Benefits

Summarised Outline of Benefits

Horizon Insurance Company is an annual health insurance plan for individuals, families and companies. Which provides you with a global cover up to US$2,500,000 per member.  Your cover is mainly for inpatient treatment covering Hospitalisation, MRI, PET and CT scans, Cancer Treatment, International Evacuations and Casualty and ER visits. (excluding conditions stated not covered on your Membership policy).

In addition to your core benefits (inpatient plan), you have the option to choose any of the additional benefits stated to suit the specific needs for you and your family and providing you with an inclusive package.

Such benefits will be subject to sub limits and waiting periods (unless stated differently). Waiting periods apply to each individual not being covered for that particular benefit for the time period indicated. Please refer to your benefit schedule for information on limits and waiting period stipulations.

In-patient and Day Patient Treatment – Please refer to Table of benefits and are Subject to authorisation

Benefit Number
Core Benefit
Limits
Benefit Details
Waiting Periods
1
Hospitalisation
Full Cover
Hospital accommodation charges for a standard single room with a private bathroom. We do not pay for deluxe/VIP suite nor items of a personal nature.i.e telephone calls, private TV, newspapers etc.
2
Intensive Care and Theatre Costs
Full Cover
Intensive care in and Intensive Care Unit/High Dependancy/Coronary Care where is medically necessary as essential to treatment or care. Includes the cost of the Operating Theatre along with the cost of the surgical appliances used by the Medical Practitioner during surgery.
3
Diagnostic tests, Pathology and X-rays
Full Cover
Blood tests, X-rays or Diagnostic tests such as an ECG when requested by attending physician when assessing your condition whilst in hospital
4
Advanced Imaging
Full Cover
Medically necessary scans such as computerised tomography (CT), positron emission tomography (PET) and diagnostic magnetic resonance imaging (MRI) whilst in-hospital
5
Reconstructive Surgery
Full Cover
Reconstructive surgery following an accident or an eligible surgery
6
Professional Services
Full Cover
Surgeon and Anaesthetist charges in an operating theatre; Drugs and Dressings as prescribed by Medical Practitioner or Specialist; Physicians fees
7
Drugs and Dressings
Full Cover
When prescribed by a Medical Practitioner or Specialist and is part of your in-hospital treatment.
8
Parent Accommodation
Full Cover
Hospital Accommodation for one parent when an insured dependant under the age of 13 on the same policy is required to be admitted into hospital for treatment overnight
9
Renal Dialysis
Full Cover
Treatment for Renal Failure whilst in-hospital
10
Organ Transplant
Full Cover
Medical costs associated with the insured person as the recipient of a human organ transplant of kidney, pancreas, heart, lung, liver, cornea or bone marrow. We do not cover the costs of the donor or donor organ.
12
Medical Evacuation Services
Full Cover
Medically necessary transportation of an insured person to nearest appropriate medical facility for treatment of a critical, life threatening eligible medical condtion.
13
Medical Transport Services
Full Cover
Costs of moving an insured person to an appropriate facility for in-patient/day care treatment within the area of cover, in the event of a non-emergency when that treatment is not available in the country of residence.
14
Compassionate Travel Costs
$120 per day to $3000 per condition
Transportation limited to economy class return ticket, and accommodation for a family member to accompany the insured for authorised in-hospital treatment outside country of residence within area of cover
15
Repatriation
Full Cover
Transportation cost back to country of residence following treatment post evacuation
16
Mortal Remains
Full Cover
Transportation cost of body/ashes back to country of residence
17
Day Patient and Out Patient Surgery
Full Cover
Treatment costs for an eligible surgical procedure in a hospital, day-care facility
18
Physiotherapy
Treatment by a registered physiotherapist when referred by the attending Specialist
19
Cancer Care/OncoCare
Full Cover
Oncology tests, drugs and consultant fees. Treatment as in-patient or out-patient including chemotherapy and radiotherapy
20
Emergency Room Consults
3 visits per year
Casualty and Emergency Rooms Services for injuries, accident and eligible life threatening conditions
21
Specialist Services prior to and following Inpatient
Full Cover
Consultant fees immediately prior to hospitalisation
22
Hospice and Palliative
120 days and USD50,000
Hospice care and Palliative Treatment on diagnosis of a terminal condition.
23
Emergency Dental
Full cover or Limit?
Emergency treatment received within 10 days for accidental damage to teeth to restore them to state prior to accident. Treatment in a hospital or dental room
24
Compassionate Companion Travel
$120 per day to a maximum of $3000
Costs of a family member to accompany an insured member following an evacuation or when a member has authorised in-hospital treatment which is not available in the country of residence.
25
Additional travel expenses
$2000 per event
26
Advanced Imaging Outpatient
MRI, PET and CT Scans on referral of medical practitioner
27
Psychiatric
30 days
In a registered psychiatric unit treated by a Registerd Psychiatrist
12 months
28
Rehabilitation
$10,000
Post operative and/or medically necessary In a registered facility under the management of a registered care giver
29
Ancillary Charges
1500
Costs associated with crutches, wheelchair, boot, slings following in-patient/day-patient treatment
30
CHRONIC CARE
1500
12 months
31
Congenital Conditions
10,000
Inpatient Treatment of a diagnosed condition caused by a congenital abnormality which presents after join date
12 months
32
Complications of pregnancy
Full refund
In-hospital and Emergency Treatment of life threatening medical conditions which arise during pregnancy or childbirth
33
Maternity
$5000
Routine pregnancy and childbirth costsassociated with normal pregnancy and childbirth, pre and postnatal checkups and delivery costs
12 months
34
Newborn Benefit
Full refund
Costs relating to inpatient treatment of a new born baby for 10 days after birth for an acute condition
12 months
Benefit Number
Core Benefit
Limits
Benefit Details
Waiting Periods
1
Out-patient services
$2000
Professional Services and Specialist consults

Physiotherapy by a registered physiotherapist

Complimentary Medicines and Treatment by a Registered Therapist

Psychiatric Treatment
12 months
2
Dental
$800
Dental consultation, treatment, x-rays, crowns and bridges
6 months
3
Optical
$200
Consultations, Frames and lenses,
6 months
4
Wellness
$300
Annual medical check ups

Cancer screening

Vaccinations

Hormone Replacement Therapy