DEDUCTIBLE OPTIONS
|
I |
II |
III |
IV |
V |
VI |
| Outside USA |
US$500 |
US$2,000 |
US$5,000 |
US$10,000 |
US$20,000 |
US$50,000 |
| Inside USA |
US$1,000 |
PLAN INFORMATION
| BENEFIT |
COVERAGE |
| Maximum coverage per person, per policy year |
US$2,500,000 |
| Age limit to apply |
Up to 79 years old |
| Waiting period |
30 days |
| Coverage outside USA |
100%* with free choice of hospitals and doctors |
| Coverage inside USA |
- 100%* within the LEVERAGE® US Network
- Outside the LEVERAGE® US Network coverage will be 60%, with a maximum daily rate of up to US$700 per standard room and up to US$1,400 for intensive care
- Emergency medical treatment will be covered at 100%*, up to policy limits
|
INPATIENT PROVISIONS
| BENEFIT |
COVERAGE |
| Standard private/semi-private hospital room |
100%* |
| Intensive care unit |
100%* |
| Adult companion accomodation expenses 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 while hospitalized |
100%* |
| Physical therapy and rehabilitation |
100%* |
| Psychiatric Treatments |
US$1,000 |
OUTPATIENT PROVISIONS
| BENEFIT |
COVERAGE |
| Emergency care |
100%* |
| Physician and specialist home visits |
100%* |
| Outpatient prescription medication |
US$6,000 |
| Nurse or therapist care at home |
US$7,000 |
| Hearing aids |
US$550 per lifetime |
| Alzheimer’s disease |
100%* |
| Allergy treatment |
100%* |
| Physical therapy and rehabilitation |
US$7,000 |
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%* |
| Dialysis services |
100%* |
| Prostheses and medical appliances implanted during surgery |
100%* |
| Organ transplant (per organ/tissue) |
US$350,000 per lifetime.
Includes expenses of the live donor |
| 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 per lifetime |
| Diagnosed after age 18 |
100%* |
| 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) |
US$4,000, no deductible applies |
| Maternity and newborn complications (options I & II) |
US$150,000 per lifetime |
| Inclusion of the newborn within 90 days after the birth (options I & II) |
Without underwriting, if born from a covered maternity |
MEDICAL EVACUATION PROVISIONS
| 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 PROVISIONS
| BENEFIT |
COVERAGE |
| High-risk sports and activities |
100%* |
| Emergency dental coverage |
100%* for treatment within the first 180 days of the covered accident |
| Palliative care |
100%* |
| Temporary coverage for accidents while the application is being underwritten |
US$30,000 |
| Deductible elimination/reduction for no claims for 3 years |
OPTIONS I:- 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 II, III & IV:- Reduction of 50% of the deductible for 1 year after the 3rd year without claims
|
| EVER Expert Medical Review® |
Unlimited access to medical reviews from recognized world experts, deductible does not apply |
