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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
*See policy wording for complete list of exclusions and limitations.

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