Cigna Inspire
EssentialCare V4 BS: Advise to take Vision Extra Premium & Dental Extra Plus with 15% co-insurance
Annual Benefit
Maximum per Insured member, spouse or dependant
Chronic Conditions
Congenital and Hereditary Conditions
This benefit will be paid in respect of:
• any abnormalities, defects, disorders or diseases present at birth or inherited genetically
Pandemics, Epidemics and Outbreaks of Infectious Illnesses
Treatment for disease or illness resulting from a pandemic, epidemic or outbreak of infectious illness, as defined by the World Health Organisation (WHO)
Emergency Out of Area of Cover
• emergency treatment for conditions where immediate treatment is required while outside of the selected area of coverage for the purpose of business or pleasure. This benefit is not intended for routine or pre-planned treatment
Global Virtual Care
Guided Health Advisor
• manage your healthcare prior to and during your assignment to help avoid medical emergencies
• our Cigna Healthcare nurses can provide your family with personalised information i.e.:
• accessing healthcare
• medications availability
• how to find a doctor
Global Telehealth with Teladoc
Video and phone GP consultations, free and confidential 24/7 access to realtime remote medical consultations with a licensed doctor, wherever you are in the world
International Employee Assistance Programme (IEAP) with Workplace Options
Free and confidential 24/7 access to specialised support and advice in multiple languages.
Counselling support:
• a single session with a counsellor to provide immediate help with difficult or uncertain situations
• telephonic and video counselling, up to 6 sessions
Behavioural coaching:
• a 6 week telephonic mindfulness programme
• online Cognitive Behavioural Therapy (CBT)
• life coaching
Up to €800,000 per year of insurance
BS: €800,000.00
Covered up to applicable policy limits
Covered up to applicable policy limits
Covered up to applicable policy limits
Treatment must commence within a period of 42 days of absence from the selected area of coverage
Included - Access via Cigna Envoy app
Included - Access via Cigna Envoy app
Make One Small Change
Coaching programmes designed to target and improve specific behaviours such as:
• smoking
• low physical activity
• food choices
• general life issues
Country Guides
Providing useful information about your country of location for your assignment, such as:
• medical
• travel
• safety
• culture
Global Health Services and Clinical Programmes Health Risk Assessments
• confidential review of your health and lifestyle habits
• identify areas that may need attention
• coaching programmes may be recommended to aid the relevant lifestyle improvements
Targeted Risk Assessments
• targeted and confidential review for any identified risk factor based on the answers to the Health Risk Assessment
Health Information Library
The online library allows access to a portfolio of helpful articles to help improve lifestyle choices, including areas such as:
• diet and recipes
• exercises
• disease prevention
• stress management
• ways to improve sleep
Nurse Case Management
Your Cigna Healthcare case manager will provide a wide range of support during your treatment:
• provide pre-authorisation and guidance on provider options
• personalised patient guidance and education
• emotional and psychological support
• provider liaison
Included - Access via Cigna Envoy app
Included - Access via Cigna Envoy app
Included - Access via Cigna Envoy app
Included - Access via Cigna Envoy app
Included - Access via Cigna Envoy app
• post care follow up Included
Decision Support Programme with Teladoc
Your Cigna Healthcare case manager can connect you to a specialist physician to help answer questions you may have regarding your diagnosis and treatment plan. This confidential service can provide you with an objective, evidence-based, and unbiased second opinion Included
Hospital Support Programme
For treatment requiring an extended hospital stay, a case manager will provide a wide range of support, both before and after hospitalisation:
• personalised patient guidance and education
• emotional and psychological support
• medication management
• facilitate smoother recovery and discharge
processes
• ensure patients receive the most appropriate care
• coordination with the family
Chronic Condition Management
Our case managers can offer you the opportunity to participate in a Chronic Condition Management programme, following a diagnosis of:
• hypertension
• diabetes
• cardiovascular condition
• metabolic disorders
Diabetes Prevention Programme with Omada (available to members located in the US)
In collaboration with Omada, a digital lifestyle change programme for diabetes prevention, you can access:
• behavioural counselling and customised engagement
• weight monitoring via digital scales
• weekly online lessons
• a virtual health coach online
• a social network to learn about:
• nutrition
• stress management
• sleep
• lifelong fitness skills
Wellness Benefits
Included
Included
*Exams and screenings required for symptomatic conditions are covered under out-patient diagnostic benefits
Routine Physical Exams*
Exams for insured members aged 7 years and above, can include, but not limited to;
• physical examination by a doctor
• height, weight, waist circumference, body mass index (BMI) & body fat percentage
• blood pressure
• urine analysis
• cholesterol test
• full blood count
• full biochemistry profile including liver and kidney function
• lung function test
• adult hearing test
• dermatological examination
Pap Smear Screening*
• 1 papanicolaou screening per year of insurance
Prostate Cancer Screening*
• 1 prostate cancer screening per year of insurance for insured males over 50 years old
Mammograms for Breast Cancer Screening or Diagnostic Purposes*
• 1 baseline mammogram for asymptomatic women aged 35-39;
• 1 mammogram for asymptomatic women aged 40-49 every 2 years or more if medically necessary;
• 1 mammogram every Year of Insurance for women aged 50 and over
Up to €1,500 per year of insurance
BS: Up to €1,500 per year of insurance
Option 3: Paid in Full
Option 3: Paid in Full
Option 3: Paid in Full
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Bowel Cancer Screening*
• 1 colonoscopy every five years for insured member over 50 years old;
• 1 colonoscopy for insured member over 40 years old if there is an immediate family history of bowel cancer
Genetic Cancer Screening
Testing and associated pre and post consultations if there is an immediate family history and a doctor has provided a referral This benefit requires prior approval
Cardiovascular Genetic Testing
Testing to assess the inherited risk of heart disease
Bone Densitometry*
1 scan every 5 years for women aged 50 and over
Option 3: Paid in Full
Not Covered
Not Covered
Not Covered Mental Health Care Benefits
Please note that mental health care benefits are not subject to the out-patient annual limit or any coinsurances/cost shares.
International Employee Assistance Programme (IEAP) with Workplace Options
Free and confidential 24/7 access to specialised support and advice in multiple languages
Counselling support:
• a single session with a counsellor to provide immediate help with difficult or uncertain situations
• telephonic and video counselling, up to 6 sessions
Behavioural coaching:
• mindfulness programme, 6 week telephonic
• online Cognitive Behavioural Therapy (CBT)
• life coaching
In-patient Mental Health Care
Treatment for mental health disorders, relating but not limited to:
• anxiety
• depression
• addiction
• obsessive compulsive disorder
• post-traumatic stress disorder
• eating disorders
• burnout
• attention deficit hyperactivity disorder (ADHD)
Out-patient Mental Health Care
Treatment for mental health disorders, including but not limited to:
• anxiety
• depression
• addiction
• obsessive compulsive disorder
• post-traumatic stress disorder
• eating disorders
• burnout
• attention deficit hyperactivity disorder (ADHD)
Out-patient Health Care Benefits
Out-patient Annual Benefit
Up to 20 days per year of insurance
Paid in Full Up to 40 sessions per year of insurance
Maximum per insured member, spouse or dependant
Please note that cancer-related treatment and mental health care are not subject to the out-patient annual limit
Out-patient Co-insurance
Please note that cancer related treatment and mental health care are not subject to the out-patient co-insurance
Adult Vaccinations
This benefit will be payable for clinically appropriate vaccinations and immunisations, namely:
• influenza
• Human Papilloma Virus (HPV) Gardasil
• pneumococcal vaccine
• varicella
• zoster
BS: €20,000 (excludes Cancer Treatment) All amounts are per year of insurance
Option 1 No co-insurance
Anything not listed will be subject to prior approval Up to out-patient annual limit
Travel Vaccinations
Immunisations related to travel, namely:
• tetanus - every 10 years
• hepatitis A
• hepatitis B
• meningitis
• rabies
• cholera
• yellow fever
• Japanese encephalitis
• polio booster
• typhoid
• malaria - tablet form, daily or weekly
Anything not listed will be subject to prior approval
Well Child Tests
This benefit will be payable for each dependant child aged 6 and under.
Cover includes 1 visit at each of the appropriate age Intervals, limited to 13 visits per dependant. Cover includes the following services:
• medical history of the child
• physical examination
• development assessment
• anticipatory guidance
• appropriate immunisations and laboratory tests:
• DPT (Diphtheria, Pertussis and Tetanus)
• MMR (Measles, Mumps and Rubella)
• HiB (Haemophilus influenza Type b)
• polio
• influenza
• hepatitis B
• meningitis
• Human Papilloma Virus (HPV)
Anything not listed will be subject to prior approval
Annual Routine Tests
1 eye test and 1 hearing test for children aged 17 years or under
Out-patient Consultations
Up to out-patient annual limit
Up to out-patient annual limit
BS: Up to €1,000
Up to out-patient annual limit
Up to out-patient annual limit
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We pay for:
• medical practitioners
• GP / family doctor
• specialist consultations
• virtual consultations
• Teladoc via the Cigna Envoy App
Virtual consultations with a healthcare provider not accessed through the Cigna Envoy App or Teladoc are limited to, 1 initial session; and 2 follow-up sessions. Further sessions subject to prior approval
Prescribed Medicines, Drugs and Dressings
We pay for:
• medicines, drugs and dressings when prescribed by a medical practitioner for eligible treatment
• vitamins when prescribed as treatment for a diagnosed vitamin deficiency condition
• the shipment of drugs where a specific drug or suitable alternative is not available in location, unless prevented by local restrictions. Drug shipment requires prior approval
Non-surgical and Minor Surgical Procedures and Treatment
We pay for treatment or surgery:
• that does not require an overnight hospital stay
to out-patient annual limit
• that does not incur a hospital room charge Up to out-patient annual limit
Surgical Appliance and/or Medical Appliance
This benefit will be paid in respect of:
• a prosthesis; or
• appliance when medically necessary and is part of the recuperation process on a short-term basis Up to out-patient annual limit
Medical Aids
This benefit will be paid in respect of an appliance which is medically necessary and is prescribed to support everyday living. This includes, but is not limited to:
• insulin pumps
• crutches
• wheelchairs
• orthopaedic supports
• prosthesis
• hearing aids
Sleep Apnea Appliance
Where sleep apnea has been diagnosed following a sleep study, this benefit will be paid on a long-term basis in respect of:
• continuous positive airway pressure (CPAP) machine once every five years
• annual servicing of CPAP
• annual replacement of CPAP consumables
• oral appliances
Diagnostic Tests
We pay for:
• pathology
• X-rays
• radiology
• electrocardiogram (ECG) and ultrasound scans
Not Covered
Up to out-patient annual limit
Up to out-patient annual limit
• magnetic resonance imaging (MRI)
• computed tomography (CT)
• positron emission tomography (PET)
Rehabilitation Therapies
We pay for:
• Treatment for the following medically necessary physical therapies intended to restore normal physical function:
• physiotherapy
• chiropractic
• osteopathy
• chiropody
• Treatment for the following medically necessary intended to restore normal physical function which has been lost as a result of an accident or an acute medical condition, such as a stroke:
• speech therapy
• oculomotor therapy
• occupational therapy
All of the treatment must be carried out by a qualified practitioner who holds the appropriate license to practice in the country where the treatment is received
Musculoskeletal Support Programme (MSK Support)
A personalised intervention programme provided by a Cigna Healthcare clinician, including:
• medical assessment
• pain management
• medication advice
• monitor progress and goals
• guidance and coaching
• ongoing support, and second opinion services
• access to educational resources
Autism Diagnostic Tests
We pay for the costs of autism diagnostic tests up to the point of a diagnosis of autism
This benefit does not cover treatment for autism
Autism Therapy
We pay for the following expenses for autism therapy when a diagnosis of autism has been given:
• applied behaviour analysis (ABA)
• communication therapies
• educational therapies
• family therapies
Please note that all autism related medications will be covered under the specified drugs and dressings benefit
This benefit requires prior approval
Alternative Therapies
We pay for treatment if it is medically necessary, orthodox and intended to restore normal physical function, including:
• homeopathy
• acupuncture
Not Covered
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If you are unsure, please contact Cigna Healthcare for confirmation of coverage before undergoing any treatment
Menopause Support
We cover treatment to relieve symptoms and offer support for menopause, such as:
• blood tests
• hormone replacement therapy (HRT)
• 1 visit with a dietician
• Online health library information
• menopause symptoms
• emotions and menopause
• early and perimenopause
• diet
Human Immunodeficieny Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS)
Including drug therapy, or antiretroviral therapy (ART)
Kidney Dialysis
The benefit will be paid on an in-patient, day-case or out-patient basis
Emergency Dental Support
Emergency Out-patient Dental Treatment
We will cover out-patient dental treatment:
• received during an emergency visit immediately after accidental damage to natural teeth; and
• to stabilise and relieve pain only
Emergency In-patient / Day-case Dental Treatment
We will cover in-patient dental treatment:
• after accidental damage to natural teeth; and
• to stabilise and relieve pain only
Health Library Support
The online library allows access to a portfolio of helpful articles to help improve oral health
Health Care Benefits
Private Ambulance
Local transport to or from a hospital by road, air or water ambulance when ordered for medical reasons
Hospital charges
For in-patient and day-case treatment we cover:
• nursing
• accommodation
• operating theatre and recovery room
• prescribed medicines, drugs and dressings
• Surgeon, Anesthetist and Physician Fees
• high dependency, intensive care and cardiac care units for as long as critical care is medically necessary
• surgical procedures
Parental Accommodation
For dependant children aged 17 or under, we will pay reasonable costs for a parent or legal guardian staying in the same hospital with the child
Diagnostic Tests
We will cover:
• pathology
up to 30 days per year of insurance
• X-rays
• radiology
• electrocardiogram (ECG) and ultrasound scans
• magnetic resonance imaging (MRI)
• computed tomography (CAT)
• positron emission tomography (PET)
Surgical Appliance / Medical Appliance
We will cover:
• an artificial limb, prosthesis or device which is inserted during surgery
• an artificial prosthesis or device which is a necessary part of the treatment immediately following surgery for as long as is required by medical necessity
• a prosthesis or appliance which is medically necessary and is part of the recuperation process on a short-term basis
Rehabilitation and Physiotherapy
We will cover treatment in the form of a combination of therapies aimed at restoring full function after an acute event such as a stroke:
• physiotherapy
• speech therapy
• occupational therapy
Reconstructive Surgery
We will cover when reconstructive treatment is required to restore appearance following illness, injury or surgery. For example, reconstruction following a car accident
This benefit requires prior approval
Sleep Surgery (Uvulopalatopharyngoplasty - UPPP)
We will cover sleep surgery following a confirmed diagnosis of sleep apnea and if symptoms have persisted after:
• completing sleep hygiene coaching; and
• documented methods of weight loss have been attempted where there is a BMI of 30 or over; and
• unsuccessful sustained CPAP treatment
This benefit requires prior approval
Gender Confirmation Surgery
We will cover male-to-female or female-to-male surgery, and related services, consistent with World Professional Association for Transgender Health (WPATH) recommendations
This benefit requires prior approval
Organ Transplant
We will cover charges made for or in connection with approved organ transplant services:
• medications
• organ procurement costs
• donor’s medical costs, excluding costs incurred due to donor search. Note: the amount payable for donor’s medical costs is reduced by the amount payable for those costs from any other plan or source. Certain transplants will not be covered based on general limitations (i.e. experimental procedures)
This benefit requires prior approval
Kidney Dialysis
We will cover kidney dialysis treatment on an in-patient, day-case or outpatient basis
Paid in Full
Paid in Full up to 120 Days
Paid in Full
Paid in Full
Not Covered
Paid in Full
Paid in Full
Home Nursing Charges
We will cover you to have home nursing as long as required by medical necessity if it is:
• recommended by a specialist immediately after in-patient or day-case treatment
• for treatment that would normally be provided in a hospital
We will cover HIV/AIDS treatment, including drug therapy, or antiretroviral therapy (ART)
Hospice and Palliative Care
We will cover in-patient, day-case or out-patient treatment for:
• the patient’s physical care
• psychological care
• hospital or hospice accommodation
• nursing care
• prescription drugs
The above treatment will be covered following:
• a diagnosis of a terminal condition;
• with a life expectancy of less than 6 months; and
• when treatment can no longer be expected to cure the condition This benefit requires prior approval
In-patient Cash Benefit
We will cover a cash benefit payable to you for each overnight stay spent in a hospital if:
• the stay starts before midnight
• the in-patient treatment and accommodation in the hospital is free of charge
• the in-patient treatment is covered under this plan
Cardiovascular and Diabetes Health Weight Loss Support
The Online Health Library allows access to a portfolio of helpful articles to help improve lifestyle choices.
These include areas such as:
• diet
• recipes
• exercises
• ways to improve sleep
Chronic Condition Management
Our case managers can offer you the opportunity to participate in a Chronic Condition Management programme, for example, following a diagnosis of:
• hypertension
• diabetes
• cardiovascular conditions
• metabolic disorders
Diabetes Prevention Programme with Omada (available to members located in the US)
In collaboration with Omada, a digital lifestyle change programme for diabetes prevention, you can access:
• behavioural counselling and customised engagement
• weight monitoring via digital scales
Paid in Full
Paid in Full Human Immunodeficiency Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS)
€60,000 per year of insurance
€150 each night up to 300 nights per year of insurance
BS: €150 each night up to 300 days
Commented [RC1]: Check if this should be 30 days rather than 300
Included – Access via Cigna Envoy app
Included
Included - via Omada
• weekly online lessons
• a virtual health coach online
• a social network to learn about:
• nutrition
• stress management
• sleep
• fitness lifelong skills
Dietician Consultations
We will cover consultations with a dietician if relating to:
• a diagnosed disease or illness, such as diabetes
Diabetes Screening
We will cover a diabetes screening:
• every 3 years for individuals from age 30; or
• every year for individuals from age 18 with a high risk factor for example, obesity or family history
Obesity Surgery
We will cover obesity surgery for members from age 18 if you have:
• a BMI of 40 or over; or
• a BMI of 35 to 39.9 with more than one weight related health condition; and
• attempted other documented methods of weight loss over a 2 year period; and
• been confirmed through psychological assessment as a suitable candidate
This benefit requires prior approval
Cancer Care Benefits
Prophylactic Surgery
This is preventative surgery to remove an organ or gland not yet showing signs of cancer, in an effort to prevent cancer developing, for example, a mastectomy.
We will cover:
• when there is a significant family history; and it is deemed appropriate following genetic testing
This benefit requires prior approval
Out-patient & In-patient Cancer Treatment
We will cover in-patient, day-case or out-patient treatment such as, but not limited to:
• consultations / specialist consultations
• oncology
• diagnostic tests and pathology
• surgery and hospitalisation
• drugs
• chemotherapy
• radiotherapy
Paid in Full 2 consultations per year of insurance
This benefit requires prior approval Paid in
Cancer Related Appliances
We will cover appliances for external cosmetic purposes because of cancer treatment, for example:
• a wig
• a prosthetic bra
Cancer Related Reconstructive Surgery
We will cover when reconstructive treatment is required to restore appearance following cancer treatment
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For example, reconstruction following a mastectomy This benefit requires prior approval
Cancer Related Dietician Consultations
We will cover consultations with a dietician following a diagnosis of cancer
Paid in Full Egg / Sperm Freezing
We will cover the freezing of oocytes (eggs), ovarian tissue, testicular tissue or sperm following a cancer diagnosis and prior to cancer treatment commencing, including:
• extraction costs
• cost of storage
This benefit requires prior approval and does not include in vitro fertilisation (IVF) treatment
Maternity and Fertility Benefits
Routine Maternity and Childbirth
For an insured employee or their spouse, we will cover routine maternity for in-patient, day-case or out-patient routine maternity expenses, including:
• standard routine examinations
• pathology tests including urine, blood and blood pressure
• 2D ultrasound scans
• childbirth, including childbirth at home
• elective caesarean sections
Complicated Maternity and Childbirth
For an insured employee or their spouse, we will cover complicated maternity for in-patient, day-case or out-patient complicated maternity expenses, including:
• medically necessary caesarean section
• complicated maternity conditions, including, but not limited to, preeclampsia/eclampsia, ectopic pregnancies and premature contractions
• complicated maternity if as a result of assisted conception
Newborn Care
We will cover:
• up to 10 days routine care for the baby following birth; and
• all treatment required for the baby during the first 90 days after birth
Paid in Full 12 months per policy lifetime
Up to €14,000
BS: Option 3
Option 3: Paid in Full
Paid in Full Noninvasive Prenatal Testing (NIPT)
We will cover genetic testing for chromosomal abnormalities in unborn baby, e.g. down syndrome Not covered
Fertility Diagnostic Tests
For insured members aged 40 or under, we will cover:
• fertility tests up to the point of a diagnosis of infertility
Please note that assisted fertility treatment is not included in this benefit
Assisted Fertility Treatment
For any insured employee or spouse, aged 40 or under, once a condition of infertility has been diagnosed, we will cover in-patient, day-case or outpatient infertility treatment, including:
• services for further diagnosis to determine the cause of infertility
• charges made by a Physician for infertility services
• infertility treatment up to a maximum of 4 cycles per lifetime
Paid in Full
• infertility drugs prescribed by the Physician This benefit requires prior approval Not covered
International Emergency Services
Emergency Medical Evacuation Benefit will be payable:
• for the cost of travel when treatment is not available locally; and
• if the medical evacuation has been determined to be medically necessary, to prevent the immediate and significant effects of illness, injury or conditions which if left untreated could result in a significant deterioration of health and represent a threat to life or limb
The medical assistance service will arrange for the transport under proper medical supervision as soon as reasonably practicable.
In all circumstances, we must be contacted to obtain prior approval for an emergency medical evacuation to be covered, and as follows:
• prior approval must be obtained from Cigna Healthcare before the evacuation takes place
• where it is not reasonably possible for prior approval to be requested before the evacuation takes place, approval must be requested within 7 days of the evacuation
Emergency Medical Repatriation Benefit will be payable:
• for the cost of travel when treatment is not available locally; and
• it has been determined to be medically necessary for the patient to be returned to their country of domicile to prevent the immediate and significant effects of illness, injury or conditions which if left untreated could result in a significant deterioration of health and represent a threat to life or limb.
The medical assistance service will arrange for the transport under proper medical supervision as soon as reasonably practicable. In all circumstances, we must be contacted to obtain prior approval for an emergency medical repatriation to be covered, and as follows:
• prior approval must be obtained from Cigna Healthcare before the repatriation takes place
• where it is not reasonably possible for prior approval to be requested before the repatriation takes place, approval must be requested within 7 days of the repatriation
Accommodation following an Emergency Medical Evacuation or Repatriation
Following an emergency medical evacuation or repatriation, we will cover:
• the reasonable cost of hotel accommodation for the patient, comprising a standard private room with ensuite facilities, when medical necessity prevents repatriation or transportation back to the location of assignment immediately after discharge from an in-patient stay
• if the patient is aged 18 or under, accommodation costs may also be covered for a parent, guardian or other responsible adult to stay with the patient in the same room
In all circumstances, we must be contacted to obtain prior approval for hotel accommodation to be covered
Paid in Full up to €5,000
Paid in Full Up to 7 nights
Accommodation for Accompanying Person in the event of an Emergency Medical Evacuation Paid in Full
Following an emergency medical evacuation, and if the patient is expected to require hospitalisation for more than 7 days at the location to which they are evacuated, we will cover:
• accommodation costs for an individual, as chosen by the patient to accompany them
In all circumstances, we must be contacted to obtain prior approval for hotel accommodation to be covered
Transport costs for Accompanying Person in the event of an Emergency Medical Evacuation or Repatriation
Following an emergency medical evacuation or repatriation, and if the patient is expected to require hospitalisation for more than 7 days at the location to which they are evacuated, we will cover:
• return travel costs (economy only) for the most economical form of transport, such as train or bus, to the place of hospitalisation for an individual, as chosen by the patient to accompany them
In all circumstances, we must be contacted to obtain prior approval for travel costs to be covered
Transport costs for Transfer of Children in the event of a Medical Evacuation or Repatriation
Following an emergency medical evacuation or repatriation, we will cover:
• the cost of travel for one parent to accompany the dependant child, under 18 years old; and
• for any individual who because of medical necessity has to go with the patient If an employee’s child who is a dependant is left alone without a parent or adult relative over the age of 18 after the employee or dependant is evacuated or repatriated, the medical assistance service will arrange as soon as reasonably practicable for the dependant to return to their country of domicile Qualified attendants (confirmed by the medical assistance service) will travel with the child who is a dependant, if the medical assistance service decides.
In all circumstances, we must be contacted to obtain prior approval for travel costs to be covered
Assistance in the event of death: Repatriation of Mortal Remains
If the insured member dies outside their country of domicile, we will cover:
• the medical assistance service will arrange as soon as reasonably practicable for the return of the bodily remains to the country of domicile of the deceased
In all circumstances, we must be contacted to obtain prior approval for the costs to be covered
Assistance in the event of death: Travel costs for Insured Family Members in the Event of Repatriation of Mortal Remains
If the insured member dies outside their country of domicile, we will cover:
• travel costs (economy only) for other insured family members to accompany bodily remains to the country of domicile of the deceased
In all circumstances, we must be contacted to obtain prior approval for travel costs to be covered
Transport costs for Compassionate Visit
BS: 70 EUR per day up to 50 days
We will cover the return travel costs (economy only) for the most economical form of transport to the place of hospitalisation for an individual, as chosen by the patient
This benefit will be payable if the patient:
• is in a different country; and
• is expected to be hospitalised for more than 7 days after an accident or sudden illness; or
• has been given a short-term terminal prognosis
In all circumstances, we must be contacted to obtain prior approval for transport costs to be covered
Accommodation for Compassionate Visit
We will cover the reasonable cost of hotel accommodation for an individual, as chosen by the patient, comprising a standard private room with en-suite facilities.
This benefit will be payable if the patient:
• is in a different country; and
• is expected to be hospitalised for more than 7 days after an accident or sudden illness; or
• has been given a short-term terminal prognosis
In all circumstances, we must be contacted to obtain prior approval for accommodation costs to be covered Not Covered
Compassionate Emergency Repatriation
We will cover:
• return travel costs for the most economical form of transport for the insured member
This benefit is payable if the insured member is:
• outside of their country of usual residence; and
• has to return home due to the death or serious acute illness or injury of a close relative, such as parent, spouse, partner, sibling or child In all circumstances, we must be contacted to obtain prior approval for travel costs to be covered
Not covered
Exclusions
As per the exclusions specified in the policy Terms and Conditions, Cigna Healthcare will not pay benefit for the following treatment in relation to medical cover.
a. Allergy Testing and Desensitization: (except testing for allergy towards medications and supplies used in treatment); any physical, psychiatric or psychological examinations or investigations during these examinations.
b. Alternative Therapies: that are not considered medically necessary or an orthodox form of treatment in the country where they are incurred. This includes, but is not limited to traditional Chinese medicine, herbal
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medication, acupressure, ayurveda, hypnotism, rolfing, aromatherapy, massage, dietary therapy, joint manipulation and meditation. Unless this benefit or treatment is specifically provided in the list of benefits.
c. Any Expenses for Weight Loss Drugs and Slimming Aids: These drugs are not covered even if they are prescribed for weight management by a medical practitioner or acknowledged as having therapeutic effects
d. Artificial Life Maintenance: Cigna Healthcare will not pay for non-medical treatment or artificial life maintenance including mechanical ventilation for more than ninety (90) consecutive days after a diagnosis of permanent neurological damage.
e. Administration Charges: costs or fees for filling in a claim form or other administration charges.
f. Appliances: including hearing aids, and spectacles which do not fall within Cigna Healthcare’s definition of surgical appliance and/or medical appliance. Unless this benefit is specifically provided in the list of benefits.
g. Birth Control: Treatment needed because of or relating to male or female birth control.
h. Chemical Contamination and Radioactivity: Treatment for any medical conditions arising directly or indirectly from chemical contamination, radioactivity or any nuclear material whatsoever including the combustion of nuclear fuel.
i. Consultations Performed by The Insured Member or A Family Member: Services rendered by any healthcare provider who is a relative of the patient or the insured member themselves.
j. Cosmetic Surgery: Any form of plastic, cosmetic or reconstructive surgery or treatment, even for psychological reasons, unless it is of medical necessity as a direct result of the patient having an accident or because of other surgery, which itself would have been covered under the plan
k. Dental or Orthodontic Treatment: Unless this benefit is specifically provided in the list of benefits.
l. Failure to seek or follow medical advice: Treatment required as direct result of not seeking or following medical advice.
m. Developmental Disorders: Treatment for or in connection with developmental disorders, including but not limited to:
• Developmental reading, arithmetic, language or articulation disorders; or
• Treatment for, or in connection with, non-medical counselling; or
• Ancillary services for learning disabilities, developmental delay, cognitive or developmental disabilities or disorders.
n. Expenses Relating To:
• Routine examinations or tests including health screens and medical examinations except for those included in the plan/s selected.
• Eye tests except for one eye test per year of insurance for a dependant child under the age of seventeen (17) years.
o. Experimental Treatment: any form of experimental treatment (or procedure) that does not amount to orthodox treatment or does not adhere to the commonly- accepted, customary or traditional practice of medicine in the country where treatment is incurred.
p. Routine Eye or Vision Treatment: unless this benefit is specifically provided under the plan/s.
q. Fertility Treatment: Treatment needed because of or relating to infertility or any type of fertility treatment, including complications arising out of such treatment, with the exception of the investigation of infertility to the point of diagnosis. Please refer to your plan benefits to check if this treatment is covered or excluded.
• Cigna Healthcare will not pay costs or expenses for the following infertility services:
• A reversal of voluntary sterilisation; or
• Infertility services when the infertility is caused by or related to voluntary sterilisation; or
• Donor charges and services; or
• Any experimental or investigational infertility procedures or therapies.
r. Funeral Costs: Costs relating to a funeral, ceremony, burial or cremation are not covered.
s. Genetic Screening: Cigna Healthcare does not pay for genetic screening or pre-implantations genetic screening when such screenings are solely performed to determine whether or not the insured member or the insured member’s descendants may be genetically likely to develop a medical condition, unless included in the list of benefits.
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t. Future Treatment Costs: costs for a treatment that has not yet take place, irrespective of whether advance authorisation has been given or a prior approval has been put in place.
u. Hazardous Sports: Treatment that arises from or is any way connected with injury, sickness or disablement as a result of :
• Taking part in a sporting activity on a professional basis; or
• Solo scuba -diving or scuba diving at depths below thirty (30) metres unless the diver is padi qualified (or equivalent) for that depth and
• Including but not limited to mountaineering, rock or cliff climbing, pot holing, parachuting or piloting
v. Hearing Tests and Hearing Aids: Unless this benefit is specifically provided in the list of benefits.
w. Hospital Accommodation: costs that are more expensive than those of a standard private room at the same hospital. Deluxe or executive rooms or VIP suites are not covered.
x. Home Visits: Unless they are Medically necessary after the sudden onset of an acute illness that leaves the insured member incapable of visiting a healthcare provider.
y. Illegal Cover: Cigna Healthcare will not offer cover or pay benefit when it is illegal to do so under applicable laws. Examples include, but are not limited to, exchange controls, local licensing regulations, sanctions, anticorruption or trade embargoes.
z. Incidental Costs: Including newspapers, taxi fares, telephone calls, guests’ meals and hotel accommodation.
aa. International Emergency Services: Any expenses for international emergency services for emergency evacuation, medical repatriation an transportation costs if:
• Not approved in advance by the medical assistance service; or
• The treatment needed is not covered by the plan; or
• In relation to non-emergency, routine or minor medical problems, tests and exams where there is no clear or significant risk of death or imminent serious injury or sickness; or
• In relation to a condition which would allow for treatment at a future date convenient to the patient and which does not require emergency evacuation or repatriation; or
• In relation to medical care or services scheduled for the patient’s or provider’s convenience which are not considered an emergency; or
• In relation to any expenses for ship-to-shore evacuations.
bb. Kidney Dialysis: Only treatment costs for kidney dialysis will be covered; travel and accommodation expenses in connection with such treatment will not be covered.
cc. Laser Eye Surgery: Treatment to change the refraction of one or both eyes, including refractive keratotomy, photorefractive keratectomy and includes the implant of multifocal lenses solely for refractive purposes or following a standard cataract removal unless this benefit is specifically provided in the list of benefits.
dd. Medical Error: Treatment required as a result of medical error.
ee. Nature cure clinics, health spas and nursing homes.
ff. Non-Medically Necessary: Treatment considered by Cigna Healthcare’s Medical Team to not be Medically Necessary.
gg. Non-Prescribed Products: Products purchased without a medical professional’s prescription.
hh. Oral and Maxillofacial Surgeries: Treatment for temporomandibular joint disorders, unless administered by a certified oral and maxillofacial surgeon when the treatment is considered medically necessary.
ii. Pre- and post-natal classes
jj. Psychiatric Treatment and Care: Cigna Healthcare will not pay for psychiatric, psychotherapy and psychological treatment costs for or in relation to relationship counselling, family counselling, academic problems or acculturation difficulties.
kk. Reckless Behaviour / Illegal Acts: treatment resulting from the insured member’s own act or omission, being a deliberate or reckless exposure to danger (except in an attempt to save human life). This includes, but is not limited to, voluntary participation in bets, gambling, criminal offences or illegal acts, or fights, except in the case of legitimate self-defence
ll. Residential Stays in a Hospital: Which are arranged wholly or partly for domestic reasons or where treatment is not required or where the hospital has effectively become the place of domicile or permanent abode.
mm. Routine Footcare: Including the paring and removing of corns and calluses or trimming of nails or thickened or misshapen nails
nn. Routine Physical Exams: Cigna Healthcare will not pay for routine physical exams for dependants aged six (6) years or under. Cover for routine physical exams is subject to the terms and conditions specified in the plan. Please refer to the plan for coverage details.
oo. Speech and Occupational Therapy: Treatment for, or in connection with, speech and/or occupational therapy unless it:
• Is recommended by a specialist,
• And is intended to restore skills which previously existed and have been lost as a result of an acute medical condition,
• And have a reasonable likelihood of being restored.
pp. Stem Cells: Cigna Healthcare does not pay for harvesting or storage of stem cells. For example, ovum, cord blood or sperm storage.
qq. Sterilisation and Contraception: Any form of sterilisation or contraception, including vasectomy.
rr. Subrogation: Costs that have been or can be paid by another insurance company, person, organisation or public programme. If the employee, spouse or dependant is covered by other insurance, Cigna Healthcare will only pay its part of the benefit. If another person, organisation or public programme is responsible for paying the costs of treatment, Cigna Healthcare may claim back any of these costs it has paid under the conditions set forth in Section 2 - Clause VIII of the General Terms and Conditions.
ss. Suicide and Self-Inflicted Injuries: Treatment that arises from or is in any way connected with attempted suicide or any injury or illness that the insured member inflicts upon themself which exceeds an upper lifetime limit of GBP 100,000 / USD 150,000/ EUR 150,000 per patient.
tt. Surrogacy: Treatment directly related to surrogacy. Cigna Healthcare will not pay maternity benefits to:
• Anyone who acts as a surrogate; or
• Anyone else acting as a surrogate for an insured member.
uu. Termination of Pregnancy: Treatment by way of the intentional termination of a pregnancy, unless two medical practitioners certify in writing that the pregnancy would endanger the life or mental stability of the mother.
vv. Treatment outside the selected area of coverage: If one of the reasons the patient travelled was for that treatment, except if the medical assistance service has arranged emergency evacuation or medical repatriation.
ww. Travel Costs: Any form of non-emergency travel costs where Cigna Healthcare has not requested the insured member to travel to their home country for treatment
xx. Vitamins and Minerals: Products classified as vitamins or minerals (except during pregnancy or to treat diagnosed, clinically significant vitamin deficiency syndromes) and supplements including, but not limited to, special infant formula and cosmetic products, even if medically recommended, prescribed or acknowledged as having therapeutic effects.
yy. War and Terrorism: Injury or disability directly or indirectly caused or contributed to whilst engaging in or taking part in a war, invasion, act of terrorist activities, rebellion (whether war has been declared or not), civil war, commotion, military or usurped power, martial law, riot or in the act of any lawfully- constituted authority, or while an insured member is carrying out army, naval or air services operations, whether or not war has been declared.