DIRECT 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 | Unlimited |
| Maximum coverage per person, per policy year | US$5,000,000 |
| 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 |
|---|---|
| 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 care | 100% UCR (if admitted immediately as an inpatient) |
| Surgeon and anesthesiologist fees | 100% UCR |
| Companion accommodation expenses of a hospitalized insured | 100% UCR max of 21 nights |
| Prescribed medications while hospitalized | 100% UCR |
| Prescribed medications following a hospitalization or outpatient surgery | US$7,000 per policy year |
| Inpatient mental health treatment and medication | US$5,000 |
| Dialysis / hemodialysis services | 100% UCR |
| Laboratory tests and X-rays | 100% UCR |
| Oncology: cancer treatment (chemotherapy and/or radiotherapy) | 100% UCR |
| Physician and specialist visits | 100% UCR |
| Physical therapy and rehabilitation | 100% UCR (during a hospitalization) |
| Prostheses and medical appliances implanted during surgery | 100% 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 treatment | US$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 medication | US$10,000 per lifetime (after a 24-month waiting period) |
| Description | Coverage |
|---|---|
| Emergency room care for an emergency physical trauma or accident only in latin amerca | 100% UCR |
| Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication | 100% UCR |
| Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc.) Pre-surgical testing only. Pre-authorization required | US$15,000 per policy year |
| Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc.) following a hospitalization | US$10,000 per policy year |
| Dialysis / hemodialysis services | 100% UCR |
| Physician visits for pre-hospitalization and as a follow up to a covered hospitalization | US$6,000 per policy year, up to 10 months from the date of discharge |
| Outpatient surgery | 100% UCR |
| Physical therapy and rehabilitation | 100% UCR, max. of 60 visits (following a covered hospitalization) |
| Treatment for Alzheimer’s disease | 100% UCR |
| Description | Coverage |
|---|---|
| Preventive health checkup, no deductible applies | Options 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 18 | US$2,000,000 per lifetime |
| Congenital and/or hereditary conditions diagnosed after age 18 | 100% UCR |
| Specialized treatments: autism and psychiatry Specialized therapies: occupational | US$2,500 |
| Durable medical equipment | 100% UCR (as follow-up care to a covered hospitalization) |
| 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 |
| Emergency dental coverage | 100% UCR for treatment within the first 180 days of the covered accident |
| Emergency transportation by air ambulance | 100% UCR, no deductible applies |
| Emergency transportation by ground ambulance | 100% UCR, no deductible applies (if admitted immediately as an inpatient) |
| Nurse or therapist care at home | 100% UCR (as follow-up care to a covered hospitalization) |
| Palliative care | 100% UCR |
| Repatriation or cremation of mortal remains | US$25,000 |
| Treatment for injuries during the training or practice of hazardous hobbies and/or non-professional sports | 100% UCR |
| Treatment for injuries during the training or practice of non-hazardous professional sports | 100% UCR |
| Temporary coverage for accidents while application is being underwritten | US$30,000 |
| 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 |
| 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 VIP | Access to a second medical opinion of renowned experts from around the world, no deductible applies |
| Description | Coverage |
|---|---|
| Emergency coverage when traveling abroad | Up 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.