GROUP GLOBAL
FLEX VIP ULTRA
A comprehensive plan
offering superior benefits
and free choice of medical providers
DEDUCTIBLE OPTIONS
| Option I | Option II | Option III | Option IV | Option V | Option VI | Option VII | |
|---|---|---|---|---|---|---|---|
| US$0 deductible | US$1,000 deductible | US$2,000 deductible | US$5,000 deductible | US$10,000 deductible | US$15,000 deductible | US$20,000 deductible |
| Option VIII | Option IX | Option X | Option XI | Option XII | |
|---|---|---|---|---|---|
| US$15 out-patient per visit excess | US$30 out-patient pervisit excess | 10% out-patientco-insurance, up to amaximum out of pocketof US$2,000 | 20% out-patientco-insurance, up to amaximum out of pocketof US$4,000 | 30% out-patientco-insurance, up to amaximum out of pocketof US$6,000 |
TABLE OF BENEFITS
| Description | Coverage |
|---|---|
| Maximum coverage per person, per policy year | US$4,500,000 |
| Maximum age to apply for coverage | Up to 74 years |
| Geographical cover options | The policyholder can choose geographical area of cover restrictions as follows: Any treatment received outside the geographic area of coverage is
For insureds residing in Africa, the area of cover will be restricted to:
For insureds residing in Armenia, Azerbaijan, Brunei, Cambodia,
|
| Description | Coverage |
|---|---|
| Adult companion accommodation (related to a coveredhospitalisation of an insured child under age 18) | Up to the maximum benefit |
| Psychiatric treatment | Up to the maximum benefit, max. of 30 days |
| Standard private room (room and board) | 100% UCR, up to the maximum benefit |
| Description | Coverage |
|---|---|
| Complementary therapy including physiotherapy, traditional chinesemedicine (TCM) and ayurvedic treatment | Up to the maximum benefit, pre-authorisation requiredafter 10 sessions |
| Day-care treatment | Up to the maximum benefit |
| General practitioner and specialist fees | Up to the maximum benefit |
| Hormone replacement therapy to relieve the symptoms of menopause | Up to US$350 |
| Nursing care at home | Up to the maximum benefit, max. of 120 days |
| Out-patient surgery | Up to the maximum benefit |
| Out-patient prescription drugs | Up to the maximum benefit |
| Psychiatric treatment | Up to US$7,500 |
| Travel vaccinations and preventive medication, e.g., against malaria | Up to US$350 |
| Description | Coverage |
|---|---|
| Congenital and/or hereditary conditions after 30 days from birth | Up to US$125,000 |
| Congenital and/or hereditary conditions from birth up to 30 days | Covered under the newborn benefit |
| Diagnostic study services (laboratory tests, X-rays, CT, PET and MRIscans) | Up to the maximum benefit |
| External prostheses | Up to US$2,500 per policy year |
| HIV-AIDS treatment | Up to US$50,000 |
| Oncology (tests, drugs and treatments approved by the FDA orequivalent domestic/ international regulatory body) | Up to the maximum benefit |
| Organ Transplant (per organ/tissue, per lifetime) | Full refund including US$50,000 for donor costs |
| Prescribed physical therapy and rehabilitation | Up to the maximum benefit, max. of 120 days per medical condition |
| Reconstructive surgery | Up to the maximum benefit |
| Renal failure and dialysis | Up to the maximum benefit |
| Routine management of chronic conditions | Up to the maximum benefit |
| Surgical procedures | Up to the maximum benefit |
| Terminal illness / palliative care | Up to US$125,000 per lifetime |
| Description | Coverage |
|---|---|
| Maternity and birth complications | Up to the maximum benefit |
| Maternity care | Up to US$15,000 |
| Newborn cover | Up to US$125,000 |
| Description | Coverage |
|---|---|
| Emergency transportation by air ambulance & emergency medicalevacuation | Up to the maximum benefit |
| Repatriation of mortal remains | Up to the maximum benefit, US$15,000 for burial or cremation costs |
| Description | Coverage |
|---|---|
| Emergency dental treatment | Up to the maximum benefit |
| Emergency non-elective treatment outside the geographical area ofcoverage | • Up to the maximum benefit for injuries • Up to US$50,000 for illnesses • Up to US$500 for out-patient hospital visits |
| Emergency transportation by ground ambulance | Up to the maximum benefit |
| Hospital cash benefit | Up to US$400 per night, max. of 30 nights |
| Passive war and terrorism | Up to the maximum benefit |
| Routine and major dental treatment cover | Up to US$1,000 for routine and up to US$2,000 for complex,subject to a 20% co-insurance |
| Second Medical Opinion VIP® | Access to the medical opinion of internationally renownedexperts from around the world regarding a condition, nodeductible applies |
| USA elective treatment (only available for insureds who chose theworldwide including USA elective treatment geographical area ofcover) | Up to US$3,000,000 |
| Description | Coverage |
|---|---|
| Evacuation to country of choice, country of residence or homecountry | Up to the maximum benefit |
| Medical history disregarded | For compulsory group policies of 10 employees or more |
| Non-emergency evacuation | Up to US$2,000 |
| Wellness and optical | Option I - US$500 Option II - US$1,000 |
WAITING PERIODS
| Description | Coverage |
|---|---|
| Dental | 9 months |
| HIV-AIDS | 36 months |
| Maternity and new-born complications | 12 months |
| Maternity care | 12 months |