Special VIP

SPECIAL VIP

Covers all your essential
health needs with an annual
coverage of US$5 million

SPECIAL VIP

Covers all your essential health needs with an annual coverage of US$5 million

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

Download PDF

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 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 policy limits

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$150 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
Physical therapy and rehabilitation	100% UCR

Outpatient Benefits

Description	Coverage
Emergency room care	100% UCR
Physician and specialist visits	100% UCR
Physician and specialist home visits (where available)	100% UCR
Outpatient prescription medication	US$30,000
Nurse or therapist care at home	US$10,000
Preventive health checkup per insured, no deductible applies (after a 10-month waiting period)	Options I & II: • US$100 up to 17 years old • US$150 at 18 years and older Option III: • US$150, all ages
Hearing aids	US$1,000 per lifetime
Treatment for Alzheimer’s disease	100% UCR
Allergy treatment	100% UCR
Physical therapy and rehabilitation	US$10,000

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
Diagnostic study services (laboratory tests, pathology, X-rays, MRI/CT/PET scans)	100% UCR
Oncology: tests, treatment (chemotherapy and/or radiotherapy) and medication	100% UCR
Surgery to reduce the risk of cancer or prophylactic surgery	US$25,000 per lifetime (after a 12-month waiting period)
Dialysis services	100% UCR
Prostheses and medical appliances implanted during surgery	100% UCR
Durable medical equipment	US$10,000
Specialized treatments: autism, sleep apnea and other sleep disorders Specialized therapies: occupational and speech	US$3,000
Congenital and/or hereditary conditions diagnosed before age 18	US$500,000 per lifetime
Congenital and/or hereditary conditions diagnosed after age 18	US$2,000,000 per lifetime
HIV-AIDS treatment	US$250,000 per lifetime (after a 48-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$5,000 per lifetime (after a 24-month waiting period)
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

Maternity Benefits

10-month waiting period, no deductible applies.

Description	Coverage
Maternity (options I & II)	• US$4,000 • Includes extraction and storage of umbilical cord blood stem cells Includes deliveries for pregnancies that are a result of any type of fertility treatments
Maternity and newborn complications (options I & II)	US$500,000
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$60,000, no deductible applies
Cost of return ticket for the insured and one companion after an evacuation by air ambulance	Up to US$500 per ticket
Repatriation or cremation of mortal remains	US$40,000

Other Benefits

Description	Coverage
Treatment for injuries during the training or practice of hazardous hobbies and/or professional low-risk sports	100% UCR
Emergency dental coverage	100% UCR for treatment within the first 180 days of the covered accident
Palliative care	100% UCR
Temporary coverage for accidents while application is being underwritten	US$30,000
Free extended coverage for eligible dependents after the policyholder’s death as a result of a covered accident or condition	1 year
Elimination/reduction of the policy deductible for no claims during the last 3 years	Options I, II & III: • 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 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
Organ/tissue transplant	US$500,000 per lifetime
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.