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Expacare - Group - Specialcare

Specialcare is the Expacare plan with the most wide-ranging benefits and offers cover that compares favourably with other leading products in the market. All the key elements of cover are included: in-patient hospital expenses, out-patient benefits, prescription drugs and vaccinations and routine medical examinations. In addition Specialcare includes cover for maternity care with treatment for birth defects and congenital illness, routine dental treatment, treatment for alcohol and drug addiction and lump sum payment on diagnosis of AIDS.

Key Benefits:

Benefits

Key Facts - In-patient & Day Case Charges

Hospital accommodation charges including theatre fees, nursing costs, prosthesis, in-patient drugs & dressings
Full refund - All in-patient and day-patient treatment claims must be pre-authorised
Surgeon / Consultant / Specialist & Anaesthetists fees
Full refund
Physicians fees & diagnostic tests
Full refund
Cancer Treatment Costs - Chemotherapy / Radiotherapy
Full refund
Organ transplant
Vital Organs heart, kidney, liver, heart and lung transplants
£200,000 : $340,000 : €300,000
Outside area of cover limit for USA / Canada
Emergency medical treatment outside area limited to six weeks, up to £40,000 : $68,500 : €60,000
Prosthetic devices
Full refund where surgically required, limited to non experimental devices. Call to check cover before incurring any costs.
Psychiatric treatment
Up to an annual limit of 30 days for in-patient treatment

Key Facts - Out-patient Charges

Complementary medicine
Up to £1,000 : $1,700 : €1,500 for Acupuncture, Chiropractic, Homeopathy and Osteopathy
Diagnostic tests (excluding scans)
Full refund
GP referred consultations
Full refund
Physiotherapy consultant referred
Full refund
Physiotherapy GP referred
Full refund
Psychiatric cover
Up to £500 : $850 : €750
Radiotherapy / Chemotherapy
Full refund
Scans - MRI / CT / PET
Full refund
Surgical Procedures
Full refund
Vaccinations administered by a medical practitioner
As part of the prescription drugs benefit of up to £5,000 : $8.500 : €7,500 (These limits do not apply to the treatment of cancer)

Key Facts - Additional Benefits

Cash benefit if the treatment is received completely free of charge
£500 : $850 : €750 each night
Nursing at home
Up to £10,000 : $17,000 : €15,000
Parental accommodation
If your child under 18 is hospitalised and covered under this plan, we will pay the hospital charges for you to stay in hospital with your child
Private ambulance
Full refund (Where medically necessary. Local road ambulance service only)

Additional Benefits

24 Hour emergency helpline
Included
Accompanying relative travel & accomodation
Full refund for travel for an accompanying insured member, if medically necessary
AIDS / HIV treatment
Compassionate lump sum if AIDS is diagnosed one £10,000 : $17,000 : €15,000 in your lifetime
Alcohol & drug abuse
Up to £10,000 : $17,000 : €15,000 over your lifetime
Annual maximum limit
£5,000,000 : $8,500,000 : €7,500,000
Children covered
Aged 18 and under (or up to and including the age of 24 if they are
in full-time education. They will be removed from cover on the renewal date following their 24th birthday)
Chinese medicine
Not covered
Chiropractors & Osteopaths
Covered within complementary medicine and treatment limit - up to £1,000 : $1,700 : €1,500
Chronic conditions & palliative care
Full refund
Compassionate home visit
Not covered
Cover for new born children
Treatment for birth defects and congenital illness, maximum of 28 days cover up to £10,000 : $17,000 : €15,000 for new born babies when we have covered birth
Cremation / burial or repatriation of remains
Up to £7,500 : US$12,750 : €11,250
Dental treatment
Full refund following an accident or routine up to £750 : $1,275 : €1,125 (£50 : $85 : €75 excess applies to each course of treatment)
Emergency medical evacuation & medical repatriation
Emergency medical evacuation
Transport and medical care en-route to the nearest suitable medical facility if you are critically ill, plus travel for an accompanying insured member if medically necessary. Return tickets are included
Extended care facility
Not covered
Health Screening
Up to £500 : $850 : €750 for one medical examination, every 2 years. This benefit is only available to adult members who have maintained 2 years of continuous cover
Hormone replacement therapy
As part of the prescription drugs benefit of up to £5,000 : $8.500 : €7,500 (These limits do not apply to the treatment of cancer)
Infertility investigations
Not covered
Maternity cash benefit
Not covered
Organ Transplants
Vital Organs heart, kidney, liver, heart and lung transplants
£200,000 : $340,000 : €300,000
Overseas cover
Emergency medical treatment outside area limited to six weeks, up to £40,000 : $68,500 : €60,000
Personal & total disability benefit
Not covered
Policy excess
Either £50 : $85 : €75 Excess is payable per person, per medical condition or £500 : $850 : €750 or £1,000 : $850 : €1500 is payable per person, per policy year
Pre-existing conditions
Covered for schemes with 5 or more employees
Pregnancy complications
Up to £12,000 : $20,400 : €18,000 provided the mother has been a member for a continuous period for at least ten months. No benefit is payable for the first ten month of cover.
Presciption drugs, dressings and medicines
As part of the prescription drugs benefit of up to £5,000 : $8.500 : €7,500 (These limits do not apply to the treatment of cancer)
Rehabilitation
As an alternative to post acute care up to 14 days cover
Routine maternity cover
Up to £6,000 : $10,200 : €9,000 provided the mother has been a member for a continuous period of at least 10 months. An elective Caesarean section is covered under this benefit subject to all usual customary and reasonable costs of a vaginal delivery.
Sight / vision benefit
Not covered
Stabilisation of acute chronic episode
Full refund
Well Baby Examination
Not covered
 
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