Global Citizen Health Plan Benefits

Features Outside U.S. U.S.(In Network) U.S.(Outside Network)
Lifetime Maximum per Insured Person $5,000,000 $5,000,000 $5,000,000
Preventative and Primary Care – Deductible is not applicable
Preventative Care For Babies/Children: (Birth to Age 18)
  1. Office Visits/examination
  2. Immunizations, Lab work & X-rays
 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Preventative Care For Adults: (Age 19 and Older)
  1. Routine Pap Smears, annual mammogram
  2. PSA For Men
  3. Annual Physical Examination/Health Screening
  4. Diagnostic lab work & X-rays
 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Primary Care Office Visits All except a $10 copay per visit1 All except a $30 copay per visit 60% to Out-of-Pocket Maximum then 100%
Professional Services - Insurer Pays After Deductible is Met
Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work. 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Inpatient Hospital Services Insurer Pays After Deductible is Met
Surgery, X-rays, in-hospital doctor visits, Organ/Tissue Transplant 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
In-patient medical emergency6 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
In-patient drugs 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Ambulatory and Therapeutic Services Insurer Pays After Deductible is Met
Ambulatory Surgical Center 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Ambulance Service 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Accidental Dental $1,000 per year, $200 per tooth $1,000 per year, $200 per tooth $1,000 per year, $200 per tooth
Acupuncture and Chiropractic Services 100% up to $2000 100% up to $2000 100% up to $2000
Durable Medical Equipment 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Infusion Therapy 100% 80% to Out-of-Pocket Maximum then 100% 60% to Out-of-Pocket Maximum then 100%
Physical/Occupational Therapy $30/visit, 12 visits per year $30/visit, 12 visits per year $30/visit, 12 visits per year
Basic Prescription Drug Benefit 50% of actual charges up to $500 $0 $0
Optional Prescription Drug Benefit Insurer Waives Deductible
Subject to $5,000 Maximum Benefit per Insured Person per Policy Period. 100% of actual charges Generics: 100% after $10 copay
Brandname: 100% after $25 copay
Injectables: 70% 		Generics: 100% after $10 copay
Brandname: 100% after $25 copay
Injectables: 70%
Global Travel Benefits Insurer Waives Deductible
Medical Evacuation Up to $100,000 n/a n/a
Repatriation of Remains Up to $25,000 n/a n/a
Accidental Death and Dismemberment $50,000 $50,000 $50,000
 
Global Citizen
Plan 1,2,3,4,5 		Deductible Coinsurance Maximum
Outside U.S. U.S.in Network U.S.out of Network
Elite $0 $0 $1,000 $2,000
500 $250 $500 $1,000 $3,000
1,000 $500 $1,000 $2,000 $4,000
2,000 $1,000 $2,000 $4,000 $8,000
5,000 $2,500 $5,000 $10,000 $10,000
10,000 $10,000 $10,000 $10,000 $10,000
25,000 $25,000 $25,000 $25,000 $10,000
 
1. Copay waived when visiting an HTH Worldwide contracted provider.
2. Deductibles are Per Person per Policy Period.
3. The Out of Pocket Maximum is calculated by adding the deductible and coinsurance maximum together. A family is charged a maximum of 2.5 deductibles.
4. Amounts paid to satisfy a deductible are credited to all other deductibles, both inside and outside the U.S. For example, if you satisfy your Outside U.S. deductible, this amount is credited to the U.S. (In Network) and U.S. (Outside Network) deductible requirement.
5. An Insured Person only has to satisfy his/her Out of Pocket Maximum once a Year for all services received outside of the U.S. and in the U.S.
6. Emergency room visits that do not result in inpatient admissions will be subject to a $50 penalty
 
Participating and Non-Participating Providers Inpatient Benefit Outpatient Benefit
Mental Health 100% up to 20 days per year 80% up to 30 visits per year
Substance Abuse 100% up to 12 days of detox 80% up to 30 visits per year
 
Other Benefits Limits
Home Health Care 100% Covered Expenses, as many as 30 visits per year
Skilled Nursing Facilities 100% with a maximum Covered Expense of $250 per day, as many as 50 days per year
Hospice 100% with a maximum Covered Expense of $5,000 per lifetime

Maternity Benefits

After 12 months of continuous coverage, Global Citizen members may renew their coverage or apply for a new plan that covers maternity costs in the same way as all other medical conditions.

To be eligible for the maternity benefit, a member must not be pregnant at the time of upgrade.

Services provided in addition to the benefits above
 Ready access to quality care
  • Access to HTH Worldwide's global community of carefully selected, contracted hospitals, physicians, dentists and behavioral health professionals in over 180 countries.
  • Detailed provider profiles including medical training.
  • Personalized appointment scheduling and recruitment.
  • Fully profiled international treatment options.
  • Competitive U.S. PPO network and centers of excellence.
  • Emergency evacuation.
  • View More Details
 HTH Global Health and Safety Resources
  • Online assistance tools with full telephone support.
  • Daily email of health and security alerts
  • Detailed descriptions of health facilities and security issues by destination
  • Translation databases for brand name drugs and medical terms/phrases.
  • Web pages capturing key personalized HTH Resources by destination.
  • View More Details

For Exclusions and Limitations, and State to State variation in benefits, see Plan Description.

Ten Day Money Back Guarantee
YOUR SATISFACTION IS GUARANTEED. We are so confident in our products that we offer the best guarantee in the business! If you are not completely satisfied with our Global Citizen Product, simply return your Certificate of Insurance and your ID Card to HTH within 10 days of your policy effective date. If you have not already used your insurance benefits, you will receive a full refund.

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