| PLAN INFORMATION | |
|---|---|
| Maximum Limits | $50,000, $100,000, $500,000, $1,000,000, $2,000,000 |
| Individual Deductible | $0, $100, $250, $500, $1,000, $2,500 |
| Coinsurance - for treatment received outside the U.S. & Canada | No Coinsurance |
| Coinsurance - for treatment received within the U.S. & Canada | In the PPO Network - The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit. Out of the PPO Network - The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit. |
| Benefit Period | Six months |
| MyIMGSM | 24 hour secure access from anywhere in the world to manage your account at anytime |
| World-class Medical Benefits | 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 for average semi-private room rate |
| 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 |
| Prescription Drugs | 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 Due to Accident | Up to the Maximum Limit |
| Dental - Sudden Dental Emergency | Up to $100 |
| Hospital Da y Indemnity | Up to $100 per night up to a maximum of 10 days |
| INTERNATIONAL EMERGENCY CARE | |
| Emergency Medical Evacuation | Up to $500,000 Lifetime Maximum (independent of the Maximum Limit) |
| Emergency Reunion | Up to $50,000 |
| Return of Mortal Remains or Cremation/Burial | Up to $50,000 for Return of Mortal Remains or $5,000 for Cremation/Burial |
| Return of Minor Children | Up to $50,000 |
| Political Evacuation | Up to $10,000 |
| Natural Disaster | $100 per day for five days |
| Identity Theft Assistance | Up to $500 per Period of Coverage |
| ADDITIONAL BENEFITS | |
| Terrorism | Up to $50,000 Lifetime Maximum |
| Sports & Activities Coverage | 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 five months of travel coverage purchased, up to a maximum of two months |
| Trip Interruption | Up to $5,000 |
| Common Carrier Accidental Death | $50,000 to beneficiary; maximum of $250,000 per family |
| Accidental Death & Dismemberment | $25,000 principle sum |
| Lost Luggage | Up to $50 per item of personal property; maximum of $250 |
| 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 to the primary insured only. )" | Up to an additional $400,000 |
| Citizenship Return Rider | Up to the Maximum Limit |
| Evacuation Plus Rider (Available on the individual plan only.) | "Up to age 65. Non Life-threatening Medical Evacuation: Up to a maximum of |
| $25,000. Natural Disaster Evacuation: Up to a maximum of $5,000." | |
| Chaperone/Faculty Leader Replacement Rider (Available on the group plan only.) | Up to $3,000 for round trip economy airline ticket |