Global Citizen Deductible Options

Worldwide benefits including the U.S.

Global Citizen Plan ^1,2,3,4,5	Deductible			Coinsurance Maximum
Global Citizen Plan ^1,2,3,4,5	Outside U.S.	U.S.in Network	U.S.out of Network	Coinsurance Maximum
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

Global Citizen EXP Deductible Options

Worldwide benefits excluding the U.S

Global Citizen EXP Plan ^1,2,3	Deductible
Elite	$0
250	$250
500	$500
1,000	$1,000
2,500	$2,500
5,000	$5,000
10,000	$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