DEDUCTIBLE OPTIONS
|
I |
II |
III |
IV |
V |
| Outside USA |
US$500 |
US$2,000 |
US$5,000 |
US$10,000 |
US$20,000 |
| Inside USA |
US$1,000 |
PLAN INFORMATION
| BENEFIT |
COVERAGE |
| Maximum coverage per insured, per policy year |
US$5,000,000 |
| Age limit |
Up to 79 years old |
| Waiting period |
30 days |
| Coverage outside the U.S. |
100%* with free choice of doctors and hospitals |
| Coverage inside the U.S. |
- 100%* within the LEVERAGE® US Network
- Outside the LEVERAGE® US network: Coverage 60%, with a daily maximum rate of US$700 for a standard room and US$1,400 for intensive care
- Emergency medical treatment: 100%* up to policy limits
|
HOSPITAL BENEFITS
| BENEFIT |
COVERAGE |
| Standard private/semi-private hospital room |
100%* |
| Intensive care unit |
100%* |
| Expenses for an accompanying adult of a hospitalized insured |
Under 18 years old |
US$150 per night, max. of 30 nights |
| Over 18 years old |
100%*, max. of 30 nights |
| Prescribed medications during hospitalization |
100%* |
| Physical therapy and rehabilitation |
100%* |
| Psychiatric Treatments |
US$1,000 |
OUTPATIENT BENEFITS
| BENEFIT |
COVERAGE |
| Emergency room care |
100%* |
| Home visits by doctors and specialists |
100%* |
| Prescribed medications |
US$15,000 |
| Home nurse or therapist care |
US$7,000 |
| Hearing aids |
US$550 lifetime |
| Alzheimer’s disease |
100%* |
| Allergy treatment |
100%* |
| Physical therapy and rehabilitation |
US$7,000 |
| Preventive medical check-up per insured, no deductible (after a 10-month waiting period) |
OPTION I |
| Visits to doctors and specialists |
100%* |
GENERAL BENEFITS
The following benefits offer the same coverage for both inpatient and outpatient procedures.
| BENEFIT |
COVERAGE |
| Surgeon and anesthesiologist fees |
100%* |
| Laboratory tests and diagnostic services (blood tests, pathology, X-rays, MRI/CT/PET scans) |
100%* |
| Oncology (cancer tests, chemotherapy/radiotherapy, medications) |
100%* |
| Dialysis services |
100%* |
| Prosthetics and implanted medical devices during surgery |
100%* |
| Organ transplant (per organ/tissue) |
US$350,000 lifetime.
Includes live donor expenses |
| Durable medical equipment |
US$8,000 |
| Specialized treatments (occupational therapy, speech therapy, sleep apnea and other sleep disorders) |
US$2,000 |
| Congenital conditions |
Diagnosed before age 18 |
US$150,000 lifetime |
| Diagnosed after age 18 |
100%* |
| 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) |
US$4,000, no deductible applies |
| Maternity and newborn complications (options I & II) |
US$150,000 lifetime |
| Newborn inclusion within 90 days after birth (options I & II) |
No medical evaluation if born in a covered maternity |
MEDICAL EVACUATION BENEFITS
| BENEFIT |
COVERAGE |
| Emergency transportation |
Ground ambulance |
100%*, no deductible applies |
| Air ambulance |
US$45,000, no deductible applies |
| Repatriation or cremation of mortal remains |
US$7,000 |
OTHER BENEFITS
| BENEFIT |
COVERAGE |
| High-risk activities and sports |
100%* |
| Emergency dental treatment due to an accident |
100% (treatment within the first 180 days of a covered accident) |
| Palliative care |
100%* |
| Temporary accident coverage while application is being processed |
US$30,000 |
| Deductible waiver/reduction after 3 years without claims |
OPTIONS I:- 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 II, III & IV:- 50% deductible reduction for 1 year after the third claim-free year
|
| EVER Expert Medical Review® |
Unlimited access to world-renowned medical expert second opinions, no deductible applies |
