GBN

GeoBlue Navigator

Limited Coverage,  Rated A- (Excellent)By: HTH,  UW: 4Ever Life4Ever Life Insurance Co.
AM Best Rating
A- (Excellent)
Carrier/Underwriter
4Ever Life Insurance Co.
Administrator
HTH
COVID-19 Excluded
Renewable
urgent-care
Urgent Care
Coverage from 5 days to 12 months
BUY

The GeoBlue Navigator health plan meets the needs of international students and faculty by offering comprehensive worldwide benefits inside and outside the U.S. without the typical limits, eligibility conditions and benefit exclusions common among traditional plans. The plan covers the member globally along with the home country as long as he stays out of his home country for a minimum of 3 months.

Please review GeoBlue Navigator USA Insurance Brochure brochure or policy document for complete and accurate coverage information.

Out-Patient

Dr. / Physician Visit

Inside USA (In Network) : After the deductible is met, 80% till co insurance maximum is satisfied then 100% Covered.
Inside USA(Out- Of - Network) : After the deductible is met,60% covered till co insurance maximum is satisfied, then 100% Covered.

Prescription Drugs / Medicines

100% of actual charge up to an annual maximum of $5000. Maximum 90 day supply. Deductible is waived.

Lab & X-rays

Inside USA (In Network) : After the deductible is met, 80% till co insurance maximum is satisfied then 100% Covered.
Inside USA(Out- Of - Network) : After the deductible is met,60% covered till co insurance maximum is satisfied, then 100% Covered.

Physical Therapy

Covered expenses up to $50 per visit and up to 6 visits per calender year. Deductible is waived .

In-Patient

Hospital Room

Inside USA (In Network) : After the deductible is met, 80% till co insurance maximum is satisfied then 100% Covered. Inside USA(Out- Of - Network) : After the deductible is met,60% covered till co insurance maximum is satisfied, then 100% Covered.

Emergency Services

Ambulance Expenses

Inside USA (In Network) : After the deductible is met, 80% till co insurance maximum is satisfied then 100% Covered. Inside USA(Out- Of - Network) : After the deductible is met,60% covered till co insurance maximum is satisfied, then 100% Covered.

Dental

Acute, spontaneous and unexpected pain

Not Covered

Accidental emergency

100% of covered expense up to a maximum of $500 per calender year.

Travel

Emergency Medical Evacuation / Repatriation

Maximum lifetime benefit up to 250,000(Deductible is waived )

Return of Remains

Maximum benefit up to 25000. (Deductible is waived )

Emergency Reunion

Not Covered

Return of minor Child(ren)

Not Covered

Trip Interruption

Not Covered

Loss of checked Baggage

Not Covered

Life

AD&D

Up to $10,000 Deductible is waived.

Other

Pre-Existing Conditions

Not Covered for services and treatements for a medical condition for which medical advice , diagnosis, care, or treatment was recommended or received during 365 days prior to the members eligibility date.. The 365 days pre-existing period can be reduced or eliminated if covered by a creditable group or individual insurance plan.

Maternity

After 364 days of continuous coverage , members may apply for new plan that covers maternity costs in the same way as all other medical conditions.
*conception must be after effective date

General Physical full Checkup

Inside USA (In Network) : After the deductible is met, 80% till co insurance maximum is satisfied then 100% Covered.
Inside USA(Out- Of - Network) : After the deductible is met,60% covered till co insurance maximum is satisfied, then 100% Covered.

Terrorism Coverage

Covered

Brochure

Support

24-Hrs Emergency Assistance

Yes. Contact Number and details can be found on the ID card.

Plan Administrator Company

HTH

Carrier / Underwriter

4Ever Life Insurance Co.

AM Best Rating

A- (Excellent)

Plan Type

Comprehensive Coverage Plan

Coverage in U.S.A.

Covered

Coverage outside U.S.A.

Not Covered

Trip Interruption

Not Covered

Co-Insurance

Outside USA: 100% Covered
Inside USA (In Network): 80% till the co insurance maximum then 100% Covered
Inside USA(Out- Of - Network) 60% till the co insurance maximum then 100%.

Plan Effective Date

The effective date of the insurance will be the 1st or 15th day of the month following the underwriting approval.

Plan End Date

Coverage for an Eligible Participant will automatically terminate on the earliest of the following dates:

1. The last day of the month after the date the insured person is no longer eligible
2. The end of the last period for which premium has been paid
3. Thedate the policy terminates
4. The date of fraudor misrepresentation of a material fact by the insured person , except as indicated in the Time Limit on Certain Defences provision.

Deductible Type

Once Annually

Renewability

Yes.Up to the age of 75 plan may be extended.(Please see the policy brochure for details)

Cancellation

Yes

PPO Network

Search Doctor and Hospital

Available Deductibles

$250, $1000, $2500, $5000

Provider Directory

24 hours Worldwide, Phone Nos. 866-281-1688

Plan Brochure

Global Navigator USA Insurance Brochure brochure

Disclaimer

Plan features listed here are high level, provided for your convenience and information purpose only. Please review the Evidence of Coverage and Plan Contract (Policy) for a detailed description of Coverage Benefits, Limitations and Exclusions. Must read the Policy Brochure and Plan Details for complete and accurate details. Only the Terms and Conditions of Coverage Benefits listed in the policy are binding.