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» Brochure
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» Details
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| Plan Highlights |
| Most economical global coverage |
Cheapest and offers limited coverage |
Short term comprehensive coverage |
Long term comprehensive enhanced coverage including dental and vision benefits |
| Lifetime Maximum Limit |
| $1 million/individual |
$5 million/individual |
$5 million/individual |
$8 million/individual |
| Deductible (Per Period of Coverage): |
| $250 to $10,000 |
$250 to $10,000 |
$250 to $25,000 |
$100 to $25,000 |
| Optional Coverage at additional cost |
| Global Term Life Insurance including Accidental Death & Dismemberment; Dental and Vision |
Global Term Life Insurance including Accidental Death & Dismemberment; Dental and Vision |
Global Term Life Insurance including Accidental Death & Dismemberment; Adventure Sports Rider; Dental and Vision |
Global Term Life Insurance including Accidental Death & Dismemberment; Terrorism; Adventure Sports Rider; |
| Emergency evacuation (not subject to deductible or coinsurance) |
| Up to $50,000 maximum per period of coverage. Not subject to deductible or coinsurance. |
Up to $50,000 maximum per period of coverage. Not subject to deductible or coinsurance. |
Up to lifetime maximum limit. Not subject to deductible or coinsurance. |
Up to maximum limit. Not subject to deductible or coinsurance. |
| Emergency Reunion |
| $10,000 lifetime maximum |
No Coverage |
$10,000 lifetime maximum |
$10,000 lifetime maximum |
| Return of Mortal Remains (not subject to deductible or coinsurance) |
| $10,000 lifetime maximum |
$25,000 lifetime maximum |
$25,000 lifetime maximum |
$50,000 lifetime maximum |
| Child Wellness (Under 18 years of age) |
| No Coverage |
$70 maximum per visit, 3 visit per period of coverage |
$200 maximum per period of coverage |
$400 maximum per period of coverage |
| Adult Wellness |
| No Coverage |
No Coverage |
$250 per period of coverage |
$500 per period of coverage |
| Maternity |
| No Coverage |
No Coverage |
No Coverage |
$2,500 deductible per pregnancy.
$50,000 lifetime maximum.
$200 newborn wellness benefit for the first 31 days - 12 months after birth.
Newborn care & congenital disorders maximum of $250,000 for the first 31 days after birth. |
| Non Emergency Dental |
| Optional Rider |
Optional Rider |
Optional Rider |
$750 maximum per calendar year; $50 individual deductible, applies to minor restorative and major restorative services. |
| Non Emergency Dental due to Accident |
| No Coverage |
No Coverage |
$500 per period of covergae |
$750 maximum per calendar year; $50 individual deductible, applies to minor restorative and major restorative services. |
| Emergency Dental due to Sudden Unexpected Pain, Natural Teeth |
| No Coverage |
No Coverage |
$100 per period of coverage |
Covered 100% |
| Traumatic Dental Injury |
| $1,000 per period of coverage |
$1,000 per period of coverage |
Up to lifetime maximum limit |
Up to lifetime maximum limit |
| Hospital Indemnity (Inpatient hospitalisation outside the U.S. only) |
Private Hospitals: $400 per overnight and $4,000 maximum limit per calendar year.
Public Hospitals: $500 per overnight and $5,000 maximum limit per calendar year. |
| Treatment outside / inside the U.S. (using Medical Concierge) |
| 50% of deductible waived, up to maximum of $2,500. No coinsurance |
| Treatment inside the U.S. |
PPO Network: Subject to deductible. No coinsurance
Non-PPO Network: Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum limit.
|
| Coinsurance |
| International - 100%; U.S. in-network - 100%; U.S out-of-network - 80% |
| Pre-Existing Conditions Limitation |
| Excluded |
$50,000 lifetime maximum; $5,000 per period of coverage after 24 months |
$50,000 lifetime maximum; $5,000 per period of coverage after 24 months |
Covered if disclosed and not excluded by rider |
| Local Ambulance (U.S. only) |
| $1,500 maximum limit per event |
$1,500 maximum limit per event |
Subject to deductible and coinsurance. |
Subject to deductible and coinsurance. |
| Outpatient Treatments |
Diagnostic / X-Ray: $250 maximum per visit
Lab tests: $300 maximum per visit
Specialists / Physician charges: $500 maximum limit (pre-inpatient / post-inpatient)
|
Diagnostic / X-Ray: $250 maximum per visit
Lab tests: $300 maximum per visit
Specialists / Physician charges: $70 per visit/examination (25 combined maximum visits)
Chiropractor charges: $50 per visit / examination
Surgery intervention consultation charges: $500 per consultation
|
Subject to deductible and coinsurance |
Subject to deductible and coinsurance |
| Mental / Nervous |
| No Coverage |
Subject to deductible and coinsurance. Outpatient after 12 months of continuous coverage |
Subject to deductible and coinsurance. $10,000 maximum. Avaliable after 12 months of continuous coverage |
Subject to deductible and coinsurance. $50,000 lifetime maximum. Avaliable after 12 months of continuous coverage |
| Hospitalization/ Room & Board |
| Subject to deductible and coinsurance for average semiprivate room rate |
Subject to deductible and coinsurance for average semiprivate room rate.All subject to $600 per day /240 day maximum |
Subject to deductible and coinsurance for average semiprivate room rate |
Subject to deductible and coinsurance for average semiprivate room rate |
| 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 |
Subject to deductible and coinsurance |
| Surgery |
| Subject to deductible and coinsurance |
Subject to deductible and coinsurance |
Subject to deductible and coinsurance |
Subject to deductible and coinsurance |
| Assistant Surgeon |
| 20% of primary surgeon’s charge |
20% of primary surgeon’s charge |
20% of primary surgeon’s charge |
20% of primary surgeon’s charge |
| Chemotherapy or Radiation Therapy |
| Subject to deductible and coinsurance |
Subject to deductible and coinsurance |
Subject to deductible and coinsurance |
Subject to deductible and coinsurance |
| Podiatry Care |
| No Coverage |
No Coverage |
$250 per period of coverage |
$500 per period of coverage |
| Physical Therapy |
| Subject to deductible and coinsurance.$40 maximum per visit - 10visit limit per event. Available for 90 days following inpatient treatment or outpatient surgery |
Subject to deductible and coinsurance.$40 maximum per visit -30 visit limit |
Subject to deductible and coinsurance.$50 maximum per visit |
Subject to deductible and coinsurance.$50 maximum per visit |
| Transplants |
| $250,000 lifetime maximum |
$250,000 lifetime maximum |
$1,000,000 lifetime maximum |
$2,000,000 lifetime maximum |
| 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 |
Subject to deductible and coinsurance. 90-day supply per prescription. Outpatient only |
International - 100% Inside U.S. - Prescription drug card co-pay: $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 |
$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 |
$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 |
$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 |
| Vision |
| Optional Rider |
Optional Rider |
Optional Rider |
$100 maximum per 24 months for exams. $150 per 24 months for materials |
| Political Evacuation and Repatriation |
| No Coverage |
No Coverage |
No Coverage |
$10,000 lifetime maximum |
