Global Crew Medical Insurance

Plan Detail

Plan Administrator: International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International

Benefits


The following is a summary schedule of benefits. Benefits are subject to the deductible and coinsurance unless otherwise noted. NA (Not Applicable); URC (Usual, Reasonable and Customary); SAAI (Same As Any Illness).
 
Benefit Silver Gold
(1st 36 months of continuous coverage)
Gold
(Beginning the 1st day of the 37th month)
Gold Plus Platinum
Lifetime Maximum Limit $5,000,000 per individual $5,000,000 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 $10,000 $250 to $10,000 $100 to $10,000
Treatment outside the U.S. and Canada 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. (Out-patient/In-patient Emergency) PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - deductible 50% waived (to a $2,500 maximum). No coinsurance.
Treatment inside the U.S. (In-patient Non-emergency Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance. Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance. Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance. Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance. Medical Concierge - deductible 50% waived (to a $2,500 maximum). No coinsurance. PPO Network - subject to deductible. No coinsurance.
Treatment inside the U.S.-
Non-PPO Network and Canada
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 90% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage
Hospitalization/Room & Board In U.S./Canada – URC of average semiprivate room rate. Outside of U.S./ Canada - URC of private room rate (not to exceed 150% of semi-private room rate) All subject to $600 per day - 240 day max. In U.S./Canada – URC of average semiprivate room rate. Outside of U.S./ Canada - URC of private room rate (not to exceed 150% of semi-private room rate) Up to a limit of $2,250 per day - semi-private room rate In U.S./Canada – URC of average semiprivate room rate. Outside of U.S./ Canada - URC of private room rate (not to exceed 150% of semi-private room rate) Private room rate
Intensive Care Unit $1,500 per day - 180 day per event Usual, Reasonable and Customary Up to a limit of $4,500 per day Usual, Reasonable and Customary Usual, Reasonable and Customary
Surgery Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary
Anesthetist’s Charges
Associated with Surgery
20% of surgery benefit Usual, Reasonable and Customary 20% of surgery benefit Usual, Reasonable and Customary Usual, Reasonable and Customary
Transplants $250,000 per transplant $1,000,000 lifetime maximum $500,000 lifetime maximum $1,000,000 lifetime maximum $2,000,000 lifetime maximum
Out-patient 25 visits: $70 doctor/specialist;
$60 psychiatrist; $50 chiropractor; $250 X-ray per exam maximum limit; $500 surgery intervention
consultation; $300 lab tests per exam maximum limit
Usual, Reasonable and Customary Physician Charges - limit of $150 per visit; Hospital Charge - $100 co-pay unless admitted; Urgent Care Facility - $25 copay; Diagnostic Lab and X-Rays limited to $5,000 per certificate period Usual, Reasonable and Customary Usual, Reasonable and Customary
Emergency Room Illness
(Additional $250 deductible if not admitted)
Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary
Emergency Room Accident Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary
Supplemental Accident NA $300 per occurrence $300 per occurrence $300 per occurrence $500 per occurrence
Local Ambulance $1,500 per event - not subject to deductible or coinsurance Usual, Reasonable and Customary $100 per event - not subject to
deductible or coinsurance
Usual, Reasonable and Customary Usual, Reasonable and Customary
Mental/Nervous Out-patient only after 12 months of continuous coverage $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage $2,500 maximum per certificate period; In-patient limited to 25 days per certificate period; Out-patient limited to max of 20 visits per certificate period at 70% eligible expenses, up to $75 maximum per visit; Lifetime maximum of $30,000 $10,000 per period - $50,000 maximum - Available after 12 months of continuous coverage SAAI - $50,000 lifetime maximum - Available after 12 months of continuous coverage
Amateur Sailboat Racing Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary
Special Crew Member Return Benefit Up to $2,500 per period of  nsurance - not subject to deductible or coinsurance Up to $2,500 per period of insurance - not subject to deductible or coinsurance Up to $2,500 per period of insurance - not subject to deductible or coinsurance Up to $2,500 per period of insurance - not subject to deductible or coinsurance Up to $2,500 per period of insurance - not subject to deductible or coinsurance
Emergency Evacuation $50,000 per period of coverage - not subject to deductible or coinsurance Up to maximum limit - not
subject to deductible or coinsurance
$250,000 limit per person per
certificate period
Up to maximum limit - not
subject to deductible or coinsurance
Up to maximum limit - not
subject to deductible or coinsurance
Emergency Reunion NA $10,000 lifetime maximum $10,000 lifetime maximum $10,000 lifetime maximum $10,000 lifetime maximum
Return of Mortal Remains $25,000 lifetime maximum per insured - not subject to deductible or coinsurance $25,000 lifetime maximum per insured - not subject to deductible or coinsurance $15,000 lifetime maximum per insured - not subject to deductible or coinsurance $25,000 lifetime maximum per insured - not subject to deductible or coinsurance $50,000 lifetime maximum per insured - not subject to deductible or coinsurance
Remote Transportation NA NA NA NA NA
Political Evacuation and Repatriation NA NA NA NA NA
Child Wellness
(Under 18 years of age)
3 visits per period of coverage - $70 maximum per period - 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 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
$400 maximum per period of
coverage - not subject to deductible or coinsurance. Available after 6 months of
continuous coverage
Adult Wellness NA $250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage $250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage $250 per period of coverage - not subject to deductible or coinsurance - Available for those 30 years of age and over after 12 months of continuous coverage $500 per period of coverage - not subject to deductible or coinsurance - Available for those 18 years of age and over after 6 months of continuous coverage
Rx Coverage Usual, Reasonable and Customary Usual, Reasonable and Customary $5,000 per certificate period for each insured person, out-patient only Usual, Reasonable and Customary Outside U.S. - URC. Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available (Certain monthly per prescription amount limits may apply and require pre-approval by the Company.)
Other Services Extended care: first 30 days;
Radiation: URC; Home nursing: 30 days per covered event; Hospice: 30 days; Prosthetic Devices: all URC
Usual, Reasonable and Customary URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum Usual, Reasonable and Customary Usual, Reasonable and Customary
Physical Therapy Maximum $40 per visit - 30 visit maximum Maximum $50 per visit Maximum $50 per visit - $1,000 max per certificate period. $10,000 lifetime maximum Maximum $50 per visit Maximum $50 per visit
Complementary Medicine NA Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy  150; Vitamin Therapy $100. Each per period of coverage Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage Acupuncture $150; Aroma Therapy $50; Herbal Therapy $50; Magnetic Therapy $75; Massage Therapy $150; Vitamin Therapy $100. Each per period of coverage
Recreational Scuba NA Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary Usual, Reasonable and Customary
Non-emergency Dental NA NA NA NA Calendar year maximum: $750; Individual deductible - $50 Schedule of Benefits - Class I 90%; Class II 70%; Class III 50%; 6 month waiting period
Emergency Dental due to Accident $1,000 per period of coverage Usual, Reasonable and Customary $500 per period of coverage Usual, Reasonable and Customary Usual, Reasonable and Customary
Emergency Dental due to Sudden Unexpected Pain NA $100 per period of coverage $100 per period of coverage $100 per period of coverage See Non-emergency Dental benefits
High School Sports Injury NA NA NA NA Up to $20,000 per certificate period
Vision NA NA NA NA Exams - up to $100
Materials - up to $150 per 24 months
Maternity Delivery, wellness, new born care & congenital disorders, Family Matters Maternity Program (*not subject to deductible or coinsurance - available after 10 months of coverage) Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage) Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage) Optional Rider* - $50,000 lifetime
maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital
disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage)
Optional Rider* - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days (Benefits reduced by 50% for births that occur in the 11th or 12th month of continuous coverage) SAAI - $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for the first 12 months, new born care & congenital disorders maximum of $250,000 for the first 31 days
Optional Riders
 
Global Medical Insurance is designed to 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 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 50 - 54 years: $20,000
Age 19 - 29 years: $75,000             Age 55 - 59 years: $15,000
Age 30 - 39 years: $50,000             Age 60 - 64 years: $10,000
Age 40 - 44 years: $35,000             Age 65 - 69 years: $7,500
Age 45 - 49 years: $25,000

Accidental Death & Dismemberment (AD&D) - included with Global Term Life Insurance(* Benefit based on age at time of death; ** “Member” means hand, foot or eye)

Accidental Loss of Life: Principle Sum*
Accidental Total Loss of 2 Members**: Principle Sum*
Accidental Total Loss of 1 Member**: 50% of Principle Sum*
Global Daily Indemnity (Amount shown is the Principle Sum per unit. Available between age 31 days - 69 years up to two units) $100 per day
Maternity (Silver, Gold, Gold Plus plan options) $50,000 lifetime maximum, $5,000 maximum for normal delivery,
$7,500 for C-section (Newborn covered for first 31 days only without additional premium. Refer to page 6 for more information)
Terrorism (Platinum plan option) $50,000 lifetime maximum
Sports (Gold Plus and Platinum plan options) $25,000 lifetime coverage for some adventure sports including
mountaineering, parachuting, and whitewater rafting
(Refer to Certificate Wording for a comprehensive list)