DEDUCTIBLE OPTIONS
PLAN INFORMATION
| BENEFIT |
COVERAGE |
| Geographic Coverage |
Worldwide (excluding the Insureds Country of Residence and countries thay may be excluded to comply with the Coverage Conditions) |
| Age limit to request coverage |
Up to 79 years old |
| Maximum coverage per person, up to 69 years old |
US$5,000,000 |
| Maximum coverage per person, from 70 years to 80 years |
US$500,000 |
MEDICAL BENEFITS
| BENEFIT |
COVERAGE |
| Pre-existing Conditions (6 months stable without presenting symptoms and without changes in Medications) |
Up to US$500,000 |
| Complications of Maternity, as defined in the Policy |
Up to US$10,000 (up to week 20 of pregnancy for normal pregnancies and up to week 12 of pregnancy of multiple pregnancies or when the pregnancy is the result of fertility treatment) |
| Serious of Emergency Illnesses and Injuries |
100% UCR |
| Treatment by authorized physicians, nurses, and specialists |
100% UCR |
| Hospitalization (Semi-Private Room) |
100% UCR |
| Surgeon and Anesthesiologist Fees |
100% UCR |
| Prescription Medications during a Hospitalization |
100% UCR |
| Treatment by Physical Terapists |
Up to US$2,500 per trip |
| Medically Necessary Durable Medical Equipment |
100% UCR |
| Emergency Dental Treatment for immediate pain relief |
Up to US$500 per trip |
MEDICAL EVACUATION BENEFITS
| BENEFIT |
COVERAGE |
| Emergency Transportation |
Air Ambulance |
100% UCR |
| Ground Ambulance |
100% UCR |
| Baggage Transportation after the Insureds medical evacuation |
Up to US$500 |
| Repatriaton of a summoned relative or travel companion after a medical evacuation or the dead of the Insured |
100% UCR, max. one (1) summoned relative or travel companion |
| Repatriation or cremation of mortal remains |
100% UCR |
| Baggage Transportation after the death of the Insured |
Up to US$500 |
| Accomadation after a Serious Illness, Injury or Serious Accident |
Up to US$300 per day, max. US$6,000 per covered event |
| Compassionate Emergency Visit to an Insured |
100% UCR, max. one (1) summoned relative or travel companion |
| Compassionate Emergency Repatriation of an Insured |
100% UCR |
| Return trip after a medical evacuation or repatriation |
100% UCR |
| Non-medical Evacuation |
100% UCR |
OTHER BENEFITS
| BENEFIT |
COVERAGE |
| Non-Profesional Activities and Sports |
Motorized |
Up to US$100,000 |
| Non-motorized |
Up to US$500,000 |
NON-MEDICAL BENEFITS
| BENEFIT |
COVERAGE |
| Personal Accident, Disability and Death |
Up to US$100,000 per Policy Year (annual travel plan) or per contract (single travel plan) |
| Loss or Theft of Personal Effects |
Up to US$2,000 per trip |
| Beggae Delay |
Up to US$500 per trip |
| Trip Delay |
Up to US$100 per day, max. US$500 |
| Missed Flight Connection |
Up to US$1,000 per trip |
| Personal Liability |
Body Injury |
Up to US$100,000 per trip |
| Property Damage |
Up to US$100,000 per trip |
| Legal Assistance and Guarantees |
Up to US$10,000 per trip |
TRIP CANCELLATION BENEFITS
| BENEFIT |
COVERAGE |
| Single Trip Plan |
Up to US$2,500 per trip |
| Annual Trip Plan |
Up to US$1,500 per trip |
