GeoBlue Navigator Crew
Covered Persons are the only people qualified to be covered by this Certificate. The following section describes who qualifies as an Eligible Participant or Eligible Dependent, as well as information on when and who to enroll and when coverage begins and ends.
Who is Eligible to Enroll Under This Certificate?
An Eligible Participant means:
- A member of the Global Citizens Association (GCA) covered under this Certificate; and
- Has submitted an enrollment form, if applicable, and the GCA membership fees to the GCA; and
- The Eligible Participant is a U.S.citizen or permanent resident of the U.S. (as defined by the immigration code of the U.S.) residing or scheduled to reside outside of the United States for a period greater than three (3) months; or
- The Eligibility Participant's home country is not the United States; and
- The Country of Assignment is other than the Eligible Participant's Home Country; and
- The Eligible Participant must be i) engaged in missionary or NGO work as an employee or volunteer for a sponsoring organization; ii) attending an Institute of higher learning on a valid student or teaching visa; or iii) employed in the maritime industry as a crew member; and
Meets the underwriting criteria otherwise established by the Insurer. Eligible Dependents An Eligible Dependent means a person who is the Eligible Participant's:
- spouse;civil union partner, or domestic partner;
- own or spouse's, civil union partner's or domestic partner's own unmarried natural child, stepchild or legally adopted child who has not yet reached age 26;
- own or spouse's, civil union partner's or domestic partner'sown unmarried child, of any age, enrolled prior to age 26, who is incapable of self-support due to continuing mental retardation or physical disability and who is chiefly dependent on the Eligible Participant. The Insurer requires written proof from a Physician of such disability and dependency within 31 days of the child's 26th birthday and annually thereafter.
As used above:
- The term "spouse" means the Eligible Participant's lawful spouse as defined in defined in the state or jurisdiction where the marriage occurred. This term includes a common law spouse if allowed by the jurisdiction where the Group Certificate is issued.
- The term "partner" means an Eligible Participant's spouse or domestic partner.
- The term "domestic partner" means a person of the same or opposite sex who:
- is not married or legally separated;
- has not been party to an action or proceeding for divorce or annulment within the last six months, or has been a party to such an action or proceeding and at least six months have elapsed since the date of the judgment terminating the marriage;
- is not currently registered as domestic partner with a different domestic partner and has not been in such a relationship forat least six months;
- occupies the same residence as the Eligible Participant;
- has not entered into a domestic partnership relationship that is temporary, social, political, commercial or economic in nature; and
- has entered into a domestic partnership arrangement with the named Insured.
- The term "domestic partnership arrangement means the Eligible Participant and another person of the same sex has any three of the following in common:
- joint lease, mortgage or deed;
- joint ownership of a vehicle;
- joint ownership of a checking account or credit account;
- designation of the domestic partner as a beneficiary for the Eligible Participant's life insurance or retirement benefits;
- designation of the domestic partner as a beneficiary of the employee's will;
- designation of the domestic partner as holding power of attorney for health care; or
- shared household expenses. A person may not be an Insured Dependent for more than one Insured Participant.
GeoBlue Navigator has three tiers of coinsurance: 100% outside the U.S., 80% in-network in the U.S., 60% out-of-network inside the U.S. All GeoBlue Navigator Plans have an unlimited lifetime maximum and a $250,000 maximum benefit for emergency medical evacuation. The Out-of-Pocket Maximum is calculated by adding the deductible and coinsurance maximum together. Please refer to the chart on page 3 brochure.
|Medical Benefits||Outside the U.S.||In-Network, U.S.||Out-of-Network, U.S.|
|Primary and Preventative Care - Deductible is Waived|
|Primary Care Office Visits - as many as 8 visits per Calender Year||All except a $10 copay per visit||All except a $30 copay per visit||60% to Coinsurance Maximum then 100%|
|Preventative Care Babies/Children:(Birth to Age 18) for Office Visits/Examination and Immunization, Lab work & X-rays||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Preventative Care For Adults:(Age 19 and Older) for Routine Pap Smears, Annual Mammogram and PSA For Men||100%||80% to Coinsurance Maximum then 100%||80% to Coinsurance Maximum then 100%|
|Annual Physical Examination Health Screening||100% Maximum Covered Expense of $250 and limited to one per Calender Year.||80% to Coinsurance Maximum then 100% Maximum Covered One Per Calender Year.||60% to Coinsurance Maximum then 100% Ma Covered Expense of $250 and limited to Expense of $250 and limited to one per Calender Year.|
|Outpatient Services - Insurer Pays after the Deductible is Met|
|Outpatient Medical Care||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Inpatient Hospital Services - Insurer Pays after the Deductible is Met|
|Surgery, X-rays, In-hospital doctor visits, Organ/Tissue Transplant||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Inpatient Medical Emergency||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Professional Services-Surgery, Anesthesia, Radiation Therapy,In-Hospital Doctor Visits, Diagnostic X-rays and Lab Work||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Other Services - Insurer Pays after the Deductible is Met, unless noted|
|Ambulatory Surgical Center||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Physical/Occupational Therapy/Medicine||Deductible is Waived. Covered Expenses up to $50 per visit, and as many as 6 visits per Calender Year.|
|Ambulance Service||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Durable Medical Equipment||100%||80% to Coinsurance Maximum then 100%||60% to Coinsurance Maximum then 100%|
|Mental. Emotional or Functional Nervous Disorders, Alchoholism or Drug Abuse|
|Inpatient Mental Health||100% up to 60 days||80% up to 60 days||60% up to 60 days|
|Outpatient Mental Health||75% up to 40 visits/60% thereafter||75% up to 40 visits/60% thereafter||75% up to 40 visits/60% thereafter|
|Inpatient Substance Abuse||100% up to 60 days detox||80% up to 60 days detox||60% up to 60 days detox|
|Outpatient Substance Abuse||75% up to 40 visits/60% thereafter||75% up to 40 visits/60% thereafter||75% up to 40 visits/60% thereafter|
|Outpatient Prescription Drugs||100% of actual charge up to an annual maximum of $5,000, Maximum 90 - day Supply.||100% of actual charge up to an annual maximum of $5,000, Maximum 90 - day Supply.||100% of actual charge up to an annual maximum of $5,000, Maximum 90 - day Supply.|
|Dental Care Required Due to an Injury||100% of Covered Expenses up to $500 per Calender Year Maximum||100% of Covered Expenses up to $500 per Calender Year Maximum||100% of Covered Expenses up to $500 per Calender Year Maximum|
|Global Travel Benefits - Insurance Waives Deductible|
|Accidental Death and Dismemberment||Deductible is Waived. Maximum Benefit: Principal Sum up to $10,000|
|Repatriation of Remains||Deductible is Waived. Maximum Benefit up to $25,000|
|Medical Evacution||Deductible is Waived. Maximum Lifetime Benefit for a II Evacations up to $250,000|
The following are specifically excluded from Mental Health and Substance Abuse Services:
- Treatment of disorders which have been diagnosed as organic mental disorders associated with permanent dysfunction of the brain.
- Developmental disorders, including but not limited to, developmental reading disorders, developmental arithmetic disorders, developmental language disorders or developmental articulation disorders.
- Counseling for activities of an educational nature; for borderline intellectual functioning;occupational problems; counseling related to consciousness raising;and for vocational or religious counseling.
- Any costs associated with voluntary support groups, such as Alanon or Alcoholics Anonymous.
- I.Q. testing.
- Custodial Care, including but not limited to geriatric day care, and halfway houses, quarter way houses, recovery houses, and other sober living residences.
- Occupational/recreational therapy programs even if combined with supportive therapy for age-related cognitive decline.
Acute Pre-Ex Coverage
means any disease, illness, sickness, malady or condition which was diagnosed or treated by a legally qualified physician prior to the effective date of coverage with consultation, advice or treatment by a legally qualified physician occurring within 6 months prior to the Coverage Date for the Covered Person.
Pre-existing Condition Limitation Benefits are not available for any services received on or within 12 months after the Eligibility Date of a Covered Person if those services are related to a Pre-existing Condition as defined in the Definitions section. This exclusion does not apply to a Newborn that is enrolled within 31 days of birth, a newly adopted child that is enrolled within 31 days from either the date of placement of the child in the home, or the date of the final decree of adoption.
You can enroll in a GeoBlue Navigator policy up to age 75. The policy does not automatically renew upon your request. You will be notified of your new plan rate at least 30 days prior to your policy expiration date. You must confirm your new policy rate in writing or by accepting the rate when logged in to our secure website. Plan rates are based on age at time of enrollment and are impacted by medical inflation. You will not be asked any medical questions and your personal health history will not determine your new rate. GeoBlue Navigator rates are standard rates for all members re-enrolling. Rates are reviewed and approved by state insurance regulators, which protects your rights and guarantees fairness. By contrast, offshore/surplus lines insurers are not required to file rates for approval.
If the Medical Benefits under this Certificate cease for You or You r Dependent due to cancellation of the Policy (except if the Policy is canceled for nonpayment of premiums) and You or Your Dependent is Confined in a Hospital on that date, Medical Benefits will be paid for Covered Expenses incurred in connection with that Hospital Confinement. However, no benefits will be paid after the earliest of:
- the date You exceed the Maximum Benefit, if any, shown in the Schedule of Benefits;
- the date You are covered for medical benefits under another group plan;
- the date You or Your Dependent is no longer Hospital Confined; or
- 10 days from the date the Certificate of Coverage is canceled
Claim means notification in a form acceptable to the Insurer that a service has been rendered or furnished to you. This notification must include full details of the service received, including your name, age, sex, identification number, the name and address of the Provider, an itemized statement of the service rendered or furnished, the date of service, the diagnosis, the Claim Charge, and any other information which THE INSURER may request in connection with services rendered to you.
Claim Charge means the amount which appears on a Claim as the Provider's charge for service rendered to you, without adjustment or reduction and regardless of any separate financial arrangement between a Plan or our Authorized Administrator and a particular Provider. (See provisions of this Certificate regarding "Separate Financial Arrangements with Providers.")
Claim Payment means the benefit payment calculated by the Insurer, after submission of a Claim, in accordance with the benefits described in this Certificate. All Claim Payments will be calculated on the basis of the Usual & Customary Fee for Covered Services rendered to you, regardless of any separate financial arrangement between a Plan or our Authorized Administrator and a particular Provider. (See provisions of this Certificate regarding "Separate Financial Arrangements with Providers.")