Benefits
Benefit Maximums |
Outside U.S. |
U.S. (In Network) |
U.S. (Outside Network) |
| Lifetime Maximum per Insured Person | Unlimited | Unlimited | Unlimited |
| Annual Maximum per Insured Person | Unlimited | Unlimited | Unlimited |
| Preventive and Primary Care | Insurer Waives Deductible | ||
| Preventive Care For Babies/Children: (Birth through Age 18) a. Office Visits/examination b. Immunizations, Lab work & X-rays done in conjunction with an office visit |
100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Preventive Care for Adults: (Age 19 and Older) a. Office Visits/examination b. Immunizations as recommended on the published Center for Disease Control (CDC) immunization schedule for adults c. Routine Pap Smears, annual mammogram d. PSA For Men e. Diagnostic lab work & X-rays done in conjunction with an office visit |
100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Annual Physical Examination/Health Screening, Subject to a $1,000 Maximum per Calendar Year and limited to one per Calendar Year | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Primary Care Physician or Specialist Office Visits | All except a $10 copay per visit1 | All except a $30 copay per visit | 60% to Coinsurance Maximum then 100% |
| Urgent Care Facility | 100% | All except a $75 copay per visit | 60% to Coinsurance Maximum then 100% |
| Professional Services | Insurer Pays After Deductible is Met | ||
| Surgery, anesthesia, radiation therapy, in-hospital doctor visits, diagnostic X-ray and lab work. | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Inpatient Hospital Services | Insurer Pays After Deductible is Met | ||
| Surgery, X-rays, in-hospital doctor visits, Organ/Tissue Transplant | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Inpatient medical emergency6 | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Inpatient drugs | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Ambulatory and Therapeutic Services | Insurer Pays After Deductible is Met, Unless Noted | ||
| Ambulatory Surgical Center | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Ambulance Service | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Accidental Dental | $1,000 per calendar year, $200 per tooth | $1,000 per calendar year, $200 per tooth | $1,000 per calendar year, $200 per tooth |
| Acupuncture and Chiropractic Services, Subject to a $2,000 Maximum per Calendar Year if under the care of a licensed Physician | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Durable Medical Equipment | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Infusion Therapy | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Physical/Occupational Therapy, Limited to 12 visits per Calendar Year | 100%, no deductible | 100%, no deductible | 100%, no deductible |
| Rehabilitation and Therapy | Insurer Pays After Deductible is Met, Unless Noted | ||
| Inpatient Mental Health | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Outpatient Mental Health | 100%, no deductible $10 Copayment1 |
100%, no deductible $30 Copayment |
60% to Coinsurance Maximum then 100%, no deductible |
| Inpatient Substance Abuse | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Outpatient Substance Abuse | 100%, no deductible $10 Copayment1 |
100%, no deductible $30 Copayment |
60% to Coinsurance Maximum then 100%, no deductible |
| Other Services | Insurer Pays After Deductible is Met | ||
| Home Health Care, Subject to a maximum of 30 visits per Calendar Year | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Skilled Nursing Facilities, Subject to a maximum of $250 per day for a maximum of 50 days per Calendar Year | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Hospice, Subject to a maximum of $5,000 per lifetime | 100% | 80% to Coinsurance Maximum then 100% | 60% to Coinsurance Maximum then 100% |
| Prescription Drug Benefit Options | Insurer Waives Deductible | ||
| Basic Prescription Drug Benefit, Subject to $2,500 Maximum per Insured Person per Calendar Year Max 90-day supply |
100% of actual charges (pay and claim only) | 100% of actual charges | 100% of actual charges |
| Optional Rider, Subject to $25,000 maximum per Insured Person per Calendar Year Max 90-day supply |
100% of actual charges (pay and claim only) | Generics: 100% after $10 copay per 30-day supply Brand name: 100% after $10 copay per 30-day supply Injectables: 70% |
Generics: 100% after $10 copay per 30-day supply Brand name: 100% after $10 copay per 30-day supply Injectables: 70% |
| Global Travel Benefits | Insurer Waives Deductible | ||
| Emergency Medical Transportation | Up to $250,000 | n/a | n/a |
| Repatriation of Mortal Remains | Up to $25,000 | n/a | n/a |
| Accidental Death and Dismemberment | $50,000 | $50,000 | $50,000 |
Plan Deductible Choices
Deductible |
Coinsurance Maximum |
|||
GeoBlue Xplorer Premier1,2,3,4,5,6 |
Outside U.S. |
U.S. In Network |
U.S. Out of Network |
|
| Elite | $0 | $0 | $1,000 | $2,000 |
| 1,000 | $500 | $1,000 | $2,000 | $4,000 |
| 2,000 | $1,000 | $2,000 | $4,000 | $8,000 |
| 5,000 | $2,500 | $5,000 | $10,000 | $10,000 |
| 10,000 | $10,000 | $10,000 | $10,000 | $10,000 |
- Copay waived when visiting a GeoBlue contracted provider outside the U.S.
- Deductibles are per person per Calendar Year.
- The Out-of-Pocket Maximum is calculated by adding the deductible and coinsurance maximum together. A family is charged a maximum of 2.5 deductibles.
- Amounts paid to satisfy a deductible are credited to all other deductibles, both inside and outside the U.S. For example, if you satisfy your Outside U.S deductible, this amount is credited to the U.S. (In Network) and U.S. (Outside Network) deductible requirement.
- An Insured Person only has to satisfy his/her Coinsurance Maximum once per calendar year for all services received outside of the U.S. and in the U.S.
- Emergency room visits that do not result in inpatient admissions will be subject to a $50 penalty.
Ten Day Money Back Guarantee
We are so confident in our products that we offer the best guarantee in the business. If you are not completely satisfied with our product, simply send an email to enrollment@geo-blue.com within 10 days of purchase and include the reason for cancellation.