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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
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Four plan options:
Silver
Gold
Gold Plus
Platinum
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®.
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.
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.
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)
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
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.
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.
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 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)
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.
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.
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
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.
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Benefit
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Silver
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Gold
(1st 36 months of continuous coverage)
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Gold
(Beginning the 1st day of the 37th month)
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Gold Plus
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Platinum
(See below for Platinum Advantages)
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Lifetime Maximum Limit
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$5,000,000 per individual
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$5,000,000 per individual
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$5,000,000 per individual
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$5,000,000 per individual
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$8,000,000 per individual
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Deductible (Per Period of Coverage)
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$250 to $10,000
50% waived within PPO network
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$250 to $10,000
50% waived within PPO network
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$250 to $10,000
50% waived within PPO network
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$250 to $10,000
50% waived within PPO network
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$100 to $10,000
50% waived within PPO network
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Family Deductible
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3 times the individual deductible
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3 times the individual deductible
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3 times the individual deductible
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3 times the individual deductible
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2 times the individual deductible
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Coinsurance within the PPO network
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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Coinsurance outside the U.S. and Canada
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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No coinsurance
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Coinsurance inside the U.S. and Canada (outside PPO network)
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
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Hospitalization/Room & Board
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$600 per day - 240 day maximum
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Average semi-private room rate
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Up to a limit of $2,250 per day
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Average semi-private room rate
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Private room rate
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Intensive Care Unit
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$1,500 per day - 180 day per event
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URC
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Up to a limit of $4,500 per day
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URC
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URC
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Surgery
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URC
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URC
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URC
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URC
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URC
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Anesthetist's Charges Associated with Surgery
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20% of surgery benefit
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URC
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20% of surgery benefit
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URC
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URC
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Transplants
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$250,000 per transplant
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$1,000,000 lifetime maximum
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$500,000 lifetime maximum
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$1,000,000 lifetime maximum
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$2,000,000 lifetime maximum
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Out-patient
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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
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URC
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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
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URC
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URC
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Emergency Room Illness
(Additional $250 deductible if not admitted)
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URC
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URC
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URC
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URC
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URC
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Emergency Room Accident
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URC
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URC
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URC
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URC
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URC
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Supplemental Accident
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NA
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$300 per occurrence
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$300 per occurrence
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$300 per occurrence
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$500 per occurrence
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Local Ambulance
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$1,500 per event - not subject to deductible or coinsurance
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URC
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$100 per event - not subject to deductible or coinsurance
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URC
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URC
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Mental/Nervous
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Out-patient only after 12 months of continuous coverage
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$10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage
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$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
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$10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage
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SAAI - $50,000 lifetime maximum - Available after 12 months of continuous coverage
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Child Wellness
(Under 18 years of age)
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3 visits per period of coverage - $70 maximum per period - Available after 12 months of continuous coverage
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$200 maximum per period of coverage - Available after 12 months of continuous coverage
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$200 maximum per period of coverage - Available after 12 months of continuous coverage
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$200 maximum per period of coverage - Available after 12 months of continuous coverage
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$400 maximum per period of coverage - Available after 6 months of continuous coverage
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Adult Wellness
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NA
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$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
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$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
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$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
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$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
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Emergency Evacuation
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$50,000 per period of coverage - not subject to deductible or coinsurance
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Up to maximum limit - not subject to deductible or coinsurance
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$250,000 limit per person per certificate period
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Up to maximum limit - not subject to deductible or coinsurance
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Up to maximum limit - not subject to deductible or coinsurance
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Emergency Reunion
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NA
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$10,000 lifetime maximum
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$10,000 lifetime maximum
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$10,000 lifetime maximum
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$10,000 lifetime maximum
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Return of Mortal Remains
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$25,000 lifetime maximum per insured - not subject to deductible or coinsurance
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$25,000 lifetime maximum per insured - not subject to deductible or coinsurance
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$15,000 lifetime maximum per insured - not subject to deductible or coinsurance
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$25,000 lifetime maximum per insured - not subject to deductible or coinsurance
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$50,000 lifetime maximum per insured - not subject to deductible or coinsurance
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Remote Transportation
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NA
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NA
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NA
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NA
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Limited to $5,000 per certificate period up to $20,000 lifetime maximum
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Political Evacuation and Repatriation
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NA
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NA
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NA
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NA
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Limited to $10,000 lifetime maximum
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Rx Coverage
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URC
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URC
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$5,000 per certificate period for each insured person, out-patient only
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URC
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Outside U.S. - URC
Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available
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Other Services
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Extended care: first 30 days;
Radiation: URC;
Home nursing: 30 days per covered event;
Hospice: 30 days; Prosthetic Devices: all URC
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URC
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URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum
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URC
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URC
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Physical Therapy
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Maximum $40 per visit - 30 visit maximum
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Maximum $50 per visit
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Maximum $50 per visit
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Maximum $50 per visit
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Maximum $50 per visit
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Complementary Medicine
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NA
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Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
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Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
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Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
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Acupuncture $150;
Aroma Therapy $50;
Herbal Therapy $50;
Magnetic Therapy $75;
Massage Therapy $150;
Vitamin Therapy $100
Each per period of coverage
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Recreational Scuba
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NA
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URC
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URC
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URC
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URC
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Non-emergency Dental
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NA
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NA
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NA
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NA
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Calendar year maximum: $750;
Individual deducible - $50 Schedule of Benefits - Class I 90%;
Class II 70%; Class III 50%; 6 month waiting period
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Emergency Dental due to Accident
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$1,000 per period of coverage
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URC
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$500 per period
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URC
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URC
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Emergency Dental due to Sudden Unexpected Pain
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NA
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$100 per period of coverage
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$100 per period of coverage
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$100 per period of coverage
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See Non-emergency Dental benefits
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High School Sports Injury
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NA
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NA
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NA
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NA
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Up to $20,000 per certificate period
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Vision
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NA
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NA
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NA
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NA
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Exams - up to $100
Materials - up to $150 per 24 months
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Maternity
Delivery, wellness, new born care & congenital disorders (*not subject to deductible or coinsurance - available after 10 months of coverage)
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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)
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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)
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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)
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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)
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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
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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.
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.
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Rider
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Description
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Global Term Life Insurance
(Amounts shown are the Principle Sums per unit)
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- 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
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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)
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Accidental Loss of Life: Principle Sum*
Accidental Loss of 2 Members**: Principle Sum*
Accidental Loss of 1 Member**: 50% of Principle Sum*
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Global Daily Indemnity (Amount shown is the Principle Sum per unit. Available between age 31 days - 69 years)
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$100 per day
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Maternity (Silver, Gold, Gold Plus plan options)
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$50,000 lifetime maximum, $5,000 maximum for normal delivery,
$7,500 for C-section (Refer below for more information)
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Terrorism (Platinum plan option)
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$50,000 lifetime maximum
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Sports (Platinum plan option)
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$25,000 lifetime coverage for some adventure sports
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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
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.
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.
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
|
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