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Health and Hospitalisation Insurance
Benefit Schedule
In the tables below, we have summarised the benefits operative within
the Foundation and Optional Modules. Please refer to the Policy Wording
for the full benefit covers and definitions.
All benefits shown are per person, per annum (unless specifically
stated) and are subject to an annual maximum limit of US $ 1,700,000.-.
| Foundation Module |
|
| Medical
Practitioner and Specialist Fees |
| i) Medical Practitioner fees including
consultations |
Full refund |
| ii) Specialist fees as an In-Patient,
Day-Patient or Out-Patient |
Full refund |
| iii) Diagnostic and surgical procedures
as an In-Patient, Day-Patient or Out-Patient |
Full refund |
| iv) Physiotherapy |
Full refund |
| Treatment administered by registered
chiropractors, osteopaths, homeopaths and acupuncturists |
Full refund |
| Hospital Charges |
| Theatre Fees and accommodation charges
whilst an In-Patient or Day-Patient in a Hospital, including
charges for nursing by a Qualified Nurse |
Full refund |
| Home Nursing |
| Immediately following Hospital discharge |
Limited to 30 days per condition |
| Prescribed Drugs and Dressings |
| Drugs, medicines, dressings and appliances
prescribed by a Medical Practitioner or Specialist |
Full refund |
| Reconstructive Surgery |
| Reconstructive surgery following an
accident or following surgery for an eligible Medical Condition |
Full refund |
| Psychiatric Illness |
| i) Out-Patient Treatment, including
Specialist consultations |
Full refund |
| ii) In-Patient treatment in a recognised
psychiatric unit of a Hospital |
Limited to 28 days per annum |
| AIDS |
| Medical expenses which arise from
or are in any way related to Human lmmuno-deficiency Virus
(HIV) and/or HIV-related illnesses, including Acquired
Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)
and/or any mutant derivative or variations thereof |
Limited to US$ 42,500.- per
lifetime |
| Accidental Damage to Teeth |
| Treatment received in a dental surgery
or in an emergency room in a Hospital immediately following
accidental damage caused to sound, natural teeth |
Full refund |
| Complications of Pregnancy |
| Treatment of a Medical Condition which
arises during the antenatal stages of pregnancy, or a Medical
Condition which arises during childbirth and requires a recognised
obstetric procedure |
Full refund |
| Parent Accommodation |
| Hospital accommodation costs in respect
of a parent or legal guardian staying with an Insured Person
who is under 12 years of age and is admitted as an In-Patient
in a Hospital |
Full refund |
| New-born Accommodation |
| Hospital accommodation costs relating
to a newborn baby to accompany its mother (being an Insured
Person) whilst she is receiving treatment as an in-patient in
a Hospital |
Full refund |
| Hormone Replacement Therapy |
| Consultations and the costs of prescribed
implants or patches |
Full refund |
| Transportation |
| Transportation costs to and from Hospitals
by the most appropriate form of transport |
Full refund |
| Evacuation |
Evacuation of an Insured Person in
the event of Treatment not being readily available at the place
of the incident to the nearest appropriate facility for the
purpose of admission to Hospital as an In-Patient or Day-Patient
Extended to cover the costs for one other person to travel with
the Insured Person as escort |
Full refund |
| Additional Travel Expenses (following
evacuation) |
Reasonable travel costs:
i) To and from medical appointments when treatment is being
received as a Day-Patient |
Full refund |
| ii) For an accompanying person to
travel to and from the hospital to visit the Insured Person
following admission as an in-patient |
Full refund |
| iii) Non-Hospital accommodation for
immediate pre and post Hospital admission periods provided that
the Insured Person is under the care of a Specialist |
Limited to US$ 140.- per person
per day and US$ 4,250.- per person per evacuation |
| Mortal Remains |
i) Transportation of a body or ashes
to Country of Nationality or Country of Residence, or
ii) Burial or cremation costs at the place of death |
Limited to US$ 8,500.- |
| Optional Modules |
|
| Chronic Conditions |
| Routine check-ups, drugs prescribed
for condition management, Hospital accommodation, nursing, surgery
and Palliative Treatment for Chronic conditions |
Limited to a maximum of US$
42,500.- per annum for 5 years from confirmed date of diagnosis |
| Routine Dental Treatment |
| Examinations, tooth cleaning, normal
compound fillings, porcelain crowns and extractions |
Limited to US$ 700.- |
| Major Restorative Dental Work |
| Removal of impacted, buried or unerupted
teeth, removal of roots, removal of solid odontomes, apicetomy,
new or repair of bridge work, new or repair of crowns, new or
repair of upper and lower dentures |
Limited to US$ 3,500.- |
| Normal
Pregnancy and Childbirth |
| Pre and postnatal check-ups and delivery
costs incurred after 12 months from purchase date of this Benefit |
Limited to US$ 8,500.- per pregnancy |
| Evacuation/Repatriation |
| Evacuation to Country of your Choice |
Full refund |
| Policy Excess |
The Foundation Module carries a US$
100.- Excess. You can amend this by selecting one of the following
options:
| Nil |
US$ 50 |
US$ 50 |
| US$ 200 |
US$ 300 |
US$ 500 |
| US$ 1,000 |
US$ 2,000 |
US$ 5,000 |
|
|
| In-Patient Only |
| Benefits restricted to costs incurred
for Treatment received as an In-Patient or Day-Patient plus
Evacuation |
Full refund |
| |
| Out-Patient treatment provided immediately
following discharge from a Hospital |
US$ 1,700.- per medical condition |
| USA Elective Treatment |
| Provision for Elective Treatment in
the USA |
|
Health and Hospitalisation Insurance
Frequently Asked Questions
Premium Rates
Benefit Schedule
Application Form
Claim Form
Sample Policy Wording
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