Schedule of Group Benefits

Below you will find our standard group health plan for 10-50 staff. We can also tailor a health plan according to your unique expat staff needs.

After satisfaction of the Annual deductible, the Personal Health plan underwritten by Colonial Medical will pay the benefits set forth in this section at the percentage payable of the allowable charge. Once the coinsurance requirement (Out-of-Pocket) has been met, benefits are payable at 100% of the allowable charge for the remainder of the calendar year unless otherwise stated.

North America Outside NA
Plan 1
PPO		 Members
Non PPO*		 Plan 1 & 2

Hospital Inpatient & Surgery

Room and Board: Hospital's average semi private charge per day of confinement

 90% 70% 100%

Intensive Care Unit

 90% 70% 100%

Inpatient ancillary services**

 90% 70% 100%

Physician Office Visits & Specialist Fees

 90% 70% 100%

Outpatient Surgery

 90% 70% 100%

Emergency Room

 90% 70% 100%

Diagnostic and Therapeutic Services (Outpatient) ***

 90% 70% 100%

Other Medical expenses

 90% 70% 100%

Maternity Expense:

(12 month waiting period, time-credit will be applied for prior coverage) Treated the same as any other condition for Insured and eligible dependents.
This benefit does not extend to dependent children.

Routine Nursery: As any other treatment including room and board, physician charges and circumcision for males prior to discharge.

 90% 70% 100%

New-Born Cover

New-Born includes: Premature Births, Congenital Conditions and Birth Anomalies. Life Time Maximum: US $25,000

 90% 70% 100%

Prescription Program

In PPO no deductible applies brand name drugs at 80% and generic drugs at 90%. Out of network (in USA only) deductible applies and no out-of-pocket lime applies. Overseas deductible applies.

 80% / 90% 70% 100%

Mental Health (Inpatient & Outpatient)

Lifetime Maximum - US $25,000 Lifetime Mental Illness, Maximum Per Insured (In-Hospital)* 60 days Lifetime Mental Illness, Maximum Per Insured (Out-of-Hospital)* 80 visits Calendar Year Mental Illness, Maximum (Out-of-Hospital)* 15 visits - US $2,500 per year

 90% 70% 100%

Notes:

* No OOP max. applies

** Blood transfusions, plasma - $5,000 per person per calendar year

*** Physical Therapy: per visit limit US$ 75, calendar year max 30 visits; Occupational therapy: per visit limit US$ 75, calendar year max 30 visits

Transplant Procedures:

Only available through the Managed Transplant Program.

Transplant must be pre-certified and approved by Colonial Medical. Failure to comply will result in treatment not being covered

Dental Care:

Limited to accidental injury of sound, natural teeth sustained while covered under the plan. (see Dental Option for additional optional cover)

Preventive Care / Wellness

(Subject to Calendar Year Maximums (CYM) with no deductible)

6 Month Waiting Period for both Adults and Children

Child Immunizations & Routine Medical Exams: 100% coinsurance not subject to deductible for children from birth to age 18 for immunization against diphtheria, hepatitis B, measles, mumps, pertussis, polio, rubella, tetanus, varicella, haemophilias, influenza B, and hepatitis A, up to the dollar limits indicated.

Child Preventive Care Services: 100% coinsurance not subject to deductible. Services include: health history, physical examinations, development assessments, anticipatory guidance, appropriate immunizations and laboratory tests.

Child Preventive Care is subject to the following limitations:

Calendar Year Maximum
Child - Birth to age 12 months US $350
Child -13 months through age 17 US $100
Child - Age 18 to 23 (only if full time student) US $200


Adult Routine Physical Exams: 90% coinsurance not subject to the deductible for charges made for or in connection with the overall health and well being for Insureds and Spouses or Domestic Partners age 18 years and over. Calendar Year Maximum US$ 500. 12 month waiting period unless covered under a previous plan.

Papanicolaou Screening Test: Treated like any other illness but not subject to deductible. Up to one test per calendar year for all eligible females.

Prostate Cancer Screening: Treated like any other illness but not subject deductible. One test per calendar year for males age 50 or over.

Mammograms: Treated like any other illness not subject to deductible per the following schedule:

Vision Care Cover

Percentage of Reasonable and Customary Cost: 100%

Annual Maximum Benefit Per Insured: US $150

Medical Evacuation and Assistance

Insured and Insured Dependents:

Lifetime Maximum Benefit Per Insured: US $150,000

Other Medical

Home Health Care: As any other treatment up to a Lifetime maximum of US $7,500.

Skilled Nursing Facility: As any other treatment.

Chiropractic Services: As any other treatment up to a US $750 Calendar Year Maximum.

Hospice Care Services: As any other treatment up to a US $10,000 Lifetime Maximum.

TMJ Treatment: As any other treatment US $1,000 Lifetime Maximum.

Policy Limitations & Exclusions

Pre-Existing Condition Limitation (Applies to Medical coverage Only) A 6/12 existing provision will apply to entrants for medical coverage. This appies to any condition treated (including prescriptions) within 6 months prior to effective date. For coverage for pre-existing conditions between 10 and 50 employees, condition is limited to US$4,000, (for less than 10 Employees, the $4,000 is not available) within 12 months of being continuously insured. Not withstanding the above, the program can waive pre-existing conditions where prior coverage is in effect.

Infertility: Procedures directly related to diagnosis are covered. Treatment, prescription drugs, and or other methods to bypass (i.e. In-vitro) are not covered.

Expenses for oral contraceptives and contraceptive devices are excluded. Expenses for prenatal vitamins, and smoking cessation products are excluded. Over the counter medications are excluded.

Plan 2 does not include any cover for North America (USA and Canada)

Overall Lifetime Maximum Per Insured:

US $2,000,000

For more information regarding our international group health plan, take a tour or select the many options available to you on our navigation panel.