Insurance Plan for EDUCATIONAL or CULTURAL EXCHANGE Program Participants. Global Adventure

Transcription

1 Insurance Plan for EDUCATIONAL or CULTURAL EXCHANGE Program Participants Global Adventure

2 Global Adventure Plan is a travel plan designed to protect you from acute, unexpected, sudden and unforeseen illnesses and accidental injuries. This plan is tailored for those holding a J-1 Visa who are participating in an educational or cultural exchange program. Global Adventure Plan meets U.S. visa insurance requirements and offers worldwide coverage, with no geographic restrictions. 2

3 Experience and Expertise in the International Marketplace Global Benefits Group has been specializing in the financial services market for more than 35 years, serving as leading underwriters, developers and distributors of products and services designed especially for the needs of overseas students and international travelers. GBG underwrites health, life, disability, travel and other specialty insurances for groups and individuals who are expatriates, third- country nationals or high net-worth local nationals. Global Benefits Group is the leading provider of health insurance to the international educational community, with customers in over 100 countries. As globalization of the world s economy has continued to accelerate, GBG has developed a specialized underwriting structure that is required to meet the needs of this select market niche. This structure is devoted to one business only: underwriting risks for organizations and individuals whose life and work transcend geographic boundaries. 3

4 Per Injury or Sickness Maximum Deductible per Plan Participant per Injury or Illness Coinsurance Co-Payment Student Health Center Hospital Emergency Room Schedule of Benefits GENERAL FEATURES AND PLAN SPECIFICATIONS COVERAGE In-Network Provider Benefit $100k, $250k or $500k Available $100 or $500 Available In-Network: 100% or 80% of the Preferred Allowance Available Out-of-Network: 80% or 60% of UCR Available $5 per visit (not subject to plan deductible) $250 per visit (not subject to plan deductible) Out-of-Network Provider Benefit Accident and Sickness Medical Benefit $100,000 per Injury or Sickness Hospital Room & Board Benefit 100% of the Preferred Allowance 80% of UCR Intensive Care/Cardiac Care Unit Benefit 100% of the Preferred Allowance 80% of UCR Hospital Miscellaneous Expense Benefit 100% of the Preferred Allowance 80% of UCR Surgeon (In or Outpatient) Benefits 100% of the Preferred Allowance 80% of UCR Assistant Surgeon Benefit 100% of the Preferred Allowance 80% of URC up to 25% of the Surgeon Allowance Pre-Admission Testing Benefit 100% of the Preferred Allowance 80% of UCR Anesthesia Benefit 100% of the Preferred Allowance 80% of URC up to 25% of the Surgeon Allowance Day Surgery Miscellaneous Benefit 100% of the Preferred Allowance 80% of UCR Diagnostic X-Ray and Lab Benefit 100% of the Preferred Allowance 80% of UCR Ambulance Benefit 100% of the Preferred Allowance 80% of UCR Physician Visit Benefit (Inpatient) Physician Office Visit Benefit (Outpatient) 100% of the Preferred Allowance, limited to 1 visit per day 100% of the Preferred Allowance, limited to 1 visit per day 80% of URC, limited to 1 visit per day 80% of URC, limited to 1 visit per day Consultant Physician Benefit 100% of the Preferred Allowance 80% of UCR Radiation/Chemotherapy Benefit 100% of the Preferred Allowance 80% of UCR Emergency Room Benefit Emergency Dental Expense Benefit Palliative Dental Physiotherapy Expense Benefit - Inpatient Physiotherapy Expense Benefit - Outpatient 100% of the Preferred Allowance subject to a $250 copay, waived if admitted 100% of the Preferred Allowance, up to $500 maximum benefit 100% of the Preferred Allowance, up to $350 maximum benefit 100% of the Preferred Allowance, up to a maximum of 1 visit per day 100% of the Preferred Allowance, up to a maximum of 1 visit per day 80% of URC, subject to a $250 deductible, waived if admitted 80% of URC, up to $500 maximum benefit 80% of URC, up to $350 maximum benefit 80% of URC, up to a maximum of 1 visit per day 80% of URC, up to a maximum of 1 visit per day Durable Medical Equipment Expense Benefit 100% of the Preferred Allowance 80% of UCR Emergency Medical Evacuation Expense Benefit 100% of actual expense, up to $50,000 Return of Mortal Remains Expense Benefit 100% of actual expense, up to $25,000 4

5 PRESCRIPTION DRUG EXPENSE BENEFIT In-Network Provider Benefit Out-of-Network Provider Benefit Dispensed by a Student Health Center 100% of each 30 day supply Dispensed while Inpatient at a Hospital 100% of the Preferred Allowance 80% of UCR Outpatient Prescription Drugs 100% of each 30 day supply 80% of each 30 day supply Option 1 - $100,000 Annual Max; $ % coinsurance Under 24 $ $ $ Option 3 - $250,000 Annual Max; $ % coinsurance Under 24 $ $ $ Option 5 - $500,000 Annual Max; $ % coinsurance Under 24 $ $ $ Option 2 - $100,000 Annual Max; $500 80% coinsurance Under 24 $ $ $ Option 4 - $250,000 Annual Max; $500 80% coinsurance Under 24 $ $ $ Option 6 - $500,000 Annual Max; $500 80% coinsurance Under 24 $ $ $ Key Benefits Options of $100,000, $250,000 and $500,000 Policy Maximums Unlimited Lifetime Maximum Options of 100% & 80% Coinsurance In-Network Options of $100 & $500 In-Network Deductible per Injury/Illness Coverage for Emergency Evacuation, Repatriation and Return of Mortal Remains The Aetna Network includes healthcare providers and hospitals nationwide Online & live multilingual customer service available 24/7 Online claims filing with 5

6 GlobalAdventurePlan_ENG_17OCT2017 Global Benefits Group Portola Parkway, Suite 110 Foothill Ranch, CA USA GBG Assist U.S. Toll-Free: Worldwide Collect: