OPTIMUM VIP

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

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General Plan Information

All benefits described only apply to the medical conditions specified under Covered Conditions)

DescriptionCoverage
Lifetime coverageUnlimited
Maximum coverage per person, per policy yearUS$1,000,000
Maximum age to apply for coverageUp to 75 years old
Waiting period30 days
Coverage outside USA100% UCR with free choice of hospitals and doctors
Coverage inside USA• 100% UCR within the USA Special Network®
• Outside the USA Special Network®, the coverage will be at 60%, 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 benefits limits

Covered Conditions

DescriptionCoverage
Neurological diseases (including cerebrovascular accidents)US$150,000 per policy year
Cardiac surgery for revascularization and angioplasty US$150,000 per policy year
Cancer (tests, medication, chemotherapy, radiotherapy, surgery for tumor and reconstructive surgery)US$200,000 per policy year
Polytrauma (including rehabilitation) US$200,000 per policy year
Chronic kidney failure (dialysis or hemodialysis) US$150,000 per policy year
Severe burns (including reconstructive surgery) US$300,000 per policy year
SepticemiaUS$150,000 per policy year
Organ and tissue transplantUS$500,000 per insured, per lifetime
Includes US$50,000 benefit for expenses of the live donor

Inpatient Benefits

All benefits described only apply to the medical conditions specified under Covered Conditions)

DescriptionCoverage
Standard hospital room100% UCR
Use of intensive care unit100% UCR
Companion accommodation expenses of a hospitalized insured 100% UCR, max. of 21 nights
Prescribed medications while hospitalized 100% UCR for covered conditions
Physical therapy and rehabilitation100% UCR for covered conditions

Outpatient Benefits

All benefits described only apply to the medical conditions specified under Covered Conditions)

DescriptionCoverage
Emergency room care100% UCR
Physician and specialist visits100% UCR for covered conditions
Physician and specialist home visits (where available)100% UCR for covered conditions
Outpatient prescription medicationUS$5,000 per policy year for covered conditions
Nurse or therapist care at homeUS$7,000 per policy year for covered conditions
Physical therapy and rehabilitationUS$7,000 per policy year for covered conditions

General Benefits For Inpatient And Outpatient Procedures

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

All benefits described only apply to the medical conditions specified under Covered Conditions)

DescriptionCoverage
Surgeon and anesthesiologist fees100% UCR for covered conditions
Diagnostic study services (laboratory tests, biopsies, X-rays, MRI/CT/PET scans) 100% UCR for covered conditions
Durable medical equipmentUS$7,000 per policy year for covered conditions
Congenital and/or hereditary conditions diagnosed before age 1810% UCR of the benefit for covered conditions, per lifetime
Congenital and/or hereditary conditions diagnosed after age 1850% UCR of the benefit for covered conditions, per lifetime
Reconstructive surgery after an accident or illness (covered by this plan)Up to the maximum benefit

Medical Evacuation Benefits

All benefits described only apply to the medical conditions specified under Covered Conditions)

DescriptionCoverage
Emergency transportation by ground ambulance100% UCR for covered conditions, no deductible applies
Emergency transportation by air ambulance US$30,000 for covered conditions, no deductible applies
Repatriation or cremation of mortal remainsUS$10,000

Other Benefits

All benefits described only apply to the medical conditions specified under Covered Conditions)

DescriptionCoverage
Treatment for injuries during the training or practice of hazardous hobbies and/or non-professional sportsUS$100,000 per lifetime for polytrauma or severe burns
Palliative care100% UCR for covered conditions
Temporary coverage for polytrauma while application is being underwrittenUS$30,000
Second Medical Opinion VIP®Access to a second medical opinion of renowned experts from around the world, no deductible applies

Optional Additional Benefits (Riders)

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.