Global Medical
| # | Outside U.S | Inside U.S (In-Network) | Inside U.S (Out-Network) |
|---|---|---|---|
| Lifetime Coverage Maximum | unlimited | unlimited | unlimited |
| Annual Coverage Maximum | unlimited | unlimited | unlimited |
| Physician Office Visits (Adult)-Deductible Waived | $10 copay per visit | $30 copay per visit | 60% to Out-of-Pocket Maximum then 100% |
| Physician Office Visits (Children 0-18)-Deductible Waived A. Unlimited Well Baby Visits B. Child Immunizations, Lab and X-rays | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Adults (19 and Older)-Deductible Waived A. Women Routine Pap Smears, Annual Mammogram B. PSA for Men | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| One Routine Physical Per Year-Deductible Waived | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Surgery, Anesthesia, Radiation Therapy, In-hospital Doctor Visits, Diagnostic X-ray and Lab Work (Outpatient) | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Surgery, X-rays, In-hospital Doctor Visits, Organ/ Tissue Transplant (Inpatient) | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Inpatient Medical Emergency, Inpatient Drugs | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Ambulatory Surgical Center | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Ambulance Service | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Accidental Dental | $1,000 per year, $200 per tooth | $1,000 per year, $200 per tooth | $1,000 per year, $200 per tooth |
| Acupuncture and Chiropractic Services | 100% up to $2,000 | 80% up to $2,000 | 60% up to $2,000 |
| Durable Medical Equipment | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Infusion Therapy | 100% | 80% to Out-of-Pocket Maximum then 100% | 60% to Out-of-Pocket Maximum then 100% |
| Physical/Occupational Therapy-Deductible Waived | $50 max each visit, 12 visits per year | $50 max each visit, 12 visits per year | $50 max each visit, 12 visits per year |
| 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 |
| Basic Prescription Drug Benefit Subject to $1,000 Maximum per Insured Person per Coverage Period (Pay and claim benefit only)-Deductible Waived | 100% of actual charges | 100% of actual charges | 100% of actual charges |
| Optional rider, subject to $25,000 Maximum Benefit per Insured Person per Coverage Period. Max 90 days supply-Deductible Waived | 100% of actual charges | Generics: 100% after $10 copay Brandname:100% after $25 copay Injectables: 70% | Generics: 100% after $10 copay Brandname:100% after $25 copay Injectables: 70% |
| Emergency Medical Transportation-Deductible Waived | Up to $250,000 | n/a | n/a |
| Repatriation of Mortal Remains-Deductible Waived | Up to $250,000 | n/a | n/a |
| Accidental Death and Dismemberment-Deductible Waived | $50,000 | $50,000 | $50,000 |
| Home Health Care | 100% Covered Expenses, as many as 30 visits per year | 100% Covered Expenses, as many as 30 visits per year | 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 year | 100% with a maximum Covered Expense of $250 per day, as many as 50 days per year | 100% with a maximum Covered Expense of $250 per day, as many as 50 days per year |
| Hospice | 100% with a maximum Covered Expense of $5,000 per lifetime | 100% with a maximum Covered Expense of $5,000 per lifetime | 100% with a maximum Covered Expense of $5,000 per lifetime |
| Plan detail information | |||
| # | Outside U.S. |
|---|---|
| Coverage Maximum | Unlimite |
| Annual deductible | Choice：$0/$1000/$2000/$5000 |
| Annual Out-of-Pocket Maximum (Including deductible) | Depends on deductible choice |
| Physician Office Visits（Primary/Specialist/Urgent Care） | You pay $0 |
| Emergency Room | You pay $0 |
| Ambulance | You pay $0 |
| Inpatient Surgery | You pay $0 |
| Outpatient Surgery | You pay $0 |
| X-rays & Lab | You pay $0 |
| Drug | 100% of actual charges, Subject to $1,000 Maximum per year |
| One Routine Physical Per Year | Free |
| Plan detail information |
1. Who is eligible to buy an 【GeoBlue Xplorer】 plan?
All U.S. citizens or permanent residents living abroad who are 74 or younger at the time of application or all legal residents of the U.S. (citizens and foreign nationals) who are age 74 or younger at the time of application if they live in the U.S. or an employee of a U.S. company, whereby the company is domiciled in the U.S. and the company pays the insurance premium.2. How do I qualify for maternity benefits?
After 364 days of continuous coverage, 【GeoBlue Xplorer】 members may apply for a new plan that covers maternity costs in the same way as all other medical conditions.3. Do all eligible family members have to apply for 【GeoBlue Xplorer】?
Yes. The 【GeoBlue Xplorer】 plan is available to individuals and their dependents. All eligible family members must apply for coverage.4. Will my policy automatically renew?
No. The policy does not automatically renew upon your request. If you want to renew your policy, please contact us:5. When does my coverage end?
We may terminate your coverage if:6. Who is the insurer?
【GeoBlue Xplorer】 is underwritten by 4 Ever Life International Limited (4ELI). 4ELI is an independent licensee of the Blue Cross and Blue Shield Association and a wholly owned subsidiary of BCS Financial Corporation. BCS is owned by a consortium of Blue Cross and Blue Shield plans and the Blue Cross Blue Shield Association. 4 Ever Life International Limited is an A.M. Best “A-” rated (Excellent) carrier.7. Does my plan deductible apply to all services?
No. Your deductible is waived for office visits. You simply pay a small copay at time of service with the contracted provider.8. Will my pre-existing condition be covered under a 【GeoBlue Xplorer】 Plan?
If you were previously covered by a U.S. health plan that issues you a Certificate of Creditable Coverage, GeoBlue will credit you for this prior coverage. The number of months of coverage shown on the Certificate will reduce or eliminate the six-month pre-existing condition waiting period. If you have six or more months of creditable coverage, your waiting period will be eliminated. If you have less than six months creditable coverage, your waiting period will be reduced by the number of months you had creditable coverage. For example, if you have two months of creditable coverage, your waiting period will be reduced from six months to four months.9. Am I guaranteed to be issued 【GeoBlue Xplorer】 coverage if I apply?
No, 【GeoBlue Xplorer】 is not a guaranteed issue plan. Each application is medically underwritten. Your application may be:10. Is the quote I receive binding?
No. The quote you receive may not apply if:11. When determining a rate while overseas, what zip code should I use?
Policies for U.S. citizens residing overseas are issued through the Global Citizens Association office in Washington, D.C. The zip code that applies is 20036.12. What is the Global Citizens Association?
Founded in 1994 to serve international students, the GCA has grown to encompass world travelers and expatriates in all corners of the globe. More information can be found here: http://www.gcassociation.org.13. Does this plan meet the Affordable Care Acts requirement for Minimum Essential Coverage?
This plan does not provide Minimum Essential Coverage and therefore does not meet the requirements of the Affordable Care Act (ACA).14. What about accessing participating providers?
GeoBlue's Global Health and Safety services help members identify, access, and pay for quality healthcare all over the world including a contracted community of elite providers in 180 countries. Please note that in the U.S. a member can simply show his/her ID card at time of service and participating providers will only bill the member for any applicable deductible or copayment. Members have access to the Blue Cross and Blue Shield Network. Whether overseas or in the U.S., members can choose to use any doctor or hospital.15. How do I calculate out of pocket expenses and the annual limit?
The total annual out-of-pocket expense limit is calculated by adding the deductible and coinsurance maximum together.| Deductible | Outside U.S. | Inside U.S. (In-Network) |
Inside U.S.(Out-Network) | Coinsurance |
|---|---|---|---|---|
| $0 | $0 | $0 | $1,000 | $2,000 |
| $1,000 | $500 | $1,000 | $2,000 | $4,000 |
| $2,000 | $1,000 | $2,000 | $4,000 | $8,000 |
| $5,000 | $2,500 | $5,000 | $10,000 | $10,000 |
| Deductible | Outside U.S. | Inside U.S. (In-Network) |
Inside U.S.(Out-Network) | Coinsurance |
|---|---|---|---|---|
| $0 | $0 | N/A | N/A | $2,000 |
| $1,000 | $1,000 | N/A | N/A | $8,000 |
| $2,500 | $2,500 | N/A | N/A | $10,000 |
| $5,000 | $5,000 | N/A | N/A | $10,000 |
16. How long will I know whether purchase 【GeoBlue Xplorer】 is successful?
The underwriting department will review the application and respond in writing within 3 – 5 days. This may mean that we send a request for additional information to the applicant. The turnaround time in these situations will depend on how quickly the applicant responds to the request. If you are applying for coverage as yourself only, you are eligible for our expedited underwriting process.17. How many days would it take to process the claim?
Under non-direct pay services, you will receive the check for any eligible expenses within 15-30 business days once the insurance company receives your claim documentation. 【GeoBlue Xplorer】 is under the big network of Blue Cross and Blue Shield, and it is contracted with lots of providers and hospitals. Under direct-pay services, your responsibility is your deductible only, since the providers and hospitals will communicate with the insurance company directly for billing.18. How is medical evacuation decisions made?
The evacuation benefit pays for a medical evacuation to the nearest hospital, appropriate medical facility, or back to the U.S. Transportation must be by the most direct and economical route. All evacuations require written certification by the attending physician that the evacuation is medically necessary.19. Are acts of terrorism covered under this plan?
Yes. The 【GeoBlue Xplorer】 plan does not exclude illnesses or injuries related to terrorism or a terrorist act.20. Where can I read the fine print?
To see plan definitions, limitations or to review a sample certificate, visit: https://www.geobluetravelinsurance.com/products/longterm/xplorer-certs.cfm
