Seguro Internacional | Full
Silver 250
Deductible: 250 USD and Max. Coverage: 5.000.000 USD/Lifetime
From
US$ 155 . 75
G L O B A L M E D I C A L I N S U R A N C E ®
Bronze
Silver
Gold
Platinum
Plan Options:A W O R L D W I D E M E D I C A L I N S U R A N C E P R O G R A M F O R I N D I V I D UA L S A N D FA M I L I E S .
Bronze
Silver
Gold
Platinum
Plan Options:A W O R L D W I D E M E D I C A L I N S U R A N C E P R O G R A M F O R I N D I V I D UA L S A N D FA M I L I E S .
2
Being a global citizen can be an exciting
experience, but it also comes with potential
complications. Your health care should not be
one of those concerns. With Global Medical
Insurance, a revolutionary program from
International Medical Group® (IMG®), you will
receive the worldwide medical coverage you
need, backed by the world-class services you
expect.
Global Medical Insurance allows you to choose
from several plan options, areas of coverage,
multiple deductibles, and modes of payment.
With your medical history in mind, the program
provides different underwriting methods to
extend medical coverage to you that may be
declined by other companies. Quite simply, we
help you build the cover you need.
With IMG, you will rest assured knowing that
we have a dedicated department working to
keep your insurance as affordable as possible.
The costs of health care are rising, but we are
committed to controlling those costs.
You need the proper worldwide coverage,
provided by a company that’s there for you
when you need us most. When you select
Global Medical Insurance, you receive IMG’s
promise to deliver exceptional medical benefits,
medical assistance, and service—all designed to
give you Global Peace of Mind®.
G l o b a l M e d i c a l I n s u r a n c e ®
P l a n H i g h l i g h t s
» Flexibility - Multiple plan options and payment modes to fit your
budget
» Choice of Coverage Area - Worldwide or Worldwide Excluding the
U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan
» Freedom to Choose - Select your own health care provider, no matter
where you are in the world
» Travel Intelligence - Receive location-specific alerts on health,
transportation, security, and weather
» Assistance Services - Available on all plans
» Preventative Care - No waiting period on wellness benefits
» Healthy Travel Preventative Coverage - Receive vaccinations and
preventative prescriptions prior to departure
» Pre-Existing Condition Waiver - For individuals with proof of
comprehensive health insurance and no significant break in coverage
(63 days)
Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way the Certificate of Insurance and
governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
S A F E T Y S O L U T I O N S
No matter your reason for being a global citizen, we know your safety is important to you. IMG’s Global Medical Insurance has solutions designed to protect you and give you Global
Peace of Mind.
P H Y S I C A L H E A L T H
You can’t plan when you get sick, and unfortunately, it can happen anytime
and anywhere. Medical bills can be expensive, and IMG plans provide the
cross-border medical coverage you need for unexpected medical care and
routine visits.
M E N T A L W E L L N E S S
Being away from your support system can be challenging. IMG provides
access to mental health services, like virtual counseling, to help with the
transition as you adapt to cultural differences, adjust to a change in job or
education, and navigate new relationships while you’re away from loved
ones.
F I N A N C I A L P R O T E C T I O N
Costs can add up while seeking medical treatment. However, access
to IMG’s international physician and provider networks and pharmacy
discount programs can help you save on out-of-pocket medical expenses
and prescription medications.
C R I S I S S U P P O R T
Navigating an emergency in a foreign country is never easy. That’s why IMG
offers a travel intelligence app to warn you of imminent dangers and security
threats. Plus, a multilingual staff of nurses, doctors, and case managers
provide 24/7 assistance services to facilitate a response to urgent and
emergency situations, such as evacuations or search and rescue missions.
W o r l d w i d e C o v e r a g e . W o r l d - C l a s s S e r v i c e s .
Being a global citizen can be an exciting
experience, but it also comes with potential
complications. Your health care should not be
one of those concerns. With Global Medical
Insurance, a revolutionary program from
International Medical Group® (IMG®), you will
receive the worldwide medical coverage you
need, backed by the world-class services you
expect.
Global Medical Insurance allows you to choose
from several plan options, areas of coverage,
multiple deductibles, and modes of payment.
With your medical history in mind, the program
provides different underwriting methods to
extend medical coverage to you that may be
declined by other companies. Quite simply, we
help you build the cover you need.
With IMG, you will rest assured knowing that
we have a dedicated department working to
keep your insurance as affordable as possible.
The costs of health care are rising, but we are
committed to controlling those costs.
You need the proper worldwide coverage,
provided by a company that’s there for you
when you need us most. When you select
Global Medical Insurance, you receive IMG’s
promise to deliver exceptional medical benefits,
medical assistance, and service—all designed to
give you Global Peace of Mind®.
G l o b a l M e d i c a l I n s u r a n c e ®
P l a n H i g h l i g h t s
» Flexibility - Multiple plan options and payment modes to fit your
budget
» Choice of Coverage Area - Worldwide or Worldwide Excluding the
U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan
» Freedom to Choose - Select your own health care provider, no matter
where you are in the world
» Travel Intelligence - Receive location-specific alerts on health,
transportation, security, and weather
» Assistance Services - Available on all plans
» Preventative Care - No waiting period on wellness benefits
» Healthy Travel Preventative Coverage - Receive vaccinations and
preventative prescriptions prior to departure
» Pre-Existing Condition Waiver - For individuals with proof of
comprehensive health insurance and no significant break in coverage
(63 days)
Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way the Certificate of Insurance and
governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
S A F E T Y S O L U T I O N S
No matter your reason for being a global citizen, we know your safety is important to you. IMG’s Global Medical Insurance has solutions designed to protect you and give you Global
Peace of Mind.
P H Y S I C A L H E A L T H
You can’t plan when you get sick, and unfortunately, it can happen anytime
and anywhere. Medical bills can be expensive, and IMG plans provide the
cross-border medical coverage you need for unexpected medical care and
routine visits.
M E N T A L W E L L N E S S
Being away from your support system can be challenging. IMG provides
access to mental health services, like virtual counseling, to help with the
transition as you adapt to cultural differences, adjust to a change in job or
education, and navigate new relationships while you’re away from loved
ones.
F I N A N C I A L P R O T E C T I O N
Costs can add up while seeking medical treatment. However, access
to IMG’s international physician and provider networks and pharmacy
discount programs can help you save on out-of-pocket medical expenses
and prescription medications.
C R I S I S S U P P O R T
Navigating an emergency in a foreign country is never easy. That’s why IMG
offers a travel intelligence app to warn you of imminent dangers and security
threats. Plus, a multilingual staff of nurses, doctors, and case managers
provide 24/7 assistance services to facilitate a response to urgent and
emergency situations, such as evacuations or search and rescue missions.
W o r l d w i d e C o v e r a g e . W o r l d - C l a s s S e r v i c e s .
3
W h y I M G ?
IMG offers exceptional service from the moment you purchase a product or service to the moment you need to use it. We know that when spending your hard-earned money, you
want it to go to a company you can trust. IMG’s longevity, stability, and credibility will give you peace of mind when making a purchase. When away from home, your number one
priority is safety. IMG provides safety solutions to address the many and varied needs of global citizens all over the world.
S E R V I C E
IMG has call centers based in the United States and United Kingdom, offering medical,
travel, and security services 24/7. Our highly trained staff have experience working in
remote and hazardous regions, juggling multiple time zones, languages, and currencies.
IMG will ensure you get the help you need, when and where you need it. IMG provides
best-in-class technology offerings allowing you to manage claims, your account, and
search for a provider through our online self-service portal, MyIMG.
S T A B I L I T Y
IMG has experience serving millions of customers worldwide since 1990 and boasts a
large collection of personalized offerings for any type of individual or group traveling,
working, or living away from home. We’re owned by SiriusPoint*, a multi-billion dollar,
AM Best “A-” rated insurance industry leader. IMG offers access to quality care through
a network of providers and facilities across the globe. Don’t just take our word for it,
our reputable assistance services have attracted the business of multiple Fortune 500
companies and other insurance providers.
*SiriusPoint is the DBA of SiriusPoint Ltd.
3
W h y I M G ?
IMG offers exceptional service from the moment you purchase a product or service to the moment you need to use it. We know that when spending your hard-earned money, you
want it to go to a company you can trust. IMG’s longevity, stability, and credibility will give you peace of mind when making a purchase. When away from home, your number one
priority is safety. IMG provides safety solutions to address the many and varied needs of global citizens all over the world.
S E R V I C E
IMG has call centers based in the United States and United Kingdom, offering medical,
travel, and security services 24/7. Our highly trained staff have experience working in
remote and hazardous regions, juggling multiple time zones, languages, and currencies.
IMG will ensure you get the help you need, when and where you need it. IMG provides
best-in-class technology offerings allowing you to manage claims, your account, and
search for a provider through our online self-service portal, MyIMG.
S T A B I L I T Y
IMG has experience serving millions of customers worldwide since 1990 and boasts a
large collection of personalized offerings for any type of individual or group traveling,
working, or living away from home. We’re owned by SiriusPoint*, a multi-billion dollar,
AM Best “A-” rated insurance industry leader. IMG offers access to quality care through
a network of providers and facilities across the globe. Don’t just take our word for it,
our reputable assistance services have attracted the business of multiple Fortune 500
companies and other insurance providers.
*SiriusPoint is the DBA of SiriusPoint Ltd.
3
4
Summary Schedule of Benefits
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Carrier Sirius Specialty Insurance Corporation
Underwriting approach Full Medical Underwriting
Period of Coverage 12 months (Annually renewable)
Area of Coverage Area 2: Worldwide excluding United States, Canada, China, Hong Kong, Japan, Singapore and Taiwan
Area 3: Worldwide
Age Up to Age 74
Lifetime Maximum $1,000,000 per individual $5,000,000 per individual $5,000,000 per individual $8,000,000 per individual
Deductible
Medical Concierge and International: 50% of the deductible waived up to a
maximum of $2,500.
$250 to $10,000 $250 to $10,000 $250 to $25,000 $100 to $25,000
Coinsurance
Medical Concierge: 100%
U.S. in-network: 100%
U.S. out-of-network: 80% up to $5,000 then 100%
International:100%
Precertification Transplants, Interfacility Ambulance Transfer, Medical Evacuation, Orphan Drugs or BIologic Drugs: No coverage if pre-certification requirements are not met
All other Treatments and supplies: 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met.
Pre-existing Conditions
(only applicable when insured is not on a certificate with creditable coverage)
Known Disclosed Conditions N/A Covered the same as any illness or
injury unless excluded by a Rider
Covered the same as any illness or
injury unless excluded by a Rider
Covered if disclosed and not
excluded by rider
Non-disclosed Conditions N/A No Coverage No Coverage Covered if disclosed and not
excluded by rider
Unknown Conditions
After 24 months of continuous coverage N/A Period of Coverage: $5,000
Lifetime Maximum: $50,000
Period of Coverage: $5,000
Lifetime Maximum: $50,000
Covered if disclosed and not
excluded by rider
Inpatient
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated, Lifetime Maximum
Eligible Medical Expenses
Physician Visits
Hospitalization Room/Board $600 per day/ 240 day max
Ancillary Services Covered under Hospitalization room &
board/professional fees $400 per day Covered under Hospitalization room &
board/professional fees
Covered under Hospitalization room &
board/professional fees
Anesthesiologist & Anesthesia
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
Charges and expenses incurred by the Insured Person during the Period of Coverage with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Charges are
Usual, Reasonable and Customary and are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”).
P L A N D E T A I L SP H Y S I C A L H E A L T H
Summary Schedule of Benefits
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Carrier Sirius Specialty Insurance Corporation
Underwriting approach Full Medical Underwriting
Period of Coverage 12 months (Annually renewable)
Area of Coverage Area 2: Worldwide excluding United States, Canada, China, Hong Kong, Japan, Singapore and Taiwan
Area 3: Worldwide
Age Up to Age 74
Lifetime Maximum $1,000,000 per individual $5,000,000 per individual $5,000,000 per individual $8,000,000 per individual
Deductible
Medical Concierge and International: 50% of the deductible waived up to a
maximum of $2,500.
$250 to $10,000 $250 to $10,000 $250 to $25,000 $100 to $25,000
Coinsurance
Medical Concierge: 100%
U.S. in-network: 100%
U.S. out-of-network: 80% up to $5,000 then 100%
International:100%
Precertification Transplants, Interfacility Ambulance Transfer, Medical Evacuation, Orphan Drugs or BIologic Drugs: No coverage if pre-certification requirements are not met
All other Treatments and supplies: 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met.
Pre-existing Conditions
(only applicable when insured is not on a certificate with creditable coverage)
Known Disclosed Conditions N/A Covered the same as any illness or
injury unless excluded by a Rider
Covered the same as any illness or
injury unless excluded by a Rider
Covered if disclosed and not
excluded by rider
Non-disclosed Conditions N/A No Coverage No Coverage Covered if disclosed and not
excluded by rider
Unknown Conditions
After 24 months of continuous coverage N/A Period of Coverage: $5,000
Lifetime Maximum: $50,000
Period of Coverage: $5,000
Lifetime Maximum: $50,000
Covered if disclosed and not
excluded by rider
Inpatient
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated, Lifetime Maximum
Eligible Medical Expenses
Physician Visits
Hospitalization Room/Board $600 per day/ 240 day max
Ancillary Services Covered under Hospitalization room &
board/professional fees $400 per day Covered under Hospitalization room &
board/professional fees
Covered under Hospitalization room &
board/professional fees
Anesthesiologist & Anesthesia
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
Charges and expenses incurred by the Insured Person during the Period of Coverage with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Charges are
Usual, Reasonable and Customary and are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”).
P L A N D E T A I L SP H Y S I C A L H E A L T H
8
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Vision Care
NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Routine Eye Examination N/A N/A N/A Maximum Limit every 24 months: $100
Contact Lenses, Contacts, Frames N/A N/A N/A Maximum Limit every 24 months: $150
Other Services
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Complementary Medicine N/A N/A N/A
Maximum Limit: $500
Services include Acupuncture,
Aromatherapy, Herbal Therapy,
Magnetic Therapy, Massage Therapy
and Vitamin Therapy
Dental Treatment N/A N/A
Max limit: $100
(Treatment due to unexpected pain to
sound natural teeth)
Max limit: $500
(Non-emergency Treatment at a
Dental Provider’s office due to an
Accident)
$750 per period of coverage $50
deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
Traumatic Dental Injury Maximum Limit: $1,000 Maximum Limit: $1,000
High School Sports N/A N/A N/A Lifetime Maximum: $20,000
Includes Collision Sports
Healthy Travel Preventative Coverage
Vaccinations and preventative prescription drugs administered by a
Physician within 30 days prior to th eInsured Person’s Initial Effective Date
and before departing to any destination
Lifetime Maximum: $250 Lifetime Maximum: $250 Lifetime Maximum: $250 Lifetime Maximum: $250
Supplemental Accident N/A N/A Maximum Limit per Accident: $300 Maximum Limit per Accident: $500
Optional Coverage
Terrorism
Platinum option only N/A N/A N/A $50,000 lifetime maximum
Sports Rider
Gold and Platinum options N/A N/A
$10,000 lifetime maximum for amateur
athletics
Adventure Sports:
Through age 49 years: $50,000 lifetime
maximum
Age 50 years through age 59 years:
$30,000 lifetime maximum
Age 60 years through age 64 years:
$15,000 lifetime maximum
$10,000 lifetime maximum for amateur
athletics
Adventure Sports:
Through age 49 years: $50,000 lifetime
maximum
Age 50 years through age 59 years:
$30,000 lifetime maximum
Age 60 years through age 64 years:
$15,000 lifetime maximum
Summary Schedule of Benefits (Continued)
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
P H Y S I C A L H E A L T H
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Vision Care
NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Routine Eye Examination N/A N/A N/A Maximum Limit every 24 months: $100
Contact Lenses, Contacts, Frames N/A N/A N/A Maximum Limit every 24 months: $150
Other Services
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Complementary Medicine N/A N/A N/A
Maximum Limit: $500
Services include Acupuncture,
Aromatherapy, Herbal Therapy,
Magnetic Therapy, Massage Therapy
and Vitamin Therapy
Dental Treatment N/A N/A
Max limit: $100
(Treatment due to unexpected pain to
sound natural teeth)
Max limit: $500
(Non-emergency Treatment at a
Dental Provider’s office due to an
Accident)
$750 per period of coverage $50
deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
Traumatic Dental Injury Maximum Limit: $1,000 Maximum Limit: $1,000
High School Sports N/A N/A N/A Lifetime Maximum: $20,000
Includes Collision Sports
Healthy Travel Preventative Coverage
Vaccinations and preventative prescription drugs administered by a
Physician within 30 days prior to th eInsured Person’s Initial Effective Date
and before departing to any destination
Lifetime Maximum: $250 Lifetime Maximum: $250 Lifetime Maximum: $250 Lifetime Maximum: $250
Supplemental Accident N/A N/A Maximum Limit per Accident: $300 Maximum Limit per Accident: $500
Optional Coverage
Terrorism
Platinum option only N/A N/A N/A $50,000 lifetime maximum
Sports Rider
Gold and Platinum options N/A N/A
$10,000 lifetime maximum for amateur
athletics
Adventure Sports:
Through age 49 years: $50,000 lifetime
maximum
Age 50 years through age 59 years:
$30,000 lifetime maximum
Age 60 years through age 64 years:
$15,000 lifetime maximum
$10,000 lifetime maximum for amateur
athletics
Adventure Sports:
Through age 49 years: $50,000 lifetime
maximum
Age 50 years through age 59 years:
$30,000 lifetime maximum
Age 60 years through age 64 years:
$15,000 lifetime maximum
Summary Schedule of Benefits (Continued)
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
P H Y S I C A L H E A L T H
9
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Mental or Nervous Counseling
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Mental or Nervous
After 12 months of continuous coverage; no waiting period for Platinum N/A Outpatient after 12 months of
continuous coverage
Maximum Limit: $10,000
Lifetime Maximum: $50,000 Lifetime Maximum: $50,000
Bereavement Counseling N/A Lifetime Max: $300 Lifetime Max: $300 Lifetime Max: $300
Remote Mental Health Service
(Non-Insurance Benefit) N/A N/A N/A
Dental
Dental Rider
Bronze, Silver and Gold plan options
$750 per period of coverage
$50 deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
$750 per period of coverage
$50 deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
$750 per period of coverage
$50 deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
Dental Treatment benefit already
included; no rider required
Vision
Vision Rider
Bronze, Silver and Gold plan options
Exams-up to $100 per 24 months
Materials-up to $150 per 24 months
Exams-up to $100 per 24 months
Materials-up to $150 per 24 months
Exams-up to $100 per 24 months
Materials-up to $150 per 24 months
Vision Care benefit already included;
no rider required
Services
Universal Rx Drug Card Copayments N/A N/A N/A
Generic: $20
Brand: (when Generic is unavailable):
$40
Copayments are per 30-day supply
Dispensing maximum per prescription:
90 days
The Family Matters Program N/A N/A N/A
Provides educational information on
pregnancy and provides suggestions
for a healthy lifestyle
Emergency Services
NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Emergency Local Ambulance
Injury/Illness resulting in an Inpatient Hospital admission Maximum Limit per incident: $1,500 Maximum Limit per incident: $1,500
Emergency Medical Evacuation Maximum Limit: $50,000 Maximum Limit: $50,000 Maximum Limit: $50,000 Up to the Lifetime Maximum
Emergency Reunion
Lifetime Maximum: $10,000
Maximum days: 15
Meal Maximum Limit per day: $25
N/A
Lifetime Maximum: $10,000
Maximum days: 15
Meal Maximum Limit per day: $25
Lifetime Maximum: $10,000
Maximum days: 15
Meal Maximum Limit per day: $25
Summary Schedule of Benefits (Continued)
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
M E N T A L H E A L T HP H Y S I C A L H E A L T HC R I S I S S U P P O R T
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Mental or Nervous Counseling
Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Mental or Nervous
After 12 months of continuous coverage; no waiting period for Platinum N/A Outpatient after 12 months of
continuous coverage
Maximum Limit: $10,000
Lifetime Maximum: $50,000 Lifetime Maximum: $50,000
Bereavement Counseling N/A Lifetime Max: $300 Lifetime Max: $300 Lifetime Max: $300
Remote Mental Health Service
(Non-Insurance Benefit) N/A N/A N/A
Dental
Dental Rider
Bronze, Silver and Gold plan options
$750 per period of coverage
$50 deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
$750 per period of coverage
$50 deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
$750 per period of coverage
$50 deductible (max. 2 per family)
Routine services-90% (deductible
waived)
Minor restorative- 70%
Major restorative- 50%
6 month waiting period
Dental Treatment benefit already
included; no rider required
Vision
Vision Rider
Bronze, Silver and Gold plan options
Exams-up to $100 per 24 months
Materials-up to $150 per 24 months
Exams-up to $100 per 24 months
Materials-up to $150 per 24 months
Exams-up to $100 per 24 months
Materials-up to $150 per 24 months
Vision Care benefit already included;
no rider required
Services
Universal Rx Drug Card Copayments N/A N/A N/A
Generic: $20
Brand: (when Generic is unavailable):
$40
Copayments are per 30-day supply
Dispensing maximum per prescription:
90 days
The Family Matters Program N/A N/A N/A
Provides educational information on
pregnancy and provides suggestions
for a healthy lifestyle
Emergency Services
NOT Subject to Deductible and Coinsurance unless otherwise noted
Eligible Expenses are limited to Usual, Reasonable and Customary amounts
Maximum Limit per Period of Coverage or if indicated. Lifetime Maximum
Emergency Local Ambulance
Injury/Illness resulting in an Inpatient Hospital admission Maximum Limit per incident: $1,500 Maximum Limit per incident: $1,500
Emergency Medical Evacuation Maximum Limit: $50,000 Maximum Limit: $50,000 Maximum Limit: $50,000 Up to the Lifetime Maximum
Emergency Reunion
Lifetime Maximum: $10,000
Maximum days: 15
Meal Maximum Limit per day: $25
N/A
Lifetime Maximum: $10,000
Maximum days: 15
Meal Maximum Limit per day: $25
Lifetime Maximum: $10,000
Maximum days: 15
Meal Maximum Limit per day: $25
Summary Schedule of Benefits (Continued)
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
M E N T A L H E A L T HP H Y S I C A L H E A L T HC R I S I S S U P P O R T
10
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Interfacility Ambulance Transfer
(United States Only) Maximum Limit per incident: $1,500 Maximum Limit per incident: $1,500
Political Evacuation and Repatriation N/A N/A N/A Lifetime Maximum: $10,000
Remote Transportation N/A N/A N/A Maximum Limit: $5,000
Lifetime Maximum: $20,000
Return of Mortal Remains Maximum Limit: $25,000 Maximum Limit: $25,000 Maximum Limit: $25,000 Maximum Limit: $50,000
Services
Global Concierge N/A N/A N/A Emergency travel assistance services
Travel Intelligence App
Optional Coverage
Global Term Life Insurance
Age 31 days -18 years
Age 19-29 years
Age 30-39 years
Age 40-44 years
Age 45-49 years
Age 50-54 years
Age 55-59 years
Age 60-64 years
Age 65-69 years
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
AD&D
included with Term Life
Accidental Loss of Life: Principal Sum*
Accidental Total Loss of 2 Members**: Principal Sum*
Accidental Total Loss of 1 Member**: 50%*
(*Benefit based on age at time of death** “Member” means hand, foot or eye)
F I N A N C I A L P R O T E C T I O N
Summary Schedule of Benefits (Continued)
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
C R I S I S S U P P O R T
M y I M G S M M e m b e r P o r t a l
It’s easy to access and manage your IMG accounts any time, from anywhere and any
device, via MyIMG.
MyIMG features include:
» Claims submission and management
» ID Card and insurance documents
access
» Precertification process initiation
» Explanation of Benefit (EOB) access
» Customer Care live chat and contact
information
» Find a Doctor locator
PLAN DETAILS BRONZE SILVER GOLD PLATINUM
Interfacility Ambulance Transfer
(United States Only) Maximum Limit per incident: $1,500 Maximum Limit per incident: $1,500
Political Evacuation and Repatriation N/A N/A N/A Lifetime Maximum: $10,000
Remote Transportation N/A N/A N/A Maximum Limit: $5,000
Lifetime Maximum: $20,000
Return of Mortal Remains Maximum Limit: $25,000 Maximum Limit: $25,000 Maximum Limit: $25,000 Maximum Limit: $50,000
Services
Global Concierge N/A N/A N/A Emergency travel assistance services
Travel Intelligence App
Optional Coverage
Global Term Life Insurance
Age 31 days -18 years
Age 19-29 years
Age 30-39 years
Age 40-44 years
Age 45-49 years
Age 50-54 years
Age 55-59 years
Age 60-64 years
Age 65-69 years
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
$5,000
$75,000
$50,000
$35,000
$25,000
$20,000
$15,000
$10,000
$7,500
AD&D
included with Term Life
Accidental Loss of Life: Principal Sum*
Accidental Total Loss of 2 Members**: Principal Sum*
Accidental Total Loss of 1 Member**: 50%*
(*Benefit based on age at time of death** “Member” means hand, foot or eye)
F I N A N C I A L P R O T E C T I O N
Summary Schedule of Benefits (Continued)
This is a summary schedule of benefits that are subject to exclusions, limitations, maximums, deductible and coinsurance unless otherwise noted. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way
the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
C R I S I S S U P P O R T
M y I M G S M M e m b e r P o r t a l
It’s easy to access and manage your IMG accounts any time, from anywhere and any
device, via MyIMG.
MyIMG features include:
» Claims submission and management
» ID Card and insurance documents
access
» Precertification process initiation
» Explanation of Benefit (EOB) access
» Customer Care live chat and contact
information
» Find a Doctor locator
11
C R I S I S S U P P O R T
Available with Select GMI Plans
*Teleconsultations will not support a diagnosis for Mental or Nervous Disorders. Coverage for a Teleconsultation is not a determination that any specific condition discussed, raised
or identified during such Consultation is covered under this insurance. We reserve the right to decline future claims relating to or arising from any condition discussed, raised or
identified during a Teleconsultation where the illness or injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Policy.
BRONZESILVERGOLDPLATINUM
P H Y S I C A L
H E A L T H F I N A N C I A L P R O T E C T I O N
U n i v e r s a l R X P h a r m a c y D i s c o u n t S a v i n g s (All plan levels)
This discount savings program allows you to purchase prescriptions at one of
over 35,000 participating pharmacies in the U.S. and receive the lower of 1)
Universal Rx contract price or 2) the pharmacy regular retail price. This program
is not insurance coverage. It is purely a discount program.
M e d i c a l C o n c i e r g e (All plan levels)
Whether you are seeking care at a local facility or in an unfamiliar location, quality
of care is a primary concern. IMG’s Medical Concierge program (available in the
U.S.) is designed to provide you with critical information and to assist you in
making the right decision for treatment. Your personal Medical Concierge will
review your specific non-emergency medical condition and provide you with
information on provider ratings, past outcomes, and general costs—all in the
area where you are planning treatment.
You will be entitled to receive a reduction in your deductible for utilizing this
unique medical service while in the United States. This level of individualized
service is unmatched in the international arena.
T e l e c o n s u l t a t i o n * (Gold & Platinum)
Online and telephonic access to a network of medical professionals available
to diagnose, treat and prescribe for non-emergency medical issues. The best
medicine brought to you and your family 24 hours a day, seven days a week.
T r a v e l I n t e l l i g e n c e (All plan levels)
A vital companion that provides access to dynamic alerts and country intelligence
to help you prepare for and stay safe while away from home.
» Travel Intelligence - Trustworthy and timely intelligence, professional advice
and support
» Safety Alerts - Alert notifications of high-risk events, including health, terrorism,
civil unrest, severe weather risks, in or near your current location
» Travel Essentials - Emergency hotline, access to travel documents, important
itinerary information
» Location Awareness - View and receive notifications of proximity threats based
on your current and last shared location
» Destination/Location Tips - Advice based on travel itinerary or countries of
interest
» Friends and Family Sharing - Add additional users to your account so they can
be notified in case of an emergency or a potential threat
C R I S I S S U P P O R T
Available with Select GMI Plans
*Teleconsultations will not support a diagnosis for Mental or Nervous Disorders. Coverage for a Teleconsultation is not a determination that any specific condition discussed, raised
or identified during such Consultation is covered under this insurance. We reserve the right to decline future claims relating to or arising from any condition discussed, raised or
identified during a Teleconsultation where the illness or injury is directly or indirectly related to any Pre-existing Condition or is otherwise excluded under this Policy.
BRONZESILVERGOLDPLATINUM
P H Y S I C A L
H E A L T H F I N A N C I A L P R O T E C T I O N
U n i v e r s a l R X P h a r m a c y D i s c o u n t S a v i n g s (All plan levels)
This discount savings program allows you to purchase prescriptions at one of
over 35,000 participating pharmacies in the U.S. and receive the lower of 1)
Universal Rx contract price or 2) the pharmacy regular retail price. This program
is not insurance coverage. It is purely a discount program.
M e d i c a l C o n c i e r g e (All plan levels)
Whether you are seeking care at a local facility or in an unfamiliar location, quality
of care is a primary concern. IMG’s Medical Concierge program (available in the
U.S.) is designed to provide you with critical information and to assist you in
making the right decision for treatment. Your personal Medical Concierge will
review your specific non-emergency medical condition and provide you with
information on provider ratings, past outcomes, and general costs—all in the
area where you are planning treatment.
You will be entitled to receive a reduction in your deductible for utilizing this
unique medical service while in the United States. This level of individualized
service is unmatched in the international arena.
T e l e c o n s u l t a t i o n * (Gold & Platinum)
Online and telephonic access to a network of medical professionals available
to diagnose, treat and prescribe for non-emergency medical issues. The best
medicine brought to you and your family 24 hours a day, seven days a week.
T r a v e l I n t e l l i g e n c e (All plan levels)
A vital companion that provides access to dynamic alerts and country intelligence
to help you prepare for and stay safe while away from home.
» Travel Intelligence - Trustworthy and timely intelligence, professional advice
and support
» Safety Alerts - Alert notifications of high-risk events, including health, terrorism,
civil unrest, severe weather risks, in or near your current location
» Travel Essentials - Emergency hotline, access to travel documents, important
itinerary information
» Location Awareness - View and receive notifications of proximity threats based
on your current and last shared location
» Destination/Location Tips - Advice based on travel itinerary or countries of
interest
» Friends and Family Sharing - Add additional users to your account so they can
be notified in case of an emergency or a potential threat
Request contact
Apply and/or receive advice from a specialized executive