Global Medical Insurance
| Global Term Life Insurance | |
| Age 31 days - 18 years: $5,000; Age 19 - 29 years: $75,000 | |
| Age 30 - 39 years: $50,000; Age 40 - 44 years: $35,000 | |
| Age 45 - 49 years: $25,000; Age 50 - 54 years: $20,000 | |
| Age 55 - 59 years: $15,000; Age 60 - 64 years: $10,000;Age 65 - 69 years: $7,500 | |
| Accidental Death & Dismemberment (AD&D) - included with Global Term Life Insurance | Accidental Loss of Life: Principal Sum* Accidental Total Loss of 2 Members**: Principal Sum* Accidental Total Loss of 1 Member**: 50% of Principal Sum*(* Benefit based on age at time of death ** “Member” means hand, foot or eye) |
| Terrorism (Platinum plan option) | $50,000 lifetime maximum for Eligible Medical Expenses arising out of Injury or Illness incurred by the Insured as a result of or in connection with an act of terrorism |
| Dental & Vision (Bronze, Silver, Gold, Platinum plan options) | Dental: $750 calendar maximum $50 deductible (max. 2 per family) Class I - 90% (deductible is waived), Class II - 70%, Class III - 50% 6 month waiting period |
| Vision: Exams - up to $100 per 24 months Materials - up to $150 per 24 months |
| Coverage Details | BRONZE | SILVER | GOLD | PLATINUM |
| Coinsurance | International - 100% U.S. in-network – 100% U.S. out-of-network - 80% |
International - 100% U.S. in-network – 100% U.S. out-of-network - 80% |
International - 100% U.S. in-network – 100% U.S. out-of-network - 80% |
International - 100% U.S. in-network – 100% U.S. out-of-network - 80% |
| Treatment outside the U.S. | 50% of deductible waived,up to a maximum of $2,500. No coinsurance |
50% of deductible waived,up to a maximum of $2,500. No coinsurance |
50% of deductible waived,up to a maximum of $2,500. No coinsurance |
50% of deductible waived,up to a maximum of $2,500. No coinsurance |
| Treatment inside the U.S.using Medical Concierge | 50% of deductible waived,up to a maximum of $2,500. No coinsurance |
50% of deductible waived,up to a maximum of $2,500. No coinsurance |
50% of deductible waived,up to a maximum of $2,500. No coinsurance |
50% of deductible waived,up to a maximum of $2,500. No coinsurance |
| Treatment inside the U.S. -PPO Network | Subject to deductible. No coinsurance |
Subject to deductible. No coinsurance |
Subject to deductible. No coinsurance |
Subject to deductible. No coinsurance |
| Treatment inside the U.S. -Non-PPO Network | Subject to deductible.Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage | Subject to deductible.Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage | Subject to deductible.Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage | Subject to deductible.Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage |
| Crew Member Return | $2,500 maximum limit.Not subject to deductible or coinsurance | $2,500 maximum limit.Not subject to deductible or coinsurance | $2,500 maximum limit.Not subject to deductible or coinsurance | $2,500 maximum limit.Not subject to deductible or coinsurance |
| Interfacility Ambulance Transfer | $1,500 maximum limit per event.Not subject to deductible or coinsurance. U.S. only | $1,500 maximum limit per event.Not subject to deductible or coinsurance. U.S. only | Subject to deductible and coinsurance .U.S. only | Not subject to deductible or coinsurance. U.S. only |
| Child Preventative Care | N/A | $70 maximum per visit, 3 visit limit per period of coverage. Not subject to deductible or coinsurance. | $200 maximum per period of coverage. Not subject to deductible or coinsurance. | $400 maximum per period of coverage. Not subject to deductible or coinsurance. |
| Assistant Surgeon | 20% of primary surgeon’s charge | 20% of primary surgeon’s charge | 20% of primary surgeon’s charge | 20% of primary surgeon’s charge |
| Emergency Evacuation | $50,000 maximum per period of coverage. Not subject to deductible or coinsurance | $50,000 maximum per period of coverage. Not subject to deductible or coinsurance | Up to lifetime maximum limit.Not subject to deductible or coinsurance | Up to maximum limit.Not subject to deductible or coinsurance |
| Emergency Local Ambulance | $1,500 maximum limit per event.Not subject to deductible or coinsurance | $1,500 maximum limit per event.Not subject to deductible or coinsurance | Subject to deductible and coinsurance | Not subject to deductible or coinsurance |
| Return of Mortal Remains | $10,000 lifetime maximum.Not subject to deductible or coinsurance | $25,000 lifetime maximum.Not subject to deductible or coinsurance | $25,000 lifetime maximum.Not subject to deductible or coinsurance | $50,000 lifetime maximum.Not subject to deductible or coinsurance |
| Maternity | N/A | N/A | N/A | $50,000 lifetime maximum. Newborn preventative care: $200 Newborn care & congenital disorders: $250,000 (first 31 days after birth). |
| Traumatic Dental Injury | $1,000 per period of coverage | $1,000 per period of coverage | Up to the lifetime maximum limit | Up to the lifetime maximum limit |
| Surgery | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Chemotherapy or Radiation Therapy | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Physical Therapy | $40 maximum per visit - 10 visit limit per event. | $40 maximum per visit - 30 visit limit | $50 maximum per visit | $50 maximum per visit |
| Emergency Reunion | $10,000 lifetime maximum.Not subject to deductible or coinsurance | NA | $10,000 lifetime maximum.Not subject to deductible or coinsurance | $10,000 lifetime maximum.Not subject to deductible or coinsurance |