Global Mission Basic^SM (GMB) covers the Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment. Each insured person will only need to satisfy their deductible once per period of coverage (12 months), with a maximum of three deductibles per family. For eligible expenses incurred in the U.S. and Canada: once the deductible is met, GMB pays 80% of the next US$5000 in eligible expenses, then 100% of eligible expenses up to the policy maximum. For eligible expenses incurred outside of the U.S. and Canada: once the deductible is met, GMB will pay 100% of eligible expenses up to the policy maximum.

MEDICAL INSURANCE	BENEFIT Subject to deductible and coinsurance
Coverage area	Worldwide
Policy maximum per individual	US$5,000,000 lifetime maximum benefit
Hospital room & board	US$600 per day (maximum of 240 consecutive days per covered event)
Intensive care unit	US$1,500 per day (maximum of 180 consecutive days per covered event)
Inpatient or outpatient surgery	URC up to lifetime maximum benefit
Anesthetist's charges associated with surgery	20% of the surgery benefit payable
Laboratory tests, X-rays, & other treatment associated with an inpatient covered event	URC up to lifetime maximum benefit
Emergency medical evacuation	US$50,000 per coverage period (not subject to deductible or coinsurance)
Local ground ambulance	US$1,500 per covered event (not subject to deductible or coinsurance)
Emergency room treatment due to an accident	URC up to lifetime maximum benefit
Emergency dental due to an accident	US$1,000 per coverage period
Maternity Available only after 12 months of continuous coverage	Limited to US$4,000 per pregnancy (not subject to coinsurance)
Professional services related to inpatient maternity expenses	US$200 per day (not subject to coinsurance)
Newborn care and treatment	US$15,000 lifetime maximum for the first 30 days after birth
Well child care	3 visits per coverage period (maximum limit of $70 per visit)
Outpatient visits or exams 25 visits, including prenatal and postnatal care, per insured person per coverage period reimbursed to the maximum limit as outlined below:
• Physician	US$70 per visit/exam
• Specialist	US$70 per visit/exam
• Psychiatrist	US$60 per visit/exam
• Chiropractor	US$50 per visit/exam
• Surgical intervention consultation	US$500 per visit/exam
Outpatient X-rays	US$250 per exam maximum limit
Outpatient lab tests	US$300 per exam maximum limit
Pre-existing Conditions Available after 24 months of continuous coverage	US$50,000 lifetime maximum benefit (maximum of US$5,000 per period of coverage)
Prescription medication related to a covered event	URC up to lifetime maximum benefit
Extended care facility services	Limited to the first 30 days of convalescent confinement
Home nursing care services	Limited to 30 days per covered event
Inpatient hospice care	Limited to the first 30 days of hospice confinement
Chemotherapy & radiation therapy	URC up to lifetime maximum benefit
Physical therapy	30 visits per coverage period (maximum limit of $40 per visit)
MRI, CAT scan, endoscopy, echocardiography, gastroscopy, colonoscopy & cystoscopy	US$600 per exam limit
Transplants Certain precertification provisions must be met	US$250,000 all inclusive per transplant
Return of mortal remains	US$25,000 lifetime maximum (not subject to deductible or coinsurance)

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.