Pre-Certification for Medical Necessity and USA Medical Concierge
For many benefits under your plan, you are required to seek Pre-Certification and/or verification of benefits from us as soon as possible and always prior to incurring cost or undertaking any medical treatment, or before being admitted to hospital (except in an emergency situation, in which event we should be informed within 48 hours or as soon as reasonably possible). For a full list of Pre-Certification requirements, refer to the Policy Wording (available upon request).
Pre-Certification means calling IMG's Utilisation Management and Review company to receive a determination of medical necessity for the proposed treatment or services. It is important to note that Pre-Certification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or guarantee of payment.
Pre-Certification may be undertaken by an insured person, the doctor, a hospital administrator or a relative - subject to all information being available and verifiable. In addition, some treatments or services in the USA requiring Pre-Certification, may also require you to contact the USA Medical Concierge Service (refer to Policy Wording for further details). Your Policy Wording contains important terms, conditions and instructions on Pre-Certification procedures. Please ensure you carefully adhere to these. Failure to follow Pre-Certification procedures may invalidate your claim, or in certain circumstances, result in a loss or reduction of cover.
Eligibility
GlobalFusion is available to individuals and families of all nationalities. USA citizens must reside abroad or plan to leave the USA on their effective date and plan to reside abroad for at least six of the next 12 months. Non-USA citizens may reside anywhere in the world including their home country, although certain eligibility restrictions may apply in respect of cover in the USA. Persons between the ages of 14 days and 74 years old may apply for cover. Persons older than 74 years of age are not eligible. Certain other restrictions may also apply. Please ask your independent insurance agent or broker for further details, or refer to the GlobalFusion Policy Wording (available upon request).
Children under the age of 19 applying individually should use the 19-24 age bracket when applying for cover. Each person requesting cover must complete the information required in the application, and all persons applying must be listed on the initial Application Form.
Renewal of Cover
Subject to the terms of the plan, GlobalFusion is annually renewable and cover is continuous when renewed. Prior to the end of each Period of Insurance (12 months) you will receive renewal information. You must continue to meet the eligibility requirements outlined above in order to renew. There are no additional medical questions at renewal. Your renewal premium is based upon a category applicable to you. This takes into account varying factors including, but not limited to, your year of inception, age, sub-plan, area of cover, annual excess, citizenship, discounts or loadings based on both claims history and pooled community claims data as well as medical inflation. Additionally, we can work with you to provide flexible renewal options. Please select your annual excess carefully, as you will be unable to select a lower annual excess when you renew your cover.
Automatic Renewal
For your convenience, if you pay by credit/debit card - we will notify you of your renewal premium in advance of your renewal date and automatically renew your plan and charge your card just before renewal, thereby preventing any accidental break in cover at renewal - unless of course you are no longer eligible or we hear from you to the contrary before renewal.
Lifetime Cover
Your GlobalFusion plan will automatically terminate upon your 75th birthday. If you are enrolled in the GlobalFusion plan by your 65th birthday and maintain continuous cover to age 75, lifetime medical cover is available. Prior to your 75th birthday you will receive a summary of benefits for continuing cover under a new plan from one of our senior citizen plans, and an enrolment form for cover. There is no additional medical underwriting. You simply need to review the benefits, and complete and return the enrolment form with your premium.
30 Day Money Back ‘No Hassle’ Guarantee
We are confident that you will be pleased with the full terms of cover. Upon receiving your GlobalFusion policy documents, please make sure you read them carefully. To ensure your satisfaction, once you are accepted in the plan we provide a 30 day period to review the fulfillment kit contents. If during that 30 day period you find that you are not satisfied with the plan for any reason, and as long as you have not already made a claim under the plan, you may submit a written request for cancellation and full refund of your premium. See the Policy Wording for full details.
Cancellation requests received after this 30 day period will be granted at the sole discretion of IMG Europe Ltd. as the plan administrator. Any refund you may receive will be based on an established refund schedule, not a pro-rated basis. See the Policy Wording for full details.