GROUP 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-patientper visit excess | 10% out-patientco-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. • S.E. Asia area of cover restriction For insureds residing in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand,Timor-Leste (East Timor) and Vietnam, the S.E. area of cover restriction will include Singapore but exclude Mainland China, Hong Kong, Japan and South Korea. |
| 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 newborn 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 |
| Medical history disregarded | For compulsory group policies of 10 employees or more |
| 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 |