| Comparison Highlights |
Comprehensive Coverage inside the U.S. Available with Xplorer Premier Plan |
Basic U.S. Benefits Upgrade Available with the Xplorer Essential Plan |
| U.S. Coverage Options Overview |
| Coverage Area |
Inside the U.S |
Inside the U.S. |
| Description of U.S. Coverage Options |
Major medical coverage allowing members freedom to seek care in the U.S. for up to 9 months per year. Comprehensive U.S. benefits for emergent, urgent, routine, preventive and elective care. |
Basic travel accident and sickness coverage
inside the U.S. for short trips to the U.S. Covers incidental illness and injury. Not designed to cover preventive, elective care or extended stays in the U.S. |
| Benefit Information |
| Medical Maximum |
Unlimited |
$1,000,000 |
| U.S. In-Network Coinsurance |
80% to coinsurance maximum
(100% thereafter) |
80% to coinsurance maximum
(100% thereafter) |
| U.S. Out-of-Network Coinsurance |
60% to coinsurance maximum
(100% thereafter) |
60% to coinsurance maximum
(100% thereafter) |
| Coverage for U.S. Citizens Inside the U.S. |
Capped at 9 months |
21 days per trip, three trips maximum per calendar year |
| Deductible Waiver |
Waived for all physician office visits and preventative care |
Waived for all physician office visits |
| Preventive Care |
Unlimited |
Not Covered |
| Patient Responsibility for In-Network Physician Office Visits |
$30 copay per visit |
$50 copay per day |
| Ability to Travel to the U.S. for Treatment |
YES |
NO |
| Elective Care In The U.S. Including Cancer
Treatment, Heart Surgery, Orthopedic
Surgery, and Other Elective Care |
COVERED |
NOT COVERED |
| Mental Health Benefits |
Inpatient: 100% up to 60 days
Outpatient: 75% up to 40 visits
(60% thereafter) |
NOT COVERED |
| Speech Therapy |
12 visits per calendar year, deductible waived, up to $30 per visit |
NOT COVERED |
| Acupuncture |
In-Network: 80% up to $2,000
Out-of-Network: 60% up to $2,000 |
NOT COVERED |
| Chiropractic Care |
In-Network: 80% up to $2,000
Out-of-Network: 60% up to $2,000 |
NOT COVERED |
| Nursing Home Expenses |
As many as 50 days per calendar year under
skilled nursing services benefit |
NOT COVERED |
| Substance Abuse |
Inpatient 100% up to 60 days detox /
Outpatient 75% up to 40 visits and 60%
thereafter |
NOT COVERED |
| Inpatient Prescription Drugs |
Unlimited |
$1,000,000 |
| Outpatient Prescription Drugs |
$1,000 Basic Prescription Benefit Enhanced Prescription Upgrade available: $25,000 |
$1,000 |
| Injectables |
70% to coinsurance maximum
(100% thereafter) |
NOT COVERED |
| Birth Control |
Up to outpatient prescription drug limit |
NOT COVERED |
| AD&D |
$50,000 |
NOT COVERED |
| Newborn Care |
| Routine Nursey Care of a Newborn Child of a Covered Pregnancy |
UNLIMITED |
NOT COVERED |
| Neonatal Intensive Care Unit |
Newborn is automatically covered; Unlimited |
Covered due to complications
of pregnancy only |
| Pre-existing Conditions |
| Pre-existing Condition Exclusion Period |
180 days
Exclusion waived with evidence
of prior health insurance |
180 days
Any evidence of prior health insurance does
not apply to pre-existing condition wait period. |
| Pre-existing Condition Look Back Period |
180 Days |
2 Years |
| Pre-existing Annual Maximum Once Covered |
Unlimited |
$500 |
