| Lifetime Maximum Limit | $1,000,000 per individual | $5,000,000 per individual | $5,000,000 per individual | $8,000,000 per individual |
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| Deductible (Per period of coverage) | $250 to $10,000 | $250 to $10,000 | $250 to $25,000 | $100 to $25,000 |
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| Treatment Outside the U.S. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. |
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| Treatment inside the U.S. using Medical Concierge | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. | 50% of deductible waived, up to a maximum of $2,500. No coinsurance. |
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| Treatment inside the U.S. - PPO Network | Subject to deductible. No coinsurance. | Subject to deductible. No coinsurance. | Subject to deductible. No coinsurance. | Subject to deductible. No coinsurance. |
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| Treatment inside the U.S. - Non-PPO Network | Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage. | Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage. | Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage. | Subject to deductible. Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage. |
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| Coinsurance | International – 100%
U.S. in-network – 100%
U.S. out-of-network – 80% | International – 100%
U.S. in-network – 100%
U.S. out-of-network – 80% | International – 100%
U.S. in-network – 100%
U.S. out-of-network – 80% | International – 100%
U.S. in-network – 100%
U.S. out-of-network – 80% |
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| Outpatient | $300 maximum per visit – lab tests; $250 maximum per visit – diagnostic x-rays $500 maximum limit – specialists/physician charges (pre-inpatient / post-inpatient) Subject to deductible and coinsurance | $300 maximum per visit – lab tests; $250 maximum per visit – diagnostic x-rays 25 combined maximum visits
$70 per visit/examination – specialists/physician charges
$50 per visit/examination – chiropractor charges (medical order or treatment plan required)
$500 maximum limit – surgery intervention consultation charges Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
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| Mental/Nervous | N/A | Outpatient after 12 months of continuous coverage. | $10,000 maximum per period of coverage with a $50,000 lifetime maximum - Available after 12 months of continuous coverage. | $50,000 lifetime maximum |
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| Hospital Emergency Room Injury | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
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| Hospital Emergency Room Illness | Subject to deductible and coinsurance. Covered only if admitted as inpatient | Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient | Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient | Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient |
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| Hospitalization / Room & Board | Subject to deductible and coinsurance for average semi-private room rate | Subject to deductible and coinsurance for average semi-private room rate. All subject to $600 per day/240 day maximum | Subject to deductible and coinsurance for average semi-private room rate | Subject to deductible and coinsurance for average private room rate |
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| Intensive Care Unit | Subject to deductible and coinsurance | Subject to deductible and coinsurance. $1,500 limit per day – 180 days of coverage per event | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
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| CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy | Subject to deductible and coinsurance. $600 maximum per examination | Subject to deductible and coinsurance. $600 maximum per examination | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
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| Surgery | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
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| Assistant Surgeon | 20% of primary surgeon’s charge | 20% of primary surgeon’s charge | 20% of primary surgeon’s charge | 20% of primary surgeon’s charge |
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| Chemotherapy or Radiation Therapy | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
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Maternity
Delivery, preventative, newborn care & congenital disorders, Family Matters Maternity Program (available after 10 or 24 months of continuous coverage based on Underwriting review of the Insured Person’s Application) | N/A | N/A | N/A | $2,500 additional deductible per pregnancy. $50,000 lifetime maximum. $200 newborn preventative care benefit for the first 31 days – 12 months after birth. $250,000 maximum for newborn care & congenital disorders for the first 31 days after birth |
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| Podiatry Care | N/A | N/A | $750 maximum limit | $750 maximum limit |
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| Physical Therapy | Subject to deductible and coinsurance. $40 maximum per visit – 10 visit limit per event. Available for 90 days following inpatient treatment or outpatient surgery | Subject to deductible and coinsurance. $40 maximum per visit – 30 visit limit | Subject to deductible and coinsurance. $50 maximum per visit | Subject to deductible and coinsurance. $50 maximum per visit |
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| Transplants | $250,000 lifetime maximum | $250,000 lifetime maximum | $1,000,000 lifetime maximum | $2,000,000 lifetime maximum |
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| Prescription Drugs, Dressings, and Durable Medical Equipment | Subject to deductible and coinsurance. Available for 90 days following related inpatient treatment or outpatient surgery. $600 outpatient maximum limit per event
(includes dressings and durable medical equipment) | Subject to deductible and coinsurance. 90-day supply per prescription following related covered event. U.S. Retail Pharmacy
out-of-network: 80%
International Retail Phamacy: 100% | Subject to deductible and coinsurance. 90-day supply per prescription. U.S. Retail Pharmacy
out-of-network: 80%
International Retail Phamacy: 100% | U.S. Retail Pharmacy: prescription drug card required. Copay per 30-day supply: $20 for generic/$40 for brand name where generic is not available. International Retail Pharmacy (subject to deductible): 100% |
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| Expatriate Prescription Services Program | N/A | N/A | N/A | Copay per 30-day supply: $20 for generic/$40 for non-preferred brand name. Must enroll via provider website: www.expatps.com Dispensing maximum: 180 days |
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Orphan or Biologic Drugs
(Available when all conditions are met) - Approved in writing by company
- Medically necessary
- Not experimental or investigational
Applies to period of coverage max. Max limit applies towards lifetime max. | Inpatient Treatment maximum limit: $250,000. Outpatient Surgery: up to the maximum limit. Subject to deductible and coinsurance. Does not apply to maximum limit per event | Outpatient and Emergency Department Treatment maximum limit: $250,000. Subject to deductible and coinsurance | Inpatient & Outpatient Treatment maximum limit: $250,000. Subject to deductible and coinsurance | Maximum limit $250,000. U.S. Retail Pharmacy & expatriate prescription services program: Subject to copayments. International retail pharmacy: Subject to deductible and coinsurance. Inpatient/outpatient medical treatment: Subject to deductible and coinsurance |
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| Healthy Travel Preventative Coverage | $250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination | $250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination | $250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination | $250 lifetime maximum.
Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination |
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| Vision | Optional Rider | Optional Rider | Optional Rider | $100 maximum per 24 months for exams. $150 per 24 months for materials |
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Emergency Local Ambulance
(Injury or illness resulting in an inpatient hospital admission) | $1,500 maximum limit per event - not subject to deductible or coinsurance. | $1,500 maximum limit per event - not subject to deductible or coinsurance. | Subject to deductible and coinsurance | Not subject to deductible and coinsurance |
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| Emergency Evacuation | $50,000 maximum per period of coverage.
Not subject to deductible or coinsurance. | $50,000 maximum per period of coverage.
Not subject to deductible or coinsurance. | Up to lifetime maximum limit.
Not subject to deductible or coinsurance. | Up to lifetime maximum limit.
Not subject to deductible or coinsurance. |
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| Emergency Reunion | $10,000 lifetime maximum. Not subject to deductible or coinsurance | N/A | $10,000 lifetime maximum. Not subject to deductible or coinsurance | $10,000 lifetime maximum. Not subject to deductible or coinsurance |
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| Interfacility Ambulance Transfer (Transfer from one licensed health care Facility to another licensed health care Facility) | $1,500 maximum limit per event.
Not subject to deductible or coinsurance. U.S. only | $1,500 maximum limit per event.
Not subject to deductible or coinsurance. U.S. only | Subject to deductible and coinsurance.
U.S. only | Not subject to deductible or coinsurance.
U.S. only |
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| Political Evacuation and Repatriation | N/A | N/A | N/A | $10,000 lifetime maximum |
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| Remote Transportation | N/A | N/A | N/A | $5,000 per period of coverage up to $20,000 lifetime maximum.
Not subject to deductible or coinsurance |
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| Return of Mortal Remains | $25,000 lifetime maximum - not subject to deductible or coinsurance. | $25,000 lifetime maximum - not subject to deductible or coinsurance. | $25,000 lifetime maximum - not subject to deductible or coinsurance. | $50,000 lifetime maximum - not subject to deductible or coinsurance. |
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| Complementary Medicine | N/A | N/A | $500 maximum limit per period of coverage | $500 maximum limit per period of coverage |
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Traumatic Dental Injury
Treatment at a hospital facility | $1,000 per period of coverage | $1,000 per period of coverage | Up to the lifetime maximum limit | Up to the lifetime maximum limit |
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| Treatment Due to Unexpected Pain to Sound, Natural Teeth | N/A | N/A | $100 per period of coverage | 100% |
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| Non-Emergency Treatment at a Dental Provider due to an Accident | N/A | N/A | $500 per period of coverage | See Non-Emergency Dental benefit |
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| Non-emergency Dental | Optional Rider | Optional Rider | Optional Rider | $750 maximum per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services |
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Hospital Indemnity
(Inpatient hospitalization outside the U.S. only) | Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. | Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. | Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. | Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage.
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. |
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| Supplemental Accident | N/A | N/A | $300 of Eligible Medical Expenses following an accident.
Not subject to deductible or coinsurance | $500 of Eligible Medical Expenses following an accident.
Not subject to deductible or coinsurance |
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Adult Preventative Care
(Age 19 or older) | N/A | N/A | $250 per period of coverage.
Not subject to deductible or coinsurance | $500 per period of coverage.
Not subject to deductible or coinsurance |
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Child Preventative Care
(Through age 18) | N/A | $70 maximum per visit, 3 visit limit per period of coverage.
Not subject to deductible or coinsurance. | $200 maximum per period of coverage.
Not subject to deductible or coinsurance. | $400 maximum per period of coverage.
Not subject to deductible or coinsurance. |
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| Pre-Existing Conditions Limitation** | Excluded | $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage.** | $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage.** | Covered if disclosed and not excluded by rider |
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| Teleconsultation* | N/A | N/A | Yes | Yes |
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| Remote Mental Health Service | N/A | N/A | N/A | Yes |
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| Travel Intelligence Portal | Yes | Yes | Yes | Yes |
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