| Benefit Description |
Silver Option |
Gold Option |
Platinum Option |
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| Coverage Area |
Two options:
Worldwide or worldwide excluding the U.S. and Canada |
Policy Maximum
Per Individual |
US$5,000,000
lifetime |
US$5,000,000
lifetime |
US$8,000,000
lifetime |
Hospitalization/
Room & Board |
US$600 per Day
(max of 240 consecutive days per covered event) |
Average semi-private room rate |
Private room rate |
| Intensive Care Unit |
US$1,500 per day
(max of 180 consecutive days per covered event) |
Usual, Reasonable,
and Customary (URC) |
Usual, Reasonable,
and Customary (URC) |
| Surgery |
URC |
URC |
URC |
| Anesthetist's charges associated with surgery |
20% of the surgery
benefit payable |
URC |
URC |
| Outpatient |
Visits/Exams - 25 visits per insured person per period of coverage to the maximum limit as outlined: physician $70; specialist $70; psychiatrist $60; chiropractor $50; surgical intervention consultation $500; X-rays - $250 per exam maximum limit; Lab Tests - $300 per exam maximum limit |
URC |
URC |
| Emergency Evacuation |
US$50,000 per coverage period
(not subject to deductible or coinsurance) |
Limited to policy maximum
(not subject to deductible or coinsurance) |
Limited to policy maximum
(not subject to deductible or coinsurance) |
| Local Ambulance |
US$1,500 per covered event (not subject to deductible or coinsurance) |
URC |
URC |
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| Emergency Room Accident |
URC |
URC |
URC |
| Emergency Room Illness |
URC - subject to an additional $250 deductible if not admitted. |
| Supplemental Accident |
NA |
US$300 per occurrence (not subject to deductible or coinsurance) |
US$500 per occurrence (not subject to deductible or coinsurance) |
| Return of Mortal Remains |
US$25,000 lifetime maximum per insured (not subject to deductible or coinsurance) |
US$25,000 lifetime maximum per insured (not subject to deductible or coinsurance) | US$50,000 lifetime maximum per insured (not subject to deductible or coinsurance) |
| Emergency Reunion |
NA (Not applicable) |
$10,000 lifetime maximum |
$10,000 lifetime maximum |
| Child Wellness |
Three visits per period of coverage - maximum $70 per visit Available for children under 18 years of age after 12 months of continuous coverage |
$200 maximum per period of coverage (not subject to deductible or coinsurance) Available for children under 18 years of age after 12 months of continuous coverage |
$500 maximum per period of coverage (not subject to deductible or coinsurance) Available for children under 18 years of age after 12 months of continuous coverage |
| Home Nursing Care |
Limited 30 days per covered event |
URC |
URC |
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| Prosthetic Devices |
all URC |
URC |
URC |
| High School Sports Injury |
NA |
NA |
Up to $5,000 maximum |
| Pre-existing Conditions |
US$5,000 per period of coverage up to a US$50,000 lifetime maximum
Available after 24 months of continuous coverage |
Same as any illness |
Mental/Nervous
Available after 12 months of continuous coverage |
Outpatient only |
US$10,000 per period of coverage, US$50,000 lifetime maximum |
Same as any illness - US$50,000 lifetime maximum |
| Adult Wellness |
NA |
US$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 |
US$500 per period of coverage (not subject to deductible or coinsurance) Available for those 18 years of age and over after 12 months of continuous coverage |
| Emergency Dental due to Accident |
US$1,000 per period of coverage |
URC |
URC |
| Complementary Medicine |
NA |
Acupuncture US$150
Aroma Therapy US$50
Herbal Therapy US$50
Magnetic Therapy US$75
Massage Therapy US$150
Vitamin Therapy US$100
(Each per period of coverage) |
| Recreational SCUBA Coverage |
NA |
URC |
URC |
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| Remote Transportation |
NA |
NA |
Limited to $5,000 per certificate period up to a $20,000 lifetime maximum |
| Rx Coverage |
URC |
URC |
URC |
| Extended Care |
Limited to the first 30 days of confinement |
URC |
URC |
| Hospice Care |
Limited to the first 30 days of hospice confinement |
URC |
URC |
| Radiation Treatment |
URC |
URC |
URC |
| Physical therapy |
30 visits per coverage period (max limit of $40 per visit) |
max US$50 per visit |
max US$50 per visit |
| Non-emergency Dental |
NA |
NA |
Calendar year maximum - $750
Individual deductible $50
Schedule of benefits - Class I: 90% Class II: 70% Class III: 50% Ortho 0% (6 month waiting period) |
| Transplants |
US$250,000 per transplant |
US$1,000,000 lifetime maximum |
US$2,000,000 lifetime maximum |
| Vision |
NA |
NA |
Exams - up to $100 per 24 months
Materials - up to $150 per 24 months |
| Maternity |
Optional Rider - US$50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months (not subject to deductible or coinsurance) Available after 10 months of coverage benefits reduced by 50% for births that occur in 11th or 12th month of continuous coverage |
Same as any Illness (SAAI) $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for first 12 months Available after 10 months of coverage |
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NA (Not applicable) | URC (Usual, Reasonable and Customary) | SAAI (Same As Any Illness)
*This information has been gathered thru product brochure and contract review. Some information was also
obtained from customer service representatives at each company. The data gathered is believed to be completely accurate. If clarification
on any of these points listed above is needed, please call the carrier or the administrator.
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