| |
GMMI |
Global Mission Basic |
| Coverage area |
Two options: worldwide or worldwide excluding the U.S. and Canada |
Two options: worldwide or worldwide excluding the U.S. and Canada |
| Policy maximum per individual |
US$5,000,000 |
US$5,000,000 |
| Hospital room & board |
Usual, reasonable, and customary charges |
US$600 per day (maximum of 240 consecutive days per covered event) |
| Intensive care unit |
Usual, reasonable, and customary charges |
US$1,500 per day (maximum of 180 consecutive days per covered event) |
| Inpatient or outpatient surgery |
Usual, reasonable, and customary charges |
Usual, reasonable, and customary charges |
| Anesthetist’s charges associated with surgery |
Usual, reasonable, and customary charges |
20% of the surgery benefit payable |
| Lab tests, X-rays, other tests associated with an inpatient covered event |
Usual, reasonable, and customary charges |
Usual, reasonable, and customary charges |
| Transplants |
US$1,000,000 lifetime |
US$250,000 all inclusive per transplant |
| Outpatient visits or exams |
Usual, reasonable, and customary charges |
25 visits per insured person per
coverage period reimbursed to the maximum limit as outlined below:
Physician – US$70/visit
Specialist – US$70/visit
Psychiatrist-US$60/visit
Chiropractor-US$50/visit
Surgical intervention consultation-US$500/visit
|
| Outpatient X-rays |
Usual, reasonable, and customary charges |
US$250 per exam maximum limit |
| Outpatient lab tests |
Usual, reasonable, and customary charges |
US$300 per exam maximum limit |
| Prescription medication related to a covered event |
Usual, reasonable, and customary charges |
Usual, reasonable, and customary charges |
| Emergency room |
Usual, reasonable, and customary charges |
Usual, reasonable, and customary charges |
| Emergency dental |
Usual, reasonable, and customary charges |
US$1,000 per coverage period |
| Local ground ambulance |
Usual, reasonable, and customary charges |
US$1,500 per covered event (not subject to deductible or coinsurance) |
| Emergency medical evacuation |
Up to policy maximum; includes Emergency Reunion benefit of US$10,000 lifetime |
US$50,000 per coverage period (not subject to deductible or coinsurance) |
| Return of Mortal Remains |
US$25,000 |
US$25,000 (not subject to deductible & coinsurance) |
| Supplemental accident |
US$300 per occurrence |
No coverage |
| Child wellness |
US$50 maximum per visit; US$150 maximum per period of coverage (not subject to deductible or coinsurance – available for eligible children under 18 years of age after 12 months of continuous coverage) |
3 visits per coverage period (maximum limit of US$70 per visit) Only available after 12 months of continuous coverage |
| Pre-existing conditions |
US$50,000 lifetime (maximum of US$5,000 per period of coverage – available after 24 months of continuous coverage) |
US$50,000 lifetime (maximum of US$5,000 per period of coverage – available after 24 months of continuous coverage) |
| Mental/nervous care |
US$10,000 per period of coverage, US$25,000 lifetime (available after 12 months of continuous coverage – inpatient and outpatient care by a licensed psychiatrist) |
Outpatient services covered only as indicated in the “Outpatient visits or exams” section |
| Wellness |
US$250 per period of coverage (not subject to deductible or coinsurance – includes routine physicals, mammograms, and ob/gyn visits for those age 30 and over after 12 continuous months of coverage – visits must be separated by at least 12 months) |
No coverage available |
| Complementary medicine |
Each per period of coverage
Acupuncture – US$150
Aroma therapy – US$50
Herbal therapy – US$50
Magnetic therapy-US$75
Massage therapy-US$150
Vitamin therapy-US$100 |
No coverage available |
| Extended care facility services |
Usual, reasonable, and customary charges |
Limited to the first 30 days of convalescent confinement |
| Home nursing care services |
Usual, reasonable, and customary charges |
Limited to 30 days per covered event |
| Inpatient hospice care |
Usual, reasonable, and customary charges |
Limited to 30 days per covered event |
| Chemotherapy & radiation therapy |
Usual, reasonable, and customary charges |
Usual, reasonable, and customary charges |
| Physical therapy |
Maximum US$50 per visit |
Maximum US$40 per visit (30 visits per coverage period) |
| MRI, CAT scan, endoscopy, echocardiography, gastroscopy, colonoscopy, & cystoscopy |
Usual, reasonable, and customary charges |
US$600 per exam maximum limit |
| Prosthetic devices |
Usual, reasonable, and customary charges |
No coverage available |
