Plan Options: Bronze, Silver, Gold, Gold Plus & Platinum
Global Mission Medical Insurance®
Worldwide Coverage. World-Class Services.
Being a global citizen can be an exciting experience, but it also comes 122219734700with potential complications. Your health care while traveling should not be one of those concerns. With Global Mission Medical Insurance, a revolutionary program, you will receive the worldwide medical coverage you need, backed by the world-class services you expect.
Global Mission Medical Insurance allows you to choose from several plan options, customize your length and area of coverage and select from multiple deductibles and modes of payment. With your medical history in mind, the program provides different underwriting methods to extend medical coverage to you that may be declined by other companies.
With us, you will rest assured knowing that we have a dedicated department working to keep your insurance as affordable as possible. The costs of health care are rising, but we are committed to controlling those costs. As part of that commitment, we offer a Medical Concierge program, an unparalleled service that saves you on out-of-pocket medical expenses. We also offer a cash incentive and to waive 50% of your deductible for choosing to receive treatment from some of the best medical facilities outside the U.S.
You need the proper worldwide coverage, provided by a company that's there for you. When you select Global Mission Medical Insurance, you receive our promise to deliver exceptional medical benefits, medical assistance and service - all designed to give you Global Peace of Mind®.
Why Us?
We are an award-winning international medical and travel insurance company that has served millions of members worldwide since our founding. A leader in the global benefits and assistance services industry, we offer a full line of international medical insurance products, as well as travel insurance plans, medical management services and 24/7 emergency medical and travel assistance.
- Global Support. With offices and partners across 31054219420013595the globe, we provide the support you need, when you need it. In fact, it is our corporate mission to be there to protect and enhance your health and well-being.
- Service Without Obstacles. With a team of international, multilingual specialists, we are accustomed to working in multiple time zones, languages and currencies. Our global reach means we can work without barriers.
- International Provider AccessSM (IPA). In addition to the expansive UnitedHealthcare PPO network available for treatment received within the U.S., our proprietary IPA network of more than 17,000 accomplished physicians and facilities allows you to access quality care worldwide. Our direct billing arrangements can also ease the time and upfront expense at select providers.
- Financial Stability. Owned by Sirius International Insurance Group — an A-rated, $2.6 billion global enterprise — we offer the financial security and reputation demanded by international consumers.
- Accessible Technology. Log on to the secure, 24-hour online portal to submit and view your claims, manage your account, search for providers, and more.
- International Emergency Care. When you’re away from home and a medical emergency occurs, you may not be able to wait for regular business hours. With our on-site medical staff, you have 24-hour access to highly qualified coordinators of emergency medical services and international treatment.
Why Global Mission Medical Insurance?
- Five plan options - Bronze, Silver, Gold, Gold Plus and Platinum - and additional, optional coverages
- Choice of coverage area - Worldwide or Worldwide Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore and Taiwan - to reflect your desired geographic area
- Flexible underwriting that fits your needs
- Emergency benefits backed by the services of an accredited, on-site clinical staff
- Premium modes - Monthly, Quarterly, Semi-Annual, and Annual - to schedule the frequency of payment that meets your needs.
- Multiple deductible options to accommodate your financial resources.
- Freedom to choose your own health care provider, no matter where you are in the world
Summary Schedule of Benefits
The following is a summary schedule of benefits for eligible medical expenses.
Charges and expenses incurred by the Insured Person during the Period of Coverage 420013595with respect to an Illness or Injury suffered or sustained by the Insured Person during the Period of Coverage and while this Certificate is in effect, so long as the Charges are Usual, Reasonable and Customary and are incurred for Treatment or supplies that are Medically Necessary (“Eligible Medical Expenses”).
| Benefit | Bronze | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum |
|---|---|---|---|---|---|---|
| Lifetime Maximum Limit | $1,000,000 per individual | $5,000,000 per individual | $5,000,000 per individual | $5,000,000 per individual122219734700 | $5,000,000 per individual | $8,000,000 per individual |
| Deductible (Per Period of Coverage) | $250 to $10,000 | $250 to $10,000 | $250 to $25,000 | $250 to $25,000 | $250 to $25,000 | $100 to $25,000 |
| Deductible Carry Forward | Included | Included | Included | Included | Included | Included |
| Treatment outside the U.S. |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance |
| Treatment inside the U.S. using Medical Concierge |
50% of deductible waived,
up to a maximum of $2,500.470012221973 No coinsurance. |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance. |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance. |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance. |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance. |
50% of deductible waived,
up to a maximum of $2,500. No coinsurance. |
| Treatment inside the U.S. - PPO Network |
Subject to deductible.
No coinsurance |
Subject to deductible.
No coinsurance |
Subject to deductible.
No coinsurance |
Subject to deductible.
No coinsurance |
Subject to deductible.
No coinsurance |
Subject to deductible.
No coinsurance |
| Treatment inside the U.S. - Non-PPO Network |
Subject to deductible.
Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage |
Subject to deductible.
Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage |
Subject to deductible.
Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage |
Subject to deductible.
Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage |
Subject to deductible.
Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage |
Subject to deductible.
Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage |
| Coinsurance | International - 100%
U.S. in-network - 100% U.S. out-of-network - 80% | International - 100%
U.S. in-network - 100% U.S. out-of-network - 80% | International - 100%
U.S. in-network - 100% U.S. out-of-network - 80% | International - 100%
U.S. in-network - 100% U.S. out-of-network - 80% | International - 100%
U.S. in-network - 100% U.S. out-of-network - 80% | International - 100%
U.S. in-network - 100% U.S. out-of-network - 80% |
| Outpatient |
$500 maximum limit - specialists/
physician charges (pre-inpatient / post-inpatient) $300 maximum per visit - lab tests; $250 maximum per visit - diagnostic x-rays |
$70 maximum limit; 25 visit limit - specialists/physician charges
$50 maximum limit - chiropractor charges $500 maximum limit - surgery intervention consultation charges $300 maximum per visit - lab tests; $250 maximum per visit -diagnostic x-rays | Subject to deductible and coinsurance |
Physician charges - $150 per visit;
Hospital charge - $100 co-pay unless admitted; urgent care facility - $25 co-pay $5,000 maximum per period of coverage 122219734700for diagnostic lab and x-rays | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Mental/Nervous | NA |
Subject to deductible and coinsurance.
Outpatient after 12 months of continuous coverage |
Subject to deductible and coinsurance.
$10,000 maximum. Available after 12 months of continuous coverage. |
Inpatient: Subject to deductible and coinsurance
Outpatient: International - 70% U.S. in-network – 70% U.S. Out-of-network - 70% Additional Outpatient Sub-limit: $75 maximum limit per visit $2,500 maximum per period of coverage |
Subject to deductible and coinsurance.
$10,000 maximum per period of coverage with a $50,000 lifetime maximum. Available after 12 months of continuous coverage |
Subject to deductible and coinsurance.
$50,000 lifetime maximum. Available after 12 months of continuous coverage |
| Hospital Emergency Room Injury | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Hospital Emergency Room Illness |
Subject to deductible and coinsurance.
Covered only if admitted as inpatient |
Subject to deductible and coinsurance.
Additional $250 deductible if not admitted as an inpatient |
Subject to deductible and coinsurance.
Additional $250 deductible if not admitted as an inpatient |
Subject to deductible and coinsurance.
Additional $250 deductible if not admitted as an inpatient |
Subject to deductible and coinsurance.
Additional $250 deductible if not admitted as an inpatient |
Subject to deductible and coinsurance.
Additional $250 deductible if not admitted as an inpatient |
| Hospitalization/Room & Board |
Subject to deductible and coinsurance
for average semi-private room rate |
Subject to deductible and coinsurance
for average semi-private room rate. All subject to $600 per day /240 day maximum |
Subject to deductible and coinsurance
for average semi-private room rate |
Subject to deductible and coinsurance
for average semi-private room rate $2,250 limit per day |
Subject to deductible and coinsurance
for average semi-private room rate |
Subject to deductible and coinsurance
for average semi-private room rate |
| Intensive Care Unit | Subject to deductible and coinsurance |
Subject to deductible and coinsurance.
$1,500 limit per day - 180 days of coverage per event | Subject to deductible and coinsurance |
Subject to deductible and coinsurance.
$4,500 limit per day | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
|
CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy |
Subject to deductible and coinsurance
$600 maximum limit per examination |
Subject to deductible and coinsurance
$600 maximum limit per examination | Subject to deductible and coinsurance |
Subject to deductible and coinsurance
$5,000 maximum limit for outpatient labs | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Surgery | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Assistant Surgeon | 20% of primary surgeon's charge | 20% of primary surgeon's charge | 20% of primary surgeon's charge | 20% of primary surgeon's charge | 20% of primary surgeon's charge | 20% of primary surgeon's charge |
| Chemotherapy or Radiation Therapy | Subject to deductible and coinsurance | Subject to deductible and coinsurance | Subject to deductible and coinsurance | $10,000 maximum per period of coverage, $50,000 lifetime maximum | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Maternity Delivery, preventative care, newborn care & congenital disorders, 122219734700Family Matters Maternity Program (available after 10 months of coverage) | NA | NA | NA | NA | NA |
$2,500 additional deductible per pregnancy.
$50,000 lifetime maximum. $200 newborn preventative care benefit for the first 31 days -12 months after birth. $250,000 maximum for newborn care & congenital disorders for the first 31 days after birth |
| Podiatry Care | NA | NA | $750 maximum limit | $750 maximum limit | $750 maximum limit | $750 maximum limit |
| Physical Therapy |
Subject to deductible and coinsurance.
$40 maximum per visit - 10 visit limit per event. Available for 90 days following inpatient treatment or outpatient surgery |
Subject to deductible and coinsurance.
$40 maximum per visit - 30 visit limit |
Subject to deductible and coinsurance.
$50 maximum per visit |
Subject to deductible and coinsurance.
$50 maximum per visit - $1,000 maximum per period of coverage $10,000 lifetime maximum |
Subject to deductible and coinsurance.
$50 maximum per visit |
Subject to deductible and coinsurance.
$50 maximum per visit |
| Transplants | $250,000 lifetime maximum | $250,000 lifetime maximum | $1,000,000 lifetime maximum | $500,000 lifetime maximum | $1,000,000 lifetime maximum | $2,000,000 lifetime maximum |
| Prescription Coverage |
Subject to deductible and coinsurance.
Available for 90 days following related inpatient treatment or outpatient surgery. $600 outpatient maximum limit per event |
Subject to deductible and coinsurance.
90-day supply per prescription following related covered event |
Subject to deductible and coinsurance.
90-day supply per prescription Outpatient only |
Subject to deductible and coinsurance.
$5,000 per period of coverage - outpatient only. 90-day supply per prescription |
Subject to deductible and coinsurance.
90-day supply per prescription |
International - 100%
Inside U.S. - Prescription drug card co-pay: $20 for generic / $40 for brand name where generic is not available. 90-day supply per prescription |
| Adult Preventative Care (Age 19 or older) | NA | NA |
$250 per period of coverage. Not subject to deductible or coinsurance.
Available after 12 months of continuous coverage | $250 per period of coverage. Not subject to deductible or coinsurance |
$250 per period of coverage. Not subject to deductible or coinsurance.
Available after 12 months of continuous coverage |
$500 per period of coverage. Not subject to deductible or coinsurance.
Available after 6 months of continuous coverage |
| Child Preventative Care (Through age 18) | NA |
$70 maximum per visit, 3 visit limit per period of coverage. Not subject to deductible or coinsurance.
Available after 12 months of continuous coverage |
$200 maximum per period of coverage. Not subject to deductible or coinsurance.
Available after 12 months of continuous coverage | $200 maximum per period of coverage. Not subject to deductible or 122219734700coinsurance |
$200 maximum per period of coverage. Not subject to deductible or coinsurance.
Available after 12 months of continuous coverage |
$400 maximum per period of coverage. Not subject to deductible or coinsurance.
Available after 6 months of continuous coverage |
| Vision | Optional Rider | Optional Rider | Optional Rider | Optional Rider | Optional Rider | $100 maximum per 24 months for exams. $150 per 24 months for materials |
| Local Ambulance due to Injury or Illness resulting in Hospitalization | $1,500 maximum limit per event. Not subject to deductible or coinsurance | $1,500 maximum limit per event. Not subject to deductible or coinsurance | Subject to deductible and coinsurance | $100 maximum limit per event. Not subject to deductible or coinsurance | Subject to deductible and coinsurance | Not subject to deductible or coinsurance |
| Emergency Evacuation | $50,000 maximum per period of coverage. Not subject to deductible or coinsurance | $50,000 maximum per period of coverage. Not subject to deductible or coinsurance | Up to lifetime maximum limit. Not subject to deductible or coinsurance | $250,000 maximum per period of coverage. Not subject to deductible or coinsurance | Up to maximum limit. Not subject to deductible or coinsurance | Up to maximum limit. Not subject to deductible or coinsurance |
| Emergency Reunion |
$10,000 lifetime maximum.
Not subject to deductible or coinsurance | NA |
$10,000 lifetime maximum.
Not subject to deductible or coinsurance |
$10,000 lifetime maximum.
Not subject to deductible or coinsurance |
$10,000 lifetime maximum.
Not subject to deductible or coinsurance |
$10,000 lifetime maximum.
Not subject to deductible or coinsurance |
| Interfacility Ambulance Transfer (Transfer from one licensed health care Facility to another licensed health care Facility) |
$1,500 maximum limit per event.
Not subject to deductible or coinsurance. U.S. only |
$1,500 maximum limit per event.
Not subject to deductible or coinsurance. U.S. only | Subject to deductible and coinsurance. U.S. only |
$1,000 maximum limit per event.
Not subject to deductible or coinsurance. U.S. only | Not subject to deductible or coinsurance. U.S. only | Not subject to deductible or coinsurance. U.S. only |
| Political Evacuation and Repatriation | NA | NA | NA | NA | NA | $10,000 lifetime maximum |
| Remote Transportation | NA | NA | NA | NA | NA |
$5,000 per period of coverage up to $20,000 lifetime maximum.
Not subject to deductible or coinsurance |
| Return of Mortal Remains | $10,000 lifetime maximum. Not subject to deductible or coinsurance | $25,000 lifetime maximum. Not subject to deductible or coinsurance | $25,000 lifetime maximum. Not subject to deductible or coinsurance | $15,000 lifetime maximum. Not subject to deductible or coinsurance | $25,000 lifetime maximum. Not subject to deductible or coinsurance | $50,000 lifetime maximum. Not subject to deductible or coinsurance |
| Complementary Medicine | NA | NA | $500 maximum limit per period of coverage | $500 maximum limit per period of coverage | $500 maximum limit per period of coverage | $500 maximum limit per period of coverage |
| Traumatic Dental Injury Treatment at a hospital facility | $1,000 per period of coverage | $1,000 per period of coverage | Up to the lifetime maximum limit | $5,000 per period of coverage | Up to the lifetime maximum limit | Up to the lifetime maximum limit |
| Treatment Due to Unexpected Pain to Sound, Natural Teeth | NA | NA | $100 per period of coverage | $100 per period of coverage | $100 per period of coverage | 100% |
| Non-Emergency Treatment at a Dental Provider due to an Accident | NA | NA | $500 per period of coverage | $500 per period of coverage | $500 per period of coverage | See Non-Emergency Dental benefit |
| Non-Emergency Dental | Optional Rider | Optional Rider | Optional Rider | Optional Rider | Optional Rider | $750 maximum per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services |
| Hospital Indemnity (Outside the U.S. only) |
Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance |
Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance |
Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance |
Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance |
Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance |
Private Hospitals: $400 per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 per overnight and $5,000 maximum 4700310575093limit per period of coverage. Not subject to deductible or coinsurance |
| Supplemental Accident | NA | NA | $300 of eligible medical expenses following an accident . Not subject to deductible or coinsurance | $300 of eligible medical expenses following an accident . Not subject to deductible or coinsurance | $300 of eligible medical expenses following an accident . Not subject to deductible or coinsurance | $500 maximum limit per accident. Not subject to deductible and coinsurance |
| Pre-Existing Conditions Limitation | Excluded | $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage | $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage | $50,000 lifetime maximum; $5,000 per period of coverage | $50,000 lifetime maximum; $5,000 per period of coverage for unknown conditions. Available after 24 months of continuous coverage | NA |
Disclaimer: Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
Optional Coverage
Global Mission Medical Insurance is designed to help 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 information and premiums, as outlined in the application, into the calculation for the total premium due.
| 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 122219734700with Global Term Life Insurance |
Accidental Loss of Life: Principle Sum* Accidental Total Loss of 2 Members**: Principle Sum* Accidental Total Loss of 1 Member**: 50% of Principle Sum* (* Benefit based on age at time of death ** "Member" means hand, foot or eye) | |
| Terrorism(Platinum plan option) |
$50,000 lifetime maximum for Eligible Medical Expenses arising out of injury or illness incurred by the Insured as a result of or in connection with an act of terrorism (Refer to rider for more details) | |
| Sports (Gold Plus and Platinum plan options) (Refer to rider for a comprehensive list of sports excluded) |
$10,000 lifetime maximum for amateur athletics Adventure Sports: Through age 49 years: $50,000 lifetime maximum Age 50 years through age 59 years: $30,000 lifetime maximum Age 60 years through age 64 years: $15,000 lifetime maximum | |
| Dental & Vision (Bronze, Silver, Gold, Gold Plus plan options) | Dental $750 calendar maximum $50 deductible (max. 2 per family) Routine services - 90% (deductible is waived), Minor restorative - 70%, Major restorative- 50% 6 month waiting period | Vision Exams - up to $100 per 24 months Materials - up to $150 per 24 months |
Disclaimer: Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided.
Comprehensive World-Class Services
Medical Concierge
Whether you are seeking care at a local facility or in an unfamiliar location, quality of care is a primary concern. The Medical Concierge program is designed to provide you with critical information and to assist you in making the right decision for treatment. Your personal Medical Concierge will review your specific non-emergency medical condition and provide you with information on provider ratings, past outcomes and general costs — all in the area where you are planning treatment.
You will be entitled to receive a reduction in your deductible for utilizing this unique medical service while in the United States. This level of individualized service is unmatched in the international arena.
Online Services
Proprietary online services located in our Client Center member/login that allows you to manage your accounts, 24 hours a day, seven days a week, from anywhere in the world. Some features include:
- Submission and management of claims
- Access to Explanations of Benefits (EOBs)
- Initiate precertification
- Access Customer Care via email or telephone
- Locate and recommend a provider/facility
- Obtain ID cards and other important documents
Teladoc
Teladoc provides access to a national network of board-certified doctors and pediatricians in the U.S. who are available 24 hours a day, seven days a week, 365 days a year to help diagnose, treat and prescribe medication (when necessary and available) for many non-emergent medical issues via phone or online video consultations. Teladoc does not replace existing primary care physician relationships, but supplements them as a convenient, affordable alternative for non-emergency medical care. The use of Teladoc will be considered as treatment inside the U.S. - PPO Network. (Available only when Worldwide coverage is purchased)
Universal Rx Pharmacy Discount Savings
This discount savings program allows you to purchase prescriptions at one of over 35,000 participating pharmacies in the U.S. and receive the lower of 1) Universal Rx contract price or 2) the pharmacy regular retail price. This program is not insurance coverage. It is purely a discount program.
eDocAmerica
The Platinum plan option offers you direct access to eDocAmerica, a worldwide medical information service, which allows you to communicate with licensed physicians, psychologists, pharmacists, dentists, dieticians and fitness trainers free of charge 24 hours a day. eDocAmerica’s services result in saved office visits, peace of mind, confidence to act, and ultimately an informed, empowered member.
The Family Matters® Maternity Program
This program is designed to provide you with educational information on your 12221973pregnancy, and suggestions for a healthy lifestyle for the expecting mom and family. A complimentary copy of the book “What to Expect When You’re Expecting” is provided to help answer the day-to-day questions faced by all expectant families. This program can also assist you in early detection of potential pregnancy complications, and encourage proper prenatal medical treatment. (Available on the Platinum plan option only)
Global Concierge and Assistance Services
The Platinum plan option provides you with more than just insurance protection. You also have exclusive access to a list of additional emergency travel assistance services handled by a dedicated service team available 24/7. Some of the assistance services provided include:
- Emergency travel arrangements
- Lost passport/travel documents assistance
- Lost luggage assistance
- Embassy or consulate referrals
- Emergency message relay
- Emergency prescription replacement
- Medical referrals
- 24-hour medical monitoring
- Emergency cash transfer and emergency translations
- Legal referrals
Eligibility
Global Mission Medical Insurance is available to individuals and families of all nationalities. U.S. citizens must plan to be residing outside U.S. on or before their effective date and renewal dates, and for at least six (6) out of the next 12 months. Additional eligibility restrictions apply to non-U.S. citizens residing in the U.S. Persons from the ages of 14 days to 74 years old may apply for coverage, and coverage ends at age 75. Persons 75 years of age and older are not eligible for coverage. Please see a sample contract for details.
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 75th birthday you will receive a summary of benefits for the Global Senior Plan®, and an enrollment form for coverage. There is no additional medical underwriting. You simply need to review the benefits, and promptly complete and return the enrollment form with your premium.
Enrollment
To apply for Global Mission Medical Insurance, simply apply online or complete and return the Application.
If approved, you will receive a fulfillment kit, which includes an identification card, declaration of insurance and a Certificate Wording containing a complete description of benefits, exclusions and terms of the plan. You are required to notify the administrator, 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 any premium received by the administrator. For additional information, please contact us.
Quality Guarantee
To ensure your satisfaction, once you are accepted in the plan, we provide a 15-day free look period to review the coverage. 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 received by the administrator. See the Certificate Wording for full details.
IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA): This insurance is not subject to, and does not provide benefits required by PPACA. Since January 1, 2014, PPACA requires U.S. citizens, U.S. nationals and certain U.S. residents to obtain PPACA compliant insurance coverage unless they are exempt from PPACA. Penalties may be imposed on persons who are required to maintain PPACA compliant coverage but do not do so. Eligibility to purchase, extend or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including PPACA. Please note that it is an insured person’s sole and exclusive responsibility to determine the insurance requirements applicable to them, and the Company and the administrator shall have no liability whatsoever, including for any penalties a person may incur, for failure to obtain coverage required by any applicable law including without limitation PPACA. For information on whether PPACA applies to you or whether you are eligible to purchase Global Mission Medical Insurance.
Global Mission Medical Insurance® - Bronze
Worldwide Coverage
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| Deductibles | $250 | $500122219734700 | $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** | 343 | 298 | 232 | 204 | 186 | 166 | ||||||
| 10 to 18** | 351 | 313 | 258 | 239 | 225 | 199 | ||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||
| 19 to 24 | 794 | 990 | 688 | 975 | 536 | 748 | 466 | 651 | 367 | 522 | 325 | 450 |
| 25 to 29 | 838 | 1,128 | 731 | 1,096 | 569 | 844 | 497 | 733 | 389 | 610 | 346 | 480 |
| 30 to 34 | 938 | 1,248 | 807 | 1,175 | 626 | 910 | 549 | 794 | 430 | 637 | 382 | 542 |
| 35 to 39 | 1,072 | 1,503 | 868 | 1,333 | 673 | 1,035 | 589 | 895 | 460 | 745 | 411 | 582 |
| 40 to 44 | 1,356 | 1,650 | 1,101 | 1,435 | 730 | 1,125 | 639 | 984 | 612 | 762 | 543 | 679 |
| 45 to 49 | 1,510 | 1,820 | 1,239 | 1,548 | 958 | 1,197 | 836 | 1,043 | 682 | 823 | 607 | 733 |
| 50 to 54 | 1,843 | 2,025 | 1,563 | 1,746 | 1,208 | 1,355122219734700 | 1,053 | 1,205 | 896 | 998 | 796 | 890 |
| 55 to 59 | 2,271 | 2,271 | 1,975 | 1,975 | 1,528 | 1,527 | 1,333 | 1,333 | 1,122 | 1,130 | 997 | 1,007 |
| 60 to 64 | 3,344 | 3,146 | 3,046 | 2,851 | 2,569 | 2,162 | 2,325 | 2,087 | 1,944 | 1,726 | 1,730 | 1,536 |
| 65 to 69 | 6,983 | 6,058 | 6,683 | 5,794 | 6,251 | 5,276 | 4,806 | 3,922 | 4,202 | 3,763 | 3,740 | 3,349 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||
| Optional Dental & Vision Rider $570 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||
**Except for Global Group, the administrator will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
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.
Global Mission Medical Insurance® - Bronze
Worldwide Coverage Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| 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** | 256 | 224 | 175 | 153 | 141 | 123 | ||||||
| 10 to 18** | 263 | 235 | 194 | 181 | 169 | 148 | ||||||
|
*Dependent child rates are only available 122219734700when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||
| 19 to 24 | 597 | 742 | 515 | 730 | 401 | 560 | 351 | 488 | 275 | 392 | 244 | 338 |
| 25 to 29 | 629 | 846 | 550 | 823 | 427 | 633 | 371 | 551 | 292 | 457 | 259 | 361 |
| 30 to 34 | 704 | 936 | 606 | 882 | 468 | 683 | 411 | 596 | 322 | 478 | 286 | 408 |
| 35 to 39 | 806 | 1,128 | 652 | 1,002 | 504 | 777 | 443 | 672 | 346 | 560 | 308 | 436 |
| 40 to 44 | 1,015 | 1,239 | 825 | 1,076 | 547 | 844 | 480 | 738 | 459 | 575 | 408 | 508 |
| 45 to 49 | 1,132 | 1,365 | 928 | 1,162 | 720 | 899 | 627 | 783 | 511 | 618 | 455 | 549 |
| 50 to 54 | 1,382 | 1,519 | 1,173 | 1,309 | 905 | 1,015 | 791 | 903 | 672 | 750 | 598 | 668 |
| 55 to 59 | 1,703 | 1,703 | 1,480 | 1,480 | 1,147 | 1,145 | 998 | 998 | 841 | 848 | 749 | 754 |
| 60 to 64 | 2,508 | 2,361 | 2,285 | 2,138 | 1,926 | 1,701 | 1,745 | 1,566 | 1,457 | 1,296 | 1,298 | 1,152 |
| 65 to 69 | 5,236 | 4,544 | 5,013 | 4,346 | 4,690 | 3,957 | 3,604 | 2,942 | 3,152 | 2,822 | 2,805 | 2,512 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||
| Optional Dental & Vision Rider $460 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||
**Except for Global Group, the administrator will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
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.
Global Mission Medical Insurance® - Silver
Worldwide Coverage
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| 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** | 396 | 345 | 268 | 236 | 215 | 192 | ||||||
| 10 to 18** | 405 | 361 | 298 | 277 | 261 | 231 | ||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission
Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||
| 19 to 24 | 918 | 1,144 | 795 | 1,127 | 619 | 864 | 539 | 752 | 423 | 604 | 376 | 520 |
| 25 to 29122219734700 | 969 | 1,304 | 846 | 1,267 | 658 | 976 | 574 | 848 | 450 | 705 | 400 | 554 |
| 30 to 34 | 1,084 | 1,443 | 934 | 1,359 | 723 | 1,052 | 635 | 918 | 498 | 737 | 442 | 627 |
| 35 to 39 | 1,239 | 1,738 | 1,004 | 1,541 | 777 | 1,197 | 681 | 1,034 | 531 | 861 | 475 | 673 |
| 40 to 44 | 1,567 | 1,908 | 1,272 | 1,659 | 844 | 1,300 | 739 | 1,139 | 707 | 881 | 628 | 784 |
| 45 to 49 | 1,746 | 2,105 | 1,432 | 1,791 | 1,109 | 1,383 | 966 | 1,206 | 789 | 951 | 702 | 848 |
| 50 to 54 | 2,131 | 2,341 | 1,807 | 2,018 | 1,396 | 1,565 | 1,218 | 1,393 | 1,035 | 1,155 | 920 | 1,029 |
| 55 to 59 | 2,627 | 2,627 | 2,283 | 2,283 | 1,768 | 1,765 | 1,541 | 1,541 | 1,297 | 1,308 | 1,153 | 1,165 |
| 60 to 64 | 3,866 | 3,637 | 3,522 | 3,296 | 2,969 | 2,621 | 2,689 | 2,413 | 2,246 | 1,995 | 2,000 | 1,777 |
| 65 to 69 | 8,073 | 7,004 | 7,726 | 6,698 | 7,227 | 6,100 | 5,556 | 4,534 | 4,858 | 4,349 | 4,323 | 3,872 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||
| Optional Dental & Vision Rider $570 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||
**Except for Global Group, the administrator will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
Note: Choosing the semi-annual payment 122219734700option (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.
Global Mission Medical Insurance® - Silver
Worldwide Coverage Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, And Taiwan
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| 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** | 297 | 260 | 201 | 177 | 163 | 143 | ||||||
| 10 to 18** | 305 | 270 | 224 | 208 | 196 | 171 | ||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||
| 19 to 24 | 690 | 858 | 596 | 844 | 463 | 646 | 405 | 565 | 317 | 454 | 282 | 391 |
| 25 to 29 | 727 | 979 | 636 | 951 | 492 | 730 | 430 | 637 | 337 | 528 | 300 | 417 |
| 30 to 34 | 813 | 1,082 | 700 | 1,020 | 542 | 790 | 475122219734700 | 688 | 373 | 553 | 331 | 472 |
| 35 to 39 | 932 | 1,304 | 753 | 1,158 | 583 | 899 | 512 | 776 | 400 | 646 | 357 | 504 |
| 40 to 44 | 1,174 | 1,432 | 952 | 1,244 | 633 | 975 | 554 | 853 | 530 | 665 | 472 | 588 |
| 45 to 49 | 1,309 | 1,578 | 1,073 | 1,342 | 833 | 1,040 | 725 | 905 | 590 | 714 | 527 | 635 |
| 50 to 54 | 1,599 | 1,756 | 1,356 | 1,513 | 1,047 | 1,174 | 915 | 1,044 | 776 | 867 | 691 | 772 |
| 55 to 59 | 1,969 | 1,969 | 1,711 | 1,711 | 1,325 | 1,324 | 1,155 | 1,155 | 972 | 980 | 865 | 873 |
| 60 to 64 | 2,899 | 2,729 | 2,642 | 2,471 | 2,228 | 1,967 | 2,017 | 1,811 | 1,685 | 1,498 | 1,501 | 1,333 |
| 65 to 69 | 6,054 | 5,252 | 5,795 | 5,024 | 5,421 | 4,576 | 4,166 | 3,401 | 3,644 | 3,263 | 3,243 | 2,903 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||
| Optional Dental & Vision Rider $460 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||
*Except for Global Group, we will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
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.
Global Mission Medical Insurance®- Gold (For enhanced, long-term benefits, see Gold Plus plan option)
Worldwide Coverage
(New Business Rates Effective 01/01/2018. The administrator reserves the 4700122219734200right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| Deductibles | $250 | $500 | $1,000 | $2,500 | $5,000 | $10,000 | $25,000 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9 years** | 551 | 470 | 352 | 320 | 282 | 255 | 230 | |||||||
| 10 to 18** | 610 | 497 | 389 | 352 | 315 | 282 | 254 | |||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||||
| 19 to 24 | 1,272 | 1,674 | 1,095 | 1,587 | 875 | 1,173 | 757 | 1,014 | 590 | 818 | 466 | 618 | 420 | 557 |
| 25 to 29 | 1,301 | 1,848 | 1,119 | 1,724 | 895 | 1,271 | 775 | 1,099 | 604 | 858 | 477 | 633 | 430 | 569 |
| 30 to 34 | 1,381 | 1,988 | 1,187 | 1,829 | 950 | 1,388 | 826 | 1,208 | 650 | 980 | 513 | 734 | 461 | 660 |
| 35 to 39 | 1,434 | 2,205 | 1,234 | 1,937 | 987 | 1,440 | 859 | 1,254 | 674 | 1,018 | 532 | 761 | 480 | 684 |
| 40 to 44 | 1,884 | 2,463 | 1,724 | 2,241 | 1,379 | 1,655 | 1,186 | 1,565 | 925 | 1,194 | 730 | 935 | 658 | 758 |
| 45 to 49122219734700 | 2,182 | 2,638 | 1,984 | 2,420 | 1,528 | 1,834 | 1,375 | 1,651 | 1,120 | 1,289 | 886 | 1,018 | 797 | 917 |
| 50 to 54 | 2,593 | 2,796 | 2,335 | 2,544 | 1,866 | 2,034 | 1,727 | 1,883 | 1,381 | 1,505 | 1,091 | 1,189 | 982 | 1,071 |
| 55 to 59 | 3,441 | 3,344 | 3,062 | 2,970 | 2,496 | 2,422 | 2,109 | 2,046 | 1,771 | 1,718 | 1,401 | 1,357 | 1,260 | 1,221 |
| 60 to 64 | 4,832 | 4,557 | 4,518 | 4,234 | 3,616 | 3,343 | 3,398 | 3,143 | 2,854 | 2,525 | 2,340 | 2,084 | 2,107 | 1,875 |
| 65 to 69 | 9,667 | 8,691 | 9,376 | 8,129 | 8,720 | 7,455 | 6,757 | 6,217 | 5,947 | 5,472 | 4,876 | 4,486 | 4,388 | 4,038 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||||
| Optional Dental & Vision Rider $570 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||||
*Except for Global Group, we will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
Note: Choosing the semi-annual payment 122219734700option (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.
Global Mission Medical Insurance® - Gold (For enhanced, long-term benefits, see Gold Plus plan option)
Worldwide Coverage Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
Annual Premiums
All amounts shown are in U.S. dollars. Please select your deductible carefully, 122219734700as you will be unable to select a lower deductible when you renew your coverage.
| Deductibles | $250 | $500 | $1,000 | $2,500 | $5,000 | $10,000 | $25,000 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9 years** | 406 | 347 | 260 | 237 | 209 | 190 | 170 | |||||||
| 10 to 18** | 450 | 367 | 288 | 261 | 233 | 209 | 189 | |||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||||
| 19 to 24 | 942 | 1,240 | 810 | 1,174 | 649 | 867 | 560 | 751 | 437 | 605 | 345 | 458 | 311 | 412 |
| 25 to 29 | 963 | 1,367 | 828 | 1,277 | 664 | 942 | 573 | 813 | 447 | 635 | 353 | 468 | 319 | 421 |
| 30 to 34 | 1,021 | 1,472 | 879 | 1,354 | 703 | 1,027 | 612 | 892 | 480 | 725 | 380 | 543 | 342 | 489 |
| 35 to 39 | 1,061 | 1,631 | 913 | 1,433 | 729 | 1,066 | 636 | 928 | 499 | 753 | 393 | 562 | 354 | 506 |
| 40 to 44 | 1,394 | 1,822 | 1,277 | 1,658 | 1,020 | 1,225 | 877 | 1,158 | 684 | 882 | 541 | 692 | 486 | 623 |
| 45 to 49 | 1,615 | 1,953 | 1,469 | 1,791 | 1,130 | 1,357 | 1,018 | 1,221 | 830 | 953 | 656 | 753 | 590 | 679 |
| 50 to 54 | 1,919 | 2,069 | 1,727 | 1,883 | 1,381 | 1,505 | 1,278 | 1,393 | 1,022 | 1,114 | 807 | 880 | 727 | 792 |
| 55 to 59 | 2,547 | 2,475 | 2,267 | 2,199 | 1,848 | 1,792 | 1,561 | 1,515 | 1,311 | 1,272 | 1,035 | 1,005 | 932 | 905 |
| 60 to 64 | 3,577 | 3,372 | 3,343 | 3,133 | 2,675 | 2,475 | 2,515 | 2,325 | 2,113 | 1,869 | 1,732 | 1,542 | 1,559 | 1,388 |
| 65 to 69122219734700 | 7,154 | 6,432 | 6,938 | 6,016 | 6,453 | 5,517 | 5,001 | 4,600 | 4,401 | 4,049 | 3,609 | 3,320 | 3,248 | 2,989 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||||
| Optional Dental & Vision Rider $460 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||||
**Except for Global Group, the administrator will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
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) 122219734700results in total payments of 120% of the annual premium.
Global Mission Medical Insurance® - Gold Plus
Worldwide Coverage
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| Deductibles | $250 | $500 | $1,000 | $2,500 | $5,000 | $10,000 | $25,000 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9 years** | 737 | 621 | 473 | 429 | 384 | 332 | 299 | |||||||
| 10 to 18** | 799 | 652 | 505 | 460 | 408 | 371 | 334 | |||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||||
| 19 to 24 | 1,448 | 2,032 | 1,204 | 1,689 | 934 | 1,311 | 821 | 1,153 | 673 | 944 | 514 | 721 | 462 | 649 |
| 25 to 29 | 1,458 | 2,186 | 1,254 | 1,880 | 972 | 1,458 | 854 | 1,282 | 699 | 1,049 | 534 | 803 | 481 | 722 |
| 30 to 34 | 1,685 | 2,606 | 1,403 | 2,169 | 1,087 | 1,681 | 957 | 1,479 | 782 | 1,211 | 598 | 923 | 538 | 831 |
| 35 to 39 | 1,880 | 2,930 | 1,564 | 2,439 | 1,212 | 1,891 | 1,067 | 1,663 | 874 | 1,362 | 667 | 1,041 | 600 | 936 |
| 40 to 44 | 2,424 | 3,233 | 2,018 | 2,691 | 1,564 | 2,086 | 1,377 | 1,835 | 1,127 | 1,502 | 860 | 1,147 | 774 | 1,033 |
| 45 to 49 | 3,031 | 3,486 | 2,522 | 2,900 | 1,955 | 2,248 | 1,722 | 1,979 | 1,408 | 1,619 | 1,075 | 1,237 | 968 | 1,113 |
| 50 to 54 | 5,338 | 5,766 | 5,137 | 5,541 | 4,563 | 4,928 | 4,015 | 4,336 | 3,286 | 3,549 | 2,509 | 2,711 | 2,259 | 2,439 |
| 55 to 59 | 7,175 | 7,043 | 6,976 | 6,843 | 6,245 | 6,179 | 5,496 | 5,437 | 4,497 | 4,448 | 3,435 | 3,398 | 3,091 | 3,058 |
| 60 to 64 | 8,949 | 8,224 | 8,687 | 7,979 | 7,706 | 7,175 | 6,782 | 6,314 | 5,549 | 5,166 | 4,238 | 3,946 | 3,815 | 3,551 |
| 65 to 69 | 20,064 | 17,406 | 19,266 | 16,728 | 18,602 | 15,945 | 15,440 | 13,234 | 11,533 | 9,885 | 10,232 | 8,770 | 9,208 | 7,892 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||||
| Optional Dental & Vision Rider $570 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||||
**Except for Global Group, the administrator will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
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.
Global Mission Medical Insurance® - Gold Plus
Worldwide Coverage Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
Annual Premiums
All amounts shown are in U.S. dollars. Please select your deductible carefully, as you will 122219734700be unable to select a lower deductible when you renew your coverage.
| Deductibles | $250 | $500 | $1,000 | $2,500 | $5,000 | $10,000 | $25,000 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9 years** | 551 | 466 | 359 | 320 | 289 | 255 | 230 | |||||||
| 10 to 18** | 599 | 490 | 381 | 344 | 309 | 277 | 250 | |||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||||
| 19 to 24 | 1,086 | 1,524 | 904 | 1,268 | 700 | 983 | 616 | 866 | 505 | 708 | 385 | 541 | 346 | 486 |
| 25 to 29 | 1,093 | 1,641 | 941 | 1,410 | 728 | 1,093 | 642 | 961 | 524 | 788 | 401 | 600 | 361 | 541 |
| 30 to 34 | 1,265 | 1,954 | 1,052 | 1,626 | 817 | 1,262 | 716 | 1,110 | 587 | 907 | 449 | 693 | 404 | 623 |
| 35 to 39 | 1,410 | 2,199 | 1,173 | 1,830 | 910 | 1,419 | 802 | 1,249 | 656 | 1,021 | 500 | 780 | 450 | 702 |
| 40 to 44 | 1,819 | 2,424 | 1,513 | 2,018 | 1,173 | 1,564 | 1,033 | 1,377 | 845 | 1,127 | 645 | 860 | 581 | 774 |
| 45 to 49 | 2,274 | 2,617 | 1,892 | 2,177 | 1,466 | 1,688 | 1,291 | 1,486 | 1,056 | 1,216 | 807 | 929 | 727 | 836 |
| 50 to 54 | 4,545 | 4,739 | 4,003 | 4,176 | 3,422 | 3,695 | 3,011 | 3,253 | 2,464 | 2,661 | 1,883 | 2,033 | 1,694 | 1,830 |
| 55 to 59 | 5,381 | 5,282 | 5,233 | 5,134 | 4,684 | 4,635 | 4,122 | 4,079 | 3,372 | 3,337 | 2,576 | 2,550 | 2,318 | 2,294 |
| 60 to 64 | 6,711 | 6,169 | 6,516 | 5,985 | 5,780 | 5,381 | 5,086 | 4,736 | 4,162 | 3,874 | 3,179 | 2,959 | 2,861 | 2,663 |
| 65 to 69 | 15,048 | 13,055 | 14,451 | 12,548 | 13,952 | 11,959 | 11,579 | 9,926 | 8,650 | 7,414 | 7,674 | 6,577 | 6,907 | 5,919 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||||
| Optional Dental & Vision Rider $460 annual premium | Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | |||||||||||||
**Except for Global Group, the administrator will not accept checks, money orders or wire 122219734700transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
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.
Global Mission Medical Insurance® - Platinum
Worldwide Coverage
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| Deductibles | $100 | $250 | $500 | $1,000 | $2,500 | $5,000 | $10,000 | $25,000 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9 years** | 2,357 | 2,145 | 1,923 | 1,638 | 1,550 | 1,466 | 1,394 | 1,255 | ||||||||
| 10 to 18** | 2,493 | 2,266 | 1,985 | 1,704 | 1,611 | 1,521 | 1,442 | 1,298 | ||||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 24 rates. | ||||||||||||||||
| 19 to 24 | 3,908 | 5,947 | 3,569 | 5,373 | 3,152 | 5,142 | 2,605 | 3,837 | 2,371 | 3,453 | 2,058 | 2,762 | 1,745 | 2,418 | 1,571 | 2,176 |
| 25 to 29 | 4021 | 7,324 | 3,672 | 6,615 | 3,244 | 6,332 | 2,680 | 4,725 | 2,439 | 4,253 | 2,118 | 3,733 | 1,796 | 2,788 | 1,617 | 2,509 |
| 30 to 34 | 4,386 | 8,299 | 4,006 | 7,496 | 3,538 | 6,961 | 2,924 | 5,354 | 2,661 | 4,819 | 2,310 | 4,230 | 1,959 | 3,267 | 1,763 | 2,940 |
| 35 to 39 | 4,630 | 9,216 | 4,229 | 8,324 | 3,735 | 7,552 | 3,087 | 5,946 | 2,809 | 5,351 | 2,438 | 4,697 | 2,068 | 3,389 | 1,861 | 3,050 |
| 40 to 44 | 5,687 | 10,080 | 5,194 | 9,105 | 4,587 | 8,195 | 3,791 | 6,503 | 3,450 | 5,853 | 2,994 | 5,138 | 2,464 | 3,902 | 2,218 | 3,512 |
| 45 to 49 | 6,956 | 8,028 | 6,354 | 7,251 | 5,751 | 6,008 | 4,638 | 5,180 | 4,220 | 4,662 | 3,663 | 4,092 | 2,968 | 3,108 | 2,671 | 2,797 |
| 50 to 54 | 14,707 | 16,712 | 13,342 | 15,253 | 13,131 | 14,020 | 10,505 | 11,216 | 9,559 | 10,094 | 8,299 | 8,861 | 6,723 | 7,066 | 6,051 | 6,360 |
| 55 to 59 | 20,921 | 20,621 | 19,109 | 18,684 | 17,435 | 17,299 | 13,948 | 13,840 | 12,693 | 12,455 | 11,019 | 10,933 | 8,648 | 8,580 | 7,783 | 7,722 |
| 60 to 64 | 23,227 | 22,058 | 21,070 | 20,194 | 19,576 | 18,486 | 16,591 | 15,535 | 15,098 | 13,981 | 13,106 | 12,272 | 10,783 | 9,787 | 9,705 | 8,808 |
| 65 to 69 | 47,212 | 41,347 | 42,990 | 37,709 | 41,454 | 36,055 | 38,383 | 33,078 | 29,939 | 27,455 | 26,101 | 23,817 | 21,878 | 19,847 | 19,691 | 17,862 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||||||
| Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | ||||||||||||||||
**Except for Global Group, the administrator will not accept checks, money 122219734700orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
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.
Global Mission Medical Insurance® - Platinum
Worldwide Coverage Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan
(New Business Rates Effective 01/01/2018. The administrator reserves the right to issue the most current rates online in the event these expire, are modified or replaced with a newer version.)
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.
| Deductibles | $100 | $250 | $500 | $1,000 | $2,500 | $5,000 | $10,000 | $25,000 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female |
| 14 days to 9 years** | 1,971 | 1,790 | 1,625 | 1,414 | 1,344 | 1,281 | 1,230 | 1,107 | ||||||||
| 10 to 18** | 2,068 | 1,880 | 1,673 | 1,462 | 1,392 | 1,324 | 1,265 | 1,139 | ||||||||
|
*Dependent child rates are only available when at least one parent or guardian is insured under the Global
Mission Medical Insurance plan.
Children applying with no parent or guardian insured by Global Mission Medical Insurance must use the Female 19 to 12221973470024 rates. | ||||||||||||||||
| 19 to 24 | 3,169 | 4,825 | 2,894 | 4,358 | 2,556 | 4,171 | 2,112 | 3,113 | 1,923 | 2,801 | 1,669 | 2,241 | 1,415 | 1,961 | 1,273 | 1,765 |
| 25 to 29 | 3257 | 5,935 | 2,975 | 5,440 | 2,627 | 4,516 | 2,171 | 3,726 | 1,976 | 3,353 | 1,716 | 2,910 | 1,455 | 2,474 | 1,310 | 2,227 |
| 30 to 34 | 3,531 | 6,682 | 3,224 | 6,034 | 2,848 | 5,604 | 2,353 | 4,311 | 2,142 | 3,879 | 1,860 | 3,405 | 1,577 | 2,629 | 1,420 | 2,366 |
| 35 to 39 | 3,704 | 7,373 | 3,382 | 6,659 | 2,988 | 6,041 | 2,469 | 4,757 | 2,246 | 4,280 | 1,950 | 3,757 | 1,655 | 2,711 | 1,489 | 2,440 |
| 40 to 44 | 4,493 | 7,964 | 4,103 | 7,193 | 3,624 | 6,474 | 2,995 | 5,137 | 2,725 | 4,624 | 2,366 | 4,058 | 1,947 | 3,083 | 1,752 | 2,774 |
| 45 to 49 | 5,496 | 6,343 | 5,019 | 5,729 | 4,543 | 4,747 | 3,663 | 4,092 | 3,334 | 3,683 | 2,894 | 3,233 | 2,345 | 2,456 | 2,110 | 2,210 |
| 50 to 54 | 11,471 | 13,034 | 10,406 | 11,897 | 10,242 | 10,935 | 8,194 | 8,748 | 7,457 | 7,873 | 6,474 | 6,911 | 5,244 | 5,511 | 4,720 | 4,960 |
| 55 to 59 | 16,256 | 16,022 | 14,848 | 14,517 | 13,548 | 13,442 | 10,838 | 10,753 | 9,862 | 9,678 | 8,562 | 8,495 | 6,720 | 6,668 | 6,048 | 6,001 |
| 60 to 64 | 17,884 | 16,985 | 16,224 | 15,550 | 15,074 | 14,234 | 12,774 | 11,962 | 11,625 | 10,766 | 10,091 | 9,450 | 8,304 | 7,536 | 7,473 | 6,783 |
| 65 to 69 | 35,881 | 31,424 | 32,672 | 28,658 | 31,505 | 27,402 | 29,172 | 25,139 | 22,754 | 20,866 | 19,837 | 18,101 | 16,628 | 15,083 | 14,965 | 13,575 |
| 70 to 74 | Please contact us or click Quotes & Purchase for premium information | |||||||||||||||
| Modal Payment Factors* Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10 | ||||||||||||||||
*Except for Global Group, IMG will not accept checks, money orders or wire transfers for semi-annual, quarterly, or monthly payment modes. These alternative payment modes are only accepted with pre-authorization to debit your credit card on the due date(s) of your future premium installment(s) prior to the expiration date.
Note: Choosing the semi-annual payment option 122219734700(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.
Administrator
IMGP.O. Box 88509
2960 North Meridian Street
Indianapolis, IN 46208-0509 USA
FOR ADDITIONAL INFORMATION
Insubuy®, Inc.4200 Mapleshade Ln, Suite 200
Plano, TX 75093
Toll Free:
(866) INSUBUY
Phone:
(972) 985-4400
Fax:
(972) 767-4470
Website:
www.insubuy.com
This invitation to inquire allows eligible applicants an opportunity to seek information about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract.
Certain contracts do contain a pre-existing condition exclusion and do not cover losses or expenses related to a pre-existing condition.
This brochure contains many of the valuable trademarks, names, titles, logos, images, designs, copyrights and other proprietary materials owned and registered and used by of International Medical Group, Inc. 122219734700and its representatives throughout the world. © 2007-2017 International Medical Group, Inc. All rights reserved.
Capitalized terms are defined in the Certificate of Insurance.
Version:
CM00500174A171211
0118