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Limited Network of Hospitals

Limited Network of Hospitals

Regular price $160.00
Regular price Sale price $160.00
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Excl. CMC, AUBMC, Rizk, Bellevue
  • Area of Cover: Lebanon.
  • Network of Hospitals: All hospitals Excluding CMC, AUBMC, Rizk, Bellevue on direct billing.
  • Limit for In-Hospital Treatments:
    • For Class A: $500,000
    • For Class B: $300,000
    • For Class SK: $ 200,000
  • Emergency Room: Full Cover
  • Maternity: For Couples and Single Mothers: Full cover after 365 days of enrollment.
  • For Complications and Legal Abortion: Covered if delivery date occurs after the maternity waiting period.
  • New Born Baby: Covered as of day 14, if eligible, free of charge
  • Epidural: Covered
  • Incubator and Nursery: Unlimited days, up to $15,000
  • Screening test for baby: Up to $100
  • Congenital Cases for babies born at Securite (Bebe Securite): All cases are covered up to the age of 12 and up to $15,000.
  • Parent Accommodation at hospital for children below age of 16: covered
  • Home care: In hospital treatments administered at home are covered

Prosthesis: (a device designed to replace a missing part of the body or to make a part of the body work better)

  • Due to Accident: Up to $10,000 per year, as per TPA's Tariff
  • Due to Sickness: Up to $7,000 per year as per TPA's Tariff
  • Coronary Stent Valves: Covered up to sickness prosthesis limit

Orthesis: (An orthopedic brace, splints, or appliance.)

  • Due to Accident: Not Covered
  • Due to Sickness: Not Covered

Additional Inpatient Benefits:

  • Dialysis for acute renal failure, excluding arteriovenostomy: covered up to 3 sessions during first initial admission
  • Sleep Disorder Disease: Only Polysomnography is covered.
  • Sleep Apnea Surgery: Not Covered
  • Parkinson: Not Covered
  • Epilepsy: Up to $2,000 (In & Out)
  • 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 the sickness
  • Infertility: Covered after 12 months of enrollment and up to $1,000 per year, for all classes, as per TPA's Tariff.
  • Cornea transplant: Not Covered
  • Cardiovascular disease: Up to $100,000
  • Work Related Accidents: Not Covered
  • Bone Marrow Aspiration & Organ Transplant Surgery: Covered up to $10,000 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 Disease: Up to $100,000
  • Tropical Disease: Not Covered
  • Sexually Transmitted Diseases: Not Covered
  • Psychiatric disorder: Not Covered
  • Hospital daily income: Not Covered
  • Morgue and burial Expenses: up to $1,000 for adherents aged 64 and below
  • Epidemic / Pandemic Diseases: Covered up to $10,000

Out of hospital benefits / Ambulatory Services (Lab, X-RAY, MRI...): Direct billing as per next care preferred network

  • Coverage: Up to $2,500 / year 85% coverage on direct billing basis
  • Amniocentesis: Not covered
  • Morphological Echography: Covered if delivery date occurs after the maternity waiting period.
  • Triple test: Covered 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
  • MRI: covered subject to a prior approval
  • Thallium myocardial scintigraphy: Not covered
  • Pet scan: covered subject to a prior approval
  • VCT 64: Not covered
  • Genetic test: Not Covered
  • OCT: covered subject to a prior approval
  • Osteodensitometry (for insured age 50 and above): Covered for a specific medical reason
  • Physiotherapy and kinesitherapy: 15 sessions per year 
  • Premarital test: Not Covered

Additional Benefits:

  • Rental of medical supplies: Not covered
  • Guaranteed Renewability: 720 days, lifetime subject to an observation period of 180 days for new members.
  • Unknown Pre existing conditions in hospital: Covered after 6 months for new members.
  • Tests related to pre-existing cases for new insured: Not covered
  • Upgrades on renewal: Observation period of 365 days for maternity and preexisting conditions
  • Claims outside of Lebanese territories or outside of network: claim processed on reimbursement basis as per NEXTCARE's Lebanese network rates and subject to 30% excess

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