|Lifetime Maximum per Insured Person||Unlimited|
|Annual Maximum per Insured Person||Unlimited|
|Preventative and Primary Care||Insurer Waives Deductible|
|Preventative Care for Babies/Children: (Birth to Age 18)
Immunizations, Lab work & X-rays
|Preventative Care for Adults: (Age 19 and Older)
Routine Pap Smears, annual mammogram
PSA For Men
Annual Physical Examination/Health Screening
Diagnostic lab work & X-rays
|Primary Care Office Visits||All except a $10 copay per visit1|
|Professional Services||Insurer Pays After Deductible is Met|
|Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work.||100%|
|Inpatient Hospital Services||Insurer Pays After Deductible is Met|
|Surgery, X-rays, in-hospital doctor visits, Organ/Tissue Transplant||100%|
|In-patient medical emergency2||100%|
|Ambulatory and Therapeutic Services||Insurer Pays After Deductible is Met, Unless Noted|
|Ambulatory Surgical Center||100%|
|Accidental Dental||$1,000 per year, $200 per tooth|
|Acupuncture and Chiropractic Services||100% up to $2,000|
|Durable Medical Equipment||100%|
deductible is waived
|$50 limit per visit, 12 visits per year|
|Rehabilitation and Therapy||Insurer Pays After Deductible is Met|
|a. Inpatient Mental Health||100% up to 60 days*|
|b. Outpatient Mental Health||75% up to 40 visits / 60% thereafter**|
|c. Inpatient Substance Abuse||100% up to 60 days detox|
|d. Outpatient Substance Abuse||75% up to 40 visits / 60% thereafter|
|Prescription Drug Benefit Options||Insurer Waives Deductible|
|Basic Prescription Drug Benefit (Pay and claim benefit only)||100% of actual charges up to $1,000|
|Optional Rider. Subject to $25,000 Maximum per Insured Person per Policy Period||100% of actual charges|
|Global Travel Benefits||Insurer Waives Deductible|
|Emergency Medical Transportation||Up to $250,000|
|Repatriation Of Mortal Remains||Up to $25,000|
|Accidental Death and Dismemberment||$50,000|
Plan Deductible Choices
GeoBlue Xplorer Essential1, 2
GeoBlue Xplorer Select1, 2
- Copay waived when visiting a GeoBlue contracted provider outside the U.S.
- Deductibles are Per Person per Calendar Year.
- The Out of Pocket Maximum is calculated by adding the deductible and coinsurance maximum together. For a family, the maximum deductible and coinsurance are increased by a factor of 2.5, regardless of the size of the family.
- Amounts paid to satisfy a deductible are credited to all other deductibles, both inside and outside the U.S. For example, if you satisfy your Outside U.S. deductible, this amount is credited to the U.S. (In Network) and U.S. (Outside Network) deductible requirements.
- An Insured Person only has to satisfy his/her Out of Pocket Maximum once a Year for all services received outside of the U.S. and in the U.S.
- Emergency room visits that do not result in inpatient admissions will be subject to a $100 penalty.
Insurer Pays after Deductible is Met
|Home Health Care||100% Covered Expenses, as many as 30 visits per year|
|Skilled Nursing Facilities||100% with a maximum Covered Expense of $250 per day, as many as 50 days per calendar year|
|Hospice||100% with a maximum Covered Expense of $5,000 per lifetime.|
For Exclusions and Limitations see Plan Description
Ten Day Money Back Guarantee
YOUR SATISFACTION IS GUARANTEED. We are so confident in our products that we offer the best guarantee in the business! If you are not completely satisfied with our product, simply return your Certificate or Policy of Coverage and Description of Emergency Medical Transportation and Other Services within 10 days of receipt and include a letter indicating your desire to cancel. If you have not already left on your trip or incurred a claim, you will receive a full refund.