Travel Insurance Plan for INTERNATIONAL J Visa Travelers

Travel Insurance Plan for INTERNATIONAL J Visa Travelers

The Global Adventure Plan offers international travelers with a J-1 and J-2 visa an alternative to more expensive health plans. It is designed to protect from acute, unexpected, sudden and unforeseen illnesses and accidental injuries. Coverage is available to all outside their home country who are enrolled and actively attending an accredited high school, college, university or work program. The plan offers worldwide coverage, with no geographic restrictions. 2

Experience and Expertise in the International Marketplace Global Benefits Group has been specializing in the educational 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. GBG 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

Schedule of Benefits Comparison Benefit Coverage Global Adventure Plus Benefit Global Adventure Benefit Benefit Maximum $100,000 per Injury or Sickness $100,000 per Injury or Sickness Plan Deductible per Participant $100 per Injury or Sickness $500 per Policy Year Student Health Center Copay Coinsurance $5 per visit (not subject to plan deductible) 100% of Usual, Customary & Reasonable (UCR) Charges $5 per visit (not subject to plan deductible) 80% of Usual, Customary & Reasonable (UCR) Charges Accident and Sickness Medical Benefit $100,000 per Injury or Sickness $100,000 per Injury or Sickness Hospital Room & Board Benefit 100% of the Semi-Private Room Rate 80% of the Semi-Private Room Rate Intensive Care/Cardiac Care Unit Benefit 100% of UCR 80% of UCR Hospital Miscellaneous Expense Benefit 100% of UCR 80% of UCR Surgeon (In or Outpatient) Benefits 100% of UCR 80% of UCR Assistant Surgeon Benefit 100% of UCR 80% of UCR Pre-Admission Testing Benefit 100% of UCR 80% of UCR Anesthesia Benefit 100% of UCR 80% of UCR Day Surgery Miscellaneous Benefit 100% of UCR 80% of UCR Diagnostic X-Ray and Lab Benefit 100% of UCR 80% of UCR Ambulance Benefit 100% of Actual Charges 80% of Actual Charges Physician Visit Benefit (Inpatient) Physician Visit Benefit (Outpatient) 80% of UCR, limited to 1 visit 800% of UCR, limited to 1 visit Consultant Physician Benefit 100% of UCR 80% of UCR Radiation/Chemotherapy Benefit 100% of UCR 80% of UCR Emergency Room Benefit 100% of UCR, subject to a $250 80% of UCR, subject to a $250 deductible, waived if admitted deductible, waived if admitted Emergency Dental Expense Benefit 100% of UCR, up to $500 maximum 80% of UCR, up to $500 maximum Palliative Dental (includes treatment for immediate relief of infected tooth or gum) 100% of UCR, up to $350 maximum 80% of UCR, up to $350 maximum Physiotherapy Expense Benefit - Inpatient Physiotherapy Expense Benefit - Outpatient Durable Medical Equipment Expense Benefit Emergency Medical Evacuation Expense Benefit Return of Mortal Remains 80% of UCR, limited to 1 visit 80% of UCR, limited to 1 visit 100% of UCR 80% of UCR 100% of actual expense, up to $50,000 100% of actual expense, up to $25,000 80% of actual expense, up to $50,000 80% of actual expense, up to $25,000 Acute Onset of a Pre-Existing Condition Benefit (U.S. citizens only) 100% of UCR, up to $5,000 maximum 80% of UCR, up to $5,000 maximum Prescription Drug Expense Benefit 100% of charges 80% of charges Accidental Death & Dismemberment Up to $25,000 Up to $25,000 4

Key Benefits Annual maximum limit of USD $100,000 Unlimited Lifetime Maximum Emergency Inpatient and Outpatient Care Worldwide direct-bill network plan Utilizing the Aetna Provider Network Online & live multilingual customer service available 24/7 Online claims filing at www.gbg.com Plans are offered by and administered (claims payment) through Global Benefits Group, Inc., a US based company 5

GlobalAdventurePlan_ENG_23MAY2017 Global Benefits Group 27422 Portola Parkway, Suite 110 Foothill Ranch, CA 92610 USA www.gbg.com