Open Heart Surgery, Coronarography, and Cardio-Vascular Sections, if medically indicated and do not fall under “preexisting cases”, are covered in total after three (3) months waiting period, otherwise “false declaration” condition is applied.

Pre-existing Case is a health condition or impairment that medically exists prior to the Adherent membership enrollment date whether it is known or not to him/her.

• Any preexisting case is covered as of the second (2^nd) year of the initial Membership, unless it is otherwise stipulated in the Membership Schedule.
• Adherent should declare of any medical information related to him/her and his/her family. In case of a non-declared information, false declaration is applied as stated in the Mutual Health Plan.

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• Congenital cases are defined as follows: diseases, anomalies, birth defects and deficiencies revealed at birth, either in an evident manner or in a potential manner diagnosed at a later stage.
• CMSM Health Plan totally covers (25) Congenital Cases for a new born baby medically eligible at birth.
• Other congenital cases, are covered up to 3,000USD for CMSM babies.
• For CMSM babies all other Congenital Cases are covered only up to 3,000USD/case.

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• If medically indicated, unless otherwise specified in the Special Conditions of the Mutual Health Plan. Cardio-Vascular, Prosthesis and other Restorable Prosthesis are 100% covered, per organ per case per surgery, up to 4,000USD for Class MUT and 5,000USD for Class

For adherents under Co-NSSF Plan, CMSM covers the difference of NSSF Prosthesis value as stated above.

As of the second (2nd) year of membership enrollment, Infertility and all related treatments, procedures and ambulatory tests are covered up to   2,000USD per year.

CMSM Health Plan takes in charge Dialysis Sessions for Acute Renal Failure only during initial admission till discharge

Radiology, C.T. scan, MRI, Ultrasonography, laboratory tests, nuclear medicine tests, Electroencephalogram, Electrocardiogram, Electromyogram, Audiogram, Stress test, Evoqued response, Ocular Angiography, Thallium myocardial Scintigraphy, Echocardiography, Holter monitoring, Laser therapy, Physiotherapy, Kinesitherapy, Tuberculin test, Testicular Pelvic Echo Doppler.

Based on medical indication and subject to the prior approval of the Administrator.

For all Adherents/Beneficiaries aged 50 years and above once per contractual year.

Covered 4 times per pregnancy if results are showing lack of immunity.

Covered on reimbursement basis with a proof of marriage.

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1. Travel Information Service Free of charge
2. Referral to Medical Correspondents Abroad Free of charge
3. Long Distance Medical Advice Free of charge
4. Delivery of Urgent Messages Free of charge
5. Evacuation & Repatriation Up to 50,000 $
6. Repatriation of Mortal Remains Up to 50,000 $
7. Medical Expenses and Hospitalization Abroad Up to 50,000 $
8. Transportation to Join Member Round Trip Ticket
9. Return of Dependent Children One-Way ticket

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A personalized Card issued in the name of each Adherent/Beneficiary, enabling him/her to access healthcare services offered by CMSM Mutual Health Plan.

• In case of Ambulatory/Prescription Medicine transaction, a virtual electronic form, processed through the personalized Access Card of the Adherent/Beneficiary, allowing him/her to benefit, when applicable, from the Ambulatory Benefit Plan and/or the Prescription Medicine Benefit Plan.
• In the cases of admission to an Emergency Room not requiring an overnight stay, the Adherent/Beneficiary must present his/her Access Card and Personal ID to the hospital, awaiting the Administrator’s decision.
• In case of stolen or loss of the Access Card, the Adherent has the obligation to notify CMSM. Until such notice is received, the Adherent/Beneficiary is accountable for all illegal transactions.