Health Plan

Effective July 2018

PRIME VIP

GENERAL PLAN INFORMATION
DESCRIPTION COVERAGE
Maximum coverage per person, per lifetime
  • US$5,000,000
Maximum coverage per person, per policy year
  • US$1,500,000
Maximum coverage per person, per policy year at 70 years and older
  • US$500,000
Age limit to apply
  • 75
Waiting period
  • 60 days
Coinsurance (inside USA)
  • 20% of the first US$5,000 after the deductible; 1 per insured, per policy year; max. of 2 per policy, per policy year
Coverage outside USA
  • 100% with free choice of hospitals and doctors*
Coverage inside USA
  • 100% in providers of the ‘Prime Network’
  • Outside the ‘Prime Network’ the coverage will be at 60%
  • Emergencies will be covered at 100% up to the policy limits
INPATIENT BENEFITS
Standard private hospital room
  • 100% through the ‘Prime Network’
  • Up to US$500 daily, max. 180 days outside the ‘Prime Network’
Intensive care unit
  • 100% through the ‘Prime Network’
  • Up to US$1,400 daily, max. 60 days outside the ‘Prime Network’
Adult companion accommodation (related to a hospitalization of a child under age 18)
  • US$150 per night, max. of 100 nights per policy year
Prescribed medication while in a hospital
  • 100%
Inpatient laboratory tests and X-rays
  • 100%
OUTPATIENT BENEFITS
Physicians and specialists visits (including home visits)
  • US$80 per visit, max. of 30 visits
Outpatient surgery
  • US$12,000
Prescribed medication following a hospitalization
  • 100% up to 6 months
Outpatient or non-hospitalization prescription medication
  • US$3,000
Outpatient diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans)
  • US$600 per exam, per Insured; max. of US$1,800 per polficy year
Nurse care at home
  • US$5,000
Preventive health checkup per insured, no deductible (options I & II)
  • US$100 (after a 12-month waiting period)
GENERAL BENEFITS (The following benefits offer the same coverage for both inpatient and outpatient procedures)
Surgeon and anesthesiologist fees
  • 100%
Cancer tests, medication and treatment (chemotherapy and radiotherapy)
  • 100%, max. US$125,000 per policy year
Dialysis
  • 100%
Prostheses and medical appliances implanted during surgery
  • 100%
Organ transplant (per organ/tissue, per lifetime)
  • US$500,000 (with rider)
Benefits for live donor
  • US$30,000 (with rider)
Durable medical equipment
  • US$1,000
Physical therapy and rehabilitation
  • US$5,000
Congenital conditions diagnosed before age 18 (per lfifetfime)
  • US$125,000
Congenital conditions diagnosed after age 18 (per lifetime)
  • UU$500,000
MATERNITY BENEFITS (10-month waiting period)
Maternity (optfions I & II)
  • US$3,000, no deductible applies
Maternity and newborn complications (optfions I & II)
  • US$25,000
  • Additional US$25,000 with optional rider
Inclusion of the newborn (options I & II)
  • Without underwriting if born from a covered maternity
MEDICAL EVACUATION BENEFITS
Emergency transportation by ground ambulance
  • 100%, no deductible applies
Emergency transportation by air ambulance
  • US$35,000, no deductible applies
Repatriation of mortal remains
  • 100%
OTHER BENEFITS
Emergency dental coverage
  • 100% for the first 30 days, max. of US$6,000 per policy year
Palliative care for terminal cases
  • US$7,500
Temporary coverage for accidents while application is being underwritten
  • US$30,000
Second Medical Opinion VIP
  • Access to the medical opinion of internationally renowned experts from around the world regarding a condition, without deductible

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

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