Individual Prepaid Medicine Plans Comparison
| Solicitar cotización | Solicitar cotización | Solicitar cotización | Solicitar cotización | Solicitar cotización | Solicitar cotización |
|---|---|---|---|---|---|
| Type | |||||
|
Open
|
Open
|
Open
|
Open
|
Open
|
Open
|
| Maximum Limit for Disability, per Primary Insured and/or Dependent | |||||
|
USD 500,000
|
USD 500,000
|
USD 120,000
|
USD 75,000
|
USD 150,000
|
USD 500,000
|
| Deductible Amount per Policyholder and/or Dependent | |||||
|
Per Contract Year for all hospital and/or outpatient Conditions: USD 250, USD 500, USD 1,000, USD 2,000 Per Outpatient Condition: USD. 250
|
Per Contract Year, per Member for all Outpatient Conditions: USD 150, USD 250, USD 500, USD 1,000, USD 2,000
|
Per Contract Year for all hospital and/or outpatient Conditions: USD 150, USD 250, USD 500, USD 1,000, USD 2,000 Per Outpatient Condition: USD 150
|
Per Contract Year for all Outpatient Conditions: USD 150, USD 250, USD 500, USD 1,000, USD 2,000 Per Outpatient Condition: USD 150
|
Per Contract Year for all Outpatient Conditions: USD 250, USD 500, USD 1,000, USD 2,000 Per Outpatient Condition: USD 250
|
Per Contract Year: USD 5,000, USD10,000, USD 15,000, USD 20,000
|
| Outpatient Disability Copayment (Company / Policyholder and/or Dependent) | |||||
|
80%/20% | 100%/0%
|
80% / 20% 100% / 0%
|
80% / 20%
|
50% / 50%
|
80% / 20%
|
100% / 0%
|
| Inpatient Disability Copayment (Company / Policyholder and/or Dependent) | |||||
|
90%/10% | 100%/0%
|
90% / 10% 100% / 0%
|
80% / 20%
|
80% / 20%
|
90% / 10%
|
100% / 0%
|
| Hospital Copay Limit per contract year per primary insured and/or Dependent | |||||
|
USD 5,000 Not applicable
|
USD 3,000 Not applicable
|
USD 8,000
|
USD 8,000
|
USD 3,000
|
Not applicable
|
| Applicable Fee Schedule Name | |||||
|
BMI Rate Schedule
|
BMI Rate Schedule
|
BMI Rate Schedule
|
BMI Rate Schedule
|
BMI Rate Schedule
|
BMI Rate Schedule
|
| Disability Period | |||||
|
365 days
|
365 days
|
365 days
|
365 days
|
365 days
|
365 days
|
| Account Accumulation Period | |||||
|
180 days
|
180 days
|
180 days
|
180 days
|
180 days
|
180 days
|
| Claim submission period | |||||
|
90 days
|
90 days
|
90 days
|
90 days
|
90 days
|
90 days
|
| All healthcare services and benefits described in this Table are subject to the Deductible and Copay, except where otherwise specified | |||||
|
|
|
|
|
|
|
| Solicitar cotización | Solicitar cotización | Solicitar cotización | Solicitar cotización | Solicitar cotización | Solicitar cotización | Solicitar cotización |
|---|---|---|---|---|---|---|
| Outpatient Care includes consultations, tests, treatments and other services and benefits described in the General Conditions of this Contract. Medications, therapies and ancestral medicine are subject to their own limits | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days
|
| Medications | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days
|
| Medication Copayment | ||||||
|
80%/20% | 100%/0%
|
80% / 20% 100% / 0%
|
80% / 20%
|
80/20 %
|
80/20 %
|
100%
|
30 Days
|
| Therapies prescribed as part of the treatment of a covered disability, provided they are medically necessary and subject to the provisions of the General Conditions of this contract | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days
|
| Ancestral Medicine | ||||||
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500, after the Deductible is applied
|
30 Days
|
| Alternative Medicine | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days
|
| Hospital Care includes physician visits, nursing care, professional consultations and other benefits described in the General Conditions of this contract. Room and board and the Intensive Care Unit are subject to their own limits | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
90 Days
|
| Daily Room and Board with no Deductible or Copayment applied | ||||||
|
USD 300 USD 400
|
USD 300 USD 400
|
USD 200
|
USD 200
|
USD 250
|
Total coverage amount, after the Deductible is applied
|
90 Days
|
| Maximum days for Room and Board | ||||||
|
Unlimited
|
Unlimited
|
240 days
|
240 days
|
240 days
|
240 days
|
90 Days
|
| Daily Intensive Care Unit with no Deductible applied at | ||||||
|
100/0% | 100/0%
|
100/0% 100/0%
|
100/0 %
|
100/0 %
|
100/0 %
|
100% after the Deductible is applied
|
90 Days
|
| Maximum days in the Intensive Care Unit | ||||||
|
Unlimited
|
Unlimited
|
240 days
|
240 days
|
240 days
|
240 days
|
90 Days
|
| Pregnancy Care, with no Deductible or Copay applied. Deductibles from USD 1,000 do not apply to Pregnancy Care benefits | ||||||
|
USD 3,500
|
Not applicable
|
USD 2,000
|
Not applicable
|
USD 3,500
|
Total coverage amount, after the Deductible is applied
|
60 Days
|
| Maternity complications: pregnancy-induced high blood pressure, threatened preterm labor, gestational diabetes, preeclampsia, complications of the unborn child and postpartum complications | ||||||
|
USD 100,000
|
Not applicable
|
USD 25,000
|
Not applicable
|
USD 50,000
|
USD 50,000 after the Deductible is applied
|
60 Days
|
| Newborn care and complications (From a covered maternity or in utero inclusion) | ||||||
|
Total coverage amount
|
Not applicable
|
Total coverage amount
|
Not applicable
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
Not applicable
|
| Medical Emergency due to Accident or Illness | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
24 Hours
|
| Congenital, Genetic and Hereditary Illnesses arising after the signing of this Contract | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp
|
| Degenerative and Rare Illnesses arising after the signing of this Contract | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp
|
| Comprehensive cancer care including reconstructive surgery and rehabilitation, provided it is Medically Necessary and/or a Disability exists | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp.
|
| Organ transplants | ||||||
|
USD 250,000
|
USD 250,000
|
USD 60,000
|
USD 40,000
|
USD 75,000
|
USD 250,000 after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp.
|
| Organ Transplant Coverage in Latin America with free choice of Doctors and Hospitals according to the costs of the place where incurred, except for Brazil, Mexico and Venezuela | ||||||
|
If applicable
|
If applicable
|
Not applicable
|
Not applicable
|
Not applicable
|
If applicable
|
|
| Chronic and Catastrophic Illnesses arising after the signing of this Contract | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp
|
| Medical Emergency due to Accident or Illness | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
24 Hours
|
| Primary Prevention Benefits as stipulated in the Zero-Rate Benefits Chapter of the General Conditions of this Contract | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days
|
| Acquired Immunodeficiency Syndrome (AIDS), SCRS and HIV Positive-related conditions | ||||||
|
USD 10,000
|
USD 10,000
|
USD 10,000
|
USD 10,000
|
USD 10,000
|
USD 10,000, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp.
|
| Medicated nutritional formulas, provided that the Condition requires their use and they are prescribed by a Physician | ||||||
|
USD 3,000
|
USD 3,000
|
USD 3,000
|
USD 3,000
|
USD 3,000
|
USD 3,000, after the Deductible is applied
|
30 Days
|
| Tubal Ligation and Vasectomy, only for the Primary Insured and/or their spouse or common-law partner | ||||||
|
Total coverage amount
|
Not applicable
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
90 Days
|
| Maximum limit for coverage of temporary Contraceptives per contract year, per Primary Insured and/or Dependent | ||||||
|
USD 100
|
USD 100
|
USD 100
|
USD 100
|
USD 100
|
USD 100, after the Deductible is applied
|
30 Days
|
| Emergency Dental Treatment as a Result of an Accident | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
24 Hours
|
| Hospital and/or Clinic accommodation charges for one companion of newborns, patients under sixteen and over seventy-five years of age (Maximum limit per day) | ||||||
|
USD 50 Max. 10 Days
|
USD 50 Max. 10 Days
|
USD 50 Max. 10 Days
|
USD 50 Max. 10 Days
|
USD 50 Max. 10 Days
|
USD 50 Max. 10 Days, after the Deductible is applied
|
90 Days
|
| Underweight and Obesity, provided there is a definitive medical diagnosis and it is Medically Necessary | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp.
|
| Coverage for Disabilities arising from the use or consumption of alcohol, drugs or narcotics | ||||||
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp.
|
| Coverage for Injuries due to Mental Health Disorders, states of dementia, including those resulting from attempted suicide | ||||||
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500, after the Deductible is applied
|
30 Days Outpt. 90 Days Hosp.
|
| Dental checkups, eye exams, frames and lenses | ||||||
|
Not applicable
|
USD 100
|
Not applicable
|
Not applicable
|
Not applicable
|
Not applicable
|
30 Days
|
| Prostheses, provided they are Medically Necessary and part of the treatment of a Disability | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Not applicable
|
Total coverage amount
|
Not applicable
|
30 Days Outpt. 90 Days Hosp.
|
| Orthopedic devices, except hearing aids, provided they are Medically Necessary and part of the treatment of a Disability | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Not applicable
|
Total coverage amount
|
Not applicable
|
30 Days
|
| Third molar extraction (Maximum limit per molar) | ||||||
|
USD. 120 Per molar
|
USD. 120 Per molar
|
USD. 120 Per molar
|
Not applicable
|
USD. 120 Per molar
|
Not applicable
|
30 Days
|
| Excimer laser (from 5.5 diopters only at: Quito - Vistotal, Guayaquil - Dr. Francisco Rivera / Dr. Antonio Ordóñez) | ||||||
|
Total coverage amount
|
Total coverage amount
|
Total coverage amount
|
Not applicable
|
Total coverage amount
|
Not applicable
|
30 Days
|
| Urgent Care or Medical Emergency resulting from an Accident, provided it is treated within the forty-eight (48) hours immediately following the Accident and does not require hospitalization, with no Deductible or Copayment applied | ||||||
|
USD. 1,000 at 100%
|
USD. 1,000 at 100%
|
USD. 1,000 at 100%
|
Not applicable
|
USD. 1,000 at 100%
|
Not applicable
|
24 Hours
|
| Medical Emergency related to a declared Pre-existing Condition, incurred during the Waiting Period established for Pre-existing Conditions, for the Primary Insured and/or Dependent | ||||||
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500
|
USD 500, after the Deductible is applied
|
24 Hours
|
| Local ambulance service | ||||||
|
USD 100
|
USD 100
|
USD 100
|
USD 100
|
USD 100
|
USD 100, after the Deductible is applied
|
24 Hours
|
| Robotic Surgery | ||||||
|
USD 25,000
|
USD 25,000
|
USD 25,000
|
USD 25,000
|
USD 25,000
|
USD 25,000, after the Deductible is applied
|
90 Days
|
| Maximum Limit per Contract Year for all declared Pre-existing Conditions, per Primary Insured and/or Dependent | ||||||
|
20 SBU
|
20 SBU
|
20 SBU
|
20 SBU
|
20 SBU
|
20 SBU, after the Deductible is applied
|
24 Months
|
| Maximum Limit per Contract Year for Pre-existing Conditions related to a disability, per Primary Insured and/or Dependent | ||||||
|
20 SBU
|
20 SBU
|
20 SBU
|
20 SBU
|
20 SBU
|
20 SBU, after the Deductible is applied
|
3 Months
|
| Waiver of Premiums upon death of the Policyholder | ||||||
|
1 Year
|
1 Year
|
1 Year
|
1 Year
|
1 Year
|
1 Year
|
1 Year
|