Ultimate Care by Securite sal

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
• Classes:
  • First (A)
  • Second (B)
  • Semi Private (K) 
• Limit per year: 720 days lifetime with no financial limitation for all classes.
• Emergency room: Full Cover
• Exclusions: covered up to $100 per lifetime
• Maternity: For couples and single mother 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 class A and B
  • Up to $20,000 per year for class K
• 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 for class A and class B
  • Due to sickness: Up to $20,000 per year for class K
• 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:  Up to $5,000 per year
• Parkinson: Treatment only, up to $5,000 per year (Combined In & Out limit)
• Epilepsy Up to $5,000 per year (Combined In & Out limit)
• New treatments, medical techniques, surgeries & tests Up to $5,000 per year (Combined In & Out limit)
• 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 SMO
• Infertility Covered after 12 months of enrolment and up to $3,000 per year, for all classes. As per TPA’s tariff
• Cardio vascular diseases:
  • Unlimited for classes A and B
  • Up to $120,000 per year for class K
• 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:
  • Up to $30,000 lifetime for classes A and B as per TPA’s tariff. Cost of organ is excluded
  • Up to $20,000 lifetime for class K as per TPA’s tariff. Cost of organ is excluded
• Bariatric surgery related to morbid obesity (e.g. Sleeve and bypass)
  • Up to $7,500 lifetime for classes A and B, as per TPA’s tariff.
  • Up to $2,500 lifetime for class K as per TPA’s tariff.
• Cancer Diseases:
  • Unlimited for classes A and B
  • Up to $120,000 per year for class K
• Tropical Disease (specific diseases as per general conditions): Covered
• Sexually transmitted diseases:
  • Up to $15,000 per year for classes A and B
  • Up to $5,000 per year for class K
• Psychiatric disorder: In-hospital treatment covered up to $10,000 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
• 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)

Additional Benefits 

• Rental of medical supplies: Up to 1 month rental
• 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 270 days for maternity and preexisting conditions is applied
• 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):
  • Policy Holder / Head of Family: Covered for $10,000 
• Claims arising from the use of motorcycle as mean of transportation are not covered.

Ambulatory  

• Option 1: 100% coverage
  • Unlimited for classes A and B
  • Up to $3,500 per year for class K

• Option 2: 85% coverage
  • Unlimited for classes A and B
  • Up to $3,500 per year for class K

• Tests related to preexisting cases for new insured Covered up to $100, once per year from day 1
• 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 has 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 Up to $1,000 per year
• OCT Covered, subject to a prior approval
• Osteodensitometry (for insured aged 50y & above) Covered for a specific medical reason  
• Physiotherapy & Kinesitherapy 25 sessions per year
• Pre-Marital tests are covered

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