SPECIAL VIP PLUS
Covers all your essential
health needs with an annual
coverage of US$5 million
SPECIAL VIP
Covers all your essential health needs with an annual coverage of US$3 million
DEDUCTIBLE OPTIONS*
Option I | Option II | Option III | Option IV | Option V | Option VI | |
---|---|---|---|---|---|---|
Inside USA | US$500 | US$2,000 | US$5,000 | US$10,000 | US$20,000 | US$50,000 |
Outside USA | US$1,000 | US$2,000 | US$5,000 | US$10,000 | US$20,000 | US$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 policy’s Conditions of Coverage.
TABLE OF BENEFITS
Description | Coverage |
---|---|
Maximum coverage per person, per policy year | US$5,000,000 |
Maximum age to apply for coverage | Up to 75 years old |
Waiting period | 30 days |
Coverage outside USA | 100% UCR with free choice of hospitals and doctors |
Coverage inside USA | • 100% UCR within the USA Special Network® • Outside the USA Special Network®, the 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 |
Description | Coverage |
---|---|
Standard hospital room | 100% UCR |
Use of intensive care unit | 100% UCR |
Adult companion accommodation expenses of a hospitalized insured under 18 years old | US$150 per night, max. of 30 nights |
Adult companion accommodation expenses of hospitalized insured over 18 years old | 100% UCR, max. of 21 nights |
Prescribed medications while hospitalized | 100% UCR |
Physical therapy and rehabilitation | 100% UCR |
Description | Coverage |
---|---|
Emergency room care | 100% UCR |
Physician and specialist visits | 100% UCR |
Physician and specialist home visits (where available) | 100% UCR |
Outpatient prescription medication | US$50,000 |
Preventive health checkup. No deductible applies (options I, II & III) (after a 10-month waiting period) | • US$100 up to 17 years old • US$200 at 18 years and older Preventive care benefits: • Colon cancer screening (at 50 years and older): US$1,200 every 10 years • Mammogram (at 40 years and older): US$400 • Pap smear (from 21 to 65 years of age): US$150 every 3 years • Prostate cancer screening (at 50 years and older): US$300 |
Hearing aids | US$1,000 per lifetime |
Treatment for Alzheimer’s disease | 100% UCR |
Allergy treatment | 100% UCR |
Outpatient physical therapy and rehabilitation, and nurse or therapist care at home | US$12,000 |
The following benefits offer the same coverage for both inpatient and outpatient procedures.
Description | Coverage |
---|---|
Surgeon and anesthesiologist fees | 100% UCR |
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans) | 100% UCR |
Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication | 100% UCR |
Surgery to reduce the risk of cancer or prophylactic surgery | US$25,000 per lifetime (after a 12-month waiting period) |
Dialysis services | 100% UCR |
Prostheses and medical appliances implanted during surgery | 100% UCR |
Durable medical equipment | US$12,000 |
Specialized treatments: autism, psychiatry, sleep apnea and other sleep disorders Specialized therapies: occupational and speech | US$5,000 |
Congenital and/or hereditary conditions diagnosed before age 18 | US$500,000 per lifetime |
Congenital and/or hereditary conditions diagnosed after age 18 | US$2,000,000 per lifetime |
HIV-AIDS treatment | US$250,000 per lifetime (after a 48-month waiting period) |
Gastric bypass bariatric surgery and any type of surgical procedure for weight loss, its complications or treatments, and/or weight loss medication | US$5,000 per lifetime (after a 24-month waiting period) |
Surgical treatment of symptomatic foot disorders | 100% UCR (after a 24-month waiting period) |
Reconstructive surgery after an accident or illness | Up to the maximum benefit |
10-month waiting period, no deductible applies.
Description | Coverage |
---|---|
Maternity (options I & II) | • US$5,000 • Includes extraction and storage of umbilical cord blood stem cells Includes deliveries for pregnancies that are a result of any type of fertility treatments |
Maternity and newborn complications (options I & II) | US$500,000 |
Inclusion of the newborn within 90 days after the birth (options I & II) | Without underwriting, if born from a covered maternity |
Description | Coverage |
---|---|
Emergency transportation - Ground ambulance | 100% UCR, no deductible applies |
Emergency transportation - Air ambulance | US$60,000, no deductible applies |
Cost of return ticket for the insured and one companion after an evacuation by air ambulance | Up to US$500 per ticket |
Repatriation or cremation of mortal remains | US$40,000 |
Description | Coverage |
---|---|
Treatment for injuries during the training or practice of hazardous hobbies and/or professional low-risk sports | 100% UCR |
Emergency dental coverage | 100% UCR for treatment within the first 180 days of the covered accident |
Palliative care | 100% UCR |
Temporary coverage for accidents while application is being underwritten | US$30,000 |
Free extended coverage for eligible dependents after the policyholder’s death as a result of a covered accident or condition | 1 year |
Elimination/reduction of the policy deductible for no claims during the last 3 years | Options I, II & III:
• Elimination for 1 year after the 3rd year without claims • Reduction of 50% of the deductible for 1 year after the 3rd year, if the deductible was not met in any of the years Options IV & V: • Reduction of 50% of the deductible for 1 year after the 3rd year without claims |
Elimination of deductible in case of a serious accident (options I, II & III) | Elimination of the annual deductible for the first hospital urgent treatment that requires a hospitalization within the first 24 hours after the serious accident |
Emergency coverage when traveling abroad | Up to US$5,000 for emergency medical treatment while traveling abroad |
Second Medical Opinion VIP® | Access to a second medical opinion of renowned experts from around the world, no deductible applies |
Description | Coverage |
---|---|
Organ/tissue transplant | US$500,000 per lifetime |
All benefits with 100% coverage are up to the policy limit. Benefits with established coverage will be up to the limits stated in each of them.