Health Plan

Effective July 2018

SPECIAL VIP CHOICE

GENERAL PLAN INFORMATION
DESCRIPTION COVERAGE
Lifetime coverage
  • Unlimited
Maximum coverage per person, per policy year
  • US$2,000,000
Age limit to apply
  • 75
Waiting period
  • 30 days
Coverage outside USA

*See list of hospitals

  • 100% UCR with free choice of hospitals and doctors
  • Inside the “Brazil Premium Providers” coverage will be at 50%*
Coverage inside USA
  • 100% UCR through the “USA Special Network”
  • Outside the “USA Special Network” coverage will be at 60% with a maximum daily room rate of up to US$700 for a standard room and up to US$1,400 for intensive care
  • Emergency medical treatment will be covered 100% UCR up to the policy limits
INPATIENT BENEFITS
Intensive care unit
  • 100% UCR
Companion during hospitalization
  • US$150 per night, max.  of 30 nights
Prescribed medications while in a hospital
  • 100% UCR
OUTPATIENT BENEFITS
Physicians and specialist visits
  • 100% UCR
Physicians and specialist home visits
  • 100% UCR
Prescription medication
  • US$2,500
Nurse care at home
  • US$15,000
Specialized treatments (autism, sleep apnea, other sleep disorders and psychiatrist)
  • US$2,000
Alzheimer’s
  • 100% UCR
GENERAL BENEFITS (The following benefits offer the same coverage for both inpatient and outpatient procedures)
Emergency medical services
  • 100% UCR
Surgeon and anesthesiologist fees
  • 100% UCR
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans)
  • 100% UCR
Cancer tests, medication and treatment (chemotherapy and/or radiotherapy)
  • 100% UCR
Surgery to reduce the risk of cancer or prophylactic surgery(per lifetime)
  • US$20,000 (after a 12-month waiting period)
Dialysis
  • 100% UCR
Prostheses and medical appliances implanted during surgery
  • 100% UCR
Organ transplant (per lifetime)
  • US$500,000
Benefits for live donors
  • US$30,000
Durable medical equipment
  • US$10,000
Physical therapy and rehabilitation
  • US$10,000
Congenital conditions diagnosed before age 18 (per lifetime)
  • US$500,000
Congenital conditions diagnosed after age 18 (per lifetime)
  • US$2,000,000
HIV-AIDS (per lifetime)
  • US$250,000 (after a 48-month waiting period)
Surgical treatment of symptomatic foot disorders
  • 100% UCR (after a 24-month waiting period)
MATERNITY BENEFITS (10-month waiting period, no deductible applies)
Maternity and newborn complications (option I)
  • US$500,000, no deductible applies
Inclusion of the newborn (options I)
  • Without underwriting if born in the policy
MEDICAL EVACUATION BENEFITS
Emergency transportation by ground ambulance
  • 100% UCR, no deductible applies
Emergency transportation by air ambulance
  • 100% UCR, no deductible applies
Insured’s and companion’s return ticket after an evacuation by air ambulance
  • US$500 per person
Repatriation of mortal remains
  • US$20,000
OTHER BENEFITS
Hazardous hobbies and sports (non-professional)
  • US$250,000
Emergency dental coverage
  • 100% UCR for the first 180 days
Palliative care for terminal cases
  • 100% UCR
Temporary coverage for accidents while application is being underwritten
  • US$30,000
Free extended coverage for eligible dependents after policyholder’s death
  • 1 years
Deductible elimination/reduction for no claims made
  • Elimination for 1 policy year after the end of the 3rd year without claims (option I & II)
  • Reduction of up to 50% for 1 policy 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

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

Download PDF Version Here

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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