DEDUCTIBLE OPTIONS
|
I |
II |
III |
IV |
| Outside USA |
US$2,500 |
US$5,000 |
US$10,000 |
US$20,000 |
| Inside USA |
US$5,000 |
PLAN INFORMATION
| BENEFIT |
COVERAGE |
| Maximum coverage per insured |
US$3,500,000 lifetime |
| Maximum charges incurred per policy year, per insured |
US$500,000 |
| Age range to apply |
60 – 90 years old |
| Waiting period |
30 days |
| Geographic Coverage |
Worldwide, with no restrictions of doctors and hospitals |
HOSPITAL BENEFITS
| BENEFIT |
COVERAGE |
| Standard private room and hospitalization services (Includes hospital food, medications, laboratory tests, imaging studies, diagnostic procedures, specialized nurses and medical/ surgical materials, among others) |
US$2,500 per day, up to 120 days.
US$750 per day for additional days |
| Intensive Care Unit |
Up to US$3,300 per day, up to 30 days.
US$1,000 per day for additional days |
| Surgeon and anesthesiologist fees |
Up to US$50,000 per surgery, maximum 2 surgeries per policy year |
| Additional hospital benefits (operating room and surgical implants) |
Up to US$35,000 per surgery, maximum 2 surgeries per policy year |
| Expense for accompanying a hospitalized insured |
US$150 per night, maximum 30 nights |
OUTPATIENT BENEFITS
| BENEFIT |
COVERAGE |
| Emergency room care |
US$5,000 per visit, maximum 5 visits per policy year |
| Outpatient surgery (included) |
Up to US$50,000 per policy year |
| Nurse or therapist care at home |
Up to US$150 per day, max 30 days per policy year |
| Visits to doctors and specialists |
Up to US$125 per consultation, max 15 consultations per year |
| Diagnostic study services (pathology, x-rays, MRI/CT/CT scan, echocardiogram, stress test, etc.). Only as pre-operative with pre-approval |
Up to US$1,000, per exam, per insured |
| Endoscopic procedures. Only as pre-op with pre-approval |
Up to US$1,250, per exam, per insured |
| Prescription medications after outpatient surgery or medical consultation |
Up to US$2,500 per insured |
| Preventive medical check-up per insured, no deductible (after a 12-month waiting period) |
US$250 per insured |
| Hearing aids |
Up to US$1,250 per insured, lifetime |
| Allergy treatment |
100%* |
GENERAL BENEFITS
The following benefits offer the same coverage for both inpatient and outpatient procedures.
| BENEFIT |
COVERAGE |
| Oncology (cancer tests, chemotherapy/radiotherapy, medications) |
Up to US$200,000 per insured |
| Prostheses and medical devices implanted during surgery |
100%* |
| Organ transplant (per organ/tissue) |
US$200.000, lifetime |
| Living donor expenses included in the organ transplant |
US$25,000, lifetime |
| Durable medical equipment |
Up to US$2,250 per insured |
| Physical therapy and rehabilitation (in-hospital or outpatient) |
Up to US$100 per visit, maximum 30 visits |
| Reconstructive surgery after an accident or illness |
100%* |
MEDICAL EVACUATION BENEFITS
| BENEFIT |
COVERAGE |
| Emergency transportation |
Ground Ambulance |
100%*, no deductible applies |
| Air Ambulance |
Up to US$30,000, no deductible applies |
| Repatriation or cremation of mortal remains |
US$10,000 |
OTHER BENEFITS
| BENEFIT |
COVERAGE |
| Emergency dental treatment due to an accident |
US$25,000 for treatment within the first 90 days of covered accident |
| Palliative care |
US$750 per day, up to 120 days |
| Temporary accident coverage while the application is being processed |
US$40,000 |
| EVER® Expert Medical Review |
Unlimited access to world-renowned medical expert second opinions, no deductible applies |
