Benefits
Benefit Maximums |
Benefits - Outside of the U.S. only |
||
| Lifetime Maximum per Insured Person | Unlimited | ||
| Annual Maximum per Insured Person | Unlimited | ||
| Preventive and Primary Care | Insurer Waives Deductible | ||
| Preventive Care For Babies/Children: (Birth through Age 18) a. Office Visits/examination b. Immunizations, Lab work & X-rays done in conjunction with an office visit |
100% | ||
| Preventive Care for Adults: (Age 19 and Older) a. Office Visits/examination b. Immunizations as recommended on the published Center for Disease Control (CDC) immunization schedule for adults c. Routine Pap Smears, annual mammogram d. PSA For Men e. Diagnostic lab work & X-rays done in conjunction with an office visit |
100% | ||
| Annual Physical Examination/Health Screening, Subject to a $1,000 Maximum per Calendar Year and limited to one per Calendar Year | 100% | ||
| Primary Care Physician or Specialist Office Visits | All except a $10 copay per visit1 | ||
| Urgent Care Facility | 100% | ||
| 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% | ||
| Inpatient medical emergency | 100% | ||
| Inpatient drugs | 100% | ||
| Ambulatory and Therapeutic Services | Insurer Pays After Deductible is Met, Unless Noted | ||
| Ambulatory Surgical Center | 100% | ||
| Ambulance Service | 100% | ||
| Accidental Dental | $1,000 per calendar year, $200 per tooth | ||
| Acupuncture and Chiropractic Services, Subject to a $2,000 Maximum per Calendar Year if under the care of a licensed Physician | 100% | ||
| Durable Medical Equipment | 100% | ||
| Infusion Therapy | 100% | ||
| Physical/Occupational Therapy, Limited to 12 visits per Calendar Year |
100%, no deductible | ||
| Rehabilitation and Therapy | Insurer Pays After Deductible is Met, Unless Noted | ||
| Inpatient Mental Health | 100% | ||
| Outpatient Mental Health | 100%, no deductible $10 Copayment1 |
||
| Inpatient Substance Abuse | 100% | ||
| Outpatient Substance Abuse | 100%, no deductible $10 Copayment1 |
||
| Other Services | Insurer Pays After Deductible is Met | ||
| Home Health Care, Subject to a maximum of 30 visits per Calendar Year | 100% | ||
| Skilled Nursing Facilities, Subject to a maximum of $250 per day for a maximum of 50 days per Calendar Year | 100% | ||
| Hospice, Subject to a maximum of $5,000 per lifetime | 100% | ||
| Outpatient Prescription Benefits (pay and claim only) | Insurer Waives Deductible | ||
| Basic Prescription Drug Benefit, Subject to $2,500 Maximum per Insured Person per Calendar Year Max 90-day supply |
100% of actual charges | ||
| Optional Enhanced Prescription Drug Rider, Subject to $25,000 maximum per Insured Person per Calendar Year Max 90-day supply |
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 | ||
Optional Benefits Basic U.S. Benefits Rider (Xplorer Essential plan only)
Benefit Maximums |
Benefits - Inside of the U.S. only |
|
| Calendar Year Maximum Medical Benefit per Insured Person | $1,000,000 | |
| Emergency Medical Care, Illness and Accidental Injury Services while temporarily visiting the United States | Insurer Pays After Deductible is Met, Unless Noted | |
| U.S. Participating Provider | U.S. Non-Participating Provider | |
| Physician's Office Visit Services | 100%, No Deductible, $50 Copayment | 60% to Coinsurance Maximum, then 100% |
| Hospital Emergency Room | 80% to Coinsurance Maximum, then 100% Additional $250 Copayment per visit - waived if admitted |
60% to Coinsurance Maximum, then 100% Additional $250 Copayment per visit - waived if admitted |
| Outpatient Professional Services (radiology, pathology and ER Physician) | 80% to Coinsurance Maximum, then 100% | 60% to Coinsurance Maximum, then 100% |
| Urgent Care Facility | 100%, No Deductible, $75 Copayment | 60% to Coinsurance Maximum, then 100% |
| X-ray and/or Lab performed at the Emergency Room or Urgent Care Facility (billed as part of the visit) | 80% to Coinsurance Maximum, then 100% | 60% to Coinsurance Maximum, then 100% |
| X-ray and/or Lab performed at the Independent facility in conjunction with the Emergency Room visit | 80% to Coinsurance Maximum, then 100% | 60% to Coinsurance Maximum, then 100% |
| Ambulance | 80% to Coinsurance Maximum, then 100% | 60% to Coinsurance Maximum, then 100% |
| Inpatient Hospital - Facility/Professional Charges | Admissions limited to Emergency Medical Care, Illness and Accidental Injury Services while temporarily visiting the United States | |
| U.S. Participating Provider | U.S. Non-Participating Provider | |
| Bed and Board Charges | 80% to Coinsurance Maximum, then 100% | 60% to Coinsurance Maximum, then 100% |
| Physician's Visits/Consultations | 80% to Coinsurance Maximum, then 100% | 60% to Coinsurance Maximum, then 100% |
| Professional Services (Surgeon, Radiologist, Pathologist, Anesthesiologist) |
80% to Coinsurance Maximum, then 100% | 60% to Coinsurance Maximum, then 100% |
| Prescription Drugs Purchased inside the United States | ||
| Limited to Emergency Medical Care, Illness and Accidental Injury Conditions covered under this package. Pre-existing Condition Limitation Applies | 100% of the Actual Cost, Deductible does not apply Maximum benefit of $1,000 per Calendar Year and the maximum supply of 30 days per covered prescription |
|
Plan Deductible Choices
| Elite | $0 |
| 1,000 | $1,000 |
| 2,500 | $2,500 |
| 5,000 | $5,000 |
| 10,000 | $10,000 |
- Copay waived when visiting a GeoBlue contracted provider outside the U.S.
- Deductibles are Per Person per Calendar Year.
- For a family, the maximum deductible is 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.
- The 10,000 Plan deductible choice is not available for Xplorer Essential with Basic U.S. Benefits.
For Exclusions and Limitations see the following:
Ten Day Money Back Guarantee
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 send an email to enrollment@geo-blue.com within 10 days of purchase and include the reason for cancellation.