DEDUCTIBLE OPTIONS
|
I |
II |
III |
IV |
V |
VI |
VII |
| Outside USA |
US$500 |
US$1,000 |
US$2,000 |
US$5,000 |
US$10,000 |
US$20,000 |
US$50,000 |
| Inside USA |
US$1,000 |
US$2,000 |
US$3,000 |
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, without restrictions of doctors and hospitals |
INPATIENT PROVISIONS
| BENEFIT |
COVERAGE |
| Standard private hospital room |
100%* |
| Special benefit for suite accommodation (subject to availability) |
100%* |
| Intensive care unit |
100%* |
| Adult companion accommodation expenses of a hospitalized insured |
Under 18 years old |
100%*, unlimited nights |
| Over 18 years old |
100%, max. of 30 nights |
| Prescribed medications while hospitalized |
100%* |
| Psychiatric Treatments |
US$5,000* |
OUTPATIENT PROVISIONS
| BENEFIT |
COVERAGE |
| Emergency care |
100%* |
| Physician and specialist visits |
100%* |
| Physician and specialist home visits |
100%* |
| Prescription medication |
100%* |
| Complementary therapies: chiropractor, psychologist, psychiatrist, osteopathy and/or acupuncture |
US$15,000 |
| Nurse or therapist care at home |
100%* |
| Preventive health checkup, per insured, no deductible applies (options I, II, III, IV, V & VI) |
- US$300 per visit, up to 6 visits, for insureds 0 to 12 months of age
- Up to US$500 from 12 months of age, including up to US$75 per preventive dental checkup in options I, II and III
|
| Hearing aids |
US$4,000 per lifetime. |
| Alzheimer’s disease |
100%* |
| Autism treatment |
- 100% if the insured was born under a covered maternity
- US$12,000 for insureds not born under a covered maternity, and who developed the condition while they were insured
|
| Allergy treatment |
100%* |
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$50,000 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$5,000,000 per lifetime Includes expenses of the live donor |
| 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 per lifetime |
| Diagnosed after age 18 |
100%* |
| HIV-AIDS |
US$1,100,000 per lifetime (after a 24-month waiting period) |
| Bariatric surgery |
US$25,000 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 & III) |
- 100%* normal delivery or scheduled cesarian delivery in a hospital with self-pay package
- US$10,000 for normal delivery (if only mother is insured)
- US$12,000 for cesarean delivery (If both parents are insured)
|
| Stem cell collection and storage (options I, II & III) |
US$2,500 per covered pregnancy |
| Maternity and newborn complications (options I, II & III) |
US$1,250,000 per lifetime |
| Inclusion of the newborn within 90 days after the birth (options I, II & III) |
Without underwriting, if born from a covered maternity |
| Free coverage for dependents up to 5 years old (option I) |
- Max. of 2 children born from a covered maternity, if both parents are insured in the policy
- Max. of 1 child born from a covered maternity, if only the mother is insured in the policy
|
| Fertility treatment (options I & II) |
US$6,000 per lifetime, after deductible (after a 24-month waiting period) |
MEDICAL EVACUATION PROVISIONS
| BENEFIT |
COVERAGE |
| Emergency transportation |
Ground ambulance |
100%*, no deductible applies |
| Air ambulance |
100%*, no deductible applies |
| Cost of return ticket for the insured and one companion after an evacuation by air ambulance |
US$3,000 per person |
| Repatriation or cremation of mortal remains |
100%* |
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 |
| Refractive eye surgery |
US$750 per eye, per lifetime (after a 24-month waiting period) |
| Palliative care |
100%* |
| Temporary coverage for accidents while the application is being underwritten |
US$40,000 |
| Free extended coverage for eligible dependents after the policyholder’s death |
2 years |
| Deductible elimination/reduction for no claims for 3 years |
OPTIONS I, II, III & IV:- 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 V & VI:- Reduction of 50% of the deductible for 1 year after the 3rd year without claims
|
| 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 per lifetime, after 10-months waiting period (options I, II & III) |
| Male Sterilization (Vasectomy) |
Up to US$1,500 per lifetime, after 24-months waiting period (options I, II & III) |
| Nutritionist visits |
Up to 5 visits per policy year |
| EVER Expert Medical Review® |
Unlimited access to medical reviews from recognized world experts, deductible does not apply |
