Health Plan

Effective July 2018

SENIOR VIP CHOICE

GENERAL PLAN INFORMATION
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 years old 

Waiting period

  • 30 days

Coverage outside the United States 

  • 100% UCR with free choice of doctors and hospitals

Coverage in the United States
  • 100% UCR with exclusive coverage in hospitals in the ‘USA Special Network’
  • Emergencies:  100% UCR coverage without restriction of hospitals
INPATIENT BENEFITS
Companion during hospitalization
  • US$100 per night, maximum of 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 prescription medication
  • Up to US$1,000 per insured, per policy year
Durable medical equipment
  • Up to US$2,000 per insured, per policy year
Hearing aids (per lifetime)
  • Up to US$1,000 per insured
OTHER BENEFITS
Cancer treatment (chemotherapy and radiotherapy), inpatient or outpatient
  • Up to US$80,000 per insured, per policy year
Physical therapy and rehabilitation (inpatient or outpatient)
  • Up to US$100 per visit, maximum of 30 visits per policy year
Emergency transportation by ground ambulance
  • 100% UCR, no deductibles applies 
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 (after a 10-month waiting period)
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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All content of this book are for afirmative purposes only. The benefits are governed by the terms described in the Conditions of Coverage of the policy.  Unless otherwise stated, the benefits are offered on a per-insured/per-policy year basis in which the chosen deductible applies.  All amounts are in US Dollars (USD).  The benefits are limited to the medical expenses covered under this policy and are subject to the usual, customary and reasonable expenses (UCR) for the geographic area where the expenses were incurred.


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