Eligibility
Worldwide coverage for 4 specific conditions
Pre-Existing Conditions Coverage
Coordination of Benefits
Hospital and Clinic Network
Medical Network in Colombia
Outpatient coverage
Deductible
・Applies per insured, per policy year, up to a maximum of 2 deductibles per family.
・A single deductible applies per family, per policy year, in the event of a joint accident in the country of residence.
・Expenses incurred during the last 90 days of the policy year that do not exceed the deductible will be applied to the following period of the policy year.
・Elimination of Deductible –
– 100% for hospital coverage inside and outside the country of residence (Except in the USA). Applies to deductible options 1, 2, 4 and 5.
– 100% coverage for outpatient surgeries and emergencies in the country of residence, without deductible or copayment. Applies to deductible options 4 and 5.
– 50% deductible in select network in the USA.
Waiting period
・100% coverage for accidents and infectious diseases from the effective date, with a period
60-day waiting period for any other covered condition.
Travel assistance service
You have 100% coverage for medical emergencies or accidents that occur outside your country of residence:
・Insureds with deductibles up to USD 5,000 will have a copay of USD 100 and the balance of the invoice will be paid to the
100% per BMI up to the policy limit.
・Insureds with deductibles of USD 10,000 or USD 20,000 will have a copay of USD 100 for the first USD 5,000 in
medical expenses. Expenses greater than US$ 5,000 will be paid based on the benefits of the policy. (Deductible applies)
BMI Access
・The BMI Access Service Center provides 24x7 assistance and exclusive benefits to all BMI health members.
・The insured should only contact BMI Access to be assigned a Medical Coordinator, who will be their
guide to coordinate any service or benefit available in your health policy.
Maximum benefits
MAXIMUM BENEFITS | COVERAGE |
Maximum limit per illness, per insured | $500,000 |
illness period | 365 days |
Claims submission period | 120 days |
Waiting period for any non-accidental illness or infectious disease | 90 days |
Waiting period for appendicitis and cholecystitis | No wait |
Exemption of premiums due to the death of the holder | 3 years |
Hospital Expenses
HOSPITAL EXPENSES | COVERAGE |
Room and board daily, after applying the deductible | 100% |
Intensive care unit, after deductible has been applied | 100% |
Maximum days of hospitalization | 240 days |
Copayment for hospitalization outside the service network (company/owner and/or dependent) | 80% / 20% |
In-network hospitalization copayment | 100% |
Outpatient expenses after applying the deductible
OUTPATIENT EXPENSES, AFTER THE DEDUCTIBLE IS APPLIED | COVERAGE |
Copayment for outpatient services | 100% |
Optional prescriptions (medications) | 100% |
Maternity, after applying the deductible
MATERNITY, AFTER THE DEDUCTIBLE IS APPLIED | COVERAGE |
Maximum limit for maternity benefit | 100% |
Maximum limit for maternity complications | $50,000 |
Newborn care and its complications | 100% |
Waiting Period for Maternity Benefit and Maternity Complications | 60 days |
Congenital, genetic and hereditary diseases (as long as maternity is covered) | 100% |
Organ transplant
ORGAN TRANSPLANT | COVERAGE |
Maximum limit for transplants in the Dominican Republic (annual renewable) | $250,000 |
Maximum limit for transplants in the select network in the US and outside the country of residence | $750,000 |
Foreign Travel Assistance (only for emergencies)
ASSISTANCE IN FOREIGN TRAVEL (ONLY FOR EMERGENCY) | COVERAGE |
Maximum limit per trip, per insured | $10,000 |
Deductible per trip, per insured | USD 150 |
Maximum days per trip | 30 days |
* This benefit is provided abroad by MULTI ASSISTANCE SERVICES and does not apply to pre-existing conditions
Other Benefits, after applying the deductible
OTHER BENEFITS, AFTER THE DEDUCTIBLE IS APPLIED | COVERAGE |
Alternative medicine | 100% |
AIDS treatment | $10,000 |
Injuries due to mental health disorder, states of insanity, including those resulting from | |
suicide attempt | USD 500 |
Medical emergency related to a declared pre-existing condition, incurred during the | |
grace period | USD 500 |
Local ambulance service (per event) | USD 100 |
robotic surgery | $20,000 |
Fallopian tube ligation, vasectomy | $3,000 |
Emergency dental treatment as a result of an accident | USD 50 (10 Days) |
Charges for hospital accommodation of a companion per patient under 16 years of age and over 65 years of age | 100% |
Thinness and obesity as long as there is a definitive medical diagnosis and it is medically necessary | USD 500 |
Coverage for disabilities resulting from the use or consumption of alcohol, drugs or narcotics | 100% |
COVID-19 coverage and its variants |
DEDUCTIBLES | OPTION 1 | OPTION 2 | OPTION 3 | OPTION 4 |
Deductible per policy year | $5,000 | $10,000 | $15,000 | $20,000 |
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