In-Hospital: General Conditions |
Financial Limitation |
Unlimited |
$150,000 Per member per year |
Network |
Full Network |
Excluding AUBMC and CMC |
Burial Cost |
Covered up to $2,000 |
Not Covered |
In-Hospital: Maternity and Congenital Cases |
Coverage of New Born |
Covered with GR from day 0 |
Covered after 14 days subject to U/W |
Baby Incubator |
Unlimited |
Covered for 6 days irrespective of the mother's stay at the hospital |
Congenital Cases |
Unlimited |
Covered up to $3,000 |
Additional Congenital Cases |
Covered |
Covered up to $3,000 |
In-Hospital: Prothesis |
Due to accident |
Unlimited |
Covered up to $5,000 |
Mesh Related to Hernia Surgeries |
Covered up to $30,000 |
Covered up to $5,000 |
Coronary Stent |
Covered up to $30,000 |
Covered up to $5,000 |
Cardiac Valve |
Covered up to $30,000 |
Covered up to $5,000 |
All kinds of Prothesis |
Covered up to $30,000 |
Covered up to $5,000 |
In-Hospital: Cancer |
Radiotherapy |
Unlimited |
Covered up to $100,000 Per member per year |
Chemotherapy |
Unlimited |
Covered up to $100,000 Per member per year |
Surgery |
Unlimited |
Covered up to $100,000 Per member per year |
Breast reconstruction |
Unlimited |
Covered up to $100,000 Per member per year |
In-Hospital: Heart Procedures |
Open Heart |
Covered - Unlimited |
Covered - Up to $50,000 Per member per year |
Angioplasty |
Covered - Unlimited |
Covered - Up to $50,000 Per member per year |
In-Hospital: Organ Transfer and Transplantation |
Surgery of Organ Transfer and/or Transplantation |
Covered up to $60,000 |
Not Covered |
Surgery of Bone Marrow Transfer and/or Transplantation |
Covered up to $60,000 |
Not Covered |
Cornea Transplant |
Covered up to $2,000 Per admission |
Not Covered |
In-Hospital: Psychiatric Illnesses |
Mental or Psychiatric Disorders, Nervous Breakdown and Psychological Tests or Evaluations |
Covered |
Not Covered |
In-Hospital: Infertility and Birth Control |
Varicocele |
Covered |
Not Covered |
In-Hospital: Sleep Disorder |
Sleep Disorder Treatments and Polysomnography |
Covered |
Not Covered |
Ambulatory: General Conditions |
Financial Limitation |
Unlimited |
Up to $2,500 Per member per year |
Network |
Full Network |
Excluding AUBMC & CMC |
Ambulatory: Diagnostic Tests |
Financial Limitation |
Unlimited |
Up to $2,500 Per member per year |
C.T Scan |
Covered |
Covered |
MRI |
Covered |
Covered |
MRI |
Covered |
Covered |
Laboratory Tests |
Covered |
Covered |
Stress Test |
Covered |
Covered |
Obstetrical Ultrasound (Eg: Echography) |
Covered |
Covered twice per delivery |
Coroscan (VCT 64) |
Covered |
Not Covered |
PET Scan |
Covered |
Not Covered |
Ocular Coherence Tomography (OCT) |
Covered |
Not Covered |