Your overall Limit
Annual beneft - maximum per beneficiary per period of cover
This includes claims paid across all sections of International Medical Insurance. 		Silver
$1,000,000
€800,000
£650,000 		Gold
$2,000,000
€1,600,000
£1,300,000 		Platinum
Unlimited
Standard Medical Benefits
Hospital charges for:
Nursing and accomodation for inpatient and daypatient treatment and recovery room. 		Silver
Paid in full for semi-private room 		Gold
Paid in full for a private room 		Platinum
Paid in full for a private room
Hospital charges for:
  • Operating theatre.
  • Prescribed medicines, drugs and dressings for inpatient or daypatient treatment.
  • Treatment room fees for outpatient surgery.
 Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Intensive care
  • Intensive therapy.
  • Coronary care.
  • High dependency unit.
 Silver
$1,000,000
€800,000
£650,000 		Gold
$2,000,000
€1,600,000
£1,300,000 		Platinum
Unlimited
Surgeons' and anaesthetists' fees
Where surgery is provided on an inpatient, daypatient or outpatient basis. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Specialists consultation fees
Paid in full for regular visits by a specialist during stays in hospital including intensive care by a specialist for as long as is required by medical necessity. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Hospital accommodation for a parent or guardian
Up to the maximum amount shown per period of cover.
If a beneficiary who is under the age of 18 years old needs inpatient treatment and has to stay in hospital overnight, we will also pay for hospital accommodation for a parent or legal guardian, if:
  • accommodation is available in the same hospital; and
  • the cost is reasonable.
 Silver
$1,000
€740
£665 		Gold
$1,000
€740
£665 		Platinum
Unlimited
Transplant services for organ, bone marrow and stem cell transplants
We will pay for inpatient treatment directly associated with an organ transplant, for the beneficiary if:
  • the transplant is medically necessary, and the organ to be transplanted has been donated by a member of the beneficiary's family or comes from a varified or legitimate source.
 Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Kidney dialysis
Where treatment is provided on an inpatient, daypatient or outpatient basis. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Pathology, radiology and diagnostic tests (excluding Advanced Medical Imaging)
Where investigations are provided on an inpatient or daypatient basis. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Advanced Medical Imaging (MRI, CT and PET scans)
Up to the maximum amount shown per period of cover. We will pay for these scans whether received on an inpatient, daypatient or an outpatient basis. 		Silver
$5,000
€3,700
£3,325 		Gold
$10,000
€7,400
£6,650 		Platinum
Paid in Full
Physiotherapy and complementary therapies
Up to the maximum amount shown per period of cover. Where treatment is provided on an inpatient or daypatient basis. 		Silver
$2,500
€1,850
£1,650 		Gold
$5,000
€3,700
£3,325 		Platinum
Paid in Full
Home nursing
Up to 30 days and the maximum amount shown per period of cover. 		Silver
$2,500
€1,850
£1,650 		Gold
$5,000
€3,700
£3,325 		Platinum
Paid in Full
Rehabilitation
Up to 30 days and the maximum amount shown per period of cover. 		Silver
$2,500
€1,850
£1,650 		Gold
$5,000
€3,700
£3,325 		Platinum
Paid in Full
Hospice and palliative care
Up to the maximum amount shown per lifetime. 		Silver
$2,500
€1,850
£1,650 		Gold
$5,000
€3,700
£3,325 		Platinum
Paid in Full
Internal prosthetic devices/surgical and medical appliances
We will pay for:
  • a prosthetic implant, device or appliance which is inserted during surgery.
 Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
External prosthetic devices/surgical and medical appliances
Up to the maximum amount shown per period of cover. We will pay for:
  • a prosthetic device or appliance which is a necessary part of the treatment immediately following surgery for as long as is required by medical necessity.
  • a prosthetic device or appliance which is medically necessary and is part of the recuperation process on a short-term basis.
For adults, we will pay for one external prosthetic device. For children up to the age of 16, we will pay for the initial prosthetic device and up to two replacement devices. 		Silver
$3,100 (for each prosthetic device)
€2,400 (for each prosthetic device)
£2,000 (for each prosthetic device) 		Gold
$3,100 (for each prosthetic device)
€2,400 (for each prosthetic device)
£2,000 (for each prosthetic device) 		Platinum
$3,100 (for each prosthetic device)
€2,400 (for each prosthetic device)
£2,000 (for each prosthetic device)
Local ambulance and air ambulance services
Medically necessary travel by local road ambulance or local air ambulance, such as a helicopter, when related to covered hospitalisation. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Inpatient cash benefit
Per night up to 30 nights per period of cover. We will make a cash payment to the beneficiary when they:
  • receive treatment in hospital which is covered under this plan;
  • stay in a hospital overnight; and
  • have not been charged for their room, board and treatment costs.
 Silver
$100
€75
£65 		Gold
$100
€75
£65 		Platinum
$200
€150
£130
Emergency inpatient dental treatment
Dental treatment in hospital after a serious accident. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Mental health care
Mental health care
Up to the maximum amount shown per period of cover Subject to the limits explained below we will pay for:
  • the treatment of mental health conditions and disorders; and
  • the diagnosis of addictions (including alcoholism);
Silver
$5,000
€3,700
£3,325 		Gold
$10,000
€7,400
£6,650 		Platinum
Paid in Full
Cancer care
Cancer care
  • Following a diagnosis of cancer, we will pay for costs for the treatment of cancer if the treatment is considered by us to be active treatment and evidence-based treatment. This includes chemotherapy, radiotherapy, oncology, diagnostic tests and drugs, whether the beneficiary is staying in a hospital overnight or receiving treatment as a daypatient or outpatient.
  • We do not pay for genetic cancer screening.
 Silver
$1,000,000
€800,000
£650,000 		Gold
$2,000,000
€1,600,000
£1,300,000 		Platinum
Unlimited
Parent and Baby Care
Routine maternity benefit care
(Gold and Platinum plans only)
Up to the maximum amount shown per period of cover. Available once the mother has been covered by the policy for 12 months or more.
  • We will pay for the following parent and baby care and treatment, on an inpatient or daypatient basis as appropriate, if the mother has been a beneficiary under this policy for a continuous period of at least 12 months or more:
    • hospital, obstetricians' and midwives' fees for routine childbirth; and
    • any fees as a result of post-natal care required by the mother immediately following routine childbirth.
  • We will not pay for surrogacy or any related treatment. We will not pay for maternity benefit care or treatment for a beneficiary acting as a surrogate or anyone acting as a surrogate for a beneficiary.
 Silver
Not covered 		Gold
$7,000
€5,500
£4,500 		Platinum
$14,000
€11,000
£9,000
Complications from maternity
(Gold and Platinum plans only) Up to the maximum amount shown per period of cover. Available once the mother has been covered by the policy for 12 months or more.
  • We will pay for inpatient or outpatient treatment relating to complications resulting from pregnancy or
  • childbirth if the mother has been a beneficiary under this policy for a continuous period of at least 12 months or more. This is limited to conditions which can only arise as a direct result of pregnancy or childbirth, including miscarriage and ectopic pregnancy.
 Silver
Not covered		 Gold
$14,000
€11,000
£9,000		 Platinum
$28,000
€22,000
£18,000
Homebirths
(Gold and Platinum plans only) Up to the maximum amount shown per period of cover. Available once the mother has been covered by the policy for 12 months or more.
  • We will pay midwives' and specialists' fees relating to routine home births if the mother has been a beneficiary under this policy for a continuous period of 12months or more.
  • Please note that the Complications from maternity cover explained above does not include cover for home childbirth. This means that any costs relating to complications which arise in relation to home childbirth will only be paid in accordance with the home childbirth limits, as explained in the list of benefits.
 Silver
Not covered		 Gold
$500
€370
£335		 Platinum
$1,100
€850
£700
Newborn care
Up to the maximum amount shown for treatment within the first 90 days following birth. Available once at least one parent has been covered by the policy for 12 months or more.
  • Provided the newborn is added to the policy, we will pay for:
    • up to 10 days routine care for the baby following birth; and
    • all treatment required for the baby during the first 90 days after birth instead of any other benefit; if at least one parent has been covered by the policy for a continuous period of 12 months or more prior to the newborn's birth.
 Silver
$25,000
€18,500
£16,500		 Gold
$75,000
€55,500
£48,000		 Platinum
$156,000
€122,000
£100,000
Congenital conditions
Up to the maximum amount shown per period of cover.
  • We will pay for treatment of congenital conditions on an inpatient or daypatient basis which manifest themselves before the beneficiary's 18th birthday if:
    • at least one parent has been covered by the policy for a continuous period of 12 months or more prior to the newborn's birth and the newborn is added to the policy within 30 days of the birth.
    • they were not evident at policy inception.
 Silver
$5,000
€3,700
£3,325		 Gold
$20,000
€14,800
£13,300		 Platinum
$39,000
€30,500
£25,000
Deductible and Cost Share Options
Deductible (various)
A deductible is the amount which you must pay before any claims are covered by your plan. 		Silver
$0 / $375 / $750 / $1,500 / $3,000 / $7,500 / $10,000

€0 / €275 / €550 / €1,100 / €2,200 / €5,500 / €7,400

£0 / £250 / £500 / £1,000 / £2,000 / £5,000 / £6,650 		Gold
$0 / $375 / $750 / $1,500 / $3,000 / $7,500 / $10,000

€0 / €275 / €550 / €1,100 / €2,200 / €5,500 / €7,400

£0 / £250 / £500 / £1,000 / £2,000 / £5,000 / £6,650 		Platinum
$0 / $375 / $750 / $1,500 / $3,000 / $7,500 / $10,000

€0 / €275 / €550 / €1,100 / €2,200 / €5,500 / €7,400

£0 / £250 / £500 / £1,000 / £2,000 / £5,000 / £6,650
Cost share after deductible and out of pocket maximum
Cost share is the percentage of each claim not covered by your plan.
The out of pocket maximum is the maximum amount of cost share you would have to pay in a period of cover.
The cost share amount is calculated after the deductible is taken into account. Only amounts you pay related to cost share contribute to the out of pocket maximum. 		Silver
First, choose your cost share percentage: 0% / 10% / 20% / 30%
Next, choose your out of pocket maximum:
$2,000 or $5,000
€1,480 or €3,700
£1,330 or £3,325 		Gold
First, choose your cost share percentage: 0% / 10% / 20% / 30%
Next, choose your out of pocket maximum:
$2,000 or $5,000
€1,480 or €3,700
£1,330 or £3,325 		Platinum
First, choose your cost share percentage: 0% / 10% / 20% / 30%
Next, choose your out of pocket maximum:
$2,000 or $5,000
€1,480 or €3,700
£1,330 or £3,325


Optional Benefits

International Outpatient
Overall Limit
Annual benefit - maximum per beneficiary per period of cover
This includes claims paid across all sections of International Medical Outpatient. 		Silver
$10,000
€7,400
£6,650 		Gold
$25,000
€18,500
£16,625 		Platinum
Unlimited
Standard Medical Benefits
Consultations with medical practitioners and specialists
Up to the maximum amount shown per period of cover. 		Silver
Limit of:
$125
€90
£80
Up to 15 visits per year 		Gold
Limit of:
$250
€185
£165
Up to 30 visits per year 		Platinum
Paid in Full
Pre-natal and post-natal care
(Gold and Platinum plans only)
Up to the maximum amount shown per period of cover. Available once the mother has been covered on this option for 12 months or more.
    We will pay for medically necessary pre-natal and post-natal care on an outpatient basis, if the mother has been a beneficiary under the International Outpatient optional benefit for a continuous period of at least 12 months or more. Examples of such treatment and tests include:
  • Routine obstetricians' and midwives' fees;
  • All scheduled ultrasounds and examinations;
  • Prescribed medicines, drugs and dressings;
  • Routine pre-natal blood tests, if required;
  • Amniocentesis procedure (also referred to as amniotic fluid test or AFT) or chorionic villous sampling (also referred to as CVS);
  • Non-invasive pre-natal testing (NIPT) for high risk individuals; and
  • Any fees as a result of post-natal care required by the mother immediately following routine childbirth.
 Silver
Not covered 		Gold
$3,500
€2,750
£2,250
 Platinum
$7,000
€5,500
£4,500
Pathology, radiology and diagnostic tests (excluding Advanced Medical Imaging)
Where investigations are provided on an outpatient basis. Up to the maximum amount shown per period of cover. 		Silver
$2,500
€1,850
£1,650
Up to 15 visits per year 		Gold
$5,000
€3,700
£3,325
Up to 30 visits per year 		Platinum
Paid in Full
Physiotherapy treatment
Where treatment is provided on an outpatient basis. 		Silver
$2,500
€1,850
£1,650
 Gold
$5,000
€3,700
£3,325
 Platinum
Paid in Full
Osteopathy and chiropractic treatment
Up to the maximum visits shown per period of cover. 		Silver
Paid in full up to 15 visits 		Gold
Paid in full up to 15 visits 		Platinum
Paid in full up to 30 visits
Acupuncture, Homeopathy and Chinese medicine
Up to a combined maximum of 15 visits per period of cover. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Restorative Speech therapy
Provided on a short-term basis following a condition such as a stroke.
Up to the maximum amount shown per period of cover 		Silver
Limit of:
$2,500
€1,850
£1,650
 Gold
Limit of:
$5,000
€3,700
£3,325
 Platinum
Paid in Full
Prescribed drugs and dressings
When prescribed by a medical practitioner on an outpatient basis.
Up to the maximum amount shown per period of cover. 		Silver
100% up to:
$500
€370
£330
 Gold
100% up to:
$2,000
€1,480
£1,330
 Platinum
Paid in Full
Rental of durable medical equipment
Up to a maximum of 45 days in the period of cover. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Adult vaccinations
Up to the maximum amount shown per period of cover. 		Silver
$250
€185
£165
 Gold
Paid in Full 		Platinum
Paid in Full
Adult vaccinations
Up to the maximum amount shown per period of cover. 		Silver
$250
€185
£165
 Gold
Paid in Full 		Platinum
Paid in Full
Dental accidents
We will pay for dental treatment required for the damage to the beneficiary's sound natural tooth/teeth as the result of an accident. Treatment must commence immediately after the accident and be completed within 30 days of the date of the accident.
Up to the maximum amount shown per period of cover 		Silver
$1,000
€740
£665
 Gold
Paid in Full 		Platinum
Paid in Full
Well child tests
Payable for children at appropriate age intervals up to the age of 6. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Child immunisations
Payable for children aged 17 or younger. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Annual routine tests
One eye test and hearing test for children aged 15 or younger. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Deductible and Cost Share Options
Deductible (various)
A deductible is the amount which you must pay before any claims are covered by your plan. 		Silver
$0 / $150 / $500 / $1,000 / $1,500

€0 / €110 / €370 / €700 / €1,100

£0 / £100 / £335 / £600 / £1,000 		Gold
$0 / $150 / $500 / $1,000 / $1,500

€0 / €110 / €370 / €700 / €1,100

£0 / £100 / £335 / £600 / £1,000 		Platinum
$0 / $150 / $500 / $1,000 / $1,500

€0 / €110 / €370 / €700 / €1,100

£0 / £100 / £335 / £600 / £1,000
Cost share after deductible and out of pocket maximum
Cost share is the percentage of each claim not covered by your plan.

The out of pocket maximum is the maximum amount of cost share you would have to pay in a period of cover.

The cost share amount is calculated after the deductible is taken into account. Only amounts you pay related to cost share contribute to the out of pocket maximum. 		Silver
First, choose your cost share percentage:
0% / 10% / 20% / 30%
Your out of pocket maximum is:
$3,000
€2,200
£2,000
 Gold
First, choose your cost share percentage:
0% / 10% / 20% / 30%
Your out of pocket maximum is:
$3,000
€2,200
£2,000
 Platinum
First, choose your cost share percentage:
0% / 10% / 20% / 30%
Your out of pocket maximum is:
$3,000
€2,200
£2,000
International Vision and Dental
Eye Examination
One eye examination per period of cover by an optometrist or ophthalmologist.
Maximum per beneficiary per period of cover.
  • We will pay for one routine eye examination per period of cover, to be carried out by either an ophthalmologist or optometrist.
  • We will not pay for more than one eye examination in any one period of cover.
 Silver
$100
€75
£65
 Gold
$200
€150
£130
 Platinum
Paid in Full
Vision Care
Expenses for:
  • Spectacle lenses
  • Contact lenses
  • Spectacle frames
  • Prescription sunglasses
When all are prescribed by an optometrist or ophthalmologist. Up to the maximum amount shown per period of cover 		Silver
$155
€125
£100
 Gold
$155
€125
£100
 Platinum
$310
€245
£200
Dental Treatment
Annual benefit
Maximum per beneficiary per period of cover 		Silver
$1,250
€930
£830
 Gold
$2,500
€1,850
£1,650
 Platinum
$5,500
€4,300
£3,500
Preventative
Available after the beneficiary has been covered on this option for 3 months. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Routine
Available after the beneficiary has been covered on this option for 3 months. 		Silver
80% refund per period of cover 		Gold
90% refund per period of cover 		Platinum
Paid in Full
Major restorative
If a beneficiary needs major restorative dental treatment before they have had International Vision and Dental cover for 12 months, we will pay 50% of the treatment costs. 		Silver
70% refund per period of cover 		Gold
80% refund per period of cover 		Platinum
Paid in Full
Orthodontic treatment
Available for beneficiaries aged 18 or younger, after they have been covered on this option for 2 consecutive years. 		Silver
40% refund per period of cover 		Gold
50% refund per period of cover 		Platinum
50% refund per period of cover
International Health and Wellbeing
Routine adult physical examinations
Up to the maximum amount shown per period of cover.

We will pay for routine adult physical examinations for persons aged 18 or older. 		Silver
$225
€165
£150
 Gold
$450
€330
£300
 Platinum
$600
€440
£400
Pap smear
Up to the maximum amount shown per period of cover.

We will pay for one papanicolaou test (pap smear) for female beneficiaries. 		Silver
$225
€165
£150
 Gold
$450
€330
£300
 Platinum
Paid in Full
Prostate cancer screening
Up to the maximum amount shown per period of cover.

We will pay for one prostate examination (prostate specific antigen (PSA) test) for male beneficiaries aged 50 or over. 		Silver
$225
€165
£150
 Gold
$450
€330
£300
 Platinum
Paid in Full
Mammograms for breast cancer screening
Up to the maximum amount shown per period of cover.

We will pay for:
  • Aged 35-39: one baseline mammogram for asymptomatic women.
  • Aged 40-49: one mammogram for asymptomatic women every two years, or more if medically necessary.
  • Aged 50 or older: one mammogram each year.
 Silver
$225
€165
£150
 Gold
$450
€330
£300
 Platinum
Paid in Full
Bowel cancer screening
Up to the maximum amount shown per period of cover.

We will pay for an annual bowel cancer screening for beneficiaries aged 55 or older. 		Silver
$225
€165
£150
 Gold
$450
€330
£300
 Platinum
Paid in Full
Bone densitometry
We will pay for one annual scan to determine the density of the beneficiary's bones. Up to the maximum amount shown per period of cover. 		Silver
$225
€165
£150
 Gold
$450
€330
£300
 Platinum
Paid in Full
Dietetic consultations
(Platinum plan only)

We will pay for up to 4 consultations with a dietician per period of cover, if the beneficiary requires dietary advice relating to a diagnosed disease or illness such as diabetes 		Silver
Not Covered 		Gold
Not Covered 		Platinum
Paid in Full
Life management assistance programme
Our Life Management service is available 24 hours a day, 7 days a week, 365 days a year. Professionals are ready to assist you with any issue that matters to you.
  • We will pay for up to 5 counselling sessions per issue per period of cover. This could be telephonic or face to face counselling support.
  • Unlimited in the moment telephonic support for live assistance.
  • Provides information, resources and counselling on any work, life, personal, or family issue that matters to you.
  • Information services provide support including assistance for day to day demands or the logistics of relocating. The information specialists can offer assistance over the phone and perform research and provide pre-qualified referrals to local resources.
 Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Online health education, health assessments and web-based coaching programmes
 Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
International Medical Evacuation
Overall Limit
Annual benefit
Maximum per beneficiary per period of cover 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Standard Medical Benefits
Medical Evacuation
Transfer to the nearest centre of medical excellence if the treatment the beneficiary needs is not available locally in an emergency. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Medical repatriation
If a beneficiary requires a medical repatriation, we will pay for them to be returned to their country of habitual residence or country of nationality. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Repatriation of mortal remains
If a beneficiary dies outside their country of habitual residence during the period of cover, we will arrange for their mortal remains to be returned to their country of habitual residence or country of nationality. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Travel cost for an accompanying person
If a beneficiary needs a parent, sibling, child, spouse or partner, to travel with them on their journey in conjunction with a medical evacuation or repatriation, because they:
  • need help getting on or off an aeroplane or other vehicle;
  • are travelling 1000 miles (or 1600km) or further;
  • are severely anxious or distressed, and are not being accompanied by a nurse, paramedic or other medical escort and; or
  • are very seriously ill or injured;
we will pay for a relative or partner to accompany them. 		Silver
Paid in Full 		Gold
Paid in Full 		Platinum
Paid in Full
Compassionate visit - travel costs
Up to a maximum of 5 trips per lifetime. Up to the maximum amount shown per period of cover. 		Silver
$1,200
€1,000
£800
 Gold
$1,200
€1,000
£800
 Platinum
$1,200
€1,000
£800
Compassionate visit - living allowance costs
Up to the maximum amount shown per day for each visit with a maximum of 10 days per visit. Up to the maximum amount shown per period of cover.
For each beneficiary we will pay for up to 5 compassionate visits over the lifetime of the cover. Compassionate visits must be approved in advance by our medical assistance service. 		Silver
$155
€125
£100
 Gold
$155
€125
£100
 Platinum
$155
€125
£100