Maximum Benefit

$10,000,000

Eligibility

75 years

Renewal

Lifetime

Coverage Area

Worldwide

Medical Treatment for Accidents and Emergencies outside of the Network

100% within the Loyal USA Medical Services network / Preferred Providers

Deductible Options
– Per Policy Year

I. $500/$1,000 II. $1,000/$2,000 III. $2,000/$3,000 IV.$5,000 V.$10,000 VI. $20,000 / ($50,000)

Co-Insurance

Does not apply

Waiting Period

90 Days / 3 Months

Reduction of Deductible after 3 years of no claims

Options I, II, III: Elimination of deductible for 1 year, after the 3rd year without claims
Options IV, V, VI: 80% reduction of deductible for 1 year, after the 3rd year without claims

Free coverage for Dependents after the death of the Policyholder

2 Years of Premium waived

Medical and Surgical Services

100% within the Loyal USA Medical Services Network / Preferred Providers

Physician Fees

100% within the Loyal USA Medical Services Network / Preferred Providers

Room and Board
– Private and Semi-Private room only

100% within the Loyal USA Medical Services network
$2,000 out of Network

Intensive Care Unit

100% within the Loyal USA Medical Services network / Preferred Providers

Cancer Treatment (Chemotherapy and Radiation), Dialysis

100% within the Loyal USA Medical Services network / Preferred Providers

Diagnostic Services (Laboratory, X-Rays, MRIs, CT Scans, and Echos)

100% within the Loyal USA Medical Services network
$3,000 out of Network
Options I, II, III, IV

Physical Therapy and Rehabilitation

100% within the Loyal USA Medical Services network / Pre-approved / Preferred Providers

Hospital accommodation charges for Companion of a Hospitalized child

$500 per night, maximum of 30 nights

Reduction in risk of cancer or prophylactic surgery / waiting period apply

$20,000 per lifetime / 18 months waiting period / Options I, II, III, IV

Bariatric Surgery, Gastric Bypass and any type of surgical procedure for loss weight, its complications or treatments / Waiting period apply

$10,000 / 18 months waiting period in Network of Loyal USA Medical Services / Preferred Providers

Medically necessary Reconstructive Surgery in case of Accident or any malformation of the nasal septum

100% Loyal USA Medical Services / Pre-approved / Preferred Providers

Emergency Room / after deductible

100% within the Loyal USA Medical Services Network / Pre-notification

Out-Patient Surgery

100% within the Loyal USA Medical Services Network

Medical and Surgical Services, Medication and Physician’s Fees

100% within the Loyal USA Medical Services Network

Cancer Treatment (Chemotherapy and Radiation), Dialysis

100% within the Loyal USA Medical Services Network
Options I, II, III, IV

Diagnostic Services (Laboratory, X-Rays, MRIs, CT Scans, and Echos)

100% within the Loyal USA Medical Services Network
Options I, II, III, IV

Physical Therapy and Rehabilitation

$15,000 within the Loyal USA Medical Services Network

Speech Therapy

$6,000 within the Loyal USA Medical Services Network

Psychiatric Therapy

Total of 18 visits a year within the Loyal USA Medical Services Network

Routine Adult Health checkup
– No Deductible

Maximum of $500 per Insured within the Loyal USA Medical Services Network

Routine Child Well Care/Immunizations
– No Deductible

< 1 year = 5 visits up to $300 per visit
1 to 17 years = $400 per policy year

Dental Exam
– 12 months waiting period
– No Deductible

$150 Routine checkup benefit / within the Loyal USA Medical Services Network

Hearing Aids – waiting period
– Pre-Authorization required

$2,000 lifetime / 12 months waiting period / within the Loyal USA Medical Services Network

Maternity Services – Per covered pregnancy – Waiting period – No Deductible

Normal delivery:
– 100% within the Network of Loyal USA Medical Services
– $7,000 out of Network
– Waiting period 10 months
– Options: I, II, III, IV
Cesarean delivery: $8,000 / within the Loyal USA Medical Services Network

Maternity Complications – Deductible apply – Excludes conditions treated as a result of infertility treatments.

$250,000 Lifetime
– 10 months waiting period
– Options I, II, III, IV

Stem Cell extraction and preservation
– per newborn child from a covered pregnancy

$3,000 within the Loyal USA Medical Services Network
– Options I, II, III, IV

Maternity services for dependents 18 yrs to 24 yrs

Normal delivery:
– In Network $3,000 / Loyal USA Medical Services
– Out of Network: N/A
– 10 months waiting period
– Options I, II, III, IV
Cesarean $1,500 / Within the Network of Loyal USA Medical Services

Automatic addition of Newborn to the policy – If notified within 90 days of birth -Only newborns from a Covered Maternity

No risk assessment

Ground Ambulance
– No deductible

100% within the Loyal USA Medical Services Network

Air Ambulance Services
– No deductible
– Pre-authorization required

100% within the Loyal USA Medical Services Network

Repatriation of Mortal Remains or Cremation services
– Pre-Authorization required

100% Must be pre-approved and coordinated by Loyal USA Medical Services

Return Travel Assistance to Country of Residence if evacuated by Air Ambulance
– For the patient and 1 companion

$3,000 per person / Within the Loyal USA Medical Services Network

Risk and/or Professionals activities

100% (professional and/or amateur) within the Loyal USA Medical Services Network

Emergency Dental treatment after an accident – Deductible apply

100% within the Loyal USA Medical Services Network

Congenital and/or Hereditary conditions diagnosed before the age of 18 from a Loyal covered maternity

$100,000 Lifetime / Within the Loyal USA Medical Services Network

Congenital and/or Hereditary Disorders diagnosed after 18 years of age

$200,000 Lifetime / Within the Loyal USA Medical Services Network

Transplant Procedures

$500,000 (per Lifetime Diagnosis)
$100,000 (maximum per donor preparation)
– Options: I, II, III, IV, V, VI

Medical equipment and Orthopedic Devices
– Pre-Authorization required

100% within the Loyal USA Medical Services Network

Term Life – Principal Insured and Spouse

Principal Insured: $150,000 – $100,000
Spouse: $150,000 – $100,000
All Plans – 10 years Term / Age limit: 60 years old