UltraCare

The Premier Health UltraCare option is the most elite health insurance benefit package, providing members with the best coverage possible. UltraCare offers 100% unlimited coverage for a variety of medical benefits including outpatient rehabilitation / therapeutic services, outpatient prescription medication, home health care services, and durable medical equipment.

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Plan Highlights

  • Worldwide coverage including inside the United States
  • Guaranteed renewability
  • Maternity benefits and complication of pregnancy included
  • Remote Second Medical Opinion and patient concierge services
  • Travel Assistance Program included
  • Deductible forgiveness for good claims history
  • Waiver of premium payments upon death of primary insured
  • Optional Disability Benefit for sickness and accident
  • Unlimited Outpatient Prescription Medication
  • Unlimited Coverage for Outpatient Rehabilitation / Therapeutic Services
  • Unlimited Home Health Care Services

Lifetime Maximum Benefits

$8,000,000 annual maximum coverage per insured

$1,000,000 lifetime maximum per human organ transplant

General
BenefitDetails
Maximum Annual Coverage$8,000,000
Area of CoverageWorldwide, including the U.S.
Deductible Options
Inside Country of Residence / Outside Country of Residence
Option 1: $1,000 / $2,000
Option 2: $2,000 / $3,000
Option 3: $5,000 / $5,000
Option 4: $10,000 / $10,000
Option 5: $20,000 / $20,000
International Network100% UCR
U.S. In-Network100% UCR
U.S. Out-of-Network70% UCR
Waiting Period30 days
Inpatient Benefits
BenefitCoverage
Hospital Room & Board
Payable up to 365 days per policy year
100%
Private room
Intensive Care Unit (ICU)
Payable up to 365 days per policy year
100%
Inpatient Ancillary Hospital Services
Including, but not limited to X-rays, drugs, bandages, operating room fees, surgical implants
100%
Inpatient Psychiatric Treatment
Subject to 12-month waiting period
100%
Inpatient Physician/Specialist Visits
Limited to one visit per day per specialty
100%
Inpatient Surgery
Including Primary Surgeon fees
100%
Neonatal Intensive Care Unit (NICU)
Covered separately from Maternity Benefits
$150,000 lifetime
Adult Companion of Hospitalized Child
For a hospitalized child under the age of 19
Up to $200 per day
10 days per policy year
Pre-Admission Testing
Must be performed 3–5 days in advance
100%
Inpatient Prescriptions100%
Extended Care Facility100%
Outpatient Benefits
BenefitCoverage
Outpatient Surgery
Including Primary Surgeon fees
100%
Assistant Surgeon100%
Anesthesiologist100%
AIDS / HIV / ARC
Subject to 24-month waiting period
Up to $500,000 lifetime
AcupunctureUp to $70 per visit
10 visits per policy year
Bariatric Surgery
Subject to 24-month waiting period
Up to $30,000 lifetime
Chiropractic ServicesUp to $80 per visit
80 visits per policy year
Congenital Disorders, Birth Defects & Hereditary ConditionsUp to $1,000,000 lifetime if diagnosed before
18 years of age. 100% if diagnosed after 18
years of age.
Diagnostic Testing
Echocardiography, Ultrasound, CAT Scan, PET Scan, MRI, Endoscopy
Gastroscopy, Colonoscopy, Cystoscopy, X-rays, laboratory, etc.
100%
Dialysis100%
Durable Medical Equipment100%
Emergency Dental Treatment100%
Emergency Room Services
Deductible waived only for deductible options of $5,000 or less
100%
Major Accident100%
Deductible waived
Emergency Ground Ambulance100%
Deductible waived
Home Health Care Services100%
Hospice Care100%
180 days lifetime
Outpatient Physician/Specialist Visits100%
Home Visits by a PhysicianUp to $80 per visit
5 visits per policy year
Oncology / Cancer Treatment100%
Cancer Risk Reduction or Prophylactic Surgery
Subject to 12-month waiting period
Up to $30,000 per insured per lifetime
Wisdom Teeth Removal
Subject to 12-month waiting period
Up to $1,200 per policy year
Podiatric Services
Subject to 24-month waiting period
100%
Prosthetic LimbsUp to $45,000 per policy year
Up to $150,000 lifetime
Reconstructive Surgery
Due to covered injury or illness
100%
Outpatient Rehabilitation / Therapeutic Services
Physical, Speech, and Occupational Therapy
100%
Organ Transplant and Related Services
Subject to 6-month waiting period.
Up to $1,000,000 per organ/tissue lifetime
Organ Acquisition
Includes organ harvesting, acquisition, transportation and living transplant donor
Up to $60,000 per transplant
Outpatient Mental / Nervous Health
Subject to 12-month waiting period
Up to $100 per visit
40 visits per policy year
Bereavement Counseling
No waiting period applies
Up to $80 per visit
3 visits per policy year
Prescription Medication100%
Wellness Benefit for Children under the age of 19
Subject to 12-month waiting period
Up to $1,000 per policy year
Deductible waived
Wellness Benefit for Adults
Subject to 12-month waiting period
Up to $350, if used every year
Up to $1,000, if used every 2 years
Deductible waived
Maternity Benefits
BenefitCoverage
Normal Delivery or C-Section
Subject to 10-month waiting period
Up to $10,000 per pregnancy
Deductible waived
Complications of Pregnancy
Subject to 10-month waiting period
Up to $1,000,000 per pregnancy
Deductible waived
Inclusion of Newborn
(requires notification to Insurer within 90 days of birth)
Covered up to policy max without
underwriting if born under a
Covered Maternity
Extraction & Storage of Stem CellsUp to $2,000 per child
Additional Benefits
BenefitCoverage
Emergency Air TransportationUp to $150,000 per event
Deductible waived
Insured's and companion's return ticket after an evacuation by
air transportation
Economy class return travel ticket for insured
and companion
Repatriation of Mortal RemainsUp to $50,000 for Repatriation;
or Up to $10,000 for Local Burial
in Lieu of Repatriation
Deductible waived
Extended Medical Death Coverage / Surviving Dependents Benefit2 years of premium waived
Deductible Reduction
Only for deductible options of $5,000 or less
100% after 3 years
Remote Second Medical Opinion and Patient Navigation Services
100%
Travel Assistance CoverageUp to $10,000 per policy year
Deductible waived

All benefits are subject to Usual, Customary and Reasonable (UCR) fees. The benefits, coverage and exclusions listed herein are only a summary, and are subject to the specific terms and conditions of the plan concerning eligible benefit, limitations, eligibility and exclusions. Please refer to the Policy Wording for details.

Penalties to the benefits payable under this plan may apply if the requirements are not met. Please refer to the section labeled Pre-Certification Requirements and Procedures in the plan’s Policy Wording. You must contact the pre-certification provider number listed on your identification card.

The following services require pre-certification: Hospitalization | Surgeries | Diagnostic Testing | Oncology Treatment | Repatriation of Mortal Remains | Therapy | Organ Transplant | Medical Air Evacuation / Air Ambulance | Rehabilitation | Home Health Care | Extended Care Facility

Failure to perform the pre-certification requirements within a minimum of 5 business days prior to the planned treatment of a non-emergency service or within 72 hours of an emergency service, will result in a penalty of 30% of the allowable charge for the entire episode of care. The penalty will not count toward the deductible or co-insurance maximum as defined on the Certificate of Coverage.

 

All amounts are in USD. For Travel Assistance, all notifications must be done within 24 hours of occurrence.

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