Overall maximum plan benefit 10,000,000

Transcription

1 International Healthcare Plans Table of Benefits AON Expats Treatment guarantee (pre-authorization) may be required for some benefits as indicated by a '1' or a '2' in the table(s) below. Please refer to Notes section for further details. All benefit and deductible amounts are per person per year, unless otherwise indicated. Overall maximum plan benefit 10,000,000 Overall Maximum Deductible A (The deductible does not apply to children up to 18 years) 220 Core Plan Maximum plan benefit In-patient benefits¹ - please refer to notes for Treatment Guarantee Hospital accommodation¹ - Semi - private A Prescription drugs and materials¹ A (in-patient and day-care treatment only) Surgical fees, including anaesthesia and theatre charges¹ A Physician and therapist fees¹ A (in-patient and day-care treatment only) Surgical appliances and prostheses¹ A Diagnostic tests¹ A (in-patient and day-care treatment only) Organ transplant¹ A Psychiatry and psychotherapy¹ A (in-patient and out-patient only) Accommodation costs for one parent staying in hospital or similar accommodation with an insured child under 16¹ A If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care in a hospital outside the members town or residence, we will cover hotel accommodation costs² A If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care for an insured child Aon Global Health Complete (Semiprivate) See overall maximum plan benefit 11 visits Max per night Max per night Max. 1000

2 under 16, in a hospital outside the members town or residence, we will cover hotel accommodation costs for both parents² A Other benefits - please refer to notes for Treatment Guarantee Day-care treatment² A Out-patient surgery² A Nursing at home or in a convalescent home² A (immediately after or instead of hospitalisation) Rehabilitation treatment² A (in-patient, day-care and out-patient treatment, immediately after acute medical treatment ceases) Local ambulance A Transport A (Taxi costs are payable when incurred by a member and also transport accompanying children under 16 are payable per 0.31per kilometer) Emergency treatment outside area of cover A (for trips of a maximum period of six weeks) Medical evacuation² A Where necessary treatment is not available locally, we will evacuate the insured person to the nearest appropriate medical centre² Where ongoing treatment is required, we will cover hotel accommodation costs² Evacuation in the event of unavailability of adequately screened blood² If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care, we will cover hotel accommodation costs² Expenses for one person accompanying an evacuated person² A Travel costs of insured family members in the event of an evacuation² A Repatriation of mortal remains² A CT scans A (in-patient and out-patient treatment) MRI, PET and CT-PET scans² A (in-patient and out-patient treatment) Oncology² A (in-patient, day-care and out-patient treatment) (Recovery and Balance training by certified institutions) Routine maternity² A (in-patient and out-patient treatment) Adoption maternity screening A (For members under 12 month old), Max. 42 days 100 per night Max

3 Complications of pregnancy and childbirth² A Circumcision on religious grounds A 250 Accidental dental treatment for insured member s over 18 year A (where these benefit amounts are reached, any additional costs may be reimbursed within the terms of any separate Dental Plan) Palliative care² A Prescribed Independent Treatment Centre² A Plastic surgery² A Prescribed stay in Asthma Centre Davos² A (Netherlands and Switzerland applies to adults only) Prescribed stay in a therapeutic camps for asthmatic children up to the age of 18 years A, B Laser eye treatment A, B (limited to one treatment per 3 years) Accommodation costs for insured member attending treatment A, B Stay in a therapeutic camps for disabled members² A, B Prescribed genetic testing² A (in-patient and out-patient treatment) 2,500, Max. 30 days per lifetime Max. 1 for a period of 3 years per day Out-patient Plan Maximum plan benefit Out-patient benefits Medical practitioner fees A Prescription drugs A Specialist fees A Diagnostic tests A Vaccinations that are included in the Dutch national program A (for children under 16 years of age) Vaccinations for travelling abroad A Alternative therapies and treatments A 75 Aon Global Health Complete See overall maximum plan benefit 75% refund Max. 150

4 (if carried out by alternative healers or therapists - doctors) Alternative therapies and treatments A (if carried out by alternative healers or therapists non-doctors) Alternative medicines A (if prescribed by a GP or doctor and provided by a pharmacy) Max. 20 visits 40 Max. 20 visits Prescribed physiotherapy² A 30 Max. 12 visits Prescribed thrombosis treatment A Exercise programme² A 350 Mechanical respiration at home A Occupational therapy² A 10 visits Prescribed speech therapy² A Prescribed skincare² A 600 Prescribed lifestyle training courses A 200 Prescribed visit to a hearing centre A Prescribed psoriasis treatment A 1000 Prescribed UVB treatment of psoriasis² A Home help² A 1000 Max 21 days Stutter therapy A 1,000 per lifetime Sanatorium A 35 Max. 28 days Prescribed dyslexia care A (in children age 7 to 10) Preventive examinations and screening for early detection of illness or disease. Checks include: A Cardiovascular exam Neurological exam Cancer screening - Annual pap smear - Mammogram - Prostate screening Maternity package A 50 Infertility treatment² A 7,000 per claim (Max. 3 attempts per prospective pregnancy) (diagnosis) per lifetime Prescribed chiropodist A, B Prescribed podotherapy and podology A, B Prescribed melatonin medicine for sleeping disorders² A, B Prescribed therapeutic swimming for rheumatism patients² A, B

5 Arch supports A, B Bedwetting Alarm A, B Preventative Courses ( proof of registration need per course) A, B Menopause consultant A, B Glasses and contact lenses plus or minus 4 dioptre A, B 250 for a period of 3 years Contact lenses plus or minus 4 dioptre for short terms use A, B 65 Prescribed dietician/nutritionist treatments² A Obesity treatment A Examination for sports injuries A Prescribed medical aids A Adhesive strips for affixing prosthetic breasts A Aerochamber A Telemonitoring A Vacuum Assisted Closure system A Supportive pessary A Neuromodulator and biofeedback equipment A Mouth guard A Wigs A Head cover A Hearing aid A Walking Aids A Prescribed monitoring equipment or sensormat for prevention of crib death A Sterilisation A 1,000 per lifetime 10 for a period of 2 years Max. 1 per lifetime Patient Association membership A 25 Lactation specialist A 75% refund, up to 115 Dental Plan Maximum plan benefit Dental treatment A (For members under 18 years old) Aon Global Health Complete

6 Orthodontic treatment A (For members under 18 years old) Orthodontic treatment A (For members 18 years and older) Dental prostheses A (For members 18 years and older) 2,000 per lifetime 70% refund Max. 1,000 per lifetime 75% refund A These benefits are grouped and are subject to a deductible of 220 B These benefits are grouped and are subject to a Repatriation Plan Medical repatriation² Where the necessary treatment is not available locally, you can choose to be medically repatriated to your home country instead of to the nearest appropriate medical centre² Where ongoing treatment is required, we will cover hotel accommodation costs² Repatriation in the event of unavailability of adequately screened blood² If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care, we will cover hotel accommodation costs² Extension of flight ticket in connection with your illness or injury which arises during repatriation, this also includes travelling family members Cost of economy flight ticket of insured member to return home to Country of residence for childbirth Reimbursement of telecommunication costs incurred with a repatriation or evacuation Expenses for one person accompanying a repatriated person² Travel costs of insured family members in the event of a repatriation² Travel costs and accommodation of insured members to be with a family member who is at peril of death or who has died Max. 7 days 1,250 75% refund 125 per event 2,000 per event

7 OPTIONAL COVERS (Adults Only) Supplementary Private Room Cover Supplementary Private Room Hospital accommodation¹ - Private Comfort Class Supplementary Dental Cover Dental Plans T - Start T - Extra T - Royal Maximum plan benefit Dental benefits Dental treatment 100% refund 100% refund 100% refund Dental surgery 100% refund 100% refund 100% refund Periodontics 75% refund 75% refund 75% refund

8 NOTES Treatment Guarantee/Pre-authorisation Treatment Guarantee/Pre-authorisation is a process whereby we guarantee cover for certain treatment and costs, as indicated in the Table of Benefits with a 1 or a 2. Please note that you and your physician should complete the relevant sections of a Treatment Guarantee Form and send it to us for approval prior to commencement of your treatment. It is highly recommended that you take advantage of this facility as this will provide you with the benefit of cashless access to hospitals for in-patient treatment, as well as giving you the advantage of your treatment being overseen by our Doctor. For further details please refer to the How to Claim Section of our Benefit Guide, or simply contact our Helpline. Chronic Conditions Chronic conditions are covered within the terms of your policy. Please refer to the definitions section of our Benefit Guide for further information or contact our Helpline. Pre-existing Conditions Pre-existing conditions are covered within the terms of your policy. For further details please refer to the Definitions section of our Benefit Guide or simply contact our Helpline. For non-underwritten policies, pre-existing conditions are covered where medical history is disregarded. For Individual applicants please note that cover is subject to underwriting i.e. cover may be excluded for pre-existing conditions, or a higher premium rate may apply to reflect the higher risk due to pre-existing medical conditions or additional risk factors. Please refer to the definitions section of our Benefit Guide for further information. Benefit limits There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit, which applies to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that particular plan. Some benefits also have a specific benefit limit, for example Nursing at home or in a convalescent home. Specific benefit limits may be provided on a "per Insurance Year" basis, a "per lifetime" basis or on a "per event" basis, such as per trip, per visit or per pregnancy. In some instances we will pay a percentage of the costs for the specific benefit e.g. "75% refund, up to 100". Where a specific benefit limit applies or where the term "" appears next to certain benefits, the refund is subject to the maximum plan benefit, if one applies to your plan(s). All limits are per member, per insurance year, unless otherwise stated in your Table of Benefits. Policy Terms and Conditions The Table of Benefits provides an outline of the cover we offer under your policy. Please note that cover is subject to our standard policy definitions, limitations and exclusions. These are detailed in our Benefit Guide, which is issued to you upon policy inception. Our current Benefit Guide can also be downloaded from our website Policy Endorsement(s) If there are any policy terms and conditions unique to your policy they will be listed below. Please read carefully in conjunction with our Benefit Guide. The deductible does not apply to children up to 18 years.