Salud S.A. Experience World
Type of plan
Experience World
Maximum coverage per insured
US$1,000,000 per policy year / US$3,000,000 per policy year
Age limit to apply
Unlimited
Waiting period
• 30 days for outpatient treatment
• 90 days for inpatient and disability treatment
• 90 days for inpatient and disability treatment
Coverage outside USA
100% worldwide without restrictions of doctors and hospitals
Coverage inside USA
• 100% through the preferred provider network
• Outside the preferred provider network coverage will be at 80%
• Emergency medical treatment will be covered 100% up to the policy limits
• Outside the preferred provider network coverage will be at 80%
• Emergency medical treatment will be covered 100% up to the policy limits
Inpatient Benefits
Standard private hospital room
100% up to the coverage limit
Special benefit for suite
N/A
Intensive care unit
100% up to the coverage limit
Adult companion accommodation during a hospitalization
At the Clínica Universidad de Navarra
• 100% during radiotherapy or chemotherapy treatments in day hospital regime
• 100% during radiotherapy or chemotherapy treatments in day hospital regime
Prescribed medications while hospitalized
100%
Psychiatric treatments
Included in the specialized treatments benefit, up to 80% of US$200
Outpatient Benefits
Emergency room
100%
Physician and specialist visits
80% up to US$80 per visit
Physician and specialist home visits
Medical consultations
• Unlimited visits, co-payment applies according to the sector where the visit takes place
Specialty medical consultations
• 4 visits
• Unlimited visits, co-payment applies according to the sector where the visit takes place
Specialty medical consultations
• 4 visits
Prescribed medications
100%
Complementary therapy
Physical rehabilitation therapy, speech therapy and respiratory therapy
• Up to 30 days worldwide
• Up to 40 sessions in Ecuador
Homeopathy, acupuncture and chiropractic therapy
• Up to 12 consultations
• Up to 30 days worldwide
• Up to 40 sessions in Ecuador
Homeopathy, acupuncture and chiropractic therapy
• Up to 12 consultations
Nurse care at home
N/A
Preventive health checkup
80% up to US$200
Hearing aids
N/A
Alzheimer’s disease
N/A
Autism
N/A
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
Inpatient
• 100%
outpatient
• 80%
Inpatient
• 100%
outpatient
• 80%
Oncology: cancer tests, treatment (chemotherapy and/or radiotherapy) and medication
100% up to 180 sessions
Dialysis
100% up to 45 days
Surgery to reduce the risk of cancer or prophylactic surgery
N/A
Prostheses and medical appliances implanted during surgery
Included in the durable medical equipment benefit of 100%
At the University of Navarra Clinic
• US$15,000 for internal trauma prostheses, intraocular lenses, breast prostheses as a result of breast tumor, abdominal meshes, cochlear implants, spinal neurostimulators and deep brain neurostimulators for Parkinson's disease, heart valves, pacemakers, defibrillators, by-pass prostheses, defibrillators and deep brain neurostimulator for Parkinson's disease, heart valves, pacemakers, defibrillators, vascular by-pass prostheses, vascular stents, portocaval shunts, biliary prostheses, portha-cat, venous reservoirs, catheters, nephrotomies, coils and CSF shunt valve
At the University of Navarra Clinic
• US$15,000 for internal trauma prostheses, intraocular lenses, breast prostheses as a result of breast tumor, abdominal meshes, cochlear implants, spinal neurostimulators and deep brain neurostimulators for Parkinson's disease, heart valves, pacemakers, defibrillators, by-pass prostheses, defibrillators and deep brain neurostimulator for Parkinson's disease, heart valves, pacemakers, defibrillators, vascular by-pass prostheses, vascular stents, portocaval shunts, biliary prostheses, portha-cat, venous reservoirs, catheters, nephrotomies, coils and CSF shunt valve
Organ and tissue transplant
80% Outpatient / 100% Inpatient
• US$250,000 per lifetime
• US$250,000 per lifetime
Benefits for live donors
80% Outpatient / 100% Inpatient
• US$20,000 per lifetime
• US$20,000 per lifetime
Durable medical equipment
For valve prostheses, pacemakers, implantable cardiodesfibrillators, stents, endoprostheses, catheters, knee, shoulder, hip prostheses stents, stents, endoprostheses, catheters, knee, shoulder, hip and osteosynthesis prostheses
• 100%
• 100%
Allergy treatments
N/A
Physical therapy and rehabilitation
Included in the complementary therapy benefit of 100% for up to 30 days worldwide and 40 sessions in Ecuador
Specialized treatments
Psychiatrist and psychologist
• 80% up to US$200
Nutritionist
• 80% up to US$200
• 80% up to US$200
Nutritionist
• 80% up to US$200
Congenital conditions diagnosed before age 18
Outpatient
• 80%
• 80%
Congenital conditions diagnosed after age 18
Outpatient
• 80%
• 80%
HIV-AIDS
Not specified
Surgical treatment of symptomatic foot disorders
N/A
Psychology
Included in the specialized treatments benefit, 80% up to US$200
Mental health prescription medication
Not specified
Maternity Benefits
Maternity
Worldwide
After a 60-day waiting period
• US$4,000 includes maternity and newborn complications and prenatal and postnatal care
After a 10-month waiting period
• US$20,000 includes maternity and newborn complications, and prenatal and postnatal care
In Ecuador, no deductible on US$200 option
• US$4,500 includes vitamins and maternal vaccinations at 80% up to US$1,000
• 80% Outpatient
• 100% Inpatient
After a 60-day waiting period
• US$4,000 includes maternity and newborn complications and prenatal and postnatal care
After a 10-month waiting period
• US$20,000 includes maternity and newborn complications, and prenatal and postnatal care
In Ecuador, no deductible on US$200 option
• US$4,500 includes vitamins and maternal vaccinations at 80% up to US$1,000
• 80% Outpatient
• 100% Inpatient
Maternity and newborn complications
Worldwide
• Included in the maternity benefit of US$4,000 and US$10,000 according to the applicable waiting period for conception
In Ecuador
• US$50,000 for maternity complications
• US$10,000 until the 28th day of birth
• 80% Outpatient
• 100% Inpatient
• Included in the maternity benefit of US$4,000 and US$10,000 according to the applicable waiting period for conception
In Ecuador
• US$50,000 for maternity complications
• US$10,000 until the 28th day of birth
• 80% Outpatient
• 100% Inpatient
Inclusion of the newborn
Not specified
Extraction and storage of umbilical cord blood stem cells
N/A
Fertility treatment
N/A
Neonatal Intensive Care Unit (NICU)
Worldwide
• Included in the maternity benefit of US$4,000 and US$10,000 according to the applicable waiting period for conception
In Ecuador
• Included in the maternity and newborn complications benefit up to US$50,000 for maternity complications and US$10,000 for newborn complications
• Included in the maternity benefit of US$4,000 and US$10,000 according to the applicable waiting period for conception
In Ecuador
• Included in the maternity and newborn complications benefit up to US$50,000 for maternity complications and US$10,000 for newborn complications
Pre-natal and post-natal care
Worldwide
• Included in the maternity benefit of US$4,000 and US$10,000 according to the applicable waiting period for conception
In Ecuador
• 1 visit per month for well-baby checkup, up to 2 years of age
• US$700 for vaccinations up to 2 years of age
• Included in the maternity benefit of US$4,000 and US$10,000 according to the applicable waiting period for conception
In Ecuador
• 1 visit per month for well-baby checkup, up to 2 years of age
• US$700 for vaccinations up to 2 years of age
Medical Evacuation Benefits
Emergency transportation by ground ambulance
US$1,000
Emergency transportation by air ambulance
National
• US$5,000
International
• US$25,000
• US$5,000
International
• US$25,000
Insured’s and companion’s return ticket after an evacuation by air ambulance
N/A
Repatriation of mortal remains
Benefit of funeral product is mentioned but no amounts or type of coverage are mentioned
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
Options US$200, US$1,000 and US$2,500
• Included, no amount specified
• Included, no amount specified
Reconstructive surgery after an accident or illness
100% for oncologic reconstructive surgery
• 80% Outpatient
• 100% Inpatient
• 80% Outpatient
• 100% Inpatient
Refractive eye surgery
Not specified
Palliative care for terminal cases
Up to US$5,000 for 15 days
• 80% Outpatient
• 100% Inpatient
• 80% Outpatient
• 100% Inpatient
Temporary coverage for accidents while application is being underwritten
• US$400 for emergencies and medical emergencies
• US$240 for prenatal checkups for pregnancy developed during the vesting period
• US$240 for prenatal checkups for pregnancy developed during the vesting period
Free extended coverage for eligible dependents after policyholder’s death
N/A
Free coverage for dependents
N/A
Deductible elimination/reduction for no claims made
N/A
Deductible elimination
N/A
Second medical opinion
Included
Prosthetic limbs
US$120,000 per lifetime / US$30,000 per event
Routine and major dental treatment
Options US$200, US$1,000 and US$2,500
• Included, no amount specified
• Included, no amount specified
Travel reimbursement for treatment in centers of excellence Latam network
N/A
War and terrorism
N/A
Term life insurance
N/A
Declared pre-existing conditions
Up to US$1,500 after 12 month waiting period
• 80% Outpatient
• 100% Inpatient
Up to US$3,000 after a 24 month waiting period
• 80% Outpatient
• 100% Inpatient
Up to 20 Ecuadorian base salaries for all pre-existing conditions in a policy year, after a 24-month waiting period
• 80% Outpatient
• 100% Inpatient
Up to 20 Ecuadorian base salaries for all disabilities
• 80% Outpatient
• 100% Inpatient
Disability
• Up to 20 Ecuadorian base salaries for all disability conditions, after a waiting period of 3 months
• 80% Outpatient
• 100% Inpatient
Up to US$3,000 after a 24 month waiting period
• 80% Outpatient
• 100% Inpatient
Up to 20 Ecuadorian base salaries for all pre-existing conditions in a policy year, after a 24-month waiting period
• 80% Outpatient
• 100% Inpatient
Up to 20 Ecuadorian base salaries for all disabilities
• 80% Outpatient
• 100% Inpatient
Disability
• Up to 20 Ecuadorian base salaries for all disability conditions, after a waiting period of 3 months
Catastrophic and chronic illnesses that survive the contracting of the service
N/A
Catastrophic and unusual conditions
N/A
Medical emergency
100%
Illness or injury in private aircraft
N/A
Contraceptive treatments
N/A
Patient concierge services
N/A
Travel assistance
• Elimination of the deductible for emergencies or accidents outside the country of residence
• Saludsa Travel: US$100,000 for medical assistance for business or pleasure trips abroad, without deductible
• US$10,000 per event, for emergencies on trips to the United States
• Saludsa Travel: US$100,000 for medical assistance for business or pleasure trips abroad, without deductible
• US$10,000 per event, for emergencies on trips to the United States
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