HEALTH PROGRAM NESTRADE
HEALTH PROGRAM NESTRADE
Annual Benefit (up to 70 years) AIDS and complications (Life Time Benefit) (Annual Limit $20,000)
$350,000 $150,000
Calendar Year Deductible (PanamĂĄ LatinoamĂŠrica) (Maximum 3 per family) Calendar Year Deductible (USA, Europe, Japan) Stop Loss (Apply for Hospitalization and Medical Fees) pre-authorized (Panama & Latin America) (USA, Europe, Japan) Co-insurance Pre-authorized Non pre-authorized EMERGENCY (Expenses incurred in the emergency room) Emergency room per Accident Emergency room for critical conditions Emergency room non critical conditions
$200.00 per person $1,000.00 per person $3,500 $6,000 80%-20% 60%-40%
Cover at 100% co-payment $20 cover at 80% after deductible
Critical Conditions: Hypertensive crisis, stroke, chest pain (first 12 hours), high continuous fever in children under five (5) years, asthmatic crisis, unconsciousness, drowsiness, acute abdominal pain, biliary colic, bleeding, acute respiratory failure, dehydration, acute intoxication, nefrouretral colic, thrombosis, severe vomiting or diarrhea, convulsions, acute allergic reactions, acute urinary retention, myocardial infarction, acute neurological episodes, state of shock of any order, coma. This benefit will be paid as indicated in the Table of Insurance.
HOSPITALIZATION. Local Hospitalization: Private Room, Food, Intensive Care Room and Special Hospital Expenses. Surgeon and Anesthesia fees. (A daily visit by physician maximum) H. Paitilla, H. Punta Pacifica, H. Nacional & H. San Fernando Co-payment $250 Other local Hospital Co-payment $200 Ambulatory Surgery - Hospital Costs Co-payment $75 Important Note: For all hospitals: from eleventh day henceforth an 80% will be reimbursed after deductible
Critical Conditions: Blood stream, open-Heart surgery, organ transplantation, trauma or blunt-force trauma by an accident, cancer and Oncology (including Radiation Therapy and Chemotherapy, major Orthopedic Surgery.
Hospitalization outside Panama under the following limits: Daily room & board for Latin America $250.00 at 100% without deductible or co-insurance Daily room & board for USA, Europe & Japan $500.00 at 80% after deductible Intensive Unite Care $1,000.00 at 80% after deductible OUT PATIENT SERVICES Specialists and General consultation X Rays Labs - in the Hospital Labs (Lab. Rally, De Sedas & Fernandez) Prescribes Medicines
Co-payment $15.00 Co-payment 30% Co-payment 30% Co-payment 15% at 80% after deductible
PREVENTIVE COVERAGE Gynecological Control (Once a year includes PAP TEST) Mammography – apply for employee for 35 years and older Urological Control (Once a year including PSA Test)
co-payment 30% co-payment 30% co-payment 30%
MATERNITY AND COMPLICATIONS AS OF ANY OTHER DISABILITY Without waiting period. (Includes 9 appointments, 3 ultrasounds, laboratories, vitamins and hospital, according to benefits as described) Healthy Newborn Maximum (Pediatric Fee)
$ 200.00 at 80% after deductible
Maternity outside of Panama, will be cover at 80% after deductible under the following limits: Cesarean Normal Birth Legal abortion Threat of miscarriage
$5,000 $3,000 $2,000 $2,000
Neonatal Critical Care (premature newborn care) from day 0 to 13 Maximum Benefit Deductible Co-insurance Healthy Child Control (until age 6) Vaccines .
$50,000 $500 80% cover by the insurance company Copayment $15.00 Copayment 40%
VACCINES (Base on the MINSA list) Vacunas (APLICA CO-PAGO DEL 40%) I DPT Sarampión (measles) MMR (measles. mumps & nibella) Polio Oral Poliomelitis (Intramuscular) DT — Diphtheria Toxoid (Toxoide Diftérico) BCG Hepatitis A Hepatitis B Hemophilus Influenza B — Hibtiter Varicela Rotavints Netunococo (Prevnar) Pentavalente Hexavalente
90710 90705 90707 90712 90713 90719 90728 86299 90744 90645 90716 90680 90669
$25.00 $25.00 $35.00 $15.00 $15.00 $20.00 $10.00 $35.00 $25.00 $25.00 $60.00 $60.00 $95.00 $65.00 $75.00
AMBULANCE COVER Domestic Ground Ambulance Up to $ 300.00 per event (at 100%) Local Air Ambulance Up to 1,500.00 per event at 80% after deductible International Air Ambulance Up to 15,000.00 per event at 80% after deductible
OTHER BENEFITS Extraction of Third Hit Molars
$ 125.00 at 100% (Do not apply deductible)
Orthopedic Boots, 2 pair per year
50% after deductible
Therapies and Inhalation therapies
80% after deductible
Injections
80% after deductible
Psychiatric Consultations
$50.00 each at 80% after deductible (20 max)
Allergy Treatment Salpingectomy – apply for the employee only Vasectomy – apply for the employee only Medicines for birth control and fertility treatment Special coverage for chronic alcoholism or drugs Keratosis and/or acne treatments Medical expenses for injuries due to states of mental disorders resulting from injuries voluntarily self-inflicted, suicide or attempted suicide, being or not use of their mental faculties
80% after deductible Maximum Limit $500.00 Maximum Limit $250.00 Maximum $5,000.00 at 80% after deductible at 80% after deductible. (pre-authorized) 80% after deductible
at 80% after deductible
Special coverage for consultation (URA $60.00) and psychological treatment, speech therapies, occupational therapies, attention deficit disorder, language therapies for a child with a medical diagnostic that needs those treatments and / or therapies – Maximum of $15,000 at 80% after deductible.
Expenses related to health issues from or during the individual participation or insurrection of a revolution, strike or rite
at 80% after deductible
Sept rhinoplasty, xanthomas, breast hyperplasia (pre-authorization), correction of the eyelid ptosis (pre-authorization)
at 80% after deductible
Medical orthopedic devices or bioelectric (pre-authorization) Maximum of $20,000
80% after deductible
Medical expenses as product of any act or claim cause by fault or negligence of the insurer
80% after deductible
This cover does not have waiting periods for any preexisting medical condition. Any expenses in excess of the usual and customary expenses, or charges that exceed the rates negotiated with participating network providers of the Company will not cover by Palig.
ASSA NETWORK PROVIDERS To know the ASSA network providers please visit the following link: https://www.assanet.com/servicio-al-cliente/red-medica/encuentre-un-doctor/
DISCOUNTS Know the discounts in different pharmacies, laboratories and clinics throughout the country. ASSA MEDIC MÓVIL Home medical attention.
300-2424
FOR MORE INFORMATION VISIT THE FOLLOWING LINK: HTTPS://ASSANET.COM/BENEFICIOS/?PAGE_ID=1267
Ejecutiva de Cuenta: Erika Guevara Erika.Guevara@mercermarshbeneficios.com 6672-8837 280-5176
Gerente de Cuenta: Marta de Quiros Marta.deQuiros@mercermarshbeneficios.com 6430-3318 270-6021
NOTE: THE INFORMATION REFERRED TO IN THE CONTRACT POLICY PREVAILS OVER THE INDICATED IN THIS DOCUMENT