MA RI N E B EN EFI TS

2016

Maersk Line Seafarer & Family Medical Plan

Welcome Booklet
VALID FROM MARCH 1,2016 PAGE | 1
ELIGIBILITY
Maersk Line Seafarer & Family Medical Plan
Schedule of Benefits and Exclusions
BENEFITS COVERAGE/LIMITS/ELIGIBILITY

Employees 18-67 years old;

can be extended individually to 70 upon
Maersk approval

Spouse / Cohabitant 18 (or local legal age)

MEMBERSHIP ELIGIBILITY to 67 years old ;
can be extended individually to 70 upon
Maersk approval

Children 30 days old to under 19 years old

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LIMITATIONS / EXCLUSIONS

Maersk Line Seafarer & Family Medical Plan

Schedule of Benefits and Exclusions
BENEFITS COVERAGE/LIMITS/ELIGIBILITY
Maximum period of cover
12 Months
(per cause or per ailment )
Lifetime limit USD 200,000
Maximum limit per annum (inpatient) USD 100,000
Maximum limit per annum (outpatient) USD 1,000 ( USD 100 deductible)
Dental USD 300 per annum

I. Hospitalization / Inpatient
Covered for semi-private room
Room and Board
category
Services of Physician, Surgeon and
Specialist, In-Patient Medications,
Covered
Diagnostic procedures and ICU
treatment
Transplants Covered
Procurement of donor organs Not Covered
Medical prostheses and appliance
Covered
whilst inpatient

II. Outpatient Benefits

Covered up to annum limit of USD 1,000 ( USD 100 deductible )

Consultation including specialists

Covered
evaluation
First aid treatment of injury or illness Covered
Treatment for minor injuries such as
lacerations, mild burns, sprain and Covered
strain fractures
Vaccines
a. Anti-tetanus
Covered
b. Anti- rabies
c. Anti- vabies
Laboratory examinations and all other
Covered
relevant diagnostic procedures

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 II. Outpatient Benefits
Covered up to annum limit of USD 1,000 ( USD 100 deductible )

One per year maximum of USD 200

Annual Physical Exam and diagnostics
subject to remaining outpatient annum
(for members 45 years and above only)
limit
Therapy
a. Prescribed physiotherapy - Covered up to USD 400 per annum
Consultants’ fees and physiologists subject to remaining outpatient annum
and physiotherapists’ fees for limit
physiotherapy treatment
b. Prescribed speech therapy, Covered up to USD 400 per annum
oculomotor therapy and occupational subject to remaining outpatient annum
therapy limit
Covered up to USD 200 per annum
Vision examination and correction-
subject to remaining outpatient annum
eyeglasses and contact lenses
limit
Costs for treatment by therapists and
complementary medicine practitioners
Covered up to USD 200 per annum
and qualified nurse (for example -
subject to remaining outpatient annum
Chiropractic treatment, osteopathy,
limit
homeopathy, Chinese herbal medicine
and acupuncture)

III. Emergency Benefits

Covered subject to applicable outpatient or inpatient limit

Emergency care services Covered

Emergency care services in Non-
accredited hospitals in the absence of Covered
accredited hospital

IV. Maternity
Maximum of USD 5,000 per cause up to 2 pregnancies

Routine Maternity and child birth Covered maximum of USD 2,500

Childbirth at home or birthing centre Covered maximum of USD 1,000

V. Dental
[Consultations, Procedures, and Medicine]
Covered up to USD 300 per annum

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 VI. Special Modalities of Treatments
Covered subject to applicable inpatient or outpatient limit

Percutaneous Adrenalectomy,
Laparoscopic procedures, Heart Covered
Surgery, Angioplasty
New Diagnostic Procedures e.g.
Covered
PET Scans , CT-PET scans
Kidney dialysis Covered
Chemotherapy Covered
Radiotherapy Covered

VII. Additional Benefits

Pre-existing conditions
Covered for outpatient ; inpatient
( i.e., ailments that are symptomatic,
coverage only starts after one year of
diagnosed or diagnosed and treated
membership
before enrolment)
Ambulance conduction (road ) Covered up to maximum of USD 500
Nursing at home or in a convalescent
home after in-patient treatment or Covered up to maximum of USD 2,500
instead of hospitalisation
Maximum of 6 months subject to inpa-
Hospice and palliative care
tient annum limit
Covered subject to applicable inpatient
Congenital illness
or outpatient limit
Rehabilitation treatment/Physical
Covered up to USD 1,500
Therapy
Repatriation of mortal remains or
Not covered
burial expense

EXCLUSIONS
Injuries sickness brought about by
political unrest, riot, strike, military
Not Covered
and paramilitary activities, including
fraternity violence.
Injuries and sickness brought about
by professional sporting activities and
sports classified as “extreme” sports- Not Covered
e.g. mountaineering, mountain climbing
parachuting and the like

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 EXCLUSIONS
Injuries and sickness due to substance
abuse such as recreational/illicit drugs,
Not Covered
alcohol and including non prescription
drugs e.g. vitamins, herbal drugs
Injuries and sickness due to sexually
transmitted disease such as AIDS, Not Covered
Hep B etc
Unprescribed medical treatment and
any medical services outside of net- Not Covered
work or not approved by underwriters
Reproductive and family planning
Not Covered
medical services
Dermatological cosmetic medical
services and routine medical diagnostic
Not Covered
procedures for employment or travel
purposes
Self-inflicted bodily harm while sane or
Not Covered
insane
Any medical treatment directly or in-
directly linked to an illness or accident
that first manifests itself whilst the
Not Covered
employee is signed on board a vessel –
including any periods spent off vessel
during a voyage – by the Assured.
Diagnostic tests for the purpose of
pre-boarding ship examinations.
Vaccinations for the purpose of
pre-boarding ship examinations. Not Covered
Medical evacuation/repatriation from
a vessel at sea to a medical facility on
land.
Expenses for sex change, hearing aids,
learning disabilities and self enhance-
Not Covered
ment e.g. weight control, podiatric care
and custodial/rest care.
NB. This document is only a summary and is secondary to the full policy wording

note
utilize national co-insurance. one example of this is
philhealth in the philippines.

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