Global Medical International
Global Medical International is for individuals while traveling outside of their Home Country to any other country, except the United States. Insured Individuals may also purchase coverage for their eligible dependents, spouse, and any unmarried dependent children, up to age 19. Married children should enroll on their own.
Even if you have good health insurance at home, you may not be covered while abroad, and few domestic insurers can provide medical evacuations or medical assistance in a foreign country. The Global Medical International Plan is designed for foreign trips or visits lasting up to 12 months and may provide peace of mind for travelers. The plan provides international insurance benefits for individuals, their spouses, and for their unmarried dependent children. "Dependents" not fitting the insurance definition under eligibility may purchase coverage on their own.
Period of Coverage
Coverage may be purchased from a minimum 15 days (if trip duration is shorter than 15 days, use the 15 day rate) up to a maximum of 12 months. Coverage may be purchased in 15 day or monthly increments. Rates are listed in the enrollment form. Coverage begins at 12:01 a.m. at the covered person’s address, on the latest of the following: a) the date of the covered person’s departure from their Home Country or the United States; b) the date the enrollment form and premium are received by the Company or its designated representative; or c) the date requested on the enrollment form. Coverage will end on the latest of the following: a) the date of covered person’s return to their Home Country or the United States (there is no continuation of coverage upon return home, except as specifically indicated in the Extended Home Country Benefit); b) the date requested on the enrollment form; c) the end of the period for which premium has been paid. Coverage may not be purchased for longer than 12 months, and coverage may not be extended, it must be repurchased with a new Period of Coverage issued (no more than 12 months in total).
Refund of premium, less a $10 processing fee, will be considered only if written request is received prior to the effective date of coverage. Once the coverage has begun, the premium is considered fully earned and no refund will be allowed. Partial refunds are not available.
Schedule of Benefits
Medical Expense Benefits
Medical Expense Benefits will be paid up to the Plan maximum elected by you.
Plan A $ 100,000 lifetime maximum
Plan B $ 250,000 lifetime maximum
Plan C $ 1,000,000 lifetime maximum
$ 50,000 maximum ages 70-79
$ 10,000 maximum ages 80+
Deductible Options
Rates shown in the enrollment form are for $250 deductible. $100, $500, $1,000 or $2,500 per person, per Period of Coverage deductibles are also available. There is a maximum of three deductibles per family.
Co-Insurance
After you pay the selected deductible amount the Plan pays 100% of the covered expenses to the selected benefit maximum. Covered expenses are based on usual and customary charges for the area in which the claim is incurred.
What Expenses are Covered?
To be considered a Covered Expense under the Plan, it must:
a) be usual and customary charges incurred for Medically Necessary medical Covered Expenses;
b) have been incurred as the result of, and within 52 weeks of a covered Sickness or Injury outside of the United States, during the Period of Coverage (except as specifically provided in the Extended Home Country Benefit, if applicable and enrolled); c) not be excluded by provisions of the Plan; and
d) be specifically included in the following list of Covered Expenses:
Covered Expenses
1. Expenses made by a hospital for room and board, general nursing care and other services, including professional
services, but not including personal services of a non-medical nature. However, covered expenses may not exceed the hospital’s average charge for semiprivate room and board accommodation.
2. Expenses made for diagnosis, treatment and surgery by
a doctor.
3. Expenses made for the cost and administration of anesthetics.
4. Expenses for x-ray services, laboratory tests, medical services and supplies.
5. Expenses for physiotherapy, if recommended by a doctor for the treatment of an Injury or Sickness, and administered by a licensed physiotherapist. Chiropractic care: limited to 80% of covered expenses, up to $35 per visit, with a maximum of 10 visits per Injury or Sickness.
6. Expenses for prescription drugs including dressings, drugs, and medicines prescribed by a doctor. The Company will pay 100% of the inpatient expenses incurred, and 50% of outpatient expenses incurred.
7. Expenses for dental expenses resulting from an accident, up to $100 per tooth, $500 maximum benefit.
Definitions
“Sickness” means an illness, disease or condition of the covered person that causes a loss for which the covered person incurs medical expenses while covered under the Policy. All related conditions and recurrent symptoms of the same or similar condition will be considered one Sickness.
“Injury” means accidental bodily harm sustained by a covered person that results directly and independently from all other causes from a covered accident. The Injury must be caused solely through external and accidental means. All injuries sustained by one person in any one accident, including all related conditions and recurrent symptoms of these injuries, are considered a single Injury.
“Medically Necessary” means a treatment, service or supply that is: 1) required to treat an Injury or Sickness; prescribed or ordered by a doctor or furnished by a Hospital; 2) performed in the least costly setting required by the covered person’s condition; and 3) consistent with the medical and surgical practices prevailing in the area for treatment of the condition at the time rendered. A service or supply may not be Medically Necessary if a less intensive or more appropriate diagnostic or treatment alternative could have been used. The Company may, at its discretion, consider the cost of the alternative to be the Covered Expense.
Emergency Medical Evacuation Benefit
Maximum Limit $250,000
The Company will pay Emergency Medical Evacuation Benefits up to the maximum of $250,000 for expenses incurred for the medical evacuation of a covered person. Benefits are payable if the covered person: 1) is traveling outside of his or her Home Country; 2) suffers an Injury or Sickness during the course of the trip; and 3) requires Emergency Medical Evacuation.
Benefits will not be payable unless: 1) the doctor ordering the Emergency Medical Evacuation certifies the severity of the Insured’s Injury or Sickness requires an Emergency Medical Evacuation; 2) all transportation arrangements made for the Emergency Medical Evacuation are by the most direct and economical conveyance and route possible; 3) the charges incurred are Medically Necessary and do not exceed the usual level of charges for similar transportation, treatment, services or supplies in the locality where the expense is incurred; and 4) do not include charges that would not have been made if there were no insurance.
“Emergency Medical Evacuation” means: 1) the covered person’s immediate transportation from the place where he or she suffers an Injury or Sickness to the nearest Hospital or other medical facility where appropriate medical treatment can be obtained; or 2) the covered person’s transportation to his or her Home Country to obtain further medical treatment in a Hospital or other medical facility or to recover after suffering an Injury or Sickness. An Emergency Medical Evacuation also includes Medically Necessary medical treatment, medical services and medical supplies necessarily received in connection with such transportation. An Emergency Medical Evacuation of covered person to their Home Country will terminate all benefits except Accidental Death and Dismemberment Benefits under the Plan. All arrangements must be made by the Assistance Provider and approved by the Company in order for expenses to be considered eligible.
Emergency Reunion Benefit
In the event of an Emergency Medical Evacuation due to a Covered Injury or Sickness, where the doctor feels it would be beneficial for the covered person to have a family member at his or her side during transport, the Company will pay the expenses incurred for travel and lodging for that relative, up to a maximum of $12,500. Covered Expenses include an economy airline ticket and other travel related expenses not to exceed $300 a day for a maximum of ten days. All arrangements must be made by the Assistance Provider and approved by the Company in order for expenses to be considered eligible.
Repatriation of Remains
Maximum Limit $50,000
The Company will pay the usual and customary Covered Expenses, up to a maximum of $50,000, to return a covered person’s body home to his or her Home Country if he or she dies while covered by the Plan. Covered expenses include, but are not limited to, expenses for embalming, cremation, coffins and transportation. All arrangements must be made by the Assistance Provider and approved by the Company in order for expenses to be considered eligible.
Accidental Death & Dismemberment Benefit
$25,000 Principal Sum
If Injury to the covered person results, within 365 days of the date of a covered accident, in any one of the losses shown below, the Company will pay the Benefit Amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same accident.
Covered Loss Benefit Amount
Life 100% of the Principal Sum
Quadriplegia 100% of the Principal Sum
Two or more Members 100% of the Principal Sum
One Member 50% of the Principal Sum
Hemiplegia 50% of the Principal Sum
Paraplegia 50% of the Principal Sum
Uniplegia 25% of the Principal Sum
Thumb and Index Finger 25% of the Principal Sum
of the Same Hand
“Quadriplegia” means total Paralysis of both upper and lower limbs. “Hemiplegia” means total Paralysis of the upper and lower limbs on one side of the body. “Uniplegia” means total Paralysis of one lower limb or one upper limb. “Paraplegia” means total Paralysis of both lower limbs or both upper limbs. “Paralysis” means total loss of use. A Doctor must determine the loss of use to be complete and not reversible at the time the claim is submitted.
“Member” means Loss of Hand or Foot, Loss of Sight, Loss of Speech, and Loss of Hearing. “Loss of Hand or Foot” means complete Severance through or above the wrist or ankle joint. “Loss of Sight” means the total, permanent Loss of Sight of one eye. “Loss of Speech” means total and permanent loss of audible communication that is irrecoverable by natural, surgical or artificial means. “Loss of Hearing” means total and permanent Loss of Hearing in both ears that is irrecoverable and cannot be corrected by any means. “Loss of a Thumb and Index Finger of the Same Hand” means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the hand). “Severance” means the complete separation and dismemberment of the part from the body.
Home Country Benefit
The Company will pay benefits if, during the Period of Coverage, a covered person returns to the United States for incidental visits of up to two weeks total, provided: a) the period of coverage is for a period of at least 30 days; and b) the primary reason for the covered person’s return to the United States is not to obtain medical treatment for an Injury or Sickness that occurred while traveling.
Optional Benefits
Optional Hazardous Activity Coverage - The Company will pay benefits if a covered person is injured and the covered accident results from: motorcycling; scuba diving; jet, snow, and water skiing; mountain climbing (where ropes or guides are normally used); sky diving; amateur racing; piloting an aircraft; bungee jumping; spelunking; whitewater rafting; surfing; and parasailing. Note: Exclusion 16 does not apply when this coverage is purchased.
Optional Athletic Coverage - The Company will pay benefits if a covered person is injured and the covered accident results from participation in amateur, club, intramural, interscholastic or intercollegiate tennis, swimming, cross country, track, baseball, softball, volleyball and golf sports only. All other sports are excluded. Note: Exclusion 6a does not apply with respect to these named sports when this coverage is purchased.
Extended Home Country Benefit - You may purchase up to one additional month of the Home Country Benefit at the time of original enrollment, if you are enrolling in the Plan for a minimum of 6 months.
Excess Benefits
All Coverages, except Accidental Death & Dismemberment, shall be excess of all other valid and collectible insurance.
Right of Subrogation
If the covered person is injured as the result of another person’s negligence, the Company has the right to seek reimbursement on his/her behalf against the negligent party for any claims paid under this Plan, unless prohibited by state law.
24 Hour Assistance Services, offered by Worldwide Assistance Services, Inc.
In addition to this health insurance program is the availability of the 24-hour Assistance network for emergency assistance anywhere in the world. Simply call the assistance center toll-free or collect. The telephone numbers from around the world will be supplied to you when you enroll in the plan. The multilingual staff will answer your call and immediately provide reliable, professional and thorough assistance.
The following services are included:
1. Referral to the nearest, most appropriate medical facility and/or provider.
2. Medical monitoring by board-certified emergency doctors.
3. Urgent message relay between family, friends, personal doctor, and insured.
4. Guarantee of payment to provider and assistance in coordinating insurance benefits.
5. Arranging and coordinating Emergency Medical Evacuations, Emergency Reunions, and Repatriations.
6. Emergency travel arrangements for disrupted travel as a consequence of a medical emergency.
7. Referral to legal assistance.
8. Assistance in locating lost or stolen items including lost ticket application processing. These services are included in the services provided by Worldwide Assistance Services, Inc.
Global Medical International Medical Insurance for individuals traveling outside of their Home Countries and outside of the USA.
