2018 Comprehensive benefit plan including high benefit limits and a worldwide open provider network.
Global Freedom is tailored exclusively for individuals and families residing in Latin America and the Caribbean who seek outstanding comprehensive international health insurance with an open medical provider network. The plan offers a range of deductibles for members and provides coverage for inpatient care, outpatient care, emergencies, preventive care, plus a pharmacy benefit and more. As with all GBG plans, Global Freedom 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 the Company directly, eliminating the need for a member to pay up-front for services. Global Freedom also includes the GBG Personal Medical Advisor, one of the world s leading Medical Second Opinion services. Geographic Coverage Areas Global Freedom 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 class worldwide coverage while maintaining affordable rates.
Worldwide: Free choice of Providers. Global Freedom Schedule of Benefits MAXIMUM BENEFIT Maximum per Policy Period $7,000,000 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: 2x 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 $300 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, Psychiatric, Homeopathic and Short Term Speech Preventive Care/Check-up for children (six months or older) and adults ; Policy Period maximum 20 visits, all therapies combined $300 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 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
EMERGENCIES (CONTINUED) 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 Prophylactic surgery (only for gynecologic cancer) Bariatric surgery (A 24-month Waiting Period applies) Congenital and Hereditary Conditions Transplant procedures (In the U.S., must use the Institutes of Excellence approved by GBG) SPECIALIZED TREATMENTS OTHER BENEFITS Up to $5,000 per Policy Period ; up to $5,000 Lifetime Maximum ; up to $10,000 Lifetime Maximum $1,000,000 Lifetime Maximum up to age 18; age 18 or older ; $1,000,000 Lifetime Maximum per diagnosis includes donor expenses and donor procurement expenses up to $50,000 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 Professional Sports ; $25,000 Lifetime Maximum Covered ; $300,000 Policy Period maximum 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 $40,000 Policy Period maximum; $150,000 Lifetime Maximum Repatriation of mortal remains Per Insured benefit maximum: $50,000 War and Terrorism benefit Term Life Insurance/Mortal Benefit - Coverage terminates at the end of the Policy Period following attainment of age 65. 50% 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) $20,000 Policyholder; $5,000 spouse; $1,000 per dependent child Included in 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). $8,500 benefit maximum per pregnancy $12,500 benefit maximum per pregnancy ; up to $1,000,000 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
MATERNITY BENEFITS (INCLUDED UNDER PLANS 2 & 3 ONLY) Optional Rider for Complications of Maternity and Perinatal (plans 4, 5, and 6 only). Coverage for Policyholder or spouse only. Infant Examinations (immunizations & routine medical exams) provided the child was born under a Covered Pregnancy Provisional coverage for newborn (for a maximum of 90 days); Covered Pregnancies only Blood cord storage $500,000 Lifetime Maximum, all pregnancies combined, Deductible applies ; up to 6 months of age maximum 6 visits $30,000 benefit maximum per pregnancy $1,000 Lifetime Maximum per Covered Pregnancy Key Benefits 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 $12,500 maternity benefit if both parents are covered on the same plan Newborn care benefits Transplant procedure benefit Worldwide portability Term life insurance benefit included PRE-AUTHORIZATION IS RECOMMENDED FOR THESE SERVICES Hospitalization Exams or Outpatient procedures that requires more than local anesthesia Any condition that is expected to accumulate over $10,000 of medical treatment per Policy Period. Inpatient private duty nursing PRE-AUTHORIZATION IS REQUIRED FOR THE FOLLOWING BENEFITS Organ, bone marrow, stem cell transplants, and other similar procedures Air Ambulance Air ambulance service will be coordinated by Insurer s air ambulance provider. Oncologic 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
LATAM_GFREEDOM_ENG_01FEB2018 Global Benefits Group 27422 Portola Parkway, Suite 110 Foothill Ranch, CA 92610 USA GBG Latin America 7600 Corporate Center Drive, Suite 500 Miami, FL 33126 USA latam.gbg.com