Benefit Schedule

Offers 100% coverage across most benefits. All plan options have an Unlimited Lifetime Maximum and a $250,000 maximum benefit for emergency medical evacuation.

Features Benefits
Lifetime Maximum per Insured Person Unlimited
Annual Maximum per Insured Person Unlimited
Preventative and Primary Care Insurer waives deductible
Preventative Care For Babies/Children: (Birth to Age 18)
  1. Office Visits/examination
  2. Immunizations, Lab work & X-rays
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%
Primary Care Office Visits All except a $10 copay per visit 1
Professional Services Insurer Pays After Deductible is Met
Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work. 100%
Inpatient Hospital Services Insurer Pays After Deductible is Met
Surgery, X-rays, in-hospital doctor visits, Organ/Tissue Transplant 100%
In-patient medical emergency 2 100%
In-patient drugs 100%
Ambulatory and Therapeutic Services Insurer Pays After Deductible is Met; Unless Noted
Ambulatory Surgical Center 100%
Ambulance Service 100%
Accidental Dental $1,000 per year, $200 per tooth
Acupuncture and Chiropractic Services 100% up to $2,000
Durable Medical Equipment 100%
Infusion Therapy 100%
Physical/Occupational Therapy
deductible is waived
$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
b. Outpatient Mental Health
75% up to 40 visits/60% thereafter
c. Inpatient Substance Abuse
100% up to 60 days detox
d. Outpatient Substance Abuse
75% up to 40 visits/60% thereafter
Optional Xplorer Essential with Basic U.S. Benefits Insurer Pays After Deductible is Met
Emergency Medical Care, Illness and Accidental Injury Services while temporarily visiting the United States
Physician's Office Visit Services U.S. Participating Provider - 100%, No Deductible, $50 Copay
U.S. Non- Participating Provider - 60%
Hospital Emergency Room U.S. Participating Provider - 80%
Additional $250 Copay per visit - waived if admitted

U.S. Non-Participating Provider - 60%
Additional $250 Copay per visit - waived if admitted
Outpatient Professional Services (radiology, pathology and ER Physician) U.S. Participating Provider - 80%
U.S. Non-Participating Provider - 60%
Urgent Care Facility U.S. Participating Provider - 100%, No Deductible, $75 Copay
U.S. Non- Participating Provider - 60%
X-ray and/or Lab performed at the Emergency Room or Urgent Care Facility (billed as part of the visit) U.S. Participating Provider - 80%
U.S. Non-Participating Provider - 60%
X-ray and/or Lab performed at the Independent facility in conjunction with the Emergency Room visit U.S. Participating Provider - 80%
U.S. Non-Participating Provider - 60%
Ambulance U.S. Participating Provider - 80%
U.S. Non- Participating Provider - 60%
Inpatient Hospital - Facility/Professional Charges Admissions limited to Emergency Medical Care, Illness and Accidental Injury Services while temporarily visiting the United States
Bed and Board Charges U.S. Participating Provider - 80%
U.S. Non-Participating Provider - 60%
Physician's Visits/Consultations U.S. Participating Provider - 80%
U.S. Non-Participating Provider - 60%
Professional Services
(Surgeon, Radiologist, Pathologist, Anesthesiologist)
U.S. Participating Provider - 80%
U.S. Non-Participating Provider - 60%
Prescription Drugs Purchased inside the United States Limited to Emergency Medical Care, Illness and Accidental Injury Conditions covered under this package. Pre-existing Condition Limitation Apply(es)
100% of the Actual Cost, Deductible does not apply Maximum benefit of $1,000 per Calendar Year and the maximum supply of 30 days per covered prescription
Optional Enhanced Prescription Benefits Insurer Waives Deductible
Basic Prescription Drug Benefit (Pay and claim benefit only) 100% of actual charges up to $1,000
Optional Prescription Drug Benefit, Subject to $25,000 Maximum per Insured Person per Policy Period 100% of actual charges
Optional Dental Benefits Annual Max - $1,500
Preventative Dental - 100%
Primary Dental - 80%
Major Dental - 50%
Orthodontic Dental - 50% up to $1000 Lifetime Max
Optional Vision Benefits Annual Max - $250
Vision Examination - 70%
Frames or Lenses - 70%
Global Travel Benefits Insurer Waives Deductible
Medical Evacuation Up to $250,000
Repatriation of Remains Up to $25,000
Accidental Death and Dismemberment $50,000
 
Plan Options Essential1,2 Deductible 3
Elite $0
250 $250
500 $500
1,000 $1,000
2,500 $2,500
5,000 $5,000
 
Plan Options Select1,2 Deductible 3
Elite $0
2,500 $2,500
5,000 $5,000

1. Copay waived when visiting a contracted provider.
2. Emergency room visits that do not result in inpatient admissions will be subject to a $50 penalty.
3. Deductibles are Per Person per Calendar Year. A family is charged a maximum of 2.5 deductibles.

Additional services provided

 Ready access to quality care

  • Access to our global community of carefully selected, contracted hospitals, physicians, dentists and behavioral health professionals in over 180 countries
  • Detailed provider profiles
  • Appointment scheduling
  • Direct Pay to providers
  • Emergency evacuation services
  • View More Details

 mPassport and Global Health and Safety Resources

  • Convenient mobile app makes it easy to identify, access and pay for quality healthcare around the world
  • Request appointments and arrange Direct Pay
  • Find local equivalency and availability for your medication
  • Translate medical terms and phrases in thirteen languages
  • Country and city-level health and security profiles
  • View More Details

For Exclusions and Limitations see the Essential Plan Description or the Select 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 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. If you have not already left on your trip or incurred a claim, you will receive a full refund.