HM Medical Clinic

Gib.lk

Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions Discover the benefits of flexible International Healthcare Plan
46.07.310.1-APSL B (9/15)

You can count on us to deliver on the goals that matter most to your business and your employees. We share your commitment to caring for your employees and it comes across in everything that we do.
Our solutions
Product summary
Benefits schedule
Questions and answers
Benefits schedule detail
Complaint procedures

Benefits backed by strength and stability
WE HAVE MORE
As a part of Aetna, Inc., we share in
DEDICATED
the heritage of more than 160 years
EMPLOYEES
WORLDWIDE.
of expertise as a leading provider of
This includes locations in: health care benefits. For more than
• Greater China (Hong Kong three decades, we've extended that • Southeast Asia (Manila, Philippines; Singapore, and Jakarta, Indonesia) strength and stability across the globe • Middle East (Dubai, Abu Dhabi, Qatar, and Kuwait) as one of the world's largest and most • United Kingdom (London, England; Birmingham, prominent providers of international • United States (Tampa, health benefits. Today, we support more Florida; New Albany, Ohio; Blue Bell, Pennsylvania and than 500,000 members worldwide. Hartford, Connecticut)

Delivering on the promise of quality health care
Global support that centres on your employees
A focus on helping your business
Your employees will have the local support of our We leverage our deep market knowledge and in-country on-the-ground teams along with the global strength expertise to help you manage and minimise costs and of our worldwide network. This means they will have challenges. This includes being a partner who takes access to exceptional care no matter where they are.
responsibility for the health and well-being of your employees. We'll work with you to understand your Your employees will have access to:
business and the needs of your global workforce so • One-on-one health care support from our International we can provide proactive support, clear guidance and Health Advisory Team (IHAT) of clinicians meaningful solutions that drive healthy outcomes. • A direct settlement provider community of more than Here's what you can expect from us:
100,000 leading hospitals and clinics • Claims reimbursement in over 135 currencies • Better management of medical costs • Web and mobile tools that help employees play a greater, • Dedicated, proactive account management more informed role in their health • Simplified compliance with built-in regulated solutions • 24x7x365 multilingual member service support • Flexible, portable solutions In short, we'll go above and beyond to make sure that As our customer, you'll gain the support of our global your professionals are well cared for, wherever they are network of professionals who share your commitment in the world.
to caring for your employees around the world.

Value-added wellness programmes
Wellness is a lifelong path, and the
journey is different for each individual.
It begins with getting members engaged in
their own well-being and supporting them
wherever they are on their journey —
whether they are healthy, at risk for disease
or injury, managing a chronic condition or
experiencing a major health event.
With this in mind, we've Health and wellness education
developed a complimentary Whether employees are healthy wellness offering for individuals looking for additional healthy lifestyle tips — or have a chronic members, which includes the condition and want to learn how to reach fol owing programmes: their optimal state of health — we offer an array of health and wellness education materials to aid them in their efforts.
Wellness Checkpoint is a culturally diverse, The health library provides helpful online health survey that provides information, including topics such as: members with information about their personal health needs and motivates them to make lasting positive changes. The tool • Coronary artery disease can also help them understand possible health risks, and provides an action plan and information that encourages healthy • Stress management We also offer additional tiers of Wellness Checkpoint for groups over 100 members, which can include varying levels of customisation — from tailored reporting to a fully-bespoke tool. Please consult with your Aetna representative for additional information.
International Healthcare Plan Overview
An innovative, flexible offering
No two companies are alike. That's why we
offer a range of plans and optional benefits so
you can maximise your health care investment
and manage costs based on your varied employee populations. You can select from Choose a base plan
one of four base plans, then choose from a and excess level.
menu of additional benefits and sums insured. This means you have the flexibility to provide different plans for different groups of employees within the same policy. For example, you can set up different categories for employees working in different regions, which provide different levels of cover, such as including extended evacuation assistance for employees who travel more frequently than others. For qualifying groups of 50 or more employees, you can benefit from the additional flexibility of a custom plan that Choose your
includes additional benefits and increased limit options.
A collaborative approach
Our team is committed to
working with you to identify Tailor the level
the plan type and benefits of cover for your
that are best for your business and the employees you're looking to cover. Core
Plus
A comprehensive range of benefits,
Essential benefits, plus:
including, but not limited to:
• Inpatient and day patient treatment • Increased hospital cash benefit • Increased chronic conditions benefit • Evacuation and transportation benefits • Increased alternative treatment (20 sessions) • Accident and emergency treatment • Increased vaccinations and inoculations outside area of cover • Outpatient care (with a capped benefit) • Increased home nursing benefit Core benefits, plus:
Plus benefits, plus:
• Chronic conditions benefit • Compassionate emergency travel • Outpatient psychiatric treatment • Increased maximum annual aggregate limit • Increased outpatient care benefit • Increased level of cover for a number of benefits, including: hospital cash, chronic conditions, congenital anomalies, durable medical equipment, AIDS, hospice care, alternative treatment (30 sessions), evacuation and additional travel expense, mortal remains and new born care Optional benefits either reduce costs* and/or upgrade cover.
See pages 6 – 10 for a full list of options, which include, but are not limited to:
• Extended emergency evacuation
• Infertility treatment
• Out of country transportation
• Outpatient consultation copay per visit*
• Routine or restorative dental and orthodontic options
• Routine pregnancy
• Traditional Chinese or Ayurvedic medicine
• USA elective treatment
• Vision care
• Wellness options
Many of the options can be flexed. For example, we offer a range of benefit
limits within our seven routine or restorative dental and orthodontic options
— with the ability to include or exclude a coinsurance.
International Healthcare Plan benefits comparison
To find out about the key features of the International Healthcare Plan, please see the following comparative
benefits schedule.*
This will be a 12 month policy starting from the date of entry or any subsequent renewal date, as applicable. It is the responsibility of the policyholder to continual y review your policy in order to ensure that the plan selected continues to meet the needs and requirements of your employees.
This policy summary does not contain the full terms of the policy; these can be found in the benefits schedule, group contract, certificate of insurance and member handbook.
Maximum annual aggregate limit A maximum of $2,500,000 per member per period of cover member per period Inpatient, day patient, emergency care and diagnostics
Inpatient care, reconstructive surgery and rehabilitation i) Accommodation is subject to any selected inpatient bed limit ii) Rehabilitation is covered in full up to 120 days per medical condition Accident and emergency treatment Covered in full for inpatient treatment outside area of cover Outpatient treatment is limited to $500 per medical condition and subject to an excess of $80 per medical condition CT PET and MRI scans Inpatient psychiatric treatment Covered in full (up to 30 days) per period of cover Accidental damage to teeth Up to $125 per night Up to $175 per night Up to $250 per night for a maximum of 20 nights per medical condition of 20 nights per of 20 nights per medical condition medical condition Parental accommodation Disease and chronic condition management
Chronic conditions Up to $5,000 per Up to $15,000 per insured person per insured person per per insured person per period of cover Congenital anomalies Up to $250,000 per $100,000 per medical condition medical condition Durable medical equipment, Up to $1,000 per medical condition prosthetic and orthotic supplies per period of cover Up to $10,000 per insured person Up to $20,000 per per period of cover insured person per Up to $25,000 per Up to $50,000 per Hormone replacement therapy Covered in full up to 18 months per lifetime Outpatient and alternative treatments
Up to $1,700 per medical condition prior to hospitalisation and up to 60 days immediately following hospitalisation. Alternative treatment up to 10 sessions in aggregate per medical condition, and subject to the benefit limit above. Outpatient surgery Outpatient psychiatric treatment Up to $5,000 per period of cover Alternative treatment See outpatient care Covered in full up Covered in full up Covered in full up to 10 sessions in to 20 sessions in to 30 sessions in medical condition medical condition medical condition Vaccinations and inoculations Up to $100 per period of cover Up to $500 per period of cover Covered in full up to 30 days Covered in full up to 28 weeks per medical condition per medical condition Evacuation and transportation
Emergency transportation Evacuation and additional i) Covered in full ii) Up to $150 per person per day and $5,000 per person per person per day and $10,000 per person ii) Non-hospital accommodation Compassionate emergency travel Offered as standard up to $3,000 per period of cover Up to $8,500 per insured person Up to $15,000 per insured person Mother and child
Complications of pregnancy Up to $100,000 per insured person Up to $250,000 per per period of cover and to a maximum of 90 days hospital stay insured person per period of cover and to a maximum of 180 days hospital stay New born accommodation Options to reduce costs
China private room restriction Hong Kong semi-private room Outpatient consultation $15 copay per visit or deductible This benefit is available where $20 copay per visit or deductible nil excess has been selected. $30 copay per visit or deductible Inpatient bed limit 6 standard options ranging from: Inpatient bed limit $75 per day, to inpatient bed limit $500 per day Options to upgrade cover
Alternative treatment without Up to $1,000 per insured person per period of cover Up to $2,000 per insured person per period of cover Chronic conditions options available – see above standard chronic conditions benefit Compassionate emergency travel See above listed compassionate emergency travel benefit — offered as standard up to $3,000 per period of cover Complications of pregnancy – Congenital anomalies – Including pre-existing congenital Up to $100,000 per medical condition Up to $250,000 per medical condition Dental 1 – routine dental treatment 14 standard options ranging from: Up to $250 per period of cover (with or without 25% coinsurance), to up to $2,500 per period of cover (with or without Dental 2 – major restorative 12 standard options ranging from: Up to $500 per period of cover (with or without 25% coinsurance), to up to $2,500 per period of cover (with or without Dental 3 – orthodontic dental 6 standard options ranging from: Up to $500 per period of cover (with or without 50% coinsurance), to up to $1,500 per period of cover (with or without Dental 4 – dental implants No cover (available to custom plans only) Dental 5 – combined routine and Up to $1,500 per period of cover restorative dental (with or without 25% coinsurance) Dental 6 – combined routine and Up to $2,500 per period of cover restorative dental with orthodontics (with or without 25% coinsurance) Dental 7 – combined routine and Up to $3,000 per period of cover restorative dental with orthodontics (with or without 25% coinsurance) and dental implants Outpatient direct settlement Outpatient consultations are available on a nil excess basis where network – nil excess treatment is received in network. This benefit is available where a The policy excess applies where outpatient consultations take place nil, $50 OR $100 policy excess has outside the direct settlement network.
Extended evacuation (to the country of choice) Out of country transportation for i) Covered in full medically necessary non-emergency ii) Up to $150 per person per day and $5,000 treatment as an inpatient or day per person per evacuation ii) Up to $250 per person per day and $10,000 ii) Non-hospital accommodation per person per evacuation No cover (available to custom plans only) Infertility treatment (minimum of 10 employees required) per member per lifetime Routine pregnancy 8 standard options ranging from: Up to $5,000 per pregnancy (with or without 20% coinsurance), to covered in full per pregnancy (with or without 20% coinsurance) Traditional Chinese or 5 standard options ranging from: Ayurvedic medicine $30 per session to a maximum of 10 sessions, to up to $750 per period of cover Two additional options are available for custom groups. USA elective treatment i) Inpatient or day patient treatment i) Covered in full received inside the direct settlement network ii) Up to $1,000,000 per member per period of cover and subject to ii) Inpatient or day patient treatment received outside the direct settlement network iii) Covered in full iii) Outpatient treatmentThe International Healthcare Plan (IHP) does not comply with the Patient Protection and Affordable Care Act (U.S. healthcare reform), and cannot be used to satisfy any requirements for health insurance cover mandated therein.
One eye exam and a maximum benefit of up to $250 per period of cover One eye exam and a maximum benefit of $500 per period of cover One eye exam and a maximum benefit of $750 per period of cover Wellness option 1 Up to $250 per insured person per period of cover Routine medical checkups and well-baby checks Wellness option 2 Up to $500 per insured person per period of cover Bilateral mammogram/breast examination and routine Up to $750 per insured person per period of cover gynaecological tests including Up to $1,000 per insured person per period of cover Testicular/prostate examination/ Up to $1,500 per insured person per period of cover Routine medical checkups Well-baby checks Wellness option 3 Up to $1,000 per insured person per period of cover Preventive screening for members who are deemed at high risk Up to $1,500 per insured person per period of cover

Excess
Policy excess level options — The excess level selected for this policy will be applicable to each new medical condition.

For groups of less than 10 employees, we require a The U.S. Dollar ($) currency is available to policyholders in completed member application form for each employee.
the Middle East.
Our standard approach to medical underwriting is moratorium; however, plan sponsors may elect to purchase enhanced underwriting terms for the group.
Bank transfers or cheques are available on an annual, semi-annual or quarterly basis. These are accepted in Moratorium underwriting
U.S. Dollars.
Our standard approach to medical underwriting.
A surcharge will apply for payments made on a semi-annual At the member level, cover is not provided for any medical or quarterly basis.
condition in existence on the date that individual is accepted into the group (date of entry) until it has been Communicating with your employees
treated such that the individual is symptom and advice-free for two consecutive years following the date of entry with To assist you in communicating your benefits to your regard to that medical condition. This policy does not cover employees and their dependants, we provide the following the treatment of pre-existing chronic conditions.
Full medical underwriting
• Electronic member packs and mailed membership cards Plan sponsors may also elect to have members fully • Printed copies of member packs and membership cards underwritten.
Should we accept cover, we may apply additional terms and exclusions, which will be shown on the member's certificate There are three options for plan sponsors to adjust of insurance.
membership when members leave or join the plan: Continuous transfer terms
• Pay as you go — Adjustments are credited or debited as
For members wishing to transfer from other policies. adjustments are made.
This feature may incur additional premium.
• Periodic adjustments — We will adjust your instalment
The acceptance by us of the member's original date of plan to incorporate membership adjustments.
entry as shown by the member's current insurer will be applied to the member's policy with us. We will maintain • End of year adjustments — We will reconcile your
the member's existing underwriting or special acceptance account at year end.
terms, as offered by the member's existing insurer, such as any moratoria or specific exclusions, and the member's Policyholder's right of termination
policy with us will be governed by the terms and conditions After the commencement date, this policy, or any cover of our policy. Any transfer will be subject to no enhanced included, may only be terminated by the policyholder, as benefits being provided. We reserve the right at all times to to all or any class of its members, with effect from the decline a continuous transfer terms request without giving renewal date. We must be given written notice of intent any reason or impose/include additional exclusions.
to non-renew within 15 days of your renewal date. If the policy is terminated by the policyholder at any other time, Medical history disregarded
whatsoever the reason, there will be no return of premium.
Available to compulsory group schemes of 10 employees or more. Cover is extended to include treatment for any medical condition or related condition where symptoms have existed or advice has been sought prior to the member's date of entry.
All members must be enrolled within 30 days of eligibility. Any employee or dependant not covered within 30 days of eligibility will be subject to individual medical underwriting.
Cover is not extended to include treatment for congenital conditions unless the member has been enrolled within the first year following birth, or unless the optional benefit for congenital anomalies — including pre-existing congenital anomalies' has been purchased.
Common questions and answers
Q. Are all employees, at home or abroad, eligible
Q. Does the plan include cover for elective treatment
for cover?
in the U.S.?
A. The plan will cover employees who live or work outside
A. Cover for elective treatment in the U.S. is only available
of the country that issued their passport. Any employee if the USA Elective Treatment option is selected. or dependant (subject to the agreement of the plan This can be purchased with the Essential, Plus and sponsor) not enrolled within 30 days of eligibility will Elite plans.
be subject to individual underwriting.
Where the plan sponsor has not elected to provide Q. Are family members eligible for cover as well?
USA Elective Treatment, members are covered for accidents and emergencies only. Travelling expenses A. Children who are not more than 18 years old residing
will be covered under the Evacuation benefit in the with the employee, or 26 years old if in full-time event of an emergency, if the visiting location does education, at the date of entry or at any subsequent not offer the appropriate treatment or care needed.
renewal date, will be accepted for cover as dependants. Children will not be accepted for cover, unless on a Q. How is the policy excess applied?
policy with a legal parent or guardian and subject to the A. Members are responsible for paying the policy excess.
identical benefits applying to all parties. A declaration of health is required with respect to all dependants Q. How do members know if inpatient treatment
who are born following assisted conception.
is covered?
New born children will be accepted for cover (subject A. All inpatient treatment is required to be pre-authorised
to the limitations of the new born benefit) from birth. prior to a planned admission into a hospital. Members Acceptance of new born babies is subject to written should contact the Aetna International Member Service notification within 30 days of birth and receipt of Centre to determine whether treatment is covered the full premium within a further 30 days following under the policy.* Q. How can members submit a claim?
Q. Is a medical examination required to enrol in
A. Upon inception, each member will receive a
the plan?
membership card. This provides them with the contact A. No. In the rare instance that we require additional
information for the Aetna International Member Service information for fair and accurate underwriting Centre and information they need to register for the purposes, we will ask the applicant to submit a Aetna International secure member website. Members medical report from his/her doctor.
can use either resource to submit a claim.
We reserve the right to deny any claim that is not submitted within 180 days of the treatment date. Claims may only be made for treatment given during a period of cover. The benefit will only be payable for expenditure incurred prior to expiry or termination.
* Settlement can be made directly to the hospital. Full details of the claims procedure are available in the member handbook.
Appendix: Benefits schedule detail
Your policy may include some of the fol owing benefits. To confirm the
benefits included in your policy, please refer to your benefits schedule.
All benefits are subject to the maximum annual aggregate Accident & emergency treatment outside area of cover:
limit and the sums insured indicated in your benefits Benefit is payable for medical expenses which arise as a schedule, the applicable medical underwriting, the result of an emergency, which requires the member to seek member's certificate of insurance and our general treatment in the accident and emergency unit of a hospital conditions and exclusions.
whilst temporarily travelling inside the USA and where All costs incurred must be medically necessary and subject the medical condition did not exist prior to travel and the to reasonable and customary charges, based on the member was treatment-, symptom- and advice- free. average treatment costs applicable to the region in which This benefit extends to include outpatient treatment the treatment was received, as determined by us. Inpatient arising as a result of an accident or emergency, whilst the accommodation costs are for a standard private room member is temporarily travelling in the USA and where unless the plan sponsor has opted to apply an alternative the medical condition did not exist prior to travel and the member was treatment-, symptom- and advice- free. For outpatient treatment, a benefit excess applies.
Inpatient care, reconstructive surgery and
In the event of accident and emergency treatment being required inside the USA, the member should contact us Charges incurred for the treatment of a medical condition, either before or as soon as possible after admission to including stabilisation of an acute exacerbation of a chronic the accident and emergency unit of the hospital. condition, when treatment is received as an inpatient or day Complications of pregnancy and/or childbirth are not patient including: covered under this benefit.
i) Accommodation and associated charges.
CT PET and MRI scans: Scans received as an inpatient,
ii) Admittance to the intensive care unit.
day patient or outpatient. iii) Nursing by a qualified nurse.
This must be pre-authorised by us.
iv) Surgical procedure fees and operating theatre fees. Organ transplant: The organ transplants covered under
this policy are as follows: heart, heart/lung, lung, kidney,
v) Medical practitioner fees including surgeon, kidney/pancreas, liver, allogenic bone marrow and consultations, specialist and anaesthetist fees.
autologous bone marrow.
vi) Diagnostic procedures including but not limited to Inpatient psychiatric treatment: Treatment received in
pathology tests, Ultrasound scans and X-rays.
a registered psychiatric unit of a hospital. All benefits are vii) Drugs, dressings, medicines and appliances prescribed conditional on pre-authorisation from us and all treatment by a medical practitioner or specialist, including being administered under the control of a registered Traditional Chinese Medicine.
psychiatrist. Without our written confirmation prior to such viii) Reconstructive surgery (including outpatient treatment, we will not be liable to pay any benefit. However, treatment) to restore natural function or appearance the initial consultation with the medical practitioner (not a required as a result of an accident or illness occurring psychiatric specialist) that results in a psychiatric referral during the period of cover and where treatment takes is covered without the requirement for pre-authorisation.
place within 12 months of the insured event occurring.
Accidental damage to teeth: Treatment received in an
ix) Rehabilitation (including outpatient treatment) in a accident and emergency ward of a hospital or dental clinic, recognised rehabilitation unit of a hospital subsequent within 10 days of incurring accidental damage to sound, to inpatient treatment lasting 3 days or more. The natural teeth, except when the accidental damage has been rehabilitation must take place within 14 days of caused through eating. Follow-up treatment is limited to discharge from the inpatient admission and must be one visit within 30 days following your initial treatment and recommended and under the direct control of a Medical must be pre-authorised by us.
Practitioner. Treatment includes the use of special treatment rooms, physical and/or speech therapy fees, and other services usually given by a rehabilitation unit.
Hospital cash: Where the member receives treatment for
AIDS: Medical expenses that arise from, or are in any way
an eligible medical condition as an inpatient and no costs related to, Human Immunodeficiency Virus (HIV) and/or HIV are incurred for accommodation and treatment, we will pay related illnesses, including Acquired Immune Deficiency a cash benefit. To claim this benefit, the member should Syndrome (AIDS) or AIDS Related Complex ask the hospital to sign and stamp their claim form. (ARC) and/or any mutant derivative or variations thereof. This benefit is not applicable to admissions into the Expenses are limited to pre- and post-diagnosis accident and emergency facility of the hospital. consultations, routine checkups for this condition, For this benefit, the policy excess does not apply.
drugs and dressings (except experimental or those unproven), hospital accommodation and nursing fees. Parental accommodation: Hospital accommodation costs
of a parent or legal guardian staying with a member who
For this benefit, the general exclusion for sexually is under 18 years of age and is admitted to hospital as an transmitted diseases does not apply.
Hospice care: Treatment provided by a hospice for the
care of a member upon diagnosis of a terminal illness.
Disease and chronic condition management
Such treatment will cover: Oncology: Covers all medically necessary treatment
i) Palliative treatment and other acute and chronic received for, or related to, the diagnosis of cancer when symptom management.
received as an inpatient, day patient or outpatient including ii) Medical social services under the direction of a medical practitioner or specialist.
Chronic conditions: Routine checkups, drugs and
iii) Physiological and dietary counselling.
dressings prescribed for management of the condition, iv) Consultation or case management services by a hospital accommodation nursing, renal dialysis, surgery medical practitioner or specialist.
and palliative treatment of chronic conditions (excluding v) Part-time or intermittent qualified nurse services for cancer). Costs for the treatment of cancer are covered up to eight hours in any one day for outpatient care.
under the oncology benefit.
Hormone replacement therapy: Medical practitioner or
For this benefit, the policy excess does not apply.
specialist consultations and the cost of prescribed tablets, Congenital anomalies: Treatment of congenital anomalies
implants or patches when treatment is for the female that manifest after the member's cover commences with menopause, which has been induced artificially and/or us, or which manifest in a dependant child born in the year through early onset (by early onset we mean prior to prior to cover commencing with us.
Durable medical equipment, prosthetic and orthotic
Outpatient and alternative treatments
supplies (DMEPOS): The following benefits are covered:
Outpatient care: Medical practitioner, specialist, consultant
i) Medically necessary durable medical equipment and nursing fees and outpatient charges including diagnostic prescribed by a treating Medical Practitioner, which and surgical procedures including pathology, X-rays, drugs is necessary to deliver or facilitate the delivery of and dressings and appliances prescribed by a medical prescribed drugs and dressings. This excludes hearing practitioner or specialist. Physiotherapy on referral by a aids unless the hearing benefit has been purchased.
medical practitioner is restricted to 10 sessions per medical ii) Ancillary charges following treatment as an inpatient or condition, after which it must be further reviewed by a day patient including the purchase or rental of crutches specialist. A medical report will be required for outpatient and costs associated with the initial purchase or rental of physiotherapy after 10 sessions. A referral letter/report must a wheelchair.
be submitted with the first claim for such treatment. iii) External prosthetics required following surgery, including braces and calipers, artificial eyes and the Outpatient psychiatric treatment: For outpatient
initial purchase and fitment of an artificial limb. psychiatric treatment, including specialist consultations, all treatment must be pre-authorised by us and must at all iv) Orthotic supplies including insoles and orthotic times be administered under the direct control of a medical practitioner. Without our written confirmation prior to such This benefit excludes provision, modifications and fitment treatment, we will not be liable to pay any benefit. However, of furniture or adaptations to the home.
the initial consultation with a medical practitioner (not a psychiatric specialist), which results in a psychiatric referral, is covered without the requirement for pre-authorisation.
Outpatient surgery: This benefit extends to cover the cost
ii) Travel to and from medical appointments when of endoscopy investigations carried out under an outpatient treatment is being received as a day patient. basis. This includes gastroscopy, bronchoscopy, colonoscopy iii) For an accompanying person to travel to and from and colposcopy, but excludes laparoscopy and arthroscopy, the hospital to visit the member following admission which are covered under the inpatient care benefit.
as an inpatient. Alternative treatment: Treatment administered by
iv) Economy class airline tickets to return the member registered chiropractors, osteopaths, homeopaths, and the escort to the country of residence or to the podiatrists and acupuncturists when given under the country where evacuation occurred.
direct control of and following referral by a medical v) Non-hospital accommodation for the member and practitioner or specialist.
escort for immediate pre- and post-hospital admission Vaccinations and inoculations: Vaccinations and
periods provided that the member is under the care of inoculations, including those that are medically necessary a specialist.
Compassionate emergency travel: Reasonable travel
Home nursing: Nursing care given outside a hospital
and accommodation expenses in respect of one member, that is immediately received subsequent to treatment as together with any minors (under the age of 16) necessarily an inpatient or day patient on the recommendation of a having to travel to and the return journey from the normal specialist. This must be provided by a qualified nurse and country of nationality or country of residence of a near not provided for domestic reasons or convenience. relative who has unexpectedly been placed on the critical list following an accident.
This must be pre-authorised by us. Mortal remains: In the event of death from an eligible
Evacuation and transportation
medical condition: Transportation of the body of a member or his/her ashes to the country of nationality or country of Emergency transportation: Emergency transportation
residence or burial or cremation costs at the place of death costs to and from hospital to receive treatment as an in accordance with reasonable and customary practice.
inpatient or day patient, by the most appropriate transport method when considered medically necessary by a medical Necessary burial or cremation fees including: practitioner or specialist. • The cost of reopening a grave and burial costs, or This benefit does not include the cost of car hire.
• The cost of opening a new grave and burial costs, including any exclusive right of burial fee, or Evacuation & additional travel expense: Evacuation of
a member in the event of an emergency, where treatment
• In the case of cremation is not readily available at the place of the incident, to the 1. The cremation fee nearest appropriate medical facility as determined by us, 2. The cost of any doctor's certificates by the most appropriate method of transportation as 3. The cost of removing a pacemaker or other medical determined by us, for the purpose of admission to hospital device which must be removed before the cremation as an inpatient or day patient. But not including costs related to other funeral expenses, Evacuation is subject to written agreement from us, prior to travel and certified instructions to us from the attending • Funeral director's fees medical practitioner or specialist, including confirmation that the required treatment is unavailable at the place of incident. • The cost of any documents needed for the release of the money, savings and property of the deceased This benefit excludes all maternity and childbirth costs • The necessary cost of a return journey for you to either except where these are covered under the benefit for complications of pregnancy, and any air-sea rescue or 1. Arrange the funeral, or mountain rescue costs that are not incurred at recognised ski 2. Attend the funeral resorts or similar winter sports resorts. Cover is provided for: i) Evacuation costs including the costs of one other person to travel with the member as an escort, if medically necessary.
Mother and child benefits
Additional options to reduce costs
Complications of pregnancy: Treatment of a defined
Outpatient consultation copay per visit: This benefit is
medical condition arising during the antenatal stages of available where nil excess has been selected. Outpatient pregnancy or during childbirth. The conditions covered consultations taking place in the network are subject are ectopic pregnancy, gestational diabetes, hydatidiform to a copay per visit. Where consultations take place out mole, miscarriage (actual or threatened), pre-eclampsia, of network, or a claim is submitted by the member for failure to progress in labour or stillbirth. Post-partum reimbursement, a deductible is payable for each visit. hemorrhage and retained placental membrane that Outpatient consultations for the following benefits can be occur during childbirth are also covered by this benefit. covered subject to their inclusion in your plan, and up to the Complications arising as a result of assisted conception, value of cover selected.
including, but not limited to, premature or multiple births are excluded from this benefit. Post natal checkups needed i) Complications of pregnancy as a result of one the above complications of pregnancy ii) Congenital anomalies are covered for a period of 6 weeks. This benefit is payable iii) CT and MRI scans after the first 12 months from the commencement date or iv) Hormone replacement therapy (HRT) date of entry, whichever is the later.
New born care: Inpatient treatment of an acute medical
vi) Outpatient care condition being suffered by a new born baby that manifests vii) Outpatient psychiatric treatment itself within 30 days following birth. Complications arising viii) Outpatient surgery as a result of assisted conception, including, but not limited to, premature or multiple births are excluded from this Inpatient bed limit: Inpatient bed costs are restricted to the
benefit. In circumstances where a congenital anomaly selected inpatient limit, unless in respect of HDU and ITU manifests itself in a new born baby, cover will be excluded admissions, which remain fully covered.
under this benefit and payable under the benefit for Hong Kong semi-private room restriction: This benefit is
congenital anomalies. available to residents of Hong Kong only. This benefit fully The new born baby must be added to the policy to avail of refunds the cost of a semi-private room or corresponding this benefit. Following the 30 day new born benefit period, rates when receiving treatment as an inpatient or day excepting any medical conditions occurring or manifesting themselves during the 30 day period immediately following China private room restriction: This benefit is available to
birth, the member's dependant will be eligible for cover residents of mainland China only. Benefit is restricted to subject to written notification within 30 days of birth and semi-private room and corresponding rates when receiving all premiums being paid in full within 30 days of the due treatment as an inpatient or day patient outside mainland date. A declaration of health is required with respect to all dependants who are born following infertility treatment (assisted conception).
Additional options to upgrade cover
New born accommodation: Hospital accommodation
Alternative treatment — Without medical referral:
costs relating to a new born baby (up to 16 weeks old) Treatment administered by registered chiropractors, to accompany its mother (being a member) whilst she is osteopaths, homeopaths, podiatrists and acupuncturists. receiving treatment as an inpatient in a hospital, following discharge from the original delivery.
Chronic conditions: Routine checkups, drugs and
dressings prescribed for management of the condition,
hospital accommodation nursing, renal dialysis, surgery
and palliative treatment of chronic conditions (excluding
cancer). Costs for the treatment of cancer are covered
under the oncology benefit.
The policy excess does not apply.
Compassionate emergency travel: Reasonable travel
This benefit excludes orthodontic treatment, routine and accommodation expenses in respect of one member, treatment and dental implants. together with any minors (under the age of 16) necessarily For this benefit, your policy excess does not apply. having to travel to and the return journey from the normal country of nationality or country of residence of a near A six month wait period applies from the purchase date of relative who has unexpectedly been placed on the critical this benefit or the member's date of entry, whichever is list following an accident.
Congenital anomalies — Including pre-existing congenital
Dental 3 — Orthodontic dental treatment: This benefit
anomalies: Treatment of congenital anomalies.
must be purchased in conjunction with routine dental or major restorative dental treatment. It covers the fees Complications of pregnancy — No wait period: Treatment
and associated costs of a dental practitioner carrying out of a defined medical condition arising during the antenatal orthodontic treatment in a dental surgery. This benefit is stages of pregnancy or during childbirth. The conditions limited to any member up to and including 18 years of age.
covered are ectopic pregnancy, gestational diabetes, For this benefit, your policy excess does not apply.
hydatidiform mole, miscarriage (actual or threatened), pre-eclampsia, failure to progress in labour or stil birth. A six month wait period applies from the purchase date of Post-partum hemorrhage and retained placental membrane this benefit or the member's date of entry, whichever is that occur during childbirth are also covered by this benefit. Complications arising as a result of assisted conception, Dental 4 — Dental implants: The treatment and cost of
including, but not limited to, premature or multiple births dental implants.
are excluded from this benefit. Post natal checkups needed as a result of one the above complications of pregnancy are For this benefit, policy excess does not apply.
covered for a period of 6 weeks.
A six month wait period applies from the purchase date of Dental 1 — Routine dental treatment: Fees of a dental
this benefit or the member's date of entry, whichever is practitioner carrying out routine dental treatment in a dental surgery. Routine dental treatment is defined as: Dental 5 — Combined routine & restorative dental: Fees of
a dental practitioner carrying out routine dental treatment • Tooth cleaning in a dental surgery. Routine dental treatment is defined as: • Normal compound fillings • Simple non-surgical extractions • Tooth cleaning• Normal compound fillings This benefit excludes orthodontic treatment, restorative treatment and dental implants. For this benefit, the policy • Simple non-surgical extractions excess does not apply. Restorative dental covers the fees of a dental practitioner A six month wait period applies from the purchase date of and associated costs for the treatment of the following this benefit or the member's date of entry, whichever is specified procedures: • Removal of impacted, buried or unerrupted teeth Dental 2 — Major restorative dental treatment: This
• Removal of roots benefit covers the fees of a dental practitioner and • Removal of solid odontomes associated costs for the treatment of the following specified procedures: • New or repair of bridge work • Removal of impacted, buried or unerrupted teeth • New or repair of crowns • Removal of roots • Root canal treatment • Removal of solid odontomes • New or repair of upper or lower dentures • Removal of wisdom teeth (whether performed in hospital • New or repair of bridge work or in dental surgery, whether performed by a dental • New or repair of crowns practitioner, specialist, or an oral or maxillofacial surgeon) • Root canal treatment This benefit excludes orthodontic treatment and • New or repair of upper or lower dentures dental implants.
• Removal of wisdom teeth (whether performed in hospital For this benefit, your policy excess does not apply.
or in dental surgery, whether performed by a dental A six month wait period applies from the purchase date of practitioner, specialist, or an oral or maxillofacial surgeon) this benefit or the member's date of entry, whichever is the later.
Dental 6 — Combined routine & restorative dental with
Restorative Dental covers the fees of a dental practitioner orthodontics: Fees of a dental practitioner carrying out
and associated costs for the treatment of the following routine dental treatment in a dental surgery. Routine specified procedures: dental treatment is defined as: • Removal of impacted, buried or unerrupted teeth • Removal of roots • Tooth cleaning • Removal of solid odontomes • Normal compound fillings • Simple non-surgical extractions • New or repair of bridge work Restorative dental covers the fees of a dental practitioner • New or repair of crowns and associated costs for the treatment of the following • Root canal treatment specified procedures: • New or repair of upper or lower dentures • Removal of impacted, buried or unerrupted teeth • Removal of wisdom teeth (whether performed in hospital • Removal of roots or in dental surgery, whether performed by a dental • Removal of solid odontomes practitioner, specialist, or an oral or maxillofacial surgeon) Orthodontic treatment covers the fees and associated • New or repair of bridge work costs of a dental practitioner carrying out orthodontic • New or repair of crowns treatment in a dental surgery to any member up to and • Root canal treatment including 18 years of age.
• New or repair of upper or lower dentures Dental implants covers the treatment and cost of • Removal of wisdom teeth (whether performed in hospital dental implants.
or in dental surgery, whether performed by a dental For this benefit, your policy excess does not apply.
practitioner, specialist, or an oral or maxillofacial surgeon) A six month wait period applies from the purchase date of Orthodontic treatment covers the fees and associated this benefit or the member's date of entry, whichever is costs of a dental practitioner carrying out orthodontic treatment in a dental surgery to any member up to and including 18 years of age.
Outpatient direct settlement network — Nil excess:
Outpatient consultations are available on a nil excess basis
This benefit excludes dental implants.
where treatment is received in network. The policy excess For this benefit, your policy excess does not apply.
applies where consultations take place out of network.
A six month wait period applies from the purchase date of Outpatient consultations for the following benefits are this benefit or the member's date of entry, whichever is covered subject to their inclusion in your plan, and up to the value of cover selected in your plan:i) Complications of pregnancy Dental 7 — Combined routine & restorative dental
with orthodontics and dental implants: Fees of a dental
ii) Congenital anomalies practitioner carrying out routine dental treatment in a iii) CT and MRI scans dental surgery. Routine dental treatment is defined as: iv) Hormone replacement therapy (HRT) • Tooth cleaning vi) Outpatient care • Normal compound fillings vii) Outpatient psychiatric treatment • Simple non-surgical extractions viii) Outpatient surgery Extended evacuation: This benefit covers the evacuation
i) Evacuation costs (restricted to economy class flight costs of a member in the event emergency treatment is tickets only) including the costs of one other person not readily available at the place of incident, to the nearest to travel with the member as an escort, if medically appropriate medical facility, country of residence, country of nationality or country of the member's choice for the ii) Travel to and from medical appointments when purpose of admission to hospital as an inpatient or day treatment is being received as a day patient. patient, including the cost of one other person to travel iii) For an accompanying person to travel to and from the with the member as an escort if medically necessary.
hospital to visit the member following admission as Evacuation is subject to written agreement from us prior to travel and certified instructions to us from the attending iv) Economy class airline ticket to return the member and medical practitioner or specialist including confirmation any escort to the country of residence or to the country that the required treatment is unavailable in the place where evacuation occurred.
of incident. The member's country of choice is limited to v) Non-hospital accommodation for the member and appropriate medical facilities being in place and where escort for immediate pre- and post-hospital admission it is medically suitable at our discretion. This option is not periods provided that the member is under the care of a operative where travel is undertaken against the advice of our medical advisors or where the nominated country does not have the appropriate facility to treat the medical Hearing benefit: The cost of one annual hearing test and
condition. Our medical advisors will decide the most hearing aids.
appropriate method of transportation for the evacuation.
For this benefit, your policy excess does not apply.
This benefit excludes any air-sea rescue or mountain Infertility treatment (minimum of 10 employees required):
rescue costs that are not incurred at recognised ski resorts Ovulation induction induced via certain oral or injectable or similar winter sports resorts, all maternity and childbirth infertility medication, artificial insemination, and advanced costs except where these are covered under the benefit for reproductive technology (ART) procedures and In vitro Complications of Pregnancy, and elective treatment in the fertilisation (IVF) with embryo transfer. USA unless this benefit has been purchased and appears on This benefit requires preauthorisation prior to any the member's benefits schedule.
treatment taking place and approval of medication and Out of country transportation: The costs of moving
procedures to be undertaken.
an insured person in the event of medically necessary non- The following exclusions apply: emergency treatment not being readily available at the place of the incident, to the nearest centre of medical • Couples in which one of the partners has undergone a excellence, within the area of cover, for the purpose sterilisation procedure with or without a surgical reversal.
of admission to hospital as an inpatient or day patient • Females with FSH levels 19 mlU/ml or greater on day three (excluding all maternity or childbirth costs, except for of their menstrual cycle, or who manifest a positive Complications of Pregnancy) and/or for the purpose of Clomid challenge. seeking any medically necessary inpatient, day patient or • Charges for: the purchase and storage of donor sperm, outpatient treatment. Cover under this benefit is subject the care of the donor required for donor egg retrievals or to written agreement from us prior to travel and certified transfers, Cryopreservation or storage of cryo-preserved instructions from the attending medical practitioner or specialist including confirmation that the required • ART for women without male partners who have not had treatment is unavailable at the place of incident. Cover at least 12 cycles of donor insemination prior to enrolling in the infertility programme for ART (6 cycles if the member is age 35 or older). • Charges associated with a gestational carrier programme (surrogate parenting) for either the member or the gestational carrier.
Routine pregnancy: Costs associated with normal
Wellness option 1: This benefit covers the cost of:
pregnancy and childbirth, including normal deliveries i) Routine medical checkups and associated tests. Such as a result of infertility treatment (assisted conception), routine checkups/tests include: blood and cholesterol voluntary caesarean section costs and medically necessary checks, height/weight body mass index, resting blood caesarean costs due to any non-medical previous pressure, urine analysis, cardiac examination, exercise caesarean sections. electrocardiogram (ECG), other vital organ function This benefit also covers the cost of pre-natal checkups, tests, and chest x-ray.
and post-natal checkups for up to six weeks after delivery, ii) Well-baby checks, effective from 24 hours after prescribed pre-natal vitamins, and delivery costs, including birth and up until the child's second birthday and as qualified Midwives. All costs relating to complications of recommended by a medical practitioner or specialist. pregnancy or childbirth following infertility treatment This includes physical examinations, measurements, (assisted conception) will be limited to this benefit.
sensory screening, neuropsychiatric evaluation, This benefit extends to include only the following for a development screening, as well as hereditary and metabolic screening, immunisations, urine analysis, tuberculin tests and hematocrit, hemoglobin and • One physical examination; other blood tests, including tests to screen for sickle • Vitamin K, hepatitis B and BCG vaccinations; • Circumcision; For this benefit, your policy excess does not apply.
• Routine blood tests for PKU, congenital hypothryriodism Wellness option 2: This benefit covers the cost of:
i) Bilateral mammogram/breast examination and routine • One hearing examination; and gynaecological tests including PAP tests.
• Reasonable accommodation costs for no more than four ii) Testicular/prostate examination/PSA/DRE tests.
nights, if the mother is admitted and not suffering any complications. iii) Routine medical checkups and associated tests. Such routine checkups/tests include: blood and cholesterol The policy excess does not apply to this benefit. A 12 month checks, height/weight body mass index, resting blood wait period applies from the purchase date of this benefit pressure, urine analysis, cardiac examination, exercise or the member's date of entry, whichever is the later.
electrocardiogram (ECG), other vital organ function The newborn must be enrolled as a member within 30 days tests, and chest x-ray. after birth in order to be eligible for any benefits (as per iv) Well-baby checks, effective from 24 hours after policy terms) after the first 24 hours.
birth and up until the child's second birthday and as Traditional Chinese or Ayurvedic medicine: This benefit
recommended by a medical practitioner or specialist. covers the cost of treatment administered by a recognised This includes physical examinations, measurements, traditional Chinese or Ayurvedic medical practitioner.
sensory screening, neuropsychiatric evaluation, development screening, as well as hereditary and For this benefit, your policy excess does not apply.
metabolic screening, immunisations, urine analysis, USA elective treatment:
tuberculin tests and hematocrit, hemoglobin and i) Inpatient or day patient treatment received in-network other blood tests, including tests to screen for sickle ii) Inpatient or day patient treatment received out-of- network (subject to 50% coinsurance) For this benefit, your policy excess does not apply.
iii) Outpatient treatment Wellness option 3 preventive screening: Preventive
All planned inpatient and day patient treatment must be screening for members who are deemed at high risk of notified to us prior to commencement of treatment.
cancer because of family history of familial adenomatous polyposis or hereditary nonpolyposis colon cancer, The International Healthcare Plan (IHP) does not comply chronic inflammatory bowel disease, family history of with the Patient Protection and Affordable Care Act breast, ovarian, endometrial, colon cancer or polyps, or (U.S. healthcare reform), and cannot be used to satisfy any a background, ethnic or lifestyle, such that the health requirements for health insurance cover mandated therein.
care provider treating the member believes he or she is Vision care: The cost of one routine eye exam per period
at elevated risk, shall include a screening by colonoscopy, of cover and the purchase of vision hardware, when the barium enema or any combination of the most reliable, member's prescription has changed. Vision hardware medically recognized screening tests available.
covers prescribed glasses or contact lenses.
For this benefit, your policy excess does not apply.
For this benefit, your policy excess does not apply.
It's our goal to provide you with the high quality service you expect and deserve. If we ever fall short, we hope you'll let us know. You can contact us any time to file a complaint or to appeal a decision we've made. Who to contact with a complaint
Aetna International
P.O. Box 6380
Dubai
United Arab Emirates
T: +971 4 438 7600 F: +971 4 428 7101 Our complaints handling procedures
Complaints will:
• Be acknowledged promptly
• Be investigated competently, efficiently and impartially
• Be assessed fairly, consistently and promptly
Where a complaint relates to the services provided by another firm we shall advise the complainant of this and forward the complaint to the other firm for resolution. Where we and another firm are jointly responsible for the complaint, we shall ensure that the complainant is informed of this and each company will contact them directly in relation to the complaint for which it is responsible.
There for your employees. Here for you. Learn more about how our solutions can work for you. Our serving agent in Sri Lanka: Guardian Insurance Brokers (Pvt) Ltd 32nd Floor, East Tower, World Trade Center Colombo 1, Sri Lanka +94 5 88 44 00 (Hunting): +94 5 88 44 01
Middle East and Africa: +971 4 433 0400
Stay connected to Aetna International
Aetna® is a trademark of Aetna Inc. and is protected throughout the world by trademark registrations and treaties.
Policies are insured by Aetna Life & Casualty (Bermuda) Limited or by another insurance company as stated in the insurance
documentation. Policies are administered by Aetna Global Benefits Limited — A Company Regulated by DFSA, registered address: 1701-F, 17th Floor, North Tower, Emirates Financial Towers, Dubai International Financial Centre, P.O. Box 6380, Dubai, UAE.
No warranty or representation is given, whether expressed or implied, as to the completeness and/or accuracy of the information contained in this document and accordingly the information given is for guidance purposes only. You are requested to verify the above information before you act upon it. You should not rely on such information and should seek your own independent legal advice. We will not be liable for any loss and damage, whether direct or indirect, from your use of the information and the materials contained therein. Aetna does not provide care or guarantee access to health services. Not all health services are covered. Health information programmes provide general health information and are not a substitute for diagnosis or treatment by a health care professional. See plan documents for a complete description of benefits, exclusions, limitations and conditions of cover. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna International plans, refer tWhenever coverage provided by any insurance contract is in violation of any U.S, U.N or EU economic or trade sanctions, such coverage shall be null and void. For example, Aetna companies cannot pay for health care services provided in a country under sanction by the United States unless permitted under a written Office of Foreign Asset Control (OFAC) license. Learn more on the U.S. Treasury's website at:
2015 Aetna Inc.
46.07.310.1-APSL B (9/15)

Source: http://gib.lk/Aetna_Corporate_Pre-sale_Brochure_September_2015.pdf