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SHIC PLUS

SCHEDULE OF BENEFITS

MEDICAL BENEFIT Maximum LIFETIME BENEFITCI$1,000,000.00 CALENDAR YEAR BENEFITCI$100,000.00 PER EPISODE BENEFITCI$100,000.00 CALENDAR YEAR DEDUCTIBLENONE
OUT-PATIENT BENEFITS Doctors/Specialists Visits (5 per year)Maximum 1st Visit80% up to $100.00 Other 4 visits are covered at80% up to $80.00 Ante-natal Care80% Maximum per Pregnancy (waiting period - 10 months)$500.00 Emergency Medical Services100% (including medication, drugs and ambulance services)$4,000.00 Haemodialysis100% Per Episode$25,000.00
ADDITIONAL BENEFIT Maximum Emergency Air Ambulance (1 trip per year)CI$10,000.00 Note: For the purpose of this part "emergency" means a sudden or unexpected occurrence or event causing a threat to life or limb. Mental Health Benefits None Dental Care Benefits None Vision Care Benefits None Prescription Drugs Benefits None
IN-PATIENT BENEFITS Co-insurance80% of First $2500.00 - 100% Thereafter Daily Room and Board Maximum per episode of illness30 days Full nursing service Maximum per episode of illness30 days Services Covered: Physicians', Specialists' and Surgeons' services including ambulant surgery Anesthesia, use of Operating Room and Recovery Room Use of all In-Patient Services of any Health Care Facility Standard Surgical Supplies including Oxygen and Surgical Appliances Medication and Drugs available only by Prescription Use of Physiotherpy, inhalation and other rehabilitative therapy facilites X-Ray and Ultrasound Services Laboratory and Pathological Studies ** MATERNITY BENEFITS WILL BE AVAILABLE AFTER A 10 MONTH WAITING PERIOD USUAL, CUSTOMARY AND REASONABLE FEE REIMBURSEMENT FOR ALL MEDICAL FEES. **

SCHEDULE OF BENEFITS

MEDICAL BENEFIT

Maximum

LIFETIME BENEFITCI$1,000,000.00

CALENDAR YEAR BENEFITCI$100,000.00

PER EPISODE BENEFITCI$100,000.00

CALENDAR YEAR DEDUCTIBLENONE

OUT-PATIENT BENEFITS

Doctors/Specialists Visits (5 per year)Maximum

1st Visit80% up to $100.00

Other 4 visits are covered at80% up to $80.00

Ante-natal Care80%

Maximum per Pregnancy (waiting period - 10 months)$500.00

Emergency Medical Services100%

(including medication, drugs and ambulance services)$4,000.00

Haemodialysis100%

Per Episode$25,000.00

ADDITIONAL BENEFIT

Maximum

Emergency Air Ambulance (1 trip per year)CI$10,000.00

Note: For the purpose of this part "emergency" means a sudden or unexpected
occurrence or event causing a threat to life or limb.

Mental Health Benefits
None
Dental Care Benefits
None
Vision Care Benefits
None
Prescription Drugs Benefits
None

IN-PATIENT BENEFITS

Co-insurance80% of First $2500.00 - 100% Thereafter

Daily Room and Board

Maximum per episode of illness30 days

Full nursing service

Maximum per episode of illness30 days

Services Covered:
Physicians', Specialists' and Surgeons' services including ambulant surgery
Anesthesia, use of Operating Room and Recovery Room
Use of all In-Patient Services of any Health Care Facility
Standard Surgical Supplies including Oxygen and Surgical Appliances
Medication and Drugs available only by Prescription
Use of Physiotherpy, inhalation and other rehabilitative therapy facilites
X-Ray and Ultrasound Services
Laboratory and Pathological Studies

**** MATERNITY BENEFITS WILL BE AVAILABLE AFTER A 10 MONTH WAITING PERIOD ****

** USUAL, CUSTOMARY AND REASONABLE FEE REIMBURSEMENT FOR ALL MEDICAL FEES. **

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