Benefits Schedule

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. In Network, U.S. Out of Network, U.S.
Lifetime Maximum per Insured Person Unlimited Unlimited Unlimited
Annual Maximum per Insured Person Unlimited Unlimited Unlimited
Preventative and Primary Care Insurer waives deductible
Primary Care Office Visits - as many as 8 visits per Calendar Year All except a $10 copay per visit 1 All except a $30 copay per visit 60% to Coinsurance Maximum then 100%
Preventative Care for Babies/Children: (Birth to Age 18)
  1. Office Visits/examination
  2. Immunizations, Lab work & X-rays
100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance 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
  5. Immunizations as recommended by the Center for Disease Control (CDC)
100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Travel Vaccinations 100% Maximum Covered Expense of $500 per Calendar Year. 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Annual Physical Examination/Health Screening 100%
Maximum Covered Expense of $250 and limited to one per Calendar Year.
80% to Coinsurance Maximum then 100%
Maximum Covered Expense of $250 and limited to one per Calendar Year.
60% to Coinsurance Maximum then 100%
Maximum Covered Expense of $250 and limited to one per Calendar Year.
Outpatient Services Insurer Pays After Deductible is Met
Outpatient Medical Care 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 The Insurer will pay 100% of Covered Expenses. 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
In-patient medical emergency 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Professional Services
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%
Other 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%
Physical/Occupational Therapy/Medicine Deductible is waived. Covered Expenses up to $50 per visit, and as many as 6 visits per Calendar Year
Ambulance Service 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Durable Medical Equipment 100% 80% to Coinsurance Maximum then 100% 60% to Coinsurance Maximum then 100%
Rehabilitation and Therapy Insurer Pays After Deductible is Met, unless noted
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
Outpatient prescription drugs Insurer waives deductible
100% of actual charge up to an annual maximum of $5,000.
Max 90-day supply
Dental Care required due to an Injury 100% of Covered Expenses up to $500 per Calendar Year maximum
Global Travel Benefits Insurer Waives Deductible
Medical Evacuation Maximum Lifetime Benefit for all Evacuations up to $250,000
Repatriation of Remains Maximum Benefit up to $25,000
Accidental Death and Dismemberment Maximum Benefit: Principal Sum up to $10,000

DEDUCTIBLE OPTIONS

Plan Options 1,2,3,4,5 Deductible Coinsurance Maximum
Outside U.S. U.S.in Network U.S. out of Network
0 $0 $0 $0 $1,000
250 $125 $250 $500 $2,000
500 $500 $500 $500 $3,000
1,000 $500 $1,000 $2,000 $4,000
2,500 $1,250 $2,500 $5,000 $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 $100 penalty

SATISFACTION GUARANTEE
We are so confident in our products that we offer you a money-back guarantee! If you are not completely satisfied with your Navigator purchase, return your ID card and include a letter indicating your desire to cancel. If you have not departed on your trip before the date of the cancellation request, you will receive a full refund.