What are the Policy Limits?
Platinum
BENEFIT PLATINUM - for the International Citizen needing worldwide coverage
Overall Maximum Limit $5,000,000 Lifetime
Deductibles Available $250, $500, $1,000, $2,500 or $5,000 per Certificate Period
Family Deductible Maximum of 3 Deductibles per family per Certificate Period
Coinsurance -- Claims incurred in US or Canada 80% of the next $5,000 of Eligible Expenses after the Deductible, then 100% to the Overall Maximum Limit. The Coinsurance will be waived if expenses are incurred within the PPO
Coinsurance -- claims incurred outside US or Canada 100% of Eligible Expenses after the Deductible to the Overall Maximum Limit
Hospital Room and Board -- In US or Canada Average Semi-private room rate
Hospital Room and Board -- Outside US or Canada Average Private room rate
Intensive Care Unit -- In US or Canada Usual, Reasonable and Customary
Intensive Care Unit -- Outside US or Canada Usual, Reasonable and Customary
Prescription Drugs Usual, Reasonable and Customary Subject to Deductible and Coinsurance
Mental Health Disorders $10,000 per Certificate Period, $25,000 Lifetime Maximum, $50 Maximum per visit per day for outpatient care (after 12 months of continuous coverage)
Maternity -- Normal Delivery After the Deductible, Underwriters will pay 50% of the next $100,000 of Eligible Medical Expenses, then 100% to a Lifetime Maximum of $250,000. Covered Maternity expenses include pre-natal, Delivery, and post-natal care (after 12 months of continuous coverage)
Maternity -- Complicated Delivery After the Deductible, Underwriters will pay 50% of the next $100,000 of Eligible Medical Expenses, then 100% to a Lifetime Maximum of $250,000. Covered Maternity expenses include pre-natal, Delivery, and post-natal care (after 12 months of continuous coverage)
Maximum for Maternity $250,000 Lifetime
Newborn Care Included as part of Maternity benefits for a maximum of 31 days
Pre-existing Conditions Same as any other Injury or Illness if disclosed on Application and not excluded or limited by Rider
Local Ambulance Usual, Reasonable and Customary
Physical Therapy $50 Maximum per visit per day
Wellness $50 per visit (including immunizations), maximum of three visits per year for children under the age of 19 (after 12 months of continuous coverage). $250 per Certificate Period (after 12 months of continuos coverage) for Members age 35 or older. Not Subject to Deductible
Human Organ/Tissue Transplants* Same as any other Illness for Covered Transplants
All Other Eligible Expenses Usual, Reasonable and Customary
Emergency Medical Evacuation $50,000 Lifetime Maximum
Repatriation of Remains $25,000 Limit
Emergency Reunion $10,000 Lifetime Maximum
Pre-notification Penalty 50%
*Covered transplants include Heart/Lung, Lung, Kidney/Pancreas, Liver and Allogenic and Autologous Bone Marrow.

 
Premier

Benefit

Coverage Area

Worldwide, except US and Canada

Overall Policy Maximum

$1,000,000 Lifetime

Deductibles Available

$250, $500, $1,000 or $2,500 per Certificate Period.

Coinsurance–Claims incurred in US or Canada

No coverage in US or Canada.

Coinsurance–claims incurred outside US or Canada

100% of Eligible Medical Expenses after the Deductible to the Overall Policy Maximum.

Hospital Room and Board–In US or Canada

No coverage in US or Canada.

Hospital Room and Board–Outside US or Canada

Average Private room rate.

Intensive Care Unit–In US or Canada

No coverage in US or Canada.

Intensive Care Unit–Outside US or Canada

3 times the Average Private room rate.

Mental or Nervous Disorders

$5,000 per Certificate Period (after 24 months of continuous coverage); $10,000 Lifetime Maximum.

Maternity–Normal Delivery

$3,500 per Pregnancy (after 24 months of continuous coverage) including pre-natal, Delivery and post-natal care.

Maternity–Complicated Delivery

$6,000 per Pregnancy (after 24 months of continuous coverage) including pre-natal, Delivery and post-natal care.

Maximum for Maternity

$10,000 Lifetime

Newborn Care

$5,000 Maximum Limit for maximum of 31 days.

Pre-existing Conditions

$25,000 Lifetime Maximum (after 24 months of continuous coverage).

Local Ambulance

$1,000 Lifetime Maximum.

Physical Therapy

No coverage.

Wellness

No coverage.

Human Organ/Tissue Transplants

Same as any other Illness for Covered Transplants.

All Other Eligible Expenses

Usual, Reasonable and Customary.

Emergency Medical Evacuation

No coverage.

Pre-certification Penalty

50%

 
Optional Term Life Insurance and Accidental Death and Dismemberment

Age

Basic Life Principal Sum

Supplemental Life Principal Sum

19 to 59

$50,000

$50,000

60 to 64

$25,000

$25,000

65 to 69

$10,000

Not Available

Dependent Child

$5,000

Not Available

 

Accidental Death

Principal Sum

Accidental Loss of Two Members

Principal Sum

Accidental Loss of One Member

50% of Principal Sum

The Benefit is based on your age at time of Death or Dismemberment. "Member" means hand, foot or eye.

 
Optional Dental Rider

 

Year 1

Year 2

Year 3

Preventative Dental Benefits Children age 9 through 16 (after 3 months of continuous coverage)

100%

100%

100%

Basic Dental Benefits (after 6 months of continuous coverage)

50%

65%

80%

Major Dental Benefits (after 6 months of continuous coverage)

30%

40%

50%

Dental Deductible

$100.00 per Certificate Period

$100.00 per Certificate Period

$100.00 per Certificate Period

Maximum Dental Benefits

$500.00 per Certificate Period

$750.00 per Certificate Period

$1,000.00 per Certificate Period