E PL M SA HEALTH INSURANCE 2012 2013
Global Benefits Group offers worldwide expertise, products and services unbound by geographic constraints. Any Country. Any Nationality. Experience and Expertise in the International Marketplace GBG Insurance Limited and Global Benefits Group have been specializing in the international insurance market for more than 30 years, serving as leading underwriters, developers and distributors of products and services designed especially for the needs of overseas workers and international travelers. GBG underwrites health, life, disability and other specialty insurances for groups and individuals who are expatriates, third-country nationals or high net-worth local nationals. As globalization of the world s economy has continued to accelerate, GBG has developed a specialized underwriting structure that is required to meet the needs of this select market niche. This structure is devoted to one business only: underwriting risks for organizations and individuals whose life and work transcend geographic boundaries. The GBG portfolio of products provides optimum security because it is supported by a world-class panel comprising some of the largest and most financially stable underwriters in the world: GBG Insurance Limited (rated B+ by A.M. Best Company) Chubb Insurance (rated A++) General Reinsurance Corporation (rated A++) Lloyd s of London (rated A) Hannover Re (rated A) Additionally, GBG partners with a multitude of local insurance companies around the world when an admitted carrier is required to meet specific country regulations. We are proud to offer this exciting and innovative structure to our clients. It provides the international marketplace with an unprecedented and unique combination: International expertise Dedicated underwriting facility Financial security Responsive customer service For the latest A.M. Best ratings: www.ambest.com 2
HEALTH INSURANCE GBG offers a high-end insurance plan with many options, and is intended for the individual seeking high healthcare benefits. GBG Health Insurance offers a range of deductibles and coverages for an individual and his or her dependents. The plan has coverage for inpatient care, outpatient care, emergencies, a pharmacy benefit and more. E > Geographic Coverage Areas Regional: For those looking for a more economical plan, GBG Health Insurance can be purchased with coverage restricted to certain countries or regions. PL Worldwide: No geographic restrictions; complete coverage anywhere in the world, including the United States and Canada. > Key Benefits of GBG Health Insurance No Annual Maximum Limit Inpatient and outpatient coverage Worldwide direct-bill network Well baby care benefits Maternity benefits Optional Life, Hospital Cash and dental coverage Online claims filing Online and live customer service SA M Key Benefits of GBG Assist As with all GBG insurance plans, GBG Health Insurance includes the world-class services of GBG Assist for case management and evacuations, if necessary, anywhere in the world any time of day. GBG Assist services also include a worldwide network of more than 550 medical facilities that will bill the insurance company directly, eliminating the need for a member to pay up-front for services. When a claim does need to be filed, GBG Assist offers state-of-the-art claims submission and reimbursement options through www.gbg.com. This process makes claim reimbursement simple, fast and easy. GBG Assist includes Nurse Assist: access to the medical advice of registered nurses 24 hours a day, 7 days a week, 365 days a year. 3
Currency USD SCHEDULE OF BENEFITS Insured Person (per policy year) Insured Individual Regional Option ANNUAL MAXIMUM ANNUAL DEDUCTIBLES No Annual or Lifetime Maximum WORLDWIDE Option* Country of Residence Family 2 x Individual Deductible 2 x Individual Deductible Country of Residence Benefits are per person per policy year and based upon medical necessity and Usual, Reasonable and Customary (URC) charges, after Annual Deductible. Additionally, many services require Pre-Authorization. Please refer to the Policy for more details. In the U.S., when a provider in our PPO network is available, benefits are paid 100% in-network, based on medical necessity and Usual, Reasonable & Customary (URC) charges. Outside of network, benefits are paid at 80%. Private or Semi-private room Intensive Care (medically necessary) Medical treatment, medicines, laboratory & diagnostic tests Inpatient Consultation by Physician or Specialist Inpatient Surgery & Surgeon Emergency Room Emergency Medical Services Extended Care/Inpatient Rehabilitation: Must be confined to facility immediately following Hospital stay. Outpatient Physician Visit Consultation by Specialist Echocardiography, Ultrasound (necessary) CAT Scan, PET Scan, MRI (necessary) Endoscopy (e.g. gastroscopy, colonoscopy) X-Rays, Laboratory Outpatient or Ambulatory Surgery Outpatient Surgeon HOSPITALIZATION & INPATIENT OUTPATIENT In-Network: ; Non-network: Maximum $/day In-Network: ; Non-network: Maximum $4,000/day 4
Currency USD In the U.S., when a provider in our PPO network is available, benefits are paid 100% in-network, based on medical necessity and Usual, Reasonable & Customary (URC) charges. Outside of network, benefits are paid at 80%. OUTPATIENT Maternity -- For Options 1-3 Only. Normal Delivery or medically necessary C-Section as result of covered pregnancy. 10 month waiting period. Premature Birth, Congenital Conditions, Birth Anomalies, as a result of a covered pregnancy. 10 months waiting period. Physical-, Chiropractic-, Occupational- & Vocational Speech-Therapy; Homeopathic and Acupuncture treatment for a covered illness. Human Organ, Bone Marrow, Stem Cell Transplants, and other similar procedures. (Expenses for Donor are covered.) Non-Emergency Use of Emergency Room Hospice -- licensed agency which provides a physician-directed coordinated plan of home and inpatient care, 24/7, to a terminally ill person. Agency must meet validation tests, as described in policy. Emergency Ambulance, including Ground and Air Ambulance Medical Evacuation Repatriation of Mortal Remains Durable Medical Equipment : Rental up to purchase price OTHER COVERED SERVICES Private Duty Nursing, Skilled Nursing, Visiting Nurse, Home Health Nursing, and Home Health Care Mental Health Inpatient and Outpatient Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), AIDS Related Complex (ARC), Sexually transmitted diseases and all related conditions. Child Examinations (child immunizations & routine medical exams) Preventive Care, Annual Exams & Immunizations Emergency Dental Care (Limited to accidental injury of sound natural teeth sustained while covered under policy.) War and Terrorism Cancer Treatments, including Chemotherapy and Radiation Following hospitalization or out-patient surgery Outpatient or Non-Hospitalization SCHEDULE OF BENEFITS PRESCRIPTION Use of the Insurer s U.S. Pharmacy Network is preferred for prescription drugs obtained in the U.S. Failure to use a participating pharmacy will result in a reduction of benefit payment. $8, Maximum per pregnancy Deductible does not apply, Maximum 80 visits $750,000 per diagnosis 50% of URC $ Maximum (Pre-authorization required after 4 visits) Outpatient Maximum 50 visits Pre-existing conditions excluded, up to age 6 months Maximum 5 visits, up to $600 per person Deductible does not apply Included, Maximum 6 months; $ thereafter, Maximum $700 5
Currency USD SCHEDULE OF BENEFITS Insured Person (per policy year) Insured Individual Regional Option ANNUAL MAXIMUM ANNUAL DEDUCTIBLES No Annual or Lifetime Maximum WORLDWIDE Option* Country of Residence Family 2 x Individual Deductible 2 x Individual Deductible Country of Residence Benefits are per person per policy year and based upon medical necessity and Usual, Reasonable and Customary (URC) charges, after Annual Deductible. Additionally, many services require Pre-Authorization. Please refer to the Policy for more details. In the U.S., when a provider in our PPO network is available, benefits are paid 100% in-network, based on medical necessity and Usual, Reasonable & Customary (URC) charges. Outside of network, benefits are paid at 80%. Private or Semi-private room Intensive Care (medically necessary) Medical treatment, medicines, laboratory & diagnostic tests Inpatient Consultation by Physician or Specialist Inpatient Surgery & Surgeon Emergency Room Emergency Medical Services Extended Care/Inpatient Rehabilitation: Must be confined to facility immediately following Hospital stay. Outpatient Physician Visit Consultation by Specialist Echocardiography, Ultrasound (necessary) CAT Scan, PET Scan, MRI (necessary) Endoscopy (e.g. gastroscopy, colonoscopy) X-Rays, Laboratory Outpatient or Ambulatory Surgery Outpatient Surgeon HOSPITALIZATION & INPATIENT OUTPATIENT In-Network: ; Non-network: Maximum $/day In-Network: ; Non-network: Maximum $4,000/day The information contained herein is for illustrative purposes only. Please contact us for policy details and/or to request a customized proposal. Online applications are available at gbg.com. HealthOnline_[E]_23AUG2012