# | Outside U.S. | U.S. (In Network) | U.S. (Outside Network) |
---|---|---|---|
Lifetime Maximum Benefit | Unlimited | Unlimited | Unlimited |
Calendar Year Maximum Benefit | Unlimited | Unlimited | Unlimited |
Preventive Care | You pay $0 | You pay 20% | You pay 40% |
Primary Care | You pay $10 | You pay $30 | You pay 40% |
Lab work & X-ray | After deductible, You pay $0 | After deductible, You pay 20% | After deductible, You pay 40% |
---|---|---|---|
Urgent Facility | You pay $0 | You pay $75 | You pay 40% |
Emergency Room | After deductible, you pay $50 copayment | After deductilbe, you pay 20% and additional $50 copayment | After deductilbe, you pay 40% and additional $50 copayment |
Ambulance | After deductible, you pay $0 | After deductible, you pay 20% | After dedutible, you pay 40% |
Surgery | After deductible, you pay $0 | After deductible, you pay 20% | After dedutible, you pay 40% |
Inpatient Service | After deductible, you pay $0 | After deductible, you pay 20% | After dedutible, you pay 40% |
Prescription | Deductible is not applicable. 100% of the actual charge up to a Calendar Year maximum of $2,500 | Deductible is not applicable. 100% of the actual charge up to a Calendar Year maximum of $2,500 | Deductible is not applicable. 100% of the actual charge up to a Calendar Year maximum of $2,500 |
Maternity Care/Obstetrical Services | Not Covered | Not Covered | Not Covered |
Dental Care required due to an Injury | Maximum of $1,000 per Calendar Year, maximum/$200 per tooth | Maximum of $1,000 per Calendar Year, maximum/$200 per tooth | Maximum of $1,000 per Calendar Year, maximum/$200 per tooth |
Plan detail information |
Outside U.S. | |
---|---|
Lifetime Maximum Benefit | Unlimite |
Calendar Year Maximum Benefit | Unlimited |
Calendar Year Deductible | Option: $0, $2500, $5000, $10,000 |
Preventive Care | You pay $0 |
Primary Care | You pay $10 |
---|---|
Lab work & X-ray | After deductible, you pay $0 |
Urgent Facility | You pay $0 |
Emergency Room | After deductible, you pay $0 |
Ambulance | After deductible, you pay $0 |
Surgery | After deductible, you pay $0 |
Inpatient Service | After deductible, you pay $0 |
Prescription | Deductible is not applicable. 100% of the actual charge up to a Calendar Year maximum of $2,500 |
Maternity Care/Obstetrical Services | Not Covered |
Plan detail information |
Beijing |
---|
Beijing United Family Healtdcare |
Beijing Oasis International Hospital |
Beijing 21st Century Hospital |
Beijing New Century Children's Hospital |
Beijing Bayley & Jackson Medical Center |
International Medical Center - Beijing |
Beijing Vista Medical Center |
Mary's Hospital for Women & Infants |
Hong Kong International Medical Clinic, Beijing |
Shanghai |
---|
Shanghai Delta West Clinic |
Yosemite Clinic |
Shanghai United Family Hospital(Pu Dong/Chang Ning) |
Shanghai Concord Medical Cancer Center |
Guangzhou |
---|
Guangzhou United Family Hospital |
Eur Am International Medical Center |
Chang Jiang International Medical Center |
Nanfang Hospital Affiliated to Nanfang Medical University |
Hong Kong |
---|
Queen Elizabeth Hospital |
Quality HealthCare Medical Centre |
Human Health Medical Centre |
Taiwan |
---|
Wan Fang Hospital |
Linkou Chang Gung Memorial Hospital |
Taoyuan Chang Gung Memorial Hospital |
Annual Deductible | Outside U.S. | Inside U.S. (In-Network) |
Inside U.S.(Out-of-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 |