SPECIAL VIP

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$5 million

DEDUCTIBLE OPTIONS*

Option IOption IIOption IIIOption IVOption VOption VI
Inside USAUS$500US$2,000US$5,000US$10,000US$20,000US$50,000
Outside USAUS$1,000US$2,000US$5,000US$10,000US$20,000US$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

DescriptionCoverage
Maximum coverage per person, per policy yearUS$5,000,000
Maximum age to apply for coverageUp to 75 years old
Waiting period30 days
Coverage outside USA100% 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
DescriptionCoverage
Standard hospital room100% UCR
Use of intensive care unit100% UCR
Adult companion accommodation expenses of a hospitalized insured under 18 years oldUS$150 per night, max. of 30 nights
Adult companion accommodation expenses of a hospitalized insured over 18 years old100% UCR, max. of 21 nights
Prescribed medications while hospitalized100% UCR
Physical therapy and rehabilitation100% UCR
DescriptionCoverage
Emergency room care100% UCR
Physician and specialist visits100% UCR
Physician and specialist home visits (where available)100% UCR
Outpatient prescription medicationUS$30,000
Nurse or therapist care at homeUS$10,000

Preventive health checkup per insured, no deductible applies
(after a 10-month waiting period)

Options I & II:
• US$100 up to 17 years old
• US$150 at 18 years and older


Option III:
• US$150, all ages

Hearing aidsUS$1,000 per lifetime
Treatment for Alzheimer’s disease100% UCR
Allergy treatment100% UCR
Physical therapy and rehabilitationUS$10,000

The following benefits offer the same coverage for both inpatient and outpatient procedures.

DescriptionCoverage
Surgeon and anesthesiologist fees100% UCR
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans)100% UCR
Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication100% UCR
Surgery to reduce the risk of cancer or prophylactic surgeryUS$25,000 per lifetime (after a 12-month waiting period)
Dialysis services100% UCR
Prostheses and medical appliances implanted during surgery100% UCR
Durable medical equipmentUS$10,000
Specialized treatments: autism, sleep apnea and other sleep disorders
Specialized therapies: occupational and speech
US$3,000
Congenital and/or hereditary conditions diagnosed before age 18US$500,000 per lifetime
Congenital and/or hereditary conditions diagnosed after age 18US$2,000,000 per lifetime
HIV-AIDS treatmentUS$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 disorders100% UCR (after a 24-month waiting period)
Reconstructive surgery after an accident or illnessUp to the maximum benefit

10-month waiting period, no deductible applies.

DescriptionCoverage
Maternity (options I & II)

• US$4,000
• 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
DescriptionCoverage
Emergency transportation - Ground ambulance100% UCR, no deductible applies
Emergency transportation - Air ambulanceUS$60,000, no deductible applies
Cost of return ticket for the insured and one companion after an evacuation by air ambulanceUp to US$500 per ticket
Repatriation or cremation of mortal remainsUS$40,000
DescriptionCoverage
Treatment for injuries during the training or practice of hazardous hobbies and/or professional low-risk sports100% UCR
Emergency dental coverage100% UCR for treatment within the first 180 days of the covered accident
Palliative care100% UCR
Temporary coverage for accidents while application is being underwrittenUS$30,000
Free extended coverage for eligible dependents after the policyholder’s death as a result of a covered accident or condition1 year
Elimination/reduction of the policy deductible for no claims during the last 3 yearsOptions 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

Second Medical Opinion VIP®Access to a second medical opinion of renowned experts from around the world, no deductible applies
DescriptionCoverage
Organ/tissue transplantUS$500,000 per lifetime
Emergency coverage when traveling abroadUp to US$5,000 for emergency medical treatment

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.