Plan Administrator: International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International
Complete details are given in certificate of insurance.
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Age and Policy Maximum |
Through age 64: $50,000, $100,000, $500,000 or $1,000,000 Ages 65 to 69: $50,000 or $100,000 Ages 70 to 79: $50,000 Ages 80 and older: $10,000 |
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Doctor Visit |
Up to Policy Maximum |
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Urgent Care |
$25 co-pay. Co-pay is not applicable when the $0 deductible is selected. |
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Hospital Room and Board |
Average semi-private room rate up to the maximum limit. Includes nursing service , miscellaneous, and Ancillary services |
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Ambulance |
Up to Policy Maximum |
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Prescription |
Up to Policy Maximum |
Complete details are given in certificate of insurance.
PREVENTATIVE CARE: Charges for Routine Physical Examinations and immunizations are excluded from coverage under this insurance.
Charges resulting directly or indirectly from or relating to any Pre-existing Condition are excluded from coverage under this insurance;
Any Injury, Illness, sickness, disease, or other physical, medical, Mental or Nervous Disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the three (3) years prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.
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Acute Onset of Pre-existing Conditions • Insured Person must be under 70 years of age • Refer to the ACUTE ONSET OF PRE-EXISTING CONDITIONS provision for further details and requirements
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United States citizens: • Age 64 and under without a Primary Health Plan: • Maximum Limit: $20,000 • Age 64 and under with a Primary Health Plan: • Up to the Period of Coverage limit • Age 65 through age 69: • Maximum Limit: $2,500
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Acute Onset of Pre-existing Conditions • Insured Person must be under 70 years of age • Refer to the ACUTE ONSET OF PRE-EXISTING CONDITIONS provision for further details and requirements
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Non-United States citizens: • Age 69 and under: • Up to the Period of Coverage limit or $1,000,000 (whichever is lower)
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Emergency Medical Evacuation • Arises or results directly from a covered Acute Onset of a Pre-existing Condition • Insured Person must be under 70 years of age
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Maximum Limit: $25,000
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PPO Providers Link: https://ipa.imglobal.com/
Subject to the Terms of the TERMINATION OF MASTER POLICY and TERMINATION OF COVERAGE FOR INSURED PERSONS subparagraphs of the CONDITIONS AND GENERAL PROVISIONS, an Insured Person can request coverage under this insurance plan to be extended a minimum of five (5) days for up to a three hundred sixty-five (365) day period until reaching a maximum of twenty-four (24) continuous months in accordance with and subject to the Terms of the plan then in effect (including the Terms of the then applicable Master Policy) and so long as extension Premium is paid when due and the Insured Person otherwise continues to meet the applicable eligibility requirements of the plan.
The Insured Person shall have three (3) days from the Initial Effective Date of Coverage (the “Review Period”) to review the benefits, conditions, limitations, exclusions and all other Terms of the Master Policy as evidenced and outlined by this Certificate. If not completely satisfied, the Insured Person may request cancellation of this insurance retroactive to the Initial Effective Date of Coverage by sending a written request to the Company by email, mail or fax and received by the Company within the Review Period, thereby qualifying to receive a full refund of Premium paid. Upon effectuation of such cancellation and refund, neither the Company nor the Insured Person shall have any further rights, liabilities or obligations under this insurance. After the Review Period, the Insured person may request cancellation by sending a written request to the Company by email, mail, or fax. However, the following conditions apply for Premium refund: (a) If any claims have been filed with the Company, the Premium is fully earned and is non-refundable. (b) If no claims have been filed with the Company: (i) a cancellation fee of fifty dollars ($50.00 USD) will be charged (ii) only Premium covering time periods after cancellation are refundable
When the Insured Person receives Treatment or the Company receives notice of a claim for benefits under this insurance, the Insured Person shall submit an International Medical Group (IMG) Claim Form as a necessary component of the Proof of Claim.