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MEDICAL INSURANCE
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BENEFIT
Subject to deductible and
coinsurance
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Coverage Area
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Worldwide
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Policy Maximum Per Individual
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US$1,000,000 lifetime
(may be increased to US$5,000,000)
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Hospital Room & Board
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Payable up to the average semi-private room rate,
including nursing service
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Hospital Pre-Admission Testing
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Subject to deductible
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Intensive Care Unit
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Up to 3 times the average semi-private room rate
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Second Surgical Opinion
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Subject to deductible & coinsurance unless requested
by the Company (payable at 100% if requested by the Company)
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Eligible Medical Expenses
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Usual, reasonable, & customary
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Transplant Benefits
Subject to special transplan pre-certification requirements, and
only when expense treatment is provided within the Managed Transplant
System Network. Covered transplants are: heart, heart/lung, lung, kidney,
kidney/pancreas, liver, and allogeneic and autologous bone marrow.
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US$500,000 lifetime maximum for covered transplants
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Maternity and Newborn Care
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Subject to special maternity pre-certification
requirements, same as any other illness
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Mental/Nervous Disorders
Inpatient treatment
Limited to 15 days per calendar year per insured person
Outpatient treatment
Maximum of 40 visits per calendar year per insured person
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Same as any other illness
50% reimbursement
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Wellness Benefit
For you and your spouse for a physical examination, including
immunizations and mammograms every 24 months. To qualify, you must have
been covered under the Mission+Plus International plan for at least 24
months and must be at least age 35 if female, or at least age 40 if male.
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Up to US$250 coverage (not subject to deductible or
coinsurance)
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Physical Therapy
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Up to US$50 maximum per charge per visit
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Chiropractic Care
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US$500 maximum per year, reimbursable at 50%
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Home Health Care
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Limited to 30 days per occurrence of illness
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Extended Care Facility
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Limited to 100 days per occurrence of illness
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Hospice Benefit
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US$7,000 lifetime per insured person
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Additional Benefits
Life Insurance
Dental Insurance
Emergency medical evacuation insurance
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Required
Optional
Optional
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