BROCHURE, RATES and APPLICATION
 lobal Medical InsuranceSM
Gold Plan
Underwritten by
SIRIUS
International Insurance Corporation
Long-Term, Worldwide Medical
Coverage for Individuals and Families
Global Medical Insurance provides
US$5,000,000 of lifetime coverage with a
full range of benefits suited for individuals and families. The plan offers two options:
worldwide coverage or worldwide coverage excluding the USA and Canada. Both options
provide coverage 24 hours a day, and you have the freedom to choose any doctor or hospital
for treatment. When you select Global Medical Insurance you receive our commitment to
deliver world class health benefits, medical assistance and total peace of mind.
As part of the eligibility requirements for Global Medical Insurance, U.S. citizens must
reside abroad or plan to leave the US on their effective date and plan to reside abroad
for at least six of the next 12 months. Non-US citizens may reside anywhere, including
their country of citizenship, although certain eligibility restrictions may apply to
non-US citizens residing in the United States.
If you are interested in this plan, you may also want to review
Global Basic Insurance. It offers
somewhat reduced benefit levels which also reduces the cost of the coverage. To see a
comparison of these two plans, please click
here.
You also have the option of adding Global Term Life InsuranceSM and
Global Daily IndemnitySM to your Global Medical
Insurance coverage.
AM I Eligible for
Global Medical Insurance?
This plan is renewable. This plan provides
medical coverage for non-U.S. citizens around the globe including the USA.
If you are U.S. citizen, you must already reside outside of the USA or plan
to depart the US within 30 days of the effective date. If you are U.S.
citizen, you also must live or travel outside of the United States for at
least 6 months of any given 12 months of policy period in order to qualify
for this plan. If you are a non-US citizen and a permanent resident of the
United States or resident of Florida, please contact us for eligibility
requirement. Insurance coverage is subject to approval
of the Underwriting Department through evaluation of applicant's medical
history.
 Click here for Instant Quotes & Online
Application
Click here for Rates for Worldwide Coverage
Click
here for Rates for Worldwide Coverage Excluding the USA & Canada
Global Term Life Insurance
Global Term Life Insurance provides protection for your family at the time of a traumatic
loss and is available with no additional underwriting. This coverage is available for a
standard annual premium of $240 and includes an Accidental Death and Dismemberment
benefit. Global Daily Indemnity
Global Daily Indemnity pays you US$100 for each covered overnight hospital stay other than
those related to maternity.
Lifetime Eligibility
Lifetime medical coverage is available if you are enrolled in the Global Medical Insurance
plan by your 65th birthday and maintain continuous coverage to age 75. Prior to your 75th
birthday you will receive a summary of benefits of a new plan, Global Senior Plan®, and
an enrollment form for coverage. There is no additional medical underwriting. You simply
need to review the benefits, and complete and return the enrollment form with your
premium.
|
Scheduled
Benefits & Limits
|
Benefit
Description
Subject to deductible and
coinsurance unless otherwise noted |
Gold Plan
|
|
Coverage Area |
Two options:
worldwide or worldwide excluding the U.S. and Canada |
|
Policy Maximum |
$5,000,000
lifetime per individual |
|
Deductible |
Ranges from $250 to $10,000
per period of coverage, 50% reduction within PPO, Carry forward
deductible - last 30 days of certificate year |
|
Family Deductible |
3x the single |
|
Coinsurance
within the U.S. and Canada |
80% of the next $5,000 of
eligible expenses after the deductible, then 100% to the overall
maximum per period of coverage |
|
Coinsurance
within the PPO network and outside the U.S. and Canada |
100% |
|
Hospitalization / Room & Board |
Average semi-private room rate |
|
Intensive Care
Unit |
Usual, Reasonable and
Customary (URC) |
|
Surgery |
URC |
|
Anesthetist's Charges Associated with Surgery |
URC |
|
Transplants |
$1,000,000
lifetime maximum |
|
Outpatient |
URC |
|
Rx Coverage |
URC |
|
Emergency
Room Illness |
URC -
subject to an additional $250 deductible if not admitted |
|
Emergency
Room Accident |
URC |
|
Local Ambulance |
URC |
|
Emergency
Evacuation |
Limited to policy maximum -
not subject to deductible or coinsurance |
|
Emergency Reunion |
$10,000
lifetime maximum |
|
Return of
Mortal Remains |
$25,000
lifetime maximum per insured -not subject to deductible or
coinsurance |
|
Maternity |
Optional Rider -
$50,000 lifetime maximum, maximum of
$5,000 for normal delivery, $7,500 for C-section, $200 child
wellness benefit for first 12 months - not subject to deductible
or coinsurance. Available after 10
months of coverage benefits reduced by 50% for births that occur
in11th or 12th month of continuous coverage |
|
Supplemental
Accident |
$300
per occurrence - not subject to deductible or coinsurance |
|
Mental/Nervous |
$10,000
per period of coverage up to a $50,000 lifetime maximum.
Available after 12 months of continuous
coverage |
|
Adult Wellness |
$250 per period of coverage
- not subject to deductible or coinsurance
Available for those 30 years of age and over
after 12 months of continuous coverage |
|
Child Wellness |
$200 maximum per period of
coverage -not subject to deductible or coinsurance
Available for children under 18 years of age
after 12 months of continuous coverage |
|
Other Services |
URC |
|
Physical Therapy |
Maximum $50 per visit |
|
High School
Sports Injury |
NA |
|
Recreational
SCUBA |
URC |
|
Remote
Transportation |
NA |
|
Political
Evacuation and Repatriation |
NA |
|
Complementary Medicine |
Acupuncture $150
Aroma Therapy $50
Herbal Therapy $50
Magnetic Therapy $75
Massage Therapy $150
Vitamin Therapy $100
Each per period of coverage |
|
Non-emergency
Dental |
NA |
|
Emergency Dental
due to Accident |
URC |
|
Emergency
Dental due to Sudden Unexpected Pain |
$100 per period of coverage |
|
Vision |
NA |
|
Global
Concierge & Assistance Services |
NA |
|
Pre-existing
Conditions |
$5,000 per period of
coverage up to a $50,000 lifetime maximum.
Available after 24 months of continuous
coverage |
|
NA (Not Applicable) / URC (Usual,
Reasonable and Customary) / SAAI (Same As Any Illness) |
 Optional Maternity Rider..................US$50,000
lifetime maximum
Benefits include: •Pre- and post-natal care
•Maximum of US$5,000 for normal delivery for each pregnancy •Maximum of US$7,500
for C-section delivery for each pregnancy •Well baby care and treatment of newborn
for first 31 days •Child wellness benefits of up to US$200 maximum per period of
coverage (not subject to deductible or coinsurance) for eligible newborn children for the
first 12 months.
Must be selected at time of
initial purchase of plan • Benefits available after 10 months of continuous coverage
• Eligible newborn children may be added without evidence of insurability as long as
an application form is submitted within 31 days of birth • Benefits will be reduced
by 50% for births that occur the 11th or 12th month of continuous coverage.
|
The foregoing list is only a summary of available benefits and coverages, and is subject
to the specific terms and conditions of the plan concerning eligible benefits,
limitations, eligibility and exclusions. Please refer to the certificate wording for a
complete description, which is available upon request.
Click here for Instant Quotes & Online
Application
Click here for Rates for Worldwide Coverage
Click
here for Rates for Worldwide Coverage Excluding the USA & Canada
Pre-Existing Conditions and Exclusions:
Pre-Existing Conditions
After coverage has been in effect for 24 continuous months, Global Medical Insurancesm
provides a US$50,000 lifetime benefit with a maximum of US$5,000 per policy period for
pre-existing conditions that existed at or prior to the effective date. This benefit is
payable whether or not you have received consultation or treatment for the condition(s)
during the 24-month period. This is important since few pre-existing conditions remain
free from consultation or treatment and often do not qualify for coverage in standard
plans. Global Medical Insurancesm does not “rider” or charge
additional premium for pre-existing conditions. If you disclose a pre-existing condition
at the time of application, and we accept you into the plan, you will be covered for
eligible medical expenses, after 24 months.
The following illnesses which exist, manifest
themselves or are treated or have treatment recommended prior to or during the first 180
days of coverage from the initial effective date are considered pre-existing conditions:
tonsillectomy, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the
reproductive system, hysterectomy, hernia, gall stones or kidney stones, any condition of
the breast, any condition of the prostate.
OTHER EXCLUSIONS AND
LIMITATIONS*
- Routine physical examinations first 12 months
- Maternity and newborn-first 12 months
- Mental and nervous-first 12 months
- Organized amateur or professional sports
- Treatment not ordered or received by a physician
- Treatment or supplies not medically necessary
- Investigational, experimental or research procedures
- Custodial care
- Weight modification
- Elective cosmetic or plastic surgery
- Treatment of impotency
- Contraceptive medication or treatment
- Drug and alcohol abuse treatment
- Organ transplants not specifically listed
- Devices to correct sight or hearing
- Routine foot care
- Treatment by a relative or family member
- Treatment as a result of war or riot
- Treatment resulting from illegal activities
- Speech therapy
- Persons HIV+ at effective date
- Services and treatment eligible for payment by any
government or other insurance
Claims Information
CLAIMS PROCEDURE
Once approved for Global Medical Insurancesm you will receive a fulfillment kit
that includes an Identification card and Claim Forms. When you receive treatment, original
itemized bills must be received by Plan Administrator within 90 days of services. Eligible
itemized bills submitted to Plan Administrator will be automatically converted from local
currencies. If you are filing an overseas claim, please remember to include the Overseas
Benefit Form with the Claim Form and other necessary documentation that you forward to the
Plan Administrator.
CLAIM FILING ALTERNATIVES
Direct Payment to Providers
In many cases the Plan Administrator works directly with the hospital or clinic, including
those outside our PPO, for payment of eligible medical expenses. To file a claim, complete
the Claim Form and submit it with original itemized bills. In this case, you will be
responsible for your deductible, coinsurance amounts and non-eligible expenses.
Reimbursement
If you have received treatment and need to be reimbursed for out-of-pocket medical
expenses, complete the Claim Form and submit your original itemized bills and paid
receipts within 90 days. We will reimburse your eligible medical expenses after applying
the deductible and coinsurance.
Please remember to submit your bills and receipts as
soon as you receive them. Do not hold them until the end of the year. The Plan
Administrator will apply eligible medical expenses to your deductible and coinsurance
throughout the year.
Coverage is free for two children aged 9 or younger
when both parents are covered under the plan.
PRE-CERTIFICATION PROCEDURES
Pre-certification (notification of illness or accident) simply means calling the company
prior to treatment. The following treatments must be pre-certified:
- Any surgery or treatment requiring hospitalization
- Outpatient surgery
- CAT scans, MRI's
- Notification within the first 90 days of pregnancy
- Within 48 hours after an emergency admission to the
hospital
- Care in an extended care facility
- Home nursing care
- Durable medical equipment including artificial limbs
- Transplants
By the Plan Administrator we will be able to verify
benefits, review length of stay and coordinate payment with the hospital or outpatient
facility. Pre-certification may be done by you, the doctor, a hospital administrator or
relative.
Click here for Instant Quotes & Online Application
Click here for Rates for Worldwide Coverage
Click
here for Rates for Worldwide Coverage Excluding the USA & Canada
Click here
for Brochure of Global Medical Insurance
If you have any questions or concerns, please contact us
today.
info@internationalriskmanagement.com
877-211-3654 or
559-294-0316
|
Experience
