Health plan

Effective July 2018

UNIVERSAL VIP

GENERAL PLAN INFORMATION
DESCRIPTION COVERAGE
Maximum coverage per person, per policy year
  • US$5,000,000
Age limit to apply
  • 75
Waiting period
  • 30 days
Geographical coverage
  • Worldwide without restrictions of doctors and hospitals
INPATIENT BENEFITS
Standard private/semi-private hospital room
  • 100%
Special benefit for suite
  • Up to US$2,000 per day within the “USA Special Network”
Intensive care unit
  • 100%
Adult companion accommodation (related to a hospitalization of a child under age 18)
  • US$350 per night, max. of 30 nights
Adult companion accommodation (related to a hospitalization of an insured 18 years and older)
  • 100%, max. of 21 nights
Prescribed medications while in a hospital
  • 100%
OUTPATIENT BENEFITS
Emergency room
  • 100%
Physicians and specialist visits
  • 100%
Physicians and specialist home visits
  • 100%
Prescription medication
  • 100%
Complementary therapy: chiropractor, psychologist, psychiatrist, osteopathy and/or acupuncture
  • US$2,500
Nurse care at home
  • 100%
Preventive health checkup per insured, no deductible (after a 10-month waiting period)
    Options I, II & III:

  • US$150 up to 17 years old
  • US$350 at 18 years and older
Preventive health checkup per insured, no deductible (after a 10-month waiting period)(continued)
    Options IV, V & VI:

  • US$100, all ages
Hearing aids (per lifetime)
  • US$2,000
Specialized treatments (occupational therapist, speech therapist, autism, sleep apnea and other sleep disorders)
  • US$3,000
Alzheimer’s
  • 100%
Allergy treatment
  • 100%
GENERAL BENEFITS (The following benefits offer the same coverage for both inpatient and outpatient procedures)
Surgeon and anesthesiologist fees
  • 100%
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans)
  • 100%
Cancer tests, medication and treatment (chemotherapy and/or radiotherapy)
  • 100%
Surgery to reduce the risk of cancer or prophylactic surgery (per lifetime)
  • US$25,000 (after a 12-month waiting period)
Dialysis
  • 100%
Prostheses and medical appliances implanted during surgery
  • 100%
Organ transplant (per organ/tissue, per lifetime)
  • US$1,100,000
Benefits for live donors
  • US$60,000
Durable medical equipment
  • 100%
Physical therapy and rehabilitation
  • 100%
Congenital conditions diagnosed before age 18 (per lifetime)
  • US$2,000,000
Congenital conditions diagnosed after age 18
  • 100%
HIV-AIDS (per lifetime)
  • US$700,000 (after a 24-month waiting period)
Bariatic surgery (per lifetime)
  • US$10,000 (after a 24-month waiting period, within special network)
Surgical treatment of symptomatic foot disorders
  • 100% (after a 24-month waiting period)
MATERNITY BENEFITS (10-month waiting period, no deductible applies)
Maternity (options I, II & III)
  • US$7,000
Extension of the maternity coverage*
  • US$1,500
Extraction and storage of stem cells (options I, II & III)
  • US$1,000 per covered pregnancy
Maternity and newborn complications (options I, II & III)
  • US$1,000,000 per lifetime
Inclusion of the newborn (options I, II & III)
  • *When the insured selects a hospital from the “Special Maternity Network.”
MEDICAL EVACUATION BENEFITS
Emergency transportation by ground ambulance
  • 100%, no deductible applies
Emergency transportation by air ambulance
  • 100%, no deductible applies
Insured’s and companion’s return ticket after an evacuation by air ambulance
  • US$1,000 per person
Repatriation of mortal remains
  • 100%
OTHER BENEFITS
Hazardous hobbies and professional sports
  • 100%
Emergency dental coverage
  • 100% for the first 180 days
Palliative care for terminal cases
  • 100%
Temporary coverage for accidents while application is being underwritten
  • US$30,000
Free extended coverage for eligible dependents after policyholder’s death
  • 2 years
Free coverage for dependents (options I & II)
  • Up to 5 years old, max. of 2 children born in the policy from a covered maternity
Deductible elimination / reduction for no claims made
  • Elimination for 1 year, after the 3rd year without claims (options I, II, III & IV)
  • Reduction of up to 50% for 1 year after the 3rd year without claims (options V & VI)
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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