Insurance Carrier Change Notice: If you purchased prior to October 21, 2020 and renew your policy, the insurance carrier for your plan will be Sirius Specialty Insurance Corporation. This is a notice only. This change will not affect your plan benefits or services and no action is required on your part.
GHS

GlobeHopper Senior

Comprehensive Coverage,  Rated A- (Excellent)By: IMG,  UW: Sirius SpecialitySirius Specialty Insurance Corporation
AM Best Rating
A- (Excellent)
Administrator/Underwriter
IMG
Sirius Specialty Insurance Corporation
100%
In Network

After deductible, the plan pays 100% up to the policy maximum.

100%
Out of Network

Plan pays 100% up to the policy maximum.

acute-onset-pre-existing-condition
Acute onset of Pre-Existing Conditions
medical-coverage-during-travel
Medical Coverage During Travel
extendable-cancelable
Extendable & Cancelable
comprehensive
Comprehensive Coverage Plan
coverage-days
Coverage from 5 days to 365 days
urgent-care
Urgent Care
COVID-19 Excluded
BUY

Out-Patient

Dr. / Physician Visit

100% after deductible is met

Urgent Care

100% after deductible is met

Surgical Treatment

100% after deductible is met

Prescription Drugs / Medicines

100% after deductible is met

Lab & X-rays

100% after deductible is met

Physical Therapy

100% after deductible is met

In-Patient

Hospital Room

100% after deductible is met

Surgical Treatment

100% after deductible is met

Hospital Intensive Care Unit

100% after deductible is met

Emergency Services

Ambulance Expenses

$5,000

Emergency Room(ER)

100% after deductible is met. Additional $250 deductible applies if not admitted as an inpatient

Dental

Acute, spontaneous and unexpected pain

$100

Accidental emergency

100% after deductible is met

Travel

Emergency Medical Evacuation / Repatriation

$250,000 maximum coverage. Has to be coordinated by insurance company

Return of Remains

$50000 maximum coverage. Has to be coordinated by insurance company

Emergency Reunion

Not Covered

Return of minor Child(ren)

Not Covered

Trip Interruption

$5,000

Loss of checked Baggage

$50 per item up to $250 max per period of coverage

Life

AD&D

$25,000

Common Carrier Accidental Death

$100,000 per adult/$250,000 per family

Other

Pre-Existing Conditions

For Sudden and Unexpected Recurrence of pre-existing conditions: Up to Maximum $2,500 for Medical Expenses Up to maximum $25,000 for Medical Evacuation

Maternity

Not Covered

General Physical full Checkup

Not Covered

Support

24-Hrs Emergency Assistance

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

Plan Administrator Company

IMG

Carrier / Underwriter

Sirius Specialty Insurance Corporation

AM Best Rating

A- (Excellent)

Eligibility

Can be purchased by US citizens and US Green card Holders, above 65, who are enrolled in Medicare Part A and B and also Medicare Advantage, traveling outside USA

Plan Type

Comprehensive Coverage Plan Plan pays up to a certain percentage of medical expenses.

Coverage in U.S.A.

Not Covered

Coverage outside U.S.A.

Covered

Co-Pay

No Copay. Plan pays certain percentage of bill

Co-Insurance

After deductible is met, plan pays 100% for covered services up to policy maximum

How the Benefits are Paid

After deductible is met, plan pays 100% for covered services up to policy maximum

Coverage Type

Lifetime of the policy

Deductible Type

Annual deductible. One time in policy period.

Renewability

Extendable (Only if initially purchased for 1 month) with $5 fee each time you extend, up to a maximum period of 365 days

Cancellation

Full refund available if cancelled before start date. Only Monthly refund available after start date if no claims have been made( $50 Cancellation Fee Applicable)

PPO Network

PPO Network

Coverage Length

Min 5 days-Max 365 days

Available Deductibles

Choose From: $0, $100, $250, $500, $1,000, $2,500

Available Coverage

Choose From: $50,000; $100,000; $500,000; $1,000,000 Ages 80+: Limited to $100,000 Ages 80+: Limited to $10,000

Provider Directory

By Provider, Phone Nos.: 800-628-4664 or 317-655-4500

Home Country Definition

U.S. Citizens: Home Country is always the United States of America

US States Restrictions

Residents of Maryland (MD) state cannot purchase this policy. Applicant with Maryland (MD) state address cannot purchase this policy. Policy still provides coverage for policy holder who is visiting MD State

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.