Global Citizen Deductible Options
Worldwide benefits including the U.S.
Global Citizen
Plan 1,2,3,4,5,6
|
Deductible
|
Coinsurance Maximum
|
|
Outside U.S.
|
U.S.in Network
|
U.S.out of Network
|
| Elite
|
$0
|
$0
|
$1,000
|
$2,000
|
| 500
|
$250
|
$500
|
$1,000
|
$3,000
|
| 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
|
Global Citizen EXP Deductible Options
Worldwide benefits excluding the U.S
|
Global Citizen EXP Plan 1,2,3,6
|
Deductible
|
| Elite
|
$0
|
| 250
|
$250
|
| 500
|
$500
|
| 1,000
|
$1,000
|
| 2,500
|
$2,500
|
| 5,000
|
$5,000
|
Global Citizen EXP Select Deductible Options
Worldwide benefits excluding the U.S, for those who have a primary health plan
|
Plan Options Select 1,2,3,6
|
Deductible
|
| Elite
|
$0
|
| 2,500
|
$2,500
|
| 5,000
|
$5,000
|
1. Copay waived when visiting an HTH Worldwide contracted provider.
2. Deductibles are Per Person per Policy Period.
3. 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.
4. 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.
5. An Insured Person only has to satisfy his/her Out of Pocket Maximum once a Year for all services received outside of the U.S. and in the U.S.
6. Emergency room visits that do not result in inpatient admissions will be subject to a $50 penalty
