Global Medical Insurance from IMG and Loewenthal Insurance Agency

Global Medical Insurance is designed to meet your total needs. The program offers you the flexibility to select from four unique benefit options, Silver, Gold, Gold Plus and Platinum - each with specialized coverages. To accommodate your financial means, you can customize your length and area of coverage with the flexibility to select from multiple deductibles and modes of payment.

When you select Global Medical Insurance, you receive IMG’s commitment to deliver world class health benefits, medical assistance and Global Peace of Mind®.

Benefit Description	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 lifetime per individual	$5,000,000 lifetime per individual	$5,000,000 lifetime per individual	$5,000,000 lifetime per individual	$8,000,000 lifetime per individual
Deductible (Per Period of Coverage)	$250 to $10,000 50% waived within PPO network	$250 to $10,000 50% waived within PPO network	$250 to $10,000 50% waived within PPO network	$250 to $10,000 50% waived within PPO network	$100 to $10,000 50% waived within PPO network
Family Deductible	Three times the individual deductible	Three times the individual deductible	Three times the individual deductible	Three times the individual deductible	Two times the individual deductible
Coinsurance within the PPO network	No coinsurance	No coinsurance	No coinsurance	No coinsurance	No coinsurance
Coinsurance outside the U.S. and Canada	No coinsurance	No coinsurance	No coinsurance	No coinsurance	No coinsurance
Coinsurance inside the U.S. and Canada	80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage	80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage	80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage	80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage	90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage
Hospitalization / Room & Board	$600 per day - 240 day maximum	Average semi-private room rate	Up to a limit of $2,250 per day	Average semi-private room rate	Private room rate
Intensive Care Unit	$1,500 per day - 180 day per event	URC	Up to a limit of $4,500 per day	URC	URC
Surgery	URC	URC	URC	URC	URC
Anesthetist's Charges Associated with Surgery	20% of surgery benefit	URC	20% of surgery benefit	URC	URC
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	URC	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; Physiotherapy - up to $75 per visit, $1,000 max per certificate period $10,000 lifetime maximum	URC	URC
Emergency Room Illness (Additional $250 deductible if not admitted)	URC	URC	URC	URC	URC
Emergency Room Accident	URC	URC	URC	URC	URC
Supplemental Accident	NA	$300 per occurrence	$300 per occurrence	$300 per occurrence	$500 per occurrence
Local Ambulance	$1,500 per covered event - not subject to deductible or coinsurance	URC	$100 per event - not subject to deductible or coinsurance	URC	URC
Mental/Nervous	Outpatient only after 12 months	$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
Child Wellness	3 visits per period of coverage - $70 maximum per period - Available after 12 months of continuous coverage	$200 maximum per period of coverage - Available after 12 months of continuous coverage	$200 maximum per period of coverage - Available after 12 months of continuous coverage	$200 maximum per period of coverage - Available after 12 months of continuous coverage	$400 maximum per period of coverage - 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
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	Limited to $5,000 per certificate period up to a $20,000 lifetime maximum
Political Evacuation and Repatriation	NA	NA	NA	NA	Limited to $10,000 lifetime maximum
Rx Coverage	URC	URC	$5,000 per certificate period for each insured person, out-patient only	URC	Outside U.S. - URC Inside U.S. - Rx drug card co-pay: $20 for generic / $40 for brand name where generic is not available
Other Services	Extended care: first 30 days; Radiation: URC; Home nursing: 30 days per covered event; Hospice: 30 days; Prosthetic Devices: all URC	URC	URC - Radiation & Chemotherapy treatments (in and out-patient) limited to $10,000 per year; $50,000 lifetime maximum	URC	URC
Physical Therapy	Maximum $40 per visit - 30 visit maximum	Maximum $50 per visit	Maximum $50 per visit	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	URC	URC	URC	URC
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% Ortho 0% (6 month waiting period)
Emergency Dental due to Accident	$1,000 per period of coverage	URC	$500 per period	URC	URC
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
Global Concierge & Assistance Services	NA	NA	NA	NA	Included
Pre-existing Conditions	$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage	$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage	$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage	$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage	SAAI
Maternity Delivery, wellness, new born care & congenital disorders (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 in 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 in 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 in 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 in 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 illness maximum of $250,000 for the first 31 days
NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)

Routine Care

Freedom to choose your provider - This program allows you the freedom to choose your own health care provider no matter where you are in the world. With open access to health care providers, you have improved access to quality care.

Locating a provider - For your convenience and to help you reduce your out-of-pocket expenses, we provide you access to two extensive provider networks that include established, globally credentialed physicians and hospitals.

The independent Preferred Provider Organization (PPO) - when seeking care within the U.S.
The International Provider Access^SM (IPA) - when seeking care outside the U.S.

Emergency Care

Emergency Medical Evacuation - The ability to access quality health care is of paramount importance when a life-threatening medical emergency arises abroad. This program provides you with important emergency benefits backed by the services of an accredited 24/7/365 clinical staff with over 200 years of combined experience.

Emergency Medical Evacuation benefit
Return of Mortal Remains benefit
Remote Transportation benefit (Platinum plan option)
Political Evacuation benefit (Platinum plan option)

Optional Riders

Optional Maternity Rider - Silver, Gold and Gold Plus plans only

$50,000 lifetime maximum
Maximum of $5,000 for normal delivery for each pregnancy - not subject to deductible or coinsurance
Maximum of $7,500 for C-section delivery for each pregnancy - not subject to deductible or coinsurance
$200 child wellness benefit for the first 12 months
New born care and congenital disorders maximum of $250,000 for the first 31 days
Must be selected at time of initial purchase of plan
Benefits available after 10 months of continuous coverage
Eligible newborn children may be added without evidence of insurability as long as an application form is submitted within 31 days of birth
Benefits will be reduced by 50% for births that occur in the 11th or 12th month of continuous coverage

Terrorism Rider - Platinum plan only

If an insured person is injured as a result of an act of Terrorism*, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum.

This benefit does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.

* For limitations and the definition of Terrorism, please see the Certificate Wording.

Sport Rider - Platinum plan only

Provides up to $25,000 of lifetime coverage for adventure sports such as mountaineering, parachuting, and whitewater rafting. Also provides up to $10,000 of lifetime coverage for amateur sports when not engaged for wage, reward, or profit including contact sports such as soccer and hockey.

IMG - Global Medical Insurance:

BENEFITS

Routine Care

Emergency Care

Optional Riders