Preventive Care by Securite sal

Why Preventive Care?

According to the World Health Organization (WHO), 75% of deaths worldwide are caused by lifestyle-related diseases, a reality that is even more significant in Lebanon. Also, up to 80% of the largest health risks can be prevented. Preventive Care was designed to change the way we think about health insurance: from simply treating illness to actively preventing it, through screenings and lifestyle support, Preventive Care combines enhanced health benefits, higher coverage limits, and a unique Preventive Healthcare plan that puts personalized care at the heart of your health journey. Through lifestyle coaching, structured health screenings and tailored guidance from a General Practitioner (GP), every member receives the support they need to better understand and manage their health, with a dedicated Health Champion accompanying them every step of the way. Because the best care is not only about treating what happens, it is about helping prevent it in the first place.

The Client Journey:

From the moment you enroll in Preventive Care, you are guided through a personalized health journey by your dedicated Health Champion who will contact you to introduce the program and arrange your appointment with our partner laboratory. During your visit, a GP will review your medical and family history, lifestyle, and overall health to create a personalized screening plan tailored to your needs. Once your screenings are completed, the GP will walk you through the results and provide tailored recommendations and practical guidance to help you make informed choices for a healthier lifestyle. Your journey does not stop there: our medical committee reviews your file quarterly and follows up whenever needed.

When joining the program and at each renewal, our medical committee assesses your health and lifestyle to determine your Wellness Score. This may qualify you for a premium discount, because taking care of your health should be rewarding.

Product Benefits

• Area of cover: Lebanon
• Network of hospitals available: Full Network on direct billing.
• Inpatient benefits:  Waiting period 180 days on pre-existing conditions
• Limit per year: 720 days lifetime with no financial limitation.
• Emergency room: Full Cover, exclusions: covered up to $100 per lifetime
• Maternity: 
  • For couples: Full cover after 230 days of enrolment.
  • For single mothers: Full cover after 270 days of enrolment.
• For complications and Legal Abortion: Covered if delivery date occurs after the maternity waiting period
• Free of charge new born baby (Securite Baby): Covered from day one
• Epidural: Covered
• Incubator & nursery: Unlimited days, up to $30,000 per delivery
• Screening test for baby: Up to $200 per delivery
• Congenital/hereditary cases: All cases covered up till the age of 12
  • With no financial limit for Securite Baby
  • Up to $30,000 per year for Non-Securite Baby
• Parent accommodation at hospital for children below 16 years: Covered
• Home Care: In-hospital treatments administered at home are covered
• Prosthesis:
  • Due to accident: Unlimited, as per TPA’s tariff
  • Due to sickness: Up to $30,000 per year, as per TPA’s tariff
• Coronary stent: Covered up to sickness prosthesis limit
• Valves: Covered up to sickness prosthesis limit
• Orthesis: due to accident or sickness: Up to $500 per year 

Additional Inpatient benefits  

• Dialysis for acute renal failure, excluding “arteriovenostomy”: Covered for all needed sessions during 1st initial admission
• Sleep disorder disease:  Covered
• Parkinson: Only treatment is covered
• Epilepsy: Covered
• New treatments, experimental, unusual and robotic procedures, etc. is covered up to $10,000 per year (Combined In and Out)
• Rehabilitation for a covered case Up to $2,000 per year
• Breast reconstruction: Covered if due to a covered partial or complete breast excision due to breast cancer (within 6 months of sickness)
• Preventive surgery for breast cancer Covered up to $3,000 including cost of prosthesis & subject to a Second Medical Opinion
• Infertility Covered after 12 months of enrolment and up to $7,500 per year as per TPA’s tariff
• Cardio vascular diseases: Unlimited coverage
• Work related accident Covered for Administrative work only

All the above limits and coverage are subject to underwriting  

• Bone marrow aspiration & organ transplant surgery including cornea transplant is covered up to $60,000 lifetime. Cost of organ is excluded.
• Bariatric surgery related to morbid obesity (e.g. Sleeve and bypass) is covered up to $7,500 lifetime
• Cancer Diseases: unlimited coverage
• Tropical Disease (specific diseases as per general conditions): Covered
• Sexually transmitted diseases are covered up to $15,000 per year
• Psychiatric disorder: In-hospital treatment covered up to $15,000 per year after 12 months of enrolment with a maximum of 30 days of hospitalization
• Nose Related Surgeries excluding cosmetic surgeries: Covered after 2 years of enrolment. In case of medical insurance continuity, the waiting period is waived 
• Unknown pre-existing conditions are covered after 6 months unless exclusions / limitations are applied during the observation period
• Hospital daily income For entrepreneurs:
  • <60 years; $50/day starting the 2nd day & up to 7 days per year
• Morgue/Burial expenses following a covered hospitalization up to $3,000
• Epidemic / Pandemic Diseases: Covered in compliance with the ICC decision number 80/LMD issued on 15/04/2020 and within the scope of the council of minister’s mobilization Covered in compliance with the ICC decision number 80/LMD issued on 15/04/2020 and within the scope of the council of minister’s decision issued on 15/03/2020:  Up to $30,000 per year (under In-patient only)
• Hazardous sports are covered for amateurs only up to $5,000

Additional Benefits 

• Second Medical Opinion (locally and Internationally) is granted for complex, acute or critical illness
• Telemedicine is covered with unlimited access: direct phone consultations with healthcare professionals
• Rental of medical supplies: Up to 1 month rental
• Guaranteed renewability Granted from day 1 subject to an observation period of 180 days
• Extension of coverage at the expiry date and while in hospital Up to 30 days
• Claims outside of Lebanese territories or outside of network: Claim processed on reimbursement basis and as per NEXTCARE‘s Lebanese network rates and subject to 30% excess
• Private transportation service/ private ambulance: Covered
• Natural Death (if the Head of Family / Policy Holder up to age 50):
  • Policy Holder / Head of Family: Covered for $10,000 
  • Spouse up to age 50: Covered for $5,000
  • Children from 15 to 25: Covered for $5,000
• Accidental Death (if the Head of Family/Policy Holder is aged between 51 & 65) is covered for $10,000 
• Claims arising from the use of motorcycle as mean of transportation are not covered unless declared and accepted, subject to an additional premium. 

Ambulatory 100% coverage  

• Direct billing as per NEXTCARE preferred network
• Waiting period 90 days
• Limit per year: No financial limitation apply
• Diagnostic tests (X-Rays, MRI, Scans, Ultrasounds and Lab Tests) is covered, subject to a prior approval
• Thallium myocardial Scintigraphy is covered, subject to a prior approval
• Pet scan is covered, subject to a prior approval
• VCT 64 is covered, subject to a prior approval
• Genetic test is covered up to $1,000 per year
• OCT Covered, subject to a prior approval
• Osteodensitometry (for insured aged 50y & above) is covered subject to a prior approval
• Physiotherapy & Kinesitherapy covered as per medical necessity
• Pre-Marital tests are covered
• Amniocentesis is covered once per pregnancy if delivery date occurs after the maternity waiting period
• Morphological Echography is covered once per pregnancy if delivery date occurs after the maternity waiting period
• Triple test is covered once per pregnancy if delivery date occurs after the maternity waiting period
• Maternity lab tests are covered if delivery date occurs after the maternity waiting period
• NIPT is covered once per pregnancy, subject to medical necessity up to $500 per pregnancy, if delivery date occurs after the maternity waiting period
• Dental panoramic Covered if due to a covered accident and up to 9 months after the accident has occurred

N.B: Claims arising from the use of motorcycle as mean of transportation are not covered unless declared and accepted, subject to an additional premium.