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IntegraGlobalHealthcare you deserve

providing the most comprehensive cover of its kind

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WelcomeA health plan with Integra Global delivers the care you deserve, whenand where you need it. It's a comprehensive lifestyle health plan forthe best care available worldwide. That's direct access to world leadingcenters of excellence and additional benefits like medical evacuation, in-patient and out-patient care, direct billing, 24 hr-7 day assistance,maternity care and wellness benefits that include vaccinations. Your health plan with Integra Global delivers comprehensive care at the touch of a button, visit our website at

www.integraglobal.com


An international health plan that fits to your lifestyleAn international health insurance plan with Integra Global delivers the care you deserve, when and where you need it. It’s a

comprehensive lifestyle health insurance plan for the best care worldwide.

Access to world class health careThe Personal Health plan allows you complete freedom of choice for doctors, specialists and hospital providers, worldwide.

You choose the medical provider you want and where you want to receive care. While in the U.S. and Canada our network

of hospitals and doctors serve as your passport to the largest health network in North America.Our global support service

means that you can rely on the best care, worldwide: when you need it, wherever you need it, in some of the world’s leading

centers of medical excellence. Best of all, you have total freedom of where you want to receive your medical care.

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Comprehensive lifestyle health insurance planExpatriates have different demands for heatlh insurance than their domestic counterparts. Integra Global's

Personal Health is an international health plan designed for an international lifestyle.

A health plan that sees the big pictureWhen abroad you don't want to worry about what your health insurance plan covers. Instead you need

comprehensive cover that takes care of the big things as well as the small. Medical evacuation, travel

assistance or claims translations, it's all included. Chronic conditions cover, hospitalization, prescription drugs,

out-patient, wellness benefits, specialists, and physician office visits: you have it covered with Personal Health.

Personal Health provides you quality cover that fits your lifestyle>


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It's your health. Your right to chooseWhether you choose our:

Plan 1 - Worldwide Health Cover including access to US and Canada medical care; or,

Plan 2 - Worldwide Health Cover but excluding access to US and Canada medical care;

You have at all times the right to choose where and by whom you receive your medical care. In the US you have personal and

direct access to any facility in the First Health network. On presenting your member I.D. card (or details), all charges/claims are

managed automatically.

The advantage of going in-network is that all network claims are billed directly to your medical insurance company. You have the

flexibility to go to providers that are not in the network but are asked to share in the cost (see the schedule of benefits for the

difference between in-network and out-of-network).

Overseas the Personal Health plan offers the same great choice at great benefits. You have free choice of your doctor or hospital.

To arrange for direct billing in the case of hospitalization or surgery, all that you need to do is call our 24/hour medical hotline on

the back of your card.


A friend overseas, a friend in AmericaWhile overseas

With Personal Health you have the choice of where you want to receive care. Outside North

America you have our caring 24/7 medical emergency hotline. They don't just help you in

case of medical evacuation (they do that too, of course) but they can also find you the best

possible care wherever you are. And your case receives follow up care, all to insure that you

are receiving the best care you deserve.

With our 24-hour worldwide assistance you have the following services available to you:

• 24-hour worldwide assitance, 365 days a year

• Medical Evacuation

• Assistance in locating local and appropriate medical care

• Evaluation and close monitoring of treatment

• Pre-Planning of medical support in remote areas

• Emergency medication, blook and vaccine transfers

• Pre-notification

• Continuous personal contacts

• Translation services

• Medically supervised repatriation

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Medical Excellence in the US (for Plan 1 members)

Personal Health uses a PPO (Preferred Provider Organization) Network, First Health. It's the oldest and largest network of directly

contracted, credentialed providers in the U.S. Firsth Health has over 4,423 hospitals and 425,750 health care professionals.

2005 US News & World Report rated the top hospitals in America. 11 out of the top 16 US Hospitals are in the First Health Network:

• John Hopkins - Baltimore, MD

• Mayo Clinic - Rochester, MN

• Massachusetts General Hospital, Boston MA

• Cleveland Clinic

• UCLA Medical Center, Los Angeles CA

• Barnes-Jewish Hospital, St. Louis, MO

• Duke University Medical Center, Durham NC

• Univ. of Calif, San Francisco Medical Center

• Brigham and Women's Hospital, Boston MA

• University of Chicago Hospitals

• Stanford Hospital and Clinics, Stanford CA

Do you have questions about your medical provider in our network? Just contact us. >


Have plan, will travelPersonal Health goes with youAs an expatriate you might move from one country to the next. Personal Health travels with you.

All that you need to do is let us know of your new address.

Direct billingWhen living overseas sometimes it feels like you are living in two or three places at once. All the more important to have

direct billing to hospital providers worldwide.

We go even a step further by having one of the largest provider networks of hospitals and physicians in the U.S. and Canada.

Just show your Personal Health ID card and billing and claims filing is taken care of for you. And it gets even better: for

prescription drugs we make it simple with our prescription drug program and prescription drug card (prescription drug card is

only valid in the US and inside our PPO network). Overseas we offer direct billing with nearly any hospital and have a

selected group of direct billing partners with western medical clinics.

Staying in the U.S.Under Plan 1, you are covered up to 180 days in the U.S. in any 12 month period. Hence you need not worry about

your extended stays in the states. Should you plan to return to the U.S. on a permanent basis the Personal Health

plan provides you with a 12 month continuation bridge cover, the only feature of its kind for US expats. Contact

Integra Global about your options if you plan to return to the U.S. on a permanent basis before your return.

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A helping hand away from homeLiving or travelling in a foreign environment you might be a long way from medical excellence. Emergency evacuation and

worldwide medical travel assistance are included in all of our health plans. From a medical emergency evacuation out of

Kathmandu to an inquiry about an English speaking doctor in Moscow, the Personal Health plan provides the assistance you

need, at the time you need it.

24/7 round the clock medical assistanceAll our members have access to 24 hour medical assitance. Should you need an English speaking doctor in Moscow, or

information on a specialist in China all that you need to do is make a phone call.

We have toll-free numbers for our members in over 30 countries worldwide. If a toll-free number is not available to you, call the

direct number collect.

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A health plan you deserveThe Personal Health plan offers you a comprehensive range of benefits (see our schedule of benefits).

From a complete range of in-patient care to out-patient services including prescription drugs the Personal

Health plan is a comprehensive health plan to fit your needs for now and in the future. All of our plans

offer you the same high level of benefits. The difference is in the region of cover and deductible.

Why don't we offer plans with different benefits?For the simple reason that we don't think it is in your long-term interest. Health insurance is about having

adequate protection. You never know when you might need it, but if you do, you want it to be there for

you. That is why we think it is better not to limit your benefits. Instead we offer you a choice of

deductibles. Your deductible is calendar year and is essentially your responsibility of medical costs you

meet before benefits are available to you. The larger deductible the lower your premium. Whatever

deductible you choose, you have the same great protection.

Looking after your needs for now and the future


Choice of Deductibles

(a) $200 (b) $500 (c) $1,000 (d) $5,000

Deductible ExplainedA deductible is actually very easy to understand. If you chose the $200 deductible, then the first $200 of the calendar year of

covered medical expenses is met by you. Thereafter, all covered medical expenses are paid out according to our schedule of

benefits, i.e., usually at 90% or 100%. Each member on the policy has a deductible.

That's all there is to it.

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Region of Cover

We offer two choices of geographical cover:

1. Worldwide including access to US and Canada medical care

2. Worldwide but excluding access to US and Canada medical care

Other than the geographical distinctions mentionded above, the Personal

Health plan does not limit where you receive your medical care.

Medical care anywhere

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Quality CoverWhat makes our plan special? We like to think it is the quality range of benefits and our caring service. All

our plans for instance cover chronic conditions. Furthermore, you won't find any specific limits on

physician office visits or prescription drugs. No one wants to develop a serious chronic medical

condition but if you do, you want your health cover to be there for you.

It is reassuring to know that if you develop a serious condition while you are covered under the

Personal Health plan then you have the cover you need to maintain your health.

But our health plan is’nt just for serious conditions cover that sets ourselves from the pack. All

our plans include maternity cover, medical evacuation, prescription drugs and a full range of

in-patient and out-patient services. Rounding it all off we offer sensational wellness benefits

to you and your dependents. Need eyeglasses or contact lenses? We have vision benefits

as well.

What are quality benefits without choice?It is great to have excellent benefits but no one wants to be forced to stay in

country or only have one provider to choose from. The Personal Health plan

offers you complete freedom of choice in choosing your medical provider.

Our members wouldn't be satisfied with anything less.


Keeping you in shapeIt is said that prevention is better than cure. We couldn't agree more. That's why the Personal Health plan has the most

generous wellness/preventive care benefits in the industry. Up to $500 benefit per year for routine physical exams,

check-ups and preventive care (after being on the policy for over 6 months). And Wellness Benefits are available to you

before your deductible. Better yet, Personal Health recognizes how important prevention is by including vaccinations

and immunizations as part of your wellness benefits.

Our Wellness Benefits not only include routine exams and vaccinations but are linked to your age and family medical

history. In this way you can take advantage of appropriate tests and exams according to your personal needs.

Separate Vision Care BenefitThe Personal Health plan provides a Vision Care benefit of $300 every 24 months (to be eligible for vision care

benefits you must be on the policy for 6 months or longer).


Claims TechnocratsHigh speed claims settlement. It took $1 Million and hundreds of hours of management time to make our underwriter's

(Colonial International) administration system what it is: fast. Every single claim is automatically checked by a system

settling 350,000 claims each year. Each claim is automatically verified against a database including eligibility details,

plan limits and benefits to avoid errors. It means more efficiency and faster claims settlement.

Your I.D. cardYour I.D. card carries all the information you need to get the care you deserve. Where ever you are! Overseas you

have one easy number to call to arrange for hospitalization, direct billing and verification of benefits.

In the US Network facilities cover 50 US states and over 50,000 networked pharmacies will accept your pharmacy I.D.

card for direct automatic billing. It's that simple.

Your Support TeamWith Integra Global our members come first. We work hard to address the concerns and needs of our members. Our

customer service support team can provide instant details of your plan benefits, pending and settled claims. We take

pride in helping out our members with their health benefits.

Our promiseIntegra Global will continue to develop our partnership philosophy with our members. It means a future of health

insurance with more convenience for members, efficient administration and claims settlement, further enhancements

of benefits and an open door to questions or problems that require immediate attention.


Integra Global acts as the Plan Adminstrator of your Personal Health

plan. We specialize in expatriate health benefits and provide services to

our members worldwide. In fact, we have members on all continents.

Our Directors have over 30 years experience in the design,

implementation, administration and service of international health plans

for expatriates, international organizations and international companies

alike. We understand the needs of our members as most of our staff are

expatriates themselves. Integra Global has a strong commitment to

providing our members with a quality health plan. Our aim is to provide

our members with the best possible international health cover now and

in the future with a strong accent on personal service.

Integra Global is backed by an excellent and strong partner: Colonial

Medical which is part of Colonial Group International. Colonial is the

underwriter and insurer of the Personal Health plan. Colonial and its

member companies are rated Excellent (A-) by A.M. Best (contact us if

you would like the latest copy of the A.M. Best report on Colonial).

Colonial International Group is based in Bermuda and made its debut as

a Motor Insurer in the 1950's. The company remains proudly

independent after successive years of growth at home and overseas.

Group Activities in Bermuda, The Cayman Islands, the Bahamas and

British Virgin Islands cover the full range of insurance and financial

planning services. Lifestyle and business insurance protection products

complement family financial security plans and pension services.

The Colonial Group International is an important member of the Gibbons

Group of companies with interests in banking, fund management,

property and technology.

About Integra Global and theUnderwriter, Colonial Medical


Applying for CoverEnrolling in the Personal Health plan is easy and can be accomplished in just a few minutes online. No medicals are required just an

application form needs to be filled out. You can fill out the application form enclosed in this brochure or you can go to our web-site and

enroll online using our secure server.

Online EnrollmentTo enroll online follow these easy steps:

1. Go to: www.integraglobal.com

2. Choose Enrollment on the navigation bar.

3. Fill out the online enrollment form and hit Submit.

That's all there is to it! Enrolling online shouldn't take you more than a

few minutes and we make it easy with our step by step format. Your

online enrollment will be confirmed personally by us within one business

day and the approval process usually takes one to three business days.

Once you have been approved we invoice you for your premium.

Coverage begins on the first day of the month.


Hard Copy EnrollmentIf you would like to use our Enrollment Form in the back of this brochure please follow these easy steps:

1. Fill out the Enrollment Form

2. Fax us the Enrollment Form: +49 6221 825 651

Or send it to our administrative offices at: Integra Global Ltd., Waldhofer Str. 102, 69123 Heidelberg, Germany

As soon as we receive your Enrollment Form we will notify you of receipt. The approval process takes usually one to three business days. Once you

have been approved we invoice you for your premium. Coverage begins on the first day of the month.

Payment of PremiumYou can choose between the following payment options:

1. Online credit card payment (VISA and Mastercard). Go to www.integraglobal.com

2. International Credit Card (VISA and Mastercard)

3. USD checks

4. International bank transfers:

Royal Bank of Scotland

Account: INGLPEHE USD 1

BIC/Swift Code: RBOS GB2L

Bank Sort Code:161029

IBAN: GB25 RBOS 1663 0000 1063 68

We also accept payments in Euro and British Sterling. Contact us for current Euro and Sterling rates.


Further QuestionsHave further questions? Need more information? We think you will be pleased with ourprofessional and friendly service. Contact us from the choices below:

E-mail [email protected]

US-toll-free 1 888 753 1377

International Tel +49 6221 825 650

Web www.integraglobal.com

Or call us toll-free from anywhere in the world by using our internet call-back servicewww.clicktophone.com/integraglobal


Plan 1a $200 Deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 1,452 1,452 1,512 1,824 2,196 2,808 4,140 5,976 8,136 12,360 Female 3,000 3,000 3,552 3,564 4,152 4,152 4,644 5,940 6,912 8,868 Child 792 792 792 792 792 792 792 792 792 792 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1b $500 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 1,368 1,368 1,428 1,716 2,076 2,652 3,900 5,640 7,668 11,652 Female 2,832 2,832 3,348 3,360 3,912 3,912 4,380 5,604 6,516 8,364 Child 744 744 744 744 744 744 744 744 744 744 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1c $1,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 1,248 1,248 1,308 1,572 1,896 2,424 3,564 5,148 7,008 10,656 Female 2,592 2,592 3,060 3,072 3,576 3,576 4,008 5,124 5,964 7,644 Child 684 684 684 684 684 684 684 684 684 684 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1d $5,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 972 972 1,008 1,212 1,464 1,872 2,760 3,984 5,424 8,232 Female 2,004 2,004 2,364 2,376 2,760 2,760 3,096 3,960 4,608 5,904 Child 528 528 528 528 528 528 528 528 528 528 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2a $200 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 876 876 912 1,092 1,320 1,680 2,484 3,588 4,884 7,416 Female 1,800 1,800 2,136 2,136 2,496 2,496 2,784 3,564 4,152 5,316 Child 480 480 480 480 480 480 480 480 480 480 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2b $500 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 816 816 852 1,032 1,236 1,584 2,340 3,372 4,596 6,984 Female 1,692 1,692 2,004 2,016 2,340 2,340 2,628 3,360 3,900 5,016 Child 444 444 444 444 444 444 444 444 444 444 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2c $1,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 756 756 780 948 1,140 1,452 2,136 3,084 4,212 6,396 Female 1,548 1,548 1,836 1,848 2,148 2,148 2,400 3,072 3,576 4,584 Child 408 408 408 408 408 408 408 408 408 408 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2d $5,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 576 576 600 732 876 1,128 1,656 2,388 3,252 4,944 Female 1,200 1,200 1,416 1,428 1,656 1,656 1,860 2,376 2,760 3,552 Child 312 312 312 312 312 312 312 312 312 312 4th child 0 0 0 0 0 0 0 0 0 0

Integra Global Individual Rates 2005/2006 - Annual Plan Rates all in US Dollars

Plan 1 - Worldwide Health Coverincluding access to US and Canadamedical care

Plan 2 - Worldwide Health Coverbut excluding access to US andCanada medical care


Plan 1a $200 Deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 755 755 786 948 1,142 1,460 2,153 3,108 4,231 6,427 Female 1,560 1,560 1,847 1,853 2,159 2,159 2,415 3,089 3,594 4,611 Child 412 412 412 412 412 412 412 412 412 412 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1b $500 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 711 711 743 892 1,080 1,379 2,028 2,933 3,987 6,059 Female 1,473 1,473 1,741 1,747 2,034 2,034 2,278 2,914 3,388 4,349 Child 387 387 387 387 387 387 387 387 387 387 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1c $1,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 649 649 680 817 986 1,260 1,853 2,677 3,644 5,541 Female 1,348 1,348 1,591 1,597 1,860 1,860 2,084 2,664 3,101 3,975 Child 356 356 356 356 356 356 356 356 356 356 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1d $5,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 505 505 524 630 761 973 1,435 2,072 2,820 4,281 Female 1,042 1,042 1,229 1,236 1,435 1,435 1,610 2,059 2,396 3,070 Child 275 275 275 275 275 275 275 275 275 275 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2a $200 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 456 456 474 568 686 874 1,292 1,866 2,540 3,856 Female 936 936 1,111 1,111 1,298 1,298 1,448 1,853 2,159 2,764 Child 250 250 250 250 250 250 250 250 250 250 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2b $500 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 424 424 443 537 643 824 1,217 1,753 2,390 3,632 Female 880 880 1,042 1,048 1,217 1,217 1,367 1,747 2,028 2,608 Child 231 231 231 231 231 231 231 231 231 231 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2c $1,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 393 393 406 493 593 755 1,111 1,604 2,190 3,326 Female 805 805 955 961 1,117 1,117 1,248 1,597 1,860 2,384 Child 212 212 212 212 212 212 212 212 212 212 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2d $5,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 300 300 312 381 456 587 861 1,242 1,691 2,571 Female 624 624 736 743 861 861 967 1,236 1,435 1,847 Child 162 162 162 162 162 162 162 162 162 162 4th child 0 0 0 0 0 0 0 0 0 0

Integra Global Individual Rates 2005/2006 - Semi-Annual Plan Rates all in US Dollars




Integra Global Individual Rates 2005/2006 - Quarterly Plan Rates all in US Dollars

Plan 1a $200 Deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 392 392 408 492 593 758 1,118 1,614 2,197 3,337 Female 810 810 959 962 1,121 1,121 1,254 1,604 1,866 2,394 Child 214 214 214 214 214 214 214 214 214 214 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1b $500 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 369 369 386 463 561 716 1,053 1,523 2,070 3,146 Female 765 765 904 907 1,056 1,056 1,183 1,513 1,759 2,258 Child 201 201 201 201 201 201 201 201 201 201 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1c $1,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 337 337 353 424 512 654 962 1,390 1,892 2,877 Female 700 700 826 829 966 966 1,082 1,383 1,610 2,064 Child 185 185 185 185 185 185 185 185 185 185 4th child 0 0 0 0 0 0 0 0 0 0

Plan 1d $5,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 262 262 272 327 395 505 745 1,076 1,464 2,223 Female 541 541 638 642 745 745 836 1,069 1,244 1,594 Child 143 143 143 143 143 143 143 143 143 143 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2a $200 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 237 237 246 295 356 454 671 969 1,319 2,002 Female 486 486 577 577 674 674 752 962 1,121 1,435 Child 130 130 130 130 130 130 130 130 130 130 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2b $500 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 220 220 230 279 334 428 632 910 1,241 1,886 Female 457 457 541 544 632 632 710 907 1,053 1,354 Child 120 120 120 120 120 120 120 120 120 120 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2c $1,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 204 204 211 256 308 392 577 833 1,137 1,727 Female 418 418 496 499 580 580 648 829 966 1,238 Child 110 110 110 110 110 110 110 110 110 110 4th child 0 0 0 0 0 0 0 0 0 0

Plan 2d $5,000 deductible 17-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69Male 156 156 162 198 237 305 447 645 878 1,335 Female 324 324 382 386 447 447 502 642 745 959 Child 84 84 84 84 84 84 84 84 84 84 4th child 0 0 0 0 0 0 0 0 0 0




Integra Global 2005/2006 - Schedule of Benefits

Schedule of Benefits

After satisfaction of the Annual deductible, the Personal Health plan underwritten by ColonialMedical will pay the benefits set forth in this section at the percentage payable of the allowablecharge. Once the coinsurance requirement (Out-of-Pocket) has been met, benefits are payable at100% of the allowable charge for the remainder of the calendar year unless otherwise stated.

Hospital Inpatient & Surgery 90% 70% 100%Room and Board: Hospital's average semi private charge per day of confinement

Intensive Care Unit 90% 70% 100%

Inpatient ancillary services* 90% 70% 100%*Blood transfusions, plasma - $5,000 per person per calendar year

Physician Office Visits & 90% 70% 90%Specialist Fees

Outpatient Surgery 90% 70% 100%

Emergency Room 90% 70% 100%

Diagnostic and Therapeutic 90% 70% 90%Services (Outpatient)**Physical Therapy Per visit limit US$ 75 Calendar year max 30 visits*Occupational therapy Per visit limit US$ 75 Calendar year max 30 visits

Other Medical expenses 90% 70% 90%

Maternity Expense 90% 70% 90%(12 month waiting period) Normal delivery limited to $10,000 per pregnancy. Treated the same as any other condition for Insured and eligible dependents. This benefit does not extend todependent children. Caesarean Section and Complications of Pregnancy limited to $12,000 per pregnancy.

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

New-Born Cover 90% 70% 100%Including Premature Births, Congenital Conditions and Birth AnomaliesLife Time Maximum: US $25,000

Prescription Program 80/90%* 70%* 90%In PPO no deductible applies brand name drugs at 80% and generic drugs at 90%. Out ofnetwork (in USA only) deductible applies and no out-of-pocket lime applies. Overseas deductible applies.

Mental Health Benefits 90% 70% 90%(Inpatient & Outpatient) Lifetime Maximum - US $25,000Lifetime Mental Illness, Maximum Per Insured (In-Hospital)* 60 daysLifetime Mental Illness, Maximum Per Insured (Out-of-Hospital)* 80 visitsCalendar Year Mental Illness, Maximum (Out-of-Hospital)* 15 visits - US $2,500 per year*Does not count towards Annual Out-Of-Pocket Maximum

Trat ProceduresLifetime maximum of US $250,000Only available through the Managed Transplant Program. Transplant must be pre-certified and approved by Colonial Medical.

In North America In North America Outside of North AmericaPlan 1 members only Plan 1 members only Plan 1 & Plan 2PPO Non PPO

No OOP max. applies


Preventive CARE/Wellness Benefits(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 birthto 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 Services100% coinsurance not subject to deductible.Services include: health history, physical examinations, developmentassessments, anticipatory guidance, appropriate immunizations andlaboratory tests.

Child Preventive Care is subject to the following limitations: Calendar Year Max.Child - Birth to age 12 months US $350Child -13 months through age 17 US $100Child - 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 foror in connection with the overall health and well being for Insuredsand Spouses or Domestic Partners age 18 years and over. Calendar Year Maximum US$ 500.

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

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

Mammograms Treated like any other illness not subject to deductible per thefollowing schedule:Ages 35-39 one baseline exam.Ages 40-49 one exam every one or two years for asymptomatic women, but no sooner than two years after a woman's baseline.Age 50 & over one exam annually.Any Age Whenever prescribed by a physician.

Vision Care Cover - 6 Month Waiting PeriodPercentage of Reasonable and Customary Cost: 100%During a 24-Month period Maximum Benefit Per Insured: US $300

Medical Evacuation and AssistanceInsured and Insured Dependents:Lifetime Maximum Benefit Per Insured: US $150,000

Other Medical Benefits

HIV/Aids TreatmentLifetime Maximum: US $25,000

Private Duty Nursing Lifetime maximum US $7,500. Per Calendar year 240 hoursBenefit payable at 90%

Skilled Nursing FacilityAs any other treatment up a US $7,500 Lifetime Maximum

Home Health Care As any other treatment up to a US $7,500 Lifetime Maximum

Chiropractic ServicesAs any other treatment up to a US$ 750 Calendar Year MaximumReferral letter required from medical physician

Durable Medical Equipment As any other treatment up to a US $15,000 Lifetime Maximum

Hospice Care ServicesAs any other treatment up to a US $10,000 Lifetime Maximum

TMJ TreatmentAs any other treatment US $1,000 Lifetime Maximum

Policy Limitations & ExclusionsPre-Existing Condition Limitation (Applies to Medical coverageOnly) Pre-Existing conditions are covered after a 12 month waitingperiod. Thereafter, at US $5,000 annual maximum and US $50,000maximum lifetime unless otherwise stated.

No cover for Spouse/Domestic Partner (with or without children)that remains in North America while the covered Insured is workingoutside North America. Where only a dependent child or childrenremain in North America, the regular Premiums will apply whilst infull-time education..

Dental Care - Limited to accidental injury of sound, natural teethsustained while covered under the plan. (see Dental Option foradditional optional cover)

For or in connection with an Injury or Sickness caused by war or anact of war whether declared or undeclared, riot, civil commotion, orpolice action whether participating or not.

New-Born Cover, Premature Births Congenital conditions and birthanomalies. Life Time Maximum $25,000

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 InsuredUS$2,000,000

Integra Global 2005/2006 - Schedule of Benefits


Integra Global 2005/2006 - Additional Plan Options - Dental Option

Plan Features Dental Plan Option

Individual Deductible $50

Family Deductible $150

Class I Expenses (no deductible applies) 100%Diagnostic - General Preventive

Class II Expenses 80%Restorative (Basic), Endodontics, Periodontics Prosthodontics - Removable (Maintenance), Fixed Bridge (Maint.)Oral Surgery

Class III Expenses 50%Restorative (Major) Prosthodontics - Removable (Installation), Fixed Bridge (Inst.)

Calendar Year Maximum $1,500

Orthodontic Lifetime Maximum $1,500

Dental PremiumsQuarterly Plan Rate Semi-Annual Plan Rate Annual Plan Rate

Primary $94.00 $181.00 $348.00Primary +1 $204.00 $393.00 $756.00Family $279.00 $537.00 $1,032.00Primary +Chid $174.00 $37.00 $648.00

Accidental Death and Dismemberment (AD&D) Option

In the event of an Accidental Death or Dismemberment of the Primary Insured the Insurer pays alump sum benefit equal to the Principal Sum subject to a Maximum benefit multiplied by apercentage as shown below.

loss of life 100%loss of sight of both eyes 100%loss of both hands or arms 100%loss of both feet or both legs 100%loss of one arm and one leg 100%loss of sight of one eye 50%loss of one foot or one leg 50%loss of one hand or arm 50%

AD&D Benefits and RatesBenefit Quarterly Plan Rate Semi-Annual Plan Rate Annual Plan Rate$25,000 $6.00 $12.00 $24.00$50,000 $13.00 $25.00 $48.00$100,000 $26.00 $50.00 $96.00$150,000 $39.00 $75.00 $144.00$250,000 $65.00 $125.00 $240.00

N.B. benefits cannot exceed 2 times annual salary.


healthcare you deserve global integra global(optima).aw 2 ... · a health plan you deserve the...

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