| A
In-Patient & Day-Patient Treatment |
| | | HeadStart | Basic | Standard | Executive | | 1 | Hospital Accommodation & Theatre | Full Cover | Full Cover | Full Cover | Full Cover | | 2 | Accidents, Emergencies, Intensive Care inc. Surgical Care, Second Surgical Opinion, Anaesthetics, Medical Practitioner charges for Surgery, Treatment, Services and Supplies routinely provided | | 3 | Surgeons, Consultants, Anaesthetists, Nurses and Ancillary Charges | | 4 | Medical Practitioners | | 5 | Prescribed Drugs, Dressings and Durable Medical Equipment | | 6 | Reconstructive Surgery-following an accident or following surgery for an eligible condition | | 7 | Diagnostic Tests and Procedures, X-rays, Pathology, & MRI/CT Scans | | 8 | Cancer Tests, Drugs, Treatment and Consultants, including cover for Chemotherapy and Radiotherapy | | 9 | Physiotherapy | | 10 | Parental Hospital Accommodation | | 11 | Post Hospitalisation Treatment - received within 90 days of being discharged from hospital | | 12 | Hospital Cash Benefit | £100/ $175/ €120/night 60 nights | £150/ $263/ €180/night 60 nights | £200/ $350/ €240/night 60 nights | £300/ $525/ €360/night 60 nights | | 13 | Organ Transplant
(major covered organs) | No Cover | £100,000/ $175,000/ €120,000 Lifetime Limit | £100,000/ $175,000/ €120,000 Lifetime Limit | £200,000/ $350,000/ €240,000 Lifetime Limit | | 14 | Prosthetic Devices | No Cover | No Cover | Full Cover | Full Cover | | 15 | Psychiatric Treatment -
after 12 months continuous cover under the Policy | Full Cover, to a maximum of 30 days | Full Cover, to a maximum of 30 days | Full Cover, to a maximum of 30 days | Full Cover, to a maximum of 30 days | |
| B
Out-Patient Treatment and Wellness Benefits |
| | | HeadStart | Basic | Standard | Executive | | 1 | Family Doctor, Treatment & Referrals | No Cover | Up to £300/ $525/ €360 per Period of Insurance | Up to £5,000/ $8,750/ €6,000 | Full Cover | | 2 | Specialists and Consultants (fees for consultations) | Up to £400/ $700/€480 per condition prior to admission, then up to £1,000/ $1,750/ €1,200 following out-patient surgery or in-patient/ day-patient treatment | Up to £1,500/ $2,625/ €1,800 per condition for pre & post hospital treatment | | 3 | X-rays, Pathology, Diagnostic Tests and Procedures | Up to £200/$350 /€240 per condition prior to admission and following out-patient surgery or in-patient/ day-patient treatment | | 4 | Prescribed Drugs, Medicines, Dressings and Durable Medical Equipment | No Cover | | 5 | Out-Patient Surgery | Full Cover | Full Cover | Full Cover | | 6 | MRI and CT Scans | | 7 | Cancer Tests, Drugs, Treatment and Consultants | | 8 | Physiotherapy, Homeopathic and Osteopathic Therapy | No Cover | Maximum 10 visits as part of the £1,500/ $2,625/ €1,800 limit | Maximum 15 visits as part of the £5,000/ $8,750/ €6,000 limit | Up to £2,500/ $4,375/ €3,000 for up to 20 visits | | 9 | Complementary Medical Treatment: Acupuncture, Aroma Therapy, Chiropractic Therapy, Herbal Therapy, Magnetic Therapy, Massage Therapy, Vitamin Therapy, Traditional Chinese Medicine when referred by a Doctor, General Medical Practitioner (GP) | No Cover | Up to £500/ $875/€600 | Up to £2,500/ $4,375/ €3,000 | | 10 | AIDS/HIV Treatment | Up to £5,000/ $8,750/ €6,000, with a Lifetime Limit of £25,000/ $43,750/ €30,000 | Up to £5,000/ $8,750/ €6,000, with a Lifetime Limit of £50,000/ $87,500/ €60,000 | | 11 | Hormone Replacement Therapy-Early Onset | Full Cover 18 Month Limit Lifetime | Full Cover 18 Month Limit Lifetime | | 12 | Home Nursing Care Primary care services of a registered nurse in the insured person's home immediately after, or instead of, in-patient/day patient treatment | Up to £75/$132/ €90/visit to a maximum of 15 visits | Up to £75/$132/ €90/visit to a maximum of 30 visits | Up to £75/$132/ €90/visit to a maximum of 45 visits | Up to £75/$132/ €90/visit to a maximum of 60 visits | | 13 | Rehabilitation | No Cover | Full Cover Up to 30 Days | Full Cover Up to 90 Days | Full Cover Up to 180 Days | | 14 | Extended Care Facility | Full Cover Up to 6 Months | Full Cover Up to 6 Months | Full Cover Up to 6 Months | | 15 | Hospice Care | | 16 | Adult Wellness and Health Check - Medical check-up including, cervical smear, mammogram, cancer screening, cardiovascular examinations, neurological examinations, vital sign tests (e.g. blood pressure, cholesterol checks)
- Hearing Test, Sight Test and Vaccinations/Inoculations
- After 12 months continuous cover under the Policy | No Cover | Up to £400/$700/ €480 (Nil Excess) | Up to £500/$875/ €600 (Nil Excess) | | 17 | Child Wellness and Health Check - Hearing Test, Sight Test and Vaccinations/Inoculations - After 12 months continuous cover under the Policy | Up to £400/$700 /€480 (Nil Excess) | Up to £500/$875 /€600 (Nil Excess) | | 18 | Psychiatric Treatment -after 12 months continuous cover under the Policy | Up to £2,500/ $4,375/ €3,000 | Up to £2,500/ $4,375/ €3,000 | |
| C
Travel, Transportation and Out Of Area Benefits |
| | | HeadStart | Basic | Standard | Executive | | 1 | Emergency Local Ambulance | Full Cover | Full Cover | Full Cover | Full Cover | | 2 | Emergency Evacuation and Transportation | Full Cover To nearest medical facility within Your Area of Cover | Full Cover To nearest medical facility, Home Country, or country of choice within Your Area of Cover | Full Cover To nearest medical facility, Home Country, or country of choice within Your Area of Cover | Full Cover To nearest medical facility, Home Country, or country of choice within Your Area of Cover | | 3 | Accompanying Relative, Travel and Accommodation | No Cover | Full Cover | Full Cover | Full Cover | | 4 | Cremation/Burial or Repatriation of Remains | Up to £5,000/ $8,750/ €6,000 | Up to £5,000/ $8,750/ €6,000 | Up to £7,500/ $13,125/ €9,000 | Up to £10,000/ $17,500/ €12,000 | | 5 | Compassionate Visit - after 12 months continuous cover under the Policy | No Cover | Up to £1,000/ $1,750/ €1,200 | Up to £1,500/ $2,625/ €1,800 | Up to £1,500/ $2,625/ €1,800 | | 6 | USA Elective Treatment within Provider Network Excludes non-emergency travel & accommodation (Applicable to Insureds who have not selected Area 3 - Worldwide Cover) | No Cover | Up to £500,000/ $875,000/ €600,000 with 20% Co-Insurance (Nil Excess) | Up to £500,000/ $875,000/ €600,000 with 20% Co-Insurance (Nil Excess) | | 7 | Worldwide Accident and Emergency Out of Area Cover | 30 Days Maximum, up to £15,000/ $26,250/ €18,000 | 45 Days Maximum, up to £20,000/ $35,000/ €24,000 | 60 Days Maximum, up to £20,000/ $35,000/ €24,000 | |
| D
Cover in respect of Pre-Existing Medical Conditions and Chronic Conditions |
| | | HeadStart | Basic | Standard | Executive | 1
or
1b | Pre-Existing Conditions – Underwriting/Cover Options
Full Medical Underwriting Option*
- After 24 months continuous cover under the Policy (unless excluded or terms applied as indicated otherwise in writing) | No Cover | Up to £1,500/ $2,625/ €1,800, with a Lifetime Limit of £15,000/ $26,250/ €18,000 | Up to £2,000/ $3,500/ €2,400, with a Lifetime Limit of £20,000/ $35,000/ €24,000 | Up to £3,000/ $5,250/ €3,600, with a Lifetime Limit of £30,000/ $52,500/ €36,000 | Moratorium Enrolment & Underwriting Option*
- After 24 months continuous cover: subject to 24 months without treatment, symptoms, medication or consultation (refer to page 18 for further details)* | Full Cover | Full Cover | Full Cover | | *Cover in respect of Pre-Existing Conditions is as selected at time of application and identified on your Certificate of Insurance. Refer to page 18 for further details and Policy Wording for full Policy definitions, terms, conditions and restrictions. | | 2 | Chronic Conditions and Palliative Care | | No Cover | Up to £3,000/ $5,400/ €4,500,with a Lifetime Limit of £30,000/ $54,000/ €45,000 | Covered as part of the pre-existing medical limits above | | 3 | Stabilisation of Acute Chronic Episode | | Up to £5,000/ $9,000/ €7,500 | Full Cover | Full Cover | |
| E
Dental Treatment |
| | | HeadStart | Basic | Standard | Executive | | 1 | Emergency Dental Treatment (In Patient or Day Patient) | No Cover | Full Cover | Full Cover | Full Cover | | 2 | Accidental Dental Damage caused to sound natural teeth lost or damaged in an accident. Out Patient Treatment/Dental Surgery must be received within 5 days from the date of the accident occurring | No Cover | Up to £250/$438/ €300 | | 3 | Emergency Dental Treatment (Out patient/Dental Surgery) For relief of pain, being treatment of an abscess, cracked or broken tooth rebuild or temporary filling within 5 days of the event | No Cover | Up To £250/$438/ €300 in aggregate - subject to 25% Co- Insurance (Nil Excess) | | 4 | Routine Dental Treatment (Out patient)*** for the restoration of natural teeth
- examinations, check-up and x-rays
- tooth cleaning and polishing
- normal compound fillings, simple or nonsurgical extractions
***incurred after 180 days from the effective date. | Up To £400/$700/ €480 in aggregate
a) £50/$88/ €60 visit, maximum two visits each Period of Insurance
b) £50/$88/ €60 /visit, maximum two visits each Period of Insurance
c) £50/$88/ €60 each tooth (£80/$140/ €96/ wisdom tooth)
Subject to 25% Co- Insurance (Nil Excess) | | 5 | Major Restorative Dental Treatment**** -Removal of impacted, buried or unerrupted teeth, removal of roots, removal of solid odontomes, apicetomy, new or repair of bridgework, new or repair of crowns (not precious metal), root canal treatment, new or repair of upper or lower dentures
**** incurred after 12 months from the Effective Date. | Up To £750/ $1,313/ €900 in aggregate, subject to 50% Co- Insurance (Nil Excess) | |
| F
Maternity Cover- after 12 months continuous coverage |
| | | HeadStart | Basic | Standard | Executive | | 1 | Pregnancy Complications Including Medically Required C-Section | Full Cover | Up to £5,000/ $8,750/ €6,000 | Up to £10,000/ $17,500/ €12,000 | Full Cover | | 2 | Normal Pregnancy and Delivery Including Premature Birth Treatment, Pre, Post and Routine Natal Care | No Cover | No Cover | Up to £5,000/ $8,750/ €6,000 subject to 20% Co- Insurance (Nil Excess) | | 3 | Newborn Hospital Accommodation | Up to 14 Days | | 4 | Newborn Examination | Up to £150/$263/ €180 | | 5 | New Baby Benefit | £100/$175/ €120 (Nil Excess) | | 6 | Cover for Newborns including non-hereditary birth defects and congenital abnormalities | £5,000/ $8,750/ €6,000, must enrol with parents in 31 days | £10,000/ $17,500/ €12,000 must enrol with parents in 31 days | £25,000/ $43,750/ €30,000 must enrol with parents in 31 days | |
| G
Non-Medical Insured Covers and Benefits |
| | | HeadStart | Basic | Standard | Executive | | 1 | Out of Country Legal Expenses | No Cover | No Cover | Up to £5,000/ $8,750/ €6,000 (£250/ $438/ €300 Excess) | Up to £10,000/ $17,500/ €12,000 (£350/ $613/ €420 Excess) | | 2 | Vision Contribution Due to Accident Benefit | No Cover | £200/$350/ €240 subject to 50% Co- Insurance | | 3 | Security & Political Evacuation & Repatriation | Up to £7,500/ $13,125/ €9,000 Lifetime Limit | Up to £10,000/ $17,500/ €12,000 Lifetime Limit | | 4 | Identity Theft Cover & Assistance | Up to £250/ $438/ €300 | Up to £500/ $875/ €600 | | 5 | Out of Country Criminal Assault Benefit - When admitted to hospital for 48 hours or more | £500/ $875/ €600/ admitted night to a maximum of £2,500/ $4,375/ €3,000 | £1,000/ $1,750/ €1,200/ admitted night to a maximum of £5,000/ $8,750/ €6,000 | | 6 | Natural Disaster Evacuation & Accommodation | Full Up to £150/ $263/ €180 per 24 hours for up to 5 days | Up to £250/ $438/ €300 per 24 hours for up to 5 days | |
| H
Other Services and Benefits |
| | | HeadStart | Basic | Standard | Executive | | 1 | 24 Hour Emergency Helpline | Included | Included | Included | Included | | 2 | Lost Property Identification and Retrieval Service** | | 3 | Medical Information Service** – Access to boardcertified physicians, licensed psychologists, and pharmacists to assist with any routine health related questions | Not Applicable | Not Applicable | |
| Sub-Plan Excesses |
| | | HeadStart | Basic | Standard | Executive | | Standard Sub-Plan Excess-Per Person, Per Condition, Per Period of Insurance (unless indicated otherwise) | £100/$180/ €150 | £100/$180/ €150 | £50/$90/ €75 | £25/$45/ €38 | | Maximum Excess Per Person Per Period of Insurance (whichever is the greatest) | 10X standard/ voluntary exces | 5X standard/ voluntary excess | 5X standard/ voluntary excess | 10X standard/ voluntary excess | | Maximum Total Family Excess Per Period of Insurance (whichever is the greatest) | 20X standard/ voluntary excess | 10X standard/ voluntary excess | 10X standard/ voluntary excess | 20X standard/ voluntary excess | |
| Voluntary Medical Excesses |
Sub-Plan Excess Options - If chosen by you and as identified on your Certificate of Insurance
(Note: Choose carefully as you cannot select a lower excess at renewal) | N/A
N/A
N/A
£250/$450/ €375
£500/$900/ €750
£1,000/
$1,800/
€1,500
£2,500/
$4,500/
€3,750
£5,000/
$9,000/
€7,500
£10,000/ $18,000/ €15,000 | N/A
N/A
N/A
£250/$450/ €375
£500/$900/ €750
£1,000/
$1,800/
€1,500
£2,500/
$4,500/
€3,750
£5,000/
$9,000/
€7,500
£10,000/ $18,000/ €15,000 | Nil
N/A
£100/$180/ €150
£250/$450/ €375
£500/$900/ €750
£1,000/
$1,800/
€1,500
£2,500/
$4,500/
€3,750
£5,000/
$9,000/
€7,500
£10,000/ $18,000/ €15,000 | Nil
£50/$90/€75
£100/$180/ €150
£250/$450/ €375
£500/$900/ €750
£1,000/
$1,800/
€1,500
£2,500/
$4,500/
€3,750
£5,000/
$9,000/
€7,500
£10,000/ $18,000/ €15,000 | |