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Executive Health Options is a comprehensive, modern major medical healthcare plan available for Canadians citizens resident worldwide. For individuals and their families, it combines these aspects of a plan you or a member of your family needs when faced with the challenge of a major medical diagnosis:
- Funding
- Advocacy
- Information and Support
Funding: Delivers a $5,000,000 US lifetime benefit which can be applied world-wide* or focused to the US. The policy provides insurance for medical and hospital expenses not covered under provincial health care plans. You select a deductible ranging from a low of $250 to $5,000 US. Coinsurance will be waived for expenses incurred in the US within our direct-pay PPOs.
Advocacy, Information and Support: As a Member of an Executive Health Plan you are entitled to these services, wherever you are in the world:
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Find a physician
Find a facility
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HCC Medical Insurance Services assists you and your doctor in identifying physicians and hospitals which have the special expertise for your diagnosed condition.
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| Advocacy Services |
When requested, CAPCO Health Group will work with you as your advocate with medical professionals and with the Plan Administrator, HCCMIS at the time of a major claim.
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Assistance Services
Available 24/7
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The HCCMIS World Service Centre is available 24 hours a day, 7 days a week to answer questions and may be reached at no cost through our worldwide toll-free numbers. Ask them for Pre-Trip Health and Safety Advisories, emergency travel and itinerary changes, BagTrak, Emergency Message Relay and Cash Transfer, Medical referrals, Lost passport assistance, Translation assistance and other travel assistance.
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| Online Assistance |
- Links to Health Sites
- Links to online Libraries
- Claims Contact Information
- Search Preferred Provider Organizations
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BENEFIT SUMMARY
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All Benefits in US dollars
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Coverage Area
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Worldwide*, including the US and Canada
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Overall Maximum Limit
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$5,000,000 US Lifetime
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Deductibles Available
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$250, $500, $1,000, $2,500 or $5,000 per Member per Certificate Period
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Coinsurance — Claims incurred in US or Canada
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The Plan pays 80 % of the next $5,000 of Eligible Expenses per Member after the Deductible, then 100 % to the Overall Maximum Limit. The Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to the Plan Administrator for review and payment directly to the provider.1
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Claims incurred outside US or Canada
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The Plan pays 100% of Eligible Medical Expenses after the Deductible to the Overall Maximum Limit.
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Hospital Room and Board
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In U.S. & Canada: Average Semi-Private Room, including nursing services: Elsewhere*: Average Private Room Rate
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Intensive Care Unit — Worldwide*
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Usual, Reasonable and Customary.
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Pre-existing Conditions
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Same as any other Injury or Illness if disclosed on Application and not excluded or limited by Rider.
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Prescription Drugs
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Usual, Reasonable and Customary (Subject to Deductible and Coinsurance) Includes inpatient and outpatient drugs prescribed by an M.D. for covered injury or illness.
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Mental Health Disorders
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$10,000 per Certificate Period, $25,000 Lifetime Maximum; $50 maximum per visit per day for outpatient care (after 12 months of continuous coverage)
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Maternity — Normal or Complicated Delivery
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After the Deductible, Plan pays 50 % of the next $100,000 of Eligible Medical Expenses, then 100 % to a Lifetime Maximum of $250,000. Covered Maternity Expenses include pre-natal, delivery and post-natal care (after 12 months of continuous coverage)
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Newborn Care
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Included as part of Maternity Benefits for a maximum of 60 days
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Physical Therapy/
Chiropractic Care
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$50 maximum per visit per day (after a covered injury or illness) Must be Medically Necessary and ordered by a Physician not affiliated with the therapy/chiropractic practice.
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Wellness
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Age 30 or older: $250 per Member per Certificate Period; Female Members age 40 or older or Women at Risk: $100 per Certificate Period for a screening mammogram. (Benefits available after 12 months of continuous coverage; not subject to Deductible.)
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Human Organ/Tissue Transplants
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Same as any other Illness for Covered Transplants2
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Local Ambulance
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Usual, Reasonable and Customary
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Emergency Medical Evacuation
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$50,000 Lifetime Maximum
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Emergency Reunion
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$10,000 Lifetime Maximum
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Repatriation of Remains
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$25,000 Limit, per Member
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All Other Eligible Expenses
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Usual, Reasonable and Customary
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Pre-certification Penalty
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50%; 100% for Transplants
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Optional Coverages
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Term Life (incl. AD&D), Dental, Sports
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* All benefits are subject to the provisions,limitations and exclusions contained in the Certificate of Insurance. Coverage area
excludes countries restricted by US economic sanctions and embargo programs and/or other applicable trade sanction laws.
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- Maximum coinsurance cost is $1,000 per Member, up to 3 Members per Certificate Period.
- Covered transplants include Heart, Heart/Lung, Lung, Kidney, Kidney/Pancreas, Liver and
Allogenic and Autologous Bone Marrow.
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Note: This is not an official document, and is provided for your reference only.
For the precise wording see the Insurance Contract. |
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EHO
