|
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$4,000 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 30 days after birth
|
| Well child care |
3 visits per coverage period
(maximum limit of $70 per visit)
|
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) |
