EVEREST

HEALTH

PLANS

DEDUCTIBLE OPTIONS

	I	II	III	IV	V	VI
Outside USA	US$500	US$1,000	US$2,000	US$5,000	US$10,000	US$20,000
Inside USA	US$1,000	US$2,000	US$3,000	US$5,000	US$10,000	US$20,000

PLAN INFORMATION

BENEFIT	COVERAGE
Maximum coverage per person, per policy year	Unlimited
Age limit to apply	Up to 79 years old
Waiting period	30 days
Geographical coverage	Worldwide, with no restrictions of doctors and hospitals

HOSPITAL BENEFITS

BENEFIT		COVERAGE
Standard private room		100%*
Special benefit for suite room use (subject to availability)		100%*
Intensive care unit		100%*
Expenses for an adult companion of a hospitalized insured	Under 18 years old	100%*, no night limit
Expenses for an adult companion of a hospitalized insured	Over 18 years old	100%, maximum of 30 nights
Prescribed medications during hospitalization		100%*
Psychiatric Treatments		US$5,000*

OUTPATIENT BENEFITS

BENEFIT		COVERAGE
Emergency room care		100%*
Visits to doctors and specialists		100%*
Home visits from doctors and specilists		100%*
Prescription medications		100%*
Complementary therapies: chiropractor, psychologist, psychiatrist, osteopathy and/or acupuncture		US$15,000
Home nurse or therapist care		100%*
Preventive medical check-up per insured, no deductible (after a waiting period of 10 months)		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		US$4,000 lifetime
Alzheimer’s disease		100%*
Autism treatment		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
Allergy treatment		100%*
Preventive vision care (Option I)		US$500, max. 2 visits per policy year
Preventive dental care (Option I)		US$500, max. 2 visits per policy year

GENERAL BENEFITS

These benefits apply equally to both inpatient and outpatient procedures.

BENEFIT		COVERAGE
Surgeon and anesthesiologist fees		100%*
Laboratory test and diagnostic services (blood 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$50,000 lifetime (after a 12-month waiting period)
Dialysis services		100%*
Prosthetics and medical devices implanted during surgery		100%*
Organ transplant (per organ/tissue)		US$5,000,000 lifetime (Includes live donor expenses)
Durable medical equipment		100%*
Physical therapy and rehabilitation		100%*
Specialized treatments (occupational therapy, speech therapy, sleep apnea and other sleep disorders)		US$6,000
Congenital conditions	Diagnosed before age 18	US$2,100,000 lifetime
Congenital conditions	Diagnosed after age 18	100%*
HIV/AIDS		US$1,100,000 lifetime (after a 24-month waiting period)
Bariatric surgery		US$25,000 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 BENEFITS

10-month waiting period, no deductible applies.

BENEFIT		COVERAGE
Maternity (options I, II, and III)		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 (options I, II, and III)		US$2,500 per covered pregnancy
Maternity and newborn complications (options I, II, and III)		US$1,250,000 lifetime
Inclusion of newborn within 90 days of birth (options I, II, and III)		No risk if born under covered maternity
Free coverage for dependents up to 5 years old (option I)		Max. of 2 children if both parents are insured Max. of 1 if only the mother is insured
Fertility treatment (options I and II)		US$6,000 lifetime, after deductible (after a 24-month waiting period)

MEDICAL EVACUATION BENEFITS

BENEFIT		COVERAGE
Emergency transport	Ground ambulance	100%*, no deductible applies
Emergency transport	Air ambulance	100%*, no deductible applies
Return ticket cost for the insured and one companion after an air ambulance evacuation		US$3,000 per insured
Repatriation or cremation of mortal remains		100%*

OTHER BENEFITS

BENEFIT		COVERAGE
High-risk activities and sports		100%*
Emergency dental treatment due to an accident		100% within the first 180 days of a covered accident
Refractive eye surgery		US$750 per eye, lifetime (after a 24-month waiting period)
Palliative care		100%*
Temporary accident coverage while the application is processed		US$40,000
Extended free coverage for policy dependents after policyholder’s death		2 years
Deductible waiver/reduction 3 years 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		Up to US$1,500, after a 24-month waiting period within the EVER® Prevent Network.
Female Sterilization (Tubal Ligation)		Up to US$1,500, lifetime, after 10-months waiting period (options I, II, and III)
Male Sterilization (Vasectomy)		Up to US$1,500, lifetime, after 24-months waiting period (options I, II, and III)
Nutritionist visits		Up to 5 visits per policy year
EVER Expert Medical Review®		Unlimited access to world-reowned medical expert second opinions, no deductible applies
ForEVER® Fit		Up to US$150 per insured, per policy year, via reimbursement