Global Medical Platinum Insurance

Global Medical Platinum insurance benefits

• Hospital room and board	Subject to deductible and coinsurance for average private room rate
  Surgery	Subject to deductible and coinsurance
  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. $50 maximum per visit
  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 $5k of eligible expenses, then 100% to the overall maximum per period of coverage
  Office visits and Diagnostic/X-Ray	Subject to deductible and coinsurance
  CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy	Subject to deductible and coinsurance
  Transplants	$2M lifetime maximum
  Maternity	$2.5k additional deductible per pregnancy. $50k lifetime maximum. $200 newborn preventative care benefit for the first 31 days -12 months after birth. $250k maximum for newborn care & congenital disorders for the first 31 days after birth
  Podiatry Care	$750 maximum limit

• Emergency local ambulance(Injury or Illness resulting in an inpatient hospital admission)	subject to deductible or coinsurance
  Emergency Room Accident	Up to the maximum limit
  Emergency room illness	Subject to deductible and coinsurance.Additional $250 deductible if not admitted as an inpatient

• Treatment Due to Unexpected Pain to Sound, Natural Teeth	100%
  Traumatic Dental Injury Treatment at a hospital facility	Up to the lifetime maximum limit
  Non-Emergency Dental	$750 maximum per period of cov-erage; $50 individual deductible, applies to minor restorative and major restorative services

• Emergency medical evacuation	Up to maximum limit. Not subject to deductible or coinsurance
  Emergency reunion	$10k maximum limit. Not subject to deductible
  Return of mortal remains or cremation/burial	$50k lifetime maximum. Not subject to deductible or coinsurance
  Child Preventative Care( Through age 18)	$400 per period of coverage. Not subject to deductible or coinsurance.
  Adult Preventative Care(Age 19 or older)	$500 per period of coverage. Not subject to deductible or coinsurance.
  Political Evacuation and Repatriation	$10k lifetime maximum

• Orphan or Biologic Drugs	Maximum limit $250k.
  Healthy Travel Preventative Coverage	$250 lifetime maximum.
  Vision	$100 maximum per 24 months for exams. $150 per 24 months for materials
  Supplemental Accident	$500 maximum limit per accident. Not subject to deductible and coinsurance

• Pre-Existing Conditions Limitation

  Covered if disclosed and not excluded by rider

• Mental/Nervous	Subject to deductible and coinsurance.$50k lifetime maximum. Available after 12 months of continuous coverage
  Prescription Coverage	Co-pay per 30-day supply: $20 for generic / $40 for brand name where generic is not available. International Retail Pharmacy(subject to deductible): 100%
  Complementary Medicine	$500 maximum limit per period of coverage
  Expatriate Prescription Services Program	Co-pay per 30-day supply: $20 for generic / $40 for non-preferred brand name. Dispensing maximum: 180 days
  Remote Transportation	$5k per period of coverage up to $20k lifetime maximum