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Three tiers of coinsurance apply: 100% outside the U.S. , 80% in network in the U.S. , 60% out of network inside the U.S. All plan options have an Unlimited Lifetime Maximum and a $250,000 maximum benefit for emergency medical evacuation.
| Features | Outside U.S. | U.S.(In Network) | U.S.(Outside Network) |
|---|---|---|---|
| Lifetime Maximum per Insured Person | Unlimited | Unlimited | Unlimited |
| Annual Maximum per Insured Person | Unlimited | Unlimited | Unlimited |
| Preventative and Primary Care | Insurer waives deductible | ||
Preventative Care For Babies/Children: (Birth to Age 18)
|
100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
Preventative Care For Adults: (Age 19 and Older)
|
100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Primary Care Office Visits | All except a $10 copay per visit 1 | All except a $30 copay per visit | 60% to Coinsurance 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 Coinsurance Maximum then 100% | 60% to Coinsurance 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 Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| In-patient medical emergency 6 | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| In-patient drugs | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Ambulatory and Therapeutic Services | Insurer Pays After Deductible is Met; Unless Noted | ||
| Ambulatory Surgical Center | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Ambulance Service | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance 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 | 80% up to $2000 | 60% up to $2000 |
| Durable Medical Equipment | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Infusion Therapy | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Physical/Occupational Therapy deductible is waived |
$50 limit per visit, 12 visits per year | $50 limit per visit, 12 visits per year | $50 limit per visit, 12 visits per year |
| Rehabilitation and Therapy | Insurer Pays After Deductible is Met | ||
| a. Inpatient Mental Health | 100% up to 60 days | 80% up to 60 days | 60% up to 60 days |
| b. Outpatient Mental Health | 75% up to 40 visits/60% thereafter | 75% up to 40 visits/60% thereafter | 75% up to 40 visits/60% thereafter |
| c. Inpatient Substance Abuse | 100% up to 60 days detox | 80% up to 60 days detox | 60% up to 60 days detox |
| d. Outpatient Substance Abuse | 75% up to 40 visits/60% thereafter | 75% up to 40 visits/60% thereafter | 75% up to 40 visits/60% thereafter |
| Prescription Drug Benefit Options | Insurer Waives Deductible | ||
| Basic Prescription Drug Benefit Subject to $1000 Maximum per Insured Person per Policy Period (Pay and claim benefit only) | 100% of actual charges | 100% of actual charges | 100% of actual charges |
|
Optional Rider, subject to $25,000 maximum benefit per Insured Person per Policy Period. Max 90 day supply |
100% of actual charges |
Generics: 100% after $10 copay Brandname: 100% after $10 copay Injectables: 70% |
Generics: 100% after $10 copay Brandname: 100% after $10 copay Injectables: 70% |
| Global Travel Benefits | Insurer Waives Deductible | ||
| Medical Evacuation | Up to $250,000 | 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 |
|
Plan Options 1,2,3,4,5,6 |
Deductible | Coinsurance Maximum | ||
|---|---|---|---|---|
| Outside U.S. | U.S.in Network | U.S.out of Network | ||
| Elite | $0 | $0 | $1,000 | $2,000 |
| 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 |
1. Copay waived when visiting a contracted provider outside the U.S..
2. Deductibles are Per Person per Calendar Year.
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
| 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 | |||
Services provided in addition to the benefits above
- Access to our global community of carefully selected, contracted hospitals, physicians, dentists and behavioral health professionals in over 190 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.
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mPassport and Global Health and Safety Resources
- Online and mobile 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 Resources by destination.
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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 product, simply return your Certificate or Policy of Insurance and Description of Emergency Medical Evacuation and Other Services within 10 days of receipt and include a letter indicating your desire to cancel.