|
Room and board (private/semi private) |
Coverage |
| Standard |
 |
| Intensive care unit |
|
|
|
Cancer treatment (chemotherapy/radiation therapy) |
|
|
Physical therapy and rehabilitation services (max. 40 sessions per policy year) |
|
|
Home health care (max. 60 days per policy year) |
US$200 |
|
End-stage renal failure (dialysis) |
|
| Prescription drugs |
Coverage |
| Following hospitalization or out-patient surgery (for a maximum of 6 months) |
|
Out-patient or non-hospitalization
- In-country |
|
| - Out-of-country |
80% |
|
|
Prosthetic limbs (lifetime maximum US $120,000) |
US$ 30,000 |
| Medical emergency evacuation: |
Coverage |
| Air ambulance |
30,000 |
| Ground ambulance and return journey |
|
| Repatriation of mortal remains |
US$5,000 |
| These services must be pre-approved and coordinated by USA Medical Services |
|
|
Pregnancy, maternity, and birth, per pregnancy por embarazo
-
10-month waiting period
- Not subject to deductible
-
In-country only
- Plans 2 only
|
US$ 2,500 |
