Dia Y Noche
|Maximum Renewable Annual Benefit $150,000.00 |
|Annual deductible per person: $200.00|
|Benefit |Coverage - Participation of the Policyholder|MaximumCoverage / Limitations |
|HOSPITALIZATION | | |
|HOSPITALIZATION INTERNALPATIENT | | |
|Daily room, intensive care, medicines, |Daily Co-payment of $100.00, maximum 5 days ||
|Hospital miscellaneous services, Imaging, |during the first 15 days, later on 80% will | |
|Laboratorytests, Pathology and Medical Fees|be covered | |
|Anesthesiologist Doctor Fees ||Maximum 40% of the Surgeon’s Fee |
|Surgical Assistant | |Maximum 20% of the Surgeon’s Fee. It |
|| |requires Pre-Authorization |
|In Site Consultations || |
|HOSPITALIZATION EXTERNAL PATIENT |Co-payment $100.00 ||
|Medicines and Hospital miscellaneous | | |
|services and Medical Fees |...
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