| Table of benefits | PremierFamily |
|---|---|
| Maximum lifetime plan benefit | $5,000,000 | €3,750,000 | £3,000,000 |
| Annual maximum plan benefit | $2,000,000 | €1,500,000 | £1,250,000 |
| Table of benefits | PremierFamily |
|---|---|
| Accommodation | Private room |
| Inpatient treatment, daypatient, operating theatre and recovery room, prescribed medicines, drugs and dressing for inpatient or daypatient treatment | 100% |
| Intensive care unit | 100% |
| Inpatient ancillary services including physical and occupational therapy as daypatient or inpatient | 100% |
| Surgeons’ and anaesthetists’ fees | 100% |
| Inpatient consultation by specialist | 100% |
| Emergency room | 100% |
| Pathology, radiology, and diagnostic tests | 100% |
| MRI, CT and PET scans | 100% |
| Private duty nursing (Lifetime maximum) | $15,000 | €12,500 | £10,000 |
| Skilled nursing facility (Lifetime maximum) | $15,000 | €12,500 | £10,000 |
| Home health care (Lifetime maximum) | $15,000 | €12,500 | £10,000 |
| Hospice care services (Lifetime maximum) | $20,000 | €15,000 | £13,000 |
| Emergency dental treatment (as a result of accident) | 100% |
| Cancer treatment | 100% |
| Child and companion accompaniment | 100% If the insured person is a child under 16 who requires hospitalisation, we will pay for necessary overnight accommodation for one parent in the same hospital, or when no such accommodation is available, for necessary bed and breakfast accommodation in a nearby hotel. Pre-approval is necessary. |
| MANAGED TRANSPLANT PROGRAMME | Transplant must be pre-certified and approved by us. Failure to comply will result in treatment not being covered by your policy. |
| Organ transplants maximum lifetime | $500,000 | €400,000 | £300,000 |
| Tissue transplants (as part of the overall organ max.) | $250,000 | €200,000 | £150,000 |
| Table of benefits | PremierFamily |
|---|---|
| Surgery as outpatient | 100% |
| Physician office visits and specialist fees | 100% |
| Diagnostic and therapeutic services (as outpatient, per visit) | 100% |
| Physical therapy (as outpatient, per visit) | 100% | $75 | €60 | £50 policy year max 50 visits |
| Occupational therapy (as outpatient, per visit) | 100% | $75 | €60 | £50 policy year max 50 visits |
| Chiropractic services Policy year maximum for chiropractic services Referral letter required from medical physician | 100% | $1,500 | €1,250 | £1,000 |
| Complementary medicine Including TCM, bonesetting, acupuncture, herbal medicine, homeopathy and osteopathy | 100% | $1,500 | €1,250 | £1,000 |
| PRESCRIPTION PROGRAMME | |
| In US (no deductible applies) | 100% generic | 90% brand |
| All other countries (deductible applies) | 100% |
| DENTAL | |
| Routine dental | $1,500 | €1,250 | £1,000 |
| Diagnostic and preventive dental | 100% |
| Dental plan option available | Yes See dental options |
| Table of benefits | PremierFamily |
|---|---|
| Pregnancy normal delivery | 100% | $20,000 | €15,000 | £13,000 |
| Complicated pregnancy | 100% | $30,000 | €25,000 | £20,000 |
| Routine nursery, included under Maternity Benefits as any other treatment including room and board, physician charges and circumcision for males prior to discharge. | |
| New born cover Included in New Born Cover are premature births, congenital conditions and birth anomalies. New Born Cover is only available for a covered pregnancy. | $30,000 | €25,000 | £20,000 |
| Table of benefits | PremierFamily |
|---|---|
| ADULTS Per policy year | $750 | €600 | £500 |
| Routine physical exams in connection with overall health and wellbeing | 100% |
| Pap smear | 100% |
| Mammograms: ages 35-39 one baseline exam; ages 40-49 one exam every one or two years for asymptomatic women, but no sooner than two years after baseline; age 50 and over one exam annually; any age whenever prescribed by a physician | 100% |
| Prostate cancer screening: one test per policy year for males age 50 or over | 100% |
| Immunizations and vaccinations | 100% |
| CHILD(REN) | |
| Maximum per policy year: birth to age 12 months | $500 | €400 | £325 |
| Maximum per policy year: 13 months and over | $300 | €225 | £200 |
| Routine medical exams and immunizations and vaccinations | 100% |
| Child preventive care services | 100% |
| Hearing tests | 100% |
Six-month waiting period applies to all Wellness Benefits, but waits are waived for policies that are paid annually. Deductible does not apply to Wellness Benefits. Overall Wellness Benefit maximums apply to all routine and Wellness Benefits for adults and children.
| Table of benefits | PremierFamily |
|---|---|
| Vision care cover | 100% |
| Maximum per 24-month period Six month waiting period applies to Vision Care Cover but waits are waived for policies that are paid annually. | $300 | €275 | £225 |
| Table of benefits | PremierFamily |
|---|---|
| Medical evacuation and assistance | 100% |
| 24/7 Emergency medical assistance hotline | Yes |
| Repatriation of mortal remains | 100% |
| Family emergency travel | 100% | $5,000 | €3,500 | £3,000 |
| Repatriation accompaniment | 100% | $5,000 | €3,500 | £3,000 |
| Repatriation family accompaniment | 100% | $3,000 | €2,250 | £2,000 |
Access to our specialist representatives provide a 24/7 international emergency response in events such as security crises, political unrest and natural disasters. The services include assistance in arranging evacuation, contingency planning, remote medical abilities, crisis management and tracking services. Any costs incurred are the responsibility of the insured person, and must be paid by you to the service provider.
| Table of benefits | PremierFamily |
|---|---|
| Best possible outcome programme | Yes |
| A dedicated diagnosis verification and treatment planning care management programme. In the event that you are diagnosed with a specified critical illness, the programme provides access to an appropriate specialist who will remotely review your medical reports to confirm your diagnosis and advise, in conjunction with your treating physician on your treatment options, to provide the best outcome. | |
| Advanced health screening programme | 100% |
| Ages 40-50 one high level physical examination every three years | $1,000 | €750 | £650 |
| Ages 50+ one high level physical examination every three years | $1,500 | €1,250 | £1,000 |
| eHealth records account | Yes |
| Table of benefits | PremierFamily |
|---|---|
| Mental Health Benefits | 100% |
| Lifetime maximum for mental health benefits (inpatient and outpatient) | $25,000 | €20,000 | £15,000 |
| Policy year mental illness, maximum (out-of-hospital) 15 visits | $2,500 | €2,000 | £1,500 per policy year |
| Lifetime mental illness, maximum per insured (in-hospital) | 60 days |
| Lifetime maximum for mental health benefits (out-of-hospital) | 80 visits |
Mental health benefits do not count towards out of pocket maximum.
| Table of benefits | PremierFamily |
|---|---|
| Expatriate Assistance Programme | Yes |
Operated by Morneau Shepell, provides assistance with the following types of issues often faced by expatriates: how to cope with isolation and loneliness, adapt across cultures, identify and cope with culture shock, address the personal impact of the relocation, strengthen relationships, improve communication, work towards life goals, deal with stress, anxiety and depression, address alcohol and drug misuse, resolve marital and relationship difficulties, find solutions for work-related issues, access crisis and trauma support while on assignment, discover ways to improve your nutrition in your new environment, focus on your health with natural healing strategies.
| Table of benefits | PremierFamily |
|---|---|
| HIV/AIDS treatment | Yes |
| Lifetime maximum | $25,000 | €20,000 | £15,000 |
| Table of benefits | PremierFamily |
|---|---|
| Durable medical equipment | Yes |
| Lifetime maximum | $20,000 | €15,000 | £13,000 |
Elected co-pay option applies for all outpatient benefits in this section.
| Table of benefits | PremierFamily |
|---|---|
| Chronic conditions | Yes |
Chronic conditions are treated like any other condition under the policy.
| Table of benefits | PremierFamily |
|---|---|
| Lump sum in case of death All causes | $10,000 | €10,000 | £10,000 |
| Table of benefits | PremierFamily |
|---|---|
| Individual deductible | No |
| Family deductible | Yes |
| Deductible options are: | $0 | €0 | £0 $100 | €75 | £65 $200 | €150 | £125 $500 | €400 | £300 $1,000 | €750 | £650 $5,000 | €4,000 | £3,000 |
| Table of benefits | PremierFamily |
|---|---|
| Family | $3,000 | €2,250 | £2,000 |
Functions just like the individual out of pocket except this is protection for the entire family. If the family out of pocket maximum is reached regardless of whether the individual out of pocket limit is reached the entire family under cover has their 90% benefits switched to 100% for the remainder of the policy year (unless where indicated). For Premier Plans out of pocket while technically possible is not practical due to the 100%. The only area where a maximum out of pocket could be reached is in the US prescriptions for brand name drugs. All other qualified benefits are at 100%.
Cover Region 1 – Worldwide including US and Canada and their territories.
For Cover Region 1 – please note that benefits listed above are only applicable when using our Preferred Provider Network. Benefits outside of network are reduced to 70% and co-insurance does not count toward out of pocket max.
Please note that Cover Region 1 is limited to 180 days in the US in any 12-month period.
Cover Region 2 – Worldwide but excluding US and Canada and their territories.
For Cover Region 2 – does not include any cover for US and Canada and their territories.
| Optional benefits plan | PremierFamily |
|---|---|
| Individual deductible | $50 | €40 | £30 |
| Family deductible | $150 | €125 | £100 |
| CLASS I EXPENSES Diagnostic – general preventive | Included under your Premier medical plan |
| CLASS II EXPENSES Restorative (basic); endodontics; periodontics; prosthodontics – removable (maintenance); fixed bridge (maintenance); oral surgery | 90% |
| CLASS III EXPENSES Restorative (major); endodontics; prosthodontics – removable (installation); fixed bridge (installation). | 60% |
Orthodontic and Class III services are available after six months of continuous enrolment in the Dental Plan. Orthodontic services are only available for children under 18 years of age.
| Optional benefits plan | PremierFamily |
|---|---|
| Policy year maximum (per insured person) | $3,000 | €2,250 | £2,000 |
| Orthodontic lifetime maximum | $2,500 | €2,000 | £1,500 |
In the event of an accidental death or dismemberment of the primary insured the insurer pays a lump sum benefit equal to the principal sum subject to a maximum benefit multiplied by a percentage as shown below.
| Optional benefits plan | PremierFamily |
|---|---|
| Policy year maximum plan benefit | $100,000 | €80,000 | £70,000 |
| Loss of life | 100% |
| Loss of sight of both eyes | 100% |
| Loss of both hands or arms | 100% |
| Loss of both feet or both legs | 100% |
| Loss of one arm and one leg | 100% |
| Loss of sight of one eye | 50% |
| Loss of one foot or one leg | 50% |
| Loss of one hand or arm | 50% |
N.B. Benefits cannot exceed two times annual salary. See rate sheet for benefit sums available.