Benefits
Medical Limits and Deductibles
Maximum Benefit per Insured Person per policy
period
Options include $50,000; $100,000; $500,000;
$1,000,000
Deductible per Insured Person per policy period
Options include $0; $100; $250; $500
Benefits are paid for Covered Expenses as follows up to the Medical Limit:
Inpatient & Outpatient Benefits
Insurer Pays After Deductible is
Met:
Professional Services:
a. Surgery, anesthesia, in-hospital doctor visits, diagnostic X-ray
and lab
100%
b. Office Visits: including X-rays and lab work billed by the
attending physician
100%
Inpatient Hospital Services:
a. Surgery, X-rays, In-hospital doctor visits
100%
b. Inpatient medical emergency
100%
Ambulatory Surgical Center
100%
Ambulance Service (non-Medical Evacuation)
100% up to $1000
Prescriptions, Dental Care, and
Physical Therapy
Insurer Pays After Deductible is Met:
Outside the U.S. Outpatient prescription drugs
100% of Reasonable charges up to $5,000
Dental Care required due to an Injury
100% of Reasonable Charges with a maximum benefit of
$500 per Trip Period
Prescriptions, Dental Care, and
Physical Therapy
Insurer Pays After Deductible is Met:
Dental Care for Relief of Pain
100% of Reasonable Charges with a maximum benefit of
$250 per Trip Period
Physical and Occupational Therapy
6 visits per Period of Insurance, $100 Maximum payment per
visit
Insurer Waives Deductible
Maximum Benefit Principal Sum up to $50,000
Maximum Benefit up to $25,000
Maximum Benefit per Trip Period for all Evacuations up to $500,000
Maximum Benefit per Trip Period up to $2,500 for the cost of one economy
round trip air fare ticket to the place of the Hospital Confinement for one (1)
person
Maximum benefit of $500 per Trip Period and limited to $100 maximum
benefit per bag or Personal Effect
Maximum benefit of $1,000 per Trip Period
Lodging & Incidentals Maximum benefit of $50 per day, up to 10 days
Hazardous Activities
Insurer Pays
After Deductible
is Met:
Benefits for claims resulting from downhill (alpine) skiing and scuba diving at a
depth of 20 meters or less (certification by the Professional Association of Diving
Instructors (PADI) or the National Association of Underwater Instructors (NAUI)
required or diving under the supervision of a certified instructor)
Maximum Benefit up
to $25,000
Mental Health and Substance Abuse are covered up to policy max as any other benefit.
24 Hour / 7 Day Global Medical Assistance
Available to U.S. residents, age 95 and younger*. See Eligibility Requirements.
Participant must be enrolled in a primary health plan. There is no pre-existing condition exclusion.
This is a non-renewable plan. Subsequent periods of insurance can be purchased, in which case a new
Deductible, and Medical Limit would apply.
For more information about the benefits, including information about exclusions and limitations, see
the Plan Description.
PLEASE NOTE: This plan is for coverage outside of the U.S. only. You may only purchase this policy
prior to departing on your trip.
Ten Day Money Back Guarantee
We are so confident in our products that we offer the best guarantee in the business. Any date prior to
your effective date of coverage, you may request a full refund of premium from us. Cancellation of
coverage must be in writing from the Eligible Participant. Simply send an email to enrollment@geo-
blue.com. After the 10-day free look, if you have not already departed on any trip, you will receive a full
refund. Other restrictions apply, see complete policy for details.
*Benefits and Eligibility vary for South Dakota residents. Learn more.
GeoBlue Travel Insurance
933 First Avenue King of Prussia, PA 19406 USA
1.855.481.6647
[email protected]
www.geobluetravelinsurance.com
© 2022 GeoBlue. All Rights reserved.
GeoBlue is the trade name of Worldwide Insurance Services, LLC (Worldwide Services Insurance
Agency, LLC in California and New York), an independent licensee of the Blue Cross and Blue Shield
Association. GeoBlue is the administrator of coverage provided under insurance policies issued by 4 Ever
Life International Limited, Bermuda, an independent licensee of the Blue Cross Blue Shield Association.
South Dakota Residents: GeoBlue is the trade name of Worldwide Insurance Services, LLC (Worldwide
Services Insurance Agency, LLC in California and New York), an independent licensee of the Blue Cross
and Blue Shield Association and is made available in cooperation with Blue Cross and Blue Shield
companies in select service areas. Coverage is provided under insurance policies underwritten by 4 Ever
Life Insurance Company, Oakbrook Terrace, Illinois NAIC #80985 under policy form series 55.1301. 4
Ever Life Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association.