit per period of coverage|
Traumatic Dental Injury
(Treatment at a hospital facility)
|$1,000 per period of coverage||Up to the lifetime max limit|
|Non-Emergency Treatment at a Dental Provider due to an Accident||NA||$500 per period of coverage||See Non-Emergency Dental benefit|
|Treatment Due to Unexpected Pain to Sound, Natural Teeth||NA||$100 per period of coverage||100%|
Optional Vision & Dental Rider*$750 per calendar year maximum
$50 deductible (max 2 per family)
Routine Services – 90% (deducible is waived)
Minor restorative – 70%
Major restorative -50%
(6 month waiting period)
|$750 max per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services|
Optional Vision & Dental Rider*Exams – up to $100 per 24 months for Routine Eye Exam
Materials – up to $150 per 24 months
Exams: up to $100 max per 24 months
Materials: up to $150 max per 24 months
(Outside the U.S. only)
Private Hospital: $400 per overnight and $4,000 max. per period of coverage
Public Hospital: $500 per overnight and $5,000 max. per period of coverage
Not subject to deductible or coinsurance
Pre-existing conditions coverage is excluded from the Bronze level of the plan. On the Silver, Gold, and Platinum plan options, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are known and not fully disclosed on the application will not be covered.
On the Silver, Gold, and Platinum plan options, unknown pre-existing conditions that existed at or prior to the effective date can be covered after 24 months of continuous coverage. These levels will provide a $50,000 lifetime benefit for eligible pre-existing conditions, subject to a maximum of $5,000 per period of coverage.
On the Silver and Gold levels, if applicants can verify their prior comprehensive health insurance, with no significant break in coverage (63 days), IMG may accept this as Creditable Coverage and provide a pre-existing conditions waiver (final decision is subject to Underwriter approval). Creditable Coverage is defined as a group health plan provided by a U.S. employer or Health Insurance Issuer, individual major medical health insurance provided by a Health Insurance Issuer, or other Public Health Plan. (any comprehensive health plan established or maintained by a State or the U.S. government).
The following illnesses which existed, 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 and are subject to the waiting period and other limitation of coverage described above: acne, asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders or the reproductive system, hysterectomy, hernia, gall bladder or gall stones and kidney stones, any condition of the breast, and any condition of the prostate.
The above 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). For a further description of benefits, please refer to the Master Certificates of the plan.