■
PLAN INFORMATION
|
Maximum coverage per person, per policy Up to 79 years oldyear |
60 – 90 years old |
Up to 79 years old |
Up to 79 years old |
Up to 79 years old |
Up to 79 years old |
Waiting period |
30 days |
30 days |
30 days |
30 days |
30 days |
Coverage outside USA |
Worldwide, with no restrictions of doctors and hospitals |
100%* with free choice of doctors and hospitals |
Worldwide, with no restrictions of doctors and hospitals |
100%* with free choice of doctors and hospitals |
Worldwide, with no restrictions of doctors and hospitals |
Coverage inside USA |
Worldwide, with no restrictions of doctors and hospitals |
- 100%* within the LEVERAGE® US Network
- Outside the LEVERAGE® US network: Coverage 60%, with a daily maximum rate of US$700 for a standard room and US$1,400 for intensive care
- Emergency medical treatment: 100%* up to policy limits
|
Worldwide, with no restrictions of doctors and hospitals |
- 100% within the EVER® US Network
- Outside the EVER® US Network: Coverage 70%, with a daily maximum rate of US$800 for a standard room US$1,500 for intensive care
- Emergency medical treatment: 100%* up to policy limits
|
Worldwide, with no restrictions of doctors and hospitals |
■
INPATIENT PROVISIONS
|
Standard private/semi-private hospital room |
US$2,500 per day, up to 120 days. US$750 per day for additional days |
100%* |
100%* |
100%* |
100%* |
Intensive care unit |
Up to US$3,300 per day, up to 30 days. US$1,000 per day for additional days |
100%* |
100%* |
100%* |
100%* |
Adult companion accomodation expenses of a hospitalized insured under 18 years old |
US$150 per night, maximum 30 nights |
US$150 per night, max. of 30 nights |
US$350 per night, max. of 30 nights |
US$150 per night, up to 45 nights |
100%*, no night limit |
Adult companion accomodation expenses of a hospitalized insured over 18 years old |
US$150 per night, maximum 30 nights |
100%*, max. of 30 nights |
100%*, max. of 30 nights |
100%*, up to 30 nights |
100%, maximum of 30 nights |
Prescribed medications while hospitalized |
N/A |
100%* |
100%* |
100%* |
100%* |
Psychiatric treatments |
N/A |
US$1,000 |
US$3,000 |
US$2,000 |
US$5,000* |
Special benefit for suite accommodation (subject to availability) |
N/A |
N/A |
Up to US$3,000 per day within the EVER® US Network |
N/A |
100%* |
■
OUTPATIENT PROVISIONS
|
Emergency care |
US$5,000 per visit, maximum 5 visits per policy year |
100%* |
100%* |
100%* |
100%* |
Physician and specialist visits |
Up to US$50,000 per policy year |
100%* |
100%* |
100%* |
100%* |
Physician and specialist home visits |
Up to US$125 per consultation, max 15 consultations per year |
100%* |
100%* |
100%* |
100%* |
Prescription medication |
Up to US$2,500 per insured |
US$15,000 |
100%* |
US$55,000 |
100%* |
Nurse or therapist care at home |
Up to US$150 per day, max 30 days per policy year |
US$7,000 |
100%* |
US$12,000 |
100%* |
Preventive health checkup, per insured, no deductible applies |
US$250 per insured |
OPTION I |
OPTIONS I, II & III:- US$150 up to 17 years old
- US$350 from 18 years old
OPTIONS IV, V & VI: |
OPTIONS I & II- US$100 up to 17 years old
- US$150 at 18 years and older
|
ALL OPTIONS:
- US$300 per visit, up to 6 visits, for insureds from 0 to 12 months old
OPTIONS I, II & III
- Up to US$500 from 12 months old, including up to US$75 for preventive dental check-up
|
Hearing aids |
Up to US$1,250 per insured, lifetime |
US$550 lifetime |
US$2,500 lifetime |
US$1,200 per lifetime |
US$4,000 lifetime |
Allergy treatment |
100%* |
100%* |
100%* |
100%* |
100%* |
Alzheimer’s disease |
N/A |
100%* |
100%* |
100%* |
100%* |
Physical therapy and rehabilitation |
N/A |
US$7,000 |
100%* |
US$12,500 |
N/A |
Complementary therapies: chiropractor, psychologist, psychiatrist, osteopathy and/or acupuncture |
N/A |
N/A |
US$5,000 |
N/A |
US$15,000 |
Autism treatment |
N/A |
N/A |
N/A |
N/A |
- 100% if the insured was born under a covered maternity
- US$12,000 if not born under covered maternity and developed the condition while insured
|
Preventive vision care (Option I) |
N/A |
N/A |
N/A |
N/A |
US$500, max. 2 visits per policy year |
Preventive dental care (Option I) |
N/A |
N/A |
N/A |
N/A |
US$500, max. 2 visits per policy year |
■
GENERAL PROVISIONS
|
Surgeon and anesthesiologist fees |
US$3,500,000 lifetime |
100%* |
100%* |
100%* |
100%* |
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/ PET scans) |
Up to US$1,000, per exam, per insured |
100%* |
100%* |
100%* |
100%* |
Oncology: cancer tests, treatment (chemotherapy and/or radiotherapy) and medication |
Up to US$200,000 per insured |
100%* |
100%* |
100%* |
100%* |
Surgery to reduce the risk of cancer or prophylactic surgery |
US$3,500,000 lifetime |
US$5,000,000 |
US$35,000 lifetime (after a 12-month waiting period) |
US$35,000 lifetime (after a 12-month waiting period) |
US$50,000 lifetime (after a 12-month waiting period) |
Dialysis services |
US$3,500,000 lifetime |
100%* |
100%* |
100%* |
100%* |
Prostheses and medical appliances implanted during surgery |
100%* |
100%* |
100%* |
100%* |
100%* |
Organ transplant (per organ/tissue) |
US$200.000, lifetime |
US$350,000 lifetime. Includes live donor expenses |
US$1,500,000 lifetime (including live donor expenses) |
US$500,000 lifetime, with an additional US$500,000 available (with rider). Includes live donor expenses |
US$5,000,000 lifetime (Includes live donor expenses) |
Durable medical equipment |
Up to US$2,250 per insured |
US$8,000 |
100%* |
US$12,000 |
100%* |
Physical therapy and rehabilitation |
Up to US$100 per visit, maximum 30 visits |
US$7,000 |
100%* |
US$12,500 |
100%* |
Specialized treatments (occupational therapy, speech therapy, sleep apnea and other sleep disorders) |
US$3,500,000 lifetime |
US$2,000 |
US$4,000 |
US$3,500 |
US$6,000 |
Congenital conditions diagnosed before age 18 |
US$3,500,000 lifetime |
US$150,000 lifetime |
US$2,100,000 lifetime |
US$500,000 lifetime |
US$2,100,000 lifetime |
Congenital conditions diagnosed after age 18 |
US$3,500,000 lifetime |
100%* |
100%* |
100%* |
100%* |
HIV-AIDS |
US$3,500,000 lifetime |
US$5,000,000 |
US$1,000,000 lifetime (after a 24-month waiting period) |
US$250,000 lifetime (after a 48-month waiting period) |
US$1,100,000 lifetime (after a 24-month waiting period) |
Bariatric surgery |
US$3,500,000 lifetime |
US$5,000,000 |
US$15,000 lifetime (after a 24-month waiting period) |
US$5,000 lifetime (after a 24-month waiting period) |
US$25,000 lifetime (after a 24-month waiting period) |
Surgical treatment of symptomatic foot disorders |
US$3,500,000 lifetime |
US$5,000,000 |
100%* (after a 24-month waiting period) |
100%* (after a 24-month waiting period) |
100%* (after a 24-month waiting period) |
Reconstructive surgery after an accident or illness |
100%* |
Up to the benefit limit |
Up to the benefit limit |
Up to the benefit limit |
Up to the benefit limit |
■
MATERNITY PROVISIONS
|
Maternity |
US$3,500,000 lifetime |
US$4,000, no deductible applies |
- US$8,500 per normal delivery or C-section (if only the mother is insured)
- US$10,000 per normal delivery or C-section (if both parents are insured)
|
- US$5,000, no deductible applies
- IIncludes stem cell extraction and storage
|
- 100%* normal delivery or scheduled C-section in a hospital with self-pay package
- US$10,000 for normal delivery or scheduled C-section (if only the mother is insured)
- US$15,000 per normal delivery or scheduled C-section (if both parents are insured)
|
Stem cell collection and storage |
US$3,500,000 lifetime |
US$5,000,000 |
US$1,000 per covered pregnancy |
US$5,000,000 |
US$2,500 per covered pregnancy |
Maternity and newborn complications |
US$3,500,000 lifetime |
US$150,000 lifetime |
US$1,000,000 lifetime |
US$500,000 lifetime |
US$1,250,000 lifetime |
Inclusion of the newborn within 90 days after the birth |
US$3,500,000 lifetime |
No medical evaluation if born in a covered maternity |
No medical evaluation if born in a covered maternity |
No medical evaluation if born in a covered maternity |
No risk if born under covered maternity |
Free coverage for dependents up to 5 years old |
US$3,500,000 lifetime |
US$5,000,000 |
US$8,000,000 |
US$5,000,000 |
- Max. of 2 children if both parents are insured
- Max. of 1 if only the mother is insured
|
Fertility treatment |
US$3,500,000 lifetime |
US$5,000,000 |
US$8,000,000 |
US$5,000,000 |
US$6,000 lifetime, after deductible (after a 24-month waiting period) |
■
MEDICAL EVACUATION PROVISIONS
|
Emergency transportation by ground ambulance |
100%*, no deductible applies |
100%*, no deductible applies |
100%*, no deductible applies |
100%*, no deductible applies |
100%*, no deductible applies |
Emergency transportation by air ambulance |
Up to US$30,000, no deductible applies |
US$45,000, no deductible applies |
100%*, no deductible applies |
US$65,000, no deductible applies |
100%*, no deductible applies |
Cost of return ticket for the insured and one companion after an evacuation by air ambulance |
US$3,500,000 lifetime |
US$5,000,000 |
US$1,200 per insured |
US$550 per insured |
US$3,000 per insured |
Repatriation or cremation of mortal remains |
US$10,000 |
US$7,000 |
100%* |
US$45,000 |
100%* |
■
OTHER PROVISIONS
|
High-risk sports and activities |
US$3,500,000 lifetime |
100%* |
100%* |
100%* |
100%* |
Emergency dental coverage |
US$25,000 for treatment within the first 90 days of covered accident |
100% (treatment within the first 180 days of a covered accident) |
100%* (treatment within the first 180 days of a covered accident) |
100%* |
100% within the first 180 days of a covered accident |
Refractive eye surgery |
US$3,500,000 lifetime |
US$5,000,000 |
US$550 per eye, per lifetime (after a 24-month waiting period) |
US$5,000,000 |
US$750 per eye, lifetime (after a 24-month waiting period) |
Palliative care |
US$750 per day, up to 120 days |
100%* |
100%* |
100%* |
100%* |
Temporary coverage for accidents while the application is being underwritten |
US$40,000 |
US$30,000 |
US$35,000 |
US$35,000 |
US$40,000 |
Free extended coverage for eligible dependents after the policyholder’s death |
US$3,500,000 lifetime |
US$5,000,000 |
2 years |
1 years |
2 years |
Deductible elimination/reduction for no claims for 3 years |
US$3,500,000 lifetime |
OPTIONS I:- Elimination for 1 year after the third year without claims
- 50% reduction of the deductible for 1 year after the third year, if the deductible has not been met in any of the years
OPTIONS II, III & IV:- 50% deductible reduction for 1 year after the third claim-free year
|
OPTIONS I, II, III & IV:- Elimination for 1 year after the third year without claims
- 50% reduction of the deductible for 1 year after the third year, if the deductible has not been met in any of the years
OPTIONS V & VI- 50% deductible reduction for 1 year after the third claim-free year
|
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
|
OPTIONS I, II, III & IV:- Elimination for 1 year after the third year without claims
- 50% reduction of the deductible for 1 year after the third year, if the deductible has not been met in any of the years
OPTIONS V & VI- 50% deductible reduction for 1 year after the third claim-free year
|
Executive checkup |
US$3,500,000 lifetime |
US$5,000,000 |
Up to US$1,000 (after a 24-month waiting period within the EVER® Prevent network) |
Up to US$750 (After 24-months waiting period inside the EVER® Prevent Network |
Up to US$1,500, after a 24-month waiting period within the EVER® Prevent Network. |
Female Sterilization (Tubal Ligation) |
US$3,500,000 lifetime |
US$5,000,000 |
N/A |
US$5,000,000 |
Up to US$1,500, lifetime, after 10-months waiting period (options I, II, and III) |
Male Sterilization (Vasectomy) |
US$3,500,000 lifetime |
US$5,000,000 |
N/A |
US$5,000,000 |
Up to US$1,500, lifetime, after 24-months waiting period (options I, II, and III) |
Nutritionist visits |
US$3,500,000 lifetime |
US$5,000,000 |
Up to 5 visits per policy year |
US$5,000,000 |
Up to 5 visits per policy year |
EVER Expert Medical Review® |
Unlimited access to world-renowned medical expert second opinions, no deductible applies |
Unlimited access to world-renowned medical expert second opinions, no deductible applies |
Unlimited access to world-renowned medical expert second opinions, no deductible applies |
Unlimited access to medical reviews from recognized world experts, deductible does not apply |
Unlimited access to world-reowned medical expert second opinions, no deductible applies |