GROUP GLOBAL
FLEX VIP BASIC
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 | US$1,000 | US$2,000 | US$5,000 | US$10,000 | US$15,000 | US$20,000 |
TABLE OF BENEFITS
| Description | Coverage |
|---|---|
| Maximum cover per person, per policy year | US$3,000,000 |
| Maximum age to apply for coverage | Up to 74 years |
| Geographical cover options | The policyholder can choose geographical area of cover restrictionsas follows: Any treatment received outside the geographic area of coverage is • Worldwide including USA elective treatment • Worldwide excluding USA |
| Geographical cover options (continued) | • Africa area of cover restriction 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 |
|---|---|
| Day-care treatment | Up to the maximum benefit |
| Nursing care at home | Up to the maximum benefit, max. of 30 days |
| Out-patient surgery | Up to the maximum benefit |
| General practitioner and specialist fees | Up to the maximum benefit, pre- and post-operative, up to 15 daysprior to and 30 days after in-patient treatment |
| Out-patient prescription drugs | Up to the maximum benefit, pre- and post-operative, up to 15 daysprior to and 30 days after in-patient treatment. |
| Physiotherapy | Up to the maximum benefit, 30 days after in-patient / Surgerytreatment (covered under physical therapy and rehabilitation) |
| Description | Coverage |
|---|---|
| Congenital and/or hereditary conditions after 30 days from birth | Up to US$50,000 |
| Congenital and/or hereditary conditions from birth up to 30 days | Covered under the newborn benefit |
| Diagnostic study services (laboratory tests, X-rays, CT, PETand MRI scans) | Up to the maximum benefit |
| External prostheses | Up to US$1,000 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 30 days per medical condition |
| Reconstructive surgery | Up to the maximum benefit |
| Renal failure and dialysis | Up to the maximum benefit |
| Surgical procedures | Up to the maximum benefit |
| Terminal illness / Palliative care | Up to US$50,000 per lifetime |
| Description | Coverage |
|---|---|
| Maternity and birth complications | Up to the maximum benefit |
| Newborn cover | Up to US$50,000 |
| Description | Coverage |
|---|---|
| Emergency transportation by air ambulance & emergency medicalevacuation | Up to the maximum benefit |
| Repatriation of mortal remains | Up to the maximum benefit, US$5,000 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 |
| Emergency transportation by ground ambulance | Up to the maximum benefit |
| Hospital cash benefit | Up to US$250 per night, max. of 30 nights |
| Passive war and terrorism | Up to the maximum benefit |
| Second Medical Opinion VIP® | Access to the medical opinion of internationally renowned experts from around the world regarding a condition (no deductible 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 |
| Out-patient treatment | • Option I - Up to US$5,000 for out-patient treatment |
WAITING PERIODS
| Description | Coverage |
|---|---|
| HIV-AIDS | 36 months |
| Maternity and newborn complications | 12 months |