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MY
CHOICE™
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MY CHOICE™
EXCLUSIVELY FOR BRAZIL AND MEXICO
WHEN YOU NEED A QUALITY PLAN
Place your confidence in Best Doctors Insurance when you make it Your Choice.
BRAZIL
| STANDARD PLAN (Inpatient) | COVERAGE |
|---|---|
| Maximum Benefit | $3,000.000 per Insured per Policy Year |
| Renewal | Lifetime guarantee |
| Eligibility to Apply | Up to age 74 |
| Coverage | Worldwide. Free choice of Hospitals and Doctors anywhere in the world |
| Private and Semi-Private Room | 100% |
| Intensive Care Unit | 100% |
| Physical Therapy, Rehabilitation during Hospitalization | 100% |
| Surgery (Including Outpatient surgery inside the Hospital or certified Surgical Facility) | 100% |
| Reconstructive surgery in case of illness or Accident | 100% |
| Surgical Implants or prosthesis (Excluding dental) | 100% |
| Prescribed Medications during Hospitalization | 100% |
| Hospital Accommodation for a companion of a Hospitalized Child | $150 per night up to 20 nights |
| Surgeon and Anesthetist Fees | 100% |
| Emergency Room | 100% |
| Routine Health Checkup (18+) (includes laboratory tests, X-rays, and any other medical expense related to the checkup) | $150 per Insured per Policy Year. No deductible applies |
| Major Diagnostic Services | 100% |
| Cancer Treatment (Chemotherapy/radiation) | 100% (Outpatient inside the Hospital or Certified Facility) |
| Dialysis | 100% (Outpatient inside the Hospital or Certified Facility) |
| HIV/AIDS | $500,000 per Insured per lifetime 24 month Waiting Period |
| Congenital and Hereditary Disorders | $500,000 per Insured per lifetime when the condition is diagnosed before age 18 100% when the condition is diagnosed at age 18 or after |
| Emergency Transportation | |
| Air Ambulance | $50,000 per Insurance per Policy Year to the closest Hospital of qualified treatment |
| Ground Ambulance | 100% if ends up in a Hospitalization |
| Repatriation of Mortal Remains or Cremation Services | $50,000 per Insured per Policy Year in the event of death resulting from a covered Accident or condition |
| Coverage for accidents that occurred during the practice of high risk activities | 100% |
| Unique Services | InterConsultation®: Confirmation of diagnosis and recommendation of the best treatment and specialists. Immediate access to this benefit available regardless of any exclusion applicable under this Policy |
| Best Doctors Concierge™: Coordination of medical appointments, hospital admission, travel arrangements, accommodation and transportation when services are rendered outside of the Insured’s Country of Residence | |
| Individual Case Management: A program to coordinate, supervise and manage complex cases of long duration | |
| THINGS YOU SHOULD KNOW | • Unless otherwise stated, the benefits are on a per Insured, per Policy Year basis in which the chosen Deductible applies. All benefits are in US Dollars (USD) • Cumulative Deductible per Insured, per Policy Year. Maximum two accumulative Deductibles per family per Policy Year • In case of Serious Accident no Deductible will apply for first Hospitalization • Costs are subject to being usual, customary and reasonable • Unless otherwise specified, all benefits in the Standard Plan will not cover outpatient services. • Deductible option selected for Standard Plan applies to all Modules |
| The availability of this module is limited to certain geographical regions. Therefore, this coverage is offered according to the country of residence where it is available, once it is requested and approved at the time of underwriting this Policy. | |
| OUTPATIENT MODULE (Requires Standard Module) | |
| Physicians and Specialists Visits | 100% |
| Outpatient Physical Therapy, rehabilitation and Home Health Care (Private Nurse) | $10,000 per Insured per Policy Year |
| Outpatient Diagnostic Services | $10,000 per Insured per Policy Year |
| Specialized Treatments (Psychiatrist, autism and occupational therapies) | $2,000 per Insured per Policy Year |
| Durable Medical Equipment Special Devices, External prosthesis, Orthotic devices | $7,000 per Insured per Policy Year |
| Outpatient Prescribed Medications | $7,000 |
| Surgical treatment for symptomatic disorders of the feet | 100% |
| Emergency Dental Coverage | 100% |
| Bariatric Surgery, gastric bypass and any type of surgical procedure for loss of weight, its complications or treatments | $5,000 per insured, per lifetime (24 months waiting period) |
| Ground Ambulance | 100% |
| MATERNITY MODULE (Requires Standard Module) (Available only for options $1,000/$2,000, $2,500 and $,3500) |
|
| Maternity | $4,500 per event, no Deductible applies. A 10-month Waiting Period applies. Cost for extraction and one year preservation of stem cells included in maternity benefit When the Main Insured maintains the policy active for 5 consecutive years with Maternity Module and the female dependent transfers into an individual MY CHOICE policy after the age of 18, she will be eligible to add Maternity Coverage without individual medical underwriting. A 10-month Waiting Period applies to the new policy |
| Inclusion of Newborn | Automatic without underwriting if born from a Covered maternity |
| Maternity Complications and Birth complications | Up to $500,000 lifetime cover |
| Child Well Care | Before 12 months of age: 5 visits up to $200 per visit From 12 months of age and until the age of 18: one annual check-up up to $100 per visit. No Deductible applies |
| ORGANS AND TISSUE TRANSPLANT MODULE (Requires Standard Module) | |
| Organs and Tissue Transplant | $1,000.000 per organ(s) or tissue per Insured, per lifetime and $40,000 for Living Donor |
| ADDITIONAL COVERAGE AVAILABLE (Rider) | |
| CriticalSelect ™ Eligibility: Age 3–59, renewable cover up to age 65 | Cash payment to cover immediate or unexpected expenses, existing debts and lifestyle changes you might need to make if faced with a critical illness Covered conditions and surgeries: Cancer, stroke, heart attack, (myocardial infarction), coronary artery by-pass surgery, kidney/renal failure, multiple sclerosis, benign brain tumor, paralysis (paraplegia), organ transplant (kidney, heart, lung, liver, pancreas or bone marrow), blindness, deafness |
MEXICO
| STANDARD PLAN (Inpatient) | COVERAGE |
|---|---|
| Maximum Benefit | $3,000.000 per Insured per Policy Year |
| Renewal | Lifetime guarantee |
| Eligibility to Apply | Up to age 74 |
| Coverage | Worldwide. Free choice of Hospitals and Doctors anywhere in the world |
| Private and Semi-Private Room | 100% |
| Intensive Care Unit | 100% |
| Physical Therapy, Rehabilitation during Hospitalization | 100% |
| Surgery (Including Outpatient surgery inside the Hospital or certified Surgical Facility) | 100% |
| Reconstructive surgery in case of illness or Accident | 100% |
| Surgical Implants or prosthesis (Excluding dental) | 100% |
| Prescribed Medications during Hospitalization | 100% |
| Hospital Accommodation for a companion of a Hospitalized Child | $150 per night up to 20 nights |
| Surgeon and Anesthetist Fees | 100% |
| Routine Health Checkup (18+) (includes laboratory tests, X-rays, and any other medical expense related to the checkup) | $150 per Insured per Policy Year. No deductible applies |
| Major Diagnostic Services | 100% |
| Cancer Treatment (Chemotherapy/radiation) | 100% (Outpatient inside the Hospital or Certified Facility) |
| Dialysis | 100% (Outpatient inside the Hospital or Certified Facility) |
| HIV/AIDS | $500,000 per Insured per lifetime 24 month Waiting Period |
| Congenital and Hereditary Disorders | $500,000 per Insured per lifetime when the condition is diagnosed before age 18 100% when the condition is diagnosed at age 18 or after |
| Emergency Transportation | |
| Air Ambulance | $50,000 per Insurance per Policy Year to the closest Hospital of qualified treatment |
| Ground Ambulance | 100% if ends up in a Hospitalization |
| Repatriation of Mortal Remains or Cremation Services | $50,000 per Insured per Policy Year in the event of death resulting from a covered Accident or condition |
| Unique Services | InterConsultation®: Confirmation of diagnosis and recommendation of the best treatment and specialists. Immediate access to this benefit available regardless of any exclusion applicable under this Policy |
| Best Doctors Concierge™: Coordination of medical appointments, hospital admission, travel arrangements, accommodation and transportation when services are rendered outside of the Insured’s Country of Residence | |
| Individual Case Management: A program to coordinate, supervise and manage complex cases of long duration | |
| THINGS YOU SHOULD KNOW | • Unless otherwise stated, the benefits are on a per Insured, per Policy Year basis in which the chosen Deductible applies. All benefits are in US Dollars (USD) • Cumulative Deductible per Insured, per Policy Year. Maximum two accumulative Deductibles per family per Policy Year • In case of Serious Accident no Deductible will apply for first Hospitalization • Costs are subject to being usual, customary and reasonable • Unless otherwise specified, all benefits in the Standard Plan will not cover outpatient services. • Deductible option selected for Standard Plan applies to all Modules |
| The availability of this module is limited to certain geographical regions. Therefore, this coverage is offered according to the country of residence where it is available, once it is requested and approved at the time of underwriting this Policy. | |
| OUTPATIENT MODULE (Requires Standard Module) | |
| Physicians and Specialists Visits | 100% |
| Outpatient Physical Therapy, rehabilitation and Home Health Care (Private Nurse) | $10,000 per Insured per Policy Year |
| Outpatient Diagnostic Services | $10,000 per Insured per Policy Year |
| Specialized Treatments (Psychiatrist, autism and occupational therapies) | $2,000 per Insured per Policy Year |
| Durable Medical Equipment Special Devices, External prosthesis, Orthotic devices | $7,000 per Insured per Policy Year |
| Outpatient Prescribed Medications | $7,000 |
| Surgical treatment for symptomatic disorders of the feet | 100% |
| Emergency Dental Coverage | 100% |
| Bariatric Surgery, gastric bypass and any type of surgical procedure for loss of weight, its complications or treatments | $5,000 per insured, per lifetime (24 months waiting period) |
| Ground Ambulance | 100% |
| ORGANS AND TISSUE TRANSPLANT MODULE (Requires Standard Module) | |
| Organs and Tissue Transplant | $1,000.000 per organ(s) or tissue per Insured, per lifetime and $40,000 for Living Donor |
| ADDITIONAL COVERAGE AVAILABLE (Rider) | |
| CriticalSelect ™ Eligibility: Age 3–59, renewable cover up to age 65 | Cash payment to cover immediate or unexpected expenses, existing debts and lifestyle changes you might need to make if faced with a critical illness Covered conditions and surgeries: Cancer, stroke, heart attack, (myocardial infarction), coronary artery by-pass surgery, kidney/renal failure, multiple sclerosis, benign brain tumor, paralysis (paraplegia), organ transplant (kidney, heart, lung, liver, pancreas or bone marrow), blindness, deafness |
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