Global Medical Silver Insurance

Plan Description

Global Medical Silver Insurance is designed to provide coverage similar to Global Medical Insurance, however, it features specific dollar limits on most benefits. This is the perfect plan for those who want coverage for a variety of medical services, but are seeking to reduce their premium costs.
You also have the option of adding Global Term Life Insurance^SM and Global Daily Indemnity^SM to your Global Medical Silver Insurance coverage.

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Global Term Life Insurance

• Global Term Life Insurance provides protection for your family at the time of a traumatic loss and is available with no additional underwriting. This coverage is available for a standard annual premium of $240 and includes an Accidental Death and Dismemberment benefit.

Global Daily Indemnity

• Global Daily Indemnity pays you US$100 for each covered overnight hospital stay other than those related to pregnancy.

Lifetime Eligibility

Individuals on the Global Medical Silver Insurance plan by their 65th birthday and maintaining continuous coverage to age 75 are eligible for IMG's Global Senior Plan^SM.

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Plan Benefits

Global Medical Silver Insurance^SM (GBI) covers the Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment. Each insured person will only need to satisfy their deductible once per period of coverage (12 months), with a maximum of three deductibles per family.

For eligible expenses incurred in the U.S. and Canada: once the deductible is met, GBI pays 80% of the next US$5000 in eligible expenses, then 100% of eligible expenses up to the policy maximum.

For eligible expenses incurred outside of the U.S. and Canada: once the deductible is met, GBI will pay 100% of eligible expenses up to the policy maximum.

MEDICAL INSURANCE	BENEFIT Subject to deductible and coinsurance
Coverage area	Worldwide
Policy maximum per individual	US$5,000,000 lifetime maximum benefit
Hospital room & board	US$600 per day (maximum of 240 consecutive days per covered event)
Intensive care unit	US$1,500 per day (maximum of 180 consecutive days per covered event)
Inpatient or outpatient surgery	URC up to lifetime maximum benefit
Anesthetist's charges associated with surgery	20% of the surgery benefit payable
Laboratory tests, X-rays, & other treatment associated with an inpatient covered event	URC up to lifetime maximum benefit
Emergency medical evacuation	US$50,000 per coverage period (not subject to deductible or coinsurance)
Local ground ambulance	US$1,500 per covered event (not subject to deductible or coinsurance)
Emergency room treatment due to an accident	URC up to lifetime maximum benefit
Emergency dental due to an accident	US$1,000 per coverage period
Maternity Available only after 12 months of continuous coverage	Limited to US$5,000 per pregnancy (not subject to coinsurance)
Professional services related to inpatient maternity expenses	US$200 per day (not subject to coinsurance)
Newborn care and treatment	US$15,000 lifetime maximum for the first 31 days after birth
Well child care	3 visits per coverage period (maximum limit of $200 per period of coverage)
Outpatient visits or exams 25 visits, including prenatal and postnatal care, per insured person per coverage period reimbursed to the maximum limit as outlined below:
• Physician	US$70 per visit/exam
• Specialist	US$70 per visit/exam
• Psychiatrist	US$60 per visit/exam
• Chiropractor	US$50 per visit/exam
• Surgical intervention consultation	US$500 per visit/exam
Outpatient X-rays	US$250 per exam maximum limit
Outpatient lab tests	US$300 per exam maximum limit
Pre-existing Conditions Available after 24 months of continuous coverage	US$50,000 lifetime maximum benefit (maximum of US$5,000 per period of coverage)
Prescription medication related to a covered event	URC up to lifetime maximum benefit
Extended care facility services	Limited to the first 30 days of convalescent confinement
Home nursing care services	Limited to 30 days per covered event
Inpatient hospice care	Limited to the first 30 days of hospice confinement
Chemotherapy & radiation therapy	URC up to lifetime maximum benefit
Physical therapy	30 visits per coverage period (maximum limit of $40 per visit)
MRI, CAT scan, endoscopy, echocardiography, gastroscopy, colonoscopy & cystoscopy	US$600 per exam limit
Transplants Certain precertification provisions must be met	US$250,000 all inclusive per transplant
Return of mortal remains	US$25,000 lifetime maximum (not subject to deductible or coinsurance)

The foregoing list is only a summary of available benefits and coverages, and is subject to the specific terms and conditions of the plan concerning eligible benefits, limitations, eligibility and exclusions. Please refer to the certificate wording for a complete description, which is available upon request.

Policy Exclusions

After coverage has been in effect for 24 continuous months, Global Medical Silver Insurance provides a US$50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of US$5,000 per period of coverage. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period. This is important since few pre-existing conditions remain free from ongoing consultation or treatment, and often do not qualify for coverage in standard plans. Global Medical Silver Insurance does not "rider" or charge additional premium for pre-existing conditions. If you properly disclose a pre-existing condition at the time of application, and are accepted into the plan, you will be covered for eligible medical expenses after 24 months of continuous coverage, subject to the foregoing limits and the other terms of the plan.*

The following illnesses which exist, manifest themselves or are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions under the plan, and are subject to the waiting period and other limitations of coverage described above: asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall stones or kidney stones, any condition of the breast, and any condition of the prostate.

OTHER EXCLUSIONS & LIMITATIONS*

Maternity and newborn care (unless the maternity rider is purchased - see details under the Benefits section)

Inpatient mental and nervous

Routine physical exams

Dental treatment unless accident related

Organized amateur or professional sports

Treatment not ordered or received by a physician

Treatment or supplies not medically necessary

Investigational, experimental or research procedures

Custodial care

Weight modification

Elective cosmetic or plastic surgery

Treatment of impotency

Contraceptive medication or treatment

Drug and alcohol abuse treatment

Organ transplants not specifically listed

Devices to correct sight or hearing

Routine foot care

Treatment by a relative or family member

Treatment as a result of war or riot

Treatment resulting from illegal activities

Speech therapy

Persons HIV+ at effective date

Services and treatment eligible for payment by any government or other insurance

* See certificate wording for a definition of pre-existing conditions and a complete list of exclusions and limitations, and for all other specific terms and conditions of the plan. Certificate wording is available upon request.