GeoBlue Voyager Essential

Plan Detail

Benefits


Medical Benefits  
Maximum Benefit per Insured Person per period of coverage > Four Options: $50,000; $100,000; $500,000; $1,000,000
Deductible per Insured Person per period of coverage > Four Options: $0; $100; $250; $500
After the Deductible is satisfied, benefits are paid for Covered Expenses as follows up to the Medical Limit:

Benefits

Insurer Pays **

Essential

Choice*

Professional Services:
Surgery, anesthesia, radiation therapy, inpatient doctor visits, X-ray and lab
100% 100%
Office visits, including X-rays and lab 100% 100%
Inpatient Hospital Services:
Surgery, X-rays and lab
100% 100%
Inpatient medical emergency 100% 100%
Ambulatory surgical center 100% 100%
Ambulance service 100% up to $1,000
Claims resulting from downhill skiing and scuba diving Maximum Benefit up to $10,000
Outpatient prescription drugs outside the U.S. 50% of Expenses up to $5,000 100% of Expenses up to $5,000
Dental care required due to an injury 100% of Covered Expenses up to $200 maximum per trip period 100% of Covered Expenses up to $500 maximum per trip period
Dental care for relief of pain 100% of Covered Expenses up to $100 maximum per trip period 100% of Covered Expenses up to $250 maximum per trip period
Physical and Occupational Therapy 6 visits per Period of Insurance. $100 Max payment per visit.

Other Benefits

Insurer Pays ***

Essential

Choice

Accidental Death and Dismemberment Maximum Benefit Principal Sum up to $25,000 Maximum Benefit Principal Sum up to $50,000
Repatriation of Mortal Remains Maximum Benefit up to $25,000
Emergency Medical Transportation Maximum Benefit per Trip Period for all Emergency Medical Transportation up to $500,000
Emergency Family Travel Arrangements Maximum Benefit per Trip Period up to $2,500 for the cost of one economy round-trip airfare ticket to the place of the Hospital Confinement for one (1) person.
Baggage & Personal Effects Coverage Maximum benefit of $500 per Trip Period and limited to $100 maximum benefit per bag or Personal Effect
Post Departure Trip Interruption Maximum benefit of $500 per Trip Period

The benefits outlined in the table show the payment percentages for Covered Expenses AFTER the Insured Person has satisfied their Deductible. Covered Expenses are based on Reasonable Charges which may be less than actual billed charges. Providers can bill the Insured Person for amounts exceeding Covered Expenses. GeoBlue Contracted Providers are contracted to accept Reasonable Charges. This plan is available to U.S. residents, age 74 or younger (84 or younger for the Choice plan), if they apply from the U.S. This is a nonrenewable plan. Subsequent periods of insurance can be purchased, in which case new Deductible, Eligibility and Pre-existing Condition Exclusions will apply.