Coverage Area

Silver	Gold	Platinum
Two options: worldwide or worldwide excluding the U.S. and Canada

Policy Maximum

Silver	Gold	Platinum
$5,000,000 lifetime per individual		$8,000,000 lifetime per individual

Deductible

Silver	Gold	Platinum
Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO	Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO, Carry forward deductible - last 30 days of certificate year	Ranges from $100 to $10,000 per period of coverage, 50% reduction within PPO, Carry forward deductible - last 30 days of certificate year

Family Deductible

Silver	Gold	Platinum
Three times the individual deductible		Two times the individual deductible

Coinsurance within the U.S. and Canada

Silver	Gold	Platinum
80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage		90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage

Coinsurance within the PPO network and outside the U.S. and Canada

Silver	Gold	Platinum
100%	100%	100%

Hospitalization / Room & Board

Silver	Gold	Platinum
$600 per day (maximum of 240 consecutive days per covered event)	Average semi-private room rate	Private room rate

Intensive Care Unit

Silver	Gold	Platinum
$1,500 per day (maximum of 180 consecutive days per covered event)	Usual, Reasonable and Customary (URC)

Surgery

Silver	Gold	Platinum
URC	URC	URC

Anesthetist's Charges Associated with Surgery

Silver	Gold	Platinum
20% of surgery benefit	URC	URC

Transplants

Silver	Gold	Platinum
$250,000 per transplant	$1,000,000 lifetime maximum	$2,000,000 lifetime maximum

Outpatient

Silver	Gold	Platinum
Visits/Exams - 25 visits per insured person per period of coverage to the maximum limit as outlined: physician $70; specialist $70; psychiatrist $60; chiropractor $50; surgical intervention consultation $500; X-rays - $250 per exam maximum limit; Lab Tests - $300 per exam maximum limit	URC	URC

Rx Coverage

Silver	Gold	Platinum
URC	URC	Prescription drug card - Copay: $20 for generic / $40 for brand name when a generic is not available

Emergency Room Illness

Silver	Gold	Platinum
URC- subject to an additional $250 deductible if not admitted

Emergency Room Accident

Silver	Gold	Platinum
URC	URC	URC

Local Ambulance

Silver	Gold	Platinum
$1,500 per covered event - not subject to deductible or coinsurance	URC	URC

Emergency Evacuation

Silver	Gold	Platinum
$50,000 per period of coverage - not subject to deductible or coinsurance	Limited to policy maximum - not subject to deductible or coinsurance

Emergency Reunion

Silver	Gold	Platinum
NA (Not Applicable)	$10,000 lifetime maximum

Return of Mortal Remains

Silver	Gold	Platinum
$25,000 lifetime maximum per insured - not subject to deductible or coinsurance		$50,000 lifetime maximum per insured -not subject to deductible or coinsurance

Maternity

Silver	Gold	Platinum
Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in 11th or 12th month of continuous coverage		Same As Any Illness (SAAI) $1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for first 12 months. Available after 10 months of coverage

Supplemental Accident

Silver	Gold	Platinum
NA	$300 per occurrence - not subject to deductible or coinsurance	$500 per occurrence - not subject to deductible or coinsurance

Mental/Nervous

Silver	Gold	Platinum
Outpatient only - (see Outpatient) Available after 12 months of continuous coverage	$10,000 per period of coverage up to a $50,000 lifetime maximum. Available after 12 months of continuous coverage	SAAI $50,000 lifetime maximum. Available after 12 months of continuous coverage

Adult Wellness

Silver	Gold	Platinum
NA	$250 per period of coverage - not subject to deductible or coinsurance Available for those 30 years of age and over after 12 months of continuous coverage	$500 per period of coverage - not subject to deductible or coinsurance Available for those 18 years of age and over after 12 months of continuous coverage

Child Wellness

Silver	Gold	Platinum
Three visits per period of coverage - maximum $70 per visit. Available for children under 18 years of age after 12 months of continuous coverage	$200 maximum per period of coverage - not subject to deductible or coinsurance Available for children under 18 years of age after 12 months of continuous coverage	$400 maximum per period of coverage - not subject to deductible or coinsurance Available for children under 18 years of age after 12 months of continuous coverage

Other Services

Silver	Gold	Platinum
Extended Care - limited to first 30 days of confinement Radiation Treatment - URC Home Nursing Care - limited 30 days per covered event Hospice Care - limited 30 days per covered event Prosthetic Devices - all URC	URC	URC

Physical Therapy

Silver	Gold	Platinum
Maximum $40 per visit 30 visit maximum per period of coverage	Maximum $50 per visit	Maximum $50 per visit

High School Sports Injury

Silver	Gold	Platinum
NA	NA	Up to $20,000 per certificate period

Recreational SCUBA

Silver	Gold	Platinum
NA	URC	URC

Remote Transportation

Silver	Gold	Platinum
NA	NA	Limited to $5,000 per certificate period up to a $20,000 lifetime maximum

Political Evacuation and Repatriation

Silver	Gold	Platinum
NA	NA	Limited to $10,000 lifetime maximum

Complementary Medicine

Silver	Gold	Platinum
NA	Acupuncture $150 Aroma Therapy $50 Herbal Therapy $50 Magnetic Therapy $75 Massage Therapy $150 Vitamin Therapy $100 Each per period of coverage

Non-emergency Dental

Silver	Gold	Platinum
NA	NA	Calendar year maximum - $750 Individual deductible - $50 Schedule of benefits - Class I: 90% Class II: 70% Class III: 50% Ortho 0% (6 month waiting period)

Emergency Dental due to Accident

Silver	Gold	Platinum
$1,000 per period of coverage	URC	URC

Emergency Dental due to Sudden Unexpected Pain

Silver	Gold	Platinum
NA	$100 per period of coverage	See non-emergency dental benefits

Vision

Silver	Gold	Platinum
NA	NA	Exams - up to $100 per 24 months Materials - up to $150 per 24 months

Global Concierge & Assistance Services

Silver	Gold	Platinum
NA	NA	Included

Pre-existing Conditions

Silver	Gold	Platinum
$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage		SAAI

NA (Not Applicable) / URC (Usual, Reasonable and Customary) / SAAI (Same As Any Illness)