Worldwide Medical Excellence
Type of plan
Excellence
Maximum coverage per insured
US$5,000,000 per policy year
Age limit to apply
75
Waiting period
60 days
Coverage outside USA
Within country of residence
• 100%
Outside the country of residence
• 100% through the network of preferred providers
• 70% of the first US$25,000, 100% after that limit
• 100%
Outside the country of residence
• 100% through the network of preferred providers
• 70% of the first US$25,000, 100% after that limit
Coverage inside USA
• 100% through the network of preferred providers
• 70% of the first US$25,000, 100% after that limit
• 70% of the first US$25,000, 100% after that limit
Inpatient Benefits
Standard private hospital room
100%
Special benefit for suite
In Spain
• US$3.172 up to US$212 per day
• US$3.172 up to US$212 per day
Intensive care unit
100%
Adult companion accommodation during a hospitalization
N/A
Prescribed medications while hospitalized
100%
Psychiatric treatments
N/A
Outpatient Benefits
Emergency room
Outside the country of residence
• 100%
Within country of residence
• 80%
• 100%
Within country of residence
• 80%
Physician and specialist visits
Outside the country of residence
• 100% in-network only, a US$20 copayment applies
Within country of residence
• 80%
• 100% in-network only, a US$20 copayment applies
Within country of residence
• 80%
Physician and specialist home visits
N/A
Prescribed medications
80% up to US$10,000 limit
Complementary therapy
N/A
Nurse care at home
US$10,000
Preventive health checkup
Wellness Program
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
Outside the country of residence
• 100%
Within country of residence
• 80%
Outside the country of residence
• 100%
Within country of residence
• 80%
Oncology: cancer tests, treatment (chemotherapy and/or radiotherapy) and medication
100%
Dialysis
US$100,000
Surgery to reduce the risk of cancer or prophylactic surgery
N/A
Prostheses and medical appliances implanted during surgery
100%
Organ and tissue transplant
Per diagnostic
• US$750,000 per lifetime
• US$750,000 per lifetime
Benefits for live donors
Included in the organ transplant benefit up to US$750,000, no limit specified
Durable medical equipment
80%
Allergy treatments
N/A
Physical therapy and rehabilitation
Outside the country of residence
• 100% up to 40 visits
Within country of residence
• 80% up to 40 visits
• 100% up to 40 visits
Within country of residence
• 80% up to 40 visits
Specialized treatments
N/A
Congenital conditions diagnosed before age 18
US$300,000 per lifetime
Congenital conditions diagnosed after age 18
Included in the congenital conditions diagnosed before age 18 up to US$300,000
HIV-AIDS
US$200,000 per lifetime, after a 12-month waiting period
Surgical treatment of symptomatic foot disorders
N/A
Psychology
N/A
Mental health prescription medication
N/A
Maternity Benefits
Maternity
No deductible, after a 10-month waiting period
Options I, II & III
Outside the country of residence
• US$10,000
Within country of residence
• US$6,000
Options I, II & III
Outside the country of residence
• US$10,000
Within country of residence
• US$6,000
Maternity and newborn complications
No deductible, after a 10 month waiting period
Options I, II & III
• US$500,000 per lifetime
Options I, II & III
• US$500,000 per lifetime
Inclusion of the newborn
Options I, II & III
• Without underwriting if born from a covered maternity as long as the newborn is added to the policy within 90 days of birth
• Without underwriting if born from a covered maternity as long as the newborn is added to the policy within 90 days of birth
Extraction and storage of umbilical cord blood stem cells
N/A
Fertility treatment
Birth covered, not detailed amount but complications are excluded
Neonatal Intensive Care Unit (NICU)
Options I, II & III
• Included in maternity and newborn complications benefit up to US$500,000
• Included in maternity and newborn complications benefit up to US$500,000
Pre-natal and post-natal care
Options I, II & III
Prenatal and postnatal
• Included in maternity benefit up to US$10,000 outside country of residence and US$6,000 in country of residence
Prenatal and postnatal
• Included in maternity benefit up to US$10,000 outside country of residence and US$6,000 in country of residence
Medical Evacuation Benefits
Emergency transportation by ground ambulance
100%
Emergency transportation by air ambulance
Outside the country of residence
• 100%
Within country of residence
• Included in the emergency transportation by ground ambulance benefit up to 100%
• 100%
Within country of residence
• Included in the emergency transportation by ground ambulance benefit up to 100%
Insured’s and companion’s return ticket after an evacuation by air ambulance
In Spain
• US$1,200 for services requiring hospitalization, not just for evacuation
• US$1,200 for services requiring hospitalization, not just for evacuation
Repatriation of mortal remains
US$10,000
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
Not specified
Refractive eye surgery
N/A
Palliative care for terminal cases
US$10,000
Temporary coverage for accidents while application is being underwritten
N/A
Free extended coverage for eligible dependents after policyholder’s death
3 years if occurs from a covered event
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
N/A
Routine and major dental treatment
N/A
Travel reimbursement for treatment in centers of excellence Latam network
N/A
War and terrorism
N/A
Term life insurance
Life benefit
• US$10,000
Additional benefit for accidental death and dismemberment
• US$10,000
Monthly income, for incapacity due to illness or accident
• US$1,000
• US$10,000
Additional benefit for accidental death and dismemberment
• US$10,000
Monthly income, for incapacity due to illness or accident
• US$1,000
Declared pre-existing conditions
Not specified
Catastrophic and chronic illnesses that survive the contracting of the service
N/A
Catastrophic and unusual conditions
N/A
Medical emergency
Outside the country of residence
• 100%
Within country of residence
• 80%
• 100%
Within country of residence
• 80%
Illness or injury in private aircraft
N/A
Contraceptive treatments
N/A
Patient concierge services
N/A
Travel assistance
US$10,000
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