| MEDICAL
INSURANCE |
BENEFIT
Subject
to deductible and coinsurance |
Coverage
Area
|
Worldwide
|
Policy
Maximum Per Individual
Hospitalization
Semiprivate room and board, Nursing services, Prescription medication,
Physician charges, Diagnostic and laboratory testing, X-rays, Chemotherapy
and radiation, Durable medical equipment, Treatment, services and
supplies routinely provided. |
US$5,000,000
lifetime |
Intensive
Care Unit
|
URC |
Surgery
Surgical care, Second surgical opinion, Anesthetics, Physician charges
for surgery, Treatment, services and supplies routinely provided. |
URC |
Transplants
Covered only within IMG's PPO Transplant Facilities. |
US$500,000
lifetime |
Outpatient
Emergency treatment of illness or injury, Surgery, Rehabilitative
treatment, Treatment, services or supplies routinely provided, Prescription
medication. |
URC |
Emergency
Surgery or dental treatment following an accident, Emergency room
following an accident. |
URC |
Emergency
Transportation by
Ground Ambulance |
URC |
Emergency
Medical Evacuation
Included with Emergency Medical Evacuation is an Emergency
Reunion benefit of US$10,000 lifetime.
|
US$50,000
lifetime |
| Repatriation |
US$25,000 |
Supplemental
Accident
The first $300 will be covered for each accidental injury. |
US$300
per occurrence (not
subject to the deductible or coinsurance) |
Maternity
After 12 months of continuous coverage, Pre and Postnatal care, Normal
delivery or C-section, Well baby care and treatment of newborn
coverage for first 31 days. |
US$25,000
lifetime
maximum of US$5,000 for normal delivery for each pregnancy
lmaximum of US$7,500 for C-Section delivery for each pregnancy |
Newborns
Eligible newborn children may be added without
evidence of insurability. An application must be submitted within
31 days of child's birth. |
URC |
Child
Wellness
Available for eligible children from 14 days to 18 years of age after
12 months of continuous coverage. |
US$50
maximum per visit; US$150 per policy period (not subject
to deductible or coinsurance) |
Pre-existing
Conditions
After 24 months of continuous coverage. |
US$50,000
lifetime (maximum of US$5,000 per policy period) |
Mental/Nervous
Care
After 12 months of continuous coverage, Inpatient and outpatient care
by a licensed psychiatrist. |
US$10,000
per period,
US$20,000 lifetime
|
Wellness
Females age 35 and over after 24 months on the plan. Routine physicals
l Mammogram, ob/gyn visit, etc. (exams must be separtated by 12 months)
Males age 40
and over, after 24 months on the plan Routine physicals. (exams
must be separated by 12 months) |
US$250
per period
(not subject to deductible or coinsurance) |
| Complimentary
Medicine |
|
| Acupuncture |
US$150 |
| Aroma
Therapy |
US$50 |
| Herbal
Therapy |
US$50 |
| Magnetic
Therapy |
US$75 |
| Massage
Therapy |
US$150 |
| Vitamin
therapy |
US$100 |
Other
Chiropractor when referred by a physician, Radiation treatment, Home
nursing care, Hospice care, Physical therapy (maximum US$50 per visit),
Prosthetic devices. |
URC |
Other
Chiropractor when referred by a physician.
- Radiation
treatment
- Home nursing
care, Hospice care
- Physical
therapy (maximum US$50 per visit)
- Prosthetic
devices
|
100% |