Plan Administrator: International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International
The Company, through the Plan Administrator, endeavors to maintain a contractual arrangement with one or more independent Preferred Provider Organizations (PPO) that has established and maintains a network of U.S.-based Physicians, Hospitals and other healthcare and health service providers who are contracted separately and directly with the PPO and who may provide re-pricings, discounts or reduced charges for Treatment or supplies provided to the Insured Person. Neither the Company nor the Plan Administrator has any authority or control over the operations or business of the PPO, or over the operations or business of any provider within the independent PPO network. Neither the PPO nor provider within the PPO network nor any of their respective agents, employees or representatives has or shall have any power or authority whatsoever to act for or on behalf of the Company or the Plan Administrator in any respect, including without limitation no power or authority to: (i) approve Applications or enrollments for initial, renewal or reinstated coverage under this insurance plan or to accept Premium payments, (ii) accept risks for or on behalf of the Company, (iii) act for, speak for, or bind the Company or the Plan Administrator in any way, (iv) waive, alter or amend any of the Terms of the Master Policy or this Certificate or waive, release, compromise or settle any of the Company’s rights, remedies, or interests thereunder or hereunder, or (v) determine Pre-certification, eligibility for coverage, verification of benefits, or make any coverage, benefit or claim adjudications or decisions of any kind. It is not a requirement of this insurance that the Insured Person seek Treatment or supplies exclusively from a provider within the independent PPO network. However, the Insured Person’s use or non-use of the PPO network may affect the scope and extent of benefits available under this insurance, including without limitation any applicable benefit reduction, Deductible, Coinsurance and Extra Deductible, as set forth above. An Insured Person may contact the Company through the Plan Administrator and request a PPO Directory for the area where the Insured Person will be receiving consultation or Treatment (therein listing the Physicians, Hospitals and other healthcare providers within the PPO network by location and specialty), or may visit the Plan Administrator’s website at http://www.myimg.imglobal.com to obtain such information.
|Doctor Visit (OPT)||25 visits: $70 doctor/specialist maximum limit; $60 psychiatrist maximum limit; $50 chiropractor maximum limit;|
|X-ray and Labs(OPT)||$250 X-Ray per exam maximum limit; $300 lab tests per exam maximum limit.|
|Hospital Room & Board (IPT)||
In U.S. – 100% of average semi-private room rate.
Outside of U.S. - 100% of private room rate (not to exceed 150% of semi-private room rate).
|Physical Therapy||Maximum $40 per visit - 30 visit maximum.|
|Pre-Existing Conditions Limitation||$50,000 lifetime maximum; $5,000 per period of coverage after 24 months|
Complete details are given in certificate of insurance.
$50,000 lifetime maximum; $5,000 per period of coverage after 24 months.
Acute Onset of Pre-existing Condition sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent care. The Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policy. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute Onset.
Global Mission Medical Insurance is annually renewable and coverage is continuous when approved. Prior to the end of each period of coverage (12 months) you will receive renewal information. You must continue to meet the eligibility requirements outlined in the contract in order to apply to renew. You have the option to renew online or you may complete a paper renewal form.
We are confident that you will be pleased with the full terms of coverage. To ensure your satisfaction, once you are accepted in the plan we provide a 15 day period to review the fulfillment kit contents. If during that 15 day period you find that you are not satisfied with the plan for any reason, you may submit a written request for cancellation and full refund of your premium. See the Certificate of Insurance for full details.
Cancellation requests received after this 15 day period will be granted at the sole discretion of IMG as the plan administrator. Any refund you may receive will be based on an established refund schedule, not a pro-rated basis. See the Certificate of Insurance for full details.