Bronze

GlobalFusion Bronze

Summary of Benefit Schedules
The tables below are summaries of policy benefits for the 3 levels. All benefits are subject to the Policy Terms, Conditions, Limitations, Exclusions, and Pre-Certification requirements. Please refer to the Policy Wordings available on the Download page.

All sub-limits below are the maximum sum insured per Person, per Period of Insurance unless otherwise stated. The lifetime maximum sum insured for all levels is $2.5M.

Level 1 Global Fusion Bronze Cover
Description: This plan is a hospital cover only plan with very limited outpatient benefits. Most people take it with a high deductible since hospitalization is a rare event. It is also called Protexplan Bronze.

A: In-Patient & Day-Patient Treatment
1.Surgery, Surgeons, Consultants, Second Surgical opinion, Medical Practioners, Nurses, Treatment, Services and Supplies routinely provided and Ancillary Charges. FULL COVER

2.
Hospitalisation / Room Board. FULL COVER

3. Intensive Care unit. FULL COVER

4. Anaesthetist’s Charges associated with Surgery. FULL COVER

5. Diagnostic, Tests and Procedures, X-Rays, Pathology, & MRI/CT Scans. FULL COVER

6. Prescribed Drugs, Dressings and Durable Medical Equipment. FULL COVER

7. Reconstructive Surgery – following an accident or following surgery for an eligible condition. FULL COVER

8. Cancer Tests, Drugs, Treatment and Consultants, including cover for Chemotherapy and Radiotherapy. FULL COVER

9. Physiotherapy. FULL COVER

10. Parental Hospital Accomodation. FULL COVER.

11. Prosthetic Devices. FULL COVER

12. Transplants. $250,000 usd per transplant

13. State Hospital Cash Benefit. $300 usd per night, 60 nights

B: Out-Patient Treatment, Wellness Benefits and Other Coverage
1. Out-Patient including: Family Doctor, Treatment and Referral, Specialists and Consultants, X-Rays, Pathology, Diagnostic Tests and Procedures No Family Doctor Cover. Specialist & Consultants: Up to $500 prior de admission*, then up to $500 usd following related Out-Patient Surgery or In-Patient treatment for 90 days after leaving the hospital, including Pre* & Post Hospital: $250 usd X-Ray per Examination Maximum Limit; $300 usd Lab test per examination (Maximum Limit).

2. Emergency Room Illness, Waived if admitted as an In-Patient or Day-Patient (Additional $250 usd Excess if not admitted). NO COVER

3. Emergency Room Accident. NO COVER

4. Supplemental Accident Benefit. NO COVER

5. Out-Patient Surgery. FULL COVER

6. MRI, CAT Scan, Echocardiography, Endoscopy, Gastroscopy, Colonoscopy, Cystoscopy. $600 usd maximum per examination.

7. Cancer Tests, Drugs, Treatment and Consultants, including cover for Chemotherapy and Radiotherapy. FULL COVER.

8. Prescribed Out-Patient Drugs, Medicines, Dressigns and Durable Medical Equipment. Up to $6000 usd. Following and in relation to In-Patient Treatment or Out-Patient Surgery. For 90 days after leaving hospital.

9. Physiotherapy, Homeopathic and Osteopathic Therapy. Physiotherapy Only: Relating to In-Patient Treatment, Out-Patient Surgery. Up to $40 usd per visit. 10 visit Maxmimum. For 90 days after leaving the hospital.

10. Complementary Medicine, Acupuncture, Aroma Therapy, Herbl Therapy, Massage Therapy, Vitamin Therapy, Traditional Chinese Medicine. NO COVER

11.AIDS/HIV Treatment. NO COVER

12.Home Nursing Care. 30 Days Limit: Up to $150 usd per visit.

13. Rehabilitation. NO COVER.

14. Extended Care Facility. NO COVER.

15. Hospice Care. NO COVER.

16. Adult Wellness and Health Check – includes Hearing Test, Sight Test and Vaccinations/Inoculations(Not subject to Annual Excess or Co-Insurance) – After 12 months of continuous coverage (6 months on Platinum). NO COVER.

17. Child Wellness and Health Check (Under 18 years of age) – Includes Hearing Test, Sight Test and Vaccinations/Inoculations (Not subject to Annual Excess or Co-Insurance) – After 12 months of continuous coverage (6 months on Platinum). NO COVER.

18a. Pre-Existing Medical Conditions. Full Medical Underwriting Option*: – After 24 month continuous cover. -Declared and Accepted Conditions (unless otherwise excluded or terms applied as indicated otherwise in writing) – Flexible Underwriting Option availale – refer to page 23. NO COVER.

OR

18b. Moratorium Enrolment & Underwriting Option* – After 24 months of continuous coverage: subject to 24 months without treatment, symptoms, medication or consultation* – Available to insureds up to age 54. NO COVER.

*Cover in respect of Pre-Existing Conditions is as selected at time of application and identified on your Certificate of Insurance. Refer to page 23 for further details and Policy Wording for full Policy definitions, terms, conditions and restrictions.

19. Newly Diagnosed Chronis Conditions. COVERED.

20. Mental/Nervous -After 12 months of continuous coverage. NO COVER.
C: Travel, Transportation and Out of Area Benefits

1. Emergency Local Ambulance. Up to $1,500 usdper event. Not subject to Annual Excess or Co-Insurance.

2. Emergency Evacuation and Transportation To the Nearest Suitable Hospital Facility
Up to $50,000 usd Not subject to Annual Excess or Co-Insurance.

3. Accompanying Relative, Travel and Accommodation. NO COVER.

4. Cremation/Burial or Return of Mortal Remains. $10,000 Lifetime Limit. No subject to Annual Excess or Co-Insurance.

5. Remote Transportation. For additional transport for on-going Treatment once stabilised. NO COVER

6. Security & Political Evacuation & Repatriation. NO COVER

7. Worldwide Accident & Emergency Out of Area Coverage. 15 days maximum.

D: Dental Treatment & Vision Care Benefits

1. Emergency Dental Due to Accident. Up to $1,000 usd

2. Emergency Dental due to sudden unexpected pain to sound natural teeth. NO COVER

Annual Excess and Co-Insurance

Annual Excess Options
– Per Insured Person, Per Period of Insurance

$250 to $10,000 50% waived (up to a maximum reduction of $2,500) for: US PPO Out-Patient & Emergency In-Patient Treatment & Non-Emergency In-Patient US Medical Concierge Provider Treatment

Family Maximum Annual Excesses.
3 x Individual Annual Excess

Annual Excess Carry Forward – If prior Annual Excesses not met, then last 30 days Expenses from the previous Period of Insurance are carried forward and applied towards satisfying the Annual Excess for the next Period of Insurance. Yes

Co-Insurance within the USA & Canada PPO Network / Co-Insurance outside the USA and Canada.
No Co-Insurance.

Co-Insurance Payable by Insured inside the USA and Canada* – When treatment is taken outside the USA & Canada PPO Network -(*No Co-Insurance for Non-Emergency In-Patient Treatment when utilising a USA Medical Concierge Provider)
20% of the next $5000 usd eligible expenses after the Annual Excess, then No Co-Insurance to the overall maximum per Period of Insurance.

Please refer to the full Policy documentation for all applicable terms, conditions, limitations and exclusions – Available upon request.


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