Direct VIP - VUMI

DIRECT VIP

Offers an annual coverage of US$5 million for hospitalization and essential outpatient treatments.

DIRECT VIP

Offers an annual coverage of US$5 million for hospitalization and essential outpatient treatments.

DEDUCTIBLE OPTIONS*

	Option I	Option II	Option III	Option IV	Option V	Option VI
Inside USA	US$500	US$2,000	US$5,000	US$10,000	US$20,000	US$50,000
Outside USA	US$1,000	US$2,000	US$5,000	US$10,000	US$20,000	US$50,000

*Only one deductible per person, per policy year applies. For family policies, a maximum of two deductibles accumulated per policy, per policy year will be applied. For more information, please refer to the policy’s Conditions of Coverage.

TABLE OF BENEFITS

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General Plan Information

Description	Coverage
Maximum coverage per person, per policy year	US$5,000,000
Maximum age to apply for coverage	Up to 75 years old
Waiting period	30 days
Coverage outside USA	100% UCR with free choice of doctors and hospitals
Coverage inside USA	• 100% UCR within the USA Special Network® • Outside the USA Special Network® the coverage will be up to US$2,000 per day for a standard room and up to US$4,000 per day for intensive care • Emergency medical treatment will be covered at 100% UCR up to the policy limits

Inpatient Benefits

Description	Coverage
Standard private/semi-private hospital room	• 100% UCR • Outside of the USA Special Network®: US$2,000 per day
Special benefit for suite accommodation (subject to availability)	Up to US$2,000 per day within the USA Special Network®
Use of intensive care unit	• 100% UCR • Outside of the USA Special Network®: US$4,000 per day
Emergency room care	100% UCR (if admitted immediately as an inpatient)
Surgeon and anesthesiologist fees	100% UCR
Adult companion accommodation expenses of a hospitalized insured under 18 years old	US$175 per night, max. of 30 nights
Adult companion accommodation expenses of a hospitalized insured over 18 years old	100% UCR, max. of 21 nights
Prescribed medications while hospitalized	100% UCR
Prescribed medications following a hospitalization or outpatient surgery	100% UCR for up to 6 months after discharge, max. of US$3,500 per policy year
Dialysis services	100% UCR
Laboratory tests and X-rays	100% UCR
Oncology: treatment (chemotherapy and/or radiotherapy)	100% UCR
Physician and specialist visits	100% UCR
Physical therapy and rehabilitation	100% UCR (during a hospitalization)
Prostheses and medical appliances implanted during surgery	100% UCR
Organ transplant (per organ/tissue)	US$1,100,000 per lifetime Includes US$60,000 benefit for expenses of the live donor
HIV/AIDS treatment	US$50,000 (if admitted as an inpatient and after a 12-month waiting period)
Gastric bypass bariatric surgery and any type of surgical procedure for weight loss, its complications or treatments, and/or weight loss medication	US$10,000 per lifetime (after a 24-month waiting period)

Outpatient Benefits

Description	Coverage
Emergency room care for an emergency physical trauma or serious accident only in latin america	100% UCR
Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication	100% UCR
Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc.) Pre-surgical testing only. Pre-authorization required	US$15,000
Dialysis services	100% UCR
Physician visits for pre-hospitalization and as a follow up to a covered hospitalization	US$6,000 for up to 10 months from the date of discharge
Outpatient surgery	100% UCR
Physical therapy and rehabilitation	100% UCR, max. of 60 visits (following a covered hospitalization)

Other Benefits

Description	Coverage
Durable medical equipment	100% UCR (as follow-up care to a covered hospitalization)
Surgical treatment of symptomatic foot disorders	100% UCR (after a 24-month waiting period)
Reconstructive surgery after an accident or illness	Up to the maximum benefit
Emergency dental coverage	100% UCR for treatment within the first 180 days of the covered accident
Emergency transportation - Ground ambulance	100% UCR, no deductible applies (if admitted immediately as an inpatient)
Emergency transportation - Air ambulance	100% UCR, no deductible applies
Nurse or therapist care at home	100% UCR (as follow-up care to a covered hospitalization)
Palliative care	100% UCR
Repatriation or cremation of mortal remains	US$25,000
Treatment for injuries during the training or practice of hazardous hobbies and/or non-professional sports	100% UCR
Temporary coverage for accidents while application is being underwritten	US$30,000
Elimination/reduction of the policy deductible for no claims during the last 3 years	Options I & II: • Elimination for 1 year after the 3rd year without claims • Reduction of 50% of the deductible for 1 year after the 3rd year, if the deductible was not met in any of the years Options III, IV & V: • Reduction of 50% of the deductible for 1 year after the 3rd year without claims
Elimination of deductible in case of a serious accident (options I, II & III)	Elimination of the annual deductible for the first hospital urgent treatment that requires a hospitalization within the first 24 hours after the serious accident
Second Medical Opinion VIP®	Access to a second medical opinion of renowned experts from around the world, no deductible applies

Optional Additional Benefits (Riders)

Description	Coverage
Emergency coverage when traveling abroad	Up to US$5,000 for emergency medical treatment

All benefits with 100% coverage are up to the policy limit. Benefits with established coverage will be up to the limits stated in each of them.