Coverage and Exclusions of the Assistance Services
1. Repatriation of remains to the home country/LATAM due to accidental death
At the request of the Member's family, INTEGRAL CARE BY BEST CARE will coordinate the repatriation of mortal remains from the United States of America to the home country.
Coordination of this assistance includes:
- Legal and consular procedures and transfer of the body to the home country.
- Legal procedures required for burial or cremation before the competent authorities.
- Removal of the body from the country or location of death.
- Preparation and embalming of the body for its preservation during the return journey to the stated place of origin.
- Provision of a standard hermetically sealed coffin with specific characteristics, in accordance with current law, for repatriation from anywhere in the world.
- Special packaging of the hermetically sealed coffin for repatriation.
- Protective cover for the coffin lining for air transport.
- Air transport of the body to the stated place of origin.
- Legal customs procedures for the release of the body at the airport.
- Transfer of the body from the airport in the home country to the place of the wake (funeral home or residence).
- The Repatriation assistance service will have no limit on the cost of providing the service and is limited to one event per year.
Exclusions
The following is excluded from this service:
- The Repatriation service applies only to the Plan Holder of the service; it does not apply to affected third parties or beneficiaries.
2. Medical repatriation to the home country/LATAM (due to serious illness or accident)
At the Member's request, INTEGRAL CARE BY BEST CARE will coordinate Medical Repatriation due to serious illness or accident from the United States of America to the home country. Coordination of this assistance includes:
- An economy-class airline ticket for the plan holder to the country of origin.
- An accompanying nurse, if essential and required by the medical center treating the plan holder.
Exclusions
- The Repatriation service applies only to the Plan Holder of the service; it does not apply to occupants or affected third parties.
- Transfer of family members or accompanying persons is not included.
- The cost of medical care arising from the illness or accident is excluded.
- Coverage of pre-existing chronic conditions.
- Coverage of persons over 70 years of age.
- Cases in which the serious illness is Covid-19 or any other illness considered pandemic.
- Pre-existing conditions (e.g., cancer, diabetes, kidney failure, etc.).
3. Air transfer to the home country/LATAM (one-way ticket) due to the death of a first-degree blood relative
In the event of the death of a relative of the Member, INTEGRAL CARE BY BEST CARE will effectively coordinate the purchase of a one-way airline ticket for the Member's transfer to the home country.
The ticket is one-way and applies only if the relative is a first-degree blood relative, for which a certificate issued by the government agency responsible for the civil registry must be submitted as supporting documentation.
Exclusions
- The cost of companions or the transfer of persons who do not meet the required degree of blood relationship.
4. Telemedicine in the United States
The Telemedicine Program provides Members with access to a technology platform and clinical telemedicine services through a link that will be provided upon completing their subscription.
Under the Program, the Member will be connected with the appropriate physicians in the Program to address the client's clinical needs, such as follow-up on Second Medical Opinion recommendations. The Program allows Members to access clinical services by video, telephone and internet, with care in Spanish and coverage throughout the United States, with services provided in the state where the plan was purchased.
Program physicians offer symptom evaluation and provide treatment recommendations as permitted by applicable law.
The medical care and services are intended to include:
- An assessment of the Member's medical needs.
- A determination of whether immediate emergency care is required.
- A recommendation of the most appropriate steps the Member should take.
- Prescription of medication, if necessary.
Service features:
- No pre-existing condition restrictions.
- No limit on the number of services.
- No age limits.
- Any condition.
5. Second medical opinion / Concierge — for Members in the United States
A review of the diagnosis and/or treatment plan provided to the Member by a healthcare provider will be arranged; this service must be requested through the same Telemedicine link. This means your case is evaluated not by just one specialist, but by a multidisciplinary team of expert physicians who practice at leading medical centers around the world.
The Concierge service includes:
- Admission to a World Medical Center of the beneficiary's choice.
- Coordination of airport reception service.
- Translation 24 hours a day, 365 days a year.
- Assistance with repatriation of remains in the event of death.
- Assistance with paperwork and visas.
- Re-evaluation and negotiation of treatment costs.
- Success fee on treatment cost reductions (maximum 25%).
6. Telephone psychological guidance service
Should the beneficiaries require it, INTEGRAL CARE BY BEST CARE will effectively coordinate and put them in contact with a psychology professional who will provide guidance in cases of emotional stress caused by school bullying, anxiety, fears, divorce, the death of a loved one, among other matters.
BEST CARE is released from liability for any decision the Member makes regarding the psychological consultation. This guidance in no case constitutes a psychological diagnosis.
7. Telephone nutritional guidance service
Should the beneficiaries require it, INTEGRAL CARE BY BEST CARE will effectively coordinate and put them in contact with a nutrition professional who will provide guidance on nutrition, diet, lifestyle and the related health aspects.
INTEGRAL CARE BY BEST CARE is released from liability for any decision the Member makes regarding the nutritional consultation.
8. In-person medical consultation with a general practitioner
Should the Member's beneficiaries require it, INTEGRAL CARE BY BEST CARE will effectively coordinate and schedule an appointment with a general practitioner, who will provide an in-clinic medical consultation on illnesses, ailments, symptoms, self-care health measures, questions about medical emergencies and first aid, information on medications, progress of various treatments, toxicology information, infections, vomiting, colic, stomach pain, contagion and interpretation of laboratory tests.
Service response time will depend on the beneficiary's location. INTEGRAL CARE BY BEST CARE is released from liability for any decision the beneficiary makes regarding the medical consultation, diagnosis, recommendations or treatments determined by the healthcare professional. Consultations will be coordinated on business days and during business hours, and the promptness of care will depend on the availability of the INTEGRAL CARE BY BEST CARE provider network.
Exclusions
The following are excluded from this service:
- Assistance Situations in which the beneficiary is in an emergency situation and uses this assistance as the sole measure.
- Assistance Situations in which the Beneficiary is under the influence of alcohol, narcotics or psychotropic substances and this circumstance makes care impossible or causes the patient to behave aggressively.
- Assistance Situations in which the Beneficiary is violent, armed or aggressive for any other reason.
- Assistance Situations in which the Beneficiary exhibits personality disorders that hinder care.
- Assistance Situations in which the Beneficiary or their family members object to the medical consultation.
- Assistance Situations in which the Beneficiary suffers from schizophrenia or anxiety attacks.
- Assistance Situations requiring care from a medical specialty other than those described in this proposal.
- Coordination outside business days (Monday to Friday) and business hours (8:00 a.m.–5:00 p.m.), as well as on holidays, will depend on the availability of the INTEGRAL CARE BY BEST CARE provider network.
9. In-person medical consultation with a gynecologist or pediatrician
Should the Member's beneficiaries require it, INTEGRAL CARE BY BEST CARE will effectively coordinate and schedule an appointment with a Gynecologist or Pediatrician, who will provide an in-clinic medical consultation on illnesses, ailments, symptoms, self-care health measures, questions about medical emergencies and first aid, information on medications, progress of various treatments, toxicology information, infections, vomiting, colic, stomach pain, contagion and interpretation of laboratory tests.
Service response time will depend on the Beneficiary's location. INTEGRAL CARE BY BEST CARE is released from liability for any decision the Beneficiary makes regarding the medical consultation, diagnosis, recommendations or treatments determined by the healthcare professional. Consultations will be coordinated on business days and during business hours, and the promptness of care will depend on the availability of the Best Care provider network.
Exclusions
The following are excluded from this service:
- Assistance Situations in which the beneficiary is in an emergency situation and uses this assistance as the sole measure.
- Assistance Situations in which the Beneficiary is under the influence of alcohol, narcotics or psychotropic substances and this circumstance makes care impossible or causes the patient to behave aggressively.
- Assistance Situations in which the Beneficiary is violent, armed or aggressive for any other reason.
- Assistance Situations in which the Beneficiary exhibits personality disorders that hinder care.
- Assistance Situations in which the Beneficiary or their family members object to the medical consultation.
- Assistance Situations in which the Beneficiary suffers from schizophrenia or anxiety attacks.
- Assistance Situations requiring care from a medical specialty other than those described in this proposal.
- Coordination outside business days (Monday to Friday) and business hours (8:00 a.m.–5:00 p.m.), as well as on holidays, will depend on the availability of the INTEGRAL CARE BY BEST CARE provider network.
10. Medication support (previously prescribed by an in-person network physician)
When, as a result of an in-person medical consultation under the plan, the Beneficiary needs to purchase medication to treat an illness identified during the consultation with a general practitioner, pediatrician or gynecologist, INTEGRAL CARE BY BEST CARE will coordinate coverage of up to $20.00 (twenty dollars, taxes included) toward the purchase of that medication at the nearest pharmacy.
INTEGRAL CARE BY BEST CARE is released from liability for any decision the Beneficiary makes regarding the medical consultation and the prescription of medication.
11. Preferential rates on medical consultations with other specialties
The Beneficiary will have access to preferential rates with the network of medical providers affiliated with BEST CARE in their local country, including general and specialty medical offices.
The special rate will apply to services such as medical consultations and clinical diagnosis.
To use this benefit, the Beneficiary must contact the INTEGRAL CARE BY BEST CARE Call Center and request information on the facility nearest to their location in order to coordinate the service.
Services will be coordinated during business hours and on business days, subject to the availability of the INTEGRAL CARE BY BEST CARE medical network.
12. Ground ambulance service for emergencies, accidents or home emergencies (not a pre-existing condition)
In the event the Beneficiary suffers a sudden and unforeseen injury as a result of an accident, or an illness that is not a pre-existing condition, requiring treatment at a hospital, at the Beneficiary's request INTEGRAL CARE BY BEST CARE will effectively coordinate the transfer of the Beneficiary to the hospital nearest to the Beneficiary's Residence or to the accident site, or to the medical center of the Beneficiary's choice if the emergency allows and it is located within the same city, so that medical care may continue under the Beneficiary's healthcare provider, prepaid medical plan, health insurance or any other health service the Beneficiary has contracted.
The costs and expenses arising from medical care must be paid by the Beneficiary.
The Medical Team coordinated by INTEGRAL CARE BY BEST CARE will advise the person requesting the service on the interim measures to be taken until professional physician-patient contact is established.
The service includes travel of up to 50 km. The cost per additional km must be paid by the Beneficiary at the time of service. In locations where no ambulance provider is available, the service will be coordinated with local Volunteer or Municipal Fire Departments.
Exclusions
The following are excluded from this service:
- Transfers from areas lacking the public or private infrastructure necessary to transfer the patient.
- Scheduled ambulances.
- Intentional attempts against the Beneficiary's own life.
- Pick-up of patients from hospitals or clinics.
- When the Assistance Situation is caused by participation in sports, competitions, preparatory trials or training.
- When the Assistance Situation is caused by participation in races or safety, endurance or speed trials.
- When the Assistance Situation is caused by the use of the Vehicle for teaching or instruction in its driving or operation.
- When the emergency results from a traffic accident, prior injury or pre-existing condition.
13. Telephone second medical opinion — beneficiary in the home country/LATAM
When the Beneficiary in the home country requires a second medical opinion on a diagnosis or treatment received from a medical specialist, INTEGRAL CARE BY BEST CARE will coordinate an appointment with a healthcare professional from its network of affiliated medical providers so that the Beneficiary's medical situation can be reviewed.
For this procedure, the beneficiary must submit tests, X-rays or any other information the medical specialist used to make the initial diagnosis.
INTEGRAL CARE BY BEST CARE is released from liability for any decision the Beneficiary makes regarding the medical guidance.
14. Funeral assistance for accidental death (for beneficiary — illness, 3-month waiting period)
The proposal includes funeral assistance for beneficiaries only (death due to illness, 3-month waiting period; due to accident, immediate coverage). Age coverage: 18 to 70 years.
a. Advisory service for issuance of documents. At the request of the Member's family, INTEGRAL CARE BY BEST CARE will guide the Member's family through the corresponding legal procedures for issuance of the deceased's death certificate.
b. Transfers from the place of death to the funeral parlor or residence and to the final resting place. At the request of the Beneficiary's family, INTEGRAL CARE BY BEST CARE will effectively coordinate and transfer the deceased from the place of death to the place of the wake and then to the final resting place. A maximum of 30 km traveled is estimated. The cost per additional km will be paid directly to the provider by the Beneficiary's family.
c. Preparation of the body for preservation for 24 hours. At the request of the Beneficiary's family, INTEGRAL CARE BY BEST CARE will effectively coordinate and send a person specialized in body preparation to prepare, dress and apply makeup to the Beneficiary's body so that it remains in good condition for 24 hours for purposes of the wake and burial.
d. Casket service. At the request of the Beneficiary's family, INTEGRAL CARE BY BEST CARE will provide the family with a casket for the Beneficiary. The family may choose between two (2) different casket styles, standard size, in treated pine, with a glass panel on the upper front, padded inside, subject to funeral home availability. If a non-standard casket is required, the cost will be passed on to the Beneficiary's family.
e. Funeral chapel service with refreshments. At the request of the Beneficiary's family, INTEGRAL CARE BY BEST CARE will effectively coordinate and provide a funeral chapel with capacity in accordance with government regulations, and will set up a refreshment service (coffee, tea, soft drinks, sandwiches, soup) for a maximum period of twenty-four (24) hours. This service is mutually exclusive with the home wake arrangement service.
f. Home wake arrangement service. At the request of the Beneficiary's family, INTEGRAL CARE BY BEST CARE will effectively coordinate and set up the space for the wake at the Beneficiary's residence, sending a crucifix for the head of the casket, two flower vases, two candelabras and furniture (up to 50 chairs). This service will replace the chapel wake.
For the proposal that includes a named beneficiary (spouse or legally recognized children), the permitted ages for coverage of the plan holder and beneficiary will be up to 70 years.
Exclusions
INTEGRAL CARE BY BEST CARE is released from its obligation to provide the funeral Services in situations arising from the following causes:
- Services contracted by the Beneficiary's family without the prior consent of INTEGRAL CARE BY BEST CARE, except in cases of proven force majeure or fortuitous event preventing the Beneficiary from contacting BEST CARE or the Assistance Personnel.
- When the necessary public or private infrastructure does not exist, or the safety conditions of the location do not allow the Service to be provided.
- If the death occurs outside the territory of Guatemala, repatriation of the body is not covered.
- In the event of suicide.
- When the Assistance Situation is caused by extraordinary natural phenomena, such as floods, earthquakes, volcanic eruptions, hurricanes, cyclonic storms, etc.
- When the Assistance Situation is caused by nuclear energy or radiation.
- When the Assistance Situation is caused by human acts arising from terrorism, war, guerrilla activity, vandalism, riot or civil commotion, etc.
- When the Assistance Situation is caused by acts of armed forces, security forces or security bodies.
- The operation of, transport in or descent from any aircraft if the insured is a pilot, officer or crew member of said aircraft, or is giving or receiving any type of training or instruction, or has any duties related to such aircraft.
15. General exclusions
INTEGRAL CARE BY BEST CARE is released from its obligation to provide the Services in Assistance Situations arising from the following causes:
- When the Assistance Situation is reported more than twenty-four (24) hours after the event occurred.
- Services contracted by the Member without the prior consent of INTEGRAL CARE BY BEST CARE, except in cases of proven force majeure or fortuitous event preventing the Member from contacting INTEGRAL CARE BY BEST CARE or the Assistance Personnel.
- When the Member and their beneficiaries refuse to cooperate with the Assistance Personnel assigned by INTEGRAL CARE BY BEST CARE to provide the Assistance Services.
- When there are indications that the Member and their beneficiaries are using the Services for the benefit of third parties.
- When the Assistance Situation existed before the effective start date of the Assistance Program (pre-existing damage).
- Due to bad faith on the part of the Member and their beneficiaries, as verified by INTEGRAL CARE BY BEST CARE Assistance Personnel.
- When the necessary public or private infrastructure does not exist, or the safety conditions of the location do not allow the Service to be provided.
- When the Assistance Situation is caused by extraordinary natural phenomena, such as floods, earthquakes, volcanic eruptions, hurricanes, cyclonic storms, epidemics, pandemics, etc.
- When the Assistance Situation is caused by nuclear energy or radiation.
- When the Assistance Situation is caused by human acts arising from terrorism, war, guerrilla activity, vandalism, riot or civil commotion, etc.
- When the Assistance Situation is caused by acts of armed forces, security forces or security bodies.
- When the Assistance Situation is caused by personnel of any official authority executing an order of seizure, raid, attachment of property, arrest, search, investigation or rescue, who are compelled to force, destroy or break any means of access to the Residence, such as doors, windows, latches, locks, etc.
- When the Assistance Situation is caused by participation in sports, competitions, preparatory trials or training.
- When the Assistance Situation is caused by participation in races or safety, endurance or speed trials.
- When the Assistance Situation is caused by the use of the Vehicle for teaching or instruction in its driving or operation.
- Reimbursement for any service contracted or coordinated outside the INTEGRAL CARE BY BEST CARE emergency center, available 24 hours a day, 365 days a year.
- Use of the assistance services by persons other than those described.
- Combining the coverage amounts of the assistance services into a single event in a way that could exceed the coverage limit per event.
- Assistance services with a usage period may not be carried over during the term of the plan.
16. Territorial scope of assistance / general scope
The Assistance Program services for the home country will be provided in the territory of the Republic of Guatemala, El Salvador, Honduras, Costa Rica, Nicaragua, the Dominican Republic, Bolivia, Mexico, Colombia, Chile, Ecuador, Uruguay, Paraguay, Argentina, Puerto Rico and Peru.
In these cases, the beneficiary is defined as the Member's immediate family, comprising persons living in the same household, which may be the legally identified spouse, up to three children under eighteen years of age who are financially dependent on the beneficiary, or parents (not over 70 years of age) in the case of single persons, which must be specified in the program enrollment form.
A Member in the U.S. will have the designated assistance services at their place of residence.
17. Definitions
- Member: the client who pays for the product.
- Network: where the Member purchases the product.
- Beneficiaries: the Member and the members of the immediate family designated by the Member, who will be entitled to the assistance services detailed in this document.
18. General service request process
Should the Member and their beneficiaries require the Assistance Program Services, the following procedure must be followed:
- Once payment for the Assistance Program has been verified in the Network, which will not be refundable for any reason, the Member will receive the Assistance Program containing the terms and conditions of the Services and the telephone number for requesting Assistance, which will be a telephone number for each home country, except for the Telemedicine and Second Medical Opinion services for the Member, which must be accessed through a link.
- Services will be provided exclusively to members and beneficiaries appearing on the most recent list provided by the Network, in order to enjoy the program benefits.
- The Member and their beneficiaries will be eligible to use the Assistance Program Services after forty-eight (48) business hours following their reporting by the Network to INTEGRAL CARE BY BEST CARE.
- The Member and their beneficiaries requiring the service will contact INTEGRAL CARE BY BEST CARE at the telephone number assigned to handle Assistance Situations and will provide the INTEGRAL CARE BY BEST CARE Assistance Personnel answering the call with all the information necessary to identify them as an active Member of the Assistance Program, and all other information needed to provide the requested service, such as a description of the problem and the type of help needed, a telephone number at which they can be reached, and their location address. If, at the time the service is requested, the person does not appear as a beneficiary in the database the Network sends to INTEGRAL CARE BY BEST CARE, INTEGRAL CARE BY BEST CARE may provide the service, provided there is express authorization, in writing or by telephone, from a Network executive authorizing the additional service.
- Using mapping and its systems, INTEGRAL CARE BY BEST CARE will locate the Assistance Personnel nearest to the place where the Assistance Situation occurs and the service is required.
- Once the Assistance Personnel who will provide the service has been assigned, INTEGRAL CARE BY BEST CARE will inform the Beneficiary of their name and estimated time of arrival, when the type of assistance so warrants.
- All Services are monitored from start to finish to minimize waiting time and verify that the Service is properly provided in accordance with the highest quality standards.
- If the Beneficiary does not appear on the list received from the Network, INTEGRAL CARE BY BEST CARE will validate the information directly with the Network before denying a service or offering it in connection.
If the procedure set forth above is not properly followed, INTEGRAL CARE BY BEST CARE will assume no liability or expense whatsoever related to the non-provision of the Assistance Services referred to in this annex.
