The medical insurance plan includes a high overall annual limit per seafarer ranging from USD 100,000 to USD 350,000 depending on desired area of cover. The plan provides comprehensive inpatient coverage as well as day- and outpatient benefits and below follows a brief outline of coverage provided:
Note that the information provided here is a guideline only, please request an up to date table of benefits that has to be read in conjunction to the current Employee Benefit Guide.
Treatment guarantee (pre-authorization) may be required for some benefits as indicated by a ‘1’ or a ‘2’ in the table(s) below. Please refer to Notes section for further details. All benefit and deductible amounts are per person per year, unless otherwise indicated.
|Prescription drugs and materials¹||Full Refund|
|Surgical fees, including anaesthesia and theatre charges¹||Full Refund|
|Physician and therapist fees¹||Full Refund|
|Surgical appliances and prostheses¹||Full Refund|
|Diagnostic tests¹||Full Refund|
|Organ transplant¹||Full Refund|
(immediately after acute medical treatment ceases)²
|Repatriation of mortal remains or burial expenses²||$500|
|CT, MRI², PET² and CT-PET² scans (in-patient and out-patient treatment)||$625|
|Oncology (in-patient and out-patient treatment)²||Full Refund|
|Routine maternity and complications of pregnancy and childbirth (in-patient and out-patient treatment)²||$500 per lifetime|
|In-patient cash benefit (per night)(where treatment has been received free of charge)||$20, Max. 25 nights|
|Emergency out-patient treatment (where these benefitamounts are reached, any additional costs may be reimbursed within the terms of any separate Out-patient Plan)||$100|
|Palliative care and long term care²||Full refund, Max. 30 days per lifetime|
|Maximum out-patient plan benefit||$500|
|Medical practitioner fees and prescription drugs||80% refund|
|Specialist fees||80% refund|
|Vaccinations (Excluded for pre-boarding ship exam)||80% refund|
|Prescribed physiotherapy||80% refund|
|Prescribed medical aids||80% refund|
|Prescribed glasses and contact lenses||80% refund, Max. $250|
Treatment Guarantee/Pre-authorisation is a process whereby we guarantee cover for certain treatment and costs, as indicated in the Table of Benefits with a 1 or a 2. If Treatment Guarantee is not obtained for the benefits listed with a 1, we reserve the right to decline your claim. If the treatment is subsequently proven to be medically necessary, we will only pay 80% of the eligible benefit, and for those listed with a 2, we will only pay 50% of the eligible benefit. For further details please refer to the “How to Claim” Section of our Benefit Guide, or simply contact our Helpline.
Chronic conditions are covered within the terms of your policy. Please refer to the definitions section of our Benefit Guide for further information or contact our Helpline.
Pre-existing conditions are covered within the terms of your policy. For further details please refer to the “Definitions” section of our Benefit Guide or simply contact our Helpline.
There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit, which applies to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that particular plan. Some benefits also have a specific benefit limit, for example “Nursing at home or in a convalescent home”. Specific benefit limits may be provided on a “per Insurance Year” basis, a “per lifetime” basis or on a “per event” basis, such as per trip, per visit or per pregnancy. In some instances we will pay a percentage of the costs for the specific benefit e.g. “65% refund, up to $7.100”. Where a specific benefit limit applies or where the term “Full refund” appears next to certain benefits, the refund is subject to the maximum plan benefit, if one applies to your plan(s).
POLICY TERMS AND CONDITIONS
The Table of Benefits provides an outline of the cover we offer under your policy. Please note that cover is subject to our standard policy definitions, limitations and exclusions. These are detailed in our Benefit Guide, which is issued to you upon policy inception. You can also request an up to date Benefit Guide by contacting firstname.lastname@example.org
If there are any policy terms and conditions unique to your policy they will be listed below. Please read carefully in conjunction with our Benefit Guide.
The benefits under this policy are provided as a supplement to the Protection and Indemnity (P+I) coverage. Benefits are payable when an insured member is on shore and this will include medical conditions that have commenced whilst on board the ship in accordance with the benefit limits described above.