Small & Medium Enterprises (10 to 50 employees) Medical Plan

• Medical Plans for SMEs (up to 50 employees) in Fresh USD
• Tailor made products are available for SMEs as well as big companies
• Fresh Payment guarantees no extra charges upon hospital admission SME 

Schedule of Benefits: 

Full Network of Hospitals for Class A, Class B, and Class SK on direct billing

Inpatient benefits Limit per year

• Class A: $300,000 | Class B: $250,000 | Class SK: $150,000
• Emergency room Full cover.

Exclusions covered up to $100 Full cover

Full cover Maternity Covered from day 1 for existing employees and after 280 Days for new employees

Normal Delivery

• Class A: $5,000 | Class B: $4,000 | Class SK: $3,000

Cesarean Delivery

• Class A: $7,500 | Class B: $6,000 | Class SK: $5,000

Legal abortion

Class A: $2,500 | Class B: $2,000 | Class SK: $1,750

• Maternity complications

Class A: $6,000 | Class B: $5,000 | Class SK: $4,000

• Free of charge new born baby (Bébé Securite) covered from Day 1

if eligible

• Epidural Covered
  
• Incubator & nursery Covered
  
• Screening test for baby Up to $200
  
• Congenital cases for babies born at Securite (Bébé Securite) 3 cases per year covered up to $5,000 each and up till the age of 12
  
• Congenital cases for babies not born at Securite 3 cases covered up to $3,000 each and up till the age of 12
• Parent accommodation at hospital for children below 12 years Covered

Prothesis:

• Due to accident
• Class A: Unlimited
• Class B: Up to $20,000 per year
• Class SK: Up to $15,000 per year
• Due to sickness
• Class A: Up to $20,000 per year
• Class B: Up to $15,000 per year
• Class SK: Up to $10,000 per year

Additional Inpatient benefits

Dialysis for acute renal failure Covered for all needed sessions during 1st initial admission.

Sleep disorders disease Only Polysomnography is covered

Breast reconstruction Covered due to a covered partial or complete breast excision due to breast cancer (within 6 months of sickness) up to

• Class A: $8,000 | Class B: $6,000 | Class C: $5,000

Infertility Covered from day 1 for existing employees and after 12 months for new employees up to $2,000 per year and $4,000 lifetime

Cornea transplant Surgery is covered. Cost of cornea is excluded

Coronary stent Covered up to sickness prosthesis limit

Valves Covered up to sickness prosthesis limit

Work related accident are covered

Bone marrow aspiration & organ transplant surgery up to $15,000 per lifetime. As per TPA’s tariff. Cost of organ is excluded

Bariatric surgery related to morbid obesity (e.g. Sleeve and bypass) up to $7,500 per lifetime. As per TPA’s tariff.

Cancer including chemotherapy & radiotherapy Covered

Tropical Disease (specific diseases as per general conditions) are covered

Sexual transmitted diseases (specific diseases as per general conditions) Up to $5,000 lifetime

Psychiatric disorder In-hospital treatment

For Class A; Up to $1,000/year after 12 months of enrolment

For Class B: Not covered

For Class SK: Not covered

• Morgue/Burial expenses following a covered hospitalization Up to $2,000 
• Pandemic Diseases Up to $30,000

Out of hospital benefits

Ambulatory Out 85% or 100%

• Class A: Unlimited
• Class B & SK: Up to $3,000
• Amniocentesis Covered
• Morphological Echography Covered
• Triple test Covered
• Dental panoramic Covered
• MRI Covered
• Thallium myocardial Scintigraphy Covered
• Pet scan Covered
• VCT 64 Covered
• OCT Covered
• Osteodensitometry covered for insured aged 50y & above
• Physiotherapy & Kinesitherapy 15 sessions per year
• Pre-Marital test Covered

Additional benefits

• Guaranteed renewability 720 days lifetime subject to an observation period of 180 days for new members
• Pre-Existing conditions covered for

Class A: $4,000 | Class B: $2,500 | Class SK: $1,500

• Upgrades on renewal (e.g. class and product upgrade): Observation period 365 days for maternity and preexisting conditions
• Extension of coverage at the expiry date and while in hospital Up to 30 days
• Claims outside of network are processed on reimbursement basis and as per NEXtCARE’s Lebanese network rates and subject to 30% excess
• Home Care: In-hospital treatments administered at home are covered
• Rental of medical supplies Up to 1 month rental
• Private transportation service/private ambulance Covered
• Natural Death (if the Head of Family/Policy Holder (aged between 18 & 45) Covered, for $10,000
• Accidental Death (if the Head of Family/Policy Holder (aged between 46 & 65) Covered, for $10,000