Lifetime maximum | Unlimited |
Annual maximum | $250,000 |
Co-insurance in network | 80% |
Co-insurance out-of-network | 60% |
Deductible in network | $500 |
Deductible in non-network | $500 |
Out of pocket in network | Unlimited |
Co-pay in ER (waived if admitted) | $350 |
Co-pay in SHC | $5 |
Co-pay primary care | $50 |
Co-pay specialist visit | $50 |
Co-pay hospitalization | $0 |
Pre-existing condition waiting period | $25,000 for emergency |
Medical evacuation | 80% up to $50,000 |
Repatriation | 80% up to $50,000 |