Most comprehensive benefit plan including rich maternity and preventive care benefits with a worldwide open provider network.

Transcription

1 2018 Most comprehensive benefit plan including rich maternity and preventive care benefits with a worldwide open provider network.

2 Global Superior is tailored exclusively for individuals and families residing in Latin America and the Caribbean who seek the highest level of comprehensive international health insurance with an open medical provider network around the world. The plan offers a range of deductibles for members and provides coverage for inpatient care, outpatient care, emergencies, preventive care, specialized treatments plus a pharmacy benefit and more. As with all GBG plans, Global Superior includes the world-class services of GBG Latin America for medical assistance and evacuations, if necessary, anywhere in the world any time of day. GBG services include a vast network of medical facilities that will bill GBG directly, eliminating the need for a member to pay up-front for services. Global Superior also includes the GBG Personal Medical Advisor, one of the world s leading Medical Second Opinion services. Geographic Coverage Areas Global Superior provides worldwide coverage with open network, including access to a U.S. Preferred Provider Network containing more than 5,000 hospitals and 550,000 providers. This extensive geographic coverage area and use of provider networks allow GBG to provide first-rate worldwide coverage while maintaining affordable rates.

3 Worldwide: free choice of Provider Global Superior Schedule of Benefits MAXIMUM BENEFIT Maximum per Policy Period: $10,000,000 PROVIDER NETWORK POLICY PERIOD DEDUCTIBLES Plan In Country of Residence Out of Country of Residence Plan In Country of Residence Out of Country of Residence Plan 1 N/A N/A Plan 4 $5,000 $5,000 Plan 2 $1,000 $2,000 Plan 5 $10,000 $10,000 Plan 3 $2,000 $3,000 Plan 6 $20,000 $20,000 Family Maximum Deductible: 2 x Individual Deductible HOSPITALIZATION BENEFITS Private/Semi-private room Intensive care unit Medical treatment, medicines, laboratory and diagnostic tests (including cancer treatment, chemotherapy/radiotherapy) Inpatient consultation by a physician or specialist Inpatient surgery, medical and nursing fees Extended Care / Inpatient Rehabilitation (must be confined to facility immediately following a Hospital stay) Private duty nursing Accommodation charges for companion of a hospitalized child Guest meals $500 per day, maximum 10 days $50 per day, maximum 10 days Inpatient psychiatric and psychotherapist consultation OUTPATIENT BENEFITS Outpatient physician/specialist visit Diagnostic exams including laboratory and imaging tests Outpatient surgery, medical and nursing fees Physical Therapy and Rehabilitation services Complementary therapy: Osteopathic, Chiropractic, Podiatric, Psychiatric, Short Term Speech, Homeopathic and Acupuncture Preventive Care/ Check-up for children (six months or older) and adults ; Policy Period maximum 80 visits, all therapies combined $900 maximum per Insured, per Policy Period; Deductible waived Prescribed drugs following a covered hospitalization, Outpatient surgery or consultation Serious Accident Hospitalization (24 hours or more) EMERGENCIES ; Deductible waived for period of first hospitalization only Ground ambulance Air Ambulance ; Deductible waived Emergency room and medical services Emergency Dental care - Limited to accidental injury of sound, natural teeth. Services must be completed within 120 days of Accident. Travel Reimbursement Benefit Up to $5,000 per Policy Period This is only a brief summary of key Plan provisions. Please refer to the Policy for complete details. Benefits are per person per Policy Period and are based upon medical necessity and Usual, Customary and Reasonable (UCR) charges, after Policy Period Deductible. Currency: USD

4 Prophylactic surgery (only for gynecological cancer) Bariatric surgery (A 24-month Waiting Period applies) Lasik surgery SPECIALIZED TREATMENTS ; up to $7,500 Lifetime Maximum ; up to $15,000 Lifetime Maximum Up to $500 Lifetime Maximum Congenital and Hereditary Conditions Transplant procedures (In the U.S., must use the Institutes of Excellence approved by GBG) OTHER BENEFITS ; $2,000,000 Lifetime Maximum per diagnosis including donor expenses and donor procurement expenses up to $60,000 Oncologic treatment Dialysis Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), AIDS Related Complex (ARC). A 24 month Waiting Period applies. Benefit is not covered if condition was diagnosed a Pre-existing Condition. GBG Personal Medical Advisor - Medical Second Opinion service ; up to$50,000 Lifetime Maximum Covered Professional sports Home Health Care/ Home Care Special treatments (prosthesis, implants, appliances, and orthotic devices, durable medical equipment, radiation therapy, chemotherapy, and highly specialized drugs) Hospice Care Durable Medical Equipment Prosthetic limbs $50,000 Policy Period maximum; $200,000 Lifetime Maximum Repatriation of mortal remains Per Insured maximum benefit: $75,000 War and Terrorism benefit Term Life Insurance/Mortal Benefit - Coverage terminates at the end of the Policy Period following attainment of age % Deductible reduction benefit (on the 4th Policy Period after 3 consecutive years without paid claims and no change in Policy Deductible) MATERNITY BENEFITS (INCLUDED UNDER PLANS 2 & 3 ONLY) $30,000 Policyholder; $7,500 spouse; $1,000 per dependent child Plans 2, 3 and 4 only A 10 month waiting period applies; no maternity related treatment for the mother or newborn is covered during this period. Deductible waived unless stated otherwise. If only the mother is covered in the Policy (normal delivery or c-section) If both the mother and the father are covered in the Policy (normal delivery or c-section) Complications of Maternity and Perinatal (provided the pregnancy is a Covered Pregnancy) $12,500 benefit maximum per pregnancy $17,500 benefit maximum per pregnancy ; up to $10,000,000 Lifetime Maximum This is only a brief summary of key Plan provisions. Please refer to the Policy for complete details. Benefits are per person per Policy Period and are based upon medical necessity and Usual, Customary and Reasonable (UCR) charges, after Policy Period Deductible. Currency: USD

5 MATERNITY BENEFITS (INCLUDED UNDER PLANS 2 & 3 ONLY) (CONTINUED) Optional Rider for Complications of Maternity and Perinatal (plans 4, 5 & 6 only). Coverage for Policyholder or spouse only Infant examinations (immunizations & routine medical exams) provided the child was born under a pregnancy covered by the maternity benefit Provisional coverage for newborn (for a maximum of 90 days); Covered Pregnancies only Blood cord storage Fertility treatment (A 24-month waiting period applies) $500,000 Lifetime Maximum, all pregnancies combined; Deductible applies ; up to 6 months of age; maximum 7 visits $50,000 benefit maximum per pregnancy $2,000 Lifetime Maximum per Covered Pregnancy $5,000 Lifetime Maximum; Deductible applies Key Benefits The highest level of worldwide health insurance coverage Policy Period maximum of $10,000,000 No Lifetime Maximum Free choice of Hospitals worldwide Inpatient and Outpatient coverage Worldwide direct-bill network Online claims filing Live customer service Maternity benefits including a $17,500 benefit if both parents are covered on the same plan Newborn care benefits Transplant procedure benefit Life benefit Worldwide portability PRE-AUTHORIZATION IS RECOMMENDED FOR THESE SERVICES Hospitalization Exam and Outpatient procedures that requires more than local anesthesia Any condition that are expected to accumulate over $10,000 of medical treatment per Policy Period Inpatient private duty nursing THE FOLLOWING SERVICES REQUIRE PRE-AUTHORIZATION Organ, bone marrow, stem cell transplants, and other similar procedures Air Ambulance Air Ambulance service will be coordinated by Insurer s Air Ambulance Provider Oncological Treatment in excess of $10,000 Home Health Benefits/ Home Care Extended Care / Inpatient Rehabilitation (Must be confined to facility immediately following a Hospital stay) Specialty Treatments and Highly Specialized Drugs Physical Therapy and Rehabilitation Services (after 60 visits combined) NOTE: Failure to Pre-authorize a procedure that requires Pre-authorization will result in a 30% penalty. This is only a brief summary of key Plan provisions. Please refer to the Policy for complete details. Benefits are per person per Policy Period and are based upon medical necessity and Usual, Customary and Reasonable (UCR) charges, after Policy Period Deductible. Currency: USD

6 LATAM_GSUPERIOR_ENG_01FEB2018 Global Benefits Group Portola Parkway, Suite 110 Foothill Ranch, CA USA GBG Latin America 7600 Corporate Center Drive, Suite 500 Miami, FL USA latam.gbg.com