Best Doctors Prepaid Medicine Medical Elite
Type of plan
Medical Elite
Maximum coverage per insured
US$10,000,000 per policy year
Age limit to apply
Unlimited
Waiting period
30 days
Coverage outside USA
100% worldwide without restrictions of doctors and hospitals
Coverage inside USA
100% without restrictions of doctors and hospitals
Inpatient Benefits
Standard private hospital room
100%
Special benefit for suite
N/A
Intensive care unit
100%
Adult companion accommodation during a hospitalization
Related to a hospitalization of an insured under age 18 or older than 75
• US$10,000
This coverage is inside and outside Ecuador and is not limited to the number of entries in the year
• US$10,000
This coverage is inside and outside Ecuador and is not limited to the number of entries in the year
Prescribed medications while hospitalized
US$200 no deductible applies, after this amount the coverage will be 100% with deductible
Psychiatric treatments
Included in the specialized treatments benefit up to US$5,000
Outpatient Benefits
Emergency room
100%
Physician and specialist visits
100%
Physician and specialist home visits
N/A
Prescribed medications
100% including ancestral, alternative and generic medicine
Complementary therapy
Speech therapist
• Included in the physical therapy and rehabilitation benefit at 100%
Home respiratory therapy
• Included in the physical therapy and rehabilitation benefit at 100%
Alternative and ancestral medicine consultations
• US$50
• Included in the physical therapy and rehabilitation benefit at 100%
Home respiratory therapy
• Included in the physical therapy and rehabilitation benefit at 100%
Alternative and ancestral medicine consultations
• US$50
Nurse care at home
Included in the physical therapy and rehabilitation benefit at 100%
Preventive health checkup
No deductible applies, for dependents born from a covered maternity
• US$300 per visit, up to 5 visits, from 0 to 12 months old
• US$100 up to 1 visit from 12 months to 18 years old
US$500 from 18 years and older
• US$300 per visit, up to 5 visits, from 0 to 12 months old
• US$100 up to 1 visit from 12 months to 18 years old
US$500 from 18 years and older
Hearing aids
N/A
Alzheimer’s disease
100%
Autism
• 100% if the insured was born under a covered maternity
• US$10,000 for insured not born under a covered maternity who develop the condition while they are insured
• US$10,000 for insured not born under a covered maternity who develop the condition while they are insured
Outpatient surgery
100%
Hormone replacement therapy to relieve the symptoms of menopause
N/A
General Benefits
Surgeon and anesthesiologist fees
100%
Diagnostic study services
Laboratory tests, pathology, X-rays, MRI/CT/PET scans
• 100%
• 100%
Oncology: cancer tests, treatment (chemotherapy and/or radiotherapy) and medication
100%
Dialysis
100%
Prophylactic surgery to reduce the risk of cancer
US$30,000 per lifetime, after a 90-day waiting period
Prostheses and medical appliances implanted during surgery
100%
Organ and tissue transplant
Per organ/tissue
• US$3,000,000 per lifetime, after a 90-day waiting period
• US$3,000,000 per lifetime, after a 90-day waiting period
Benefits for live donors
US$50,000 per lifetime, included in the organ transplant benefit
Durable medical equipment
100%
Allergy treatments
100%
Physical therapy and rehabilitation
100% including rehabilitative cardiac therapy, respiratory therapy and speech therapy
Specialized treatments
Psychiatrist, occupational therapist, sleep apnea and other sleep disorders
• US$5,000
• US$5,000
Congenital conditions diagnosed before age 18
100%
Congenital conditions diagnosed after age 18
100%
HIV-AIDS
Not specified, this benefit according to the law or zero rate will have coverage for 1 evaluation per year up to US$60 to know the health status of the insured, it could also be considered as a pre-existing condition and have coverage up to 20 Ecuadorian basic salaries, i.e. US$9,000
Surgical treatment of symptomatic foot disorders
• 100%
Non-surgical treatment of symptomatic foot disorders
• US$400
Non-surgical treatment of symptomatic foot disorders
• US$400
Psychology
10 visits
Mental health prescription medication
N/A
Maternity Benefits
Maternity
No deductible applies, after a 60-day waiting period
Options I, II & III
• 100% per pregnancy for normal or cesarean delivery, in the country of residence
• US$15,000 per pregnancy for normal or cesarean delivery, outside the country of residence within the maternity network, when both parents are in the policy
• US$10,000 per pregnancy for normal or cesarean delivery, outside the country of residence within the maternity network, when only the mother is covered
Options I, II & III
• 100% per pregnancy for normal or cesarean delivery, in the country of residence
• US$15,000 per pregnancy for normal or cesarean delivery, outside the country of residence within the maternity network, when both parents are in the policy
• US$10,000 per pregnancy for normal or cesarean delivery, outside the country of residence within the maternity network, when only the mother is covered
Maternity and birth complications
After deductible according to the deductible option, after a 60-day waiting period
Options I, II & III
• US$1,000,000 per covered pregnancy, per lifetime
Including obstetric emergencies, up to 6 months after normal delivery or cesarean section and/or late puerperium and pre-term newborn care, neonatal care, specialist care and intensive care
Options I, II & III
• US$1,000,000 per covered pregnancy, per lifetime
Including obstetric emergencies, up to 6 months after normal delivery or cesarean section and/or late puerperium and pre-term newborn care, neonatal care, specialist care and intensive care
Inclusion of the newborn
Options I, II & III
• Without underwriting if born from a covered maternity within the maternity network and when the newborn is added to the policy within 60 days after birth
Intra-uterine Inclusion
• 100% coverage within the Ecuadorian territory
Notification period from 20 to 32 weeks of gestation
• Without underwriting if born from a covered maternity within the maternity network and when the newborn is added to the policy within 60 days after birth
Intra-uterine Inclusion
• 100% coverage within the Ecuadorian territory
Notification period from 20 to 32 weeks of gestation
Extraction and storage of umbilical cord blood stem cells
No deductible applies, after a 60-day waiting period
Options I, II & III
• US$2,000 per covered pregnancy for extraction and storage for 1 year
Options I, II & III
• US$2,000 per covered pregnancy for extraction and storage for 1 year
Fertility treatment
N/A
Neonatal Intensive Care Unit (NICU)
Option I
• Included in the maternity and newborn complications benefit up to US$1,000,000
• Included in the maternity and newborn complications benefit up to US$1,000,000
Pre-natal and post-natal care
Included in the maternity benefit
Medical Evacuation Benefits
Emergency transportation by ground ambulance
100% no deductible applies
Emergency transportation by air ambulance
100% no deductible applies
Emergency transportation by river ambulance
Included in the emergency transportation by ground ambulance benefit
Insured’s and companion’s return ticket after an evacuation by air ambulance
US$2,000 per person, for a return economy class ticket
Repatriation of mortal remains
100%
Other Benefits
Injuries during the training or practice of hazardous hobbies and sports (non-professional)
N/A
Injuries during the training or practice of professional sports
N/A
Emergency dental coverage
100%
Reconstructive surgery after an accident or illness
100%
Refractive eye surgery
N/A
Palliative care for terminal cases
100%
Temporary coverage for accidents while application is being underwritten
US$30,000 per lifetime, for medical expenses arising from bodily injury sustained in an accident occurring from the time the completed application and full premium are received until the date coverage begins or 60 days from the date the application is received, whichever comes first
Free extended coverage for eligible dependents after policyholder’s death
1 year for contractual dependents and beneficiaries
Free coverage for dependents
N/A
Elimination/reduction of deductible for no claims made or not having met the deductible
Options I, II, III & IV
• Reduction of up to 50% for 1 policy year after the end of the 3rd year without claims
• Reduction of up to 50% for 1 policy year after the end of the 3rd year without claims
Deductible elimination
• Elimination of deductible in the first hospitalization in case of a serious accident
• Elimination of deductible up to US$5,000 in case of an accident or emergency that occurs while the insured is traveling outside of his/her country of residence
• Elimination of deductible up to US$5,000 in case of an accident or emergency that occurs while the insured is traveling outside of his/her country of residence
Second medical opinion
Included
Prosthetic limbs
Included in the durable medical equipment benefit at 100%
Routine and major dental treatment
US$50
Travel reimbursement for treatment in centers of excellence Latam network
US$2,000 per person, for a return economy class ticket
War and terrorism
N/A
Term life insurance
N/A
Declared pre-existing conditions
Up to 20 Ecuadorian base salaries for all pre-existing conditions in a policy year, after a 24-month waiting period
Disability
• Up to 20 Ecuadorian base salaries for all pre-existing conditions in a policy year, after a 3-month waiting period
Disability
• Up to 20 Ecuadorian base salaries for all pre-existing conditions in a policy year, after a 3-month waiting period
Catastrophic and chronic illnesses that survive the contracting of the service
100% after a 30-day waiting period for outpatient services and 90 days for inpatient services
Coverage within Ecuadorian territory for conditions named and determined by the national health authority
Coverage within Ecuadorian territory for conditions named and determined by the national health authority
Catastrophic and unusual conditions
US$1,000 additional to the amount of drugs prescribed for treatment with growth stimulants
Medical emergency
US$1,000 with no deductible, after this amount the coverage will be 100% with deductible, after a 24 hour waiting period
Illness or injury in private aircraft
100%
Contraceptive treatments
US$300
Patient concierge services
Best Doctors Concierge
Travel assistance
N/A
Hospital cash benefit
N/A
Optional additional benefits
Evacuation to country of choice, country of residence or home country
N/A
Non-emergency evacuation
N/A
Pre-existing conditions waiting period waiver
N/A