Benefit	Platinum
Coverage Area	Worldwide
Overall Policy Maximum	$5,000,000 Lifetime
Deductibles Available	$250, $500, $1,000 or $2,500 per Certificate Period.
Coinsurance -- Claims incurred in US or Canada	80% of the next $5,000 of Eligible Medical Expenses after the Deductible, then 100% to the Overall Policy Maximum.
Coinsurance -- claims incurred outside US or Canada	100% of Eligible Medical Expenses after the Deductible to the Overall Policy Maximum.
Hospital Room and Board -- In US or Canada	Average Semi-private room rate.
Hospital Room and Board -- Outside US or Canada	Average Private room rate.
Intensive Care Unit -- In US or Canada	3 times the Average Semi-private room rate.
Intensive Care Unit -- Outside US or Canada	3 times the Average Private room rate.
Mental or Nervous Disorders	$10,000 per Certificate Period (after 12 months of continuous coverage); $25,000 Lifetime Maximum.
Maternity -- Normal Delivery	Same as any other Illness (after 12 months of continuous coverage) including pre-natal, Delivery and post-natal care.
Maternity -- Complicated Delivery	Same as any other Illness (after 12 months of continuous coverage).
Maximum for Maternity	$50,000 Lifetime
Newborn Care	$25,000 Maximum Limit for maximum of 31 days.
Pre-existing Conditions	Same as any other Injury or Illness if disclosed on Application and not excluded or limited by Rider.
Local Ambulance	$2,500 Lifetime Maximum.
Physical Therapy	$50 Maximum per visit.
Wellness	$150 per Certificate Period (after 24 months of continuous coverage) for Members age 35 or older. Not subject to Deductible.
Human Organ/Tissue Transplants	Same as any other Illness for Covered Transplants.
All Other Eligible Expenses	Usual, Reasonable and Customary.
Emergency Medical Evacuation	$25,000 Lifetime Maximum.
Pre-certification Penalty	50%

Premier

 

Benefit	Premier
Coverage Area	Worldwide, except US and Canada
Overall Policy Maximum	$1,000,000 Lifetime
Deductibles Available	$250, $500, $1,000 or $2,500 per Certificate Period.
Coinsurance–Claims incurred in US or Canada	No coverage in US or Canada.
Coinsurance–claims incurred outside US or Canada	100% of Eligible Medical Expenses after the Deductible to the Overall Policy Maximum.
Hospital Room and Board–In US or Canada	No coverage in US or Canada.
Hospital Room and Board–Outside US or Canada	Average Private room rate.
Intensive Care Unit–In US or Canada	No coverage in US or Canada.
Intensive Care Unit–Outside US or Canada	3 times the Average Private room rate.
Mental or Nervous Disorders	$5,000 per Certificate Period (after 24 months of continuous coverage); $10,000 Lifetime Maximum.
Maternity–Normal Delivery	$3,500 per Pregnancy (after 24 months of continuous coverage) including pre-natal, Delivery and post-natal care.
Maternity–Complicated Delivery	$6,000 per Pregnancy (after 24 months of continuous coverage) including pre-natal, Delivery and post-natal care.
Maximum for Maternity	$10,000 Lifetime
Newborn Care	$5,000 Maximum Limit for maximum of 31 days.
Pre-existing Conditions	$25,000 Lifetime Maximum (after 24 months of continuous coverage).
Local Ambulance	$1,000 Lifetime Maximum.
Physical Therapy	No coverage.
Wellness	No coverage.
Human Organ/Tissue Transplants	Same as any other Illness for Covered Transplants.
All Other Eligible Expenses	Usual, Reasonable and Customary.
Emergency Medical Evacuation	No coverage.
Pre-certification Penalty	50%

Optional Term Life Insurance and Accidental Death and Dismemberment

 

Age	Basic Life Principal Sum	Supplemental Life Principal Sum
19 to 59	$50,000	$50,000
60 to 64	$25,000	$25,000
65 to 69	$10,000	Not Available
Dependent Child	$5,000	Not Available

 

Accidental Death	Principal Sum
Accidental Loss of Two Members	Principal Sum
Accidental Loss of One Member	50% of Principal Sum

The Benefit is based on your age at time of Death or Dismemberment. "Member" means hand, foot or eye.