GeoBlue Navigator Crew

Detail

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?

Eligible Participant

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.

Benefit

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

Exclusion

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.

Renew

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.

Cancel

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

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.")

Scenario	Coverage Under Full Pre-Existing Plan
My father had a heart attack a few years ago. After his travel to the US, he started experiencing heart pain. I took him to the cardiologist. Is this covered?	Yes. Cardiologist visits are covered underneath a Full Pre-Existing coverage plan.
My mother-in-law has been experiencing heart pain for last few days, and had a heart attack on the last day. Is this covered?	Yes. Under a Full Pre-Existing Plan, there is not time limitation between symptoms and seeking care.
My uncle had cancer a few years ago. He is on a Green Card and has been living in the US. Recently, the cancer has come back. Is this covered?	Yes. Chemotherapy & Radiation treatment are covered under this plan. One note- the recurring cancer diagnosis must occur after the effective date.
My cousin had a back injury a few years back. He recently starting feeling back pain and went to seek the advise of a Chiropractor & get physical therapy. Is this covered?	Yes. Chiropractic care & physical therapy regarding pre-existing conditions are covered underneath full pre-existing plans.
My aunt had a sudden heart attack. After staying a few days in the hospital, she needs prescription drugs, follow up blood tests, and doctors visits. Are these covered?	Yes. Any sudden medical event, along with any follow up visits, i.e. blood tests, x-rays, EKG, etc., will be covered by full pre-existing plans.
My mother is diabetic. She was prescribed medication but often forgets to take it often. She experienced a diabetic shock and needed to visit the emergency room. Will this emergency visit be covered?	Yes. Our plans cover you no matter whether your visitor was taking their prescribed medication or not. Full pre-existing plans will cover no matter what happens.

Scenario	Coverage Under INF Acute Onset Plan
My father had a heart attack a few years ago. After his travel to the US, he started experiencing heart pain. I took him immediately to the emergency room. Is this covered?	Yes. Cardiologist visits are covered underneath a Full Pre-Existing coverage plan.
My mother-in-law had a sudden drop in blood sugar. I took her to the Urgent Care clinic. Is this covered?	Yes, as long as you seek medical attention within 12 hours you are covered.
My uncle was playing a game of cricket in the neighborhood and started to experience chest pain. He was hospitalized for 3 days and required several blood tests, and heart scans. Will this be covered?	Yes. Our plans will cover any sudden recurrence caused by a pre-existing conditions. Our plans have no pre-authorization, meaning the hospital can get the treatment your visitors needs faster.
My father-in-law had several kidney issues over the past few years. After several hours of pain, we took him to the hospital to have kidney stones removed. Is this covered?	Yes. As long as the treatment is sought within the first 12 hours of first exhibiting symptoms, any pre-existing condition will be covered. Our plans have no look back period for pre-existing conditions.
My cousin has diabetes. After a few days in the US, she contracted a Urinary Tract Infection which required hospitalization. Is this covered?	Yes. Under our plans, Urinary Tract Infections are considered new sicknesses and are covered by Acute Onset coverage plans.
My mother is a heart patient. She was prescribed medication but often forgets to take it often. She experienced a sudden heart attack and needed to visit the emergency room. Will this emergency visit be covered?	Yes, our plans cover any incident regardless if your visitor was taking their prescribed medication.