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Benefits
Exclusions
Claims
FAQ
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Global Medical Insurance offers worldwide coverage to a wide variety of international clientele, including expatriates, international executives, diplomats, students, entertainers and other international travelers.
Global Medical Insurance offers you the choice of three plan options: Silver, Gold and Platinum. You also have the opportunity to select a coverage area: worldwide or worldwide excluding the U.S. and Canada. Simply choose the plan option and coverage area that best fits your needs. Each one offers a full range of benefits suited for individuals and families, provides coverage 24 hours a day, and you have the freedom to choose any doctor or hospital for treatment.
BENEFITS:
SUMMARY SCHEDULE OF BENEFITS:
Benefits are subject to the deductible and coinsurance unless otherwise noted. NA (Not Applicable); URC (Usual, Reasonable and Customary); SAAI (Same As Any Illness).
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Benefit
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Silver
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Gold
(1st 36 months of continuous coverage)
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Gold
(Beginning the 1st day of the 37th month)
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Gold Plus
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Platinum
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Lifetime Maximum Limit
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$5,000,000 per individual
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$5,000,000 per individual
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$5,000,000 per individual
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$5,000,000 per individual
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$8,000,000 per individual
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Deductible (per period of coverage)
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$250 to $10,000
50% waived within PPO network
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$250 to $10,000
50% waived within PPO network
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$250 to $10,000
50% waived within PPO network
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$250 to $10,000
50% waived within PPO network
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$100 to $10,000
50% waived within PPO network
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Family Deductible
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3 times the individual deductible
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3 times the individual deductible
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3 times the individual deductible
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3 times the individual deductible
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2 times the individual deductible
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Coinsurance within the PPO network
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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Coinsurance outside the U.S. and Canada
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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Coinsurance inside the U.S. and Canada (outside PPO network)
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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Hospitalization/Room & Board
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$600 per day – 240 day maximum
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Average semi-private room rate
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Up to a limit of $2,250 per day
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Average semi-private room rate
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Private room rate
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Intensive Care Unit
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$1,500 per day – 180 day per event
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URC
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Up to limit of $4,500 per day
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URC
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URC
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Surgery
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URC
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URC
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URC
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URC
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URC
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Anesthetist’s Charges - Associated with Surgery
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20% of surgery benefit
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URC
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20% of surgery benefit
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URC
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URC
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Transplants
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$250,000 per transplant
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$1,000,000 lifetime maximum
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$500,000 lifetime maximum
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$1,000,000 lifetime maximum
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$2,000,000 lifetime maximum
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Out-patient
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25 visits: $70 doctor/specialist; $60 psychiatrist; $50 chiropractor; $250 X-ray per exam maximum limit; $500 surgery intervention consultation; $300 lab tests per exam maximum limit
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URC
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Physician Charges – limit of $150 per visit; Hospital Charge - $100 co-pay unless admitted; Urgent Care Facility - $25 co-pay; Diagnostic Lab and X-rays limited to $5,000 per certificate period; Physiotherapy – up to $50 per visit, $1,000 max per certificate period $10,000 lifetime maximum
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URC
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URC
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Emergency Room Illness (Additional $250 deductible if not admitted)
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URC
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URC
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URC
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URC
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URC
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Emergency Room Accident
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URC
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URC
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URC
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URC
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URC
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Supplemental Accident
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NA
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$300 per occurrence
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$300 per occurrence
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$300 per occurrence
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$500 per occurrence
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Local Ambulance
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$1,500 per event – not subject to deductible or coinsurance
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URC
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$100 per event – not subject to deductible or coinsurance
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URC
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URC
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Mental/Nervous
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Out-patient only after 12 months of continuous coverage
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$10,000 per period - $50,000 maximum – Available after 12 months of continuous coverage
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$2,500 maximum per certificate period; In patient limited to 25 days per certificate period; Out-patient limited to max of 20 visits per certificate period at 70% eligible expenses, up to $75 maximum per visit; Lifetime maximum of $30,000
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$10,000 per period - $50,000 maximum – Available after 12 months of continuous coverage
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SAAI - $50,000 lifetime maximum – Available after 12 months of continuous coverage
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Child Wellness
(Under 18 years of age)
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3 visits per period of coverage - $70 maximum per period – Available after 12 months of continuous coverage
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$200 maximum per period of coverage - Available after 12 months of continuous coverage
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$200 maximum per period of coverage - Available after 12 months of continuous coverage
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$200 maximum per period of coverage - Available after 12 months of continuous coverage
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$400 maximum per period of coverage - Available after 6 months of continuous coverage
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Adult Wellness
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NA
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$250 per period of coverage – not subject to deductible or coinsurance – Available for those 30 years of age and over after 12 months of continuous coverage
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$250 per period of coverage – not subject to deductible or coinsurance – Available for those 30 years of age and over after 12 months of continuous coverage
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$250 per period of coverage – not subject to deductible or coinsurance – Available for those 30 years of age and over after 12 months of continuous coverage
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$500 per period of coverage – not subject to deductible or coinsurance – Available for those 18 years of age and over after 6 months of continuous coverage
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You also have the option of adding Global Term Life Insurance and Global Daily Indemnity to your Global Medical Insurance coverage.
Global Term Life Insurance: This coverage is available for a standard annual premium of US$240 and includes an Accidental Death and Dismemberment benefit.
Global Daily Indemnity pays you US$100 for each covered overnight hospital stay other than those related to maternity.
Lifetime Eligibility
Lifetime medical coverage is available if you are enrolled in the Global Medical Insurance plan by your 65th birthday and maintain continuous coverage to age 75. Prior to your 75th birthday you will receive a summary of benefits of a new plan, Global Senior Plan, and an enrollment form for coverage. There is no additional medical underwriting. You simply need to review the benefits, and complete and return the enrollment form with your premium.
EXCLUSIONS: Your coverage is subject to various exclusions, which are completely set out in the Exclusions section of the policy document. The following, although not an exhaustive list, are some of these exclusions:
Eligibility: As part of the eligibility requirements for Global Medical Insurance, U.S. citizens must reside abroad or plan to leave the U.S. on their effective date and plan to reside abroad for at least six of the next 12 months. Non-U.S. citizens may reside anywhere, including their country of citizenship, although certain eligibility restrictions may apply to non-U.S. citizens residing in the U.S.
Pre-existing conditions and exclusions:
Silver and Gold:
After coverage has been in effect for 24 continuous months, the Silver and Gold plan options provide a US$50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of US$5,000 per period of coverage. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period. The Silver and Gold plan options do not rider or charge additional premium for pre-existing conditions. If you properly disclose a pre-existing condition at the time of application and are accepted into the plan, you will be covered for eligible medical expenses after 24 months of continuous coverage, subject to the foregoing limits and the other terms of the plan.*
The following illnesses which exist, manifest themselves or are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions and are subject to the waiting period and other limitations of coverage described above: asthma, allergies, tonsillectomy, back conditions,
adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall stones or kidney stones, any condition of the breast, and any condition of the prostate.
Platinum:
On the Platinum plan option, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are not fully disclosed on the application will not be covered.
OTHER EXCLUSIONS & LIMITATIONS*
- Treatment not ordered or received by a physician
- Treatment or supplies not medically necessary
- Investigational, experimental or research procedures
- Custodial care
- Weight modification
- Elective cosmetic or plastic surgery
- Treatment of impotency
- Contraceptive medication or treatment
- Drug and alcohol abuse treatment
- Organ transplants not specifically listed
- Routine foot care
- Treatment by a relative or family member
- Treatment as a result of war or riot
- Treatment resulting from illegal activities
- Speech therapy
- Persons HIV+ at effective date
- Organized amateur or professional sports
- Maternity and newborn care (unless the maternity rider or Platinum plan option is purchased - see Summary Schedule of Benefits)
- Services and treatment eligible for payment by any government or other insurance
- Adult routine physical examinations are excluded under the Silver plan option and for the first 12 months for the Gold and Platinum plan options
- Devices to correct sight or hearing are excluded under the Silver and Gold plan options
- Inpatient mental and nervous is excluded under the Silver plan option and for the first 12 months for the Gold and Platinum plan options
- Outpatient mental and nervous for the first 12 months on all plan options
*This website contains only a consolidated and summary description of some of the current Global Medical Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.
CLAIMS:
IMG must be notified prior to treatment or within 48 hours of an emergency.
Pre-certification, Emergency Evacuation and Return of Mortal Remains
For pre-certification, emergency evacuation and return of mortal remains, please call: IMG in the US: 1-800-628-4664 (toll free) or 1-317-655-4500. Call IMG outside the US: 001-317-655-4500 (collect if necessary). This information will also be provided on your ID card.
To Report Claims
Please mail completed claim forms to International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers, claim forms and Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 317-655-4505 or e-mail: insurance@imglobal.com
Direct Payment to Providers
In many cases IMG works directly with the hospital or clinic, including those outside our independent Preferred Provider Organization, for payment of eligible medical expenses. To file a claim, complete a claim form and submit it with original itemized bills. In this case, you will be responsible for your deductible, coinsurance amounts and non-eligible expenses.
Reimbursement
If you have received treatment and need to be reimbursed for out-of-pocket medical expenses, complete a claim form and submit your original itemized bills and paid receipts within 90 days. We will reimburse your eligible medical expenses after applying the deductible and coinsurance.
Please remember to submit your bills and receipts as soon as you receive them. Do not hold them until the end of the year. IMG will apply eligible medical expenses to your deductible and coinsurance throughout the year.
F.A.Q.
Quality Guarantee
Your satisfaction is very important to the plan underwriter, and to IMG as the plan administrator. If, for any reason, you are not pleased with this product, you may submit a written request for cancellation and refund of your premium. In order to be considered for a full refund, your request for cancellation must be received by IMG prior to your effective date. If you do not have any claims filed with IMG, you may cancel your plan after your effective date, however, the following conditions will apply: 1) you will be required to pay a US$25 cancellation fee and 2) only full month premiums will be considered for refunds (e.g., if you choose to cancel your coverage two months and two weeks prior to the date your coverage ends, IMG will only consider the two full months for a refund). If you have filed claims, your premium is non-refundable.
About IMG:
Since 1990, International Medical Group has provided a unique, full service approach to insurance coverage. Dedicated exclusively to the international insurance market, IMG provides coverage services to individuals and families in more than 150 countries.
IMG™s multilingual claims administrators, on-site medical staff, and customer service professionals work together to give you true Global Peace of Mind. IMG representatives are available 24 hours a day, seven days a week, 365 days a year for medical emergencies, evacuations and pre-certifications. You can rest assured that IMG will be there for you whether it be for routine treatment or during a medical emergency.
Global Medical Insurance is a surplus lines product underwritten by Sirius International Insurance Corporation (publ) (the "Company"). Distributed, managed and administered, as agent for and on behalf of the Company, by International Medical Group, Inc. ("IMG®").
Plan Underwriter:
While IMG provides complete plan administration expertise, Sirius International Insurance Corporation (publ), offers the financial security and reputation demanded by international consumers. Rated A (excellent) by A.M. Best and A- by Standard & Poor's*, Sirius International shares IMG's vision of the international marketplace and offers the stability of a well-established insurance company.
Sirius International is part of the White Mountains Insurance Group Ltd. With approximately $2 billion of regulatory capital and over $2 billion in gross premiums, the Group ranks among the top insurance and reinsurance organizations in the world.
*Sources: A.M. Best reconfirmed their rating in a press release dated April 22, 2004; Standard & Poor's reconfirmed their rating in a press release dated November 19, 2004
IMG, International Medical Group, the IMG block design logo, imglobal, Patriot Travel Medical Insurance, Patriot America, Coverage without boundaries, and global Peace of Mind are the trademarks, service marks and/or registered marks of International Medical Group, Inc.
Sirius, Sirius International, and the Sirius design logo are the trademarks, service marks and/or registered marks.
DOWNLOADS:
Global Medical Insurance BROCHURE PDF
Global Medical Claim Form PDF
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