PROTECT VIP

Is a modular plan that provides flexibility to choose the coverage you need

DIRECT VIP

Offers an annual coverage of US$5 million for hospitalization and essential outpatient treatments.

HOSPITALIZATION MODULE (BASE PLAN) DEDUCTIBLE OPTIONS* (INSIDE** OR OUTSIDE THE U.S.)

Option IOption IIOption IIIOption IVOption VOption VIOption VII
US$500US$1,000US$2,000US$5,000US$10,000US$20,000US$50,000

*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.

**For coverage in the United States, the U.S. Coverage Module must be acquired.

TABLE OF BENEFITS

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Base Plan General Information

DescriptionCoverage
Maximum coverage per person, per policy yearUS$5,000,000
Maximum age to apply for coverageUp to 75 years old
Waiting Period30 days
Geographical coverageWorldwide without restrictions of Doctors andHospitals (excluding the U.S., unless the optional U.S.Coverage Module is acquired)

Hospitalization Benefits Module

DescriptionCoverage
Private/Semi-Private Hospital Room100% UCR
Use of intensive care uni100% UCR
Emergency room care100% UCR (if admitted immediately as an inpatient)
Surgeon and Anesthesiologist fees100% UCR
Adult companion accommodation expenses of a hospitalized Insured under 18 years oldUS$175 per night, max. of 30 nights
Adult companion accommodation expenses of a hospitalized Insured over 18 years old100% UCR, max. of 21 nights
Prescribed medications while hospitalized100% UCR
Prescribed medications following a hospitalization or outpatient surgery100% UCR for up to 6 months after discharge, max. of US$3,500 per policy year
Dialysis services inpatient or outpatient100% UCR
Laboratory tests and X-rays100% UCR
Oncology: inpatient or outpatient treatment(chemotherapy and radiotherapy)100% UCR
Physician and specialist visits100% UCR
Physical therapy and rehabilitation100% UCR (during a hospitalization)
Prostheses and medical appliances implanted during surgery100% UCR
Organ transplant (per organ/tissue)US$1,100,000 per LifetimeIncludes US$60,000 benefit for expenses of the LiveDonor
HIV/AIDSUS$50,000 (if admitted as an inpatient and after a 12-month waiting period)
Gastric bypass bariatric surgery and any type ofsurgical procedure for weight loss, its complicationsor treatments, and/or weight loss medicationUS$10,000 per lifetime (after a 24-month waiting period)
Durable medical equipment100% UCR (as follow-up care to a covered hospitalization)
Emergency dental coverage100% UCR for treatment within the first 180 days of the covered accident
Evacuation benefitsMedical emergency evacuation:• Air Ambulance: 100% UCR, no Deductible applies• Ground Ambulance: 100% UCR, no Deductibleapplies (if admitted immediately as an inpatient) Repatriation of mortal remains:US$25,000 (must be pre-approved and coordinated bythe company)
Nurse or therapist care at home100% UCR (as follow-up care to a covered hospitalization)
Palliative care 100% UCR
Treatment for Injuries during the training or practiceof Hazardous Hobbies and/or non-Professional Sports100% UCR
Elimination/reduction of the Policy Deductible for notmeeting the Deductible during the last 3 yearsOptions II & III:• Elimination for 1 year after the 3rd year if theDeductible was not met in any of the years
Options IV & V:• Reduction of up to 50% for 1 year after the 3rd year ifthe Deductible was not met in any of the years
Second Medical Opinion VIP®Access to a second medical opinion of renownedexperts from around the world, no Deductible applies

Outpatient Benefits Module

DescriptionCoverage
Outpatient benefits deductibleUS$500 or US$1,000
Outpatient benefits maximum coverage per person, per policy yearUS$20,000
Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc.) Pre-surgical testing only.Pre-authorization required100% UCR
Outpatient Prescription MedicationUS$4,000
Physician and specialist visits100% UCR
Outpatient surgery100% UCR
Physical therapy and rehabilitation100% UCR, max. of 60 visits (following a coveredHospitalization)
Speech therapy100% UCR
Occupational therapy100% UCR
Sleep apnea and other sleep disorders100% UCR
Autism treatment100% UCR
Allergy treatment100% UCR

U.S. Coverage Module (Optional)*

DescriptionCoverage
Maximum coverage per person, per policy year within the U.SUp to policy limits
Coverage inside USAInside the Protect VIP USA Network®:• 100% UCR
Outside the Protect VIP USA Network®:• 60% of the covered expenses (with a maximumdaily room rate of up to US$700 for a standard roomand up to US$1,400 for intensive care unit)• Emergency medical treatment: 100% UCR
Special benefit for Suite accommodation (subject toavailability)Up to US$2,000 per day within the Protect VIP USANetwork® (no coverage available outside the ProtectVIP USA Network®)

*The Hospitalization Benefits Module (Base Plan) must be chosen before any other optional module can be added.

All benefits with 100% coverage are up to the policy limit.