Limited Network of Hospitals

Prosthesis: (a device designed to replace a missing part of the body or to make a part of the body work better)

• Due to Accident: Up to $30,000 per year, as per TPA's Tariff
• Due to Sickness: Up to $10,000 per year as per TPA's Tariff
• Coronary Stent Valves: Covered up to sickness prosthesis limit

Orthesis: (An orthopedic brace, splints, or appliance.)

• Due to Accident: Not Covered
• Due to Sickness: Not Covered

Additional Inpatient Benefits:

• Dialysis for acute renal failure, excluding arteriovenostomy: covered up to 3 sessions during first initial admission
• Sleep Disorder Disease: Only Polysomnography is covered.
• Sleep Apnea Surgery: Not Covered
• Parkinson: Covered up to $ 2,000 (in & Out)
• Epilepsy: Up to $2,000 (In & Out)
• New treatments, Medical Techniques, Surgeries & Tests: Not Covered
• Rehabilitation for a covered case: Not Covered
• Breast Reconstruction: Covered if due to a covered partial or complete breast excision due to breast cancer within 6 months of the sickness
• Infertility: Covered after 12 months of enrollment and up to $1,000 per year, for all classes, as per TPA's Tariff.
• Cornea transplant: Not Covered
• Cardiovascular disease: Up to $100,000
• Work Related Accidents: Not Covered
• Bone Marrow Aspiration & Organ Transplant Surgery: Covered up to $15,000 lifetime, as per TPA's tariff. Cost of organ is excluded.
• Bariatric Surgery related to morbid obesity (e.g. Sleeve and Bypass): Not Covered
• Cancer Disease: Up to $100,000
• Tropical Disease: Not Covered
• Sexually Transmitted Diseases: Not Covered
• Psychiatric disorder: Not Covered
• Hospital daily income: Not Covered
• Morgue and burial Expenses: up to $1,000 for adherents aged 64 and below
• Epidemic / Pandemic Diseases: Covered up to $10,000

Out of hospital benefits / Ambulatory Services (Lab, X-RAY, MRI...): Direct billing as per next care preferred network

• Coverage: Up to $2,500 / year 85% coverage on direct billing basis
• Amniocentesis: Not covered
• Morphological Echography: Covered if delivery date occurs after the maternity waiting period.
• Triple test: Covered if delivery date occurs after the maternity waiting period.
• Maternity lab tests: Covered 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
• MRI: covered subject to a prior approval
• Thallium myocardial scintigraphy: Not covered
• Pet scan: covered subject to a prior approval
• VCT 64: Not covered
• Genetic test: Not Covered
• OCT: covered subject to a prior approval
• Osteodensitometry (for insured age 50 and above): Covered for a specific medical reason
• Physiotherapy and kinesitherapy: 15 sessions per year 
• Premarital test: Not Covered

Additional Benefits:

• Rental of medical supplies: Not covered
• Guaranteed Renewability: 720 days, lifetime subject to an observation period of 180 days for new members.
• Unknown Pre existing conditions in hospital: Covered after 6 months for new members.
• Tests related to pre-existing cases for new insured: Not covered
• Upgrades on renewal: Observation period of 365 days for maternity and preexisting conditions
• Claims outside of Lebanese territories or outside of network: claim processed on reimbursement basis as per NEXTCARE's Lebanese network rates and subject to 30% excess