| PLAN INFORMATION | |
|---|---|
| Maximum Limits | $1,000,000, $5,000,000, $8,000,000 |
| Individual Deductible | $0, $100, $250, $500, $1,000, $2,500, $5,000, $10,000, $25,000 |
| Family Deductible | Three times the individual deductible |
| Coinsurance - for treatment received outside the U.S. & Canada | No Coinsurance |
| Coinsurance - for treatment received within the U.S. & Canada | In the PPO Network - No Coinsurance. Out of the PPO Network - The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limits. |
| Benefit Period | 12 months |
| Global Concierge & Assistance Services | Access to a dedicated service team for assistance services |
| MyIMGSM | 24 hour secure access from anywhere in the world to manage your account at anytime |
| eDocAmerica | Access to board-certified physicians, licensed psychologists, pharmacists, dentists, dieticians and fitness trainers to assist with any routine health related questions |
| World-class Medical Benefits | Premium coverage available for in-patient and out-patient medical expenses |
| International Emergency Care | A wide range of international emergency benefits available including emergency evacuation, emergency reunion, return of mortal remains, return of minor children and more |
| MEDICAL BENEFITS | |
| Hospital Room and Board | Up to the Maximum Limit |
| Intensive Care | Up to the Maximum Limit |
| Medical Expenses | Up to the Maximum Limit |
| Out-patient Medical Expenses | Up to the Maximum Limit |
| Local Ambulance | Up to the Maximum Limit |
| Emergency Room Accident | Up to the Maximum Limit |
| Emergency Room Illness with In-patient Admission | Up to the Maximum Limit |
| Emergency Room Illness without In-patient Admission | Up to the Maximum Limit with additional $250 deductible |
| Dental - Injury ue to Accident | Up to the Maximum Limit |
| Dental - Sudden Dental Emergency | Up to $250 |
| Hospital Dai y Indemnity | Up to $250 per night for a maximum of 10 days |
| Supplemen al Accident | Up to $300 |
| INTERNATIONAL EMERGENCY CARE | |
| Emergency Medical Evacuation | Up to the Maximum Limit |
| Emergency Reunion | Up to $100,000 |
| Return of Mortal Remains or Cremation/Burial | Up to $100,000 for Return of Mortal Remains or $5,000 for Cremation/Burial |
| Return of Minor Children | Up to $100,000 |
| Political Evacuation | Up to $100,000 |
| Natural Disaster | $250 per day for five days |
| Remote Transportation | $5,000 per certificate period. $20,000 Lifetime Maximum. |
| Identity Theft Assistance | Up to $500 |
| Lost / Theft (Luggage, valuables, personal papers) | Up to $500 |
| Felonious Assault | Up to $10,000 |
| ADDITIONAL BENEFITS | |
| Terrorism | Up to the Maximum Limit |
| Sports & Leisure Activities | Up to the Maximum Limit for basic sports |
| Sudden and Unexpected Recurrence of a Pre-existing Condition - Medical (for U.S. citizens only) | Up to age 65 with primary health plan: URC up to plan maximum. Up to age 65 without primary health plan: $20,000 Lifetime Maximum. Age 65+: $2,500 Lifetime Maximum. |
| Sudden and Unexpected Recurrence of a Pre-existing Condition - Medical (for non-U.S. citizens only) | Up to age 65: $50,000 Lifetime Maximum for eligible medical expenses. Age 65+: $2,500 Lifetime Maximum. |
| Sudden and Unexpected Recurrence of a Pre-existing Condition - Emergency Medical Evacuation | Up to $25,000 of eligible costs and expenses |
| Incidental Home Country Coverage | Up to a cumulative two weeks |
| End of Trip Home Country Coverage | One month for every four months of travel coverage, up to a maximum of three months |
| Trip Interruption | Up to $10,000 |
| Common Carrier Accidental Death | $100,000 per adult, $25,000 per child, maximum of $250,000 per family |
| Accidental Death & Dismemberment | $50,000 principle sum |
| Small Pet Common Air Carrier Accidental Death | Up to $500 |
| OPTIONAL RIDERS | |
| Adventure Sports Rider (Available to insureds up to age 65.) | Age 0-49: $50,000 Lifetime Maximum; Age 50-59: $30,000 Lifetime Maximum; Age 60-64: $15,000 Lifetime Maximum |
| Enhanced AD&D Rider (Available on the individual plan only. Available for the primary insured only.) | Up to an additional $400,000 |
| Citizenship Return Rider | Up to the Maximum Limit |
| Personal Liability - Injury to third party Personal Liability - Damage to third person property | $2,000 limit after $100 deductible. $500 limit after $100 deductible. |
| Evacuation Plus Rider (Available on the individual plan only.) | Up to age 65. Non Life-threatening Medical Evacuation: Up to a maximum of $50,000; Natural Disaster Evacuation: Up to a maximum of $10,000 |
| Chaperone/Faculty Leader Replacement Rider (Available on the group plan only.) | Up to $3,000 for round trip economy airline ticket |