Global Navigator Insurance

Global Navigator has three tiers of coinsurance: 100% outside the U.S. , 80% in network in the U.S. , 60% out of network inside the U.S. All Global Navigator plans have a $5,000,000 lifetime maximum and a $250,000 maximum benefit for emergency medical evacuation
BROCHURE
 
Plan Benefits Outside the U.S. In Network, U.S. Out-of-Network, U.S.
Preventative and Primary Care - Deductible is not applicable
Primary Care Office Visits - as many as 4 visits per Calendar Year All except a $10 copay per visit All except a $30 copay per visit 60% to Coinsurance Maximum then 100%
Preventative Care for Babies or Children: (Birth to Age 18)
  1. Office Visits/examination
  2. Immunizations, Lab work & X-rays
100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Preventative Care For Adults: (Age 19 and Older)
  1. Routine Pap Smears, annual mammogram
  2. PSA For Men
100% 80% to Coinsurance Maximum then 100% 80% to Coinsurance Maximum then 100%
Annual Physical Examination or Health Screening 100% Maximum Covered Expense of $250 and limited to one per Calendar Year. 80% to Coinsurance Maximum then 100% Maximum Covered Expense of $250 and limited to one per Calendar Year. 60% to Coinsurance Maximum then 100% Maximum Covered Expense of $250 and limited to one per Calendar Year.
Outpatient Services - Insurer pays after the Deductible is Met
Outpatient Medical Care 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Inpatient Hospital Services - Insurer pays after the Deductible is Met
Surgery, X-rays, In-hospital doctor visits, Organ or Tissue Transplant The Insurer will pay 100% of Covered Expenses. 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
In-patient medical emergency 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Professional Services
Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work
100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Other Services - Insurer pays after the Deductible is Met, unless noted
Ambulatory Surgical Center 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Physical/Occupational Therapy or Medicine: Deductible is waived. Covered Expenses up to $50 per visit, and as many as 6 visits per Calendar Year
Ambulance Service 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Durable Medical Equipment 100% 80% to Coinsurance Maximum then 100% 80% to Coinsurance Maximum then 100%
Mental, Emotional or Functional Nervous Disorders, Alcoholism or Drug Abuse
a. Mental, Emotional or Functional Nervous Disorders - Inpatient: Up to 20 days of inpatient confinement per Calendar Year 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
b. Mental, Emotional or Functional Nervous Disorders - Outpatient: First 10 visits per Calendar Year 50% 50% 50%
c. Alcoholism or Drug Abuse - Inpatient in a Hospital, Non-hospital Residential Treatment Center or Day Care Center Up to 10 days per Calendar Year 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
d. Alcoholism or Drug Abuse - Outpatient: Up to 10 visits per Calendar Year 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Outpatient prescription drugs: 100% of actual charge up to an annual maximum of $1,000. Maximum 90 - day supply
Dental Care required due to an Injury: 100% of Covered Expenses up to $500 per Calendar Year maximum
Accidental Death and Dismemberment: Maximum Benefit: Principal Sum up to $10,000
Repatriation of Remains: Maximum Benefit up to $25,000
Medical Evacuation: Maximum Lifetime Benefit for all Evacuations up to $250,000
 
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