Benefits
Exclusions
Rates
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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:
Benefit DescriptionSubject to deductible and coinsurance unless otherwise noted |
Silver |
Gold |
Platinum |
Coverage Area |
Two options: worldwide or worldwide excluding the U.S. and Canada |
Two options: worldwide or worldwide excluding the U.S. and Canada |
Two options: worldwide or worldwide excluding the U.S. and Canada |
Policy Maximum |
$5,000,000
lifetime per individual |
$5,000,000
lifetime per individual |
$8,000,000
lifetime per individual |
Deductible |
Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO |
Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO, Carry forward deductible - last 30 days of certificate year |
Ranges from $100 to $10,000 per period of coverage, 50% reduction within PPO, Carry forward deductible - last 30 days of certificate year |
Family Deductible |
3x the single |
3x the single |
2x the single |
Coinsurance within the U.S. and Canada |
80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage |
80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage |
90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage |
Coinsurance within the PPO network and outside the U.S. and Canada |
100% |
100% |
100% |
Hospitalization / Room & Board |
$600 per day (maximum of 240 consecutive days per covered event) |
Average semi-private room rate |
Private room rate |
Intensive Care Unit |
$1,500 per day (maximum of 180 consecutive days per covered event) |
Usual, Reasonable and Customary (URC) |
Usual, Reasonable and Customary (URC) |
Surgery |
URC |
URC |
URC |
Anesthetist's Charges Associated with Surgery |
20% of surgery benefit |
URC |
URC |
Transplants |
$250,000
per transplant |
$1,000,000
lifetime maximum |
$2,000,000
lifetime maximum |
Outpatient |
Visits/Exams - 25 visits per insured person per period of coverage to the maximum limit as outlined: physician $70 specialist $70; psychiatrist $60; chiropractor $50; surgical intervention consultation $500;
X-rays - $250 per exam maximum limit; Lab Tests - $300 per exam maximum limit |
URC |
URC |
Rx Coverage |
URC |
URC |
URC |
Emergency Room Illness |
URC
- subject to an additional $250 deductible if not admitted |
URC
-subject to an additional $250 deductible if not admitted |
URC
-subject to an additional $250 deductible if not admitted |
Emergency Room Accident |
URC |
URC |
URC |
Local Ambulance |
$1,500
per covered event-
not subject to deductible or coinsurance |
URC |
URC |
Emergency Evacuation |
$50,000 per period of coverage - not subject to deductible or coinsurance |
Limited to policy maximum - not subject to deductible or coinsurance |
Limited to policy maximum - not subject to deductible or coinsurance |
Emergency Reunion |
NA (Not Applicable) |
$10,000
lifetime maximum |
$10,000
lifetime maximum |
Return of Mortal Remains |
$25,000
lifetime maximum per insured - not subject to deductible or coinsurance |
$25,000
lifetime maximum per insured -not subject to deductible or coinsurance |
$50,000
lifetime maximum per insured -not subject to deductible or coinsurance |
Maternity |
Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in11th or 12th month of continuous coverage |
Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in11th or 12th month of continuous coverage |
Same As Any Illness (SAAI) $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for first 12 months. Available after 10 months of coverage |
Supplemental Accident |
NA |
$300
per occurrence - not subject to deductible or coinsurance |
$500
per occurrence - not subject to deductible or coinsurance |
Mental/Nervous |
Outpatient only - (see Outpatient) Available after 12 months of continuous coverage |
$10,000
per period of coverage up to a $50,000 lifetime maximum. Available after 12 months of continuous coverage |
SAAI
$50,000 lifetime maximum. Available after 12 months of continuous coverage |
Adult Wellness |
NA |
$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 |
$500 per period of coverage - not subject to deductible or coinsurance Available for those 18 years of age and over after 12 months of continuous coverage |
Child Wellness |
Three visits per period of coverage -maximum $70 per visit. Available for children under 18 years of age after 12 months of continuous coverage |
$200 maximum per period of coverage -not subject to deductible or coinsurance Available for children under 18 years of age after 12 months of continuous coverage |
$400 maximum per period of coverage - not subject to deductible or coinsurance Available for children under 18 years of age after 12 months of continuous coverage |
Other Services |
Extended Care - limited to first 30 days of confinement
Radiation Treatment-URC
Home Nursing Care-limited 30 days per covered event
Hospice Care- limited 30 days per covered event/
Prosthetic Devices - all URC |
URC |
URC |
Physical Therapy |
Maximum $40 per visit 30 visit maximum per period of coverage |
Maximum $50 per visit |
Maximum $50 per visit |
High School Sports Injury |
NA |
NA |
Up to $5,000 maximum |
Recreational SCUBA |
NA |
URC |
URC |
Remote Transportation |
NA |
NA |
Limited to $5,000 per certificate period up to a $20,000 lifetime maximum |
Political Evacuation and Repatriation |
NA |
NA |
Limited to $10,000 lifetime maximum |
Complementary Medicine |
NA |
Acupuncture $150Aroma Therapy $50Herbal Therapy $50Magnetic Therapy $75Massage Therapy $150Vitamin Therapy $100Each per period of coverage |
Acupuncture $150Aroma Therapy $50Herbal Therapy $50Magnetic Therapy $75Massage Therapy $150Vitamin Therapy $100Each per period of coverage |
Non-emergency Dental |
NA |
NA |
Calendar year maximum - $750Individual deductible - $50Schedule of benefits -Class I: 90% Class II: 70%Class III: 50% Ortho 0%(6 month waiting period) |
Emergency Dental due to Accident |
$1,000 per period of coverage |
URC |
URC |
Emergency Dental due to Sudden Unexpected Pain |
NA |
$100 per period of coverage |
See non-emergency dental benefits |
Vision |
NA |
NA |
Exams - up to $100 per 24 monthsMaterials - up to $150 per 24 months |
Global Concierge & Assistance Services |
NA |
NA |
Included |
Pre-existing Conditions |
$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage |
$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage |
SAAI |
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness) |
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:
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.
RATES:
New Business Rates through 30-APR-2008 (Includes 2.5% surplus lines tax where applicable)
SILVER WORLDWIDE COVERAGE - ANNUAL PREMIUMS |
|
$250.00 |
$500.00 |
$1,000.00 |
$2,500.00 |
$5,000.00 |
$10,000.00 |
deductible |
deductible |
deductible |
deductible |
deductible |
deductible |
Age |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
14 Days-9** |
First 2 Free*, Then 310 |
First 2 Free*, Then 270 |
First 2 Free*, Then 210 |
First 2 Free*, Then 184 |
First 2 Free*, Then 169 |
First 2 Free*, Then 150 |
10-18** |
317 |
282 |
233 |
217 |
204 |
180 |
* The first two Dependent Children between the ages of 14 days to 9 years are free only when both parents or guardians are insured under the Global Medical Insurance plan. **Dependent child rates are only available when at least one parent or guardian is insured under the Global Medical Insurance plan. Children applying with no parent or guardian insured by Global Medical Insurance must use the Male 19-24 rates. |
19-24 |
718 |
895 |
622 |
881 |
484 |
675 |
422 |
588 |
331 |
473 |
294 |
407 |
25-29 |
758 |
1,020 |
662 |
991 |
515 |
764 |
449 |
663 |
352 |
551 |
313 |
433 |
30-34 |
848 |
1,128 |
730 |
1,063 |
566 |
823 |
496 |
718 |
389 |
576 |
345 |
490 |
35-39 |
950 |
1,333 |
770 |
1,182 |
596 |
918 |
522 |
793 |
408 |
661 |
364 |
516 |
40-44 |
1,202 |
1,463 |
976 |
1,273 |
647 |
997 |
567 |
873 |
542 |
676 |
482 |
602 |
45-49 |
1,339 |
1,614 |
1,098 |
1,373 |
850 |
1,062 |
741 |
925 |
605 |
730 |
538 |
650 |
50-54 |
1,635 |
1,796 |
1,386 |
1,548 |
1,071 |
1,201 |
935 |
1,068 |
794 |
886 |
706 |
789 |
55-59 |
1,976 |
1,976 |
1,718 |
1,718 |
1,330 |
1,328 |
1,159 |
1,159 |
976 |
984 |
868 |
876 |
60-64 |
2,909 |
2,738 |
2,651 |
2,480 |
2,235 |
1,973 |
2,024 |
1,816 |
1,691 |
1,502 |
1,505 |
1,337 |
65-69 |
6,075 |
5,271 |
5,814 |
5,041 |
5,439 |
4,591 |
4,181 |
3,412 |
3,656 |
3,274 |
3,254 |
2,914 |
70 - 74 |
Please contact IMG or your agent for premium information concerning this age. |
|
Optional Maternity Rider $2,500 annual premium* |
SILVER WORLDWIDE COVERAGE EXCLUDING U.S/CANADA - ANNUAL PREMIUMS |
|
$250.00 |
$500.00 |
$1,000.00 |
$2,500.00 |
$5,000.00 |
$10,000.00 |
deductible |
deductible |
deductible |
deductible |
deductible |
deductible |
Age |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
14 Days-9** |
First 2 Free*, Then 232 |
First 2 Free*, Then 203 |
First 2 Free*, Then 158 |
First 2 Free*, Then 138 |
First 2 Free*, Then 127 |
First 2 Free*, Then 112 |
10-18** |
238 |
212 |
175 |
163 |
153 |
134 |
* The first two Dependent Children between the ages of 14 days to 9 years are free only when both parents or guardians are insured under the Global Medical Insurance plan. **Dependent child rates are only available when at least one parent or guardian is insured under the Global Medical Insurance plan. Children applying with no parent or guardian insured by Global Medical Insurance must use the Male 19-24 rates. |
19-24 |
539 |
671 |
466 |
660 |
363 |
506 |
317 |
441 |
248 |
355 |
221 |
306 |
25-29 |
569 |
766 |
497 |
744 |
385 |
572 |
336 |
498 |
264 |
413 |
234 |
326 |
30-34 |
636 |
846 |
548 |
798 |
424 |
618 |
372 |
538 |
291 |
432 |
259 |
369 |
35-39 |
714 |
1,000 |
578 |
888 |
447 |
689 |
392 |
595 |
307 |
496 |
273 |
387 |
40-44 |
901 |
1,098 |
731 |
955 |
486 |
748 |
425 |
655 |
407 |
510 |
362 |
451 |
45-49 |
1,004 |
1,211 |
823 |
1,030 |
638 |
797 |
556 |
694 |
453 |
548 |
404 |
487 |
50-54 |
1,226 |
1,347 |
1,040 |
1,161 |
803 |
901 |
702 |
801 |
595 |
665 |
530 |
592 |
55-59 |
1,482 |
1,482 |
1,288 |
1,288 |
997 |
996 |
869 |
869 |
731 |
738 |
651 |
657 |
60-64 |
2,182 |
2,054 |
1,988 |
1,860 |
1,676 |
1,480 |
1,518 |
1,363 |
1,268 |
1,127 |
1,129 |
1,003 |
65-69 |
4,556 |
3,953 |
4,361 |
3,781 |
4,080 |
3,443 |
3,136 |
2,559 |
2,742 |
2,456 |
2,441 |
2,185 |
70 - 74 |
Please contact IMG or your agent for premium information concerning this age. |
|
Optional Maternity Rider $2,500 annual premium* |
GOLD WORLDWIDE COVERAGE - ANNUAL PREMIUMS |
|
$250.00 |
$500.00 |
$1,000.00 |
$2,500.00 |
$5,000.00 |
$10,000.00 |
deductible |
deductible |
deductible |
deductible |
deductible |
deductible |
Age |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
14 Days-9** |
First 2 Free*, Then 501 |
First 2 Free*, Then 423 |
First 2 Free*, Then 322 |
First 2 Free*, Then 290 |
First 2 Free*, Then 260 |
First 2 Free*, Then 235 |
10-18** |
545 |
445 |
345 |
312 |
280 |
252 |
* The first two Dependent Children between the ages of 14 days to 9 years are free only when both parents or guardians are insured under the Global Medical Insurance plan. **Dependent child rates are only available when at least one parent or guardian is insured under the Global Medical Insurance plan. Children applying with no parent or guardian insured by Global Medical Insurance must use the Male 19-24 rates. |
19-24 |
1,171 |
1,543 |
1,008 |
1,468 |
784 |
1,048 |
691 |
928 |
567 |
786 |
447 |
593 |
25-29 |
1,212 |
1,722 |
1,058 |
1,626 |
820 |
1,167 |
721 |
1,026 |
593 |
894 |
464 |
614 |
30-34 |
1,339 |
1,927 |
1,176 |
1,807 |
915 |
1,343 |
811 |
1,188 |
664 |
1,002 |
523 |
749 |
35-39 |
1,388 |
2,135 |
1,234 |
1,941 |
954 |
1,492 |
845 |
1,308 |
691 |
1,117 |
543 |
770 |
40-44 |
1,791 |
2,340 |
1,583 |
2,091 |
1,226 |
1,622 |
1,089 |
1,441 |
887 |
1,145 |
702 |
899 |
45-49 |
2,015 |
2,434 |
1,800 |
2,196 |
1,395 |
1,708 |
1,237 |
1,511 |
1,010 |
1,166 |
796 |
916 |
50-54 |
2,449 |
2,642 |
2,204 |
2,403 |
1,715 |
1,875 |
1,562 |
1,701 |
1,280 |
1,392 |
1,004 |
1,094 |
55-59 |
3,101 |
3,014 |
2,843 |
2,762 |
2,219 |
2,157 |
1,957 |
1,902 |
1,648 |
1,601 |
1,286 |
1,249 |
60-64 |
4,359 |
4,109 |
4,031 |
3,781 |
3,375 |
3,125 |
3,080 |
2,850 |
2,556 |
2,262 |
2,098 |
1,868 |
65-69 |
9,001 |
7,849 |
8,672 |
7,521 |
8,018 |
6,863 |
6,235 |
5,633 |
5,409 |
4,869 |
4,457 |
4,014 |
70 - 74 |
Please contact IMG or your agent for premium information concerning this age. |
| |
Optional Maternity Rider $2,500 annual premium* |
GOLD WORLDWIDE COVERAGE EXCLUDING U.S/CANADA - ANNUAL PREMIUMS |
|
$250.00 |
$500.00 |
$1,000.00 |
$2,500.00 |
$5,000.00 |
$10,000.00 |
deductible |
deductible |
deductible |
deductible |
deductible |
deductible |
Age |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
14 Days-9** |
First 2 Free*, Then 376 |
First 2 Free*, Then 317 |
First 2 Free*, Then 242 |
First 2 Free*, Then 217 |
First 2 Free*, Then 195 |
First 2 Free*, Then 176 |
10-18** |
408 |
334 |
259 |
234 |
210 |
189 |
* The first two Dependent Children between the ages of 14 days to 9 years are free only when both parents or guardians are insured under the Global Medical Insurance plan. **Dependent child rates are only available when at least one parent or guardian is insured under the Global Medical Insurance plan. Children applying with no parent or guardian insured by Global Medical Insurance must use the Male 19-24 rates. |
19-24 |
878 |
1,157 |
756 |
1,101 |
588 |
786 |
519 |
696 |
425 |
590 |
336 |
445 |
25-29 |
909 |
1,291 |
794 |
1,220 |
615 |
875 |
541 |
770 |
445 |
671 |
349 |
461 |
30-34 |
1,004 |
1,446 |
882 |
1,355 |
686 |
1,008 |
608 |
892 |
498 |
752 |
393 |
562 |
35-39 |
1,042 |
1,601 |
925 |
1,456 |
716 |
1,119 |
634 |
981 |
519 |
838 |
407 |
578 |
40-44 |
1,343 |
1,755 |
1,187 |
1,569 |
920 |
1,216 |
816 |
1,081 |
666 |
859 |
526 |
675 |
45-49 |
1,512 |
1,826 |
1,349 |
1,647 |
1,046 |
1,281 |
928 |
1,134 |
759 |
875 |
597 |
687 |
50-54 |
1,837 |
1,982 |
1,654 |
1,803 |
1,286 |
1,406 |
1,172 |
1,276 |
960 |
1,044 |
753 |
821 |
55-59 |
2,326 |
2,261 |
2,132 |
2,072 |
1,664 |
1,618 |
1,467 |
1,427 |
1,236 |
1,201 |
965 |
937 |
60-64 |
3,269 |
3,083 |
3,024 |
2,836 |
2,531 |
2,344 |
2,311 |
2,137 |
1,917 |
1,696 |
1,574 |
1,402 |
65-69 |
6,751 |
5,887 |
6,504 |
5,641 |
6,014 |
5,147 |
4,676 |
4,225 |
4,057 |
3,652 |
3,343 |
3,011 |
70 - 74 |
Please contact IMG or your agent for premium information concerning this age. |
|
Optional Maternity Rider $2,500 annual premium* |
* Optional Maternity Rider - Up to US$50,000 lifetime maximum for: Pre- and post-natal care; Maximum of US$5,000 for normal delivery for each pregnancy; Maximum of US$7,500 for C-section delivery for each pregnancy; Well baby care and treatment of newborn for first 31 days; Child wellness benefits of up to US$200 maximum per period of coverage (not subject to deductible or coinsurance) for eligible newborn children for the first 12 months; Must be selected at time of initial purchase of plan; Benefits available after 10 months of continuous coverage; Eligible newborn children may be added without evidence of insurability as long as an application form is submitted within 31 days of birth.
Benefits will be reduced by 50% for births that occur in the 11th or 12th month of continuous coverage.
PLATINUM WORLDWIDE COVERAGE - ANNUAL PREMIUMS |
|
$100.00 deductible |
$250.00 deductible |
$500.00 deductible |
$1,000.00 deductible |
$2,500.00 deductible |
$5,000.00 deductible |
$10,000.00 deductible |
| |
|
|
|
|
|
|
Age |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
14 Days-9** |
First 2 Free*, Then 1,618 |
First 2 Free*, Then 1,471 |
First 2 Free*, Then 1,320 |
First 2 Free*, Then 1,125 |
First 2 Free*, Then 1,064 |
First 2 Free*, Then 1,006 |
First 2 Free*, Then 958 |
10-18** |
2.020 |
1,836 |
1,608 |
1,381 |
1,305 |
1,232 |
1,168 |
* The first two Dependent Children between the ages of 14 days to 9 years are free only when both parents or guardians are insured under the Global Medical Insurance. **Dependent child rates are only available when at least one parent or guardian is insured under the Global Medical Insurance. Children applying with no parent or guardian insured by Global Medical Insurance must use the Male 19-24 rates. |
19-24 |
3,585 |
6,105 |
3,259 |
5,510 |
2,890 |
5,272 |
2,380 |
3,934 |
2,169 |
3,552 |
1,886 |
3,099 |
1,613 |
2,484 |
25-29 |
3,690 |
6,685 |
3,354 |
6,080 |
3,004 |
5,775 |
2,463 |
4,313 |
2,237 |
3,863, |
1,945 |
3,443 |
1,652 |
2,551 |
30-34 |
4,008 |
7,410 |
3,644 |
6,736 |
3,273 |
6,352 |
2,679 |
4,873 |
2,441 |
4,380 |
2,107 |
3,787 |
1,785 |
2,981 |
35-39 |
4,130 |
8,135 |
3,754 |
7,395 |
3,405 |
6,779 |
2,767 |
5,348 |
2,519 |
4,762 |
2,169 |
4,154 |
1,831 |
3,048 |
40-44 |
5,140 |
8,855 |
4,672 |
8,049 |
4,200 |
7,257 |
3,387 |
5,762 |
3,075 |
5,186 |
2,615 |
4,234 |
2,194 |
3,459 |
45-49 |
5,700 |
6,750 |
5,181 |
6,136 |
4,694 |
5,184 |
3,771 |
4,484 |
3,411 |
4,036 |
2,895 |
3,250 |
2,407 |
2,681 |
50-54 |
6,290 |
7,270 |
5,718 |
6,608 |
5,614 |
6,068 |
4,501 |
4,865 |
4,152 |
4,469 |
3,509 |
3,765 |
2,882 |
3,086 |
55-59 |
8,420 |
8,205 |
7,654 |
7,458 |
7,069 |
6,885 |
5,649 |
5,507 |
5,052 |
4,927 |
4,348 |
4,241 |
3,523 |
3,440 |
60-64 |
11,575 |
10,945 |
10,522 |
9,949 |
9,775 |
9,205 |
8,281 |
7,711 |
7,609 |
7,089 |
6,416 |
5,747 |
5,373 |
4,849 |
65-69 |
23,205 |
20,315 |
21,093 |
18,466 |
20,344 |
17,724 |
18,855 |
16,225 |
14,795 |
13,424 |
12,913 |
11,683 |
10,745 |
9,736 |
70-74 |
Please contact IMG or your agent for premium information concerning this age. |
| |
PLATINUM WORLDWIDE COVERAGE EXCLUDING U.S/CANADA - ANNUAL PREMIUMS |
|
$100.00 deductible |
$250.00 deductible |
$500.00 deductible |
$1,000.00 deductible |
$2,500.00 deductible |
$5,000.00 deductible |
$10,000.00 deductible |
|
|
|
|
|
|
|
Age |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
M |
F |
14 Days-9** |
First 2 Free*, Then 1,353 |
First 2 Free*, Then 1,230 |
First 2 Free*, Then 1,116 |
First 2 Free*, Then 971 |
First 2 Free*, Then 923 |
First 2 Free*, Then 880 |
First 2 Free*, Then 844 |
10-18** |
1,676 |
1,523 |
1,356 |
1,185 |
1,128 |
1,073 |
1,025 |
* The first two Dependent Children between the ages of 14 days to 9 years are free only when both parents or guardians are insured under the Global Medical Insurance. **Dependent child rates are only available when at least one parent or guardian is insured under the Global Medical Insurance. Children applying with no parent or guardian insured by Global Medical Insurance must use the Male 19-24 rates. |
19-24 |
2,854 |
4,709 |
2,595 |
4,281 |
2,316 |
3,887 |
1,934 |
3,099 |
1,777 |
2,812 |
1,562 |
2,474 |
1,359 |
2,013 |
25-29 |
2,931 |
5,178 |
2,664 |
4,707 |
2,402 |
4,482 |
1,995 |
3,383 |
1,827 |
3,048 |
1,608 |
2,733 |
1,390 |
2,064 |
30-34 |
3,169 |
5,722 |
2,882 |
5,201 |
2,603 |
4,912 |
2,157 |
3,807 |
1,979 |
3,436 |
1,729 |
2,990 |
1,489 |
2,385 |
35-39 |
3,265 |
6,266 |
2,968 |
5,696 |
2,701 |
5,233 |
2,225 |
4,160 |
2,039 |
3,721 |
1,777 |
3,265 |
1,522 |
2,437 |
40-44 |
4,019 |
6,805 |
3,653 |
6,187 |
3,298 |
5,593 |
2,690 |
4,469 |
2,453 |
4,039 |
2,111 |
3,331 |
1,792 |
2,746 |
45-49 |
4,442 |
5,229 |
4,038 |
4,753 |
3,667 |
4,346 |
2,977 |
3,512 |
2,708 |
3,178 |
2,323 |
2,588 |
1,954 |
2,159 |
50-54 |
5,256 |
5,620 |
4,778 |
5,109 |
4,361 |
4,701 |
3,523 |
3,797 |
3,264 |
3,501 |
2,781 |
2,972 |
2,309 |
2,465 |
55-59 |
6,481 |
6,319 |
5,892 |
5,744 |
5,450 |
5,314 |
4,385 |
4,280 |
3,935 |
3,844 |
3,409 |
3,337 |
2,792 |
2,728 |
60-64 |
8,843 |
8,377 |
8.039 |
7,723 |
7,481 |
7,053 |
6,359 |
5,933 |
5,858 |
5,461 |
4,961 |
4,457 |
4,180 |
3,788 |
65-69 |
17,565 |
15,403 |
15,969 |
14,002 |
15,407 |
13,441 |
14,291 |
12,317 |
11,244 |
10,216 |
9,834 |
8,911 |
8,208 |
7,452 |
70-74 |
Please contact IMG or your agent for premium information concerning this age bracket |
|
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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