Coverage: the whole country of Panama. This plan works with co-payment and though a network of providers. In this plan the insured person assumes an amount or a percentage of the medical attention received.
We want you to understand your health insurance policy, so you can take full advantage of it.

Policy Info:

General Info:

Maximum Lifetime per Person: $300,000

Stop Loss: is the maximum amount you will ever have to co-pay each policy year: $4,000. After this the insurance company will pay 100%.

Deductible: $200 for prescribed medicine. This deductible covers all the medicines you are prescribed in your policy year.

Hospital Expenses:

Require Pre-Authorization: If a procedure is planned for you have to let the insurance company know before being admitted into the hospital.

Includes for Hospital Expenses:

• Days 1-4: co-payment of $150.00 daily per event.
• Days 5-10: your policy covers 100%.
• Days 11+: your policy covers 80%.
• Daily Room and Board (Private Room) ~ 100%
• Intensive Care Unit ~ 100%
• Hospital Miscellaneous Expenses ~ 100%
• Medical Fees for Surgery and Anesthesia ~ 100%
• Medical Fees for Hospital Visits ~ 100%

Ambulatory Expenses:

Outpatient Examinations ~ Specialist ~ Co-payment of $18.00
Outpatient Examinations ~ General Doctor ~ Co-payment of $12.00
X- Rays and Laboratory ~ Co-payment of 25%
Special Examination (Pre-authorized) ~ Co-payment of 30%
Hem dialysis (Pre-authorized) ~ Co-payment of 30%
Chemotherapy or Radiotherapy (Pre-authorized) ~ Co-payment of 30%
Chiropractic (Pre-authorized) ~ Co-payment of $15.00 ~ Max 5 sessions a year
Acupuncture (Pre-authorized) ~ Co-payment of $15.00 ~ Max 5 sessions a year, 20 sessions per life
Physical Therapy and Rehabilitation ~ Co-payment of $5.00 ~ Max 20 sessions a year, more than this has to be pre-authorized.

Emergency Room:

Per Accident: your policy covers 100%

Detailed Illness: Co-payment of $50.00

What is a Detailed Illness: Attentions to acute cases of: Nephritic Colic, Hepatic Colic, Episodes of chest angina, infarct of the myocardium or coronary insufficiency, pulmonary embolism, acute bronchial asthma attack, loss of knowledge or obnubilation and/or sudden, acute allergic reactions or anaphylactic disorientation, hemorrhages of all type, including gynecological and obstetrics, vomits and severe diarrheas with or without dehydration, acute abdominal pain, convulsions, state of “shock” and the like, acute urine retention, high fever in infants.

Ambulatory Surgery:

• In Hospital ~ Co-payment of $200 per event
• In Doctor’s Office ~ Co-payment of 30%
• Medical Fees (Doctor Provider) ~ Your policy covers 100%

Maternity Benefits:

Applied to Single and Married Mothers

Period before benefit applies: covered if the pregnancy occurs from the first day of the 13th month of the period of the policy. In other words, you have to have the policy for 4 months (using a 9 month pregnancy) before getting pregnant for the policy to cover the birth.

Before the Birth:

Maximum per event ~ $3,000.00
Prenatal Consultation ~ Co-payment of $18.00 ~ Max 8 visits
Prenatal Ultrasounds ~ Co-payment of 25% ~ Max 3 times

After the Birth:
New Born Child: the baby will be included under the mothers policy for the first 9 days of life, after the 10th day he/she must be registered as a dependant ~ Your policy covers 100% of costs up to $5,000.00

Premature Child: the baby is born before the 37 week of pregnancy ~ Your policy covers 100% of the costs up to $10,000.00

Neonatal Congenital, Hereditary, or Acquired Illnesses: The policy covers illnesses acquired by inheritance or at the time of birth as long as the mother is covered by the policy ~ Your policy covers 100% of the costs up to $30,000.00

Preventive Medicine within the Network:

Healthy Child Control:

For children up to 6 years old
Co-payment of 50%

Control consultation:

0 – 12 months ~ 8 visits per year
13 – 24 months ~ 4 visits per year
3 – 6 years ~ 2 visits per year

Compulsory vaccines regulated by the Ministry of Health during Control Visits:

BCG (Tuberculosis) ~ $10.00
DPT (Difteria, Tosferina, Tétano) ~ $10.00
MMR o SPR (Sarampión, Rubéola, Paperas) ~$25.00
POLIO (Poliomielitis) ~ $10.00
Hepatitis A ~ $30.00
Hepatitis B ~ $25.00
Hibtiter (Meningitis) ~ $30.00
Varicela (Chicken Pox) ~ $75.00
Pentavalente (Difteria, Tétanos, Tosferina, Meningitis por Haemophilus Tipo B y Hepatitis B)

Women:

Co-payment of 50%
Annual Control and Pap Smear Test 
Annual Mammography after the age of 40

Men:

Co-payment of 50%
PSA test after the age of 40

Ambulance Benefit:

Land Transportation: Your policy covers 100% ~ Max $100.00
Air Transportation: Your policy covers 100% ~ Max $1,000.00

Private Nurse:
Pre-authorization required ~ Covers 100%, limit 30 sessions ~ Max 8 hour sessions

AIDS:

Calendar Year: Your policy covers 100% ~ Max $5,000.00
Lifetime: Your policy covers 100% ~ Max $25,000.00

Out of Network Services in Panama:

If you decide to use a doctor or hospital who is not in the Blue Cross, Blue Shield Network ~ Reimbursement will be 60% of the cost agreed with medical providers in Panama

EMERGENCIES OUTSIDE OF PANAMA:

Accident or Illness ~ including hospitalization expenses and medical fees ~ Your policy will reimburse 60% of the cost agreed with medical providers in Panama.