PROTECT VIP

Is a modular plan that provides flexibility to choose the coverage you need

PROTECT VIP

Is a modular plan that provides flexibility to choose the coverage you need.

HOSPITALIZATION MODULE (BASE PLAN) DEDUCTIBLE OPTIONS* (INSIDE** OR OUTSIDE THE U.S.)

Option I ***Option II***Option III ***Option IVOption VOption VIOption VIIOption VIII
US$0US$500US$1,000US$2,000US$5,000US$10,000US$20,000US$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 Conditions of Coverage of the policy.

**For coverage in the United States, the U.S. Coverage Module must be acquired.

***Not available for the U.S. Coverage Module. When selecting any of these options, a US$2,000 deductible will apply on the U.S. Coverage Module.

TABLE OF BENEFITS

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Base Plan General Information

DescriptionCoverage
Maximum coverage per person, per policy yearUS$5,000,000
Age limit to applyUp to 75 years old
Waiting period30 days
Geographical coverageWorldwide without restrictions of doctors and hospitals (excluding the U.S., unless the optional U.S. Coverage Module is acquired)

Hospitalization Benefits Module (Base Plan)

DescriptionCoverage
Standard private/semi-private hospital room100% UCR
Use of intensive care unit100% UCR
Emergency room care100% UCR (if admitted immediately as an inpatient)
Surgeon and anesthesiologist fees100% UCR
Adult companion accommodation expenses - Of a hospitalized insured under 18 years oldUS$175 per night, max. of 30 nights
Adult companion accommodation expenses - Of a hospitalized insured over 18 years old100% UCR, max. of 21 nights
Prescription medications while hospitalized100% UCR
Prescription medications following a hospitalization or outpatient surgery100% UCR for up to 6 months after discharge, max. of US$3,500 per policy year
Dialysis services: inpatient or outpatient100% UCR
Laboratory tests and X-rays100% UCR
Oncology: inpatient or outpatient treatment (chemotherapy and radiotherapy)100% UCR
Physician and specialist visits100% UCR
Physical therapy and rehabilitation100% UCR (during a hospitalization)
Prostheses and medical appliances implanted during surgery100% UCR
Organ transplant (per organ/tissue)US$1,100,000 per lifetime
HIV/AIDS treatmentUS$50,000 (if admitted as an inpatient and after a 12-month waiting period)
Gastric bypass bariatric surgery and any type of surgical procedure for weight loss and its complications or treatmentsUS$10,000 per lifetime (after a 24-month waiting period)
Durable medical equipment100% UCR (as follow-up care to a covered hospitalization)
Emergency dental coverage100% UCR for treatment within the first 180 days of the covered accident
Evacuation benefitsMedical emergency evacuation:
• Air ambulance: 100% UCR, no deductible applies
• Ground ambulance: 100% UCR, no deductible applies (if admitted immediately as an inpatient)

Repatriation of mortal remains:
US$25,000 (must be pre-approved and coordinated by the company)
Nurse or therapist care at home100% UCR (as follow-up care to a covered hospitalization)
Palliative care100% UCR
Treatment for injuries during the training or practice of hazardous hobbies and/or non-professional sports100% UCR
Temporary coverage for accidents while application is being underwrittenUS$30,000
Elimination/reduction of the policy deductible for no claims during the last 3 years• Elimination for 1 year after the 3rd year without claims (options II & III)
• Reduction of up to 50% for 1 year after the 3rd year without claims (options IV & V)
Second Medical Opinion VIP®Access to a second medical opinion of renowned experts from around the world, no deductible applies

Outpatient Benefits Module (Optional)*

DescriptionCoverage
Outpatient benefits deductibleUS$500 or US$1,000
Outpatient benefits maximum coverage per person, per policy yearUS$20,000
Diagnostic study services (pathology, X-rays, MRI/CT/PET scans, etc.)
Pre-surgical testing only. Pre-authorization required		100% UCR
Outpatient prescription medicationUS$4,000
Physician and specialist visits100% UCR
Outpatient surgery100% UCR
Physical therapy and rehabilitation100% UCR, max. of 60 visits (following a covered hospitalization)
Speech therapy100% UCR
Occupational therapy100% UCR
Sleep apnea and other sleep disorders100% UCR
Autism treatment100% UCR
Allergy treatment100% UCR

The maximum allowable amount for all combined outpatient benefit expenses is US$20,000 per policy year.

U.S. Coverage Module (Optional)*

DescriptionCoverage
Maximum coverage per person, per policy year within the U.S.Up to policy limits
Coverage inside USAInside the Protect VIP USA Network®:
• 100% UCR

Outside the Protect VIP USA Network®:
• 60% of the covered expenses (with a maximum daily room rate of up to US$700 for a standard room and up to US$1,400 for intensive care unit)
• Emergency medical treatment: 100% UCR
Special benefit for suite accommodation (subject to availability)Up to US$2,000 per day within the Protect VIP USA Network®.
(no coverage available outside the Protect VIP USA Network®)

*The Hospitalization Benefits Module (Base Plan) must be acquired before any other optional module can be added.

Optional Additional Benefits (Riders)

DescriptionCoverage
Travel VIP LightUp to US$5,000 for emergency medical treatment while traveling abroad

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.