GLOBAL FLEX
VIP ULTRA
A comprehensive plan
offering superior benefits
and free choice of medical providers
DEDUCTIBLE OPTIONS
| Option I | Option II | Option III | Option IV | Option V | Option VI | Option VII | |
|---|---|---|---|---|---|---|---|
| US$0 | US$1,000 | US$2,000 | US$5,000 | US$10,000 | US$15,000 | US$20,000 |
| Option VIII | Option IX | Option X | Option XI | Option XII | |
|---|---|---|---|---|---|
| US$15 out-patient per visit excess | US$30 out-patient per visit excess | 10% out-patient co-insurance, up to a maximum out of pocket of US$2,000 | 20% out-patient co-insurance, up to a maximum out of pocket of US$4,000 | 30% out-patient co-insurance, up to a maximum out of pocket of US$6,000 |
TABLE OF BENEFITS
| Description | Coverage |
|---|---|
| Maximum coverage per person, per policy year | US$4,500,000 |
| Age limit to apply | Up to 74 years |
| Geographical cover options | The policyholder can choose geographical area of cover restrictions as follows: Any treatment received outside the geographic area of coverage is limited to the emergency non-elective treatment benefit. • Worldwide including USA elective treatment • Worldwide excluding USA • Africa area of cover restriction For insureds residing in Africa, the area of cover will be restricted to: Africa, India, Pakistan, Sri Lanka, Bangladesh, Jordan, Lebanon, Mainland China, and the Philippines. •Asia area of cover restriction For insureds residing in Armenia, Azerbaijan, Brunei, Cambodia, Georgia, Indonesia, Kazakhstan, Kyrgyzstan, Laos, Malaysia, Myanmar, Mongolia, the Philippines, Tajikistan, Thailand, Timor-Leste (East Timor), Turkey, Turkmenistan, Uzbekistan and Vietnam, the Asia area of cover restriction will include Singapore but exclude Mainland China, Hong Kong, Japan, and South Korea. •Indian sub-continent area of cover restriction For insureds residing in Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka the Indian sub-continent area of cover restriction will include all named countries and Singapore. |
| Description | Coverage |
|---|---|
| Adult companion accommodation (related to a covered hospitalisation of an insured child under age 18) | Up to policy maximum |
| Psychiatric treatment | Up to policy maximum, max. of 30 days |
| Standard private room (room and board) | 100% UCR, up to policy maximum |
| Description | Coverage |
|---|---|
| Complementary therapy including physiotherapy, traditional Chinese medicine (TCM) and Ayurvedic treatment | Up to policy maximum, pre-authorisation required after 10 sessions |
| Day-care treatment | Up to policy maximum |
| General practitioner and specialist fees | Up to policy maximum |
| Hormone replacement therapy to relieve the symptoms of menopause | Up to US$350 |
| Nursing care at home | Up to policy maximum, max. of 120 days |
| Out-patient surgery | Up to policy maximum |
| Prescription drugs | Up to policy maximum |
| Psychiatric treatment | Up to US$7,500 |
| Travel vaccinations and preventive medication e.g. against malaria | Up to US$350 |
| Description | Coverage |
|---|---|
| Congenital conditions after 30 days from birth | Up to US$125,000 |
| Congenital conditions from birth up to 30 days | Covered under the new-born benefit |
| Diagnostic study services (laboratory tests, X-rays, CT, PET and MRI scans) | Up to policy maximum |
| External prostheses | Up to US$2,500 per policy year |
| HIV- AIDS treatment | Up to US$50,000 |
| Oncology treatments (cancer tests, drugs and treatment) | Up to policy maximum |
| Organ transplant (per organ/tissue, per lifetime) | Full refund including US$50,000 for donor costs |
| Prescribed physical therapy and rehabilitation | Up to policy maximum, max. of 120 days per medical condition |
| Reconstructive surgery | Up to policy maximum |
| Renal failure and dialysis | Up to policy maximum |
| Routine management of chronic conditions | Up to policy maximum |
| Surgical procedures | Up to policy maximum |
| Terminal illness / palliative care | Up to US$125,000 per lifetime |
| Description | Coverage |
|---|---|
| Maternity and birth complications | Up to policy maximum |
| Maternity care | Up to US$15,000 |
| New-born cover | Up to US$125,000 |
| Description | Coverage |
|---|---|
| Emergency transportation by air ambulance & emergency medical evacuation | Up to policy maximum |
| Repatriation of mortal remains | Up to policy maximum, US$15,000 for burial or cremation costs |
| Description | Coverage |
|---|---|
| Emergency dental treatment | Up to policy maximum |
| Emergency non-elective treatment outside the geographical area of coverage | • Up to policy maximum for injuries • Up to US$50,000 for illnesses • Up to US$500 for out-patient hospital visits |
| Emergency transportation by ground ambulance | Up to policy maximum |
| Hospital cash benefit | Up to US$400 per night, max. of 30 nights |
| Passive war and terrorism | Up to policy maximum |
| Routine and major dental treatment cover | Up to US$1,000 for routine and up to US$2,000 for complex, subject to a 20% co-insurance |
| Second Medical Opinion VIP | Access to the medical opinion of internationally renowned experts from around the world regarding a condition (no deductible applies) |
| Description | Coverage |
|---|---|
| Evacuation to country of choice, country of residence or home country | Up to policy maximum |
| Non-emergency evacuation | Up to US$2,000 |
| USA elective treatment (only available for insureds who chose the worldwide including USA elective treatment geographical area of cover) | Up to US$3,000,000 |
| Wellness and optical | Option I - US$500 Option II - US$1,000 |
WAITING PERIODS
| Description | Coverage |
|---|---|
| Dental | 9 months |
| HIV-AIDS | 36 months |
| Maternity and new-born complications | 12 months |
| Maternity care | 12 months |