| A
In-Patient & Day-Patient Treatment |
| | | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | | 1 | Surgery, Surgeons, Consultants, Second Surgical Opinion, Medical Practitioners, Nurses, Treatment, Services and Supplies routinely provided and Ancillary Charges | Full Cover | Full Cover | Full Cover | Full Cover | Full cover | | 2 | Hospitalisation/Room & Board | Up to $600 / £350 /€400 per day 240 day Maximum | Up to $2,250 / £1,250 / €1,500 per day | | | 3 | Intensive Care Unit | Up to $1,500 / £850 / €1,000 per day – 180 day per event | Up to $4,500 / £2,500 / €3,000 per day | | 4 | Anaesthetist’s Charges associated with Surgery | 20% of Surgery Benefit | 20% of Surgery Benefit | | 5 | Diagnostic Tests and Procedures, X-Rays, Pathology, & MRI/CT Scans | Full Cover | Full Cover | | 6 | Prescribed Drugs, Dressings and Durable Medical Equipment | | 7 | Reconstructive Surgery-following an accident or following surgery for an eligible condition | | 8 | Cancer Tests, Drugs, Treatment and Consultants, including cover for Chemotherapy and Radiotherapy | FULL COVER Except: Radiation & Chemotherapy Treatments (In and Out-patient) limited to $10,000 / £5,500 / €6,700 with a $50,000 / £27,500 / €33,500 Lifetime Limit | | 9 | Physiotherapy | Full Cover | | 10 | Parental Hospital Accommodation | | 11 | Prosthetic Devices | | 12 | Transplants | $250,000/
£137,500 / €167,500 Per Transplant | $1,000,000 / £550,000 / €670,000 Lifetime Limit | $500,000 / £275,000 / €335,000 Lifetime Limit | $1,000,000 / £550,000 / €670,000 Lifetime Limit | $2,000,000 / £1,100,000 / €1,340,000 Lifetime Limit | |
| B
Out-Patient Treatment, Wellness Benefits and Other Coverages |
| | | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | | 1 | Out-Patient including: Family Doctor, Treatment and Referrals, Specialists and Consultants, X-Rays, Pathology, Diagnostic Tests and Procedures | 25 Visit Maximum Maximums Per Visit/Examination: $70/ £40 / €50 Doctor/Specialist; $60 / £35 / €40 Psychiatrist; $50 / £30 / €35 Chiropractor; $250 / £140 / €170 X-Ray per Examination Maximum Limit; $500 / £275 / €335 Surgery Intervention Consultation; $300 / £165 / €200 Lab Tests per Examination Maximum Limit | Full Cover | FULL COVER Except: $150 / £85 / €100 Physician Charges Maximum per Visit; Hospital Charge $100 / £55 / €67 Co-Pay unless admitted; Urgent Care Facility - $25 / £15 / €20 Co-Pay; Diagnostic Lab and X-Rays limited to $5,000 / £2,750 / €3,350 per Period of Insurance | Full Cover | Full Cover | | 2 | Emergency Room Illness, Waived if admitted as an In-Patient or Day-Patient (Additional $250/£138/€168 Excess if not admitted) | Full Cover | Full Cover | | 3 | Emergency Room Accident | | 4 | Supplemental Accident Benefit | No Cover | $300 / £165 / €200 per covered accident | $300 / £165 / €200 per covered accident | $300 / £165 / €200 per covered accident | $500 / £275 / €335 per covered accident | | 5 | Supplemental Accident Benefit Out-Patient Surgery | Full Cover | Full Cover | Full Cover | Full Cover | Full Cover | | 6 | MRI, CAT Scan Echocardiography, Endoscopy, Gastroscopy Colonoscopy, Cystoscopy | $600 / £330 /€400 Maximum Per Examination | | 7 | Cancer Tests, Drugs, Treatment and Consultants, including cover for Chemotherapy and Radiotherapy | | FULL COVER Except: Radiation & Chemotherapy Treatments (in and out-patient) limited to $10,000 / £5,500 / €6,700 with a $50,000 / £27,500 / €33,500 Lifetime Limit | | 8 | Prescribed Out-Patient Drugs, Medicines, Dressings and Durable Medical Equipment | Up to $5,000 / £2,750 / €3,350 | Outside U.S. : FULL COVER Inside U.S. : FULL COVER and must use the Out-Patient Prescription Drug Card. A Co-Pay:$20 for generic, $40 for brand name where generic is not available and Not Subject to Annual Excess or Co-Insurance when using the Out-Patient Prescription Drug Card. No coverage if the Out-Patient Prescription Drug Card is not used | | 9 | Physiotherapy, Homeopathic and Osteopathic Therapy | Up to $40 / £25 / €30 per visit 30 visit Maximum | Up to $50 / £30 / €35 per visit Maximum of 1 visit per day 45 visit Maximum | Up to $50 / £30 / €35 per visit Maximum of 1 visit per day 30 visit Maximum Up to $1,000 / £550 / €670 per Period of Insurance $10,000 / £5,500 / €6,700 Lifetime Limit | Up to $50 / £30 / €35 per visit Maximum of 1 visit per day 45 visit Maximum | Up to $50 / £30 / €35 per visit Maximum of 1 visit per day 60 visit Maximum | | 10 | Complementary Medicine Acupuncture, Aroma Therapy, Herbal Therapy, Magnetic Therapy, assage Therapy, Vitamin, Therapy, Traditional Chinese Medicine | No Cover | Up to $200 / £110 / €135 | Up to $200 / £110 / €135 | Up to $200 / £110 / €135 | Up to $200 / £110 / €135 | | 11 | AIDS/HIV Treatment | No Cover | Up to $5,000 / £2,750 / €3,350 per Period of Insurance $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $5,000 / £2,750 / €3,350 per Period of Insurance $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $5,000 / £2,750 / €3,350 per Period of Insurance $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $5,000 / £2,750 / €3,350 per Period of Insurance $50,000 / £27,500 / €33,500 Lifetime Limit | | 12 | Home Nursing Care | 30 Days Limit: Up to $150 / £85/ €100 per vi | 45 Days Limit: Up to $150 / £85 / €100 per visit | 30 Days Limit : Up to $150 / £85/ €100 per visit | 45 Days Limit : Up to $150 / £85/ €100 per visit | 60 Days Limit : Up to $150 / £85/ €100 per visit | | 13 | Rehabilitation | No Cover | Full Cover Up to 90 Days | Full Cover Up to 45 Days | Full Cover Up to 90 Days | Full Cover Up to 180 Days | | 14 | Extended Care Facility | Full Cover Up to 30 Days | Full Cover Up to 90 Days | | 15 | Hospice Care | No Cover | Full Cover Up to 180 Days | Full Cover Up to 180 Days | | 16 | Adult Wellness and Health Check
- includes Hearing Test, Sight Test and Vaccinations/Inoculations
(Not subject to Annual Excess or Co-Insurance)
- After 12 months continuous coverage (6 months on Platinum) | Up to $250 / £140 / €170 Available for those 30 years of age and over | Up to $250 / £140 / €170 Available for those 30 years of age and over | Up to $250 / £140 / €170 Available for those 30 years of age and over | Up to $500 / £275 / €335 Available for those 18 years of age and over | | 17 | Child Wellness and Health Check (Under 18 years of age)
- includes Hearing Test, Sight Test and Vaccinations/Inoculations
(Not subject to Annual Excess or Co-Insurance)
- After 12 months continuous coverage (6 months on Platinum) | 3 visits per Period of Insurance Up to $70 / £40 / €50 per visit | Up to $200 /£110 / €135 | Up to $200 /£110 / €135 | Up to $200 /£110 / €135 | Up to $400 / £220 / €270 | | 18 | Pre-Existing Medical Conditions Standard Underwriting: - After 24 months continuous cover - Declared and Accepted conditions (unless otherwise excluded or terms applied as indicated otherwise in writing)
- Flexible Underwriting Option available – refer Flexible Underwriting page for detail. | Up to $5,000 / £2,750 / €3,350 $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $5,000 / £2,750 / €3,350 $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $5,000 / £2,750 / €3,350 $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $5,000 / £2,750 / €3,350 $50,000 / £27,500 / €33,500 Lifetime Limit | Full Cover No requirement for 24 months continuous cover | | 19 | Newly Diagnosed Chronic Conditions | Covered | Covered | Covered | Covered | Covered | | 20 | Mental/Nervous - After 12 months continuous coverage | Out-Patient Only - See Section B1 | Up to $10,000 / £5,500 / €6,700 $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $2,500 / £1,375 / €1,675 25 days In-Patient Limit 20 visit Out-Patient Limit at 70% eligible expenses, up to $75 / £42 / €51 per visit; $30,000 / £16,500 / €20,100 Lifetime Limit | Up to $10,000 / £5,500 / €6,700 $50,000 / £27,500 / €33,500 Lifetime Limit | Up to $50,000 / £27,500 / €33,500 Lifetime Limit | |
| C
Travel, Transportation and Out Of Area Benefits |
| | | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | | 1 | Emergency Local Ambulance | Up to $1,500 /£825 / €1000 per event Not subject to Annual Excess or Co-Insurance | Full Cover | Up to $100 / £55 / €70 per event Not subject to Annual Excess or Co-Insurance | Full Cover | Full Cover | | 2 | Emergency Evacuation and Transportation To the Nearest Suitable Hospital Facility | Up to $50,000 / £27,500 / €33,500 Not subject to Annual Excess or Co-Insurance | FULL COVER Not subject to Annual Excess or Co-Insurance | Up to $250,000 / £137,500 / €167,500 | FULL COVER Not subject to Annual Excess or Co-Insurance | FULL COVER Not subject to Annual Excess or Co-Insurance | | 3 | Accompanying Relative, Travel and Accommodation | No Cover | $10,000 / £5,500 / €6,700 Lifetime Limit | $10,000 / £5,500 / €6,700 Lifetime Limit | $10,000 / £5,500 / €6,700 Lifetime Limit | $10,000 / £5,500 / €6,700 Lifetime Limit | | 4 | Cremation/Burial or Return of Mortal Remains | $25,000 / £13,750 / €16,750 Lifetime Limit Not subject to Annual Excess or Co-Insurance | $25,000 / £13,750 / €16,750 Lifetime Limit Not subject to Annual Excess or Co-Insurance | $15,000 / £8,250 / €10,050 Lifetime Limit Not subject to Annual Excess or Co-Insurance | $25,000 / £13,750 / €16,750 Lifetime Limit Not subject to Annual Excess or Co-Insurance | $50,000 / £27,500 / €33,500 Lifetime Limit Not subject to Annual Excess or Co-Insurance | | 5 | Remote Transportation - for additional transport for on-going Treatment once stabilised | No Cover | No Cover | No Cover | No Cover | Up to $5,000 / £2,750 / €3,350 $20,000 / £11,000 / €13,400 Lifetime Limit | | 6 | Security & Political Evacuation & Repatriation | $10,000 / £5,500 / €6,700 Lifetime Limit | | 7 | Worldwide Accident & Emergency Out of Area Coverage (USA Treatment Must Be within PPO Network) | 30 Days Maximum | 30 Days Maximum | 30 Days Maximum | 30 Days Maximum | 30 Days Maximum | |
| D
Dental Benefits |
| | | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | | 1 | Emergency Dental Due to Accident | Up to $1,000 / £550 / €670 | Full Cover | Up to $500 / £275 / €345 | Full Cover | Full Cover | | 2 | Emergency Dental due to Sudden Unexpected Pain To Sound Natural Teeth | No Cover | Up to $100 / £55 / €70 | Up to $100 / £55 / €70 | Up to $100 / £55 / €70 | See Non-Emergency Dental Benefits | | 3 | Non-Emergency Dental Sections D3, D4 & D5 Combined: i) Calendar Year Maximum Sum Insured ii) Dental Annual Excess iii) Maximum Annual Excesses per Family per Calendar Year - After 6 months continuous cover | No Cover | No Cover | No Cover | i) $750 /£425 /€500; ii) $50 / £30 / €35 iii) 2 | | 4 | Class I Treatment*: - Preventative & Diagnostic - Emergency Palliative Treatment. - After 6 months continuous cover * Refer To Policy Wording for Full Details & Listing | 90% Coverage, Dental Annual Excess Waived | | 5 | Class II Treatment*: - Radiographs & X-Rays - Oral Surgery & Extractions - Routine Compound Fillings, Restorations, Re-cementing crowns, inlays and bridges & Prosthetic Repairs - Endodontics & Root Canals - Periodontics & Gum Disease - Minor Restorative Services - After 6 months continuous cover * Refer To Policy Wording for Full Details & Listing | 70% Coverage, after Dental Annual Excess | | 6 | Class III Treatment*: - Prosthodontic Services including: appliances, bridges, full and partial dentures that replace missing natural teeth that were extracted while the person is covered with this Plan. - Major Restorative Treatment including: Crowns, Jackets, gold-related services required when teeth can not be restored using other filling material. - After 6 months continuous cover * Refer To Policy Wording for Full Details & Listing | 50% Coverage, after Dental Annual Excess | |
| E
Additional Benefits & Services |
| | | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | | 1 | High School Sports Injury | No Cover | No Cover | No Cover | No Cover | Up to $20,000 / £11,000 / €13,400 | | 2 | Recreational Scuba | No Cover | Full Cover | Full Cover | Full Cover | | 3 | Vision Care
Not subject to Annual Excess or Co-Insurance (Benefit payable per 24 months) | No Cover | No Cover | No Cover | Exams – up to $100 / £55 / €67 Materials – up to $150 / £85 / €100 | | 4 | Medical Information Service | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Included | | 5 | Global Concierge & Assistance Services | |
| F
Maternity |
| | | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | Maternity - Only available to Female Insureds - After 10 months of continuous cover
*All benefits reduced by 50% for births occurring in the 11th or 12th month of continuous coverage | Optional Add-On Coverage
Additional Premium Applies* | Optional Add-On Coverage
Additional Premium Applies* | Optional Add-On Coverage
Additional Premium Applies* | Optional Add-On Coverage
Additional Premium Applies* | Maternity Coverage Included – See Below | | Maternity Annual Excess | Section F1 & F2 : Not subject to Annual Excess or Co-Insurance | Section F1 & F2 : Not subject to Annual Excess or Co-Insurance | Section F1 & F2 : Not subject to Annual Excess or Co-Insurance | Section F1 & F2 : Not subject to Annual Excess or Co-Insurance | $1,000 / £550 / €670 Maternity Annual Excess (Annual Excess Does Not Apply) | | Lifetime Maximum | *$50,000 / £27,500 / €33,500 Lifetime Limit | *$50,000 / £27,500 / €33,500 Lifetime Limit | *$50,000 / £27,500 / €33,500 Lifetime Limit | *$50,000 / £27,500 / €33,500 Lifetime Limit | *$50,000 / £27,500 / €33,500 Lifetime Limit | | 1 | Normal Delivery - Including Premature Birth Treatment, Pre, Post and Routine Natal Care | *Up to $5000 / £2750 /€3350 | *Up to $5000 / £2750 /€3350 | *Up to $5000 / £2750 /€3350 | *Up to $5000 / £2750 /€3350 | Included within and up to Lifetime Limit | | 2 | C-Section | *Up to $7500 / £4125 / €5025 | *Up to $7500 / £4125 / €5025 | *Up to $7500 / £4125 / €5025 | *Up to $7500 / £4125 / €5025 | | 3 | New Born Baby Wellness
- Not subject to Annual or Annual Maternity Excess or Co-Insurance
- for the first 12 months of life | $200 /£110 / €134 | $200 /£110 / €134 | $200 /£110 / €134 | $200 /£110 / €134 | $200 /£110 / €134 | | 4 | Cover for New Borns including non-hereditary birth defects and congenital abnormalities | *Up to $250,000 / £137,500 / €167,500 for the first 31 days | *Up to $250,000 / £137,500 / €167,500 for the first 31 days | *Up to $250,000 / £137,500 / €167,500 for the first 31 days | *Up to $250,000 / £137,500 / €167,500 for the first 31 days | *Up to $250,000 / £137,500 / €167,500 for the first 31 days | |
| Optional Add-On Coverages |
| | (Upon selection at initial Application and subject to additional premium) | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | Terrorism Coverage Add-On
Increases coverage from $10,000 / £5,500 / €6,700 Lifetime Limit to: | Not Applicable | Not Applicable | Not Applicable | Not Applicable | $50,000 / £27,500 / €33,500 Lifetime Limit | Sports Coverage* Coverage Add-On
i) Listed Extreme Sports
ii) Amateur Sports *Non-Professional | Not Applicable | Not Applicable | Not Applicable | Not Applicable | i) $25,000 / £13,750 / €16,750 Lifetime Limits
ii) $10,000 / £5,500 / €6,700 Lifetime Limit | |
| Annual Excess and Co-Insurance |
| | | Silver | Gold (1st 36 months of continuous coverage) | Gold (Beginning the 1st day of the 37th month) | Gold Plus | Platinum | Annual Excess Options
- Per Insured Person, Per Period of Insurance | $250 to $10,000, £138 to £5,500, €168 to €6,700 | $250 to $10,000, £138 to £5,500, €168 to €6,700 | $250 to $10,000, £138 to £5,500, €168 to €6,700 | $250 to $10,000, £138 to £5,500, €168 to €6,700 | $100 to $10,000, £55 to £5,500, €67 to €6,700 | | 50% waived (up to a maximum reduction of $2,500 / £1,375 / €1,675) for: USA PPO Out-Patient & Emergency In-Patient Treatment & Non-Emergency In-Patient USA Medical Concierge Provider Treatment | | Family Maximum Annual Excesses | 3 x Individual Annual Excess | 3 x Individual Annual Excess | 3 x Individual Annual Excess | 3 x Individual Annual Excess | 2 x Individual Annual Excess | | Annual Excess Carry Forward - If prior Annual Excess not met, then last 30 days Expenses from the previous Period of Insurance are carried forward and applied towards satisfying the Annual Excess for the next Period of Insurance | YES | YES | YES | YES | YES | | Co-Insurance within the USA & Canada PPO Network | No Co-Insurance | No Co-Insurance | No Co-Insurance | No Co-Insurance | No Co-Insurance | | Co-Insurance outside the USA & Canada | No Co-Insurance | No Co-Insurance | No Co-Insurance | No Co-Insurance | No Co-Insurance | Co-Insurance Payable by Insured inside the USA & Canada
– When treatment is taken outside the USA & Canada PPO Network*
– (*No Co-Insurance for Non-Emergency In-Patient Treatment when utilizing a USA Medical Concierge Provider) | 20% of the next $5,000 / £2,750 / €3,350 / eligible expenses after the Annual Excess, then No Co-Insurance to the overall maximum per Period of Insurance | 20% of the next $5,000 / £2,750 / €3,350 / eligible expenses after the Annual Excess, then No Co-Insurance to the overall maximum per Period of Insurance | 20% of the next $5,000 / £2,750 / €3,350 / eligible expenses after the Annual Excess, then No Co-Insurance to the overall maximum per Period of Insurance | 20% of the next $5,000 / £2,750 / €3,350 / eligible expenses after the Annual Excess, then No Co-Insurance to the overall maximum per Period of Insurance | 10% of the next $5,000 / £2,750 / €3,350 / eligible expenses after the Annual Excess, then No Co-Insurance to the overall maximum per Period of Insurance | |