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Global Mission Medical Insurance®

Long-Term, Worldwide Medical Insurance Program for Missionaries and their Families.

Plan Options: Bronze, Silver, Gold, Platinum

Global Mission Medical Insurance®

Worldwide Coverage. World-Class Services.

Being a global citizen can be an exciting experience, but it also comes with 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, area of coverage, 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, waiving 50% of your deductible for choosing to receive treatment from some of the best medical facilities outside the United States.

You need the proper worldwide coverage, provided by a company that's there for you when you need us most. 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 have provided global benefits and assistance services to millions of members in nearly every country. We're committed to being there with our members wherever they may be in the world, delivering Coverage Without Boundaries®. With 24/7 medical management services, multilingual claims administrators and highly trained customer service professionals, we are confident in its ability to provide the products international members need, backed by the services they want.

  • Global Support. With offices and partners across the 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?

  • Plan Flexibility - Multiple plan options and payment modes to fit your budget
  • Choice of Coverage Area - Worldwide or Worldwide Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore and Taiwan
  • Freedom to Choose - Select your own health care provider, no matter where you are in the world
  • Travel Intelligence - Receive location-specific alerts on health, transportation, security and weather
  • Assistance Services - (i.e., Evacuations, Return of Mortal Remans, Emergency Reunion) Available on all plans at no additional charge
  • Preventative Care - No waiting period on wellness benefits
  • Healthy Travel Preventative Coverage - Receive vaccinations and preventative prescriptions prior to departure
  • Pre-Existing Condition Waiver - For individuals with proof of comprehensive health insurance and no significant break in coverage (63 days)

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 with 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").

BenefitBronzeSilverGold
Platinum
Lifetime Maximum Limit$1,000,000 per individual$5,000,000 per individual$5,000,000 per individual$8,000,000 per individual
Deductible (Per Period of Coverage)$250 to $10,000$250 to $10,000$250 to $25,000$100 to $25,000
Deductible Carry ForwardIncludedIncludedIncludedIncluded
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
Treatment inside the U.S. using Medical Concierge 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
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
CoinsuranceInternational - 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 $300 maximum per visit - lab tests; $250 maximum per visit - diagnostic X-rays
$500 maximum limit - specialists/ physician charges (pre-inpatient / post-inpatient)
Subject to deductible and coinsurance
$300 maximum per visit - lab tests; $250 maximum per visit -diagnostic X-rays
25 combined maximum visits $70 per visit/examination - specialists/physician charges $50 per visit/examination - chiropractor charges $500 per consultation - surgery intervention consultation charges
Subject to deductible and coinsurance
Subject to deductible and coinsuranceSubject to deductible and coinsurance
Mental/NervousNA 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.
Subject to deductible and coinsurance.
$50,000 lifetime maximum.
Available after 12 months of continuous coverage
Hospital Emergency Room InjurySubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject 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
Hospitalization/Room & Board Subject to deductible and coinsurance for average semi-private room rate Subject to deductible and coinsurance for average semiprivate room rate. All subject to $600 per day /240 day maximum Subject to deductible and coinsurance for average semiprivate room rate Subject to deductible and coinsurance for average private room rate
Intensive Care UnitSubject to deductible and coinsurance Subject to deductible and coinsurance.
$1,500 limit per day - 180 days of coverage per event
Subject to deductible and coinsuranceSubject 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 coinsuranceSubject to deductible and coinsurance
SurgerySubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsurance
Assistant Surgeon20% of primary surgeon's charge20% of primary surgeon's charge20% of primary surgeon's charge20% of primary surgeon's charge
Chemotherapy or Radiation TherapySubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsuranceSubject to deductible and coinsurance
Maternity
Delivery, preventative care, newborn care & congenital disorders, Family Matters Maternity Program (available after 10 months of coverage)
NANANA $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 CareNANA$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
Transplants$250,000 lifetime maximum$250,000 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
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
Healthy Travel Preventative Coverage $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the insured person’s initial effective date and before departing to any destination
VisionOptional RiderOptional RiderOptional Rider$100 maximum per 24 months for exams. $150 per 24 months for materials
Emergency Local Ambulance(Injury or Illness resulting in an inpatient hospital admission)$1,500 maximum limit per event. Not subject to deductible or coinsurance$1,500 maximum limit per event. Not subject to deductible or coinsuranceSubject to deductible and coinsuranceNot 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 coinsuranceUp to lifetime maximum limit. Not subject to deductible or coinsuranceUp 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
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 Not subject to deductible or coinsurance. U.S. only
Political Evacuation and RepatriationNANANA$10,000 lifetime maximum
Remote TransportationNANANA $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$50,000 lifetime maximum. Not subject to deductible or coinsurance
Complementary MedicineNANA$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 coverageUp to the lifetime maximum limitUp to the lifetime maximum limit
Treatment Due to Unexpected Pain to Sound, Natural TeethNANA$100 per period of coverage100%
Non-Emergency Treatment at a Dental Provider due to an AccidentNANA$500 per period of coverageSee Non-Emergency Dental benefit
Non-Emergency DentalOptional RiderOptional RiderOptional Rider$750 maximum per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services
Hospital Indemnity
(Inpatient hospitalization outside the U.S. only)
Private Hospitals: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance
Private Hospitals: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance
Private Hospitals: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance
Private Hospitals: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage
Public Hospitals: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage. Not subject to deductible or coinsurance
Supplemental Accident NANA$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
Adult Preventative Care
(Age 19 or older)
NANA$250 per period of coverage. Not subject to deductible or coinsurance.$500 per period of coverage. Not subject to deductible or coinsurance.
Child Preventative Care(Through age 18)NA$70 maximum per visit, 3 visit limit per period of coverage. Not subject to deductible or coinsurance.$200 maximum per period of coverage. Not subject to deductible or coinsurance.$400 maximum per period of coverage. Not subject to deductible or 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*Covered if disclosed and not excluded by rider

*If applicants can verify their prior comprehensive health insurance, with no significant break in coverage (63 days), the administrator may accept this as Creditable Coverage and provide a pre-existing conditions waiver (final decision is subject to Underwriters approval). Creditable Coverage is defined as a group health plan provided by a U.S. employer or Health Insurance Issuer, individual major medical health insurance provided by a Health Insurance Issuer, or other Public Health Plan (any comprehensive health plan established or maintained by a State or the U.S. government).

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 the options that meet your needs.

RiderDescription
Global Term Life Insurance
(Amounts shown are the Principle Sums per unit)
Age 31 days - 18 years: $5,000
Age 19 - 29 years: $75,000
Age 30 - 39 years: $50,000
Age 40 - 44 years: $35,000
Age 45 - 49 years: $25,000
Age 50 - 54 years: $20,000
Age 55 - 59 years: $15,000
Age 60 - 64 years: $10,000
Age 65 - 69 years: $7,500
Accidental Death & Dismemberment (AD&D) - included with Global Term Life Insurance 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 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, and Gold plan options)
Dental
$750 per period of coverage
$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

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

    It’s easy to access and manage your accounts any time, from anywhere and any device, via MyAccount. Additional features include:

    • Claims submission and management
    • ID Card and insurance documents access
    • Precertification process initiation
    • Explanation of Benefit (EOB) access
    • Customer Care and contact information
    • Find a Doctor locator provider/facility
  • 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 pregnancy, 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

    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

COVERAGE you can count on WITH 24/7 SERVICE ANYWHERE IN THE WORLD

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 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 United States. Persons from the ages of 14 days to 74 years may apply for coverage, up until the age of 75. Persons 75 years of age and older are not eligible for coverage. Please see a sample contract for further 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 you are applying as a family, you may include yourself, your spouse and dependents on one application. If you have dependents who are 19 and older, you must complete a separate application for those individuals. You must accurately complete all questions outlined in the application in order to be considered for coverage.

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 a 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, please contact your attorney or CPA.

Global Mission Medical Insurance® - Bronze Worldwide Coverage

(New Business Rates Effective 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
480417325286260232
10 to 18*491438361335315279
*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. Child only plans in China will receive a rate up of 150%.
19 to 241,1121,3869631,3657501,047652911514731455630
25 to 291,1731,5791,0231,5347971,1826961,026545854484672
30 to 341,3131,7471,1301,6458761,2747691,112602892535759
35 to 391,5012,1041,2151,8669421,4498251,2536441,043575815
40 to 441,6542,0131,3431,7518911,3737801,200747930662828
45 to 491,8422,2201,5121,8891,1691,4601,0201,2728321,004741894
50 to 541,8432,0251,5631,7461,2081,3551,0531,205896998796890
55 to 592,0442,0441,7781,7781,3751,3741,2001,2001,0101,017897906
60 to 643,0102,8312,7412,5662,3121,9462,0931,8781,7501,5531,5571,382
65 to 696,2855,4526,0155,2155,6264,7484,3253,5303,7823,3873,3663,014
70 to 74 Please contact us or click Quotes & Purchase for premium information
Optional Dental & Vision Rider $570 annual premiumModal Payment Factors** Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10

**Except for Global Group, the administrator will not accept wires for semi-annual, quarterly, or monthly payment modes. 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). 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 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
358314245214197172
10 to 18*368329272253237207
*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. Child only plans in China will receive a rate up of 150%.
19 to 248361,0397211,022561784491683385549342473
25 to 298811,1847701,152598886519771409640363505
30 to 349861,3108481,235655956575834451669400571
35 to 391,1281,5799131,4037061,088620941484784431610
40 to 441,2381,5121,0071,3136671,030586900560702498620
45 to 491,3811,6651,1321,4188781,097765955623754555670
50 to 541,3821,5191,1731,3099051,015791903672750598668
55 to 591,5331,5331,3321,3321,0321,031898898757763674679
60 to 642,2572,1252,0571,9241,7331,5311,5711,4091,3111,1661,1681,037
65 to 694,7124,0904,5123,9114,2213,5613,2442,6482,8372,5402,5252,261
70 to 74 Please contact us or click Quotes & Purchase for premium information
Optional Dental & Vision Rider $460 annual premiumModal Payment Factors** Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10

**Except for Global Group, the administrator will not accept wires for semi-annual, quarterly, or monthly payment modes. 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). 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 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
554483375330301269
10 to 18*567505417388365323
*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. Child only plans in China will receive a rate up of 150%.
19 to 241,2851,6021,1131,5788671,2107551,053592846526728
25 to 291,3571,8261,1841,7749211,3668041,187630987560776
30 to 341,5182,0201,3081,9031,0121,4738891,2856971,032619878
35 to 391,7352,4331,4062,1571,0881,6769531,4487431,205665942
40 to 441,9122,3281,5522,0241,0301,5869021,3908631,075766956
45 to 492,1302,5681,7472,1851,3531,6871,1791,4719631,1608561,035
50 to 542,1312,3411,8072,0181,3961,5651,2181,3931,0351,1559201,029
55 to 592,3642,3642,0552,0551,5911,5891,3871,3871,1671,1771,0381,049
60 to 643,4793,2733,1702,9662,6722,3592,4202,1722,0211,7961,8001,599
65 to 697,2666,3046,9536,0286,5045,4905,0004,0814,3723,9143,8913,485
70 to 74 Please contact us or click Quotes & Purchase for premium information
Optional Dental & Vision Rider $570 annual premiumModal Payment Factors** Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10

**Except for Global Group, the administrator will not accept wires for semi-annual, quarterly, or monthly payment modes. 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). 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 Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan

(New Business Rates Effective 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
416364281248228200
10 to 18*427378314291274239
*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. Child only plans in China will receive a rate up of 150%.
19 to 249661,2018341,182648904567791444636395547
25 to 291,0181,3718901,3316891,022602892472739420584
30 to 341,1381,5159801,4287591,106665963522774463661
35 to 391,3051,8261,0541,6218161,2597171,086560904500706
40 to 441,4321,7471,1611,5187721,1906761,041647811576717
45 to 491,5971,9251,3091,6371,0161,2698851,104720871643775
50 to 541,5991,7561,3561,5131,0471,1749151,044776867691772
55 to 591,7721,7721,5401,5401,1931,1921,0401,040875882779786
60 to 642,6092,4562,3782,2242,0051,7701,8151,6301,5171,3481,3511,200
65 to 695,4494,7275,2164,5224,8794,1183,7493,0613,2802,9372,9192,613
70 to 74 Please contact us or click Quotes & Purchase for premium information
Optional Dental & Vision Rider $460 annual premiumModal Payment Factors** Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10

**Except for Global Group, the administrator will not accept wires for semi-annual, quarterly, or monthly payment modes. 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). 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 Worldwide Coverage

(New Business Rates Effective 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
1,032869662601538465419
10 to 18*1,119913707644571519468
*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. Child only plans in China will receive a rate up of 150%.
19 to 242,0272,8451,6862,3651,3081,8351,1491,6149421,3227201,009647909
25 to 292,0413,0601,7562,6321,3612,0411,1961,7959791,4697481,1246731,011
30 to 342,3593,6481,9643,0371,5222,3531,3402,0711,0951,6958371,2927531,163
35 to 392,6324,1022,1903,4151,6972,6471,4942,3281,2241,9079341,4578401,310
40 to 442,9573,9442,4623,2831,9082,5451,6802,2391,3751,8321,0491,3999441,260
45 to 493,6984,2533,0773,5382,3852,7432,1012,4141,7181,9751,3121,5091,1811,358
50 to 545,3385,7665,1375,5414,5634,9284,0154,3363,2863,5492,5092,7112,2592,439
55 to 596,4586,3396,2786,1595,6215,5614,9464,8934,0474,0033,0923,0582,7822,752
60 to 648,0547,4027,8187,1816,9356,4586,1045,6834,9944,6493,8143,5513,4343,196
65 to 6918,05815,66517,33915,05516,74214,35113,89611,91110,3808,8979,2097,8938,2877,103
70 to 74 Please contact us or click Quotes & Purchase for premium information
Optional Dental & Vision Rider $570 annual premiumModal Payment Factors** Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10

**Except for Global Group, the administrator will not accept wires for semi-annual, quarterly, or monthly payment modes. 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). 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 Worldwide Coverage Excluding the U.S., Canada, China, Hong Kong, Japan, Macau, Singapore, and Taiwan

(New Business Rates Effective 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
771652503448405357322
10 to 18*839686533482433388350
*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. Child only plans in China will receive a rate up of 150%.
19 to 241,5202,1341,2661,7759801,3768621,212707991539757484680
25 to 291,5302,2971,3171,9741,0191,5308991,3457341,103561840505757
30 to 341,7712,7361,4732,2761,1441,7671,0021,5548221,270629970566872
35 to 391,9743,0791,6422,5621,2741,9871,1231,7499181,4297001,092630983
40 to 442,2192,9571,8462,4621,4311,9081,2601,6801,0311,3757871,049709944
45 to 492,7743,1932,3082,6561,7892,0591,5751,8131,2881,4849851,1338871,020
50 to 544,5454,7394,0034,1763,4223,6953,0113,2532,4642,6611,8832,0331,6941,830
55 to 594,8434,7544,7104,6214,2164,1723,7103,6713,0353,0032,3182,2952,0862,065
60 to 646,0405,5525,8645,3875,2024,8434,5774,2623,7463,4872,8612,6632,5752,397
65 to 6913,54311,75013,00611,29312,55710,76310,4218,9337,7856,6736,9075,9196,2165,327
70 to 74 Please contact us or click Quotes & Purchase for premium information
Optional Dental & Vision Rider $460 annual premiumModal Payment Factors** Annual 1.00 Semi Annual .55 Quarterly .28 Monthly .10

**Except for Global Group, the administrator will not accept wires for semi-annual, quarterly, or monthly payment modes. 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). 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 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
2,3572,1451,9231,6381,5501,4661,3941,255
10 to 18*2,4932,2661,9851,7041,6111,5211,4421,298
*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. Child only plans in China will receive a rate up of 150%.
19 to 243,9085,9473,5695,3733,1525,1422,6053,8372,3713,4532,0582,7621,7452,4181,5712,176
25 to 294,0217,3243,6726,6153,2446,3322,6804,7252,4394,2532,1183,7331,7962,7881,6172,509
30 to 344,3868,2994,0067,4963,5386,9612,9245,354 2,6614,8192,3104,2301,9593,2671,7632,940
35 to 394,6309,2164,2298,3243,7357,5523,0875,9462,8095,3512,4384,6972,0683,3891,8613,050
40 to 445,68710,0805,1949,1054,5878,1953,7916,5033,4505,8532,9945,1382,4643,9022,2183,512
45 to 496,9568,0286,3547,2515,7516,0084,6385,1804,2204,6623,6634,0922,9683,1082,6712,797
50 to 5414,70716,71213,34215,25313,13114,02010,50511,2169,55910,0948,2998,8616,7237,0666,0516,360
55 to 5920,92120,62119,10918,68417,43517,29913,94813,84012,69312,45511,01910,9338,6488,5807,7837,722
60 to 6423,22722,05821,07020,19419,57618,48616,59115,53515,09813,98113,10612,27210,7839,7879,7058,808
65 to 6947,21241,34742,99037,70941,45436,05538,38333,07829,93927,45526,10123,81721,87819,84719,69117,862
70 to 74Please 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 wires for semi-annual, quarterly, or monthly payment modes. 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). 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 01/02/2019. 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. The amount includes the base medical premium and a service fee. 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
AgeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
14 days to
9 years*
1,9711,7901,6251,4141,3441,2811,2301,107
10 to 18*2,0681,8801,6731,4621,3921,3241,2651,139
*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 24 rates. Child only plans in China will receive a rate up of 150%.
19 to 243,1694,8252,8944,3582,5564,1712,1123,1131,9232,8011,6692,2411,4151,9611,2731,765
25 to 293,2575,9352,9755,4402,6274,5162,1713,7261,9763,3531,7162,9101,4552,4741,3102,227
30 to 343,5316,6823,2246,0342,8485,6042,3534,3112,1423,8791,8603,4051,5772,6291,4202,366
35 to 393,7047,3733,3826,6592,9886,0412,4694,7572,2464,2801,9503,7571,6552,7111,4892,440
40 to 444,4937,9644,1037,1933,6246,4742,9955,1372,7254,6242,3664,0581,9473,0831,7522,774
45 to 495,4966,3435,0195,729 4,5434,7473,6634,0923,3343,6832,8943,2332,3452,4562,1102,210
50 to 5411,47113,03410,40611,89710,24210,9358,1948,7487,4577,8736,4746,9115,2445,5114,7204,960
55 to 5916,25616,02214,84814,51713,54813,44210,83810,7539,8629,6788,5628,4956,7206,6686,0486,001
60 to 6417,88416,98516,22415,55015,07414,23412,77411,96211,62510,76610,0919,4508,3047,5367,4736,783
65 to 6935,88131,42432,67228,65831,50527,40229,17225,13922,75420,86619,83718,10116,62815,08314,96513,575
70 to 74Please 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 wires for semi-annual, quarterly, or monthly payment modes. 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). 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.

Administrator

IMG
P.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: +1 (866) INSUBUY
Phone: +1 (972) 985-4400
Fax: +1 (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. and its representatives throughout the world. © 2007-2019 International Medical Group, Inc. All rights reserved.

Capitalized terms are defined in the Certificate of Insurance.

Version: CM00500561A181203
0119

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The U.S. Department of State requires all J visa holders to purchase compliant insurance.

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Make an instant purchase online and get instant visa letter.

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