EXAMPLES OF CLAIM PAYMENTS
1. An Insured has a US$500 deductible on a Global Medical plan. Insured visits a PPO 
(in network) doctor, and is charged US$350. Insured then visits a Non PPO doctor 
(out of network) and is charged US$600.
PPO/In Network Charges: Because the deductible is reduced by 50% In Network, and 
coinsurance is waived, the charge of US$250 satisfies the deductible and the remaining 
US$100 is paid at 100%.
Non PPO/Out of Network Charges: Because the insured is Out of Network, the full 
US$500 deductible must be satisfied and coinsurance must be paid. Therefore, US$250 of 
the US$600 charge, goes toward satisfying the deductible and the remaining US$350 will 
be paid at 80%.
2. An Insured has a US$500 deductible on a Global Medical Plan. Insured visits a 
Non PPO (Out of Network) doctor, and is charged US$350. Insured then visits a PPO 
(In Network) doctor and is charged US$600.
Non PPO/Out of Network Charges: Because the insured is Out of Network, the full 
US$500 deductible must be satisfied and coinsurance must be paid. Therefore, the entire 
US$350 charge is applied to the deductible. The insured still requires an additional US$150 
to satisfy the deductible in full.
PPO/In Network Charges: Because the deductible is reduced by 50% In Network, and 
coinsurance is waived, the insured need not finish satisfying the US$500 deductible.  
US$350 has already been applied to the US$500 deductible  which satisfies the US$250 
deductible required In Network. These charges are covered at 100%.
HOW DO I FILE A CLAIM?
In Order To File A Claim You Must Follow These Steps:
1. All claims must be submitted and received by IMG within 90 days of the date of service.
2. Each new illness or accident must have a completed Claim Form submitted. This form must 
be fully completed. All questions must be answered in detail.
3. All claims submitted must be original itemized billings. Remember to keep copies for your 
records. IMG will not accept photocopies, balance billings or receipts for payments. All bills
must be fully itemized with the patient s name, diagnosis, treatment, date of service, and 
amount charged.
4. Your providers may be requested to submit medical records for services rendered. Be sure 
that all names and addresses are legible.
5. Submit your completed information and original itemized claims to:
INTERNATIONAL MEDICAL GROUP, INC.
Claims Department
P.O. Box 88500
Indianapolis, Indiana  46208 0500
If you need to talk with us about a claim, call 1 800 628 4664 or (317) 655 4500 and ask for
your claim s customer service representative, or write to us at the above address or our email
address at insurance@imglobal.com.
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