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MEDICARE BENEFITS

 

URC

= Usual , Reasonable  Customary

= Habituel Raisonable Normalement

Subject to deductible and
coinsurance

Coverage Area

 

Worldwide

Policy Maximum Per Individual

 

US$5,000,000 lifetime

Hospitalization

Semi-private room and board • Nursing services • Prescription medication • Physician charges • Diagnostic and laboratory testing • X-rays • Chemotherapy and radiation • Durable medical equipment • Treatment, services and supplies routinely provided

URC

Intensive Care Unit

 

URC

Surgery

Surgical care • Second surgical opinion • Anesthetics • Physician charges for surgery • Treatment, services and supplies routinely provided

URC

Transplants

Limited to certain transplants and covered only within designated transplant facilities that are members of IMG's independently-

contracted PPO network

US$1,000,000 lifetime

Outpatient

Emergency treatment of illness or injury • Surgery • Rehabilitative treatment • Treatment, services or supplies routinely provided  • Prescription medication

URC

Emergency

Surgery or dental treatment following an accident • Emergency room following an accident

URC

Emergency Transportation by
Ground Ambulance

 

URC

Emergency Medical Evacuation

Included with Emergency Medical Evacuation is an Emergency Reunion benefit of US$10,000 lifetime

Up to policy maximum

Repatriation

 

US$25,000

Supplemental Accident

The first $300 will be covered for each accidental injury

US$300 per occurrence

Maternity

Available after 12 months of continuous coverage • Pre and Post-natal care • Normal delivery or C-section • Well baby care and treatment of newborn for first 31 days

US$50,000 lifetime

Newborns

Eligible newborn children may be added without evidence of insurability under certain circumstances • An application form must be submitted within 31 days of child's birth

URC

Child Wellness

Available for eligible children from 14 days to 18 years of age after 12 months of continuous coverage

US$50 maximum per visit; US$150 per policy period

Pre-existing Conditions

After 24 months of continuous coverage

US$50,000 lifetime

Mental/Nervous Care

Available after 12 months of continuous coverage • Inpatient and outpatient care by a licensed psychiatrist

US$10,000 per period of coverage

Wellness

Females age 35 and over, after 12 months of continuous coverage • Routine physicals • Mammogram, ob/gyn visit, etc. (exams must be separated by 12 months) Males age 35 and over, after 12 months of continuous coverage • Routine physicals (exams must be separated by 12 months)

US$250 per policy period

Complementary Medicine

 

(Each per policy period)

Acupuncture

 

US$150

Aroma Therapy

 

US$50

Herbal Therapy

 

US$75