GeoBlue Xplorer Essential

Plan Detail

Benefits


Benefits Outside U.S. Only
Preventive and Office Visits – Insurer Waives Deductible
Physician Office Visits (Adult) All except a $10 copay per visit
Physician Office Visits (Children 0-18) 100%
Unlimited Well Baby Visits 100%
Child Immunizations, Lab and X-rays 100%
Women (19 and Older) Routine Pap Smears, Annual Mammogram 100%
PSA for Men 100%
One Routine Physical Per Year 100%
Professional Services – Insurer Pays After Deductible is Met
Surgery, Anesthesia, Radiation Therapy, In-hospital Doctor Visits, Diagnostic X-ray and Lab Work. 100%
Preventive and Office Visits – Insurer Waives Deductible
Surgery, X-rays, In-hospital Doctor Visits, Organ/Tissue Transplant 100%
Inpatient Medical Emergency 100%
Inpatient Drugs 100%
Ambulatory and Therapeutic Services – Insurer Pays After Deductible is Met
Ambulatory Surgical Center 100%
Ambulance Service 100%
Accidental Dental $1,000 per year, $200 per tooth
Acupuncture and Chiropractic Services 100% up to $2,000
Durable Medical Equipment 100%
Infusion Therapy 100%
Physical/Occupational Therapy* $50 max each visit, 12 visits per year
Inpatient Mental Health 100% up to 60 days
Outpatient Mental Health 75% up to 40 visits/60% thereafter
Inpatient Substance Abuse 100% up to 60 days detox
Outpatient Substance Abuse 75% up to 40 visits/60% thereafter
Prescription Drug Benefit Options – Insurer Waives Deductible
Basic Prescription Drug Benefit 100% of actual charges up to $1000
Optional Rider, subject to $25,000 maximum per Insured Person per Coverage Period. Maximum Benefit 100% of actual charges
Global Travel Benefits – Insurer Waives Deductible
Emergency Medical Transportation Up to $250,000
Repatriation of Mortal Remains Up to $25,000
Accidental Death and Dismemberment $50,000
Other Benefits Limits
Home Health Care 100% Covered Expenses, as many as 30 visits per year
Skilled Nursing Facilities 100% with a maximum Covered Expense of $250 per day, as many as 50 days per year
Hospice 100% with a maximum Covered Expense of $5,000 per lifetime

GeoBlue Xplorer Essential covers most services outside the U.S. at 100%. All plans have an unlimited lifetime maximum and a $250,000 maximum benefit for emergency medical evacuation.