Junior Single Advanced Care by Securite sal

Product Benefits:

• Area of cover: Lebanon
• Network of Hospitals: Full Network on direct billing excluding: CMC, AUBMC, Bellevue and LAUMC Rizk
• Inpatient benefits: 720 days lifetime up to:
  • $500,000 for class A
  • $300,000 for class B
  • $200,000 for class K
• Emergency room: Full Cover
• Maternity and all related treatments / tests: Not Covered
• Home Care: In-hospital treatments administered at home are covered
• Prosthesis: 
  • 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: Covered up to sickness prosthesis limit
• Valves Orthesis due to accident or sickness: Not covered

Additional Inpatient benefits:  

• Dialysis for acute renal failure, excluding “arteriovenostomy”: Covered Up to 3 sessions during 1st initial admission
• Sleep disorder disease: Only polysomnography is covered
• Parkinson Treatment only: up to $2,000 per year (Combined In & Out limit)
• Epilepsy: Up to $2,000 per year (Combined In & Out limit)
• 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 sickness)
• Preventive surgery for breast cancer: Not covered
• Infertility: Covered after 12 months of enrolment and up to $1,000 per year. As per TPA’s tariff
• Cardio vascular diseases: Up to $100,000 per year
• Work related accident: Not Covered
• Bone marrow aspiration & organ transplant surgery including cornea transplant: Up to $15,000 per 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 Diseases: Up to $100,000 per year
• Tropical Disease (specific diseases as per general conditions): Not Covered
• Sexually transmitted diseases: Not covered
• Psychiatric disorder In-hospital treatment: Not covered
• Nose Related Surgeries excluding cosmetic surgeries: Covered after 2 years of enrolment
• Morgue/Burial expenses following a covered hospitalization: Up to $ 1,000 for members aged 64 and below
• 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 $10,000 per year (under In-patient only)

Additional Benefits 

• Guaranteed renewability granted from day 1 subject to an observation period of 180 days
• Unknown pre-existing conditions Covered after 6 months unless exclusions/limitations are applied during observation period
• Upgrades on renewal (e.g. class and product): Subject to underwriting after submitting a new medical application; and if upgrade is granted a waiting period of 365 days for maternity and preexisting conditions is applied
• 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
• Natural Death:
  • Head of Family / Policy Holder up to age 50: 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) Covered for $10,000

1. N.B: Claims arising from the use of motorcycle as mean of transportation are not covered.

2. All the above limits and coverage are subject to underwriting 

Ambulatory (Out of Hospital Benefits) 

• 85% coverage Up to $2,500 per year
• Amniocentesis: Covered once per pregnancy if delivery date occurs after the maternity waiting period
• Morphological Echography: Covered once per pregnancy if delivery date occurs after the maternity waiting period
• Triple test: Covered once per pregnancy 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 occurred
• MRI Covered, subject to a prior approval
• Thallium myocardial Scintigraphy Covered, subject to a prior approval
• Pet scan Covered, subject to a prior approval
• VCT 64 Covered, subject to a prior approval
• Genetic test Not covered
• Osteodensitometry (for insured aged 50y & above): Covered for a specific medical reason  
• Physiotherapy & Kinesitherapy 15 session per year

N.B: Claims arising from the use of motorcycle as mean of transportation are not covered.