MEDICAL INSURANCE
|
BENEFIT
Subject to deductible and
coinsurance
|
| Coverage area |
Worldwide
|
| Policy maximum per individual |
US$5,000,000 lifetime maximum benefit
|
| Hospital room & board |
US$600 per day
(maximum of 240 consecutive days per covered event)
|
| Intensive care unit |
US$1,500 per day
(maximum of 180 consecutive days per covered event)
|
| Inpatient or outpatient surgery |
URC up to lifetime maximum benefit
|
| Anesthetist's charges associated with surgery |
20% of the surgery benefit payable
|
| Laboratory tests, X-rays, & other treatment associated with an inpatient covered event |
URC up to lifetime maximum benefit
|
| Emergency medical evacuation |
US$50,000 per coverage period (not subject to deductible or coinsurance)
|
| Local ground ambulance |
US$1,500 per covered event (not subject to deductible or coinsurance)
|
| Emergency room treatment due to an accident |
URC up to lifetime maximum benefit
|
| Emergency dental due to an accident |
US$1,000 per coverage period
|
Maternity
Available only after 12 months of continuous coverage
|
Limited to US$5,000 per pregnancy (not subject to coinsurance)
|
|
Professional services related to inpatient maternity expenses
|
US$200 per day (not subject to coinsurance)
|
|
Newborn care and treatment
|
US$15,000 lifetime maximum for the first 31 days after birth
|
|
Well child care
|
3 visits per coverage period (maximum limit of $200 per period of coverage)
|
Outpatient visits or exams
25 visits, including prenatal and postnatal care, per insured person per
coverage period reimbursed to the maximum limit as outlined below:
|
|
| Physician |
US$70 per visit/exam |
| Specialist |
US$70 per visit/exam |
| Psychiatrist |
US$60 per visit/exam |
| Chiropractor |
US$50 per visit/exam |
| Surgical intervention consultation |
US$500 per visit/exam |
| |
|
|
Outpatient X-rays
|
US$250 per exam maximum limit
|
|
Outpatient lab tests
|
US$300 per exam maximum limit
|
Pre-existing Conditions
Available after 24 months of continuous coverage
|
US$50,000 lifetime maximum benefit
(maximum of US$5,000 per period of coverage)
|
|
Prescription medication related to a covered event
|
URC up to lifetime maximum benefit
|
|
Extended care facility services
|
Limited to the first 30 days of convalescent confinement
|
|
Home nursing care services
|
Limited to 30 days per covered event
|
|
Inpatient hospice care
|
Limited to the first 30 days of hospice confinement
|
|
Chemotherapy & radiation therapy
|
URC up to lifetime maximum benefit
|
|
Physical therapy
|
30 visits per coverage period (maximum limit of $40 per visit)
|
|
MRI, CAT scan, endoscopy, echocardiography, gastroscopy,
colonoscopy & cystoscopy
|
US$600 per exam limit
|
Transplants
Certain precertification provisions must be met
|
US$250,000 all inclusive per transplant
|
|
Return of mortal remains
|
US$25,000 lifetime maximum (not subject to deductible or coinsurance)
|