A | B | C | D | E | F | G | |
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1 | |||||||
2 | |||||||
3 | Safety Wing Remote Health | IMG Insurance | |||||
4 | Standard | Premium | Headstart | Standard | |||
5 | OVERALL AGGREGATE MAXIMUM SUM INSURED PER PERIOD OF INSURANCE PER INSURED PERSON | Schedule of Cover and Excesses | $2,625,000 | ||||
6 | Deductible | $250 | $0 | $180 | $180 | ||
7 | A In-Patient & Day-Patient Treatment | ||||||
8 | 1 | Hospital Accommodation & Theatre | Full Cover | Full Cover | Full Cover | Full Cover | |
9 | 2 | Accidents, Emergencies, Intensive Care inc. Surgical Care, Second Surgical Opinion, Anaesthetics, Medical Practitioner charges for Surgery, Treatment, Services and Supplies routinely provided | |||||
10 | 3 | Surgeons, Consultants, Anaesthetists, Nurses and Ancillary Charges | |||||
11 | 4 | Medical Practitioners | |||||
12 | 5 | Prescribed Drugs, Dressings and Durable Medical Equipment | |||||
13 | 6 | Reconstructive Surgery-following an accident or following surgery for an eligible condition | |||||
14 | 7 | Diagnostic Tests and Procedures, X-rays, Pathology, & MRI/CT Scans | |||||
15 | 8 | Cancer Tests, Drugs, Treatment and Consultants, including cover for Chemotherapy and Radiotherapy | |||||
16 | 9 | Physiotherapy | |||||
17 | 10 | Parental Hospital Accommodation | |||||
18 | 11 | Post Hospitalisation Treatment Received within 90 days of being discharged from hospital | No Cover | No Cover | |||
19 | 12 | Hospital Cash Benefit | $125/night 30 nights | $125/night 30 nights | $175/night 60 nights | $350/night 60 nights | |
20 | 13 | Organ Transplant (major covered organs) | $150,000 Lifetime Limit | $150,000 Lifetime Limit | No Cover | $175,000 Lifetime Limit | |
21 | 14 | Prosthetic Devices | No Cover | No Cover | No Cover | Full Cover | |
22 | 15 | Psychiatric Treatment | No Cover | No Cover | Full Cover, to a maximum of 30 days after 12 months of policy | Full Cover, to a maximum of 30 days after 12 months of policy | |
23 | |||||||
24 | |||||||
25 | Standard | Premium | Headstart | Standard | |||
26 | B Out-Patient Treatment and Wellness Benefits | ||||||
27 | 1 | Family Doctor, Treatment & Referrals | Up to $1,000. 10% co-pay. | Up to $1,000. 10% co-pay. | No Cover | Up to $8,750 | |
28 | 2 | Specialists and Consultants (fees for consultations) *Coverage is NOT dependent upon admission | Up to $700 per condition prior to admission*, then up to $1,750 following out-patient surgery or in-patient/ day-patient treatment | ||||
29 | 3 | X-rays, Pathology, Diagnostic Tests and Procedures *Coverage is NOT dependent upon admission | Up to $350 per condition prior to admission* and following out-patient surgery or in-patient/ day-patient treatment | ||||
30 | 4 | Prescribed Drugs, Medicines, Dressings and Durable Medical Equipment | No Cover | ||||
31 | 5 | Out-Patient Surgery | Up to $500,000 | Up to $500,000 | Full Cover | Full Cover | |
32 | 6 | MRI and CT Scans | Up to $5,000 | Up to $5,000 | |||
33 | 7 | Cancer Tests, Drugs, Treatment and Consultants | Full Cover | Full Cover | |||
34 | 8 | Physiotherapy, Homeopathic and Osteopathic Therapy | Maximum 10 visits. Up to $60 per visit - part of the $1,000 limit. | Maximum 10 visits. Up to $60 per visit - part of the $1,000 limit. | No Cover | Maximum 15 visits- part of the $8,750 limit | |
35 | 9 | Complementary Medical Treatment: Acupuncture, Aroma Therapy, Chiropractic Therapy, Herbal Therapy, Magnetic Therapy, Massage Therapy, Vitamin Therapy, Traditional Chinese Medicine when referred by a Doctor, General Medical Practitioner (GP) | Maximum 10 visits. Up to $30 per visit - part of the $1,000 limit. | Maximum 10 visits. Up to $30 per visit - part of the $1,000 limit. | Up to $875 | ||
36 | 10 | AIDS/HIV Treatment | HIV cover after 24 months of policy | HIV cover after 24 months of policy | Up to $15,000, with a Lifetime Limit of $50,000 | ||
37 | 11 | Hormone Replacement Therapy-Early Onset | No Cover | No Cover | Full Cover 18 Month Lifetime Limit | ||
38 | 12 | Home Nursing Care Primary care services of a registered nurse in the Insured Person’s home immediately after, or instead of, In-Patient/Day-Patient Treatment | No Cover | No Cover | Up to $132/visit to a maximum of 15 visits | Up to $132/visit to a maximum of 45 visits | |
39 | 13 | Rehabilitation | Full Cover up to 90 days | Full Cover up to 90 days | No Cover | Full Cover Up to 90 Days | |
40 | 14 | Extended Care Facility | No Cover | No Cover | Full Cover Up to 6 Months | ||
41 | 15 | Hospice Care | |||||
42 | 16 | Adult Wellness and Health Check: Medical check-up including, cervical smear, mammogram, cancer screening, cardiovascular examinations, neurological examinations, vital sign tests (e.g. blood pressure, cholesterol checks) | Up to $250 across routine health checks, screenings and vaccination (including travel vaccinations) | Up to $700 after 12 months of policy (Nil Excess) | |||
43 | 17 | Child Wellness and Health Check: Hearing Test, Sight Test and Vaccinations/Inoculations | Up to $250 if covered as dependents | ||||
44 | 18 | Psychiatric Treatment | No cover | Up to $4,375 after 12 months of policy | |||
45 | |||||||
46 | Standard | Premium | Headstart | Standard | |||
47 | C Travel, Transportation and Out of Area Benefits | ||||||
48 | 1 | Emergency Local Ambulance | Full Cover | Full Cover | Full Cover | Full Cover | |
49 | 2 | Emergency Medical Evacuation and Transportation | Full Cover To nearest medical facility within Your Area of Cover | Full Cover To nearest medical facility within Your Area of Cover | Full Cover To nearest medical facility within Your Area of Cover | Full Cover To nearest medical facility, Home Country, or country of choice within Your Area of Cover | |
50 | 3 | Accompanying Relative, Travel and Accommodation | Economy class airfare for a locally-accompanying person who has travelled as an escort | Economy class airfare for a locally-accompanying person who has travelled as an escort | No Cover | Full Cover | |
51 | 4 | Cremation/Burial or Repatriation of Remains | No Cover | No Cover | Up to $10,000 | Up to $15,000 | |
52 | 5 | Compassionate Visit | No Cover | No Cover | No Cover | Up to $5,250 after 12 months of policy | |
53 | 6 | USA Elective Treatment within Provider Network Excludes non-emergency travel & accommodation (Applicable to Insureds who have not selected Area 3 - Worldwide Cover) | 30 days Out of area cover for non pre existing conditions or up to 6 months with full coverage with purchase of add-on | 30 days Out of area cover for non pre existing conditions or up to 6 months with full coverage with purchase of add-on | Up to $875,000 with 20% Co-Insurance (Nil Excess) | ||
54 | 7 | Worldwide Accident and Emergency Out of Area Cover | 45 Days Maximum, up to $35,000 | ||||
55 | |||||||
56 | E | Standard | Premium | Headstart | Standard | ||
57 | D Dental Treatment | ||||||
58 | 1 | Emergency Dental Treatment (In-Patient or Day-Patient) | No Cover | Cover up to $500,000 in the event an accident and claim within 10 days of accident | No Cover | Full Cover | |
59 | 2 | Accidental Dental Damage caused to sound natural teeth lost or damaged in an accident. Out-patient Treatment/Dental Surgery must be received within 5 days from the date of the accident occurring | Up to $438 | ||||
60 | 3 | Emergency Dental Treatment (Out-Patient/Dental Surgery) -For the immediate relief of severe pain, being treatment of an abscess, cracked or broken tooth rebuild or temporary filling within 24 hours from the onset of pain and no more than 5 days from the event | See Dental Coverage Below | See Dental Coverage Below | |||
61 | 4 | Routine Dental Treatment (Out-Patient) for the restoration of natural teeth a) examinations, check-up and x-rays b) tooth cleaning and polishing c) normal compound fillings, simple or non-surgical extractions | |||||
62 | 5 | Major Restorative Dental Treatment -Removal of impacted, buried or unerrupted teeth, removal of roots, removal of solid odontomes, apicetomy, new or repair of bridgework, new or repair of crowns (not precious metal), root canal treatment, new or repair of upper or lower dentures | |||||
63 | Dental Treatment | ||||||
64 | |||||||
65 | Standard | Premium | Headstart | Standard | |||
66 | E Non-Medical Insured Covers and Benefits | ||||||
67 | 1 | Out of Country Legal Expenses | No Cover | No Cover | No Cover | Up to $8,750 ($438 Excess) | |
68 | 2 | Security & Political Evacuation & Repatriation | Up to $13,125 Lifetime Limit | ||||
69 | 3 | Identity Theft Cover & Assistance | Up to $438 | ||||
70 | 4 | Out of Country Criminal Assault Benefit When admitted to hospital for 48 hours or more | $875 per admitted night to a maximum of $4,375 | ||||
71 | 5 | Natural Disaster Evacuation & Accommodation | Up to $263 per day for up to 5 days | ||||
72 | |||||||
73 | Standard | Premium | Headstart | Standard | |||
74 | F Other Services and Benefits | ||||||
75 | 1 | 24 Hour Emergency Helpline | Full Cover | Full Cover | Full Cover | Full Cover | |
76 | 2 | USA Medical Concierge Service For eligible treatment in the USA | No Cover | No Cover | |||
77 | 3 | Medical Information Service – Access to board-certified physicians, licensed psychologists, and pharmacists to assist with any routine health related questions | Coming in 2021 | Coming in 2021 | No Cover | ||
78 | |||||||
79 | |||||||
80 | Dental Treatment & Vision Care Benefits | ||||||
81 | |||||||
82 | Standard | Premium | Headstart | Standard | |||
83 | Dental Care Benefits | ||||||
84 | 1 | Emergency Dental Due to Accident | No Cover | Full Cover | No Cover | Full Cover | |
85 | 2 | Emergency Dental Due to Sudden Unexpected Pain to Sound Natural Teeth | Up to $1,500 | Up to $100 | |||
86 | 3 | Non-Emergency Dental Sections D4, D5 & D6 Combined: i) Calendar Year Maximum Sum Insured ii) Dental Annual Excess iii) Maximum Annual Excesses per Family per Calendar Year | Up to $500 | i) $750; ii) $50; iii) 2; after 6 months of policy cover | |||
87 | 4 | Class I Treatment*: - Preventative & Diagnostic - Emergency Palliative Treatment - includes up to two dental check-ups per calendar year to include scraping, cleaning and polishing * Refer To Rider Endorsement for full details | Up to $1,500 | 90% Coverage, Dental Annual Excess Waived; after 6 months of policy cover | |||
88 | 5 | Class II Treatment*: - Radiographs & X-Rays - Oral Surgery & Extractions - Routine Compound Fillings, Restorations, Re-cementing crowns, inlays and bridg- es & Prosthetic Repairs - Endodontics & Root Canals - Periodontics & Gum Disease - Minor Restorative Services * Refer to Rider Endorsement for full details | Up to $1,500 | 70% Coverage, after Dental Annual Excess; after 6 months of policy cover | |||
89 | 6 | Class III Treatment*: - Prosthodontic Services including: appliances, bridges, full and partial dentures that replace missing natural teeth that were extracted while the person is covered with this Plan. - Major Restorative Treatment including: Crowns, Jackets, gold-related services required when teeth cannot be restored using other filling material. * Refer to Rider Endorsement for full details | No Cover | 50% Coverage, after Dental Annual Excess; after 6 months of policy cover | |||
90 | Vision Care Benefits | ||||||
91 | 7 | Vision Care Not subject to Annual Excess or Co-Insurance. (Benefit payable per 24 months) | No Cover | No Cover | No Cover | Exams – up to $100 Materials – up to $150 | |
92 | |||||||
93 | |||||||
94 | |||||||
95 | |||||||
96 |