Golden Care Limited
Golden Care Limited
- 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
- 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