DEDUCTIBLE OPTIONS
|
I |
II |
III |
IV |
V |
VI |
| Outside USA |
US$500 |
US$2,000 |
US$5,000 |
US$10,000 |
US$20,000 |
US$50,000 |
| Inside USA |
US$1,000 |
PLAN INFORMATION
| BENEFIT |
COVERAGE |
| Maximum coverage per person, per policy year |
US$5,000,000 |
| Age limit to apply |
Up to 79 years old |
| Waiting period |
30 days |
| Coverage outside USA |
100%* with free choice of hospitals and doctors |
| Coverage inside USA |
- 100% within the EVER® US Network
- Outside the EVER® US Network, the coverage will be at 70%, with a maximum daily room rate of up to US$800 for a standard room and up to US$1,500 for intensive care
- Emergency medical treatment will be covered 100%, up to the policy limits
|
INPATIENT PROVISIONS
| BENEFIT |
COVERAGE |
| Standard private/semi-private hospital room |
100%* |
| Intensive care unit |
100%* |
| Adult companion accommodation expenses of a hospitalized insured |
Under 18 years old |
US$150 per night, max. of 45 nights |
| Over 18 years old |
100%*, max. of 30 nights |
| Prescribed medications while hospitalized |
100%* |
| Physical therapy and rehabilitation |
100%* |
| Psychiatric treatments |
US$2,000 |
OUTPATIENT PROVISIONS
| BENEFIT |
COVERAGE |
| Emergency care |
100%* |
| Physician and specialist visits |
100%* |
| Physician and specialist home visits |
100%* |
| Prescription medication |
US$15,000 |
| Nurse or therapist care at home |
US$12,000 |
| Preventive health checkup per insured, no deductible applies (options I & II) (after a 10-month waiting period) |
- US$100 up to 17 years old
- US$150 at 18 years and older
|
| Hearing aids |
US$1,200 per lifetime |
| Alzheimer’s disease |
100%* |
| Allergy treatment |
100%* |
| Physical therapy and rehabilitation |
US$12,500 |
GENERAL PROVISIONS
The following benefits offer the same coverage for both inpatient and outpatient procedures.
| BENEFIT |
COVERAGE |
| Surgeon and anesthesiologist fees |
100%* |
| Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/ PET scans) |
100%* |
| Oncology: cancer tests, treatment (chemotherapy and/or radiotherapy) and medication |
100%* |
| Surgery to reduce the risk of cancer or prophylactic surgery |
US$35,000 per lifetime (after a 12-month waiting period) |
| Dialysis services |
100%* |
| Prostheses and medical appliances implanted during surgery |
100%* |
| Organ transplant (per organ/tissue) |
US$500,000 per lifetime, with an additional US$500,000 available (with annex). Includes expenses of the live donor |
| Durable medical equipment |
US$12,000 |
| Specialized treatments (occupational therapy, speech therapy, sleep apnea and other sleep disorders) |
US$3,500 |
| Congenital conditions |
Diagnosed before age 18 |
US$500,000 per lifetime |
| Diagnosed after age 18 |
100%* |
| HIV-AIDS |
US$250,000 per lifetime (after a 48-month waiting period) |
| Bariatric surgery |
US$5,000 per lifetime (after a 24-month waiting period) |
| Surgical treatment of symptomatic foot disorders |
100%* (after a 24-month waiting period) |
| Reconstructive surgery after an accident or illness |
Up to the benefit limit |
MATERNITY PROVISIONS
10-month waiting period, no deductible applies.
| BENEFIT |
COVERAGE |
| Maternity (options I & II) |
- US$5,000, no deductible applies
- Includes extraction and storage of umbilical cord blood stem cells
|
| Maternity and newborn complications (options I & II) |
US$500,000 per lifetime |
| Inclusion of the newborn within 90 days after the birth (options I & II) |
Without underwriting, if born from a covered maternity |
MEDICAL EVACUATION PROVISIONS
| BENEFIT |
COVERAGE |
| Emergency transportation |
Ground ambulance |
100%*, no deductible applies |
| Air ambulance |
US$65,000, no deductible applies |
| Cost of return ticket for the insured and one companion after an evacuation by air ambulance |
US$550 per person |
| Repatriation or cremation of mortal remains |
US$45,000 |
OTHER PROVISIONS
| BENEFIT |
COVERAGE |
| High-risk sports and activities |
100%* |
| Emergency dental coverage |
100%* for treatment within the first 180 days of the covered accident |
| Palliative care |
100%* |
| Temporary coverage for accidents while application is being underwritten |
US$35,000 |
| Free extended coverage for eligible dependents after policyholder’s death |
1 years |
| Deductible elimination/reduction for no claims for 3 yearss |
OPTIONS I, II & III:- Elimination for 1 year after the 3rd year without claims
- Reduction of 50% of the deductible for 1 year after the 3rd year, if the deductible was not met in any of the years
OPTIONS IV & V:- Reduction of 50% of the deductible for 1 year after the 3rd year without claims
|
| Executive checkup |
Up to US$750 (After 24-months waiting period inside the EVER® Prevent Network |
| EVER Expert Medical Review® |
Unlimited access to medical reviews from recognized world experts, deductible does not apply |
