Global Medical Bronze Insurance

Global Medical Bronze insurance benefits

• Hospital room and board	Subject to deductible and coinsurance for average private room rate
  Surgery	Up to the maximum limit
  Intensive care unit	Subject to deductible and coinsurance
  Assistant Surgeon	20% of primary surgeon’s charge
  Hospital Indemnity(Inpatient hospitalization outside the U.S. only)?	Private Hospitals: $400 maximum limit per overnight and $4k maximum limit per period of coverage Public Hospitals: $500 maximum limit per overnight and $5k maximum limit per period of coverage. Not subject to deductible or coinsurance

• Chemotherapy or Radiation Therapy	Subject to deductible and coinsurance
  Physical therapy	Subject to deductible and coinsurance. $40 maximum per visit - 10 visit limit per event. Available for 90 days following inpatient treatment or outpatient surgery
  Treatment Outside the U.S.	50% of deductible waived, up to a maximum of $2.5k. No coinsurance
  Treatment Inside the U.S. (using Medical Concierge)	50% of deductible waived, up to a maximum of $2.5k. No coinsurance
  Treatment Inside the U.S. (PPO Network)	Subject to deductible. No coinsurance
  Treatment Inside the U.S. (Non PPO Network)	Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage
  Office visits and Diagnostic/X-Ray	$300 maximum per visit - lab tests; $250 maximum per visit - diagnostic X-rays $500 maximum limit - specialists/physician charges (pre-inpatient / post-inpatient) Subject to deductible and coinsurance
  CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy	Subject to deductible and coinsurance. $600 maximum limit per examination
  Transplants	$250k lifetime maximum

• Emergency local ambulance(Injury or Illness resulting in an inpatient hospital admission)	$1.5k maximum limit per event. Not subject to deductible or coinsurance
  Emergency Room Accident	Up to the maximum limit
  Emergency room illness	Subject to deductible and coinsurance. Covered only if admitted as inpatient

• Traumatic Dental Injury Treatment at a hospital facility	$1k per period of coverage
  Non-Emergency Dental	Optional Rider

• Emergency medical evacuation	$50k maximum per period of coverage. Not subject to deductible or coinsurance
  Emergency reunion	$10k maximum limit. Not subject to deductible
  Return of mortal remains or cremation/burial	$10k maximum limit. Not subject to deductible

• Healthy Travel Preventative Coverage	$250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination
  Vision	Optional Rider
  Orphan or Biologic Drugs (Available when all conditions are met) » Approved in writing by company » Medically necessary » Not experimental or investigational Applies to period of coverage max. Max limit applies towards lifetime max.	Inpatient Treatment maximum limit: $250k. Outpatient Surgery: up to the maximum limit. Subject to deductible and coinsurance. Does not apply to maximumlimit per event

• Pre-Existing Conditions Limitation

  Excluded

• Prescription Coverage

  Subject to deductible and coinsurance.Available for 90 days following related inpatient treatment or outpatient surgery.$600 maximum limit per event(includes dressings and durable medical equipment)