Prime Care Medical Plan - 2nd CLASS - Yearly Price Starting at
Regular price $580.00
Benefits summary
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Area of Cover: Lebanon.
- Network of Hospitals: All hospitals on direct billing.
- Limit for In-Hospital Treatments: Unlimited
- Maternity:
- For Couples: Full cover after 180 days of enrollment.
- For Single Mother: Full cover after 12 months of enrolment.
- New Born Baby: Covered as of day 1, free of charge
- Epidural: Covered
- Incubator and Nursery: Unlimited days, up to USD 30,000
- Screening test for baby: Up to USD 200
- Congenital Cases for babies born at Securite (Bebe Securite): All cases are covered up to the age of 12 and with no financial limit.
- Parent Accommodation at hospital for children below age of 16: covered
- Home care: In hospital treatments administered at home are covered
- Prothesis:
- Due to Accident: Unlimited, as per TPA's Tariff
- Due to Sickness: Up to USD 30,000 per year as per TPA's Tariff
- Additional Inpatient Benefits:
- Dialysis for acute renal failure, excluding arteriovenostomy: covered for all needed sessions during first initial admission
- Sleep Disorder Disease: Polysomnography is covered.
- Sleep Apnea Surgery: Up to USD 5,000
- Parkinson: Up to USD 5,000 (In & Out)
- Epilepsy: Up to USD 5,000 (In & Out)
- New treatments, Medical Techniques, Surgeries & Tests: Up to USD 5,000 (In & Out)
- Rehabilitation for a covered case: Up to USD 2,000
- 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 USD 3,000 per year, for all classes, as per TPA's Tariff.
- Cornea transplant: surgery is covered, cost of cornea is excluded.
- Cardiovascular disease: unlimited
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Coronary stent: covered up to sickness prothesis limit
- Valves: covered up to sickness prothesis limit
- Work Related Accidents: Covered
- Bone Marrow Aspiration & Organ Transplant Surgery: covered up to USD 30,000 lifetime, as per TPA's tariff. Cost of organ is excluded.
- Bariatric Surgery related to morbid obesity (e.g. Sleeve and Bypass): covered up to USD 7,500 lifetime, as per TPS's tariff.
- Cancer Disease: unlimited
- Chemotherapy and radiotherapy: covered
- Tropical Disease: Specific diseases as per general conditions are covered.
- Sexually Transmitted Diseases: covered up to USD 15,000 per year.
- Psychiatric disorder: in-hospital treatment covered up to USD 1000 per year after 12 months of enrollment.
- Hospital daily income: For entrepreneurs below 60 USD 50 a day starting the second day and up to 7 days a year
- Morgue and burial expenses: up to USD 3000
- Out of hospital benefits / Ambulatory Services (Lab, X-RAY, MRI...): Direct billing as per next care preferred network
- Coverage: 85% on direct billing basis
- Amniocentesis: covered
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Morphological Echography: once per pregnancy
- Triple test: covered once per pregnancy
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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: covered subject to a prior approval
- Pet scan: covered subject to a prior approval
- VCT 64: covered subject to a prior approval
- Genetic test: up to USD 1000 a year
- OCT: covered subject to a prior approval
- Osteodensitometry (for insured age 50 and above): covered for a specific medical reason in private diagnostic centers
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Physiotherapy and kinesitherapy: 25 sessions per year
- Premarital test: covered
- Additional Benefits:
- Waiver of medical premium of family: Applicable for adherents aged below 65 years, for a period of the policy year and 1 additional year in case of death, terminal illness, or total disability of the bread winner.
- Family discount: applicable for 3+ (for every year)
- Rental of medical supplies: up to 1 month rental
- Guaranteed Renewability: 720 days, lifetime subject to an observation period of 180 days for new members.
- Pre existing conditions in hospital: Covered after 1 year for new members.
- Tests related to pre existing cases for new insured: up to USD 100 one a year from day 1
- Upgrades on renewal: Observation period of 180 days for maternity and preexisting conditions
- Extension of coverage at the expiry date and while in hospital: up to 120 days
- Claims outside of Lebanese territories or outside of network: claim processed on reimbursement basis as per NEXtCARE's Lebanese network rtes and subject to 20% excess
- Travel insurance:
- Travel insurance up to 65 years of age: Covers 24/7 help desk. Covers death abroad, repatriation of mortal remains, up to USD 10,000. Covers accidental and acute sickness not due to any Pre-Existing condition, up to €30,000 per trip and up to 90 days per year. Card should be requested at least 48 hours before traveling.
- Travel insurance 66 and above: covers 24/7 help desk, death abroad, repatriation of mortal remains up to USD 10000
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Private transportation service/ private ambulance: covered
- Death in case of a personal accident: covered up to USD 10000 a year
- Pandemic coverage:
- Territorial scope: Lebanon only
- Total maximum limit per insured/ per contractual period/ per case (including the cost of a positive test): LBP 40,000,000
- Maximum limit/ day for in hospital confinement per contactual period: LBP 2,150,000
- Network: Participating healthcare providers within the network of the administrator which are approved by the ministry of public health for the treatment of the respective pandemic/ epidemic
