Optimum VIP

OPTIMUM VIP

Offers protection for specific chronic conditions up to
US$1 million annually.

OPTIMUM VIP

Offers protection for specific chronic conditions up to US$1 million annually.

DEDUCTIBLE OPTIONS*

	Option I	Option II	Option III	Option IV	Option V	Option VI
Inside USA	US$1,000	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 Information

(All benefits described only apply to the medical conditions specified under Covered Conditions)

Description	Coverage
Maximum coverage per person, per policy year	US$1,000,000
Maximum age to apply for coverage	Up to 75 years old
Waiting period	30 days
Coverage outside USA	100% UCR with free choice of hospitals and doctors
Coverage inside USA	• 100% UCR within the USA Special Network® • Outside the USA Special Network®, the coverage will be at 60%, with a maximum daily room rate of up to US$700 for a standard room and up to US$1,400 for intensive care • Emergency medical treatment will be covered 100% UCR, up to the benefits limits

Covered Conditions

Description	Coverage
Neurological diseases (including cerebrovascular accidents)	US$150,000
Cardiac surgery for revascularization and angioplasty	US$150,000
Cancer (tests, medication, chemotherapy, radiotherapy, surgery for tumor and reconstructive surgery)	US$200,000
Polytrauma (including rehabilitation)	US$200,000
Chronic kidney failure (dialysis or hemodialysis)	US$150,000
Severe burns (including reconstructive surgery)	US$300,000
Septicemia	US$150,000
Organ and tissue transplant	US$500,000 per lifetime Includes US$50,000 benefit for expenses of the live donor

Inpatient Benefits

Description	Coverage
Standard hospital room	100% UCR
Use of intensive care unit	100% UCR
Adult companion accommodation expenses of a hospitalized insured under 18 years old	US$100 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 for covered conditions
Physical therapy and rehabilitation	100% UCR for covered conditions

Outpatient Benefits

Description	Coverage
Emergency room care	100% UCR
Physician and specialist visits	100% UCR for covered conditions
Physician and specialist home visits (where available)	100% UCR for covered conditions
Outpatient prescription medication	US$5,000 for covered conditions
Nurse or therapist care at home	US$7,000 for covered conditions
Physical therapy and rehabilitation	US$7,000 for covered conditions

General Benefits For Inpatient And Outpatient Procedures

The following benefits offer the same coverage for both inpatient and outpatient procedures.

Description	Coverage
Surgeon and anesthesiologist fees	100% UCR for covered conditions
Diagnostic study services (laboratory tests, biopsies, X-rays, MRI/CT/PET scans)	100% UCR for covered conditions
Durable medical equipment	US$7,000 for covered conditions
Congenital and/or hereditary conditions diagnosed before age 18	10% of the benefit for covered conditions, per lifetime
Congenital and/or hereditary conditions diagnosed after age 18	50% of the benefit for covered conditions, per lifetime
Reconstructive surgery after an accident or illness	Up to the maximum benefit

Medical Evacuation Benefits

Description	Coverage
Emergency transportation - Ground ambulance	100% UCR for covered conditions, without deductible
Emergency transportation - Air ambulance	US$30,000 for covered conditions, without deductible
Repatriation or cremation of mortal remains	US$10,000

Other Benefits

Description	Coverage
Treatment for injuries during the training or practice of hazardous hobbies and/or non-professional sports	US$100,000 per lifetime, for polytrauma or severe burns
Palliative care	100% UCR for covered conditions
Temporary coverage for polytrauma while application is being underwritten	US$30,000
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.