• SME Full
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Small & Medium Enterprises (10 to 50 employees) Medical Plan - Full Network of Hospitals

$210.00
$210.00
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Schedule of Benefits: 
  • Full Network of Hospitals for Class A, Class B, and Class SK on direct billing
  • Inpatient benefits: Unlimited per year
  • Exclusions covered up to $100 Full cover
  • Maternity: Covered from day 1 for insured members at inception 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
  • Epidural: Covered
  • Incubator & nursery: Covered
  • Screening test for baby: Up to $200
  • Congenital cases for babies born with Securite (Bébé Securite): Covered up to $5,000 per person 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
  • Coronary stent: Covered up to sickness prosthesis limit
  • Valves: Covered up to sickness prosthesis limit

Additional Inpatient Benefits:

  • Dialysis for acute renal failure: Covered for all needed sessions during 1st initial admission.
  • Sleep disorders disease: Covered up to $5,000 (In & Out)
  • 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
  • Epilepsy: Covered up to $5,000 (In & Out)
  • Parkinson: Up to $5,000 (In & Out)
  • New treatments, medical techniques, surgeries & tests: Covered up to $5,000 (In & Out)
  • Cornea transplant Surgery: Covered. Cost of cornea is excluded
  • 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): Covered
  • Sexual transmitted diseases (specific diseases as per general conditions): Up to $5,000 lifetime
  • Rehabilitation for a covered case: Covered up to $2,000 (In & Out)
  • Sleep Apnea: Covered up to $5,000 (In & Out)
  • 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: Covered up to $2,000 
  • Epidemic / Pandemic Diseases: Covered up to $30,000
Out of hospital benefits
  • Ambulatory: Out 85% or 100%
    • Class A: Unlimited
    • Class B: Up to $3,000
    • Class 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 50 years & 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.
  • Unknown Pre-Existing conditions covered for
    • Class A: $4,000
    • Class B: $2,500
    • Class C: $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: Covered 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


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