Prime VIP - VUMI

PRIME VIP

Offers a wide range of benefits with a lifetime coverage of US$5 million

PRIME VIP

Offers a wide range of benefits with a lifetime coverage of US$5 million

DEDUCTIBLE OPTIONS*

	Option I	Option II	Option III	Option IV	Option V
Inside USA	US$1,500	US$3,000	US$5,000	US$10,000	US$20,000
Outside USA	US$1,500	US$3,000	US$5,000	US$10,000	US$20,000

*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 lifetime	US$5,000,000
Maximum coverage per person, per policy year	US$1,500,000
Maximum coverage per person, per policy year at 70 years and older	US$500,000
Maximum age to apply for coverage	Up to 75 years old
Waiting period	60 days
Coinsurance (inside USA)	20% of the first US$5,000 after the deductible; 1 per insured, per policy year; max. of 2 per policy, per policy year
Coverage outside USA	100% UCR with free choice of hospitals and doctors*
Coverage inside USA	• 100% UCR within the Prime Network® • Outside the Prime Network®, the coverage will be at 60% • Emergencies will be covered at 100% UCR, up to the policy limits

*Excluding the Hospitales Star Médica hospitals in Mexico.

Inpatient Benefits

Description	Coverage
Standard private hospital room	• 100% UCR within the Prime Network® • Up to US$500 daily, max. of 180 days outside the Prime Network®
Use of intensive care unit	• 100% UCR within the Prime Network® • Up to US$1,400 daily, max. of 60 days outside the Prime Network®
Adult companion accommodation expenses of a hospitalized insured under 18 years old	US$150 per night, max. of 100 nights per policy year
Prescribed medication while hospitalized	100% UCR
Inpatient laboratory tests and X-rays	100% UCR

Outpatient Benefits

Description	Coverage
Emergency room care	100% UCR
Physician and specialist visits (including home visits where available)	US$80 per visit, max. of 30 visits
Outpatient surgery	US$12,000
Prescribed medication following a hospitalization	100% UCR for up to 6 months
Outpatient or non-hospitalization prescription medication	US$3,000
Outpatient diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans)	US$600 per exam, per insured; max. of US$1,800 per policy year
Nurse or therapist care at home	US$5,000
Preventive health checkup per insured, no deductible applies (options I & II)	US$100 (after a 12-month waiting period)

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
Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication	100% UCR, max. of US$125,000 per policy year
Dialysis services	100% UCR
Prostheses and medical appliances implanted during surgery	100% UCR
Durable medical equipment	US$1,000
Physical therapy and rehabilitation	US$5,000
Congenital and/or hereditary conditions diagnosed before age 18	US$125,000 per lifetime
Congenital and/or hereditary conditions diagnosed after age 18	US$500,000 per lifetime
Reconstructive surgery after an accident or illness	Up to the maximum benefit

Maternity Benefits

10-month waiting period, no deductible applies.

Description	Coverage
Maternity (options I & II)	US$3,000 Includes deliveries for pregnancies that are a result of any type of fertility treatments
Maternity and newborn complications (options I & II)	US$25,000
Inclusion of the newborn within 90 days after the birth (options I & II)	Without underwriting, if born from a covered maternity

Medical Evacuation Benefits

Description	Coverage
Emergency transportation - Ground ambulance	100% UCR, no deductible applies
Emergency transportation - Air ambulance	US$35,000, no deductible applies
Repatriation or cremation of mortal remains	100% UCR

Other Benefits

Description	Coverage
Emergency dental coverage	100% UCR for treatment within the first 30 days of the covered accident, max. of US$6,000 per policy year
Palliative care	US$7,500
Temporary coverage for accidents 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
Organ/tissue transplant	US$500,000 per lifetime
Maternity and newborn complications (options I & II)	Additional US$25,000
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.