International Major Medical Insurance | FAQ

Who is the insurer?

The Global Medical plan is insured by Sirius International Insurance Corporation. Sirius offers financial security and a worldwide reputation, This well-established insurance company is rated 'A' (Excellent) by A.M. Best Company and 'A-' by Standard & Poor's.

What's the difference between the Bronze, Silver, Gold, and Platinum level of the Global Medical?

The Global Medical plan is available in four levels so that you can choose the coverage level that’s right for you.

• Platinum — The Platinum level is the most comprehensive offering medical coverage, dental, vision, wellness, political evacuation, remote transportation, and maternity coverage. The Platinum provides $8 million lifetime coverage per insured and is considered to be the “Cadillac” insurance plan due to its comprehensive benefit structure.
• Gold — The Gold level is the second most comprehensive health insurance plan, offering $5 million lifetime coverage per insured person. The plan covers doctor visits, hospitalization, prescription medication, medical evacuation, repatriation, mental health, wellness, and more.
• Silver — The Silver level is a capped benefit plan offering an affordable option for those concerned about their budget, but also wanting international coverage. This plan is well designed for those individuals traveling to countries with affordable health treatment.
• Bronze — The Bronze level is also a capped benefit plan offering the most economical pricing of the four plan levels. This plan also provides worldwide coverage to meet the tightest budgets and is designed to cover accidents and illnesses that happen on your plan.

Which coverage is right for me?

The Global Medical Plan is available in four different levels — Bronze, Silver, Gold, and Platinum — all of which offers two areas of coverage: including or excluding the US, Canada, China, Hong Kong, Japan, Macau, Singapore and Taiwan. If you do not need coverage in these countries, you may obtain lower premiums by selecting the "Worldwide Excluding" option.

Am I eligible for the Global Medical insurance plan?

The Global Medical plan is available to individuals and families from around the world who are at least age 14 days and not over age 74 and meet the following requirements:

• US citizens: Must be residing outside of the United States as of the Effective Date (or renewal date) and plan to reside outside of the United States for at least six (6) of the next twelve (12) months thereafter
• Non-US citizens: Eligible for new business and renewal if considered a non-resident alien or has an exempted Visa type (A, F, G, J, M, R, Q)
• Non-US citizens: Not eligible for new business or renewal if they meet the substantial presence test or if resident alien with non-exempted Visa.

The following is a link to information regarding the substantial presence test:
http://www.irs.gov/Individuals/International-Taxpayers/Substantial-Presence-Test

Is coverage under the Global Medical Plan renewable?

Yes. Global Medical products are annually renewable. There are no medical questions at renewal. Renewal is subject to your continued eligibility and timely payment of premiums. Members will receive a renewal notice via email 45 days prior to their anniversary date that will include more information about the renewal and subsequent premium increase.

What should I expect during the underwriting process?

The Global Medical is a medically underwritten plan, which means that your family's medical status and history will be used to determine your eligibility for coverage. Once you have submitted your application it will be reviewed within 5 business days by an underwriter. Within that period you will hear back from the underwriters and they will either:

• Issue coverage and complete your application
• Request further documentation regarding your past medical history
• Apply a rider to your coverage that limits or excludes certain medical conditions
• Apply a premium increase due to your medical and/or family history
• Deny coverage

You will be notified on the status of your application once complete or if further information is needed. If a rider or premium increase is added to your plan you will be notified. If you are issued a rider you will be provided with a 30 day ‘free look’ period. If you do not like our counter offer, you can simply cancel coverage within the 30 day free look and we’ll refund 100% of your premium.

Preferred Provider Network (PPO) & Medical Concierge

The Global Medical plan also allows you to take advantage of the Medical Concierge program in the United States to assist you with finding providers and to give you more information on provider ratings, past outcomes and general costs in the area where you plan to seek treatment. By utilizing the Medical Concierge services, your deductible will be 50% waived (to a maximum of $2,500) and your coinsurance will be waived.

Simply present your identification card at the provider's office so that they may contact us to verify benefits and billing information. For your convenience, there is also an international network and both networks are searchable through the Student Zone, which is accessible with your Certificate number and date of birth once coverage has been approved.

In addition to the extensive PPO network in the US, the Global Medical plan offers an International Provider Access network of over 17,000 physicians, clinics, and hospitals worldwide. These providers have agreed to accept direct payment to make it easier for you so that you don’t have to pay upfront.

Telemedicine

The Global Medical plan in the levels Gold and Platinum now includes CareClix as a new option for seeking medical treatment inside the U.S. This telemedicine platform provides access to a network of board-certified medical and mental health providers, and is available 24 hours a day, seven days a week for many non-emergency medical issues via phone or online video consultations.

How do I file a claim?

Filing a claim is easy. Once your Application is accepted, you will receive a kit which contains Claimant's Statement and Authorization forms. Complete this Claimant's Statement and Authorization form, attach original, itemized bills, and forward them for processing. Be sure to complete your Claimant's Statement entirely and sign it. If you have already paid certain expenses, attach copies of your payment receipts. You will be reimbursed for eligible medical or dental expenses. In many cases, payments will be made directly to the hospital or physician that treated you. Remember, you are responsible for the deductible, coinsurance, and any ineligible charges.

Is there a waiting period for maternity?

Maternity benefits are only available on the Platinum level of the Global Medical plan with a waiting period of 12 months. Coverage on the Platinum level includes prenatal, delivery, postnatal, child wellness, congenital disorders, etc. There is an additional $2,500 deductible per pregnancy and the plan will cover maternity up to a lifetime maximum of $50,000. Please note that you cannot be pregnant at the time of application.

What other optional coverage can I get with this plan?

There are five optional coverage options that you can add to your Global Medical plan and they include:

• Global Term Life Insurance (Amounts shown are the Principal Sums per unit)
  • Age 31 days – 18 years: $5,000
  • Age 19–29 years: $75,000
  • Age 30–39 years: $50,000
  • Age 40–44 years: $35,000
  • Age 45–49 years: $25,000
  • Age 50–54 years: $20,000
  • Age 55–59 years: $15,000
  • Age 60–64 years: $10,000
  • Age 65–69 years: $7,500
• Accidental Death & Dismemberment (AD&D) – Included with Global Term Life Insurance
  • Accidental Loss of Life: Principal Sum*
  • Accidental Total Loss of 2 Members**: Principal Sum*
  • Accidental Total Loss of 1 Member**: 50% of Principal Sum (*Benefit based on age at time of death; **Member means hand, foot, or eye)
• Dental & Vision (available on the Bronze, Silver, and Gold plan options) — Dental is covered up to $750 lifetime maximum with a $50 deductible (max. 2 per family) after a 6 month waiting period. Routine Services – 90% (deductible is waived); Minor restorative – 70%; Major restorative – 50%. Vision will cover routine eye exams up to $100 per 24 month; Materials covered up to $150 per 24 months.
• Terrorism Rider (available on the Platinum only) — If injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum. This benefit does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.
• Sports Rider (available on the Gold and Platinum only) — Provides up to $10,000 lifetime maximum for amateur athletics
  • Adventure Sports:
    • Through age 49 years: $50,000 lifetime maximum
    • Age 50–59 years: $30,000 lifetime maximum
    • Age 60–64 years: $15,000 lifetime maximum

For more information about these riders, please see the Global Medical Brochure

How can I pay for this plan?

The Global Medical plan can be purchased online using a credit card or debit card. When applying for the plan, you will be able to choose your frequency of payment from paying annually, semi-annually, quarterly, or monthly. Keep in mind that there are higher administrative costs the more frequent the payment. While your payment details are required to be included on your online application, your card will not be charged until the underwriting review process has been completed.

What does Usual Reasonable and Customary (URC) mean?

Usual Reasonable and Customary is a term that insurance companies use to describe a limitation on their responsibility to pay for eligible medical expenses. Basically, URC refers to the fee typically charged by a provider for a specific procedure in a specific geographic area. So if a particular procedure typically costs $5,000 in the New York City area, and most providers customarily charge about $5,000 for that procedure, the insurance company will not pay your provider in New York City $10,000 for the same exact procedure. Instead, they will limit their payment amount to "Usual Reasonable and Customary" - in this example, $5,000.

What is Liferworks?

LifeWorks will provide 24/7 counseling services through a master’s level counselor. Through virtual counseling services, individuals are able to get immediate counseling in crisis situations. Additional services available through the Employment Assistance program include an in-person counseling option while within the United States, LifeWorks services, legal and financial advice, management consultations, and access to many other support resources

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