We want you to understand your health insurance policy, so you can take full advantage of it.

General Info

Maximum Lifetime per Person: $300,000

Stop Loss: is the maximum amount you will ever have to co-pay each policy year: $4,000. After this the insurance company will pay 100%.

Deductible: $200 for prescribed medicine. This deductible covers all the medicines you are prescribed in your policy year.

Hospital Expenses:

Require Pre-Authorization: If a procedure is planned for you have to let the insurance company know before being admitted into the hospital.

Includes for Hospital Expenses:

Days 1-4: co-payment of $150.00 daily per event.

Days 5-10: your policy covers 100%.

Days 11+: your policy covers 80%.

Daily Room and Board (Private Room) ~ 100%

Intensive Care Unit ~ 100%

Hospital Miscellaneous Expenses ~ 100%

Medical Fees for Surgery and Anesthesia ~ 100%

Medical Fees for Hospital Visits ~ 100%

Ambulatory Expenses:

Outpatient Examinations ~ Specialist ~ Co-payment of $18.00

Outpatient Examinations ~ General Doctor ~ Co-payment of $12.00

X- Rays and Laboratory ~ Co-payment of 25%

Special Examination (Pre-authorized) ~ Co-payment of 30%

Hem dialysis (Pre-authorized) ~ Co-payment of 30%

Chemotherapy or Radiotherapy (Pre-authorized) ~ Co-payment of 30%

Chiropractic (Pre-authorized) ~ Co-payment of $15.00 ~ Max 5 sessions a year

Acupuncture (Pre-authorized) ~ Co-payment of $15.00 ~ Max 5 sessions a year, 20 sessions per life

Physical Therapy and Rehabilitation ~ Co-payment of $5.00 ~ Max 20 sessions a year, more than this has to be pre-authorized.

Emergency Room:

Per Accident: your policy covers 100%

Detailed Illness: Co-payment of $50.00

What is a Detailed Illness? Attentions to acute cases of: Nephritic Colic, Hepatic Colic, Episodes of chest angina, infarct of the myocardium or coronary insufficiency, pulmonary embolism, acute bronchial asthma attack, loss of knowledge or obnubilation and/or sudden, acute allergic reactions or anaphylactic disorientation, hemorrhages of all type, including gynecological and obstetrics, vomits and severe diarrheas with or without dehydration, acute abdominal pain, convulsions, state of “shock” and the like, acute urine retention, high fever in infants.

Ambulatory Surgery:

In Hospital ~ Co-payment of $200 per event

In Doctor’s Office ~ Co-payment of 30%

Medical Fees (Doctor Provider) ~ Your policy covers 100%

Maternity Benefits:

Applied to Single and Married Mothers

Period before benefit applies: covered if the pregnancy occurs from the first day of the 13^th month of the period of the policy. In other words, you have to have the policy for 4 months (using a 9 month pregnancy) before getting pregnant for the policy to cover the birth.

Before the Birth:

Maximum per event ~ $3,000.00

Prenatal Consultation ~ Co-payment of $18.00 ~ Max 8 visits

Prenatal Ultrasounds ~ Co-payment of 25% ~ Max 3 times

After the Birth:

New Born Child: the baby will be included under the mothers policy for the first 9 days of life, after the 10^th day he/she must be registered as a dependant ~ Your policy covers 100% of costs up to $5,000.00

Premature Child: the baby is born before the 37 week of pregnancy ~ Your policy covers 100% of the costs up to $10,000.00

Neonatal Congenital, Hereditary, or Acquired Illnesses: The policy covers illnesses acquired by inheritance or at the time of birth as long as the mother is covered by the policy ~ Your policy covers 100% of the costs up to $30,000.00

Preventive Medicine within the Network:

Healthy Child Control:

For children up to 6 years old

Co-payment of 50%

Control consultation:

0 – 12 months ~ 8 visits per year

13 – 24 months ~ 4 visits per year

3 – 6 years ~ 2 visits per year

Compulsory vaccines regulated by the Ministry of Health during Control Visits:

BCG (Tuberculosis) ~ $10.00

DPT (Difteria, Tosferina, Tetano) ~ $10.00

MMR o SPR (Sarampion, Rubiola, Paperas) ~$25.00

POLIO (Poliomielitis) ~ $10.00

Hepatitis A ~ $30.00

Hepatitis B ~ $25.00

Hibtiter (Meningitis) ~ $30.00

Varicela (Chicken Pox) ~ $75.00

Pentavalente (Difteria, Tetanos, Tosferina, Meningitis por Haemophilus Tipo B y Hepatitis B)

Women:

Co-payment of 50%

Annual Control and Pap Smear Test

Annual Mammography after the age of 40

Men:

Co-payment of 50%

PSA test after the age of 40

Ambulance Benefit:

Land Transportation: Your policy covers 100% ~ Max $100.00

Air Transportation: Your policy covers 100% ~ Max $1,000.00

Private Nurse:

Pre-authorization required ~ Covers 100%, limit 30 sessions ~ Max 8 hour sessions

AIDS:

Calendar Year: Your policy covers 100% ~ Max $5,000.00

Lifetime: Your policy covers 100% ~ Max $25,000.00

Out of Network Services in Panama:

If you decide to use a doctor or hospital that is not in the Blue Cross, Blue Shield Network ~ Reimbursement will be 60% of the cost agreed with medical providers in Panama

EMERGENCIES OUTSIDE OF PANAMA:

Accident or Illness ~ including hospitalization expenses and medical fees ~ Your policy will reimburse 60% of the cost agreed with medical providers in Panama.

These requirements are written in Spanish as well so you can print and take this page to the lab and tell them which ones you need.

Panamanians from 40 to 45 years old (Female and Male)

Fee for Exam $48.10

• Hemograma Completo ~ Complete Hemogram
• Glicemia ~ Glicemia
• Urinalisis ~ Urianalysis
• Perfil Lipi­dico ~ Lipid Profile
• PSA (Para los Hombres) ~ Prostate Exam

Foreigners 18 to 45 years old (Female and Male)

• All of the examinations above including HIV

Fee for Exam $61.10

Panamanians from 46 years old and up (Female and Male)

Fee for Exam $57.85

• Examen Fi­sico ~ Physical Exam*
• Hemograma Completo ~ Complete Hemogram
• Post-Pandrial (en ayuna y en dos horas) ~ Glucose Test (in the morning without eating anything and then 2 hours later)
• Urinalisis ~ Urianalysis
• Perfil Lipi­dico~ Lipid Profile
• PSA (Para los Hombres) ~ Prostate Exam
• EKG (Realizado con un Cardiologo) ~ EKG (done with a cardiologist)**

Foreigners from 46 + (Female and Male)

• All examinations above including HIV

Fee for Exam $70.85

*PHYSICAL EXAM:

Dr. Diagenes Giraldo – Cli­nica San Fernando – 305-6363 ($15.00)

Dr. Rogelio Perez – Centro Medico Nacional – 227-5444 ($15.00)

Dr. Jorge Paz Rodri­guez – Wellmed Clinic – 269-1795 ($25.00)

**CARDIOLOGY -EKG:

Dr. Ricardo Lyma Young - Cli­nica San Fernando – 305-6300 ($25.00)

Dr. Jorge Paz Rodri­guez – Wellmed Clinic – 269-1795 ($25.00)

LABORATORIES

Laboratorio Raly - 225-0885

Laboratorio Cli­nico Fernandez - 213-9253

Laboratorio De Sedas - 263-8786

NOTE: THESE COSTS MUST BE CANCELLED BY THE APPLICANT.

We Recommend: going to the Laboratorio Fernandez and the Wellmed Clinic which are conveniently located right next to each other in the shopping center in Marbella on the second floor. For the Wellmed and the other clinics or to get the EKG please make a previous appointment or let us know when it is convenient for you so we can make an appointment.

Exams Delivery: We can send you a lab technician or a doctor to your hotel or residence, but this will have an extra cost of $12 approximately.

BOTICA EL JAVILLO In any of their locations

OBTAIN a 20% discount GUARANTEED.

Blue Cross and Blue Shield of Panama offers as an additional benefit the exclusive service of “Home Delivery”, without any additional cost. This benefit has been designed to help you save time and money in the purchase of all your medicine.

The advantages of this service are:

~ You can order by the phone

~ You will receive in your house, office, or any location you prefer, your order in less than 24 hours.

~ $1.00 charge for delivery, no matter the size of your order.

~ Coverage Area: in the North until Las Cumbres, in the South until Ave. Balboa, in the East until Tocumen, and in the west until the Americas Bridge.

~ Applies for all medicines with or without prescription, covered or not covered by your policy.

~ Options of payment: Visa, MasterCard, American Express, Clave, Check or Cash.

All you have to do is call 800-0026 or 302-3225.

Order placement Schedule:

Monday – Friday: 9:00 a.m. – 9:00 p.m.

Saturday: 9:00 a.m. – 1:00 p.m.

Delivery Schedule:

Orders placed from Monday through Saturday will be delivered:

Before 7:30 p.m. ~ the same day before 9:00 p.m.

After 7:30 p.m. ~ before noon of the next day

You can also order on the phone and go directly to any of their following locations:

Ri­o Abajo, next to the Super 99 ~ Telephone: 224-1206

Vi­a Espana, ground floor of the San Fernando Hospital ~ Telephone: 229-6745

Plaza 5 de Mayo, ground floor of Hotel Internacional ~ Telephone: 262-5768

Paitilla Mall  ~ Telephone: 215-2581

Colon ~ Hospital 4 Altos, Local No.12 ~ Telephone: 433-7526

Urbanizacion El Crisol, Plaza Dragon Local No. 5

Almanza – Carrizo Dental Clinic ~Located in Centro Medico Nacional, Justo Arosemena Avenue and 38 St. Second floor – Office # 213 – Telephone: 227-4048

50% for a general or specialty consultation

40% in preventive treatments

20% for fillings (silver)

15% for other procedures

America’s Gym ~ Located in Consultorios America, Vi­a Espana Piso 8 – Telephone: 229-4388 Ext. 1040

15% monthly discount.

Curves Gym ~ Located in Paitilla Mall, Centro Comercial Camino de Cruces, and in San Francisco in the 64th St. Telephone: 360-2240/2241.

66% discount in subscription fee and first week free.

Derma Beauty Care ~ Located in Chile Avenue and 40, office 2A Telephone: 225-2412/673-2850

The specialists in nutrition, oxygenation, and rejuvenation of the skin offer you a 30% discount in your first visit for the following procedures: deep facial cleaning, micro derma abrasion, and ultrasonic peeling.

Optic Sosa & Arango ~ Located in Albrook Mall, Marbella, Ave. Justo Arosemena, El Dorado, Calidonia, San Miguelito, Los Pueblos, Shopping Plaza La Dona, La Chorrera, Colon, Chitre, Santiago, and David.

Free Vision (eyesight) exam

15% discount for the purchase of complete glasses.

Benefits are transferable to your direct family.

Economic packages for complete glasses from $42.00

Filaki Salon ~ Located in Marbella Galeri­a Mar Plaza, No.2. Telephone: 263-1647 / 263-1676

20% discount in all your beauty services.

Dagmar Boutique ~ Located in Marbella Galeri­a Mar Plaza, No.2. Telephone: 263-1647 / 263-1676

20% discount in all your purchases paid in cash.

Champs Sport ~ Located in Los Pueblos, El Dorado, in front of Banco Nacional in Vi­a Espana Telefono: 217-7235 / 223-1315.

15% discount for the purchase of sneakers at regular price.

Central Clinic Lab ~ 15% discount.

Pharmacy Discounts ~ for the purchase of medicine with a medical prescription.

Lucy Pharmacy ~ locaed next to the Cli­nica de Urgencia in Vi­a Espana. Tel. 213-9766. ~ 10% discount.

Super Pharmacy America ~ located in Vi­a Espana on the ground floor of Consultorios America. 10% discount if paid in cash, 5% with credit card.

Yavic Pharmacy ~ located on the ground floor of the Hospital Nacional 10% discount if paid with credit card, 15% if paid in cash.

Revilla Drugstore in Chiriqui ~ Located in the Cervantes Park, Obaldi­a, 5 Esquinas, Mercado y Concepcion. Telephone 775-2901/775-1245. 10% discount if paid in cash.

Marbella Pharmacy ~ Ubicada en el Centro Medico Royal Center, Planta Baja. Telephone 263-1887. 12% discount if paid in cash.

Applicant Name

Local Coverage

PLAN MEDIRED

Monthly Premium – Principal (age)

$

Monthly Premium – Spouse (age)

$ 0.00

Monthly Premium – # of Children

$ 0.00

TOTAL MONTHLY PREMIUM

$ (Premium + tax 5% )

Premiums in Panama are significantly lower than in many other countries.

To get a quote or more information please contact us at:

forlacol@gmail.com or by phone at +507 6676 5151 (Ursula)

The main policyholder must be aware that the initial premium is negotiated in favor of the insurance company, which will be dependent on age.

Actuarial Age:

The corresponding premiums of the main insured and their spouse will be calculated on the actuarial age or age reached in six months at the moment of effectiveness of the insurance and to the inflationary factor in the supplies and medical benefits that are felt. In other words your age is in the 6 months closer to the next bracket when you are applying for the policy you will be charged as if you were already in the following bracket.

Maximum Age to be submitted – 62 YEARS OLD

FORM OF PAYMENT

Direct payment

• Quarter
• Semestrer
• Annual

Monthly Payments:

• Debit from a Bank Account (ACH)
• Credit Card (Visa, Master Card, Dinners)