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GMMI Global Mission Basic Coverage area Two options: worldwide or worldwide excluding the U.S. and Canada Two options: worldwide or worldwide excluding the U.S. and Canada Policy maximum per individual US$5,000,000 US$5,000,000 Hospital room & board Usual, reasonable, and customary charges US$600 per day (maximum of 240 consecutive days per covered event) Intensive care unit Usual, reasonable, and customary charges US$1,500 per day (maximum of 180 consecutive days per covered event) Inpatient or outpatient surgery Usual, reasonable, and customary charges Usual, reasonable, and customary charges Anesthetist’s charges associated with surgery Usual, reasonable, and customary charges 20% of the surgery benefit payable Lab tests, X-rays, other tests associated with an inpatient covered event Usual, reasonable, and customary charges Usual, reasonable, and customary charges Transplants US$1,000,000 lifetime US$250,000 all inclusive per transplant Outpatient visits or exams Usual, reasonable, and customary charges 25 visits per insured person per coverage period reimbursed to the maximum limit as outlined below: Physician – US$70/visit Specialist – US$70/visit Psychiatrist-US$60/visit Chiropractor-US$50/visit Surgical intervention consultation-US$500/visit Outpatient X-rays Usual, reasonable, and customary charges US$250 per exam maximum limit Outpatient lab tests Usual, reasonable, and customary charges US$300 per exam maximum limit Prescription medication related to a covered event Usual, reasonable, and customary charges Usual, reasonable, and customary charges Emergency room Usual, reasonable, and customary charges Usual, reasonable, and customary charges Emergency dental Usual, reasonable, and customary charges US$1,000 per coverage period Local ground ambulance Usual, reasonable, and customary charges US$1,500 per covered event (not subject to deductible or coinsurance) Emergency medical evacuation Optional - Up to policy maximum; includes Emergency Reunion benefit of US$10,000 lifetime Optional - US$50,000 per coverage period (not subject to deductible or coinsurance) Return of Mortal Remains US$25,000 US$25,000 (not subject to deductible & coinsurance) Supplemental accident US$300 per occurrence No coverage Child wellness US$50 maximum per visit; US$150 maximum per period of coverage (not subject to deductible or coinsurance – available for eligible children under 18 years of age after 12 months of continuous coverage) 3 visits per coverage period (maximum limit of US$70 per visit) Only available after 12 months of continuous coverage Pre-existing conditions US$50,000 lifetime (maximum of US$5,000 per period of coverage – available after 24 months of continuous coverage) US$50,000 lifetime (maximum of US$5,000 per period of coverage – available after 24 months of continuous coverage) Mental/nervous care US$10,000 per period of coverage, US$25,000 lifetime (available after 12 months of continuous coverage – inpatient and outpatient care by a licensed psychiatrist) Outpatient services covered only as indicated in the “Outpatient visits or exams” section Wellness US$250 per period of coverage (not subject to deductible or coinsurance – includes routine physicals, mammograms, and ob/gyn visits for those age 30 and over after 12 continuous months of coverage – visits must be separated by at least 12 months) No coverage available Complementary medicine Each per period of coverage Acupuncture – US$150 Aroma therapy – US$50 Herbal therapy – US$50 Magnetic therapy-US$75 Massage therapy-US$150 Vitamin therapy-US$100 No coverage available Extended care facility services Usual, reasonable, and customary charges Limited to the first 30 days of convalescent confinement Home nursing care services Usual, reasonable, and customary charges Limited to 30 days per covered event Inpatient hospice care Usual, reasonable, and customary charges Limited to 30 days per covered event Chemotherapy & radiation therapy Usual, reasonable, and customary charges Usual, reasonable, and customary charges Physical therapy Maximum US$50 per visit Maximum US$40 per visit (30 visits per coverage period) MRI, CAT scan, endoscopy, echocardiography, gastroscopy, colonoscopy, & cystoscopy Usual, reasonable, and customary charges US$600 per exam maximum limit Prosthetic devices Usual, reasonable, and customary charges No coverage available The foregoing list is only a summary of available benefits and coverages, and is subject to the specific terms and conditions of the plan concerning eligible benefits, limitations, eligibility and exclusions.  Please refer to the Certificate Wording for a complete description, which is available upon request.   Copyright 2007, MissionTripInsurance.com All rights reserved. All other trademarks, symbols, and logos are property of their respective owners.