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Global Mission Medical InsuranceSM
Long term major medical for missionaries
The flexible, long-term, worldwide medical insurance program for missionaries and their families
Global Mission Medical Insurance
Instant Quotes & Purchase
Paper Application

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Four plan options:
Silver
Gold
Gold Plus
Platinum

Flexible Worldwide Coverage. Comprehensive World-class Services.
Being a missionary in the global community can be an exciting experience, yet one that can pose potential complications. Your health care while abroad should not be one of those concerns. Global Mission Medical Insurance is a revolutionary program from International Medical Group® (IMG®) that offers the flexible worldwide coverage you need, backed by the world-class services you expect. Unlike other health care programs on the market, Global Mission Medical Insurance allows you to custom build a plan that is specifically tailored for you. With this booklet, you can easily create the blueprint for your own benefits package. You can conveniently compare the benefits of several plan options, and learn about the unique services and the dynamic company that provides them. Choosing and applying for the best coverage available is easy.

Global Mission Medical Insurance is designed to meet your total needs. The program offers you the flexibility to select from an assortment of unique benefit options - each with specialized coverages. To accommodate your financial means, you can customize your length and area of coverage with the flexibility to select from multiple deductibles and modes of payment. With your medical history in mind, the program also provides flexible underwriting methods to extend coverage to you that may be declined by other companies.

Additionally, the program provides world-class services. To maximize the outcome of your medical care, our on-site clinical staff is ready to assist you at a moment's notice, and our extensive global provider networks are quickly and easily accessible. You also have direct access to our Medical Concierge, an unequalled service that provides you with personalized assistance in locating the best provider for your specific needs, while saving you on out-of-pocket and medical expenses. You can also efficiently save time managing routine areas of your account by utilizing our secure, online service tools. In addition, IMG is available for service at your convenience - either through phone, email or Live Chat.

You need to know that you have the proper worldwide coverage. When you select Global Mission Medical Insurance, you receive IMG's commitment to deliver exceptional health benefits, medical assistance and service - all designed to give you Global Peace of Mind®.

The IMG Advantage
For more than 20 years, IMG has dedicated its efforts to providing international medical insurance, travel insurance and world-class services to the international community. It's our specialty. We understand the intricacies of international health care. Our team of quality assured professionals is committed to helping you solve any problems, while making sure you receive superior service.

Many companies claim to offer great service. At IMG, we have set a higher industry standard by integrating independent credentialing services with in-house, fully owned and operated service divisions. These accreditations promote continuous improvement in quality and efficiency while ensuring ongoing compliance. This allows us to deliver the world-class service you deserve. We've served over a million people worldwide in more than 170 countries and we're with you, wherever you go - bringing support for all your insurance needs.

International Service Centers - To ensure that we are available when and where needed, we maintain multiple international service and assistance centers. From our offices, we provide administrative support and marketing services to our international producers, and claims administration and emergency medical assistance to those living and traveling worldwide. Our offices offer the benefit of multiple time zones and services in tune with local practices.

Single Resource - All IMG service centers are designed to have the necessary services, staff and capabilities to provide international service to you, regardless of your location. Every department and service division is integrated on the same proprietary system and in real-time. One call. One company. We are your single international resource.

Service Without Obstacles - Working in multiple time zones, working in multiple languages, and working with multiple currencies are not obstacles for us. We maintain an international staff for our international client base. Our claims specialists and multilingual customer service professionals work seamlessly with you in order to communicate without barriers. We back up what we promise - Coverage Without Boundaries® that provides Global Peace of Mind.

International Provider AccessSM (IPA) - IMG's proprietary network of over 17,000 accomplished physicians and facilities allows you to access quality care worldwide. Our direct billing arrangements can also ease the time and up front expense at select providers.

International Emergency Care - When you're overseas and a medical emergency occurs, you may not be able to wait for regular business hours. With our on-site physician and registered nurses, you have 24 hour access to highly qualified coordinators of emergency medical services and international treatment.

Accessible Technology - Through technology we make it easy for you to reach us and vice versa. We provide you with a secure member Web site to quickly and easily access real-time information, view the status of your claims and manage your accounts. You also have access to Live Chat to speak directly to a Customer Care representative online, and you can easily reach us via email. We will respond to all inquiries promptly. Of course, the phone and fax lines are open as well.

Financial Stability - Our globally recognized underwriter, Sirius International Insurance Corporation (publ), offers the financial security and reputation demanded by international consumers. Rated A (excellent) by A.M. Best and A- by Standard & Poor's*, Sirius International shares our vision of the international marketplace and offers the stability of a well-established insurance company.

*Sources: A.M. Best affirmed their rating in a press release dated July 21, 2009;
Standard & Poor's affirmed their rating in a press release dated December 9, 2009.

Flexible Worldwide Coverage
Global Mission Medical Insurance is versatile and tailored for you so you can easily design the benefits package that you need. The program provides comprehensive benefits suitable for individuals and families, fully portable 24 hour coverage and the peace of mind you need. On the following pages, you can build your plan by reviewing and choosing from the coverage options and services available. More detailed benefit and service descriptions are provided as inserts in the pocket in the back of this booklet. Please refer to those companion inserts while reviewing the information herein.

Flexible Benefits

Silver plan option - Affordable medical security designed for the more budget-conscious consumer and those planning to receive care in lower cost areas of the world. Silver offers a wide range of scheduled benefits equipped to meet your essential needs.

Gold plan option - Ideally suited for those who desire full major medical coverage, but for a limited period of time. Gold provides comprehensive benefits for the first three years of coverage. After three years, certain benefits are reduced (see Summary Schedule of Benefits - pages 5 & 6). As a result, Gold is priced more competitively than the Gold Plus option.

Gold Plus plan option - Comprehensive major medical plan designed for people who need longterm coverage. Benefit levels continue beyond year three as long as the coverage remains in effect.

Platinum plan option - Provides the superior benefits package for the most discerning global consumer. Platinum offers a package of enhanced benefits and services. It is designed for the client who wants the convenience of comprehensive medical, dental, and vision benefits in one plan.

Optional Riders - All plan options offer additional, optional coverages (see below for more information).
  • Global Term Life InsuranceSM (including AD&D)
  • Global Daily IndemnitySM
  • Maternity (Silver, Gold & Gold Plus plan options)
  • Terrorism (Platinum plan option)
  • Sports (Platinum plan option)

Budget/Coverage Area Options

Four plan options - The four plan options offer unique, specialized coverages while providing varied premium levels. This allows you the flexibility to stay in line with your financial plan.

Two coverage areas: Worldwide or Worldwide Excluding the U.S. and Canada - You have the opportunity to select the coverage area that best reflects your geographic area of need. Each provides full coverage, but premiums reflect the cost of care in different parts of the world. Regardless of the coverage area you choose, you maintain the freedom to choose your own provider.

Multiple deductible options - To accommodate your financial resources, you can select from seven different deductible options - all providing different premium levels. Additionally, your deductible will be reduced 50% when eligible treatment is received within a PPO network.
  • $100* (Platinum plan option)
  • $250
  • $500
  • $1,000
  • $2,500
  • $5,000
  • $10,000

No additional cost for children - No matter the plan option or coverage area you choose, for families the first two children between 14 days and 9 years are covered at no additional cost for the first year (see page 9 for further details). This is a valuable savings for any budget.

Four premium modes - Schedule the frequency of payment that meets your means.
  • Annual
  • Semi-annual
  • Quarterly
  • Monthly

Underwriting to Fit Your Needs

We have earned our reputation for excellence in the international community by maintaining the ability to be flexible and respond to our clients' needs. Understanding that everyone has a unique medical background, with Global Mission Medical Insurance we have developed multiple ways to administer coverage to you - including situations where you may have been declined by other companies.

Your application will be reviewed based on the full disclosure of your medical history that you provide.

Standard underwriting - Standard underwriting provides the full pre-existing conditions benefit as outlined below.

Exclusionary rider(s) - With an exclusionary rider, we are able to extend coverage for your medical needs, with the exception of the specific excluded condition named in the rider. This allows standard pre-existing condition benefits for non-ridered conditions that may otherwise have been declined.

Flexible underwriting option - The flexible underwriting option will allow us to extend coverage to you even if you have significant, ongoing and/or chronic pre-existing conditions. For a nominal administration fee, coverage is extended for a pre-existing condition following 24 months of continuous coverage, during which you are symptom, advice or treatment free for that particular condition.

For further underwriting information, please see below.
* For convenience, all amounts listed in this booklet are in U.S. dollars.

Comprehensive World-class Services
From routine care to complex case management to emergency medical situations, you're never far from IMG's support services. Global Mission Medical Insurance not only provides flexible coverage, it also provides you with prompt access to the invaluable international services and IMG resources - regardless of your location. For a further description of services, please refer to the Description of Services insert included in the back of this booklet.

Routine Care

Freedom to choose your provider - Global Mission Medical Insurance allows you the freedom to choose your own health care provider no matter where you are in the world. With open access to health care providers, you have improved access to quality care.

Locating a provider - For your convenience and to help you reduce your out-of-pocket expenses, we provide you access to two extensive provider networks that include established, globally credentialed physicians and hospitals.
  • The independent Preferred Provider Organization (PPO) - when seeking care within the U.S.
  • The International Provider Access (IPA) - when seeking care outside the U.S.

Emergency Care

Emergency Medical Evacuation - The ability to access quality health care is of paramount importance when a life-threatening medical emergency arises abroad. Global Mission Medical Insurance provides you with important emergency benefits backed by the services of an accredited 24/7/365 clinical staff with over 200 years of combined experience.
  • Emergency Medical Evacuation benefit
  • Return of Mortal Remains benefit
  • Remote Transportation benefit (Platinum plan option)
  • Political Evacuation benefit (Platinum plan option)

Medical Concierge

Unique medical service - Whether you are seeking care in a local facility or in a location you are not familiar with, the quality of the care you are receiving is a primary concern. Our Medical Concierge program is designed to provide you critical information on provider ratings, treatment outcome and cost of care prior to receiving medical treatment. Your personal Medical Concierge will review your specific non-emergency medical condition and provide you with complete information on provider ratings, past outcomes and general costs - all in the area where you are planning treatment.

IMG's Medical Concierge helps maximize your outcome when seeking medical care. This level of individualized service is unmatched in the international arena. Please note due to the high level of data required for this service, Medical Concierge service and ratings may not be available in all parts of the world.

Clinical Staff Available for You

Medical professionals to coordinate your care - In the event you need medical care, our on-site clinical staff coordinates with the medical provider and treating facility to respond to the unique needs and circumstances you may face. Having provided services in more than 170 countries, we are experts at assessing the need for services and ensuring they are delivered in a timely, cost-effective manner.

This individualized approach gives you peace of mind knowing that you have experienced, knowledgeable professionals ready to help at a moment's notice, anywhere around the globe.

Managing Your Plan

International service assistance - IMG's international services are designed to help you maximize the outcome of your medical care.
  • Access to quality health care worldwide
  • Professionally trained multilingual claims administrators and service professionals with proven international experience
  • Claim inquiries, status of claim information and reimbursement options available online and by phone, fax and email
  • Experienced international currency conversion
  • Claim settlement directly to providers or to you via check or direct deposit
  • Verification of benefits and explanation of benefits to providers

24/7/365 access to information - To help you save time managing routine areas of your account, we make it easy for you to get the information you need.
  • MyIMGSM - secure member Web site
  • Online renewals
  • Easily accessible online provider searches
  • Retrieve explanation of benefits
  • Check the status of claims - real time information available
  • Update address information & request ID cards
  • Change your mode of payment
  • Multiple international service and assistance centers
  • Live Web Chat, email, phone, fax

Summary Schedule of Benefits
The following is a summary schedule of benefits. Benefits are subject to the deductible and coinsurance unless otherwise noted. NA (Not Applicable); URC (Usual, Reasonable and Customary); SAAI (Same As Any Illness). For a further description of benefits, please refer to the Description of Benefits & Optional Riders below.

Benefit
Silver
Gold
(1st 36 months of continuous coverage)
Gold
(Beginning the 1st day of the 37th month)
Gold Plus
Platinum
(See below for Platinum Advantages)
Lifetime Maximum Limit
$5,000,000 per individual
$5,000,000 per individual
$5,000,000 per individual
$5,000,000 per individual
$8,000,000 per individual
Deductible (Per Period of Coverage)
$250 to $10,000
50% waived within PPO network
$250 to $10,000
50% waived within PPO network
$250 to $10,000
50% waived within PPO network
$250 to $10,000
50% waived within PPO network
$100 to $10,000
50% waived within PPO network
Family Deductible
3 times the individual deductible
3 times the individual deductible
3 times the individual deductible
3 times the individual deductible
2 times the individual deductible
Coinsurance within the PPO network
No coinsurance
No coinsurance
No coinsurance
No coinsurance
No coinsurance
Coinsurance outside the U.S. and Canada
No coinsurance
No coinsurance
No coinsurance
No coinsurance
No coinsurance
Coinsurance inside the U.S. and Canada (outside PPO network)
80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
Hospitalization/Room & Board
$600 per day - 240 day maximum
Average semi-private room rate
Up to a limit of $2,250 per day
Average semi-private room rate
Private room rate
Intensive Care Unit
$1,500 per day - 180 day per event
URC
Up to a limit of $4,500 per day
URC
URC
Surgery
URC
URC
URC
URC
URC
Anesthetist's Charges Associated with Surgery
20% of surgery benefit
URC
20% of surgery benefit
URC
URC
Transplants
$250,000 per transplant
$1,000,000 lifetime maximum
$500,000 lifetime maximum
$1,000,000 lifetime maximum
$2,000,000 lifetime maximum
Out-patient
25 visits: $70 doctor/specialist; $60 psychiatrist; $50 chiropractor; $250 X-ray per exam maximum limit; $500 surgery intervention consultation; $300 lab tests per exam maximum limit
URC
Physician Charges - limit of $150 per visit; Hospital Charge - $100 co-pay unless admitted; Urgent Care Facility - $25 co-pay; Diagnostic Lab and X-Rays limited to $5,000 per certificate period; Physiotherapy - up to $50 per visit, $1,000 max per certificate period $10,000 lifetime maximum
URC
URC
Emergency Room Illness (Additional $250 deductible if not admitted)
URC
URC
URC
URC
URC
Emergency Room Accident
URC
URC
URC
URC
URC
Supplemental Accident
NA
$300 per occurrence
$300 per occurrence
$300 per occurrence
$500 per occurrence
Local Ambulance
$1,500 per event - not subject to deductible or coinsurance
URC
$100 per event - not subject to deductible or coinsurance
URC
URC
Mental/Nervous
Out-patient only after 12 months of continuous coverage
$10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage
$2,500 maximum per certificate period; In-patient limited to 25 days per certificate period; Out-patient limited to max of 20 visits per certificate period at 70% eligible expenses, up to $75 maximum per visit; Lifetime maximum of $30,000
$10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage
SAAI - $50,000 lifetime maximum - Available after 12 months of continuous coverage
Child Wellness (Under 18 years of age)
3 visits per period of coverage - $70 maximum per period - Available after 12 months of continuous coverage
$200 maximum per period of coverage - Available after 12 months of continuous coverage
$200 maximum per period of coverage - Available after 12 months of continuous coverage
$200 maximum per period of coverage - Available after 12 months of continuous coverage
$400 maximum per period of coverage - Available after 6 months of continuous coverage
Adult Wellness
NA
$250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage
$250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage
$250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage
$500 per period of coverage - not subject to deductible or coinsurance - Available for those 18 years of age and over after 6 months of continuous coverage
Emergency Evacuation
$50,000 per period of coverage - not subject to deductible or coinsurance
Up to maximum limit - not subject to deductible or coinsurance
$250,000 limit per person per certificate period
Up to maximum limit - not subject to deductible or coinsurance
Up to maximum limit - not subject to deductible or coinsurance
Emergency Reunion
NA
$10,000 lifetime maximum
$10,000 lifetime maximum
$10,000 lifetime maximum
$10,000 lifetime maximum
Return of Mortal Remains
$25,000 lifetime maximum per insured - not subject to deductible or coinsurance
$25,000 lifetime maximum per insured - not subject to deductible or coinsurance
$15,000 lifetime maximum per insured - not subject to deductible or coinsurance
$25,000 lifetime maximum per insured - not subject to deductible or coinsurance
$50,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation
NA
NA
NA
NA
Limited to $5,000 per certificate period up to $20,000 lifetime maximum
Political Evacuation and Repatriation
NA
NA
NA
NA
Limited to $10,000 lifetime maximum
Rx Coverage
URC
URC
$5,000 per certificate period for each insured person, out-patient only
URC
Outside U.S. - URC
Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available
Other Services
Extended care: first 30 days;
Radiation: URC;
Home nursing: 30 days per covered event;
Hospice: 30 days; Prosthetic Devices: all URC
URC
URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum
URC
URC
Physical Therapy
Maximum $40 per visit - 30 visit maximum
Maximum $50 per visit
Maximum $50 per visit
Maximum $50 per visit
Maximum $50 per visit
Complementary Medicine
NA
Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
Recreational Scuba
NA
URC
URC
URC
URC
Non-emergency Dental
NA
NA
NA
NA
Calendar year maximum: $750;
Individual deducible - $50 Schedule of Benefits - Class I 90%;
Class II 70%; Class III 50%; 6 month waiting period
Emergency Dental due to Accident
$1,000 per period of coverage
URC
$500 per period
URC
URC
Emergency Dental due to Sudden Unexpected Pain
NA
$100 per period of coverage
$100 per period of coverage
$100 per period of coverage
See Non-emergency Dental benefits
High School Sports Injury
NA
NA
NA
NA
Up to $20,000 per certificate period
Vision
NA
NA
NA
NA
Exams - up to $100
Materials - up to $150 per 24 months
Maternity
Delivery, wellness, new born care & congenital disorders (*not subject to deductible or coinsurance - available after 10 months of coverage)
Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th or 12th month of continuous coverage)
Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th or 12th month of continuous coverage)
Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th or 12th month of continuous coverage)
Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births in that occur in the 11th or 12th month of continuous coverage)
SAAI -
$1,000 additional deductible,
$50,000 lifetime maximum,
$200 child wellness benefit for the first 2 months, new born care & congenital disorders maximum of $250,000 for the first 31 days

The Advantages of the Platinum Plan Option
The Platinum plan option is the complete international protection plan. It offers enhanced and additional benefits, access to a dedicated service team ready to assist you, and access to our exclusive Global Concierge and Assistance ServicesSM. For a further description of Platinum benefits and services, please refer to the Description of Benefits & Optional Riders section and the Description of Services section.

Comprehensive Major Medical Plan - The Platinum plan option offers higher benefit maximums and additional coverages - Lifetime Maximum of $8,000,000, Transplants up to $2,000,000, as well as increased benefits for Hospital Room & Board, Return of Mortal Remains, Supplemental Accident, Mental & Nervous and Adult & Child Wellness. The plan also includes benefits for Remote Transportation, Political Evacuation & Repatriation and High School Sports Injuries.

One Plan with Medical, Dental and Vision Benefits- In addition to the medical benefits, the Platinum plan option includes a dental plan with coverage for Class I Diagnostic & Preventive Services, Class II Basic Services and Class III Major Services. It also includes a vision benefit that provides coverage for exams and materials.

Remote Transportation Benefit - If you experience a medical problem that is not immediately life-threatening, but severe enough to result in death or permanent disability if not treated right away, Remote Transportation will provide for eligible charges arising out of the transportation for you to a qualified facility for further treatment.

Political Evacuation and Repatriation Benefit- In the event the U.S. Department of State issues an evacuation order of the host country, IMG will coordinate the evacuation of any covered insured(s) to the nearest place of safety or repatriation to the insured's home country of residence.

Mental & Nervous and Maternity Coverage - Expenses associated with these conditions are covered the same as any illness.

High School Sports Injury Benefit - Protection is available for your children while participating in sanctioned, organized sports at the high school level or below.

Consultation for care and advice - The Platinum plan option offers you direct access to a medical information service which allows you to communicate with licensed physicians, psychologists, pharmacists, dentists, dieticians and fitness trainers. They are available to assist you with routine health related questions 24 hours a day.

Global Concierge and Assistance Services - The Platinum plan option provides you with more than insurance protection - you also have exclusive access to a list of additional services handled by a dedicated service team available 24/7.

Optional Riders
Global Mission Medical Insurance is designed to protect individuals and families from the high cost of medical expenses. In addition to tailored benefits packages, the program offers several optional coverages. You may review and choose any from the following list that meet your needs. To apply, simply add in the appropriate premiums, as outlined in the application, into the calculation for the total premium due. For a further description of optional riders, please refer to the Description of Benefits & Optional Riders section below.

Rider
Description
Global Term Life Insurance
(Amounts shown are the Principle Sums per unit)
  • Age 31 days - 18 years: $5,000
  • Age 19 - 29 years: $75,000
  • Age 30 - 39 years: $50,000
  • Age 40 - 44 years: $35,000
  • Age 45 - 49 years: $25,000
  • Age 50 - 54 years: $20,000
  • Age 55 - 59 years: $15,000
  • Age 60 - 64 years: $10,000
  • Age 65 - 69 years: $7,500
Accidental Death & Dismemberment (AD&D) - included with Global Term Life Insurance
(* Benefit based on age at time of death; ** "Member" means hand, foot or eye)
Accidental Loss of Life: Principle Sum*
Accidental Loss of 2 Members**: Principle Sum*
Accidental Loss of 1 Member**: 50% of Principle Sum*
Global Daily Indemnity (Amount shown is the Principle Sum per unit. Available between age 31 days - 69 years)
$100 per day
Maternity (Silver, Gold, Gold Plus plan options)
$50,000 lifetime maximum, $5,000 maximum for normal delivery,
$7,500 for C-section (Refer below for more information)
Terrorism (Platinum plan option)
$50,000 lifetime maximum
Sports (Platinum plan option)
$25,000 lifetime coverage for some adventure sports

Flexible Underwriting
Global Mission Medical Insurance provides flexible underwriting methods to extend coverage to you. Your application may be underwritten by Standard Underwriting or the Flexible Underwriting Option.

Standard Underwriting - All disclosed medical conditions which have not been specifically excluded or restricted by a rider, will be covered after coverage has been in effect for 24 continuous months (subject to the foregoing limits and the other terms of the plan*).

The Silver, Gold and Gold Plus plan options provide a $50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of $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 of continuous coverage.

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 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.

On the Platinum plan option, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are not fully disclosed on the application will not be covered.

Flexible Underwriting Option - Where you may have otherwise been declined for coverage, the Flexible Underwriting Option allows us to extend coverage to you. After 24 months of continuous coverage, a pre-existing condition which has not been specially excluded by a rider will be covered the same as any other pre-existing condition, so long as in that 24 month period no treatment has been received for that condition. If treatment has been sought, then the 24 month period starts over from the treatment date. Treatment includes: 1) Consulted any physician for Medical Treatment or Advice (other than routine check-ups); or 2) Taken medication (including prescription drugs, special diets or injections).

Other Exclusions and Limitations*
  • Adult routine physical examinations are excluded under the Silver plan option, and for the first 12 months for the Gold, Gold Plus and Platinum plan options
  • Out-patient mental and nervous is excluded for the first 12 months on all plan options
  • In-patient mental and nervous is excluded under the Silver plan option and for the first 12 months for the Gold, Gold Plus and Platinum plan options
  • Maternity, newborn and congenital disorders (unless the maternity rider or Platinum plan option is purchased - see the Summary Schedule of Benefits above)
  • Maternity expenses (including prenatal, delivery, postnatal, newborn and congenital disorders) when the pregnancy is a result of fertility treatment
  • Organ transplants not specifically listed
  • Devices to correct sight or hearing are excluded under the Silver, Gold and Gold Plus plan options
  • Treatment or supplies not medically necessary
  • Treatment not ordered or received by a physician
  • Treatment by a relative or family member
  • Treatment as a result of war or riot
  • Treatment resulting from illegal activities
  • Organized amateur or professional sports
  • Services and treatment eligible for payment by any government or other insurance
  • Investigational, experimental or research procedures
  • Routine foot care
  • Elective cosmetic or plastic surgery
  • Drug and alcohol abuse treatment
  • Speech therapy
  • Custodial care
  • Weight modification
  • Treatment of impotency
  • Contraceptive medication or treatment
  • Persons HIV+ at effective date

*This brochure contains only a consolidated and summary description of some of the current Global Mission Medical Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance program in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

For Florida residents seeking international coverage, please see the Florida specific brochure.

Eligibility & Enrollment
Eligibility

Global Mission Medical Insurance is available to individuals and families of all nationalities. U.S. citizens must reside abroad or plan to leave the U.S. on their effective date and plan to reside abroad for at least six of the next 12 months. Coverage for non-U.S. citizens is worldwide, although certain eligibility restrictions may apply. Persons between the ages of 14 days and 74 years old may apply for coverage. Persons older than 74 years of age are not eligible. Certain other restrictions may also apply. Please call (866) INSU-BUY for further details.

For families, when both parents are covered under Global Medical Insurance, the first two eligible dependent children between the ages of 14 days to 9 years are covered at no additional cost*. Children under the age of 19 applying individually should use the male 19-24 age bracket when applying for coverage (please see the rates below). Each person requesting coverage must complete the information required in the application.

Renewal of Coverage

Subject to the terms of the plan, Global Mission Medical Insurance is annually renewable and coverage is continuous when renewed. Prior to the end of each period of coverage (12 months) you will receive renewal information. You must continue to meet the eligibility requirements outlined above in order to renew. You have the option to renew online or you may complete a paper application. There are no additional medical questions at renewal, and we can work with you to provide flexible renewal options. Please select your deductible and plan option carefully, as you will be unable to select a lower deductible or increase your plan option when you renew your coverage.

If you are a U.S. citizen and return to the U.S. for a scheduled furlough or deputation, it is possible to renew this policy. The intent to return directly to overseas service within 12 months must always be maintained. At renewal, you must advise IMG of your scheduled furlough dates and anticipated return overseas. If you have completed or resigned from service, you may continue coverage through the remainder of your policy period, at which time insurance will terminate on the renewal date.

Lifetime Coverage

Lifetime medical coverage is available if you are enrolled in the Global Mission Medical Insurance program by your 65th birthday and maintain continuous coverage to age 75. Prior to your 65th birthday you will receive a summary of benefits for a new plan, Global Senior Plan®, and an enrollment form for coverage. There is no additional medical underwriting. You simply need to review the benefits, and complete and return the enrollment form with your premium.

How to Apply

You can apply for Global Mission Medical Insurance Online, or simply complete and return the paper application. If you are applying as a family, you may include yourself, your spouse and dependents on one application. If you or a dependent are 19 years of age or older, you must complete a separate application. You must accurately complete all questions outlined in the application in order to be considered for coverage. An attending physician statement may be required depending upon your answers to the medical questions, and IMG reserves the right to request additional medical information.

Once receive your completed application with premium, we will promptly evaluate it based on the information provided. If approved, you will be mailed or emailed a fulfillment kit which includes an identification card, declaration of insurance and a Certificate of Insurance (containing a complete description of benefits, exclusions and terms of the plan), claim filing information, and claim forms. You are required to notify IMG, as required by the terms of the plan, if you or any family member suffers from or is treated for any illness, injury or other medical condition between the time of your application and the issuance of the certificate. If your application is not approved, you will receive a full refund of premium.

We are confident that you will be pleased with the full terms of coverage. To ensure your satisfaction, once you are accepted in the plan we provide a 15 day period to review the fulfillment kit contents. If during that 15 day period you find that you are not satisfied with the plan for any reason, you may submit a written request for cancellation and full refund of your premium. See the Certificate of Insurance for full details.

Cancellation requests received after this 15 day period will be granted at the sole discretion of IMG as the plan administrator. Any refund you may receive will be based on an established refund schedule, not a pro-rated basis. See the Certificate of Insurance for full details.

* For families, the first two eligible dependent children between the ages of 14 days to 9 years are covered at no additional cost for the first year of coverage. On the first renewal date, premium will be 50% of the published rate. For subsequent renewals, the regular renewal premium will apply.

Rates
ANNUAL PREMIUMS
All amounts shown are in U.S. dollars. Please select your deductible carefully, as you will be unable to select a lower deductible when you renew your coverage.
(New Business Rates through 7/1/2011. Rates include surplus lines tax where applicable.)

GLOBAL MISSION MEDICAL INSURANCE®- SILVER

WORLDWIDE COVERAGE EXCLUDING U.S./CANADA
Available only to applicants with addresses outside the U.S. & Canada
Deductibles
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 232
First 2
Free Then 203
First 2
Free Then 158
First 2
Free Then 138
First 2
Free Then 127
First 2
Free Then 112
10 to 18
238
238
212
212
175
175
163
163
153
153
134
134
19 to 24
539
671
466
660
363
506
317
441
248
355
221
306
25 to 29
569
766
497
744
385
572
336
498
264
413
234
326
30 to 34
636
846
548
798
424
618
372
538
291
432
259
369
35 to 39
714
1,000
578
888
447
689
392
595
307
496
273
387
40 to 44
901
1,098
731
955
486
748
425
655
407
510
362
451
45 to 49
1,004
1,211
823
1,030
638
797
556
694
453
548
404
487
50 to 54
1,226
1,347
1,040
1,161
803
901
702
801
595
665
530
592
55 to 59
1,482
1,482
1,288
1,288
997
996
869
869
731
738
651
657
60 to 64
2,182
2,054
1,988
1,860
1,676
1,480
1,518
1,363
1,268
1,127
1,129
1,003
65 to 69
4,556
3,953
4,361
3,781
4,080
3,443
3,136
2,559
2,742
2,456
2,441
2,185
70
5,604
4,862
5,364
4,650
5,018
4,235
3,857
3,148
3,373
3,021
3,002
2,688
71
5,884
5,105
5,632
4,883
5,269
4,447
4,050
3,305
3,541
3,171
3,153
2,822
72
6,178
5,361
5,914
5,127
5,533
4,669
4,253
3,470
3,718
3,331
3,310
2,963
73
6,487
5,629
6,209
5,383
5,809
4,902
4,465
3,644
3,904
3,497
3,476
3,111
74
6,812
5,910
6,520
5,652
6,100
5,148
4,689
3,826
4,099
3,672
3,649
3,276

WORLDWIDE COVERAGE
Deductibles
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 310
First 2
Free Then 270
First 2
Free Then 210
First 2
Free Then 184
First 2
Free Then 169
First 2
Free Then 150
10 to 18
317
317
282
282
233
233
217
217
204
204
180
180
19 to 24
718
895
622
881
484
675
422
588
331
473
294
407
25 to 29
758
1,020
662
991
515
764
449
663
352
551
313
433
30 to 34
848
1,128
730
1,063
566
823
496
718
389
576
345
490
35 to 39
950
1,333
770
1,182
596
918
522
793
408
661
364
516
40 to 44
1,202
1,463
976
1,273
647
997
567
873
542
676
482
602
45 to 49
1,339
1,614
1,098
1,373
850
1,062
741
925
605
730
538
650
50 to 54
1,635
1,796
1,386
1,548
1,071
1,201
935
1,068
794
886
706
789
55 to 59
1,976
1,976
1,718
1,718
1,330
1,328
1,159
1,159
976
984
868
876
60 to 64
2,909
2,738
2,651
2,480
2,235
1,973
2,024
1,816
1,691
1,502
1,505
1,337
65 to 69
6,075
5,271
5,814
5,041
5,439
4,591
4,181
3,412
3,656
3,274
3,254
2,914
70
7,472
6,483
7,151
6,200
6,690
5,647
5,143
4,851
4,497
4,027
4,002
3,584
71
7,846
6,807
7,509
6,510
7,025
5,929
5,400
5,094
4,722
4,228
4,203
3,763
72
8,238
7,148
7,884
6,835
7,375
6,225
5,670
5,349
4,958
4,440
4,413
3,952
73
8,650
7,505
8,278
7,177
7,744
6,537
5,953
5,616
5,206
4,662
4,633
4,149
74
9,083
7,881
8,692
7,536
8,131
6,864
6,251
5,897
5,466
4,895
4,865
4,357


GLOBAL MISSION MEDICAL INSURANCE®- GOLD

WORLDWIDE COVERAGE EXCLUDING U.S./CANADA
Available only to applicants with addresses outside the U.S. & Canada
Deductibles
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 318
First 2
Free Then 272
First 2
Free Then 203
First 2
Free Then 185
First 2
Free Then 164
First 2
Free Then 148
10 to 18
352
352
287
287
225
225
204
204
182
182
164
164
19 to 24
736
969
633
918
507
679
438
587
342
473
270
358
25 to 29
753
1,069
648
998
518
736
448
637
350
497
276
366
30 to 34
799
1,151
687
1,058
550
803
478
698
376
567
297
424
35 to 39
814
1,251
700
1,099
560
818
487
711
382
578
302
432
40 to 44
1,069
1,397
978
1,272
783
939
673
889
525
677
415
531
45 to 49
1,238
1,498
1,127
1,373
867
1,041
781
937
636
732
503
578
50 to 54
1,472
1,587
1,325
1,444
1,060
1,155
980
1,068
784
855
620
675
55 to 59
1,917
1,863
1,706
1,655
1,390
1,348
1,175
1,139
987
957
780
756
60 to 64
2,691
2,538
2,516
2,358
2,013
1,862
1,892
1,750
1,590
1,407
1,303
1,161
65 to 69
5,384
4,840
5,222
4,527
4,856
4,152
3,764
3,463
3,312
3,047
2,716
2,499
70
7,058
6,139
6,796
5,881
6,283
5,366
4,882
4,400
4,235
3,803
3,489
3,135
71
7,410
6,446
7,136
6,175
6,597
5,635
5,126
4,620
4,447
3,993
3,664
3,292
72
7,781
6,768
7,493
6,484
6,928
5,916
5,383
4,851
4,670
4,193
3,847
3,456
73
8,171
7,106
7,869
6,808
7,275
6,212
5,653
5,094
6,538
4,904
4,403
4,040
74
3,629
8,580
7,817
8,263
7,489
7,639
6,833
5,935
5,603
5,149
4,843
4,242

WORLDWIDE COVERAGE
Deductibles
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 430
First 2
Free Then 368
First 2
Free Then 275
First 2
Free Then 250
First 2
Free Then 221
First 2
Free Then 200
10 to 18
476
476
388
388
304
304
275
275
246
246
221
221
19 to 24
995
1,310
856
1,241
685
917
592
793
462
640
365
483
25 to 29
1,018
1,445
875
1,348
700
995
606
860
473
671
373
495
30 to 34
1,080
1,555
929
1,430
743
1,085
646
944
507
766
401
573
35 to 39
1,100
1,691
946
1,485
757
1,105
658
961
517
780
408
584
40 to 44
1,445
1,888
1,322
1,719
1,058
1,269
910
1,201
710
915
561
717
45 to 49
1,673
2,024
1,522
1,856
1,172
1,407
1,055
1,266
860
989
679
781
50 to 54
1,989
2,144
1,790
1,951
1,432
1,561
1,325
1,444
1,060
1,155
837
913
55 to 59
2,590
2,517
2,305
2,236
1,879
1,822
1,587
1,540
1,333
1,293
1,053
1,022
60 to 64
3,637
3,430
3,401
3,186
2,720
2,516
2,557
2,365
2,148
1,901
1,761
1,568
65 to 69
7,275
6,541
7,057
6,118
6,563
5,611
5,086
4,679
4,476
4,118
3,670
3,377
70
9,410
8,185
9,062
7,841
8,378
7,155
6,509
5,867
5,647
5,071
4,653
4,180
71
9,880
8,594
9,514
8,233
8,796
7,513
6,835
6,161
5,929
5,325
4,885
4,389
72
10,375
9,024
9,991
8,645
9,237
7,889
7,177
6,469
6,226
5,591
5,130
4,608
73
10,895
9,475
10,492
9,077
9,700
8,283
7,537
6,792
6,538
5,870
5,387
4,839
74
11,440
10,423
11,017
9,985
10,185
9,111
7,914
7,471
6,865
6,457
5,656
5,323

GLOBAL MISSION MEDICAL INSURANCE®- GOLD PLUS

WORLDWIDE COVERAGE EXCLUDING U.S./CANADA
Available only to applicants with addresses outside the U.S. & Canada
Deductibles
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 430
First 2
Free Then 365
First 2
Free Then 280
First 2
Free Then 250
First 2
Free Then 225
First 2
Free Then 200
10 to 18
469
469
384
384
298
298
269
269
242
242
217
217
19 to 24
922
1,215
794
1,156
617
825
545
731
446
620
353
467
25 to 29
954
1,420
834
1,342
646
963
568
847
467
738
366
507
30 to 34
1,054
1,591
926
1,491
755
1,109
638
981
523
827
413
618
35 to 39
1,146
1,761
1,018
1,602
788
1,231
697
1,079
571
922
448
636
40 to 44
1,477
1,931
1,306
1,726
1,012
1,338
898
1,189
733
945
579
743
45 to 49
1,663
2,009
1,484
1,812
1,151
1,409
1,021
1,247
835
963
657
756
50 to 54
2,021
2,180
1,819
1,983
1,415
1,547
1,289
1,404
1,056
1,148
828
903
55 to 59
2,559
2,487
2,345
2,279
1,830
1,780
1,614
1,570
1,360
1,321
1,062
1,031
60 to 64
3,596
3,391
3,326
3,120
2,784
2,578
2,542
2,351
2,109
1,866
1,731
1,542
65 to 69
7,426
6,476
7,154
6,205
6,615
5,662
5,144
4,648
4,463
4,017
3,677
3,312
70
11,100
8,093
10,689
7,753
9,882
7,074
7,679
5,801
6,661
5,014
5,488
4,133
71
11,655
8,497
11,224
8,140
10,376
7,428
8,062
6,091
6,994
5,264
5,762
4,339
72
12,238
8,922
11,785
8,547
10,895
7,799
8,466
6,395
7,344
5,528
6,051
4,556
73
12,850
9,368
12,374
8,975
11,440
8,189
8,889
6,715
7,711
5,804
6,353
4,784
74
13,492
10,305
12,993
9,872
12,012
9,008
9,333
7,387
8,097
6,384
6,671
5,263

WORLDWIDE COVERAGE
Deductibles
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 576
First 2
Free Then 485
First 2
Free Then 370
First 2
Free Then 335
First 2
Free Then 300
First 2
Free Then 200
10 to 18
625
625
510
510
395
395
360
360
320
320
290
290
19 to 24
1,230
1,620
1,058
1,541
823
1,153
726
1,021
595
825
469
623
25 to 29
1,273
1,894
1,111
1,789
861
1,284
757
1,129
623
983
487
675
30 to 34
1,406
2,120
1,235
1,988
961
1,477
852
1,307
697
1,102
549
824
35 to 39
1,527
2,349
1,357
2,135
1,049
1,641
930
1,439
760
1,229
597
847
40 to 44
1,970
2,574
1,741
2,300
1,349
1,784
1,198
1,585
976
1,260
772
989
45 to 49
2,217
2,677
1,980
2,416
1,535
1,879
1,361
1,662
1,111
1,283
876
1,008
50 to 54
2,694
2,906
2,424
2,643
1,887
2,063
1,718
1,871
1,408
1,531
1,104
1,203
55 to 59
3,411
3,315
3,127
3,038
2,441
2,373
2,153
2,092
1,813
1,761
1,415
1,374
60 to 64
4,795
4,520
4,434
4,159
3,713
3,438
3,388
3,135
2,812
2,488
2,308
2,055
65 to 69
11,385
8,634
9,539
8,273
8,820
7,549
6,859
6,196
5,950
5,356
4,903
4,415
70
14,800
10,790
14,252
10,337
13,176
9,432
10,238
7,735
8,881
6,685
7,317
5,510
71
15,540
11,330
14,965
10,854
13,835
9,904
10,750
8,121
9,326
7,019
7,683
5,786
72
16,317
11,896
15,713
11,396
14,527
10,399
11,287
8,527
9,792
7,370
8,067
6,075
73
17,133
12,491
16,499
11,966
15,253
10,919
11,852
8,954
10,281
7,739
8,471
6,379
74
17,989
13,740
17,324
13,163
16,016
12,011
12,444
9,849
10,795
8,513
8,894
7,017

GLOBAL MISSION MEDICAL INSURANCE®- PLATINUM

WORLDWIDE COVERAGE EXCLUDING U.S./CANADA
Available only to applicants with addresses outside the U.S. & Canada
Deductibles
$100
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 1,597
First 2
Free Then 1,451
First 2
Free Then 1,317
First 2
Free Then 1,146
First 2
Free Then 1,089
First 2
Free Then 1,038
First 2
Free Then 996
10 to 18
1,676
1,676
1,523
1,523
1,356
1,356
1,185
1,185
1,128
1,128
1,073
1,073
1,025
1,025
19 to 24
2,854
4,709
2,595
4,281
2,316
3,887
1,934
3,099
1,777
2,812
1,562
2,474
1,359
2,013
25 to 29
2,931
5,178
2,664
4,707
2,402
4,482
1,995
3,383
1,827
3,048
1,608
2,733
1,390
2,064
30 to 34
3,169
5,722
2,882
5,201
2,603
4,912
2,157
3,807
1,979
3,436
1,729
2,990
1,489
2,385
35 to 39
3,265
6,266
2,968
5,696
2,701
5,233
2,225
4,160
2,039
3,721
1,777
3,265
1,522
2,437
40 to 44
4,019
6,805
3,653
6,187
3,298
5,593
2,690
4,469
2,453
4,039
2,111
3,331
1,792
2,746
45 to 49
4,442
5,229
4,038
4,753
3,667
4,346
2,977
3,512
2,708
3,178
2,323
2,588
1,954
2,159
50 to 54
5,256
5,620
4,778
5,109
4,361
4,701
3,523
3,797
3,264
3,501
2,781
2,972
2,309
2,465
55 to 59
6,481
6,319
5,892
5,744
5,450
5,314
4,385
4,280
3,935
3,844
3,409
3,337
2,792
2,728
60 to 64
8,843
8,377
8,039
7,723
7,481
7,053
6,359
5,933
5,858
5,461
4,961
4,457
4,180
3,788
65 to 69
17,565
15,403
15,969
14,002
15,407
13,441
14,291
12,317
11,244
10,216
9,834
8,911
8,208
7,452
70
21,606
18,945
19,642
17,222
18,951
16,533
17,578
15,150
13,831
12,566
12,096
10,961
10096
9,165
71
22,686
19,892
20,627
18,084
19,898
17,359
18,456
15,908
14,522
13,195
12,700
11,509
10,601
9,624
72
23,821
20,886
21,655
18,987
20,983
18,227
19,379
16,703
15,248
13,854
13,336
12,084
11,131
10,106
73
25,011
21,931
22,737
19,937
21,939
19,138
20,349
17,537
16,010
14,547
14,003
12,689
11,688
10,611
74
26,262
23,028
23,875
20,934
23,035
20,095
21,366
18,415
16,811
15,274
14,703
13,323
12,272
11,140

WORLDWIDE COVERAGE
Deductibles
$100
$250
$500
$1,000
$2,500
$5,000
$10,000
Age
Male Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
*14 days to 9 years
First 2
Free Then 1,910
First 2
Free Then 1,738
First 2
Free Then 1,558
First 2
Free Then 1,328
First 2
Free Then 1,256
First 2
Free Then 1,188
First 2
Free Then 1,130
10 to 18
2,020
2,020
1,836
1,836
1,608
1,608
1,381
1,381
1,305
1,305
1,232
1,232
1,168
1,168
19 to 24
3,585
6,105
3,259
5,510
2,890
5,272
2,380
3,934
2,169
3,552
1,886
3,099
1,613
2,484
25 to 29
3,690
6,685
3,354
6,080
3,004
5,775
2,463
4,313
2,237
3,863
1,945
3,443
1,652
2,551
30 to 34
4,008
7,410
3,644
6,736
3,273
6,352
2,679
4,873
2,441
4,380
2,107
3,787
1,785
2,981
35 to 39
4,130
8,135
3,754
7,395
3,405
6,779
2,767
5,348
2,519
4,762
2,169
4,154
1,831
3,048
40 to 44
5,140
8,855
4,672
8,049
4,200
7,257
3,387
5,762
3,075
5,186
2,615
4,243
2,194
3,459
45 to 49
5,700
6,750
5,181
6,136
4,694
5,184
3,771
4,484
3,411
4,036
2,895
3,250
2,407
2,681
50 to 54
6,290
7,270
5,718
6,608
5,614
6,068
4,501
4,865
4,152
4,469
3,509
3,765
2,882
3,086
55 to 59
8,420
8,205
7,654
7,458
7,069
6,885
5,649
5,507
5,052
4,927
4,348
4,241
3,523
3,440
60 to 64
11,575
10,945
10,522
9,949
9,775
9,205
8,281
7,711
7,609
7,089
6,416
5,747
5,373
4,849
65 to 69
23,205
20,315
21,093
18,466
20,344
17,724
18,855
16,225
14,795
13,424
12,913
11,683
10,745
9,736
70
28,541
24,990
25,945
22,719
25,023
21,801
23,192
19,957
18,198
16,511
15,883
14,370
13,216
11,975
71
29,967
26,240
27,243
23,855
26,275
22,890
24,352
20,954
19,108
17,337
16,677
15,089
13,877
12,574
72
32,651
27,552
28,604
25,048
27,588
24,034
25,569
22,002
20,062
18,204
17,511
15,843
14,571
13,203
73
33,040
28,929
30,035
26,300
28,968
25,237
26,847
23,102
21,067
19,114
18,387
16,636
15,300
13,863
74
34,692
30,376
31,537
27,614
30,417
26,498
28,190
24,257
22,119
20,069
19,306
17,468
16,065
14,556

Modal Payment Factors***
Annual
1.00
Semi Annual
.55
Quarterly
.28
Monthly
.10
***For semi-annual, quarterly, and monthly payment modes, IMG will only accept valid Visa, MasterCard, American Express, Discover or JCB credit cards, or eCheck, on a preauthorized basis prior to the expiration date. Your credit card will be debited automatically on the due date(s) of your future premium installment(s).

Note: Choosing the semi-annual payment option (modal payment factor .55) results in total payments of 110% of the annual premium, choosing the quarterly payment option (modal payment factor .28) results in total payments of 112% of the annual premium, and choosing the monthly payment option (modal payment factor .10) results in total payments of 120% of the annual premium.

Please refer to the Certificate Wording for specific terms, conditions and other details regarding the benefits, limitations, eligibility and exclusions outlined in this booklet. Certificate Wording is available upon request prior to purchase.

The summary description of coverages, benefits and eligibility in this brochure is accurate at the date of printing, subject to the terms of the plan. Any updates or changes made subsequent to printing will be included in the fulfillment kit sent upon approval of your application, and/or from time to time thereafter.

IMG, International Medical Group, the IMG block design logo, imglobal, Global Mission Medical Insurance, Global Term Life Insurance, Global Daily Indemnity, Global Senior Plan, Coverage Without Boundaries, and Global Peace of Mind are the trademarks, service marks and/or registered marks of International Medical Group, Inc. Sirius and Sirius International are the trademarks, service marks and/or registered marks of Sirius International Insurance Corporation (publ). © 2007-2010 International Medical Group, Inc. All rights reserved.


07/01/2010