TREATMENT OR SERVICES

MAXIMUM PLAN REIMBURSEMENT

MEDICAL FEE of the OFFICE DES MIGRATIONS INTERNATIONALES

100 % of costs

HOSPITALISATION AND SURGERY

Hospital Charges, including emergency room, room and board, operating facilities, private room, the daily "Forfait Journalier", convalescent facilities, Surgeons' and Doctors' Fees, Ambulance

100 % of reasonable and customary costs

(If hospitalised outside of France, limited to 200% of the FSST or 400% FSST in the event of an accident or major medical emergency)

PRESCRIPTION DRUGS

100% of costs

OUTPATIENT MEDICAL

Physicians Fees

Routine Medical Examinations

Physical Therapy

Nursing and Paramedical Fees

Diagnostic Laboratory Analyses

X-ray Exams

Orthopedic Fees

Eye Examinations

Prosthetic Appliances other than Dental

100 % of reasonable and customary costs up to 400% of the FSST

(Outside of France, when there is no accident or major medical emergency, reimbursements are limited to 200% of the FSST)

MATERNITY

Inpatient and Outpatient Medical Treatment for Pregnancy and Childbirth

Aggregate Maximum of 2,000 € per Pregnancy

100 % of reasonable and customary costs up to 400% of the FSST

(Outside of France reimbursements are limited to 200% of the FSST)

PSYCHOLOGICAL SERVICES, PSYCHIATRIC CARE, AND DETOXIFICATION

(1) Psychological Services with Approved Psychologists (Coverage is limited to practitioners on the Direct-Billing list)

(2) Inpatient Psychiatric Care or Detoxification

(3) Outpatient Psychiatric Care or Detoxification

(4) Psychoanalysis is not covered

Aggregate Maximum of 2,000 € every 12 months

(1) 100% of cost up to 31 € per session

(2) 100% of reasonable and customary cost

(3) 100% of reasonable and customary costs up to 400% of the FSST (Outside of France reimbursements are limited to 200% of the FSST)

DENTAL CARE

Preventive Treatment, Teeth Cleaning

Diagnostic Examinations, X-rays

Necessary Basic Care, including

Fillings, Extractions, Root Canals,

Periodontic Treatment, Oral Surgery, Crowns, and Dental Prostheses

100 % of reasonable and customary costs up to 400% of the FSST

(Outside of France, when there is no accident or major medical emergency, reimbursements are limited to 200% of the FSST)

VISION CARE

(1) Eyeglass frames

(2) Eyeglass lenses

(3) Contact lenses

(1) 107 € per frame

(2) 39 € per lens

(3) 138 € per pair

One Pair of Eyeglasses and One Pair of Contact Lenses Maximum per Calendar Year

REPATRIATION

(1) Medical repatriation

(2) Repatriation of body in the event of death

(1) 100% of cost

(2) 7,623 € per person