DIRECT VIP CHOICE

Our most innovative and
comprehensive plan for all
your health needs

DEDUCTIBLE OPTIONS*

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

DescriptionCoverage
Lifetime coverageUnlimited
Maximum coverage per person, per policy yearUS$5,000,000
Maximum age to apply for coverageUp to 75 years old
Waiting period30 days
Geographical coverageWorldwide without restrictions of doctors and hospitals
DescriptionCoverage
Standard private/semi-private hospital room• 100% UCR
• Outside of USA Special Network® : US$2,000 per day
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
• Outside of USA Special Network®: US$4,000 per day
Emergency room care100% UCR (if admitted immediately as an inpatient)
Surgeon and anesthesiologist fees100% UCR
Companion accommodation expenses of a hospitalized insured100% UCR max of 21 nights
Prescribed medications while hospitalized100% UCR
Prescribed medications following a hospitalization or outpatient surgeryUS$7,000 per policy year
Inpatient mental health treatment and medicationUS$5,000
Dialysis / hemodialysis services100% UCR
Laboratory tests and X-rays100% UCR
Oncology: cancer treatment (chemotherapy and/or radiotherapy)100% UCR
Physician and specialist visits100% UCR
Physical therapy and rehabilitation100% UCR (during a hospitalization)
Prostheses and medical appliances implanted during surgery100% UCR
Organ transplant (per organ/tissue)US$1,100,000 per lifetime
Includes US$60,000 benefit for expenses of the live donor
HIV/AIDS treatmentUS$50,000 per policy year (only if admitted as an inpatient and after a 12-month waiting period)
Gastric bypass bariatric surgery and any type of surgical procedure for weight loss, its complications or treatments, and/or weight loss medicationUS$10,000 per lifetime (after a 24-month waiting period)
DescriptionCoverage
Emergency room care for an emergency or accident only in Latin America100% UCR
Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication100% UCR
Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc.) Pre-surgical testing only. Pre-authorization requiredUS$15,000 per policy year
Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc.) following a hospitalizationUS$10,000 per policy year
Dialysis / hemodialysis services100% UCR
Physician visits for pre-hospitalization and as a follow up to a covered hospitalizationUS$6,000 per policy year, up to 10 months from the date of discharge
Outpatient surgery100% UCR
Physical therapy and rehabilitation100% UCR, max. of 60 visits (following a covered hospitalization)
Treatment for Alzheimer’s disease100% UCR
DescriptionCoverage
Preventive health checkup, no deductible appliesOptions I & II:
• 100% UCR for insureds from 0 to 6 months of age,up to 5 visits
• US$600 per policy year for insureds from 6 monthsto 17 years of age
• US$600 per policy year for insureds from 18 years of ageand older

Options III & IV:
• US$600 per policy year for all ages
Congenital and/or hereditary conditions diagnosed before age 18US$2,000,000 per lifetime
Congenital and/or hereditary conditions diagnosed after age 18100% UCR
Specialized treatments: autism and psychiatry
Specialized therapies: occupational
US$2,500
Durable medical equipment100% UCR (as follow-up care to a covered hospitalization)
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
Emergency dental coverage100% UCR for treatment within the first 180 days of the covered accident
Emergency transportation by air ambulance100% UCR, no deductible applies
Emergency transportation by ground ambulance100% UCR, no deductible applies (if admitted immediately as an inpatient)
Nurse or therapist care at home100% UCR (as follow-up care to a covered hospitalization)
Palliative care100% UCR
Repatriation or cremation of mortal remainsUS$25,000
Treatment for injuries during the training or practice of hazardous hobbies and/or non-professional sports100% UCR
Treatment for injuries during the training or practice of non-hazardous professional sports100% UCR
Temporary coverage for accidents while application is being underwrittenUS$30,000
Elimination/reduction of the policy deductible for no claims during the last 3 yearsOptions 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
Elimination of deductible in case of a serious accident (options I & II)Elimination of the annual deductible for the first hospital treatment that requires a hospitalization within the first 24 hours after the serious accident
Second Medical Opinion VIPAccess to a second medical opinion of renowned experts from around the world, no deductible applies
DescriptionCoverage
Emergency coverage when traveling abroadUp to US$5,000 for emergency medical treatment

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.