| PROFIT | GOLD | PLATINUM |
| Lifetime ceiling | $5,000,000 per person | $8,000,000 per person |
| Deductible (Per period of coverage) | $250 to $25,000 | $100 to $25,000 |
| Treatment within the U.S., PPO network | Subject to deductible. No coinsurance. | Subject to deductible. No coinsurance. |
| Treatment within the U.S., out of PPO network | Subject to deductible. The plan pays 80% of eligible expenses up to $5,000, then 100% up to the maximum limit per period. | Subject to deductible. The plan pays 80% of eligible expenses up to $5,000, then 100% up to the maximum limit per period. |
| Coinsurance | International - 100% U.S. USA in-network - 100% U.S. out-of-network - 80% | International - 100% U.S. USA in-network - 100% U.S. out-of-network - 80% |
| Nervous/mental | Subject to deductible and coinsurance. Maximum of $10,000. Available after 12 months of permanent coverage | Subject to deductible and coinsurance. 50,000 lifetime maximum limit. Available after 12 months of permanent coverage |
| Hospital emergency room Injury | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Hospital emergency room Illness | Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient | Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient |
| Hospitalization/room and board | Subject to deductible and subject to charge at the average semi-private room rate. | Subject to deductible and coinsurance at the average private room rate. |
| Surgery | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Maternity Childbirth, preventive care, newborn care and congenital insufficiencies. Family Matters Maternity Program (available 10 months after coverage) | NA | Additional $2,500 deductible per pregnancy. 50,000 lifetime maximum limit. 200 for preventive newborn care. Benefit during the first 31 days - 12 months after birth. 250,000 maximum for newborn care and congenital disorders for the first 31 days after birth. |
| Podiatry | Maximum limit of $750 | Maximum limit of $750 |
| Physiotherapy | Subject to deductible and coinsurance. Maximum of $50 per visit | Sujeto a deducible y coaseguro. Maximum of $50 per visit |
| Transplants | Lifetime maximum of $1,000,000 | Maximum of $2,000,000 for life |
| Prescription Drugs, Dressings and Durable Medical Equipment | Subject to deductible and coinsurance. 90-day supply per prescription. Outpatient only | International - 100% Within the U.S.A. Prescription drug co-payment with card: $20 for generic/$40 for brand name when generic is not available. 90-day supply per prescription |
| Vision | Optional Annex | Maximum of $100 every 24 months for exams. $150 every 24 months for materials |
| Local emergency Ambulance (Injury or illness resulting from the patient's admission to a hospital) | Subject to deductible and coinsurance | Not subject to deductible or coinsurance |
| Emergency Evacuation | Up to a maximum lifetime limit. Not subject to deductible or coinsurance | Up to the maximum limit. Not subject to deductible or coinsurance |
| Political evacuation and repatriation | NA | 10,000 lifetime maximum |
| Remote transport | NA | 5,000 per period of coverage up to a $20,000 lifetime maximum. Not subject to deductible or coinsurance |
| Repatriation of Mortal Remains | Lifetime maximum of $25,000. Not subject to deductible or coinsurance | Lifetime maximum of $50,000. Not subject to deductible or coinsurance |
| Treatment due to unexpected pain in a healthy, natural tooth | 100 per period of coverage | 100% |
| Non-emergency treatment with a dental provider due to an accident | $500 per period of coverage | View non-emergency dental benefit |
| Non-emergency dental care | Optional Annex | Maximum of $750 per period of coverage; $50 individual deductible applies to minor and major restorative services |
| Adult preventive care (19 years and older) | 250 per period of coverage. Not subject to deductible or coinsurance. | $500 per coverage period br/> Not subject to deductible or coinsurance |
| Preventive care for children (Up to 18 years of age) | 200 per period of coverage. Not subject to deductible or coinsurance | $400 per coverage period. Not subject to deductible or coinsurance |
| Limitation due to pre-existing health problem*. | Lifetime maximum of $50,000; 5,000 per period of coverage for unknown health problems. Available after 24 months of permanent coverage. | Covered if declared and not excluded in the annex. |
