Schedule of Benefits - Premier International
We offer the most comprehensive international health insurance plans available in the marketplace. After satisfaction of the annual deductible, the Premier Personal Health plan underwritten by LAMP Insurance Company Limited will pay the benefits set forth in this section at the percentage payable of the allowable charge. Once the coinsurance requirement has been met, benefits are payable at 100% of the allowable charge for the remainder of the Policy Year unless otherwise stated.
| In North America Plan 1 Members only |
Outside North America Plan 1 & 2 |
||
|---|---|---|---|
| PPO | Non PPO1 | ||
Hospital Inpatient & SurgeryAccommodation: Hospital's average private charge per day of confinement |
100% | 80% | 100% |
Intensive Care Unit |
100% | 80% | 100% |
Inpatient ancillary services ** Blood transfusions, plasma - $10,000 per person per policy year |
100% | 80% | 100% |
Physician Office Visits & Specialist Fees |
100% | 80% | 100% |
Outpatient Surgery |
100% | 80% | 100% |
Emergency Room |
100% | 80% | 100% |
Diagnostic and Therapeutic Services (Outpatient) **** Physical Therapy: per visit limit US$ 75, policy year max 50 visits; |
100% | 80% | 100% |
Other Medical expenses |
100% | 80% | 100% |
Maternity Expense:(12 month waiting period) Routine Nursery, as any other treatment including accommodation, physician charges and circumcision for males prior to discharge. |
100% | 80% | 100% |
New-Born CoverIncluding Premature Births, Congenital Conditions and Birth Anomalies. |
100% | 80% | 100% |
Prescription ProgramIn PPO no deductible applies brand name drugs at 90% and generic drugs at 100%. Out of network (in USA only) deductible applies and no out-of-pocket lime applies. Overseas deductible applies. |
90% / 100% | 80% | 100% |
Mental Health Benefits (Inpatient & Outpatient)Lifetime Maximum - US $25,000 *** Does not count towards Out-Of-Pocket Maximum |
100% | 80% | 100% |
Notes:
1There is no Out-of-Pocket limit for treatment outside of PPO network.
Out of Pocket limits per Policy Year
Individual US $1,000. Family US $3,000
Applicable to in-PPO network treatment only.
There is no Out-of-Pocket limit for treatment out of PPO network in North America.
Transplant Procedures
Lifetime maximum of US $500,000 (Tissue Transplant: Lifetime maximum
of US$250,000)
Only available through the Managed Transplant Program.
Transplant must be pre-certified and approved by LAMP Insurance
Company Limited. Failure to comply will result in treatment not being
covered by your individual or group health insurance policy.
Dental Care
Class I Expenses: Diagnostic - General; Preventive - 100% . Subject to Policy Year Maximum of $1,500
Other than the dental benefit listed above, Dental Care is limited to accidental injury of sound, natural teeth
sustained while covered under the plan
(see Dental Option for additional
optional cover beyond our regular international health insurance policies)
Accidental Death and Dismemberment (AD&D) Cover
In the event of an Accidental Death or Dismemberment of the Primary Insured Person the Insurer pays a lump sum benefit equal to $100,000 subject to a Maximum benefit multiplied by a percentage as shown in the AD&D Option on the following page. Additional benefits can be purchased per rate schedule on following page. Benefits cannot exceed 2 times salary.
Travel for family emergency
In the event that a close relative living abroad suffers a serious accident, illness or passes away, the Insurer will pay up to $5,000 per Policy Year towards the cost of travel for an unscheduled journey to visit them in the country the relative resides.
Preventive Care / Wellness Benefits
(Subject to Policy Year Maximums (CYM) with no deductible)
6 Month Waiting Period for both Adults and Children - this does not apply if premium is paid annually.
Child Immunizations & Routine Medical Exams
100% coinsurance not subject to
deductible for children from birth to age 18 for immunization against diphtheria, hepatitis B, measles,
mumps, pertussis, polio, rubella, tetanus, varicella, haemophilias, influenza B, and hepatitis A, up to
the dollar limits indicated.
Child Preventive Care Services
100% coinsurance not subject to deductible.
Services include: health history, physical examinations, development assessments, anticipatory guidance,
appropriate immunizations and laboratory tests.
Child Preventive Care is subject to the following limitations:
| Policy Year Maximum | |
|---|---|
Child - Birth to age 12 months | US $500 |
Child -13 months through age 1 | US $300 |
Child - Age 18 to 23 (only if full time student) | US $300 |
Adult Routine Physical Exams
100% coinsurance not subject to the deductible for charges made for or
in connection with the overall health and well being for Insureds and Spouses or Domestic Partners age 18 years and over.
Policy Year Maximum US$ 750.
Papanicolaou Screening Test
Treated like any other illness but not subject to deductible. Up to one
test per policy year for all eligible females.
Prostate Cancer Screening
Treated like any other illness but not subject deductible. One test per
policy year for males age 50 or over.
Mammograms
Treated like any other illness not subject to deductible per the following schedule:
- 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 a woman's baseline.
- Age 50 & over: one exam annually.
- Any Age: Whenever prescribed by a physician.
Advanced Health Screening Program
(12 month waiting period) Treated like any other illness
but not subject to deductible per following schedule:
- Ages 40-50: one high level physical examination every 3 years. Policy Year Maximum US$1,000.
- Ages 50+: one high level physical examination every 3 years. Policy Year Maximum US$1,500.
Vision Care Cover
(6 Month Waiting Period applies) Percentage of Reasonable and Customary Cost: 100%
During a 24-Month period Maximum Benefit Per Insured: US $300
Medical Evacuation and Assistance
Insured and Insured Dependents
Other Medical Benefits
Complimentary medicine: As any other benefit up to $1,500 per Policy Year
HIV/Aids Treatment: Lifetime Maximum: US $25,000
Private Duty Nursing: Lifetime maximum US $15,000. Per Calendar year 240 hours Benefit payable at 90%
Skilled Nursing Facility: As any other treatment up a US $15,000 Lifetime Maximum
Home Health Care: As any other treatment up to a US $15,000 Lifetime Maximum.
Chiropractic Services: As any other treatment up to a US$ 1,500 Policy Year Maximum. Referral letter required from medical physician.
Durable Medical Equipment: As any other treatment up to a US $20,000 lifetime maximum.
Hospice Care Services: As any other treatment up to a US $20,000 Lifetime Maximum.
TMJ Treatment: As any other treatment US $2,000 Lifetime Maximum.
Medical Concierge Benefits
Complimentary access to the following exclusive services is available as a benefit to Premier Personal Health Plan members
Best Outcome Health Program
(in partnership with Preferred Group Health, a global patient organisation)
A dedicated Diagnosis Verification and Treatment Planning care management program. In the event that you are
diagnosed with a specified critical illness, the program provides access to an appropriate specialist from a
top rated US hospital 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.
Blood Care Program
(in partnership with the Blood Care Foundation, a charitable, not-for-profit organization)
A blood care program which delivers screened blood, in an emergency, to its members in any part of the world.
The Foundation operates a alarm centers and a global network of blood banks, which work to internationally
approved standards. The service provides peace of mind to expatriates and their families, that in the event
of a medical emergency, particularly in developing countries, where a blood transfusion may be required,
screened blood, resuscitation fluids, and sterile transfusion equipment are always only a phone call away.
Premier Personal Health Record Storage (in partnership with, and powered by Zaptag)
A secure means of storing and managing your Premier Personal Health information. A personal Medical Card, combining a portable USB device with a online medical records storage facility, which provides the capability for individuals to take ownership of and build their complete medical history and records. The Premier Personal Health management portal empowers individuals to securely control and access their medical and health insurance information, from any computer, anywhere in the world. A lifeline particularly for expatriates and their families when traveling away from their home medical environment and for medical staff to check critical medical information in the event of a medical emergency.
Policy Limitations & Exclusions
Pre-Existing Condition Limitation (Applies to Medical coverage Only) Pre-Existing conditions are covered after a 12 month waiting period. Thereafter, at US $5,000 annual maximum and US $50,000 maximum lifetime unless otherwise stated.
New-Born Cover, Premature Births Congenital conditions and birth anomalies: Life Time Maximum $30,000
Infertility: Procedures directly related to diagnosis are covered. Treatment, prescription drugs, and or other methods to bypass (i.e. In-vitro) are not covered.
Expenses for oral contraceptives and contraceptive devices are excluded. Expenses for prenatal vitamins, and smoking cessation products are excluded. Over the counter medications are excluded.
Plan 2 does not include any cover for North America (USA and Canada)
Overall Lifetime Maximum Per Insured: US $3,000,000
Annual Maximum Per Insured:US $2,000,000
For more information regarding our international health plan, take a tour or select the many options available to you on our navigation panel.