ABSOLUTE VIP CHOICE
Our most innovative and
comprehensive plan for all
your health needs
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 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 Conditions of Coverage of the policy.
TABLE OF BENEFITS
| Description | Coverage |
|---|---|
| Lifetime coverage | Unilimited |
| Maximum coverage per person, per policy year | Unlimited |
| Maximum age to apply for coverage | Up to 75 years old |
| Waiting Period | 30 days |
| Geographical coverage | Worldwide, without restrictions of doctors and hospitals |
| Description | Coverage |
|---|---|
| Private hospital room | 100% UCR |
| Special benefit for suite accommodation (subject to availability) | Up to US$3,000 per day within the USA Special Network® |
| Use of intensive care unit | 100% UCR |
| Companion accommodation expenses of a hospitalized insured | 100% UCR, max. of 21 nights |
| Prescribed medications while hospitalized and following a hospitalization or outpatient surgery | 100% UCR |
| Inpatient mental health treatment | 100% UCR, max of 30 days |
| Description | Coverage |
|---|---|
| Emergency room care | 100% UCR |
| Physician and specialist visits | 100% UCR |
| Physician and specialist home visits (where available) | 100% UCR |
| Outpatient or non-hospitalization prescription medication | 100% UCR |
| Complementary therapy: chiropractic, psychiatric, speech, occupational, osteopathy and/or acupuncture | 100% UCR up to 100 visits, all therapies combined |
| Nurse or therapist care at home | 100% UCR |
| Preventive health checkup, per insured, no deductible applies (options I, II, III & IV) | 100% UCR from 0 to 6 months of age, up to 6 visits US$600 per policy year from 6 months to 17 years of age, including up to US$75 for preventive dental checkup in options I & II US$800 per policy year from 18 years of age and older, including up to US$75 for preventive dental checkup in options I & II |
| Hearing aids | US$3,000 per lifetime |
| Treatment for Alzheimer’s disease | 100% UCR |
| Autism treatment | 100% UCR if the insured was born in the policy under a covered maternity US$10,000 for insureds not born under a covered maternity, and who developed the condition while they were insured |
| Allergy treatment | 100% UCR |
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/PET scans) | 100% UCR |
| Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication | 100% UCR |
| Prophylactic surgery to reduce the risk of cancer | 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 transplant (per organ/tissue) | US$3,000,000 per lifetime Includes US$80,000 benefit for expenses of the live donor |
| Durable medical equipment | 100% UCR |
| Physical therapy and rehabilitation | 100% UCR |
| Specialized treatments: sleep apnea and other sleep disorders | US$4,000 |
| Congenital and/or hereditary conditions (including US$40,000 for cochlear implants) diagnosed before age 18 | US$2,000,000 per lifetime |
| Congenital and/or hereditary conditions (including US$40,000 for cochlear implants) diagnosed after age 18 | 100% UCR |
| HIV-AIDS treatment | US$1,000,000 per lifetime (after a 24-month waiting period) |
| Gastric bypass bariatric surgery and any type of surgical procedure for weight loss, its complications or treatments, and/or weight loss medication | US$15,000 per lifetime (after a 24-month waiting period) |
| Treatments of symptomatic foot disorders (after a 24-month waiting period) | 100% UCR for surgical treatments of the feet US$15,000 per lifetime for foot-related illnesses treatment such as Morton's neuroma, bunions (hallux valgus), hammer toe, and plantar fasciitis |
| Reconstructive surgery | Up to the maximum benefit |
| Psychology | US$5,000 |
| Mental health prescription medication (inpatient and/or outpatient) | US$5,000 |
10-month waiting period, no deductible applies.
| Description | Coverage |
|---|---|
| Maternity | Option I: • US$10,000, no deductible applies Option II: • US$10,000 after deductible Includes deliveries for pregnancies that are a result of any type of fertility treatments |
| Extraction and storage of newborn stem cells (option I) | US$2,000 per covered delivery |
| Maternity and newborn complications (option I) | US$1,000,000 per lifetime, no deductible applies |
| Inclusion of the newborn within 90 days after the birth (options I & II) | Without underwriting, if born from a covered maternity |
| Free coverage for dependents up to 10 years old (option I) Included in the policy within 90 days from birth. After 90 days, premium payment will be required. | • Max. of 2 children born from a covered maternity, if both parents are insured in the policy • Max. of 1 child born from a covered maternity, if only the mother is insured in the policy |
| Fertility treatment (option I)** | US$5,000 per lifetime, after deductible (after a 24-month waiting period) |
*Included in the policy within 90 days from birth. After 90 days, premium payment will be required.
**The coverage of these treatments does not exonerate the insured from the exclusions related to a pregnancy resulting from them, as detailed in the policy.
| Description | Coverage |
|---|---|
| Emergency transportation by ground ambulance | 100% UCR, no deductible applies |
| Emergency transportation by air ambulance | 100% UCR , no deductible applies |
| Cost of return ticket for the insured and one companion after an evacuation by air ambulance | Up to US$2,000 per ticket |
| Repatriation or cremation of mortal remains | 100% UCR |
| Description | Coverage |
|---|---|
| Treatment for injuries during the training or practice of hazardous hobbies and/or professional sports | 100% UCR |
| Emergency dental coverage | 100% UCR for treatment within the first 180 days of the covered accident |
| Refractive eye surgery | US$1.500 per eye, per lifetime (after a 24-month waiting period) |
| Palliative care | 100% UCR |
| Temporary coverage for accidents while the application is being underwritten | US$30,000 |
| Free extended coverage for eligible dependents after the policyholder’s death as a result of a covered accident or condition | 2 years |
| Elimination of deductible in case of a serious accident (all options) | Elimination of the annual deductible for the first hospital urgent treatment that requires a hospitalization within the first 24 hours after the serious accident |
| Second Medical Opinion VIP® | Access to a second medical opinion of renowned experts from aroundthe world, no deductible applies |
| Travel VIP Light | Up to US$5,000 for emergency medical treatment while traveling abroad (with rider) |
| Description | Coverage |
|---|---|
| Maternity and birth complications (option II) | US$500,000 per lifetime, after deductible |
| Emergency coverage when traveling abroad | Up to US$5,000 for emergency medical treatment |
*Coverage subject to the purchase of the riders.