CMSM HEALTH CARE BENEFITS

Your health matters to us. With Flame, you can rest assured that you and your family will be receiving best in class healthcare coverage at the best rates.

IN-HOSPITAL BENEFITS

CMSM Mutual Health Plan covers Adherent/Beneficiary’s normal delivery or cesarean section in Mutual Class -MUT- up to the fourth month (inclusive) of pregnancy at the date of membership, as well as abortion medically justified, abnormal pregnancy, Epidural (in Normal delivery) and complications related to pregnancy and its results.

  • To benefit from the above mentioned coverage new Adherent/Beneficiary has to apply for Membership as a couple (Husband and Wife).
  • In the case of wife solely applying for Membership, a waiting period of twelve (12) months is applied, as well as same waiting period is applied on Adherent/Beneficiary in First Class -A-.

 

New born baby coverage

  • In case the new born baby needs an Intensive Care Neonatal or Incubator stay (ICN), CMSM covers only the difference of NSSF/ MOH share on a reimbursement basis.
  • In-hospital confined baby who join CMSM Health Plan after 14 days of birth will benefit from an ICN required stay. “Congenital Cases for Babies” conditions, detailed hereafter, will be applied.
  • Screening tests are covered for new born CMSM babies up to 50 USD only.
  • If performed during same delivery confinement period, CMSM covers the professional fees and expenses of a newborn baby male circumcision.

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 (2nd) 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

AMBULATORY BENEFITS

All Ambulatory Benefits are limited to the healthcare services delivered exclusively through Administrator Providers Network in Lebanon, as per applicable CMSM Health Plan detailed below:

  • 85% excluding doctor fees.
  • Up to Ten (10) claims per Adherent/Beneficiary per contractual period.
  • In hospital specific Exclusions and Limitations conditions aren’t applied on Ambulatory Benefits.
  • Diagnostic Tests
  • MRI
  • Osteodensitometry
  • Toxoplasmosis tests
  • Pre-Marital tests

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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TRAVEL INSURANCE PLAN

This plan covers the Adherents and/Beneficiaries worldwide when travelling for personal or for leisure reasons not exceeding a period of 31 consecutive days. This plan does not cover any trip for professional or therapeutic reason.

  • Period of Coverage: Up to 31 consecutive days.
  • Scope of Coverage: Worldwide excluding Lebanon.
  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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ADHERENT GUIDE

  • A Membership Form provided by CMSM should be filled and duly signed by the adherent including a Medical Questionnaire.
  • Once accepted, the adherent will receive an Access Medical Card.

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.

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