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 person | US$3,500,000 per lifetime |
| Maximum charges incurred per insured, per policy year | US$500,000 |
| Age range to apply | 60 – 90 years old |
| Waiting period | 30 days |
| Geographic Coverage | Worldwide, no physician and hospital restrictions |
INPATIENT PROVISIONS
| BENEFIT | COVERAGE |
|---|---|
| Standard private room and hospitalization services (includes hospital food, medicines, laboratory tests, imaging studies, diagnostic procedures, specialized nurses and medical/ surgical supplies, among others) | US$2,500 per day, up to 120 days. US$750 per day for additional days |
| Intensive care unit (includes medications, laboratory tests, imaging studies, diagnostic procedures, specialized nurses and medical/surgical supplies, among others) | Up to US$3,300 per day, up to 30 days. US$1,000 per day for additional days |
| Surgeon, assistant 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 a companion of a hospitalized insured | US$150 per night, maximum 30 nights |
OUTPATIENT PROVISIONS
| BENEFIT | COVERAGE |
|---|---|
| Emergency care | US$5,000 per visit, maximum 5 visits per policy year |
| Outpatient surgery (all inclusive) | Up to US$50,000 per policy year |
| Nurse or therapist care at home | Up to US$150 per day, maximum 30 days per policy year |
| Visits to physicians and specialists (including home visits) | Up to US$125 per consultation, maximum 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 preoperative with preapproval | Up to US$1,250, per exam, per insured |
| Prescription drugs, following outpatient surgery or medical consultation | Up to US$2,500 per insured |
| Preventive medical check-up, per insured, no deductible (All options) | US$250 per insured (after a 12-month waiting period) |
| Hearing aids | Up to US$1,250 per insured, per lifetime |
| Allergy treatment | 100%* |
GENERAL PROVISIONS
The following benefits offer the same coverage for both inpatient and outpatient procedures.
| BENEFIT | COVERAGE |
|---|---|
| Oncology: cancer tests, treatment (chemotherapy and/or radiotherapy) in-hospital or outpatient | Up to US$200,000 per insured |
| Prostheses and medical devices implanted during surgery | 100%* |
| Organ transplant (per organ/tissue) | US$200,000, per lifetime. US$25,000, per lifetime, in expenses of the live donor |
| Living donor expenses included in Organ Transplantation | US$25,000, per lifetime |
| Durable medical equipment | Up to US$2,250 per insured |
| Physical therapy and rehabilitation (inpatient or outpatient) | Up to US$100 per visit, maximum 30 visits |
| Reconstructive surgery after an accident or illness | 100%* |
MEDICAL EVACUATION PROVISIONS
| 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 PROVISIONS
| BENEFIT | COVERAGE | |
|---|---|---|
| Emergency dental treatment following an accident | US$25,000 for treatment within the first 90 days of the covered accident of the covered accident | |
| Paliative 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 | Access to unlimited second medical opinions from renowned experts worldwide, with no deductible | |