Services Maximum Services Maximum

THE BEST LIVES ARE BUILT ON

Benefit Benefit
THE STRONGEST FOUNDATIONS
DOCTORS VISIT HOSPITAL BENEFITS
Office $ 1000 Local Room & Board $ 2,500 per day
(10 visits per disability, per policy year)
Room & Board (MM) $ 1,000 per day
Annual Wellness Check-up $ 1000 (120 days per disability, per policy year)
(1 visit per policy year)
IS EXECUTIVE HEALTH PLAN FOR YOU? Hospital Miscellaneous $ 25,000*3
(Charges related to hospital confinement) per disability
Are you between the ages of 19 and 64 years and desire Consultation - on referral $ 2,000
quality health insurance coverage at a price you can afford? (1 visit per disability, 4 per policy year)
Hospital Out Patient $ 12,500
This plan is for you! Executive Health is a comprehensive Specialist
(Hospital care provided without admission) per disability
non-group health plan that offers a wide range of benefits (5 visits per disability, per policy year)
$ 1,800
Doctor’s Hospital Visit $ 2,000
for you and your family. Overseas emergency and non- Psychiatrist (MM) 50% of cost up to (1 visit per day, 120 days per disability per
emergency benefits are also provided for medical care the Consultation Fee
policy year)
while in other Sagicor territories. (Maximum of $50,000 SURGICAL BENEFITS
for the life of the policy)
Surgeon’s Fee $40,000 + MM
CONVERSION PRIVILEGE Dietician - on referral $1,500 (Maximum basic amount per procedure)
(3 visits per year; paid by reimbursement)
If you are on a Sagicor group plan and experience changes
Assistant Surgeon’s Fee $12,000 + MM
in your employment, you can continue your coverage by OTHER BENEFITS (Maximum basic amount per procedure)
transferring to this individual plan within thirty (30) days of
Prescription Drugs $ 10,000 + MM*1 Anaesthetist $16,000 + MM
the employment change. If you transfer within this period
you will not be required to do a medical and there is no Dental & Optical (combined) $ 15,000 Intensive Care (MM) 100% of cost
Benefit restrictions include: (5 days per disability, per policy year) up to
waiting period for pre-existing conditions, if the benefits •1 oral exam and dental cleaning every 6
on your group plan were equivalent or superior to those of months
$25,000 per day
Executive Health. •1 eye exam and 1 pair of lenses per 12 month Nursing Services - on referral $ 1,500
period [Registered Nurse only]
•1 frame per 24 month period (Private duty per 8 hour shift - max of 15 shifts)
COORDINATION OF BENEFITS
If you or your dependents are covered under another health Physiotherapy - on referral $ 1,500 OVERSEAS EMERGENCY BENEFIT
(10 sessions per disability, per policy year)
plan, for example National Health Fund (NHF) or JADEP, Coverage is available for first 30 days per trip Maximum of
your benefits may be coordinated so that you pay less out- Speech Therapy $1,000 for medical emergencies.
US$100,000
(10 sessions per disability, per policy year) (Maximum of 90 days per policy year)
of-pocket for medical expenses. N.B. Failure to contact CMN may result in (per policy year)
Local Ambulance $1,200 reduction of benefits
UTILIZATION MANAGEMENT Lab, X-Ray, ECG, etc. $ 5,000 + MM*1 OVERSEAS NON-EMERGENCY BENEFIT
Keys to keeping your premiums down: Ultra Sound and CAT Scan & MRI 80% of Cost [Paid directly from MM]
• Your card must ONLY be used by you. Do not lend Overseas Room & Board J$ 10,000
Renal Dialysis (MM) 80% R&C up to
your card to anyone. (2 sessions per week; 52 weeks per year) max of $ 9,300 Hospital Miscellaneous/ Diagnos- 80% of R&C
• Do not use your card for anything other than medical per session tic/ Surgery
expenses.
• Protect your plan. Report abuse or loss of your card Chemotherapy (MM) $ 500,000 Overseas Deductible US $ 1,000
promptly to any Sagicor office. per annum*2
Air Transport (per round-trip) J$ 10,000
• Never sign a claim form unless it is completely filled Radiotherapy (MM) $ 500,000 (Maximum of 2 round trips per policy year)
out by the provider. per annum*2
N.B. Pre-authorization must be given by Sagicor prior
• Do not use your card just to exhaust an existing MATERNITY BENEFITS including Pre-Natal and Delivery to obtaining treatment overseas.
balance before the anniversary of the plan.
Normal Delivery $ 25,000
C/Section $ 50,000
Miscarriage $ 13,000
 MAJOR MEDICAL
Lifetime Maximum (LTM) $ 3,000,000
Local Deductible (Annual) $ 7,500
Co-insurance 80/20
Over-aged Dependent Coverage YES
* Initially, amounts are paid from the basic benefit listed at
1

80% of cost. Once exhausted, amounts are paid directly from

MM at 80% of cost, by reimburement, after first satisfying the
deductible
*2 Benefits are paid directly from MM at 80% of cost up to the
maximum amounts listed. EXECUTIVE HEALTH is one of the solutions offered
*3 Benefits are paid at 100% of cost up to basic maximum, by Sagicor to help you attain your financial goals. Please ask your
then goes into MM at 80% of cost after satisfying the Sagicor representative how our products can form part of a wise
deductible. approach to your complete financial well-being.

SPECIAL CONDITIONS
THINGS YOU SHOULD KNOW
• The maternity benefit is optional for women 51 years and
over. Who are your dependents?
• 9 month waiting period for maternity - all maternity • Your spouse (married or unmarried).
related expenses, including doctor’s visits, are paid from • Your children, stepchildren and legally adopted children up
the maternity benefit. to their 19th birthday.

EXECUTIVE
• 12 month waiting period for all pre-existing conditions
• 6 month waiting period for major medical benefits (sur- Is coverage available for my child after age 19?
gery, major diagnostics (MRI, CAT scan) & hospitaliza- Yes. Your policy includes over-aged dependent coverage for your
tion), except for medical emergencies. child up to their 23rd birthday if attending a tertiary institution
on a full time basis. A letter is required from the local or overseas
OPTIONS
• Individual
tertiary institution each year.

When can I change my spouse on my health insurance plan?

H E A LT H
• Individual + 1 (Spouse or Child)
• Family You can cancel a spouse at any time. Change of spouse is usually
allowed only at the plan’s anniversary but is allowed at any time
if spouses are legally married. A marriage certificate is required
KEY TERMS & DEFINITIONS to effect the change.
R&C (Reasonable and Customary) Fees:
These are the rates charged by an individual provider or When can I add my newborn baby?
institution in keeping with the going rate or charges for these You can add your baby 14 days after birth. However, if the
medical services. The rates are applied according to a pre- newborn is still hospitalized at the date of eligibility, the effective
determined schedule. date will be the day following the date of discharge from the
MM (Major Medical): hospital.
An additional benefit which provides funding for major
medical expenses arising from catastrophic illness, injury, or
costly diagnostic procedures. This benefit is in addition to the
amounts payable from the basic benefit after satisfying the Sagicor Life Jamaica Limited
annual deductible. H.O.: 28-48 Barbados Ave., New Kgn. P.O. Box 439, Kingston 5
LTM (Lifetime Maximum): Tel.: (876) 929-8920-9, Fax: (876) 929-4730
This refers to the maximum amount payable over the lifetime www.sagicorjamaica.com
of the insured, from the Major Medical benefit.