Coversure Prime Plan Table of Benefits 2013

1. Overall limits

1.1 Under the terms and conditions of the plan, we will pay reasonable costs up to an overall maximum, for you in each plan year (unless a lifetime limit is shown):

Excluding dental with 10% out-patient co pay

$3,400,000

Including dental with 10% out-patient co pay

$3,400,000

Excluding dental without out-patient co pay

$3,400,000

Including dental without out-patient co pay

$3,400,000

 

2. In-patient and daycare treatment (see section 19 for deductibles).

2.1 Accidents and emergencies.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

2.2 Hospital accommodation.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

2.3 Intensive care, theatre costs, nursing fees, medical expenses and other charges, surgeons’, consultants’, anaesthetists’ and medical practitioners’ fees, prescribed drugs, MRI, PET and CT scans, X-rays, pathology, diagnostic tests and procedures and physiotherapy by a registered physiotherapist.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

2.4 Reconstructive surgery following an accident or following surgery for an eligible medical condition.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

2.5 Prostheses: artificial body parts surgically implanted to form permanent parts of your body.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

2.6 Parent accommodation for a parent or legal guardian with an insured child under the age of 18 in hospital for an eligible medical condition.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

2.7 Dental treatment that medically requires you to be admitted in to hospital to restore damage to your natural teeth following an accident that is covered under your plan.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

2.8 Psychiatric treatment and psychotherapy for up to 30 days, available after you have had 12 months’ continuous cover from the date that the benefit was first introduced on your plan..

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

3. Out-patient treatment (see section 19 for deductibles).

3.1 Consultations to include medical practitioners’ fees, prescribed drugs and dressings, X-rays,pathology, diagnostic tests and procedures.

Excluding dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Including dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

3.2 Physiotherapy by a registered physiotherapist, when referred by a medical practitioner, consultant or specialist Complementary medicine and treatment by a therapist, when referred by a medical practitioner, consultant or specialist.

Excluding dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Including dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

3.3 Complementary medicine and treatment by a therapist, when referred by a medical practitioner, consultant or specialist. This benefit covers osteopathic, chiropractic, homeopathic, podiatry and acupuncture treatment only.

Excluding dental with 10% out-patient co pay

Paid up to 90% of $3,400

Including dental with 10% out-patient co pay

Paid up to 90% of $3,400

Excluding dental without out-patient co pay

Paid up to $3,400

Including dental without out-patient co pay

Paid up to $3,400

 

3.4 Traditional Chinese medicine

Excluding dental with 10% out-patient co pay

Paid up to 90% of $3,400

Including dental with 10% out-patient co pay

Paid up to 90% of $3,400

Excluding dental without out-patient co pay

Paid up to $3,400

Including dental without out-patient co pay

Paid up to $3,400

 

3.5 Psychiatric treatment and psychotherapy available after you have had 12 months’ continuous cover from the date that the benefit was first introduced on your plan.

Excluding dental with 10% out-patient co pay

Paid up to 90% of $3,400

Including dental with 10% out-patient co pay

Paid up to 90% of $3,400

Excluding dental without out-patient co pay

Paid up to $3,400

Including dental without out-patient co pay

Paid up to $3,400

 

3.6 MRI, PET and CT scans

Excluding dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Including dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

3.7 Out-patient surgical operations

Excluding dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Including dental with 10% out-patient co pay

Paid up to 90% of $3,400,000

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

4. Out-patient dental treatment

4.1 Treatment for the immediate relief of dental pain, accidental damage to natural teeth and restoring natural teeth including X-rays, fillings, extractions, root-canal treatment, gum treatment, semiprecious and replacement crowns. This benefit is available after you have had 182 days’ continuous cover from the date that the benefit was first introduced on your plan (see section 19 for deductibles).

Excluding dental with 10% out-patient co pay

Not covered

Including dental with 10% out-patient co pay

Paid up to 75% of $1,275

Excluding dental without out-patient co pay

Not covered

Including dental without out-patient co pay

Paid up to 75% of $1,275

 

4.2 One dental checkup in each plan year to include scraping, cleaning and polishing.

Excluding dental with 10% out-patient co pay

Not covered

Including dental with 10% out-patient co pay

Not covered

Excluding dental without out-patient co pay

Not covered

Including dental without out-patient co pay

Not covered

 

5. Cancer care (see section 19 for deductibles)

5.1 Treatment aimed to cure cancer, including bone marrow transplants.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

5.2 Stabilising acute episodes of a cancer which is diagnosed as a chronic medical condition.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

5.3 Consultations, tests, drugs and dressings to maintain the symptoms of a cancer which is diagnosed as a chronic medical condition.

Excluding dental with 10% out-patient co pay

Covered in the benefit limit shown in section 7.2

Including dental with 10% out-patient co pay

Covered in the benefit limit shown in section 7.2

Excluding dental without out-patient co pay

Covered in the benefit limit shown in section 7.2

Including dental without out-patient co pay

Covered in the benefit limit shown in section 7.2

 

5.4 Palliative and hospice care when cancer is diagnosed as a terminal medical condition.

Excluding dental with 10% out-patient co pay

Covered in the benefit limit shown in section 8.1

Including dental with 10% out-patient co pay

Covered in the benefit limit shown in section 8.1

Excluding dental without out-patient co pay

Covered in the benefit limit shown in section 8.1

Including dental without out-patient co pay

Covered in the benefit limit shown in section 8.1

 

6. Wellness benefit

6.1 Adults (18 and over): routine health checks including cancer screening, cardiovascular examinations, neurological examinations, vital sign tests (for example, blood pressure, cholesterol checks) and vaccinations.

6.2 Children (0-17): well-child tests and vaccinations

Excluding dental with 10% out-patient co pay

Paid up to $850

Including dental with 10% out-patient co pay

Paid up to $850

Excluding dental without out-patient co pay

Paid up to $850

Including dental without out-patient co pay

Paid up to $850

 

7. Chronic medical conditions (see section 19 for deductibles)

7.1 Stabilising acute episodes of chronic medical conditions.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

7.2 In-patient, daycare and out-patient treatment to include consultations, tests, drugs and dressings to maintain the symptoms of chronic medical conditions.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

7.3 Please note: If a chronic medical condition becomes terminal, cover under the chronic medical conditions benefit will end. We will only cover terminal medical conditions under the terminal illness benefit.

 

8. Terminal illness

8.1 Palliative and hospice care for a terminal medical condition.

Excluding dental with 10% out-patient co pay

Paid up to a lifetime limit of $102,000

Including dental with 10% out-patient co pay

Paid up to a lifetime limit of $102,000

Excluding dental without out-patient co pay

Paid up to a lifetime limit of $102,000

Including dental without out-patient co pay

Paid up to a lifetime limit of $102,000

 

9. Hormone replacement therapy

9.1 Hormone replacement therapy for pre- and postmenopausal symptoms.

Excluding dental with 10% out-patient co pay

Paid up to a lifetime limit of $255

Including dental with 10% out-patient co pay

Paid up to a lifetime limit of $255

Excluding dental without out-patient co pay

Paid up to a lifetime limit of $255

Including dental without out-patient co pay

Paid up to a lifetime limit of $255

 

10. HIV or AIDS - available after you have had four years’ continuous cover from the date that the benefit was first introduced on your plan (see section 19 for deductibles).

10.1 Treatment for HIV or AIDS and related medical conditions.

Excluding dental with 10% out-patient co pay

Paid up to a lifetime limit of $85,000

Including dental with 10% out-patient co pay

Paid up to a lifetime limit of $85,000

Excluding dental without out-patient co pay

Paid up to a lifetime limit of $85,000

Including dental without out-patient co pay

Paid up to a lifetime limit of $85,000

 

11. Emergency local ambulance

11.1 Costs of appropriate ambulance transport needed because of an emergency or medical necessity to the nearest available and appropriate local hospital.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

12. Organ transplants (see section 19 for deductibles)

12.1 Transplants of kidney, liver, heart, lung or heart and lung and any related treatment that you need as a result of a covered medical condition.

Excluding dental with 10% out-patient co pay

Paid up to $425,000

Including dental with 10% out-patient co pay

Paid up to $425,000

Excluding dental without out-patient co pay

Paid up to $425,000

Including dental without out-patient co pay

Paid up to $425,000

 

13. Nursing at home

13.1 Primary care services of a registered nurse in your home immediately after, or instead of, in-patient or daycare treatment.

Excluding dental with 10% out-patient co pay

Paid up to $8,500

Including dental with 10% out-patient co pay

Paid up to $8,500

Excluding dental without out-patient co pay

Paid up to $8,500

Including dental without out-patient co pay

Paid up to $8,500

 

13.2 Please note: The benefit for nursing at home does not apply to terminal medical conditions. We will only cover terminal medical conditions under the terminal illness benefit.

 

14. Compassionate emergency visit

14.1 Costs you have to pay for an economy class return ticket from a country within your area of cover to visit a close family member, if their medical condition results in them being placed on a critical list, or their death. You are limited to one return journey in each plan year.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

15. Hospital cash benefit

15.1 Cash payment made to you for each night you are in hospital for in-patient treatment that you receive free of charge.

Excluding dental with 10% out-patient co pay

$425 paid for each night, up to $12,750

Including dental with 10% out-patient co pay

$425 paid for each night, up to $12,750

Excluding dental without out-patient co pay

$425 paid for each night, up to $12,750

Including dental without out-patient co pay

$425 paid for each night, up to $12,750

 

16. Evacuation and repatriation

16.1 The costs to transport you to the nearest location within your area of cover where appropriate medical facilities are available. We will only pay this benefit, including treatment received, if you suffer from a medical condition; (a) that means you need to be placed on a critical list, or (b) for which, in our opinion, appropriate treatment is not available locally.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

16.2 Economy class ticket to the country where you live following your evacuation.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

16.3 Costs of your dependants, a close family member or business colleague having to accompany you for a medical evacuation. This benefit will only become available under the conditions detailed in clause (a) of section 16.1 above and must be pre-authorised by us.

We will provide cover for the following:

• return economy flight

• overnight accommodation to include breakfast

• return taxi from the airport to the hotel

• return taxi from the hotel to the hospital once a day

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

17. Mortal remains

17.1 If you die outside of your home country, we will pay the costs of preparing and transporting your body, mortal remains or ashes to your home country, or we will pay the costs of preparing your body or mortal remains for local burial or cremation.

Excluding dental with 10% out-patient co pay

Paid in full

Including dental with 10% out-patient co pay

Paid in full

Excluding dental without out-patient co pay

Paid in full

Including dental without out-patient co pay

Paid in full

 

18. Emergency medical treatment outside area of cover (see section 19 for deductibles).

18.1 Emergency medical treatment outside of your area of cover.

Excluding dental with 10% out-patient co pay

Paid up to $59,500

Including dental with 10% out-patient co pay

Paid up to $59,500

Excluding dental without out-patient co pay

Paid up to $59,500

Including dental without out-patient co pay

Paid up to $59,500

 

19. Deductibles

19.1 Out-patient treatment excess on sections 3, 5, 7 and 10. This deductible is applied for each out-patient claim.

Excluding dental with 10% out-patient co pay

10.00%

Including dental with 10% out-patient co pay

10.00%

Excluding dental without out-patient co pay

N/A

Including dental without out-patient co pay

N/A

 

19.2 In-patient, daycare and out-patient treatment excess on sections 2, 3, 5, 7, 10, 12 and 18. This deductible is applied for each medical condition in each plan year.

Excluding dental with 10% out-patient co pay

Paid up to $59,500

Including dental with 10% out-patient co pay

Paid up to $59,500

Excluding dental without out-patient co pay

Paid up to $59,500

Including dental without out-patient co pay

Paid up to $59,500

 

19.3 Out-patient dental treatment co-insurance on section 4.1. This deductible is applied to each claim.

Excluding dental with 10% out-patient co pay

N/A

Including dental with 10% out-patient co pay

25.00%

Excluding dental without out-patient co pay

N/A

Including dental without out-patient co pay

25.00%

 

20. red24 security services

20.1 AdviceLine - 24/7 personal security information and advice for all travel safety queries.

Excluding dental with 10% out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal

Including dental with 10% out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal

Excluding dental without out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal

Including dental without out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal

 

20.2 ActionResponse - 24/7 international rescue and response service for a potentially life-threatening, non-medical event.

Excluding dental with 10% out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal

Including dental with 10% out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal

Excluding dental without out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal

Including dental without out-patient co pay

Included on your plan. Please contact red24 or visit www.red24.com/interglobal


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