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LIFE & HEALTH INSURANCE INSURANCE FTZ Coca Cola Industries
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It provides worldwide protection, 24 hours a day for life and health events since the effective day of the policy (excluding suicide during the first year). Each insured could convert this plan to an individual policy if he or she decides to exit the group plan or reaches age 70. Life and Health coverages
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LIFE INSURANCE
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Coverage 3 times annual salary, max of $300,000 minimum of $25,000, rounded to the next thousand. 65 Each insured will be covered for the principal amount, up to age 65. Covertible Clause: This benefit could be converted into an individual plan during the 30 day period following the exit of the program or at age 70.
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ã Long term and permanent disability to age 60. ã Accidental Death and Dismemberment. LIFE INSURANCE Indemnity Riders
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Benefit: 26 monthly salaries. The first payment shall be made after 3 months of proof of total and permament disability but not before a period of 6 months of total and continous disability has elapsed. A total of 60 monthly payments shall be made taking into consideration a rate of $17.70 US dollars per $1,000 of insurance coverage. LIFE INSURANCE Total and Permanent Disability to age 60.
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Benefit: Up to 2 annual salaries, max of $150,000. and a minimum of $25,000. It reduces 50% at age 65 with a minimum of $25,000. In case of a dismemberment, the following table will apply: –2 members 100% –Vision of two eyes100% –1 member and the sight of 1 eye100% –1 member 50% –Vision of one eye 50% LIFE INSURANCE Accidental Death and Dismemberment
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Suicide or self injury Mental Ilness Risks of War Acts against the law (ex. homicide) Active participation in wars, strikes, etc. Accidents in airplanes except as a passenger in a registered airline carrier. LIFE INSURANCE Exclusions for Accidental Death and Dismemberment
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HEALTH INSURANCE
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Plan underwriten by Pan American Life. It offers 24 hour worldwide coverage. Any chosen provider or physician can be used. Health Insurance
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HEALTH INSURANCE Elegibility Full time, permanent employees up to age 70. New employees will be eligible up to age 60. Spouse up to age 70 or 60 respectively. Children since birth, until age 19 or 22 if full time students.
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Each benefit is payable at 80%, meaning that Pan American will cover 80% of the usual and customary charges and the insured is responsible for 20%. HEALTH INSURANCE Co-insurance clause
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HEALTH INSURANCE Benefits Lifetime Maximum $500,000 It reduces at age 65. Lifetime AIDS coverage $75,000 Prescription drugs, X Rays and Labs Inpatient and outpatient doctor´s visits 80% Annual Deductible (Country of Residence)$100 Annual Deductible (USA)$1000 Reimbursement percentage (coinsurance)80%
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HEALTH INSURANCE Benefits Radiologist and Physical Therapist Services 80% Daily Room and Board $125,00 Ground Ambulance $100,00 MATERNITY BENEFIT: As any other illness at 80% in LatinAmerica
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ãReasonable and customary charges according to market values of the country in which the person was treated. HEALTH INSURANCE Reimbursement Procedure
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ãSelf-injuries ãAlergies ãTreatment of alcoholism or drug related problems ãAny injury related to participation in war, strikes or unlawful event HEALTH INSURANCE Exclusions
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ãRoutine medical check ups, including vision care. ãPre-existing conditions not negotiated beforehand with the carrier. ãArtificial insemination or in vitro. ãCosmetic surgery except as a result of a covered accident. ãOthers as detailed in the policy. HEALTH INSURANCE Exclusions
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ãAnnual deductible$50.00 per person ãReinbursement ãType Coverage ãI 100% ãII 80% ãIII 50% ãIV 50% ãMaximum Benefit : $1,000 por year, per person (I,II,III) ã $1,000 lifetime per person (IV) ãOral exams limited to 2 per year, per family member. DENTAL CARE
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ãI. -Oral exams -Prophylaxis -Gum Treatment (for children up to age 14) -X Rays -Lab test and diagnosis II. - Routine extractions -Oral surgery -Anesthesia -Terapeutic injections -Restaurations: synthetic process DENTAL CARE Types of eligible treatments:
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-Restauration of teeth or brigdes -Gum disease -Periodoncy -Fillings -Crowns -Prosthesis – including bridges y dentures IV - Orthodontics: Treatment and application. A treatment plan shall be sent to the carrier for approval, at least 90 days in advance. DENTAL CARE Types of eligible treatments:
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Claim form completed and signed by the insured and Physician. Original prescriptions, doctor´s receipts, x rays and lab references, etc. HEALTH INSURANCE Claims Procedure At least three weeks, depending upon the complexity of each claim. ¿How long does it take to get the reimbursement check?
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