SPECIAL VIP

Covers all your essential
health needs with an annual
coverage of US$3 million

SPECIAL VIP

Covers all your essential health needs with an annual coverage of US$3 million

DEDUCTIBLE OPTIONS*

Option IOption IIOption IIIOption IVOption VOption VI
Outside USAUS$500US$2,000US$5,000US$10,000US$20,000US$50,000
Inside 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$3,000,000
Age limit to apply Up 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
Intensive care unit100% 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 a hospitalized insured over 18 years old)100% UCR , max. of 21 nights
Prescribed medications while hospitalized100% UCR
Physical therapy and rehabilitation100% UCR
DescriptionCoverage
Emergency room care100% UCR
Physician and specialist visits 100% UCR
Physician and specialist home visits 100% UCR
Prescription medication US$12.500
Nurse or therapist care at homeUS$10,000
Preventive health checkup per insured, no deductible applies (options I & II) (after a 10-month waiting period)• US$100 up to 17 years old
• US$150 at 18 years and older
Hearing aids US$1,000 per lifetime
Specialized treatments (occupational therapy, speech therapy, autism, sleep apnea and other sleep disorders)US$3,000
Alzheimer’s disease100% UCR
Allergy treatment100% UCR
Physical therapy and rehabilitationUS$10,000
DescriptionCoverage
Surgeon and anesthesiologist fees 100% UCR
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans)100% UCR
Oncology: cancer tests, treatment (chemotherapy and/or radiotherapy) and medication100% UCR
Surgery to reduce the risk of cancer or prophylactic surgery US$25,000 per lifetime (after a 12-month waiting period)
Dialysis services100% UCR
Prostheses and medical appliances implanted during surgery 100% UCR
Organ/tissue transplantUS$500,000 per lifetime (with rider) Includes US$30,000 benefit for expenses of the live donor
Durable medical equipment US$10,000
Congenital conditions diagnosed before age 18US$500,000 per lifetime
Congenital conditions diagnosed after age 18 US$2,000,000 per lifetime
HIV-AIDS US$250,000 per lifetime (after a 48-month waiting period)
Bariatric surgery 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 illness UpUp to the benefit limit
DescriptionCoverage
Maternity (options I, II)• US$4,000, no deductible applies
• Includes extraction and storage of umbilical cord blood stem cells
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 by ground ambulance100% UCR , no deductible applies
Emergency transportation by air ambulance US$60,000, no deductible applies
Cost of return ticket for the insured and one companion after an evacuation by air ambulanceUS$500 per person
Repatriation or cremation of mortal remainsUS$40,000
DescriptionCoverage
Injuries during the training or practice of hazardous hobbies and/or professional low-risk sports100% UCR
Emergency dental coverage 100% UCR for treatment within the first 180 days of the covered accident
Palliative care100% UCR
Temporary coverage for accidents while application is being underwritten US$30,000
Free extended coverage for eligible dependents after policyholder’s death 1 year
Deductible elimination/reduction for no claims madeOptions I, II & III:
• Elimination for 1 year, after the 3rd year without claims (options I, II, III)
• 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
Travel VIP LightUp to US$5,000 for emergency medical treatment while traveling abroad (with rider)
Second Medical Opinion VIP®Access to the medical opinion of internationally renowned experts from around the world regarding a condition, without deductible