Global Medical Insurance
Long-Term comprehensive medical plan for individuals and families
Schedule of Benefits
All amounts listed are in U.S. dollars. Click the titles to see further information.
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $5,000,000 lifetime per individual |
$8,000,000 lifetime per individual |
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| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $250 to $10,000 50% waived within PPO network | $100 to $10,000 50% waived within PPO network | |||
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| 3 times the individual deductible | 2 times the individual deductible | |||
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| No coinsurance | No coinsurance | No coinsurance | No coinsurance | No coinsurance |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| No coinsurance | No coinsurance | No coinsurance | No coinsurance | No coinsurance |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| 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 | |||
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $600 per day - 240 day maximum | Average semi-private room rate | Up to a limit of $2,250 per day | Average semi-private room rate | Private room rate |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $1,500 per day - 180 day per event | URC | Up to a limit of $4,500 per day | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| URC | URC | URC | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| 20% of surgery benefit | URC | 20% of surgery benefit | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $250,000 per transplant | $1,000,000 lifetime maximum | $500,000 lifetime maximum | $1,000,000 lifetime maximum | $2,000,000 lifetime maximum |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| 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 | URC | Physician Charges - limit of $150 per visit; Hospital Charge - $100 co-pay unless admitted; Urgent Care Facility - $25 copay; 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 | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| URC | URC | URC | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| URC | URC | URC | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| URC | URC | URC | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $1,500 per covered event - not subject to deductible or coinsurance | URC | $100 per event - not subject to deductible or coinsurance | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| Outpatient only after 12 months | $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage | $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 | $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage | SAAI - $50,000 lifetime maximum - Available after 12 months of continuous coverage |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| 3 visits per period of coverage - $70 maximum per period - Available after 12 months of continuous coverage | $200 maximum per period of coverage - Available for children under 18 years of age after 12 months of continuous coverage | $400 maximum per period of coverage - Available after 6 months of continuous coverage | ||
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| 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 6 months of continuous coverage | ||
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $50,000 per period of coverage - not subject to deductible or coinsurance | Up to maximum limit - not subject to deductible or coinsurance | $250,000 limit per person per certificate period | Up to maximum limit - not subject to deductible or coinsurance | |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | $10,000 lifetime maximum | |||
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $25,000 lifetime maximum per insured - not subject to deductible or coinsurance | $15,000 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 | |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | NA | NA | NA | Limited to $5,000 per certificate period up to a $20,000 lifetime maximum |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | NA | NA | NA | Limited to $10,000 lifetime maximum |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| URC | URC | $5,000 per certificate period for each insured person, out-patient only | URC | Outside U.S. - URC Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| Extended care: first 30 days; Radiation: URC; Home nursing: 30 days per covered event; Hospice: 30 days; Prosthetic Devices: all URC | URC | URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| Maximum $40 per visit - 30 visit maximum | Maximum $50 per visit | Maximum $50 per visit | Maximum $50 per visit | Maximum $50 per visit |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | Acupuncture $150
Aroma Therapy $50 Herbal Therapy $50 Magnetic Therapy $75 Massage Therapy $150 Vitamin Therapy $100 Each per period of coverage |
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| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | URC | URC | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | NA | NA | NA | Calendar year maximum - $750
Individual deductible - $50 Schedule of benefits - Class I: 90% Class II: 70% Class III: 50% Ortho 0% (6 month waiting period) |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| $1,000 per period of coverage | URC | $500 per period | URC | URC |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | $100 per period of coverage | $100 per period of coverage | $100 per period of coverage | See non-emergency dental benefits |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | NA | NA | NA | Up to $20,000 per certificate period |
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| NA | NA | NA | NA | Exams - up to $100 Materials - up to $150 per 24 months |
Delivery, wellness, new born care & congenital disorders (not subject to deductible or coinsurance - available after 10 months of coverage)
| Silver | Gold (1st 36 months of continuous coverage) |
Gold (Beginning the 1st day of the 37th month) |
Gold Plus | Platinum |
| Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section - not subject to deductible or coinsurance, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th or 12th month of continuous coverage) | SAAI - $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days | |||
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)
* This Web page contains only a consolidated and summary description of all current 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 Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.