HEALTH PLAN

DIRECT VIP CHOICE

*Only one deductible per person, per policy year applies. For family policies, a maximum of two deductibles accumulated per policy, per policy year will be applied. For more information, please refer to the Conditions of Coverage of the policy.

DESCRIPTION COVERAGE
Lifetime coverage
  • Unlimited
Maximum coverage per person per policy year
  • US$5,000,000
Age limit to apply
  • 75
Waiting period
  • 30 days
Geographical coverage
  • Worldwide without restrictions of doctors and hospitals
HOSPITALIZATION BENEFITS
Standard private/semi-private hospital room
  • 100% UCR
  • Outside of ‘USA Special Network’: US$2,000 per day
Special benefit for suite
  • Up to US$2,000 per day within the “USA Special Network”
Intensive care unit
  • 100% UCR
  • Outside of ‘USA Special Network’: US$4,000 per day
Emergency room
  • 100% UCR (if admitted immediately as an inpatient)
Surgeon and anesthesiologist fees
  • 100% UCR
Companion during hospitalization
  • US$175 per night, max. 30 nights
Prescribed medications while in a hospital
  • 100% UCR
Prescribed medications following a hospitalization or outpatient surgery
  • 100% UCR for up to 6 months after discharge, max. US$3,500 per policy year
Dialysis / hemodialysis
  • 100% UCR
Laboratory tests and X-rays
  • 100% UCR
Cancer treatment (chemotherapy and radiotherapy)
  • 100% UCR
Physicians and specialist visits
  • 100% UCR
Physical therapy and rehabilitation
  • 100% UCR (during a hospitalization)
Prostheses and medical appliances implanted during surgery
  • 100% UCR
Organ transplant (per organ/tissue, per lifetime)
  • US$1,100,000
Benefits for live organ donors
  • US$60,000
HIV/AIDS
  • US$50,000 per policy year (only if admitted as an inpatient and after a 12-month waiting period)
Bariatric surgery (per lifetime)
  • US$10,000 (after a 24-month waiting period, within special network)
OUTPATIENT BENEFITS
Cancer tests, medication and treatment
  • 100% UCR
Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc). Pre-surgical testing only. Pre-authorization required
  • US$15,000 per policy year
Dialysis / hemodialysis
  • 100% UCR
Physician visit as a follow up to a covered hospitalization
  • US$6,000 per policy year, up to 10 months from the date of discharge
Outpatient surgery
  • 100% UCR
OTHER BENEFITS
Preventive health checkup per insured, no deductible
  • Options I & II:
  • 100% UCR from 0 to 6 months of age, up to 5 visits
  • US$300 per policy year from 6 months to 17 years of age
  • US$600 per policy year from 18 years of age and older
  • Options III & IV:
  • US$300 per policy year for all ages (after a 3-month waiting period)
Durable medical equipment
  • 100% UCR (as follow-up care to a covered hospitalization)
Emergency dental care
  • 100% UCR for the first 180 days
Emergency transportation by air ambulance
  • 100% UCR, no deductible
Emergency transportation by ground ambulance
  • 100% UCR, no deductible (if admitted immediately as an inpatient)
Nurse care at home
  • 100% UCR (as follow-up care to a covered hospitalization)
Palliative care for terminal cases
  • 100% UCR
Repatriation of mortal remains
  • US$25,000
Temporary coverage for accidents while application is being underwritten
  • US$30,000
Non-professional hazardous hobbies and sports
  • 100% UCR
Deductible elimination/reduction for no claims made
  • Elimination for 1 year, after the 3rd year without claims
    (options I & II)
  • Reduction of up to 50% for 1 year after the 3rd year without claims (options III & IV)
Second medical opinion VIP
  • Access to the medical opinion of internationally renowned experts from around the world regarding a condition, without deductible

Effective July 2016

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