HEALTH PLAN

SENIOR VIP

DESCRIPTION COVERAGE
Maximum lifetime coverage per person
  • US$3,000,000

Maximum charges incurred per policy year, per insured

  • US$350,000
Age range to apply for coverage
  • 60 – 90

Waiting period

  • 30 days

Coverage outside the United States (excluding Brazil)

  • 100% with free choice of doctors and hospitals

Coverage in the United States
  • 100% with exclusive coverage in hospitals of the ‘USA Special Network’
  • Emergency 100% coverage without restriction of hospitals
INPATIENT BENEFITS
Companion during hospitalization
  • US$100 per night, maximum 20 nights

Standard room and board (includes costs of medication, laboratory exams, imaging studies, diagnostic procedures, specialized nurses and other expenses during a hospitalization)

  • Up to US$2,500 per day for the first 120 days; US$750 per day for additional days

Intensive care unit

  • Up to US$3,250 per day for the first 30 days; US$1,000 per day for additional days
Surgeon, assistant surgeon and anesthesiologist fees during a hospitalization
  • Up to US$25,000 per surgery, maximum of 2 surgeries per policy year
OUTPATIENT BENEFITS

Outpatient surgery (everything included)

  • Up to US$25,000 per surgery, maximum of 2 surgeries per policy year
Nurse care at home
  • Up to US$100 per day, maximum of 30 days per policy year
Physician and specialist visits (including home visits)
  • Up to US$100 per consultation, maximum of 12 consultations per policy year
Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, echocardiogram, stress tests, etc.)
  • Up to US$500 per exam, per insured
Endoscopic procedures
  • Up to US$500 per exam, per insured
Outpatient prescribed medication
  • Up to US$1,000 per insured
Durable medical equipment
  • Up to US$2,000 per insured
Hearing aids (per lifetime)
  • Up to US$1,000 per insured
OTHERS BENEFITS
Cancer treatment (chemotherapy and radiotherapy), inpatient or outpatient
  • Up to US$80,000 per insured
Physical therapy and rehabilitation (inpatient or outpatient)
  • Up to US$100 per visit, maximum 30 visits
Emergency transportation by ground ambulance
  • 100%, without deductible
Emergency transportation by air ambulance
  • US$30,000 no deductible applies
Emergency dental coverage (per lifetime)
  • Up to US$25,000 per insured
Organ and tissue transplant
  • US$175,000 per diagnostic, per lifetime
  • Additional US$325,000 with optional rider
Benefits for live donors
  • US$15,000
Repatriation of mortal remains
  • Up to US$7,500 per insured
Palliative care for terminal cases
  • Up to US$750 per day, maximum of 120 days
Preventive medical check-up, no deductible (all options)
  • US$150 per insured (affter a 10-month waiting period)
Second Medical Opinion VIP
  • Access to the medical opinion of internationally renowned experts from around the world regarding condition, without deductible

Effective July 2017

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