Prime Select

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SELECT

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ACCESS TO THE BEST HOSPITALS IN THE U.S.A.

This plan provides members with great solutions for major impact illnesses.

BENEFIT	COVERAGE
Maximum Benefit	•US$1,000,000
Eligibility to Apply for Coverage	•From 18 to 74 years old
Renewal	• Lifetime guarantee, as long as Policy conditions are met
Coverage	• Worldwide • Free choice of hospitals and doctors
Private and Semi-Private Room	•100%
Intensive Care Unit	•100%
Surgery (Including Outpatient Surgery)	•100%
Emergency Room	•100%
Surgeon and Anesthetist Fees	•100%
Major Diagnostic Services	•100%
Cancer Treatment	•100%
Dialysis	•100%
Congenital and Hereditary Disorders	• $100.000 per Insured per lifetime (When the condition is diagnosed before age 18) • 100% (When the condition is diagnosed at age 18 or after)
Organ and Tissue Transplants	• $300.000 per Organ or Tissue, lifetime per Insured, including US$20.000 for living donor
Outpatient Physical Therapy, Rehabilitation and Home Health Care (Private nurse)	• $4.000 per Insured per Policy Year
Surgical treatment for symptomatic disorders of the feet	•100%
Emergency Dental Coverage	• 100%
Physician and Specialist Visits	• 100%
Reconstructive Surgery in Case of Illness or Accident	•100%
Durable Medical Equipment Special Devices, External prosthesis, Orthotic devices	• $6.500 per Insured per Policy Year
Surgical Treatment of Symptomatic Foot Disorders	•100%
Surgical Implants or prosthesis (Excluding dental)	•100%
Prescribed Medications	• $10,000 per Insured per Policy Year (outside hospitalization) • 100% during hospitalization
Prophylactic surgery for reduction of cancer risk	• $10.000 per Insured per lifetime • 12-month Waiting Period
Emergency Transport •Air ambulance to the nearest hospital for proper treatment •Ground ambulance to the nearest hospital for proper treatment No deductible applies	• $30.000 per Insured per Policy year to the closest Hospital of qualified treatment • No deductible applies • 100% to the closest Hospital of qualified treatment • No deductible applies
Repatriation of Mortal Remains or Cremation Services	• $5.000 per Insured per Policy Year, in the event of death resulting from a covered Accident or condition
Coverage for accidents that occurred during the practice of high risk activities	•100%
Temporary Emergency coverage while application is evaluated	• $25.000
Alzheimer Disease	•100%
Additional Benefits	•Deductible will be waived up to US$5,000 in case of accident or emergency while insured is traveling outside his/her country of residence.
Additional Benefits	•In the event of a serious accident, as defined in the Policy, the deductible will be waived during the first medically necessary hospitalization immediately following said serious accident.
EXCLUSIVE SERVICES	InterConsultation™ Confirmation of diagnosis and recommendation of the best treatment and specialists. Immediate access to this benefit available regardless of any exclusion applicable under this Policy. Best Doctors Concierge™ Coordination of medical appointments, hospital admission, travel arrangements, accommodation and transportation when services are rendered outside of the Insured’s Country of Residence. Directed Care A program to coordinate, supervise and manage complex cases of long duration.
REMINDERS
•Unless otherwise indicated, all benefits are per Insured, per Policy Year with the application of the selected deductible.
•All amounts are shown in US Dollars (US$).
•The deductible is cumulative per insured, per policy year, with a maximum equivalent to two deductibles per policy year.
•Covered medical expenses subject to usual, customary, and reasonable (UCR).

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