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 IOption IIOption IIIOption IVOption V
US$2,000US$5,000US$10,000US$20,000US$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

DescriptionCoverage
Lifetime coverage Unlimited
Maximum coverage per person, per policy yearUS$5,000,000
Age limit to applyUp to 75 years old
Waiting period30 days
Coverage outside USA

• 100% UCR with free choice of hospitals and doctors

Coverage inside USA

• 100% UCR within the USA Special Network ®
• Outside the USA Special Network®
, coverage will be at 80%, 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
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 hospitalized100% UCR
Physical therapy and rehabilitation 100% UCR
Private duty nursing100% UCR, max. of 100 days per policy year
Inpatient mental health treatment (psychiatric hospitalization)100% UCR, max. of 30 days per policy year
DescriptionCoverage
Emergency room care100% UCR
Physician and specialist visits100% UCR
Physician and specialist home visits (where available) 100% UCR

Prescription medication following a hospitalization or outpatient
surgery

100% UCR for up to 6 months
Outpatient prescription medication US$3,000

Complementary therapy: chiropractic, speech, occupational, osteopathy
and/or acupuncture

100% UCR, max. of 80 visits combined per policy year
Nurse or therapist care at home100% 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
• US$600 per policy year for insureds from 6 months and older

Treatment for Alzheimer’s disease100% UCR
Allergy treatment100% UCR
Physical therapy and rehabilitationUS$10,000
Outpatient mental health100% UCR, max. of 30 visits

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

DescriptionCoverage
Emergency medical services100% UCR
Surgeon and anesthesiologist fees 100% UCR

Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/
PET scans)

100% UCR
Highly specialized prescription medication100% UCR
Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication 100% UCR
Surgery to reduce the risk of cancer or prophylactic surgeryUS$30,000 per lifetime (after a 12-month waiting period)
Dialysis services100% UCR
Prostheses and medical appliances implanted during surgery100% UCR
Organ/tissue transplant

US$750,000 per lifetime
Includes US$40,000 benefit for expenses of the live donor

Durable medical equipment 100% UCR
Specialized treatments: autism, sleep apnea and other sleep disordersUS$2,000

Congenital and/or hereditary conditions
Diagnosed before age 18

US$2,000,000 per lifetime

Congenital and/or hereditary conditions
Diagnosed after age 18

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
weight loss and its complications or treatments

US$10,000 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 (covered by this plan)Up to the benefit limit

10-month Waiting Period.

DescriptionCoverage
Maternity, cesarean or normal birth (options I and II)

Option I:
• US$8,500, no deductible applies
Option II:
• US$8,500, after deductible

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
waiting period

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)
(options I and II)

Option I:
• US$5,000 per pregnancy, max. of 90 days, no deductible applies
Option II:
• US$5,000 per pregnancy, max. of 90 days, after deductible

*Included in the policy within 90 days from birth. After 90 days, premium payment will be required.

DescriptionCoverage
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
evacuation by air ambulance

US$2,000 per person
Repatriation or cremation of mortal remainsUS$20,000
DescriptionCoverage
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
covered accident

Palliative care100% 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
death as a result of a covered accident or condition

2 years

Elimination/reduction of the policy deductible for no claims during the
last 3 years

Options I & II:
• 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 III & IV:
• Reduction of 50% of the deductible for 1 year after the 3rd year
without claims

Second Medical Opinion VIP ®

Access to a second medical opinion of renowned experts from around
the world, no deductible applies

DescriptionCoverage
Travel VIP Light

Up to US$5,000 for emergency medical treatment while
traveling abroad

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.