SPECIAL VIP
Covers all your essential
health needs with an annual
coverage of US$3 million
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.
**Excludes Venezuela.
TABLE OF BENEFITS
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| Description | Coverage |
|---|---|
| Lifetime coverage | Unlimited |
| Maximum coverage per person, per policy year | US$3,000.000 |
| 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 • Inside the “Brazil Premium Providers” coverage will be at 50% |
| Coverage inside USA | • 100% UCR within the USA Special Network® • Outside the USA Special Network®, 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 policy limits |
| Description | Coverage |
|---|---|
| Standard hospital room | 100% UCR |
| Use of intensive care unit | 100% UCR |
| Companion accommodation expenses of a hospitalized insured | US$150 per night, max. of 30 nights |
| Prescribed medications while hospitalized | 100% UCR |
| Physical therapy and rehabilitation | 100% UCR |
| Description | Coverage |
|---|---|
| Emergency room care | 100% UCR |
| Physician and specialist visits | 100% UCR |
| Physician and specialist home visits (where available) | 100% UCR |
| Outpatient prescription medication | US$5,000 |
| Nurse or therapist care at home | US$15,000 |
| Preventive health checkup, no deductible applies (options I & II) | US$200 per insured (after a 12-month waiting period) |
| Treatment for Alzheimer’s disease | 100% UCR |
| Allergy treatment | 100% UCR |
| Physical therapy and rehabilitation | US$10,000 |
| 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 |
| Surgery to reduce the risk of cancer or prophylactic surgery | US$20,000 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$500,000 per lifetime Includes US$30,000 benefit for expenses of the live donor |
| Durable medical equipment | US$10,000 |
| Specialized treatments: autism, sleep apnea and other sleep disorders Specialized therapies: psychiatric and occupational | US$2,000 |
| Congenital and/or hereditary conditions diagnosed before age 18 | US$500,000 per lifetime |
| Congenital and/or hereditary conditions diagnosed after age 18 | US$2,000,000 per lifetime |
| HIV-AIDS treatment | US$250,000 per lifetime (after a 48-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 |
| Description | Coverage |
|---|---|
| Maternity and newborn complications (option I) | US$500,000, no deductible applies (After a 10-month waiting period) |
| Inclusion of the newborn within 90 days after the birth (option I) | Without underwriting, if born in the policy, after the 10-month waiting period |
| 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 | US$500 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 thecovered accident |
| Palliative care | 100% UCR |
| Temporary coverage for accidents while 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 | 1 year |
| 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 |
| Travel VIP Light | Up to US$5,000 for emergency medical treatment while traveling abroad (with rider) |