360 VIP CHOICE
Provides annual coverage of US$5 million for hospital and
treatments worldwide
360 VIP CHOICE
Provides annual coverage of US$5 million for hospital treatments worldwide and 100%
DEDUCTIBLE OPTIONS*
| Option I | Option II | Option III | Option IV | Option V |
|---|---|---|---|---|
| US$2,000 | US$5,000 | US$10,000 | US$20,000 | US$50,000 |
*Only one (1) deductible per person, per policy year applies. For family policies, a maximum of two (2) deductibles accumulated per policy, per policy year will be applied.
TABLE OF BENEFITS
| Description | Coverage |
|---|---|
| Lifetime coverage | Unlimited |
| Maximum coverage per person, per policy year | US$5,000,000 |
| Age limit to apply | 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 ® |
| Description | Coverage |
|---|---|
| Standard hospital room | 100% UCR |
| Special benefit for suite accommodation (subject to availability) | Up to US$2,000 per day within the USA Special Network® |
| Use of intensive care unit | 100% UCR |
| Companion accommodation expenses of a hospitalized Insured | US$300 per night, up to US$3,000 per policy year |
| Prescribed medications while hospitalized | 100% UCR |
| Physical therapy and rehabilitation | 100% UCR |
| Private duty nursing | 100% UCR, max. of 100 days per policy year |
| Inpatient mental health treatment (psychiatric hospitalization) | 100% UCR, max. of 30 days per policy year |
| Description | Coverage |
|---|---|
| Emergency room care | 100% UCR |
| Physician and specialist visits | 100% UCR |
| Physician and specialist home visits (where available) | 100% UCR |
Prescription medication following a hospitalization or outpatient | 100% UCR for up to 6 months |
| Outpatient prescription medication | US$3,000 |
Complementary therapy: chiropractic, speech, occupational, osteopathy | 100% UCR, max. of 80 visits combined per policy year |
| Nurse or therapist care at home | 100% UCR, max. of 100 days per policy year |
| Preventive health checkup (all options) | • 100% UCR for insureds from 0 to 6 months of age, up to 5 visits |
| Treatment for Alzheimer’s disease | 100% UCR |
| Allergy treatment | 100% UCR |
| Physical therapy and rehabilitation | US$10,000 |
| Outpatient mental health | 100% UCR, max. of 30 visits |
The following benefits offer the same coverage for both inpatient and outpatient procedures.
| Description | Coverage |
|---|---|
| Emergency medical services | 100% UCR |
| Surgeon and anesthesiologist fees | 100% UCR |
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/ | 100% UCR |
| Highly specialized prescription medication | 100% UCR |
| Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication | 100% UCR |
| Surgery to reduce the risk of cancer or prophylactic surgery | US$30,000 per lifetime (after a 12-month waiting period) |
| Dialysis services | 100% UCR |
| Prostheses and medical appliances implanted during surgery | 100% UCR |
| Organ/tissue transplant | US$750,000 per lifetime |
| Durable medical equipment | 100% UCR |
| Specialized treatments: autism, sleep apnea and other sleep disorders | US$2,000 |
Congenital and/or hereditary conditions | US$2,000,000 per lifetime |
Congenital and/or hereditary conditions | 100% UCR |
| HIV-AIDS treatment | 100% UCR (after a 24-month waiting period) |
| HPV treatment and vaccine | US$5,000 per lifetime |
Gastric bypass bariatric surgery and any type of surgical procedure for | US$10,000 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 (covered by this plan) | Up to the benefit limit |
10-month Waiting Period.
| Description | Coverage |
|---|---|
| Maternity, cesarean or normal birth (options I and II) | Option I: |
| Maternity and newborn complications (options I, II, III and IV) | US$1,000,000, per lifetime after deductible |
| Inclusion of the newborn within 90 days after the birth (options I and II) | Without underwriting, if born in the policy, after the 10-month |
| Free coverage for dependents (options I and II) | Up to 5 years old for children born from a covered maternity* |
Provisional coverage for the newborn (born from a covered maternity) | Option I: |
*Included in the policy within 90 days from birth. After 90 days, premium payment will be required.
| Description | Coverage |
|---|---|
| Emergency transportation Ground ambulance | 100% UCR |
| Emergency transportation Air ambulance | 100% UCR, no deductible applies |
Cost of return ticket for the Insured and one companion after an | US$2,000 per person |
| Repatriation or cremation of mortal remains | US$20,000 |
| Description | Coverage |
|---|---|
| Treatment for injuries during the training or practice of hazardous hobbies and/or non-professional sports | US$250,000 |
| Emergency dental coverage | 100% UCR for treatment within the first 180 days of the |
| Palliative care | 100% UCR |
| Additional benefit for a covered critical illness | US$2,500 per person, per lifetime |
Free extended coverage for eligible dependents after the policyholder’s | 2 years |
Elimination/reduction of the policy deductible for no claims during the | Options I & II: |
| Second Medical Opinion VIP ® | Access to a second medical opinion of renowned experts from around |
| Description | Coverage |
|---|---|
| Travel VIP Light | Up to US$5,000 for emergency medical treatment while |
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.