Medical Plans for Individuals & Families in Fresh

USD
 Fresh Payment guarantees no extra charges upon hospital admission

Golden Care Full Golden Care Reduced Golden Care Basic

Network Network Network
Area of cover Lebanon
Networks available Full Network on direct billing Full Network on direct billing
Full Network on direct
excluding: CMC, AUBMC, Rizk, excluding: Bellevue and All
billing
Bellevue University Hospitals*
Inpatient benefits
Classes First (A) - Second (B) - Semi Private (SK)
Limit per year A: $300,000
Unlimited for all classes B: $200,000
SK:$100,000
Deductible per in
claim (Optional) N/A

Emergency room Full Cover.

Exclusions covered up to Full Cover
$100
Maternity
(not applicable for
Junior single)
Full cover after 180 days of
Full cover after 365 days of enrollment
For couples enrollment
For single mother Full cover after 12 months
Not covered
of enrollment, for all classes
Free of charge new
born baby (Bébé Covered from day one Covered after 14 days, if eligible
Securite)
Epidural Covered
Incubator & Unlimited days,
10 days up to $4,000
nursery up to $30,000
Screening test for
Up to $200 Not covered
baby
Congenital cases All cases covered up till the age of 7 and up to
All cases covered up till the
for babies born at A: $10,000 per year
age of 12 and with no
Securite (Bébé B: $7,000 per year
financial limit
Securite) C: $5,000 per year
Congenital cases All cases covered up till the
for babies not born age of 12 and with no Not covered
at Securite financial limit
Parent
accommodation at
hospital for Covered
children below 16
years
Home Care
In-hospital treatments administered at home are covered
Prosthesis
Unlimited, Up to $10,000 per year,
Due to accident
as per TPA’s tariff as per TPA’s tariff

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 Golden Care Full Golden Care Reduced Golden Care Basic
Network Network Network
Up to $30,000 per year, as
Due to sickness Up to $7,000 per year, as per TPA’s tariff
per TPA’s tariff
Orthesis
Due to accident Up to $500 Not covered
Due to sickness Up to $500 Not covered
Additional
Inpatient benefits
Dialysis for acute
Covered for all needed
renal failure,
sessions during 1st initial Up to 3 sessions during 1st initial admission
excluding
admission
“arteriovenostomy”
Sleep disorder Polysomnography is
Not covered
disease covered
Sleep Apnea Up to $5,000
Not covered
Surgery
Parkinson Up to $5,000 (In & Out) Not covered
Epilepsy Up to $5,000 (In & Out) Not covered
New treatments,
medical
Up to $5,000 (In & Out) Not covered
techniques,
surgeries & tests
Rehabilitation for a
Up to $2,000 Not covered
covered case
Breast Covered if due to a covered partial or complete breast excision due to breast cancer (within 6 months
reconstruction of sickness)
Infertility Covered after 12 months of
enrolment and up to $3,000 Covered after 12 months of enrolment and up to $1,000 per year. As
per year, for all classes. As per TPA’s tariff
per TPA’s tariff
Cornea transplant Surgery is covered. Cost of
Not covered
cornea is excluded
Cardio vascular
Unlimited Up to $20,000
diseases
Coronary stent
Covered up to sickness prosthesis limit
Valves
Work related
Covered Not Covered
accident
Bone marrow Up to $30,000 per lifetime.
aspiration & organ As per TPA’s tariff. Cost of Up to $10,000 per lifetime. As per TPA’s tariff. Cost of organ is excluded
transplant surgery organ is excluded
Bariatric surgery
related to morbid Up to $7,500 per lifetime.
Not covered
obesity (e.g. Sleeve As per TPA’s tariff
and bypass)
Cancer Diseases Unlimited Up to $ 20,000
Tropical Disease
(specific diseases as
Covered Not covered
per general
conditions)
Sexually
transmitted
diseases (specific Up to $15,000 per year Not covered
diseases as per
general conditions)
Psychiatric disorder In-hospital treatment
covered up to $10,000 per Not covered
year after 12 month of

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 Golden Care Full Golden Care Reduced Golden Care Basic
Network Network Network
enrolment with a maximum
of 30 days of hospitalization
Hospital daily For entrepreneurs <60
income years; $50/day starting the
Not covered
2nd day & up to 7 days per
year
Morgue/Burial
expenses Up to $3,000 Up to $ 1,000 for adherents aged 64 and below

Epidemic /
Pandemic Up to $30,000 Up to $10,000
Diseases
Out of hospital
Direct billing as per NEXT CARE preferred network
benefits
Ambulatory
Option 1 Unlimited, 100% coverage N/A
Option 2
Unlimited, 85% coverage Up to $2,500 per year, 85% coverage
Amniocentesis Covered Not covered
Morphological
Once per pregnancy
Echography
Triple test Covered once per pregnancy
Dental panoramic Covered if due to a covered accident and up to 9 months after the accident occurred
MRI Covered, subject to a prior approval
Thallium
Covered, subject to a prior
myocardial Not covered
approval
Scintigraphy
Pet scan Covered, subject to a prior approval
VCT 64 Covered, subject to a prior
Not covered
approval
Genetic test Up to $1,000 per year Not covered
OCT Covered, subject to a prior approval
Osteodensitometry
(for insured aged 50y & Covered for a specific medical reason in private diagnostic centers
above)
Physiotherapy &
25 sessions per year 15 sessions per year
Kinesitherapy
Pre-Marital test Covered Not covered
Doctor Visit N/A
(N/A for Junior single)
Prescription drugs
(not applicable for Junior N/A
single)
Additional Benefits
Waiver of medical We waive the medical
premium of family premium of the family for a
(for adherents period of the policy year
Not covered
below 65 years) and 1 additional year in
case of death, terminal
illness, or total disability of
the bread winner
Family discount Applicable for Family of 3 & Plus
Junior single special
Special rate for people between 18 and 35 years who are single
rate
Life style discount For every Km you run outdoor, earn $0.5, up to $100 per year. To be monitored by your Nike+ App,
linked to your Facebook account
Rental of medical
Up to 1 month rental Not covered
supplies

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 Golden Care Full Golden Care Reduced Golden Care Basic
Network Network Network
Guaranteed
720 days, lifetime subject to an observation period of 180 days for new members
renewability
Pre-Existing
conditions Covered after 1 year for new members
In Hospital
Tests related to
Covered up to $100, once
preexisting cases Not covered
per year from day 1
for new insured
Upgrades on
Observation period 180
renewal
days for maternity and Observation period 365 days for maternity and preexisting conditions
(e.g. class and
preexisting conditions
product)
Extension of
coverage at the
Up to 30 days N/A
expiry date and
while in hospital
Claims outside of
Lebanese Claim processed on reimbursement basis and as per NEXT CARE‘s Lebanese network rates and subject
territories or to 30% excess
outside of network
Travel insurance Worldwide excluding USA, Canada, Australia & Japan
Travel insurance up Covers 24/7 help desk.
to 65 years Covers death abroad,
repatriation of mortal
remains, up to $10,000.
Covers 24/7 help desk. Covers death abroad, repatriation of mortal
Covers accidental and acute
remains, up to $10,000.
sickness not due to any Pre-
Covers accidental and acute sickness not due to any Pre-Existing
Existing condition, up to
condition, up to €30,000 per trip and up to 5 days per year. Card should
€30,000 per trip and up to
be requested at least 48 hours before traveling
90 days per year. Card
should be requested at
least 48 hours before
traveling
Travel insurance 66
Covers 24/7 help desk. Covers death abroad, repatriation of mortal remains, up to $10,000
years and above
Private
transportation
Covered Not covered
service/ private
ambulance
Accidental death
Covered, for $10,000
Natural Death
Covered, for $10,000

 All University Hospitals include:

American University of Beirut Medical Center, Hammoud Hospital University Medical Center, Hopital Libanais Geitaoui, Hopital
Universitaire Dar Al Amal, Rafik Hariri University Hospital RHUH, St. George Hospital - University Medical Center - Rizk Hospital,
Mount Lebanon Hospital, Hotel-Dieu De France.

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Medical Plans for SMEs in Fresh USD
 Up to 50 employees
 Tailor made products are available for SMEs as well as companies above 50 employees. Please refer to the
company.
 Fresh Payment guarantees no extra charges upon hospital admission
Full Network Full Network Reduced Network
Class A Class A Class B Class SK Class A Class B Class SK
Area of cover Lebanon
Full Network on direct billing excluding
Networks available Full Network on direct billing CMC, AUBMC, Rizk, Bellevue, St. Georges
Orthodox
Inpatient benefits
Limit per year $300,000 $250,000 $150,000 $200,000 $150,000 $100,000
Full cover.
Exclusions
Emergency room Full cover Full cover
covered up to
$100
Covered from day 1 for existing
Covered from day 1 for existing employees and
Maternity employees and after 365 Days for new
after 280 Days for new employees
employees
Normal Delivery $5,000 $4,000 $3,000 $4,000 $3,000 $2,000
Cesarean Delivery $7,500 $6,000 $5,000 $6,000 $4,500 $3,500
Legal abortion $2,500 $2,000 $1,750 $2,000 $1,500 $1,250
Maternity complications $6,000 $5,000 $4,000 $5,000 $4,000 $3,000
Free of charge new born baby
Covered from day one Covered after 14 days, if eligible
(Bébé Securite)
Epidural Covered
Incubator & nursery Covered
Screening test for baby Up to $200 Up to $100
Congenital cases for babies born 3 cases per year covered up to $5,000 each and 3 cases per year covered up to $3,000
at Securite (Bébé Securite) up till the age of 12 each and up till the age of 12
Congenital cases for babies not 3 cases covered up to $3,000 each and up till 3 cases covered up to $2,000 each and up
born at Securite the age of 12 till the age of 12
Parent accommodation at hospital
Covered
for children below 12 years
Prosthesis
Up to Up to Up to Up to Up to
Due to accident Unlimited $20,000 $15,000 $20,000 $15,000 $10,000
per year per year per year per year per year
Up to Up to Up to Up to Up to
Up to $20,000
Due to sickness $15,000 $10,000 $15,000 $10,000 $7,500
per year
per year per year per year per year per year
Additional Inpatient benefits
Covered for all needed sessions during 1st initial Up to 3 sessions during 1st initial
Dialysis for acute renal failure
admission admission
Sleep disorders disease Polysomnography is only covered
Covered due to a covered partial or complete breast excision due to breast cancer (within 6
Breast reconstruction months of sickness) up to
$8,000 $6,000 $5,000 $6,000 $5,000 $4,000
Covered from day 1 for existing employees and after 12 months for new employees
Infertility
up to $2,000 per year and $4,000 lifetime up to $1,500 per year and $3,000 lifetime
Cornea transplant Surgery is covered. Cost of cornea is excluded
Coronary stent Covered up to sickness prosthesis limit
Valves Covered up to sickness prosthesis limit
Work related accident Covered Not covered
Bone marrow aspiration & organ The share that is supplementary to NSSF up to
Not covered
transplant surgery $15,000 per lifetime. Cost of organ is excluded
Bariatric surgery related to morbid
up to $7,500 per lifetime Not covered
obesity (e.g. Sleeve and bypass)

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 Full Network Full Network Reduced Network
Class A Class A Class B Class SK Class A Class B Class SK
Cancer including chemotherapy &
Covered
radiotherapy
Tropical Disease (specific diseases as per
Covered
general conditions)
Sexual transmitted diseases (specific
Up to $5,000 lifetime Not covered
diseases as per general conditions)
Psychiatric disorder Up to
In-hospital treatment $1,000/year
after 12 Not covered Not covered
month of
enrolment
Morgue/Burial expenses Up to $2,000 Up to $1,000
Epidemic / Pandemic Diseases Up to $30,000 Up to $10,000
Out of hospital benefits
Ambulatory
Out 85% or 100% Unlimited Up to $3,000 Up to $2,000
Amniocentesis Covered Not covered
Morphological Echography Covered Covered
Triple test Covered Not covered
Dental panoramic Covered Covered
MRI Covered Covered
Thallium myocardial Scintigraphy Covered Not covered
Pet scan Covered Not covered
VCT 64 Covered Not covered
OCT Covered Not covered
Osteodensitometry (for insured aged
Covered Covered
50y & above)
Physiotherapy & Kinesitherapy 15 sessions per year 10 sessions per year
Pre-Marital test Covered Not covered
Doctor Visit Up to USD 700 Up to USD 500
Prescription drugs 85% or 100% Covered Covered
Medicines registered & approved by the
Covered Covered
Ministry of Health
Treatment of acute diseases Covered Covered
Vaccines Not Covered Not covered
Chronic medicines Not Covered Not covered
Dermatological products Up to USD 700 Up to USD 500
Additional benefits
Guaranteed renewability 720 days lifetime subject to an observation period of 180 days for new members
Pre-Existing conditions $4,000 $2,500 $1,500 $2,000 $1,500 $1,000
Upgrades on renewal(e.g. class and
Observation period 365 days for maternity and preexisting conditions
product upgrade)
Extension of coverage at the expiry date
Up to 30 days Up to 15 days
and while in hospital
Claim processed on reimbursement basis and as per NEXtCARE’ s Lebanese network
Claims outside of network
rates and subject to 30% excess
Home Care In-hospital treatments administered at home are covered
Rental of medical supplies Up to 1 month rental Not covered
Private transportation service/private
Covered Not covered
ambulance
Accidental Death Covered, for $10,000
Natural Death Covered, for $10,000
Bundle with property all risk and benefit from a reduced rate of $1 per SQM to insure
Property All Risk Bundle
your office

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