Xperience Care Plus


Table of Benefits 2016

GET WELL - DAY TO DAY COVER BUDGET    
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE PLAN**
Overall Annual Limit Rs 15,000 Rs 25,000 Rs 35,000 Limited to Member's Contribution*
Sub - Limit        
GP Consultations Rs 2,000 Rs 4,000 Rs 6,000 Limited to Member's Contribution*
Specialist Consultations Rs 3,000 Rs 6,000 Rs 9,000 Limited to Member's Contribution*
Medicine (Day to Day) Rs 2,000 Rs 4,000 Rs 6,000 Limited to Member's Contribution*
Radiology/ Pathology Rs 2,000 Rs 4,000 Rs 6,000 Limited to Member's Contribution*
Optical Benefits
- Annual Test – Every Year
- Lenses – Every Year subject to Change
- Frames every 2 Years
Rs 2,500 Rs 5,000 Rs 10,000 Limited to Member's Contribution*
Contact Lenses
(Every Year – Nil if Glasses Claimed)
NIL Rs 2,500 Rs 5,000 Limited to Member's Contribution*
Dental Benefits
- Annual Check Up
- Annual Scaling & Polishing
Rs 2,500 Rs 5,000 Rs 10,000 Limited to Member's Contribution*
Hearing Aids Rs 6,000 Rs 8,000 Rs 10,000 Limited to Member's Contribution*


 

GET WELL - INPATIENT COVER BUDGET
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE PLAN**
  Medical & Surgical (Per Illness Per Year)
Overall Annual Limit Rs 50,000 Rs 125,000 Rs 300,000 Rs 50,000
Sub - Limit        
Doctors Fees Scale of Cost Scale of Cost Scale of Cost Scale of Cost
Room Fees

Rs 3,000 per day

Rs 4,000 per day

At Cost At Cost
Drugs & Gasses At Cost At Cost At Cost At Cost
Diagnostic Test At Cost At Cost At Cost At Cost
Prosthesis & Appliances Rs 20,000 Rs 50,000 Rs 100,000 At Cost
Child Delivery Normal & Caesarian
Prenatal Tests
Confinement (All Costs)
Ante Natal Cost
Day to Day
Rs 15,000
Day to Day
Day to Day
Rs 25,000
Day to Day
Day to Day
Rs 35,000
Day to Day
Day to Day
Rs 50,000
Day to Day
Psychiatric Admissions NIL Rs 12,000 Rs 20,000 At Cost


 

PREVENTIVE CARE* BUDGET
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE PLAN**
GP CHECK UP Overall Annual Limit Rs 3,000* Rs 6,000* Rs 9,000* Limited to Member's Contribution*
- Physical Examination
- Blood Pressure Check
- ECG (Over 40 Years)
Once Per Year Once Per Year Once Per Year Limited to Member's Contribution*
PATHOLOGY TESTS        
- Full Blood Count
- Fasting Blood Sugar
- Urea & Electrolytes
- Uric Acid
- Serum Cholesterol, Triclyceride, HDL, LDL
Once Per Year Once Per Year Once Per Year Limited to Member's Contribution*
WOMEN’S WELLNESS        
- Mamogram (Over 40 Years)
- Papsmear (Over 30 Years)
Once Per Year Once Per Year Once Per Year Limited to Member's Contribution*
MEN’S WELLNESS        
- Prostate (Over 50 Years) Once Per Year Once Per Year Once Per Year Limited to Member's Contribution*


 

DIABETES & HYPERTENSION BUDGET
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE PLAN**
Consultations - GP Rs 1,200 Rs 1,500 Rs 1,800 Limited to Member's Contribution*
Consultations - Specialists Rs 1,200 Rs 1,800 Rs 2,400 Limited to Member's Contribution*
Medicines (Chronic Conditions) Rs 2,000 Rs 4,000 Rs 6,000 Limited to Member's Contribution*
Monitoring Device Rs 1,500 Rs 1,500 Rs 1,500 Limited to Member's Contribution*
Disease Management Programme Yes Yes Yes Limited to Member's Contribution*


 

LIFESTYLE BENEFITS BUDGET
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE
PLAN**
Weigh-Less Programme Rs 100 per Month
(Maximum 3 months)
Rs 200 per Month
(Maximum 3 months)
Rs 300 per Month
(Maximum 3 months)
Limited to Member's Contribution*
Allen Carr’s Easyway (Stop Smoking) Rs 100 per Month
(Maximum 6 months)
Rs 200 per Month
(Maximum 6 months)
Rs 300 per Month
(Maximum 6 months)
Limited to Member's Contribution*
Gym Membership (only available if
Rs 1M Catastrophe Cover or more
has been selected)
NIL RRs 200 per Month
Maximum 5 months
(Attend gym 3 times
a week)
Rs 300 per Month
Maximum 5 months
(Attend gym 3 times
a week)
Limited to Member's Contribution*


 

CATASTROPHE COVERS (LIFETIME PER ANY ONE ILLNESS) BUDGET
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE
PLAN**
Level 1 Rs 250,000 Rs 250,000 Rs 250,000 Not available
Level 2 Rs 500,000 Rs 500,000 Rs 500,000 Not available
Level 3 Rs 1,000,000 Rs 1,000,000 Rs 1,000,000 Rs 1,000,000
Level 4 Rs 2,000,000 Rs 2,000,000 Rs 2,000,000 Rs 2,000,000
Level 5 Rs 3,000,000 Rs 3,000,000 Rs 3,000,000 Rs 3,000,000
Level 6 Rs 4,000,000 Rs 4,000,000 Rs 4,000,000 Rs 4,000,000
Level 7 Rs 5,000,000 Rs 5,000,000 Rs 5,000,000 Rs 5,000,000


 

EXCESSES PAYABLE BY THE INSURED BUDGET
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE
PLAN**
Day to Day Benefits 20 %
(Minimum Rs 200)
20 %
(Minimum Rs 200)
20 %
(Minimum Rs 200)
N/A
Inpatient – Surgical NIL NIL NIL NIL
Inpatient – Medical 20 %
(Maximum Rs 5,000)
20 %
(Maximum Rs 5,000)
20 %
(Maximum Rs 5,000)
20 %
(Maximum Rs 5,000)


 

PREVENTIVE COVER* BUDGET
PLAN
PREMIUM
PLAN
EXECUTIVE
PLAN
ELITE
PLAN**
Preventive Care 20 %
(Minimum Rs 200)
20 %
(Minimum Rs 200)
20 %
(Minimum Rs 200)
N/A
Chronic Conditions 20 %
(Minimum Rs 200)
20 %
(Minimum Rs 200)
20 %
(Minimum Rs 200)
N/A
Lifestyle Cover NIL NIL NIL N/A
Catastrophe Cover Rs 50,000
(Per Illness)
Rs 50,000
(Per Illness)
Rs 50,000
(Per Illness)
Rs 50,000
(Per Illness)

                                                                                                                                                                                        Underwritten by Swan General Ltd

 

Standard Underwriting Terms and Conditions:

 

• 3 Months Waiting Period on General Claims is applicable.

• 12 Months Waiting Period on Pregnancy and/or Pregnancy-Related Claims is applicable.

• Full Exclusion on Pre-Existing Conditions is applicable.

• Full Exclusion on Undisclosed Medical Conditions is applicable.

• Road Ambulance is covered as per benefits selected when medically necessary only.

• Territorial limits – Worldwide excluding USA, Canada and Japan if treatment is not available in Mauritius.

• Child Dependents are not eligible to maternity cover.

• Standard Underwriting Terms and Conditions may differ upon the assessment of the Applicant’s Membership Application Form and a Medical check-up might also be requested during the assessment.

 

General Notes:

 

• *Preventive Care, Diabetes/Hypertension and Lifestyle Benefits are sub-limits of the overall outpatient – Day to Day cover.

• **Elite Plan consists of an inpatient of Rs 50,000 and a minimum of Rs 1,000,000 Catastrophe Cover.

• Outpatient cover under the Elite Plan is subject to an additional contribution chosen by member cumulative up to its annual limit contributed (Minimum Rs 500 per month).

• All inpatient claims must be authorised by the Administrator.

• Reimbursement claims must be submitted within 3 months.

• Treatments Not Available within Mauritius will be covered but must be Authorised by the Administrator in all instances.

 

NB: - The full terms and conditions of the Xperience CarePlus are detailed in the Policy Wording.

 


Xperience Bliss